2013-05-10T08:16:33-05:00 2012-06-30 861065772 DELOITTE TAX LLP 250 EAST FIFTH STREET SUITE 1900 CINCINNATI OH 45202 990 2011-07-01 310536649 CONVALESCENT HOSPITAL FOR CHILDREN AND ORPHAN ASYLUM CONV 5136368778 3333 BURNET AVENUE CINCINNATI OH 452293039 MICHAEL L BAUER 5136368778 2013-05-09 1 JAMES SOWAR P00529407 5137847100 2011 2016-02-24 21:20:13Z PHILLIP C LONG 3333 BURNET AVENUE CINCINNATI OH 452293039 55242147 0 X N/A X 1833 OH SUPPORT ORGANIZATIONS DEDICATED TO TREATMENT & RESEARCH OF DISEASES OR DISORDERS AFFECTING CHILDREN. 19 18 0 18 0 0 4033 6975 0 0 5547004 5800396 0 0 5551037 5807371 2721290 2831110 0 0 0 0 0 0 0 289560 305457 3010850 3136567 2540187 2670804 86210493 86881454 268395 225047 85942098 86656407 X THE 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. 0 0 2831110 2831110 CONVALESCENT 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, 2011 THROUGH JUNE 30, 2012 (THE YEAR COVERED BY THIS RETURN), CHCOA PROVIDED FINANCIAL SUPPORT AMOUNTING TO $2,831,110 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. 2831110 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 19 18 1 0 0 0 0 0 0 1 1 0 0 1 1 1 1 0 0 1 1 0 X SCOTT J HAMLIN 5136368778 3333 BURNET AVENUE CINCINNATI OH 452293039 ROBERT H ANNING II 1.00 X 0 0 0 C FRANCIS BARRETT 1.00 X 0 0 0 LEE A CARTER 1.00 X 0 0 0 DAVID CROALL 1.00 X 0 0 0 INGRID DAOUD MD 1.00 X 0 0 0 VALLIE GEIER 1.00 X 0 0 0 MARIAN LEIBOLD 1.00 X 0 0 0 DEBBIE LONG 1.00 X 0 0 0 MARIANNE MILLER 1.00 X 0 0 0 SUSAN SHELTON 1.00 X 0 0 0 MARK STEPANIAK 1.00 X 0 0 0 THOMAS WILLIAMS 1.00 X 0 0 0 MARKAY WINSTON PHD 1.00 X 0 0 0 ALISON ZIMMERMAN 1.00 X 0 0 0 PAMELA TERP 1.00 X X 0 0 0 PHILLIP C LONG 1.00 X X 0 0 0 MARIE HUENEFELD 1.00 X X 0 0 0 RONALD SALATIN 1.00 X X 0 0 0 MICHAEL L BAUER 1.00 X X 0 255467 25732 0 255467 25732 0 0 1 0 FIFTH THIRD BANK FIFTH THIRD CENTER CINCINNATI OH 45263 INVESTMENT MANAGEMENT 211585 1 6975 6975 1954599 1954599 53280573 49434776 3845797 3845797 3845797 5807371 0 0 5800396 2831110 2831110 305457 305457 3136567 2831110 305457 0 1395608 1134445 84814885 85727009 20000 86210493 86881454 268395 225047 268395 225047 X 82488044 83109195 3454054 3547212 85942098 86656407 86210493 86881454 X 2670804 -1956495 X 0 1 1 X 0 X X X 0 0 0 CHMC 310833936 3 0 1 1 2831110 1 2831110 3454054 93158 3547212 2706528 747526 3454054 2496544 209984 2706528 3353546 -857002 2496544 1.00000 1 0 0 5807371 3136567 2670804 -1956495 -1956495 714309 3850876 -1956495 -1956495 5807371 0 5807371 3136567 0 3136567 0 3136567 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 CINCINNATI CHILDREN'S HOSPITAL MEDICAL CENTER, A SUPPORTED ORGANIZATION OF CHCOA. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: 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 2009 TO 2012 STATE 2009 TO 2012 1 CHILDREN'S HOSPITAL MEDICAL CENTER 3333 BURNET AVENUE CINCINNATI OH 452293039 310833936 501(C)(3) 2831110 FAIR MARKET VALUE GENERAL SUPPORT 1 0 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE 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. 0 0 0 0 0 0 0 0 0 MICHAEL L BAUER 0 210408 0 36024 0 9035 0 1944 0 23788 0 281199 0 0 SUPPLEMENTAL INFORMATION PART III CONVALESCENT 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. ELECTIVE EMPLOYEE DEFERRALS UNDER IRC SEC. 457(B) 4. ELECTIVE EMPLOYEE DEFERRALS UNDER IRC SEC. 457(F) 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. FORM 990, PART VI, SECTION A, LINE 2 C. FRANCIS BARRETT AND MARIAN LEIBOLD HAVE A FAMILY RELATIONSHIP. FORM 990, PART VI, SECTION A, LINE 2 LEE CARTER AND SUSAN SHELTON HAVE A BUSINESS RELATIONSHIP OUTSIDE OF CHCOA. FORM 990, PART VI, SECTION B, LINE 11 THE 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 12C ALL 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 15 CHCOA 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 19 CHCOA'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. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -1,956,495. WRITTEN DOCUMENT RETENTION AND DESTRUCTION POLICY FORM 990, PART VI, SECTION B, LINE 14 CHCOA'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 WHISTLEBLOWER POLICY FORM 990, PART VI, SECTION B, LINE 13 CHCOA'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. NUMBER OF HOURS WORKED FORM 990, PART VII MICHAEL L. BAUER IS EMPLOYED BY CINCINNATI CHILDREN'S HOSPITAL MEDICAL CENTER ("CCHMC"), A RELATED ORGANIZATION. MR. BAUER DEVOTES AN AVERAGE OF 40 HOURS/WEEK FOR HIS DUTIES TO CCHMC AND AFFILIATED ENTITIES. TRANSACTIONS WITH RELATED ORGANIZATIONS FORM 990, SCHEDULE R DURING 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. CHILDREN'S HOSPITAL MEDICAL CENTER 3333 BURNET AVE CINCINNATI OH 45229 310833936 PEDIATRIC HEALTHCARE OH 501(C)(3) 3 TCH 0 0 1 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 CHILDREN'S HOSPITAL MEDICAL CENTER B 2831110 CASH