2022-05-16T16:06:53-05:00 2021-06-30 861065772 DELOITTE TAX LLP 695 TOWN CENTER DRIVE SUITE 1200 COSTA MESA CA 926261924 990 2020-07-01 951690977 CHILDREN'S HOSPITAL LOS ANGELES CHIL 3236602450 4650 SUNSET BOULEVARD LOS ANGELES CA 900270982 SCOTT LIEBERENZ SVP & CHIEF FINANCIAL OFFICER 3236602450 2022-05-16 1 SCOTT LIEBERENZ 999009999 JOHN W SADOFF JR P00540589 7144367100 3 AAL1 IAL1 2020 2022-09-23 18:48:47Z PAUL S VIVIANO 4650 SUNSET BOULEVARD LOS ANGELES CA 900270982 1511451982 0 X WWW.CHLA.ORG X 1901 CA PROMOTION AND ADVANCEMENT OF CHILDREN'S HEALTH THROUGH PATIENT CARE, RESEARCH, AND EDUCATION. 18 14 7191 349 -28844 0 175227569 261581920 1127120467 1056282434 77246348 27161039 46371923 13687063 1425966307 1358712456 3081501 1816033 0 0 685554127 684895147 0 0 17981235 637272789 646906479 1325908417 1333617659 100057890 25094797 2416252249 2698695774 736047455 880084234 1680204794 1818611540 X SEE SCHEDULE O. 0 0 854303969 1816033 1021561640 MEDICAL CARE PROVIDED TO CHILDREN:IT IS THE POLICY OF THE HOSPITAL TO STRIVE TO MAINTAIN QUALITY HEALTH CARE DELIVERY IN A MANNER THAT RESPECTS THE DIGNITY OF THE INDIVIDUAL AND FAMILY, REGARDLESS OF THE ABILITY TO PAY. UNDER THE HOSPITAL'S POLICY, MEDICAL CARE MAY BE PROVIDED WITHOUT CHARGE OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATES TO PEOPLE WHO ARE UNINSURED OR UNDERINSURED AND CANNOT AFFORD TO PAY FOR THEIR OWN MEDICAL CARE. THE HOSPITAL PROVIDES ADDITIONAL COMMUNITY SUPPORT BY PROVIDING CARE TO PATIENTS WHO PARTICIPATE IN PROGRAMS, LIKE MEDI-CAL, THAT DO NOT PAY FULL CHARGES. APPROXIMATELY THREE-FOURTHS OF THE HOSPITAL'S PATIENTS ARE COVERED BY MEDI-CAL PROGRAMS. 55715350 20516031 GRADUATE MEDICAL EDUCATION PROVIDES TRAINING AND EDUCATION TO MEDICAL STUDENTS IN LOS ANGELES COUNTY WHO, IN TURN, PROVIDE SERVICES TO PATIENTS AT THE HOSPITAL. ALSO, INCLUDES EDUCATION REVENUE FROM THE RESIDENCY AND FELLOWSHIP PROGRAMS AT CHLA. THE HOSPITAL SUBSIDIZES A LARGE PART OF THE COST OF TRAINING PHYSICIANS, ALLIED HEALTH PROFESSIONALS, AND OTHER HEALTH CARE WORKERS IN ITS EMERGENCY ROOM, CLINICS, INPATIENT AREAS, AND OTHER PARTS OF ITS FACILITIES. 133157263 14204763 RESEARCH REVENUES FURTHER THE EXEMPT PURPOSE OF CHLA BY PROVIDING THE PATIENTS OF CHLA ACCESS TO NEW TECHNOLOGIES, DISCOVERIES AND MEDICATIONS FOR TREATMENT. RESULTS OF THIS RESEARCH IS DISSEMINATED THROUGH PUBLICATIONS IN SCIENTIFIC JOURNALS AND PRESENTATIONS BY THE PRINCIPAL INVESTIGATORS. THE HOSPITAL SUBSIDIZES A LARGE PART OF THE COST OF MEDICAL RESEARCH TAKING PLACE IN ITS FACILITIES. 2521054 4314714 OTHER PROGRAM SERVICE REVENUES ALSO INCLUDE RESIDENTS HOUSING AND MISCELLANEOUS TUITION AND EDUCATION INCOME. 2521054 4314714 1045697636 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 1 0 1 0 0 0 0 0 0 1 0 1 1 1 0 1 1 0 1 0 0 0 0 0 0 1 0 1 1 0 0 1 1 1 0 0 0 1 758 0 1 7191 1 1 1 0 0 0 1 1 1 1 0 1 1 0 1 0 X 18 14 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 CA X JUDITH M KLINE 3233617450 4650 SUNSET BLVD LOS ANGELES CA 900270980 PAUL S VIVIANO DIRECTOR, PRESIDENT AND CEO 55.00 0.00 X X 1479177 0 33053 MARK D KRIEGER MD DIRECTOR, FACULTY PHYSICIAN 20.00 0.00 X 877125 0 0 MATTHEW MATT KEEFER MD DIRECTOR, FACULTY PHYS. (BEG 07/20) 28.00 0.00 X 371998 0 0 ROBERT BOB E SHADDY MD DIRECTOR, FACULTY PHYSICIAN 10.00 0.00 X 456208 0 0 JEFFREY JEFF WORTHE DIRECTOR, CHAIR OF BOARD 2.00 0.00 X X 0 0 0 ALIA TUTOR DIRECTOR 1.00 0.00 X 0 0 0 BURT LEVITCH DIRECTOR 1.00 0.00 X 0 0 0 BYRON H POLLITT JR DIRECTOR (BEGIN 07/20) 1.00 0.00 X 0 0 0 CHERYL KUNIN FAIR DIRECTOR 1.00 0.00 X 0 0 0 CHRISTOPHER C MARTIN FAIA DIRECTOR 1.00 0.00 X 0 0 0 DIANA M BONTA RN DRPH DIRECTOR 1.00 0.00 X 0 0 0 ELISABETH BETH HUNT PRICE DIRECTOR 1.00 0.00 X 0 0 0 GEORGE H BROWN DIRECTOR (BEGIN 07/20) 1.00 0.00 X 0 0 0 KEVIN H BROGAN DIRECTOR 1.00 0.00 X 0 0 0 KIMBERLY KIM SHEPHERD DIRECTOR 1.00 0.00 X 0 0 0 LAURENCE LARRY E PAUL MD DIRECTOR 1.00 0.00 X 0 0 0 SHERI SANI DIRECTOR (BEGIN 09/20) 1.00 0.00 X 0 0 0 TODD E MOLZ DIRECTOR 1.00 0.00 X 0 0 0 M SCOTT LIEBERENZ SVP, CHIEF FINANCIAL OFFICER 55.00 0.00 X 779709 0 107797 JUDITH M KLINE CORPORATE SECRETARY 55.00 0.00 X 246366 0 16150 LARA KHOURI SVP, CHIEF STRATEGY OFFICER 55.00 0.00 X 731833 0 107128 JAMES STEIN MD SVP, CHIEF MEDICAL OFFICER 55.00 0.00 X 764246 0 78732 NANCY LEE SVP, CHIEF CLINICAL OFFICER 55.00 0.00 X 733586 0 30976 STEVE GARSKE SVP, CHIEF INFORMATION OFFICER 55.00 0.00 X 586335 0 83367 GRACE OH SVP, GENERAL COUNSEL 55.00 0.00 X 542233 0 105214 ALEXANDRA CARTER SVP, CHIEF DEVELOPMENT OFFICER 55.00 0.00 X 487616 0 76154 MAMOON SYED SVP, CHIEF PEOPLE OFFICER 55.00 0.00 X 440053 0 82471 RINA JURADO DIRECTOR, SURGERY 55.00 0.00 X 824260 0 20163 RHONDA R FOSTER VP, CNO / PATIENT CARE SVCS 55.00 0.00 X 471697 0 73124 JODI SHIRLYN OGDEN RIVERA VP, RESEARCH OPERATIONS 55.00 0.00 X 454828 0 70607 ELLEN ZAMAN EXEC DIR, EXTERNAL AFFAIRS 55.00 0.00 X 487784 0 33841 BHAVANA KUMAR ARORA CMO, CHLA HEALTH NETWORK 55.00 0.00 X 450619 0 7704 11185673 0 926481 1938 0 1 1 AMN HEALTHCARE INC 12400 HIGH BLUFF DR SAN DIEGO CA 92130 HEALTHCARE WORKFORCE MANAGEMENT 19509644 SODEXO INC & AFFILIATES 9801 WASHINGTON BLVD GAITHERSBURG MD 20878 FOOD AND HOUSEKEEPING SERVICES 19336645 PACIFIC NATIONAL GROUP INC 2392 BATEMAN AVE DUARTE CA 91010 CONSTRUCTION MANAGEMENT 12393115 PCAM LLC 3165 GARFIELD AVE LOS ANGELES CA 90040 PARKING SERVICES 4899881 HEALTHCARE DESIGN & CONSTRUCTION LLC 18302 IRVINE BLVD SUITE 120 TUSTIN CA 92780 CONSTRUCTION MANAGEMENT 4644315 186 301704 170885497 90394719 10496461 261581920 PATIENT REVENUE 621110 1021561640 1021561640 GRADUATE MEDICAL EDU. 900099 15893939 15893939 RESEARCH REVENUE 900099 14204763 14204763 EDUCATION REVENUE 900099 4622092 4622092 1056282434 16710226 -28844 16739070 244087 244087 2438020 0 2438020 2438020 2438020 163098628 152647815 10450813 10450813 10450813 0 301704 91711 -91711 -91711 PARKING GARAGE 812930 2741674 2741674 CAFETERIA 722514 2591980 2591980 CHILD DEVELOPMENT CTR. 624410 903162 903162 4859851 4314714 545137 11096667 1358712456 1060597148 -28844 36562232 X 1816033 1816033 7135679 1433538 5257188 444953 168100 168100 579143933 447363842 121444964 10335127 -93650 -71956 -19777 -1917 57662957 44177848 12407151 1077958 40878128 30760823 9356329 760976 2297759 2297759 1780964 69719 1711245 632200 632200 317615 317615 860053 860053 216414767 150957914 62205025 3251828 4814504 4771509 42995 189681764 174904782 14687045 89937 37834318 30844767 6570278 419273 228519 228519 16658459 14181381 2476085 993 743830 209435 519457 14938 2522104 761824 1720538 39742 19719965 18696049 1023916 57804283 55160034 2644249 8670925 5552652 3051497 66776 QUALITY ASSURANCE FEES 51706287 51706287 0 0 LEASE EXPENSE 10934970 5079633 5855337 0 DUES AND SUBSCRIPTIONS 3945386 505020 2220228 1220138 TAXES AND LICENSES 3302105 686512 2609693 5900 