2023-05-10T15:55:31-05:00 2022-06-30 135565207 KPMG LLP 550 SOUTH HOPE STREET SUITE 1500 LOS ANGELES CA 90071 990 2021-07-01 956097416 CHOC FOUNDATION CHOC 7149973000 1201 WEST LA VETA AVENUE ORANGE CA 92868 KERRI RUPPERT SCHILLER EVP/CFO/ASSISTANT SECRETARY 7149973000 2023-05-10 1 KERRI RUPPERT SCHILLER 999009999 HOLLY MOEN P01800653 2139724000 2023-05-05 3 AAL1 IAL1 2021 2023-04-26 12:10:37Z KIMBERLY C CRIPE 1201 WEST LA VETA AVENUE ORANGE CA 92868 58811701 0 X WWW.CHOC.ORG X 1964 CA SUPPORTING CLINICAL AND NONCLINICAL SERVICES, AND MEDICAL EDUCATION, RESEARCH AND ALLIED FIELDS OF PEDIATRIC AT CHILDREN'S HOSPITAL OF ORANGE COUNTY, CHILDREN'S HOSPITAL AT MISSION AND ITS AFFILIATES. 25 24 65 0 0 0 35930822 42661080 0 0 2595378 2909843 824891 33688 39351091 45604611 21394170 27636383 0 0 8375797 8679093 0 0 5788080 3313058 3877136 33083025 40192612 6268066 5411999 110874633 109760102 9220904 11545387 101653729 98214715 CHOC FOUNDATION WAS FORMED TO HELP SUPPORT CLINICAL AND NONCLINICAL SERVICES, MEDICAL EDUCATION, RESEARCH AND ALLIED FIELDS OF PEDIATRICS AT CHILDREN'S HOSPITAL OF ORANGE COUNTY, CHILDREN'S HOSPITAL AT MISSION AND TO SUPPORT ITS AFFILIATES. 0 0 27537778 27537778 CHILDREN'S HOSPITAL OF ORANGE COUNTY (CHOC) - PROVIDES SPECIALIZED PEDIATRIC SERVICES FOR THE CARE OF CHILDREN AND YOUNG ADULTS. DURING THIS YEAR, THERE WERE 69,587 DAYS OF INPATIENT CARE; 101,878 EMERGENCY ROOM VISITS; 11,639 SURGERIES; AND 345,196 PRIMARY AND SPECIALTY CARE CLINIC VISITS. FUNDS RAISED HELPS TO OFFSET COST OF SERVICES PROVIDED TO INDIGENT FAMILIES. 98605 98605 CHILDREN'S HOSPITAL AT MISSION (CCMH) - FUNDS SUPPORT AFFILIATED ACUTE CARE PEDIATRIC HOSPITAL. FACILITY PROVIDES PEDIATRIC, NEONATAL AND CARE FOR EMERGENCY SERVICES. THERE WERE 8,867 INPATIENT CARE DAYS, 12,906 EMERGENCY ROOM VISITS; 430 SURGERIES AND 17,672 OUTPATIENT VISITS. 4906101 CHOC FOUNDATION GENERATES COMMUNITY AWARENESS AND RESOURCES FOR CHOC AND CCMH. THE FOUNDATION SECURES PHILANTHROPIC SUPPORT FOR THE HEALTH AND WELL BEING OF CHILDREN. 32542484 1 1 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 0 0 0 0 0 0 1 0 0 1 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 1 44 0 1 65 1 0 0 0 0 0 1 1 0 0 0 0 0 0 X 25 24 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 CA X MARY NGUYEN 7145094124 1201 WEST LA VETA AVENUE ORANGE CA 92868 KIMBERLY CRIPE PRESIDENT & CEO 5.00 35.00 X X 0 1766114 103462 CHRIS AINSWORTH DIRECTOR 1.00 0.00 X 0 0 0 STEPHANIE ARGYROS DIRECTOR 1.00 0.00 X 0 