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 (see instructions)) | (iv) Is the organization listed in your governing document? | (v) Amount of monetary support (see instructions) | (vi) Amount of other support (see instructions) | |
|---|---|---|---|---|---|---|
| Yes | No | |||||
| (A)
CHILDREN'S HEALTH SYSTEM INC |
541278830 | 3 | No | 0 | 0 | |
| (B)
CHILDREN'S HOSPITAL OF THE KING'S DAUGHTERS |
540506321 | 3 | No | 65,575 | 0 | |
| (C)
EASTERN VIRGINIA MEDICAL SCHOOL |
546055378 | 2 | No | 662,678 | 0 | |
| (D)
EDMARC |
541092904 | 7 | No | 62,500 | 0 | |
| (E)
OLD DOMINION UNIVERSITY RESEARCH FOUNDATION |
546068198 | 2 | No | 2,950 | 0 | |
| (F)
CHILDREN'S SURGICAL SPECIALTY GROUP INC FBO CHKD |
311610834 | 3 | No | 36,993 | 0 | |
| (G)
CHILDREN'S SPECIALTY GROUP PLLC FBO CHKD |
541871633 | 3 | No | 38,327 | 0 | |
| Total 7 | 869,023 | 0 | ||||
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 | 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) 2011 | (b) 2012 | (c) 2013 | (d) 2014 | (e) 2015 | (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) 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.) | ||||||
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.).. | ||||||
| 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 | ||||
| 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....... | ||||
| Facts And Circumstances Test |
|---|
| Return Reference | Explanation |
|---|---|
| Part IV, Section A, Line 1 | SINCE ITS CREATION IN 1984, THE ORGANIZATION, HAS HAD A CLOSE AND CONTINUING HISTORICAL RELATIONSHIP WITH THE HOSPITAL and its affiliates TO PROVIDE SUPPORT TO THE HOSPITAL AND ITS AFFILIATEs, carrying out activities for the benefit of the hospital in support of furthering its tax exempt purposes. |
| Part IV, Section A, Line 2 | THE FOUNDATION PROVIDED SUPPORT TO ORGANIZATIONS THAT PROMOTE THE HEALTH OF CHILDREN THAT MAY BE OPERATED, SUPERVISED OR CONTROLLED BY OR IN CONNECTION with THE HEALTH SYSTEM PARENT, SO LONG AS SUCH ORGANIZATIONS ARE DESCRIBED IN SECTION 501(C)(3) AND SECTION 509(A)(1) OR SECTION 509(A)(2), and other organizations for the benefit of its supported organizations tax exempt purpose. |
| Part IV, Section A, Line 6 | The organization occasionally provides support for the benefit of the hospital through the hospital's affiliates and other organizations. |
| Part IV, Section B, Line 1 | THE ORGANIZATION'S MEMBER IS THE SYSTEM PARENT. Pursuant to the hospital's bylaws and as permitted by Virginia Code Section 13.1-852.1 the hospital is managed by its sole member, the health system parent with the power to appoint and remove a majority of the board. THEREFORE, THE HOSPITAL BOARD EFFECTIVELY APPOINTS THE MAJORITY BOARD OF THE ORGANIZATION. |
| Part IV, Section B, Line 2 | ON OCCASION THE HOSPITAL CARRIES OUT ITS EXEMPT PURPOSE BY MAKING GRANTS TO 501(C)(3) and other ORGANIZATIONS FOR THE BENEFIT OF HOSPITAL'S CHARITABLE CLASS. IF THE HOSPITAL DIRECTS THE ORGANIZATION TO DO SO, THEN THE ORGANIZATION WILL MAKE SUCH GRANTS, PROVIDED THAT THE GRANT ACCOMPLISHES THE TAX-EXEMPT PURPOSES OF THE HOSPITAL. For administrative convenience, the organization may make grants directly to 501 (C)(3) and other organizations. |
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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 |
|---|---|
