CONVALESCENT HOSPITAL FUND FOR CHILDREN: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization
CONVALESCENT HOSPITAL FUND FOR CHILDREN (EIN 31-0536649)
Tax period
2012-07-01 to 2013-06-30
Filed
2014-05-12
IRS object ID
201431329349300633
Schema version
2012v2.1
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2014-05-12T09:07:33-05:00Timestamp
Tax Period End Date2013-06-30TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN861065772EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1DELOITTE TAX LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1250 EAST FIFTH STREET SUITE 1900AddressLine1
CityCINCINNATICity
StateOHState
ZIP Code45202ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2012-07-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN310536649EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1CONVALESCENT HOSPITAL FOR CHILDREN ANDBusinessNameLine1
Business Name Line2ORPHAN ASYLUMBusinessNameLine2
FieldValueIRS element (for citing)
Name ControlCONVNameControl
Phone5136368778Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line13333 BURNET AVENUEAddressLine1
CityCINCINNATICity
StateOHState
ZIP Code452293039ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameMICHAEL L BAUERName
TitleTREASURERTitle
Phone5136368778Phone
Date Signed2014-05-12DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameJAMES SOWARName
PTINP00529407PTIN
Phone5137847100Phone
FieldValueIRS element (for citing)
Tax Year2012TaxYear
Build TS2015-11-30 17:44:51ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonPHILLIP C LONGNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line13333 BURNET AVENUEAddressLine1
CityCINCINNATICity
StateOHState
ZIP Code452293039ZIPCode
FieldValueIRS element (for citing)
Gross Receipts59500974GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteN/AWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1833YearFormation
State Legal DomicileOHStateLegalDomicile
Activity Or Mission DescriptionSUPPORT ORGANIZATIONS DEDICATED TO TREATMENT & RESEARCH OF DISEASES OR DISORDERS AFFECTING CHILDREN.ActivityOrMissionDescription
Nbr Voting Members Governing Body19NbrVotingMembersGoverningBody
Nbr Independent Voting Members18NbrIndependentVotingMembers
Total Nbr Employees0TotalNbrEmployees
Total Nbr Volunteers18TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year6975ContributionsGrantsPriorYear
Contributions Grants Current Year3559ContributionsGrantsCurrentYear
Program Service Revenue Prior Year0ProgramServiceRevenuePriorYear
Program Service Revenue CY0ProgramServiceRevenueCY
Investment Income Prior Year5800396InvestmentIncomePriorYear
Investment Income Current Year10470496InvestmentIncomeCurrentYear
Other Revenue Prior Year0OtherRevenuePriorYear
Other Revenue Current Year0OtherRevenueCurrentYear
Total Revenue Prior Year5807371TotalRevenuePriorYear
Total Revenue Current Year10474055TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year2831110GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY2920113GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year0SalariesEtcPriorYear
Salaries Etc Current Year0SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year305457OtherExpensePriorYear
Other Expenses Current Year286994OtherExpensesCurrentYear
Total Expenses Prior Year3136567TotalExpensesPriorYear
Total Expenses Current Year3207107TotalExpensesCurrentYear
Revenues Less Expenses Prior Year2670804RevenuesLessExpensesPriorYear
Revenues Less Expenses CY7266948RevenuesLessExpensesCY
Total Assets BOY86881454TotalAssetsBOY
Total Assets EOY100235835TotalAssetsEOY
Total Liabilities BOY225047TotalLiabilitiesBOY
Total Liabilities EOY0TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY86656407NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY100235835NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionTHE PURPOSE OF CONVALESCENT HOSPITAL FOR CHILDREN AND ORPHAN ASYLUM IS TO PROVIDE FINANCIAL SUPPORT TO ORGANIZATIONS LOCATED IN HAMILTON COUNTY, OHIO THAT PARTICIPATE IN THE TREATMENT OF, OR RESEARCH INTO, DISEASES OR DISORDERS AFFECTING CHILDREN.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense2920113Expense
Grants2920113Grants
