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 10-01-2013 , 2013, and ending 09-30-2014
BCheck if applicable:
CName of organization
VALLEY CHILDREN'S HOSPITAL
FKA CHILDREN'S HOSPITAL CENTRAL CA
Doing Business As
 
 
Number and street (or P.O. box if mail is not delivered to street address)
9300 VALLEY CHILDRENS PLACE
 
Room/suite
City or town, state or province, country, and ZIP or foreign postal code
MADERA, CA936368761
D Employer identification number

94-1294954
E Telephone number

G Gross receipts $ 624,728,553
F Name and address of principal officer:
MICHELE WALDRON
9300 VALLEY CHILDRENS PLACE
MADERA,CA936368761
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
WWW.VALLEYCHILDRENS.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: 1949
M State of legal domicile: CA
Part I
Summary
Activities & Governance 1 Briefly describe the organization’s mission or most significant activities: PROVIDE HIGH QUALITY, COMPREHENSIVE HEALTHCARE SERVICES TO CHILDREN
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a) ........ 3 18
4 Number of independent voting members of the governing body (Part VI, line 1b) ..... 4 15
5 Total number of individuals employed in calendar year 2013 (Part V, line 2a) ...... 5 3,180
6 Total number of volunteers (estimate if necessary) ............. 6 479
7a Total unrelated business revenue from Part VIII, column (C), line 12 ........ 7a 1,684,302
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) ......... 12,419,292 67,879,982
9 Program service revenue (Part VIII, line 2g) ......... 506,950,233 441,288,249
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 9,969,173 20,981,798
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 13,563,512 11,851,088
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)................... 542,902,210 542,001,117
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 251,643 393,947
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) 243,834,887 253,148,976
16a Professional fundraising fees (Part IX, column (A), line 11e)..... 0 0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet0    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e).... 195,731,750 177,068,432
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 439,818,280 430,611,355
19 Revenue less expenses. Subtract line 18 from line 12....... 103,083,930 111,389,762
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 934,209,103 1,043,817,916
21 Total liabilities (Part X, line 26)............. 260,668,503 270,286,629
22 Net assets or fund balances. Subtract line 21 from line 20..... 673,540,600 773,531,287
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: TO PROVIDE HIGH QUALITY COMPREHENSIVE HEALTHCARE SERVICES TO CHILDREN REGARDLESS OF THEIR ABILITY TO PAY AND TO CONTINUOUSLY IMPROVE THE HEALTH AND WELL-BEING OF CHILDREN.
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 $ 22,734,981 including grants of $ 393,947 ) (Revenue $ 181,029,403 )
SEE SCHEDULE O
4b (Code:   ) (Expenses $ 302,355,095 including grants of $ 0 ) (Revenue $ 260,258,846 )
SEE SCHEDULE O
4c (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4d Other program services (Describe in Schedule O.)
(Expenses $   including grants of $   ) (Revenue $   )
4e Total program service expensesMediumBullet325,090,076
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 AClick to see attachment........................
1
Yes
 
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 IIClick to see attachment........
4
Yes
 
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
 
No
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
Yes
 
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
Yes
 
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
 
No
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.... Click to see attachment
20a
Yes
 
b
If "Yes" to line 20a, did the organization attach a copy of its audited financial statements to this return?
20b
Yes
 
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... Click to see attachment
21
Yes
 
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........ Click to see attachment
22
Yes
 
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................ Click to see attachment
24a
Yes
 
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
No
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
 
No
d
Did the organization act as an "on behalf of" issuer for bonds outstanding at any time during the year?...
24d
 
No
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........ Click to see attachment
25a
 
No
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................... Click to see attachment
25b
 
No
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.................... Click to see attachment
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......... Click to see attachment
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 .......................... Click to see attachment
28a
 
No
b
A family member of a current or former officer, director, trustee, or key employee? If "Yes,"
complete Schedule L, Part IV..................... Click to see attachment
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... Click to see attachment
28c
Yes
 
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
Yes
 
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... Click to see attachment
35b
Yes
 
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............. Click to see attachment
36
 
No
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
293
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
3,180
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
Yes
 
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
Yes
 
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
 
No
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
 
No
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
 
No
f
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract?..
7f
 
No
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
18
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
15
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
Yes
 
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
Yes
 
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
Yes
 
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
Yes
 
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
Yes
 
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
Yes
 
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
Yes
 
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:
MediumBulletMICHELE WALDRON CFO9300 VALLEY CHILDRENS PLACEMADERACA93636 (559) 353-3000
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) TODD SUNTRAPAK........................................................................
CEO
 40.00
.......................10.00 		X   X       703,774 0 73,481
(2) DR DAVID KRAUSE........................................................................
BOARD CHAIR, TERMED 1/24/15
 1.00
.......................1.00 		X   X       0 0 0
(3) BILL SMITTCAMP........................................................................
VICE CHAIRMAN
 1.00
.......................1.00 		X   X       0 0 0
(4) DR ROBERT KUBO........................................................................
BOARD TREASURER
 1.00
.......................1.00 		X   X       0 0 0
(5) DR LINDA FRALEY........................................................................
BOARD SECRETARY
 1.00
.......................1.00 		X   X       0 0 0
(6) BRUCE ALLBRIGHT........................................................................
BOARD MEMBER
 1.00
.......................   		X           0 0 0
(7) GREG COLEMAN........................................................................
BOARD MEMBER
 1.00
.......................   		X           0 0 0
(8) DAVE NALCHAJIAN........................................................................
FOUNDATION CHAIRMAN OF BOARD
 1.00
.......................1.00 		X           0 0 0
(9) DR TIM HANSEN........................................................................
CHIEF OF STAFF, TERMED 1/25/14
 1.00
.......................   		X           75,000 0 0
(10) RILEY WALTER........................................................................
BOARD MEMBER
 1.00
.......................   		X           0 0 0
(11) JEFF MAYER........................................................................
BOARD MEMBER
 1.00
.......................1.00 		X           0 0 0
(12) NANCY MASICH........................................................................
GUILD COOR., TERMED 12/31/13
 1.00
.......................   		X           0 0 0
(13) MICHAEL HANSON........................................................................
BOARD MEMBER
 1.00
.......................   		X           0 0 0
(14) PAT RICCHIUTI........................................................................
BOARD MEMBER
 1.00
.......................   		X           0 0 0
(15) DR CHARLES SMITH........................................................................
BOARD MEMBER
 1.00
.......................   		X           0 0 0
(16) KIM RUIZ BECK........................................................................
BOARD MEMBER
 1.00
.......................1.00 		X           0 0 0
(17) JEANNINE CAMPOS GRECH........................................................................
BOARD MEMBER
 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) PAUL MCDOUGAL........................................................................
FOUNDATION BOARD CHAIRMAN
 1.00
.......................1.00 		X           0 0 0
(19) DR SAHAR BARAYAN........................................................................
CHIEF OF STAFF, EFFECTIVE 1/28/14
 1.00
.......................   		X           20,000 0 257,637
(20) NOREEN WADE........................................................................
BOARD MEMBER
 1.00
.......................   		X           0 0 0
(21) MICHELE R WALDRON........................................................................
CFO
 45.00
.......................5.00 		    X       562,868 0 81,158
(22) DAVID CHRISTENSEN........................................................................
VP, MEDICAL AFFAIRS & CMO
 40.00
.......................   		      X     565,375 0 46,416
(23) BEVERLY HAYDEN-PUGH........................................................................
VP, CHIEF NURSING OFFICER
 40.00
.......................   		      X     392,773 0 80,831
(24) JESSIE HUDGINS........................................................................
VP, FACILITIES
 40.00
.......................   		      X     380,277 0 70,864
(25) NATALE PONTICELLO JR........................................................................
VP, HUMAN RESOURCES, EFF. 1/7/13
 40.00
.......................   		      X     308,326 0 0
(26) JANE WILLSON........................................................................
VP, CORPORATE DEVELOPMENT
 40.00
.......................   		      X     354,820 0 45,124
(27) DAVID SINGH........................................................................
VP, REV CYCLE MGMT/ANCILLARY
 40.00
.......................   		      X     334,807 0 29,280
(28) RICK WOLF........................................................................
VP, GENERAL COUNCIL
 40.00
.......................   		      X     367,486 0 46,179
(29) KIRK LARSON........................................................................
VP AND CIO, TERMED 4/4/14
 40.00
.......................   		      X     318,709 0 31,438
(30) STEPHANIE VANCE........................................................................
ED, FINANCE, VP EFFECTIVE 1/5/14
 40.00
.......................   		        X   279,843 0 35,200
(31) RANDALL GUERRERO........................................................................
ED, CRITICAL CARE (TERMED 4/30/14)
 40.00
.......................   		        X   255,754 0 32,790
(32) JEFFREY LEFORS........................................................................
EXECUTIVE DIRECTOR, PROF SVCS + CHG
 40.00
.......................   		        X   281,292 0 39,484
(33) DANIEL DAVIS........................................................................
EXECUTIVE DIRECTOR, ACUTE/PT CARE SU
 40.00
.......................   		        X   267,588 0 35,369
(34) CHRISTOPHER LONG........................................................................
EXEC DIR COMM & ADVOCACY
 40.00
.......................   		        X   238,767 0 32,802
(35) GORDON ALEXANDER........................................................................
FORMER CEO, TERMED 11/13/11
 34.00
.......................6.00 		          X 271,154 0 0
(36) MARTA BOYER........................................................................
FORMER VP, HR, TERMED 5/4/12
 40.00
.......................   		          X 252,692 0 11,267
1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)............MediumBullet 6,231,305 0 949,320
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organizationMediumBullet523
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
Yes
 
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
SPECIALTY MEDICAL GROUP9300 VALLEY CHILDRENS PLACEMADERACA93636 SUBSPEC PHYSICIAN SERVICES 14,049,997
PEDIATRIC ANETHESIA ASSOCIATION6235 N FRESNO ST STE 103FRESNOCA93710 ANETHESIA/CRITICAL CARE 9,111,224
CROTHALL HEALTHCARE INC1654 MARTHALER LANEWEST ST PAULMN55118 HOUSEKEEPING SERVICES 3,459,206
PARKPLACE INTERNATIONALDEPT CH 19800PALATINEIL600559800 CONSULTING 1,371,845
METROPOLITAN BUILDERS4554 E LAMONAFRESNOCA93703 CONSTRUCTION SERVICES 1,269,230
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet69
Form 990 (2013)
Form 990 (2013)
Page 9
Part VIII
Statement of Revenue
Check if Schedule O contains a response or note to any line in this Part VIII .............
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512-514
Contributions, Gifts, GrantAmt and OtherAmt Similar Amounts 1a Federated campaigns..1a  
b Membership dues....1b  
c Fundraising events....1c  
d Related organizations...1d 46,444,666
e Government grants (contributions)1e 20,992,483
f All other contributions, gifts, grants, and
similar amounts not included above1f 		442,833
g Noncash contributions included in lines
1a-1f:$ 		5,400
h Total. Add lines 1a-1f.......MediumBullet 67,879,982
Program Service RevenueAmt Business Code
2a PATIENT SERVICES 900099 441,127,329 441,127,329    
b OUTSIDE LAB SERVICES 900099 160,920 160,920    
c
d
e
f All other program service revenue .        
g Total. Add lines 2a–2f........MediumBullet 441,288,249
OtherAmt RevenueAmt 3 Investment income (including dividends, interest, and other similar amounts).......MediumBullet 9,356,890     9,356,890
4 Income from investment of tax-exempt bond proceeds..MediumBullet 862,720     862,720
5 Royalties...........MediumBullet        
(i) Real (ii) Personal
6a Gross rents 107,008  
b Less: rental expenses 35,815  
c Rental income or (loss) 71,193  
d Net rental income or (loss).......MediumBullet 71,193     71,193
(i) Securities (ii) Other
7a Gross amount from sales of assets other than inventory 93,182,565 31,036
b Less: cost or other basis and sales expenses 82,377,502 73,911
c Gain or (loss) 10,805,063 -42,875
d Net gain or (loss)..........MediumBullet 10,762,188     10,762,188
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 541,428
b Less: cost of goods sold ..b 240,208
c Net income or (loss) from sales of inventory..MediumBullet 301,220     301,220
Miscellaneous Revenue Business Code
11a CAFETERIA REVENUE 900099 2,774,398     2,774,398
b MANAGEMENT SERVICES 541610 1,684,302   1,684,302  
c            
d All other revenue .... 7,019,975     7,019,975
e Total. Add lines 11a–11d ...... MediumBullet 11,478,675
12 Total revenue. See Instructions......MediumBullet 542,001,117 441,288,249 1,684,302 31,148,584
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 21 180,781 180,781
2 Grants and other assistance to individuals in the United States. See Part IV, line 22 213,166 213,166
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 .... 5,741,759   5,741,759  
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 171,916,957 136,343,174 35,573,783  
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) .... 11,827,021 9,379,497 2,447,524  
9 Other employee benefits ....... 49,235,155 36,878,486 12,356,669  
10 Payroll taxes ........... 14,428,084 10,874,464 3,553,620  
11 Fees for services (non-employees):        
a Management ...... 2,235,437 65,610 2,169,827  
b Legal ......... 603,195   603,195  
c Accounting ........... 198,900   198,900  
d Lobbying ...........        
e Professional fundraising services. See Part IV, line 17    
f Investment management fees ...... 2,087,856   2,087,856  
g Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) ........ 31,426,257 31,020,972 405,285  
12 Advertising and promotion .... 823,119 823,119    
13 Office expenses ....... 58,635,489 52,094,155 6,541,334  
14 Information technology ...... 4,867,369   4,867,369  
15 Royalties ..        
16 Occupancy ........... 4,405,283 3,501,890 903,393  
17 Travel ............ 536,399 185,746 350,653  
18 Payments of travel or entertainment expenses for any federal, state, or local public officials ......        
19 Conferences, conventions, and meetings .... 250,174 56,949 193,225  
20 Interest ........... 8,030,433 6,258,310 1,772,123  
21 Payments to affiliates .......        
22 Depreciation, depletion, and amortization ..... 24,221,356 13,640,048 10,581,308  
23 Insurance .............. 2,955,141 91,278 2,863,863  
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 PURCHASED SERVICES 18,152,072 11,894,138 6,257,934  
b BAD DEBT 6,098,578 6,098,578    
c HOSPITAL FEE PROGRAM 4,949,542 4,949,542    
d DUES 1,467,221 140,126 1,327,095  
e All other expenses 5,124,611 400,047 4,724,564  
25 Total functional expenses. Add lines 1 through 24e 430,611,355 325,090,076 105,521,279 0
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 ............. 13,866 1 13,760
2 Savings and temporary cash investments ......... 113,166,000 2 183,903,715
3 Pledges and grants receivable, net ........... 841,900 3 638,970
4 Accounts receivable, net ............. 54,124,351 4 57,985,202
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 .............. 5,821,066 8 6,244,120
9 Prepaid expenses and deferred charges .......... 5,012,311 9 8,214,772
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 461,530,461
b Less: accumulated depreciation ..... 10b 207,877,347 258,251,547 10c 253,653,114
11 Investments—publicly traded securities .......... 203,327,625 11 248,661,417
12 Investments—other securities. See Part IV, line 11 ..... 217,453,510 12 236,186,300
13 Investments—program-related. See Part IV, line 11 ..... 3,543,309 13 2,828,218
14 Intangible assets ...............   14  
15 Other assets. See Part IV, line 11 ........... 72,653,618 15 45,488,328
16 Total assets. Add lines 1 through 15 (must equal line 34)...... 934,209,103 16 1,043,817,916
Liabilities 17 Accounts payable and accrued expenses ......... 58,927,373 17 56,821,562
18 Grants payable .................   18  
19 Deferred revenue ................   19  
20 Tax-exempt bond liabilities ............. 150,931,191 20 146,008,626
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.................... 50,809,939 25 67,456,441
26 Total liabilities. Add lines 17 through 25......... 260,668,503 26 270,286,629
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 .............. 670,379,140 27 771,171,330
28 Temporarily restricted net assets ........... 3,161,460 28 2,359,957
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 ........... 673,540,600 33 773,531,287
34 Total liabilities and net assets/fund balances ........ 934,209,103 34 1,043,817,916
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
542,001,117
2
Total expenses (must equal Part IX, column (A), line 25) ............
2
430,611,355
3
Revenue less expenses. Subtract line 2 from line 1 ..............
3
111,389,762
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) ..
4
673,540,600
5
Net unrealized gains (losses) on investments ...............
5
10,083,186
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
-21,482,261
10
Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line 33, column (B))
10
773,531,287
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 A
(Form 990 or 990EZ)

