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 | |||||
| Total | ||||||
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. |
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| 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 |
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| Return Reference | Explanation |
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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 |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 1 | THE EXECUTIVE COMMITTEE CONSISTS OF THE CHAIRMAN OF THE BOARD OF DIRECTORS, WHO ALSO SERVES AS CHAIRMAN OF THE EXECUTIVE COMMITTEE, THE VICE CHAIRMAN, THE SECRETARY, THE TREASURER, THE IMMEDIATE PAST CHAIRMAN, THE CHAIRMAN OF THE SERVICES & QUALITY COMMITTEE, THE VICE-CHAIRMAN OF THE BOARD OF DIRECTORS OF ARKANSAS CHILDREN'S HOSPITAL FOUNDATION, INC., THE CHAIRMAN OF THE BOARD OF DIRECTORS OF ARKANSAS CHILDREN'S RESEARCH INSTITUTE, INC., AND THREE AT-LARGE MEMBERS OF THE BOARD OF DIRECTORS ELECTED BY THE BOARD AT ITS ANNUAL MEETING. THE THREE AT-LARGE MEMBERS ARE ELECTED TO A TWO-YEAR TERM. THE ACH CHIEF MEDICAL OFFICER, THE ACH CHIEF OF STAFF, THE UAMS CHAIRMAN OF THE DEPARTMENT OF PEDIATRICS, AND THE ACH PRESIDENT/CHIEF EXECUTIVE OFFICER ARE ALSO EX-OFFICIO MEMBERS OF THE EXECUTIVE COMMITTEE WITHOUT VOTE. THE EXECUTIVE COMMITTEE HAS THE POWER TO TRANSACT ALL REGULAR BUSINESS OF THE HOSPITAL DURING THE PERIOD BETWEEN THE MEETINGS OF THE BOARD, SUBJECT TO ANY PRIOR LIMITATIONS IMPOSED BY THE BOARD AND WITH THE UNDERSTANDING THAT ALL MATTERS OF MAJOR IMPORTANCE WILL BE REFERRED TO THE BOARD OF DIRECTORS. THE EXECUTIVE COMMITTEE REVIEWS THE BUDGET PREPARED BY THE FINANCE COMMITTEE AND SUBMITS IT TO THE BOARD WITH THE EXECUTIVE COMMITTEE'S RECOMMENDATION AT THE LAST MEETING BEFORE THE END OF THE FISCAL YEAR. THE EXECUTIVE COMMITTEE RECEIVES A MONTHLY REPORT FROM THE FINANCE COMMITTEE CHAIRMAN RELATING TO THE MONTHLY FINANCIAL REPORTS. THE EXECUTIVE COMMITTEE HAS FINAL OVERSIGHT OF LONG RANGE PLANNING ACTIVITIES AND IS ALSO RESPONSIBLE FOR REVIEWING LEGAL ACTIVITIES INVOLVING THE HOSPITAL. MINUTES OF THE EXECUTIVE COMMITTEE MEETINGS ARE SUBMITTED TO THE BOARD, AND ITS ACTIONS ARE SUBJECT TO APPROVAL OR DISAPPROVAL AS SOON AS PRACTICAL AT A REGULAR BOARD MEETING. FORM 990, PART VI, SECTION A, LINE 2: ALTHOUGH NOT CONSIDERED COVERED RELATIONSHIPS AS NOTED IN PART VI, SECTION A, LINE 2, THE FOLLOWING DIRECTORS WERE ALL EMPLOYEES OF THE UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCES (UAMS) DURING THE TAX YEAR: JAYANT DESHPANDE, M.D., RICK JACKSON, M.D., RICHARD JACOBS, M.D., AND DANIEL RAHN, M.D. |
