Department of the Treasury Internal Revenue Service
Public Charity Status and Public Support
Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.
Attach to Form 990 or Form 990-EZ. See separate instructions. Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
DRISCOLL CHILDREN'S HOSPITAL
Employer identification number
74-2577746
Part I
Reason for Public Charity Status
(All organizations must complete this part.) See instructions.
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
11
e
By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons other than foundation managers and other than one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2).
f
If the organization received a written determination from the IRS that it is a Type I, Type II, or Type III supporting organization, check this box
..................................................
g
Since August 17, 2006, has the organization accepted any gift or contribution from any of the following persons?
(i) A person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
and (iii) below, the governing body of the supported organization?
................
11g(i)
(ii)
A family member of a person described in (i) above?
......................
11g(ii)
(iii)
A 35% controlled entity of a person described in (i) or (ii) above?
................
11g(iii)
h
Provide the following information about the supported organization(s).
(i) Name of supported organization
(ii) EIN
(iii) Type of organization (described on lines 1- 9 above or IRC section (see instructions))
(iv) Is the organization in col. (i) listed in your governing document?
(v) Did you notify the organization in col. (i) of your support?
(vi) Is the organization in col. (i) organized in the U.S.?
(vii) Amount of monetary support
Yes
No
Yes
No
Yes
No
Total
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990EZ.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2013
Schedule A (Form 990 or 990-EZ) 2013
Page 2
Part II
Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi) (Complete only if you checked the box on line 5, 7, or 8 of Part I or if the
organization failed to qualify under Part III. If the organization fails to
qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year (or fiscal year beginning in)
(a) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....
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)
(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
Gross receipts from related activities, etc. (see instructions)
..................
12
13
First five years.
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here.................................................
Section C. Computation of Public Support Percentage
14
Public support percentage for 2013 (line 6, column (f) divided by line 11, column (f))
.........
14
15
Public support percentage for 2012 Schedule A, Part II, line 14
...............
15
16a
33 1/3% support test—2013.
If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization
.......................
b
33 1/3% support test—2012.
If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization
.....................
17a
10%-facts-and-circumstances test—2013.
If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain
in Part IV how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization
.....................................................
b
10%-facts-and-circumstances test—2012.
If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part IV how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported organization
................................................
18
Private foundation.
If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions
.....................................................
Schedule A (Form 990 or 990-EZ) 2013
Schedule A (Form 990 or 990-EZ) 2013
Page 3
Part III
Support Schedule for Organizations Described in Section 509(a)(2) (Complete only if you checked the box on line 9 of Part I or if the organization
failed to qualify under Part II. If the organization fails to qualify under
the tests listed below, please complete Part II.)
Section A. Public Support
Calendar year (or fiscal year beginning in)
(a) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2
Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......
3
Gross receipts from activities that are not an unrelated trade or business under section 513..
4
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5
The value of services or facilities furnished by a governmental unit to the organization without charge..
6
Total. Add lines 1 through 5.
7a
Amounts included on lines 1, 2, and 3 received from disqualified persons...
b
Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c
Add lines 7a and 7b..
8
Public support (Subtract line 7c from line 6.)
Section B. Total Support
Calendar year (or fiscal year beginning in)
(a) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(f) Total
9
Amounts from line 6...
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
11
Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
12
Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)
..
13
Total support. (Add lines 9, 10c, 11, and 12.)..
14
First five years.
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here.............................................
Section C. Computation of Public Support Percentage
15
Public support percentage for 2013 (line 8, column (f) divided by line 13, column (f))
.........
15
16
Public support percentage from 2012 Schedule A, Part III, line 15
...............
16
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2013 (line 10c, column (f) divided by line 13, column (f))
......
17
18
Investment income percentage from 2012 Schedule A, Part III, line 17
.............
18
19a
33 1/3% support tests—2013.
If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
........
b
33 1/3% support tests—2012.
If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
.....
20
Private foundation.
If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions
.....
Schedule A (Form 990 or 990-EZ) 2013
Schedule A (Form 990 or 990-EZ) 2013
Page 4
Part IV
Supplemental Information.
Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; and Part III, line 12. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
Explanation
Schedule A (Form 990 or 990-EZ) 2013
Additional Data
Software ID:
Software Version:
-
TIN:
SCHEDULE O (Form 990 or 990-EZ)
Department of the Treasury Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ
Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
Attach to Form 990 or 990-EZ.
Information about Schedule O (Form 990 or 990-EZ) and its instructions is at
www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
DRISCOLL CHILDREN'S HOSPITAL
Employer identification number
74-2577746
Return Reference
Explanation
FORM 990, PART VI, QUESTION 6
CLASSES OF MEMBERS OR STOCKHOLDERS ROBERT DRISCOLL, JULIA DRISCOLL, AND ROBERT DRISCOLL JR. FOUNDATION IS THE SOLE MEMBER OF DRISCOLL CHILDREN'S HOSPITAL.
FORM 990, PART VI, QUESTION 7B
MEMBERS OR STOCKHOLDERS THE MEMBER HAS TO APPROVE THE BOARD MEMBERS ELECTIONS.
FORM 990, PART VI, QUESTION 11B
PROCESS TO REVIEW THE FORM 990 THE ORGANIZATION ENGAGES AN OUTSIDE ACCOUNTING FIRM TO PREPARE FORM 990. ONCE PREPARED, THE FORM IS REVIEWED BY THE ORGANIZATION'S INTERNAL ACCOUNTANTS. THE CFO WILL PRESENT THE FORM 990 TO THE GOVERNING BODY PRIOR TO FILING.
FORM 990, PART VI, QUESTION 12C
PROCESS FOR MONITORING COMPLIANCE WITH CONFLICT OF INTEREST POLICY THE ORGANIZATION HIRES AN EMPLOYEE TO LEAD COMPLIANCE EFFORTS WITH THE CONFLICT OF INTEREST POLICY. IN ADDITION, THE BOARD COMMITTEE REVIEWS ISSUES AND REPORTS ANY THAT ARISE.
FORM 990, PART VI, QUESTION 15A &15B
REVIEW OF COMPENSATION THE 2012 & 2013 COMPENSATION WAS REVIEWED BY THE CONSULTING GROUP SULLIVAN COTTER ASSOCIATES. THEY REVIEW ALL SENIOR OFFICER COMPENSATION AND MAKE RECOMMENDATIONS REGARDING THEIR COMPENSATION LEVELS.
FORM 990, PART VI, QUESTION 19
GOVERNING DOCUMENTS AVAILABLE TO THE PUBLIC THE ORGANIZATION DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC.
FORM 990, PART V, QUESTIONS 1A AND 2B
NUMBER OF EMPLOYEES DRISCOLL CHILDREN'S HOSPITAL REPORTS PAYROLL AND CONTRACTOR REPORTING FOR ALL ENTITIES WITHIN THE DRISCOLL SYSTEM INCLUDING: DRISCOLL CHILDREN'S HEALTH PLAN 74-2838488 ROBERT AND JULIA DRISCOLL FOUNDATION 74-1170270 DRISCOLL HEALTHCARE SERVICES 01-0962276 CHILDRENS PHYSICIAN SERVICES OF SOUTH TX 74-2620408 DRISCOLL PHYSICIANS GROUP 74-2988134 DRISCOLL MATERNAL & FETAL PHYSICIANS GROUP 72-1234461 DRISCOLL VALLEY PHYSICIANS GROUP 20-1234322 DRISCOLL CHILDREN'S HOSPITAL DEVELOPMENT FDN 74-2358461
FORM 990, PART XI, LINE 9
OTHER CHANGES IN NET ASSETS ASSETS RELEASED FROM RESTRICTION $ (24,493) CHANGE IN BENEFICIAL TRUST INTEREST $ (345,000) INTERCOMPANY SUPPORT $ 4,823,937 --------------- $ 4,454,444
