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.") .... | 13,737,614 | 9,640,829 | 15,174,469 | 17,713,906 | 18,880,744 | 75,147,562 |
| 2 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf....... | 0 | |||||
| 3 | The value of services or facilities furnished by a governmental unit to the organization without charge.. | 0 | |||||
| 4 | Total. Add lines 1 through 3 | 13,737,614 | 9,640,829 | 15,174,469 | 17,713,906 | 18,880,744 | 75,147,562 |
| 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).. | 13,823,644 | |||||
| 6 | Public support. Subtract line 5 from line 4. | 61,323,918 | |||||
Calendar year
(or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | 13,737,614 | 9,640,829 | 15,174,469 | 17,713,906 | 18,880,744 | 75,147,562 |
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources... | 450,513 | 510,491 | 272,691 | 352,207 | 296,429 | 1,882,331 |
| 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.).. | 144,758 | 262,816 | 137,524 | 193,332 | 194,169 | 932,599 |
| 11 | Total support Add lines 7 through 10. | 77,962,492 | |||||
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 |
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|
2
Underdistributions, if any, for years prior to 2014 (reasonable cause required--see instructions) |
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| 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) |
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|
6
Remaining underdistributions for 2014. Subtract lines 3h and 4b from line 1 (if amount greater than zero, see instructions) |
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|
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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| Software ID: | |
| Software Version: |
Attach to Form 990 or 990-EZ.
Information about Schedule O (Form 990 or 990-EZ) and its instructions is at| Return Reference | Explanation |
|---|---|
| PROGRAM SERVICES | FORM 990, PART III, LINE 4A DOERNBECHER CHILDREN'S HOSPITAL FOUNDATION IS A 501(C)(3) ORGANIZATION THAT EXISTS TO SOLICIT PRIVATE PHILANTHROPIC SUPPORT FOR OHSU DOERNBECHER CHILDREN'S HOSPITAL AND TO INVEST AND MANAGE GIFTS TO HONOR DONORS' WISHES. EACH YEAR THE COMMITMENT AND GENEROSITY OF THOUSANDS OF DONORS - INDIVIDUALS, COMPANIES, FOUNDATIONS AND ORGANIZATIONS - HELPS PROVIDE INNOVATIVE HEALTH CARE, EDUCATE TOMORROW'S PEDIATRIC EXPERTS, AND SUPPORT PIONEERING RESEARCH TO BENEFIT CHILDREN IN OREGON, SOUTHWEST WASHINGTON AND BEYOND. IN FY14-15 THE DOERNBECHER FOUNDATION TRANSFERRED MORE THAN $10.1 MILLION IN PROGRAM SUPPORT TO THE HEALING, DISCOVERY, TEACHING AND OUTREACH MISSIONS OF DOERNBECHER CHILDREN'S HOSPITAL. AMONG OTHER ACCOMPLISHMENTS DURING THE 2014-2015 FISCAL YEAR: 1) DOERNBECHER RECEIVED A $4 MILLION GIFT FROM THE CAMBIA HEALTH FOUNDATION TO BENEFIT THE OHSU DOERNBECHER CHILDREN'S HOSPITAL BRIDGES PALLIATIVE CARE PROGRAM. 