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 07-01-2013 , 2013, and ending 06-30-2014
BCheck if applicable:
CName of organization
ARKANSAS CHILDREN'S HOSPITAL
 
Doing Business As
 
 
Number and street (or P.O. box if mail is not delivered to street address)
1 CHILDRENS WAY
 
Room/suite
City or town, state or province, country, and ZIP or foreign postal code
LITTLE ROCK, AR72202
D Employer identification number

71-0236857
E Telephone number

G Gross receipts $ 562,297,006
F Name and address of principal officer:
MARCELLA DODERER
1 CHILDRENS WAY
LITTLE ROCK,AR72202
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
WWW.ARCHILDRENS.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: 1912
M State of legal domicile: AR
Part I
Summary
Activities & Governance 1 Briefly describe the organization’s mission or most significant activities: TO IMPROVE CHILDREN'S HEALTH BY PROVIDING INTEGRATED "PREP": PATIENT CARE, RESEARCH, EDUCATION, AND PREVENTION
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a) ........ 3 29
4 Number of independent voting members of the governing body (Part VI, line 1b) ..... 4 24
5 Total number of individuals employed in calendar year 2013 (Part V, line 2a) ...... 5 4,915
6 Total number of volunteers (estimate if necessary) ............. 6 2,830
7a Total unrelated business revenue from Part VIII, column (C), line 12 ........ 7a 0
b Net unrelated business taxable income from Form 990-T, line 34 ......... 7b 0
Revenues Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 27,150,943 32,456,742
9 Program service revenue (Part VIII, line 2g) ......... 492,992,212 512,741,985
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 4,581,341 4,273,158
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 12,086,901 12,681,858
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)................... 536,811,397 562,153,743
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 6,892,049 6,765,979
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) 248,100,785 260,050,732
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).... 245,800,638 247,750,171
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 500,793,472 514,566,882
19 Revenue less expenses. Subtract line 18 from line 12....... 36,017,925 47,586,861
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 722,882,134 762,641,298
21 Total liabilities (Part X, line 26)............. 203,968,163 217,255,423
22 Net assets or fund balances. Subtract line 21 from line 20..... 518,913,971 545,385,875
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 IMPROVE CHILDREN'S HEALTH BY PROVIDING INTEGRATED "PREP": PATIENT CARE, RESEARCH, EDUCATION, AND PREVENTION
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 $ 430,955,679 including grants of $ 6,765,979 ) (Revenue $ 519,098,724 )
ARKANSAS CHILDREN'S HOSPITAL (ACH) IS A NOT-FOR-PROFIT PEDIATRIC HOSPITAL THAT SERVES AS THE ONLY TERTIARY HEALTH CARE FACILITY FOR CHILDREN IN THE STATE OF ARKANSAS. ACH HAS THE ONLY BURN CENTER IN ARKANSAS AND PROVIDES TREATMENT TO ADULTS AS WELL AS CHILDREN. DURING THE YEAR ENDED JUNE 30, 2014, ACH EXPERIENCED THE FOLLOWING: 14,550 ADMISSIONS WITH AN AVERAGE STAY OF 5.59 DAYS; 79,643 PATIENT DAYS; 218.2 AVERAGE DAILY CENSUS; 342 OPERATING BEDS, INCLUDING 170 INTENSIVE CARE BEDS AND 159 MEDICAL/SURGICAL BEDS; 246,455 OUTPATIENT VISITS, EXCLUDING ER VISITS WHICH WERE 53,259; AND 14,465 SURGERIES INCLUDING 21 HEART TRANSPLANTS AND 4 KIDNEY TRANSPLANTS. CONTINUED ON SCHEDULE O:IN ADDITION TO PROVIDING CHARITY CARE, ACH WORKS WITH THE CENTRAL ARKANSAS COMMUNITY AND ORGANIZATIONS THROUGHOUT THE STATE TO PROVIDE THE FOLLOWING: FREE PHYSICALS, STAFF FOR HEALTH CAMPS, PROGRAMS ON HEALTH CARE TO ELEMENTARY STUDENTS, AND INFORMATION AND LEARNING EXPERIENCES FOR CHILDREN AND FAMILIES AT HEALTH FAIRS AND SEMINARS.ACH IS THE STATE'S ONLY PEDIATRIC LEVEL 1 TRAUMA CENTER, AN INDICATION THAT IT PROVIDES THE HIGHEST STANDARD OF CARE FOR INJURED CHILDREN.
4b (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4c (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4d Other program services (Describe in Schedule O.)
(Expenses $   including grants of $   ) (Revenue $   )
4e Total program service expensesMediumBullet430,955,679
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
Yes
 
11
If the organization’s answer to any of the following questions is "Yes," then complete Schedule D, Parts VI, VII, VIII, IX, or X as applicable.
a
Did the organization report an amount for land, buildings, and equipment in Part X, line 10?
If "Yes," complete Schedule D, Part VI.Click to see attachment...................
11a
Yes
 
b
Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VIIClick to see attachment.......
11b
 
No
c
Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VIIIClick to see attachment.......
11c
 
No
d
Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part IXClick to see attachment............
11d
Yes
 
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
Yes
 
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
Yes
 
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
Yes
 
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
265
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
4,915
b
If at least one is reported on line 2a, did the organization file all required federal employment tax returns?
Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file (see instructions)
2b
Yes
 
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?...
3a
 
No
b
If “Yes,” has it filed a Form 990-T for this year? If “No” to line 3b, provide an explanation in Schedule O...
3b
 
 
4a
At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account, securities account, or other financial account)?..........................
4a
 
No
b
If "Yes," enter the name of the foreign country: MediumBullet
See instructions for filing requirements for Form TD F 90-22.1, Report of Foreign Bank and Financial Accounts.
5a
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year?..
5a
 
No
b
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
5b
 
No
c
If "Yes," to line 5a or 5b, did the organization file Form 8886-T? ............
5c
 
 
6a
Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible as charitable contributions?...
6a
 
No
b
If "Yes," did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible?........................
6b
 
 
7
Organizations that may receive deductible contributions under section 170(c).
a
Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor?....................
7a
 
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
29
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
24
2
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................
2
 
No
3
Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? .
3
Yes
 
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed? ...........................
4
Yes
 
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
 
No
6
Did the organization have members or stockholders? ................
6
 
No
7a
Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or more members of the governing body? ....................
7a
 
No
b
Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body? ...................
7b
 
No
8
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a
The governing body? .........................
8a
Yes
 
b
Each committee with authority to act on behalf of the governing body? ............
8b
Yes
 
9
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If "Yes," provide the names and addresses in Schedule O.......
9
 
No
Section B. Policies (This Section B requests information about policies not required by the Internal Revenue Code.)
Yes
No
10a
Did the organization have local chapters, branches, or affiliates? ............
10a
 
No
b
If "Yes," did the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes?
10b
 
 
11a
Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form? ............................
11a
Yes
 
b
Describe in Schedule O the process, if any, used by the organization to review this Form 990. .....
12a
Did the organization have a written conflict of interest policy? If "No," go to line 13.......
12a
Yes
 
b
Were officers, directors, or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ..........................
12b
Yes
 
c
Did the organization regularly and consistently monitor and enforce compliance with the policy? If "Yes," describe in Schedule O how this was done.......................
12c
Yes
 
13
Did the organization have a written whistleblower policy? ...............
13
Yes
 
14
Did the organization have a written document retention and destruction policy? .........
14
Yes
 
15
Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
a
The organization’s CEO, Executive Director, or top management official ...........
15a
Yes
 
b
Other officers or key employees of the organization ................
15b
Yes
 
If "Yes" to line 15a or 15b, describe the process in Schedule O (see instructions).
16a
Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? ......................
16a
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
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:
MediumBulletGENA WINGFIELD1 CHILDRENS WAYLITTLE ROCKAR72202 (501) 364-2555
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) JONATHAN BATES MD........................................................................
PRESIDENT/CEO (PARTIAL YEAR)
 40.00
.......................0.00 		X   X       2,733,770 0 5,620
(2) MARCELLA DODERER........................................................................
PRESIDENT/CEO
 45.00
.......................5.00 		X   X       348,041 0 8,700
(3) TOM BAXTER........................................................................
CHAIRMAN OF THE BOARD
 1.20
.......................0.00 		X   X       0 0 0
(4) JOHN BALE JR........................................................................
TRUSTEE/DIRECTOR
 .40
.......................0.00 		X           0 0 0
(5) RON CLARK........................................................................
TRUSTEE/DIRECTOR
 .50
........................20 		X           0 0 0
(6) HASKELL DICKINSON........................................................................
TRUSTEE/DIRECTOR
 .10
.......................0.00 		X           0 0 0
(7) JAYANT DESHPANDE MD........................................................................
SVP AND CMO
 50.00
.......................0.00 		X   X       470,275 0 0
(8) TAMIKA EDWARDS........................................................................
TRUSTEE/DIRECTOR (PARTIAL YEAR)
 .20
.......................0.00 		X           0 0 0
(9) HARRY C ERWIN III........................................................................
TRUSTEE/DIRECTOR
 .30
........................40 		X           0 0 0
(10) JEFF GARDNER........................................................................
TRUSTEE/DIRECTOR
 .20
.......................0.00 		X           0 0 0
(11) SHARILYN GASAWAY........................................................................
TRUSTEE/DIRECTOR
 .30
........................40 		X           0 0 0
(12) CHARLES GLASIER MD........................................................................
TRUSTEE/DIRECTOR (PARTIAL YEAR)
 44.20
.......................0.00 		X           65,000 0 0
(13) PAUL R HART........................................................................
TRUSTEE/DIRECTOR
 .20
........................10 		X           0 0 0
(14) J FRENCH HILL........................................................................
TRUSTEE/DIRECTOR (PARTIAL YEAR)
 .20
........................10 		X           0 0 0
(15) JUDGE MARION HUMPHREY........................................................................
TRUSTEE/DIRECTOR
 .40
.......................0.00 		X           0 0 0
(16) DORSEY JACKSON........................................................................
PAST CHAIRMAN
 .90
.......................0.00 		X   X       0 0 0
(17) RICHARD JACOBS MD........................................................................
ACHRI PRESIDENT/UAMS DOP CHAIR
 .60
.......................49.80 		X           0 229,131 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) DIANE MACKEY........................................................................
TRUSTEE/DIRECTOR (PARTIAL YEAR)
 .10
........................10 		X           0 0 0
(19) HOLLY MARR........................................................................
TRUSTEE/DIRECTOR
 .60
.......................0.00 		X           0 0 0
(20) RICK JACKSON MD........................................................................
CHIEF OF STAFF
 40.00
.......................1.00 		X           645,000 0 0
(21) MARK MCCASLIN........................................................................
TREASURER
 .50
........................10 		X   X       0 0 0
(22) PAT MCCLELLAND........................................................................
TRUSTEE/DIRECTOR
 .60
.......................0.00 		X           0 0 0
(23) TINA BOWERS LEE........................................................................
TRUSTEE/DIRECTOR
 0.00
.......................0.00 		X           0 0 0
(24) BARBARA G MOORE........................................................................
TRUSTEE/DIRECTOR
 .70
........................30 		X           0 0 0
(25) BEVERLY A MORROW........................................................................
TRUSTEE/DIRECTOR
 .90
.......................0.00 		X           0 0 0
(26) W ROBERT MORROW MD........................................................................
MEDICAL DIRECTOR (PARTIAL YEAR)
 40.00
.......................0.00 		X   X       124,353 0 0
(27) JEFFREY NOLAN........................................................................
TRUSTEE/DIRECTOR
 .50
........................20 		X           0 0 0
(28) DANIEL RAHN MD........................................................................
TRUSTEE/DIRECTOR
 .20
........................10 		X           0 0 0
(29) JAMES SKIP RUTHERFORD........................................................................
SECRETARY
 .60
.......................0.00 		X   X       0 0 0
(30) MARK SAVIERS........................................................................
VICE CHAIRMAN
 .60
........................20 		X   X       0 0 0
(31) PATRICK SCHUECK........................................................................
TRUSTEE/DIRECTOR
 .30
........................20 		X           0 0 0
(32) CHARLES B WHITESIDE III........................................................................
TRUSTEE/DIRECTOR
 .70
........................50 		X           0 0 0
(33) GINGER BLACKMON........................................................................
TRUSTEE/DIRECTOR
 .40
........................60 		X           0 0 0
(34) MELISSA GRAHAM MD........................................................................
TRUSTEE/DIRECTOR
 .40
.......................0.00 		X           0 0 0
(35) KELLIE ROBINSON........................................................................
TRUSTEE/DIRECTOR
 .40
........................50 		X           0 0 0
(36) GENA WINGFIELD........................................................................
SVP AND CFO
 44.00
.......................1.00 		    X       426,704 0 39,613
(37) CHARLES LARRY BECKIUS........................................................................
VP FACILITIES
 48.00
.......................0.00 		      X     205,905 0 21,298
(38) DAVID BERRY........................................................................
SVP AND COO
 45.00
........................10 		      X     423,890 0 57,846
(39) LORI BROWN........................................................................
CHIEF NURSING OFFICER (PARTIAL YEAR)
 40.00
.......................0.00 		      X     277,914 0 6,601
(40) SCOTT GORDON........................................................................
EXECUTIVE VICE PRESIDENT
 20.00
.......................20.00 		      X     454,514 0 26,497
(41) CYNTHIA HOLLAND........................................................................
VP ANCILLARY SERVICES
 50.00
.......................0.00 		      X     197,971 0 20,772
(42) KATHERINE LEA........................................................................
VP PATIENT CARE SERVICES
 48.00
.......................0.00 		      X     172,969 0 17,773
(43) DARRELL LEONHARDT........................................................................
CHIEF INFORMATION OFFICER
 40.00
.......................0.00 		      X     268,741 0 22,939
(44) LEE ANNE EDDY........................................................................
SVP/CHIEF NURSING OFFICER
 40.00
.......................0.00 		      X     227,929 0 15,405
(45) MARY SALASSI-SCOTTER........................................................................
VP PATIENT CARE SERVICES
 47.00
.......................0.00 		      X     171,121 0 18,678
(46) CHARLES E JOHNSON........................................................................
DIRECTOR - CV SURGERY
 40.00
.......................0.00 		        X   219,980 0 14,666
(47) CARL CHIPMAN........................................................................
RN FIRST ASST CV SURGERY
 40.00
.......................0.00 		        X   224,407 0 16,609
(48) JAMES KOONCE........................................................................
DENTIST
 40.00
.......................0.00 		        X   320,787 0 21,316
(49) KIRT SIMMONS........................................................................
ORTHODONTIST
 48.00
.......................0.00 		        X   251,142 0 21,339
(50) ANDREE TROSCLAIR........................................................................
VP OF HUMAN RESOURCES
 40.00
.......................0.00 		        X   217,653 0 20,015
1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)............MediumBullet 8,448,066 229,131 355,687
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organizationMediumBullet211
Yes
No
3
Did the organization list any former officer, director or trustee, key employee, or highest compensated employee on line 1a? If "Yes," complete Schedule J for such individual ..............
3
 
