Form990
Click to see attachment
Department of the Treasury
Internal Revenue Service
Return of Organization Exempt From Income Tax
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except private foundations)
MediumBullet Do not enter Social Security numbers on this form as it may be made public. By law, the IRS
generally cannot redact the information on the form.
MediumBullet Information about Form 990 and its instructions is at www.IRS.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
A For the 2013 calendar year, or tax year beginning 01-01-2013 , 2013, and ending 12-31-2013
BCheck if applicable:
CName of organization
CALIFORNIA HEALTHCARE INSTITUTE
 
Doing Business As
 
 
Number and street (or P.O. box if mail is not delivered to street address)
888 PROSPECT STREET NO 220
 
Room/suite
City or town, state or province, country, and ZIP or foreign postal code
LA JOLLA, CA92037
D Employer identification number

94-3174767
E Telephone number

G Gross receipts $ 3,570,517
F Name and address of principal officer:
TODD GILLENWATER
888 PROSPECT STREET NO 220
LA JOLLA,CA92037
I
Tax-exempt status: ( 6 ) LeftBullet (insert no.) or
J
Website:MediumBullet
WWW.CHI.ORG
H(a)
Is this a group return for
subordinates?
H(b)
Are all subordinates
included?
If "No," attach a list. (see instructions)
H(c)
Group exemption number MediumBullet  
K Form of organization:
 
L Year of formation: 1993
M State of legal domicile: CA
Part I
Summary
Activities & Governance 1 Briefly describe the organization’s mission or most significant activities: TO RESEARCH & DEVELOP POLICIES AND ACTIONS THAT ADVANCE BIOMEDICAL SCIENCE IN CALIFORNIA.
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a) ........ 3 35
4 Number of independent voting members of the governing body (Part VI, line 1b) ..... 4 34
5 Total number of individuals employed in calendar year 2013 (Part V, line 2a) ...... 5 15
6 Total number of volunteers (estimate if necessary) ............. 6 0
7a Total unrelated business revenue from Part VIII, column (C), line 12 ........ 7a 0
b Net unrelated business taxable income from Form 990-T, line 34 ......... 7b 0
Revenues Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 526,706 682,318
9 Program service revenue (Part VIII, line 2g) ......... 2,827,640 2,877,058
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 6,582 11,031
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 0 0
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)................... 3,360,928 3,570,407
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 0 0
14 Benefits paid to or for members (Part IX, column (A), line 4)..... 0 0
15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10) 1,931,616 1,925,214
16a Professional fundraising fees (Part IX, column (A), line 11e)..... 0 0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet408,555    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e).... 1,378,100 1,568,874
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 3,309,716 3,494,088
19 Revenue less expenses. Subtract line 18 from line 12....... 51,212 76,319
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 2,060,274 2,299,004
21 Total liabilities (Part X, line 26)............. 1,607,876 1,770,287
22 Net assets or fund balances. Subtract line 21 from line 20..... 452,398 528,717
Part II
Signature Block
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.
Sign Here
JumboBullet
Signature of officer Date
JumboBullet
Type or print name and title
Paid Preparer Use Only
Print/Type preparer's name
Preparer's signature
Date
PTIN
Firm's name MediumBullet

Firm's EIN MediumBullet
Firm's address MediumBullet



Phone no.
May the IRS discuss this return with the preparer shown above? (see instructions) ............
For Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y
Form 990 (2013)
Form 990 (2013)
Page 2
Part III
Statement of Program Service Accomplishments
Check if Schedule O contains a response or note to any line in this Part III ..............
1
Briefly describe the organization’s mission: THE CALIFORNIA HEALTHCARE INSTITUTE (CHI) WAS FOUNDED IN 1993 AS AN INDEPENDENT ORGANIZATION DEVOTED TO RESEARCHING AND ADVOCATING POLICY TO FORWARD THE INTERESTS OF CALIFORNIA'S BIOMEDICAL COMMUNITY. CHI HAS BUILT A MEMBERSHIP OF OVER 275 LEADING BIOMEDICAL COMPANIES, ACADEMIC AND RESEARCH INSTITUTIONS AND COMPANIES INVOLVED IN SUPPORTING THE BIOMEDICAL COMMUNITY.
2
Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? ......................
If "Yes," describe these new services on Schedule O.
3
Did the organization cease conducting, or make significant changes in how it conducts, any program services? ............................
If "Yes," describe these changes on Schedule O.
4
Describe the organization’s program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.
4a (Code:   ) (Expenses $ 62,986 including grants of $   ) (Revenue $ 225,737 )
ON NOVEMBER 21, 2013, CHI CELEBRATED OUR 20TH ANNIVERSARY AS A POWERFUL AND RESPECTED VOICE FOR THE INDUSTRY AT GENENTECH IN SOUTH SAN FRANCISCO. THIS YEAR'S ANNUAL MEETING BROUGHT TOGETHER LEADERS FROM DIFFERENT SEGMENTS OF THE BIOMEDICAL ECOSYSTEM. TOPICS DISCUSSED INCLUDED THE MANY FACES OF PATIENT CARE, ADVANCING INNOVATION AND ACCESS UNDER AN EVOLVING HEALTHCARE LANDSCAPE, COVERAGE AND PAYMENT FOR INNOVATION AND NURTURING INNOVATION IN CALIFORNIA. THIS YEAR, WE ALSO BE PRESENTED A FOUNDER'S AWARD.
4b (Code:   ) (Expenses $ 192,320 including grants of $   ) (Revenue $ 155,000 )
CHI-CALIFORNIA HEALTHCARE INSTITUTE AND AVALERE HEALTH PRODUCED A WHITE PAPER, DRIVING TOWARD VALUE: PRINCIPLES TO ENSURE PATIENT ACCESS TO MEDICAL INNOVATION IN NEW PAYMENT AND DELIVERY MODEL. THE FINAL PRODUCT OF THIS RESEARCH PROJECT AIMED TO INCREASE THE UNDERSTANDING OF THE NEW POST-MARKET ENVIRONMENT FOR NEW TECHNOLOGIES IN TERMS OF EXPLAINING THE SHIFT IN RISK TO NEW RISK-BEARING ENTITIES AND NEW MECHANISMS OF EVALUATING VALUE, EXPOSE HOW THE VALUE OF NEW TECHNOLOGIES IS NOT DEFINED APPROPRIATELY BY THESE NEW ACTORS NOR ADEQUATELY ACCOUNTED FOR BY NEW MECHANISMS AND THE IMPLICATIONS OF SUCH AN ENVIRONMENT ON INNOVATION AND PATIENT ACCESS, AND ADVANCE POLICY PRINCIPLES THAT ENSURE EVALUATIONS OF NEW TECHNOLOGIES IN THE POST-MARKET ENVIRONMENT ARE TRANSPARENT, FAIR, AND RECOGNIZED INNOVATION.
4c (Code:   ) (Expenses $ 83,159 including grants of $   ) (Revenue $ 79,500 )
ON MAY 8TH, 2013, CHI GATHERED LEGISLATORS, THEIR STAFF AND LEADERS FROM THE LIFE SCIENCES AND ACADEMIC COMMUNITIES IN CALIFORNIA FOR A CELEBRATION OF CALIFORNIA BIOMEDICAL INNOVATION AT OUR NATION'S CAPITAL. HUNDREDS OF ATTENDEES ENJOYED CONVERSATION WITH PUBLIC POLICYMAKERS AND CALIFORNIA'S BIOTECH OPINION LEADERS ABOUT THE ISSUES THAT MATTER MOST TO OUR INDUSTRY. AT THE INVITATION-ONLY DINNER FOLLOWING THE RECEPTION, CHI RECOGNIZED THE DELEGATION'S HISTORIC 14-MEMBER FRESHMAN CLASS.
(Code:   ) (Expenses $ 1,922,389 including grants of $   ) (Revenue $ 2,416,821 )
CHI HELD ITS INAUGURAL LIFE SCIENCES ACADEMY IN 2013. THIS EDUCATIONAL PROGRAM HOSTED A NUMBER OF KEY LEGISLATORS AND OPINION-LEADERS WHO DISCUSSED BIOMEDICAL INDUSTRY PRIORITY ISSUES. LEGISLATIVE BIOMEDICAL CHAMPIONS, NEW LEGISLATORS AND CHI MEMBER ORGANIZATION PROFESSIONALS ENGAGED IN CANDID, GIVE AND TAKE DISCUSSIONS ON PANELS -- EACH FOCUSING ON A PRIORITY ISSUE FOR CHI MEMBERS.
4d Other program services (Describe in Schedule O.)
(Expenses $ 1,922,389 including grants of $   ) (Revenue $ 2,416,821 )
4e Total program service expensesMediumBullet2,260,854
Form 990 (2013)
Form 990 (2013)
Page 3
Part IV
Checklist of Required Schedules
Yes
No
1
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If "Yes," complete Schedule A........................
1
 
No
2
Is the organization required to complete Schedule B, Schedule of Contributors (see instructions)? Click to see attachment...
2
Yes
 
3
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If "Yes," complete Schedule C, Part IClick to see attachment..........
3
 
No
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities, or have a section 501(h) election in effect during the tax year? If "Yes," complete Schedule C, Part II........
4
 
 
5
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19? If "Yes," complete Schedule C,
Part IIIClick to see attachment............................
5
Yes
 
6
Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If "Yes," complete Schedule D, Part IClick to see attachment........................
6
 
No
7
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas, or historic structures? If "Yes," complete Schedule D, Part IIClick to see attachment...
7
 