DescriptionCONVALESCENT HOSPITAL FOR CHILDREN AND ORPHAN ASYLUM ("CHCOA") WAS FORMED FOR THE SOLE PURPOSE OF PROVIDING FINANCIAL SUPPORT TO OTHER PUBLICLY SUPPORTED ORGANIZATIONS LOCATED IN HAMILTON COUNTY, OHIO THAT PARTICIPATE IN THE TREATMENT OF, OR RESEARCH INTO, DISEASES OR DISORDERS AFFECTING CHILDREN. DURING CHCOA'S FISCAL YEAR OF JULY 1, 2012 THROUGH JUNE 30, 2013 (THE YEAR COVERED BY THIS RETURN), CHCOA PROVIDED FINANCIAL SUPPORT AMOUNTING TO $2,920,113 TO CINCINNATI CHILDREN'S HOSPITAL MEDICAL CENTER ("CCHMC"), AN OHIO NOT-FOR-PROFIT PEDIATRIC HOSPITAL LOCATED IN HAMILTON COUNTY, OHIO. SUCH FINANCIAL SUPPORT IS PROVIDED FROM EXPENDABLE INCOME RECEIVED FROM INVESTMENTS OF RESTRICTED AND UNRESTRICTED FUNDS. IT IS THE POLICY OF CHCOA TO INVEST SUCH ASSETS, THEREBY INCREASING FUND PRINCIPAL AND ENHANCING FUTURE EXPENDABLE INCOME.CCHMC UTILIZED THE FINANCIAL SUPPORT FROM CHCOA TO SUPPORT THE OPERATING COSTS OF ITS PEDIATRIC REHABILITATION PROGRAM, DISABILITY SERVICES PROGRAM, ADOLESCENT PSYCHIATRIC SERVICES PROGRAM, SPECIAL NEEDS CHILDREN PROGRAM, PSYCHOLOGY PAIN MANAGEMENT PROGRAM, PSYCHOLOGY ADHERENCE PROGRAM, ADOLESCENT PSYCHOLOGY SERVICES PROGRAM, AND TO SUPPORT THE GENERAL OPERATIONS OF CCHMC.BECAUSE OF THE DIRECT FINANCIAL SUPPORT OF CHCOA TO CCHMC, CCHMC HAS BEEN CONSISTENTLY ABLE TO REINVEST IN ITS PROGRAMS AND MAINTAINS A NATIONAL POSITION AS ONE OF THE PREMIER PEDIATRIC HEALTH CARE PROVIDERS IN THE NATION.IN MAY 2011, CHCOA'S BOARD OF TRUSTEES MADE A REVOCABLE $3,750,000 PLEDGE OF UNRESTRICTED PRINCIPAL TO CCHMC TO PROVIDE CONTINUING CAPITAL AND OPERATING SUPPORT TO "CHANGE THE OUTCOME". THE PLEDGE IS FOR $750,000 A YEAR FOR FIVE YEARS COMMENCING IN FISCAL 2012. ADDITIONALLY, CHCOA'S BOARD OF TRUSTEES MADE A REVOCABLE PLEDGE OF $1,250,000 OF UNRESTRICTED PRINCIPAL TO CCHMC TO PROVIDE SUPPORT FOR THE PERLMAN CENTER EXPANSION. THE PLEDGE IS FOR $250,000 A YEAR FOR FIVE YEARS COMMENCING IN 2012. CHCOA GIFTED $1 MILLION IN FISCAL YEAR 2013 AND FISCAL YEAR 2012, RESPECTIVELY, UNDER THESE PLEDGES.Description
Total Program Service Expense2920113TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required0ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments1TermOrPermanentEndowments
Report Land Bldg Equip0ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities0ReportOtherLiabilities
Report Fin48 Footnote1ReportFin48Footnote
Independent Audit Financial Stmt1IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt0ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital0Hospital
Grants To Organizations1GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With10960NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Number Of Employees0NumberOfEmployees
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members19NbrVotingGoverningBodyMembers
Number Independent Voting Members18NumberIndependentVotingMembers
Family Or Business Relationship1FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders0MembersOrStockholders
Election Of Board Members0ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy0WhistleblowerPolicy
Document Retention Policy0DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1MICHAEL L BAUERBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number5136368778TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line13333 BURNET AVENUEAddressLine1
CityCINCINNATICity
StateOHState
ZIP Code452293039ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (19 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekAverage Hours Per Week RelatedAverageHoursPerWeekRelatedIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficer
ROBERT H ANNING II
TRUSTEE1.000.00X000
C FRANCIS BARRETT
TRUSTEE1.000.00X000
LEE A CARTER
TRUSTEE1.004.00X000
DAVID CROALL
TRUSTEE1.000.00X000
INGRID DAOUD MD
TRUSTEE1.000.00X000
VALLIE GEIER
TRUSTEE1.001.00X000
MARIAN LEIBOLD
TRUSTEE1.000.00X000
DEBBIE LONG
TRUSTEE1.000.00X000
MARIANNE MILLER
TRUSTEE1.000.00X000
SUSAN SHELTON
TRUSTEE1.000.00X000
MARK STEPANIAK
TRUSTEE1.000.00X000
THOMAS WILLIAMS
TRUSTEE1.000.00X000
MARKAY WINSTON PHD
TRUSTEE1.000.00X000
ALISON ZIMMERMAN
TRUSTEE1.000.00X000
PAMELA TERP
CHAIRMAN1.002.00X000X
PHILLIP C LONG
PRESIDENT1.000.00X000X
MARIE HUENEFELD
VICE-PRESIDENT1.000.00X000X
RONALD SALATIN
SECRETARY1.000.00X000X
MICHAEL L BAUER
TREASURER1.0049.00X025914627818X
FieldValueIRS element (for citing)
Total Reportable Comp From Org0TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs259146TotalReportableCompFrmRltdOrgs
Total Other Compensation27818TotalOtherCompensation
Number Individuals GT100 K0NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation

Name Of Contractor NameOfContractor

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1FIFTH THIRD BANKBusinessNameLine1

Address Of Contractor AddressOfContractor

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1FIFTH THIRD CENTERAddressLine1
CityCINCINNATICity
StateOHState
ZIP Code45263ZIPCode
FieldValueIRS element (for citing)
Description Of ServicesINVESTMENT MANAGEMENTDescriptionOfServices
Compensation188296Compensation
FieldValueIRS element (for citing)
Number Of Contractors GT100 K1NumberOfContractorsGT100K
All Other Contributions3559AllOtherContributions
Total Contributions3559TotalContributions

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column2348973TotalRevenueColumn
Exclusion$2,348,973ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities57148442Securities

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities49026919Securities

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities8121523Securities

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column8121523TotalRevenueColumn
Exclusion$8,121,523ExclusionAmount

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column10474055TotalRevenueColumn
Related Or Exempt Function Income0RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$10,470,496ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total2920113Total
Program Services2920113ProgramServices

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total286994Total
Management And General286994ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total3207107Total
Program Services2920113ProgramServices
Management And General286994ManagementAndGeneral
Fundraising0Fundraising

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY1134445BOY
EOY1627889EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY20000BOY
EOY2369824EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY85727009BOY
EOY96238122EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY86881454BOY
EOY100235835EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY225047BOY
EOY0EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY225047BOY
EOY0EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY83109195BOY
EOY96183822EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY3547212BOY
EOY4052013EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY86656407BOY
EOY100235835EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY86881454BOY
EOY100235835EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses7266948ReconcilationRevenueExpenses
Reconciliation Unrealized Invest4081322ReconciliationUnrealizedInvest
Reconcilation Other Changes2231158ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited

FS Audited Basis FSAuditedBasis

FieldValueIRS element (for citing)
Financial Statement SeparateXFinancialStatementSeparate
FieldValueIRS element (for citing)
Audit Committee1AuditCommittee
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Supporting Organization509a3XSupportingOrganization509a3
Supporting Org509a3 Type3 Func IntXSupportingOrg509a3Type3FuncInt
Certification CheckboxXCertificationCheckbox
Contrib By Controlling Individual0ContribByControllingIndividual
Contribution By Related Party0ContributionByRelatedParty
Contrib By35 Controlled Entity0ContribBy35ControlledEntity

Supported Org Information SupportedOrgInformation

Name Name

FieldValueIRS element (for citing)
Business Name Line1CHMCBusinessNameLine1
FieldValueIRS element (for citing)
EIN310833936EIN
Type Of Organization3TypeOfOrganization
Listed In Governing Doc0ListedInGoverningDoc
Supported Organization Notified1SupportedOrganizationNotified
Organized In US1OrganizedInUS
Amount$2,920,113Amount
FieldValueIRS element (for citing)
Total Number Of Supported Orgs1TotalNumberOfSupportedOrgs
Sum Of Amounts2920113SumOfAmounts

Schedule D IRS990ScheduleD

Current Year CurrentYear

FieldValueIRS element (for citing)
Beginning Of Year Balance3547212BeginningOfYearBalance
Investment Earnings Or Losses504801InvestmentEarningsOrLosses
End Of Year Balance4052013EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