0 0 CHRISTINE BIXBY MD DIRECTOR 1.00 0.00 X 0 0 0 TONY BOUTELLE DIRECTOR 1.00 0.00 X 0 0 0 ANNIKA CHASE DIRECTOR 1.00 0.00 X 0 0 0 JIM CONROY DIRECTOR 1.00 0.00 X 0 0 0 MICHELE CORTES DIRECTOR 1.00 0.00 X 0 0 0 LILI DAFTARIAN DIRECTOR 2.00 0.00 X 0 0 0 NILOOFAR FAKHIMI DIRECTOR, SECRETARY 2.00 0.00 X X 0 0 0 MONICA FURMAN DIRECTOR, CHAIR 3.50 0.00 X X 0 0 0 CHRISTOPHER HARRISON DIRECTOR, VICE CHAIR 2.00 0.00 X X 0 0 0 ERIC HART DIRECTOR 1.00 0.00 X 0 0 0 KEVIN J HAYES DIRECTOR 1.00 0.00 X 0 0 0 STEVE HOLLEY DIRECTOR 1.00 0.00 X 0 0 0 JASON KNIGHT MD DIRECTOR 1.00 0.00 X 0 0 0 GIGI KROLL MD DIRECTOR 1.00 0.00 X 0 0 0 DELPHINE LEE DIRECTOR, VICE CHAIR 2.00 0.00 X X 0 0 0 MATT LEINART DIRECTOR 1.00 0.00 X 0 0 0 ADRIENNE MATROS PSY D DIRECTOR 1.00 0.00 X 0 0 0 RYAN MOORE DIRECTOR 1.00 0.00 X 0 0 0 AMY MORHAIME DIRECTOR 1.00 0.00 X 0 0 0 TUSDI VOPAT DIRECTOR 1.00 0.00 X 0 0 0 DANA WHITE DIRECTOR 1.00 0.00 X 0 0 0 JANE YADA DIRECTOR 1.00 0.00 X 0 0 0 KERRI RUPPERT SCHILLER EXECUTIVE VP & CFO 3.00 37.00 X 0 899653 73762 DOUGLAS CORBIN SR. VP, CHIEF DEVELOPMENT 40.00 0.00 X 706681 0 53261 WAYNE COMBS ASSOCIATE VP, OPS & ADMIN SVCS 40.00 0.00 X 281505 0 34225 KARA KIPP ASSOC CHIEF DEVELOPMENT OFFICER 40.00 0.00 X 243789 0 55468 PATRICE POIDMORE ASSOC VP, CORPORATE & COMMUNITY ENG 40.00 0.00 X 284370 0 29113 ZACHARIAH ABRAMS ASSISTANT VP, COMMUNITY ENGAGEMENT 40.00 0.00 X 243204 0 10998 MADELINE HALL SR. DIRECTOR, FOUNDATION 40.00 0.00 X 197559 0 12619 1957108 2665767 372908 25 0 1 0 CI PARTNERS DIRECT LLC 1601 EASTMAN AVE SUITE 202 VENTURA CA 930036471 CONSULTING 235360 GOBEL GROUP LLC PO BOX 2011 WEST CHESTER PA 19380 CONSULTING 123000 2 4447291 38213789 958574 42661080 2054343 2054343 10602033 9746533 855500 855500 855500 3494245 4447291 3460557 33688 33688 45604611 0 0 2943531 27636383 27636383 781057 468634 78106 234317 5882828 2529616 705939 2647273 153367 65948 18404 69015 1404067 603749 168488 631830 457774 196843 54933 205998 857930 219735 247735 390460 4385 4385 87740 87740 654192 117260 87123 449809 500069 117739 99225 283105 18806 5580 1880 11346 241695 158473 19598 63624 686013 224204 224204 237605 87424 87424 70874 5520 8001 57353 153130 50533 50533 52064 12693 2871 2871 6951 DUES 348731 1745 217 346769 PROVISION FOR BAD DEBT 134986 134986 TAXES AND LICENSES 18468 2665 2666 13137 40192612 32542484 1862048 5788080 3141195 4889209 30656343 21969128 24265618 26994422 117570 941512 1746596 1150214 749511 596382 45676550 47809428 6267846 6560021 