No
8
Did the organization maintain collections of works of art, historical treasures, or other similar assets? If "Yes," complete Schedule D, Part III Click to see attachment....................
8
 
No
9
Did the organization report an amount in Part X, line 21 for escrow or custodial account liability; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If "Yes," complete Schedule D, Part IVClick to see attachment..............
9
 
No
10
Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments, permanent endowments, or quasi-endowments? If "Yes," complete Schedule D, Part VClick to see attachment......
10
 
No
11
If the organization’s answer to any of the following questions is "Yes," then complete Schedule D, Parts VI, VII, VIII, IX, or X as applicable.
a
Did the organization report an amount for land, buildings, and equipment in Part X, line 10?
If "Yes," complete Schedule D, Part VI.Click to see attachment...................
11a
Yes
 
b
Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VIIClick to see attachment.......
11b
 
No
c
Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VIIIClick to see attachment.......
11c
 
No
d
Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part IXClick to see attachment............
11d
 
No
e
Did the organization report an amount for other liabilities in Part X, line 25? If "Yes," complete Schedule D, Part XClick to see attachment
11e
 
No
f
Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If "Yes," complete Schedule D, Part XClick to see attachment.........................
11f
Yes
 
12a
Did the organization obtain separate, independent audited financial statements for the tax year?
If "Yes," complete Schedule D, Parts XI and XII Click to see attachment.................
12a
 
No
b
Was the organization included in consolidated, independent audited financial statements for the tax year? If "Yes," and if the organization answered "No" to line 12a, then completing Schedule D, Parts XI and XII is optional Click to see attachment
12b
Yes
 
13
Is the organization a school described in section 170(b)(1)(A)(ii)? If "Yes," complete Schedule E....
13
 
No
14a
Did the organization maintain an office, employees, or agents outside of the United States?.....
14a
 
No
b
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, investment, and program service activities outside the United States, or aggregate foreign investments valued at $100,000 or more? If "Yes," complete Schedule F, Parts I and IV.........
14b
 
No
15
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or other assistance to or for any foreign organization? If “Yes,” complete Schedule F, Parts II and IV
15
 
No
16
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or other assistance to or for foreign individuals? If “Yes,” complete Schedule F, Parts III and IV...
16
 
No
17
Did the organization report a total of more than $15,000 of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11e? If "Yes," complete Schedule G, Part I (see instructions)....
17
 
No
18
Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If "Yes," complete Schedule G, Part II............
18
 
No
19
Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If "Yes," complete Schedule G, Part III...................
19
 
No
20a
Did the organization operate one or more hospital facilities? If "Yes," complete Schedule H....
20a
 
No
b
If "Yes" to line 20a, did the organization attach a copy of its audited financial statements to this return?
20b
 
 
Form 990 (2013)
Form 990 (2013)
Page 4
Part IV
Checklist of Required Schedules (continued)
21
Did the organization report more than $5,000 of grants or other assistance to any domestic organization or government on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II...
21
 
No
22
Did the organization report more than $5,000 of grants or other assistance to individuals in the United States on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III........
22
 
No
23
Did the organization answer "Yes" to Part VII, Section A, line 3, 4, or 5 about compensation of the organization’s current and former officers, directors, trustees, key employees, and highest compensated employees? If "Yes," complete Schedule J....................... Click to see attachment
23
Yes
 
24a
Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If “Yes,” answer lines 24b through 24d and complete Schedule K. If “No,” go to line 25a................
24a
 
No
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
 
c
Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds?......................
24c
 
 
d
Did the organization act as an "on behalf of" issuer for bonds outstanding at any time during the year?...
24d
 
 
25a
Section 501(c)(3) and 501(c)(4) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If "Yes," complete Schedule L, Part I........
25a
 
 
b
Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If "Yes," complete Schedule L, Part I...................
25b
 
 
26
Did the organization report any amount on Part X, line 5, 6, or 22 for receivables from or payables to any current or former officers, directors, trustees, key employees, highest compensated employees, or disqualified persons? If so, complete Schedule L, Part II....................
26
 
No
27
Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial contributor or employee thereof, a grant selection committee member, or to a 35% controlled entity or family member of any of these persons? If "Yes," complete Schedule L, Part III.........
27
 
No
28
Was the organization a party to a business transaction with one of the following parties (see Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):
a
A current or former officer, director, trustee, or key employee? If "Yes," complete Schedule L, Part IV ..........................
28a
 
No
b
A family member of a current or former officer, director, trustee, or key employee? If "Yes,"
complete Schedule L, Part IV.....................
28b
 
No
c
An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof) was an officer, director, trustee, or direct or indirect owner? If "Yes," complete Schedule L, Part IV...
28c
 
No
29
Did the organization receive more than $25,000 in non-cash contributions? If "Yes," complete Schedule M..
29
 
No
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If "Yes," complete Schedule M.............
30
 
No
31
Did the organization liquidate, terminate, or dissolve and cease operations? If "Yes," complete Schedule N,
Part I...........................
31
 
No
32
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If "Yes," complete Schedule N, Part II......................
32
 
No
33
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If "Yes," complete Schedule R, Part I........ Click to see attachment
33
 
No
34
Was the organization related to any tax-exempt or taxable entity? If "Yes," complete Schedule R, Part II, III, or IV, and Part V, line 1........................ Click to see attachment
34
Yes
 
35a
Did the organization have a controlled entity within the meaning of section 512(b)(13)?
35a
 
No
b
If ‘Yes’ to line 35a, did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If "Yes," complete Schedule R, Part V, line 2...
35b
 
 
36
Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If "Yes," complete Schedule R, Part V, line 2.............
36
 
 
37
Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If "Yes," complete Schedule R, Part VIClick to see attachment
37
 
No
38
Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11b and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Form 990 (2013)
Form 990 (2013)
Page 5
Part V
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response or note to any line in this Part V ..............
Yes
No
1a
Enter the number reported in Box 3 of Form 1096 Enter -0- if not applicable ..
1a
33
b
Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable .
1b
0
c
Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................
1c
Yes
 
2a
Enter the number of employees reported on Form W-3, Transmittal of Wage and
Tax Statements, filed for the calendar year ending with or within the year covered by this return ..................
2a
15
b
If at least one is reported on line 2a, did the organization file all required federal employment tax returns?
Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file (see instructions)
2b
Yes
 
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?...
3a
 
No
b
If “Yes,” has it filed a Form 990-T for this year? If “No” to line 3b, provide an explanation in Schedule O...
3b
 
 
4a
At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account, securities account, or other financial account)?..........................
4a
 
No
b
If "Yes," enter the name of the foreign country: MediumBullet
See instructions for filing requirements for Form TD F 90-22.1, Report of Foreign Bank and Financial Accounts.
5a
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year?..
5a
 
No
b
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
5b
 
No
c
If "Yes," to line 5a or 5b, did the organization file Form 8886-T? ............
5c
 
 
6a
Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible as charitable contributions?...
6a
 
No
b
If "Yes," did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible?........................
6b
 
 
7
Organizations that may receive deductible contributions under section 170(c).
a
Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor?....................
7a
 
 
b
If "Yes," did the organization notify the donor of the value of the goods or services provided?.....
7b
 
 
c
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282?...........................
7c
 
 
d
If "Yes," indicate the number of Forms 8282 filed during the year ....
7d
 
e
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?............................
7e
 
 
f
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract?..
7f
 
 
g
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required?............................
7g
 
 
h
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C?..........................
7h
 
 
8
Sponsoring organizations maintaining donor advised funds and section 509(a)(3) supporting organizations. Did the supporting organization, or a donor advised fund maintained by a sponsoring organization, have excess business holdings at any time during the year?............
8
 
 
9
Sponsoring organizations maintaining donor advised funds.
a
Did the organization make any taxable distributions under section 4966?..........
9a
 
 
b
Did the organization make a distribution to a donor, donor advisor, or related person?.......
9b
 
 
10
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on Part VIII, line 12 ...
10a
 
b
Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
10b
 
11
Section 501(c)(12) organizations. Enter:
a
Gross income from members or shareholders .........
11a
 
b
Gross income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them.) ..........
11b
 
12a
Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?
12a
 
 
b
If "Yes," enter the amount of tax-exempt interest received or accrued during the year. ....................
12b
 
13
Section 501(c)(29) qualified nonprofit health insurance issuers.
a
Is the organization licensed to issue qualified health plans in more than one state?
Note. See the instructions for additional information the organization must report on Schedule O.
13a
 
 
b
Enter the amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans ....
13b
 
c
Enter the amount of reserves on hand ............
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
No
b
If "Yes," has it filed a Form 720 to report these payments? If "No," provide an explanation in Schedule O..
14b
 
 
Form 990 (2013)
Form 990 (2013)
Page 6
Part VI
Governance, Management, and Disclosure For each "Yes" response to lines 2 through 7b below, and for a "No" response to lines 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.
Check if Schedule O contains a response or note to any line in this Part VI ..............
Section A. Governing Body and Management
Yes
No
1a
Enter the number of voting members of the governing body at the end of the tax year .....................
1a
35
If there are material differences in voting rights among members of the governing body, or if the governing body delegated broad authority to an executive committee or similar committee, explain in Schedule O.
b
Enter the number of voting members included in line 1a, above, who are independent ...................
1b
34
2
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................
2
 
No
3
Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? .
3
 
No
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed? ...........................
4
 
No
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
 
No
6
Did the organization have members or stockholders? ................
6
 
No
7a
Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or more members of the governing body? ....................
7a
 
No
b
Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body? ...................
7b
 