16035702 5733371 10090713 211618 1333617659 1045697636 269938788 17981235 6000 6000 122033701 104424094 109850000 83885912 239971200 234372466 0 0 696808 626915 13106908 13361298 13461725 24481587 1948951282 957597533 976488302 991353749 721360416 1026904435 3381613 4135712 215895576 215143606 2416252249 2698695774 171943929 221574470 22815685 18146710 459549440 456731185 81738401 183631869 736047455 880084234 X 1212070272 1280373261 468134522 538238279 1680204794 1818611540 2416252249 2698695774 X 25094797 113404527 -92578 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 317615 317615 0 PART II-B, LINE 1: 1. NATIONAL ASSOCIATION OF CHILDREN'S HOSPITALS (NACH) - MEMBERSHIP DUES 2. HOSPITAL ASSOCIATION OF SOUTHERN CALIFORNIA (HASC) - MEMBERSHIP DUES 3. CALIFORNIA CHILDREN'S HOSPITAL ASSOCIATION (CCHA) - MEMBERSHIP DUES 4. CALIFORNIA ASSOCIATION OF HOSPITALS AND HEALTH SYSTEMS (CAHHS) - MEMBERSHIP DUES 5. THE MARGOLIN GROUP, INC. - STATE LOBBYING ACTIVITY 6. ASSOCIATION OF AMERICAN MEDICAL COLLEGES (AAMC) - MEMBERSHIP DUES 7. CALIFORNIA ADVOCACY LLC - STATE LOBBYING ACTIVITY PART II-B: CHILDREN'S HOSPITAL LOS ANGELES DOES NOT PARTICIPATE IN OR INTERVENE IN (INCLUDING THE PUBLISHING OR DISTRIBUTING OF STATEMENTS), ANY POLITICAL CAMPAIGN ON BEHALF OF (OR IN OPPOSITION TO) ANY CANDIDATE FOR PUBLIC OFFICE. 650266946 58919128 114386968 71053296 752519746 613593715 79575519 18292383 61194671 650266946 607373502 59730321 13083122 66593230 613593715 596010538 51602973 28227452 68467461 607373502 543706004 53936257 57761047 59392770 596010538 0.60380 0.39620 0 0 127048321 127048321 1112833095 484715054 628118041 552176634 472882479 79294155 156893232 156893232 991353749 HOSPITAL FEE PROGRAM RECEIVABLE 114913553 CAPITAL ACCUMULATION ACCOUNT 5860565 GOLDMAN SACH-SWAP COLLATERAL 8200000 RECEIVABLES UNDER GOVERNMENT PROGRAM 23937406 RIGHT-OF-USE ASSET 60521408 OTHER 1710674 215143606 HOSPITAL FEE PROGRAM LIABILITY 42322951 LIABILITY UNDER UNITRUST AGREEMENTS 1228193 INTEREST RATE SWAP 12888744 LEASE LIABILITY - LONG TERM 45332957 PAYABLES UNDER GOVERNMENT PROGRAMS 29752319 OTHER NONCURRENT LIABILITIES 52106705 183631869 X PART V, LINE 4: ENDOWMENT FUNDS ARE INTENDED TO BE USED ACCORDING TO THE DONOR'S WISHES WHICH VARY FROM ONGOING PROGRAM SUPPORT, TO SPECIFIC RESEARCH, TO BUILDING OR ASSET ACQUISITION, OR SUPPORT OF ACADEMIC CHAIRS WITHIN THE ORGANIZATION. PART X, LINE 2: THE HOSPITAL IS RECOGNIZED BY THE INTERNAL REVENUE SERVICE AS EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(A) OF THE INTERNAL REVENUE CODE AS CHARITABLE ORGANIZATIONS QUALIFYING UNDER SECTION 501(C)(3) AND SIMILAR CALIFORNIA STATUTES. INCOME FROM THE HOSPITAL'S LIMITED LIABILITY CORPORATIONS, CHLA ESBT AND CHLA MEDICAL FOUNDATION (C CORPORATION) ARE TAXABLE TO CHLA. THE INCOME TAX PROVISION RECORDED IN THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS IS IMMATERIAL FOR THE YEARS ENDED JUNE 30, 2021 AND 2020. THE HOSPITAL ACCOUNTS FOR INCOME TAXES IN ACCORDANCE WITH ASC 740, INCOME TAXES. IT IS HOSPITAL'S POLICY TO CLASSIFY THE EXPENSE RELATED TO INTEREST AND PENALTIES, IF ANY, TO BE PAID ON UNDERPAYMENTS OF INCOME TAXES WITHIN OTHER EXPENSES. THE HOSPITAL HAS EVALUATED ITS UNCERTAIN TAX POSITIONS AND THERE WERE NO MATERIAL PENALTIES OR INTEREST RECOGNIZED FOR THE YEARS ENDED JUNE 30, 2021 AND 2020. THE HOSPITAL'S INCOME TAX RETURNS FOR THE YEARS ENDED JUNE 30, 2018, THROUGH JUNE 30, 2021, ARE SUBJECT TO EXAMINATION BY BOTH THE FEDERAL AND STATE TAX JURISDICTIONS. WALK & PLAY LA 301704 301704 18978 61325 11408 301704 301704 18978 61325 11408 91711 -91711 1 1 X 1 X 350.000000000000 1 X 1 1 0 1 1 1 333 232727 0 232727 0.00020 5 233406 375389961 324511825 50878136 0.03820 6 233739 375622688 324511825 51110863 0.03840 14 614432 8550710 0 8550710 0.00640 8 7520 58410523 28372362 30038161 0.02250 1 2448 3383191 0 3383191 0.00250 1 0 134908359 78351957 56556402 0.04240 2 150 772350 0 772350 0.00060 26 624550 206025133 106724319 99300814 0.07440 32 858289 581647821 431236144 150411677 0.11280 1 135 148610 148610 0.00010 3 100565 571069 219000 352069 0.00030 2 22 613349 613349 0.00050 6 100722 1333028 219000 1114028 0.00090 1 0 0 4749122 4749122 X 1 1 1 1 CHILDREN'S HOSPITAL LOS ANGELES 4650 SUNSET BLVD LOS ANGELES CA 900270982 WWW.CHLA.ORG 930000032 X X X X X X CHILDREN'S HOSPITAL LOS ANGELES 1 0 0 1 X X X X X X X X X 18 1 0 0 1 X SEE PART V, SECTION C, SUPPLEMENTAL INFORMATION X 1 18 1 SEE PART V, SECTION C, SUPPLEMENTAL INFORMATION 0 1 X 350.000000000000 400.000000000000 X X 1 1 X X X X 1 X HTTPS://WWW.CHLA.ORG/BILLING-AND-INSURANCE-PAYING-CARE X HTTPS://WWW.CHLA.ORG/BILLING-AND-INSURANCE-PAYING-CARE X HTTPS://WWW.CHLA.ORG/BILLING-AND-INSURANCE-PAYING-CARE X X X X X X 1 X 0 X X X X 1 X 0 0 CHILDREN'S HOSPITAL LOS ANGELES PART V, SECTION B, LINE 5: THE 2019 COMMUNITY HEALTH NEEDS ASSESSMENT WAS CONDUCTED BY THE CENTER FOR NONPROFIT MANAGEMENT (CNM) AND THE OFFICE OF COMMUNITY AFFAIRS AT CHILDREN'S HOSPITAL LOS ANGELES IN COLLABORATION WITH OTHER INSTITUTIONS, ORGANIZATIONS AND AGENCIES AS WELL AS MEMBERS OF THE CHILDREN'S HOSPITAL COMMUNITY BENEFIT ADVISORY COMMITTEE.WE ARE IN THE PROCESSING OF COMPLETING THE 2022 CHNA.THE CNM TEAM HAS EXTENSIVE EXPERIENCE THROUGH BEING INVOLVED IN AND CONDUCTING MORE THAN 30 CHNA'S FOR HOSPITALS THROUGHOUT LOS ANGELES COUNTY AND SAN DIEGO COUNTY. THE CNM TEAM ALSO CONDUCTED 2016 CHNAS FOR TWO KAISER FOUNDATION HOSPITALS (WEST LOS ANGELES AND BALDWIN PARK), CITRUS VALLEY HEALTH PARTNERS, THE GLENDALE HOSPITALS COLLABORATIVE AND THE METRO HOSPITALS COLLABORATIVE AS WELL AS CHLA'S PREVIOUS 2016 CHNA.CHLA HAS CONDUCTED A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) IN AN EFFORT TO UNDERSTAND THE HEALTH AND SOCIAL NEEDS OF THE COMMUNITY AND AS REQUIRED BY STATE AND FEDERAL LAW. THE CHNA IS A PRIMARY TOOL USED BY THE HOSPITAL TO DETERMINE ITS COMMUNITY BENEFIT PLAN. THIS ASSESSMENT INCORPORATES COMPONENTS OF PRIMARY DATA COLLECTION AND SECONDARY DATA ANALYSIS THAT FOCUS ON THE HEALTH AND SOCIAL NEEDS OF THE SERVICE AREA. SOURCES OF DATA INCLUDE THE U.S. CENSUS 2010 DECENNIAL CENSUS AND AMERICAN COMMUNITY SURVEY, CALIFORNIA HEALTH INTERVIEW SURVEY, CALIFORNIA DEPARTMENT OF PUBLIC HEALTH, CALIFORNIA EMPLOYMENT DEVELOPMENT DEPARTMENT, LOS ANGELES COUNTY HEALTH SURVEY, LOS ANGELES HOMELESS SERVICES AUTHORITY, UNIFORM DATA SET, CDC NATIONAL HEALTH STATISTICS, NATIONAL CANCER INSTITUTE, U.S. DEPARTMENT OF EDUCATION, AND OTHERS. WHEN PERTINENT, THESE DATA SETS ARE PRESENTED IN THE CONTEXT OF CALIFORNIA STATE. THE 2019 COMMUNITY HEALTH NEEDS ASSESSMENT METHODOLOGY AND PROCESS INVOLVED THE COLLECTION OF BOTH SECONDARY DATA AND PRIMARY DATA. APPROXIMATELY 300 SECONDARY DATA INDICATORS ON A VARIETY OF HEALTH, SOCIAL, ECONOMIC, AND ENVIRONMENTAL TOPICS WERE COLLECTED BY ZIP CODE, SERVICE PLANNING AREA (SPA), COUNTY, AND STATE LEVELS (AS AVAILABLE). IN ADDITION, PRIMARY DATA COLLECTION INCLUDED AN ONLINE SURVEY, A YOUTH-LED PHOTOVOICE PROJECT WITH YOUTH AND YOUNG ADULT REPRESENTATION FROM ALL OVER LOS ANGELES COUNTY AND A COMMUNITY FORUM WITH INDIVIDUALS WHO REPRESENT THE BROAD INTERESTS OF THE COMMUNITY SERVED BY THE HOSPITAL. ADDITIONALLY, INPUT WAS OBTAINED FROM LOS ANGELES COUNTY DEPARTMENT OF PUBLIC HEALTH OFFICIALS. FOR THE COMMUNITY FORUM, COMMUNITY STAKEHOLDERS IDENTIFIED BY KEY DEPARTMENTS AT CHILDREN'S HOSPITAL LOS ANGELES WERE CONTACTED AND ASKED TO PARTICIPATE IN THE PRIORITIZATION OF NEEDS PROCESS. PARTICIPANTS INCLUDED INDIVIDUALS WHO ARE LEADERS AND REPRESENTATIVES OF MEDICALLY UNDERSERVED, LOW-INCOME, MINORITY AND CHRONIC DISEASE POPULATIONS, OR REGIONAL, STATE OR LOCAL HEALTH OR OTHER DEPARTMENTS OR AGENCIES THAT HAVE CURRENT DATA OR OTHER INFORMATION RELEVANT TO THE HEALTH NEEDS OF THE COMMUNITY SERVED BY THE HOSPITAL FACILITY.A NUMBER OF INSTITUTIONS, ORGANIZATIONS, AND DEPARTMENTS CONTRIBUTED TIME AND RESOURCES TO ASSIST WITH THE ASSESSMENT. THESE INCLUDE ASIAN PACIFIC HEALTH CARE VENTURE, CHILDREN'S HOSPITAL LOS ANGELES - CHAPLAIN, CHILDREN'S HOSPITAL LOS ANGELES - CLINICAL PROGRAMS, CHILDREN'S AGENCIES, COMMUNITY HEALTH COUNCILS, INC., LOS ANGELES COUNTY DEPARTMENT OF PUBLIC HEALTH, ESPERANZA HOUSING CORPORATION, ALTAMED AT CHILDREN'S HOSPITAL, COMMUNITY CLINIC ASSOCIATION OF LOS ANGELES, COUNTY HOSPITAL LOS ANGELES - COMMUNITY AFFAIRS, CHILDREN'S HOSPITAL LOS ANGELES - FAMILY ADVISORY COUNCIL, CHILDREN'S HOSPITAL LOS ANGELES - PEDIATRIC RESIDENCY PROGRAM, CHILDREN'S HOSPITAL LOS ANGELES - PROMOTORAS, CITY COUNCIL, COMMUNITY CLINIC ASSOCIATION OF L.A. COUNTY, FIRST 5 LA, YOUTH POLICY INSTITUTE, AND MATERNAL AND CHILD HEALTH ACCESS. CHILDREN'S HOSPITAL LOS ANGELES PART V, SECTION B, LINE 11: AS PART OF THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA), HEALTH AND SOCIAL NEEDS WERE IDENTIFIED THROUGH AN EXAMINATION OF PRIMARY AND SECONDARY DATA AND THEN PRIORITIZED THROUGH A STRUCTURED PROCESS USING THE RELATIVE WORTH METHOD. THE PRIORITY DOMAINS THAT ARE BEING ADDRESSED ARE: HEALTH ACCESS, ECONOMIC ADVANCEMENT AND COMMUNITY GROWTH. OTHER HEALTH AND SOCIAL NEEDS THAT WERE IDENTIFIED, SUCH AS MENTAL HEALTH, CHRONIC DISEASE CONDITIONS, COMMUNITY SAFETY, AND EARLY CHILDHOOD DEVELOPMENT, ARE ALREADY BEING ADDRESSED BY OTHER LOCAL AND REGIONAL COMMUNITY ORGANIZATIONS. THE HOSPITAL IS DEDICATED TO MAKING A DIFFERENCE IN THE LIVES OF CHILDREN, ADOLESCENTS AND THEIR FAMILIES AND IS ADDRESSING THE PRIORITY AREAS IDENTIFIED IN THE CHNA BY PROVIDING PROGRAMS AND SERVICES THAT ARE FAMILY CENTERED AND COMMUNITY BASED. - HEALTH ACCESS - CHILDREN'S HOSPITAL LOS ANGELES IS PROMOTING HEALTHY BEHAVIORS AND PREVENTION OF DISEASE THROUGH OUTREACH AND EDUCATION AT LOCAL SCHOOLS, COMMUNITY EVENTS AND EXPOSITIONS. THE HOSPITAL IS ALSO EXPANDING ACCESS TO HEALTH CARE RESOURCES AND INFORMATION REGARDING TRANSITION AND TRANSFER OF CARE FOR YOUNG ADULT PATIENTS LIVING WITH CHRONIC ILLNESS AND DISABILITY. CHLA HAS PARTNERED WITH COMMUNITY ORGANIZATIONS TO COORDINATE CHILD HEALTH AND SAFETY CAMPAIGNS.- ECONOMIC ADVANCEMENT - THE HOSPITAL IS WORKING TO ADVANCE CURRENT EFFORTS TO EXPAND INTERNSHIPS, MENTORSHIPS AND WORK EXPERIENCE OPPORTUNITIES FOR YOUNG ADULTS AND UNEMPLOYED INDIVIDUALS AND WILL COLLABORATE WITH COMMUNITY AND CIVIC STAKEHOLDERS TO MAXIMIZE ECONOMIC OPPORTUNITY STRATEGIES THAT ADDRESS HEALTH DISPARITIES AND THE SOCIAL DETERMINANTS OF HEALTH.- COMMUNITY GROWTH - CHILDREN'S HOSPITAL LOS ANGELES HAS COLLABORATED WITH COMMUNITY CLINICS TO PROMOTE PEDIATRIC HEALTH AND WELLNESS AND MAKE AVAILABLE INFORMATION AND RESOURCES TO PROVIDERS WHO CARE FOR FAMILIES IN UNDERSERVED AREAS AND COLLABORATE WITH LOCAL COMMUNITY BASED ORGANIZATIONS TO WORK ON INITIATIVES THAT DESIGN AND INFORM THE DEVELOPMENT OF INTERVENTIONS THAT ADDRESS HEALTH INEQUITIES, PARTICULARLY IN UNDERSERVED COMMUNITIES. PART V, SECTION B, LINE 7A: THE COMMUNITY HEALTH NEEDS ASSESSMENT ("CHNA") OF THE HOSPITAL CAN BE LOCATED AT THE FOLLOWING WEB ADDRESS: HTTPS://WWW.CHLA.ORG/COMMUNITY-BENEFIT-AND-COMMUNITY-AFFAIRS PART V, SECTION B, LINE 10A: THE IMPLEMENTATION STRATEGY OF THE HOSPITAL CAN BE LOCATED AT THE FOLLOWING WEB ADDRESS: HTTPS://WWW.CHLA.ORG/COMMUNITY-BENEFIT-AND-COMMUNITY-AFFAIRS 7 1 - SOUTH BAY 3440 TORRANCE BLVD SUITE 100 TORRANCE CA 90503 OUTPATIENT CLINIC 2 - SANTA MONICA 1301 20TH ST SUITE 460 SANTA MONICA CA 90404 OUTPATIENT CLINIC 3 - ENCINO 5363 BALBOA BLVD SUITE 121 ENCINO CA 91316 OUTPATIENT CLINIC 4 - VALENCIA 23838 VALENCIA BLVD SUITE 140 VALENCIA CA 91355 OUTPATIENT CLINIC 5 - ARCADIA 468 E SANTA CLARA ST ARCADIA CA 91006 OUTPATIENT CLINIC 6 - BAKERSFIELD 9500 STOCKDALE HWY 104 BAKERSFIELD CA 93311 OUTPATIENT CLINIC 7 - WILSHIRE 3250 WILSHIRE BLVD LOS ANGELES CA 90010 UNIVERSITY CENTER FOR EXCELLENCE IN DEVELOPMENTAL DISABILITIES CLINIC PART I, LINE 7: THE ORGANIZATION USES THE COST-TO-CHARGE RATIO METHODOLOGY TO DETERMINE UNREIMBURSED COST OF CARE PROVIDED TO MEDI-CAL PATIENTS. ALL OTHER COSTS ARE ACCOUNTED FOR USING AN INTERNAL SOFTWARE CALLED CBISA (COMMUNITY BENEFIT INVENTORY FOR SOCIAL ACCOUNTABILITY), WHICH FEATURES A BLEND OF BOTH STATISTICAL AND NARRATIVE INFORMATION.IN OCTOBER 2010, CMS APPROVED LEGISLATION ENACTED BY THE STATE OF CALIFORNIA THAT PROVIDED FOR SUPPLEMENTAL MEDI-CAL PAYMENTS TO BE PAID TO CERTAIN HOSPITALS FROM FUNDS COLLECTED FROM PARTICIPATING HOSPITALS UNDER THE STATE'S QUALITY ASSURANCE FEE PROGRAM. SUCH AMOUNTS WERE ALLOCATED AND PAID TO CHLA BASED ON PRIOR YEAR PATIENT DATA, WHICH INCLUDES MEDI-CAL PATIENTS. PART II, COMMUNITY BUILDING ACTIVITIES: THE HOSPITAL SPONSORS VARIOUS COMMUNITY SERVICES TO BENEFIT THE PHYSICALLY, MENTALLY, AND GENETICALLY DISABLED AS PART OF ITS CHARITABLE MISSION. THESE SERVICES INCLUDE PARENTAL COUNSELING, EDUCATIONAL SEMINARS, FAMILY SUPPORT GROUPS, AND AN OUTREACH ORGANIZATION FOR FAMILIES ADMINISTERED BY THE HOSPITAL IN AN AGENCY RELATIONSHIP AND FUNDED BY THE STATE OF CALIFORNIA. ADDITIONALLY, A LARGE NUMBER OF HEALTH-RELATED EDUCATIONAL PROGRAMS ARE PROVIDED FOR THE BENEFIT OF THE COMMUNITY, INCLUDING HEALTH ENHANCEMENTS AND WELLNESS, TELEPHONE INFORMATION SERVICES, AND PROGRAMS DESIGNED TO IMPROVE THE GENERAL STANDARDS OF THE HEALTH OF THE COMMUNITY. CHILDREN'S HOSPITAL LOS ANGELES OFFERS MANY COMMUNITY SERVICES AND PROGRAMS IN RESPONSE TO THE NEEDS OF CHILDREN, YOUTH AND FAMILIES. COMMUNITY BENEFIT SERVICES AND ACTIVITIES ARE DESIGNED TO PROVIDE TREATMENT AND PROMOTE HEALTH AS A RESPONSE TO IDENTIFIED COMMUNITY NEEDS. OUR OBJECTIVES ARE TO IMPROVE ACCESS TO HEALTH CARE SERVICES, ENHANCE PUBLIC HEALTH OF THE COMMUNITY, ADVANCE MEDICAL OR HEALTH CARE KNOWLEDGE THAT PROVIDES PUBLIC BENEFIT, AND RELIEVE OR REDUCE THE BURDEN OF GOVERNMENT