Department of the Treasury Internal Revenue Service
Public Charity Status and Public Support
Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.
Attach to Form 990 or Form 990-EZ. See separate instructions. Information about Schedule A (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
VALLEY CHILDREN'S HEALTHCARE FOUNDATION FKA CHILDREN'S HOSPITAL CENTRAL CA FDN
Employer identification number
94-2797447
Part I
Reason for Public Charity Status
(All organizations must complete this part.) See instructions.
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
11
e
By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons other than foundation managers and other than one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2).
f
If the organization received a written determination from the IRS that it is a Type I, Type II, or Type III supporting organization, check this box
..................................................
g
Since August 17, 2006, has the organization accepted any gift or contribution from any of the following persons?
(i) A person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
and (iii) below, the governing body of the supported organization?
................
11g(i)
(ii)
A family member of a person described in (i) above?
......................
11g(ii)
(iii)
A 35% controlled entity of a person described in (i) or (ii) above?
................
11g(iii)
h
Provide the following information about the supported organization(s).
(i) Name of supported organization
(ii) EIN
(iii) Type of organization (described on lines 1- 9 above or IRC section (see instructions))
(iv) Is the organization in col. (i) listed in your governing document?
(v) Did you notify the organization in col. (i) of your support?
(vi) Is the organization in col. (i) organized in the U.S.?
(vii) Amount of monetary support
Yes
No
Yes
No
Yes
No
Total
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990EZ.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2013
Schedule A (Form 990 or 990-EZ) 2013
Page 2
Part II
Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi) (Complete only if you checked the box on line 5, 7, or 8 of Part I or if the
organization failed to qualify under Part III. If the organization fails to
qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year (or fiscal year beginning in)
(a) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....
5,561,054
11,729,957
9,223,675
5,815,550
8,171,822
40,502,058
2
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......
3
The value of services or facilities furnished by a governmental unit to the organization without charge..
4
Total. Add lines 1 through 3
5,561,054
11,729,957
9,223,675
5,815,550
8,171,822
40,502,058
5
The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included
on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
5,714,506
6
Public support. Subtract line 5 from line 4.
34,787,552
Section B. Total Support
Calendar year
(or fiscal year beginning in)
(a) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(f) Total
7
Amounts from line 4..
5,561,054
11,729,957
9,223,675
5,815,550
8,171,822
40,502,058
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...
959,309
1,048,431
964,574
946,534
1,027,173
4,946,021
9
Net income from unrelated business activities, whether or not the business is regularly carried on..
69,997
152,150
287,241
91,773
82,929
684,090
10
Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)..
11
Total support (Add lines 7 through 10).
46,132,169
12
Gross receipts from related activities, etc. (see instructions)
..................
12
13
First five years.
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here.................................................
Section C. Computation of Public Support Percentage
14
Public support percentage for 2013 (line 6, column (f) divided by line 11, column (f))
.........
14
75.410 %
15
Public support percentage for 2012 Schedule A, Part II, line 14
...............
15
16a
33 1/3% support test—2013.
If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization
.......................
b
33 1/3% support test—2012.
If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization
.....................
17a
10%-facts-and-circumstances test—2013.
If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain
in Part IV how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization
.....................................................
b
10%-facts-and-circumstances test—2012.
If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part IV how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported organization
................................................
18
Private foundation.
If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions
.....................................................
Schedule A (Form 990 or 990-EZ) 2013
Schedule A (Form 990 or 990-EZ) 2013
Page 3
Part III
Support Schedule for Organizations Described in Section 509(a)(2) (Complete only if you checked the box on line 9 of Part I or if the organization
failed to qualify under Part II. If the organization fails to qualify under
the tests listed below, please complete Part II.)
Section A. Public Support
Calendar year (or fiscal year beginning in)
(a) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2
Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......
3
Gross receipts from activities that are not an unrelated trade or business under section 513..
4
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5
The value of services or facilities furnished by a governmental unit to the organization without charge..
6
Total. Add lines 1 through 5.
7a
Amounts included on lines 1, 2, and 3 received from disqualified persons...
b
Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c
Add lines 7a and 7b..
8
Public support (Subtract line 7c from line 6.)
Section B. Total Support
Calendar year (or fiscal year beginning in)
(a) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(f) Total
9
Amounts from line 6...
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
11
Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
12
Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)
..
13
Total support. (Add lines 9, 10c, 11, and 12.)..
14
First five years.
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here.............................................