No
8
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a
The governing body? .........................
8a
Yes
 
b
Each committee with authority to act on behalf of the governing body? ............
8b
Yes
 
9
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If "Yes," provide the names and addresses in Schedule O.......
9
 
No
Section B. Policies (This Section B requests information about policies not required by the Internal Revenue Code.)
Yes
No
10a
Did the organization have local chapters, branches, or affiliates? ............
10a
 
No
b
If "Yes," did the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes?
10b
 
 
11a
Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form? ............................
11a
Yes
 
b
Describe in Schedule O the process, if any, used by the organization to review this Form 990. .....
12a
Did the organization have a written conflict of interest policy? If "No," go to line 13.......
12a
Yes
 
b
Were officers, directors, or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ..........................
12b
Yes
 
c
Did the organization regularly and consistently monitor and enforce compliance with the policy? If "Yes," describe in Schedule O how this was done.......................
12c
Yes
 
13
Did the organization have a written whistleblower policy? ...............
13
Yes
 
14
Did the organization have a written document retention and destruction policy? .........
14
Yes
 
15
Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
a
The organization’s CEO, Executive Director, or top management official ...........
15a
Yes
 
b
Other officers or key employees of the organization ................
15b
Yes
 
If "Yes" to line 15a or 15b, describe the process in Schedule O (see instructions).
16a
Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? ......................
16a
 
No
b
If "Yes," did the organization follow a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and take steps to safeguard the organization’s exempt status with respect to such arrangements? ............
16b
 
 
Section C. Disclosure
17
List the States with which a copy of this Form 990 is required to be filedMediumBullet
CA
18
Section 6104 requires an organization to make its Form 1023 (or 1024 if applicable), 990, and 990-T (501(c)(3)s only) available for public inspection. Indicate how you made these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how) the organization made its governing documents, conflict of interest policy, and financial statements available to the public during the tax year.
20
State the name, physical address, and telephone number of the person who possesses the books and records of the organization:
MediumBulletHOLLY FRISQUE888 PROSPECT STREET STE 220LA JOLLACA92037 (858) 551-6677
Form 990 (2013)
Form 990 (2013)
Page 7
Part VII
Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
Check if Schedule O contains a response or note to any line in this Part VII ..............
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization’s tax year.
RoundBullet List all of the organization’s current officers, directors, trustees (whether individuals or organizations), regardless of amount
of compensation. Enter -0- in columns (D), (E), and (F) if no compensation was paid.

RoundBullet List all of the organization’s current key employees, if any. See instructions for definition of "key employee."
RoundBullet List the organization’s five current highest compensated employees (other than an officer, director, trustee or key employee)
who received reportable compensation (Box 5 of Form W-2 and/or Box 7 of Form 1099-MISC) of more than $100,000 from the
organization and any related organizations.

RoundBullet List all of the organization’s former officers, key employees, or highest compensated employees who received more than $100,000
of reportable compensation from the organization and any related organizations.

RoundBullet List all of the organization’s former directors or trustees that received, in the capacity as a former director or trustee of the
organization, more than $10,000 of reportable compensation from the organization and any related organizations.

List persons in the following order: individual trustees or directors; institutional trustees; officers; key employees; highest
compensated employees; and former such persons.
Check this box if neither the organization nor any related organization compensated any current officer, director, or trustee.
(A)
Name and Title 		(B)
Average hours per week (list any hours for related organizations below dotted line) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; OfficerInd; Key Employee; Highest compensated employee; FormerOfcrDirectorTrusteeInd;
(1) DAVID E I PYOTT........................................................................
CHAIRMAN
 1.00
.......................   		X   X       0 0 0
(2) RICK WINNINGHAM........................................................................
CHAIRMAN - ELECT
 1.00
.......................   		X   X       0 0 0
(3) CHRISTIAN W NOLET........................................................................
AUDIT COMMITTEE CHAIRMAN
 1.00
.......................   		X   X       0 0 0
(4) STEVE E KROGNES........................................................................
FINANCE COMMITTEE CHAIRMAN
 1.00
.......................   		X   X       0 0 0
(5) JOHN C MARTIN PHD........................................................................
NOMINATING & GOVERNANCE COMMITTEE CHAIRMAN
 1.00
.......................   		X   X       0 0 0
(6) MARK CARLSON MD........................................................................
DIRECTOR
 1.00
.......................   		X           0 0 0
(7) PETER CLAUDE........................................................................
DIRECTOR
 1.00
.......................   		X           0 0 0
(8) MICHAEL V DRAKE MD........................................................................
DIRECTOR
 1.00
.......................   		X           0 0 0
(9) PETER C FARRELL PHD........................................................................
DIRECTOR
 1.00
.......................   		X           0 0 0
(10) MICHAEL FRIEDMAN MD........................................................................
DIRECTOR
 1.00
.......................   		X           0 0 0
(11) RICHARD J GREGORY PHD........................................................................
DIRECTOR
 1.00
.......................   		X           0 0 0
(12) PAUL HASTINGS........................................................................
DIRECTOR
 1.00
.......................   		X           0 0 0
(13) PETER BARTON HUTT........................................................................
DIRECTOR
 1.00
.......................   		X           0 0 0
(14) VERA JANUSHKOWSKY........................................................................
DIRECTOR
 1.00
.......................   		X           0 0 0
(15) TRACY T LEFTEROFF........................................................................
DIRECTOR
 1.00
.......................   		X           0 0 0
(16) MICHAEL MARLETTA PHD........................................................................
DIRECTOR
 1.00
.......................   		X           0 0 0
(17) ALBERTO MAS........................................................................
DIRECTOR
 1.00
.......................   		X           0 0 0
Form 990 (2013)
Form 990 (2013)
Page 8
Part VII
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)
(A)
Name and Title 		(B)
Average hours per week (list any hours for related organizations below dotted line) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; OfficerInd; Key Employee; Highest compensated employee; FormerOfcrDirectorTrusteeInd;
(18) HEATHER MASON........................................................................
DIRECTOR
 1.00
.......................   		X           0 0 0
(19) DANIEL MCINTYRE........................................................................
DIRECTOR
 1.00
.......................   		X           0 0 0
(20) DANA G MEAD JR........................................................................
DIRECTOR
 1.00
.......................   		X           0 0 0
(21) ALAN C MENDELSON........................................................................
DIRECTOR
 1.00
.......................   		X           0 0 0
(22) PETER G MILNER MD FACC........................................................................
DIRECTOR
 1.00
.......................   		X           0 0 0
(23) MICHAEL A MUSSALLEM........................................................................
DIRECTOR
 1.00
.......................   		X           0 0 0
(24) MAULIK NANAVATY PHD........................................................................
DIRECTOR
 1.00
.......................   		X           0 0 0
(25) JOSHUA J OFMAN MD MSHS........................................................................
DIRECTOR
 1.00
.......................   		X           0 0 0
(26) ROBERT PEREZ........................................................................
DIRECTOR
 1.00
.......................   		X           0 0 0
(27) JOHN D STOBO MD........................................................................
DIRECTOR
 1.00
.......................   		X           0 0 0
(28) DAVID STOVER PHC........................................................................
DIRECTOR
 1.00
.......................   		X           0 0 0
(29) KATIE SZYMAN........................................................................
DIRECTOR
 1.00
.......................   		X           0 0 0
(30) ERIC TOPOL MD........................................................................
DIRECTOR
 1.00
.......................   		X           0 0 0
(31) MARC TREMBLAY........................................................................
DIRECTOR
 1.00
.......................   		X           0 0 0
(32) KEITH VALENTINE........................................................................
DIRECTOR
 1.00
.......................   		X           0 0 0
(33) DAVID WILSON........................................................................
DIRECTOR
 1.00
.......................   		X           0 0 0
(34) GRANT YONEHIRO........................................................................
DIRECTOR
 1.00
.......................   		X           0 0 0
(35) DAVID GOLLAHER PHD........................................................................
PRESIDENT/CEO
 40.00
.......................   		    X       476,570 0 28,595
(36) MOLLY INGRAHAM........................................................................
SECRETARY/VP BUSINESS DEVELOPMENT
 40.00
.......................   		    X       205,389 0 11,443
(37) TODD GILLENWATER........................................................................
SR. VICE PRESIDENT - PUBLIC POLICY
 40.00
.......................   		      X     245,573 0 17,314
(38) EVE BUKOWSKI........................................................................
VICE PRESIDENT - STATE GOVERNMENT AFFAIRS
 40.00
.......................   		        X   122,786 0 12,177
(39) HOLLY FRISQUE........................................................................
VICE PRESIDENT - ADMINISTRATION
 40.00
.......................   		        X   135,472 0 11,128
1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)............MediumBullet 1,185,790 0 80,657
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organizationMediumBullet5
Yes
No
3
Did the organization list any former officer, director or trustee, key employee, or highest compensated employee on line 1a? If "Yes," complete Schedule J for such individual ..............
3
 
No
4
For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If "Yes," complete Schedule J for such individual...........................
4
Yes
 
5
Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If "Yes," complete Schedule J for such person ........
5
 