FieldValueIRS element (for citing)
Beginning Of Year Balance3454054BeginningOfYearBalance
Investment Earnings Or Losses93158InvestmentEarningsOrLosses
End Of Year Balance3547212EndOfYearBalance

Current Year Minus2 Years CurrentYearMinus2Years

FieldValueIRS element (for citing)
Beginning Of Year Balance2706528BeginningOfYearBalance
Investment Earnings Or Losses747526InvestmentEarningsOrLosses
End Of Year Balance3454054EndOfYearBalance

Current Year Minus3 Years CurrentYearMinus3Years

FieldValueIRS element (for citing)
Beginning Of Year Balance2496544BeginningOfYearBalance
Investment Earnings Or Losses209984InvestmentEarningsOrLosses
End Of Year Balance2706528EndOfYearBalance

Current Year Minus4 Years CurrentYearMinus4Years

FieldValueIRS element (for citing)
Beginning Of Year Balance3353546BeginningOfYearBalance
Investment Earnings Or Losses-857002InvestmentEarningsOrLosses
End Of Year Balance2496544EndOfYearBalance
FieldValueIRS element (for citing)
Permanent Endowment EOY Balance1.00000PermanentEndowmentEOYBalance
Endowments Held By Unrelated Orgs1EndowmentsHeldByUnrelatedOrgs
Endowments Held By Related Orgs0EndowmentsHeldByRelatedOrgs
Total Of Book Value Land Buildings0TotalOfBookValueLandBuildings
Footnote In Part XIIIXFootnoteInPartXIII
Tot Revenue Etc Audited Fincl Stmt14555377TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments4081322NetUnrealizedGainsInvestments
Revenue Not Rptd F9904081322RevenueNotRptdF990
Revenue Subtotal10474055RevenueSubtotal
Revenue Not Rptd On Fin Stmt0RevenueNotRptdOnFinStmt
Total Revenue Per Form99010474055TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt3207107TotExpensesEtcAuditedFinclStmt
Expenses Not Rptd F9900ExpensesNotRptdF990
Expenses Subtotal3207107ExpensesSubtotal
Expenses Not Rptd On Fin Stmt0ExpensesNotRptdOnFinStmt
Total Expenses Per Form9903207107TotalExpensesPerForm990

Form990 Schedule D Part XIII Form990ScheduleDPartXIII (2 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS:PART V, LINE 4:CONVALESCENT HOSPITAL FOR CHILDREN AND ORPHAN ASYLUM'S ("CHCOA") PERMANENTLY RESTRICTED ENDOWMENT FUNDS ARE RESTRICTED BY DONORS TO BE MAINTAINED BY CHCOA IN PERPETUITY. THESE FUNDS ARE INVESTED AND UTILIZED TO GENERATE EXPENDABLE INCOME THAT CHCOA MAY USE TO PROVIDE FINANCIAL SUPPORT TO PUBLICLY SUPPORTED ORGANIZATIONS LOCATED IN HAMILTON COUNTY, OHIO THAT PARTICIPATE IN THE TREATMENT OF, OR RESEARCH INTO, DISEASES OR DISORDERS AFFECTING CHILDREN, ONE OF WHICH IS CINCINNATI CHILDREN'S HOSPITAL MEDICAL CENTER, A SUPPORTED ORGANIZATION OF CHCOA.
DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48:PART X, LINE 2:THE CORPORATION HAS RECEIVED A DETERMINATION FROM THE INTERNAL REVENUE SERVICE THAT IT IS RECOGNIZED AS EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THE CORPORATION FOLLOWS ACCOUNTING STANDARDS CODIFICATION 740 "INCOME TAXES" (ASC 740) RELATED TO THE ACCOUNTING FOR INCOME TAXES. THE FOLLOWING ARE THE TAX YEARS THAT REMAIN SUBJECT TO EXAMINATION BY MAJOR TAX JURISDICTION: FEDERAL 2010 TO 2013 STATE 2010 TO 2013

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records Maintained1RecordsMaintained

