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
ARKANSAS CHILDREN'S HOSPITAL FOUNDATION INC
Employer identification number
71-0568795
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.") ....
18,076,952
26,154,853
21,586,182
22,018,755
24,547,652
112,384,394
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
18,076,952
26,154,853
21,586,182
22,018,755
24,547,652
112,384,394
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)..
2,275,500
6
Public support. Subtract line 5 from line 4.
110,108,894
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..
18,076,952
26,154,853
21,586,182
22,018,755
24,547,652
112,384,394
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...
4,620,053
5,182,994
5,175,906
6,315,861
6,178,920
27,473,734
9
Net income from unrelated business activities, whether or not the business is regularly carried on..
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).
139,858,128
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
78.730 %
15
Public support percentage for 2012 Schedule A, Part II, line 14
...............
15
76.830 %
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
ARKANSAS CHILDREN'S HOSPITAL FOUNDATION INC
Employer identification number
71-0568795
Return Reference
Explanation
FORM 990, PART VI, SECTION A, LINE 1
DURING THE INTERVALS BETWEEN THE MEETINGS OF THE BOARD OF DIRECTORS, THE EXECUTIVE COMMITTEE POSSESSES AND MAY EXERCISE ALL POWERS AND FUNCTIONS OF THE BOARD OF DIRECTORS IN THE DIRECTION OF THE AFFAIRS OF THE CORPORATION IN ALL CASES WHERE SPECIFIC DIRECTIONS HAVE NOT HAVE BEEN GIVEN BY THE BOARD OF DIRECTORS. IN ADDITION TO EXERCISING THE FOREGOING INTERIM POWERS, THE EXECUTIVE COMMITTEE EXCLUSIVELY EXERCISES THE BOARD'S AUTHORITY, PURSUANT TO A.C.A. SECTION 4-33-825(D), WITH RESPECT TO THE FOLLOWING: (A) TO MANAGE, INVEST, AND REINVEST THE FUNDS AND PROPERTY OF THE CORPORATION, TO SELECT AND EMPLOY BROKERS, INVESTMENT ADVISORS AND FUND MANAGERS, AND TO SUPERVISE THE PERFORMANCE THEREOF, AND GENERALLY TO EXERCISE THE INVESTMENT FUNCTION AND POWERS OF THE BOARD; (B) TO ESTABLISH THE CORPORATION'S ANNUAL BUDGETS, TO MONITOR INCOME AND EXPENSES IN COMPARISON TO BUDGET, TO BORROW FUNDS FOR PURPOSES THAT SEEM IN THE BEST INTEREST OF THE CORPORATION, AND GENERALLY TO EXERCISE THE FINANCE FUNCTION AND POWERS OF THE BOARD; (C) TO PURCHASE REAL OR PERSONAL PROPERTY ON THE CREDIT OF THE CORPORATION, AND IN CONNECTION WITH SUCH PURCHASE, OR IN CONNECTION WITH OTHER BORROWINGS OF THE CORPORATION, TO AUTHORIZE THE CORPORATION'S OFFICERS TO EXECUTE AND DELIVER PROMISSORY NOTES OR OTHER EVIDENCES OF INDEBTEDNESS OF THE CORPORATION, AND TO MORTGAGE OR PLEDGE CORPORATE PROPERTY TO SECURE PAYMENT OF SUCH INDEBTEDNESS, AND TO REPAY SUCH INDEBTEDNESS; AND, (D) TO APPLY THE UNRESTRICTED FUNDS OF THE CORPORATION TO OR FOR THE BENEFIT OF ARKANSAS CHILDREN'S HOSPITAL AND ARKANSAS CHILDREN'S HOSPITAL RESEARCH INSTITUTE, INC., AND TO MAKE ALL RELATED DETERMINATIONS SUBJECT TO THE APPROVAL OF THE ACH BOARD. THE EXECUTIVE COMMITTEE IS COMPRISED OF THE FOLLOWING: THE CHIEF EXECUTIVE OFFICER OF ACH, WHO IS ALSO THE CHAIRMAN OF THE FOUNDATION BOARD OF DIRETORS; SIX (6) MEMBERS OF THE ACH BOARD; ONE (1) MEMBER OF THE ARKANSAS CHILDREN'S HOSPITAL RESEARCH INSTITUTE BOARD; AND THREE AT LARGE DIRECTORS WHO ARE NOMINATED BY THE EXECUTIVE COMMITTEE OF THE FOUNDATION AND WHO ARE ELECTED TO THE EXECUTIVE COMMITTEE BY THE ACH BOARD.
FORM 990, PART VI, SECTION A, LINE 6
THE FOUNDATION'S SOLE MEMBER IS ARKANSAS CHILDREN'S HOSPITAL (ACH).
FORM 990, PART VI, SECTION A, LINE 7A
ARKANSAS CHILDREN'S HOSPITAL (THE MEMBER) HAS THE RIGHT TO ELECT ALL DIRECTORS OF THE FOUNDATION, AND HAS THE RIGHT TO REMOVE AND REPLACE ANY AND ALL DIRECTORS OF THE FOUNDATION WITH OR WITHOUT CAUSE WHENEVER, IN ITS BEST JUDGMENT, THE BEST INTERESTS OF THE CORPORATION WILL BE SERVED.
FORM 990, PART VI, SECTION A, LINE 7B
ARKANSAS CHILDREN'S HOSPITAL (ACH) MUST APPROVE ANY AMENDMENTS TO THE FOUNDATION'S ARTICLES OF INCORPORATION AND BYLAWS. ALL RIGHTS OF THE MEMBER WITH RESPECT TO THE FOUNDATION ARE EXERCISED THROUGH THE BOARD OF DIRECTORS OF ACH.
