2014-05-15T13:22:26-05:00 2013-06-30 KPMG LLP 355 S Grand Ave Suite 2000 Los Angeles CA 90071 990 2012-07-01 952321786 Children's Hospital of Orange County % DONALD NOBLE CHIL 7149973000 1201 West La Veta Avenue Suite Orange CA 92868 KERRI SCHILLER 7145094038 2014-05-14 true 2139724000 2012 2015-11-30 17:44:51Z X CHOC Children's Hospital KIMBERLY C CRIPE 1201 West La Veta Avenue ORANGE CA 92868 584272460 false X www.choc.org X 1964 CA TO NURTURE, ADVANCE AND PROTECT THE HEALTH AND WELL-BEING OF CHILDREN. 14 10 2962 1010 128409 22107 24244487 21994560 495929988 521014460 2436624 3629775 1251846 2154307 523862945 548793102 27220000 0 0 0 185063132 213265927 0 0 0 285831348 306509163 498114480 519775090 25748465 29018012 1011574818 1052908254 534124235 512692429 477450583 540215825 TO NURTURE, ADVANCE AND PROTECT THE HEALTH AND WELL-BEING OF CHILDREN. false false 473438757 521014460 CHILDREN'S HOSPITAL OF ORANGE COUNTY - PROVIDES SPECIALIZED PEDIATRIC SERVICES FOR THE CARE OF CHILDREN. DURING THIS YEAR, THERE WERE 58,087 DAYS OF INPATIENT CARE; 52,338 EMERGENCY ROOM VISITS; 7,916 SURGERIES;1,713 DAY HEALTH VISITS AND 135,957 PRIMARY AND SPECIALTY CARE CLINIC VISITS.OUR CALIFORNIA MEDICAL FOUNDATION PROVIDED 279,511 PEDIATRIC SUBSPECIALTY SERVICE ENCOUNTERS TO PATIENTS THROUGHOUT ORANGE COUNTY AND BEYOND. SEE SCHEDULE O FOR ADDITIONAL INFORMATION.SEE OUR COMPLETE COMMUNITY BENEFIT REPORT ON OUR WEBSITE AT WWW.CHOC.ORG. 473438757 true true false true false false false false false true true false false false true true false true false false false false false false false false true true false false true true false false false false false false false false false true false false false false false true true true false false true X 494 0 true 2962 true true true false false false false false false false false false X 14 10 false false false false true true true true true false false true true true true true true true true false CA X DONALD NOBLE 7145094038 1201 WEST LA VETA AVENUE ORANGE CA 92868 X KIMBERLY C CRIPE 30.0 10.0 X X 0 1220673 80318 VIJAY DHAR MD 2.0 1.0 X David Dukes 2.0 1.0 X X 0 0 0 Tim Ristoff 1.0 2.0 X MARSHALL ROWEN MD 1.5 3.0 X MARK STEVENS 4.0 3.0 X X Thomas Tierney 2.0 1.5 X 0 0 0 Dick Ackerman 1.0 1.0 X 0 0 0 Ralph Clayman MD 2.0 1.5 X 0 0 0 MICHAEL COGLAZIER 1.0 1.0 X 0 0 0 Janet T Davidson 2.0 2.5 X 0 0 0 JEFF ELGHANAYAN 2.5 3.5 X X DOuglas McCombs 1.5 1.5 X X PHILLIP RICHARDSON MD 1.0 1.0 X 0 0 0 DEBRA MATHIAS 35.0 5.0 X 0 736796 17718 KERRI RUPPERT SCHILLER 25.0 15.0 X 0 611490 126779 Matthew E Niedzwiecki 40.0 X 321617 0 62527 Hale Kuhlman 40.0 X 268680 0 38920 Maria Minon MD 40.0 X 636621 42338 Louise White 40.0 X 331784 0 58165 Jay Gabriel 40.0 X 424288 0 81401 MARK L HEADLAND 40.0 X 413568 0 34084 Waldo Romero 40.0 X 361944 0 62277 Susan Burrows 40.0 X 339234 0 64107 JANET LANSING 40.0 X 333457 0 33852 3431193 2568959 702486 494 false true false MCCARTHY BUILDING COMPANIES 20401 S W BIRCH STREET SUITE 300 NEWPORT BEACH CA 92660 General Construction 72800227 PEDIATRIC SUBSPECIALTY FACULTY 455 S MAIN STREET ORANGE CA 92868 MEDICAL DIR & SERV 49522717 COMFORCE TECHNICAL SERVICES PO BOX 9695 UNIONDALE NY 115559695 TEMP EMPLOYEMENT SER 9066379 MICHAEL L DAVIS 1835 NEWPORT BLVD A109 361 COSTA MESA CA 92627 CONSTRUCTION INSPECT 1496441 DGWB ADVERTISING 217 N MAIN STREET SUITE 200 SANTA ANA CA 92701 ADVERTISING SERVICES 1427180 259 19230147 1722413 1042000 21994560 NET PATIENT REVENUE 900099 440685427 440685427 PREMIUM REVENUE 900099 39294993 39294993 MGMT/OCCUPANCY SERVICES 900099 9829460 9829460 DRUGS/MEDICAL SUPPLIES SOLD 900099 10190131 10190131 COVERAGE FEE REVENUE 900099 4431356 4431356 16583093 16454684 128409 521014460 1405451 1405451 0 0 199566 199566 0 199566 199566 37703682 35479358 2224324 2224324 2224324 0 0 0 CAFETERIA/CATERING SALES 900099 1031730 1031730 