Recipient Table RecipientTable

Recipient Name Business RecipientNameBusiness

FieldValueIRS element (for citing)
Business Name Line1CHILDREN'S HOSPITAL MEDICAL CENTERBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line13333 BURNET AVENUEAddressLine1
CityCINCINNATICity
StateOHState
ZIP Code452293039ZIPCode
FieldValueIRS element (for citing)
EIN Of Recipient310833936EINOfRecipient
IRC Section501(C)(3)IRCSection
Amount Of Cash Grant2920113AmountOfCashGrant
Method Of ValuationFAIR MARKET VALUEMethodOfValuation
Purpose Of GrantGENERAL SUPPORTPurposeOfGrant
FieldValueIRS element (for citing)
Total Nbr Of501 C3 And Govt Grants1TotalNbrOf501C3AndGovtGrants
Total Nbr Of Other Organizations0TotalNbrOfOtherOrganizations

Form990 Schedule I Part IV Form990ScheduleIPartIV

FieldValueIRS element (for citing)
IdentifierPROCEDURE FOR MONITORING GRANTS IN THE U.S.:Identifier
Return ReferencePART I, LINE 2:ReturnReference
ExplanationSCHEDULE I, PART I, LINE 2: SCHEDULE I, PART I, LINE 2: CCHMC SENIOR MANAGEMENT SUBMITS A PROPOSAL FOR FUNDING TO THE CHCOA BOARD OF TRUSTEES. THE CHCOA BOARD REVIEWS THE PROPOSAL AND THEN MAKES A DETERMINATION AS TO WHAT RESEARCH, PATIENT CARE, AND FUNDRAISING PROJECTS WILL BE SUPPORTED WITH CHCOA FUNDING. UPON CHCOA BOARD APPROVAL, FUNDS ARE DISTRIBUTED TO CCHMC. CCHMC SENIOR MANAGEMENT PROVIDES PERIODIC UPDATES TO THE CHCOA BOARD OF TRUSTEES THROUGHOUT THE YEAR INDICATING HOW DONATED FUNDS ARE UTILIZED IN FURTHERANCE OF CCHMC'S CHARITABLE PURPOSES.Explanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan0SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII

FieldValueIRS element (for citing)
Name PersonMICHAEL L BAUERNamePerson
TitleTREASURERTitle
Base Compensation Filing Org0BaseCompensationFilingOrg
Comp Based On Related Orgs221086CompBasedOnRelatedOrgs
Bonus Filing Org0BonusFilingOrg
Bonus Related Orgs31008BonusRelatedOrgs
Other Compensation Filing Org0OtherCompensationFilingOrg
Other Compensation Related Orgs7052OtherCompensationRelatedOrgs
Deferred Comp Filing Org0DeferredCompFilingOrg
Deferred Comp Related Orgs1944DeferredCompRelatedOrgs
Nontaxable Benefits Filing Org0NontaxableBenefitsFilingOrg
Nontaxable Benefits Related Orgs25874NontaxableBenefitsRelatedOrgs
Total Compensation Filing Org0TotalCompensationFilingOrg
Total Compensation Related Orgs286964TotalCompensationRelatedOrgs
Comp Report Prior990 Filing Org0CompReportPrior990FilingOrg
Comp Report Prior990 Related Orgs0CompReportPrior990RelatedOrgs