110874633 109760102 1691348 1214120 7529556 10331267 9220904 11545387 X 24143586 19534781 77510143 78679934 101653729 98214715 110874633 109760102 X 5411999 -8871638 20625 X 0 1 X 1 0 X 33196520 34672332 47533330 35930822 42661080 193994084 33196520 34672332 47533330 35930822 42661080 193994084 29490053 164504031 837950 1524336 1522319 2611096 2054343 8550044 2486635 2376214 2153478 1843428 3494245 12354000 214898128 0.76550 0.76220 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 78860530 697983 -8915444 2409259 68233810 65006824 5405046 9662669 1214009 78860530 47131994 17023243 1758020 906433 65006824 42523863 2656275 3007201 1055345 47131994 39537672 1351071 2355682 720562 42523863 0.26600 0.73400 0 0 459686 237206 222480 1286910 913008 373902 596382 CHARITABLE REMAINDER TRUSTS 536678 OPERATING LEASE RIGHT OF USE ASSETS 6023343 6560021 OPERATING LEASE RIGHT OF USE LIAB 6485448 PAYABLE TO RELATED ORGANIZATIONS 3845819 10331267 X 36753598 -8871638 20625 -8851013 45604611 0 45604611 40192612 0 40192612 0 40192612 PART V, LINE 4: INTENDED USE OF ORGANIZATION'S ENDOWMENT FUNDS: THE ENDOWMENT FUND IS USED TO SUPPORT HOSPITAL PROGRAMS ADDRESSING THE NEEDS OF THE UNDERSERVED, SOCIAL SERVICES TO PATIENTS AND FAMILIES IN NEED, AND RESEARCH AND TREATMENT OF CHILDREN'S DISEASES AND DISORDERS. PART X, LINE 2: U.S. GAAP REQUIRES THE ORGANIZATION'S MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE ORGANIZATION AND RECOGNIZE A TAX LIABILITY IF THE ORGANIZATION HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE INTERNAL REVENUE SERVICE. MANAGEMENT HAS ANALYZED TAX POSITIONS TAKEN BY THE ORGANIZATION AND HAS CONCLUDED THAT AS OF JUNE 30, 2022, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY OR DISCLOSURE IN THE CONSOLIDATED FINANCIAL STATEMENTS. PART XI, LINE 2D - OTHER ADJUSTMENTS: CHANGE IN VALUE OF SPLIT-INTEREST AGREEMENTS 20,625. CHOC GALA 5823822 3347087 2476735 293522 282763 414345 1276961 209143 GUILDS 829595 578178 251417 36800 7307 144253 2430 60626 2 1288119 522026 766093 95129 148700 136117 129131 223330 7941536 4447291 3494245 425451 438770 694715 1408522 493099 3460557 33688 0 CHILDREN'S HOSPITAL OF ORANGE COUNTY 1201 W LA VETA AVE ORANGE CA 92868 952321786 501 (C)(3) 27537778 0 N/A HOSPITAL OPERATIONS CHILDREN'S HOSPITAL AT MISSION 1201 W LA VETA AVE ORANGE CA 92868 330528802 501 (C)(3) 98605 0 N/A HOSPITAL OPERATIONS 2 PART I, LINE 2: PROCEDURE FOR MONITORING THE USE OF GRANT FUNDS CHOC FOUNDATION RECEIVES CONTRIBUTIONS