2012-11-15T13:37:00-06:00 2012-06-30 560747981 DIXON HUGHES GOODMAN LLP 4510 COX ROAD SUITE 200 GLEN ALLEN VA 230603394 990 2011-07-01 510220692 CHILDREN'S HOSPITAL AND HEALTHCARE SERVICES FOUNDATION CHIL 8042285814 2924 BROOK ROAD RICHMOND VA 232201298 CHRIS BROUGHTON-SPRUILL 8042285814 2012-11-13 1 JANET L BROCKLEHURST CPA P00449539 8042827636 2011 2016-02-24 21:20:13Z CHILDREN'S HOSPITAL FOUNDATION CHRIS BROUGHTON-SPRUILL 2924 BROOK ROAD RICHMOND VA 232201298 24842547 0 X WWW.CHFRICHMOND.ORG X 1978 VA FUND AND ADVOCATE FOR PEDIATRIC INITIATIVES THAT IMPROVE THE STATUS OF HEALTH CARE AND THE QUALITY OF LIFE FOR CHILDREN IN OUR REGION. 4 4 9 70 0 0 9743717 6116850 0 0 3459700 5522059 239739 252727 13443156 11891636 5255919 4068748 0 0 619142 584401 0 0 1279033 1065542 1433875 6940603 6087024 6502553 5804612 139663641 138260831 1396826 888745 138266815 137372086 X CHILDREN'S HOSPITAL AND HEATLTHCARE SERVICES FOUNDATION PROVIDES FINANCIAL SUPPORT TO, AND ENGAGES IN FUNDRAISING ACTIVITIES TO SUPPORT THE HEALTH AND GENERAL WELFARE OF CHILDREN. THE FOUNDATION'S PRIMARY FOCUS WITH REGARD TO FINANCIAL SUPPORT WILL BE THE CHILDREN'S HOSPITAL AND PEDIATRIC SERVICES AT VIRGINIA COMMONWEALTH UNIVERSITY HEALTH SYSTEM AUTHORITY, COLLECTIVELY KNOWN AS CHILDREN'S HOSPITAL OF RICHMOND. 0 0 4068748 FUND AND ADVOCATE FOR PEDIATRIC INITIATIVES THAT IMPROVE THE STATUS OF HEALTH CARE AND THE QUALITY OF LIFE FOR CHILDREN IN OUR REGION. 4068748 1 1 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 0 0 0 0 0 0 0 1 0 0 1 0 1 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 1 8 0 1 9 1 0 0 0 0 0 1 1 0 0 0 0 X 4 4 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 VA X CHRIS BROUGHTON-SPRUILL 8042285814 2924 BROOK ROAD RICHMOND VA 232201298 ELEANOR M GOODE 1.00 X X 0 0 0 J RICHARD TASHJIAN 1.00 X 0 0 0 COLEMAN WORTHAM III 1.00 X 0 0 0 GEORGE C FREEMAN III 1.00 X 0 0 0 MARY C BROUGHTON-SPRUILL 45.00 X 178066 0 19074 178066 0 19074 1 0 1 0 DIRECT MAIL SOLUTIONS INC 2001 DABNEY ROAD RICHMOND VA 23230 PROVIDES MARKETING AND MAILING SERVICES 342391 JOHN HANCOCK LIFE INSURANCE 200 CLARENDON STREET BOSTON MA 02117 LIFE INSURANCE PREMIUM FROM DONOR 166374 2 83700 6033150 6116850 3227821 3227821 15072425 12778187 2294238 2294238 2294238 425451 83700 172724 252727 252727 11891636 0 0 5774786 4068748 4068748 208424 26053 182371 301418 37677 263741 12877 1610 11267 29253 3656 25597 32429 4054 28375 26941 26941 32000 32000 115324 115324 158646 158646 521916 521916 75729 75729 64127 64127 11568 11568 15484 15484 DONOR RESTRICTED GIFT - 166374 166374 DONATION DAY EXPENSES 154625 154625 OUTSIDE EVENT EXPENSES 91141 91141 6087024 4068748 739243 1279033 1986357 681329 936556 621639 2150000 500000 11758 20888 92631 54613 49586 38018 114594989 117754073 998320 998320 