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.
right arrow Attach to Form 990 or Form 990-EZ. right arrow See separate instructions.
right arrow 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 HOSPITAL
FKA CHILDREN'S HOSPITAL CENTRAL CA
Employer identification number

94-1294954
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
f
g
(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) right arrow (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 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 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)..  
6 Public support. Subtract line 5 from line 4.  
Section B. Total Support
Calendar year (or fiscal year beginning in) right arrow (a) 2009 (b) 2010 (c) 2011 (d) 2012 (e) 2013 (f) Total
7 Amounts from line 4..            
8 Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...            
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).  
12
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.................................................right arrow
Section C. Computation of Public Support Percentage
14
14
 
15
15
 
16a
b
17a
b
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 ..................................................... right arrow
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) right arrow (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) right arrow (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
Section C. Computation of Public Support Percentage
15
15
 
16
16
 
Section D. Computation of Investment Income Percentage
17
17
 
18
18
 
19a
b
20
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:  
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
VALLEY CHILDREN'S HOSPITAL
FKA CHILDREN'S HOSPITAL CENTRAL CA
Employer identification number

94-1294954
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
VALLEY CHILDREN'S HOSPITAL
FKA CHILDREN'S HOSPITAL CENTRAL CA 		Employer identification number

94-1294954
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
VALLEY CHILDREN'S HOSPITAL
FKA CHILDREN'S HOSPITAL CENTRAL CA 		Employer identification number

94-1294954
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
VALLEY CHILDREN'S HOSPITAL
FKA CHILDREN'S HOSPITAL CENTRAL CA 		Employer identification number

94-1294954
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
VALLEY CHILDREN'S HOSPITAL
FKA CHILDREN'S HOSPITAL CENTRAL CA
Employer identification number

94-1294954
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? .........................................
 
No
b
Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ....
Yes
 
c
Media advertisements? ....................................
 
No
 
d
Mailings to members, legislators, or the public? .........................
Yes
 
 
e
Publications, or published or broadcast statements? .......................
 
No
 
f
Grants to other organizations for lobbying purposes? .......................
 
No
 
g
Direct contact with legislators, their staffs, government officials, or a legislative body? ........
Yes
 
6,305
h
Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ......
 
No
 
i
Other activities? ..........................
Yes
 
2,350,398
j
Total. Add lines 1c through 1i ...............................
2,356,703
2a
Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....
 
No
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
 
 
2
Did the organization make only in-house lobbying expenditures of $2,000 or less? ................
2
 
 
3
Did the organization agree to carry over lobbying and political expenditures from the prior year? ..........
3
 
 
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
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
 
b
Carryover from last year ....................................
2b
 
c
Total ............................................
2c
 
3
Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .
3
 
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
 
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
PART II-B, LINE 1 VALLEY CHILDREN'S HOSPITAL HAS HAD DIRECT CONTACT WITH AND HAS ENCOURAGED OTHERS TO HAVE DIRECT CONTACT WITH LOCAL, STATE AND FEDERAL LEGISLATORS REGARDING CHILDREN'S HEALTH CARE PUBLIC POLICY. THESE CONTACTS HAVE PROVIDED INFORMATION REGARDING THE PROVISION OF HEALTH CARE SERVICES TO CHILDREN, THE ANTICIPATED EFFECT ON CHILDREN'S HEALTH OF PENDING LEGISLATIVE PROPOSALS, AND REQUESTS FOR ASSISTANCE IN SUPPORTING ACCESS TO CHILDREN'S HEALTH CARE BY MAINTAINING CURRENT STATE AND FEDERAL FUNDING LEVELS FOR MEDI-CAL AND OTHER PUBLIC PROGRAMS. EXPENSES ASSOCIATED WITH THIS ACTIVITY ARE LESS THAN 1% OF TOTAL HOSPITAL EXPENDITURES. VALLEY CHILDREN'S HOSPITAL HAS MADE NO CONTRIBUTIONS TO ANY POLITICAL CANDIDATE OR ELECTED OFFICIAL. SALARIES RELATED TO LOBBYING $6,305 ASSOCIATION DUES RELATED TO LOBBYING NACH 22,055 CALIFORNIA CHILDREN'S HOSPITAL ASSOCIATION 42,140 CALIFORNIA HOSPITAL ASSOCIATION 2,260,301 HOSPITAL COUNCIL OF NORTHERN & CENTRAL CALIF. 25,902 TOTAL EXPENDITURES RELATED TO LEGISLATIVE MATTERS $2,356,703
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
VALLEY CHILDREN'S HOSPITAL
FKA CHILDREN'S HOSPITAL CENTRAL CA
Employer identification number

94-1294954
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 .................   9,527,143 9,527,143
b Buildings ................   264,489,427 78,216,526 186,272,901
c Leasehold improvements ............   3,756,225 2,333,523 1,422,702
d Equipment ................   159,361,414 110,026,313 49,335,101
e Other .................   24,396,252 17,300,985 7,095,267
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......SchDMdBullet 253,653,114
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    
(3)Other
(A) LIMITED PARTNERSHIPS 		236,186,300 F








Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)Small Bullet 236,186,300
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  
MALPRACTICE RESERVE 5,333,379
ACCRUED PENSION LIABILITY 45,505,622
457 LIABILITY 2,219,281
1732 LIABILITY 1,777,433
OTHER 4,444
WORKERS COMP 7,348,020
INS LIABILITY 4,473,980
DC SERP LIABILITY 794,282

Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)Small Bullet 67,456,441
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  
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  
e Add lines 2a through 2d ..................... 2e  
3 Subtract line 2e from line 1..................... 3  
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  
c Add lines 4a and 4b....................... 4c  
5 Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ...... 5  
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  
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  
e Add lines 2a through 2d...................... 2e  
3 Subtract line 2e from line 1..................... 3  
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  
5 Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ...... 5  
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
Schedule D (Form 990) 2013

Additional Data


Software ID:  
Software Version:  




SCHEDULE H (Form 990)
Department of the Treasury
Internal Revenue Service
Hospitals
MediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, question 20.
MediumBullet Attach to Form 990. MediumBullet See separate instructions.
MediumBullet Information about Schedule H (Form 990) 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 HOSPITAL
FKA CHILDREN'S HOSPITAL CENTRAL CA
Employer identification number

94-1294954
Part I
Financial Assistance and Certain Other Community Benefits at Cost
Yes
No
1a
Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a ...
1a
Yes
 
b
If "Yes," was it a written policy? .......................
1b
Yes
 
2
If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.
3
Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.
a
Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?
If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:
3a
Yes
 
%
b
Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate
which of the following was the family income limit for eligibility for discounted care: .........
3b
Yes
 
%
c
If the organization used factors other than FPG in determining eligibility, describe in Part VI the income based criteria for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.
4
Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? ..............

4

Yes

 
5a
Did the organization budget amounts for free or discounted care provided under its financial assistance policy during the tax year? ............................

5a

 

No
b
If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? ......
5b
 
 
c
If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? ..............
5c
 
 
6a
Did the organization prepare a community benefit report during the tax year? ..........
6a
Yes
 
b
If "Yes," did the organization make it available to the public? ..............
6b
Yes
 
Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.
7
Financial Assistance and Certain Other Community Benefits at Cost
Financial Assistance and
Means-Tested
Government Programs
 (a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community benefit expense (d) Direct offsetting revenue (e) Net community benefit expense (f) Percent of total expense
a Financial Assistance at cost
(from Worksheet 1) .. 		    67,000   67,000 0.020 %
b Medicaid (from Worksheet 3,
column a) .... 		    308,978,080 274,512,053 34,466,027 8.120 %
c Costs of other means-tested
government programs (from
Worksheet 3, column b) . 		    487,585 251,657 235,928 0.060 %
d Total Financial Assistance
and Means-Tested
Government Programs . 		    309,532,665 274,763,710 34,768,955 8.200 %
Other Benefits
     620,056   620,056 0.150 %
e Community health
improvement services and
community benefit operations
(from Worksheet 4) ..
f Health professions education
(from Worksheet 5) .. 		    7,768,216 494,782 7,273,434 1.710 %
g Subsidized health services
(from Worksheet 6) .. 		           
h Research (from Worksheet 7)     714,385 371,338 343,047 0.080 %
i Cash and in-kind
contributions for community
benefit (from Worksheet 8) 		    203,998   203,998 0.050 %
j Total. Other Benefits ..     9,306,655 866,120 8,440,535 1.990 %
k Total. Add lines 7d and 7j .     318,839,320 275,629,830 43,209,490 10.190 %
For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2013
Schedule H (Form 990) 2013
Page
Part II
Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.
(a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community building expense (d) Direct offsetting
revenue 		(e) Net community building expense (f) Percent of total expense
1 Physical improvements and housing            
2 Economic development            
3 Community support            
4 Environmental improvements            
5 Leadership development and training for community members            
6 Coalition building            
7 Community health improvement advocacy            
8 Workforce development     5,000   5,000 0 %
9 Other            
10 Total     5,000   5,000  
Part III
Bad Debt, Medicare, & Collection Practices
Section A. Bad Debt Expense
Yes
No
1
Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................
1
Yes
 
2
Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......
2
1,790,063
3
Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......
3
0
4
Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.
Section B. Medicare
5
Enter total revenue received from Medicare (including DSH and IME).....
5
668,180
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
942,331
7
Subtract line 6 from line 5. This is the surplus (or shortfall)........
7
-274,151
8
Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:
Section C. Collection Practices
9a
Did the organization have a written debt collection policy during the tax year? ..........
9a
Yes
 
b
If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI.......................

9b

Yes

 
Part IV
Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)
(a) Name of entity (b) Description of primary
activity of entity 		(c) Organization's
profit % or stock
ownership % 		(d) Officers, directors,
trustees, or key
employees' profit %
or stock ownership % 		(e) Physicians'
profit % or stock
ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13
Schedule H (Form 990) 2013
Schedule H (Form 990) 2013
Page
Part VFacility Information
Section A. Hospital Facilities
(list in order of size from largest to smallest—see instructions)
How many hospital facilities did the organization operate during the tax year?2
Name, address, primary website address, and state license number 		Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital ResearchGrp Facility ER-24Hours ER-Other Other (Describe) Facility reporting group
1 VALLEY CHILDREN'S HOSPITAL
9300 VALLEY CHILDRENS PLACE
MADERA,CA936368761
WWW.VALLEYCHILDRENS.ORG 		    X             A
2 VALLEY CHILDREN'S HOME CARE
7555 N DEL MAR AVE
FRESNO,CA93711
WWW.VALLEYCHILDRENS.ORG 		    X             A
Schedule H (Form 990) 2013
Schedule H (Form 990) 2013
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)
FACILITY REPORTING GROUP - A
Name of hospital facility or facility reporting group  
If reporting on Part V, Section B for a single hospital facility only: line number of
hospital facility (from Schedule H, Part V, Section A) 		 
Yes No
Community Health Needs Assessment (Lines 1 through 8c are optional for tax years begining on or before March 23, 2012)
1 During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 9.................... 1 Yes  
If "Yes," indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
2 Indicate the tax year the hospital facility last conducted a CHNA: 20 12
3 In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted .................... 3 Yes  
4 Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Part VI................................ 4 Yes  
5 Did the hospital facility make its CHNA report widely available to the public? ............. 5 Yes  
If "Yes," indicate how the CHNA report was made widely available (check all that apply):
a
b
c
d
6 If the hospital facility addressed needs identified in its most recently conducted CHNA, indicate how (check all that apply as of the end of the tax year):
a
b
c
d
e
f
g
h
i
7 Did the hospital facility address all of the needs identified in its most recently conducted CHNA? If "No," explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs ........ 7 Yes  
8a Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)? ........................... 8a   No
b If "Yes" to line 8a, did the organization file Form 4720 to report the section 4959 excise tax? ...... 8b    
c If "Yes" to line 8b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $  

Schedule H (Form 990) 2013
Schedule H (Form 990) 2013
Page
Part VFacility Information (continued)

