Document 6447875

Transcription

Document 6447875

.OUB m,. ISGS-IWi?
Undcf section SOi (c), 52T, or <494T(3i(1) of the Internal R^ventw; Code (excepi bfack lung
tcriae'T'e*
" Th& Di-gani?al ion ttisy have to use a c i p y of tfits raiifm to salisfy stats rgportins ("equiremanls.
F o r l t e 2012 caJcnrfar year, or tax year bftginnrng
Ctw* if
a n^ ending
C Name of orgsntselbn
i
1 Address
•
•
terras.
Ihiili*
D EmptoycridenSificatiorvnttfnbor
CHILDKEN'S CANCER RECOVERY FOUNDATION
33-0418563
Doing Busin&ssAs
Nyrnber-and street (or P.O bti; if rfiaii is noldetersd lo street adrfi^ss^
rfttam
17*1771*1-
P.O.
Room/suile £ Telepiione numbsr
BOX 2 3 8
Cfty, town, or post oHItw. stale, and Zip' code-
HERSHEY, PA
a
Q
.17033-0238
Hia} Is fhls a proup return
F Name snd address erf fjrincipa! ufilcenDOUG
P.O.
RUNKXE
BOX 2 3 8 , HERSHEX, PA
forpfMJaes?
EUYes Q D NO
H'(bl Araallstfitate Bttta4e«? •
Yes • [ N o
17033
QnsBitM) L H 4947faift|6M_J'.527
501 (cj i
f Tax^xempi status; i J U
J Website: ••• WWW. CHILDREMSCANCERgECOVERy - ORG
K Fotmcfprganiznton: I A J f c p r p g r a l i a i r X I j Tnjst
Q
717-545-7600
17^218,643
GrE^K BKRplsS
If 'No," aliacfi a tet. (EBQ irsTructiofvs}
I4(i^ Grotip-tjj^fnption n^wter ^
i LYeafofituFnaliQrr 1 9 9 0 [ M SUieofisgaldomidteiCA
Assoriallon
Briefly tfescribe the orgsnisation-s m ^ i o n or most significant sctiviUes: T O _ A S S I S T
^ H I L M 1 M _ M ^ 5 _ ^ ^ ^ G S
OF 1 8 AND THEIR JTAMILXES TOO ARE PACING THE HARDSHIPS OF A CANCER
2
Check lliis hay. ^
3
4
KtsmtxiFof voiing members of the efnt'ertiifig body ^Paft VI, tine, la)
tsSoi^ej- of independent voiins memb^s o? the governing body (Part V!, line lb)
'
1 ff tho orflani^fiticn dsconiinuediis operations or disposed of mora thara 2S%cfEt8 net assets.
3
5
Total numberoJ individuals employed in calenctor year 201?.ipsn V, line23) ...
6 Tctal number of vefunleers (estimate tf necessary)
...
....
Ta Tots! ur-.reltUed business nsvenue from Part Vfli, column ( 0 , line T2
.
.. _
7a
b Ksi unrstated business {a^abt&.i'ncomeJrom Form SB0-T.]iTie34 -.. ...•,..
7b
Prior Year
Contnbulions and granis (Pari Vli!. line! h)
ProQwrr-servir^ revunue ^Part VIII, line 2g)
.
..
4
2
0
235
0.
0.
4
5
6
Current YEar
7,652,702.
,,....
Inveslmem insome (Part viii, coiumn (A), lines3,4, and ?dj
Other revenue (Part VIH,cd'Jfnii{AJ. lines 5,6*18c, &c, l O c . a n d l t a )
,
Totdrgyenuc-add lines 8 thfounti 1"! (must cquatPari VII!, column (A), iine ;£) .
Grarite»sicisiniiiaraniDUntspaid(parttX,cokimn(A),tinesV3}
,. ,,..., ,, . ...
SoneWB pajd !o orformembcts (Port IX, column {AJJine^} ....... ,
. , , . . „•.
Salaries. otliercompensaficn.emptoyeB benerftts-(Part W, cciumn (A), lines 5-10],
Professional fgndraising lees (Pan W, ceiumntAJ, line l i e ) , ,
Toiaf fgndraising expenses (Part IX, column (DJ, Bne 25)
&*-
„
2^443f
Otfier expenses (Part IX.cokimn (Al, Sines I1a-T3d, nf-24e)
IB
., ,,
Total expenses Add lines } 3-1 ? (must equal Part IX, column (A), line 25}
Revenue lesseXoenses. Subiracl line 1S from line 1??
., . ,.
BBDlrmlMj ol Curfenl Veaf
20 Tolal assets (Pan X. line S6J
21 Tots) liabilllles (Part X. line 26)
End of Year
462,480,
327,072.
135f4<
. ,
,
22 fet assets or fund balances. Subtract line 21 from line 20
716^572.
I ' S l , 576.'
534,9!
Under penaiiies of perjiity, I decora ihal! have exaifiinod tltiKretuiR.tncludina sccompanying schartufes and statemfints, and tn the t)g$£ of my (cnowiedpe anti SieliBf, ft i
p;epa[ar lias any ltrnwlcd.ije
imatlcntd
true, correct, and comriielEjJtelaration of g i e p a i ^ l h e r l h m officar) is baseri on
lyiayjjie IRS discuas this telnrn with the piepartr sh&y/n.above? (ste inslructorts)
S3?cn: i?.io-;s
. ^.^^..-^^
LHA For Paperwork Reductson Act Notice, see the separate insfrUctions.
SEE SCHEDUL! O FOR ORGANI3ATION MISSION STATEMENT COWTINUATTOW
form 990(201?)
Form 990 (2012)
CHILDREN'S
CANCER
RECOVERY
FOUNDATION
33-0418563
Paqe2
:ipia(ra^)|-;| Statement of Program Service Accomplishments
Check if Schedule O contains a response to any question in this Part 111
1
[Xj
Briefly describe the organization's mission:
CHILDREN'S CANCER RECOVERY FOUNDATION ASSISTS CHILDREN AND THEIR
FAMILIES WHO ARE FACING THE HARDSHIPS OF A CANCER DIAGNOSIS. THE
FOUNDATION FOCUSES ON IMPROVING THE MENTAL, SOCIAL, FINANCIAL,
EMOTIONAL AND SPIRITUAL WELL-BEING OF THESE FAMILIES.
2
3
4
Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 99Q-EZ7
If "Yes," describe these new services on Schedule O.
Did the organization cease conducting, or make significant changes in how it conducts, any program services?
^^^
• Y C S FXINO
^_^
I I Yes I X I No
If "Yes." describe these changes on Schedule O.
Describe the organization's program service accomplishments for each of its three largest program services, as measured by expenses.
Section 501 {c)(3) and 501 (c){4) organizations are required to report the amount of grants and allocations to others, the total expenses, and
revenue, if any, for each program service reported.
4a
(Code-
) (Expenses $
1 0 , 2 9 3 , 7 9 3 .
including grants of $
1 0 , 0 5 2 , 8 0 5
.
) (Revenues
)
INTERNATIONAL AID PROGRAM: THE FOUNDATION OPERATED AN EXTENSIVE
INTERNATIONAL AID PROGRAM WHICH PROVIDED CANCER TREATMENT MEDICATIONS
AND MEDICAL SUPPLIES TO HOSPITALS, CLINICS AND DOCTORS IN DEVELOPING
AND IMPOVERISHED COUNTRIES. AID INCLUDED MEDICINES AND SUPPLIES TO
ASSIST IN MANAGING POST-TREATMENT SIDE EFFECTS OF CANCER INCLUDING
LYMPHEDEMA AND TREATMENT-RELATED INFECTIONS.
4b
(Code:
) (Expenses S
3 , 0 0 5 , 1 6 5 .
) (Revenue $
COMMUNITY OUTREACH:THE FOUNDATION CONDUCTED AN EXTENSIVE EDUCATION
PROGRAM FOCUSING ON CANCER PREVENTION AND RECOVERY. THE FOUNDATION'S
UNIQUE WHOLE-PERSON INTEGRATED CANCER CARE MODEL IS AN AWARD-WINNING
EFFORT INCORPORATING NUTRITION, EXERCISE, SOCIAL SUPPORT AND
SPIRITUALITY INTO THE TRADITIONAL HEALTHCARE EQUATION. COMMUNITY
OUTREACH ALSO FOCUSED ON ENVIRONMENTAL CARCINOGENS AND THEIR CONNECTION
TO PEDIATRIC CANCER. THE FOUNDATION ASSERTS THAT 80.0% OF CHILDHOOD
CANCERS CAN BE PREVENTED. PUBLIC EDUCATION IS AT THE HEART OF THIS
EFFORT.
4c
(Code- _ _ _ _ _ _ _ _ ) (Expenses $
Ly
J
r
yQ
1 *
) (Revenues
THE GIFTS PROGRAM: THE FOUNDATION DELIVERED GIFTS TO OVER 14,000
PEDIATIRC CANCER PATIENTS WHILE THEY WERE IN TREATMENT. THE "BEAR-ABLE
GIFTS" PROGRAM INCLUDED TOYS, CRAFTS, GAMES AND THE LIKE. THE GIFTS
WERE DISTRIBUTED THROUGH 260 HOSPITAL AFFILIATES THROUGHOUT THE U.S.
4d
Other program services (Describe in Schedule O.)
4e
Total program service expenses •
(Expenses $
D 3 , J J Z •
including grants of 3
} (Revenue $
]
1 3 , 5 5 8 , 8 7 1 .
Form 9 9 0 (2012)
232002
12-10-12
Form 990(2012)
CHILDREN'S CANCER RECOVERY FOUNDATION
33-0418563
Paqe3
Part IV Checklist of Required Schedules
Yes
1
Is the organization described in section 501 (c)(3) or 4947(a)(1) (other than a private foundation)?
If "Yes," complete Schedule A
Is the organization required to complete Schedule S, Schedule of Contributor^
No
X
X
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for
public office? If "Yes," complete Schedule C, Part I
8
Section 501 (c)(3) organizations. Did the organization engage in lobbying activities, or have a section 501 (h) election in effect
during the tax year? If "Yes," complete Schedule C, Part II
X
Is the organization a section 501(c)(4), 501(c)(5), or 501 (c)(6) organization that receives membership dues, assessments, or
similar amounts as defined in Revenue Procedure 98-19? If "Yes," complete Schedule C, Part III
X
Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the right to
provide advice on the distribution or investment of amounts in such funds or accounts? If "Yes," complete Schedule D, Part I
X
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas, or historic structures? If "Yes," complete Schedule D, Part II
X
Did the organization maintain collections of works of art, historical treasures, or other similar assets? If "Yes," complete
Schedule D, Part III
Did the organization report an amount in Part X, line 21, for escrow or custodial account liability; serve as a custodian for
amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services?