Form990 Schedule J Part III Form990ScheduleJPartIII

FieldValueIRS element (for citing)
IdentifierSUPPLEMENTAL INFORMATIONIdentifier
Return ReferencePART IIIReturnReference
ExplanationCONVALESCENT HOSPITAL FOR CHILDREN AND ORPHAN ASYLUM RELIED ON CINCINNATI CHILDREN'S HOSPITAL MEDICAL CENTER ("CCHMC"), A RELATED ORGANIZATION, TO ESTABLISH THE COMPENSATION OF INDIVIDUALS LISTED ON FORM 990, PART VII. CCHMC USED ONE OR MORE OF THE METHODS DESCRIBED BELOW TO ESTABLISH AN APPROPRIATE LEVEL OF COMPENSATION: COMPENSATION COMMITTEE INDEPENDENT COMPENSATION CONSULTANT FORM 990 OF OTHER ORGANIZATIONS COMPENSATION SURVEY OR STUDY APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE EXPLANATION OF BENEFITS: THE EMPLOYEE BENEFIT PLAN CONTRIBUTION AMOUNTS LISTED ON SCHEDULE J, PART II MAY INCLUDE ONE OR MORE OF THE FOLLOWING BENEFITS PROVIDED BY CCHMC, A RELATED ORGANIZATION OF CHCOA: 1. ELECTIVE EMPLOYEE DEFERRALS UNDER IRC SEC. 403(B) 2. DISCRETIONARY EMPLOYER CONTRIBUTIONS UNDER IRC SEC. 403(B) 3. EMPLOYER CONTRIBUTIONS TO A DEFINED BENEFIT PENSION PLAN UNDER IRC SEC. 401(A) (NOTE: THE SPECIFIC VALUE OF ANY CONTRIBUTIONS MADE BY CCHMC TO THE DEFINED BENEFIT PENSION PLAN ON BEHALF OF INDIVIDUALS LISTED ON SCHEDULE J, PART II IS NOT DETERMINABLE) IN ADDITION TO THE RETIREMENT PLAN CONTRIBUTIONS DISCLOSED ON FORM 990, PART VII AND SCHEDULE J, PART II, THE FOLLOWING NON-TAXABLE EMPLOYEE WELFARE BENEFITS WERE MADE AVAILABLE TO THE EMPLOYED, COMPENSATED OFFICERS AND KEY EMPLOYEES LISTED ON FORM 990, PART VII AND SCHEDULE J, PART II: 1. HEALTH AND DENTAL INSURANCE BENEFITS 2. GROUP LIFE INSURANCE (PORTIONS OF WHICH ARE TAXED) 3. UNEMPLOYMENT BENEFITS 4. DISABILITY BENEFITS THE OFFICERS EMPLOYED BY CCHMC THAT ARE LISTED ON FORM 990, PART VII AND SCHEDULE J, PART II ARE ALSO ELIGIBLE FOR ANY OTHER AVAILABLE EMPLOYEE BENEFITS.Explanation