Financial Assistance Policy Yes No
9 Did the hospital facility have in place during the tax year a written financial assistance policy that:
Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 9 Yes  
10 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 10 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.000000000000%
If "No," explain in Part VI the criteria the hospital facility used.
11 Used FPG to determine eligibility for providing discounted care?................. 11 Yes  
If "Yes," indicate the FPG family income limit for eligibility for discounted care: 350.000000000000%
If "No," explain in Part VI the criteria the hospital facility used.
12 Explained the basis for calculating amounts charged to patients?................. 12 Yes  
If "Yes," indicate the factors used in determining such amounts (check all that apply):
a
b
c
d
e
f
g
h
i
13 Explained the method for applying for financial assistance?................... 13 Yes  
14 Included measures to publicize the policy within the community served by the hospital facility?....... 14 Yes  
If "Yes," indicate how the hospital facility publicized the policy (check all that apply):
a
b
c
d
e
f
g
Billing and Collections
15 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 15 Yes  
16 Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:
a
b
c
d
e
17 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?.......... 17   No
If "Yes," check all actions in which the hospital facility or a third party engaged:
a
b
c
d
e
Schedule H (Form 990) 2013
Schedule H (Form 990) 2013
Page
Part VFacility Information (continued)

18 Indicate which efforts the hospital facility made before initiating any of the actions listed in line 17 (check all that apply):
a
b
c
d
e
Policy Relating to Emergency Medical Care
Yes No
19 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 19 Yes  
If "No," indicate why:
a
b
c
d
Charges to Individuals Eligible for Assistance under the FAP (FAP-Eligible Individuals)
20 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a
b
c
d
21 During the tax year, did the hospital facility charge any FAP-eligible individual to whom the hospital facility provided emergency or other medically necessary services more than the amounts generally billed to individuals who had insurance covering such care? ............................ 21   No
If "Yes," explain in Part VI.
22 During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ......................... 22 Yes  
If "Yes," explain in Part VI.
Schedule H (Form 990) 2013
Schedule H (Form 990) 2013
Page
Part V
Facility Information (continued)
Section C. Supplemental Information for Part V, Section B.Provide descriptions required for Part V, Section B, lines 1j, 3, 4, 5d, 6i, 7, 10, 11, 12i, 14g, 16e, 17e, 18e, 19c, 19d, 20d, 21, and 22. If applicable, provide separate descriptions for each facility in a facility reporting group, designated by "Facility A," "Facility B," etc.
Form and Line Reference Explanation
PART V, SECTION B FACILITY REPORTING GROUP A
FACILITY REPORTING GROUP A CONSISTS OF: - FACILITY 1: VALLEY CHILDREN'S HOSPITAL, - FACILITY 2: VALLEY CHILDREN'S HOME CARE
FACILITY REPORTING GROUP - A PART V, SECTION B, LINE 3: A TOTAL OF 14 FOCUS GROUPS WERE CONDUCTED AND INCLUDED COUNTY PUBLIC HEALTH DIRECTORS, PRIMARY CARE CLINIC PROVIDERS, COMMUNITY-BASED AGENCY LEADERS, AND OTHERS. ORGANIZATIONS OR INDIVIDUALS PARTICIPATING IN THE FOCUS GROUPS INCLUDED THE FOLLOWING.- FRESNO COUNTY PUBLIC HEALTH DIRECTOR- TULARE COUNTY PUBLIC HEALTH DIRECTOR- MADERA COUNTY PUBLIC HEALTH DIRECTOR- KINGS COUNTY PUBLIC HEALTH DIRECTOR- FIRST 5 MADERA COUNTY EXECUTIVE DIRECTOR- FIRST 5 FRESNO COUNTY COMMUNICATIONS DIRECTOR- CLINICA SIERRA VISTA CHIEF EXECUTIVE OFFICER- CENTRAL VALLEY HEALTH POLICY INSTITUTE EXECUTIVE DIRECTOR FOR INPUT ON ALL COUNTIES IN THE HOSPITAL'S SERVICE AREA IN ADDITION TO THE FEEDBACK RECEIVED THROUGH THE FOCUS GROUPS, VALLEY CHILDREN'S HOSPITAL INCORPORATED INTO THE CHNA INFORMATION GATHERED BY HOSPITAL STAFF AS PART OF THEIR ACTIVE INVOLVEMENT IN A VARIETY OF COMMUNITY BASED INITIATIVES OR ORGANIZATIONS, INCLUDING THOSE LISTED BELOW. - ABC 30 FRESNO COMMUNITY ADVISORY COMMITTEE- BI-ANNUAL BABIES FIRST COORDINATING COUNCIL- BINATIONAL HEALTH WEEK PLANNING COMMITTEES FOR MADERA AND FRESNO COUNTIES - CALIFORNIA BREAST FEEDING COALITION COMMUNICATION COMMITTEE - CALIFORNIA CENTRAL VALLEY COALITION FOR COMPASSIONATE CARE - CALIFORNIA SAFE TEEN DRIVING COMMITTEE- CHILD ABUSE PREVENTION COUNCILS OF CENTRAL CALIFORNIA- CENTRAL CALIFORNIA PERINATAL MENTAL HEALTH COLLABORATIVE - CENTRAL VALLEY CONCUSSION CONSORTIUM- CENTRAL VALLEY HEALTH AND NUTRITION COLLABORATIVE - CENTRAL VALLEY SCHOOL HEALTH ADVISORY PANEL - CHILDHOOD WEIGHT MANAGEMENT TASK FOR FRESNO AND MADERA COUNTIES- COUNTY PEDIATRIC DEATH REVIEW TEAMS - EXCEPTIONAL PARENTS UNLIMITED - FRESNO BABIES FIRST BREASTFEEDING TASK FORCE - FRESNO COUNTY INTERAGENCY TEAM MEMBER- FRESNO COUNTY SEXUAL ASSAULT RESPONSE TEAM- FRESNO HEALTHY COMMUNITIES ACCESS PARTNERS - FRESNO-KINGS-MADERA REGIONAL HEALTH AUTHORITY - HUMAN RIGHTS COMMISSION - INTERAGENCY COUNCIL FOR CHILDREN (FRESNO AND MADERA COUNTIES) - KERN COUNTY MEDICALLY VULNERABLE INFANT PROJECT - KINGS COUNTY MULTI-DISCIPLINARY TEAM- MADERA BREAST FEEDING COALITION- MADERA COUNTY CHILD ABUSE PREVENTION COUNCIL- MADERA COUNTY CHILD FORENSIC INTERVIEW TEAM - MADERA COUNTY INTERAGENCY TEAM MEMBER- MARCH OF DIMES CENTRAL VALLEY DIVISION - MARIPOSA COUNTY INTERAGENCY TEAM MEMBER- MODEL OF CARE PARTNERSHIP OVERSIGHT COMMITTEE, FRESNO COUNTY - RAPHAEL HEALTH MINISTRY OUR LADY OF PERPETUAL HELP CHURCH - RESOURCE CENTER FOR SURVIVORS, FRESNO COUNTY RAPE CRISIS SERVICES- ROMAN CATHOLIC DIOCESE OF FRESNO, HEALTH MINISTRY OFFICE - SAFE KIDS CENTRAL CENTRAL CALIFORNIA - TULARE COUNTY HEALTHY FOR LIFE COLLABORATIVE- UNITED WAY OF FRESNO COUNTY- TEEN PARENT SUPPORT PROGRAM - FIRST 5 FRESNO- TULARE COUNTY HEALTHY FOR LIFE COLLABORATIVE- TULARE COUNTY SEXUAL ASSAULT RESPONSE TEAM- MEXICAN CONSULATE - VENTANILLA DE SALUD PROGRAM- WOMEN'S INITIATIVE UNITED WAY FRESNO COUNTY
FACILITY REPORTING GROUP - A PART V, SECTION B, LINE 4: - ADVENTIST HEALTH CENTRAL CALIFORNIA - COMMUNITY REGIONAL MEDICAL CENTER - FRESNO HEART HOSPITAL AND SURGICAL HOSPITAL - KAISER PERMANENTE FRESNO REGION - KAWEAH DELTA HEALTH CARE DISTRICT - MADERA COMMUNITY HOSPITAL - SAINT AGNES MEDICAL CENTER - SIERRA VIEW DISTRICT HOSPITAL
FACILITY REPORTING GROUP - A PART V, SECTION B, LINE 12I: 200% OR LESS FEDERAL POVERTY GUIDELINES (FPG) - FULL CHARITABLE DISCOUNT $0 CHARGES.201%-350% FPG - LOW INCOME DISCOUNT NO MORE THAN APPLICABLE MEDI CAL RATES IN EFFECT AT DATE OF SERVICE. WHERE MEDI CAL RATES CANNOT BE DETERMINED 75% DISCOUNT FROM CHARGES.350% - HIGH MEDICAL COST DISCOUNT, INCOME FOR THE LAST 12 MONTHS DOES NOT EXCEED 350% OF FPG AND THEY HAVE NOT RECEIVED A DISCOUNTED RATE FROM THE HOSPITAL AS A RESULT OF THEIR THIRD-PARTY INSURANCE COVERAGE AND THEIR ANNUAL OUT-OF-POCKET MEDICAL EXPENSES (EXCLUDING CO-PAYS, INDEMNITY BALANCES, AND SHARE OF COST) FOR THE PRIOR 12 MONTHS EXCEED 10% OF THEIR FAMILY'S ANNUAL INCOME. NO MORE THAN APPLICABLE MEDI CAL RATES IN EFFECT AT DATE OF SERVICE. WHERE MEDI CAL RATES CANNOT BE DETERMINED 75% DISCOUNT FROM CHARGES.351% AND GREATER THAN FPG - PROMPT PAY DISCOUNT 25% DISCOUNT FROM CHARGES FOR PATIENTS WHO PAY THEIR BALANCE IN FULL WITHIN 30 DAYS.
FACILITY REPORTING GROUP - A PART V, SECTION B, LINE 14G: ADDITIONALLY THE POLICY IS SENT BY US POSTAL SERVICE TO COMMUNITY AGENCIES TO BE DISTRIBUTED.
FACILITY REPORTING GROUP - A PART V, SECTION B, LINE 20D: 200% OR LESS FEDERAL POVERTY GUIDELINES (FPG) - FULL CHARITABLE DISCOUNT $0 CHARGES.201%-350% FPG - LOW INCOME DISCOUNT NO MORE THAN APPLICABLE MEDI CAL RATES IN EFFECT AT DATE OF SERVICE. WHERE MEDI CAL RATES CANNOT BE DETERMINED 75% DISCOUNT FROM CHARGES.350% - HIGH MEDICAL COST DISCOUNT, INCOME FOR THE LAST 12 MONTHS DOES NOT EXCEED 350% OF FPG AND THEY HAVE NOT RECEIVED A DISCOUNTED RATE FROM THE HOSPITAL AS A RESULT OF THEIR THIRD-PARTY INSURANCE COVERAGE AND THEIR ANNUAL OUT-OF-POCKET MEDICAL EXPENSES (EXCLUDING CO-PAYS, INDEMNITY BALANCES, AND SHARE OF COST) FOR THE PRIOR 12 MONTHS EXCEED 10% OF THEIR FAMILY'S ANNUAL INCOME. NO MORE THAN APPLICABLE MEDI CAL RATES IN EFFECT AT DATE OF SERVICE. WHERE MEDI CAL RATES CANNOT BE DETERMINED 75% DISCOUNT FROM CHARGES.351% AND GREATER THAN FPG - PROMPT PAY DISCOUNT 25% DISCOUNT FROM CHARGES FOR PATIENTS WHO PAY THEIR BALANCE IN FULL WITHIN 30 DAYS.
FACILITY REPORTING GROUP - A PART V, SECTION B, LINE 22: IF A PATIENT DID NOT QUALIFY FOR FULL CHARITABLE DISCOUNT, LOW INCOME DISCOUNT, HIGH MEDICAL COST DISCOUNT OR 25% PROMPT PAY DISCOUNT THEN THEY COULD BE CHARGED GROSS CHARGES FOR THEIR SERVICES.
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
Schedule H (Form 990) 2013
Schedule H (Form 990) 2013
Page
Part VFacility Information (continued)