ON BEHALF OF CHILDREN'S HOSPITAL OF ORANGE COUNTY AND CHILDREN'S HOSPITAL AT MISSION, BOTH AFFILIATED 501(C)(3) ORGANIZATIONS. DONATIONS ARE GENERALLY RESTRICTED OR DESIGNATED BY DONORS FOR VARIOUS PURPOSES AT INCEPTION. THE FUNDS ARE THEN DISTRIBUTED TO THE APPROPRIATE ORGANIZATION ACCORDING TO DONOR STIPULATIONS FOR MEDICAL PROGRAMS OR FOR THE ENTERPRISE MASTER PLAN (EMP) CONSTRUCTION AS DESIGNATED. 0 1 0 0 0 0 0 0 0 KIMBERLY CRIPE PRESIDENT & CEO 0 1071266 0 430240 0 264608 0 68315 0 35147 0 1869576 0 58318 KERRI RUPPERT SCHILLER EXECUTIVE VP & CFO 0 587246 0 160933 0 151474 0 44383 0 29379 0 973415 0 27953 DOUGLAS CORBIN SR. VP, CHIEF DEVELOPMENT 444143 0 143283 0 119255 0 26366 0 26895 0 759942 0 21179 0 WAYNE COMBS ASSOCIATE VP, OPS & ADMIN SVCS 235681 0 45824 0 0 0 4837 0 29388 0 315730 0 0 0 PATRICE POIDMORE ASSOC VP, CORPORATE & COMMUNITY ENG 238367 0 46003 0 0 0 14512 0 14601 0 313483 0 0 0 KARA KIPP ASSOC CHIEF DEVELOPMENT OFFICER 205519 0 38270 0 0 0 13104 0 42364 0 299257 0 0 0 ZACHARIAH ABRAMS ASSISTANT VP, COMMUNITY ENGAGEMENT 195350 0 40056 0 7798 0 10760 0 238 0 254202 0 0 0 MADELINE HALL SR. DIRECTOR, FOUNDATION 175036 0 22523 0 0 0 5283 0 7336 0 210178 0 0 0 PART I, LINE 3 CHOC FOUNDATION RELIES ON CHC, A RELATED ORGANIZATION, TO ESTABLISH THE COMPENSATION OF THE TOP MANAGEMENT OFFICIAL. CHC'S PROCESS INCLUDES: A COMPENSATION COMMITTEE, AN INDEPENDENT COMPENSATION CONSULTANT, COMPENSATION SURVEYS / STUDIES, AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. PLEASE REFER TO THE SCHEDULE O DISCLOSURE FOR PART VI, LINE 15 FOR ADDITIONAL DETAIL. PART I, LINE 4B THE COMPANY ESTABLISHED A NONQUALIFIED DEFERRED COMPENSATION PLAN EFFECTIVE JANUARY 1, 2010 IN WHICH CERTAIN INDIVIDUALS LISTED ON THE FORM 990, PART VII AND SCHEDULE J ARE PARTICIPANTS. UNDER THE ESTABLISHED SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (THE PLAN) OR SERP, FOR EACH PLAN YEAR THAT BEGINS PRIOR TO THE PARTICIPANT'S CASH DATE, CHOC SHALL CREATE A NEW SERP ACCOUNT ON ITS BOOKS FOR THE PARTICIPANT AND SHALL CREDIT TO SUCH ACCOUNT AT TIMES SPECIFIED. THE PARTICIPANTS OF THE PLAN ARE GENERAL CREDITORS OF THE COMPANY. THE PARTICIPANT'S SERP ACCOUNT SHALL BE UTILIZED SOLELY AS A DEVICE FOR THE MEASUREMENT AND DETERMINATION OF THE AMOUNTS TO BE PAID TO THE PARTICIPANT UNDER THIS PLAN. THE PARTICIPANT IS ENTITLED TO HIS/HER SERP BENEFIT AMOUNT UPON THE EARLIEST OF (1) REMAINING EMPLOYED WITH THE COMPANY TO THE THIRD ANNIVERSARY OF THE FIRST DAY OF THE