TY 2015 Form 990

(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)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)
(1) CONNIE ARAM...................................................................... PRESIDENT	10.00 .................	X	X
(2) SHARYL SICOLI...................................................................... PRESIDENT-ELECT	10.00 .................	X	X
(3) ROBIN BRISTOL...................................................................... PAST PRESIDENT/STRATEGIC PLANNING CHAIR	8.00 .................	X	X
(4) JOANN WEBER...................................................................... SECRETARY	5.00 .................	X	X
(5) DARCY FREDERICKSON...................................................................... TREASURER	5.00 .................	X	X
(6) MELISSA DUCE...................................................................... TREASURER-ELECT	5.00 .................	X	X
(7) LIBBY STRONG...................................................................... CHARITABLE GIVING CHAIR	10.00 .................	X	X
(8) MARILYN SCHULTZ...................................................................... GUILD COUNCIL CHAIR	3.00 .................	X	X
(9) DEB ANDREWS...................................................................... MEMBER	3.00 .................	X
(10) MARIANNE BUCKMAN...................................................................... MEMBER	3.00 .................	X
(11) ERIN BURSCH...................................................................... MEMBER	3.00 .................	X
(12) KAREN CLAPPER...................................................................... MEMBER	3.00 .................	X
(13) PATRICIA COMMERS...................................................................... MEMBER	3.00 .................	X
(14) JOANN GRIFFIN...................................................................... MEMBER	3.00 .................	X
(15) LINDA EBGELBERT LANE...................................................................... MEMBER	10.00 .................	X
(16) LYNN MANDLE...................................................................... MEMBER	3.00 .................	X
(17) CAROL MARCH...................................................................... MEMBER	3.00 .................	X

(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)
(18) ERIN MCDOWELL........................................................................ MEMBER	3.00 .......................	X	0	0	0
(19) KAT MENAGED........................................................................ MEMBER	3.00 .......................	X	0	0	0
(20) CONNIE MERZ........................................................................ MEMBER	3.00 .......................	X	0	0	0
(21) VIRGINIA MEUERS........................................................................ MEMBER	3.00 .......................	X	0	0	0
(22) YVONNE PETERSON........................................................................ MEMBER	3.00 .......................	X	0	0	0
(23) JOHN RIHM........................................................................ MEMBER	3.00 .......................	X	0	0	0
(24) KELLY SANTOS........................................................................ MEMBER	3.00 .......................	X	0	0	0
(25) SUSAN ROSE WARD........................................................................ MEMBER	3.00 .......................	X	0	0	0
(26) TRACY WEBER........................................................................ MEMBER	3.00 .......................	X	0	0	0
(27) ROBERTA KELLER........................................................................ FORMER MEMBER (ENDED 2015)	3.00 .......................	X	0	0	0
(28) NANCY MOELLER........................................................................ FORMER MEMBER (ENDED 2015)	3.00 .......................	X	0	0	0
(29) CAROL STEHLY........................................................................ FORMER MEMBER (ENDED 2015)	3.00 .......................	X	0	0	0

- TIN:

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.
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Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public
Inspection

Name of the organization

CHILDREN'S HOSPITAL ASSOCIATION INC

Employer identification number

41-0711605

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.)

A church, convention of churches, or association of churches described in section 170(b)(1)(A)(i).

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E (Form 990 or 990-EZ))

A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).

A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital's name, city, and state:

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in section 170(b)(1)(A)(iv). (Complete Part II.)

A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in section 170(b)(1)(A)(vi). (Complete Part II.)

A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)

An organization that normally receives: (1) more than 331/3% of its support from contributions, membership fees, and gross 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.)

An organization organized and operated exclusively to test for public safety. See section 509(a)(4).

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box in lines 11a through 11d that describes the type of supporting organization and complete lines 11e, 11f, and 11g.

Type I. A supporting organization operated, supervised, or controlled by its supported organization(s), typically by giving the supported organization(s) the power to regularly appoint or elect a majority of the directors or trustees of the supporting organization. You must complete Part IV, Sections A and B.

Type II. A supporting organization supervised or controlled in connection with its supported organization(s), by having control or management of the supporting organization vested in the same persons that control or manage the supported organization(s). You must complete Part IV, Sections A and C.

Type III functionally integrated. A supporting organization operated in connection with, and functionally integrated with, its supported organization(s) (see instructions). You must complete Part IV, Sections A, D, and E.

Type III non-functionally integrated. A supporting organization operated in connection with its supported organization(s) that is not functionally integrated. The organization generally must satisfy a distribution requirement and an attentiveness requirement (see instructions). You must complete Part IV, Sections A and D, and Part V.

Check this box if the organization received a written determination from the IRS that it is a Type I, Type II, Type III functionally integrated, or Type III non-functionally integrated supporting organization.

Enter the number of supported organizations ..............

Provide the following information about the supported organization(s).

(i)Name of supported organization	(ii) EIN	(iv) Is the organization listed in your governing document?		(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)
(i)Name of supported organization	(ii) EIN	Yes	No	(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)


Total

For Paperwork Reduction Act Notice, see the Instructions for
Form 990 or 990-EZ.

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2015

Page 2

Part II

Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2011	(b) 2012	(c) 2013	(d) 2014	(e) 2015	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any unusual grants.) ....	1,055,635	881,867	1,063,143	1,084,046	929,190	5,013,881
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	1,055,635	881,867	1,063,143	1,084,046	929,190	5,013,881
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)..						198,479
6	Public support. Subtract line 5 from line 4.						4,815,402

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2011	(b) 2012	(c) 2013	(d) 2014	(e) 2015	(f) Total
7	Amounts from line 4..	1,055,635	881,867	1,063,143	1,084,046	929,190	5,013,881
8	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...	81,237	113,538	222,493	224,307	121,716	763,291
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.)..	21,149	21,658	29,330	33,896	32,381	138,414
11	Total support. Add lines 7 through 10.						5,915,586

Gross receipts from related activities, etc. (see instructions) ..................

1,521,748

First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here........................................ right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2015 (line 6, column (f) divided by line 11, column (f)) .........

81.400 %

Public support percentage for 2014 Schedule A, Part II, line 14 ...............

81.550 %

16a

33 1/3% support test—2015. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization ....................... right arrow

33 1/3% support test—2014. If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2015. If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the facts-and-circumstances test, check this box and stop here. Explain
in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization ..................................................... right arrow

10%-facts-and-circumstances test—2014. If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly
supported organization ................................................ right arrow

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) 2015

Page 3

Part III

Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 9 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2011	(b) 2012	(c) 2013	(d) 2014	(e) 2015	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2	Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......
3	Gross receipts from activities that are not an unrelated trade or business under section 513...
4	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5	The value of services or facilities furnished by a governmental unit to the organization without charge..
6	Total. Add lines 1 through 5.
7a	Amounts included on lines 1, 2, and 3 received from disqualified persons...
b	Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c	Add lines 7a and 7b..
8	Public support. (Subtract line 7c from line 6.)

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2011	(b) 2012	(c) 2013	(d) 2014	(e) 2015	(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.)..

First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization,
check this box and stop here............................................. right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2015 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2014 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2015 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2014 Schedule A, Part III, line 17 .............

19a

331/3% support tests—2015. If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ....... right arrow

33 1/3% support tests—2014. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .... right arrow

Private foundation. If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions .... right arrow

Schedule A (Form 990 or 990-EZ) 2015

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 11 of Part I. If you checked 11a of Part I, complete Sections A and B. If you checked 11b of Part I, complete Sections A and C. If you checked 11c of Part I, complete Sections A, D, and E. If you checked 11d of Part I, complete Sections A and D, and complete Part V.)

Section A. All Supporting Organizations

Yes

Are all of the organization’s supported organizations listed by name in the organization’s governing documents?
If "No," describe in Part VI how the supported organizations are designated. If designated by class or purpose,
describe the designation. If historic and continuing relationship, explain.

Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or (2)? If "Yes," explain in Part VI how the organization determined that the supported organization was described in section 509(a)(1) or (2).

Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer (b) and (c) below.

Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the public support tests under section 509(a)(2)? If "Yes," describe in Part VI when and how the organization made the determination.

Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) purposes? If "Yes," explain in Part VI what controls the organization put in place to ensure such use.

Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked 11a or 11b in Part I, answer (b) and (c) below.

Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? If “Yes,” describe in Part VI how the organization had such control and discretion despite being controlled or supervised by or in connection with its supported organizations.

Did the organization support any foreign supported organization that does not have an IRS determination under sections 501(c)(3) and 509(a)(1) or (2)? If “Yes,” explain in Part VI what controls the organization used to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B) purposes.

Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer (b) and (c) below (if applicable). Also, provide detail in Part VI, including (i) the names and EIN numbers of the supported organizations added, substituted, or removed; (ii) the reasons for each such action; (iii) the authority under the organization's organizing document authorizing such action; and (iv) how the action was accomplished (such as by amendment to the organizing document).

Type I or Type II only. Was any added or substituted supported organization part of a class already designated in the organization's organizing document?

Substitutions only. Was the substitution the result of an event beyond the organization's control?

Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (i) its supported organizations, (ii) individuals that are part of the charitable class benefited by one or more of its supported organizations, or (iii) other supporting organizations that also support or benefit one or more of the filing organization’s supported organizations? If “Yes,” provide detail in Part VI.

Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (defined in section 4958(c)(3)(C)), a family member of a substantial contributor, or a 35% controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ) .

Did the organization make a loan to a disqualified person (as defined in section 4958) not described in line 7? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ).

Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons as defined in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or (2))? If “Yes,” provide detail in Part VI.

Did one or more disqualified persons (as defined in line 9a) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.

Did a disqualified person (as defined in line 9a) have an ownership interest in, or derive any personal benefit from, assets in which the supporting organization also had an interest? If “Yes,” provide detail in Part VI.

10a

Was the organization subject to the excess business holdings rules of section 4943 because of section 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer line 10b below.

10a

Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to determine whether the organization had excess business holdings).

10b

Schedule A (Form 990 or 990-EZ) 2015

Page 5

Part IV

Supporting Organizations (continued)

Yes

Has the organization accepted a gift or contribution from any of the following persons?

A person who directly or indirectly controls, either alone or together with persons described in (b) and (c) below, the governing body of a supported organization?

11a

A family member of a person described in (a) above?

11b

A 35% controlled entity of a person described in (a) or (b) above? If “Yes” to a, b, or c, provide detail in Part VI.

11c

Section B. Type I Supporting Organizations

Yes

Did the directors, trustees, or membership of one or more supported organizations have the power to regularly appoint or elect at least a majority of the organization’s directors or trustees at all times during the tax year? If “No,” describe in Part VI how the supported organization(s) effectively operated, supervised, or controlled the organization’s activities. If the organization had more than one supported organization, describe how the powers to appoint and/or remove directors or trustees were allocated among the supported organizations and what conditions or restrictions, if any, applied to such powers during the tax year.

Did the organization operate for the benefit of any supported organization other than the supported organization(s) that operated, supervised, or controlled the supporting organization? If “Yes,” explain in Part VI how providing such benefit carried out the purposes of the supported organization(s) that operated, supervised or controlled the supporting organization.

Section C. Type II Supporting Organizations

Yes

Were a majority of the organization’s directors or trustees during the tax year also a majority of the directors or trustees of each of the organization’s supported organization(s)? If “No,” describe in Part VI how control or management of the supporting organization was vested in the same persons that controlled or managed the supported organization(s).

Section D. All Type III Supporting Organizations

Yes

Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s tax year, (i) a written notice describing the type and amount of support provided during the prior tax year, (ii) a copy of the Form 990 that was most recently filed as of the date of notification, and (iii) copies of the organization’s governing documents in effect on the date of notification, to the extent not previously provided?

Were any of the organization’s officers, directors, or trustees either (i) appointed or elected by the supported organization(s) or (ii) serving on the governing body of a supported organization? If "No," explain in Part VI how the organization maintained a close and continuous working relationship with the supported organization(s).

By reason of the relationship described in (2), did the organization’s supported organizations have a significant voice in the organization’s investment policies and in directing the use of the organization’s income or assets at all times during the tax year? If "Yes," describe in Part VI the role the organization’s supported organizations played in this regard.

Section E. Type III Functionally-Integrated Supporting Organizations

Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):

The organization satisfied the Activities Test. Complete line 2 below.

The organization is the parent of each of its supported organizations. Complete line 3 below.

The organization supported a governmental entity. Describe in Part VI how you supported a government entity (see instructions)

Activities Test. Answer (a) and (b) below.

Yes

Did substantially all of the organization’s activities during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was responsive? If "Yes," then in Part VI identify those supported organizations and explain how these activities directly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these activities constituted substantially all of its activities.

Did the activities described in (a) constitute activities that, but for the organization’s involvement, one or more of the organization’s supported organization(s) would have been engaged in? If "Yes," explain in Part VI the reasons for the organization’s position that its supported organization(s) would have engaged in these activities but for the organization’s involvement.

Parent of Supported Organizations. Answer (a) and (b) below.

Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations? Provide details in Part VI.

Did the organization exercise a substantial degree of direction over the policies, programs and activities of each of its supported organizations? If "Yes," describe in Part VI. the role played by the organization in this regard.

Schedule A (Form 990 or 990-EZ) 2015

Page 6

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations

Check here if the organization satisfied the Integral Part Test as a qualifying trust on Nov. 20, 1970. See instructions. All other Type III non-functionally integrated supporting organizations must complete Sections A through E.

	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

Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions)

Schedule A (Form 990 or 990-EZ) 2015

Page 7

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations (continued)

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 2015 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-2015	(iii) Distributable Amount for 2015
1 Distributable amount for 2015 from Section C, line 6
2 Underdistributions, if any, for years prior to 2015 (reasonable cause required--see instructions)
3 Excess distributions carryover, if any, to 2015:
a
b
c
d From 2013.......
e From 2014.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2015 distributable amount
i Carryover from 2010 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from 3f.
4Distributions for 2015 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2015 distributable amount
c Remainder. Subtract lines 4a and 4b from 4.
5 Remaining underdistributions for years prior to 2015, if any. Subtract lines 3g and 4a from line 2 (if amount greater than zero, see instructions)
6 Remaining underdistributions for 2015. Subtract lines 3h and 4b from line 1 (if amount greater than zero, see instructions)
7 Excess distributions carryover to 2016. Add lines 3j and 4c.
8 Breakdown of line 7:
a
b
c Excess from 2013.......
d From 2014.......
e From 2015.......

Schedule A (Form 990 or 990-EZ) (2015)

Schedule A (Form 990 or 990-EZ) 2015

Page 8

Part VI

Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; Part III, line 12; Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11a, 11b, and 11c; Part IV, Section B, lines 1 and 2; Part IV, Section C, line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 1c, 2a, 2b, 3a and 3b; Part V, line 1; Part V, Section B, line 1e; Part V Section D, lines 5, 6, and 8; and Part V, Section E, lines 2, 5, and 6. Also complete this part for any additional information. (See instructions).

Facts And Circumstances Test

Return Reference	Explanation
SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME:	VENDING MACHINE REVENUE - 2011 AMOUNT: $ 11,946. 2012 AMOUNT: $ 14,027. 2013 AMOUNT: $ 14,970. 2014 AMOUNT: $ 18,148. 2015 AMOUNT: $ 18,622. MISCELLANEOUS REVENUE - 2011 AMOUNT: $ 9,203. 2012 AMOUNT: $ 7,631. 2013 AMOUNT: $ 14,360. 2014 AMOUNT: $ 15,748. 2015 AMOUNT: $ 13,759.

Schedule A (Form 990 or 990-EZ) 2015

Additional Data

Software ID:
Software Version:

- TIN:

Schedule B
(Form 990, 990-EZ,
or 990-PF)

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

Attach to Form 990, 990-EZ, or 990-PF.