No
4
For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If "Yes," complete Schedule J for such individual...........................
4
Yes
 
5
Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If "Yes," complete Schedule J for such person ........
5
Yes
 
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
UNIVERSITY OF ARKANSAS FOR MEDICAL SCIEN4301 WEST MARKHAMLITTLE ROCKAR72205 MEDICAL SERVICES 60,647,602
NABHOLZ CONSTRUCTION CORPPO BOX 2090CONWAYAR72033 GENERAL CONSTRUCTION CONTRACTOR 7,936,584
ARAMARK24836 NETWORK PLACECHICAGOIL60673 FOOD SERVICE 6,198,817
CROMWELL ARCHITECTS ENGINEERS101 SOUTH SPRING STREETLITTLE ROCKAR72201 ARCHITECT/ENGINEERING 1,661,237
ARUP INCPO BOX 27964SALT LAKE CITYUT84127 REFERRED PATIENT LAB TESTING 1,592,256
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet82
Form 990 (2013)
Form 990 (2013)
Page 9
Part VIII
Statement of Revenue
Check if Schedule O contains a response or note to any line in this Part VIII .............
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512-514
Contributions, Gifts, GrantAmt and OtherAmt Similar Amounts 1a Federated campaigns..1a  
b Membership dues....1b  
c Fundraising events....1c  
d Related organizations...1d 16,674,899
e Government grants (contributions)1e 15,781,843
f All other contributions, gifts, grants, and
similar amounts not included above1f 		 
g Noncash contributions included in lines
1a-1f:$ 		 
h Total. Add lines 1a-1f.......MediumBullet 32,456,742
Program Service RevenueAmt Business Code
2a PAYMENTS FOR MED SVCS 900099 512,741,985 512,741,985    
b
c
d
e
f All other program service revenue .        
g Total. Add lines 2a–2f........MediumBullet 512,741,985
OtherAmt RevenueAmt 3 Investment income (including dividends, interest, and other similar amounts).......MediumBullet 4,208,864     4,208,864
4 Income from investment of tax-exempt bond proceeds..MediumBullet        
5 Royalties...........MediumBullet        
(i) Real (ii) Personal
6a Gross rents 1,264,262  
b Less: rental expenses 1,488  
c Rental income or (loss) 1,262,774  
d Net rental income or (loss).......MediumBullet 1,262,774     1,262,774
(i) Securities (ii) Other
7a Gross amount from sales of assets other than inventory 198,569 7,500
b Less: cost or other basis and sales expenses 62,500 79,275
c Gain or (loss) 136,069 -71,775
d Net gain or (loss)..........MediumBullet 64,294     64,294
8a Gross income from fundraising events (not including
$  
of contributions reported on line 1c). See Part IV, line 18 ..
a  
b Less: direct expenses ...b  
c Net income or (loss) from fundraising events..MediumBullet      
9a Gross income from gaming activities.
See Part IV, line 19 ...
a  
b Less: direct expenses ...b  
c Net income or (loss) from gaming activities...MediumBullet        
10a Gross sales of inventory, less
returns and allowances .
a  
b Less: cost of goods sold ..b  
c Net income or (loss) from sales of inventory..MediumBullet        
Miscellaneous Revenue Business Code
11a NUTRITIONAL SERVICES 900099 3,755,912     3,755,912
b NW AR CLINICS O/I 900099 1,716,967 1,716,967    
c CHILD ENRICHMENT 900099 1,306,433     1,306,433
d All other revenue .... 4,639,772 4,639,772    
e Total. Add lines 11a–11d ...... MediumBullet 11,419,084
12 Total revenue. See Instructions......MediumBullet 562,153,743 519,098,724 0 10,598,277
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 6,346,337 6,346,337
2 Grants and other assistance to individuals in the United States. See Part IV, line 22 419,642 419,642
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 .... 8,475,856 3,242,818 5,233,038  
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 210,157,317 170,199,495 39,957,822  
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) .... 7,653,804 6,344,212 1,309,592  
9 Other employee benefits ....... 18,261,034 15,110,748 3,150,286  
10 Payroll taxes ........... 15,502,721 12,850,152 2,652,569  
11 Fees for services (non-employees):        
a Management ...... 2,426,012 1,242,904 1,183,108  
b Legal ......... 260,473   260,473  
c Accounting ........... 312,724   312,724  
d Lobbying ........... 104,823 104,823    
e Professional fundraising services. See Part IV, line 17    
f Investment management fees ......        
g Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) ........ 92,781,186 88,081,335 4,699,851  
12 Advertising and promotion .... 447,623 430,121 17,502  
13 Office expenses ....... 11,230,695 5,142,854 6,087,841  
14 Information technology ...... 11,107,014 6,668,296 4,438,718  
15 Royalties ..        
16 Occupancy ........... 5,565,225 4,125,882 1,439,343  
17 Travel ............ 1,699,604 1,588,283 111,321  
18 Payments of travel or entertainment expenses for any federal, state, or local public officials ......        
19 Conferences, conventions, and meetings .... 298,947 230,245 68,702  
20 Interest ........... 7,347,239   7,347,239  
21 Payments to affiliates .......        
22 Depreciation, depletion, and amortization ..... 24,818,883 21,630,066 3,188,817  
23 Insurance .............. 1,853,633 1,243,984 609,649  
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 MEDICAL SUPPLIES 75,367,119 75,367,119    
b PROVISION FOR BAD DEBT 3,116,333 3,116,333    
c MINOR EQUIPMENT 1,669,638 1,312,310 357,328  
d DUES & SUBSCRIPTIONS 1,364,842 676,772 688,070  
e All other expenses 5,978,158 5,480,948 497,210  
25 Total functional expenses. Add lines 1 through 24e 514,566,882 430,955,679 83,611,203 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 ............. 11,920 1 12,339
2 Savings and temporary cash investments ......... 39,240,431 2 41,205,732
3 Pledges and grants receivable, net ...........   3  
4 Accounts receivable, net ............. 50,585,370 4 48,158,543
5 Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
Schedule L ..................
23,104 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 .............. 7,448,404 8 7,925,875
9 Prepaid expenses and deferred charges .......... 9,202,239 9 6,044,785
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 543,741,176
b Less: accumulated depreciation ..... 10b 269,611,026 253,333,000 10c 274,130,150
11 Investments—publicly traded securities .......... 246,540,780 11 251,092,720
12 Investments—other securities. See Part IV, line 11 ..... 461,560 12 410,404
13 Investments—program-related. See Part IV, line 11 ..... 927,440 13 800,468
14 Intangible assets ...............   14  
15 Other assets. See Part IV, line 11 ........... 115,107,886 15 132,860,282
16 Total assets. Add lines 1 through 15 (must equal line 34)...... 722,882,134 16 762,641,298
Liabilities 17 Accounts payable and accrued expenses ......... 51,848,216 17 53,347,387
18 Grants payable .................   18  
19 Deferred revenue ................   19  
20 Tax-exempt bond liabilities ............. 152,119,947 20 163,714,022
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.................... 0 25 194,014
26 Total liabilities. Add lines 17 through 25......... 203,968,163 26 217,255,423
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 .............. 495,293,881 27 524,564,887
28 Temporarily restricted net assets ........... 23,620,090 28 20,820,988
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 ........... 518,913,971 33 545,385,875
34 Total liabilities and net assets/fund balances ........ 722,882,134 34 762,641,298
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
562,153,743
2
Total expenses (must equal Part IX, column (A), line 25) ............
2
514,566,882
3
Revenue less expenses. Subtract line 2 from line 1 ..............
3
47,586,861
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) ..
4
518,913,971
5
Net unrealized gains (losses) on investments ...............
5
-1,228,875
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
-19,886,082
10
Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line 33, column (B))
10
545,385,875
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
Yes
 
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
Yes
 
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
ARKANSAS CHILDREN'S HOSPITAL
 
Employer identification number

71-0236857
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
ARKANSAS CHILDREN'S HOSPITAL
 
Employer identification number

71-0236857
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
ARKANSAS CHILDREN'S HOSPITAL
  		Employer identification number

71-0236857
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
ARKANSAS CHILDREN'S HOSPITAL
  		Employer identification number

71-0236857
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
ARKANSAS CHILDREN'S HOSPITAL
  		Employer identification number

71-0236857
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
ARKANSAS CHILDREN'S HOSPITAL
 
Employer identification number

71-0236857
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? .........................
 
No
 
e
Publications, or published or broadcast statements? .......................
 
No
 
f
Grants to other organizations for lobbying purposes? .......................
Yes
 
84,823
g
Direct contact with legislators, their staffs, government officials, or a legislative body? ........
Yes
 
 
h
Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ......
 