OR OTHER COMMUNITY EFFORTS.THE CHLA COMMUNITY HEALTH OUTREACH NETWORK - DUE TO COVID-19 RESTRICTIONS, CHLA COMMUNITY HEALTH OUTREACH NETWORK IN-PERSON OUTREACH CONTINUES TO BE PLACED ON HOLD AND HAS REMAINED IN A VIRTUAL FORMAT. CHLA'S OFFICE OF COMMUNITY AFFAIRS CREATED THE COMMUNITY IMPACT VIRTUAL SERIES TO VIRTUALLY PROVIDE HEALTH EDUCATION AND HEALTH PROMOTION INFORMATION TO THE COMMUNITY ORGANIZATION AND COMMUNITY MEMBERS INCLUDING TOPICS IMPACTED BY COVID-19, SUCH AS PARENTING CONSIDERATIONS AND THE IMPORTANCE OF FLU PREVENTION AND COVID-19 VACCINATIONS REACHING OVER 400 INDIVIDUALS INCLUDING REPRESENTATIVES FROM COMMUNITY ORGANIZATIONS, COMMUNITY MEMBERS AND FAMILIES VIA 10 VIRTUAL SESSIONS.CAREERS IN HEALTH AND MENTORSHIP PROGRAM (CHAMP) CHLA'S CHAMP PROVIDES UNDERREPRESENTED ADULTS FROM THE LOS ANGELES COMMUNITY THE OPPORTUNITY TO PARTICIPATE IN A SERIES OF COMPREHENSIVE JOB READINESS AND LEADERSHIP DEVELOPMENT WORKSHOPS THAT ARE LED BY CHLA STAFF AND HOSPITAL PARTNERS. SINCE ITS INCEPTION, OVER 250 YOUNG ADULTS ENTERED THE CHLA CHAMP. AFTER SUCCESSFULLY COMPLETING THE WORKSHOP SERIES, "CHAMPERS" ARE PLACED IN NONCLINICAL, PROJECT-BASED INTERNSHIPS IN PARTICIPATING HOSPITAL DEPARTMENTS.CAMP CHLA, A HEALTH CAREERS EXPLORATION PROGRAM, PROVIDES HIGH SCHOOL STUDENTS A FIRSTHAND LOOK INTO THE DAILY LIVES OF HEALTH CARE PROFESSIONALS. SINCE ITS INCEPTION IN 2006, OVER 1,000 STUDENTS FROM OUR COMMUNITY HAVE HAD THE OPPORTUNITY TO: JOB-SHADOW HEALTH CARE PROFESSIONALS, PARTICIPATE IN HANDS-ON SKILLS LABS, GAIN EXPOSURE TO DIFFERENT HEALTH CAREER PATHS AND SHARE THEIR EXPERIENCES WITH OTHER CAMPERS. FOR THE SECOND YEAR DUE TO COVID-19 RESTRICTIONS, 2 SESSIONS OF 60 STUDENTS EACH PARTICIPATED IN THE FIRST VIRTUAL CAMP SESSIONS SINCE ITS INCEPTION. STUDENTS ENGAGED WITH MANY PEDIATRIC DEPARTMENTS INCLUDING NEONATOLOGY, HOSPITAL MEDICINE, GEN PEDS, ED, REHABILITATION, HEMATOLOGY/ONCOLOGY AND PSYCHIATRY.CHLA CONTINUES TO DEEPEN ITS COMMITMENT TO THE COMMUNITY AT LARGE THROUGH THE INNOVATION AND IMPLEMENTATION OF ITS COMMUNITY SERVICES AND PROGRAMS TO IMPROVE THE COMMUNITY'S HEALTH AND SAFETY. THROUGH OUR COMMUNITY BENEFIT PROCESS WE WILL GAIN A BETTER UNDERSTANDING OF THE SOCIAL DETERMINANTS OF HEALTH; AND INNOVATE AND IMPLEMENT SERVICES AND PROGRAMS TO IMPROVE THE HEALTH AND SAFETY OF THE COMMUNITY. PART III, LINE 3: THE HOSPITAL RECOGNIZES PATIENT SERVICE REVENUE ON THE BASIS OF CONTRACTUAL RATES FOR THE SERVICES RENDERED FOR THOSE PATIENTS WHO HAVE THIRD-PARTY PAYOR COVERAGE. FOR UNINSURED PATIENTS WHO DO NOT QUALIFY FOR CHARITY CARE, THE HOSPITAL RECOGNIZES REVENUE ON THE BASIS OF ITS STANDARD RATES (OR ON THE BASIS OF DISCOUNTED RATES, IF NEGOTIATED OR PROVIDED BY POLICY). PATIENTS COVERED BY INSURANCE, BUT REQUIRED TO PAY DEDUCTIBLES OR COPAYMENTS, ARE CONSIDERED TO BE UNINSURED FOR THOSE PORTIONS. BASED ON HISTORICAL EXPERIENCE, THE HOSPITAL BELIEVES THAT A SIGNIFICANT PORTION OF ITS PATIENT ACCOUNTS WILL BE UNCOLLECTIBLE. THUS, IT RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS RELATED TO PATIENT ACCOUNTS IN THE PERIOD THE SERVICES ARE PROVIDED.BAD DEBTS ARE NOT INCLUDED AS COMMUNITY BENEFITS AND CONTAIN -0- CHARITY COST. BAD DEBTS ARE CALCULATED BASED ON UNCOLLECTIBLE ACCOUNTS NET OF CONTRACTUALS. PART III, LINE 4: NET PATIENT SERVICE REVENUE IS REPORTED AT THE ESTIMATED NET REALIZABLE AMOUNTS FROM PATIENTS, THIRD-PARTY PAYORS, AND OTHERS, INCLUDING ESTIMATED VARIABLE CONSIDERATION FOR RETROACTIVE ADJUSTMENTS DUE TO TERMS UNDER REIMBURSEMENT AGREEMENTS WITH THIRD-PARTY PAYORS, SETTLEMENT OF AUDITS, REVIEWS, AND INVESTIGATIONS. RETROACTIVE ADJUSTMENTS ARE ESTIMATED AND ACCRUED IN THE PERIOD IN WHICH THE RELATED SERVICES ARE RENDERED AND ADJUSTED IN FUTURE PERIODS AS FINAL SETTLEMENTS ARE DETERMINED.PATIENT ACCOUNTS RECEIVABLE ARE RECORDED ON AN ACCRUAL BASIS AT NET REALIZABLE VALUE UPON BILLING FOR SERVICES PROVIDED TO PATIENTS.THE HOSPITAL'S CHARITY CARE AND UNINSURED DISCOUNT POLICIES REMAINED UNCHANGED DURING FISCAL YEARS 2021 AND 2020 (SEE NOTE 5). PART III, LINE 8: CHLA IS NOT INCLUDING ANY MEDICARE SHORTFALL AS PART OF ITS COMMUNITY BENEFIT. FURTHER, CHLA USES FEDERAL MEDICARE COST ALLOCATION METHODOLOGY, AS REPORTED IN ITS MEDICARE COST REPORT, TO DETERMINE THE ALLOWABLE COSTS OF CARE RELATING TO MEDICARE PAYMENTS RECEIVED. PART III, LINE 9B: THE HOSPITAL'S POLICY STATES THAT IF THE PATIENT/GUARANTOR IS UNABLE TO PAY FOR SERVICES DUE TO THEIR CURRENT FINANCIAL SITUATION, THEY COULD BE ELIGIBLE FOR UNCOMPENSATED CARE, IN WHICH CASE THE HOSPITAL'S APPLICABLE POLICY AND PROCEDURE IS FURTHER REFERENCED. IF THE PATIENT/GUARANTOR DOES NOT QUALIFY, THE HOSPITAL FOLLOWS ALL APPLICABLE FEDERAL AND STATE GUIDELINES FOR DEBT COLLECTION, INCLUDING THE REQUIREMENT OF FAIR TREATMENT, THE PROHIBITION OF MAKING FALSE STATEMENTS AND RESTRICTIONS ON THE TIME OF DAY THAT DEBT COLLECTORS MAY CONTACT THE DEBTOR. PART VI, LINE 2: CHLA CONTINUES ITS COMMITMENT TO THE CHILDREN AND FAMILIES OF THE LOS ANGELES AREA THROUGH ITS COMMUNITY BENEFIT ACTIVITIES WHICH ENSURE THAT OUR HOSPITAL WILL REMAIN RESPONSIVE TO THE NEEDS OF THE COMMUNITY. CHILDREN'S HOSPITAL LOS ANGELES STRIVES TO ACCOMPLISH OUR OBJECTIVES THROUGH OUR STRATEGIC PLAN, DEVELOPED IN ACCORDANCE WITH THE 2019 COMMUNITY HEALTH NEEDS ASSESSMENT. 2019 COMMUNITY HEALTH NEEDS ASSESSMENT STRATEGIES INCLUDE: - PRESERVE ACCESS TO PEDIATRIC CARE: CARRY OUT ADVOCACY EFFORTS THAT FOCUS ON CHILDREN'S HEALTH INITIATIVES INCLUDING BEHAVIORAL HEALTH AND PREVENTIVE SERVICES; EXPAND ACCESS TO PEDIATRIC HEALTH SERVICES: EXPLORE PARTNERSHIP OPPORTUNITIES WITH COMMUNITY ORGANIZATIONS TO ADDRESS ACCESS ISSUES AND GAPS; INCREASE AWARENESS OF PEDIATRIC HEALTH CARE RESOURCES AND INFORMATION: CONDUCT OUTREACH REGARDING AVAILABLE PROGRAMS AND SERVICES THAT ADDRESS CHILDREN AND ADOLESCENT HEALTH, EMOTIONAL AND SOCIAL ISSUES.- BUILD WORKFORCE PIPELINE FOR YOUTH AND YOUNG ADULTS: ADVANCE CURRENT HOSPITAL EFFORTS TO INCREASE INTERNSHIPS, MENTORSHIPS, AND WORK EXPERIENCE INITIATIVES; DIVERSIFY WORKFORCE PIPELINE: DEVELOP WORKFORCE TRAINING PROGRAMS FOR SPECIAL POPULATIONS; SUPPORT LOCAL BUSINESS GROWTH: EXPLORE OPPORTUNITIES TO STRENGTHEN ALLIANCES WITH THE LOCAL BUSINESS COMMUNITY SPECIFICALLY WOMEN AND MINORITY OWNED SMALL BUSINESSES.