Attach to Form 990 or Form 990-EZ.
Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
| (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 listed in your governing document? | (v) Amount of monetary support (see instructions) | (vi) Amount of other support (see instructions) | |
|---|---|---|---|---|---|---|
| Yes | No | |||||
| (A)
DAYTON CHILDREN'S HOSPITAL |
310672132 | Yes | 7,883,891 | 0 | ||
| (B)
CHILDREN'S HOME CARE OF DAYTON |
311356037 | No | 84,822 | 0 | ||
Total 2
|
7,968,713 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (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. | ||||||
Calendar year
(or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (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 VI.).. | ||||||
| 11 | Total support Add lines 7 through 10. | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (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.) | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (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 VI.) .. | ||||||
| 13 | Total support. (Add lines 9, 10c, 11, and 12.).. | ||||||
| Section A - Adjusted Net Income | (A) Prior Year |
(B) Current Year (optional) |
||||
| 1 | Net short-term capital gain | 1 | ||||
| 2 | Recoveries of prior-year distributions | 2 | ||||
| 3 | Other gross income (see instructions) | 3 | ||||
| 4 | Add lines 1 through 3 | 4 | ||||
| 5 | Depreciation and depletion | 5 | ||||
| 6 | Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) | 6 | ||||
| 7 | Other expenses (see instructions) | 7 | ||||
| 8 | Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) | 8 | ||||
| Section B - Minimum Asset Amount | (A) Prior Year |
(B) Current Year (optional) |
||||
| 1 | Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year): | 1 | ||||
| a | Average monthly value of securities | 1a | ||||
| b | Average monthly cash balances | 1b | ||||
| c | Fair market value of other non-exempt-use assets | 1c | ||||
| d | Total (add lines 1a, 1b, and 1c) | 1d | ||||
| e | Discount claimed for blockage or other factors (explain in detail in Part VI): | |||||
| 2 | Acquisition indebtedness applicable to non-exempt use assets | 2 | ||||
| 3 | Subtract line 2 from line 1d | 3 | ||||
| 4 | Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions). | 4 | ||||
| 5 | Net value of non-exempt-use assets (subtract line 4 from line 3) | 5 | ||||
| 6 | Multiply line 5 by .035 | 6 | ||||
| 7 | Recoveries of prior-year distributions | 7 | ||||
| 8 | Minimum Asset Amount (add line 7 to line 6) | 8 | ||||
| Section C - Distributable Amount | Current Year | |||||
| 1 | Adjusted net income for prior year (from Section A, line 8, Column A) | 1 | ||||
| 2 | Enter 85% of line 1 | 2 | ||||
| 3 | Minimum asset amount for prior year (from Section B, line 8, Column A) | 3 | ||||
| 4 | Enter greater of line 2 or line 3 | 4 | ||||
| 5 | Income tax imposed in prior year | 5 | ||||
| 6 | Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions) | 6 | ||||
| 7 | Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions) | |||||
| Section D - Distributions | Current Year | |
|---|---|---|
| 1 Amounts paid to supported organizations to accomplish exempt purposes | ||
|
2
Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity |
||
| 3 Administrative expenses paid to accomplish exempt purposes of supported organizations | ||
| 4 Amounts paid to acquire exempt-use assets | ||
| 5 Qualified set-aside amounts (prior IRS approval required) | ||
| 6 Other distributions (describe in Part VI). See instructions | ||
| 7Total annual distributions. Add lines 1 through 6. | ||
|
8
Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions |
||
| 9 Distributable amount for 2014 from Section C, line 6 | ||
| 10 Line 8 amount divided by Line 9 amount | ||
| Section E - Distribution Allocations (see instructions) |
(i) Excess Distributions |
(ii) Underdistributions Pre-2014 |
(iii) Distributable Amount for 2014 |
|
|---|---|---|---|---|
|
1
Distributable amount for 2014 from Section C, line 6 |
||||
|
2
Underdistributions, if any, for years prior to 2014 (reasonable cause required--see instructions) |
||||
| 3 Excess distributions carryover, if any, to 2014: | ||||
| a From 2009.......X | ||||
| b From 2010.......X | ||||
| c From 2011.......X | ||||
| d From 2012.......X | ||||
| e From 2013....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2014 distributable amount | ||||
|
i
Carryover from 2009 not applied (see instructions) |
||||
| j Remainder. Subtract lines 3g, 3h, and 3i from 3f. | ||||
| 4Distributions for 2014 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2014 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from 4. | ||||
|
5
Remaining underdistributions for years prior to 2014, if any. Subtract lines 3g and 4a from line 2 (if amount greater than zero, see instructions) |
||||
|
6
Remaining underdistributions for 2014. Subtract lines 3h and 4b from line 1 (if amount greater than zero, see instructions) |
||||
|
7 Excess distributions carryover to 2015. Add lines 3j and 4c. |
||||
| 8 Breakdown of line 7: | ||||
| a From 2010.......X | ||||
| b From 2011.......X | ||||
| c From 2012.......X | ||||
| d From 2013....... | ||||
| e From 2014....... | ||||
| Facts And Circumstances Test |
|---|
| Return Reference | Explanation |
|---|---|
| PART IV, SECTION A, LINE 1 AND PART IV, SECTION B, LINE 2 | CHILDREN'S HOME CARE OF DAYTON IS A SUBSIDIARY OF DAYTON CHILDREN'S HOSPITAL (DCH) AND ASSISTS DCH IN THE COMPLETION OF ITS MISSION BY PROVIDING CONTINUITY OF CARE FOR DCH PATIENTS. PART IV, SECTION B, LINE 1 ALL OF THE POWER TO SUPPORT/REMOVE THE DIRECTORS IS HELD BY DAYTON CHILDREN'S HOSPITAL (DCH). |
| Software ID: | |
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Attach to Form 990 or 990-EZ.