No
Section B. Independent Contractors
1
Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization. Report compensation for the calendar year ending with or within the organization’s tax year.
(A)
Name and business address 		(B)
Description of services 		(C)
Compensation
CORPORATE EVENT PLANNERS USA3926 FOREST DRIVEDOYLESTOWNPA18902 EVENT PLANNING 173,220
W STRATEGIES1455 PENNSYLVANIA AVENUE NW SUITEWASHINGTONDC20004 CONTRACT ADVOCACY 140,933
CARPENTER HAWKINS SIEVERS LLC1718 CAPITOL AVENUESACRAMENTOCA95811 CONTRACT ADVOCACY 112,564
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet3
Form 990 (2013)
Form 990 (2013)
Page 9
Part VIII
Statement of Revenue
Check if Schedule O contains a response or note to any line in this Part VIII .............
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512-514
Contributions, Gifts, GrantAmt and OtherAmt Similar Amounts 1a Federated campaigns..1a  
b Membership dues....1b  
c Fundraising events....1c  
d Related organizations...1d  
e Government grants (contributions)1e  
f All other contributions, gifts, grants, and
similar amounts not included above1f 		682,318
g Noncash contributions included in lines
1a-1f:$ 		 
h Total. Add lines 1a-1f.......MediumBullet 682,318
Program Service RevenueAmt Business Code
2a MEMBER DUES 900099 2,856,125 2,856,125    
b REGISTRATION FEES 900099 20,933 20,933    
c
d
e
f All other program service revenue .        
g Total. Add lines 2a–2f........MediumBullet 2,877,058
OtherAmt RevenueAmt 3 Investment income (including dividends, interest, and other similar amounts).......MediumBullet 11,141     11,141
4 Income from investment of tax-exempt bond proceeds..MediumBullet        
5 Royalties...........MediumBullet        
(i) Real (ii) Personal
6a Gross rents    
b Less: rental expenses    
c Rental income or (loss)    
d Net rental income or (loss).......MediumBullet        
(i) Securities (ii) Other
7a Gross amount from sales of assets other than inventory    
b Less: cost or other basis and sales expenses   110
c Gain or (loss)   -110
d Net gain or (loss)..........MediumBullet -110     -110
8a Gross income from fundraising events (not including
$  
of contributions reported on line 1c). See Part IV, line 18 ..
a  
b Less: direct expenses ...b  
c Net income or (loss) from fundraising events..MediumBullet      
9a Gross income from gaming activities.
See Part IV, line 19 ...
a  
b Less: direct expenses ...b  
c Net income or (loss) from gaming activities...MediumBullet        
10a Gross sales of inventory, less
returns and allowances .
a  
b Less: cost of goods sold ..b  
c Net income or (loss) from sales of inventory..MediumBullet        
Miscellaneous Revenue Business Code
11a            
b            
c            
d All other revenue ....        
e Total. Add lines 11a–11d ...... MediumBullet  
12 Total revenue. See Instructions......MediumBullet 3,570,407 2,877,058 0 11,031
Form 990 (2013)
Form 990 (2013)
Page 10
Part IX
Statement of Functional Expenses
Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A).Check if Schedule O contains a response or note to any line in this Part IX ...............
Do not include amounts reported on lines 6b,
7b, 8b, 9b, and 10b of Part VIII. 		(A)
Total expenses 		(B)
Program service expenses 		(C)
Management and general expenses 		(D)
Fundraising expenses
1 Grants and other assistance to governments and organizations in the United States. See Part IV, line 21    
2 Grants and other assistance to individuals in the United States. See Part IV, line 22    
3 Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16    
4 Benefits paid to or for members    
5 Compensation of current officers, directors, trustees, and key employees .... 984,886 560,351 174,263 250,272
6 Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....        
7 Other salaries and wages 718,135 489,697 189,679 38,759
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....        
9 Other employee benefits ....... 144,751 89,250 30,934 24,567
10 Payroll taxes ........... 77,442 47,749 16,550 13,143
11 Fees for services (non-employees):        
a Management ......        
b Legal ......... 8,071 1,131 6,940  
c Accounting ........... 22,754 3,189 19,565  
d Lobbying ........... 242,326 242,326    
e Professional fundraising services. See Part IV, line 17    
f Investment management fees ......        
g Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) ........ 21,043 8,517 12,481 45
12 Advertising and promotion .... 81,819 57,704 3,178 20,937
13 Office expenses ....... 64,457 18,905 36,042 9,510
14 Information technology ...... 82,761 18,016 63,910 835
15 Royalties ..        
16 Occupancy ........... 212,366 71,794 140,504 68
17 Travel ............ 225,338 117,406 69,534 38,398
18 Payments of travel or entertainment expenses for any federal, state, or local public officials ......        
19 Conferences, conventions, and meetings .... 13,407 9,455 521 3,431
20 Interest ...........        
21 Payments to affiliates .......        
22 Depreciation, depletion, and amortization ..... 30,466   30,466  
23 Insurance .............. 15,059   15,059  
24 Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a EVENTS 450,815 448,776 2,039 0
b PRINTING AND REPRODUCTI 47,659 42,050 1,195 4,414
c DUES/SUBSCRIPTIONS 36,825 29,212 3,437 4,176
d MISCELLANEOUS 13,708 5,326 8,382 0
e All other expenses        
25 Total functional expenses. Add lines 1 through 24e 3,494,088 2,260,854 824,679 408,555
26 Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here MediumBullet if following SOP 98-2 (ASC 958-720).        
Form 990 (2013)
Form 990 (2013)
Page 11
Part X Balance Sheet Check if Schedule O contains a response or note to any line in this Part X ..............
(A)
Beginning of year 		(B)
End of year
Assets 1 Cash–non-interest-bearing ............. 284,276 1 244,061
2 Savings and temporary cash investments ......... 1,482,494 2 1,778,548
3 Pledges and grants receivable, net ...........   3  
4 Accounts receivable, net ............. 78,650 4 25,700
5 Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
Schedule L ..................
  5  
6 Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L
  6  
7 Notes and loans receivable, net .............   7  
8 Inventories for sale or use ..............   8  
9 Prepaid expenses and deferred charges .......... 121,444 9 129,340
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 217,025
b Less: accumulated depreciation ..... 10b 105,107 82,947 10c 111,918
11 Investments—publicly traded securities ..........   11  
12 Investments—other securities. See Part IV, line 11 .....   12  
13 Investments—program-related. See Part IV, line 11 .....   13  
14 Intangible assets ...............   14  
15 Other assets. See Part IV, line 11 ........... 10,463 15 9,437
16 Total assets. Add lines 1 through 15 (must equal line 34)...... 2,060,274 16 2,299,004
Liabilities 17 Accounts payable and accrued expenses ......... 498,286 17 595,574
18 Grants payable .................   18  
19 Deferred revenue ................ 1,109,590 19 1,174,713
20 Tax-exempt bond liabilities .............   20  
21 Escrow or custodial account liability. Complete Part IV of Schedule D..   21  
22 Loans and other payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
persons. Complete Part II of Schedule L..........   22  
23 Secured mortgages and notes payable to unrelated third parties ..   23  
24 Unsecured notes and loans payable to unrelated third parties ....   24  
25 Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D....................   25  
26 Total liabilities. Add lines 17 through 25......... 1,607,876 26 1,770,287
Net Assets or Fund Balance Organizations that follow SFAS 117 (ASC 958), check here MediumBullet and complete lines 27 through 29, and lines 33 and 34.
27 Unrestricted net assets .............. 452,398 27 528,717
28 Temporarily restricted net assets ...........   28  
29 Permanently restricted net assets ...........   29  
Organizations that do not follow SFAS 117 (ASC 958), check here MediumBullet and complete lines 30 through 34.
30 Capital stock or trust principal, or current funds ........   30  
31 Paid-in or capital surplus, or land, building or equipment fund .....   31  
32 Retained earnings, endowment, accumulated income, or other funds   32  
33 Total net assets or fund balances ........... 452,398 33 528,717
34 Total liabilities and net assets/fund balances ........ 2,060,274 34 2,299,004
Form 990 (2013)
Form 990 (2013)
Page 12
Part XI
Reconcilliation of Net Assets
Check if Schedule O contains a response or note to any line in this Part XI ..............
1
Total revenue (must equal Part VIII, column (A), line 12) ............
1
3,570,407
2
Total expenses (must equal Part IX, column (A), line 25) ............
2
3,494,088
3
Revenue less expenses. Subtract line 2 from line 1 ..............
3
76,319
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) ..
4
452,398
5
Net unrealized gains (losses) on investments ...............
5
 
6
Donated services and use of facilities .................
6
 
7
Investment expenses .....................
7
 
8
Prior period adjustments .....................
8
 
9
Other changes in net assets or fund balances (explain in Schedule O) ........
9
0
10
Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line 33, column (B))
10
528,717
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response or note to any line in this Part XII .............
Yes
No
1
Accounting method used to prepare the Form 990:  
If the organization changed its method of accounting from a prior year or checked "Other," explain in
Schedule O.
2a
Were the organization’s financial statements compiled or reviewed by an independent accountant?
2a
 
No
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were compiled or reviewed on a separate basis, consolidated basis, or both:
b
Were the organization’s financial statements audited by an independent accountant?
2b
Yes
 
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were audited on a separate basis, consolidated basis, or both:
c
If "Yes," to line 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant?
2c
Yes
 
If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O.
3a
As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A-133?
3a
 
No
b
If "Yes," did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits.
3b
 
 
Form 990 (2013)
Form 990, Special Condition Description:
Special Condition Description
Additional Data


Software ID:  
Software Version:  
Schedule B
(Form 990, 990-EZ,
or 990-PF)
Department of the Treasury
Internal Revenue Service
Schedule of Contributors
Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
Arrow Bullet Information about Schedule B (Form 990, 990-EZ, or 990-PF) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
Name of the organization
CALIFORNIA HEALTHCARE INSTITUTE
 