Information about Schedule B (Form 990, 990-EZ, or 990-PF) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Name of the organization

CHILDREN'S HOSPITAL ASSOCIATION INC

Employer identification number

41-0711605

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

4947(a)(1) nonexempt charitable trust not treated as a private foundation

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

4947(a)(1) nonexempt charitable trust treated as a private foundation

501(c)(3) taxable private foundation

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

For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, contributions totaling $5,000 or more (in money or other property) from any one contributor. Complete Parts I and II. See instructions for determining a contributor's total contributions.

Special Rules

For an organization described in section 501(c)(3) filing Form 990 or 990-EZ that met the 33¹/3% support test of the regulations
under sections 509(a)(1) and 170(b)(1)(A)(vi), that checked Schedule A (Form 990 or 990-EZ), Part II, line 13, 16a, or 16b, and that received from any one contributor, during the year, total contributions of the greater of (1) $5,000 or (2) 2% of the amount on (i) Form 990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts I and II.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, total contributions of more than $1,000 exclusively for religious, charitable, scientific, literary, or educational purposes, or for the prevention of cruelty to children or animals. Complete Parts I, II, and III.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, contributions exclusively for religious, charitable, etc., purposes, but no such contributions totaled more than $1,000. If this box is checked, enter here the total contributions that were received during the year for an exclusively religious, charitable, etc., purpose. Do not complete any of the parts unless the General Rule applies to this organization because it received nonexclusively religious, charitable, etc., contributions totaling $5,000 or more during the year ......... 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) (2015)

Schedule B (Form 990, 990-EZ, or 990-PF) (2015) Page 2

Name of organization CHILDREN'S HOSPITAL ASSOCIATION INC

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	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2015)

Schedule B (Form 990, 990-EZ, or 990-PF) (2015)

Page 3

Name of organization CHILDREN'S HOSPITAL ASSOCIATION INC		Employer identification number 41-0711605

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) (2015)

Schedule B (Form 990, 990-EZ, or 990-PF) (2015)

Page 4


Name of organization CHILDREN'S HOSPITAL ASSOCIATION INC			Employer identification number 41-0711605
Part III Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year from any one contributor. 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.) $ Use duplicate copies of Part III if additional space is needed.

(a)
No.from Part I

(b) Purpose 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

(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

(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

(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) (2015)

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," on 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.
Information about Schedule D (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public Inspection

Name of the organization

CHILDREN'S HOSPITAL ASSOCIATION INC

Employer identification number

41-0711605

Part I

Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" on Form 990, Part IV, line 6.

			(a) Donor advised funds	(b) Funds and other accounts

1	Total number at end of year ....
2	Aggregate value of contributions to (during year)
3	Aggregate value of grants from (during year)
4	Aggregate value at end of year ....

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? ...........

Yes No

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? ............................

Yes No

Part II

Conservation Easements. Complete if the organization answered "Yes" on Form 990, Part IV, line 7.

Purpose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e.g., recreation or education) Preservation of an historically important land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

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.


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

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the
tax year SchDMd Bullet

Number of states where property subject to conservation easement is located SchDMd Bullet

Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and enforcement of the conservation easements it holds? ............

Yes No

Staff and volunteer hours devoted to monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

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)? .............................

Yes No

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" on Form 990, Part IV, line 8.

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.

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)

Revenue included on Form 990, Part VIII, line 1 ......................... SchDMd Bullet

(ii)

Assets included in Form 990, Part X ............................... SchDMd Bullet

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:

Revenue included on Form 990, Part VIII, line 1 .......................... SchDMd Bullet

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) 2015

Page 2

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)

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):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.

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?...

Yes No

Part IV

Escrow and Custodial Arrangements. Complete if the organization answered "Yes" on Form 990, Part IV, line 9, or reported an amount on Form 990, Part X, line 21.

Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................

Yes No


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

Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability?

Yes No

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" on Form 990, Part IV, line 10.

		(a)Current year	(b)Prior year	(c)Two years back	(d)Three years back	(e)Four years back

1a	Beginning of year balance ....	610,179	621,978	563,924	525,436	530,999
b	Contributions ...
c	Net investment earnings, gains, and losses	-13,093	13,262	82,863	61,654	-5,563
d	Grants or scholarships ...	27,734	25,061	24,809	23,166
e	Other expenditures for facilities and programs ...
f	Administrative expenses ....
g	End of year balance ......	569,352	610,179	621,978	563,924	525,436

Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:

Board designated or quasi-endowment SchDMd Bullet

13.270 %

Permanent endowment SchDMd Bullet

55.630 %

Temporarily restricted endowment SchDMd Bullet

31.100 %

The percentages on lines 2a, 2b, and 2c should equal 100%.

Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes

(i) unrelated organizations .................

3a(i)

(ii) related organizations .................

3a(ii)

If "Yes" on 3a(ii), are the related organizations listed as required on Schedule R? .........

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' on 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 ...
b	Buildings
c	Leasehold improvements
d	Equipment ...	7,696	6,917	779
e	Other ...
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				779

Schedule D (Form 990) 2015

Page 3

Part VII

InvestmentsOther Securities. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11b. See Form 990, Part X, line 12.

(a) Description of security or category (including name of security)	(b)Book value	(c)Method of valuation: Cost or end-of-year market value
(1)Financial derivatives
(2)Closely-held equity interests
(3)Other
(A)
(B)
(C)
(D)
(E)
(F)
(G)
(H)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

Part VIII

InvestmentsProgram Related. Complete if the organization answered 'Yes' on 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

(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)

Part IX

Other Assets. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11d. See Form 990, Part X, line 15.

(a) Description				(b) Book value
(1) INTEREST RECEIVABLE				3,458
(2) BENEFICIAL INTEREST IN PERPERTUAL TRUST				821,104
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........				824,562

Part X

Other Liabilities. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.

1.(a) Description of liability	(b) Book value
(1) Federal income taxes

(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)
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) 2015

Page 4

Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total revenue, gains, and other support per audited financial statements .......			1	1,098,639
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains (losses) on investments ....	2a	-191,719
b	Donated services and use of facilities .........	2b	154,085
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIII.) ............	2d	42,874
e	Add lines 2a through 2d .....................			2e	5,240
3	Subtract line 2e from line 1..................			3	1,093,399
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	0
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......			5	1,093,399

Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total expenses and losses per audited financial statements ...........			1	1,508,193
2	Amounts included on line 1 but not on Form 990, Part IX, line 25:
a	Donated services and use of facilities .........	2a	154,085
b	Prior year adjustments ............	2b
c	Other losses ................	2c
d	Other (Describe in Part XIII.) ............	2d	117,386
e	Add lines 2a through 2d....................			2e	271,471
3	Subtract line 2e from line 1...................			3	1,236,722
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	0
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......			5	1,236,722

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:	THE ENDOWMENT FUND IS USED TO ACCOMPLISH THE ORGANIZATION'S TAX EXEMPT PURPOSE.
PART X, LINE 2:	THE ASSOCIATION IS EXEMPT FROM FEDERAL AND MINNESOTA TAXATION PURSUANT TO THE PROVISIONS OF SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND SECTION 290.05 OF THE MINNESOTA STATUTES AND IS ONLY SUBJECT TO FEDERAL AND STATE INCOMES TAXES ON NET UNRELATED BUSINESS INCOME. SINCE THE ASSOCIATION HAD NO UNRELATED BUSINESS TAXABLE INCOME IN 2014 AND 2013, THE ACCOMPANYING FINANCIAL STATEMENTS DO NOT INCLUDE ANY PROVISION FOR FEDERAL OR STATE INCOME TAXES. MANAGEMENT HAS EVALUATED ITS TAX POSITIONS AND HAS CONCLUDED THAT THEY DO NOT RESULT IN ANYTHING THAT WOULD REQUIRE EITHER RECORDING OR DISCLOSURE IN THE FINANCIAL STATEMENTS.
PART XI, LINE 2D - OTHER ADJUSTMENTS:	CHANGE IN VALUE OF PERPETUAL TRUSTS -74,512. SPECIAL EVENTS EXPENSES IN EXCESS OF DIRECT BENEFIT 117,386.
PART XII, LINE 2D - OTHER ADJUSTMENTS:	SPECIAL EVENTS EXPENSES IN EXCESS OF DIRECT BENEFIT 117,386.

