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        <Explanation>FIN 48 FINANCIAL STATEMENT FOOTNOTE FROM THE COMBINED FINANCIAL STATEMENTS OF CHILDREN'S NATIONAL MEDICAL CENTER (MEDICAL CENTER) AND SUBSIDIARIES, OF WHICH Children's Research Institute is a SUBSIDIARY, IS AS FOLLOWS: THE MEDICAL CENTER IS A NOT-FOR-PROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND IS EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. ON SUCH BASIS, THE EXEMPT ENTITIES WILL NOT INCUR ANY LIABILITY FOR FEDERAL INCOME TAXES, EXCEPT FOR POSSIBLE UNRELATED BUSINESS INCOME. THE MEDICAL CENTER EVALUATES UNCERTAIN TAX POSITIONS USING A TWO-STEP APPROACH FOR RECOGNIZING AND MEASURING TAX BENEFITS TAKEN OR EXPECTED TO BE TAKEN IN AN UNRELATED BUSINESS ACTIVITY TAX RETURN AND DISCLOSURES REGARDING UNCERTAINTIES IN TAX POSITIONS. THE MEDICAL CENTER HAD NO UNCERTAIN TAX POSITIONS DURING THE YEARS ENDED JUNE 30, 2013 AND 2012.</Explanation>
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        <ReturnReference>SCHEDULE J, PART I, LINE 3</ReturnReference>
        <Explanation>CHILDREN'S RESEARCH INSTITUTE ("CRI") RELIES ON ITS PARENT, CHILDREN'S NATIONAL MEDICAL CENTER, TO DETERMINE COMPENSATION FOR CRI'S PRESIDENT. CHILDREN'S NATIONAL MEDICAL CENTER USED A COMPENSATION COMMITTEE, WRITTEN EMPLOYMENT CONTRACT, INDEPENDENT COMPENSATION CONSULTANT, COMPENSATION SURVEY OR STUDY, AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE.</Explanation>
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        <Explanation>THE FOLLOWING INDIVIDUALS PARTICIPATE IN A NON-QUALIFIED SUPPLEMENTAL RETIREMENT PLAN. THE CONTRIBUTIONS TO THE SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN ARE INCLUDED IN SCHEDULE J, PART II, COLUMN (C) AS PART OF DEFERRED COMPENSATION: KURT D NEWMAN, MD - $208,511 MARK L BATSHAW, MD - $250,000 DOUGLAS MYERS - $64,490 MENDAL TUCHMAN, MD - $52,139 ERIC HOFFMAN, MD - $95,229 VIRRORIO GALLO, PHD - $51,801 JOHN VAN DEN ANKER, MD - $14,658</Explanation>
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        <ReturnReference>Form 990, Part III, Line 4A</ReturnReference>
        <Explanation>CENTER FOR TRANSLATIONAL SCIENCE: The Center for Translational Science supports the full spectrum of investigators (faculty, trainees, and staff) at Children's National who are performing patient-centered clinical and translational research (CTR), and health services research (HSR). The pool of such investigators at Children's is large and growing, and these individuals approach their work with a wide range of experience, expertise, and support. It houses both large programs of extramurally funded research (e.g. the Clinical and Translational Science Award (CTSA) funded by NIH, the HRSA-funded Pediatric Emergency Care and Applied Research Network/PECARN) and faculty with limited funding working on specific, limited projects. This growing Center expensed $15,561,887 in FY 2013.</Explanation>
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      <GeneralExplanation>
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        <ReturnReference>Form 990, Part III, LINE 4B</ReturnReference>
        <Explanation>CENTER FOR GENETIC MEDICINE RESEARCH: The Center for Genetic Medicine Research researches, diagnoses, and treats genetic disorders--diseases and conditions in children that are caused by inherited genes that do not function normally. Founded in 1999, the Center emphasizes translational research (bench-to-bedside) and harnesses emerging technologies for genetic and proteomic analysis. Approximately 80 scientists (including 49) stress open, collaborative, multidisciplinary research. Researchers at the Center for Genetic Medicine Research conduct basic and clinical research into some of childhood's most well-known genetic disorders, including asthma and lung disease, diabetes, inborn errors of metabolism, macular degeneration, muscular dystrophies, sickle cell disease, obesity &amp; metabolic syndrome and white matter disease. Almost all of the Center's programs combine basic, clinical, and/or community research, including studies of: muscle physiology, genetics &amp; metabolism and Duchenne muscular dystrophy. The Center for Genetic Medicine Research had $18,796,232 in expenses FY 2013.</Explanation>
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      <GeneralExplanation>