If "Yes," complete Schedule D, Part IV
10
Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments, permanent
11
endowments, or quasi-endowments? If "Yes," complete Schedule D, Part V
If the organization's answer to any of the following questions is "Yes," then complete Schedule D, Parts VI, VII, VIII, IX, or X
X
X
X
10
as applicable.
a Did the organization report an amount for land, buildings, and equipment in Part X, line 10? If "Yes," complete Schedule D,
PartVI
b Did the organization report an amount for investments - other securities in Part X, line 12 that is 5% or more of its total
assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VII
11a
X
lib
X
11c
X
11d
X
X
c Did the organization report an amount for investments - program related in Part X, line 13 that is 5% or more of its total
assets reported in PartX, line 16? If "Yes," complete Schedule D, Part VIII
d Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in
PartX, line 16? ff "Yes," complete Schedule D, Part IX
e Did the organization report an amount for other liabilities in PartX, line 25? If "Yes," complete Schedule D, PartX
f Did the organization's separate or consolidated financial statements for the tax year include a footnote that addresses
the organization's liability for uncertain tax positions under FIN 48 (ASC 740)? If "Yes," complete Schedule D, PartX
12a Did the organization obtain separate, independent audited financial statements for the tax year? If "Yes," complete
lie
11f
X
Schedule D, Parts XI and XII
b Was the organization included in consolidated, independent audited financial statements for the tax year?
If "Yes," and if the organization answered "No" to line 12a, then completing Schedule D, Parts XI and XII is optional
13 Is the organization a school described in section 170(b}(1)(A)(ii)? If "Yes," complete ScheduleE
12a
X
14a Did the organization maintain an office, employees, or agents outside of the United States?
b Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business,
15
investment, and program service activities outside the United States, or aggregate foreign investments valued at $100,000
or more? If "Yes," complete Schedule F, Parts I and IV
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or assistance to any organization
or entity located outside the United States? If "Yes," complete Schedule F, Parts II and IV
12b
X
13
14a
X
14b
X
15
X
16
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or assistance to individuals
located outside the United States? If "Yes," complete Schedule F, Parts III and IV
16
17
Did the organization report a total of more than $15,000 of expenses for professional fundraising services on Part IX,
column (A), lines 6 and 11e? If "Yes," complete Schedule G, Part I
17
X
18
Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines
1cand8a?//"Y'es,"compfeteSc/jec/u/eG, Part//
18
X
X
19
Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If 'Yes,"
complete Schedule G, Part III
20a Did the organization operate one or more hospital facilities'' If "Yes," complete Schedule H
b If "Yes" to line 20a, did the organization attach a copy of its audited financial statements to this return?
19
20a
20b
X
X
Form 9 9 0 (2012)
232003
12-10-12
C H I L D R E N ' S CANCER
Form 990 (2012)
P a p & M i C h e c k l i s t of R e q u i r e d S c h e d u l e s (continued)
RECOVERY
FOUNDATION
33-0418563
Paqe4
Yes
21
22
23
United States on Part IX, column (A), line 1? If "Yes," complete Schedule I, Parts I andII
21
X
Did the organization report more than $5,000 of grants and other assistance to individuals in the United States on Part IX,
column (A), line 2? If "Yes," complete Schedule I, Parts I and III
22
X
Did the organization answer "Yes" to Part VII, Section A, fine 3, 4, or 5 about compensation of the organization's current
and former officers, directors, trustees, key employees, and highest compensated employees? If "Yes," complete
Scheduled
24a Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the
last day of the year, that was issued after December 31,2002? If "Yes," answer lines 24b through 24d and complete
Schedule K. If "No", go to line 25
b Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?
c Did the organization maintain an escrow account other than a refunding escrow at any time during the year to defease
any tax-exempt bonds?
d Did the organization act as an "on behalf of" issuer for bonds outstanding at any time during the year?
25a Section 501(c)(3) and 501(c)(4) organizations. Did the organization engage in an excess benefit transaction with a
disqualified person during the year? If "Yes," complete Schedule L, Part I
b Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and
26
27
28
31
32
33
34
24c
24d
X
25a
26
x
of any of these persons? If "Yes," complete Schedule L, Part III
Was the organization a party to a business transaction with one of the following parties (see Schedule L, Part IV
27
x
28a
x
x
A family member of a current or former officer, director, trustee, or key employee? If "Yes," complete Schedule L, Part IV
An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof) was an officer,
director, trustee, or direct or indirect owner? If "Yes," complete ScheduleL, Part IV
2Bb
Did the organization receive more than $25,000 in non-cash contributions? If "Yes," complete ScheduleM
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation
29
contributions? tf "Ves," complete Schedule M
Did the organization liquidate, terminate, or dissolve and cease operations?
If "Yes," complete ScheduleN, Parti
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets?If "Yes," complete
ScheduleN, PartII
30
x
31
x
32
x
33
X
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations
sections 301.7701-2 and 301.7701-3?/f "Yes," complete Schedule R, Parti
Was the organization related to any tax-exempt or taxable entity? If "Yes," complete Schedule R, Part II, III, or IV, and
b If "Yes" to line 35a, did the organization receive any payment from or engage in any transaction with a controlled entity
within the meaning of section 512(b)(13)? If "Yes," complete Schedule R, Part V, Iine2
36 Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization?
38
24a
24b
person outstanding as of the end of the organization's tax year? If "Yes," complete Schedule L, Part II
Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial
contributor or employee thereof, a grant selection committee member, or to a 35% controlled entity or family member
PartV,line1
35a Did the organization have a controlled entity within the meaning of section 512(b)(13)?
37
23
that the transaction has not been reported on any of the organization's prior Forms 990 or 990-EZ? If "Yes," complete
Schedule L, Part I
25b
Was a loan to or by a current or former officer, director, trustee, key employee, highest compensated employee, or disqualified
instructions for applicable filing thresholds, conditions, and exceptions):
A current or former off leer, director, trustee, or key employee? If "Yes," complete Schedule L, Part IV
29
30
No
Did the organization report more than $5,000 of grants and other assistance to any government or organization in the
x
28c
34
35a
X
X
X
35b
If "Yes," complete Schedule R, PartV,line2
Did the organization conduct more than 5% of its activities through an entity that is not a related organization
36
and that is treated as a partnership for federatincome tax purposes? If "Yes," complete Schedule R, Part VI
Did the organization complete Schedule O and provide explanations in Schedule Ofor Part VI, lines l i b and 19?
Note. All Form 990 filers are required to complete Schedule O
37
38
Form 9 9 0 (2012)
232004
12-10-12
C H I L D R E N ' S CANCER RECOVERY FOUNDATION
iPgrt-.y';! Statements Regarding Other IRS Filings and Tax Compliance
33-0418563
Form 990 (2012)
PageS
Check if Schedule O contains a response to any question in this Part V
•
Yes
1 a Enter the number reported in Box 3 of Form 1096 Enter -0- if not applicable
1a
b Enter the number of Forms W-2G included in line 1 a. Enter -O- if not applicable
1b
c Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming
(gambling) winnings to prize winners?
No
5
0
1c
2a Enter the number of employees reported on Form W-3, Transmittal of Wage and Tax Statements,
filed for the calendar year ending with or within the year covered by this return
2a
b If at least one is reported on line 2a, did the organization file all required federal employment tax returns?
0
2b
Note. If the sum of lines 1 a and 2a is greater than 250, you may be required to e-file (see instructions)
3a Did the organization have unrelated business gross income of $1,000 or more during the year?
b If "Yes," has it filed a Form 990-T for this year? If "No," provide an explanation in Schedule O
3a
3b
4a At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a
financial account in a foreign country (such as a bank account, securities account, or other financial account)?
4a
b If "Yes," enter the name of the foreign country: •
See instructions for filing requirements for Form TD F 90-22.1, Report of Foreign Bank and Financial Accounts.
5a Was the organization a party to a prohibited tax shelter transaction at any time during the tax year?
b Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
c If "Yes," to line 5a or 5b, did the organization file Form 8886-T?
6a Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit
any contributions that were not tax deductible as charitable contributions?
b If "Yes," did the organization include with every solicitation an express statement that such contributions or gifts
were not tax deductible9
7 Organizations that may receive deductible contributions under section 170(c).
X
X
: : :>: A;
; X
,
5a
5b
5c
;
X
X
6a
6b
X
a Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor? 7a
b If "Yes," did the organization notify the donor of the value of the goods or services provided 9
7b
c Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required
to file Form 8282?
d If "Yes," indicate the number of Forms 8282 filed during the year
7d
e Did the organization receive any funds, directty or indirectfy, to pay premiums on a personal benefit con tract?
f Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract?
g If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required?
h If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C?
8 Sponsoring organizations maintaining donor advised funds and section 509(a)(3) supporting organizations. Did the supporting
organization, or a donor advised fund maintained by a sponsoring organization, have excess business holdings at any time during the year?
9 Sponsoring organizations maintaining donor advised funds.
a Did the organization make any taxable distributions under section 4966?
b Did the organization make a distribution to a donor, donor advisor, or related person?
10 Section 501 (c)(7) organizations. Enter:
a Initiation fees and capital contributions included on Part VIII, line 12
b Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
11 Section 501 (c)(12) organizations. Enter:
a Gross income from members or shareholders
b Gross income from other sources (Do not net amounts due or paid to other sources against
7e
7f
X
X
7q
7h
8
10a
10b
i
11a
12a
.
•>
:
13a
* !
*
13b
13c
14a Did the organization receive any payments for indoor tanning services during the tax year"?
b If "Yes," has it filed a Form 720 to report these payments? If "No," provide an explanation in Schedul 3 0
232005
12-10-12
X
9a
9b
amounts due or received from them)
11b
12a Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?
b If "Yes," enter the amount of tax-exempt interest received or accrued during the year
12b
13 Section 501 (c)(29) qualified nonprofit health insurance issuers.
a Is the organization licensed to issue qualified health plans in more than one state?
Note. See the instructions for additional information the organization must report on Schedule O
b Enter the amount of reserves the organization is required to maintain by the states in which the
organization is licensed to issue qualified health plans
c Enter the amount of reserves on hand
7c
X
14a
14b
Form 9 9 0 (2012)
33-0418563
Page6
Form 990 (2012)
;Pa'rt.;\f| :i j G o v e r n a n c e , M a n a g e m e n t , a n d D i s c l o s u r e For eacrt "Ves" response to lines 2 through 7b below, and for a "No" response
to line 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instnictions.
Check if Schedule O contains a response to any question in this Part VI
^^_^^
.
I X1
Section A. Governing Body and Management
Yes
1 a Enter the number of voting members of the governing body at the end of the tax year
If there are material differences m voting rights among members of the governing body, or if the governing
body delegated broad authority to an executive committee or similar committee, explain in Schedule 0
1a
b Enter the number of voting members included in line 1 a, above, who are independent
1b
2 Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other
officer, director, trustee, or key employee?
3
Did the organization delegate control over management duties customarily performed by or under the direct supervision
4
5
of officers, directors, or trustees, or key employees to a management company or other person? ,
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed?
Did the organization become aware during the year of a significant diversion of the organization's assets?
6 Did the organization have members or stockholders?
7a Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or
more members of the governing body? ,
b Are any governance decisions of the organization reserved to {or subject to approval by) members, stockholders, or
persons other than the governing body?
8
•
"
' -
2
2
X
3
4
6
X
X
X
X
7a
X
7b
X
5
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following
a The governing body?
b Each committee with authority to act on behalf of the governing body?