No
 
i
Other activities? ..........................
Yes
 
222,276
j
Total. Add lines 1c through 1i ...............................
307,099
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: IN ORDER TO EFFECTIVELY ADVOCATE FOR AND ASSIST WITH THE IMPROVEMENT OF CHILDREN'S HEALTH, ARKANSAS CHILDREN'S HOSPITAL HAS AN OFFICE OF GOVERNMENT RELATIONS THAT WORKS WITH OTHER ORGANIZATIONS, ON A STATE AND NATIONAL LEVEL, TO FORMULATE POLICY AND TO ARTICULATE OUR PUBLIC POLICY AGENDA. IN ADDITION, A PERCENTAGE OF DUES PAID TO THE AMERICAN HOSPITAL ASSOCIATION, ARKANSAS HOSPITAL ASSOCIATION, ASSOCIATION OF AMERICAN MEDICAL COLLEGES, CHILDREN'S HOSPITAL ASSOCIATION, LITTLE ROCK REGIONAL CHAMBER OF COMMERCE AND THE ARKANSAS STATE CHAMBER OF COMMERCE WAS FOR LOBBYING.
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
ARKANSAS CHILDREN'S HOSPITAL
 
Employer identification number

71-0236857
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 .... 212,925,418 176,416,750 166,396,164 145,568,315 135,770,735
b Contributions ........ 25,377,876 27,950,863 13,882,530 4,959,714 7,045,011
c Net investment earnings, gains, and losses 27,631,730 11,723,854 1,770,907 21,536,391 13,385,881
d Grants or scholarships .....          
e Other expenditures for facilities
and programs ........ 		5,127,265 3,166,049 5,632,851 5,668,256 10,633,312
f Administrative expenses ....          
g End of year balance ...... 260,807,759 212,925,418 176,416,750 166,396,164 145,568,315
2
Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:
a
Board designated or quasi-endowment SchDMd Bullet75.000 %
b
Permanent endowment SchDMd Bullet13.000 %
c
Temporarily restricted endowment SchDMd Bullet12.000 %
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)
 
No
(ii) related organizations ........................
3a(ii)
Yes
 
b
If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........
3b
Yes
 
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 .................   13,099,002 13,099,002
b Buildings ................   318,359,115 153,150,535 165,208,580
c Leasehold improvements ............        
d Equipment ................   175,361,286 107,960,148 67,401,138
e Other .................   36,921,773 8,500,343 28,421,430
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......SchDMdBullet 274,130,150
Schedule D (Form 990) 2013

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








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








Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)Small Bullet  
Part IX
Other Assets. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11d. See Form 990, Part X, line 15.
(a) Description (b) Book value
(1) FUNDS HELD BY TRUSTEE UNDER BOND AGREEMENTS 11,670,032
(2) ESTIMATED 3RD PARTY SETTLEMENT (MCD) 102,606,521
(3) UPL RECEIVABLE 8,947,707
(4) GME RECEIVABLE 1,137,644
(5) OTHER RECEIVABLES 4,457,884
(6) BOND ISSUE COSTS 3,961,613
(7) INTEREST RECEIVABLE - FUNDED DEPR 78,881


Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........Small Bullet 132,860,282
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  
OBLIGATIONS UNDER CAPITAL LEASES 194,014








Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)Small Bullet 194,014
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
PART V, LINE 4: EARNINGS FROM ENDOWMENT FUNDS WILL BE USED TO SUPPORT VARIOUS HOSPITAL PROGRAMS. THE FILING ORGANIZATION DOES NOT HOLD ANY ENDOWMENTS; ALL ENDOWMENTS ARE HELD BY ARKANSAS CHILDREN'S HOSPITAL FOUNDATION, A RELATED ORGANIZATION.
PART X, LINE 2: EFFECTIVE JULY 1, 2007, THE HOSPITAL ADOPTED FIN 48 (ASC 740), ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES. FOR FY14, THE HOSPITAL DID NOT RECOGNIZE ANY ADJUSTMENT RELATED TO UNCERTAIN TAX POSITIONS.
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
ARKANSAS CHILDREN'S HOSPITAL
 
Employer identification number

71-0236857
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

 

No
5a
Did the organization budget amounts for free or discounted care provided under its financial assistance policy during the tax year? ............................

5a

Yes

 
b
If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? ......
5b
 
No
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) .. 		    11,479,819 0 11,479,819 2.230 %
b Medicaid (from Worksheet 3,
column a) .... 		    275,039,656 286,856,986 -11,817,330 0 %
c Costs of other means-tested
government programs (from
Worksheet 3, column b) . 		           
d Total Financial Assistance
and Means-Tested
Government Programs . 		    286,519,475 286,856,986 -337,511 2.230 %
Other Benefits
     17,788,418 11,707,864 6,080,554 1.180 %
e Community health
improvement services and
community benefit operations
(from Worksheet 4) ..
f Health professions education
(from Worksheet 5) .. 		    21,476,766 7,039,670 14,437,096 2.810 %
g Subsidized health services
(from Worksheet 6) .. 		    43,636,124 21,117,434 22,518,690 4.380 %
h Research (from Worksheet 7)     4,812,081   4,812,081 0.940 %
i Cash and in-kind
contributions for community
benefit (from Worksheet 8) 		    582,114 82,572 499,542 0.100 %
j Total. Other Benefits ..     88,295,503 39,947,540 48,347,963 9.410 %
k Total. Add lines 7d and 7j .     374,814,978 326,804,526 48,010,452 11.640 %
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     30,191   30,191 0.010 %
3 Community support     49,789   49,789 0.010 %
4 Environmental improvements            
5 Leadership development and training for community members     1,860   1,860 0 %
6 Coalition building     11,700   11,700 0 %
7 Community health improvement advocacy     27,423   27,423 0.010 %
8 Workforce development     14,200   14,200 0 %
9 Other     54,927   54,927 0.010 %
10 Total     190,090   190,090 0.040 %
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
1,754,309
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
 