PLAN YEAR FOR WHICH THE SERP ACCOUNT WAS CREATED; (2) REMAINING EMPLOYED WITH THE COMPANY TO THE PARTICIPANT'S 60TH BIRTHDAY; (3) REMAINING EMPLOYED WITH THE COMPANY TO THE DATE THE PARTICIPANT HAS BOTH ATTAINED AT LEAST AGE 55 AND HAS COMPLETED AT LEAST 10 YEARS OF SERVICE; (4) DISABILITY; (5) INVOLUNTARY SEPARATION FROM SERVICE WITHOUT REASONABLE CAUSE; (6) VOLUNTARY SEPARATION FROM SERVICE FOR GOOD REASON OR (7) DEATH. THE FOLLOWING INDIVIDUALS RECEIVED PAYMENTS FROM THE PLAN DURING THE YEAR: MS. CRIPE ($233,272), MS. SCHILLER ($103,827), AND MR. CORBIN ($78,666). COMPENSATION FROM AN AFFILIATED ORGANIZATION KIMBERLY CRIPE IS COMPENSATED THROUGH CHILDREN'S HEALTHCARE OF CALIFORNIA (CHC), HOWEVER, IN ADDITION TO HER RESPONSIBILITIES FOR CHC, SHE ALSO SERVES AS AN OFFICER OF CHILDREN'S HOSPITAL OF ORANGE COUNTY, CHOC FOUNDATION, CRC REAL ESTATE CORPORATION AND CHILDREN'S HOSPITAL AT MISSION (ALL IRC SECTION 501(C)(3) AFFILIATES). MS. CRIPE DEVOTES APPROXIMATELY 13% OF HER TIME EACH WEEK TO CHOC FOUNDATION RESPONSIBILITIES WITH THE BALANCE OF HER TIME BEING SPENT ON THE OTHER RELATED ORGANIZATIONS' BUSINESS AFFAIRS. KERRI RUPPERT SCHILLER IS COMPENSATED THROUGH CHILDREN'S HEALTHCARE OF CALIFORNIA (CHC), HOWEVER, IN ADDITION TO HER RESPONSIBILITIES FOR CHC, SHE ALSO SERVES AS AN OFFICER OF CHILDREN'S HOSPITAL OF ORANGE COUNTY, CHOC FOUNDATION, CRC REAL ESTATE CORPORATION AND CHILDREN'S HOSPITAL AT MISSION (ALL IRC SECTION 501(C)(3) AFFILIATES). MS. SCHILLER DEVOTES APPROXIMATELY 8% OF HER TIME EACH WEEK TO CHOC FOUNDATION RESPONSIBILITIES WITH THE BALANCE OF HER TIME BEING SPENT ON THE OTHER RELATED ORGANIZATIONS' BUSINESS AFFAIRS. X 15 908759 AVERAGE MARKET VALUE X OTHER 3 49815 RETAIL PRICE 0 1 1 PART I, COLUMN (B): THE NUMBER LISTED IN PART I, LINE 9 COLUMN (B) WAS DETERMINED BASED ON THE NUMBER OF CONTRIBUTIONS RECEIVED. PART I, LINE 32B: THE ORGANIZATION ROUTINELY HIRES UNRELATED THIRD-PARTIES TO SELL NON-CASH CONTRIBUTIONS SUCH AS INVESTMENT CUSTODIANS THAT SELL MARKETABLE SECURITIES DONATED TO THE ORGANIZATION, OR REALTORS THAT ASSIST IN SELLING REAL ESTATE DONATED TO THE ORGANIZATION. THE ORGANIZATION DOES NOT HIRE THIRD PARTIES TO SOLICIT NON-CASH CONTRIBUTIONS. FORM 990, PART I, LINE 5 AND PART V, LINE 2 INFORMATION REGARDING COMMON PAYMASTER CHILDREN'S HOSPITAL OF ORANGE COUNTY (CHOC) ACTS AS A COMMON PAYMASTER, ISSUING FORMS W-2 AND 1099 ON BEHALF OF CHOC FOUNDATION. CHOC FOUNDATION HAS 65 EMPLOYEES, HOWEVER BECAUSE OF THE COMMON