Schedule D (Form 990) 2015

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE G (Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information Regarding
Fundraising or Gaming Activities

Complete if the organization answered "Yes" on Form 990, Part IV, lines 17, 18, or 19, or if the organization entered more than $15,000 on Form 990-EZ, line 6a. right arrow

Attach to Form 990 or Form 990-EZ.
right arrow

Information about Schedule G (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public Inspection

Name of the organization
CHILDREN'S HOSPITAL ASSOCIATION INC

Employer identification number

41-0711605

Part I

Fundraising Activities. Complete if the organization answered "Yes" on Form 990, Part IV, line 17.

Form 990-EZ filers are not required to complete this part.

Indicate whether the organization raised funds through any of the following activities. Check all that apply.

a	Mail solicitations	e	Solicitation of non-government grants
b	Internet and email solicitations	f	Solicitation of government grants
c	Phone solicitations	g	Special fundraising events
d	In-person solicitations

Did the organization have a written or oral agreement with any individual (including officers, directors, trustees

or key employees listed in Form 990, Part VII) or entity in connection with professional fundraising services?

YesNo

If "Yes," list the ten highest paid individuals or entities (fundraisers) pursuant to agreements under which the fundraiser is
to be compensated at least $5,000 by the organization.

(i) Name and address of individual or entity (fundraiser)	(iii) Did fundraiser have custody or control of contributions?
	Yes	No










Total . . . . . . . . . . . . . . . . . . . .

List all states in which the organization is registered or licensed to solicit contributions or has been notified it is exempt from registration or licensing.

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 50083H

Schedule G (Form 990 or 990-EZ) 2015

Page 2

Part II

Fundraising Events. Complete if the organization answered "Yes" on Form 990, Part IV, line 18, or reported more than $15,000 of fundraising event contributions and gross income on Form 990-EZ, lines 1 and 6b. List events with gross receipts greater than $5,000.

		(a) Event #1 ANNUAL BALL (event type)	(b) Event #2 TABLE TALK (event type)	(d) Total events (add col. (a) through col. (c))
1	Gross receipts . . . . .	521,362	53,430	574,792
2	Less: Contributions . . . .	294,854	36,771	331,625
3	Gross income (line 1 minus line 2) . . . . . .	226,508	16,659	243,167

4	Cash prizes . . . . .
5	Noncash prizes . . . .	76,450	9,848	86,298
6	Rent/facility costs . . . .	36,373	800	37,173
7	Food and beverages . . .	57,061	6,011	63,072
8	Entertainment . . . .	52,928		52,928
9	Other direct expenses . . .	32,606	4,128	36,734
10	Direct expense summary. Add lines 4 through 9 in column (d) . . . . . . . . . .			276,205
11	Net income summary. Subtract line 10 from line 3, column (d). . . . . . . . . .			-33,038

Part III

Gaming. Complete if the organization answered "Yes" on Form 990, Part IV, line 19, or reported more than $15,000 on Form 990-EZ, line 6a.

		(a) Bingo	(b) Pull tabs/Instant bingo/progressive bingo	(c) Other gaming	(d) Total gaming (add col.(a) through col.(c))
1	Gross revenue . . . . .

2	Cash prizes . . . . .
3	Noncash prizes . . . .
4	Rent/facility costs . . . .
5	Other direct expenses . . .	32,606	4,128	36,734

Volunteer labor . . . .

	Yes %
	No

	Yes %
	No

	Yes %
	No

Direct expense summary. Add lines 2 through 5 in column (d) . . . . . . . . . . right arrow

Net gaming income summary. Subtract line 7 from line 1, column (d). . . . . . . . . right arrow

Enter the state(s) in which the organization conducts gaming activities:

Is the organization licensed to conduct gaming activities in each of these states? . . . . . . . .

YesNo

If "No," explain:

10a

Were any of the organization's gaming licenses revoked, suspended or terminated during the tax year? . . .

YesNo

If "Yes," explain:

Schedule G (Form 990 or 990-EZ) 2015

Page 3

Does the organization conduct gaming activities with nonmembers? . . . . . . . . . . .

YesNo

Is the organization a grantor, beneficiary or trustee of a trust or a member of a partnership or other entity

formed to administer charitable gaming? . . . . . . . . . . . . . . . . .

YesNo

Indicate the percentage of gaming activity conducted in:

The organization's facility . . . . . . . . . . . . . . . . . .

13a

An outside facility . . . . . . . . . . . . . . . . . . . .

13b

Enter the name and address of the person who prepares the organization's gaming/special events books and records:

Name

Address

15a

Does the organization have a contract with a third party from whom the organization receives gaming

revenue? . . . . . . . . . . . . . . . . . . . . . . . .

YesNo

If "Yes," enter the amount of gaming revenue received by the organization right arrow

$ and the

amount of gaming revenue retained by the third party right arrow

$ .

If "Yes," enter name and address of the third party:

Name

Address

Gaming manager information:

Name

Gaming manager compensation right arrow

Description of services provided right arrow

Director/officer Employee Independent contractor

Mandatory distributions:

Is the organization required under state law to make charitable distributions from the gaming proceeds to

retain the state gaming license? . . . . . . . . . . . . . . . . . . .

YesNo

Enter the amount of distributions required under state law distributed to other exempt organizations or spent

in the organization's own exempt activities during the tax year right arrow

Part IV

Supplemental Information. Provide the explanations required by Part I, line 2b, columns (iii) and (v); and Part III, lines 9, 9b, 10b, 15b, 15c, 16, and 17b, as applicable. Also complete this part to provide any additional information (see instructions).

Return Reference	Explanation

Schedule G (Form 990 or 990-EZ) 2015

Additional Data

Software ID:
Software Version:

- TIN:

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," on 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

2015

Open to Public
Inspection

Name of the organization
CHILDREN'S HOSPITAL ASSOCIATION INC

Employer identification number
41-0711605

Part I

General Information on Grants and Assistance

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? ........................

Yes No

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 Domestic Organizations and Domestic Governments. Complete if the organization answered "Yes" on 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 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) CHILDREN'S HOSPITALS AND CLINICS OF MINNESOTA
347 NORTH SMITH AVENUE
ST PAUL,MN55102

41-1754276

501(C)(3)

966,515

N/A

PROGRAM SUPPORT

Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image

Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50055P

Schedule I (Form 990) 2015

Page 2

Part III

Grants and Other Assistance to Domestic Individuals. Complete if the organization answered "Yes" on 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)
(2)
(3)
(4)
(5)
(6)
(7)

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:

GRANT APPLICATIONS FROM PROGRAMS AT CHILDREN'S HOSPITALS AND CLINICS OF MINNESOTA ARE SOLICITED IN AUGUST, WITH A DEADLINE AT THE END OF SEPTEMBER. THE OFFICE MANAGER PREPARES A BOOK OF SUBMITTED APPLICATIONS FOR MEMBERS OF THE FINANCE COMMITTEE TO REVIEW. IN OCTOBER OR NOVEMBER, THE FINANCE COMMITTEE MEETS TO CHOOSE THE PROGRAMS AND FUND AMOUNTS TO BE GIVEN TO EACH PROGRAM WITH THE AID OF A MATRIX THAT SCORES EACH PROGRAM BASED ON THE CRITERIA DEVELOPED BY THE FINANCE COMMITTEE. GRANT RECIPIENTS ARE REQUIRED TO FILL OUT A REPORT AT THE END OF JUNE AND AGAIN AT THE END OF DECEMBER.