GIFT SHOP PROCEEDS 900099 247142 247142 PARKING 900099 128877 128877 546992 546992 1954741 548793102 520886051 128409 5784082 0 0 0 0 1566076 1566076 479954 431959 47995 170775350 153697815 17077535 4133143 3719829 413314 24327270 21894543 2432727 11984134 10785721 1198413 13908753 12517878 1390875 792579 713321 79258 207829 187046 20783 0 0 286601 257941 28660 92613648 83352283 9261365 0 8838634 7954771 883863 0 0 8879881 7991893 887988 634328 570895 63433 0 649933 584940 64993 8925990 8033391 892599 0 25524499 22972049 2552450 8725888 7853299 872589 PRCHSD SRVCS FRM OTR HOSP. 55514415 55514415 SUPPLIES 46785505 42106954 4678551 DUES & SUBSCRIPTIONS 1465627 1319064 146563 RECRUITMENT 189139 170225 18914 32565914 29242449 3323465 519775090 473438757 46336333 0 68148796 109003634 201733579 60311263 10184726 8303119 102874643 113774764 0 0 0 0 0 0 2321459 8405248 7766068 8918000 924397374 222651346 596254896 701746028 0 0 35058 35058 0 0 1216000 1216000 21039593 41195140 1011574818 1052908254 80997492 72703698 0 0 686965 720040 366161293 363848347 0 0 0 0 118989 12731653 0 0 86159496 62688691 534124235 512692429 X 434014107 496842415 42750324 42687258 686152 686152 477450583 540215825 1011574818 1052908254 X 29018012 13502474 20244756 X false true X true true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 52984 52984 false grants to other organizations for lobbying purposes form 990, schedule c, part II-B, line 1i during fye 06/30/2013, children's hospital of orange county paid dues, a portion of which supports lobbying purposes to various healthcare associations including: Hospital association of southern california $22,418 national association of children's hospitals $ 7,334 California Children's Hospital Association $23,232 Total dues paid for lobbying purposes: $52,984 4919888 5159 61328 54503 4931872 4406780 584493 -7094 0 64290 4919889 3691065 643580 72135 0 0 0 4406780 3339711 351279 1363 0 1288 0 3691065 3076071 262998 11676 0 11034 0 3339711 0.86090 0.13910 false true true 45060833 45060833 622168864 92724431 529444433 13720574 9091484 4629090 228197688 120014268 108183420 15249415 821163 14428252 701746028 0 DERIVATIVE FINANCIAL INSTRUMENTS 41949105 LIABILITY FOR WORKER'S COMP. 7944115 PAYABLE TO ST. JOSEPH HOSPITAL 3046510 POSTRETIREMENT BENEFIT OBLIGATION 2892496 PAYABLE TO RELATED PARTIES 4465 OTHER LIABILITIES 6852000 62688691 X 573511658 13502474 780000 22092362 36374836 537136822 11656280 11656280 548793102 508898810 780000 780000 508118810 11656280 11656280 519775090 ORGANIZATION'S LIABILITY FOR UNCERTAIN TAX POSITIONS UNDER ASC 740: Accounting principles generally accepted in the United States of America require CHOC's management to evaluate tax positions taken by CHOC and recognize a tax liability if CHOC 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 CHOC and has concluded that as of June 30, 2013, there are no uncertain positions taken or expected to be taken that would require recognition of a liability or disclosure in the combined financial statements. RECONCILIATION OF REVENUE & EXPENSE PART XI, LINE 2D CHANGE IN BENEFICIAL INTEREST IN CHOC Foundation for Children - 20,244,756 NET INCOME OF OCMRRG - 1,847,606 ----------- 22,092,362 PART XI AND PART XII, LINE 4B RECLASS OF NON-OPERATING EXPENSES - 11,656,280 Use of endowment funds part v, line 4 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. true true X true X true X true true false true true 949569 949569 0.00180 180283370 176297491 3985879 0.00760 181232939 176297491 4935448 0.00940 8400300 108131 8292169 0.01590 16950032 1988410 14961622 0.02870 2338721 2338721 0.00450 27689053 2096541 25592512 0.04910 208921992 178394032 30527960 0.05850 3328163 1500 3326663 0.00640 3328163 1500 3326663 0.00640 true 18967359 128446 268172 -139726 X true true 1 1 Children's Hospital of Orange County