2) THE 12TH DOERNBECHER FREESTYLE RAISED $2.4 MILLION FOR THE AREA OF GREATEST NEED AT THE HOSPITAL. TO DATE, THIS UNIQUE PARTNERSHIP HAS RAISED NEARLY $14 MILLION. 3) THE 2014 HEART OF DOERNBECHER AUCTION RAISED MORE THAN $1 MILLION TO SUPPORT PEDIATRIC CANCER PROGRAMS. 4) AS A PROUD MEMBER OF CHILDREN'S MIRACLE NETWORK HOSPITALS, DURING FY15, DOERNBECHER RAISED MORE THAN $2 MILLION THROUGH OUR CORPORATE SPONSORS: COSTCO, CREDIT UNIONS FOR KIDS, WALMART, RITE AID AND FROM THE 15TH ANNUAL 99.5 THE WOLF'S HUNT FOR A CURE RADIOTHON. 5) THE FIVE FRIENDS OF DOERNBECHER CHAPTERS, WHICH INCLUDE CLOSE TO 150 MEMBERS, AWARDED GRANTS TOTALING $175,000 TO FIVE DOERNBECHER SCIENTISTS AND PHYSICIANS. THE REMAINING FUNDS RAISED BY THE CHAPTERS AND THE CARDS FOR KIDS PROGRAM SUPPORTED PEDIATRIC CANCER PROGRAMS. 6) THE KIDS MAKING MIRACLES (KMM) PROGRAM RAISED OVER $400,000 THIS YEAR THROUGH THE EFFORTS OF 65 SCHOOLS AND THOUSANDS OF STUDENTS ACROSS OREGON AND SOUTHWEST WASHINGTON. |
| FORM 990 REVIEW PROCESS | Form 990 Part VI Line 11b THE VP - CHIEF FINANCIAL STRATEGIST AND THE CONTROLLER REVIEW THE DRAFT FORM 990, WHICH IS PREPARED BY AN OUTSIDE ACCOUNTING FIRM FROM WORK PAPERS PREPARED BY FOUNDATION STAFF. THE FORM 990 IS THEN PROVIDED TO THE FOUNDATION FINANCE AND AUDIT COMMITTEE. THE FINANCE AND AUDIT COMMITTEE REVIEWS AND APPROVES THE DRAFT FORM. THE FORM 990 IS PROVIDED TO THE ENTIRE BOARD OF DIRECTORS. THE VP - CHIEF FINANCIAL STRATEGIST REVIEWS AND SIGNS THE RETURN BEFORE IT IS FILED. TO PROTECT THE PRIVACY OF OUR DONORS, SCHEDULE B IS REDACTED FROM THE DRAFT 990 THAT WAS REVIEWED BY THE FINANCE AND AUDIT COMMITTEE AND PROVIDED TO THE BOARD OF DIRECTORS. |
| EXPLANATION OF MONITORING AND ENFORCEMENT OF CONFLICTS | Form 990 Part VI Line 12c AN ANNUAL CONFLICT OF INTEREST QUESTIONNAIRE AND STATEMENT ARE PROVIDED TO EACH COVERED PERSON TO DISCLOSE ANY INTERESTS THAT COULD GIVE RISE TO CONFLICTS OF INTEREST. COVERED PERSONS INCLUDE ANY CURRENT AND FORMER OFFICER, DIRECTOR, MEMBER OF A COMMITTEE WITH BOARD DELEGATED POWERS, HIGHEST COMPENSATED EMPLOYEES, OR KEY EMPLOYEE, ANY OF WHOM HELD THE NAMED POSITION WITHIN FIVE YEARS FROM DATE THE POSITION TERMINATED. EACH RESPONDENT IS ASKED TO SIGN A DISCLOSURE STATEMENT WHICH AFFIRMS THAT THEY HAVE RECEIVED A COPY OF THE POLICY, HAVE READ AND UNDERSTAND THE POLICY, HAVE AGREED TO COMPLY WITH THE POLICY, AND HAVE RESPONDED TO THE QUESTIONNAIRE TO THE BEST OF THEIR ABILITY. THE COMPLETED QUESTIONNAIRE WILL BE PROVIDED TO THE EXECUTIVE COMMITTEE PRIOR TO JUNE 30 OF EACH YEAR. AFTER REVIEWING THE DISCLOSURE STATEMENTS AS WELL AS ANY OTHER POTENTIAL OR REAL CONFLICTS OF INTEREST THAT ARE IDENTIFIED, THE EXECUTIVE COMMITTEE SHALL NOTIFY THE OHSU FOUNDATION VICE PRESIDENT - CHIEF FINANCIAL STRATEGIST OF ANY POSITIVE RESPONSES TO ANY QUESTIONS ON THE DISCLOSURE STATEMENT; AND WILL FOLLOW UP WITH RESPECT TO ANY OTHER DISCLOSURES THAT INDICATE AN ACTUAL OR POTENTIAL CONFLICT OF INTEREST. THIS MAY INCLUDE, BUT NOT LIMITED TO, ASKING THE PERSON NOT TO PARTICIPATE IN RELATED DECISIONS