2023-05-10T15:57:39-05:00 2022-06-30 135565207 KPMG LLP 550 SOUTH HOPE STREET SUITE 1500 LOS ANGELES CA 90071 990 2021-07-01 330265266 CHILDREN'S HEALTHCARE OF CALIFORNIA CHIL 7149973000 1201 WEST LA VETA AVENUE ORANGE CA 92868 KERRI RUPPERT SCHILLER EVP/CFO/ASSISTANT SECRETARY 7145098451 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 31774408 0 X WWW.CHOC.ORG X 1986 CA SEE SCHEDULE O 8 7 5 0 274283 446578 16475000 10761723 1599996 1600396 16100933 18268265 0 592 34175929 30630976 0 0 0 0 3793277 3210360 0 0 824801 3966822 5037642 7760099 8248002 26415830 22382974 509065328 482213994 1951774 3263202 507113554 478950792 X SEE SCHEDULE O 0 0 7010802 0 1600988 CHILDREN'S HEALTHCARE OF CALIFORNIA (CHC) SUPPORTS THE MISSION OF CHILDREN'S HOSPITAL OF ORANGE COUNTY (CHOC) AND CHILDREN'S HOSPITAL AT MISSION (CCMH). CHOC AND CCMH PROVIDE PEDIATRIC SERVICES TO CHILDREN IN ORANGE COUNTY AND ITS SURROUNDING AREA. THE ACTIVITIES OF CHC HELP TO OFFSET SERVICES TO INDIGENT FAMILIES AND PROVIDE ACCESS TO CURRENT STATE OF THE ART MEDICAL EQUIPMENT, PERSONNEL, AND FACILITIES. DURING THE YEAR, THERE WERE 78,454 DAYS OF INPATIENT CARE; 114,784 EMERGENCY ROOM VISITS (INCLUDING PEDIATRIC TRAUMA VISITS); 12,069 SURGERIES AND 345,196 CLINIC VISITS PROVIDED BY CHOC AND CCMH. OUR CALIFORNIA MEDICAL FOUNDATION PROVIDED 458,214 PEDIATRIC SUBSPECIALTY SERVICE ENCOUNTERS, AS WELL AS 272,050 PRIMARY CARE VISITS TO PATIENTS THROUGHOUT ORANGE COUNTY AND BEYOND. 7010802 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 0 0 5 1 1 1 0 0 0 0 0 0 0 0 0 1 0 X 8 7 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 CA X MARY NGUYEN 7145094124 1201 WEST LA VETA AVENUE ORANGE CA 92868 KIMBERLY C CRIPE PRESIDENT & CEO 4.00 36.00 X X 1766114 0 103462 SAM AURIEMMA DIRECTOR/CHAIR A&C 1.00 3.00 X 0 0 0 CHRIS FURMAN CHAIR 3.00 4.00 X X 0 0 0 JIM MORRIS DIRECTOR 3.00 2.00 X 0 0 0 KIMBERLY SENTOVICH DIRECTOR 1.00 2.00 X 0 0 0 DOUGLAS MCCOMBS DIR/VICE CHAIR, CHAIR FINANCE 5.00 7.00 X X 0 0 0 JANET DAVIDSON DIRECTOR 1.00 3.50 X 0 0 0 JOE KIANI DIRECTOR 2.00 3.00 X 0 0 0 MARSHALL ROWEN MD DIRECTOR 3.00 1.00 X 0 0 0 KERRI RUPPERT SCHILLER EVP/CFO/ASSISTANT SECRETARY 9.00 31.00 X 899654 0 73762 PAUL VAN DOLAH EVP/COO 0.50 39.50 X 714066 0 0 JAY GABRIEL CHIEF LEGAL OFFICER/SECRETARY 4.00 36.00 X 0 729962 78375 SHAHAB DADJOU SVP/CSO THRU 10/21 3.00 37.00 X 946111 0 44586 MATT GERLACH FORMER EVP/COO 0.00 0.00 X 635843 0 0 4961788 729962 300185 5 1 1 0 KORN FERRY 1900 AVENUE OF THE STARS SUITE 260 LOS ANGELES CA 90067 CONSULTING 1148120 1 10761723 10761723 MANAGEMENT FEES 621990 1600396 1600396 1600396 12896948 274283 12622665 6514749 1143432 5371317 5371317 5371317 MISC REVENUE 621990 592 592 592 30630976 1600988 274283 17993982 X 2903168 2467693 145158 290317 28376 24120 1419 2837 174734 148523 8737 17474 104082 88470 5204 10408 392100 333285 19605 39210 477893 406209 23895 47789 600000 510000 30000 60000 1049626 892182 52481 104963 1723747 1465186 86187 172374 16494 14019 825 1650 4490 3817 224 449 16189 13761 809 1619 477266 405676 23863 47727 LICENSES & TAXES 198892 169058 9945 