Section D. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility
(list in order of size, from largest to smallest)
How many non-hospital health care facilities did the organization operate during the tax year?  
Name and address Type of Facility (describe)
1
2
3
4
5
6
7
8
9
10
Schedule H (Form 990) 2013
Schedule H (Form 990) 2013
Page
Part VI
Supplemental Information
Provide the following information.
1 Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2 Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs reported in Part V, Section B.
3 Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4 Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5 Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6 Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7 State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.
Form and Line Reference Explanation
PART V, SECTION B FACILITY REPORTING GROUP A
FACILITY REPORTING GROUP A CONSISTS OF: - FACILITY 1: VALLEY CHILDREN'S HOSPITAL, - FACILITY 2: VALLEY CHILDREN'S HOME CARE
FACILITY REPORTING GROUP - A PART V, SECTION B, LINE 3: A TOTAL OF 14 FOCUS GROUPS WERE CONDUCTED AND INCLUDED COUNTY PUBLIC HEALTH DIRECTORS, PRIMARY CARE CLINIC PROVIDERS, COMMUNITY-BASED AGENCY LEADERS, AND OTHERS. ORGANIZATIONS OR INDIVIDUALS PARTICIPATING IN THE FOCUS GROUPS INCLUDED THE FOLLOWING.- FRESNO COUNTY PUBLIC HEALTH DIRECTOR- TULARE COUNTY PUBLIC HEALTH DIRECTOR- MADERA COUNTY PUBLIC HEALTH DIRECTOR- KINGS COUNTY PUBLIC HEALTH DIRECTOR- FIRST 5 MADERA COUNTY EXECUTIVE DIRECTOR- FIRST 5 FRESNO COUNTY COMMUNICATIONS DIRECTOR- CLINICA SIERRA VISTA CHIEF EXECUTIVE OFFICER- CENTRAL VALLEY HEALTH POLICY INSTITUTE EXECUTIVE DIRECTOR FOR INPUT ON ALL COUNTIES IN THE HOSPITAL'S SERVICE AREA IN ADDITION TO THE FEEDBACK RECEIVED THROUGH THE FOCUS GROUPS, VALLEY CHILDREN'S HOSPITAL INCORPORATED INTO THE CHNA INFORMATION GATHERED BY HOSPITAL STAFF AS PART OF THEIR ACTIVE INVOLVEMENT IN A VARIETY OF COMMUNITY BASED INITIATIVES OR ORGANIZATIONS, INCLUDING THOSE LISTED BELOW. - ABC 30 FRESNO COMMUNITY ADVISORY COMMITTEE- BI-ANNUAL BABIES FIRST COORDINATING COUNCIL- BINATIONAL HEALTH WEEK PLANNING COMMITTEES FOR MADERA AND FRESNO COUNTIES - CALIFORNIA BREAST FEEDING COALITION COMMUNICATION COMMITTEE - CALIFORNIA CENTRAL VALLEY COALITION FOR COMPASSIONATE CARE - CALIFORNIA SAFE TEEN DRIVING COMMITTEE- CHILD ABUSE PREVENTION COUNCILS OF CENTRAL CALIFORNIA- CENTRAL CALIFORNIA PERINATAL MENTAL HEALTH COLLABORATIVE - CENTRAL VALLEY CONCUSSION CONSORTIUM- CENTRAL VALLEY HEALTH AND NUTRITION COLLABORATIVE - CENTRAL VALLEY SCHOOL HEALTH ADVISORY PANEL - CHILDHOOD WEIGHT MANAGEMENT TASK FOR FRESNO AND MADERA COUNTIES- COUNTY PEDIATRIC DEATH REVIEW TEAMS - EXCEPTIONAL PARENTS UNLIMITED - FRESNO BABIES FIRST BREASTFEEDING TASK FORCE - FRESNO COUNTY INTERAGENCY TEAM MEMBER- FRESNO COUNTY SEXUAL ASSAULT RESPONSE TEAM- FRESNO HEALTHY COMMUNITIES ACCESS PARTNERS - FRESNO-KINGS-MADERA REGIONAL HEALTH AUTHORITY - HUMAN RIGHTS COMMISSION - INTERAGENCY COUNCIL FOR CHILDREN (FRESNO AND MADERA COUNTIES) - KERN COUNTY MEDICALLY VULNERABLE INFANT PROJECT - KINGS COUNTY MULTI-DISCIPLINARY TEAM- MADERA BREAST FEEDING COALITION- MADERA COUNTY CHILD ABUSE PREVENTION COUNCIL- MADERA COUNTY CHILD FORENSIC INTERVIEW TEAM - MADERA COUNTY INTERAGENCY TEAM MEMBER- MARCH OF DIMES CENTRAL VALLEY DIVISION - MARIPOSA COUNTY INTERAGENCY TEAM MEMBER- MODEL OF CARE PARTNERSHIP OVERSIGHT COMMITTEE, FRESNO COUNTY - RAPHAEL HEALTH MINISTRY OUR LADY OF PERPETUAL HELP CHURCH - RESOURCE CENTER FOR SURVIVORS, FRESNO COUNTY RAPE CRISIS SERVICES- ROMAN CATHOLIC DIOCESE OF FRESNO, HEALTH MINISTRY OFFICE - SAFE KIDS CENTRAL CENTRAL CALIFORNIA - TULARE COUNTY HEALTHY FOR LIFE COLLABORATIVE- UNITED WAY OF FRESNO COUNTY- TEEN PARENT SUPPORT PROGRAM - FIRST 5 FRESNO- TULARE COUNTY HEALTHY FOR LIFE COLLABORATIVE- TULARE COUNTY SEXUAL ASSAULT RESPONSE TEAM- MEXICAN CONSULATE - VENTANILLA DE SALUD PROGRAM- WOMEN'S INITIATIVE UNITED WAY FRESNO COUNTY
FACILITY REPORTING GROUP - A PART V, SECTION B, LINE 4: - ADVENTIST HEALTH CENTRAL CALIFORNIA - COMMUNITY REGIONAL MEDICAL CENTER - FRESNO HEART HOSPITAL AND SURGICAL HOSPITAL - KAISER PERMANENTE FRESNO REGION - KAWEAH DELTA HEALTH CARE DISTRICT - MADERA COMMUNITY HOSPITAL - SAINT AGNES MEDICAL CENTER - SIERRA VIEW DISTRICT HOSPITAL
FACILITY REPORTING GROUP - A PART V, SECTION B, LINE 12I: 200% OR LESS FEDERAL POVERTY GUIDELINES (FPG) - FULL CHARITABLE DISCOUNT $0 CHARGES.201%-350% FPG - LOW INCOME DISCOUNT NO MORE THAN APPLICABLE MEDI CAL RATES IN EFFECT AT DATE OF SERVICE. WHERE MEDI CAL RATES CANNOT BE DETERMINED 75% DISCOUNT FROM CHARGES.350% - HIGH MEDICAL COST DISCOUNT, INCOME FOR THE LAST 12 MONTHS DOES NOT EXCEED 350% OF FPG AND THEY HAVE NOT RECEIVED A DISCOUNTED RATE FROM THE HOSPITAL AS A RESULT OF THEIR THIRD-PARTY INSURANCE COVERAGE AND THEIR ANNUAL OUT-OF-POCKET MEDICAL EXPENSES (EXCLUDING CO-PAYS, INDEMNITY BALANCES, AND SHARE OF COST) FOR THE PRIOR 12 MONTHS EXCEED 10% OF THEIR FAMILY'S ANNUAL INCOME. NO MORE THAN APPLICABLE MEDI CAL RATES IN EFFECT AT DATE OF SERVICE. WHERE MEDI CAL RATES CANNOT BE DETERMINED 75% DISCOUNT FROM CHARGES.351% AND GREATER THAN FPG - PROMPT PAY DISCOUNT 25% DISCOUNT FROM CHARGES FOR PATIENTS WHO PAY THEIR BALANCE IN FULL WITHIN 30 DAYS.
FACILITY REPORTING GROUP - A PART V, SECTION B, LINE 14G: ADDITIONALLY THE POLICY IS SENT BY US POSTAL SERVICE TO COMMUNITY AGENCIES TO BE DISTRIBUTED.
FACILITY REPORTING GROUP - A PART V, SECTION B, LINE 20D: 200% OR LESS FEDERAL POVERTY GUIDELINES (FPG) - FULL CHARITABLE DISCOUNT $0 CHARGES.201%-350% FPG - LOW INCOME DISCOUNT NO MORE THAN APPLICABLE MEDI CAL RATES IN EFFECT AT DATE OF SERVICE. WHERE MEDI CAL RATES CANNOT BE DETERMINED 75% DISCOUNT FROM CHARGES.350% - HIGH MEDICAL COST DISCOUNT, INCOME FOR THE LAST 12 MONTHS DOES NOT EXCEED 350% OF FPG AND THEY HAVE NOT RECEIVED A DISCOUNTED RATE FROM THE HOSPITAL AS A RESULT OF THEIR THIRD-PARTY INSURANCE COVERAGE AND THEIR ANNUAL OUT-OF-POCKET MEDICAL EXPENSES (EXCLUDING CO-PAYS, INDEMNITY BALANCES, AND SHARE OF COST) FOR THE PRIOR 12 MONTHS EXCEED 10% OF THEIR FAMILY'S ANNUAL INCOME. NO MORE THAN APPLICABLE MEDI CAL RATES IN EFFECT AT DATE OF SERVICE. WHERE MEDI CAL RATES CANNOT BE DETERMINED 75% DISCOUNT FROM CHARGES.351% AND GREATER THAN FPG - PROMPT PAY DISCOUNT 25% DISCOUNT FROM CHARGES FOR PATIENTS WHO PAY THEIR BALANCE IN FULL WITHIN 30 DAYS.
FACILITY REPORTING GROUP - A PART V, SECTION B, LINE 22: IF A PATIENT DID NOT QUALIFY FOR FULL CHARITABLE DISCOUNT, LOW INCOME DISCOUNT, HIGH MEDICAL COST DISCOUNT OR 25% PROMPT PAY DISCOUNT THEN THEY COULD BE CHARGED GROSS CHARGES FOR THEIR SERVICES.
Schedule H (Form 990) 2013
Additional Data


Software ID:  
Software Version:  
Schedule I
(Form 990)
Department of the Treasury
Internal Revenue Service
Grants and Other Assistance to Organizations,
Governments and Individuals in the United States
Complete if the organization answered "Yes," to Form 990, Part IV, line 21 or 22.
lBullet Attach to Form 990
lBullet Information about Schedule I (Form 990) 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 HOSPITAL
FKA CHILDREN'S HOSPITAL CENTRAL CA
Employer identification number
94-1294954
Part I
General Information on Grants and Assistance
1
Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ....................................
2
Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.
Part II
Grants and Other Assistance to Governments and Organizations in the United States. Complete if the organization answered "Yes" to
Form 990, Part IV, line 21, for any recipient that received more than $5,000. Part II can be duplicated if additional space is needed.
(a) Name and address of organization
or government		 (b) EIN (c) IRC Code section
if applicable		 (d) Amount of cash grant (e) Amount of non-cash
assistance		 (f) Method of valuation
(book, FMV, appraisal,
other)		 (g) Description of
non-cash assistance		 (h) Purpose of grant
or assistance
(1) MARCH OF DIMES
4201W SHAW 105
FRESNO,CA93722 		13-1846366 501(C)(3) 15,000       MARCH FOR BABIES SPONSOR
(2) EXCEPTIONAL PARENTS UNLIMITED
4440 N FIRST STREET
FRESNO,CA93726 		77-0263702 501(C)(3) 30,923       GRANT REIMBURSEMENT FOR LEAN PROJECT/FIESTA SPONSORSHIP
(3) HINDS HOSPICE
1616 W SHAW AVE STE A-5
FRESNO,CA93711 		77-0071360 501(C)(3) 6,000       TABLE SPONSORSHIP
(4) UCSF FOUNDATION SPONSORSHIP
155 N FRESNO STREET
FRESNO,CA93701 		94-6000669 501(C)(3) 7,500       DONATION
(5) KRAMES STAYWELL CONTENT SERVICES
PO BOX 759
MORRISVILLE,PA190670759 		13-4036258   8,000       PROVIDE HEALTH INFORMATION VIA WEBSITE
(6) SOCIOUS INC
2500 S POWER ROAD 118
MESA,AZ85209 		27-0007008   21,000       ONLINE FORUM TO PROVIDE HEALTH EDUCATION AND ADVICE
(7) REGENT OF THE UNIVERSITY OF CALIFORNIA - SPONSORSHIP
10920 WILSHIRE BLVD SUITE 1060
LOS ANGELES,CA90024 		95-6006143 501(C)(3) 25,000       SPONSOSRHIP GIFT PAYMENT
(8) FIRSTSOURCE SOLUTIONS USA LLC
5182 RELIABLE PARKWAY
CHICAGO,IL60686 		27-1422188   38,358       INSURANCE ENROLLMENT ASSISTANCE








2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................ Bullet Image
5
3
Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image
3
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2013

Schedule I (Form 990) 2013
Page 2
Part III
Grants and Other Assistance to Individuals in the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 22.
Part III can be duplicated if additional space is needed.
(a)Type of grant or assistance (b)Number of
recipients		 (c)Amount of
cash grant		 (d)Amount of
non-cash assistance		 (e)Method of valuation (book,
FMV, appraisal, other)		 (f)Description of non-cash assistance
(1) NURSING SCHOLARSHIP 7 17,573      
(2) EDUCATION SCHOLARSHIP - NEONATAL FOCUS 2 3,347      
(3) CAFETERIA MEALS 11980   69,245 FMV MEAL COUPONS FOR PATIENT FAMILIES AS NEEDED
(4) TAXI, BUS AND TRANSIT SERVICES 573   121,327 BOOK SUBSIDIATION OF BUS AND TRANSIT SERVICES
(5) EDUCATION SCHOLARSHIP RESPIRATORY FOCUS 1 1,674      




Part IV
Supplemental Information. Provide the information required in Part I, line 2, Part III, column (b), and any other additional information.
Return Reference Explanation
PART I, LINE 2: NURSING SCHOLARSHIPS ARE DESIGNED TO HELP EMPLOYEES MEET FINANCIAL NEEDS THAT ARE NOT COVERED BY OTHER TUITION REIMBURSEMENT PROGRAMS. A SCHOLARSHIP COMMITTEE REVIEWS APPLICATIONS BI-ANNUALLY BASED ON CERTAIN CRITERIA. RECIPIENTS ARE CHOSEN BY THE COMMITTEE AND THE CHIEF NURSING OFFICER APPROVES THE SELECTIONS. ALL RECIPIENTS ARE EMPLOYEES OF THE HOSPITAL AND THE HOSPITAL IS MADE AWARE WHEN THE RECIPIENT COMPLETES THEIR EDUCATION. OTHER SERVICES PROVIDED ARE PURCHASED FROM VARIOUS VENDORS AND ARE SUPPLIED TO PATIENTS AND THEIR FAMILIES. THE RECORDS FOR THESE PURCHASED SERVICES ARE MAINTAINED BY THE HOSPITAL.
Schedule I (Form 990) 2013


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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
VALLEY CHILDREN'S HOSPITAL
FKA CHILDREN'S HOSPITAL CENTRAL CA
Employer identification number