8a
8b
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the
orqamzation's mailing address? If "Yes," provide the names and addresses in Schedule 0
9
9
No
4
X
X
X
S e c t i o n B. P o l i c i e s (This Section B requests information about policies not required by the Internal Revenue Code.)
Yes
10a Did the organization have local chapters, branches, or affiliates?
b If "Yes," did the organization have written policies and procedures governing the activities of such chapters, affiliates,
and branches to ensure their operations are consistent with the organization's exempt purposes?
11a Has the organization provided a compfete copy of this Form 990 to alt members of its governing body before filing the form?
b Describe in Schedule O the process, if any, used by the organization to review this Form 990.
10b
ITa
X
12a Did the orgamzatton have a written conflict of interest policy? If "No," go to line 13
12a
b Were officers, directors, or trustees, and key employees required to disclose annually interests that could give rise to conflicts?
c Did the organization regularly and consistently monitor and enforce compliance with the policy? If "Ves," describe
in Schedule O how this was done
13 Did the organization have a written whistleblower policy?
12b
X
X
14
15
Did the organization have a written document retention and destruction policy?
Did the process for determining compensation of the following persons include a review and approval by independent
persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
a The organization's CEO, Executive Director, or top management official
b Other officers or key employees of the organization
If "Yes" to line 15a or 15b, describe the process in Schedule O (see instructions).
X
X
X
12c
13
14
X
15a
15b
16a Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a
taxable entity during the year?
No
X
10a
X
i:
X
16a
b If "Yes," did the organization follow a written policy or procedure requiring the organization to evaluate its participation
in joint venture arrangements under applicable federal tax law, and take steps to safeguard the organization's
'•
:
:.-
16b
exempt status with respect to such arranqements?
Section C. Disclosure
17
List the states with which a copy of this Form 990 is required to be filed • A L , A K , A Z , A R , C A , C T , DC , G A ,
18
Section 6104 requires an organization to make its Forms 1023 (or 1024 if applicable), 990, and 990-T (Section 501 (c)(3)s only) available
for public inspection Indicate how you made these available. Check all that apply
1 X I Own website
I X I Another's website
1 X 1 Upon request
I I Other (explain in Schedule O)
Describe in Schedule O whether (and if so, how), the organization made its governing documents, conflict of interest policy, and financial
statements available to the public during the tax year
19
20
IL,KS,KY
,LA
State the name, physical address, and telephone number of the person who possesses the books and records of the organization. •
DOUG RUNKLE - 717-545-7600
6380 FLANK DRIVE SUITE 400, HARRISBURG, PA
232555
12-10-12
SEE SCHEDULE O FOR
FULL L I S T OF
6
17112
STATES
Form 9 9 0 (2012)
33-0418563
;P^rfe-:VH;| Compensation of Officers, Directors, Trustees, Key Employees, Highest Compensated
Employees, and Independent Contractors
Form 990 (2012)
Check if Schedule O contains a response to any question in this Part VII
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization's tax year.
Page?
•
• List all of the organization's current officers, directors, trustees (whether individuals or organizations), regardless of amount of compensation.
Enter -0- in columns (D), (E), and (F) if no compensation was paid.
• List all of the organization's current key employees, if any. See instructions for definition of "key employee."
• List the organization's five current highest compensated employees (other than an officer, director, trustee, or key employee) who received reportable
compensation (Box 5 of Form W-2 and/or Box 7 of Form 1099-MISC) of more than $100,000 from the organization and any related organizations.
• List alt of the organization's former officers, key employees, and highest compensated employees who received more than $100,000 of
reportable compensation from the organization and any related organizations.
• List ail of the organization's former directors or trustees that received, in the capacity as a former director or trustee of the organization,
more than $10,000 of reportable compensation from the organization and any related organizations.
List persons in the following order: individual trustees or directors; institutional trustees; officers; key employees; highest compensated employees;
and former such persons.
I
l Check this box if neither the organization nor any related organization compensated any current officer, director, or trustee.
(A)
Name and Title
(C)
(BJ
Position
Average
(Qo not check more tnan one
hours per
box, unless peraon Is both an
officer
and a director/lfustee)
week
o
(list any
•a
hours for
a
related
1
organizations
o
below
a 8 1
o
line)
1
i
(1)
DOUG
RUNKLE
PRESIDENT
(2)
T I M GRUNSTRA
20.00
20.00
0.50
TREASURER
(3)
ART GRANITO
JESSICA
TRUSTEE
232007 12-10-12
SCHAEFER
IE)
Reportable
compensation
from related
organizations
(W-2/1099-M1SC)
(F)
Estimated
amount of
compensation
from the
organization
and related
organizations
X
x
0.
121,000.
9,753.
X
X
0.
0.
0.
x
X
0.
0.
0.
0.
0.
0.
0.50
SECRETARY
(4)
(D)
Reportable
compensation
from
the
organization
(W-2/1099-MISC)
0.50
X
Form 9 9 0 (2012)
33-0418563
PageS
Form 990 (2012)
P^ffi'tyfE Section A, Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)
(B)
(C)
(A)
(D)
(E)
(F)
Position
Average
Reportable
Reportable
Name and title
Estimated
[do not check more than one
hours per box, unless person is both an
compensation
compensation
amount of
officer and a direclor/trustee)
week
from
from related
other
(list any
the
organizations
compensation
hours for
organization
(W-2/1099-MISC)
from the
related
(W-2/1099-MISC)
organization
organizations
and related
below
organizations
line)
1b Sub-total
121,000
•
c Total from continuation sheets to Part VII, Section A
0
0
•
d Total (add lines l b and 1c)
121,000
0
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable
compensation from the organization •
9,753
0
9,753
Yes
No
Did the organization list any former officer, director, or trustee, key employee, or highest compensated employee on
X
line la? If "Yes," complete Schedule J for such individual
For any individual listed on line l a , is the sum of reportable compensation and other compensation from the organization
and related organizations greater than $1SCOOO9 If "Yes," complete Schedule J for such individual
Did any person listed on line 1 a receive or accrue compensation from any unrelated organization or individual for services
rendered to the organization? // "Ves," complete Schedule J for such person
Section B. Independent Contractors
1
. .. .
Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from
the organization Report compensation for the calendar year ending with or within the organization's tax year.
(B)
(A)
Description of services
Name and business address
ASSOCIATED COMMUNITY S E R V I C E S , 2 9 7 7 7
COMMUNITY OUTREACH
TELEGRAPH A V E . STE 3 0 0 0 , SOUTHFIELD, M I
CONTRACT COMMUNICATIONS
3 6 3 0 S PLAZA T R L , V I R G I N I A BEACH, VA 2 3 4 5 2 COMMUNITY OUTREACH
B R I C K M I L L MARKETING SERVICES
COMMUNITY OUTREACH
24 M I L L BROOK ROAD, W I L T O N , NH 0 3 0 8 6
2
X
^^^__
(C)
Compensation
3,066,031.
609,941.
359,373.
Total number of independent contractors (including but not limited to those listed above) who received more than
$100,000 of compensation from the organization •
3
Form 9 9 0 (2012)
232008
12-10-12
Form 990 (2012)
*
H
n 5
1 a
gjt
Check if Schedule 0 contains a response :o any question n this Part VIII
(A)
A
"
x
*
Total revenue
Federated campaigns
la
b
Membership dues
lb
c
Fundraising events
1c
d
Related organizations
1d
e
Government grants (contributions)
1e
f
All other contributions, gifts, grants, and
g
O c
17
1f
10,310,562.
Noncash coninbutlons Included in lines la-lf-$
•
17,130,106.
:
:
•>
<:
v.
Business Code
••'•
,
..>•
-:
'
2 a
"S*
«^
b
n v
d
(D)
Revenue excluded
from tax under
sections 512,
513, or 514
:>:'"
130,106.
h Total. A d d lines l a - l f
a>
•
(C)
Unrelated
business
revenue
(B)
Related or
exempt function
revenue
PageQ
;•
similar amounts not included above
fli : 0
33-0418563
c
"""
e
Q.
f
All other program service revenue
.
q Total. A d d lines 2a-2f
3
•
: ' • > • •
'
,:"
Investment income (including dividends, interest, a n d
other similar amounts)
•"
4
Income from investment of tax-exempt bond proceeds
••
5
Royalties
•
340.
340.
/,
(i) Real
6 a
(ii) Personal
Gross rents
b
Less: rental expenses
c
Rental income or (loss)
d
Wet rental income or (loss)
- •
7 a Gross amount from sales of
:
'
'•
•
(i) Securities
(ii) Other
assets other than inventory
b
V
:••
•
:
Less, cost or other basis
and sales expenses
c
Gain or (loss)
d
Net gam or (loss)
8 a
3
C
including $
>
•
Gross income from fundraising events (not
of
K
contributions reported on line 1c). See
tr
5
PartIV, line 18
a
24,099.
b
Less: direct expenses
b
9,894.
c
Net income or (loss) from fundraising events
9 a
b
c
10 a
•
;
14,205.
,:
Gross income from gaming activities. See
PartIV, line 19
a
Less: direct expenses
b
14,205.
]
••.;
:
:
'V.
:
*•
•
Net income or (loss) from gaming activities
Gross sales of inventory, Jess returns
r
and allowances
a
b
Less: cost of goods sold
b
c
Net income or (loss) from sales of inventory
Miscellaneous Revenue
11 a MANAGEMENT SERVICES TO A F F I L I A T E S
b
y
L I S T RENTAL ROYALTIES
..
.
'
,--,v
i,
•
.;.
Business Code
900099
62,331.
900099
1,767.
62,331.
1,767.
C
12
232009
12-10-12
d
All other revenue
e
T o t a l . A d d lines 11 a-11 d
Total revenue See instructions
•
•
64,098.
17,208,749.
—
•
•'•••
."-••-"
62.331.
0.
16,312.
Form 9 9 0 (2012)
Form 990 (2012)
33-0418563
PagelO
ip^l^fciX; Statement of Functional Expenses
Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A).
IXI
Check if Schedule 0 contains a response to any question in this Part IX
(A)
(B)
Do not include amounts reported on lines 6b,
Total expenses
Program service
7b, 8b, 9b, and 10b of Pari Vltt.
expenses
1 Grants and other assistance to governments and
(C)
Management and
general expenses
(D)
Fundraising
expenses
:
*
••:
: ,
organizations in the United States See Part IV, line 21
2
Grants and other assistance to individuals in
the United States. See Part IV, line 22
Grants and other assistance to governments,
3
%
'
* • # &
>
organizations, and individuals outside the
United States. See Part IV, lines 15 and 16
Benefits paid to or for members
4
5
Compensation of current officers, directors,
trustees, and key employees
Compensation not included above, to disqualified
persons (as defined under section 4958(f}(l)) and
persons described in section 4958(c)(3)(B)
6
7
8
9
10
11
: " " i i : "-.y
,'
81,074.
23,532.
26,147.
Other salaries and wages
Pension plan accruals and contributions (include
section 401 (k) and 403(b) employer contributions)
26,709.
16,552.