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (11 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
FORM 990, PART VI, SECTION A, LINE 2C. FRANCIS BARRETT AND MARIAN LEIBOLD HAVE A FAMILY RELATIONSHIP.
FORM 990, PART VI, SECTION A, LINE 2LEE CARTER AND SUSAN SHELTON HAVE A BUSINESS RELATIONSHIP OUTSIDE OF CHCOA.
FORM 990, PART VI, SECTION B, LINE 11THE CONVALESCENT HOSPITAL FOR CHILDREN AND ORPHAN ASYLUM ("CHCOA") FORM 990 IS PREPARED BY SENIOR MANAGEMENT FROM CINCINNATI CHILDREN'S HOSPITAL MEDICAL CENTER ("CCHMC"), A RELATED ORGANIZATION. EXTERNAL TAX CONSULTANTS THEN REVIEW THE FORM 990 FOR COMPLETENESS AND ACCURACY. THE FORM 990 IS THEN MADE AVAILABLE TO ALL CHCOA BOARD MEMBERS IN ADVANCE OF FILING.
FORM 990, PART VI, SECTION B, LINE 12CALL OF CHCOA'S BOARD MEMBERS RECEIVE AN ANNUAL QUESTIONNAIRE REQUESTING INFORMATION REGARDING FAMILY AND BUSINESS RELATIONSHIPS THAT COULD POTENTIALLY RESULT IN A CONFLICT OF INTEREST UNDER CHCOA'S CONFLICT OF INTEREST POLICY. ONCE THE QUESTIONNAIRES HAVE BEEN COMPLETED BY ALL OF CHCOA'S BOARD MEMBERS, THE QUESTIONNAIRES ARE REVIEWED AND IF CHCOA DETERMINES THAT A RELATIONSHIP EXISTS THAT PRESENTS A CONFLICT OF INTEREST, CHCOA FOLLOWS THE PROVISIONS SET FORTH IN CHCOA'S CONFLICT OF INTEREST POLICY TO RESOLVE THE CONFLICT AND DETERMINES THE APPROPRIATE REPORTING TO BOARD COMMITTEES AND, IF REQUIRED, FORM 990 DISCLOSURE.
FORM 990, PART VI, SECTION B, LINE 15CHCOA DOES NOT HAVE ANY EMPLOYEES. HOWEVER, CHCOA DOES HAVE OFFICERS THAT ARE EMPLOYED BY CINCINNATI CHILDREN'S HOSPITAL MEDICAL CENTER ("CCHMC"), A RELATED ORGANIZATION. CCHMC HAS A COMPENSATION COMMITTEE THAT ANNUALLY REVIEWS THE RECOMMENDATIONS OF CCHMC MANAGEMENT REGARDING EMPLOYEE PERFORMANCE EVALUATION AND COMPENSATION ADJUSTMENTS FOR DISQUALIFIED PERSONS TO ENSURE THAT CCHMC HAS COMPLIED WITH THE PROVISIONS OF THE REBUTTABLE PRESUMPTION OF REASONABLENESS UNDER IRC SEC. 4958.
FORM 990, PART VI, SECTION C, LINE 19CHCOA'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MAINTAINED ON FILE BY CCHMC SENIOR MANAGEMENT AND ARE AVAILABLE TO THE PUBLIC UPON REQUEST EITHER IN-PERSON, BY TELEPHONE, OR BY WRITTEN REQUEST.
FORM 990, PART XI, LINE 9:CONTRIBUTIONS RECEIVABLE FROM REMAINDER TRUST 1,999,025. CHANGE IN VALUE OF SPLIT-INTEREST AGREEMENTS 232,133.CHANGES IN NET ASSETS OR FUND BALANCES:
FORM 990, PART VI, SECTION B, LINE 14CHCOA'S BOARD OF TRUSTEES HAS NOT FORMALLY ADOPTED A WRITTEN DOCUMENT RETENTION AND DESTRUCTION POLICY. HOWEVER, CHCOA IS A RELATED ORGANIZATION OF CINCINNATI CHILDREN'S HOSPITAL MEDICAL CENTER ("CCHMC"). CCHMC HAS A WRITTEN DOCUMENT RETENTION AND DESTRUCTION POLICY AND CHCOA ABIDES BY THE PROVISIONS OF THIS POLICY.WRITTEN DOCUMENT RETENTION AND DESTRUCTION POLICY
FORM 990, PART VI, SECTION B, LINE 13CHCOA'S BOARD OF TRUSTEES HAS NOT FORMALLY ADOPTED A WRITTEN WHISTLEBLOWER POLICY. HOWEVER, CHCOA IS A RELATED ORGANIZATION OF CINCINNATI CHILDREN'S MEDICAL CENTER ("CCHMC"). CCHMC HAS A WRITTEN WHISTLEBLOWER POLICY AND CHCOA ABIDES BY THE PROVISIONS OF THIS POLICY.WRITTEN WHISTLEBLOWER POLICY
FORM 990, PART VIIMICHAEL L. BAUER IS EMPLOYED BY CINCINNATI CHILDREN'S HOSPITAL MEDICAL CENTER ("CCHMC"), A RELATED ORGANIZATION. MR. BAUER DEVOTES AN AVERAGE OF 50 HOURS/WEEK FOR HIS DUTIES TO CCHMC AND AFFILIATED ENTITIES.NUMBER OF HOURS WORKED
FORM 990, SCHEDULE RDURING THE TIME PERIOD COVERED BY THIS RETURN, CONVALESCENT HOSPITAL FOR CHILDREN AND ORPHAN ASYLUM RECEIVED CERTAIN ACCOUNTING AND ADMINISTRATIVE SERVICES FROM CINCINNATI CHILDREN'S HOSPITAL MEDICAL CENTER AT NO COST. THE VALUE OF THESE SERVICES IS AN UNSPECIFIED AMOUNT.TRANSACTIONS WITH RELATED ORGANIZATIONS

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII

Name Of Disregarded Entity NameOfDisregardedEntity

FieldValueIRS element (for citing)
Business Name Line1CHILDREN'S HOSPITAL MEDICAL CENTERBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line13333 BURNET AVEAddressLine1
CityCINCINNATICity
StateOHState
ZIP Code45229ZIPCode
FieldValueIRS element (for citing)
EIN310833936EIN
Primary ActivitiesPEDIATRIC HEALTHCAREPrimaryActivities
Legal Domicile StateOHLegalDomicileState
Exempt Code Section501(C)(3)ExemptCodeSection
Public Charity Status3PublicCharityStatus

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1TCHBusinessNameLine1
FieldValueIRS element (for citing)
Controlled Org0ControlledOrg
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org1GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org0GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Dividends Related Organization0DividendsRelatedOrganization
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs0PerformOfServicesByOtherOrgs
Sharing Of Facilities1SharingOfFacilities
Sharing Of Paid Employees1SharingOfPaidEmployees
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable

Name Of Other Organization NameOfOtherOrganization

FieldValueIRS element (for citing)
Business Name Line1CHILDREN'S HOSPITAL MEDICAL CENTERBusinessNameLine1
FieldValueIRS element (for citing)
Transaction TypeBTransactionType
Amount Involved2920113AmountInvolved
Method Of Amt DeterminationCASHMethodOfAmtDetermination

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