Information about Schedule O (Form 990 or 990-EZ) and its instructions is at| Return Reference | Explanation |
|---|---|
| DESCRIPTION OF PROGRAM SERVICES | FORM 990, PART III, LINE 4A DAYTON CHILDREN'S HOSPITAL FOUNDATION (THE FOUNDATION) EXISTS SOLELY TO BENEFIT DAYTON CHILDREN'S HOSPITAL (DCH) AND SUBSIDIARIES, AND TO ASSIST DCH IN PERFORMING ITS CHARITABLE MISSION. THE FOUNDATION IS FUNDED FROM BEQUESTS, AND DEFERRED AND PLANNED GIFTS FROM OUTSIDE DONORS. THE FOUNDATION ASSISTS DCH IN FULFILLING ITS CHARITABLE PURPOSE IN THE FOLLOWING FOUR WAYS: 1) THE FOUNDATION ACCUMULATES THE PROCEEDS OF BEQUESTS AND DEFERRED AND PLANNED GIFTS AS AN ENDOWMENT FOR DCH'S FUTURE CAPITAL NEEDS. THE INCOME FROM THIS ENDOWMENT WILL BE USED TO SUPPORT DCH'S YEAR TO YEAR CAPITAL EQUIPMENT NEEDS IN THE FUTURE. IN ADDITION, INCOME FROM THE FOUNDATION MAY BE USED TO FUND ALL OR A PORTION OF EXTRAORDINARY CAPITAL PROJECTS SUCH AS ADDITIONS OR RENOVATIONS TO DCH'S BUILDING AND GROUNDS. IN 2014-2015 THE FOUNDATION EXPENDED $1,158,839 FOR CAPITAL PROJECTS. 2) THE FOUNDATION MAKES CERTAIN OTHER PERIODIC GRANTS FOR CHILD ADVOCACY EFFORTS WHICH ARE RELATED TO DCH'S MISSION. IN 2014-2015 THE FOUNDATION EXPENDED $800,000 FOR ADVOCACY PROGRAMS. AN ENDOWMENT HAS BEEN ESTABLISHED WHICH SUPPORTS THE CHILD CARE AND COMFORT PROGRAM WITHIN THE CHILDREN'S HOME CARE OF DAYTON (CHCOD - A WHOLLY-OWNED SUBSIDIARY OF DCH) EACH YEAR. THE FOUNDATION EXPENDED $84,822 FOR THE CHILD CARE AND COMFORT PROGRAM IN 2014-2015. AN ENDOWMENT HAS BEEN ESTABLISHED TO PROVIDE ANNUAL SUPPORT OF DCH'S CHILD LIFE PROGRAM. THE FOUNDATION EXPENDED $30,831 FOR THE CHILD LIFE PROGRAM IN 2014-2015. AN ENDOWMENT HAS BEEN ESTABLISHED TO PROVIDE ANNUAL SUPPORT OF THE CHILD ADVOCACY CENTERS (CAC) IN MONTGOMERY, GREENE, AND WARREN COUNTIES. THE FOUNDATION EXPENDED $52,695 FOR THE CACS IN 2014-2015. 3) THE FOUNDATION HAS ESTABLISHED ENDOWMENTS, THE INCOME FROM WHICH WILL BE USED EACH YEAR TO ASSIST DCH TO RECRUIT AND RETAIN THE TOP PEDIATRIC MEDICAL PROFESSIONALS. CURRENT ENDOWED CHAIRS ARE AS FOLLOWS: CHILD ABUSE, CRITICAL CARE, NEUOSURGERY, PULMONARY, DEVELOPMENTAL PEDIATRICS, PEDIATRIC NEUROLOGY, GENERAL PEDIATRIC SURGERY, PEDIATRIC CANCER AND BLOOD DISORDERS, ANESTHESIA, INFECTIOUS DISEASES, AND RECRUITMENT OF SUBSPECIALTY PHYSICIANS WHO WOULD OTHERWISE NOT BE AVAILABLE