Section C. Computation of Public Support Percentage
15
Public support percentage for 2013 (line 8, column (f) divided by line 13, column (f))
.........
15
16
Public support percentage from 2012 Schedule A, Part III, line 15
...............
16
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2013 (line 10c, column (f) divided by line 13, column (f))
......
17
18
Investment income percentage from 2012 Schedule A, Part III, line 17
.............
18
19a
33 1/3% support tests—2013.
If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
........
b
33 1/3% support tests—2012.
If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
.....
20
Private foundation.
If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions
.....
Schedule A (Form 990 or 990-EZ) 2013
Schedule A (Form 990 or 990-EZ) 2013
Page 4
Part IV
Supplemental Information.
Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; and Part III, line 12. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
Explanation
Schedule A (Form 990 or 990-EZ) 2013
Additional Data
Software ID:
Software Version:
-
TIN:
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.
Attach to Form 990 or 990-EZ.
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
VALLEY CHILDREN'S HEALTHCARE FOUNDATION FKA CHILDREN'S HOSPITAL CENTRAL CA FDN
Employer identification number
94-2797447
Return Reference
Explanation
FORM 990, PART VI, SECTION A, LINE 6
VALLEY CHILDREN'S HOSPITAL IS THE SOLE MEMBER OF THE CORPORATION. CERTAIN MEMBER RIGHTS INCLUDE THE RIGHT TO APPROVE, ELECT, AND REMOVE ELECTED BOARD MEMBERS OF THE FOUNDATION.
FORM 990, PART VI, SECTION A, LINE 7A
SEE ANSWER FOR LINE 6 ABOVE
FORM 990, PART VI, SECTION A, LINE 7B
SEE ANSWER FOR LINE 6 ABOVE
FORM 990, PART VI, SECTION B, LINE 11
THE BOARD TREASURER PRESENTS THE DRAFT FORM 990 AT THE BOARD MEETING THAT IS HELD BEFORE THE FILING DATE AND ANSWERS QUESTIONS OR ADDRESSES ANY CONCERNS AT THIS MEETING. HARDCOPY IS MADE AVAILABLE FOR REVIEW AT THE MEETING AND IN THE FOUNDATION OFFICE. CHANGES CAN THEN BE MADE IF WARRANTED BEFORE THE 990 IS FILED.
FORM 990, PART VI, SECTION B, LINE 12C
THE FOUNDATION BOARD OF TRUSTEES MAINTAINS A CONFLICT OF INTEREST POLICY WITHIN THE FOUNDATION'S CORPORATE BYLAWS. THE POLICY REQUIRES EACH TRUSTEE TO DISCLOSE PERSONAL FINANCIAL INTERESTS BY EXECUTING ANNUAL STATEMENTS AND REPORTING SPECIFIC INTERESTS ON AN AD HOC BASIS. A STANDING HOSPITAL GOVERNANCE COMMITTEE IS TASKED TO REVIEW DISCLOSED INTERESTS, TO ASSESS WHETHER A CONFLICT OF INTEREST EXISTS AND MAKE RECOMMENDATIONS REGARDING FURTHER ACTION AS MAY BE NECESSARY TO MITIGATE OR ELIMINATE A CONFLICT. FOUNDATION SUPPORT STAFF ARE EMPLOYED BY VALLEY CHILDREN'S HOSPITAL AND ARE THEREFORE SUBJECT TO THE HOSPITAL'S CONFLICT OF INTEREST POLICY.