4,811.
5,346.
Other employee benefits
Payroll taxes
Fees for services (n on-employees):
10,551.
11,926.
6,657.
7,395.
1,933.
2,146.
1,961.
2,385.
d Lobbying
e Professional fundraising services See Part IV, line 17
f Investment management fees
g Other. (If fine 11g amount exceeds 10% of line 25,
column (A) amount, list line 11g expenses on Sch 0.)
12
13
14
15
Advertising and promotion
Office expenses
Information technology
Royalties
16
17
Occupancy
Travel
18
Payments of travel or entertainment expenses
19
20
for any federal, state, or local public officials
Conferences, conventions, and meetings
Interest
a
b
c
d
10,052,805.
130,753.
a Management
b Legal
c Accounting
21
22
23
24
10,052,805.
Payments to affiliates
Depreciation, depletion, and amortization
Insurance
Other expenses Itemize expenses not covered
above (List miscellaneous expenses in line 24e If line
24e amount exceeds 10% of line 25, column (A)
amount, list line 24e expenses on Schsdule 0 )
G I F T PROGRAM
POSTAGE AND DELIVERY
BANK SERVICE CHARGES
EMERGENCY F I N A N C I A L ASS
e All other expenses
25 Total iunctional expenses. Add lines 1 thiouqh 24e
26 Joint costs Complete this line only if the organization
11,718.
23,000.
11,718.
23,000.
2,387,706.
2,387,706.
3,553,235.
24,920.
2,960,362.
24,920.
592,873.
70,590.
19,898.
43,766.
13,551.
12,706.
3,934.
496.
14,118.
2,413.
496.
783.
4,652.
485.
141.
4,652.
•1
171,206.
102,873.
..• •
*.
157.
"'
171,206.
109,812.
76,467.
59,922.
62,012.
16,809,161.
59,922.
17,303^
13,558,871.
41,305.
806,653.
3,404.
2,443,637.
5,756,220.
2,817,265.
568,748.
2,370,207.
6,939.
76,467.
reported in column (B) joint costs from a combined
educational campaign and fundraising solicitation
Ctieck here • "
| X I if fcllowina SOP 9B-2 [ASC 953-720)
Form 9 9 0 (2012)
232010 12-10-12
10
Form 990 (5012)
P&ft:X ; Balance Sheet
33-0418563
Page 11
1 |
Check if Schedule 0 contains a response to any question in this Part X
(A)
Beginning of year
221,084.
49,658.
45,097.
5,000.
1
2
Cash - non-interest-bearing
Savings and temporary cash investments
3
4
Pledges and grants receivable, net
Accounts receivable, net
5
Loans and other receivables from current and former officers, directors,
trustees, key employees, and highest compensated employees. Complete
6
01
7
8
9
10a
Notes and loans receivable, net
Inventories for sale or use
Prepaid expenses and deferred charges
Land, buildings, and equipment, cost or other
basis. Complete Part VI of Schedule D
b Less: accumulated depreciation
11
Investments - publicly traded securities
ID
* * *
*
'y
6
7
8
120,341.
6,265.
84,831.
77,430.
•'•
8,184.
10c
11
Accounts payable and accrued expenses
Grants payable
Deferred revenue
20
21
22
Tax-exempt bond liabilities
Escrow or custodial account liability. Complete Part IV of Schedule D
Loans and other payables to current and former officers, directors, trustees,
key employees, highest compensated employees, and disqualified persons.
Complete Part II of Schedule L
22
23
24
25
Secured mortgages and notes payable to unrelated third parties
Unsecured notes and loans payable to unrelated third parties
Other liabilities (including federal income tax, payables to related third
parties, and other liabilities not included on lines 17-24). Complete Part X of
23
24
13
14
6,851.
462,480.
252,072.
Schedule D
Total liabilities. Add lines 17 through 25
27
28
Unrestricted net assets
Temporarily restricted net assets
•o
29
Permanently restricted net assets
Organizations that do not follow SFAS 117 (ASC 958), check here • 1
and complete lines 30 through 34.
o
15
16
17
11,937.
716,572.
181,576.
18
19
20
21
:
75,000.
327,072.
25
26
0.
181,576.
90,311.
45,097.
27
489,899.
45,097.
1 X | and
u
c
to
3
LL
7,401.
12
17
18
19
Organizations that follow SFAS 117 (ASC 958), check here •
complete lines 27 through 29, and lines 33 and 34.
•'
*
:
Other assets. See Part IV, line 11
Total assets. Add lines 1 throuqh 15 (must equal line 34)
in
V
207,707.
6,298.
9
;••'•
10a
10b
:o
5
15
16
26
Z
:>.
t <
Investments - other securities. See Part fV, line 11
Investments - program-related. See Part IV, line 11
Intangible assets
(0
in
in
3
4
12
13
14
'3
in
':
70,180.
367,952.
45,097.
0.
1
2
Part 11 of Schedule L
Loans and other receivables from other disqualified persons (as defined under
section 4958(f)(1)), persons described in section 4958(c)(3)(8), and contributing
employers and sponsoring organizations of section 501 (c)(9) voluntary
employees' beneficiary organizations (see instr). Complete Part II of Sch L
«
(B)
End of year
30
31
32
Capital stock or trust principal, or current funds
Paid-in or capital surplus, or land, building, or equipment fund
Retained earnings, endowment, accumulated income, or other funds
33
34
Total net assets or fund balances
Total liabilities and net assets/fund balances
28
29
••'
30
31
32
135,408.
462,480.
33
34
534,996.
716,572.
Form 9 9 0 (2012)
232011
12-10-12
11
;Psgrt-Xl:;] Reconciliation of Net Assets
Form 990 (2012)
33-0418563
PaQe12
•
Check if Schedule O contains a response to any question in this Part XI
1
Total revenue (must equal Part VIII, column (A), line 12)
i
2
3
Total expenses (must equal Part IX, column (A), line 25)
Revenue less expenses. Subtract line 2 from line 1
2
4
5
6
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A))
Net unrealized gains (losses) on investments
Donated services and use of facilities
7
8
Investment expenses
Prior period adjustments
9
10
Other changes in net assets or fund balances (explain in Schedule 0)
Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line 33,
3
4
5
6
7
8
9
10
column (B))
17 , 2 0 8 , 7 4 9 .
16 , 8 0 9 , 1 6 1 .
399,588.
135,408.
0.
534,996.
Part XII Financial Statements and Reoorting
Check if Schedule O contains a response to any question in this Part XII
Yes
Accounting method used to prepare the Form 990: I I Cash
ULl Accrual
I I Other
If the organization changed its method of accounting from a prior year or checked "Other," explain in Schedule O.
2a Were the organization's financial statements compiled or reviewed by an independent accountanf?
•
No
1
X
2a
If "Yes," check a box below to indicate whether the financial statements for the year were compiled or reviewed on a
separate basis, consolidated basis, or both:
I
I Separate basis
I I Consolidated basis
I I Both consolidated and separate basis
b Were the organization's financial statements audited by an independent accountant?
If "Yes," check a box below to indicate whether the financial statements for the year were audited on a separate basis,
consolidated basis, or both.
c
2b
I X I Separate basis
1 J Consolidated basis
I I Both consolidated and separate basis
If "Yes" to line 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit,
review, or compilation of its financial statements and selection of an independent accountant?
If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O.
3a As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit
Act and OMB Circular A-133?
b If "Yes," did the organization undergo the required audit or audits? If the organization did not undergo the required audit
or audits, explain why in Schedule O and describe any steps taken to undergo such audits
.
. ..
2c
X
3a
3b
Form 9 9 0 (2012)
232012
12-10-12
12
SCHEDULE A
(Form990or990-EZ)
Deparimerit of the Treasury
Internal Revenue Service
OMB No 15.15-0047
Public Charity Status and Public Support
2012
Comptete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.
• • Attach to Form 990 or Form 990-EZ. • * See separate instructions.
Name of the organization
Jnsfe£ei;i:6.rv
Employer identification number
33-0418563
:(?art;:fi/
R e a s o n for P u b l i c C h a r i t y S t a t u s (All organizations must complete this part.) See instructions.
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
I
EH
I I
| I
A church, convention of churches, or association of churches described in section 170(b)(1)(A)(i).
A school described in section 170(b)(1KA)(ii). (Attach Schedule E.)
A hospital or a cooperative hospital service organization described in section •J70(b)(1)(A)(iii).
A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(rii). Enter the hospital's name,
5 I
city, and state:
I An organization operated for the benefit of a college or university owned or operated by a governmental unit described in
section 170(b)(1)(AKiv). (Complete Part II.)
6 I
1 A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).
7 I X I An organization that normally receives a substantial part of its support from a governmental unit or from the genera! public described in
section 170(b)(1)(A)(vi). (Complete Part II.)
8 I I A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)
9 I
10 I
11 I
I An organization that normally receives: (1) more than 33 1/3% of its support from contributions, membership fees, and gross receipts from
activities related to its exempt functions • subject to certain exceptions, and (2) no more than 33 1/3% of its support from gross investment
income and unrelated business taxable income (less section 511 tax) from businesses acquired by the organization after June 30,1975.
See section 509(a)(2). (Complete Part III.)
i An organization organized and operated exclusively to test for public safety. See section 509(a)(4).
I An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or
more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box that
describes the type of supporting organization and complete lines 11e through 11h.
aI
I Type I
b I I Type II
c I 1 Type III - Functionally integrated
eI
f
g
dI
I Type 111 - Non-functionally integrated
I By checking this box, 1 certify that the organization is not controlled directly or indirectly by one or more disqualified persons other than
foundation managers and other than one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2).
If the organization received a written determination from the IRS that it is a Type I, Type II, or Type III
supporting organization, check this box
Since August 17, 2006. has the organization accepted any gift or contribution from any of the following persons?
A person who directly or indirectly controls, either alone or together with persons described in (ii) and (iii) below,
the governing body of the supported organization?
(ii) A family member of a person described tn (i) above?
(iii) A 35% controlled entity of a person described in (i) or (ii) above?
•
Yes
(i)
h
No
11q(i)
11g(ii)
iintiii)
Provide the following information about the supported organizationfs).
(i) Name of supported
organization
(il)EIN
(vi) Is the
(iii) Type of organization ;iv) Is the organization (v) Did you notify the
(vii) Amount of monetary
(described on lines 1-9 n col (i) listed in your organization in col. organization in col.
support
9
above or IRC section governing document (i) of your support? (i) organized in the
U.S.?
(see instructions))
Yes
No
Yes
No
No
Yes
Total
LHA For Paperwork Reduction Act Notice, see the Instructions for
Form 990 or 990-EZ.
•s
Schedule A (Form 990 or 990-EZ) 2012
232021
12-04-13
13
Schedule A (Form 990 or 990-EZ) 2012 C H I L D R E N ' S CANCER RECOVERY FOUNDATION
33-0418563
•Partiillj Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
Page 2
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization
fails to qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year (or fiscal year beginning in) •
1 Gifts, grants, contributions, and
membership fees received. (Do not
include any "unusual grants.")