94-1294954
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
 
 
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
 
 
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
Yes
 
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........
4b
Yes
 
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
Yes
 
b
Any related organization? .........................
5b
Yes
 
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
Yes
 
b
Any related organization? .........................
6b
Yes
 
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
 
No
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
 
No
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)TODD SUNTRAPAKCEO (i)
(ii)		 552,982
0 		119,790
0 		31,002
0 		56,800
0 		16,681
0 		777,255
0 		0
0
(2)DR SAHAR BARAYANCHIEF OF STAFF, EFFECTIVE 1/28/14 (i)
(ii)		 20,000
0 		0
0 		0
0 		0
257,637 		0
0 		20,000
257,637 		0
0
(3)MICHELE R WALDRONCFO (i)
(ii)		 426,167
0 		126,493
0 		10,208
0 		68,647
0 		12,511
0 		644,026
0 		0
0
(4)DAVID CHRISTENSENVP, MEDICAL AFFAIRS & CMO (i)
(ii)		 447,090
0 		108,725
0 		9,560
0 		29,735
0 		16,681
0 		611,791
0 		0
0
(5)BEVERLY HAYDEN-PUGHVP, CHIEF NURSING OFFICER (i)
(ii)		 305,765
0 		76,079
0 		10,929
0 		76,661
0 		4,170
0 		473,604
0 		0
0
(6)JESSIE HUDGINSVP, FACILITIES (i)
(ii)		 284,260
0 		73,985
0 		22,032
0 		62,524
0 		8,340
0 		451,141
0 		0
0
(7)NATALE PONTICELLO JRVP, HUMAN RESOURCES, EFF. 1/7/13 (i)
(ii)		 256,642
0 		50,000
0 		1,684
0 		0
0 		0
0 		308,326
0 		0
0
(8)JANE WILLSONVP, CORPORATE DEVELOPMENT (i)
(ii)		 279,247
0 		62,999
0 		12,574
0 		45,124
0 		0
0 		399,944
0 		0
0
(9)DAVID SINGHVP, REV CYCLE MGMT/ANCILLARY (i)
(ii)		 259,309
0 		65,776
0 		9,722
0 		29,280
0 		0
0 		364,087
0 		0
0
(10)RICK WOLFVP, GENERAL COUNCIL (i)
(ii)		 294,296
0 		72,719
0 		471
0 		33,668
0 		12,511
0 		413,665
0 		0
0
(11)KIRK LARSONVP AND CIO, TERMED 4/4/14 (i)
(ii)		 254,712
0 		63,628
0 		369
0 		23,098
0 		8,340
0 		350,147
0 		0
0
(12)STEPHANIE VANCEED, FINANCE, VP EFFECTIVE 1/5/14 (i)
(ii)		 211,060
0 		41,809
0 		26,974
0 		22,689
0 		12,511
0 		315,043
0 		0
0
(13)RANDALL GUERREROED, CRITICAL CARE (TERMED 4/30/14) (i)
(ii)		 205,301
0 		39,044
0 		11,409
0 		20,279
0 		12,511
0 		288,544
0 		0
0
(14)JEFFREY LEFORSEXECUTIVE DIRECTOR, PROF SVCS + CHG (i)
(ii)		 220,806
0 		41,181
0 		19,305
0 		31,144
0 		8,340
0 		320,776
0 		0
0
(15)DANIEL DAVISEXECUTIVE DIRECTOR, ACUTE/PT CARE SU (i)
(ii)		 225,997
0 		36,724
0 		4,867
0 		22,858
0 		12,511
0 		302,957
0 		0
0
(16)CHRISTOPHER LONGEXEC DIR COMM & ADVOCACY (i)
(ii)		 197,704
0 		33,014
0 		8,049
0 		20,291
0 		12,511
0 		271,569
0 		0
0
(17)GORDON ALEXANDERFORMER CEO, TERMED 11/13/11 (i)
(ii)		 0
0 		0
0 		271,154
0 		0
0 		0
0 		271,154
0 		0
0
(18)MARTA BOYERFORMER VP, HR, TERMED 5/4/12 (i)
(ii)		 0
0 		0
0 		252,692
0 		11,267
0 		0
0 		263,959
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, LINES 4A-B PART I, LINES 4A: SEVERANCE PAYMENTS TOTALLING $271,154 AND $252,692 WERE MADE TO GORDON ALEXANDER, FORMER CEO AND MARTA BOYER, FORMER VP OF HUMAN RESOURCES, RESPECTIVELY, DURING THE CALENDAR YEAR AND ARE INCLUDED IN PART II, COLUMN B(III). THE SEVERANCE AGREEMENTS ARE SUBJECT TO A CONFIDENTIALITY CLAUSE. TERMS AND CONDITIONS OF THE AGREEMENTS WILL BE PROVIDED TO THE IRS UPON REQUEST. PART I, LINES 4B: SUPPLEMENTAL NONQUALIFIED RETIREMENT PLANS INCLUDE 1) A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP), 2) A DEFERRED COMPENSATION PLAN FOR SELECTED EXECUTIVES AND 3) A NONCONTRIBUTORY, NONQUALIFIED DEFERRED COMPENSATION PLAN FOR A SELECT GROUP OF MANAGEMENT CALLED THE DEFINED CONTRIBUTION SUPPLEMENTAL EMPLOYEE RETIREMENT PLAN (DCSERP). TODD SUNTRAPAK AND DANNY DAVIS ARE ELIGIBLE TO CONTRIBUTE TO THE DEFINED CONTRIBUTION PLAN, BUT NO CONTRIBUTIONS WERE MADE. NO AMOUNTS WERE PAID OUT OF THE PLANS DURING THE YEAR. EMPLOYEE AND EMPLOYER CONTRIBUTIONS TO THE DEFERRED COMPENSATION PLAN. EMPLOYER CONTRIBUTIONS TO THE DCSERP, AND THE CHANGE IN ACTUARIAL VALUE OF SERP BENEFITS FOR THE YEAR ENDING 9/30/2014 ARE AS FOLLOWS: MICHELE WALDRON - DEFERRED COMPENSATION PLAN $17,500; DCSERP $29,058; CHANGE IN SERP ACTUARIAL VALUE $23,773 TODD SUNTRAPAK - DEFERRED COMPENSATION PLAN $8,750; DCSERP $43,135; CHANGE IN SERP ACTUARIAL VALUE $20,531 BEVERLY HAYDEN-PUGH - DEFERRED COMPENSATION PLAN $17,500; DCSERP $13,186; CHANGE IN SERP ACTUARIAL VALUE $25,693 JESSIE HUDGINS - DEFERRED COMPENSATION PLAN $17,500; DCSERP $11,539; CHANGE IN SERP ACTUARIAL VALUE $16,617 MARTA BOYER - DEFERRED COMPENSATION PLAN $0; DCSERP $0; CHANGE IN SERP ACTUARIAL VALUE $0 DAVID CHRISTENSEN - DEFERRED COMPENSATION PLAN $17,500; DCSERP $35,419; CHANGE IN SERP ACTUARIAL VALUE $1,805 RICK WOLF - DEFERRED COMPENSATION PLAN $8,750; DCSERP $15,939; CHANGE IN SERP ACTUARIAL VALUE $1,669 JANE WILLSON - DEFERRED COMPENSATION PLAN $17,500; DCSERP $35,679; CHANGE IN SERP ACTUARIAL VALUE $9,053 DAVID SINGH - DEFERRED COMPENSATION PLAN $17,500; DCSERP $11,653; CHANGE IN SERP ACTUARIAL VALUE $0 STEPHANIE VANCE - DEFERRED COMPENSATION PLAN $17,500; NOT ELIGIBLE FOR DCSERP OR SERP KIRK LARSON - DEFERRED COMPENSATION PLAN $8,750; DCSERP $15,350; CHANGE IN SERP ACTUARIAL VALUE $0 JEFFREY LEFORS- DEFERRED COMPENSATION PLAN $17,500; NOT ELIGIBLE FOR DCSERP OR SERP RANDALL GUERRERO - DEFERRED COMPENSATION PLAN $10,000; NOT ELIGIBLE FOR DCSERP OR SERP NATALIE PONTICELLO - NOT ELIGIBLE FOR DEFERRED COMPENSATION PLAN, DCSERP OR SERP
PART I, LINE 5 AN EXECUTIVE INCENTIVE PLAN HAS BEEN ESTABLISHED THAT ALLOWS FOR PAYMENT OF INCENTIVES BASED ON BOTH ORGANIZATION-WIDE AND INDIVIDUAL GOALS. SUCH GOALS ARE RELATED TO A VARIETY OF METRICS INCLUDING REVENUE, OPERATIONAL AND QUALITY RESULTS OF THE HOSPITAL AND FOUNDATION. THE INCENTIVE PLAN HAS BEEN APPROVED BY THE COMPENSATION COMMITTEE OF THE BOARD OF TRUSTEES. THE COMMITTEE REVIEWS THE FORECASTED PAYOUTS AT THE END OF EACH YEAR BASED ON THE FINANCIAL AND OPERATING RESULTS.
PART I, LINE 6 SEE EXPLANATION FOR LINE 5, ABOVE
Schedule J (Form 990) 2013

Additional Data


Software ID:  
Software Version:  
Schedule K
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Information on Tax Exempt Bonds
SchKMediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, line 24a. Provide descriptions,
explanations, and any additional information in Part VI.
SchKMediumBullet Attach to Form 990. SchKMediumBullet See separate instructions.
SchKMediumBulletInformation about Schedule K (Form 990) 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 HOSPITAL
FKA CHILDREN'S HOSPITAL CENTRAL CA
Employer identification number
94-1294954
Part I
Bond Issues
(a) Issuer name (b) Issuer EIN (c) CUSIP # (d) Date issued (e) Issue price (f) Description of purpose (g) Defeased (h) On
behalf of
issuer 		(i) Pool
financing
Yes No Yes No Yes No
A COUNTY OF MADERA
  		94-6000518 556902DN1 02-04-2010 39,512,854 TO REFUND SERIES 2006 BONDS ISSUED ON 6/26/06.   X   X   X
Part II
Proceeds
A B C D
1 Amount of bonds retired . . . . . . . . . . . . . .        
2 Amount of bonds legally defeased . . . . . . . . . . .        
3 Total proceeds of issue . . . . . . . . . . . . . . 39,512,854      
4 Gross proceeds in reserve funds . . . . . . . . . . . . 3,907,773      
5 Capitalized interest from proceeds . . . . . . . . . . .        
6 Proceeds in refunding escrows . . . . . . . . . . . .        
7 Issuance costs from proceeds . . . . . . . . . . . .        
8 Credit enhancement from proceeds . . . . . . . . . . .        
9 Working capital expenditures from proceeds . . . . . . . . .        
10 Capital expenditures from proceeds . . . . . . . . . . .        
11 Other spent proceeds . . . . . . . . . . . . . . 35,605,081      
12 Other unspent proceeds . . . . . . . . . . . . . .        
13 Year of substantial completion . . . . . . . . . . . .
Yes No Yes No Yes No Yes No
14 Were the bonds issued as part of a current refunding issue? . . . . . X              
15 Were the bonds issued as part of an advance refunding issue? . . . . .   X            
16 Has the final allocation of proceeds been made? . . . . . . . . X              
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? . . . . . . . . . . . . . . X              
Part III
Private Business Use
A B C D
Yes No Yes No Yes No Yes No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? . . . . . . .   X            
2 Are there any lease arrangements that may result in private business use of bond-financed property? . . . . . . . . .   X            
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50193E
Schedule K (Form 990) 2013
Schedule K (Form 990) 2013
Page 2
Part III
Private Business Use (Continued)
A B C D
Yes No Yes No Yes No Yes No
3a Are there any management or service contracts that may result in private business use of bond-financed property? . . . . . . . . . . . .   X            
b If "Yes" to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property?                
c Are there any research agreements that may result in private business use of bond-financed property? . . . . . . . . . . . . . . .   X            
d If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property?                
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government . . SchKMediumBullet 0 %      
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government . . . . . . . SchKMediumBullet 0 %      
6 Total of lines 4 and 5 . . . . . . . . . . . . . 0 %      
7 Does the bond issue meet the private security or payment test? . . . . .   X            
8a Has there been a sale or disposition of any of the bond financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were issued?. . . . . . . . . . . . . . . . . X              
b If "Yes" to line 8a, enter the percentage of bond-financed property sold or disposed of. 0 %      
c If "Yes" to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? . . . . . . . . . . . . .   X            
9 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under
Regulations sections 1.141-12 and 1.145-2? . . . . . . . 		X              
Part IV
Arbitrage
A B C D
Yes No Yes No Yes No Yes No
1 Has the issuer filed Form 8038-T? . . . . .   X            
2 If "No" to line 1, did the following apply? . . . .
a Rebate not due yet? . . . . . . . . X              
b Exception to rebate? . . . . . . . . X              
c No rebate due? . . . . . . . .   X            
If you checked "No rebate due" in line 2c, provide in
Part VI the date the rebate computation was performed
3 Is the bond issue a variable rate issue? . . . .   X            
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?   X            
b Name of provider . . . . . . . . .  
  		 
  		 
  		 
 
c Term of hedge . . . . . . . . . .        
d Was the hedge superintegrated? . . . .                
e Was the hedge terminated? . . . . . .                
Schedule K (Form 990) 2013
Schedule K (Form 990) 2013
Page 3
Part IV
Arbitrage (Continued)
A B C D
Yes No Yes No Yes No Yes No
5a Were gross proceeds invested in a guaranteed investment contract (GIC)? . . . . . . . . .   X            
b Name of provider . . . . . . . . .  
  		 
  		 
  		 
 
c Term of GIC . . . . . . . . . .        
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? . . . . .                
6 Were any gross proceeds invested beyond an available temporary period? . . . . . . . .   X            
7 Has the organization established written procedures to monitor the requirements of section 148? . . . X              
Part V
Procedures To Undertake Corrective Action
A B C D
Yes No Yes No Yes No Yes No
Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations? X              
Part VI
Supplemental Information. Provide additional information for responses to questions on Schedule K (see instructions).
Return Reference Explanation
PART III, SECTION 8A & 8B CERTAIN OBSOLETE OR BROKEN EQUIPMENT WAS DISPOSED OF. IN SOME CASES, NOMINAL SCRAP PROCEEDS, AGGREGATING $132, WERE RECEIVED. PART IV, SECTION 2 PROCEEDS USED TO REDEEM SERIES 2006 CERTIFICATES MET THE 6 MONTH EXCEPTION TO REBATE. HOWEVER, RESERVE FUND PROCEEDS ARE BEING TREATED AS SUBJECT TO REBATE.
Schedule K (Form 990) 2013

Additional Data


Software ID:  
Software Version:  

Schedule L
(Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
Transactions with Interested Persons
MediumBullet Complete if the organization answered
"Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c,
or Form 990-EZ, Part V, line 38a or 40b.
MediumBullet Attach to Form 990 or Form 990-EZ. MediumBullet See separate instructions.
MediumBulletInformation about Schedule L (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 HOSPITAL
FKA CHILDREN'S HOSPITAL CENTRAL CA
Employer identification number

94-1294954
Part I
Excess Benefit Transactions (section 501(c)(3) and section 501(c)(4) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.
1(a) Name of disqualified person (b) Relationship between disqualified person and organization (c) Description of transaction (d) Corrected?
Yes No





2
Enter the amount of tax incurred by organization managers or disqualified persons during the year under section 4958. ........................... Bullet Image$
 