Employer identification number

94-3174767
Organization type (check one):
Filers of:
Section:
Form 990 or 990-EZ





Form 990-PF




Check if your organization is covered by the General Rule or a Special Rule.  
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.
General Rule
Special Rules
......................... Arrow Bullet $  
Caution. An organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its
Form 990-EZ or on its Form 990PF, Part I, line 2, to certify that it does not meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).
For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.
Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2013)

Schedule B (Form 990, 990-EZ, or 990-PF) (2013)
Page 2
Name of organization
CALIFORNIA HEALTHCARE INSTITUTE
  		Employer identification number

94-3174767
Part I
Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
RESTRICTED
RESTRICTED
 

   
RESTRICTED
RESTRICTED
RESTRICTED, RESTRICTEDRESTRICTED

$RESTRICTED


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

   
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

   
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

   
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

   
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

   
 
 

$  


(Complete Part II for noncash contributions.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2013)

Schedule B (Form 990, 990-EZ, or 990-PF) (2013)
Page 3
Name of organization
CALIFORNIA HEALTHCARE INSTITUTE
  		Employer identification number

94-3174767
Part II
Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
Schedule B (Form 990, 990-EZ, or 990-PF) (2013)

Schedule B (Form 990, 990-EZ, or 990-PF) (2013)
Page 4
Name of organization
CALIFORNIA HEALTHCARE INSTITUTE
  		Employer identification number

94-3174767
Part III
Exclusively religious, charitable, etc., individual contributions to section 501(c)(7), (8), or (10) organizations
that total more than $1,000 for the year. Complete columns (a) through (e) and the following line entry.
For organizations completing Part III, enter the total of exclusively religious, charitable, etc.,
contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet$  
Use duplicate copies of Part III if additional space is needed.
(a) No.
from
Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
     
 
(a) No.
from
Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
     
 
(a) No.
from
Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
     
 
(a) No.
from
Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
     
 
Schedule B (Form 990, 990-EZ, or 990-PF) (2013)

Additional Data


Software ID:  
Software Version:  
SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527
SchCMd Bullet Complete if the organization is described below.SchCMd Bullet Attach to Form 990 or Form 990-EZ.
SchCMd Bullet See separate instructions.SchCMd Bullet Information about Schedule C (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public
Inspection
If the organization answered "Yes" to Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet Section 527 organizations: Complete Part I-A only.
If the organization answered "Yes" to Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)): Complete Part II-A. Do not complete Part II-B.
Round Bullet Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered "Yes" to Form 990, Part IV, Line 5 (Proxy Tax) or Form 990-EZ, Part V, line 35c (Proxy Tax), then
Round Bullet Section 501(c)(4), (5), or (6) organizations: Complete Part III.
Name of the organization
CALIFORNIA HEALTHCARE INSTITUTE
 
Employer identification number

94-3174767
Part I-A
Complete if the organization is exempt under section 501(c) or is a section 527 organization.

1
Provide a description of the organization’s direct and indirect political campaign activities in Part IV.
2
Political expenditures ....................................SchCMd Bullet
$  
3
Volunteer hours ........................................
 

Part I-B
Complete if the organization is exempt under section 501(c)(3).
1
Enter the amount of any excise tax incurred by the organization under section 4955 .........SchCMd Bullet
$  
2
Enter the amount of any excise tax incurred by organization managers under section 4955 ......SchCMd Bullet
$  
3
If the organization incurred a section 4955 tax, did it file Form 4720 for this year? ..............
4a
Was a correction made? .........................................
b
If "Yes," describe in Part IV.
Part I-C
Complete if the organization is exempt under section 501(c), except section 501(c)(3).
1
Enter the amount directly expended by the filing organization for section 527 exempt function activities SchCMd Bullet
$  
2
Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ...................................SchCMd Bullet

$  
3
Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b..SchCMd Bullet

$  
4
Did the filing organization file Form 1120-POL for this year? ..........................
5
Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.
(a) Name (b) Address (c) EIN (d) Amount paid from filing organization's funds. If none, enter -0-. (e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.










For Paperwork Reduction Act Notice, see the instructions for Form 990 or 990-EZ.
Cat. No. 50084S
Schedule C (Form 990 or 990-EZ) 2013

Schedule C (Form 990 or 990-EZ) 2013
Page 2
Part II-A
Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).
A Check SchCMd Bulletexpenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet
Limits on Lobbying Expenditures
(The term "expenditures" means amounts paid or incurred.) 		(a) Filing
organization's
totals 		(b) Affiliated group
totals
1a Total lobbying expenditures to influence public opinion (grass roots lobbying) ......    
b Total lobbying expenditures to influence a legislative body (direct lobbying) .......    
c Total lobbying expenditures (add lines 1a and 1b) ...................    
d Other exempt purpose expenditures ........................    
e Total exempt purpose expenditures (add lines 1c and 1d) ...............    
f Lobbying nontaxable amount. Enter the amount from the following table in both
columns.		    
If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:
Not over $500,00020% of the amount on line 1e.
Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.
Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.
Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.
Over $17,000,000$1,000,000.
g Grassroots nontaxable amount (enter 25% of line 1f) .................    
h Subtract line 1g from line 1a. If zero or less, enter -0-. ................    
i Subtract line 1f from line 1c. If zero or less, enter -0-. ................    
j If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting
section 4911 tax for this year? ......................................

4-Year Averaging Period Under Section 501(h)
(Some organizations that made a section 501(h) election do not have to complete all of the five
columns below. See the instructions for lines 2a through 2f on page 4.)
Lobbying Expenditures During 4-Year Averaging Period
Calendar year (or fiscal year
beginning in) 		(a) 2010 (b) 2011 (c) 2012 (d) 2013 (e) Total
2a Lobbying nontaxable amount          
b Lobbying ceiling amount
(150% of line 2a, column(e)) 		 
c Total lobbying expenditures          
d Grassroots nontaxable amount          
e Grassroots ceiling amount
(150% of line 2d, column (e))		  
f Grassroots lobbying expenditures          
Schedule C (Form 990 or 990-EZ) 2013


Schedule C (Form 990 or 990-EZ) 2013
Page 3
Part II-B
Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).
For each "Yes" response to lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.
(a)
No
Yes
(b)
Amount
1
During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:
a
Volunteers? .........................................
 
 
b
Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ....
 
 
c
Media advertisements? ....................................
 
 
 
d
Mailings to members, legislators, or the public? .........................
 
 
 
e
Publications, or published or broadcast statements? .......................
 
 
 
f
Grants to other organizations for lobbying purposes? .......................
 
 
 
g
Direct contact with legislators, their staffs, government officials, or a legislative body? ........
 
 
 
h
Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ......
 
 
 
i
Other activities? ..........................
 
 
 
j
Total. Add lines 1c through 1i ...............................
 
2a
Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....
 
 
b
If "Yes," enter the amount of any tax incurred under section 4912 .................
 
c
If "Yes," enter the amount of any tax incurred by organization managers under section 4912 .....
 
d
If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? .......
 
 
Part III-A
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).
Yes
No
1
Were substantially all (90% or more) dues received nondeductible by members? ................
1
 
No
2
Did the organization make only in-house lobbying expenditures of $2,000 or less? ................
2
 
No
3
Did the organization agree to carry over lobbying and political expenditures from the prior year? ..........
3
Yes
 
Part III-B
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2, are answered "No" OR (b) Part III-A, line 3, is answered “Yes."
1
Dues, assessments and similar amounts from members .....................
1
2,856,125
2
Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political
expenses for which the section 527(f) tax was paid).
a
Current year .........................................
2a
861,218
b
Carryover from last year ....................................
2b
173,000
c
Total ............................................
2c
1,034,218
3
Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .
3
714,031
4
If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ................................
4
320,187
5
Taxable amount of lobbying and political expenditures (see instructions) ..............
5
 
Part IV
Supplemental Information
Provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; Part II-A (affiliated group list); Part II-A, line 2; and Part ll-B, line 1. Also, complete this part for any additional information.
Return Reference Explanation
Schedule C (Form 990 or 990EZ) 2013

Additional Data


Software ID:  
Software Version:  

SCHEDULE D
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Financial Statements
SchDMd Bullet Complete if the organization answered "Yes," to Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b
SchDMd Bullet Attach to Form 990. SchDMd Bullet See separate instructions. SchDMd Bullet Information about Schedule D (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
CALIFORNIA HEALTHCARE INSTITUTE
 
Employer identification number

94-3174767
Part I
Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" to Form 990, Part IV, line 6.
(a) Donor advised funds (b) Funds and other accounts
1 Total number at end of year .........    
2 Aggregate contributions to (during year) ...    
3 Aggregate grants from (during year) .....    
4 Aggregate value at end of year ........    
5
Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ............
6
Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................
Part II
Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.
1
Purpose(s) of conservation easements held by the organization (check all that apply).
2
Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.
Held at the End of the Year
a Total number of conservation easements ....................... 2a  
b Total acreage restricted by conservation easements .................. 2b  
c Number of conservation easements on a certified historic structure included in (a) ..... 2c  
d Number of conservation easements included in (c) acquired after 8/17/06, and not on a historic structure listed in the National Register .................... 2d  
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the tax year SchDMd Bullet  
4
Number of states where property subject to conservation easement is located SchDMd Bullet  
5
Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................
6
Staff and volunteer hours devoted to monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet  
7
Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet $  
8
Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .......................................
9
In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" to Form 990, Part IV, line 8.
1a
If the organization elected, as permitted under SFAS 116 (ASC 958), not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII, the text of the footnote to its financial statements that describes these items.
b
If the organization elected, as permitted under SFAS 116 (ASC 958), to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items:
(i)
Revenues included in Form 990, Part VIII, line 1 ........................SchDMd Bullet $  
(ii)
Assets included in Form 990, Part X ..............................SchDMd Bullet $  
2
If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 (ASC 958) relating to these items:
a
Revenues included in Form 990, Part VIII, line 1 ..........................SchDMd Bullet $  
b
Assets included in Form 990, Part X ...............................SchDMd Bullet $  
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 52283D
Schedule D (Form 990) 2013