PAYMASTER ARRANGEMENT RESULTING IN THE FORMS W-2 BEING ISSUED UNDER CHOC'S EMPLOYER IDENTIFICATION NUMBER, THERE ARE NO W-2S ISSUED DIRECTLY BY CHOC FOUNDATION. FORM 990, PART VI, SECTION A, LINE 6 MEMBERS OR STOCKHOLDERS THE SOLE MEMBER OF CHOC FOUNDATION IS CHILDREN'S HEALTHCARE OF CALIFORNIA (CHC). FORM 990, PART VI, SECTION A, LINE 7A PERSONS WHO MAY ELECT MEMBER OF THE GOVERNING BODY DIRECTORS OF CHOC FOUNDATION SHALL BE ELECTED ANNUALLY BY THE MEMBER, BASED ON THE NOMINATION (S) PROVIDED BY CHOC FOUNDATION'S BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7B THE GOVERNING BODY'S DECISIONS SUBJECT TO APPROVAL THE APPROVAL OF THE MEMBER SHALL BE REQUIRED WITH RESPECT TO ANY OF THE FOLLOWING ACTIONS: (1) CHANGING THE PURPOSES AND POWERS OF CHOC FOUNDATION; (2) OBLIGATING CHOC FOUNDATION TO UNDERTAKE ANY CAPITAL EXPENDITURE IN EXCESS OF $1,000,000; (3) ADOPTING CHOC FOUNDATION'S ANNUAL OPERATING AND CAPITAL BUDGETS; (4) ADOPTING A LONG-TERM CAPITAL BUDGET; (5) BUYING, SELLING, LEASING, MORTGAGING, PLEDGING, OR OTHERWISE HYPOTHECATING ANY REAL PROPERTY; (6) INCURRING ANY INDEBTEDNESS IN EXCESS OF $5,000,000; (7) OBLIGATING CHOC FOUNDATION TO ACT AS GUARANTOR WITH RESPECT TO ANY DEBT OF ANY PERSON OR OTHER ENTITY; (8) ACCEPTING ANY DONATION WHICH IS CONDITIONED UPON CHOC FOUNDATION'S UNDERTAKING ANY UNBUDGETED CAPITAL EXPENDITURE IN EXCESS OF $5,000,000 OR ANY UNBUDGETED EXPENDITURE IN EXCESS OF $5,000,000; (9) ENTERING INTO ANY CONTRACT WHICH INVOLVES ANY OF THE FOLLOWING: (A) ANY FINANCIAL OBLIGATION ON THE PART OF CHOC FOUNDATION IN AN AMOUNT IN EXCESS OF $5,000,000, (B) ANY PURPOSE OR ACTIVITY WHICH IS OUTSIDE THE SCOPE OF CHOC FOUNDATION'S ORDINARY COURSE OF BUSINESS, OR (C) A TERM IN EXCESS OF FIVE YEARS (UNLESS THE CONTRACT IS TERMINABLE AT WILL); (10) INVOLVING CHOC FOUNDATION IN ANY MERGER, ACQUISITION, CORPORATE RESTRUCTURING, OR FORMAL AFFILIATION; (11) INVOLVING CHOC FOUNDATION AS A MEMBER, SHAREHOLDER, OR PARTNER IN ANY NEW CORPORATION, PARTNERSHIP, OR OTHER LEGAL ENTITY; (12) DISSOLVING CHOC FOUNDATION; (13) ENTERING INTO ANY TRANSACTION INVOLVING THE SALE, LEASE, CONVEYANCE, EXCHANGE, TRANSFER OR OTHER DISPOSITION OF ALL OR SUBSTANTIALLY ALL OF CHOC FOUNDATION'S ASSETS; (14) AMENDING CHOC FOUNDATION'S ARTICLES OF INCORPORATION; (15) ADOPTING NEW BYLAWS OR AMENDING EXISTING BYLAWS, IN THE EVENT THAT SUCH ACTION WOULD AFFECT ANY OF THE MEMBER'S RIGHTS UNDER THE BYLAWS OR AS PROVIDED BY APPLICABLE LAW. FORM 990, PART VI, SECTION