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        <ReturnReference>Form 990, Part VI, Line 4C</ReturnReference>
        <Explanation>CENTER FOR NEUROSCIENCE RESEARCH ("CNR"): The CNR has grown rapidly in the past 8 years with a significant increases in the program and the generation of important scientific discoveries. The CNR currently comprises 39 faculty members with full appointments at our academic affiliate, the George Washington University School of Medicine and Health Sciences (GW). In recognition of these accomplishments, CNMC constructed a new floor of laboratory space in 2008 to serve as home for the CNR and to provide additional space for recruitments. The CNR currently resides in over 12,000 square feet of open architecture research space. We believe that the CNR is now uniquely poised to accomplish its mission, as its research program, research labs and supporting infrastructures, is now physically located on the 6th floor of the main building of CNMC. This allows close interactions between basic neuroscientists, translational neuroscientists and clinician neuroscientists, including child neurologists, neonatologists, and critical care pediatricians. This unique and exciting setting has supported and promoted a large number of research projects that span basic, translational and clinical research in neurodevelomental disorders. The CNR includes eight major areas of research, including neural stem cells and developmental neurobiology, brain injury and brain protection, perinatal hypoxia and hyperoxia, epilepsy, neuro-oncology, neurofibromatosis, attention deficit hyperactivity disorder, and autism. The CNR comprises an expanding group of highly productive lab-based developmental neuroscientists, all of whom have established strong research programs and collaborations in the area of neurodevelopmental disorders. While these investigators have distinct expertise and research programs, their research as a whole is focused on childhood neurological disorders, from early stages of when the nervous system is first established, to postnatal stages that include the formation of neuronal connections and the wrapping of neuronal processes by the myelin insulator. Thus, investigators at the CNR have a common goal for which they are all striving. The Center for Neuroscience Research had $7,440,677 in expenses FY 2013.</Explanation>
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        <ReturnReference>Form 990, Part III, LINE 4D</ReturnReference>
        <Explanation>CANCER AND TRANSPLANT BIOLOGY $ 6,814,925. SHEIKH ZAYED INST. FOR SURGICAL INNOVATION $ 5,612,207.</Explanation>
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      <GeneralExplanation>
        <Identifier>ORGANIZATION MEMBERS</Identifier>
        <ReturnReference>Form 990, Part VI, LINES 6, 7A, AND 7B</ReturnReference>
        <Explanation>CHILDREN'S NATIONAL MEDICAL CENTER IS THE SOLE MEMBER OF CHILDREN'S RESEARCH INSTITUTE AND HAS THE RIGHT TO ELECT DIRECTORS OF CHILDREN'S RESEARCH INSTITUTE. THE ARTICLES AND BY-LAWS OF CHILDREN'S RESEARCH INSTITUTE DESCRIBE CERTAIN RIGHTS RESERVED TO THE SOLE MEMBER.</Explanation>
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        <ReturnReference>Form 990, Part VI, Line 11B</ReturnReference>
        <Explanation>THE RELEVANT COMMITTEES OF THE ORGANIZATION AND ITS PARENT ORGANIZATION, CHILDREN'S NATIONAL MEDICAL CENTER, REVIEW APPLICABLE PORTIONS OF THE 990. THE LEGAL AFFAIRS AND AUDIT COMMITTEE REVIEW THE FINANCIAL DISCLOSURES, THE NOMINATING AND GOVERNANCE COMMITTEE REVIEW THE GOVERNANCE SECTIONS AND THE PUBLIC BENEFIT SECTIONS, AND THE EXECUTIVE COMPENSATION COMMITTEE REVIEW THE COMPENSATION DISCLOSURES. THE COMPLETED FORM 990 IS THEN MADE AVAILABLE TO THE ENTIRE GOVERNING BOARD OF THE CHILDREN'S RESEARCH INSTITUTE BEFORE FILING.</Explanation>
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        <ReturnReference>Form 990, Part VI, Line 12C</ReturnReference>