18936075 17646564 139663641 138260831 83806 98997 1277250 749229 35770 40519 1396826 888745 X 109196546 108289152 4151544 3597282 24918725 25485652 138266815 137372086 139663641 138260831 X 5804612 -6699341 X X 0 1 1 X 0 X 5468767 7272322 4167735 9231079 6069770 32209673 5468767 7272322 4167735 9231079 6069770 32209673 5197588 27012085 7963665 4492713 2195376 2615068 3227821 20494643 52704316 0.51250 0.53440 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 115593309 4811558 -340916 1311558 118752393 91526302 3531962 21621506 1086461 115593309 79418176 3189540 9779438 860852 91526302 91796842 7656757 -15564716 4378223 92484 79418176 0.91440 0.07700 0.00860 0 0 92631 54613 38018 38018 BENEFICIAL INTEREST IN PERPETUAL TRUSTS 16340229 ASSETS HELD IN CHARITABLE REMAINDER TRUSTS 136441 CONTRIBUTIONS RECEIVABLE FROM REMAINDER TRUSTS 1169894 17646564 LIABILITY UNDER UNITRUST AGRMT 25146 CHARITABLE GIFT ANNUITY LIABILITY 15373 40519 11891636 6087024 5804612 -5743187 -956154 -6699341 -894729 5192295 -5743187 -956154 -6699341 11891636 0 11891636 6087024 0 6087024 0 6087024 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: THE ENDOWMENT FUNDS ARE INTENDED TO SUPPORT THE CHARITABLE PROGRAMS AND ACTIVITIES OF CHILDREN'S HOSPITAL OF RICHMOND. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE FOUNDATION IS EXEMPT FROM INCOME TAX UNDER THE INTERNAL REVENUE CODE SECTION 501(C)(3) AND THE TAX STATUTES OF THE COMMONWEALTH OF VIRGINIA; ACCORDINGLY, THE ACCOMPANYING FINANCIAL STATEMENTS DO NOT REFLECT A PROVISION OR LIABILITY FOR FEDERAL AND STATE INCOME TAXES. THE FOUNDATION HAS DETERMINED THAT IT DOES NOT HAVE ANY MATERIAL UNRECOGNIZED TAX BENEFITS OR OBLIGATIONS AS OF JUNE 30, 2012. FISCAL YEARS ENDING ON OR AFTER JUNE 30, 2009 REMAIN SUBJECT TO EXAMINATION BY FEDERAL AND STATE TAXING AUTHORITIES. THE FOUNDATION HAS BEEN CLASSIFIED AS A PUBLIC CHARITY UNDER INTERNAL REVENUE CODE SECTION 509(A)(1) AND 170(B)(1)(A)(VI). PART XI, LINE 8 - OTHER ADJUSTMENTS: CHANGE IN VALUE OF SPLIT INTEREST AGREEMENTS -956,154. PART XI LINE 8 AS WELL AS PART XII, LINE 2D REPRESENTS THE CHANGE IN THE VALUE OF SPLIT INTEREST AGREEMENTS. JUNIOR BOARD BALL 467204 82500 384704 161663 GOLF EVENT FOR YOUTH 41846 1200 40646 11061 1 100 100 509150 83700 425450 172724 172724 252726 1 AMERICAN ACADEMY FOR CEREBRAL PALSY & DEVELOPMENTAL MEDICINE 555 EAST WELLS STREET MILWAUKEE WI 53202 620692749 501(C)(3) 10000 TO PROVIDE GENERAL EDUCATION SUPPORT CRIPPLED CHILDREN'S HOSPITAL 2924 BROOK ROAD RICHMOND VA 232201298 540506309 501(C)(3) 588021 TO SUPPORT CHARITABLE PURPOSE MCV ASSOCIATED PHYSICIANS PO BOX 980646 RICHMOND VA 23298 541581185 501(C)(3) 1688578 TO SUPPORT CHARITABLE PURPOSE VIRGINIA COMMONWEALTH UNIVERSITY HEALTH SYSTEM AUTHORITY 1250 E MARSHALL STREET SUITE 