455 South Main Street Orange CA 92868

X X X Children's Hospital of Orange County 1 true X X X X X X X X X 10 true true true X X X X X X X false false true true 200. true 400. true X X X true true X X X X X true false X X X X true X false false 23 ORANGE PRIMARY CARE CLINIC

455 SOUTH MAIN STREET ORANGE CA 92868

clinic CLINICA CHOC PARA NINOS-SANTA ANA

406 SOUTH MAIN STREET SANTA ANA CA 92701

clinic SANTA ANA BOYS AND GIRLS CLUB

1000 WEST HIGHLAND SANTA ANA CA 92703

clinic ASTHMA BREATHMOBILE

455 SOUTH MAIN STREET ORANGE CA 92868

clinic COSTA MESA CLINIC

136 BROADWAY COSTA MESA CA 92627

clinic GARDEN GROVE CLINIC

10602 CHAPMAN AVENUE GARDEN GROVE CA 92840

clinic CHOC CHILDREN'S ENDOCRINE & DIABETES CTR

520 SUPERIOR AVE SUITE 160 NEWPORT BEACH CA 92663

clinic CHOC CHILDREN'S HOSPITAL

SPECIALTY CLINICS 455 SOUTH MAIN S ORANGE CA 92868

clinics CHOC UROLOGY CENTER SUITE 100

505 S MAIN ST ORANGE CA 92868

clinic PEDIATRIC PSYCHOLOGY

1120 W LA VETA AVENUE SUITE 470 ORANGE CA 92868

CLINIC BLOOD&DONORAPHERESIS

505 SOUTH MAIN STREET SUITE 185 ORANGE CA 92868

CLINIC CHOC NEUROLOGY CENTER

1120 W LA VETA AVENUE SUITE 125 ORANGE CA 92868

CLINIC CORONA CARDIOLOGY & GASTROENTEROLOGY

260 E Ontario Avesuite 204 corona CA 92882

clinic Fountain Valley GASTROENTEROLOGY

11100 Warner Ave suite 252 Fountain Valley CA 92708

CLINIC Irvine CARDIOLOGY

16300 SAND CANYON AVE SUITE 811 IRVINE CA 92618

CLINIC Laguna Niguel OUTPATIENT OFFICE

23521 Paseo de Valencia Suite 200 Laguna Hills CA 92653

CLINIC Mission Viejo CLINIC

27800 Medical Center Road BLDG 2 Mission Viejo CA 92691

CLINIC Newport Beach OTOLARYNGOLOGY

446 Old Newport Blvd Newport Beach CA 92663

CLINIC Children's Specialists Cardiology

505 S Main St Suite 200 ORANGE CA 92868

CLINIC Children's Specialists Pediatric Surgery

505 S Main St Suite 225 Orange CA 92868

CLINIC Batavia Woods Medical Center

725 W La Veta Suite 100 Orange CA 92868

CLINIC Children's Specialists Opthamology

392 S Glassell Suite 100 Orange CA 92866

CLINIC Children's Specialists Otolaryngology

1010 W La Veta Suite 640 ORANGE CA 92868

CLINIC SCHEDULE H, PART I, LINE 6A THE ORGANIZATION'S COMMUNITY BENEFIT REPORT IS CONTAINED IN A REPORT PREPARED BY CHILDREN'S HOSPITAL OF ORANGE COUNTY (CHOC CHILDREN'S) AND CHOC CHILDREN'S AT MISSION HOSPITAL (CCMH) ANNUALLY AND IS FILED IN ACCORDANCE WITH CALIFORNIA SB697. SCHEDULE H, PART I, LINE 7 THE ORGANIZATION USES THE COST-TO-CHARGE RATIO METHODOLOGY TO DETERMINE THE COST OF CHARITY CARE AND UNREIMBURSED COST OF CARE PROVIDED TO MEDI-CAL PATIENTS. COSTS ARE ACCOUNTED FOR USING AN INTERNAL DECISION SUPPORT SYSTEM. THE COST-TO-CHARGE RATIO FOLLOWS THE METHOD DEFINED BY THE MEDICARE COST REPORT AND IS UPDATED MONTHLY USING THE MOST RECENT ORGANIZATIONAL INFORMATION. In fiscal year 2012, the CMS issued final required federal approval for the fee for service portion of a 