Schedule D (Form 990) 2013
Page 2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3
Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):
a
d
b
e
 
c
4
Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.
5
During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?........
Part IV
Escrow and Custodial Arrangements. Complete if the organization answered "Yes" to Form 990,
Part IV, line 9, or reported an amount on Form 990, Part X, line 21.
1a
Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................
b
If "Yes," explain the arrangement in Part XIII and complete the following table:
Amount
c Beginning balance ................................. 1c  
d Additions during the year .............................. 1d  
e Distributions during the year ............................. 1e  
f Ending balance ................................... 1f  
2a
Did the organization include an amount on Form 990, Part X, line 21? .....................
b
If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ........
Part V
Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.
(a)Current year (b)Prior year b (c)Two years back (d)Three years back (e)Four years back
1a Beginning of year balance ....          
b Contributions ........          
c Net investment earnings, gains, and losses          
d Grants or scholarships .....          
e Other expenditures for facilities
and programs ........ 		         
f Administrative expenses ....          
g End of year balance ......          
2
Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:
a
Board designated or quasi-endowment SchDMd Bullet  
b
Permanent endowment SchDMd Bullet  
c
Temporarily restricted endowment SchDMd Bullet  
The percentages in lines 2a, 2b, and 2c should equal 100%.
3a
Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes
No
(i) unrelated organizations ........................
3a(i)
 
 
(ii) related organizations ........................
3a(ii)
 
 
b
If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........
3b
 
 
4
Describe in Part XIII the intended uses of the organization's endowment funds.
Part VI
Land, Buildings, and Equipment. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11a. See Form 990, Part X, line 10.
Description of property (a) Cost or other basis (investment) (b)Cost or other basis (other) (c) Accumulated depreciation (d) Book value
1a Land .................      
b Buildings ................        
c Leasehold improvements ............   33,985 33,985 0
d Equipment ................   183,040 71,122 111,918
e Other .................        
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......SchDMdBullet 111,918
Schedule D (Form 990) 2013

Schedule D (Form 990) 2013
Page 3
Part VII
Investments—Other Securities. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11b. See Form 990, Part X, line 12.
(a) Description of security or category
(including name of security)		 (b)Book value (c) Method of valuation:
Cost or end-of-year market value
(1)Financial derivatives    
(2)Closely-held equity interests    
Other








Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)Small Bullet  
Part VIII
Investments—Program Related. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11c. See Form 990, Part X, line 13.
(a) Description of investment (b) Book value (c) Method of valuation:
Cost or end-of-year market value








Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)Small Bullet  
Part IX
Other Assets. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11d. See Form 990, Part X, line 15.
(a) Description (b) Book value








Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........Small Bullet  
Part X
Other Liabilities. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.
1.(a) Description of liability (b) Book value
Federal income taxes  








Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)Small Bullet  
2. Liability for uncertain tax positions In Part XIII, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC 740). Check here if the text of the footnote has been provided in Part XIII ..................................................
Schedule D (Form 990) 2013

Schedule D (Form 990) 2013
Page 4
Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return Complete if the organization answered 'Yes' to Form 990, Part IV, line 12a.
1 Total revenue, gains, and other support per audited financial statements ....... 1 3,674,286
2 Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a Net unrealized gains on investments .......... 2a  
b Donated services and use of facilities ......... 2b  
c Recoveries of prior year grants ........... 2c  
d Other (Describe in Part XIII.) ............ 2d 103,769
e Add lines 2a through 2d ..................... 2e 103,769
3 Subtract line 2e from line 1..................... 3 3,570,517
4 Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b . 4a  
b Other (Describe in Part XIII.) ........... 4b -110
c Add lines 4a and 4b....................... 4c -110
5 Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ...... 5 3,570,407
Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' to Form 990, Part IV, line 12a.
1 Total expenses and losses per audited financial statements ........... 1 3,611,675
2 Amounts included on line 1 but not on Form 990, Part IX, line 25:
a Donated services and use of facilities .......... 2a  
b Prior year adjustments .............. 2b  
c Other losses ................ 2c  
d Other (Describe in Part XIII.) ............ 2d 117,587
e Add lines 2a through 2d...................... 2e 117,587
3 Subtract line 2e from line 1..................... 3 3,494,088
4 Amounts included on Form 990, Part IX, line 25, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b .. 4a  
b Other (Describe in Part XIII.) ............ 4b  
c Add lines 4a and 4b....................... 4c 0
5 Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ...... 5 3,494,088
Part XIII
Supplemental Information
Provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b;
Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.
Return Reference Explanation
PART X, LINE 2: CHI HAS CONSIDERED THE TAX POSITIONS TAKEN IN ITS TAX RETURNS AND BELIEVES THAT ALL OF THE POSITIONS TAKEN IN THEIR FEDERAL AND STATE EXEMPT ORGANIZATION TAX RETURN ARE MORE LIKELY-THAN-NOT TO BE SUSTAINED UPON EXAMINATION.
PART XI, LINE 2D - OTHER ADJUSTMENTS: REVENUES FROM RELATED ORGANIZATION PER CONSOLIDATED GAAP STATEMENTS 103,769.
PART XI, LINE 4B - OTHER ADJUSTMENTS: LOSS ON ASSET DISPOSAL -110.
PART XII, LINE 2D - OTHER ADJUSTMENTS: EXPENSES FROM RELATED ORGANIZATION PER CONSOLIDATED GAAP STATEMENTS 117,477. LOSS ON ASSET DISPOSAL 110.
Schedule D (Form 990) 2013

Additional Data


Software ID:  
Software Version:  




Schedule J
(Form 990)
Department of the Treasury
Internal Revenue Service
Compensation Information
For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, line 23.
SchJMediumBullet Attach to Form 990. SchJMediumBullet See separate instructions.
SchJMediumBullet Information about Schedule J (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
CALIFORNIA HEALTHCARE INSTITUTE
 
Employer identification number

94-3174767
Part I
Questions Regarding Compensation
Yes
No
1a
Check the appropiate box(es) if the organization provided any of the following to or for a person listed in Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.
b
If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain....
1b
Yes
 
2
Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked in line 1a? ..
2
Yes
 
3
Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.
4
During the year, did any person listed in Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:
a
Receive a severance payment or change-of-control payment? ................
4a
 
No
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........
4b
 
No
c
Participate in, or receive payment from, an equity-based compensation arrangement? .........
4c
 
No
If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.
Only 501(c)(3) and 501(c)(4) organizations only must complete lines 5-9.
5
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:
a
The organization? ...........................
5a
 
 
b
Any related organization? .........................
5b
 
 
If "Yes," to line 5a or 5b, describe in Part III.
6
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:
a
The organization? ...........................
6a
 
 
b
Any related organization? .........................
6b
 
 
If "Yes," to line 6a or 6b, describe in Part III.
7
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............
7
 
 
8
Were any amounts reported in Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................
8
 
 
9
If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................
9
 
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50053T
Schedule J (Form 990) 2013

Schedule J (Form 990) 2013
Page 2
Part II
Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.
For each individual whose compensation must be reported in Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions, on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.
Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.
(A) Name and Title (B) Breakdown of W-2 and/or 1099-MISC compensation (C) Retirement and other deferred compensation (D) Nontaxable
benefits		 (E) Total of columns
(B)(i)-(D) 		(F) Compensation
reported as deferred
in prior Form 990
(i) Base compensation (ii) Bonus & incentive compensation (iii) Other reportable compensation
(1)DAVID GOLLAHER PHDPRESIDENT/CEO (i)
(ii)		 374,870
0 		101,700
0 		0
0 		11,553
0 		17,042
0 		505,165
0 		0
0
(2)MOLLY INGRAHAMSECRETARY/VP BUSINESS DEVELOPMENT (i)
(ii)		 165,389
0 		40,000
0 		0
0 		0
0 		11,443
0 		216,832
0 		0
0
(3)TODD GILLENWATERSR. VICE PRESIDENT - PUBLIC POLICY (i)
(ii)		 200,573
0 		45,000
0 		0
0 		8,893
0 		8,421
0 		262,887
0 		0
0
Schedule J (Form 990) 2013