(b) 2009
fa) 2008
(CJ2010
fd) 2011
(e) 2012
ff) Total
9790400. 4471208. 8965566. 7652702. 17130106. 48009982.
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)
9790400. 4471208.
?. "•'•
y
":-.
:V. '^
:
:
Public Support. Subtraci line 5fromline 4. •" |^:. ;:...' '..'
6
8965566. 7652702. 17130106. 48009982.
y/'
48009982.
'•..;,;:
Section B. Total Support
7 Amounts from line 4
8
(b) 2009
(c) 2010
(d)2011
(e)2012
(f) Total
Gross income from interest,
dividends, payments received on
securities loans, rents, royalties
and income from similar sources
9
(a) 2008
9790400. 4471208. 8965566. 7652702. 17130106. 48009982.
31,147.
14,678.
10,485.
8,401.
2,107.
66,818.
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 IV.)
11 Total support. Add lines 7 through 10
'f i-
";:"
225,853.
i*"
y.:
14,205. 240,058.
48316858.
12
864,190.
12 Gross receipts from related activities etc. (see mstructi ans)
13 First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3)
organization, check this box and stop here
•
•
Section C. Computation of Public Support Percentage
99.36
14 Public support percentage for 2012 (line 6, column (f) divided by line 11, column (f))
14
99.33
15 Public support percentage from 2011 Schedule A, Part 11, line 14
15
16a 33 1/3% support test - 2012. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box and
%
%
stop here. The organization qualifies as a publicly supported organization
b 33 1/3% support test - 2011. If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization
17a 10% -facts-and-circumstances test - 2012. If the organization did not check a box on line 13, 16a, or 16b, and line 14 is 10% or more,
and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain in Part IV how the organization
meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported organization
b 10% -facts-and-circumstances test - 2011. If the organization did not check a box on line 13,16a, 16b, or 17a, and line 15 is 10% or
more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain in Part IV how the
• I
I
organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported organization
• 1 I
18 Private foundation. If the organization did not checks box on line 13,16a, 16b, 17a, or 17b, check this box and see instructions
•• I 1
232022
12-01-12
14
Page 3
iiKartftHij Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 9 of Part I or if the organization failed to qualify under Part II. If the organization fails to
qualify under the tests listed below, please complete Part II.)
Section A. Public Support
1 Gifts, grants, contributions, and
membership fees received. (Do not
include any "unusual grants.")
(a) 2 D D 8
(c)2010
(b) 2009
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
(dj 2011
(e)2012
{f) Tota!
(e)2012
(0 Total
*
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 older ifian disqualified persons that
exceed ttie greater of $5,000 or 1 % of the
amount on [Ine 13 for the year
c Add lines 7a and 7b
8
P u b l i c s u p p o r t (Subtract line 7c from lire 6.)
'•ly'ii-::-
W^^MM^
••••:.':'.^!,::''!'i:,:",:.":
Section B. Total Support
Calendar year (or fiscal year beginning in} •
(a) 2008
(c»2010
(b) 2009
<dj 2011
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
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 toss from the sale of capital
13
Total SUppOlt. (Addllnes9. 10c, 11, and 12)
14 First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization,
check this box and stop here
•
•
Section C. Computation of Public Support Percentage
15 Public support percentage for 2012 (line 8, column (f) divided by tine 13, column (f))
16 Public support percentaqe from 2011 Schedule A, Part III, line 15
%
%
15
16
Section P. Computation of Investment Income Percentage
17
17 Investment income percentage for 2012 (line 10c. column (f) divided by line 13, column (f)}
18
18 Investment income percentage from 2011 Schedule A, Part 111, line 17
19a 33 1/3% support tests - 2012. If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not
more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
%
%
• 1
I
b 33 1/3% support tests -2011. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3%, and
line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
• I I
20 Private foundation. If the organization did not check a box on line 14,19a, or 19b, check this box and see instructions
• i I
232023 12-04-12
15
Schedule B
Schedule of Contributors
(Form 990, 990-EZ,
or 990-PF)
•
OMB No. 1545-0047
Attach to Form 990, Form 990-EZ, or Form 990-PF.
2012
Department of Die Treasuiy
internal Revenue Service
C H I L D R E N ' S CANCER RECOVERY
FOUNDATION
33-0418563
Organization type (check one):
Filers of:
Section:
Form 990 or 990-EZ
I X I 501 (c)(
Form 990-PF
3 ) (enter number) organization
I
I 4947(a)(1) nonexempt charitable trust not treated as a private foundation
I
1 527 political organization
I
I 501(c)(3) exempt private foundation
I
1 4947(a)(1) nonexempt charitable trust treated as a private foundation
I
I 501 (c)(3) taxable private foundation
Check if your organization is covered by the General Rule or a Special Rule.
Note. Only a section 501 (c)(7}, (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.
General Rule
I
I For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, $5,000 or more (in money or property) from any one
contributor. Complete Parts I and II.
Special Rules
I X I For a section 501 (c)(3} organization filing Form 990 or 990-EZ that met the 33 1/3% support test of the regulations under sections
509(a)(1} and 170(b)(1)(A)(vt) and received from any one contributor, during the year, a contribution of the greater of (1) $5,000 or (2) 2%
of the amount on (i) Form 990, Part VIII, line 1h,or(ii) Form 990-EZ, line 1. Complete Parts land II.
I
I For a section 501(c)(7), (8), or (10) organization filing Form 990 or 990-EZ that received from any one contributor, during the year,
total contributions of more than $1,000 for use exclusively for religious, charitable, scientific, literary, or educational purposes, or
the prevention of cruelty to children or animals. Complete Parts I, II, and III.
I
I For a section 501 (c)(7), (8), or (10) organization filing Form 990 or 990-EZ that received from any one contributor, during the year,
contributions for use exclusively for religious, charitable, etc., purposes, but these contributions did not total to more than $1,000.
[f this box is checked, enter here the total contributions that were received during the year for an exclusively religious, charitable, etc.,
purpose. Do not complete any of the parts unless the General Rule applies to this organization because it received nonexclusively
religious, charitable, etc., contributions of $5,000 or more during the year
• $
Caution. An organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990, 990-EZ, or 99D-PF),
but it must answer "No" on Part IV, line 2, of its Form 990; or check the box on line H of its Form 990-EZ or on Part I, line 2 of its Form 990-PF, to
certify that it does not meet the filing requirements of Schedule B (Form 990, 990-EZ, or 990-PF).
LHA For Paperwork Reduction Act Notice, see the Instructions for Form 990, 990-EZ, or 990-PF.
223451
12-21-12
Schedule B (Form 990, 99D-EZ, or 990-PF) (2012)
Page 3
Schedule B (Form 990, 990-EZ, or 990-PF) (2012)
Name ol organization
33-0418563
Part II
N o n c a s h P r o p e r t y (see instructions). Use duplicate copies of Part 11 if additional space is needed.
(a)
No.
from
Parti
(c)
FMV (or estimate)
(see instructions)
(b)
Description of noncash property given
MEDICINE
/
(d)
Date received
VACCINES
1
$
(a)
No.
from
Parti
3,120,125.
(c)
FMV (or estimate)
(see instructions)
(b)
04/30/12
(d)
Date received
MEDICINES
2
$
(a)
No.
from
Parti
lb)
6,929,162.
12/13/12
(c)
FMV (or estimate)
(see instructions)
<d)
Date received
(c)
FMV (or estimate)
(see instructions)
(d)
Date received
$
(a)
No.
from
Parti
(b)
$
(a)
No.
from
Parti
(b)
FMV (or estimate)
(see instructions)
(d)
Date received
$
(a)
No.
from
Parti
(c)
FMV (or estimate)
{see instructions)
(d)
Date received
$
223153 12-21-12
Schedule B (Form 99D, 990-EZ, or 990-PF) (2012)
Schedule B (Form 990, 990-EZ, or 990-PF) (2012)
Name o! organization
Page 4
Employer identitication number
33-0418563
mmm
(a) No.
from
Parti
Exclusively religious, charitable, etc., individual contributions to section 501(c)(7), (8), or (10) organizations thai total more than $1,000 (or the
year. Complete columns (a) through (e) and the following line entry. For organizations completing Part 111, enter
the total of exc/us/ve/y religious, charitable, etc., contributions of $1,000 or less for the year (Enterthis intormasm once) ^ *
Use duplicate copies of Part 111 if additional space is needed.
(b) Purpose of gift
(c) Use of gift
(d) Description of how gift is held
(e) Transfer of gift
Transferee's name, address, and ZIP + 4
(a) No.
from
Parti
(b) Purpose of gift
Relationship of transferor to transferee
(c) Use of gift
(a) No.
from
Parti
(b) Purpose of gift
(c) Use of gift
(a) No.
from
Parti
(b) Purpose of gift
(c) Use of gift
Schettule B (Form 990. 990-EZ, or 990-PF) (2012)
223454 12-21-12
19
OMBNo, 1515-0017
Supplemental Financial Statements
SCHEDULE D
(Form 990)
2012
• Complete if the organization answered "Yes," to Form 990,
Part IV, line 6, 7, 8, 9,10,11a, 11b, 11c, 11d, l i e , 11f, 12a, or 12b.
• Attach to Form 990. • See separate instructions.
Department of the Treasury
Inlemal Revenue Service
:-lrisp£Q$iipn::;
Parti
33-0418563
Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the
organization answered "YesB to Form 990, Part IV, line 6.
(a) Donor advised funds
(b) Funds and other accounts
1
2
Total number at end of year
Aggregate contributions to (during year)
3
4
Aggregate grants from (during year)
Aggregate value at end of year
5
Did the organization inform all donors and donor advisors in writing that the assets held in donor advised funds
are the organization's property, subject to the organization's exclusive legal control?
6 Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be used only
for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring
impermissible private benefit?
Jg&mWM C o n s e r v a t i o n E a s e m e n t s . Complete if the organization answered "Yes" to Form 990, Part IV, line 7.
•
Yes
I
I Yes
•
No
LJ
No
Purpose(s) of conservation easements held by the organization (check all that apply).
1
I
I
1 Preservation of land for public use (e.g., recreation or education)
Protection of natural habitat
I Preservation of open space
1
I
I Preservation of an historically important land area
I Preservation of a certified historic structure
Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last
day of the tax year.
Held atthe End of the Tax Year
Total number of conservation easements
2a
Total acreage restricted by conservation easements
Number of conservation easements on a certified historic structure included in (a)
Number of conservation easements included in (c) acquired after 8/17/06, and not on a historic structure
2b
2c
listed in the National Register
2d
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the tax
year • "
3
4
5
6
7
Number of states where property subject to conservation easement is located •
Does the organization have a written policy regarding the periodic monitoring, inspection, handling of
violations, and enforcement of the conservation easements it holds?
Staff and volunteer hours devoted to monitoring, inspecting, and enforcing conservation easements during the year •
Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year • $
I
1 Yes
•
No
•
Yes
•
No
8
Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i)
and section 170(h)(4)(B)(ii)?