30 month California Provider Fee Program that, combined with federal matching funds, has been used to provide supplemental Medi-Cal payments to hospitals in the state. In fiscal year 2013, CHOC recognized revenues under this program of $24,911,000 and Provider Fees and other expenses totaling $8,866,000. The CMS also issued final approval in fiscal 2013 for the managed care portion of this 30 month Provider Fee program. The approvals were in May 2013 for the period July 1, 2011 to June 30, 2012 and in June 2013 for the period July 1, 2012 to June 30, 2013. CHOC recognized revenues of $26,368,000 for each of the 12 month periods for a total revenue of $52,736,000 and Provider Fees and other expenses of $9,385,000 for each 12 month period for total expenses of $18,770,000. All of the amounts RELATED TO THE TWO YEAR PERIOD above were recognized as net patient revenue and operating expenses, respectively, in the year ended June 30, 2013 RESULTING IN LESS UNREIMBURSED MEDI-CAL THAN IN PREVIOUS YEARS. SCHEDULE H, PART II COMMUNITY BUILDING ACTIVITIES: Community support IS BEST EXEMPLIFIED BY THE ORGANIZATION'S INCREASED EMPHASIS ON COMMUNITY OUTREACH AND COMMUNITY EDUCATION, WHICH INCLUDES INJURY PREVENTION, SAFETY AND WELLNESS. The organization has 88 different community benefit programs categorized according to the California community benefits law, SB697. Within these categories, the category which most closely correlates to line 3, community support, is Healthcare Access. Through Healthcare Access, the organization increases access to quality pediatric healthcare resources and information to families, especially low-income and medically underserved, throughout Orange County. This is accomplished through community outreach clinics and education. SCHEDULE H, PART III, LINE 1 HFMA Statement no. 115, which requires bad debt to be recognized as a reduction from net patient revenue has been adopted as an accounting standard in the U.S and IS effective with CHOC's 2012 Form 990. SCHEDULE H, PART III, LINE 2 THE ORGANIZATION CHARGES BAD DEBT FOR (A) THE WRITE-OFF OF PATIENT ACCOUNTS WHERE FAMILIES DID NOT COOPERATE WITH CHOC IN THE COMPLETION OF MEDI-CAL OR CHARITY CARE APPLICATIONS AND WHERE INSUFFICIENT INFORMATION COULD BE OBTAINED REGARDING THE FINANCIAL STATUS OF THE FAMILY, AND (B) A PROVISION FOR OUTSTANDING ACCOUNTS RECEIVABLE FROM SELF-PAY (INCLUDING PENDING MEDI-CAL AND PENDING CHARITY) ACCOUNTS. THE ORGANIZATION APPLIES ITS CHARITY CARE POLICY TO DETERMINE ELIGIBILITY BASED ON FAMILIES' SATISFYING THE APPLICATION REQUIREMENTS AND THE ORGANIZATION'S ELIGIBILITY CRITERIA. THE ORGANIZATION DOES, HOWEVER, HAVE FAMILIES WHO FAIL TO COMPLETE THE REQUIRED PAPERWORK DESPITE THE ORGANIZATION'S EFFORTS TO EDUCATE ALL FAMILIES OF THE CHARITY CARE OPTIONS. IN THESE CASES, AN ASSESSMENT OF CHARITY CARE ELIGIBILITY IS MADE BASED ON KNOWN INFORMATION. SCHEDULE