B, LINE 11B PROCESS OF REVIEW PRIOR TO FILING, THE TAX RETURN AND RELATED SCHEDULES ARE PROVIDED TO THE EXECUTIVE COMPENSATION COMMITTEE, AN EMPOWERED BOARD COMMITTEE DELEGATED WITH THIS AUTHORITY. THE CHIEF FINANCIAL OFFICER REVIEWS THE MATERIALS WITH THE COMMITTEE PRIOR TO FILING THE RETURN. PRIOR TO THE FILING OF THE FORM 990 WITH THE INTERNAL REVENUE SERVICE, A COMPLETE COPY OF THE FINAL FORM 990 IS ALSO SHARED ELECTRONICALLY WITH ALL BOARD MEMBERS VIA DIRECTOR'S DESK, A SECURE WEB SITE THAT PROVIDES A CONFIDENTIAL AND SECURE ACCESS FOR ALL BOARD MATERIALS TO OUR BOARD MEMBERS FORM 990, PART VI, SECTION B, LINE 12C PROCESS OF DETERMINING COMPENSATION OF THE CEO AND OFFICERS THE COMPLIANCE OFFICER IS CHARGED WITH MONITORING PROPOSED OR ONGOING TRANSACTIONS FOR CONFLICTS OF INTEREST AND ADDRESSING ANY POTENTIAL OR ACTUAL CONFLICTS. PURSUANT TO THE CONFLICT OF INTEREST POLICY, AN ANNUAL CONFLICT OF INTEREST QUESTIONNAIRE, AIMED AT DETERMINING ANY FAMILY AND BUSINESS RELATIONSHIPS AND TRANSACTIONS OR OTHER TRANSACTIONS THAT MAY POSE A POTENTIAL CONFLICT, IS DISTRIBUTED TO ALL COVERED PERSONS (I.E., BOARD MEMBERS, OFFICERS AND EXECUTIVE LEADERSHIP). COVERED PERSONS ARE REQUIRED TO DISCLOSE REAL OR POTENTIAL CONFLICTS AT THE TIME WHEN SUCH CONFLICTS ARISE. WHEN AN INDIVIDUAL BECOMES A COVERED PERSON AND ANNUALLY THEREAFTER, EACH COVERED PERSON IS REQUIRED TO SIGN A STATEMENT AFFIRMING THAT HE/SHE: (1) HAS RECEIVED A COPY OF THE CONFLICT OF INTEREST POLICY AND UNDERSTANDS SAID POLICY; (2) HAS READ THE POLICY AND UNDERSTANDS SAID POLICY; AND (3) AGREES TO COMPLY WITH ALL REQUIREMENTS OF THE POLICY, INCLUDING COMPLETING THE CONFLICT OF INTEREST QUESTIONNAIRE. THE COMPLETED QUESTIONNAIRES ARE REVIEWED BY THE COMPLIANCE OFFICER AND ANY PERSONS WITH ACTUAL OR POTENTIAL CONFLICTS ARE CONTACTED VIA WRITTEN COMMUNICATION. THE PROCEDURES FOR ADDRESSING ANY CONFLICT OF INTEREST MAY INCLUDE BUT ARE NOT LIMITED TO THE FOLLOWING: (1) THE CONFLICTING INTEREST IS FULLY DISCLOSED TO THE BOARD OF DIRECTORS; (2)THE INTERESTED PERSON RESPONDS TO FACTUAL QUESTIONS RELATED TO THE CONFLICT, THE SUBSTANCE OF THE TRANSACTION OR THE ARRANGEMENT BEING CONSIDERED; (3) THE PERSON WITH THE CONFLICT OF INTEREST IS EXCLUDED FROM ANY DISCUSSION OR APPROVAL OF SUCH TRANSACTION; (4) IF APPLICABLE ALTERNATIVES TO THE PROPOSED TRANSACTION ARE INVESTIGATED, COMPETITIVE BIDS OR COMPARABLE VALUATIONS ARE OBTAINED; AND (5) THE TRANSACTION OR ACTION MUST BE APPROVED BY A MAJORITY OF