Schedule J (Form 990) 2013
Page 3
Part III
Supplemental Information
Provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II.
Also complete this part for any additional information.
Return Reference Explanation
PART I, LINE 1A CHI RECOGNIZES THE BENEFITS OF A HEALTHY LIFESTYLE AND IS COMMITTED TO PROVIDING BENEFITS THAT ENCOURAGE WELLNESS FOR ALL EMPLOYEES. AS PART OF THIS COMMITMENT, CHI WILL PROVIDE ALL FULL-TIME EMPLOYEES WITH THE OPPORTUNITY TO JOIN A HEALTH CLUB IN RETURN FOR THE EMPLOYEE'S COMMITMENT TO UTILIZE THE CLUB ON A REGULAR BASIS. ELIGIBILITY FOR THE HEALTH CLUB MEMBERSHIP BENEFIT WILL BEGIN UPON THE EMPLOYEE'S COMPLETION OF 30 DAYS OF EMPLOYMENT. SAN DIEGO BASED EMPLOYEES WILL HAVE THE OPPORTUNITY TO JOIN THE LA JOLLA SPORTS CLUB, OR A COMPARABLE HEALTH CLUB FACILITY IN THEIR LOCAL AREA. LIKEWISE, SACRAMENTO AND DC EMPLOYEES WILL ALSO HAVE THE OPPORTUNITY TO JOIN A HEALTH CLUB IN THEIR AREA. HEALTH CLUB MEMBERSHIP WILL BE COVERED FOR EMPLOYEES ONLY, WITH A MAXIMUM MONTHLY CHARGE OF $75.00. FOR NEW MEMBERSHIP ENROLLMENTS, CHI WILL COVER A ONE-TIME ENROLLMENT EXPENSE REIMBURSEMENT OF UP TO $100. EMPLOYEES MUST UTILIZE THE HEALTH CLUB NO LESS THAN TWO TIMES PER WEEK AND MUST PROVIDE CHI WITH A MONTHLY USAGE STATEMENT PROVIDED BY THEIR HEALTH CLUB. FOR HEALTH CLUBS THAT DO NOT PROVIDE USAGE REPORTS, EMPLOYEES CAN SUBMIT A MONTHLY SUMMARY OF THEIR HEALTH CLUB USAGE BY FILLING OUT A HEALTH CLUB USAGE REPORT. TEMPORARY LAPSE IN USAGE DUE TO PLANNED TIME OFF OR BUSINESS-RELATED ACTIVITIES WILL BE EXCUSED. EMPLOYEES UNABLE TO UTILIZE THE HEALTH CLUB DUE TO A TEMPORARY OR UNFORESEEN DISABILITY WILL NEED TO FREEZE THEIR MEMBERSHIP DURING THIS TIME OR COVER THE HEALTH CLUB EXPENSES ON THEIR OWN. ENROLLMENT AT THE LA JOLLA SPORTS CLUB AND/OR PAYMENT FOR OTHER MONTHLY HEALTH CLUB DUES WILL NEED TO BE ARRANGED THROUGH THE DIRECTOR OF ADMINISTRATION. PLEASE NOTE THAT UNDER IRS GUIDELINES, THE VALUE OF THE GYM MEMBERSHIP WILL BE INCLUDED IN YOUR COMPENSATION AS TAXABLE INCOME.
SCHEDULE J PART I LINE 3 THE CALIFORNIA HEALTHCARE INSTITUTE (CHI) BOARD OF DIRECTORS, EXECUTIVE COMMITTEE (THE COMMITTEE) FUNCTIONS AS THE COMPENSATION COMMITTEE FOR PURPOSES OF DETERMINING EXECUTIVE SALARY COMPARABILITY AND ENSURING ALL OF CHI'S COMPENSATION PRACTICES ARE CARRIED OUT IN A RESPONSIBLE MANNER THAT ARE ALSO COMPLIANT WITH STATE AND FEDERAL REGULATIONS. THE COMMITTEE ALSO HAS OVERALL RESPONSIBILITY FOR EVALUATING THE PERFORMANCE AND COMPENSATION OF THE PRESIDENT AND CEO (EXECUTIVE). THE COMMITTEE HAS RESPONSIBILITY TO PROVIDE THE EXECUTIVE WITH CONSTRUCTIVE FEEDBACK REGARDING HIS PERFORMANCE. THE COMMITTEE MAY USE THE EXECUTIVE'S PERFORMANCE EVALUATION AS A MECHANISM TO MEASURE CHI'S PROGRESS TOWARDS ITS STRATEGIC GOALS. THE EXECUTIVE'S JOB DESCRIPTION WILL BE REVIEWED ANNUALLY. CHANGES TO ESSENTIAL FUNCTIONS OR RESPONSIBILITIES WILL BE MADE AS APPROPRIATE. THE CHAIR OF THE BOARD OF DIRECTORS WILL BE RESPONSIBLE FOR ENSURING THE JOB DESCRIPTION REMAINS CURRENT. A SET OF ANNUAL GOALS AND OBJECTIVES WILL BE DEVELOPED BY THE EXECUTIVE FOR APPROVAL BY THE EXECUTIVE COMMITTEE. THESE MAY BE UPDATED OR ADJUSTED THROUGHOUT THE YEAR IF NECESSARY, AS AGREED TO BY THE EXECUTIVE AND THE EXECUTIVE COMMITTEE. THE EXECUTIVE IS EXPECTED TO COMPLETE A SELF-ASSESSMENT SURVEY AND REPORT ON HIS OWN ASSESSMENT OF PROGRESS TOWARDS GOALS. THIS PROCESS IS ALSO INTENDED TO ALLOW THE EXECUTIVE THE OPPORTUNITY TO INDICATE ANY OBSTACLES IMPEDING PROGRESS OR SPECIFIC RESOURCES NECESSARY TO ACHIEVE SUCCESS. THE SELF-ASSESSMENT WILL BE SHARED AND DISCUSSED WITH THE EXECUTIVE COMMITTEE AND SUCH DISCUSSION WILL INFORM THE DEVELOPMENT OF AN ANNUAL VERBAL AND WRITTEN PERFORMANCE EVALUATION FOR THE EXECUTIVE. THE CHAIR OF THE BOARD OF DIRECTORS WILL BE RESPONSIBLE FOR DEVELOPING A WRITTEN PERFORMANCE EVALUATION, WHICH WILL BE DELIVERED VERBALLY TO THE EXECUTIVE AND DOCUMENTED IN WRITING. ANY CHANGES IN SALARY FOR THE EXECUTIVE WILL BE DETERMINED USING THE FOLLOWING PROCESS: THE COMMITTEE SHALL CAREFULLY DOCUMENT ALL OF ITS DELIBERATIONS REGARDING THE COMPENSATION OF THE EXECUTIVE. PRIOR TO CONSIDERING, RECOMMENDING OR APPROVING ANY CHANGE IN SALARY FOR EXECUTIVE, THE COMMITTEE SHALL OBTAIN AND REVIEW THIRD PARTY BENCHMARK DATA FOR POSITIONS COMPARABLE TO THAT OF THE EXECUTIVE TO ENSURE COMPARABILITY OF TOTAL COMPENSATION. AFTER THE COMMITTEE HAS REVIEWED AND DOCUMENTED ITS FINDINGS REGARDING RELEVANT COMPARABILITY DATA, THE COMMITTEE WILL MAKE A RECOMMENDATION OF AN APPROPRIATE SALARY, BONUS AND ANY OTHER FRINGE BENEFITS OR PERQUISITES TO THE CHAIR OF THE BOARD, SUBJECT TO APPROVAL BY THE BOARD OF DIRECTORS. THE COMMITTEE WILL CONSIDER ANY CHANGES TO THE EXECUTIVE'S SALARY BASED ON THE EXECUTIVE'S PERFORMANCE AGAINST EXPECTATIONS AND GOALS, AS WELL AS THE COMPARABILITY DATA IT HAS REVIEWED. THE CHAIR OF THE BOARD WILL RECOMMEND A SALARY CHANGE FOR APPROVAL BY THE BOARD TO BE EFFECTIVE ON AN AGREED UPON DATE, TYPICALLY THE ANNIVERSARY OF EXECUTIVE'S HIRE DATE. THE CHAIR OF THE BOARD OR HIS/HER DESIGNEE WILL DELEGATE TO A CHI STAFF MEMBER IMPLEMENTATION OF THE RESOLVED COMPENSATION AND/OR BENEFIT CHANGES. THE BOARD OF DIRECTORS WILL NOT IMPLEMENT AN INCREASE IN SALARY FOR EXECUTIVE WITHOUT HAVING FIRST ENGAGED IN THE PROCESS DEFINED ABOVE.
Schedule J (Form 990) 2013

Additional Data


Software ID:  
Software Version:  
SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
MediumBullet Attach to Form 990 or 990-EZ.
MediumBullet Information about Schedule O (Form 990 or 990-EZ) and its instructions is at
www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public
Inspection
Name of the organization
CALIFORNIA HEALTHCARE INSTITUTE
 