19889 RECRUITING 68063 57853 3403 6807 OTHER DIRECT EXPENSE 12882 10950 644 1288 8248002 7010802 412399 824801 15510995 4038390 165192025 182811996 0 0 0 0 0 0 0 0 0 0 0 0 349262 768759 161890 77056 101023 84834 320098993 286262833 7680807 8115976 0 0 0 0 132223 131206 509065328 482213994 1689444 2856266 0 0 0 0 0 0 0 0 0 0 0 0 0 0 262330 406936 1951774 3263202 X 507113554 478950792 0 0 507113554 478950792 509065328 482213994 X 22382974 -50855905 310169 X 0 1 X 1 0 X X 2 CHILDREN'S HOSPITAL OF ORANGE COUNTY 952321786 3 1 0 1015000 CHILDREN'S HOSPITAL AT MISSION 330528802 3 0 0 469992 2 0 1484992 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 1 PART I, LINE 12 CHC PROVIDED OR PURCHASED FOR THE BENEFIT OF THE CHILDREN'S HOSPITAL OF ORANGE COUNTY AND CHILDREN'S HOSPITAL AT MISSION VARIOUS SERVICES, FACILITIES, AND GOODS. SEE FORM 990 PART IX FOR FURTHER DETAILS. THE TOTAL AMOUNT OF SUPPORT LISTED WAS FOR BOTH SUPPORTED ORGANIZATIONS AND OTHER RELATED EXEMPT ORGANIZATIONS THAT ARE AN INTEGRAL PART OF THE CHILDREN'S HEALTHCARE OF CALIFORNIA HEALTHCARE SYSTEM AND ARE LISTED ON FORM 990 SCHEDULE R. PART IV, SECTION A, QUESTION 1 CHILDREN'S HEALTHCARE OF CALIFORNIA (CHC) IS THE SOLE MEMBER OF CHILDREN'S HOSPITAL OF ORANGE COUNTY (CHOC) AND CHILDREN'S HOSPITAL AT MISSION (CCMH). CHC, CHOC, AND CCMH HAVE THE SAME PRESIDENT & CEO; THE SAME CFO, AND SOME OF THE DIRECTORS ARE THE SAME FOR ALL THREE ORGANIZATIONS. PART IV, SECTION A, QUESTION 6 CHC ALSO PROVIDES SUPPORT TO CHILDREN'S HOSPITAL AT MISSION. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 161890 77056 84834 84834 DUE TO RELATED PARTY 406936 406936 X 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. X X X X 1 1 0 0 0 0 0 0 0 KIMBERLY C CRIPE PRESIDENT & CEO 1071266 0 430240 0 264608 0 68315 0 35147 0 1869576 0 58318 0 SHAHAB DADJOU SVP/CSO THRU 10/21 579049 0 151737 0 215325 0 33430 0 11156 0 990697 0 27630 0 KERRI RUPPERT SCHILLER EVP/CFO/ASSISTANT SECRETARY 587246 0 160933 0 151475 0 44383 0 29379 0 973416 0 27953 0 JAY GABRIEL CHIEF LEGAL OFFICER/SECRETARY 0 500430 0 114068 0 115464 0 36024 0 42351 0 808337 0 20609 PAUL VAN DOLAH EVP/COO 605535 0 104694 0 3837 0 0 0 0 0 714066 0 0 0 MATT GERLACH FORMER EVP/COO 0 0 29815 0 606028 0 0 0 0 0 635843 0 29815 0 PART I, LINES 4A-B SEVERANCE ARRANGEMENTS, PART I, LINE 4A THE ORGANIZATION'S PERSONNEL LISTED ON FORM 990 PART VII AND SCHEDULE J PARTICIPATE IN A SEPARATION ARRANGEMENT THAT PROVIDES FOR A PORTION OF THE EMPLOYEE'S ANNUAL SALARY BASED ON THEIR POSITION IN THE ORGANIZATION. FOR THE SENIOR EXECUTIVE LEVEL, THE AMOUNT IS BASED ON YEARS OF SERVICE UP TO A MAXIMUM NUMBER OF MONTHS. IN 2021 SHAHAB DADJOU RECEIVED A SEVERANCE PAYMENT IN THE AMOUNT OF $95,543 AND MATTHEW GERLACH RECEIVED A SEVERANCE PAYMENT IN THE AMOUNT OF $606,028. SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN CHILDREN'S HOSPITAL OF ORANGE COUNTY ("CHOC OR "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 INDIVIDUAL RECEIVED PAYMENTS FROM THE PLAN DURING CALENDAR YEAR 2021: MS. CRIPE ($233,272), MS. SCHILLER ($103,827), MR. GABRIEL ($76,932), MR. GERLACH ($29,815), AND MR. DADJOU ($102,624). COMPENSATION FOOTNOTES KIMBERLY C. 