9
In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and balance sheet, and
include, if applicable, the text of the footnote to the organization's financial statements that describes the organization's accounting for
conservation easements.
liPatrt-lHyl Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" to Form 990, Part IV, line 8.
la
^ ^
If the organization elected, as permitted under SFAS 116 (ASC 958), not to report in its revenue statement and balance sheet works of art,
historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII,
the text of the footnote to its financial statements that describes these items.
b Jf the organization elected, as permitted under SFAS 116 (ASC 958), to report in its revenue statement and balance sheet works of art, historical
treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts
relating to these items:
(i) Revenues included in Form 990, Part VIII, line 1
(ii) Assets included in Form 990, Part X
2
•
•
$
$
If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide
the following amounts required to be reported under SFAS 116 (ASC 958) relating to these items:
a Revenues included in Form 990, Part V!U, line 1
b Assets included in Form 990, Part X
•
•
LHA For Paperwork Reduction Act Notice, see the Instructions for Form 990.
232051
12-10-12
20
$
$
Schedule D (Form 990) 2012
33-0418563 Paqe2
illn Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assetsfconf/nuedj
Using the organization's acquisition, accession, and other records, check any of the following that are a significant use of its collection items
(check all that apply):
I
I Public exhibition
1
I
I Scholarly research
1 Preservation for future generations
d
I
I Loan or exchange programs
e
I
) Other
Provide a description of the organization's collections and explain how they further the organization's exempt purpose in Part XIII.
During the year, did the organization solicit or receive donations of art, historical treasures, or other similar assets
to be sold to raise funds rather than to be maintained as part of the organization's collection?
I I Yes
P a r t IV
E s c r o w a n d C u s t o d i a l A r r a n g e m e n t s . Complete if the organization answered "Yes" to Form 990, Part IV, line 9, or
reported an amount on Form 990, Part X, line 21.
1a Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not included
on Form 990, Part X?
•
Yes
I
1 No
•
No
•
No
If "Yes," explain the arrangement in Part XIII and complete the following table:
Amount
Beginning balance
Additions during the year
1c
1d
Distributions during the year
Ending balance
2a Did the organization include an amount on Form 990, Part X, line 21 ?
b If "Yes," explain the arranqement in Part XIII Check here if the explanation has been provided in Part XIII
Part V
E n d o w m e n t F u n d s . Complete if the organization answered "Yes" to Form 990, Part IV, line 10.
(a) Current year
(b) Prior year
(c) Two years back
1e
If
•
Yes
•
(d) Three years back (e) Four years back
1a Beginningof year balance
b Contributions
c Net investment earnings, gains, and losses
d Grants or scholarships
e Other expenditures for facilities
and programs
f Administrative expenses
g Endof year balance
Provide the estimated percentage of the current year end balance (line 1 g, column (a)) held as:
Board designated or quasi-endowment •
_%
Permanent endowment • •
Temporarily restricted endowment • •
%
%
The percentages in lines 2a, 2b, and 2c should equal 100%.
3a Are there endowment funds not in the possession of the organization that are held and administered for the organization
by:
(i) unrelated organizations
(ii) related organizations
b If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R?
Describe in Part Xlll the intended uses of the organization's endowment funds.
Part VI
Yes
No
3a{i)
3a(ii)
3b
Land, Buildings, and Equipment. See Form 990, Part x, line ID.
Description of property
(a) Cost or other
basis (investment)
(b) Cost or other
basis (other)
(c) Accumulated
depreciation
(d) Book value
1 a Land
b Buildings
c Leasehold improvements
d Equipment
84,831.
77,430.
7,401.
i
e Other
Total. Add lines l a through 1e. (Column (d) must equal Form 990, Pari X, column (B), line 10(c).)
•
7,401.
232053
12-10-12
21
33 - 0 4 1 8 5 6 3 Paqe3
I ' ^ a t f c l d l I n v e s t m e n t s - O t h e r S e c u r i t i e s . See Form 990, Part X, line 12.
(a) Description Of Security Or Category (including name of security)
(b) Book value
(c) Method of valuation: Cost or end-of-year market value
(1) Financial derivatives
(2) Closely-held equity interests
(3) Other
(A)
(B)
(C)
(D)
(E)
(F)
(G)
(H)
(1)
Total.(Col (b) must equal Form 990, Part X, col (B}line12)^
P K V i i l I n v e s t m e n t s - P r o g r a m R e l a t e d . See Form 990, Part x, line 13.
(b) Book value
(a) Description of investment type
(c) Method of valuation: Cost or end-of-year market value
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
Total. (Col. lb) must equal Form 990, Part X. col (Bllme 13 ) •
:
:I*pt-.JIX!: O t h e r A s s e t s . See Form 990, Part X, line 15.
(a) Description
(b) Book value
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
Total. (Column (b) must epual Form 990, Part X, col. (B) line 15.)
i^tftM'}.
O t h e r Liabilities. See Form 990, Part X, line 25.
1.
(a) Description of liability
•
(b) Book value
';:
(1) Federal income taxes
(2)
(3)
(4)
(5)
(6)
(7)
-M
(8)
(9)
00)
:>•
•;,:
01)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 25.)
•
2. FIN 48 (ASC 740) Footnote. In Part XIII, provide the text of the footnote to the organization's financial statements that reports the organization's
liability for uncertain tax positions under FIN 48 (ASC 740). Check here if the text of the footnote has been provided in Part XIII
IX I
232053
12-10-12
22
3 3 - 0 4 1 8 5 6 3 Paqe4
lEarfciXI : Reconciliation of Revenue per Audited Financial Statements With Revenue per Return
17,218,643.
1 Total revenue, gams, and other support per audited financial statements
1
ScheduleD(Form990)2012
2
Amounts included on line 1 but not on Form 990, Part VIII, line 12
a Net unrealized gains on investments
b Donated services and use of facilities
c Recoveries of prior year grants
2a
d Other (Describe in Part XIII.)
2d
2b
2c
9,894.
e Add lines 2a through 2d
3 Subtract line 2e from line 1
4
2e
3
Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b
b Other (Describe in Part XIII.)
5 Total revenue. Add lines 3 and 4c. (This must equal Form 990. Part 1, line 12.)
9,894.
17,208,749.
4a
4b
0.
17,208,749.
Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return
16,819,055.
1 Total expenses and losses per audited financial statements
1
2
Amounts included on line 1 but not on Form 990, Part IX, line 25:
a Donated services and use of facilities
4c
5
2a
2b
b Prior year adjustments
c Other losses
d Other {Describe in Part XIII.)
2c
2d
e Add lines 2a through 2d
3 Subtract line 2e from line 1
4 Amounts included on Form 990, Part IX, line 25, but not on line 1:
a investment expenses not included on Form 990, Part Vl|l, line 7b
b Other (Describe in Part XIII.)
5
9,894.
2e
3
9,894.
16,809,161.
4c
0.
16,809,161.
4a
4b
Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.)
5
Part XIII Supplemental Information
Complete this part to provide the descriptions required for Part II, lines 3, 5, and 9; Part IN, lines 1a and 4, Part IV, lines l b and 2b; Part V, line 4; Part
X, line 2; Part XI, lines 2d and 4b; and Part Xlf, lines 2d and 4b. Also complete this part to provide any additionaf information.
PART X, LINE 2: THE FOUNDATION IS EXEMPT FROM INCOME TAXES UNDER
SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE ON ACTIVITIES RELATED TO
THE FOUNDATIONS EXEMPT PURPOSE.
THE FOUNDATION ADHERES TO THE PROVISIONS OF FINANCIAL ACCOUNTING STANDARDS
BOARD (FASB) CODIFICATION 740, INCOME TAXES (ASC 740). ASC 740 PRESCRIBES
A COMPREHENSIVE MODEL FOR FINANCIAL STATEMENT RECOGNITION, MEASUREMENT,
CLASSIFICATION AND DISCLOSURE OF UNCERTAIN TAX POSITIONS. THE FOUNDATION
23205-1
12-10-12
23
33-0418563
Pages
•Ifeiart;ffiltj Supplemental Information (continued)
HAS CONCLUDED THAT IT DOES NOT HAVE ANY UNCERTAIN TAX POSITIONS THAT
REQUIRE RECOGNITION OR DISCLOSURE IN THE FINANCIAL STATEMENTS. MANAGEMENT
BELIEVES IT IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR YEARS
PRIOR TO 2009.
PART XI, LINE 2D - OTHER ADJUSTMENTS:
FUNDRAISING EVENTS EXPENSES DEDUCTED FROM REVENUE
9,894
PART XII, LINE 2D - OTHER ADJUSTMENTS:
FUNDRAISING EVENTS EXPENSES DEDUCTED FROM REVENUE
9,894
2320S5
12-10-13
24
Scheduler (Form 990) 2012
33-0418563
IJ^ft-W' Grants and Other Assistance to Individuals Outside the United States. Compiete if the organization answered "Yes" to Form 990, Part IV, line 16.
Part III can be duplicated if additional space is needed.
(c) Number of (d) Amount of
(e) Manner of
(f) Amount of
(g) Description of
(a) Type of grant or assistance
(b) Region
recipients
cash grant
cash disbursement
non-cash
non-cash assistance
assistance
Page 3
(h) Method of
valuation
(book, FMV,
appraisal, other)
Schedule F (Form 990) 2012
232073
12-10-12
27
CHILDREN'S
CANCER
RECOVERY
FOUNDATION
33-0418563
page4
ifiariW: Foreign Forms
1
Was the organization a U.S. transferor of property to a foreign corporation during the tax year? If "Yes," the
organization may be required to file Form 926, Return by a U. S. Transferor of Property to a Foreign
Corporation (see Instructions for Form 926)
2
L_J Yes
^_^
I X I No
L U Yes
QT] No
^_^
I Yes
I X | No
E H Yes
[ X ] No
I
I Yes
I X I No
•
Yes
QT] No
Did the organization have an interest in a foreign trust during the tax year? If "Ves," the organization
may be required to file Form 3520, Annual Return to Report Transactions with Foreign Trusts and
Receipt of Certain Foreign Gifts, and/or Form 3520-A, Annual Information Return of Foreign Trust With
a U.S. Owner (see Instructions for Forms 3520 and 3520-A)
3
Did the organization have an ownership interest in a foreign corporation during the tax year? If "Yes,"
the organization may be required to file Form 5471, Information Return of U.S. Persons With Respect To
Certain Foreign Corporations, (see Instructions for Form 5471)
4
Was the organization a direct or indirect shareholder of a passive foreign investment company or a
qualified electing fund during the tax year? If "Yes," the organization may be required to file Form 8621,
Information Return by a Shareholder of a Passive Foreign Investment Company or Qualified Electing Fund. •
(see Instmctions for Form 8621)
5
Did the organization have an ownership interest in a foreign partnership during the tax year? If "Yes,"
the organization may be required to file Form 8865, Return of U.S. Persons With Respect To Certain
Foreign Partnerships, (see Instructions for Form 8865)
6
I
Did the organization have any operations in or related to any boycotting countries during the tax year? If
"Yes," the organization may be required to file Form 5713, International Boycott Report, (see Instructions
forForm5713)
232074
12-10-12
Supplemental Information Regarding
Fundraising or Gaming Activities
SCHEDULEG
(Form 990 or 990-EZ)
OMBNo. 1545-0047
2012
Complete if the organization answered "Yes" to Form 990, Part IV, lines 17,18, or 19,
or if the organization entered more than $15,000 on Form 990-EZ, line 6a.