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
2,917,471
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
3,754,448
7
Subtract line 6 from line 5. This is the surplus (or shortfall)........
7
-836,977
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?1
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 ARKANSAS CHILDREN'S HOSPITAL
1 CHILDRENS WAY
LITTLE ROCK,AR72202
WWW.ARCHILDRENS.ORG
AR4640 		X X X X   X X      
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)
ARKANSAS CHILDREN'S HOSPITAL
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) 		1
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   No
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   No
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: 400.000000000000%
If "No," explain in Part VI the criteria the hospital facility used.
12 Explained the basis for calculating amounts charged to patients?................. 12   No
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   No
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
ARKANSAS CHILDREN'S HOSPITAL PART V, SECTION B, LINE 1J: IN ADDITION TO THE ITEMS CHECKED IN BOXES A - I, OTHER INFORMATION WAS INCLUDED IN THE NEEDS ASSESSMENT. AS THE ONLY PEDIATRIC HOSPITAL IN THE STATE OF ARKANSAS, ACH CONSIDERS ITS COMMUNITY TO BE ALL CHILDREN IN THE STATE, ESTIMATED AT 710,000. THE NEEDS ASSESSMENT ALSO INCLUDES DETAILED INFORMATION ABOUT THE NEIGHBORHOOD IMMEDIATELY SURROUNDING THE HOSPITAL GIVEN THE ORGANIZATION'S ROLE IN SUPPORTING ITS NEIGHBORHOOD. LIMITED INFORMATION WAS ALSO INCLUDED REFERENCING THE HEALTH STATUS OF ADULTS SINCE PEDIATRIC HEALTH STATUS CAN BE CLOSELY LINKED TO THAT OF ADULTS IN THE HOUSEHOLD. LASTLY, THE NEEDS ASSESSMENT INCLUDED INTERVENTIONS SUGGESTED BY THE COMMUNITY THAT THE HOSPITAL COULD CONSIDER AS IT DEVELOPED ITS IMPLEMENTATION PLAN.
ARKANSAS CHILDREN'S HOSPITAL PART V, SECTION B, LINE 3: THE HOSPITAL CONSIDERED BOTH SECONDARY AND PRIMARY DATA AS IT DETERMINED THE HEALTH NEEDS OF ARKANSAS' CHILDREN. SECONDARY DATA SETS REVIEWED INCLUDE THE U.S. CENSUS BUREAU, THE ANNIE E. CASEY KIDS' COUNT DATA CENTER, ARKANSAS STATE AGENCIES DATABASES, THE ARKANSAS STATISTICAL ABSTRACT, THE YOUTH RISK BEHAVIOR SURVEY, ARKANSAS CHILDREN'S HOSPITAL PEDIATRIC HEALTH INFORMATION SYSTEM, AND A VARIETY OF LOCAL ORGANIZATIONS' RESEARCH.PRIMARY DATA WAS ALSO COLLECTED TO DETERMINE PERCEIVED NEEDS OF THE COMMUNITY. FOCUS GROUPS, KEY STAKEHOLDER INTERVIEWS, AND A PHONE SURVEY SYNTHESIZED THE INPUT OF COMMUNITY MEMBERS, EDUCATORS, AND PROFESSIONALS WITH A WIDE VARIETY OF EXPERTISE IN THE HEALTH NEEDS OF CHILDREN. EIGHT FOCUS GROUPS WERE HELD IN THE CITIES OF BATESVILLE, FORREST CITY, GURDON, LAVACA, JONESBORO, SPRINGDALE, AND LITTLE ROCK, ARKANSAS. GENERALLY THESE GROUPS INCLUDED PARENTS, SCHOOL OFFICIALS, COMMUNITY LEADERS, AND ELECTED OFFICIALS. ANONYMITY WAS ASSURED AS A MEANS OF OBTAINING HONEST AND FRANK INPUT. THEREFORE, SPECIFIC NAMES WILL NOT BE PUBLISHED.KEY STAKEHOLDER INTERVIEWS WERE HELD WITH 23 INDIVIDUALS. THESE INCLUDE THE FOLLOWING: EXECUTIVE DIRECTOR OF ARKANSAS COMMUNITY HEALTH CENTERS, DIRECTOR OF THE ARKANSAS DEPARTMENT OF HEALTH, ASSOCIATE MEDICAL DIRECTOR OF ARKANSAS BLUE CROSS/BLUE SHIELD, THE COMMISSIONER OF ARKANSAS DEPARTMENT OF EDUCATION, PROFESSOR AT THE COLLEGE OF PUBLIC HEALTH, SENIOR VICE PRESIDENT OF ARKANSAS FOUNDATION FOR MEDICAL CARE, ASSOCIATE DIRECTOR OF ARKANSAS STATE UNIVERSITY CHILDHOOD SERVICES, CHIEF OPERATING OFFICER FOR WHITE RIVER HEALTH CENTER, EXECUTIVE DIRECTOR OF BOYS, GIRLS, ADULTS COMMUNITY DEVELOPMENT CENTER, PROFESSOR OF PEDIATRICS AND DIRECTOR OF THE INJURY PREVENTION CENTER AT ACH, DIRECTOR OF SOCIAL WORK AT ACH, DIRECTOR OF DISEASE PREVENTION AND HEALTH PROMOTION AT ARKANSAS CENTER FOR HEALTH IMPROVEMENT, VICE PRESIDENT OF NURSING SERVICES AT ST. BERNARD'S HOSPITAL, EXECUTIVE DIRECTOR OF THE ARKANSAS CHILDREN'S TRUST FUND, ASSOCIATE BRANCH CHIEF OF FAMILY HEALTH BRANCH OF THE ARKANSAS DEPARTMENT OF HEALTH, BUSINESS LEADER AND MEMBER OF RONALD MCDONALD CHILDREN'S CHARITY OF ARKOMA, VICE CHAIR OF ARKANSAS CHILDREN'S BEHAVIORAL HEALTH CARE COMMISSION, DIRECTOR OF DELTA AREA HEALTH EDUCATION CENTER AT UAMS, DIRECTOR OF THE DIVISION OF CHILDCARE AND EARLY CHILDHOOD EDUCATION WITH THE ARKANSAS DEPARTMENT OF HUMAN SERVICES, ASSOCIATE PROFESSOR OF PEDIATRICS AT UAMS, SECTION CHIEF OF THE TOBACCO PREVENTION AND CESSATION PROGRAMS WITH THE ARKANSAS DEPARTMENT OF HEALTH, DEAN OF THE CLINTON SCHOOL OF PUBLIC SERVICE, AND SEVERAL ACH "AMBASSADORS" WHO WERE CURRENT OR FORMER PATIENTS.IN ADDITION, A TELEPHONE SURVEY OF 1,000 RANDOMLY SELECTED FAMILIES (250 FROM EACH OF THE STATE'S FOUR CONGRESSIONAL DISTRICTS) WAS CONDUCTED. QUESTIONS FOCUSED ON VARIOUS TOPICS RELATED TO THE STATUS OF CHILDREN'S HEALTH AND ACCESS TO CARE MATTERS.
ARKANSAS CHILDREN'S HOSPITAL PART V, SECTION B, LINE 5D: THE CHNA IS ALSO MADE AVAILABLE THROUGH A NEWS CONFERENCE AND THE NATURAL WONDERS PARTNERSHIP COUNCIL AND MORE THAN TWO DOZEN COMPANIES THAT COLLABORATE IN THAT GROUP. THE TECHNICAL NEEDS ASSESSMENT IS REPACKAGED INTO A FORMAT MORE SUITABLE FOR PUBLIC USE, WITH AN EFFORT TO MAKE THE ISSUES UNDERSTANDABLE TO A BROADER AUDIENCE. THIS PUBLIC-FACING REPORT, "NATURAL WONDERS: THE STATE OF CHILDREN'S HEALTH IN ARKANSAS" IS WIDELY DISTRIBUTED THROUGH THIS PARTNERSHIP AND MADE AVAILABLE FOR ANYONE THAT REQUESTS IT.
ARKANSAS CHILDREN'S HOSPITAL PART V, SECTION B, LINE 6I: THE FRANKLIN ELEMENTARY SCHOOL-BASED HEALTH CENTER BEGAN SERVING PATIENTS IN MARCH 2014, AND A NURSE PRACTITIONER WORKS AT THE SCHOOL 20 HOURS PER WEEK. THE HOSPITAL EXCEEDED ITS PLANS FOR ADDRESSING FOOD INSECURITY ON THE ACH CAMPUS THROUGH A VARIETY OF INVESTMENTS TO REDUCE THE NUMBER OF THE COMMUNITY'S HUNGRY CHILDREN. UNITED STATES DEPARTMENT OF AGRICULTURE (USDA) MEALS ARE BEING PROVIDED TO CHILDREN YEAR-ROUND IN A GROUND-BREAKING EFFORT, AND THE HOSPITAL HAS ESTABLISHED NEW PARTNERSHIPS WITH A LOCAL PANTRY TO PROVIDE FOOD TO HUNGRY FAMILIES. FAMILIES CAN NEWLY ENROLL IN THE SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM (SNAP) ON CAMPUS, THANKS TO PARTNERSHIPS WITH STATE AGENCIES. THE FEDERALLY-FUNDED HOME VISITING NETWORK ($3.3 MILLION) IS STILL IN OPERATION AND IS MOVING FORWARD WITH DEVELOPING NEW CAPACITY. OTHER GRANTS THAT TOTAL ABOUT $2.3 MILLION ANNUALLY INCLUDE A LARGE TRAUMA CENTER GRANT FROM THE STATE, BURN AND HEARING OUTREACH GRANTS, AND A STATEWIDE INJURY PREVENTION PROGRAM GRANT. HOWEVER, THE HEALTHY BABY COALITION PROJECT ENDED AHEAD OF SCHEDULE DUE TO LIMITED IMPACT, WHICH IS A CHANGE FROM THE IMPLEMENTATION PLAN.IN MAY 2014, ACH HOSTED A TWO-DAY SUMMIT TO RAISE AWARENESS OF THE STATE OF CHILDREN'S HEALTH IN ARKANSAS TO GROW NEW PARTNERSHIPS FOR COMMUNITY HEALTH INVESTMENTS. THE EVENT, WHICH PROVIDED AN IN-DEPTH LOOK AT HEALTH AND WELLNESS ISSUES THAT AFFECT ARKANSAS CHILDREN, WAS WELL ATTENDED BY MORE THAN 150 HEALTH CARE AND EDUCATION STAKEHOLDERS, ADVOCATES, STATE AGENCY REPRESENTATIVES AND BUSINESS LEADERS. THE AGENDA INCLUDED NATIONALLY RECOGNIZED SPEAKERS WHO ADDRESSED TOPICS BROADLY APPLICABLE TO ATTENDEES, INCLUDING TOXIC STRESS AND THE IMPORTANCE OF EARLY EDUCATION AND SUPPORT IN ENSURING OPTIMAL BRAIN DEVELOPMENT FOR CHILDREN.
ARKANSAS CHILDREN'S HOSPITAL PART V, SECTION B, LINE 7: THE CHNA IDENTIFIED SEVERAL AREAS FOR WHICH A COLLABORATIVE STRATEGY IS THE BEST APPROACH TO SOLVING COMPLEX SOCIAL ISSUES. THE HOSPITAL WORKS THROUGH THE NATURAL WONDERS PARTNERSHIP COUNCIL (NWPC) TO DETERMINE LEADERSHIP IN VARIOUS ISSUE AREAS AND TO PROVIDE A FORUM IN WHICH COLLABORATIONS ARE DEVELOPED. WHILE ACH PLAYS A LEADERSHIP ROLE IN SEVERAL AREAS INCLUDING INJURIES, PARENTING, AND ORAL HEALTH, FOR OTHER AREAS, THERE ARE MORE NATURAL LEADERS. ACH PROVIDES SPECIALTY CARE, RESEARCH, AND EDUCATION SERVICES IN MANY OF THE AREAS IDENTIFIED IN THE CHNA. AREAS IN WHICH ACH PLAYS A SUPPORTING/PARTNERSHIP ROLE, RATHER THAN A LEADERSHIP ROLE, INCLUDE: - HIGH SCHOOL GRADUATION RATE - MENTAL HEALTH - FOOD INSECURITY - SEXUAL HEALTH - SUBSTANCE ABUSE - ACCESS TO CARE - OBESITY - ASTHMA CARE - HOMELESSNESSSOME ISSUES ARE OVERLY COMPLEX. REGARDING POVERTY, THE HOSPITAL'S IMPLEMENTATION PLAN RECOGNIZES THAT POVERTY IS BEYOND THE SCOPE AND RESOURCES OF ACH TO MAKE A SIGNIFICANT IMPACT.
ARKANSAS CHILDREN'S HOSPITAL PART V, SECTION B, LINE 14G: THE FINANCIAL ASSISTANCE POLICY ITSELF IS NOT ATTACHED TO THE BILLING INVOICES, HOWEVER, THE FOLLOWING INFORMATION IS NOTED ON THE STATEMENTS: ARKANSAS CHILDREN'S HOSPITAL PROVIDES FINANCIAL ASSISTANCE TO OUR PATIENTS AND FAMILIES THAT QUALIFY; APPLICATION FORMS ARE AVAILABLE AT ALL REGISTRATION AREAS OR BY CONTACTING CUSTOMER SERVICE (PHONE NUMBER IS INCLUDED); IF PATIENTS ARE NOT ELIGIBLE FOR INSURANCE OR A GOVERNMENT ASSISTANCE PROGRAM, ARKANSAS CHILDREN'S HOSPITAL OFFERS A PROMPT PAY DISCOUNT AS WELL. IN ADDITION, FINANCIAL COUNSELORS ASSIST FAMILIES IN APPLYING FOR MEDICAID, SSI, AND CHILDREN'S MEDICAL SERVICES.
ARKANSAS CHILDREN'S HOSPITAL PART V, SECTION B, LINE 20D: AN AVERAGE OF THE CONTRACT RATES WAS USED.
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
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?3
Name and address Type of Facility (describe)
1 WEST LITTLE ROCK PEDIATRIC CLINIC
BELLA ROSA CENTER 16101 CANTRELL RD
LITTLE ROCK,AR72223 		OUTPATIENT HOSPITAL CLINIC
2 CENTERS FOR CHILDREN
519 LATHAM DRIVE
LOWELL,AR72745 		OUTPATIENT HOSPITAL CLINIC
3 CENTERS FOR CHILDREN
520 CARSON STREET
JONESBORO,AR72401 		OUTPATIENT HOSPITAL CLINIC
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
ARKANSAS CHILDREN'S HOSPITAL PART V, SECTION B, LINE 1J: IN ADDITION TO THE ITEMS CHECKED IN BOXES A - I, OTHER INFORMATION WAS INCLUDED IN THE NEEDS ASSESSMENT. AS THE ONLY PEDIATRIC HOSPITAL IN THE STATE OF ARKANSAS, ACH CONSIDERS ITS COMMUNITY TO BE ALL CHILDREN IN THE STATE, ESTIMATED AT 710,000. THE NEEDS ASSESSMENT ALSO INCLUDES DETAILED INFORMATION ABOUT THE NEIGHBORHOOD IMMEDIATELY SURROUNDING THE HOSPITAL GIVEN THE ORGANIZATION'S ROLE IN SUPPORTING ITS NEIGHBORHOOD. LIMITED INFORMATION WAS ALSO INCLUDED REFERENCING THE HEALTH STATUS OF ADULTS SINCE PEDIATRIC HEALTH STATUS CAN BE CLOSELY LINKED TO THAT OF ADULTS IN THE HOUSEHOLD. LASTLY, THE NEEDS ASSESSMENT INCLUDED INTERVENTIONS SUGGESTED BY THE COMMUNITY THAT THE HOSPITAL COULD CONSIDER AS IT DEVELOPED ITS IMPLEMENTATION PLAN.
ARKANSAS CHILDREN'S HOSPITAL PART V, SECTION B, LINE 3: THE HOSPITAL CONSIDERED BOTH SECONDARY AND PRIMARY DATA AS IT DETERMINED THE HEALTH NEEDS OF ARKANSAS' CHILDREN. SECONDARY DATA SETS REVIEWED INCLUDE THE U.S. CENSUS BUREAU, THE ANNIE E. CASEY KIDS' COUNT DATA CENTER, ARKANSAS STATE AGENCIES DATABASES, THE ARKANSAS STATISTICAL ABSTRACT, THE YOUTH RISK BEHAVIOR SURVEY, ARKANSAS CHILDREN'S HOSPITAL PEDIATRIC HEALTH INFORMATION SYSTEM, AND A VARIETY OF LOCAL ORGANIZATIONS' RESEARCH.PRIMARY DATA WAS ALSO COLLECTED TO DETERMINE PERCEIVED NEEDS OF THE COMMUNITY. FOCUS GROUPS, KEY STAKEHOLDER INTERVIEWS, AND A PHONE SURVEY SYNTHESIZED THE INPUT OF COMMUNITY MEMBERS, EDUCATORS, AND PROFESSIONALS WITH A WIDE VARIETY OF EXPERTISE IN THE HEALTH NEEDS OF CHILDREN. EIGHT FOCUS GROUPS WERE HELD IN THE CITIES OF BATESVILLE, FORREST CITY, GURDON, LAVACA, JONESBORO, SPRINGDALE, AND LITTLE ROCK, ARKANSAS. GENERALLY THESE GROUPS INCLUDED PARENTS, SCHOOL OFFICIALS, COMMUNITY LEADERS, AND ELECTED OFFICIALS. ANONYMITY WAS ASSURED AS A MEANS OF OBTAINING HONEST AND FRANK INPUT. THEREFORE, SPECIFIC NAMES WILL NOT BE PUBLISHED.KEY STAKEHOLDER INTERVIEWS WERE HELD WITH 23 INDIVIDUALS. THESE INCLUDE THE FOLLOWING: EXECUTIVE DIRECTOR OF ARKANSAS COMMUNITY HEALTH CENTERS, DIRECTOR OF THE ARKANSAS DEPARTMENT OF HEALTH, ASSOCIATE MEDICAL DIRECTOR OF ARKANSAS BLUE CROSS/BLUE SHIELD, THE COMMISSIONER OF ARKANSAS DEPARTMENT OF EDUCATION, PROFESSOR AT THE COLLEGE OF PUBLIC HEALTH, SENIOR VICE PRESIDENT OF ARKANSAS FOUNDATION FOR MEDICAL CARE, ASSOCIATE DIRECTOR OF ARKANSAS STATE UNIVERSITY CHILDHOOD SERVICES, CHIEF OPERATING OFFICER FOR WHITE RIVER HEALTH CENTER, EXECUTIVE DIRECTOR OF BOYS, GIRLS, ADULTS COMMUNITY DEVELOPMENT CENTER, PROFESSOR OF PEDIATRICS AND DIRECTOR OF THE INJURY PREVENTION CENTER AT ACH, DIRECTOR OF SOCIAL WORK AT ACH, DIRECTOR OF DISEASE PREVENTION AND HEALTH PROMOTION AT ARKANSAS CENTER FOR HEALTH IMPROVEMENT, VICE PRESIDENT OF NURSING SERVICES AT ST. BERNARD'S HOSPITAL, EXECUTIVE DIRECTOR OF THE ARKANSAS CHILDREN'S TRUST FUND, ASSOCIATE BRANCH CHIEF OF FAMILY HEALTH BRANCH OF THE ARKANSAS DEPARTMENT OF HEALTH, BUSINESS LEADER AND MEMBER OF RONALD MCDONALD CHILDREN'S CHARITY OF ARKOMA, VICE CHAIR OF ARKANSAS CHILDREN'S BEHAVIORAL HEALTH CARE COMMISSION, DIRECTOR OF DELTA AREA HEALTH EDUCATION CENTER AT UAMS, DIRECTOR OF THE DIVISION OF CHILDCARE AND EARLY CHILDHOOD EDUCATION WITH THE ARKANSAS DEPARTMENT OF HUMAN SERVICES, ASSOCIATE PROFESSOR OF PEDIATRICS AT UAMS, SECTION CHIEF OF THE TOBACCO PREVENTION AND CESSATION PROGRAMS WITH THE ARKANSAS DEPARTMENT OF HEALTH, DEAN OF THE CLINTON SCHOOL OF PUBLIC SERVICE, AND SEVERAL ACH "AMBASSADORS" WHO WERE CURRENT OR FORMER PATIENTS.IN ADDITION, A TELEPHONE SURVEY OF 1,000 RANDOMLY SELECTED FAMILIES (250 FROM EACH OF THE STATE'S FOUR CONGRESSIONAL DISTRICTS) WAS CONDUCTED. QUESTIONS FOCUSED ON VARIOUS TOPICS RELATED TO THE STATUS OF CHILDREN'S HEALTH AND ACCESS TO CARE MATTERS.
ARKANSAS CHILDREN'S HOSPITAL PART V, SECTION B, LINE 5D: THE CHNA IS ALSO MADE AVAILABLE THROUGH A NEWS CONFERENCE AND THE NATURAL WONDERS PARTNERSHIP COUNCIL AND MORE THAN TWO DOZEN COMPANIES THAT COLLABORATE IN THAT GROUP. THE TECHNICAL NEEDS ASSESSMENT IS REPACKAGED INTO A FORMAT MORE SUITABLE FOR PUBLIC USE, WITH AN EFFORT TO MAKE THE ISSUES UNDERSTANDABLE TO A BROADER AUDIENCE. THIS PUBLIC-FACING REPORT, "NATURAL WONDERS: THE STATE OF CHILDREN'S HEALTH IN ARKANSAS" IS WIDELY DISTRIBUTED THROUGH THIS PARTNERSHIP AND MADE AVAILABLE FOR ANYONE THAT REQUESTS IT.
ARKANSAS CHILDREN'S HOSPITAL PART V, SECTION B, LINE 6I: THE FRANKLIN ELEMENTARY SCHOOL-BASED HEALTH CENTER BEGAN SERVING PATIENTS IN MARCH 2014, AND A NURSE PRACTITIONER WORKS AT THE SCHOOL 20 HOURS PER WEEK. THE HOSPITAL EXCEEDED ITS PLANS FOR ADDRESSING FOOD INSECURITY ON THE ACH CAMPUS THROUGH A VARIETY OF INVESTMENTS TO REDUCE THE NUMBER OF THE COMMUNITY'S HUNGRY CHILDREN. UNITED STATES DEPARTMENT OF AGRICULTURE (USDA) MEALS ARE BEING PROVIDED TO CHILDREN YEAR-ROUND IN A GROUND-BREAKING EFFORT, AND THE HOSPITAL HAS ESTABLISHED NEW PARTNERSHIPS WITH A LOCAL PANTRY TO PROVIDE FOOD TO HUNGRY FAMILIES. FAMILIES CAN NEWLY ENROLL IN THE SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM (SNAP) ON CAMPUS, THANKS TO PARTNERSHIPS WITH STATE AGENCIES. THE FEDERALLY-FUNDED HOME VISITING NETWORK ($3.3 MILLION) IS STILL IN OPERATION AND IS MOVING FORWARD WITH DEVELOPING NEW CAPACITY. OTHER GRANTS THAT TOTAL ABOUT $2.3 MILLION ANNUALLY INCLUDE A LARGE TRAUMA CENTER GRANT FROM THE STATE, BURN AND HEARING OUTREACH GRANTS, AND A STATEWIDE INJURY PREVENTION PROGRAM GRANT. HOWEVER, THE HEALTHY BABY COALITION PROJECT ENDED AHEAD OF SCHEDULE DUE TO LIMITED IMPACT, WHICH IS A CHANGE FROM THE IMPLEMENTATION PLAN.IN MAY 2014, ACH HOSTED A TWO-DAY SUMMIT TO RAISE AWARENESS OF THE STATE OF CHILDREN'S HEALTH IN ARKANSAS TO GROW NEW PARTNERSHIPS FOR COMMUNITY HEALTH INVESTMENTS. THE EVENT, WHICH PROVIDED AN IN-DEPTH LOOK AT HEALTH AND WELLNESS ISSUES THAT AFFECT ARKANSAS CHILDREN, WAS WELL ATTENDED BY MORE THAN 150 HEALTH CARE AND EDUCATION STAKEHOLDERS, ADVOCATES, STATE AGENCY REPRESENTATIVES AND BUSINESS LEADERS. THE AGENDA INCLUDED NATIONALLY RECOGNIZED SPEAKERS WHO ADDRESSED TOPICS BROADLY APPLICABLE TO ATTENDEES, INCLUDING TOXIC STRESS AND THE IMPORTANCE OF EARLY EDUCATION AND SUPPORT IN ENSURING OPTIMAL BRAIN DEVELOPMENT FOR CHILDREN.
ARKANSAS CHILDREN'S HOSPITAL PART V, SECTION B, LINE 7: THE CHNA IDENTIFIED SEVERAL AREAS FOR WHICH A COLLABORATIVE STRATEGY IS THE BEST APPROACH TO SOLVING COMPLEX SOCIAL ISSUES. THE HOSPITAL WORKS THROUGH THE NATURAL WONDERS PARTNERSHIP COUNCIL (NWPC) TO DETERMINE LEADERSHIP IN VARIOUS ISSUE AREAS AND TO PROVIDE A FORUM IN WHICH COLLABORATIONS ARE DEVELOPED. WHILE ACH PLAYS A LEADERSHIP ROLE IN SEVERAL AREAS INCLUDING INJURIES, PARENTING, AND ORAL HEALTH, FOR OTHER AREAS, THERE ARE MORE NATURAL LEADERS. ACH PROVIDES SPECIALTY CARE, RESEARCH, AND EDUCATION SERVICES IN MANY OF THE AREAS IDENTIFIED IN THE CHNA. AREAS IN WHICH ACH PLAYS A SUPPORTING/PARTNERSHIP ROLE, RATHER THAN A LEADERSHIP ROLE, INCLUDE: - HIGH SCHOOL GRADUATION RATE - MENTAL HEALTH - FOOD INSECURITY - SEXUAL HEALTH - SUBSTANCE ABUSE - ACCESS TO CARE - OBESITY - ASTHMA CARE - HOMELESSNESSSOME ISSUES ARE OVERLY COMPLEX. REGARDING POVERTY, THE HOSPITAL'S IMPLEMENTATION PLAN RECOGNIZES THAT POVERTY IS BEYOND THE SCOPE AND RESOURCES OF ACH TO MAKE A SIGNIFICANT IMPACT.
ARKANSAS CHILDREN'S HOSPITAL PART V, SECTION B, LINE 14G: THE FINANCIAL ASSISTANCE POLICY ITSELF IS NOT ATTACHED TO THE BILLING INVOICES, HOWEVER, THE FOLLOWING INFORMATION IS NOTED ON THE STATEMENTS: ARKANSAS CHILDREN'S HOSPITAL PROVIDES FINANCIAL ASSISTANCE TO OUR PATIENTS AND FAMILIES THAT QUALIFY; APPLICATION FORMS ARE AVAILABLE AT ALL REGISTRATION AREAS OR BY CONTACTING CUSTOMER SERVICE (PHONE NUMBER IS INCLUDED); IF PATIENTS ARE NOT ELIGIBLE FOR INSURANCE OR A GOVERNMENT ASSISTANCE PROGRAM, ARKANSAS CHILDREN'S HOSPITAL OFFERS A PROMPT PAY DISCOUNT AS WELL. IN ADDITION, FINANCIAL COUNSELORS ASSIST FAMILIES IN APPLYING FOR MEDICAID, SSI, AND CHILDREN'S MEDICAL SERVICES.
ARKANSAS CHILDREN'S HOSPITAL PART V, SECTION B, LINE 20D: AN AVERAGE OF THE CONTRACT RATES WAS USED.
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
ARKANSAS CHILDREN'S HOSPITAL
 