3
Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ....... Bullet Image$
 

Part II
Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990-EZ, Part V, line 38a, or Form 990, Part IV, line 26; or if the organization reported an amount on Form 990, Part X, line 5, 6, or 22
(a) Name of interested person (b) Relationship with organization (c) Purpose of loan (d) Loan to or from the organization? (e)Original principal amount (f)Balance due (g) In default? (h) Approved by board or committee? (i)Written agreement?
To From Yes No Yes No Yes No
Total ......Small Bullet $  
Part III
Grants or Assistance Benefitting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.
(a) Name of interested person (b) Relationship between interested person and the organization (c) Amount of assistance (d) Type of assistance (e) Purpose of assistance
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 50056A
Schedule L (Form 990 or 990-EZ) 2013
Schedule L (Form 990 or 990-EZ) 2013
Page 2
Part IV
Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.
(a) Name of interested person (b) Relationship between interested person and the organization (c) Amount of transaction (d) Description of transaction (e) Sharing of organization's revenues?
Yes No
(1) WISHON RADIOLOGY MEDICAL GROUP
  		ENTITY FOR WHICH DR. CHARLES SMITH, DIRECTOR, IS AN OFFICER 338,706 DR. SMITH PROVIDES MEDICAL DIRECTOR SERVICES AND TELERADIOLOGIST COVERAGE THROUGH WISHON RADIOLOGY MEDICAL GROUP   No
Part V
Supplemental Information
Provide additional information for responses to questions on Schedule L (see instructions).
Return Reference Explanation
Schedule L (Form 990 or 990-EZ) 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
VALLEY CHILDREN'S HOSPITAL
FKA CHILDREN'S HOSPITAL CENTRAL CA
Employer identification number