Schedule I (Form 990) 2015

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE M
(Form 990)

Department of the Treasury

Internal Revenue Service

Noncash Contributions

Complete if the organizations answered "Yes" on Form 990, Part IV, lines 29 or 30.
Right pointing arrow large image

Attach to Form 990.
Right pointing arrow large image

Information about Schedule M (Form 990) and its instructions is at www.irs.gov/form990

OMB No. 1545-0047

2015

Open to Public Inspection

Name of the organization

CHILDREN'S HOSPITAL ASSOCIATION INC

Employer identification number

41-0711605

Part I

Types of Property

	(a) Check if applicable	(b) Number of contributions or items contributed	(c) Noncash contribution amounts reported on Form 990, Part VIII, line 1g	(d) Method of determining noncash contribution amounts
1 Art—Works of art ....
2 Art—Historical treasures .
3 Art—Fractional interests ..
4 Books and publications ..
5 Clothing and household goods .......
6 Cars and other vehicles ..
7 Boats and planes ....
8 Intellectual property ...
9 Securities—Publicly traded .	X	1	36,551	STOCK MARKET QUOTES
10 Securities—Closely held stock .
11 Securities—Partnership, LLC, or trust interests ....
12 Securities—Miscellaneous ..
13 Qualified conservation contribution—Historic structures .....
14 Qualified conservation contribution—Other ...
15 Real estate—Residential .
16 Real estate—Commercial ..
17 Real estate—Other ...
18 Collectibles .....
19 Food inventory ...
20 Drugs and medical supplies .
21 Taxidermy ......
22 Historical artifacts ....
23 Scientific specimens ..
24 Archeological artifacts ...
25 Other ( EVENT AUCTION ITEMS )	X	276	84,348	ESTIMATED FMV
26 Other ( )
27 Other ( )
28 Other ( )

Number of Forms 8283 received by the organization during the tax year for contributions
for which the organization completed Form 8283, Part IV, Donee Acknowledgement

Yes

30a

During the year, did the organization receive by contribution any property reported in Part I, lines 1 through 28, that

it must hold for at least three years from the date of the initial contribution, and which is not required to be used

for exempt purposes for the entire holding period? ..................

30a

If "Yes," describe the arrangement in Part II.

Does the organization have a gift acceptance policy that requires the review of any non-standard contributions?

Yes

32a

Does the organization hire or use third parties or related organizations to solicit, process, or sell noncash

contributions? ..........................

32a

If "Yes," describe in Part II.

If the organization did not report an amount in column (c) for a type of property for which column (a) is checked,

describe in Part II.

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 51227J

Schedule M (Form 990) (2015)

Page 2

Part II

Supplemental Information. Provide the information required by Part I, lines 30b, 32b, and 33, and whether the organization is reporting in Part I, column (b), the number of contributions, the number of items received, or a combination of both. Also complete this part for any additional information.

Return Reference	Explanation
PART I, COLUMN (B):	THE ORGANIZATION REPORTS THE NUMBER OF CONTRIBUTORS ON PART I, COLUMN (B).

Schedule M (Form 990) (2015)

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or 990-EZ 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

2015

Open to Public
Inspection

Name of the organization

CHILDREN'S HOSPITAL ASSOCIATION INC

Employer identification number

41-0711605

Return Reference	Explanation
FORM 990, PART VI, SECTION A, LINE 1	THE ASSOCIATION HAS AN EXECUTIVE COMMITTEE CONSISTING OF THE OFFICERS OF THE CORPORATION, THE GUILD COUNCIL CHAIR, THE CHAIR OF THE STRATEGIC PLANNING COMMITTEE, AND THE CHAIR OF THE CHARITABLE GIVING COMMITTEE. THE EXECUTIVE COMMITTEE SHALL ACT ON BEHALF OF THE BOARD OF DIRECTORS BETWEEN REGULAR MEETINGS SUBJECT TO THE DIRECTION AND CONTROL OF THE BOARD OF DIRECTORS. THE EXECUTIVE COMMITTEE MEETING MINUTES SHALL BE RATIFIED BY THE BOARD. THE EXECUTIVE COMMITTEE MAY ENGAGE PAID PERSONNEL, DEFINE THEIR DUTIES, AND REVIEW THEIR COMPENSATION ANNUALLY.
FORM 990, PART VI, SECTION A, LINE 2	SHARYN DUCE AND MELISSA DUCE - FAMILY RELATIONSHIP
FORM 990, PART VI, SECTION A, LINE 4	THE BYLAWS WERE AMENDED, EFFECTIVE AUGUST 10, 2015, TO REMOVE VOTING RIGHTS FOR AFFILIATE BOARD MEMBERS.
FORM 990, PART VI, SECTION A, LINE 6	THE MEMBERSHIP OF THE ASSOCIATION HAS THE FOLLOWING CLASSES: A. BOARD MEMBER B. GUILD MEMBER C. AFFILIATE BOARD MEMBER: AFFILIATE BOARD MEMBERS SHALL HAVE PREVIOUSLY SERVED AS A REGULAR BOARD MEMBER OR GUILD MEMBER AND SHALL BE APPROVED BY THE BOARD OF DIRECTORS. THEY SHALL PAY DUES AS DETERMINED BY THE BOARD OF DIRECTORS. AFFILIATE BOARD MEMBERS MAY SERVE AS MEMBERS OF COMMITTEES, BUT MAY NOT SERVE AS CHAIR OF ANY COMMITTEE. THEY SHALL HAVE FULL MEMBERSHIP PRIVILEGES WITH THE EXCEPTION OF VOTING. D. CONTRIBUTING MEMBER: ANY PERSON OR ENTITY WHO SHALL MAKE A FINANCIAL OR IN-KIND CONTRIBUTION OR DONATION TO THIS ASSOCIATION SHALL BE DEEMED A CONTRIBUTING MEMBER. NO DUES WILL BE REQUIRED OF CONTRIBUTING MEMBERS, HOWEVER, ALL PRIVILEGES OF MEMBERSHIP WILL BE GRANTED WITH THE EXCEPTION OF VOTING. E. HONORARY MEMBER: HONORARY MEMBERS MAY BE ELECTED BY UNANIMOUS VOTE BY THE BOARD OF DIRECTORS FOR OUTSTANDING SERVICES TO THE ASSOCIATION. NO DUES WILL BE REQUIRED OF HONORARY MEMBERS, HOWEVER, ALL PRIVILEGES OF MEMBERSHIP WILL BE GRANTED WITH THE EXCEPTION OF VOTING.
FORM 990, PART VI, SECTION A, LINE 7A	THE VOTING MEMBERS ELECT THE BOARD OF DIRECTORS AND APPROVE AMENDMENTS TO THE ASSOCIATION'S GOVERNING DOCUMENTS.
FORM 990, PART VI, SECTION A, LINE 7B	BOARD MEMBERS WHO HAVE PARTICIPATED IN MEETINGS AND DISCUSSIONS VOTE ON ALL ISSUES.
FORM 990, PART VI, SECTION B, LINE 11	THE CURRENT TREASURER, PRESIDENT, TREASURER-ELECT, PRESIDENT-ELECT AND THE TREASURER OF THE TAX YEAR FOR WHICH THE FORM 990 IS PREPARED REVIEW THE FORM 990 BEFORE FILING WITH THE IRS. THE TAX RETURN IS AVAILABLE ON REQUEST TO ALL BOARD MEMBERS.
FORM 990, PART VI, SECTION B, LINE 15	THE ASSOCIATION DOES NOT COMPENSATE BOARD MEMBERS. EMPLOYEE COMPENSATION IS SET BY THE PERSONNEL COMMITTEE. THE PERSONNEL COMMITTEE CONSULTS WITH THE HUMAN RESOURCES DEPARTMENT OF CHILDREN'S HOSPITAL, WHO IS CONTRACTED TO HANDLE THE ASSOCIATION'S PAYROLL. CHILDREN'S HOSPITAL PROVIDES LOW, MEDIUM AND HIGH PAY SCALES FOR GRADE LEVELS BASED ON INTERNAL AND EXTERNAL DATA FOR POSITIONS WITH SIMILAR JOB DESCRIPTIONS. EACH YEAR, USING THIS INFORMATION, THE PERSONNEL COMMITTEE MAKES DECISIONS ON LEVELS OF COMPENSATION FOR EACH EMPLOYEE.
FORM 990, PART VI, SECTION C, LINE 19	THE ASSOCIATION DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, OR FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC.
FORM 990, PART XI, LINE 9:	CHANGE IN VALUE OF PERPETUAL TRUSTS -74,512.
FORM 990, PART I, LINE 6	THE ASSOCIATION'S VOLUNTEERS, BOTH BOARD AND GUILD MEMBERS, PERFORM THE FUNCTIONS NECESSARY FOR THE OPERATION OF THE ASSOCIATION THAT WOULD OTHERWISE REQUIRE THE USE OF PAID PROFESSIONALS. FUNCTIONS INCLUDE: ONGOING REVIEW AND REVISION, WITH BOARD APPROVAL, OF THE ASSOCIATION'S BYLAWS, PROCEDURES, AND JOB DESCRIPTIONS BY THE BYLAWS/PROCEDURES COMMITTEE; PLANNING, SOLICITATION AND RELATIONSHIP BUILDING OF CORPORATE CONTACTS AND SUPPORTERS BY THE CHARITABLE GIVING COMMITTEE; SOLICITATION OF FUNDS THROUGH THE ANNUAL APPEAL, PROMOTION AND MONITORING OF THE ASSOCIATION'S TRIBUTE PROGRAM AND RECOGNITION OF INDIVIDUAL DONORS BY THE DONOR RELATIONS COMMITTEE; MANAGEMENT OF THE ENTIRE ASSOCIATION BY THE EXECUTIVE COMMITTEE; BUDGETING, FINANCIAL OPERATIONS, SOLICITATION AND REVIEW OF GRANT APPLICATIONS, AWARDING OF GRANTS BY THE FINANCE COMMITTEE; LIAISON TO THE GUILDS, PROVIDING NEEDED ASSISTANCE AND INFORMATION BY THE GUILD COUNCIL COMMITTEE; LUNCHEON PLANNING BY THE HOSPITALITY COMMITTEE; EVALUATING AND PLACING IN NOMINATION BOARD MEMBERS TO SERVE AS OFFICERS AND COMMITTEE CHAIRS BY THE NOMINATING COMMITTEE; MANAGEMENT, HIRING AND REVIEW OF THE PAID STAFF OF THE ASSOCIATION BY THE PERSONNEL COMMITTEE; PURCHASING, MARKETING, SALES AND EMPLOYEE MANAGEMENT OF THE PETER PAN GIFT SHOP BY THE PETER PAN COMMITTEE; PROMOTION OF FUNDRAISING EVENTS AND INCREASE OF AWARENESS OF CHA AND ITS MISSION BY THE PUBLIC RELATIONS COMMITTEE; RESEARCHING, EVALUATING, AND PRESENTING NEW FUNDRAISING OPPORTUNITIES TO THE BOARD BY THE RESEARCH AND DEVELOPMENT COMMITTEE; MONITORING THE ASSOCIATION'S PROGRESS ON THE STRATEGIC PLAN AND IDENTIFYING TRENDS AND NEEDS OF THE COMMUNITY PERTINENT TO THE ASSOCIATION BY THE STRATEGIC PLANNING COMMITTEE. THE ROLE OF EVENT PLANNING, PUBLICITY, EXECUTION AND FOLLOW UP OF FUNDRAISING EVENTS IS COMPLETED BY THE GALA AND TABLE TALK COMMITTEES AND BY THE GUILDS AS THEY PERFORM THE MAJOR FUNDRAISING WORK OF THE ORGANIZATION.
FORM 990, PART V, LINE 2A	THE ASSOCIATION HAD 9 EMPLOYEES IN 2015. THEIR W-2'S WERE ISSUED BY CHILDREN'S HOSPITALS AND CLINICS OF MINNESOTA AND THE ASSOCIATION REIMBURSED CHILDREN'S HOSPITALS AND CLINICS OF MINNESOTA FOR THE COMPENSATION.