2-300 RICHMOND VA 23219 541848065 1476562 TO SUPPORT CHARITABLE PURPOSE MCV FOUNDATION 1228 EAST BROAD STREET RICHMOND VA 232980234 546053660 501(C)(3) 212300 TO SUPPORT CHARITABLE PURPOSE 4 1 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: THE CHILDREN'S HOSPITAL FOUNDATION TYPICALLY OBTAINS INVOICES FOR EXPENSES FROM THE DONEE FOR REIMBURSEMENT AND/OR CONFIRMATION FROM THE DONEE ORGANIZATION MANAGEMENT THAT THE FUNDS WERE EXPENDED FOR ITS INTENDED PURPOSE. X X 0 0 0 0 0 0 0 0 0 MARY C BROUGHTON-SPRUILL 169066 0 0 0 9000 0 8945 0 10129 0 197140 0 0 0 PART I, LINE 3 MARKET COMPARABLES FROM SIMILAR FOUNDATIONS ARE USED TO COMPLETE A REVIEW AND ESTABLISH A RANGE TO BE USED BY THE BOARD OF DIRECTORS TO EVALUATE ANNUALLY THE CURRENT COMPENSATION FOR THE PRESIDENT OF THE FOUNDATION. THE BASE WAS ESTABLISHED IN 2006 BUT IT IS EVALUATED ANNUALLY TO ENSURE PROPER COMPENSATION. SEE SUPPLEMENTAL INFORMATION BELOW 0 PART IV A DIRECTOR OF THE FOUNDATION IS ALSO AN OFFICER OF AN ENTITY THE FOUNDATION DOES BUSINESS WITH. THE DOLLAR AMOUNT PAID TO THE ENTITY DID NOT MEET THE REPORTING THRESHOLD FOR 2011. X 1 166374 FAIR MARKET VALUE 0 0 1 THIRD PARTY USE: PART I, LINE 32B: CHHSF USES A THIRD PARTY TO SELL NONCASH CONTRIBUTIONS, BUT DOES NOT USE A THIRD PARTY TO SOLICIT OR PROCESS CONTRIBUTIONS. FORM 990, PART VI, SECTION B, LINE 11 A COPY OF THE FORM 990 IS FURNISHED TO EACH MEMBER OF THE BOARD OF DIRECTORS PRIOR TO FILING. AFTER A COMMENT PERIOD EXPIRES, THE FOUNDATION PRESIDENT SIGNS AND FILES THE FORM. FORM 990, PART VI, SECTION B, LINE 12C ALL OFFICERS, DIRECTORS AND KEY EMPLOYEES SHALL DISCLOSE ANNUALLY A POTENTIAL CONFLICT TO THE CHAIRMAN OF THE BOARD OF DIRECTORS FOR INVESTIGATION AND RESOLUTION. UPON APPOINTMENT TO THE BOARD OR EMPLOYMENT AND ANNUALLY THEREAFTER, BOARD MEMBERS, OFFICERS AND KEY EMPLOYEES SHALL COMPLETE AN AFFIRMATION STATEMENT AND DISCLOSURE FORM FOR REVIEW BY THE BOARD. FORM 990, PART VI, SECTION B, LINE 15 MARKET COMPARABLES ARE USED TO COMPLETE A REVIEW AND ESTABLISH A RANGE TO BE USED BY THE BOARD OF DIRECTORS TO EVALUATE ANNUALLY THE CURRENT COMPENSATION FOR THE PRESIDENT OF THE FOUNDATION. THE BASE WAS ESTABLISHED IN 2006 BUT IT IS EVALUATED ANNUALLY TO ENSURE PROPER COMPENSATION. FORM 990, PART VI, SECTION C, LINE 19 FORM 990 PUBLIC VIEWING DOCUMENT IS AVAILABLE FOR INSPECTION UPON REQUEST AT THE FOUNDATION'S HEADQUARTERS. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -5,743,187. CHANGE IN VALUE OF SPLIT INTEREST AGREEMENTS -956,154. TOTAL TO FORM 990, PART XI, LINE 5: -6,699,341. PART XII, LINE 2B AND 2C THE BOARD OF DIRECTORS OVERSEES THE AUDIT OF THE FINANCIAL STATEMENTS AND THE SELECTION OF AN INDEPENDENT ACCOUNTANT. DURING THE TAX YEAR, THE FOUNDATION DID NOT CHANGE ITS OVERSIGHT OR SELECTION PROCESS.