94-1294954
Return Reference Explanation
FORM 990 PART III, LINE 4A: STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS - PROGRAM SERVICE ONE I. DESCRIPTION OF PROGRAM SERVICE ONE 60 YEARS AGO, OUR FOUNDING MOTHERS HAD A DREAM TO CARE FOR CHILDREN IN A HOSPITAL AS SPECIAL AS ITS PATIENTS. VALLEY CHILDREN'S HOSPITAL HAS FLOURISHED EVER SINCE, CARING FOR HUNDREDS OF THOUSANDS OF CHILDREN. OUR MISSION GUIDES US AS WE TRAVEL THE ROAD TO OUR FUTURE ALONGSIDE STAFF, PHYSICIANS, CHILDREN, FAMILIES, OUR COMMUNITY AND OUR PARTNERS THROUGHOUT THE REGION. MISSION THE MISSION OF VALLEY CHILDREN'S HOSPITAL IS TO PROVIDE HIGH QUALITY, COMPREHENSIVE HEALTH CARE SERVICES TO CHILDREN REGARDLESS OF THEIR ABILITY TO PAY, AND TO CONTINUOUSLY IMPROVE THE HEALTH AND WELL-BEING OF CHILDREN. VISION OUR VISION CAPTURES THE PATH WE'VE TRAVELED AND SHOWCASES OUR COMMITMENT AND PASSION TO BE THE BEST. OUR CLEAR FOCUS IS TO CONTINUE TO PROVIDE THE BEST CARE AND THE BEST QUALITY PEDIATRIC SERVICES AVAILABLE ANYWHERE WITH A VISION TO BECOME THE NATION'S BEST CHILDREN'S HOSPITAL. CORE VALUES THE FOLLOWING CORE ORGANIZATIONAL VALUES GUIDE THE INVESTMENTS AND SUPPORT PROVIDED BY VALLEY CHILDREN'S HOSPITAL'S COMMUNITY BENEFITS PROGRAM. EXCELLENCE - WE DEPEND ON EXCEPTIONAL PEOPLE TO PROVIDE EXCEPTIONAL QUALITY HEALTH CARE AND SERVICES THROUGHOUT VALLEY CHILDREN'S HOSPITAL. WE SET HIGH STANDARDS AND WE SUPPORT EACH OTHER AS WE STRIVE TO ACHIEVE THEM. WE INVEST IN EACH OTHER AND WE VALUE THE INDIVIDUAL AND CULTURAL DIFFERENCES THAT MAKE US STRONG. WE ARE PROUD OF OUR SUPERIOR SERVICES AS MEASURED BY QUALITY OUTCOMES. COMPASSIONATE CARE - WE TREAT EVERY CHILD, EVERY FAMILY, EACH OTHER, OUR VISITORS AND OUR VENDORS WITH RESPECT, KINDNESS, HOPE, JOY AND GOOD HUMOR. WE DISPLAY OUR HELPFUL, HEALING, FAMILY-CENTERED SPIRIT AT EVERY OPPORTUNITY. WE RECOGNIZE THE IMPORTANCE OF PLAYFULNESS IN HUMAN INTERACTION AND IN THE HEALTH OF CHILDREN. WE LOOK FOR WAYS TO EASE SUFFERING AND PROVIDE COMFORT. INTEGRITY - WE ARE HONEST, ETHICAL AND RESPONSIBLE IN OUR WORK AND IN THE WAY WE DEAL WITH OTHERS. WE KEEP OUR PROMISES AND ADMIT OUR MISTAKES. WE KNOW OURSELVES AND WE AVOID HIDDEN AGENDAS. BY THE WAY WE LIVE OUR LIVES EVERYDAY, WE ARE WORTHY OF THE TRUST PEOPLE PLACE IN US. INNOVATION - WE EMBRACE CHANGE, CREATIVITY, CONTINUOUS LEARNING AND PERSONAL GROWTH. WE INCORPORATE NEW IDEAS, TECHNOLOGY AND METHODS TO IMPROVE THE HEALTH CARE AND SERVICES WE PROVIDE. WE ANTICIPATE FUTURE TRENDS AND WE CREATE STRATEGIC PLANS TO INSURE FUTURE GROWTH AND CONTINUED VITALITY. COLLABORATION - WE BUILD ENDURING INTERNAL AND EXTERNAL RELATIONSHIPS, JOINING WITH COLLEAGUES ACROSS ORGANIZATIONAL BOUNDARIES TO IMPROVE THE CARE AND SERVICES WE PROVIDE. WE ENCOURAGE AND REWARD BOTH INDIVIDUAL AND TEAM ACHIEVEMENTS. WE PUT THE COMMON GOOD AHEAD OF NARROW INTERESTS. STEWARDSHIP - WE ARE RESOURCEFUL, ADAPTABLE AND RESILIENT. WE HAVE A "CAN DO" ATTITUDE THAT GETS THE JOB DONE. WE ARE FISCALLY RESPONSIBLE AND EFFICIENT WITH OUR TIME. WE PROTECT OUR RESERVES AND MANAGE OUR OPERATING COSTS IN ORDER TO INVEST IN OUR FUTURE. WE ARE EACH PERSONALLY DEDICATED TO MAKING VALLEY CHILDREN'S HOSPITAL BETTER BECAUSE WE WERE HERE. COMMITMENT TO THE COMMUNITY AS A NOT-FOR-PROFIT ORGANIZATION GOVERNED BY ITS OWN BOARD OF TRUSTEES, VALLEY CHILDREN'S HOSPITAL IS SOLELY COMMITTED TO ADDRESSING THE MEDICAL NEEDS OF OUR REGION'S SICKEST CHILDREN. WITH 356 BEDS, A MEDICAL STAFF OF OVER 550 PHYSICIANS AND APPROXIMATELY 3,000 TOTAL EMPLOYEES, VALLEY CHILDREN'S HOSPITAL OFFERS ACCESSIBILITY TO OVER 40 FETAL, NEONATAL AND PEDIATRIC SUBSPECIALTIES, ALL COMMITTED TO PROVIDING THE HIGHEST LEVEL OF QUALITY CARE POSSIBLE. EXAMPLES INCLUDE THE HOSPITAL'S NEONATAL AND PEDIATRIC INTENSIVE CARE UNITS THAT MAINTAIN LOW MORTALITY RATES, WHEN COMPARED NATIONALLY, WHILE TREATING SOME OF THE SICKEST CHILDREN. WHILE PROVIDING EXCEPTIONAL CARE IS THE SINGLE GREATEST CONTRIBUTION THE HOSPITAL MAKES FOR OUR CHILDREN AND THEIR FAMILIES, THE HOSPITAL ALSO APPRECIATES THAT IT IS UNIQUELY POSITIONED TO SUPPORT THE NEEDS OF CHILDREN IN OTHER WAYS AS WELL. AS AN EXTENSION OF THE HOSPITAL'S MISSION AND VISION, THE GOAL OF VALLEY CHILDREN'S HOSPITAL'S COMMUNITY BENEFITS PROGRAM IS TO ADVANCE THE HEALTH AND WELLBEING OF UNDERSERVED, MEDICALLY NEEDY CHILDREN THROUGH COLLABORATION AND COMMON CONCERN. II. SERVICE AREA DEMOGRAPHICS AND PATIENT VOLUME SERVICE AREA DEMOGRAPHICS AS THE ONLY PEDIATRIC SPECIALTY HOSPITAL LOCATED IN CENTRAL CALIFORNIA, VALLEY CHILDREN'S HOSPITAL'S PRIMARY SERVICE AREA EXTENDS FROM SOUTH SAN JOAQUIN COUNTY IN THE NORTH TO KERN COUNTY IN THE SOUTH, AND FROM THE CENTRAL COAST TO THE SIERRA NEVADA. THE SERVICE AREA INCLUDES 11 COUNTIES AND IS HOME TO OVER 1.3 MILLION CHILDREN AGES 0-20. VALLEY CHILDREN'S HOSPITAL'S PATIENT VOLUME IN 2014, VALLEY CHILDREN'S HOSPITAL HAD 12,695 INPATIENT CASES, 90,908 EMERGENCY DEPARTMENT VISITS AND A COMBINED 209,229 OUTPATIENT CENTER, DAY SURGERY, RADIOLOGY AND LABORATORY VISITS. MEDI-CAL COVERED 76% OF THE HOSPITAL'S TOTAL INPATIENT DAYS AND 74% OF TOTAL OUTPATIENT VISITS AT THE HOSPITAL. OVER 1/2 OF THE HOSPITAL'S INPATIENT POPULATION CONSISTED OF CHILDREN 4 YEARS OF AGE OR YOUNGER AND ALMOST 2/3 WERE AN ETHNICITY OTHER THAN CAUCASIAN.
FORM 990, PART III, LINE 4A III. COMMUNITY BENEFITS PROGRAM ACCORDING TO THE CATHOLIC HEALTH ASSOCIATION'S 2012 GUIDE FOR PLANNING AND REPORTING COMMUNITY BENEFIT, COMMUNITY BENEFITS ARE GENERALLY DEFINED AS THOSE ACTIVITIES THAT PROVIDE TREATMENT AND/OR PROMOTE HEALTH AND HEALING IN RESPONSE TO IDENTIFIED COMMUNITY NEEDS, AND MEET AT LEAST ONE OF THE FOLLOWING OBJECTIVES: - IMPROVE ACCESS TO HEALTH CARE SERVICES - ENHANCE HEALTH OF THE COMMUNITY - ADVANCE MEDICAL OR HEALTH CARE KNOWLEDGE - RELIEVE OR REDUCE THE BURDEN OF GOVERNMENT OR PRIVATE, COMMUNITY-BASED EFFORTS ALSO INCLUDED IN THE DEFINITION IS THE PROVISION OF CHARITY CARE AND THE UNREIMBURSED COST OF PROVIDING HEALTH CARE SERVICES TO THOSE ENROLLED IN PUBLIC PROGRAMS, INCLUDING MEDI-CAL. FOR FY 2014, VALLEY CHILDREN'S HOSPITAL DEDICATED IN EXCESS OF $43,209,000 IN COMMUNITY BENEFITS THAT CONTINUE THE HOSPITAL'S LONG TRADITION OF BEING AN ACTIVE AND INTEGRAL PART OF CENTRAL CALIFORNIA. A SUMMARY OF THE HOSPITAL'S COMMUNITY BENEFITS PROGRAM ACTIVITIES IN 2014: - COMMUNITY HEALTH EDUCATION * CHILDREN'S HEALTH CONNECT VALLEY CHILDREN'S HOSPITAL OFFERED TO THE COMMUNITY AN ON-LINE FORUM WHERE USERS WERE ABLE TO JOIN GROUPS AND DISCUSSIONS, VIEW EDUCATIONAL VIDEOS, ASK QUESTIONS, HEAR EXPERT ADVICE AND SHARE PERSONAL STORIES. * HEALTH ENCYCLOPEDIA VALLEY CHILDREN'S HOSPITAL PROVIDED ACCESS TO ON LINE EDUCATIONAL INFORMATION VIA THE HEALTH ENCYCLOPEDIA LINK ON ITS WEBSITE. HEALTH ENCYCLOPEDIA CONTAINS THOUSANDS OF PAGES OF INFORMATION ON PEDIATRIC DISEASES, CONDITIONS AND TREATMENTS, AS WELL AS SECTIONS ON HOW TO KEEP KIDS HEALTHY. THE ENCYCLOPEDIA IS AVAILABLE IN ENGLISH AND SPANISH. - HEALTH CARE SUPPORT SERVICES HEALTH CARE SUPPORT SERVICES WERE PROVIDED BY THE HOSPITAL TO HELP ADDRESS THE HEALTH CARE NEEDS OF CHILDREN AND THEIR FAMILIES WHILE AT THE HOSPITAL, AT HOME, AND IN THE COMMUNITY. * CAFETERIA MEALS MEAL COUPONS WERE PROVIDED TO BREAST-FEEDING MOMS WHOSE INFANTS WERE IN THE HOSPITAL. SOCIAL WORKERS ALSO PROVIDED PATIENTS' FAMILIES WITH MEAL COUPONS WHEN THEY ARRIVED AND WERE NOT PREPARED FOR A LONG STAY AT THE HOSPITAL. * CANCER SURVIVORSHIP PROGRAM THE CHILDHOOD CANCER SURVIVORSHIP PROGRAM AT VALLEY CHILDREN'S HOSPITAL PROVIDES SPECIALIZED, HIGH-QUALITY CARE TO HELP SURVIVORS OF CHILDHOOD CANCER LIVE HEALTHIER, HAPPIER LIVES. THE PROGRAM INCLUDES AN ANNUAL ASSESSMENT OF THE SURVIVOR'S HEALTH, ACADEMIC AND SOCIAL DEVELOPMENT, AND AN INDIVIDUALIZED ACTION PLAN TO ADDRESS LONG-TERM EFFECTS FROM CANCER TREATMENT. * CAPACITY FOR MEETING THE NEEDS OF MEDICALLY COMPLEX CHILDREN VALLEY CHILDREN'S HOSPITAL RECOGNIZES THE CRITICAL ROLE THAT COMMUNITY-BASED PROVIDERS AND ORGANIZATIONS PLAY IN MEETING THE NEEDS OF MEDICALLY COMPLEX CHILDREN AND IS COMMITTED TO MAKING SURE THEY HAVE THE CLINICAL SKILLS TO TAKE CARE OF THIS PATIENT POPULATION. A. SCHOOL NURSES - VALLEY CHILDREN'S HOSPITAL PARTNERED WITH THE CALIFORNIA SCHOOL NURSE ORGANIZATION AND INDIVIDUAL SCHOOL DISTRICTS TO PROVIDE TRAINING TO SCHOOL NURSES ON A VARIETY OF CLINICAL PROCEDURES AND TOPICS CRITICAL TO KEEPING CHILDREN HEALTHY. ADDITIONALLY, VALLEY CHILDREN'S HOSPITAL PARTICIPATED IN AND HOSTED THE SCHOOL HEALTH ADVISORY PANEL'S QUARTERLY MEETINGS. THE PANEL IS A CONSORTIUM OF SCHOOL DISTRICT HEALTH DIRECTORS THROUGHOUT THE CENTRAL VALLEY THAT SERVES AS A LINK BETWEEN SCHOOL-BASED HEALTH CARE PROFESSIONALS AND CHILDREN'S HOSPITAL FOR THE PURPOSE OF IDENTIFYING AND ADDRESSING EMERGING ISSUES IMPACTING THE HEALTH AND WELLBEING OF STUDENTS IN GRADES K-12. B. HOSPITALS/COMMUNITY BASED ORGANIZATIONS - VALLEY CHILDREN'S HOSPITAL PROVIDED SIGNIFICANT OUTREACH EDUCATION TO HOSPITALS AND COMMUNITY BASED ORGANIZATIONS TO MAKE SURE THEY HAVE THE CLINICAL EXPERTISE NEEDED TO CARE FOR MEDICALLY COMPLEX CHILDREN. TOPICS COVERED INCLUDED CARE FOR HIGH RISK NEWBORNS, GENERAL PEDIATRIC TRAUMA, ABUSIVE HEAD TRAUMA AND OTHER AREAS OF PEDIATRIC MALTREATMENT, AND THE PREVENTION OF HUMAN TRACKING OF CHILDREN. * CHILD ABUSE PREVENTION MORE THAN 3 MILLION AMERICAN CHILDREN ARE REPORTED AS ABUSED OR NEGLECTED EVERY YEAR. THAT'S JUST WHAT'S REPORTED - IMAGINE HOW MANY CASES NEVER REACH AN AGENCY. ON ANY GIVEN DAY, THREE TO FIVE PERCENT OF CHILDREN'S HOSPITAL'S INPATIENT POPULATION IS HERE BECAUSE OF ABUSE OR NEGLECT. THE NUMBER OF CHILDREN BEING TREATED AT THE HOSPITAL FOR CHILD ABUSE HAS INCREASED FROM 22 IN 2000 TO OVER 923 IN 2014. THE HOSPITAL HAS OPERATED THE SCAN (SUSPECTED CHILD ABUSE AND NEGLECT) TEAM IN PLACE SINCE 1999. THIS IS A MULTI-DISCIPLINARY TEAM THAT INCLUDES PHYSICIANS, NURSES, SOCIAL WORKERS, LAW ENFORCEMENT, CHILD WELFARE, PUBLIC HEALTH AND OTHER INDIVIDUALS AND GROUPS (AS NECESSARY). IT'S DESIGNED TO HELP IDENTIFY AND ACT UPON SUSPECTED CASES OF ABUSE. THE HOSPITAL'S GUILD'S CHILD ABUSE PREVENTION AND TREATMENT CENTER ADDRESSES ABUSE IN A DIFFERENT WAY. THE CENTER OPERATES A CLINIC ONE DAY A WEEK AND SEES FOLLOW-UP PATIENTS AND OUTSIDE REFERRALS. STAFF ARE TRAINED IN BOTH THE PHYSICAL AND PSYCHO-SOCIAL ASPECTS OF CHILD ABUSE. THEIR FOCUS IS SPECIFICALLY ON ELEMENTS OF ABUSE, NEGLECT AND ENDANGERMENT - NOT COMPLETELY ON INJURY TREATMENT. ANOTHER AMBITIOUS ELEMENT OF THE DEPARTMENT IS PREVENTION. IN 2014, STAFF PARTNERED WITH ORGANIZATIONS LIKE THE CHILD ABUSE PREVENTION COUNCILS OF CALIFORNIA, COMPREHENSIVE YOUTH SERVICES, CHILD WELFARE SERVICES, EXCEPTIONAL PARENTS UNLIMITED AND COUNTY HEALTH DEPARTMENTS TO PROVIDE EDUCATION, TRAINING AND TECHNICAL ASSISTANCE TO PARENTS AND CAREGIVERS. THERE ARE MANY AGENCIES IN THE HOSPITAL'S SERVICE AREA THAT ADDRESS THIS HORRIFYING PROBLEM AND DO THEIR BEST TO HELP KIDS EVERY DAY. CHILDREN'S HOSPITAL IS A REGIONAL POWERHOUSE WHEN IT COMES TO PEDIATRIC CARE, AND IT WORKS VERY HARD TO LEVERAGE THAT STRENGTH IN CHILD ABUSE PREVENTION. THE HOSPITAL HAS LOFTY GOALS, AND IT WANTS TO MAKE SURE THAT IF CHILDREN ARE HARMED, CHILDREN'S HOSPITAL - AND EVERYTHING IT HAS TO OFFER - WILL BE THERE TO TREAT AND DEFEND THEM. * DISASTER PREPAREDNESS THE HOSPITAL DONATED STORAGE SPACE TO THE CALIFORNIA DEPARTMENT OF PUBLIC HEALTH TO STORE PHARMACEUTICALS TO BE USED IN REGIONAL DISASTERS OR MEDICAL EMERGENCIES. * DEVELOPMENTAL DISABILITIES THE HOSPITAL CONTINUED TO PARTICIPATE IN COALITIONS FOCUSED ON IMPROVING CARE COORDINATION FOR INFANTS AND CHILDREN WITH, OR AT RISK FOR, DEVELOPMENTAL DELAYS, INCLUDING KERN COUNTY'S MEDICALLY VULNERABLE INFANT WORK GROUP INITIATIVE, AND FIRST 5 FRESNO'S MODEL OF CARE PARTNERSHIP OVERSIGHT COMMITTEE AND SYSTEMS OF CARE COMMITTEE. ALSO, THE HOSPITAL CONTINUED TO PROVIDE EDUCATION AND TECHNICAL ASSISTANCE OFFERED THROUGH ITS HIGH RISK INFANT FOLLOW UP PROGRAM TO OTHER PROVIDERS AND COMMUNITY BASED AGENCIES REGARDING SCREENING AND ASSESSMENT FOR DEVELOPMENTAL DELAYS IN HIGH RISK INFANTS. LAST, CHILDREN'S HOSPITAL CONTINUED TO SUPPORT THE MARCH OF DIMES' EFFORTS AT REDUCING PREMATURE BIRTHS AND PROMOTING HEALTHY MOMS AND HEALTHY BABIES THROUGH FUNDRAISING AND ADVOCACY. * ENROLLMENT INTO HEALTH INSURANCE VALLEY CHILDREN'S HOSPITAL COMMITTED SIGNIFICANT RESOURCES TO HELP FAMILIES FIND HEALTH INSURANCE COVERAGE FOR THEMSELVES AND THEIR UNINSURED CHILDREN, INCLUDING FINANCIAL COUNSELORS AS WELL AS A CONTRACTED VENDOR WITH EXPERTISE IN ENROLLMENT SERVICES. WITH THESE RESOURCES, THE HOSPITAL IDENTIFIED AND PROVIDED ENROLLMENT ASSISTANCE TO UNINSURED AND UNDER-INSURED PATIENTS WHO QUALIFIED FOR MEDI-CAL, CALIFORNIA CHILDREN'S SERVICES PROGRAM, OR THE HOSPITAL'S FINANCIAL ASSISTANCE PROGRAM. ONCE ELIGIBILITY WAS DETERMINED, THE HOSPITAL AND/OR THE CONTRACTED VENDOR ASSISTED THE FAMILY WITH COMPLETING NECESSARY APPLICATIONS AND SUBMITTING THEM TO THE APPROPRIATE AGENCIES. VALLEY CHILDREN'S HOSPITAL ALSO SUPPORTED OUTREACH AND ENROLLMENT SERVICES OFFERED THROUGH THE FRESNO HEALTHY COMMUNITIES ACTION PROGRAM. * FAMILY ASSISTANCE FUND WHEN SUPPORT FOR SERVICES WERE NOT AVAILABLE THROUGH A COMMUNITY PROGRAM OR ANOTHER FUNDING SOURCE, HOSPITAL SOCIAL WORKERS WERE ABLE TO ACCESS THESE FUNDS TO HELP PATIENTS AND FAMILIES OBTAIN ITEMS NEEDED UPON RETURN HOME OR TO ASSIST WITH TRANSPORTATION FOR FOLLOW UP CARE. * INJURY PREVENTION RECOGNIZING THAT UNINTENTIONAL INJURY IS THE NATION'S LEADING CAUSE OF DEATH IN CHILDREN AGES 1-14, CHILDREN'S HOSPITAL OPERATES AN INJURY PREVENTION PROGRAM TO INCREASE COMMUNITY AWARENESS OF CHILDHOOD INJURIES AND THOSE MEASURES THAT CAN BE TAKEN TO DECREASE THEIR PREVALENCE THROUGHOUT CENTRAL CALIFORNIA.