H, PART III, LINE 3 THE HOSPITAL FOLLOWS HFMA STATEMENT 15 AND THEREFORE NO PART OF BAD DEBT, AS DEFINED BY STATEMENT 15, REPRESENTS AMOUNTS ATTRIBUTABLE TO PATIENTS ELIGIBLE TO RECEIVE FINANCIAL ASSISTANCE. SCHEDULE H, PART III, LINE 4 AUDITED FINANCIAL STATEMENT FOOTNOTE: PATIENT ACCOUNTS RECEIVABLE ARE RECORDED AT THE INVOICED AMOUNT NET OF ANY EXPECTED CONTRACTUAL ADJUSTMENTS AND DO NOT BEAR INTEREST. THE ALLOWANCE FOR DOUBTFUL ACCOUNTS IS CHOC'S BEST ESTIMATE OF THE AMOUNT OF PROBABLE CREDIT LOSSES IN CHOC'S EXISTING PATIENT ACCOUNTS RECEIVABLE. CHOC DETERMINES THE ALLOWANCE BASED ON HISTORICAL WRITE-OFF EXPERIENCE. CHOC REVIEWS ITS ALLOWANCE FOR DOUBTFUL ACCOUNTS ON A MONTHLY BASIS AS WELL AS AGE OF ACCOUNTS AND OTHER FACTORS. PAST-DUE BALANCES OVER 90 DAYS AND OVER A SPECIFIED AMOUNT ARE REVIEWED INDIVIDUALLY FOR COLLECTABILITY. THERE ARE OTHER FACTORS THAT CAN IMPACT COLLECTIONS, SUCH AS CHANGES IN THE ECONOMY, WHICH IN TURN HAVE AN IMPACT ON UNEMPLOYMENT RATES AND THE NUMBER OF UNINSURED AND UNDERINSURED PATIENTS, THE INCREASED BURDEN OF CO-PAYMENTS TO BE MADE BY PATIENTS WITH INSURANCE AND BUSINESS PRACTICES RELATED TO COLLECTION EFFORTS. THESE FACTORS CONTINUOUSLY CHANGE AND CAN HAVE AN IMPACT ON COLLECTION TRENDS AND THE ESTIMATION PROCESS. ACCOUNT BALANCES ARE CHARGED OFF AGAINST THE ALLOWANCE AFTER ALL MEANS OF COLLECTION HAVE BEEN EXHAUSTED AND THE POTENTIAL FOR RECOVERY IS REMOTE, BUT IN NO CASE BEYOND ONE YEAR FROM DATE OF SERVICE. SCHEDULE H, PART III, LINE 8 THE ALLOWABLE COST IS BASED ON A COST TO CHARGE RATIO OF .2382. SHORTFALLS ARE CONSIDERED A COMMUNITY BENEFIT BECAUSE THE DOLLAR VALUE OF BENEFITS PROVIDED BY LEGISLATIVE CATEGORY LINK TO THE DOLLARS IDENTIFIED BY COMMUNITY NEEDS. CHOC REPORTS UNPAID COSTS OF PUBLIC PROGRAMS AS GOVERNMENT PAYOR SHORTFALLS. THE PRINCIPAL MEASURE FOR MONITORING COMMUNITY BENEFIT SERVICES IS THE DOLLAR VALUE OF BENEFITS RETURNED TO THE COMMUNITY PER DOLLAR OF TAX EXEMPTION VALUE RECEIVED. SCHEDULE H, PART III, LINE 9B THE HOSPITAL'S WRITTEN BAD-DEBT COLLECTION POLICY STATES THE FOLLOWING: 1. IF A PATIENT QUALIFIES FOR ASSISTANCE UNDER THE FINANCIAL ASSISTANCE PROGRAM (FAP) AND IS MAKING EVERY EFFORT TO SETTLE AN OUTSTANDING BILL WITHIN A REASONABLE TIME PERIOD, CHOC OR ITS AGENT WILL NOT SEND, NOR INTIMATE THAT IT WILL SEND, THE UNPAID ACCOUNT TO AN OUTSIDE AGENCY IF DOING SO MAY NEGATIVELY IMPACT A PATIENT'S CREDIT. IF CHOC IS FORCED TO SEND THE ACCOUNT TO AN OUTSIDE COLLECTION AGENCY, THE AMOUNT REFERRED TO THE AGENCY WILL REFLECT THE REDUCED PAYMENT LEVEL FOR WHICH THE PATIENT WAS ELIGIBLE UNDER THE FAP. AT NO TIME WILL A PATIENT ACCOUNT BE REFERRED TO AN OUTSIDE COLLECTION AGENCY IF THE ACCOUNT IS LESS THAN 150 DAYS FROM ORIGINAL BILLING. 