| organization's mission: | FORM 990 PART I LINE 1 THE FOUNDATION SUPPORTS CHILDREN'S HEALTH SYSTEM (CHS) AND CHILDREN'S HOSPITAL OF THE KING'S DAUGHTERS (CHKD) BY MANAGING ASSETS FOR CHKD AND PROVIDING FUNDS FOR HOSPITAL PROGRAMS, EQUIPMENT AND RESEARCH. GOVERNING BODY & MANAGEMENT ITEMS PART VI, SECTION A QUESTIONS 6, 7A & 7B Line 6 Children's Health Foundation, Inc. is a Virginia non-stock corporation and has a sole member. The sole member of Children's Health Foundation, Inc. is Children's Health System, Inc., a Virginia non-stock not-for-profit corporation. Line 7a Children's Health System, Inc., the sole member of Children's Health Foundation, Inc., elects the directors who serve on the Board of Directors of Children's Health Foundation, Inc. Line 7b The following decisions of the Board of Directors of Children's Health Foundation, Inc. are subject to approval by its sole member, Children's Health System, Inc.: 1) amendments to the Articles of Incorporation and Bylaws of the corporation; 2) annual capital and operating budgets; 3) the undertaking of unbudgeted operating expenditures, capital expenditures, borrowing of funds, lending of funds, and real property leases in excess of certain amounts, 4) creating any lien, mortgage, or other security interest in real property belonging to the corporation; 5) creation, reorganization or dissolution of a subsidiary corporation; 6) certain gifts, donations, or other transfers of assets or funds; 7) the selection of independent auditors and legal counsel; 8) general investment policies of the corporation; and 9) the adoption, alteration, amendment, or repeal of a capital plan, strategic plan or long-range plan. Part VI B, LINE 11 The 990 is prepared using the annual financial statements that are reviewed by the board and audited annually as a part of the consolidated financial statements of Children's Health System, Inc. Upon completion of the draft of the return, a detail review is performed by several members of staff and management. Prior to filing with the IRS, the board is provided a copy to review. |
| POLICIES & DISCLOSURE ITEMS | Part VI B, Line 12 Conflict Policy Considerations CHF CONFLICT OF INTEREST POLICY INCLUDES OFFICERS, MEMBERS OF THE BOARD OF DIRECTORS AND BOARD COMMITTEES, KEY EMPLOYEES, ALL OTHER EMPLOYEES, PROFESSIONAL STAFF AND SUBSTANTIAL DONORS. ANNUALLY, A QUESTIONNAIRE IS DISTRIBUTED AND COLLECTED FROM OFFICERS, MEMBERS OF THE BOARD OF DIRECTORS AND BOARD COMMITTEES AND KEY EMPLOYEES. RESPONSES TO THE QUESTIONNAIRES ARE REVIEWED BY THE LEGAL AND FINANCE DEPARTMENTS. FOR KNOWN CONFLICTS, THE PERSON INVOLVED RECUSES HIMSELF OR HERSELF FROM DELIBERATIONS REGARDING THE TRANSACTION. VIOLATIONS OF THE CONFLICTS OF INTEREST POLICY ARE REPORTED TO THE CHF BOARD CHAIR OR THE CHF COMPLIANCE OFFICER, AS APPLICABLE, AND MAY REQUIRE CORRECTIVE ACTION UP TO AND INCLUDING TERMINATION OF EMPLOYMENT. PART VI B, LINE 15 COMPENSATION PROCESS CONSIDERATIONS AN INDEPENDENT COMPENSATION CONSULTANT APPROVED AND RETAINED BY THE COMPENSATION COMMITTEE OF THE BOARD ANNUALLY, USUALLY IN APRIL, PROVIDES EDUCATION AND PRESENTS TO THE FULL BOARD COMPARATIVE SALARIES AND SALARY RANGES FROM A DATA BASE COMPRISED OF CHILDREN'S HOSPITALS AND OTHER APPLICABLE HOSPITALS FOR OFFICERS & EXECUTIVES FOR THE BOARD TO REVIEW. THE COMPENSATION COMMITTEE WITH THE AID OF THE CONSULTANT REVIEWS AND MAKES DECISIONS AS TO EXECUTIVE SALARIES OF CHS AND ITS SUBSIDIARIES. THOSE SALARY CHANGES AND APPROVALS ARE DOCUMENTED BY MINUTES MAINTAINED BY THE COMPENSATION COMMITTEE AND SIGNED BY THE CHAIRMAN OF THE BOARD. |
| PART VI, LINE 19 | FINANCIAL STATEMENTS (PART OF THE CONSOLIDATED FINANCIAL STATEMENTS OF CHILDREN'S HEALTH SYSTEM, INC.) ALONG WITH GOVERNING DOCUMENTS OF THE ORGANIZATION INCLUDING THE CONFLICT OF INTEREST POLICY ARE AVAILABLE TO THE PUBLIC THROUGH DIRECT INQUIRY AND REQUEST. |
| Reconciliation of Net Assets | OTHER CHANGES IN NET ASSETS CONSIST OF $4,300 IN DONATED SERVICES. |
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