FORM 990, PART VI, SECTION B, LINE 15
THE OFFICERS AND SUPPORT STAFF OF THE FOUNDATION ARE EMPLOYED BY THE HOSPITAL. AS SUCH, THE FOUNDATION DOES NOT HAVE EMPLOYEES THAT IT PAYS DIRECTLY. AS PROVIDED BY THE HOSPITAL BYLAWS, A COMPENSATION COMMITTEE HAS BEEN ESTABLISHED THAT CONSISTS OF A CHAIR AND AT LEAST THREE MEMBERS OF THE BOARD OF TRUSTEES. THE PRIMARY ROLE OF THIS COMMITTEE IS TO ENSURE THAT COMPENSATION IS REASONABLY RELATED TO THE DUTIES PERFORMED FOR THE HOSPITAL AND WITH THE COMPETITIVE EMPLOYMENT MARKET. DUTIES AND ACTIVITIES SPECIFIC TO CEO, OFFICERS, AND KEY EMPLOYEES OF THE ORGANIZATION INCLUDE: 1) PERIODIC REVIEW BASED ON THE INDEPENDENT ADVICE OF AN EXTERNAL QUALIFIED COMPENSATION CONSULTANT 2) REVIEW OF MARKET DATA FOR EQUIVALENT POSITIONS 3) REVIEW AND APPROVAL OF TERMS AND CONDITIONS OF THE CEO'S EMPLOYMENT AND OVERSIGHT TO ASSURE FORMAL AND TIMELY PERFORMANCE ASSESSMENTS ARE CONDUCTED 4) REVIEW AND APPROVAL OF EXECUTIVE LEVEL COMPENSATION TO ASSURE THAT TERMS AND CONDITIONS OF EMPLOYMENT ARE MARKET COMPETITIVE
FORM 990, PART VI, SECTION C, LINE 19
A COPY OF FOUNDATION'S ARTICLES OF INCORPORATION IS ON FILE WITH THE CALIFORNIA SECRETARY OF STATE. A COPY OF THE CORPORATE BYLAWS OF THE FOUNDATION IS AVAILABLE TO THE GENERAL PUBLIC UPON REQUEST. CONFLICT OF INTEREST MANAGEMENT IS DESCRIBED IN ARTICLE 10 OF THE BYLAWS. THE HOSPITAL PREPARES CONSOLIDATED ANNUAL FINANCIAL STATEMENTS WHICH ARE AUDITED BY AN INDEPENDENT ACCOUNTING FIRM PRIOR TO SUBMITTAL TO RELEVANT STATE AGENCIES.
FORM 990, PART XI, LINE 9:
CHANGE IN FAIR VALUE OF GIFT ANNUITY -20,686. RESERVE FOR UNCOLLECTIBLE PLEDGES -82,887.
FORM 990, PART III, LINE 4A
STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS - PROGRAM SERVICE ONE DISTRIBUTION TO VALLEY CHILDREN'S HOSPITAL, A NONPROFIT 501(C)(3) ORGANIZATION, FOR EQUIPMENT AND OPERATIONAL EXPENSES: $46,444,660 THE VALLEY CHILDREN'S HEALTHCARE FOUNDATION IS A CHARITABLE TAX-EXEMPT ORGANIZATION BENEFITING VALLEY CHILDREN'S HOSPITAL. THE FOUNDATION'S MISSION IS CLEAR AND UNEQUIVOCAL: "GENERATE FUNDS TO SUPPORT THE GOALS OF VALLEY CHILDREN'S HOSPITAL." AS THE FUNDRAISING ARM OF THE HOSPITAL, THE FOUNDATION UTILIZES A VARIETY OF PROGRAMS TO RAISE PHILANTHROPIC FUNDS TO MEET THE HOSPITAL'S MISSION. THE FOUNDATION IS A PARTICIPATING MEMBER OF THE CHILDREN'S MIRACLE NETWORK, AND OTHER WIDELY ANTICIPATED VALLEY EVENTS, INCLUDING THE ANNUAL KID'S DAY AND THE HARVEST BALL. IN ADDITION, THE FOUNDATION HAS DEVELOPED CORPORATE, ANNUAL CAUSE-MARKETING, OUTSIDE SPECIAL EVENTS, TRIBUTES, DIRECT MAIL, AND MAJOR AND PLANNED GIFT PROGRAMS. WHILE THE ONLY "MEMBER" OF THE FOUNDATION IS THE HOSPITAL'S BOARD OF TRUSTEES, THE WORK OF THE FOUNDATION IS DIRECTED AND ASSISTED BY THE BOARD OF DIRECTORS COMPRISING 24 VOLUNTEER COMMUNITY MEMBERS. FOUNDED IN 1981, THE FOUNDATION HAS DEVELOPED AND LED COMMUNITY-BASED PHILANTHROPIC EFFORTS TO SUPPORT THE HOSPITAL IN ADDITION TO THE WORK OF THE HOSPITAL GUILDS. IN ITS INITIAL YEARS, THE FOUNDATION'S FUND RAISING EFFORTS WERE LARGELY FOCUSED ON SPECIAL EVENTS AND ANNUAL PROGRAMS. PRESENTLY THE FOUNDATION IS FOCUSED ON BUILDING PROGRAMS TO SUPPORT A MAJOR GIFTS CULTURE TO COMPLIMENT THE CORE ANNUAL FUNDING PROGRAMS.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.