FORM 990, PART VI, SECTION A, LINE 4
SIGNIFICANT CHANGES TO GOVERNING DOCUMENTS THE PRIMARY CHANGES MENTIONED INCLUDED: 1. THE DRISCOLL GOVERNING BOARD MUST SEEK APPROVAL FROM THE DRISCOLL FOUNDATION FOR ANY SALE, LEASE, EXCHANGE, PLEDGE, MORTGAGE, OR OTHER TRANSFER IN ANY SALE, CONVEYANCE, OR MORTGAGE OF ANY REAL PROPERTY OF DRISCOLL CHILDREN'S HOSPITAL'S PROPERTY OR ASSETS IN EXCESS OF $ 1,000,000. 2. TERM LIMITS (1 YEAR TERMS FOR A TOTAL OF 12 YEARS) 3. CHAIRMAN OF THE BOARD (1 YEAR TERM, MAXIMUM OF 5 ONE-YEAR TERMS) 4. VICE CHAIRMEN WILL BE THE CHAIRMEN ELECT. 5. CHIEF FINANCIAL OFFICER SHALL HAVE CHARGE AND CUSTODY OF AND RESPONSIBLE FOR FUNDS AND SECURITIES OF DRISCOLL CHILDREN'S HOSPITAL AND INCLUDING AFFILIATED ENTITIES. 6. The Executive Committee of the Board will consist of: (1) Chair of the Board, who is also the Chair of the Executive Committee; (2) Vice Chair of the Board/Chair-Elect; (3) Finance Committee Chair; (4) President/Chief Executive Officer, and (5) three additional Directors. 7. The Finance and Audit Committee must consist of: (1) Finance Chair, who is appointed by the Chair of the Board; (2) Chair of the Board; (3) Chief Financial Officer; (4) President/Chief Executive Officer and (5)at least one additional Director appointed by the Chair of the Board. THESE CHANGES TO THE DRISCOLL GOVERNING BOARD BYLAWS WERE APPROVED ON APRIL 22, 2013 AND FORWARDED TO THE CHAIR OF THE DRISCOLL FOUNDATION BOARD FOR CONSIDERATION AND APPROVAL ON JUNE 24, 2013.
FORM 990 PART IX LINE 11G
DESCRIPTION:CONSULTING FEES - EPIC TOTAL FEES:9853
FORM 990 PART IX LINE 11G
DESCRIPTION:PHYSICIAN EDUCATION CONTRACTS TOTAL FEES:3335464
FORM 990 PART IX LINE 11G
DESCRIPTION:PHYSICIAN ADMIN. CONTRACTS TOTAL FEES:1088027
FORM 990 PART IX LINE 11G
DESCRIPTION:PHYSICIAN COVERAGE CONTRACTS TOTAL FEES:14343376
FORM 990 PART IX LINE 11G
DESCRIPTION:PROFESSIONAL FEES TOTAL FEES:1091372
FORM 990 PART IX LINE 11G
DESCRIPTION:COLLECTION FEES TOTAL FEES:914954
FORM 990 PART IX LINE 11G
DESCRIPTION:MEDICAL SERVICES TOTAL FEES:2475973
FORM 990 PART IX LINE 11G
DESCRIPTION:OTHER SERVICES TOTAL FEES:2526564
FORM 990 PART IX LINE 11G
DESCRIPTION:SURVEY SERVICES TOTAL FEES:322018
FORM 990 PART IX LINE 11G
DESCRIPTION:TEMPORARY HELP SERVICES TOTAL FEES:778586
FORM 990 PART IX LINE 11G
DESCRIPTION:CONTRACT LABOR TOTAL FEES:1842883
FORM 990 PART IX LINE 11G
DESCRIPTION:EQUIPMENT RENTAL TOTAL FEES:556156
FORM 990 PART IX LINE 11G
DESCRIPTION:MEDICAL EQUIPMENT RENTAL TOTAL FEES:351650
FORM 990 PART IX LINE 11G
DESCRIPTION:PROFESSIONAL FEES - DEV. FDN. TOTAL FEES:6963
FORM 990 PART IX LINE 11G
DESCRIPTION:OTHER SERVICES - DEV. FDN. TOTAL FEES:2651
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.