• Attach to Form 990 or Form 990-EZ. • See separate instructions.
33-0418563
F u n d r a i s i n g A c t i v i t i e s . Complete if the organization answered "Yes" to Form 990, Part IV, line 17. Form 990-EZ filers are not
required to complete this part.
1
Indicate whether the organization raised funds through any of the following activities. Check all that apply.
a I X I Mail solicitations
e I X I Solicitation of non-government grants
b I X I Internet and email solicitations
f I I Solicitation of government grants
g I X I Special fundraising events
c I X I Phone solicitations
d I X I ln-person solicitations
2 a Did the organization have a written or oral agreement with any individual (including officers, directors, trustees or
key employees listed in Form 990, Part VII) or entity in connection with professional fundraising services?
L.X 1 Yes
^__^
I 1 No
b If "Yes," list the ten highest paid individuals or entities (fundraisers) pursuant to agreements under which the fundraiser is to be
compensated at least $5,000 by the organization.
(i) Name and address of individual
or entity (fundraiser)
(ii) Activity
Yes
ASSOCIATED COMMUNITY SERVICES
- 2 9 7 7 7 TELEGRAPH AVE,
SUITE
CONTRACT COMMUNICATIONS
3630
S.
PLAZA T R A I L ,
BRICKMILL MARKETING
-
No
IMMUNITY OUTREACH
X
5,583,686.
3,066,031.
2,517,655.
VIRGINIA
ZOMMUNITY OUTREACH
X
746,675.
609,941.
136,734.
COMMUNITY OUTREACH
X
360,534.
359,373.
1,261.
COMMUNITY OUTREACH
X
2,594.
8,600.
0.
6,693,589.
4,043,945.
2,655,650.
SERVICES
4 SPURWOOD
COURT, THE WOODLANDS, TX
Total
3
(v) Amount paid
(iv) Gross receipts to (or retained by) (vi) Amount paid
to (or retained by)
from activity
fundraiser
organization
listed in col. (i)
-
2 4 MILL BROOK ROAD, WILTON,
BETHANY BRECHLER -
(iii) Did
fundraiser
have custodv
or control of
contributions'?
•
List all states in which the organization is registered or licensed to solicit contributions or has been notified it is exempt from registration
or licensing.
M,rAKrAZtI^fCArCOrCT:rDEfFhfGAfliIfID/J'LrINrIArKSfKYf-LArnEfnDfMArHIrmirMSfnO
MT,NE,NV,NH,NJ,NM,NY,NC,ND,OH,OK,OR,PA,RI,SC,SD,TN,TX,UT,VT,VA,WA,WV,WI,Vre
DC
LHA Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
SEE PART IV FOR CONTINUATIONS
232081
01-07-13
30
Schedule G (Form 990 or 9gO-EZ) 2012
ScheduleG(Form990or990-EZ)2012 C H I L D R E N ' S
:.P,&rt;M:
CANCER
RECOVERY
FOUNDATION
33-0418563
Pa q e2
F u n d r a i s i n g E v e n t s . Complete if the organization answered "Yes" to Form 990, Part IV, line 18, or reported more than $15,000
of fundraising event contributions and gross income on Form 990-EZ, lines 1 and 6b. List events with gross receipts greater than $5,000.
(c) Other events
(a) Event #1
(b) Event #2
(d) Total events
NONE
30LF
(add col (a) through
lOURNAMENT
I R A I L RIDE
col. (c))
{event type)
(event type}
(total number)
c
>
ID
10,670.
13,429.
24,099.
10,670.
13,429.
24,099.
528.
768.
1,296.
3,331.
100.
3,431.
Food and beverages
250.
771.
1,021.
Entertainment
Other direct expenses
511.
325.
3,310.
325.
3,821.
9,894^
14,205.
1
Gross receipts
2
Less: Contributions
3
Gross income {line 1 minus line 2)
4
Cash prizes
5
Noncash prizes
6
Rent/facility costs
7
8
9
ID
0)
m
c
01
b
10 Direct expense summary. Add lines 4 througi 9 in column (d)
11 Net income summary- Combine line 3, column (d), and line 10
P a r t HI
G a m i n g . Complete if the organization answered "Yes" to Form 990, Part IV, line 19, or eported more than
•
•
(
$15,000 on Form 990-EZ, line 6a.
(a) Bingo
(b) Pull tabs/instant
bingo/progressive bingo
(d) Total gaming (add
col. (a) through col. (c))
(c) Other gaming
>
en
1
Gross revenue
2
Cash prizes
3
Noncash prizes
4
Rent/facility costs
5
Other direct expenses
6
Volunteer labor
7
Direct expense summary. Add lines 2 through 5 in column (d)
••
8
Net qaminq income summary. Combine line 1 , column d. and line 7
•
c
<D
Q.
Q
9
1
1
1
1 Nn
YP*
%[
1
1 Ye.;
iNo
% l _ l Yes
1 1 No
%
'"
(
)
Enter the state(s) in which the organization operates gaming activities:
a Is the organization licensed to operate gaming activities in each of these states?
•
Yes
•
No
P I Yes
•
No
b If "No," explain-
10a Were any of the organization's gaming licenses revoked, suspended or terminated during the tax year9
b If "Yes," explain:
Schedule G (Form 990 or 990-EZ) 2012
232082 01-07-13
31
Schedule G (Form 990 or 990-EZ) 2012 C H I L D R E N ' S
11
12
CANCER
RECOVERY
FOUNDATION
33-0418563
Does the organization operate gaming activities with nonmembers?
Is the organization a grantor, beneficiary or trustee of a trust or a member of a partnership or other entity formed
to administer charitable gaming?
13 Indicate the percentage of gaming activity operated in:
a The organization's facility
I Yes
L_J Yes
Page3
I J No
I
I No
%
%
13a
b An outside facility
14 Enter the name and address of the person who prepares the organization's gaming/special events books and records:
Name
I
13b
•
Address
•
15a Does the organization have a contract with a third party from whom the organization receives gaming revenue?
b If "Yes," enter the amount of gaming revenue received by the organization •
of gaming revenue retained by the third party • • $
.
$
I
1 Yes
I
1 No
and the amount
c If "Yes," enter name and address of the third party:
Name
•
Address
16
•
Gaming manager information:
Name
•
Gaming manager compensation • • $
Description of services provided • "
I
17
I Director/officer
I
J Employee
I
I Independent contractor
Mandatory distributions:
a Is the organization required under state law to make charitable distributions from the gaming proceeds to
retain the state gaming license?
b Enter the amount of distributions required under state law to be distributed to other exempt organizations or spent in the
organization's own exempt activities during the tax year • $
iPafefcly;]
I—I Yes
I
1 No
Supplemental Information. Complete this part to provide the explanations required by Part 1, line 2b, columns (iii) and {v), and Part II
lines 9, 9b, 10b, 15b, 15c, 16, and 17b, as applicable. Also complete this part to provide any additional information (see instructions).
SCHEDULE G, PART I, LINE 2B, LIST OF TEN HIGHEST PAID FUNDRAISERS:
(I) NAME OF FUNDRAISER: ASSOCIATED COMMUNITY SERVICES
(I) ADDRESS OF FUNDRAISER:
29777 TELEGRAPH AVE, SUITE 3000, SOUTHFIELD, MI
48034
(I) NAME OF FUNDRAISER: CONTRACT COMMUNICATIONS
(I) ADDRESS OF FUNDRAISER: 3630 S. PLAZA TRAIL, VIRGINIA BEACH, VA
232083 01-07-13
23452
Schedule G (Form 990 or990-EZ) 2012
32
Schedule G (Form 990 or 990-EZ) 2012 C H I L D R E N ' S C A N C E R
pgjrfrp; Supplemental Information (continued)
RECOVERY
FOUNDATION
33-0418563
Page*
(I) NAME OF FUNDRAISER: BRICKMILL MARKETING SERVICES
(I) ADDRESS OF FUNDRAISER: 24 MILL BROOK ROAD, WILTON, NH
03086
(I) NAME OF FUNDRAISER: BETHANY BRECHLER
(I) ADDRESS OF FUNDRAISER: 4 SPURWOOD COURT, THE WOODLANDS, TX
77381
Schedule G (Form 990 or 990-EZ) 2012
232081
05-01-12
33
Noncash Contributions
SCHEDULE M
{Form 990)
•
OMBNo 1545-004?
2012
Complete if the organizations answered "Yes" on Form
990, Part IV, lines 29 or 30.
• Attach to Form 990.
33-0418563
Part I
Types of Property
(a)
Check if
applicable
(c)
(b)
Noncash contribution
Number of
amounts reported on
contributions or
items contributed Form 990. Part VIII. line l a
(d)
Method of determining
noncash contribution amounts
1 Art - Works of art
2 Art - Historical treasures
3 Art - Fractional interests
4 Books and publications
5 Clothing and household goods
6 Cars and other vehicles
7 Boats and planes
6 Intellectual property
9 Securities - Publicly traded
10 Securities - Closely held stock
11 Securities - Partnership, LLC, or
12
13
trust interests
Securities - Miscellaneous
Qualified conservation contribution Historic structures
Qualified conservation contribution - Other
14
15 Real estate - Residential
16 Real estate - Commercial
17 Real estate - Other
18 Collectibles
19 Food inventory
20 Drugs and medical supplies
21 Taxidermy
22 Historical artifacts
23 Scientific specimens
24 Archeological artifacts
( TOYS AND SMAL )
25 Other •
26 Other •
(
}
27 Other
•
{
28 Other
• _L
29
X
520,819
X
40,879
10,049,287.
255,163
FMV, DONOR VALUATION
FMV, DONOR VALUATION
Number of Forms 8283 received by the organization during the tax year for contributions
for which the organization completed Form 8283, Part IV, Donee Acknowledgement
29
Yes
No
30a During the year, did the organization receive by contribution any property reported in Part I, lines 1-28 that it must hold for
at least three years from the date of the initial contribution, and which is not required to be used for exempt purposes for
the entire holding period 9
b If "Yes," describe the arrangement in Part 11
31 Does the organization have a gift acceptance policy that requires the review of any non-standard contributions'?
30a
X
31
32a Does the organization hire or use third parties or related organizations to solicit, process, or sell noncash
32a
X
contributions?
b If "Yes," describe in Part II.
33 |f the organization did not report an amount in column {c) for a type of property for which column (a) is checked,
describe in Part II.
LHA
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Schedule M (Form 990) (2012)
232141
13-20-12
34
SCHEDULE 0
OMBNo. 1515-0047
Supplemental Information to Form 990 or 990-EZ
(Form 990 or 990-EZ)
Complete to provide information for responses to specific questions on
Form 990 or 990-EZ or to provide any additional information.
• Attach to Form 990 or 990-EZ.