2. IN DEALING WITH IDENTIFIED UNINSURED PATIENTS AT OR BELOW 400% OF THE FEDERAL POVERTY LEVEL, CHOC WILL NOT USE WAGE GARNISHMENTS OR LIENS ON PATIENT'S OR PATIENT FAMILY'S PRIMARY RESIDENCE AS A MEANS OF COLLECTING UNPAID CHOC BILLS. THIS REQUIREMENT DOES NOT PRECLUDE CHOC FROM PURSUING REIMBURSEMENT FROM THIRD PARTY LIABILITY SETTLEMENTS. SCHEDULE H, PART V, LINE 3 The Community Benefits Key Informant Survey, which was conducted in September 2010 and updated in 2013, targeted local health care leaders to determine community opinions on the health needs in Orange County, as well as the barriers faced by patients in accessing health care. Those who completed the survey included 21 persons from Health Provider Community Benefit Organizations, 14 from County or City Governments, 13 from hospitalS, 11 from Community Clinics/ FQHC's, and 8 from Health Advocacy/Education Organizations. The SURVEY also included health care providers, educators, and researchers. SCHEDULE H, PART V, LINE 4 The september 2010 Health Needs Assessment was conducted in collaboration with nine Orange County not-for-profit hospitals, including Hoag Memorial Hospital Presbyterian, St. Joseph Hospital, Mission Hospital, St. Jude Hospital, Kaiser Foundation Hospital, University of California Irvine Medical Center, CHOC Children's (Orange) and CHOC Children's at Mission Hospital. SCHEDULE H, PART V, LINE 5 THE CHNA REPORT IS AVAILABLE AT HTTP://WWW.CHOC.ORG/ABOUT/ SCHEDULE H, PART V, LINE 7 One of the seven areas of high priority need identified in the CHNA was "Child Health and Academic Achievement". CHOC's core mission is the provision of health care to the pediatric population; while CHOC did not explicitly develop plans to address child health and academic achievement, per se, CHOC does provide services that impact a child's academic achievement. SCHEDULE H, PART V, LINE 20D, OTHER The maximum amounts that may be charged to FAP-eligible individuals for emergency or other medically necessary services are determined by a blended Medi-Cal rate. This rate is the percentage of charges based on the contracted Medi-Cal reimbursement rate plus the additional disproportionate share (DSH) reimbursement received by the facility. The total reimbursement is compared to gross charges and the percentage of overall reimbursement is the maximum charged to FAP-eligible individuals. SCHEDULE H PART VI LINE 2 NEEDS ASSESSMENT: IN ADDITION TO THE TRI-ANNUAL COMMUNITY HEALTH NEEDS ASSESSMENT, CHOC REGULARLY TRACKS KEY DEMOGRAPHIC CHANGES IN THE PEDIATRIC POPULATION OF ITS COMMUNITY AND THE UTILIZATION OF KEY SERVICES DELIVERED, AND EVALUATES THE PROGRAMS IT PROVIDES TO MEET IDENTIFIED NEEDS. THROUGH CONSTANT CONTACT WITH A VARIETY OF COMMUNITY CONSTITUENTS, CHOC IS ABLE TO LEARN ABOUT EMERGING TRENDS AND NEEDS. IT THEN EVALUATES OPTIONS TO MEET THOSE NEEDS, EITHER ALONE OR IN COLLABORATION WITH OTHERS IN THE COMMUNITY. All OF THE PROGRAMS ASSOCIATED WITH THE COMMUNITY HEALTH NEEDS ASSESSMENT ARE AVAILABLE IN THE REPORT ON THE HOSPITAL'S WEBSITE AT