Employer identification number
71-0236857
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) ARKANSAS ADVOCATES FOR CHILDREN & FAMILIES
1400 WEST MARKHAM SUITE 306
LITTLE ROCK,AR72201 		71-0492205 501(C)(3) 11,540       GENERAL SUPPORT
(2) ARKANSAS CENTER FOR HEALTH IMPROVEMENT (UAMS)
1401 W CAPITOL AVE SUITE 300
LITTLE ROCK,AR72201 		71-6046242 GOV'T ENTITY 200,000       HEALTH IMPROVEMENT PROGRAMS
(3) ARKANSAS CHILDREN'S HOSPITAL FOUNDATION
1 CHILDRENS WAY
LITTLE ROCK,AR72202 		71-0568795 501(C)(3) 1,006,250       ENDOWMENT AND GENERAL SUPPORT
(4) ARKANSAS CHILDREN'S HOSPITAL RESEARCH INSTITUTE
13 CHILDRENS WAY
LITTLE ROCK,AR72202 		71-0694931 501(C)(3) 3,508,787 1,382,322 FMV INDIRECT SUPPORT GENERAL SUPPORT
(5) HOME INSTRUCTION FOR PARENTS OF PRESCHOOL YOUNGSTERS (HIPPY)
1221 BISHOP
LITTLE ROCK,AR72202 		13-3672592 501(C)(3) 5,000 37,888 FMV PROVIDE OFFICE SPACE & PHONE GENERAL SUPPORT
(6) JUNIOR LEAGUE OF LITTLE ROCK
401 SOUTH SCOTT STREET
LITTLE ROCK,AR72201 		71-0245505 501(C)(3) 13,370       GENERAL SUPPORT
(7) LITTLE ROCK POLICE DEPARTMENT
600 W MARKHAM
LITTLE ROCK,AR72201 		71-6014465 GOV'T ENTITY 7,000       GENERAL SUPPORT
(8) RONALD MCDONALD HOUSE CHARITIES
1009 WOLFE STREET
LITTLE ROCK,AR72202 		71-0525252 501(C)(3) 9,908       GENERAL SUPPORT
(9) NEW FUTURES FOR YOUTH
323 CENTER STREET SUITE 1275
LITTLE ROCK,AR72201 		71-0664490 GOV'T ENTITY 25,000       CENTRAL LR PROMISE NEIGHBORHOOD
(10) CAMP ALDERSGATE
2000 ALDERSGATE ROAD
LITTLE ROCK,AR72205 		68-0560043 501(C)(3) 19,104 1,249 FMV MEDICAL SUPPLIES GENERAL SUPPORT AND CAMPS FOR CHILDREN WITH PHYSICAL CONDITIONS.
(11) NATIONAL ASSOCIATION OF CHILDREN'S HOSPITALS
PO BOX 79334
BALTIMORE,MD21279 		51-0120256 501(C)(6) 26,260       GME ADVOCACY
(12) CHILDREN'S PROTECTION CENTER
1123 BISHOP
LITTLE ROCK,AR72202 		26-1086937 501(C)(3)   23,323 FMV PROVIDE OFFICE SPACE GENERAL SUPPORT
(13) CLINTON FOUNDATION
1200 PRESIDENT CLINTON AVE
LITTLE ROCK,AR72201 		31-1582024 501(C)(3) 10,000       GENERAL SUPPORT
(14) HEIFER INTERNATIONAL
1 WORLD AVENUE
LITTLE ROCK,AR72201 		35-1019477 501(C)(3) 4,000 1,379 COST PROVIDE SUPPLIES FOR MEETING GENERAL SUPPORT
(15) UNIVERSITY OF ARKANSAS AT LITTLE ROCK
2801 SOUTH UNIVERSITY
LITTLE ROCK,AR72204 		71-0236904 GOV'T ENTITY 7,060       GENERAL SUPPORT
(16) WOMEN'S FOUNDATION OF ARKANSAS
200 RIVER MARKET AVENUE SUITE 100
LITTLE ROCK,AR72201 		30-0034070 501(C)(3) 5,140       GENERAL SUPPORT
(17) ACANSA ARTS FESTIVAL
1501 NORTH UNIVERSITY SUITE 209
LITTLE ROCK,AR72207 		71-0589695 501(C)(3) 8,000       GENERAL SUPPORT
2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................ Bullet Image
16
3
Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image
1
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) MEALS 2541 2,790 179,276 COST MEALS FOR FAMILIES/LACTATING MOTHERS
(2) INSURANCE PREMIUMS 55   123,720 COST PAYMENT OF PREMIUMS FOR PATIENT'S FAMILIES ALLOWED BY COBRA
(3) TRANSPORTATION COSTS (BUS TOKENS, CAB FARE, GAS CARDS) 1581 47,329   COST  
(4) FUNERAL EXPENSES 14 8,313   COST  
(5) RENT, MORTGAGE EXPENSE, UTILITIES, LODGING 71 8,805   COST  
(6) CAR SEATS FOR INFANTS AND CHILDREN 608   31,890 COST CAR SEATS FOR INFANTS AND CHILDREN
(7) GROCERY GIFT CARDS AND OTHER MISC. ASSISTANCE 186 17,519   COST  
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: THE HOSPITAL CONSIDERS REQUESTS FROM NON-PROFIT OR GOVERNMENTAL ENTITIES FOR PROGRAMS OR ACTIVITIES THAT ALIGN WITH ITS PLAN TO ADDRESS NEEDS AS IDENTIFIED IN THE CHNA OR THAT OTHERWISE SUPPORT THE HOSPITAL'S MISSION. THE HOSPITAL ANTICIPATES THAT THESE NON-PROFIT OR GOVERNMENTAL ENTITIES WILL MONITOR THE USE OF FUNDS IN ACCORDANCE WITH NON-PROFIT OR GOVERNMENTAL REQUIREMENTS. THE HOSPITAL PROVIDES SOME ASSISTANCE TO INDIGENT FAMILIES. THE HOSPITAL'S SOCIAL WORK DEPARTMENT EVALUATES THE NEED ON A CASE BY CASE BASIS AND PROVIDES THE APPROPRIATE ASSISTANCE, WHICH IS TYPICALLY FOOD, CLOTHING, SHELTER, OR TRAVEL VOUCHERS. CASH OR CASH EQUIVALENT ASSISTANCE IS SOMETIMES PROVIDED. THE ASSISTANCE PROVIDED IS DOCUMENTED BY THE HOSPITAL'S SOCIAL WORK DEPARTMENT.
Schedule I (Form 990) 2013