DISINTERESTED PERSONS. FORM 990, PART VI, SECTION B, LINE 15 PROCESS OF DETERMINING COMPENSATION OF THE CEO AND OTHER OFFICERS AN INDEPENDENT BOARD COMMITTEE OF CHC CHARGED WITH THE DUTIES OF THE COMPENSATION COMMITTEE, WHOSE MEMBERS ARE DISINTERESTED AND INDEPENDENT, IS IN PLACE WITH A WRITTEN COMPENSATION COMMITTEE CHARTER. THIS COMMITTEE ANNUALLY RETAINS AN INDEPENDENT HEALTHCARE COMPENSATION CONSULTING FIRM TO PROVIDE RELEVANT COMPARABILITY DATA AND OTHER COMPENSATION STUDIES. THE CEO, OFFICERS AND EXECUTIVE MANAGEMENT SALARIES, INCENTIVES AND BENEFITS, AS WELL AS OVERALL COMPENSATION PHILOSOPHY AND POLICIES, ARE DISCUSSED WITH THE INDEPENDENT CONSULTANT REPRESENTATIVES AND THE COMPENSATION COMMITTEE MEMBERS, IN PERSON, IN CLOSED SESSIONS WITH NO STAFF MEMBERS PRESENT. THIS ANNUAL REVIEW WAS LAST PERFORMED IN NOVEMBER 2022. ALL COMPARATIVE MARKET DATA, SUCH AS ANNUAL COMPENSATION SURVEY COMPRISED OF A PEER GROUP OF COMPARABLY-SIZED PEDIATRIC HOSPITALS, IS WELL DOCUMENTED AND THERE ARE MINUTES FROM THESE MEETINGS THAT DOCUMENT THE MEMBERS PRESENT AND VOTING, THE COMPARATIVE DATA USED AND HOW IT WAS OBTAINED AND THE DELIBERATIONS AND DECISIONS OF THE COMMITTEE. THE RESULTS AND RECOMMENDATIONS FROM THE COMMITTEE ARE SHARED IN AN EXECUTIVE SESSION WITH THE CHC BOARD OF DIRECTORS. FORM 990, PART VI, SECTION C, LINE 19 DISCLOSURE COPY - FORM 990, PART VI, SECTION C, LINE 19 WHILE FEDERAL TAX LAWS DO NOT MANDATE THAT THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS BE MADE AVAILABLE FOR PUBLIC INSPECTION, THE ORGANIZATION MAKES ITS FINANCIAL STATEMENTS AVAILABLE UPON REQUEST. FORM 990, PART XI, LINE 9: CHANGE IN VALUE OF SPLIT-INTEREST AGREEMENTS 20,625. CHILDREN'S HEALTHCARE OF CALIFORNIA (CHC) 1201 WEST LA VETA AVENUE ORANGE CA 92868 330265266 HEALTHCARE CA 501(C)(3) LINE 12A, I N/A 0 CHILDREN'S HOSPITAL OF ORANGE COUNTY 1201 WEST LA VETA AVENUE ORANGE CA 92868 952321786 HEALTHCARE CA 501(C)(3) LINE 3 CHC 0 CHILDREN'S HOSPITAL AT MISSION 1201 WEST LA VETA AVENUE ORANGE CA 96868 330528802 HEALTHCARE CA 501(C)(3) LINE 3 CHC 0 CRC REAL ESTATE CORPORATION 1201 WEST LA VETA AVENUE ORANGE CA 92868 330612565 REAL ESTATE CA 501(C)(3) LINE 12B, II CHC 0 PROVIDENCE SPEECH AND HEARING CENTER 1301 PROVIDENCE AVENUE ORANGE CA 92868 956154473 HEALTHCARE CA 501(C)(3) LINE 7 CHOC 0 ORANGE COUNTY MEDICAL RECIPROCAL INS CO 2999 NORTH 4TH STREET SUITE 250 PHOENIX AZ 85108 201620666 INSURANCE AZ C 0 0 1 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0 0 0