OR RECOMMENDING APPROPRIATE DISCIPLINARY AND CORRECTIVE ACTION TO THE FOUNDATION EXECUTIVE DIRECTOR AND/OR THE PRESIDENT OF THE BOARD OF DIRECTORS FOR THE DOERNBECHER FOUNDATION. AS POTENTIAL CONFLICTS OF INTEREST ARE IDENTIFIED THROUGHOUT THE COURSE OF A YEAR, EACH RESPONDENT HAS AN OBLIGATION TO ADVISE THE EXECUTIVE COMMITTEE IN WRITING OF THE EXISTENCE OF ANY SUCH REAL OR POTENTIAL CONFLICT OF INTEREST. A RESPONDENT MAY MAKE A PRESENTATION AT THE EXECUTIVE COMMITTEE MEETING, BUT AFTER SUCH PRESENTATION, HE OR SHE SHALL LEAVE THE MEETING DURING THE DISCUSSION OF, AND THE VOTE ON, THE TRANSACTION OR ARRANGEMENT THAT CREATES THE ACTUAL OR POTENTIAL CONFLICT OF INTEREST. THE EXECUTIVE COMMITTEE SHALL DETERMINE TO ITS SATISFACTION WHETHER THE FOUNDATION CAN OBTAIN A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT WITH REASONABLE EFFORTS FROM A PERSON OR ENTITY THAT WOULD NOT GIVE RISE TO AN ACTUAL OR POTENTIAL CONFLICT OF INTEREST. IF A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT IS NOT REASONABLY ATTAINABLE UNDER CIRCUMSTANCES THAT WOULD NOT GIVE RISE TO AN ACTUAL OR POTENTIAL CONFLICT OF INTEREST, THE EXECUTIVE COMMITTEE SHALL DETERMINE BY A MAJORITY VOTE OF THE DISINTERESTED COMMITTEE MEMBERS WHETHER THE TRANSACTION OR ARRANGEMENT IS IN THE FOUNDATION'S BEST INTEREST AND WHETHER THE TRANSACTION IS FAIR TO THE FOUNDATION, AND SHALL MAKE ITS DECISION AS TO WHETHER TO ENTER INTO THE TRANSACTION OR ARRANGEMENT. THE EXECUTIVE COMMITTEE WILL INFORM THE RESPONDENT, IN WRITING, OF ITS DECISION. IF THE EXECUTIVE COMMITTEE HAS REASONABLE CAUSE TO BELIEVE THAT A RESPONDENT HAS FAILED TO DISCLOSE AN ACTUAL OR POSSIBLE CONFLICT OF INTEREST, IT SHALL INFORM THE RESPONDENT OF THE BASIS FOR SUCH BELIEF AND AFFORD THE RESPONDENT AN OPPORTUNITY TO EXPLAIN THE ALLEGED FAILURE TO DISCLOSE. IF, AFTER HEARING THE RESPONSE OF THE RESPONDENT AND MAKING FURTHER INVESTIGATION AS MAY BE WARRANTED IN THE CIRCUMSTANCES, THE EXECUTIVE COMMITTEE DETERMINES THAT THE RESPONDENT HAS IN FACT FAILED TO DISCLOSE AN ACTUAL OR POSSIBLE CONFLICT OF INTEREST, IT SHALL RECOMMEND APPROPRIATE DISCIPLINARY AND CORRECTIVE ACTION TO THE FOUNDATION EXECUTIVE DIRECTOR AND/OR THE PRESIDENT OF THE BOARD OF DIRECTORS FOR THE DOERNBECHER FOUNDATION. |
| OTHER ORGANIZATION DOCUMENTS PUBLICLY AVAILABLE | Form 990 Part VI Line 19 WHILE FEDERAL TAX LAWS DO NOT MANDATE THAT THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS BE MADE AVAILABLE FOR PUBLIC INSPECTIONS, LIMITED INFORMATION ON THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS IS AVAILABLE AT THE ORGANIZATION'S WEBSITE. THIS INFORMATION IS NOT READILY AVAILABLE FOR THE GENERAL PUBLIC AND REQUESTS FOR THIS INFORMATION ARE ASSESSED ON A CASE BY CASE BASIS BY THE RELEVANT FOUNDATION EMPLOYEE BEFORE DISCLOSURE. |
| OTHER CHANGES IN NET ASSETS | Form 990 Part XI Line 9 CHANGE IN VALUE OF LIFE INCOME AGREEMENTS $113,456 ------------- TOTAL $113,456 |
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