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2015

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: TO CREATE SUBSTANTIAL FUNDS TO SUPPORT THE HEALTH CARE-RELATED NEEDS OF CHILDREN AND THEIR FAMILIES.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	26
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	26
5	Total number of individuals employed in calendar year 2015 (Part V, line 2a) ......	5	9
6	Total number of volunteers (estimate if necessary) .............	6	375
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

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	1,084,046	942,816
9	Program service revenue (Part VIII, line 2g) .........	7,120	9,075
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	671,961	126,732
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	12,599	14,776
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	1,775,726	1,093,399
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	943,398	966,515
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)	101,181	105,712
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 75,119
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	188,003	164,495
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	1,232,582	1,236,722
19	Revenue less expenses. Subtract line 18 from line 12.......	543,144	-143,323
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	4,402,736	3,923,435
21	Total liabilities (Part X, line 26).............	1,039,478	969,731
22	Net assets or fund balances. Subtract line 21 from line 20.....	3,363,258	2,953,704

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 968,629 including grants of $ 966,515 ) (Revenue $ 9,075 )
	THE PRINCIPAL PURPOSE IS TO ESTABLISH AND MAINTAIN FUND TO BE USED FOR THE CARE OF NEEDY CHILDREN AT ANY MEDICAL FACILITY DEEMED APPROPRIATE BY THE BOARD OF DIRECTORS, ALSO TO AID, ASSIST AND CONTRIBUTE TO OTHER ORGANIZATIONS OPERATED FOR CHARITABLE, SCIENTIFIC, AND EDUCATIONAL PURPOSES. SUCH FUNDS ARE OBTAINED FROM VARIOUS ACTIVITIES DIRECTLY RELATED TO OR CLEARLY IDENTIFIED WITH THE ABOVE PURPOSE AND CONDUCTED BY ASSOCIATION MEMBERS.PLEDGES AND PAYMENTS FOR 2015 INCLUDED:AUTISM AND SPECIAL NEEDS: IMPROVING THE CARE AND EXPERIENCE FOR PATIENTS AND FAMILIES ($10,000) - THE UNIQUE DEVELOPMENTAL AND BEHAVIORAL CONCERNS OF CHILDREN ON THE AUTISM SPECTRUM AND THOSE WITH SIMILAR SPECIAL NEEDS PRESENT A VARIETY OF CHALLENGES FOR MEDICAL PROVIDERS AND TEAMS AT CHILDREN'S MINNESOTA. THIS ADDED COMPLEXITY CAN COMPLICATE VISITS, LEAD TO LESS DESIRABLE HEALTH OUTCOMES AND DECREASED PATIENT AND FAMILY SATISFACTION. THE GOAL OF THIS PROGRAM IS TO IMPROVE THE QUALITY OF EXPERIENCES FOR CHILDREN WITH AUTISM AND SPECIAL NEEDS WHEN RECEIVING CARE AT CHILDREN'S MINNESOTA. BY PARTNERING WITH THE AUTISM SOCIETY OF MINNESOTA (AUSM), CLINICAL STAFF WILL BE TRAINED IN PRACTICAL TECHNIQUES AND BE PROVIDED WITH RESOURCES WHICH WILL ALLOW THEM TO BETTER ANTICIPATE AND MANAGE THE COMMON CHALLENGES ENCOUNTERED WHEN WORKING WITH THESE CHILDREN. IMPROVED STAFF COMPETENCY WILL LEAD TO DECREASED COMPLICATIONS IN THE CARE OF THOSE ON THE AUTISM SPECTRUM AND HELP CHILDREN'S BECOME MORE OF AN ESSENTIAL PARTNER IN ENSURING BETTER HEALTH OUTCOMES FOR THESE CHILDREN AND FAMILIES.CHAPLAINCY ON-CALL ($40,000) - THIS ON-CALL PASTORAL CARE PROGRAM ENSURES THAT HIGH QUALITY SPIRITUAL AND EMOTIONAL SUPPORT IS AVAILABLE TO PATIENTS AND FAMILIES, EVEN AFTER REGULAR DAYTIME HOURS AND ON WEEKENDS. CHILD LIFE IN THE EMERGENCY DEPARTMENT ($45,000) - CHILD LIFE SPECIALISTS ARE AN INTEGRAL PART OF THE MULTIDISCIPLINARY EMERGENCY CARE TEAM AT CHILDREN'S MINNESOTA. THEY ASSESS AND SUPPORT THE PSYCHOSOCIAL AND EMOTIONAL WELL-BEING OF PATIENTS AND FAMILIES WHO ARE IN NEED OF SUPPORT FOR INVASIVE PROCEDURES, TRAUMA, NEW DIAGNOSIS AND UNPLANNED MEDICAL CARE. THESE SPECIALISTS DEVELOP PATIENT SPECIFIC, DEVELOPMENTALLY APPROPRIATE INTERVENTIONS WHICH HELP CREATE A SAFE, CHILD FRIENDLY ENVIRONMENT WHICH HAS BEEN PROVED TO DECREASE PATIENT ANXIETY AND THE PERCEPTION OF PAIN. THIS TRANSLATES INTO HIGHER QUALITY OUTCOMES AND INCREASED PATIENT AND FAMILY SATISFACTION. THE GOAL OF THIS PROGRAM IS TO EXPAND CHILD LIFE COVERAGE IN THE ST. PAUL EMERGENCY DEPARTMENT AND THE NUMBER OF PATIENTS SERVED.CHILDREN'S AND PUBLIC HEALTH: PARTNERING TOGETHER TO IMPROVE QUALITY OF LIFE FOR A CHILD WITH ASTHMA ($18,000) - THIS PROGRAM IS A COLLABORATION BETWEEN ST. PAUL-RAMSEY COUNTY PUBLIC HEALTH (SPRCPH) AND CHILDREN'S ASTHMA CLINIC STAFF. THE ASTHMA CLINIC STAFF WILL IDENTIFY CHILDREN LIVING IN RAMSEY COUNTY WITH ASTHMA WHO MAY BENEFIT FROM AN ENVIRONMENTAL CHANGE. THESE PATIENTS WILL BE ASSIGNED AN ENVIRONMENTAL SPECIALIST FROM SPRCPH WHO WILL EVALUATE THE HOME FOR POTENTIAL ASTHMA TRIGGERS. SPECIFIC RECOMMENDATIONS FOR CHANGE WILL BE IDENTIFIED AND THROUGH THE SUPPORT OF STATE GRANT, EACH FAMILY WILL RECEIVE PRODUCTS AND SUPPORT TO HELP REDUCE THE LEVEL OF ALLERGEN EXPOSURE AND ASTHMA TRIGGERS. THE ULTIMATE GOAL IS TO TEACH PATIENTS AND THEIR FAMILIES HOW TO MORE EFFECTIVELY MANAGE THEIR ASTHMA, SO CHILDREN CAN GO TO SCHOOL, BE ACTIVE DURING THE DAY AND SLEEP WELL AT NIGHT.CHILDREN'S HOSPITAL CLINIC OF ST. PAUL ($176,000) - THIS GRANT PROVIDES FINANCIAL SUPPORT FOR THE UNREIMBURSED AND UNDER