- FOSTER NEIGHBORHOOD REVITALIZATION: ADVANCE LOCAL INITIATIVES THAT PROMOTE QUALITY OF LIFE FOR ALL RESIDENTS IN A NEIGHBORHOOD.CHLA COMPLETED 2019 COMMUNITY HEALTH NEEDS ASSESSMENT AND CONTINUES TO STRENGTHEN ITS COMMITMENT TO UNDERSTANDING THE HEALTH NEEDS OF THE COMMUNITIES IT SERVES.WE ARE IN THE PROCESSING OF COMPLETING THE 2022 CHNA. PART VI, LINE 3: EVERY PATIENT OR HIS OR HER REPRESENTATIVE SHALL, UPON ADMISSION AS AN INPATIENT, RECEIVE A WRITTEN NOTICE CONTAINING INFORMATION ABOUT THE AVAILABILITY OF CHARITY CARE AND DISCOUNT CARE. THE NOTICE SHALL INCLUDE INFORMATION ABOUT THIS POLICY, AS WELL AS CONTACT INFORMATION FOR A HOSPITAL EMPLOYEE OR OFFICE FROM WHICH THE PATIENT OR REPRESENTATIVE MAY OBTAIN FURTHER INFORMATION ABOUT THIS POLICY. THIS SAME NOTICE SHALL BE GIVEN TO PATIENTS WHO RECEIVE EMERGENCY OR OUTPATIENT CARE, AND WHO MAY RECEIVE A BILL FOR SUCH CARE, BUT WHO WERE NOT ADMITTED. THE NOTICE SHALL BE PROVIDED IN ENGLISH AND IN THE LANGUAGE SPOKEN BY THE PATIENT'S FAMILY IF AVAILABLE. NOTICES REGARDING THIS POLICY WILL BE CLEARLY AND CONSPICUOUSLY POSTED IN LOCATIONS VISIBLE TO THE PUBLIC INCLUDING, BUT NOT LIMITED TO, ALL OF THE FOLLOWING: THE EMERGENCY DEPARTMENT, BILLING OFFICE, ADMISSIONS OFFICE, AND OUTPATIENT SETTINGS. THESE POSTED NOTICES WILL EXPLAIN THAT CHLA HAS A VARIETY OF OPTIONS AVAILABLE, INCLUDING FINANCIAL ASSISTANCE, TO INDIVIDUALS WHO ARE UNINSURED OR UNDERINSURED. THESE NOTICES WILL INCLUDE A CONTACT OFFICE AND TELEPHONE NUMBER AN INDIVIDUAL CAN CALL TO OBTAIN MORE INFORMATION ABOUT THIS FINANCIAL ASSISTANCE POLICY AND TO APPLY FOR FINANCIAL ASSISTANCE. PART VI, LINE 4: OUR HOSPITAL SERVICES REACH THOUSANDS ACROSS SOUTHERN CALIFORNIA, WITH A PRIMARY SERVICE AREA OF LOS ANGELES COUNTY--A REGION THAT SPANS 4,057 SQUARE MILES AND INCLUDES VAST URBAN COMMUNITIES, SUBURBAN AREAS AND RURAL NEIGHBORHOODS AND INCLUDES 8 SERVICE PLANNING AREAS (SPAS) AS DESIGNATED BY THE LOS ANGELES COUNTY HEALTH DEPARTMENT. APPROXIMATELY 85% OF THE HOSPITAL'S PATIENTS ORIGINATE FROM L.A. COUNTY. LOS ANGELES COUNTY IS HOME TO MORE THAN 10 MILLION RESIDENTS--APPROXIMATELY 26 PERCENT OF THE STATE'S POPULATION. IT IS THE MOST POPULOUS COUNTY IN THE NATION, AND ONE OF THE MOST ETHNICALLY AND RACIALLY DIVERSE AS WELL.CHILDREN (AGES 0-11) REPRESENTED 15.5% OF THE POPULATION IN LOS ANGELES COUNTY, WHILE ADOLESCENTS (AGES 12-17) REPRESENTED 7.7%. THE MAJORITY POPULATION RACE/ETHNICITY IN LA COUNTY IS HISPANIC OR LATINO (32.0%). WHITES MAKE UP 29.0% OF THE POPULATION. ASIANS COMPRISE 13.0% OF THE POPULATION, AND AFRICAN AMERICANS ARE 9.0% OF THE POPULATION. THE CATEGORIES OF OTHER AND TWO OR MORE RACES COMPRISED 17.0% OF THE POPULATION. IN LA COUNTY, 56.9% OF THE POPULATION SPEAKS A LANGUAGE OTHER THAN ENGLISH AT HOME AND 25.8% ARE LINGUISTICALLY ISOLATED. IN LOS ANGELES, APPROXIMATELY ONE FIFTH OF THE POPULATION LIVED AT OR BELOW 100% OF THE FPL (20.6%). FURTHERMORE, IN LOS ANGELES COUNTY, 27.4% OF CHILDREN, UNDER AGE 18 YEARS, LIVED IN POVERTY. THERE ARE 98 HOSPITALS SERVING THE COMMUNITY IN LOS ANGELES COUNTY. PART VI, LINE 5: CHILDREN'S HOSPITAL LOS ANGELES OFFERS MANY COMMUNITY SERVICES AND PROGRAMS IN RESPONSE TO THE NEEDS OF CHILDREN, YOUTH AND FAMILIES. COMMUNITY BENEFIT SERVICES AND ACTIVITIES ARE DESIGNED TO PROVIDE TREATMENT AND PROMOTE HEALTH AS A RESPONSE TO IDENTIFIED COMMUNITY NEEDS. OUR OBJECTIVES ARE TO IMPROVE ACCESS TO HEALTH CARE SERVICES, ENHANCE PUBLIC HEALTH OF THE COMMUNITY, ADVANCE MEDICAL OR HEALTH CARE KNOWLEDGE THAT PROVIDES PUBLIC BENEFIT, AND RELIEVE OR REDUCE THE BURDEN OF GOVERNMENT OR OTHER COMMUNITY EFFORTS AND HAVE INCLUDED PROGRAMS SUCH AS THE FOLLOWING:SAMUELS FAMILY LATINO AND AFRICAN AMERICAN HIGH SCHOOL INTERNSHIP PROGRAM (LA-HIP): THE OVERALL GOAL OF THE SAMUELS FAMILY LA-HIP IS TO PROVIDE LATINO AND AFRICAN AMERICAN PUBLIC HIGH SCHOOL STUDENTS THAT HAVE A GENUINE INTEREST IN SCIENCE, TECHNOLOGY, ENGINEERING AND MATH (STEM) WITH THE OPPORTUNITY TO LEARN HANDS-ON LABORATORY-BASED RESEARCH AND TO SUPPORT THEM IN THEIR QUEST TO BECOME SCIENTISTS OR PHYSICIAN SCIENTISTS. LA-HIP WAS FOUNDED 16 YEARS AGO AND HAS TRAINED 200 HIGH SCHOOL STUDENTS FROM THE LOS ANGELES AREA. LA-HIP IS A COMPREHENSIVE YEARLONG INTERNSHIP PROGRAM THAT COMBINES BIOMEDICAL RESEARCH WITH COLLEGE READINESS WORKSHOPS, ACADEMIC ENHANCEMENT, AND SAT PREPARATORY CURRICULUM. THIS 2021 CLASS OF 16 OUTSTANDING STUDENTS IN THE PROGRAM, ALL OF WHOM UNDERTOOK ORIGINAL RESEARCH PROJECTS WORKING WITH FACULTY, FELLOWS, AND GRADUATE STUDENT MENTORS IN THE SABAN RESEARCH INSTITUTE. CAREERS IN HEALTH AND MENTORSHIP PROGRAM (CHAMP): CHLA'S CHAMP PROVIDES UNDERREPRESENTED ADULTS FROM THE LOS ANGELES COMMUNITY THE OPPORTUNITY TO PARTICIPATE IN A SERIES OF COMPREHENSIVE JOB READINESS, LEADERSHIP DEVELOPMENT WORKSHOPS AND INTERNSHIPS. OVER 280 YOUNG ADULTS LIVING WITHIN THE LOS ANGELES COMMUNITY HAVE BEEN PROVIDED THE OPPORTUNITY TO STRENGTHEN THEIR CAREER PATHWAYS BY GAINING UNIQUE WORK EXPERIENCES AND MENTORSHIP BY OUR HOSPITAL'S LEADERS THAT ARE AFFILIATED WITH NON-CLINICAL SYSTEMS. THE STUDENTS APPLYING CAME FROM VARIOUS EDUCATIONAL INSTITUTIONS INCLUDING TRADE TECHS, COMMUNITY COLLEGES, UNIVERSITIES (UNDERGRADUATE AND GRADUATE), AND PRIVATE PROFESSIONAL ORGANIZATIONS, MANY FROM UNDERSERVED AREAS IN LOS ANGELES COUNTY AND ACROSS THE COUNTRY. CHAMPERS ARE PAIRED WITH DEPARTMENTS ACROSS THE ORGANIZATION THAT HAVE INCLUDED AREAS SUCH AS AMBULATORY OPERATIONS, FOUNDATION, IT, RESEARCH, FACILITIES, ACADEMIC AFFAIRS, ETC. APPROXIMATELY 50% HAVE BEEN OFFERED A POSITION, IN A HEALTHCARE SETTING INCLUDING BUT NOT LIMITED TO CHLA, CEDARS SINAI, THE UCLA HEALTH SYSTEM, THE KAISER SYSTEM, AND USC AND MORE THAN 75% OF THE STUDENTS WENT ON TO CONTINUE TO PURSUE HIGHER EDUCATION INCLUDING PROGRAMS FOR DEGREES SUCH AS MASTER'S IN BUSINESS ADMINISTRATION (MBA), MASTER'S IN PUBLIC HEALTH (MPH), MASTER'S IN HEALTH ADMINISTRATION (MHA), TO NAME A FEW. THIS YEAR DUE TO COVID-19, ONE OF THE 2 SESSIONS REMAINED VIRTUAL AND THE LATTER WAS HELD AS A HYBRID SESSION.PROJECT SEARCH:CHILDREN'S HOSPITAL LOS ANGELES LAUNCHED THE NATIONALLY RECOGNIZED PROJECT SEARCH PROGRAM IN COLLABORATION WITH THE LOS ANGELES UNIFIED SCHOOL DISTRICT, PATHPOINT, LANTERNMAN REGIONAL CENTER, AND SOUTH-CENTRAL LOS ANGELES REGIONAL CENTER THIS YEAR. THIS PROGRAM PROVIDES INTERNSHIP OPPORTUNITIES TO PREPARE YOUNG PEOPLE WITH SIGNIFICANT DISABILITIES FORSUCCESS IN INTEGRATED, COMPETITIVE EMPLOYMENT BY PLACING YOUNG ADULT INTERNS THROUGHOUT VARIOUS DEPARTMENTS AT CHLA. THE PROGRAM PROVIDES REAL-LIFE WORK EXPERIENCE COMBINED WITH SKILLS TRAINING, CAREER EXPLORATION, AND INDEPENDENT-LIVING SKILLS. WE RECRUITED 4 NEW STUDENTS FOR THE 2021 PROJECT SEARCH COHORT. FOOD INSECURITY INITIATIVES:TO ADDRESS FOOD INSECURITY IN ITS LOCAL COMMUNITY, CHILDREN'S HOSPITAL SPONSORED AND PROVIDED VOLUNTEERS FOR OVER 45 PRODUCE BOX GIVEAWAY EVENTS IN THE EAST HOLLYWOOD/VIRGIL VILLAGE NEIGHBORHOOD NEAR THE HOSPITAL. IN PARTNERSHIP WITH THE EAST HOLLYWOOD NEIGHBORHOOD COUNCIL, THE OFFICE OF COUNCILMEMBER MITCH O'FARRELL AND RICK'S PRODUCE MARKET, MORE THAN 1,400 BOXES, ABOUT 35,000 POUNDS OF FRESH PRODUCEHAVE BEEN GIVEN TO FAMILIES AND INDIVIDUALS FACING FOOD INSECURITY. ADDITIONALLY, CHLA MOBILIZED EMPLOYEE VOLUNTEERS FROM THE HOSPITAL'S COMMUNITY IMPACT CHAMPIONS NETWORK (CICN) TO SUPPORT ADDITIONAL FOOD