| FORM 990, PART VI, SECTION A, LINE 2 | JOHN BALE IS AN ELECTED MEMBER OF THE ACH BOARD OF DIRECTORS. HIS WIFE, SHARON BALE, IS THE PRESIDENT OF THE ACH AUXILIARY BOARD AND IN THAT ROLE IS A DESIGNATED MEMBER OF THE ACH BOARD OF DIRECTORS. |
| FORM 990, PART VI, SECTION A, LINE 3 | THE HOSPITAL'S SVP/CHIEF QUALITY AND CHIEF MEDICAL OFFICER POSITION IS HELD BY DR. JAY DESHPANDE WHO HOLDS FACULTY APPOINTMENTS IN THE UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCES, COLLEGE OF MEDICINE DEPARTMENTS OF PEDIATRICS AND ANESTHESIOLOGY. AS HE IS A UAMS EMPLOYEE, THE HOSPITAL REIMBURSES UAMS FOR HIS ROLE, WHICH IS TO HELP BROADEN AND STRENGTHEN THE HOSPITAL'S QUALITY EFFORTS AND OVERALL QUALITY PROGRAM FOR PATIENT CARE. |
| FORM 990, PART VI, SECTION A, LINE 4 | THE GOVERNING DOCUMENTS WERE CHANGED DURING FY15 TO CLARIFY LANGUAGE, TO STREAMLINE THE ANNUAL BOARD OF DIRECTORS APPOINTMENTS/ELECTIONS, AND TO ADD AND CHANGE SOME DEFINITIONS: - ELIMINATED THE REFERENCE TO PSYCHIATRIC ADMISSIONS IN THE "PURPOSE" SECTION, DUE TO THE FACT THAT ACH NO LONGER HAS AN INPATIENT PSYCHIATRY UNIT. - CLARIFIED THE "ELECTED DIRECTORS" SECTION TO ELIMINATE THE NEED TO REAFFIRM ALL DIRECTORS ON AN ANNUAL BASIS. - MODIFIED THE "EXECUTIVE COMMITTEE" SECTION TO INCLUDE THE CHAIRMAN OF THE SERVICES & QUALITY COMMITTEE AND TO DEFINE THE TERMS OF THE THREE AT-LARGE MEMBERS OF THE EXECUTIVE COMMITTEE TO BE TWO YEARS. IN ADDITION, A MODIFICATION WAS MADE TO CHANGE THE TITLE OF "MEDICAL DIRECTOR" TO "ACH CHIEF MEDICAL OFFICER". |
| FORM 990, PART VI, SECTION B, LINE 11 | HOSPITAL MANAGEMENT REVIEWS THE DRAFT FORM 990 AND RECONCILES IT TO THE HOSPITAL'S INTERNAL FINANCIALS AND CONSOLIDATED AUDIT REPORT. THE REVIEWED DRAFT OF THE FORM 990 IS PRESENTED TO THE FINANCE COMMITTEE BY HOSPITAL MANAGEMENT. IF THE REVIEW BY THE COMMITTEE RESULTS IN REVISIONS TO THE FORM 990, THOSE REVISIONS ARE MADE. THE FORM 990 TO BE FILED IS THEN PROVIDED TO THE ENTIRE BOARD PRIOR TO FILING. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE HOSPITAL HAS A BOARD OF DIRECTORS CONFLICT OF INTEREST POLICY THAT IS REVIEWED WITH ALL NEW BOARD MEMBERS DURING THEIR BOARD ORIENTATION. IN ADDITION, PERIODICALLY EXTERNAL COUNSEL WILL REVIEW THE POLICY WITH THE FULL BOARD DURING A REGULAR BOARD MEETING. ANNUAL DISCLOSURE OF POTENTIAL CONFLICTS OR AFFIRMATIVE CONFIRMATION THAT NONE EXIST IS REQUIRED OF ALL BOARD MEMBERS. THE ANNUAL DISCLOSURES ARE REVIEWED AND APPROVED BY A MAJORITY OF THE DISINTERESTED DIRECTORS ON THE EXECUTIVE COMMITTEE. ALL CONFLICT DISCLOSURES ARE THEN COMPILED AND LISTED IN THE BOARD BOOK AT THE NEXT REGULARLY SCHEDULED MEETING. DETERMINATION OF WHETHER A LISTED CONFLICT IS MATERIAL IS DETERMINED BY THE CORPORATE COMPLIANCE OFFICER, WITH ADVICE FROM LEGAL COUNSEL IF STILL UNCERTAIN. DURING THE YEAR, WHILE BOARD MEMBERS MAY PARTICIPATE IN INITIAL DISCUSSION, BOARD MEMBERS WHO HAVE A CONFLICT ARE PROHIBITED FROM PARTICIPATING IN DELIBERATIONS AND DECISIONS IN THE RELATED TRANSACTION AND ABSTAIN FROM VOTING, WHICH IS NOTED IN THE MINUTES. |