Departrnent of the Treasury
2012
^^•S^ftSiSectiqn'i-^'ii-i-V^::!:
33-0418563
FOUNDATION
FORM 990, PART I, LINE 1, DESCRIPTION OF ORGANIZATION MISSION:
DIAGNOSIS.
FORM 990, PART III, LINE 4D, OTHER PROGRAM SERVICES:
THE HELPING HANDS FUND PROGRAM: THE FOUNDATION PROVIDED EMERGENCY
FINANCIAL ASSISTANCE TO THE FAMILIES OF PEDIATRIC CANCER PATIENTS.
BECAUSE OF THE HIGH DEMAND, FUNDING WAS LIMITED TO PAYMENT OF PAST-DUE
UTILITY BILLS, RENT EVICTION NOTICES AND CHILDHOOD SCHOLARSHIPS.
EXPENSES $ 65,932.
INCLUDING GRANTS OF $ 0.
REVENUE $ 0.
FORM 990, PART VI, SECTION B, LINE 11: A COPY OF THE FORM 990 HAS BEEN
PROVIDED TO THE BOARD OF TRUSTEES AND IS REVIEWED BY THEM.
THE PRESIDENT
ALSO MEETS WITH A REPRESENTATIVE OF THE ACCOUNTING FIRM THAT PREPARED THE
FORM 990 AND RELATED SCHEDULES TO DISCUSS THE CONTENT AND ANSWER ANY
QUESTIONS OF THE BOARD OF TRUSTEES.
FINAL CHANGES, IF ANY, ARE THEN MADE
TO THE FORM 990 AND RELATED SCHEDULES.
THE FINAL COPY OF THE FORM 990 AND
RELATED SCHEDULES IS THEN PROVIDED TO THE BOARD OF TRUSTEES.
FORM 990, PART VI, SECTION B, LINE 12C: THE QUESTION IS RAISED AND
APPROPRIATE DISCLOSURES ARE MADE AT THE FIRST BOARD MEETING OF EACH
CALENDAR YEAR.
FORM 990, PART VI, SECTION B, LINE 15A: THE BOARD OF TRUSTEES AND OFFICERS
SERVE WITHOUT COMPENSATION FROM CCRF. THE NON-INDEPENDENT OFFICERS
COMPENSATION (IF ANY) ARE PAID THROUGH CANCER RECOVERY FOUNDATION
INTERNATIONAL, THE COMMON PAYER FOR THE CRFI GROUP OF CHARITIES IN THE
LHA For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
232211
O1-Od-13
35
Schedule O (Form 990 or 990-EZ) (2012)
Page 2
33-0418563
UNITED STATES. COMPENSATION IS DETERMINED BY THE CEO OF CRFI, WHO USES A
COMBINATION OF FORM 990S FROM OTHER ORGANIZATIONS, COMPENSATION STUDIES,
AND A DISCUSSION WITH THE INDEPENDENT BOARD MEMBERS.
FORM 990, PART VI, LINE 17, LIST OF STATES RECEIVING COPY OF FORM 990:
AL,AK,AZ,AR,CA,CT,DC,GA,IL,KS,KY,LA,ME,MP,MA,MI,MN,MS,MO,NH,NJ,NM,NY,NC,ND
OH,OR,PA,RI,SC,TN,UT,VA,WA,WV,WI,CO,FL,OK
FORM 990, PART VI, SECTION C, LINE 19: ANY DISCLOSURES REQUIRED BY FEDERAL
AND STATE LAW ARE INCLUDED IN OUR DIRECT RESPONSE AND FULFILLMENT PIECES.
OUR WEBSITE IS UTILIZED WHERE APPROPRIATE.
WE FULLY COMPLY WITH ALL
CORPORATE AND NON-PROFIT REGISTRATION REQUIREMENTS IN ALL 50 STATES AS
APPLICABLE.
THE DOCUMENTS ARE AVAILABLE FOR INSPECTION AT OUR SITE DURING
NORMAL BUSINESS HOURS.
FORM 990, PART IX, LINE 11G, OTHER FEES
COMMUNITY OUTREACH SERVICES:
2,817,265
PROGRAM SERVICE EXPENSES
568,748
MANAGEMENT AND GENERAL EXPENSES
FUNDRAISING EXPENSES
3,386,013
TOTAL EXPENSES
CONTRACT LABOR
143,097
PROGRAM SERVICE EXPENSES
24,125
MANAGEMENT AND GENERAL EXPENSES
FUNDRAISING EXPENSES
167,222.
TOTAL EXPENSES
TOTAL OTHER FEES ON FORM 990, PART IX, LINE 11G, COL A
232212
01-04-13
3,553,235.
36
OMB No. 1545-0047
Related Organizations and Unrelated Partnerships
SCHEDULER
(Form 990)
•
Internal Revenue Servrce
2012
Complete if the organization answered "Yes" to Form 990, Part IV, line 33, 34, 35, 36, or 37.
• Attach to Form 990.
• See separate instructions.
i^QjP'en: :ta:Pu.bJicr:>
33-0418563
:
^'F£|>;-:
Identification of Disregarded Entities (Complete if the organization answered "Yes" to Form 990, Part IV, line 33.}
(a)
Name, address, and EIN (if applicable)
of disregarded entity
tfSrtft?
(b)
Primary activity
(c)
Legal domicile (state or
foreign country)
(e)
End-of-year assets
(f)
Direct controlling
entity
Identification of Related Tax-Exempt Organizations (Complete if the organization answered "Yes" to Form 990, Part IV, line 34 because it had one or more related tax-exempt
organizations during the tax year.)
(a)
Name, address, and EIN
of related organization
(b)
Primary activity
CANCER RECOVERY FOUNDATION INTERNATIONAL
TO PROVIDE EDUCATIONi
INC. - 2 0 - 8 2 4 0 2 4 1 , 6380 FLANK DRIVE,
HARRISBURG, PA 17112
TRAINING, AND SUPPORT TO
AFFILIATED ENTITIES.
(c)
Legal domicile (state or
foreign country)
PENNSYLVANIA
LHA
(d)
Exempt Code
section
501(C)(6)
<e)
Public charity
status (if section
501 (c)(3))
(0
(9)
Direct controlling
entity
Section 512(bX13)
controlled
entity?
Yes
tf/A
No
X
Schedule R (Form 990) 2012
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
232161
12-10-12
(d)
Total income
37
ScheduleR(Form990)2012
:
;i?art :l&
CHILDREN'S
CANCER
RECOVERY
33-0418563
FOUNDATION
paQe2
Identification of Related Organizations Taxable as a Partnership (Complete if the organization answered "Yes" to Form 990, Part iV, line 34 because it had one or more related
organizalhns treated as a partnership during the tax year.)
(a)
Name, address, and E1N
(c)
Primary activity
Legal
domicile
(state or
foreign
country)
(d)
Direct controlling
entity
(e)
Predominant income
(related, unrelated,
excluded from tax under
sections 512-514)
ffl
Share of total
income
(g)
Share of
end-of-year
assets
(h)
Disproportionate allocations?
Yes
No
(k)
(i)
0)
General or Percentage
CodeV-UBI
ownership
amount in box managing
partner?
20 of Schedule
Yes
No
K-1 (Form 1065)
';Ra'rt-:iV: ! c ' e n t ' f ' c a t ' o n ^ Related Organizations Taxable as a Corporation or Trust (Complete if the organization answered "Yes" to Form 990, Part iV, line 34 because it had one or more related
..; organizations treated as a corporation or trust during the tax year.)
(a)
Name, address, and BIN
232162 12-10-12
(bj
Primary activity
(c)
(d)
Legal domicile
[stale or
foreign
country)
Direct controlling
entity
38
(e)
Type of entity
(C corp, S corp,
or trust)
(f)
Share of total
income
(g)
Share of
end-of-year
assets
(h)
Percentage
ownership
(i)
Section
512(b}(13)
controlled
entity?
Yes
No
Schedule R {Form 990) 2012
Schedule R {Form 990) 2012
FattV'
FOUNDATION
33-0418563
Paqe3
Transactions With Related Organizations (Complete if the organization answered "Yes" to Form 990, Part IV, line 34,35b. or 36.)
Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.
Yes
1 Dunng the tax year, did the organization engage in any of the following transactions with one or more related organizations listed in Parts ll-IV?
a Receipt of (ij interest (ii) annuities (iii) royalties or (iv) rent from a controlled entity
b Gift, grant, or capital contribution to related organization{s)
1d
1e
X
X
X
X
X
1a
1b
c Gift, grant, or capital contribution from related organization^)
d Loans or loan guarantees to or for related organ)zatlon(s)
e Loans or loan guarantees by related organtzation(s)
1c
f Dividends from related organization(s)
g Sale of assets to related organ izat ion (s)
h Purchase of assets from related organ izat ion (s)
No
If
X
ig
1h
1i
A
i
Exchange of assets with related organization(s)
j
Lease of facilities, equipment, or other assets to related organization{s)
JI
X
k Lease of facilities, equipment, or other assets from related organ izat ion (s)
1k
11
X
X
X
I Performance of services or membership or fundraising solicitations for related organ izat ion (s)
m Performance of services or membership or fundraising solicitations by related organ izat ion (s)
n Sharing of facilities, equipment, mailing lists, or other assets with related organ izat ion (s)
o Sharing of paid employees with related organization{s)
1m
In
1o
X
X
p Reimbursement paid to related organ izat ion (s) for expenses
q Reimbursement paid by related organ izat ion (s) for expenses
JJL
JlSL
X
X
r
Other transfer of cash or property to related organ izat ion (s)
s Other transfer of cash or property from related organization(s) . . .
.
_. .
.
2 If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.
(b)
Transaction
type (a-s)
(a)
Name of other organization
CANCER RECOVERY FOUNDATION
(1) I N C .
Amount involved
1r
Is
X
(d)
Method of determining amount involved
INTERNATIONAL,
0
1 8 0 , 1 2 5 . ACTUAL EXPENSES
INCURRED
(2)
(3)
(4)
(5)
(6)
232163 12-10-12
39
:::
:::iRart-V!:
CHILDREN'S
CANCER
RECOVERY
33-0418563
FOUNDATION
Page4
u
Unrelated Organizations Taxable as a Partnership (Complete if the organization answered °Yes to Form 990, Part IV, line 37.)
Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue)
that was not a related organization. See instructions regarding exclusion for certain investment partnerships.
(a)
Name, address, and EIN
of entity
(b)
Primary activity
(c)
Legal domicile
(state or foreign
country)
(e)
Predominant income
(related, unrelated,
excluded from tax
under section 512-514)
Are all
partneis sec.
501(c)(3)
Oiqs.?
Yes N o
(t)
Share of
total
income
(g)
Share of
end-of-year
assets
(h)
Disproportionate
ailocatiCHis?
Yes N o
(i)
CodeV-UBI
amount in box 20
of Schedule K-l
(Form 1065)
(J)
Seneral or
rnanaging
partner?
(k)
Percentage
ownership
Yes N o
232164
12-10-12
40
i;ffft&yU;:j Supplemental Information
33-0418563
Page 5
Complete this part to provide additional information for responses to questions on Schedule R (see instructions).
232165 12-10-12
41

Document 6447875

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