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 75% OF HER TIME EACH WEEK TO CHILDREN'S HOSPITAL OF ORANGE COUNTY 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 63% OF HER TIME EACH WEEK TO CHILDREN'S HOSPITAL OF ORANGE COUNTY RESPONSIBILITIES WITH THE BALANCE OF HER TIME BEING SPENT ON THE OTHER RELATED ORGANIZATIONS' BUSINESS AFFAIRS. PAUL VAN DOLAH IS COMPENSATED THROUGH CHILDREN'S HEALTHCARE OF CALIFORNIA (CHC), HOWEVER, IN ADDITION TO HIS RESPONSIBILITIES FOR CHC, HE ALSO SERVES AS AN OFFICER OF CHILDREN'S HOSPITAL OF ORANGE COUNTY, CHILDREN'S HOSPITAL AT MISSION AND CRC REAL ESTATE CORPORATION (ALL IRC SECTION 501(C)(3) AFFILIATES). MR. VAN DOLAH DEVOTES APPROXIMATELY 85% OF HIS TIME EACH WEEK TO CHILDREN'S HOSPITAL OF ORANGE COUNTY RESPONSIBILITIES WITH THE BALANCE OF HIS TIME BEING SPENT ON CHILDREN'S HOSPITAL AT MISSION'S BUSINESS AFFAIRS. SHAHAB DADJOU WAS COMPENSATED THROUGH CHILDREN'S HEALTHCARE OF CALIFORNIA (CHC), HOWEVER, IN ADDITION TO HIS RESPONSIBILITIES FOR CHC, HE ALSO SERVED AS THE CHIEF STRATEGY OFFICER OF CHILDREN'S HOSPITAL OF ORANGE COUNTY AND CHILDREN'S HOSPITAL AT MISSION (BOTH IRC SECTION 501(C)(3) AFFILIATES). MR. DADJOU DEVOTED APPROXIMATELY 90% OF HIS TIME EACH WEEK TO CHILDREN'S HOSPITAL OF ORANGE COUNTY AND CHILDREN'S HOSPITAL AT MISSION BUSINESS AFFAIRS. FORM 990, PART I, LINE 1, DESCRIPTION OF THE ORGANIZATION'S MISSION: THE RECEIPT OF DISTRIBUTIONS AND GRANTS TO MAKE DISTRIBUTIONS AND GRANTS TO CHILDREN'S HOSPITAL OF ORANGE COUNTY AND TO AFFILIATED EXEMPT ORGS FOR FURTHERANCE OF THEIR OBJECTIVES. FORM 990, PART III, LINE 1, DESCRIPTION OF THE ORGANIZATION'S MISSION: THE PRIMARY EXEMPT PURPOSE OF CHILDREN'S HEALTHCARE OF CALIFORNIA INCLUDES WITHOUT LIMITATION THE RECEIPT OF DISTRIBUTIONS AND GRANTS FOR THE MAKING OF DISTRIBUTIONS AND GRANTS TO CHILDREN'S HOSPITAL OF ORANGE COUNTY (CHOC) AND TO AFFILIATED EXEMPT ORGANIZATIONS IN THE FURTHERANCE OF THEIR CHARITABLE OBJECTIVES AND PURPOSES. THESE AFFILIATED ORGANIZATIONS INCLUDE: CHILDREN'S HOSPITAL OF ORANGE COUNTY CHILDREN'S HOSPITAL AT MISSION CHOC FOUNDATION CRC REAL ESTATE CORPORATION PROVIDENCE SPEECH AND HEARING CENTER FORM 990, PART VI, SECTION B, LINE 11B PROCESS OF REVIEW PRIOR TO FILING, THE TAX RETURN AND RELATED SCHEDULES ARE PRESENTED TO AND RECEIVED BY THE CHC 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 FINAL 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 WEBSITE THAT PROVIDES A CONFIDENTIAL AND SECURE ACCESS FOR ALL BOARD MATERIALS TO OUR BOARD MEMBERS. FORM 990, PART VI, SECTION B, LINE 12C MONITORING AND ENFORCING COMPLIANCE OF CONFLICT OF INTEREST POLICY 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 OR KEY EMPLOYEES). COVERED PERSONS ARE REQUIRED TO DISCLOSE REAL OR POTENTIAL CONFLICT 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 INFORMED VIA WRITTEN COMMUNICATION. THE PROCEDURES FOR ADDRESSING ANY CONFLICT OF INTEREST INCLUDES BUT IS 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 SUBSTANCE OF THE