DISTRIBUTION EVENTS TO PROVIDE AN ADDITIONAL 1,100 BOXES TO THE COMMUNITY, RAISING THE OVERALL TOTAL TO MORE THAN 2,500 BOXES OR 50,000 POUNDS OF FOOD. CHILDREN'S HOSPITAL ALSO SEEDED AND SPONSORED THE CITY'S GARDEN AT LOS ANGELES CITY COLLEGE (LACC). EMPLOYEE VOLUNTEERS FROM THE CICN HAVE BEEN BUSY HELPING TO PLANT AND SEED THE GARDEN, WHICH WILL PROVIDE LACC STUDENTS AND THE COMMUNITY WITH A PLACE TO COME TOGETHER, GROW THEIR OWN FRESH PRODUCE, AND LEARN ABOUT NUTRITION AND DIVERSE CUISINES. PART VI, LINE 7, REPORTS FILED WITH STATES CA 1 CALIFORNIA HEALTH FOUNDATION AND TRUST 1215 K STREET SUITE 800 SACRAMENTO CA 95814 941498687 501(C)(3) 1031183 SUPPORT CHARITABLE ACTIVITIES AT HOSPITALS AND HEALTH SYSTEMS IN CALIFORNIA RONALD MCDONALD HOUSE CHARITIES OF SOUTHERN CALIFORNIA 4650 FOUNTAIN AVENUE LOS ANGELES CA 90029 953167869 501(C)(3) 500000 DONATION NATIONAL MEDICAL FELLOWSHIPS INC 347 FIFTH AVENUE SUITE 510 NEW YORK NY 10016 010963657 501(C)(3) 175000 PRIMARY CARE LEADERSHIP PROGRAM SUPPORT LOS ANGELES CITY COLLEGE FOUNDATION 855 N VERMONT AVENUE LOS ANGELES CA 90029 956207819 501(C)(3) 30000 LACC COMMUNITY GARDEN CONTRIBUTION/SPONSORSHIP AND VIRTUAL GALA RICK'S PRODUCE MARKET 755 N VIRGIL AVE LOS ANGELES CA 90029 821841207 25000 EAST HOLLYWOOD COMMUNITY PRODUCE BOXES UC SANTA BARBARA FOUNDATION UNIVERSITY OF CALIFORNIA SANTA BARBARA CA 93106 237314834 501(C)(3) 15000 DONATION TO SUPPORT THE ISMAEL "MAYO" DE LA ROCHA ENDOWED SCHOLARSHIP FUND JVS SOCAL 6505 WILSHIRE BLVD SUITE 200 LOS ANGELES CA 90048 951643388 501(C)(3) 12500 SPONSORSHIP HATHAWAY-SYCAMORES CHILD & FAMILY SERVICES 100 W WALNUT STREET SUITE 375 PASADENA CA 91124 951691005 501(C)(3) 10000 VIRTUAL GALA SPONSORSHIP 7 1 PART I, LINE 2: CHLA AWARDS GRANTS TO VARIOUS ORGANIZATIONS FOR PURPOSES THAT ARE CONSISTENT WITH OUR MISSION AND VALUES. IN ADDITION, DUE DILIGENCE IS PERFORMED TO ENSURE THE FUNDS ARE USED FOR THEIR INTENDED PURPOSES. X X X X 1 1 0 0 0 0 0 1 0 PAUL S VIVIANO DIRECTOR, PRESIDENT AND CEO 1008293 0 231800 0 239084 0 4491 0 28562 0 1512230 0 211694 0 M SCOTT LIEBERENZ SVP, CHIEF FINANCIAL OFFICER 605588 0 81000 0 93121 0 87247 0 20550 0 887506 0 68216 0 MARK D KRIEGER MD DIRECTOR, FACULTY PHYSICIAN 730625 0 146500 0 0 0 0 0 0 0 877125 0 0 0 RINA JURADO DIRECTOR, SURGERY 57386 0 0 0 766874 0 3739 0 16424 0 844423 0 0 0 JAMES STEIN MD SVP, CHIEF MEDICAL OFFICER 632016 0 71800 0 60430 0 78002 0 730 0 842978 0 36079 0 LARA KHOURI SVP, CHIEF STRATEGY OFFICER 521841 0 86600 0 123392 0 79210 0 27918 0 838961 0 92901 0 NANCY LEE SVP, CHIEF CLINICAL OFFICER 563246 0 75800 0 94540 0 4548 0 26428 0 764562 0 74540 0 STEVE GARSKE SVP, CHIEF INFORMATION OFFICER 442370 0 59400 0 84565 0 65864 0 17503 0 669702 0 65065 0 GRACE OH SVP, GENERAL COUNSEL 418359 0 55500 0 68374 0 61765 0 43449 0 647447 0 63570 0 ALEXANDRA CARTER SVP, CHIEF DEVELOPMENT OFFICER 402849 0 57200 0 27567 0 62802 0 13352 0 563770 0 7857 0 RHONDA R FOSTER VP, CNO / PATIENT CARE SVCS 406396 0 63201 0 2100 0 55585 0 17539 0 544821 0 0 0 JODI SHIRLYN OGDEN RIVERA VP, RESEARCH OPERATIONS 324961 0 57114 0 72753 0 51781 0 18826 0 525435 0 48198 0 MAMOON SYED SVP, CHIEF PEOPLE OFFICER 357210 0 49400 0 33443 0 55023 0 27448 0 522524 0 10856 0 ELLEN ZAMAN EXEC DIR, EXTERNAL AFFAIRS 212513 0 27495 0 247776 0 3705 0 30136 0 521625 0 233898 0 BHAVANA KUMAR ARORA CMO, CHLA HEALTH NETWORK 403456 0 47163 0 0 0 4433 0 3271 0 458323 0 0 0 ROBERT BOB E SHADDY MD DIRECTOR, FACULTY PHYSICIAN 266750 0 189458 0 0 0 0 0 0 0 456208 0 0 0 MATTHEW MATT KEEFER MD DIRECTOR, FACULTY PHYS. (BEG 07/20) 371998 0 0 0 0 0 0 0 0 0 371998 0 0 0 JUDITH M KLINE CORPORATE SECRETARY 246366 0 0 0 0 0 3871 0 12279 0 262516 0 0 0 PART I, LINE 4A: RINA JURADO RECEIVED SEVERANCE IN THE AMOUNT OF $698,276 IN CALENDAR YEAR 2020, WHICH WAS TREATED AS TAXABLE COMPENSATION. PART I, LINE 4B: THE FOLLOWING INDIVIDUALS PARTICIPATED IN CHLA'S 457(F) PLAN FOR EXECUTIVE DEFERRED COMPENSATION (EDCP), A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN. AMOUNTS DEFERRED UNDER SECTION 457(F) PLAN ARE SUBJECT TO SUBSTANTIAL RISK OF FORFEITURE. THESE AMOUNTS WILL BE REPORTED AS COMPENSATION FOR THE YEAR PAID. AMOUNTS RECOGNIZED AS TAXABLE COMPENSATION ON THE EMPLOYEES 2020 FORM W-2 (EXCEPT PAUL VIVIANO - DEFERRED COMPENSATION) REFLECT PAYMENTS RECEIVED BY THE EMPLOYEE DURING CALENDAR YEAR 2020 THAT WERE PREVIOUSLY REPORTED AS DEFERRED COMPENSATION IN PRIOR YEAR FORM 990S: PAUL S. VIVIANO - $211,694 M. SCOTT LIEBERENZ - $68,216 ALEXANDRA CARTER - $7,857 STEVE GARSKE - $65,065 LARA KHOURI - $92,901 NANCY LEE - $74,540 GRACE OH - $63,570 JAMES STEIN, M.D. - $36,079 MAMOON SYED - $10,856 JODI SHIRLYN ODEN RIVERA - $48,198 THE FOLLOWING INDIVIDUAL PARTICIPATED IN CHLA'S CAPITAL ACCUMULATION ACCOUNT (CAA) WHICH IS A 457(F)) SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN. AMOUNTS DEFERRED UNDER SECTION 457(F) PLAN ARE SUBJECT TO SUBSTANTIAL RISK OF FORFEITURE. THESE AMOUNTS WILL BE REPORTED AS COMPENSATION FOR THE YEAR PAID. AMOUNTS RECOGNIZED AS TAXABLE COMPENSATION ON THE EMPLOYEE'S 2020 FORM W-2 REFLECT PAYMENTS RECEIVED BY THE EMPLOYEE DURING CALENDAR YEAR 2020: ELLEN ZAMAN - $233,898 PART I, LINE 7 CHLA MAINTAINS AN ENTERPRISE INCENTIVE PROGRAM (THE PLAN) THAT AWARDS INCENTIVE COMPENSATION BASED UPON ACHIEVEMENT OF ORGANIZATIONAL OBJECTIVES AS DETERMINED ANNUALLY BY THE BOARD OF DIRECTORS. ALTHOUGH THE AMOUNT OF INCENTIVE THAT EACH PARTICIPANT MAY BE AWARDED IS BASED ON A FIXED FORMULA, THE PRESIDENT AND CHIEF EXECUTIVE OFFICER AND BOARD OF DIRECTORS HAS THE FULL DISCRETION AND AUTHORITY TO DETERMINE QUESTIONS CONCERNING THE INTERPRETATION OR ADMINISTRATION OF THE PLAN, INCLUDING, WITHOUT LIMITATION, ALL QUESTIONS RELATING TO PLAN ELIGIBILITY, FINANCIAL FUNDING, PERFORMANCE GOALS AND RESULTS, AND APPROPRIATE PAYMENTS, AND THE DETERMINATIONS OF THE PRESIDENT AND CHIEF EXECUTIVE OFFICER AND BOARD OF DIRECTORS IS CONCLUSIVE AND BINDING AS TO ALL PERSONS AND FOR ALL PURPOSES. PART VII, SECTION A, LINE 5 PURSUANT TO THE AFFILIATE AGREEMENT WITH THE UNIVERSITY OF SOUTHERN CALIFORNIA (USC), AN UNRELATED ORGANIZATION, THE FOLLOWING COMPENSATION AMOUNTS WERE PAID TO THE FOLLOWING LISTED INDIVIDUALS BY USC. USC WAS SUBSEQUENTLY REIMBURSED BY CHLA FOR THE AMOUNTS: MARK D. KRIEGER, M.D. - $568,750 MATTHEW KEEFER, M.D. - $371,998 ROBERT E. SHADDY, M.D. - $166,750 A CALIFORNIA HEALTH FACILITIES FINANCING AUTHORITY 521643828 13033LB22 2012-08-15 182930717 SEE PART VI 0 0 0 B CALIFORNIA HEALTH FACILITIES FINANCING AUTHORITY 521643828 13032UNH7 2017-06-06 295974620 SEE PART VI 0 0 0 C CALIFORNIA HEALTH FACILITIES FINANCING AUTHORITY 521643828 13032UNJ3 2017-06-06 52180000 SEE PART VI 0 0 0 A 60170000 182930717 2310722 180619995 1 0 1 1 B 296178103 2528240 33225192 260424671 1 1 1 1 C 52180000 494240 51685760 1 