Additional Data


Software ID:  
Software Version:  


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

71-0236857
Part I
Questions Regarding Compensation
Yes
No
1a
Check the appropiate box(es) if the organization provided any of the following to or for a person listed in Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.
b
If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain....
1b
Yes
 
2
Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked in line 1a? ..
2
Yes
 
3
Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.
4
During the year, did any person listed in Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:
a
Receive a severance payment or change-of-control payment? ................
4a
 
No
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........
4b
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
 
No
b
Any related organization? .........................
5b
 
No
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
 
No
b
Any related organization? .........................
6b
 
No
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)JONATHAN BATES MDPRESIDENT/CEO (PARTIAL YEAR) (i)
(ii)		 2,658,468
0 		72,000
0 		3,302
0 		5,000
0 		620
0 		2,739,390
0 		1,231,283
0
(2)MARCELLA DODERERPRESIDENT/CEO (i)
(ii)		 239,100
0 		108,513
0 		428
0 		0
0 		8,700
0 		356,741
0 		0
0
(3)JAYANT DESHPANDE MDSVP AND CMO (i)
(ii)		 0
0 		0
0 		470,275
0 		0
0 		0
0 		470,275
0 		0
0
(4)RICHARD JACOBS MDACHRI PRESIDENT/UAMS DOP CHAIR (i)
(ii)		 0
0 		0
0 		0
229,131 		0
0 		0
0 		0
229,131 		0
0
(5)RICK JACKSON MDCHIEF OF STAFF (i)
(ii)		 0
0 		0
0 		645,000
0 		0
0 		0
0 		645,000
0 		0
0
(6)GENA WINGFIELDSVP AND CFO (i)
(ii)		 385,761
0 		40,000
0 		943
0 		29,503
0 		10,110
0 		466,317
0 		0
0
(7)CHARLES LARRY BECKIUSVP FACILITIES (i)
(ii)		 185,943
0 		19,000
0 		962
0 		14,600
0 		6,698
0 		227,203
0 		0
0
(8)DAVID BERRYSVP AND COO (i)
(ii)		 382,947
0 		40,000
0 		943
0 		47,736
0 		10,110
0 		481,736
0 		0
0
(9)LORI BROWNCHIEF NURSING OFFICER (PARTIAL YEAR) (i)
(ii)		 252,019
0 		25,000
0 		895
0 		5,000
0 		1,601
0 		284,515
0 		0
0
(10)SCOTT GORDONEXECUTIVE VICE PRESIDENT (i)
(ii)		 425,890
0 		25,000
0 		3,624
0 		16,500
0 		9,997
0 		481,011
0 		41,768
0
(11)CYNTHIA HOLLANDVP ANCILLARY SERVICES (i)
(ii)		 180,240
0 		17,000
0 		731
0 		14,075
0 		6,697
0 		218,743
0 		0
0
(12)KATHERINE LEAVP PATIENT CARE SERVICES (i)
(ii)		 156,768
0 		16,000
0 		201
0 		12,218
0 		5,555
0 		190,742
0 		0
0
(13)DARRELL LEONHARDTCHIEF INFORMATION OFFICER (i)
(ii)		 245,651
0 		20,000
0 		3,090
0 		13,183
0 		9,756
0 		291,680
0 		0
0
(14)LEE ANNE EDDYSVP/CHIEF NURSING OFFICER (i)
(ii)		 202,657
0 		25,000
0 		272
0 		10,617
0 		4,788
0 		243,334
0 		0
0
(15)MARY SALASSI-SCOTTERVP PATIENT CARE SERVICES (i)
(ii)		 154,553
0 		16,000
0 		568
0 		12,165
0 		6,513
0 		189,799
0 		0
0
(16)CHARLES E JOHNSONDIRECTOR - CV SURGERY (i)
(ii)		 216,000
0 		3,605
0 		375
0 		13,027
0 		1,639
0 		234,646
0 		0
0
(17)CARL CHIPMANRN FIRST ASST CV SURGERY (i)
(ii)		 217,517
0 		4,449
0 		2,441
0 		9,762
0 		6,847
0 		241,016
0 		0
0
(18)JAMES KOONCEDENTIST (i)
(ii)		 316,099
0 		497
0 		4,191
0 		16,252
0 		5,064
0 		342,103
0 		0
0
(19)KIRT SIMMONSORTHODONTIST (i)
(ii)		 249,601
0 		500
0 		1,041
0 		16,250
0 		5,089
0 		272,481
0 		0
0
(20)ANDREE TROSCLAIRVP OF HUMAN RESOURCES (i)
(ii)		 196,875
0 		20,000
0 		778
0 		15,228
0 		4,787
0 		237,668
0 		0
0
Schedule J (Form 990) 2013

Schedule J (Form 990) 2013
Page 3
Part III
Supplemental Information
Provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II.
Also complete this part for any additional information.
Return Reference Explanation
PART I, LINE 1A CHARTER TRAVEL IS USED FOR STAFF TO TRAVEL TO THE NORTHWEST PART OF THE STATE, PRIMARILY TO THE ACH CLINIC LOCATED IN LOWELL, AR. UTILIZATION OF CHARTER TRAVEL, RATHER THAN HAVING STAFF DRIVE TO THE LOCATION, IS OCCASIONALLY DEEMED THE MOST EFFICIENT METHOD OF TRAVEL. STAFF WHO TRAVEL TO THIS LOCATION MAY INCLUDE EMPLOYEES LISTED AS OFFICERS AND KEY EMPLOYEES, AS WELL AS PHYSICIANS, NURSES, AND OTHER ADMINISTRATIVE OR PATIENT CARE STAFF. TAX INDEMNIFICATION AND GROSS-UP PAYMENTS ARE DUE TO THE EDUCATION LOAN FORGIVENESS AMOUNT FOR LORI BROWN, SVP AND CNO, BEING GROSSED-UP FOR RELATED INCOME TAXES IN ACCORDANCE WITH HER EMPLOYMENT AGREEMENT. IN FY14, AS PART OF THE HIRING OF THE NEW CEO, THE RELATED CONTRACT HAD AN ALLOWANCE FOR TEMPORARY LIVING AND RELOCATION ASSISTANCE. TEMPORARY LIVING COSTS WERE $2,090. THESE COSTS WERE PROPERLY TAXED.
PART I, LINE 4B ARKANSAS CHILDREN'S HOSPITAL HAS SUPPLEMENTAL EXECUTIVE RETIREMENT PLANS TO PROVIDE EXECUTIVES WITH RETIREMENT AND DEATH BENEFITS. THE PLANS ARE INTENDED TO CONSTITUTE UNFUNDED PLANS FOR A SELECT GROUP OF MANAGEMENT OR HIGHLY COMPENSATED EMPLOYEES WITHIN THE MEANING OF TITLE I OF THE EMPLOYEE RETIREMENT INCOME SECURITY ACT OF 1974, AS AMENDED. THE ORIGINAL SUPPLEMENTAL RETIREMENT PLAN (SERP) WAS FROZEN TO NEW PARTICIPANTS IN FY14; HOWEVER, TWO EXECUTIVES REMAINED IN THE PLAN. DURING THE 2013 TAX YEAR, THE FOLLOWING ACH REPORTABLE INDIVIDUALS WERE ELIGIBLE TO PARTICIPATE: DAVID BERRY SR. VP/COO GENA WINGFIELD SR. VP/CFO SCOTT GORDON, EXECUTIVE VP, VESTED IN HIS SUPPLEMENTAL RETIREMENT PLAN IN 2011 AT AGE 63 DUE TO HAVING 20 YEARS OF SERVICE; THEREFORE THE PLAN VALUE WAS TAXABLE INCOME TO HIM AND PAYMENT WAS MADE FROM THE PLAN BENEFIT TO OFFSET THE TAX LIABILITY. THE TAX WITHHOLDING AND APPLICABLE INTEREST ON THE TAX WITHHOLDING AMOUNT WAS DEDUCTED FROM THE FINAL PAYMENT OF THE LUMP SUM BENEFIT AMOUNT WHICH IS GENERALLY NOT PAID UNTIL THE EARLIER OF TERMINATION OF EMPLOYMENT OR ATTAINMENT OF NORMAL RETIREMENT AGE OF 65. THE FINAL PAYMENT (GROSS AMOUNT $72,340.46) WAS MADE IN TAX YEAR 2013 AND WAS REFLECTED IN HIS 2013 W-2. THE AMOUNT OF COMPENSATION REPORTED AS DEFERRED IN PRIOR FORM 990 WAS $41,768. JONATHAN BATES, M.D., PRESIDENT/CEO RETIRED IN JULY OF 2013 AND VESTED IN HIS SUPPLEMENTAL RETIREMENT PLAN AT AGE 67. HIS 2013 W-2 REFLECTS THE LUMP-SUM PAYMENT OF THE ENTIRE VESTED BALANCE ($2,421,469), WITH APPROPRIATE TAXES (FEDERAL, STATE, FICA) PROPERLY WITHHELD. THE AMOUNT REPORTED AS DEFERRED IN PRIOR FORM 990 WAS $1,231,283. EFFECTIVE 6/30/2014, ACH INITIATED A NEW EXECUTIVE COMPENSATION PLAN, THE "DEFERRED COMPENSATION PLAN" (DCP). THE DCP IS A 457(F) NONQUALIFIED SUPPLEMENTAL RETIREMENT PLAN, PROVIDING ANNUAL CONTRIBUTIONS TO CERTAIN EXECUTIVES AT A PERCENTAGE OF THEIR BASE SALARY IN EFFECT ON JUNE 30 OF THE PLAN YEAR. PER THE PLAN DOCUMENT, EACH DCP CONTRIBUTION FOR A PLAN YEAR AND ITS ASSOCIATED EARNINGS VEST ON THE EARLIER OF: - THE FIRST DAY OF THE PLAN YEAR FOLLOWING THREE YEARS OF SERVICE WHICH BEGINS ON THE FIRST DAY OF THE PLAN YEAR FOR WHICH THE CONTRIBUTION IS CREDITED. - ATTAINMENT OF AGE 65 AND AT LEAST 3 YEARS OF SERVICE AS A DCP PARTICIPANT - DEATH OR PERMANENT DISABILITY - INVOLUNTARY TERMINATION (OTHER THAN FOR CAUSE) - PLAN TERMINATION FOR TAX YEAR 2013 (FISCAL YEAR 2014), THE FOLLOWING ACH REPORTABLE EMPLOYEES WERE ELIGIBLE TO PARTICIPATE IN THE DCP PLAN: - MARCELLA DODERER: PRES/CEO - DAVID BERRY: SR. VP/COO - GENA WINGFIELD: SR. VP/CFO
FORM 990, PART VII, SECTION A, LINE 5: DIRECTORS WILLIAM MORROW, M.D., JAY DESHPANDE, M.D., RICK JACKSON, M.D., AND CHARLES GLASIER, M.D. WERE COMPENSATED BY UAMS AS EMPLOYEES FOR SERVICES RENDERED TO ARKANSAS CHILDREN HOSPITAL (ACH) AND FOR WHICH ACH REMITTED PAYMENT LISTED AS "REPORTABLE COMPENSATION FROM THE ORGANIZATION" IN PART VII. DIRECTOR RICHARD JACOBS, M.D., COMPENSATED BY UAMS AS THE CHAIRMAN OF THE UAMS DEPARTMENT OF PEDIATRICS, IS A MEMBER OF VARIOUS ACH ADMINISTRATIVE COMMITTEES; HOWEVER, THE "REPORTABLE COMPENSATION FROM THE ORGANIZATION" LISTED IN PART VII IS FOR COMPENSATION FOR HIS ROLE AS PRESIDENT OF THE ARKANSAS CHILDREN'S HOSPITAL RESEARCH INSTITUTE, A RELATED ORGANIZATION. THE AMOUNTS NOTED AS COMPENSATION IN SCHEDULE J FOR THE PHYSICIANS NOTED ABOVE WERE THE DESIGNATED AMOUNTS PER THE RELATED CONTRACTS WITH UAMS.
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
ARKANSAS CHILDREN'S HOSPITAL
 