        <Explanation>CHILDREN'S RESEARCH INSTITUTE ("CRI") REQUIRES THAT EACH OFFICER, DIRECTOR, AND KEY EMPLOYEE COMPLETE A CONFLICT OF INTEREST FORM AT LEAST EVERY YEAR. IN ADDITION EACH OFFICER, DIRECTOR, AND KEY EMPLOYEE IS INSTRUCTED AND REQUIRED TO AMEND THE CONFLICT OF INTEREST FORM IMMEDIATELY UPON A CHANGE IN STATUS OF ANY OF THE QUESTIONS ON THE FORM. THESE FORMS ARE REVIEWED ANNUALLY BY THE CHIEF LEGAL OFFICER AND CONFLICTS AND INTERESTS ARE NOTED. THE CHILDREN'S RESEARCH INSTITUTE BOARD MAKES A DETERMINATION, BASED ON THE RECOMMENDATION OF THE CHIEF LEGAL OFFICER AS TO WHICH PERSONS SHOULD BE CONSIDERED "INTERESTED PARTIES" BASED ON THE CRITERIA SET FORTH IN THE BOARD'S GOVERNANCE POLICY. CRI FORMALLY ADOPTED THE CONFLICT OF INTEREST POLICY OF ITS PARENT, CHILDREN'S NATIONAL MEDICAL CENTER, DURING ITS MAY-JUNE 2011 BOARD MEETINGS.</Explanation>
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        <ReturnReference>Form 990, Part VI, Lines 13 AND 14</ReturnReference>
        <Explanation>Children's Research Institute ("CRI") is governed by the policies of its parent, Children's National Medical Center ("CNMC"). These policies include a written whistleblower policy and a written document retention and destruction policy.</Explanation>
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        <ReturnReference>Form 990, Part VI, LineS 15A AND 15B</ReturnReference>
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        <ReturnReference>FORM 990, PART VI, LINE 19</ReturnReference>
        <Explanation>Children's Research Institute makes its governing documents, conflict of interest policy, and financial statements available upon request.</Explanation>
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        <ReturnReference>FORM 990 PART IX LINE 11G</ReturnReference>
        <Explanation>DESCRIPTION:NURSING AND PERSONNEL SVCS TOTAL FEES:271592</Explanation>
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        <Explanation>DESCRIPTION:PROFESSIONAL FEES CONSULTANTS TOTAL FEES:1213401</Explanation>
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        <Explanation>DESCRIPTION:SUBCONTRACTS TOTAL FEES:6320699</Explanation>
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        <ReturnReference>FORM 990 PART IX LINE 11G</ReturnReference>
        <Explanation>DESCRIPTION:OTHER PURCHASED RESEARCH SERVI TOTAL FEES:635902</Explanation>
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        <ReturnReference>FORM 990 PART IX LINE 11G</ReturnReference>
        <Explanation>DESCRIPTION:MANAGEMENT FEES TOTAL FEES:360000</Explanation>
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        <ControlledOrg>false</ControlledOrg>
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      <Form990ScheduleRPartIV>
        <NameOfRelatedOrg>
          <BusinessNameLine1>BEAR CUB REINSURANCE LTD</BusinessNameLine1>
        </NameOfRelatedOrg>
        <AddressForeign>
          <AddressLine1>PO BOX 69 KY1-1102</AddressLine1>
          <City>GRANDCAYMAN</City>
          <Country>CJ</Country>
        </AddressForeign>
        <PrimaryActivity>REINSURANCE</PrimaryActivity>
        <LegalDomicileForeignCountry>CJ</LegalDomicileForeignCountry>
        <DirectControllingEntityName>
          <BusinessNameLine1>NA</BusinessNameLine1>
        </DirectControllingEntityName>
        <TypeOfEntity>C Corp</TypeOfEntity>
        <ControlledOrg>false</ControlledOrg>
      </Form990ScheduleRPartIV>
      <ReceiptOfIntAnnRentsRoyalties>false</ReceiptOfIntAnnRentsRoyalties>
      <GiftGrantOrCapContrToOtherOrg>false</GiftGrantOrCapContrToOtherOrg>
      <GiftGrantOrCapContrFrOtherOrg>true</GiftGrantOrCapContrFrOtherOrg>
      <LoansOrGuaranteesToOtherOrg>false</LoansOrGuaranteesToOtherOrg>
      <LoansOrGuaranteesFromOtherOrg>false</LoansOrGuaranteesFromOtherOrg>
      <SaleOfAssetsToOtherOrg>false</SaleOfAssetsToOtherOrg>
      <PurchaseOfAssetsFromOtherOrg>false</PurchaseOfAssetsFromOtherOrg>
      <ExchangeOfAssets>false</ExchangeOfAssets>
      <RentalOfFacilitiesToOtherOrgs>false</RentalOfFacilitiesToOtherOrgs>
      <RentalOfFacilitiesFrOtherOrgs>false</RentalOfFacilitiesFrOtherOrgs>
      <PerformOfServicesForOtherOrgs>false</PerformOfServicesForOtherOrgs>
      <PerformOfServicesByOtherOrgs>true</PerformOfServicesByOtherOrgs>
      <SharingOfFacilities>true</SharingOfFacilities>
      <SharingOfPaidEmployees>true</SharingOfPaidEmployees>
      <ReimbursementPaidToOtherOrg>true</ReimbursementPaidToOtherOrg>
      <ReimbursementPaidByOtherOrg>false</ReimbursementPaidByOtherOrg>
      <OtherTransferToOtherOrg>false</OtherTransferToOtherOrg>
      <OtherTransferFromOtherOrg>true</OtherTransferFromOtherOrg>
    </IRS990ScheduleR>
  </ReturnData>
</Return>