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 B 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 C 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 1 0 1 0 0 0 1 B 0 1 1 0 0 0 0 0 1 C 0 1 0 0 1 1 GOLDMAN SACHS 13.000000000000 0 0 0 0 1 A 1 B 1 C 1 SCHEDULE K, PART I, BOND ISSUES: PART I(F): THE CURRENT REFUNDING OF THE SERIES 1999 BONDS (ISSUED ON 05/26/1999), SERIES 2009 BONDS (ISSUED ON 12/18/2009) AND SERIES 2010B BONDS (ISSUED ON 05/20/2010). SCHEDULE K, PART I, BOND ISSUES: PART I(F): THE SERIES 2017A BONDS WERE ISSUED TO FINANCE HOSPITAL PROJECTS; THE ADVANCE REFUNDING OF THE BORROWER'S SERIES 2010A BONDS (ISSUED ON 05/20/2010); AND THE CURRENT REFUNDING OF THE BORROWER'S SERIES 2007 BONDS (ISSUED ON 04/24/2007) AND SERIES 2012B BONDS (ISSUED ON 08/15/2012). SCHEDULE K, PART I, BOND ISSUES: PART I(F): THE CURRENT REFUNDING OF THE SERIES 2007 BONDS (ISSUED ON 04/24/2007) AND THE SERIES 2012B BONDS (ISSUED ON 08/15/2012). PART IV, LINE 2B, COLUMN A: BOND A: THE 2012 BONDS MET THE 6 MONTH EXCEPTION TO REBATE. PART IV, LINE 6, COLUMN B: THIS QUESTION IS BEING ANSWERED WITHOUT REGARD TO A YIELD-RESTRICTED ADVANCE REFUNDING ESCROW FINANCED WITH PROCEEDS OF THE BONDS. PART VI: DIFFERENCES BETWEEN THE ISSUE PRICE (PART I) AND TOTAL PROCEEDS (PART II, LINE 3) ARE DUE TO INVESTMENT EARNINGS. MARTHA GARSKE MARTHA GARSKE IS THE WIFE OF STEVE GARSKE (KEY EMPLOYEE) 168100 EMPLOYMENT 0 X 1 4500 FMV X 5266 FMV X 171711 FMV X 245 8372344 COST OR SELLING PRICE X 71 780343 FMV X PROFESSIONAL SERVICES 2 499246 FMV X PERS PROT EQUIP 46 313783 FMV X OTHER IN-KIND 16 310192 FMV X GIFT CARDS 7 39076 FMV 0 0 1 0 PART I, COLUMN (B): THE HOSPITAL IS REPORTING THE NUMBER OF CONTRIBUTIONS. FORM 990, PART III, LINE 1 WE CREATE HOPE AND BUILD HEALTHIER FUTURES. AS A LEADING ACADEMIC CHILDREN'S HOSPITAL, WE FULFILL OUR MISSION BY: CARING FOR CHILDREN, ADOLESCENTS, YOUNG ADULTS, FAMILIES AND EACH OTHER; ADVANCING KNOWLEDGE; PREPARING FUTURE GENERATIONS; BUILDING OUR FINANCIAL STRENGTH. FORM 990, PART III, LINE 4A DURING FISCAL YEAR 2021, CHLA'S OPERATIONS WERE SIGNIFICANTLY IMPACTED BY THE CHALLENGES OF THE COVID-19 GLOBAL PANDEMIC AS SHELTER-IN-PLACE ORDERS AND GOVERNMENT MANDATES TO SUSPEND ELECTIVE PROCEDURES WERE IMPLEMENTED IN ORDER TO COMBAT THE OUTBREAK. CHLA HONORED ITS COMMITMENT TO ITS COMMUNITIES BY TAKING COVID-19 PREPAREDNESS MEASURES SUCH AS IMPLEMENTING SIGNIFICANT NEW SAFETY MEASURES AT ITS HOSPITALS, CREATING AND EXPANDING BED CAPACITY, ACQUIRING PERSONAL PROTECTIVE EQUIPMENT AND OTHER SUPPLIES, EXPANDING TESTING CAPABILITIES, REDEPLOYING CAREGIVERS TO AREAS OF NEED, AND INVESTING IN ALTERNATIVE MEANS OF CARE. THE CANCELLATION OR POSTPONEMENT OF ALL ELECTIVE PROCEDURES AND NON-URGENT AMBULATORY VISITS RESULTED IN A SIGNIFICANT REDUCTION IN PATIENT VOLUMES. IN ADDITION TO LOST REVENUE ASSOCIATED WITH LOWER PATIENT VOLUMES, CHLA EXPERIENCED AN INCREASE IN OPERATING COSTS ASSOCIATED WITH THE RESPONSE TO THE COVID-19 PANDEMIC PARTIALLY DUE TO NURSING SHORTAGES AND EFFORTS TO RETAIN EMPLOYEES, AS WELL AS AN INCREASE IN SUPPLY EXPENSES AS A RESULT OF SHORTAGES, DELAYS AND SIGNIFICANT PRICE INCREASES IN MEDICAL SUPPLIES, PARTICULARLY PERSONAL PROTECTIVE EQUIPMENT AND CERTAIN PHARMACEUTICALS, WHICH ADVERSELY IMPACTED OPERATING RESULTS IN FISCAL YEAR 2021. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS PREPARED BY DELOITTE TAX LLP, WORKING IN CONJUNCTION WITH CHLA'S FINANCE DEPARTMENT. CHLA'S DIRECTOR OF FINANCE AND CONTROLLER HAS DIRECT RESPONSIBILITY FOR THIS EFFORT, SUBJECT TO SUPERVISION BY THE CHIEF FINANCIAL OFFICER. AFTER AN INITIAL DRAFT OF THE FORM 990 IS PREPARED, IT IS CIRCULATED FOR REVIEW AND COMMENT BY RELEVANT MEMBERS OF THE EXECUTIVE TEAM WHO HAVE RESPONSIBILITY AND/OR KNOWLEDGE ABOUT THE VARIOUS MATTERS DISCLOSED AND/OR DESCRIBED IN THE FORM. THE CHIEF FINANCIAL OFFICER AND GENERAL COUNSEL, IN PARTICULAR, REVIEW THE FORM 990 AND ENSURE ACCURACY OF DESCRIPTIONS AND THAT DISCLOSURE IS COMPLETE. THE DRAFT FORM 990 IS REVIEWED BY THE AUDIT COMMITTEE OF CHLA, ACTING ON BEHALF OF THE BOARD OF DIRECTORS OF CHLA. ONCE THE DRAFT FORM 990 HAS BEEN REVIEWED AND DISCUSSED BY THE AUDIT COMMITTEE, ANY CHANGES RESULTING FROM THEIR REVIEW IS INCORPORATED INTO THE FINAL DRAFT OF THE FORM 990. THE FINAL DRAFT OF THE FORM 990 IS THEN DISTRIBUTED TO THE BOARD OF DIRECTORS VIA A SECURE WEB SITE FOR THEIR REVIEW AND COMMENTS PRIOR TO THE FILING OF THE FORM 990. FORM 990, PART VI, SECTION B, LINE 12C CHLA MONITORS AND ENFORCES COMPLIANCE WITH ITS CONFLICT OF INTEREST POLICY THROUGH ANNUAL CIRCULATION OF A CONFLICT OF INTEREST QUESTIONNAIRE WHICH IS TO BE ANSWERED BY MEMBERS OF ITS BOARD OF DIRECTORS AND BOARD OF TRUSTEES, OFFICERS, MEDICAL STAFF MEMBERS, AND CERTAIN KEY EMPLOYEES. FURTHERMORE, INDIVIDUALS COVERED BY THE POLICY ARE REQUIRED TO DISCLOSE ANY PERSONAL INTERESTS THAT COULD CREATE A CONFLICT OF INTEREST ON A CONTINUOUS BASIS THROUGHOUT THE YEAR. ANY DISCLOSURES PRESENTING A CONFLICT OF INTEREST ARE EVALUATED BY A COMBINATION OF CHLA'S CONFLICT OF INTEREST COMMITTEE, GENERAL COUNSEL, CHIEF COMPLIANCE OFFICER, CHIEF EXECUTIVE OFFICER, CHIEF MEDICAL OFFICER, RESEARCH COMPLIANCE AND INTEGRITY OFFICER, AND BOARD OF DIRECTORS AND ITS AUDIT COMMITTEE, DEPENDING ON THE INDIVIDUAL MAKING THE DISCLOSURE. DISCLOSURES WILL BE INITIALLY ASSESSED BY CHLA'S OFFICE OF COMPLIANCE AND PRIVACY AND, IF A CONFLICT EXISTS, IT WILL BE REFERRED TO CHLA'S CONFLICT OF INTEREST COMMITTEE FOR FURTHER EVALUATION. IF A CONFLICT EXISTS INVOLVING A CHLA BOARD MEMBER, THE BOARD OF DIRECTORS IS RESPONSIBLE FOR REVIEWING THE CONFLICT AND DETERMINING THE CONFLICT RESOLUTION, WHICH MAY INCLUDE, BUT IS NOT LIMITED TO, A CONFLICT MANAGEMENT STIPULATION REQUIRING THE BOARD MEMBER'S RECUSAL FROM CERTAIN CHLA MATTERS. FORM 990, PART VI, SECTION B, LINE 15 THE PROCESS FOR DETERMINING THE COMPENSATION OF THE CHIEF EXECUTIVE OFFICER OF CHLA IS CONDUCTED BY THE BOARD OF DIRECTORS OF CHLA. IN DETERMINING THE CHIEF EXECUTIVE OFFICER'S COMPENSATION DURING THE TAX PERIOD OF THIS INFORMATION RETURN THE BOARD WORKED WITH AND RELIED UPON THE COUNSEL AND EXPERTISE OF SULLIVAN, COTTER AND ASSOCIATES, INC., A FIRM WITH EXPERIENCE AND EXPERTISE IN THE AREA OF NON-PROFIT ORGANIZATION EXECUTIVE COMPENSATION. SULLIVAN COTTER PROVIDED REPORTS TO THE BOARD, WHICH FURNISHED THE BASIS FOR THE ESTABLISHMENT OF THE CHIEF EXECUTIVE OFFICER'S COMPENSATION PACKAGE. THEIR REPORTS WERE BASED ON A REVIEW OF THE EXECUTIVE COMPENSATION PRACTICES OF A VARIETY OF HOSPITALS AND HEALTHCARE SYSTEMS THAT ARE CONSIDERED COMPARABLE TO CHLA BASED ON VARIOUS METRICS SUCH AS HOSPITAL TYPE AND REVENUE. THE BOARD DELIBERATED ON THE ISSUE OF THE CHIEF EXECUTIVE OFFICER'S COMPENSATION PACKAGE IN LIGHT OF THESE REPORTS AND SULLIVAN COTTER WERE AVAILABLE TO ANSWER ANY QUESTIONS REGARDING