COMPENSATED COMPREHENSIVE HEALTH CARE THAT IS GIVEN TO THE DISADVANTAGED CHILDREN IN OUR COMMUNITY THAT COME TO THE ST. PAUL CLINIC. WITHOUT THIS PROGRAM, MANY OF THE CHILDREN SEEN AT THE CLINIC WOULD NOT HAVE ACCESS TO REGULAR HEALTH CARE.FIRST STEPS ($30,000) - FIRST STEPS IS A PRIMARY CHILD ABUSE PREVENTION AND SUPPORT PROGRAM FOR TEEN PARENTS WHO GIVE BIRTH AT THE BIRTH CENTER OF UNITED AND CHILDREN'S HOSPITAL. TRAINED COMMUNITY VOLUNTEERS PROVIDE THE SERVICE TO EACH FAMILY, ADDRESSING THE FINANCIAL, SOCIAL AND PARENTING CHALLENGES UNIQUE TO THIS AGE GROUP.IMPLEMENTATION OF A QUALITY IMPROVEMENT INITIATIVE FOR SUBCUTANEOUS INSULIN USE IN CHILDREN WITH MILD DIABETIC KETOACIDOSIS IN THE EMERGENCY DEPARTMENT ($25,000) - THIS PROGRAM WILL STUDY THE TREATMENT GUIDELINES REGARDING USE OF SUBCUTANEOUS INSULIN ADMINISTRATION FOR CHILDREN WITH TYPE 1 DIABETES WHO PRESENT TO THE EMERGENCY DEPARTMENT (ED) WITH MILD DIABETIC KETOACIDOSIS OR HYPERGLYCEMIA WITHOUT ACIDOSIS. CURRENTLY, SOME CHILDREN MAY BE ADMITTED TO THE HOSPITAL WHEN THEY COULD POTENTIALLY BE MANAGED AT HOME. THE DEVELOPMENT OF A CHILDREN'S EMERGENCY DEPARTMENT QUALITY IMPROVEMENT GUIDELINE IS EXPECTED TO LEAD TO THE STANDARDIZATION OF CARE AND MAY RESULT IN DECREASED RESOURCE UTILIZATION, IMPROVED HEALTH CARE OUTCOMES AND REDUCED ECONOMIC BURDEN ON FAMILIES.MCNEELY PEDIATRIC DIABETES TRANSFORMATION PROJECT FROM GALA FUND-A-NEED ($95,508) - THE GOAL OF THIS INNOVATIVE PROGRAM IS TO GIVE CHILDREN WITH TYPE 1 DIABETES THE VERY BEST CARE, AND TO KEEP THEM HEALTHY UNTIL THERE'S A CURE FOR THIS DISEASE. THIS PIONEERING VISION, A COMBINATION OF TECHNOLOGICAL INTERVENTION AND COMMUNITY OUTREACH, WILL CONVERGE AS THE FOUNDATION OF A NEW MODEL FOR PEDIATRIC TYPE 1 DIABETES. THIS MODEL WILL HAVE LIFE CHANGING EFFECTS ON CHILDREN LIVING WITH TYPE 1 DIABETES BOTH IN MINNESOTA AND AROUND THE NATION.MCRC - MIDWEST CHILDREN'S RESOURCE CENTER ($150,000) - THIS GRANT SUBSIDIZES HARDSHIP CASES AND CHARITABLE SERVICES FOR ABUSED CHILDREN. MCRC'S GOAL IS TO DIAGNOSE, TREAT, PROTECT AND PREVENT FUTURE MALTREATMENT OF CHILDREN. AS A CHILD ADVOCACY CENTER AND HOSPITAL-BASED CLINIC, MCRC PROVIDES SPECIALIZED MEDICAL EVALUATIONS AND CASE MANAGEMENT IN ALLEGED CHILD ABUSE CASES, SERIOUS NEGLECT, WITNESS TO VIOLENCE, AND PROVIDES INDIVIDUAL AND GROUP TRAINING TO MEDICAL, LAW ENFORCEMENT, CHILD PROTECTION, AND OTHER PERSONNEL. WITH THE FINANCIAL SUPPORT OF CHA, MCRC WAS ESTABLISHED IN 1986 AND HAS LED THE WAY FOR THE HOSPITAL-BASED INTERDISCIPLINARY APPROACH TO CHILD MALTREATMENT.MENTAL HEALTH SPECIAL NEEDS FUND ($40,000) - THIS FUND ENABLES THE PSYCHOLOGICAL SERVICES DEPARTMENT OF CHILDREN'S, TO WORK WITH FAMILIES HAVING LIMITED RESOURCES FOR MENTAL HEALTH SERVICES FOR THEIR EMOTIONALLY VULNERABLE CHILDREN. IN ADDITION, THIS FUND WILL HELP TO PURCHASE UPDATED TECHNOLOGY TO BETTER ASSIST PATIENTS AND IMPROVE EFFICIENCY AND TESTING RESULT ACCURACY FOR PSYCHOLOGISTS.MUSIC THERAPY PROGRAM ($18,000) - IN A PEDIATRIC HEALTHCARE SETTING, SCIENTIFICALLY BASED THERAPEUTIC MUSICAL INTERVENTIONS ARE PLANNED SPECIFICALLY TO ADDRESS PATIENT NEEDS RELATED TO PAIN MANAGEMENT, PHYSICAL REHABILITATION, RESPIRATION, CARDIAC CONDITIONS, ANXIETY AND MOOD/EMOTIONAL STATES. THIS FUND ALLOWS ADDITIONAL SERVICE HOURS SO A LARGER POPULATION OF CHILDREN AND FAMILIES WILL BENEFIT FROM MUSIC THERAPY AS A TREATMENT PLAN.NAS BUNDLE (NEONATAL ABSTINENCE SYNDROME ($6,000) - NEONATAL ABSTINENCE REFERS TO SYMPTOMS OF WITHDRAWAL THAT BABIES MAY DEVELOP AFTER BIRTH IF THEIR MOTHERS HAVE TAKEN ADDICTIVE MEDICATIONS OR DRUGS DURING PREGNANCY. MANY OF THESE SYMPTOMS CAN BE MINIMIZED BY UTILIZING RESOURCES TO HELP CALM AND SOOTHE THEM. FUNDS FOR THIS PROGRAM WILL BE USED TO PURCHASE SPECIFIC ITEMS THAT HAVE BEEN FOUND TO BE HELPFUL IN THE CARE OF THESE BABIES, AND SENT HOME WITH THE FAMILIES SO THEY CAN USE THE TOOLS THAT HAVE BEEN MODELED DURING HOSPITALIZATION.NICU DEVELOPMENTAL FOLLOW-UP PROGRAM ($3,000) - CHILDREN WHO ARE HOSPITALIZED IN THE NICU ARE AT A GREATER RISK FOR GROWTH, NEUROLOGIC AND DEVELOPMENTAL DELAY. FUNDS FOR THIS PROGRAM WILL BE USED FOR THE PURCHASE OF TWO BAYLEY SCALES OF INFANT DEVELOPMENT. THESE KITS WILL BE USED BY TRAINED REHABILITATION SPECIALIST TO ASSESS DEVELOPMENT IN COGNITION, LANGUAGE AND MOTOR SKILLS, THE PROGRESS OF CHILDREN WHO WERE HOSPITALIZED IN THE NICU WILL BE MONITORED AT REGULAR INTERVALS TO IDENTIFY ISSUES THAT ARISE BEFORE SCHOOL-AGE, SO APPROPRIATE TREATMENT CAN BEGIN AS SOON AS APPROPRIATE.RUNAWAY INTERVENTION PROGRAM ($40,000) - THE GOAL OF THIS PROJECT IS TO REDUCE TRAUMATIC RESPONSES AND IMPROVE THE HEALTH AND COPING OF SEXUALLY EXPLOITED TEENS AND THEIR PARENTS THROUGH DEVELOPMENTALLY APPROPRIATE CASE MANAGEMENT SERVICES BY ADVANCED PRACTICE NURSES WITH SPECIAL TRAINING IN SEXUAL ABUSE. THIS GRANT WILL FUND A COUNSELOR TO PROVIDE MOBILE MENTAL HEALTH CARE TO RUNAWAY AND HOMELESS YOUTH.ADDITIONAL TO EMERGENCY FUND SERVICES FROM GREAT CLIPS GOLF EVENT - $123,825IN ADDITION TO THE PROGRAM PLEDGES, CHA MADE A $100,000 PAYMENT ON THE $500,000 PLEDGE TO THE HOSPITAL'S CHA STORYLAND GARDEN AT THE ST. PAUL CAMPUS. CHA ALSO MADE A $25,000 PAYMENT ON THE $150,000 PLEDGE TO THE NICU MULTIPLES NEIGHBORHOOD AT THE ST. PAUL CAMPUS.