Employer identification number
71-0236857
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 PULASKI COUNTY ARKANSAS
  		71-6006487 745392HD5 05-28-2009 109,526,869 SEE SCHEDULE K, PART VI.   X   X   X
B PULASKI COUNTY ARKANSAS
  		71-6006487 745392GK0 12-08-2005 33,917,692 SEE SCHEDULE K, PART VI.   X   X   X
C PULASKI COUNTY ARKANSAS
  		71-6006487 745392HR4 11-17-2010 31,051,199 SEE SCHEDULE K, PART VI.   X   X   X
D ARKANSAS DEVELOPMENT FINANCE AUTHORITY
  		71-0503641   09-05-2013 19,800,000 SEE SCHEDULE K, PART VI.   X   X   X
Part II
Proceeds
A B C D
1 Amount of bonds retired . . . . . . . . . . . . . . 10,930,000 5,505,000 12,635,000 1,142,721
2 Amount of bonds legally defeased . . . . . . . . . . .        
3 Total proceeds of issue . . . . . . . . . . . . . . 111,070,517 34,659,477 31,051,199 19,800,000
4 Gross proceeds in reserve funds . . . . . . . . . . . . 7,398,857      
5 Capitalized interest from proceeds . . . . . . . . . . . 439,815      
6 Proceeds in refunding escrows . . . . . . . . . . . .        
7 Issuance costs from proceeds . . . . . . . . . . . . 1,296,277 307,020 192,600  
8 Credit enhancement from proceeds . . . . . . . . . . . 1,876,252 603,623 206,911  
9 Working capital expenditures from proceeds . . . . . . . . .        
10 Capital expenditures from proceeds . . . . . . . . . . . 100,097,782 33,748,834   19,800,000
11 Other spent proceeds . . . . . . . . . . . . . . 30,651,688   30,651,688  
12 Other unspent proceeds . . . . . . . . . . . . . .        
13 Year of substantial completion . . . . . . . . . . . . 2012 2006 2010
Yes No Yes No Yes No Yes No
14 Were the bonds issued as part of a current refunding issue? . . . . .   X   X X     X
15 Were the bonds issued as part of an advance refunding issue? . . . . .   X   X   X   X
16 Has the final allocation of proceeds been made? . . . . . . . . X   X   X   X  
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? . . . . . . . . . . . . . . X   X   X   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   X   X    
2 Are there any lease arrangements that may result in private business use of bond-financed property? . . . . . . . . .   X   X   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 X     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? X   X          
c Are there any research agreements that may result in private business use of bond-financed property? . . . . . . . . . . . . . . .   X   X   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 0.070 % 0.070 %    
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        
6 Total of lines 4 and 5 . . . . . . . . . . . . . 0.070 % 0.070 %    
7 Does the bond issue meet the private security or payment test? . . . . .   X   X   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   X   X    
b If "Yes" to line 8a, enter the percentage of bond-financed property sold or disposed of.        
c If "Yes" to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? . . . . . . . . . . . . .                
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   X   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   X   X   X
2 If "No" to line 1, did the following apply? . . . .
a Rebate not due yet? . . . . . . . .   X   X X   X  
b Exception to rebate? . . . . . . . .   X   X   X   X
c No rebate due? . . . . . . . . X   X     X   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   X   X   X
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?   X   X   X   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   X   X   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     X   X   X
7 Has the organization established written procedures to monitor the requirements of section 148? . . . X   X   X   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   X   X   X  
Part VI
Supplemental Information. Provide additional information for responses to questions on Schedule K (see instructions).
Return Reference Explanation
DATE REBATE COMPUTATION PERFORMED ISSUER NAME: PULASKI COUNTY, ARKANSAS DATE THE REBATE COMPUTATION WAS PERFORMED: 07/18/2013 ISSUER NAME: PULASKI COUNTY, ARKANSAS DATE THE REBATE COMPUTATION WAS PERFORMED: 08/03/2010
SCHEDULE K SUPPLENTAL INFORMATION PART I, LINE A - DESCRIPTION OF PURPOSE. PROCEEDS USED TO ACCOMPLISH THE UTILITY PROJECT AND THE SOUTH WING PROJECT. THE UTILITY PROJECT INCLUDES MAJOR INFRASTRUCTURE IMPROVEMENTS, INCLUDING ADDED CAPACITY FOR THE SOUTH WING. THE SOUTH WING PROJECT IS NEW CONSTRUCTION THAT ADDED APPROXIMATELY 243,114 SQUARE FEET INCLUDING A NEW EMERGENCY DEPARTMENT, ADDITIONAL OUTPATIENT CLINIC AREAS AND A NET ADDITION OF 54 INPATIENT BEDS. PART I, LINE B - DESCRIPTION OF PURPOSE. THE PROJECT GENERALLY INCLUDED THE CONSTRUCTION OF A FOUR STORY PARKING DECK, CONSTRUCTION OF A 116,525 SQUARE FOOT OFFICE BUILDING, THE ACQUISITION OF TWO MAGNETIC RESONANCE IMAGING SYSTEMS, AND THE ACQUISITION OF OPERATING ROOM EQUIPMENT. PART I, LINE C - DESCRIPTION OF PURPOSE. TO REFUND HOSPITAL REVENUE BONDS (ARKANSAS CHILDREN'S HOSPITAL PROJECT), SERIES 2002A AND SERIES 2002B REFUNDING, ISSUED 7/31/2002. PART I, LINE D - DESCRIPTION OF PURPOSE: PROCEEDS USED TO PURCHASE TWO SIKORSKY S-76D HELICOPTERS TO BE USED FOR MEDICAL TRANSPORT. PART II, LINE 3, BOND A - TOTAL PROCEEDS DIFFER FROM ISSUE PRICE DUE TO CUMULATIVE INVESTMENT EARNINGS. PART II, LINE 3, BOND B - TOTAL PROCEEDS DIFFER FROM ISSUE PRICE DUE TO CUMULATIVE INVESTMENT EARNINGS. PART II, LINE 4 - THE AMOUNTS SHOWN HERE CONSIST SOLELY OF DEBT SERVICE RESERVE FUNDS. THE ORGANIZATION ALSO HAS THE FOLLOWING AMOUNTS IN BONA FIDE DEBT SERVICE FUNDS AS OF 6/30/2014: SERIES 2009: $2,593,746; SERIES 2005: $722,697; SERIES 2010: $993,174. PART II, LINE 13 - BOND D - YEAR OF SUBSTANTIAL COMPLETION: THE HELICOPTERS WERE ACCEPTED IN NOVEMBER 2013 IN "GREEN" CONDITION AS THEY WERE NOT CONFIGURATED AND EQUIPPED FOR MEDICAL TRANSPORT AT THAT STAGE. BOTH HELICOPTERS ARE EXPECTED TO BE ACCEPTED AS READY FOR SERVICE IN MAY 2015. PART IV, LINE 6, BOND A - SUCH AMOUNTS WERE APPROPRIATELY YIELD RESTRICTED
Schedule K (Form 990) 2013

Additional Data


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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
ARKANSAS CHILDREN'S HOSPITAL
 
Employer identification number

71-0236857
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
(1) LORI BROWN KEY EMPLOYEE ADVANCED HEALTHCARE EDUCATION   X 71,409 0   No   No Yes  
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) WINDSTREAM
  		PERFORMANCE OF SERVICES 1,155,872 SEE PART V. WINDSTREAM IS A TELECOMMUNICATIONS SERVICES COMPANY AND DIRECTOR JEFF GARDNER IS CHAIRMAN OF THE BOARD OF WINDSTREAM. TRANSACTIONS WITH INTERESTED PERSONS WERE PERFORMED IN ACCORDANCE WITH THE ACH BOARD OF DIRECTORS CONFLICT OF INTEREST POLICY.   No
(2) JENNIFER J BECKIUS FAMILY MEMBER 30,781 SEE PART V. JENNIFER J. BECKIUS IS A FAMILY MEMBER OF KEY EMPLOYEE LARRY BECKIUS; HOWEVER, CONSISTENT WITH ARKANSAS CHILDREN'S HOSPITAL POLICY, SHE DOES NOT WORK WITHIN MR. BECKIUS'S LINE OF AUTHORITY.   No
(3) MISTY DAWN BERRY FAMILY MEMBER 44,555 SEE PART V. MISTY DAWN BERRY IS A FAMILY MEMBER OF KEY EMPLOYEE DAVID BERRY; HOWEVER, CONSISTENT WITH ARKANSAS CHILDREN'S HOSPITAL POLICY, SHE DOES NOT WORK WITHIN MR. BERRY'S LINE OF AUTHORITY.   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
ARKANSAS CHILDREN'S HOSPITAL
 