FORM 990, PART III, LINE 4A SUPPORTED BY A CAST OF OVER 90 HOSPITAL EMPLOYEE VOLUNTEERS, THE PROGRAM COVERED THE FOLLOWING TOPICS IN 2014: DISTRACTED & RECKLESS TEEN DRIVING, PEDIATRIC TRAUMA, WATER SAFETY, WHEELED SPORTS SAFETY, CHILD PASSENGER SAFETY, THE CHOKING GAME, SPORTS INJURIES, LITHIUM (BUTTON) BATTERY INGESTION, AIR POWERED GUN INJURIES, TOY SAFETY, CHILD MALTREATMENT, MUNCHAUSEN SYNDROME BY PROXY, AND ABUSIVE HEAD TRAUMA. THE PROGRAM PROVIDED EDUCATION TO THOUSANDS OF CHILDREN AND FAMILIES AT A HOST OF COMMUNITY-BASED VENUES THROUGHOUT THE CENTRAL VALLEY. IN ADDITION, THE HOSPITAL PROVIDED TRAINING AND CONDUCTED OUTREACH TO HEALTH CARE, EDUCATION, LAW ENFORCEMENT, AND CHILD WELFARE PROFESSIONALS THROUGH NATIONAL, STATE, REGIONAL, AND LOCAL CONFERENCES AND SEMINARS. THE PROGRAM ALSO PROVIDED TELEVISION INTERVIEWS AND MEDIA EVENTS TO ADDRESS CHILD SAFETY ISSUES. THE HOSPITAL NOW PROVIDES A MONTHLY CHILD SAFETY SEGMENT ON TWO LOCAL NEWS PROGRAMS BROADCAST THROUGHOUT THE CENTRAL VALLEY. VALLEY CHILDREN'S HOSPITAL ALSO CHAIRED SAFE KIDS CENTRAL VALLEY, LEADING THE COALITION OF 16 LOCALLY BASED AGENCIES IN A VARIETY OF PROJECTS FOCUSED ON DECREASING UNINTENTIONAL DEATH AND INJURY TO KIDS AGED 14 AND UNDER. * LITERACY PROGRAM LITERACY, WHICH IS DEFINED AS THE ABILITY TO READ AND WRITE, IS ESSENTIAL TO FULLY DEVELOPING A SENSE OF WELL-BEING AND CITIZENSHIP. EXPERTS ESTIMATE THAT NEARLY 40 PERCENT OF U.S. 4TH GRADERS DO NOT ACHIEVE BASIC LEVELS OF READING PROFICIENCY. READING DIFFICULTIES AND ILLITERACY CONTRIBUTE TO INCREASED SCHOOL ABSENTEEISM, SCHOOL DROP-OUTS, JUVENILE DELINQUENCY, INCREASED CRIME, TEEN PREGNANCY, DRUG USE AND OTHER PROBLEMS THAT IMPACT OUR COMMUNITY. STUDIES SHOW THE EASIEST WAY TO INCREASE LITERACY AMONG PRE-SCHOOL AND SCHOOL AGE CHILDREN IS TO SIMPLY READ TO THEM. TO MAKE A MEANINGFUL CONTRIBUTION TO LITERACY IN OUR COMMUNITY, VALLEY CHILDREN'S HOSPITAL'S LITERACY PROGRAM PROMOTES AND ENCOURAGES CHILDREN AND THEIR FAMILIES TO BECOME LIFELONG READERS. THE HOSPITAL'S "BESIDES BOOK BUDDIES" INITIATIVE SPECIFICALLY FOCUSES ON DEVELOPING READING READINESS AND EARLY READING SKILLS FOR OUR YOUNG PATIENTS. HOSPITAL VOLUNTEERS BRING BOOKS TO THE CHILDREN, READ THEM STORIES AND ENGAGE THEM IN ACTIVITIES THAT COORDINATE WITH THE STORIES. SEPARATE FROM "BESIDES BOOK BUDDIES", HOSPITAL VOLUNTEERS VISIT OUTPATIENT PRACTICE WAITING ROOMS TO READ TO CHILDREN, SHOWING PARENTS AND CHILDREN THE PLEASURES AND TECHNIQUES OF LOOKING AT BOOKS TOGETHER. ADDITIONALLY, BOOKS ARE AVAILABLE IN HOSPITAL CLINICS AND DEPARTMENTS, AND FAMILIES ARE ENCOURAGED TO TAKE THEM HOME TO USE WITH THEIR CHILDREN. IN 2014, VALLEY CHILDREN'S HOSPITAL DISTRIBUTED ALMOST 8,000 BOOKS TO PATIENTS AND FAMILIES. * CHILDHOOD WEIGHT MANAGEMENT VALLEY CHILDREN'S HOSPITAL SUPPORTED A NUMBER OF EFFORTS AIMED AT ADDRESSING THE ISSUE OF CHILDHOOD OBESITY IN OUR COMMUNITY. THE HOSPITAL CONTINUED TO SERVE AS THE ADVOCACY COORDINATOR FOR THE KAISER HEAL ZONE PROJECT IN THE CITY OF MADERA BY FACILITATING ADVOCACY IN SUPPORT OF INCREASED ACCESS TO HEALTHY FOODS AND PHYSICAL ACTIVITY. ADDITIONALLY, AS THE FOUNDER AND CHAIR OF THE CHILDHOOD WEIGHT MANAGEMENT TASK FORCE FOR FRESNO AND MADERA COUNTIES, VALLEY CHILDREN'S HOSPITAL PLAYED A LEAD ROLE IN SUPPORTING THE TASK FORCE'S ACTIVITIES IN 2014. * POISON CONTROL THE CENTRAL CALIFORNIA POISON CONTROL CENTER IS LOCATED ON THE VALLEY CHILDREN'S HOSPITAL CAMPUS AND, AS IN YEARS PAST, RECEIVED A DONATION OF OFFICE SPACE IN 2014. THE CENTRAL CALIFORNIA DIVISION OF THE CALIFORNIA POISON CONTROL CENTER ANSWERS CALLS FROM THROUGHOUT THE REGION AND PROVIDES EXPERT ADVICE AND INFORMATION REGARDING EXPOSURE TO POTENTIALLY HARMFUL SUBSTANCES. THE PHONES ARE STAFFED 24 HOURS A DAY, 7 DAYS A WEEK. IN ADDITION TO PROVIDING EMERGENCY TELEPHONE ADVICE REGARDING POISON EXPOSURES, THE POISON CONTROL CENTER OPERATES SEVERAL PROGRAMS CRITICAL TO A CULTURALLY DIVERSE, AGRICULTURALLY BASED COMMUNITY LIKE THE CENTRAL VALLEY. THE CENTER HAS BEEN EXPRESSLY RESPONSIVE TO THE GROWING AND LARGELY UNDERSERVED LATINO POPULATION BY DEVELOPING SPECIALIZED TEACHING TOOLS AND PROGRAM INTERVENTIONS IN SPANISH, AND PROVIDING CUSTOMIZED TRAININGS FOR COMMUNITY HEALTH WORKERS IN SPANISH. ALSO, THE CENTER CONTRACTS WITH THE STATE DEPARTMENT OF PESTICIDE REGULATION (DPR) TO ASSIST PHYSICIANS IN COMPLYING WITH MANDATORY REPORTING REQUIREMENTS FOR PESTICIDE EXPOSURES. THE POISON CONTROL CENTER ALSO PROVIDES THE STATE DPR WITH CASE DATA AND INFORMATION ON THE HEALTH ISSUES RELATED TO PESTICIDE EXPOSURE IN CALIFORNIA. * REINTEGRATION VALLEY CHILDREN'S HOSPITAL SUPPORTS A NUMBER OF PROGRAMS OR INITIATIVES DESIGNED TO HELP CHILDREN WHO SUFFER FROM PERMANENT OR LONG-TERM DISABILITIES REINTEGRATE AS EASILY AS POSSIBLE INTO REGULAR DAILY ACTIVITIES. VALLEY CHILDREN'S HOSPITAL'S ADAPTIVE SPORTS PROGRAM PROVIDES RECREATIONAL AND ATHLETIC EXPERIENCES FOR CHILDREN WITH DISABILITIES. EXPERIENCES OFFERED IN 2014 INCLUDED WATER SKIING, ROCK CLIMBING, ICE HOCKEY, BASKETBALL, KAYAKING, WHEEL CHAIR RACING, AND TRACK AND FIELD. OPEN TO AGES UP TO 21 YEARS OF AGE, THE PROGRAM IS THE ONLY ONE OF ITS KIND IN THE CENTRAL VALLEY. IT'S DESIGNED FOR INDIVIDUALS WITH PHYSICAL AND HEALTH IMPAIRMENTS AND CONDITIONS RANGING FROM CEREBRAL PALSY TO SPINAL CORD INJURIES. THROUGH HARD WORK AND DETERMINATION, PARTICIPANTS LEARN THAT IT'S POSSIBLE FOR THEM, TOO, TO TAKE PART IN ATHLETIC ACTIVITIES, EXCEED EXPECTATIONS AND ACHIEVE THEIR DREAMS. SINCE ITS INCEPTION IN 2008, THE PROGRAM HAS SERVED OVER 300 DISABLED CHILDREN. * RONALD MCDONALD HOUSE VALLEY CHILDREN'S HOSPITAL OWNS THE LAND ON WHICH THE RONALD MCDONALD HOUSE (RMH) OF CENTRAL CALIFORNIA IS LOCATED AND LEASES THE LAND TO THE RMH FOR $1 PER YEAR. THE LEASE ARRANGEMENT HELPS MAKE IT POSSIBLE FOR THE RMH TO OFFER ITS SERVICES TO FAMILIES WHOSE CHILDREN ARE BEING TREATED AT THE HOSPITAL. * TRANSPORTATION ACCESS TO PUBLIC TRANSPORTATION HAS BEEN A PROBLEM IN THE CENTRAL VALLEY FOR YEARS AND THUS VALLEY CHILDREN'S HOSPITAL CONTINUES TO WORK WITH THE COMMUNITY TO IMPROVE PUBLIC TRANSPORTATION AND ACCESS TO CARE. VALLEY CHILDREN'S HOSPITAL'S SOCIAL WORK DEPARTMENT ASSISTED FAMILIES WITH TRANSPORTATION BY PROVIDING TAXI VOUCHERS AND BUS TOKENS AND THE HOSPITAL SUBSIDIZED BUS AND TRANSIT SERVICES FROM FRESNO AND THE KINGS COUNTY RURAL AREAS.
FORM 990 PART III, LINE 4B: STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS - PROGRAM SERVICE TWO COMMITMENT TO MEDI-CAL - VALLEY CHILDREN'S HOSPITAL'S COMMITMENT TO SERVING ITS COMMUNITY IS EVIDENCED BY THE LARGE NUMBER OF PATIENTS ITS SERVES THAT ARE COVERED BY MEDI-CAL. IN 2014, 76% OF HOSPITAL INPATIENT DAYS WERE COVERED BY MEDI-CAL. THE COMBINED NET EFFECT OF TOTAL MEDI-CAL REIMBURSEMENT AND DISPROPORTIONATE SHARE FUNDING IN RELATION TO THE COST OF THESE SERVICES RESULTED IN A NET LOSS TO THE HOSPITAL IN 2014 OF $43,769,692. THIS FIGURE IS SEPARATE FROM AND DOES NOT INCLUDE THE COMMUNITY BENEFIT ACTIVITIES AND EXPENSES NOTED IN PREVIOUS SECTIONS, AND ALSO EXCLUDES THE REVENUE AND EXPENSES ASSOCIATED WITH THE HOSPITAL FEE PROGRAM, WHICH IS DESCRIBED IN MORE DETAIL BELOW. HOSPITAL FEE PROGRAM - IN 2009, CALIFORNIA IMPLEMENTED THE HOSPITAL FEE PROGRAM THROUGH WHICH HOSPITALS IN CALIFORNIA, INCLUDING CHILDREN'S HOSPITAL CENTRAL CALIFORNIA, RECEIVED SUPPLEMENTAL MEDI-CAL PAYMENTS. CALIFORNIA IMPLEMENTED THE PROGRAM TO HELP OFFSET A PORTION OF HOSPITAL MEDI-CAL PAYMENT SHORTFALLS ACCRUED OVER CURRENT AND PRIOR YEARS. THE PROGRAM WAS FUNDED BY A QUALITY ASSURANCE FEE PAID BY HOSPITALS THAT THE STATE THEN USES TO COLLECT ADDITIONAL FEDERAL FUNDING. HOSPITAL FEE PROGRAMS LIKE CALIFORNIA'S ARE ALLOWABLE UNDER FEDERAL LAW, AND THE US DEPARTMENT OF HEALTH AND HUMAN SERVICES APPROVED CALIFORNIA'S PROGRAM. IN 2014, VALLEY CHILDREN'S HOSPITAL RECOGNIZED PROGRAM REVENUE OF $9,303,665, NET OF THE HOSPITAL'S QUALITY ASSURANCE FEE AND HOSPITAL CONTRIBUTIONS TO THE CALIFORNIA HEALTH FOUNDATION AND TRUST (CHFT). CHFT WAS ESTABLISHED UNDER THE PROGRAM FOR THE PURPOSE OF SUPPORTING CHARITABLE ACTIVITIES. CHARITY CARE - IN KEEPING WITH OUR MISSION, VALLEY CHILDREN'S HOSPITAL CONTINUES TO ACCEPT ALL PATIENTS, REGARDLESS OF THEIR ABILITY TO PAY. IN 2014, CHILDREN'S HOSPITAL PROVIDED $67,000 IN CHARITY CARE. THE AMOUNT REPRESENTS COSTS ASSOCIATED WITH PATIENTS WHO MEET CERTAIN CRITERIA UNDER THE HOSPITAL'S CHARITY CARE POLICY WITHOUT CHARGE, OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATES IN RELATION TO THE COST OF THESE SERVICES. CHARITY CARE INCLUDES COUNTY INDIGENT AND FREE CARE, WHICH IS BASED ON THE PATIENT'S INABILITY TO PAY FOR SERVICES. IN ORDER TO ASSIST FAMILIES WITH ONGOING CARE NEEDS, VALLEY CHILDREN'S HOSPITAL'S FINANCIAL ASSISTANCE POLICY REQUIRES PATIENT FAMILIES TO APPLY FOR APPROPRIATE GOVERNMENT FUNDING IN CONJUNCTION WITH APPLYING FOR FINANCIAL ASSISTANCE (CHARITY CARE). AS A RESULT, MANY FAMILIES QUALIFY FOR GOVERNMENT PROGRAMS AND DO NOT ULTIMATELY REQUIRE CHARITY CARE. THE HOSPITAL'S CHARITY CARE AMOUNT IS SEPARATE FROM AND DOES NOT INCLUDE THE COMMUNITY BENEFIT ACTIVITIES AND EXPENSES NOTED IN PREVIOUS SECTIONS.
FORM 990, PART VI, SECTION A, LINE 2 GREG COLEMAN, DIRECTOR AND PAT RICCHIUTI, DIRECTOR, HAVE A BUSINESS RELATIONSHIP. IN ADDITION, PAT RICCUTTI, DIRECTOR AND BILL SMITTCAMP, VICE CHAIRMAN, ALSO HAVE A BUSINESS RELATIONSHIP.
FORM 990, PART VI, SECTION A, LINE 3 THE HOSPITAL HIRED KEVIN SHIMAMOTO DURING THE YEAR TO ACT AS THE INTERIM CHIEF INFORMATION OFFICER. DUTIES INCLUDED COMPLETE OVERSIGHT AND MANAGEMENT OF THE HOSPITAL'S INFORMATION TECHNOLOGY DEPARTMENT.
FORM 990, PART VI, SECTION A, LINE 6 THE AMENDED AND RESTATED BYLAWS OF VALLEY CHILDREN'S HOSPITAL, EFFECTIVE 10/17/13, ESTABLISHED VALLEY CHILDREN'S HEALTHCARE AS THE SOLE MEMBER OF THE CORPORATION. CERTAIN MEMBER RIGHTS, INCLUDING THE RIGHT TO APPROVE, FIX THE NUMBER, ELECT, AND REMOVE ELECTED TRUSTEES, ARE INCLUDED IN THESE BYLAWS.
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 A DRAFT OF THE FORM 990 IS UPLOADED TO A SECURED BOARD PORTAL PRIOR TO THE FILING DATE. BOARD MEMBERS ARE ASKED TO REVIEW THE FORM 990 AND PRESENT ANY QUESTIONS THEY MAY HAVE TO THE CFO. THE CFO PRESENTS HIGHLIGHTS OF KEY SECTIONS OF THE FORM 990 AT THE BOARD OF TRUSTEES MEETING THAT IS HELD BEFORE THE FILING DATE AND ANSWERS QUESTIONS OR ADDRESSES ANY CONCERNS AT THIS MEETING. CHANGES CAN THEN BE MADE IF WARRANTED BEFORE THE 990 IS FILED.
FORM 990, PART VI, SECTION B, LINE 12C THE HOSPITAL BOARD OF TRUSTEES MAINTAINS A CONFLICT OF INTEREST POLICY WITHIN THE HOSPITAL'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 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. THE HOSPITAL MAINTAINS A SEPARATE BUT SIMILAR POLICY GOVERNING INDIVIDUALS EMPLOYED IN COVERED POSITIONS.
FORM 990, PART VI, SECTION B, LINE 15 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 THE 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, OFFICER, 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 VALLEY CHILDREN'S HOSPITAL'S ARTICLES OF INCORPORATION IS ON FILE WITH THE CALIFORNIA SECRETARY OF STATE. A COPY OF THE CORPORATE BYLAWS OF VALLEY CHILDREN'S HOSPITAL IS AVAILABLE TO THE GENERAL PUBLIC UPON REQUEST. CONFLICT OF INTEREST MANAGEMENT IS DESCRIBED IN ARTICLE 10 OF THE BYLAWS. THE HOSPITAL PREPARES ANNUAL FINANCIAL STATEMENTS WHICH ARE AUDITED BY AN INDEPENDENT ACCOUNTING FIRM PRIOR TO SUBMITTAL TO RELEVANT STATE AGENCIES.
FORM 990, PART XI, LINE 9: PENSION-RELATED CHANGES OTHER THAN NET PERIODIC PENSION COST -21,482,262. ROUNDING 1.
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
VALLEY CHILDREN'S HOSPITAL
FKA CHILDREN'S HOSPITAL CENTRAL CA
Employer identification number

94-1294954
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) VALLEY CHILDREN'S HEALTHCARE FOUNDATION

9300 VALLEY CHILDRENS PLACE

MADERA,CA93636
94-2797447 		PHILANTHROPY/FUNDRAISING FOR THE HOSPITAL CA 501(C)(3) LINE 7 N/A
 
No
(2) VALLEY CHILDREN'S MEDICAL GROUP

9300 VALLEY CHILDRENS PLACE

MADERA,CA93636
46-4150987 		HEALTH CARE CA 501(C)(3) LINE 9 VALLEY CHILDREN'S HEALTHCARE
 
 
No
(3) VALLEY CHILDREN'S HEALTHCARE

9300 VALLEY CHILDRENS PLACE

MADERA,CA93636
46-4158433 		HEALTH CARE CA 501(C)(3) LINE 11B, II N/A
 
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
Yes
 
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
Yes
 
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
Yes
 
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
(1) VALLEY CHILDREN'S HEALTHCARE FOUNDATION

 C 46,444,666 CASH VALUE





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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