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 expenses968,629

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	0	0	0

(A) Name and business address	(B) Description of services	(C) Compensation





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 0

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c	331,625
d	Related organizations		1d
e	Government grants (contributions)		1e

f	All other contributions, gifts, grants, and similar amounts not included above		1f	611,191

g	Noncash contributions included in lines 1a-1f:$ 120,899
h Total.Add lines 1a-1f.......		942,816

			Business Code
2a	MEMBERSHIP DUES	900099	9,075	9,075
b
c
d
e
f	All other program service revenue.
g Total.Add lines 2a–2f.....			9,075

3 Investment income (including dividends, interest, and othersimilar amounts) ..........			143,881			143,881
4 Income from investment of tax-exempt bond proceeds
5 Royalties...........
		(ii) Personal	(i) Real
6a	Gross rents
b	Less: rental expenses
c	Rental income or (loss)
d	Net rental income or (loss)......
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory		513,565
b	Less: cost or other basis and sales expenses		530,714
c	Gain or (loss)		-17,149
d	Net gain or (loss).....			-17,149			-17,149
8a	Gross income from fundraising events (not including $ 331,625of contributions reported on line 1c). See Part IV, line 18 ....
	a		243,450
b	Less: direct expenses ...b		276,205
c	Net income or (loss) from fundraising events..			-32,755			-32,755
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..
10a	Gross sales of inventory, less returns and allowances ..
	a		127,596
b	Less: cost of goods sold ..b		112,446
c	Net income or (loss) from sales of inventory..			15,150			15,150
Business Code			Miscellaneous Revenue
11a	VENDING MACHINE		900099	18,622			18,622
b	MISCELLANEOUS REVENUE		900099	13,759			13,759
c
d	All other revenue ....
e	Total. Add lines 11a–11d ......			32,381
12	Total revenue. See Instructions......			1,093,399	9,075	0	141,508

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21	966,515	966,515
2	Grants and other assistance to individuals in the United States. See Part IV, line 22
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 ....
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	85,207	1,704	73,278	10,225
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....
9	Other employee benefits .......	13,957	279	12,003	1,675
10	Payroll taxes ...........	6,548	131	5,631	786
11	Fees for services (non-employees):
a	Management ......	62,991		62,991
b	Legal .........
c	Accounting ...........	13,715		13,715
d	Lobbying ...........
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)
12	Advertising and promotion ....	69,659		7,586	62,073
13	Office expenses .......	5,850		5,490	360
14	Information technology ......	2,586		2,586
15	Royalties ..
16	Occupancy ...........
17	Travel ............
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .
19	Conferences, conventions, and meetings ....	7,598		7,598
20	Interest ...........
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization ..	1,025		1,025
23	Insurance ...	1,071		1,071
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
b
c
d
e	All other expenses
25	Total functional expenses. Add lines 1 through 24e	1,236,722	968,629	192,974	75,119
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 if following SOP 98-2 (ASC 958-720).

1	Cash–non-interest-bearing ........			358,575	1	325,541
2	Savings and temporary cash investments .........				2
3	Pledges and grants receivable, net ......			7,750	3	9,442
4	Accounts receivable, net .............			3,257	4	15,109
5	Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of Schedule L
					5
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L
					6
7	Notes and loans receivable, net ....				7
8	Inventories for sale or use ........			12,092	8	19,151
9	Prepaid expenses and deferred charges ......			2,200	9	1,200
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	7,696
b	Less: accumulated depreciation	10b	6,917	1,090	10c	779
11	Investments—publicly traded securities .			3,117,088	11	2,727,651
12	Investments—other securities. See Part IV, line 11 .....				12
13	Investments—program-related. See Part IV, line 11 ..				13
14	Intangible assets ...............				14
15	Other assets. See Part IV, line 11 ...........			900,684	15	824,562
16	Total assets. Add lines 1 through 15 (must equal line 34)...			4,402,736	16	3,923,435

17	Accounts payable and accrued expenses .....	33,973	17	33,044
18	Grants payable ...	1,005,505	18	936,687
19	Deferred revenue .........		19
20	Tax-exempt bond liabilities .........		20
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		25
26	Total liabilities. Add lines 17 through 25..	1,039,478	26	969,731

	Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets	1,936,292	27	1,638,777
28	Temporarily restricted net assets ...........	214,592	28	177,065
29	Permanently restricted net assets	1,212,374	29	1,137,862
	Organizations that do not follow SFAS 117 (ASC 958), check here 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 ...........	3,363,258	33	2,953,704
34	Total liabilities and net assets/fund balances ........	4,402,736	34	3,923,435