SUCH REPORTS AND OTHER RELEVANT MATTERS. BASED ON SUCH DELIBERATIONS, BOARD NEGOTIATED A WRITTEN CONTRACT WITH THE CHIEF EXECUTIVE OFFICER. THE PROCESS FOR DETERMINING THE COMPENSATION OF OFFICERS AND OTHER KEY EMPLOYEES OF CHLA IS CONDUCTED BY THE BOARD OF DIRECTORS OF CHLA, WITH SUPPORT AND GUIDANCE FROM THE CHIEF EXECUTIVE OFFICER AND HUMAN RESOURCES DEPARTMENT. IN DETERMINING SUCH EMPLOYEE'S COMPENSATION, DURING THE COMPENSATION SEASON THE HUMAN RESOURCES DEPARTMENT AND THE BOARD WORKED WITH AND RELIED UPON THE COUNSEL AND EXPERTISE OF SULLIVAN COTTER, A FIRM WITH EXPERIENCE AND EXPERTISE IN THE AREA OF NON-PROFIT ORGANIZATION EXECUTIVE COMPENSATION, INCLUDING PEDIATRIC SYSTEMS. SULLIVAN COTTER PROVIDED AN EXECUTIVE COMPENSATION REPORT TO THE HUMAN RESOURCES DEPARTMENT AND THE BOARD WHICH FURNISHED THE BASIS FOR THE ESTABLISHMENT OF SUCH EMPLOYEE'S COMPENSATION PACKAGE DURING THE FOLLOWING YEAR. SULLIVAN COTTERS REPORT WAS BASED ON A REVIEW OF EXECUTIVE COMPENSATION PRACTICES OF A VARIETY OF HOSPITALS AND HEALTHCARE SYSTEMS THAT ARE CONSIDERED COMPARABLE TO CHLA BASED ON VARIOUS METRICS SUCH AS HOSPITAL TYPE AND REVENUE. IN ADDITION, THE CHIEF EXECUTIVE OFFICER MADE A RECOMMENDATION TO THE BOARD WITH RESPECT TO EACH OF SUCH EMPLOYEE'S COMPENSATION PACKAGE IN LIGHT OF THE SULLIVAN COTTER REPORT AND IN LIGHT OF THE EXECUTIVE'S PERFORMANCE. AT THE BOARD MEETING ADDRESSING SUCH MATTERS, SULLIVAN COTTER WERE AVAILABLE TO ANSWER ANY QUESTIONS REGARDING SUCH REPORT AND OTHER RELEVANT MATTERS, AND RECOMMENDATIONS FROM THE CHIEF EXECUTIVE OFFICER WERE REQUESTED BY AND PROVIDED TO THE BOARD. BASED ON SUCH DELIBERATIONS, THE BOARD MADE A DECISION REGARDING THE COMPENSATION PACKAGE FOR SUCH EMPLOYEES FOR THE FOLLOWING YEAR. FORM 990, PART VI, SECTION C, LINE 19 CHLA DOES NOT MAKE ITS GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY AVAILABLE TO THE PUBLIC. CHLA'S FINANCIAL STATEMENTS ARE CONTAINED IN ITS FORM 990, WHICH IS AVAILABLE FOR PUBLIC INSPECTION DURING BUSINESS HOURS. FORM 990, PART IX, LINE 11G PROFESSIONAL MEDICAL FEES: PROGRAM SERVICE EXPENSES 120,601,193. MANAGEMENT AND GENERAL EXPENSES 23,960,924. FUNDRAISING EXPENSES 323,656. TOTAL EXPENSES 144,885,773. MEDICAL-RELATED SERVICES: PROGRAM SERVICE EXPENSES 9,563,452. MANAGEMENT AND GENERAL EXPENSES 88,654. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 9,652,106. OTHER PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 20,793,269. MANAGEMENT AND GENERAL EXPENSES 38,155,447. FUNDRAISING EXPENSES 2,928,172. TOTAL EXPENSES 61,876,888. FORM 990, PART XI, LINE 9: CHANGE IN VALUE OF SPLIT INTEREST AGREEMENTS 204,187. TRANSFERS AND OTHERS -4,756,251. CHANGE IN SWAP MARK TO MARKET 4,459,486. CHLA HOLDINGS LLC 4650 SUNSET BLVD LOS ANGELES CA 90027 273653228 INVESTMENT VEHICLE CA 41555 0 CHILDREN'S HOSPITAL LOS ANGELES CHILDREN'S HEALTH SYSTEM OF LOS ANGELES LLC 4650 SUNSET BLVD LOS ANGELES CA 90027 951690977 HEALTHCARE SERVICES CA 0 0 CHILDREN'S HOSPITAL LOS ANGELES CHLA HEALTH NETWORK LLC 4650 SUNSET BLVD LOS ANGELES CA 90027 951690977 HEALTHCARE SERVICES CA 0 0 CHILDREN'S HOSPITAL LOS ANGELES CHLA INTERNATIONAL LLC 4650 SUNSET BLVD LOS ANGELES CA 90027 471738947 HEALTHCARE SERVICES CA 0 0 CHILDREN'S HOSPITAL LOS ANGELES CHLA TEACHING CLINICS LLC 4650 SUNSET BLVD LOS ANGELES CA 90027 820677283 HEALTHCARE SERVICES CA 0 0 CHILDREN'S HOSPITAL LOS ANGELES CHLA FOUNDATION LLC 4650 SUNSET BLVD LOS ANGELES CA 90027 951690977 HEALTHCARE SERVICES CA 0 0 CHILDREN'S HOSPITAL LOS ANGELES 4520 SUNSET BLVD LLC 4650 SUNSET BLVD LOS ANGELES CA 90027 833837347 REAL ESTATE HOLDING CA 763199 0 CHILDREN'S HOSPITAL LOS ANGELES 4470 SUNSET BLVD LLC 4650 SUNSET BLVD LOS ANGELES CA 90027 872150138 REAL ESTATE HOLDING CA 0 0 CHILDREN'S HOSPITAL LOS ANGELES ANTELOPE VALLEY GUILD 4650 SUNSET BLVD MS 4 LOS ANGELES CA 90027 956118987 FUNDRAISING CA 501(C)(3) SCHEDULE A, LINE 12D N/A 0 CENTENNIAL GUILD 4650 SUNSET BLVD MS 4 LOS ANGELES CA 90027 141878642 FUNDRAISING CA 501(C)(3) SCHEDULE A, LINE 12D N/A 0 CHILDRENS CHAIN 4650 SUNSET BLVD MS 4 LOS ANGELES CA 90027 954559789 FUNDRAISING CA 501(C)(3) SCHEDULE A, LINE 12D N/A 0 DELTA DELTA DELTA 4650 SUNSET BLVD MS 4 LOS ANGELES CA 90027 237294093 FUNDRAISING CA 501(C)(3) SCHEDULE A, LINE 12D N/A 0 EL SEGUNDO AUXILIARY 4650 SUNSET BLVD MS 4 LOS ANGELES CA 90027 956118991 FUNDRAISING CA 501(C)(3) SCHEDULE A, LINE 12D N/A 0 FLINTRIDGE GUILD 4650 SUNSET BLVD MS 4 LOS ANGELES CA 90027 956118993 FUNDRAISING CA 501(C)(3) SCHEDULE A, LINE 12D N/A 0 HEALING ARTS REACHING KIDS 4650 SUNSET BLVD MS 4 LOS ANGELES CA 90027 204459362 FUNDRAISING CA 501(C)(3) SCHEDULE A, LINE 12D N/A 0 LA PROVIDENCIA GUILD 4650 SUNSET BLVD MS 4 LOS ANGELES CA 90027 956128178 FUNDRAISING CA 501(C)(3) SCHEDULE A, LINE 12D N/A 0 LAS MADRINAS INC 4650 SUNSET BLVD MS 4 LOS ANGELES CA 90027 951959907 FUNDRAISING CA 501(C)(3) SCHEDULE A, LINE 12D N/A 0 MARY DUQUE JUNIORS 4650 SUNSET BLVD MS 4 LOS ANGELES CA 90027 953786303 FUNDRAISING CA 501(C)(3) SCHEDULE A, LINE 12D N/A 0 MEN'S GUILD 4650 SUNSET BLVD MS 4 LOS ANGELES CA 90027 260109744 FUNDRAISING CA 501(C)(3) SCHEDULE A, LINE 12D N/A 0 MONROVIA GUILD 4650 SUNSET BLVD MS 4 LOS ANGELES CA 90027 956121929 FUNDRAISING CA 501(C)(3) SCHEDULE A, LINE 12D N/A 0 PASADENA GUILD 4650 SUNSET BLVD MS 4 LOS ANGELES CA 90027 956121932 FUNDRAISING CA 501(C)(3) SCHEDULE A, LINE 12D N/A 0 PENINSULA COMMITTEE 4650 SUNSET BLVD MS 4 LOS ANGELES CA 90027 237091175 FUNDRAISING CA 501(C)(3) SCHEDULE A, LINE 12D N/A 0 SANTA MONICA BAY AUXILIARY 4650 SUNSET BLVD MS 4 LOS ANGELES CA 90027 237293607 FUNDRAISING CA 501(C)(3) SCHEDULE A, LINE 12D N/A 0 SOUTH BAY AUXILIARY 4650 SUNSET BLVD MS 4 LOS ANGELES CA 90027 956118996 FUNDRAISING CA 501(C)(3) SCHEDULE A, LINE 12D N/A 0 SPIRITUAL CARE 4650 SUNSET BLVD MS 4 LOS ANGELES CA 90027 200872821 FUNDRAISING CA 501(C)(3) SCHEDULE A, LINE 12D N/A 0 TOLUCA GUILD 4650 SUNSET BLVD MS 4 LOS ANGELES CA 90027 956098666 FUNDRAISING CA 501(C)(3) SCHEDULE A, LINE 12D N/A 0 WESTSIDE GUILD 4650 SUNSET BLVD MS 4 LOS ANGELES CA 90027 956059321 FUNDRAISING CA 501(C)(3) SCHEDULE A, LINE 12D N/A 0 YOUNG PROFESSIONALS COUNCIL 4650 SUNSET BLVD MS 4 LOS ANGELES CA 90027 461301196 FUNDRAISING CA 501(C)(3) SCHEDULE A, LINE 12D N/A 0 VIRTUAL PICU SYSTEMS LLC 4470 W SUNSET BLVD STE 440 LOS ANGELES CA 90027 201414664 HEALTHCARE SERVICES CA CHILDREN'S HOSPITAL LOS ANGELES RELATED 137484 902221 0 1 0.98330 CHLA ESBT 4650 SUNSET BLVD LOS ANGELES CA 90027 203115169 INVESTMENT CA CHILDREN'S HOSPITAL LOS ANGELES T 111366 1.00000 1 CHLA MEDICAL FOUNDATION 4650 SUNSET BLVD LOS ANGELES CA 90027 824816550 HEALTHCARE SERVICES CA CHILDREN'S HOSPITAL LOS ANGELES C 1.00000 1 CHARITABLE REMAINDER TRUST (6) 999999999 CHARITABLE TRUST CA CHILDREN'S HOSPITAL LOS ANGELES T 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0