| FORM 990, PART VI, SECTION B, LINE 15 | COMPENSATION FOR THE ORGANIZATION'S CEO, SENIOR VICE PRESIDENTS, VICE PRESIDENTS, AND KEY EMPLOYEES IS REVIEWED BY THE COMPENSATION COMMITTEE WHICH IS ESTABLISHED THROUGH THE BYLAWS OF ARKANSAS CHILDREN'S HOSPITAL TO DISCHARGE THE DUTY OF THE BOARD IN FULFILLING ITS OVERSIGHT RESPONSIBILITIES FOR DETERMINING THE ADEQUACY AND REASONABLENESS OF THE COMPENSATION PAID THE CEO AND OTHER EMPLOYEES THAT THE COMMITTEE BELIEVES ARE IN A POSITION TO EXERCISE A SUBSTANTIAL INFLUENCE OVER THE AFFAIRS OF THE HOSPITAL. THE COMMITTEE IS COMPOSED OF MEMBERS WHO PERSONALLY RECEIVE NO COMPENSATION, FEES, OR OTHER BENEFITS FROM THE HOSPITAL, RELATED ORGANIZATIONS OR FROM THE UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCES. THE COMMITTEE MAY RELY UPON REASONED WRITTEN OPINIONS OF QUALIFIED LEGAL, ACCOUNTING, VALUATION AND EXECUTIVE COMPENSATION EXPERTS. THE COMMITTEE HAS THE SOLE AUTHORITY TO RETAIN AND TERMINATE ANY SPECIAL ADVISORS USED TO ASSIST IN THE EVALUATION OF COMPENSATION. THE COMMITTEE CONTEMPORANEOUSLY, WITH MAKING ITS DETERMINATION OF REASONABLENESS WITH RESPECT TO THE COMPENSATION OF DISQUALIFIED PERSONS, DOCUMENTS IN A WRITTEN REPORT TO THE EXECUTIVE COMMITTEE AND THE BOARD, THE BASIS FOR ITS DECISION. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE HOSPITAL'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST AS REQUIRED. |
| FORM 990, PART IX, LINE 11G | PHYSICIAN'S REMUNERATION: PROGRAM SERVICE EXPENSES 71,159,650. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 71,159,650. TESTING: PROGRAM SERVICE EXPENSES 3,749,685. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,749,685. OTHER FEES FOR SERVICE: PROGRAM SERVICE EXPENSES 8,807,512. MANAGEMENT AND GENERAL EXPENSES 3,719,117. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 12,526,629. REPAIRS & MAINTENANCE: PROGRAM SERVICE EXPENSES 4,272,760. MANAGEMENT AND GENERAL EXPENSES 1,914,743. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 6,187,503. |
| FORM 990, PART XI, LINE 9: | UNEXPENDED GRANT CARRYOVER ADJUSTMENTS -46,365. |
| FORM 990, PART XII, LINE 2C | THERE WERE NO CHANGES TO THE OVERSIGHT PROCESS OR SELECTION PROCESS OF INDEPENDENT ACCOUNTANTS. |
| FORM 990, PART XII, LINE 3B | THE CONSOLIDATED ORGANIZATION IS REQUIRED TO UNDERGO AN AUDIT AS SET FORTH IN THE SINGLE AUDIT ACT AND OMB CIRCULAR A-133 AND DID UNDERGO THAT REQUIRED AUDIT. |
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