TRANSACTION OR ARRANGEMENT BEING CONSIDERED; (3) THE PERSON WITH THE CONFLICT OF INTEREST IS EXCLUDED FROM ANY DISCUSSION OR APPROVAL OF SUCH TRANSACTION;(4) ALTERNATIVES TO THE PROPOSED TRANSACTION ARE INVESTIGATED, COMPETITIVE BIDS OR COMPARABLE VALUATIONS ARE OBTAINED; (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, THE VOTING, THE COMPARATIVE DATA USED, HOW IT WAS OBTAINED, THE DELIBERATIONS, AND DECISIONS OF THE COMMITTEE. THE RESULTS AND RECOMMENDATIONS FROM THE COMMITTEE ARE SHARED IN AN EXECUTIVE SESSION WITH THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION C, LINE 19 DISCLOSURE POLICY WHILE FEDERAL TAX LAWS DO NOT MANDATE THAT THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE FOR PUBLIC INSPECTION, THE ORGANIZATION MAKES ITS FINANCIAL STATEMENTS AVAILABLE UPON REQUEST. FORM 990, PART IX, LINE 11G CONSULTING & MANAGEMENT FEES: PROGRAM SERVICE EXPENSES 1,296,020. MANAGEMENT AND GENERAL EXPENSES 76,236. FUNDRAISING EXPENSES 152,474. TOTAL EXPENSES 1,524,730. OTHER PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 169,166. MANAGEMENT AND GENERAL EXPENSES 9,951. FUNDRAISING EXPENSES 19,900. TOTAL EXPENSES 199,017. FORM 990, PART XI, LINE 9: VALUATION ADJUSTMENT - INNOVATIVE INST. 310,169. 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 CHILDREN'S HEALTHCARE OF CALIFORNIA (CHC). CHC HAS 5 EMPLOYEES, HOWEVER BECAUSE OF THE COMMON PAYMASTER ARRANGEMENT, THE FORMS W-2 WERE ISSUED UNDER CHOC'S EMPLOYER IDENTIFICATION NUMBER. CHILDREN'S HOSPITAL OF ORANGE COUNTY 1201 WEST LA VETA AVENUE ORANGE CA 92868 952321786 HEALTHCARE CA 501(C)(3) LINE 3 CHC 1 CHILDREN'S HOSPITAL AT MISSION 1201 WEST LA VETA AVENUE ORANGE CA 92868 330528802 HEALTHCARE CA 501(C)(3) LINE 3 CHC 1 CHOC FOUNDATION 1201 WEST LA VETA AVENUE ORANGE CA 92868 956097416 FUNDRAISING CA 501(C)(3) LINE 7 CHC 1 CRC REAL ESTATE CORPORATION 1201 WEST LA VETA AVENUE ORANGE CA 92868 330612565 REAL ESTATE CA 501(C)(3) LINE 12B, II CHC 1 PROVIDENCE SPEECH AND HEARING 1201 WEST LA VETA 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 PHEONIX AZ 85108 101620666 INSURANCE AZ C 0 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 1 CHILDREN'S HOSPITAL AT ORANGE COUNTY L 1015000 MGMT SERVICES CHILDREN'S HOSPITAL AT MISSION L 469992 MGMT SERVICES CHOC FOUNDATION L 40396 MGMT SERVICES CRC REAL ESTATE CORPORATION L 75000 MGMT SERVICES CHILDREN'S HOSPITAL AT ORANGE COUNTY M 392100 MGMT SERVICES CHILDREN'S HOSPITAL AT MISSION C 6870000 CASH TRANSFER CRC REAL ESTATE CORPORATION C 3891723 CASH TRANSFER PART V, LINE 2, COLUMN (C) THE METHODS USED BY CHC TO DETERMINE THE VALUE OF THE AMOUNTS LISTED IN SCHEDULE R PART V LINE 2 COLUMN (C) WERE: (C) CONTRIBUTIONS FROM RELATED ORGANIZATIONS ARE DETERMINED BASED ON THE RECIPIENT CHARITABLE ORGANIZATION'S ANNUAL OPERATIONAL AND CAPITAL NEEDS AND WERE APPROVED BY CHC'S BOARD. (L) MANAGEMENT FEES ARE DEVELOPED INTERNALLY BY MANAGEMENT IN CONJUNCTION WITH THE ANNUAL OPERATING AND CAPITAL BUDGETS BASED ON RESOURCES REQUIRED BY AFFILIATES AND SUPPORTED BY TIME STUDIES, WORK PRODUCTS AND OTHER STATISTICS TO SUPPORT ALLOCATIONS.