Employer identification number

71-0236857
Return Reference Explanation
FORM 990, PART VI, SECTION A, LINE 1 THE EXECUTIVE COMMITTEE CONSISTS OF THE CHAIRMAN OF THE BOARD OF DIRECTORS, WHO ALSO SERVES AS CHAIRMAN OF THE EXECUTIVE COMMITTEE, THE VICE CHAIRMAN, THE SECRETARY, THE TREASURER, THE IMMEDIATE PAST CHAIRMAN, THE VICE-CHAIRMAN OF THE BOARD OF DIRECTORS OF ARKANSAS CHILDREN'S HOSPITAL FOUNDATION, INC., THE CHAIRMAN OF THE BOARD OF DIRECTORS OF ARKANSAS CHILDREN'S RESEARCH INSTITUTE, INC., AND THREE ADDITIONAL MEMBERS OF THE BOARD OF DIRECTORS ELECTED BY THE BOARD AT ITS ANNUAL MEETING. THE ACH MEDICAL DIRECTOR, THE ACH CHIEF OF STAFF, THE UAMS CHAIRMAN OF THE DEPARTMENT OF PEDIATRICS, AND THE ACH PRESIDENT/CHIEF EXECUTIVE OFFICER ARE ALSO EX-OFFICIO MEMBERS OF THE EXECUTIVE COMMITTEE WITHOUT VOTE. THE EXECUTIVE COMMITTEE HAS THE POWER TO TRANSACT ALL REGULAR BUSINESS OF THE HOSPITAL DURING THE PERIOD BETWEEN THE MEETINGS OF THE BOARD, SUBJECT TO ANY PRIOR LIMITATIONS IMPOSED BY THE BOARD AND WITH THE UNDERSTANDING THAT ALL MATTERS OF MAJOR IMPORTANCE WILL BE REFERRED TO THE BOARD OF DIRECTORS. THE EXECUTIVE COMMITTEE REVIEWS THE BUDGET PREPARED BY THE FINANCE COMMITTEE AND SUBMITS IT TO THE BOARD WITH THE EXECUTIVE COMMITTEE'S RECOMMENDATION AT THE LAST MEETING BEFORE THE END OF THE FISCAL YEAR. THE EXECUTIVE COMMITTEE RECEIVES A MONTHLY REPORT FROM THE FINANCE COMMITTEE CHAIRMAN RELATING TO THE MONTHLY FINANCIAL REPORTS. THE EXECUTIVE COMMITTEE HAS FINAL OVERSIGHT OF LONG RANGE PLANNING ACTIVITIES AND IS ALSO RESPONSIBLE FOR REVIEWING LEGAL ACTIVITIES INVOLVING THE HOSPITAL. MINUTES OF THE EXECUTIVE COMMITTEE MEETINGS ARE SUBMITTED TO THE BOARD, AND ITS ACTIONS ARE SUBJECT TO APPROVAL OR DISAPPROVAL AS SOON AS PRACTICAL AT A REGULAR BOARD MEETING. FORM 990, PART VI, SECTION A, LINE 2: ALTHOUGH NOT CONSIDERED COVERED RELATIONSHIPS AS NOTED IN PART VI, SECTION A, LINE 2, THE FOLLOWING DIRECTORS WERE ALL EMPLOYEES OF THE UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCES (UAMS) DURING THE TAX YEAR: JAYANT DESHPANDE, M.D., CHARLES GLASIER, M.D., RICK JACKSON, M.D., RICHARD JACOBS, M.D., ROBERT MORROW, M.D., AND DANIEL RAHN, M.D.
FORM 990, PART VI, SECTION A, LINE 3 THE HOSPITAL'S SVP/CHIEF QUALITY AND CHIEF MEDICAL OFFICER POSITION IS HELD BY DR. JAY DESHPANDE WHO HOLDS FACULTY APPOINTMENTS IN THE UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCES, COLLEGE OF MEDICINE DEPARTMENTS OF PEDIATRICS AND ANESTHESIOLOGY. AS HE IS A UAMS EMPLOYEE, THE HOSPITAL REIMBURSES UAMS FOR HIS ROLE, WHICH IS TO HELP BROADEN AND STRENGTHEN THE HOSPITAL'S QUALITY EFFORTS AND OVERALL QUALITY PROGRAM FOR PATIENT CARE.
FORM 990, PART VI, SECTION A, LINE 4 THE ACH BYLAWS WERE UPDATED TO REFLECT THE FOLLOWING CHANGES: - CONSOLIDATION OF THE DUTIES OF THE COMPENSATION COMMITTEE TO INCLUDE APPROVAL (IN ADDITION TO REVIEW) OF SENIOR EXECUTIVE STAFF COMPENSATION AND BENEFITS. IN ADDITION, THE COMPENSATION COMMITTEE WILL SET THE TERMS OF EMPLOYMENT, COMPENSATION, AND BENEFITS FOR THE CHIEF EXECUTIVE OFFICER. - DOCUMENTED THAT THE COMPENSATION COMMITTEE WILL ACT IN ACCORDANCE WITH THE TERMS AND PROVISIONS OF THE COMPENSATION COMMITTEE CHARTER APPROVED BY THE BOARD OF DIRECTORS.
FORM 990, PART VI, SECTION B, LINE 11 HOSPITAL MANAGEMENT REVIEWS THE DRAFT FORM 990 AND RECONCILES IT TO THE HOSPITAL'S INTERNAL FINANCIALS AND CONSOLIDATED AUDIT REPORT. THE REVIEWED DRAFT OF THE FORM 990 IS PRESENTED TO THE FINANCE COMMITTEE BY HOSPITAL MANAGEMENT. IF THE REVIEW BY THE COMMITTEE RESULTS IN REVISIONS TO THE FORM 990, THOSE REVISIONS ARE MADE. THE FORM 990 TO BE FILED IS THEN PROVIDED TO THE ENTIRE BOARD PRIOR TO FILING.
FORM 990, PART VI, SECTION B, LINE 12C THE HOSPITAL HAS A BOARD OF DIRECTORS CONFLICT OF INTEREST POLICY THAT IS REVIEWED WITH ALL NEW BOARD MEMBERS DURING THEIR BOARD ORIENTATION. IN ADDITION, PERIODICALLY EXTERNAL COUNSEL WILL REVIEW THE POLICY WITH THE FULL BOARD DURING A REGULAR BOARD MEETING. ANNUAL DISCLOSURE OF POTENTIAL CONFLICTS OR AFFIRMATIVE CONFIRMATION THAT NONE EXIST IS REQUIRED OF ALL BOARD MEMBERS. THE ANNUAL DISCLOSURES ARE REVIEWED AND APPROVED BY A MAJORITY OF THE DISINTERESTED DIRECTORS ON THE EXECUTIVE COMMITTEE. ALL CONFLICT DISCLOSURES ARE THEN COMPILED AND LISTED IN THE BOARD BOOK AT THE NEXT REGULARLY SCHEDULED MEETING. DETERMINATION OF WHETHER A LISTED CONFLICT IS MATERIAL IS DETERMINED BY THE CORPORATE COMPLIANCE OFFICER, WITH ADVICE FROM LEGAL COUNSEL IF STILL UNCERTAIN. DURING THE YEAR, WHILE BOARD MEMBERS MAY PARTICIPATE IN INITIAL DISCUSSION, BOARD MEMBERS WHO HAVE A CONFLICT ARE PROHIBITED FROM PARTICIPATING IN DELIBERATIONS AND DECISIONS IN THE RELATED TRANSACTION AND ABSTAIN FROM VOTING, WHICH IS NOTED IN THE MINUTES.
FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION FOR THE ORGANIZATION'S CEO, SENIOR VICE PRESIDENTS, VICE PRESIDENTS, AND KEY EMPLOYEES IS REVIEWED BY THE COMPENSATION COMMITTEE WHICH IS ESTABLISHED THROUGH THE BYLAWS OF ARKANSAS CHILDREN'S HOSPITAL TO DISCHARGE THE DUTY OF THE BOARD IN FULFILLING ITS OVERSIGHT RESPONSIBILITIES FOR DETERMINING THE ADEQUACY AND REASONABLENESS OF THE COMPENSATION PAID THE CEO AND OTHER EMPLOYEES THAT THE COMMITTEE BELIEVES ARE IN A POSITION TO EXERCISE A SUBSTANTIAL INFLUENCE OVER THE AFFAIRS OF THE HOSPITAL. THE COMMITTEE IS COMPOSED OF MEMBERS WHO PERSONALLY RECEIVE NO COMPENSATION, FEES, OR OTHER BENEFITS FROM THE HOSPITAL, RELATED ORGANIZATIONS OR FROM THE UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCES. THE COMMITTEE MAY RELY UPON REASONED WRITTEN OPINIONS OF QUALIFIED LEGAL, ACCOUNTING, VALUATION AND EXECUTIVE COMPENSATION EXPERTS. THE COMMITTEE HAS THE SOLE AUTHORITY TO RETAIN AND TERMINATE ANY SPECIAL ADVISORS USED TO ASSIST IN THE EVALUATION OF COMPENSATION. THE COMMITTEE CONTEMPORANEOUSLY, WITH MAKING ITS DETERMINATION OF REASONABLENESS WITH RESPECT TO THE COMPENSATION OF DISQUALIFIED PERSONS, DOCUMENTS IN A WRITTEN REPORT TO THE EXECUTIVE COMMITTEE AND THE BOARD, THE BASIS FOR ITS DECISION.
FORM 990, PART VI, SECTION C, LINE 19 THE HOSPITAL'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST AS REQUIRED.
FORM 990, PART IX, LINE 11G PHYSICIAN'S REMUNERATION: PROGRAM SERVICE EXPENSES 73,602,890. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 73,602,890. OTHER FEES FOR SERVICE: PROGRAM SERVICE EXPENSES 14,478,445. MANAGEMENT AND GENERAL EXPENSES 4,699,851. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 19,178,296.
FORM 990, PART XI, LINE 9: UNEXPENDED GRANT CARRYOVER ADJUSTMENTS 113,918. ACH FUNDS INVESTED THROUGH ACHF -20,000,000.
FORM 990, PART XII, LINE 3B THE CONSOLIDATED ORGANIZATION IS REQUIRED TO UNDERGO AN AUDIT AS SET FORTH IN THE SINGLE AUDIT ACT AND OMB CIRCULAR A-133 AND DID UNDERGO THAT REQUIRED AUDIT.
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
ARKANSAS CHILDREN'S HOSPITAL
 
Employer identification number

71-0236857
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) ARKANSAS CHILDREN'S HOSPITAL FOUNDATION

1 CHILDRENS WAY

LITTLE ROCK,AR72202
71-0568795 		FUNDRAISING AR 501(C)(3) LINE 7 ARKANSAS CHILDREN'S HOSPITAL
 
Yes
 
(2) ARKANSAS CHILDREN'S HOSPITAL RESEARCH INSTITUTE

13 CHILDRENS WAY

LITTLE ROCK,AR72202
71-0694931 		RESEARCH AR 501(C)(3) LINE 11A, I ARKANSAS CHILDREN'S HOSPITAL
 
Yes
 
(3) ARKANSAS CHILDREN'S HOSPITAL BUILDING RESEARCH FACILITY INC

1 CHILDRENS WAY

LITTLE ROCK,AR72202
91-1940376 		BUILDING MANAGEMENT AR 501(C)(3) LINE 11A, I ARKANSAS CHILDREN'S HOSPITAL
 
Yes
 
(4) ARKANSAS CHILDREN'S HOSPITAL AUXILIARY

1 CHILDRENS WAY

LITTLE ROCK,AR72202
71-0606585 		FUNDRAISING AR 501(C)(3) LINE 11A, I ARKANSAS CHILDREN'S HOSPITAL
 
 
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
(1) CHILDREN'S HEALTHCARE SYSTEM INC

1 CHILDRENS WAY
LITTLE ROCK,AR72202
58-6304957 		MANAGEMENT SERVICES AR ARKANSAS CHILDREN'S HOSPITAL
  		C 157,962 403,335 50.000 % Yes  












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
Yes
 
b Gift, grant, or capital contribution to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1b
Yes
 
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
Yes
 
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
Yes
 
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
Yes
 
m Performance of services or membership or fundraising solicitations by related organization(s) . . . . . . . . . . . . . . . . . . . .
1m
Yes
 
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
Yes
 
s Other transfer of cash or property from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1s
Yes
 
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) CHILDREN'S HEALTHCARE SYSTEM INC

 A 5,092 FMV
(2) ARKANSAS CHILDREN'S HOSPITAL FOUNDATION

 B 1,006,250 FMV
(3) ARKANSAS CHILDREN'S HOSPITAL RESEARCH INSTITUTE

 B 3,508,787 FMV
(4) ARKANSAS CHILDREN'S HOSPITAL FOUNDATION

 C 16,674,899 FMV
(5) ARKANSAS CHILDREN'S HOSPITAL FOUNDATION

 M 5,206,091 COST
(6) CHILDREN'S HEALTHCARE SYSTEM INC

 M 159,750 FMV
(7) ARKANSAS CHILDREN'S HOSPITAL RESEARCH INSTITUTE

 N 1,382,322 COST
(8) ARKANSAS CHILDREN'S HOSPITAL AUXILIARY

 N 147,423 COST
(9) CHILDREN'S HEALTHCARE SYSTEM INC

 O 197,017 FMV
(10) ARKANSAS CHILDREN'S HOSPITAL AUXILIARY

 O 253,919 FMV
(11) ARKANSAS CHILDREN'S HOSPITAL BUILDING RESEARCH FACILITY INC

 O 96,472 FMV
(12) ARKANSAS CHILDREN'S HOSPITAL RESEARCH INSTITUTE

 O 189,757 FMV
(13) ARKANSAS CHILDREN'S HOSPITAL AUXILIARY

 Q 63,193 FMV
(14) ARKANSAS CHILDREN'S HOSPITAL RESEARCH INSTITUTE

 Q 1,288,510 FMV
(15) ARKANSAS CHILDREN'S HOSPITAL FOUNDATION

 Q 505,877 FMV
(16) ARKANSAS CHILDREN'S HOSPITAL FOUNDATION

 R 20,040,352 FMV
(17) ARKANSAS CHILDREN'S HOSPITAL RESEARCH INSTITUTE

 S 26,050,264 FMV
(18) ARKANSAS CHILDREN'S HOSPITAL FOUNDATION

 S 3,190,155 FMV
(19) ARKANSAS CHILDREN'S HOSPITAL BUILDING RESEARCH FACILITY INC

 S 144,823 FMV
(20) ARKANSAS CHILDREN'S HOSPITAL AUXILIARY

 S 1,353,935 FMV
(21) ARKANSAS CHILDREN'S HOSPITAL FOUNDATION

 E 163,714,022 BOOK VALUE
(22) ARKANSAS CHILDREN'S HOSPITAL FOUNDATION

 O 265,342 FMV
(23) CHILDREN'S HEALTHCARE SYSTEM INC

 Q 51,808 FMV
(24) ARKANSAS CHILDREN'S HOSPITAL RESEARCH INSTITUTE

 R 67,509 FMV
(25) ARKANSAS CHILDREN'S HOSPITAL FOUNDATION

 N 1,706,900 COST
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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