IN THE COMMUNITY. EXPENDITURES FOR THE ENDOWED MEDICINE CHAIRS IN 2014-2015 TOTALED $3,957,867. GRANTS ARE MADE TO DCH AS A WHOLE RATHER THAN TO SPECIFIC PHYSICIANS OR INDIVIDUALS. MAJORITY APPROVAL BY THE BOARD OF TRUSTEES DETERMINES WHETHER THE GRANT IS FUNDED BY THE FOUNDATION. THE FOUNDATION'S TREASURER'S APPROVAL IS REQUIRED PRIOR TO ALL DISBURSEMENTS OF FUNDS. |
| DESCRIPTION OF CLASSES OF MEMEBERS OR STOCKHOLDERS | FORM 990, PART VI, LINE 6 DAYTON CHILDREN'S HOSPITAL (DCH) IS THE SOLE MEMBER OF DAYTON CHILDREN'S HOSPITAL FOUNDATION. |
| DESCRIPTION OF CLASSES OF PERSONS AND THE NATURE OF THEIR RIGHTS | FORM 990, PART VI, LINE 7A DCH IS THE SOLE MEMBER OF THE FOUNDATION. THE BOARD OF DCH APPOINTS THE FOUNDATION BOARD MEMBERS. |
| DESCRIBE THE PROCESS USED BY MGMT AND/OR GOVERNING BODY TO REVIEW 990 | FORM 990, PART VI, LINE 11A THE CFO REVIEWS KEY DISCLOSURES WITH APPROPRIATE COMMITTEES OF THE BOARD OF TRUSTEES. THEN PRIOR TO FILING, THE FORM 990 IS ELECTRONICALLY LOADED TO A SECURE HOSPITAL WEBSITE FOR THE ENTIRE BOARD OF TRUSTEES TO REVIEW. AN EMAIL IS SENT TO ALL MEMBERS NOTIFYING THEM THAT THE FORM IS AVAILABLE FOR THEIR REVIEW AND THAT IT WILL BE FILED ON OR BEFORE 5/15/16. DESCRIPTION OF PROCESS TO MONITOR TRANSACTIONS FOR CONFLICTS OF INTEREST FORM 990, PART VI, LINE 12C AT THE BEGINNINGS OF EACH MEETING, THE CHAIRMAN OF THE BOARD ASKS EACH MEMBER TO IDENTIFY AND DISCLOSE ANY POTENTIAL CONFLICTS OF INTEREST BASED ON THE AGENDA OR ANY CHANGES IN THEIR BUSINESS PRACTICE THAT MIGHT BE RELEVANT. IF THERE ARE ANY CONFLICTS, THE MEMBER(S) EXCUSE THEMSELVES AND DO NOT PARTICIPATE IN THE DISCUSSION AND DO NOT VOTE ON THE ITEM. THIS THEN IS NOTED IN THE MINUTES OF THAT MEETING. BOARD MEMBERS ANNUALLY AGREE TO ABIDE BY WRITTEN CONFLICT OF INTEREST AND CONFIDENTIALITY POLICIES. AVAIL OF GOV DOCS, CONFLICT OF INTEREST POLICY, & FIN STMTS TO GEN PUBLIC FORM 990, PART VI, LINE 19 DAYTON CHILDREN'S HOSPITAL CONFLICT OF INTEREST POLICY IS MADE AVAILABLE ON OUR WEBSITE. THE FINANCIAL STATEMENTS AND THE ORGANIZING DOCUMENTS ARE MADE AVAILABLE AS REQUIRED BY THE EXTENT OF THE LAW. |
| RECONCILIATION OF NET ASSETS | PART XI, LINE 9 ENDOWMENT TRANSFERRED FROM HOSPITAL 3,053,571 BEQUESTS TRANSFERRED FROM HOSPITAL 281,361 TOTAL FOR PART XI, LINE 9 3,334,932 |
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