Employer identification number

94-3174767
Return Reference Explanation
FORM 990, PART III, LINE 2 CHI HELD ITS INAUGURAL LIFE SCIENCES ACADEMY IN 2013. THIS EDUCATIONAL PROGRAM HOSTED A NUMBER OF KEY LEGISLATORS AND OPINION-LEADERS WHO DISCUSSED BIOMEDICAL INDUSTRY PRIORITY ISSUES. LEGISLATIVE BIOMEDICAL CHAMPIONS, NEW LEGISLATORS AND CHI MEMBER ORGANIZATION PROFESSIONALS ENGAGED IN CANDID, GIVE AND TAKE DISCUSSIONS ON PANELS -- EACH FOCUSING ON A PRIORITY ISSUE FOR CHI MEMBERS. CHI-CALIFORNIA HEALTHCARE INSTITUTE AND AVALERE HEALTH PRODUCED A WHITE PAPER, DRIVING TOWARD VALUE: PRINCIPLES TO ENSURE PATIENT ACCESS TO MEDICAL INNOVATION IN NEW PAYMENT AND DELIVERY MODEL. THE FINAL PRODUCT OF THIS RESEARCH PROJECT AIMED TO INCREASE THE UNDERSTANDING OF THE NEW POST-MARKET ENVIRONMENT FOR NEW TECHNOLOGIES IN TERMS OF EXPLAINING THE SHIFT IN RISK TO NEW RISK-BEARING ENTITIES AND NEW MECHANISMS OF EVALUATING VALUE, EXPOSE HOW THE VALUE OF NEW TECHNOLOGIES IS NOT DEFINED APPROPRIATELY BY THESE NEW ACTORS NOR ADEQUATELY ACCOUNTED FOR BY NEW MECHANISMS AND THE IMPLICATIONS OF SUCH AN ENVIRONMENT ON INNOVATION AND PATIENT ACCESS, AND ADVANCE POLICY PRINCIPLES THAT ENSURE EVALUATIONS OF NEW TECHNOLOGIES IN THE POST-MARKET ENVIRONMENT ARE TRANSPARENT, FAIR, AND RECOGNIZED INNOVATION.
FORM 990, PART VI, SECTION B, LINE 11 A QUALIFIED AND AUTHORIZED PERSON SHALL COMPLETE THE ANNUAL FORM 990 INFORMATIONAL RETURN UNDER THE DIRECTION OF THE VICE PRESIDENT OF ADMINISTRATION AND PRESIDENT & CEO. THE RETURN SHALL BE REVIEWED BY THE CHAIRMAN OF THE FINANCE COMMITTEE AND PRESIDENT AND THEN PRESENTED TO ALL BOARD MEMBERS VIA PAPER COPY PRIOR TO ITS FILING WITH THE IRS. AT THE NEXT BOARD MEETING, THE CHAIRMAN OF THE FINANCE COMMITTEE MAY REVIEW THE RETURN WITH THE BOARD.
FORM 990, PART VI, SECTION B, LINE 12C UPON ELECTION ONTO THE BOARD OF DIRECTORS, NEW BOARD MEMBERS RECEIVE A CONFLICT OF INTEREST QUESTIONNAIRE WHICH THEY ARE REQUIRED TO COMPLETE AND RETURN AT OR BEFORE THEIR INITIAL BOARD MEETING. THE CHI EXECUTIVE ASSISTANT TRACKS THE PROMPT COMPLETION AND RECEIPT OF EACH FORM AND FOLLOWS UP ANNUALLY UPON THE EXPIRATION OF THE FORM TO RECEIVE A RENEWED QUESTIONNAIRE FROM EACH ACTIVE BOARD MEMBER.
FORM 990, PART VI, SECTION B, LINE 15 THE CALIFORNIA HEALTHCARE INSTITUTE (CHI) BOARD OF DIRECTORS, EXECUTIVE COMMITTEE (THE COMMITTEE) FUNCTIONS AS THE COMPENSATION COMMITTEE FOR PURPOSES OF DETERMINING EXECUTIVE SALARY COMPARABILITY AND ENSURING ALL OF CHI'S COMPENSATION PRACTICES ARE CARRIED OUT IN A RESPONSIBLE MANNER THAT ARE ALSO COMPLIANT WITH STATE AND FEDERAL REGULATIONS. THE COMMITTEE ALSO HAS OVERALL RESPONSIBILITY FOR EVALUATING THE PERFORMANCE AND COMPENSATION OF THE PRESIDENT AND CEO (EXECUTIVE). THE COMMITTEE HAS RESPONSIBILITY TO PROVIDE THE EXECUTIVE WITH CONSTRUCTIVE FEEDBACK REGARDING HIS PERFORMANCE. THE COMMITTEE MAY USE THE EXECUTIVE'S PERFORMANCE EVALUATION AS A MECHANISM TO MEASURE CHI'S PROGRESS TOWARDS ITS STRATEGIC GOALS.
FORM 990, PART VI, SECTION C, LINE 19 THESE PUBLIC DOCUMENTS ARE MADE AVAILABLE FOR INSPECTION TO ANYONE UPON REQUEST DURING REGULAR BUSINESS HOURS AT CHI'S LA JOLLA OFFICE. ADVANCED REQUEST TO VIEW THESE DOCUMENTS IS NOT REQUIRED. IDENTIFICATION IS NOT REQUIRED TO VIEW THESE DOCUMENTS. COPIES ARE PROVIDED UPON REQUEST, FREE OF CHARGE.
PART XII, LINE 2C THERE HAS NOT BEEN ANY CHANGES FROM THE PRIOR YEAR.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2013

Additional Data


Software ID:  
Software Version:  
SCHEDULE R
(Form 990)
Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
MediumBulletComplete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBulletAttach to Form 990. MediumBullet See separate instructions.
MediumBullet Information about Schedule R (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
CALIFORNIA HEALTHCARE INSTITUTE
 
Employer identification number

94-3174767
Part I
Identification of Disregarded Entities Complete if the organization answered "Yes" on Form 990, Part IV, line 33.
(a)
Name, address, and EIN (if applicable) of disregarded entity


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Total income


 		(e)
End-of-year assets


 		(f)
Direct controlling
entity










Part II
Identification of Related Tax-Exempt Organizations Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.
(a)
Name, address, and EIN of related organization


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Exempt Code section


 		(e)
Public charity status
(if section 501(c)(3))

 		(f)
Direct controlling
entity

 		(g)
Section 512(b)(13) controlled entity?
Yes No
(1) CALIFORNIA HEALTHCARE INSTITUTE POLICAL ACTION COMMITTEE (CHIPAC)

888 PROSPECT STREET SUITE 220

LA JOLLA,CA92037
20-2215812 		POLITICAL ACTION COMMITTEE CA 527    
 
No
(2) CALIFORNIA HEALTHCARE INSTITUTE FOUNDATION

888 PROSPECT STREET SUITE 220

LA JOLLA,CA92037
33-0637072 		OUTREACH, RESEARCH AND EDUCATION PROGRAM FOR LIFE SCIENCES INDUSTRY CA 501(C)(3) PF  
 
No










For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2013
Schedule R (Form 990) 2013
Page 2
Part III
Identification of Related Organizations Taxable as a Partnership Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.
(a)
Name, address, and EIN of
related organization



 		(b)
Primary activity




 		(c)
Legal
domicile
(state or foreign
country)


 		(d)
Direct controlling
entity



 		(e)
Predominant income(related, unrelated, excluded from tax under sections 512-514)

(f)
Share of total income




 		(g)
Share of end-of-year
assets



 		(h)
Disproprtionate allocations?




 		(i)
Code V-UBI
amount in box 20 of
Schedule K-1
(Form 1065)
 		(j)
General or
managing
partner?



 		(k)
Percentage
ownership
Yes No Yes No












Part IV
Identification of Related Organizations Taxable as a Corporation or Trust Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.
(a)
Name, address, and EIN of
related organization
 		(b)
Primary activity
 		(c)
Legal
domicile
(state or foreign
country)
 		(d)
Direct controlling
entity
 		(e)
Type of entity
(C corp, S corp,
or trust) 		(f)
Share of total income
 		(g)
Share of end-of-year
assets
 		(h)
Percentage
ownership
 		(i)
Section 512(b)(13) controlled entity?
Yes No












Schedule R (Form 990) 2013
Schedule R (Form 990) 2013
Page 3
Part V
Transactions With Related Organizations Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36.
Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.
Yes
No
1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?
a Receipt of (i) interest (ii) annuities (iii) royalties or (iv) rent from a controlled entity . . . . . . . . . . . . . . . . . . . . . . .
1a
 
No
b Gift, grant, or capital contribution to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1b
 
No
c Gift, grant, or capital contribution from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1c
 
No
d Loans or loan guarantees to or for related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1d
 
No
e Loans or loan guarantees by related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1e
 
No
f Dividends from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1f
 
No
g Sale of assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1g
 
No
h Purchase of assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1h
 
No
i Exchange of assets with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1i
 
No
j Lease of facilities, equipment, or other assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1j
 
No
k Lease of facilities, equipment, or other assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .
1k
 
No
l Performance of services or membership or fundraising solicitations for related organization(s) . . . . . . . . . . . . . . . . . . . .
1l
 
No
m Performance of services or membership or fundraising solicitations by related organization(s) . . . . . . . . . . . . . . . . . . . .
1m
 
No
n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) . . . . . . . . . . . . . . . . . . . . .
1n
 
No
o Sharing of paid employees with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1o
Yes
 
p Reimbursement paid to related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1p
 
No
q Reimbursement paid by related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1q
 
No
r Other transfer of cash or property to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1r
 
No
s Other transfer of cash or property from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1s
 
No
2
If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.
(a)
Name of related organization 		(b)
Transaction
type (a-s) 		(c)
Amount involved 		(d)
Method of determining amount involved





Schedule R (Form 990) 2013
Schedule R (Form 990) 2013
Page 4
Part VI
Unrelated Organizations Taxable as a Partnership Complete if the organization answered "Yes" on Form 990, Part IV, line 37.
Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.
(a)
Name, address, and EIN of entity 		(b)
Primary activity 		(c)
Legal domicile
(state or foreign
country) 		(d)
Predominant income (related, unrelated, excluded from tax under sections 512-514)

(e)
Are all partners
section
501(c)(3)
organizations? 		(f)
Share of total income




 		(g)
Share of
end-of-year
assets 		(h)
Disproprtionate allocations? 		(i)
Code V?UBI
amount in box 20
of Schedule K-1
(Form 1065) 		(j)
General or
managing
partner? 		(k)
Percentage
ownership
Yes No Yes No Yes No






























Schedule R (Form 990) 2013
Schedule R (Form 990) 2013
Page 5
Part VII
Supplemental Information
Provide additional information for responses to questions on Schedule R (see instructions).
Return Reference Explanation
Schedule R (Form 990) 2013
Additional Data


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