FORM 990, PART VI, SECTION B, LINE 11
THE DRAFT FORM 990, WHICH IS RECONCILED TO THE FOUNDATION'S INTERNAL FINANCIAL STATEMENTS AND THE ARKANSAS CHILDREN'S HOSPITAL CONSOLIDATED AUDIT REPORT, IS INITIALLY REVIEWED IN DETAIL WITH THE FOUNDATION'S PRESIDENT AND VICE PRESIDENT. THE DRAFT IS ALSO REVIEWED IN DETAIL WITH BOTH THE SVP/CFO AND VP OF FINANCIAL OPERATIONS OF ARKANSAS CHILDREN'S HOSPITAL. IF THE REVIEW BY THE FOUNDATION'S MANAGEMENT RESULTS IN REVISIONS TO THE DRAFT FORM 990, THOSE REVISIONS ARE MADE, AND THE FORM 990 TO BE FILED, LESS DONORS' NAMES AND ADDRESSES ON SCHEDULE B, IS PROVIDED TO THE FOUNDATION BOARD'S EXECUTIVE COMMITTEE PRIOR TO THE RETURN BEING FILED. IN ADDITION, THE FORM 990, LESS DONORS' NAMES AND ADDRESSES ON SCHEDULE B, IS PROVIDED TO BOTH THE CHAIRMAN OF THE BOARD AND THE TREASURER OF ARKANSAS CHILDREN'S HOSPITAL AND IS AVAILABLE TO THE FULL FOUNDATION BOARD UPON REQUEST.
FORM 990, PART VI, SECTION B, LINE 12C
THE FOUNDATION BOARD IS GOVERNED BY THE ARKANSAS CHILDREN'S HOSPITAL'S BOARD OF DIRECTORS CONFLICT OF INTEREST POLICY. ANNUAL DISCLOSURE OF CONFLICTS IS REQUIRED OF ALL BOARD MEMBERS. THE ANNUAL DISCLOSURES ARE REVIEWED BY THE FOUNDATION'S PRESIDENT AND BY THE FOUNDATION BOARD'S CHAIRMAN. DISCLOSURES ARE ALSO RECEIVED BY BOTH THE SVP/CFO AND VP OF FINANCIAL OPERATIONS OF ARKANSAS CHILDREN'S HOSPITAL FOR REPORTING PURPOSES. DURING THE YEAR, WHILE BOARD MEMBERS MAY PARTICIPATE IN INITIAL DISCUSSION, BOARD MEMBERS WHO HAVE A CONFLICT ARE PROHIBITED FROM PARTICIPATING IN DELIBERATIONS AND DECISIONS IN THE RELATED TRANSACTION AND ABSTAIN FROM VOTING, WHICH IS NOTED IN THE MINUTES.
FORM 990, PART VI, SECTION B, LINE 15
COMPENSATION FOR THE FOUNDATION'S PRESIDENT, SENIOR VICE PRESIDENT, AND VICE PRESIDENT IS REVIEWED BY THE ARKANSAS CHILDREN'S HOSPITAL BOARD COMPENSATION COMMITTEE WHICH IS ESTABLISHED THROUGH THE BYLAWS OF ARKANSAS CHILDREN'S HOSPITAL TO DISCHARGE THE DUTY OF THE BOARD IN FULFILLING ITS OVERSIGHT RESPONSIBILITIES FOR DETERMINING THE ADEQUACY AND REASONABLENESS OF THE COMPENSATION PAID THE CEO AND OTHER EMPLOYEES THAT THE COMMITTEE BELIEVES ARE IN A POSITION TO EXERCISE A SUBSTANTIAL INFLUENCE OVER THE AFFAIRS OF THE HOSPITAL AND ITS RELATED ORGANIZATIONS. THE COMMITTEE IS COMPOSED OF MEMBERS WHO PERSONALLY RECEIVE NO COMPENSATION, FEES, OR OTHER BENEFITS FROM THE HOSPITAL OR RELATED ORGANIZATIONS. THE COMMITTEE MAY RELY UPON REASONED WRITTEN OPINIONS OF QUALIFIED LEGAL, ACCOUNTING, VALUATION AND EXECUTIVE COMPENSATION EXPERTS. THE COMMITTEE HAS THE SOLE AUTHORITY TO RETAIN AND TERMINATE ANY SPECIAL ADVISORS USED TO ASSIST IN THE EVALUATION OF COMPENSATION. THE COMMITTEE CONTEMPORANEOUSLY, WITH MAKING ITS DETERMINATION OF REASONABLENESS WITH RESPECT TO THE COMPENSATION OF DISQUALIFIED PERSONS, DOCUMENTS IN A WRITTEN REPORT TO THE EXECUTIVE COMMITTEE AND THE BOARD, THE BASIS FOR ITS DECISIONS. SALARY RANGES FOR THE NOTED POSITIONS WERE REVIEWED IN DETAIL WITH EXTERNAL COMPENSATION CONSULTANTS IN FY13.
FORM 990, PART VI, SECTION C, LINE 19
THE FOUNDATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST AS REQUIRED.
FORM 990, PART XI, LINE 9:
ACH FUNDS INVESTED THROUGH ACHF: 20,000,000. TRANSFER OF NET ASSETS TO ANNUITY RESERVE: -3,219. BOARD DESIGNATED ENDOWMENT TO ACHRI FOR MATCH -60,115.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.