WWW.CHOC.ORG AS WELL AS A PAPER COPY THAT IS AVAILABLE UPON REQUEST FOR PUBLIC INSPECTION. SCHEDULE H PART VI, LINE 3 PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE: PATIENTS ARE INFORMED OF THEIR ELIGIBILITY FOR ASSISTANCE UNDER FEDERAL, STATE, OR LOCAL GOVERNMENT PROGRAMS AND UNDER THE HOSPITAL'S CHARITY CARE POLICY IN OUR FINANCIAL ASSISTANCE AND DISCOUNT PROGRAM POLICY. THIS INFORMATION, EITHER IN FULL OR IN SUMMARY, IS POSTED IN ALL OF THE HIGH TRAFFIC PATIENT AREAS: ADMITTING, EMERGENCY ROOM, CLINIC AND THE BUSINESS OFFICE. THE PATIENTS ARE ALSO INFORMED IF THERE IS A FINANCIAL NEED IDENTIFIED BY THE HOSPITAL FINANCIAL COUNSELORS WHEN SPEAKING TO THE FAMILIES ABOUT THEIR INSURANCE OR LACK OF INSURANCE. PATIENTS ARE PROVIDED A COPY OF THE HOSPITAL'S PATIENT FINANCIAL ASSISTANCE AND DISCOUNT PAYMENT PROGRAM POLICY. FAMILIES ARE ALSO NOTIFIED ON EVERY PATIENT STATEMENT THAT IF THERE IS A FINANCIAL NEED THEY SHOULD CALL THE DESIGNATED PHONE NUMBER FOR MORE INFORMATION AND ASSISTANCE. FINANCIAL ASSISTANCE COMMUNICATION - AS PART OF THE HOSPITALS' ONGOING PUBLIC AWARENESS CAMPAIGNS, THE MISSION STATEMENTS (INCLUDING THE FINANCIAL ASSISTANCE POLICY) ARE INCLUDED WHEREVER POSSIBLE ON PROGRAM BROCHURES, FACILITY BROCHURES, MEDICAL EDUCATION INFORMATION, COMMUNITY EDUCATION MATERIALS, CONFERENCE INVITATIONS AND ADMISSION MATERIALS. ADDITIONALLY, THE HOSPITALS' FINANCIAL ASSISTANCE POLICY IS EMPHASIZED IN PUBLIC RELATIONS AND MEDIA RELATIONS EFFORTS, FOUNDATION CAMPAIGNS, AND SELECTED MARKETING CAMPAIGNS. THE FINANCIAL ASSISTANCE POLICY IS ALSO INCLUDED AS PART OF THE ANNUAL COMMUNITY BENEFIT REPORT. SCHEDULE H, PART VI, LINE 4 COMMUNITY INFORMATION - THE HOSPITAL SERVES ALL OF ORANGE COUNTY AND A LIMITED, ALTHOUGH SIGNIFICANT, NUMBER OF PATIENTS FROM THE WESTERN RIM OF RIVERSIDE COUNTY, THE NORTHERN PORTION OF SAN DIEGO COUNTY AND SOUTHEAST AREAS OF LOS ANGELES COUNTY. THE PRIMARY SERVICE AREA IS THE CENTRAL-NORTHERN PORTION OF ORANGE COUNTY, AND IS THE SOURCE OF APPROXIMATELY 73% OF ITS PATIENTS. SIGNIFICANT CITIES IN THIS AREA ARE: SANTA ANA, ANAHEIM, FULLERTON, ORANGE, AND GARDEN GROVE. THE SECONDARY SERVICE AREA INCLUDES ALL THE OTHER ORANGE COUNTY CITIES AND UNINCORPORATED AREAS. THE COMMUNITY SERVED BY THE HOSPITAL INCLUDES FEDERALLY-DESIGNATED MEDICALLY UNDERSERVED AREAS AND POPULATIONS. COMMUNITY CHARACTERISTICS - POPULATION AND SOCIOECONOMIC DATA PROJECTIONS FOR 2013 ARE PROVIDED BY CLARITAS, A THIRD-PARTY VENDOR THAT MAKES PROJECTIONS BASED ON DEMOGRAPHIC ANALYSIS OF ORANGE COUNTY, INCLUDING THE COMBINED SERVICE AREAS OF BOTH HOSPITALS CHOC AND CCMH. TOTAL POPULATION OF THE COUNTY WAS 3.12 MILLION, ACCORDING TO 2013 ESTIMATES, MAKING IT THE THIRD LARGEST COUNTY IN CALIFORNIA. THE MEDIAN AGE IS 36.8, AND CHILDREN UP TO 17 YEARS OF AGE MAKE UP 23.8% OF THE TOTAL POPULATION. THE LARGEST RACE/ETHNICITY SUBGROUP IS WHITE, AT 43%. LATINOS/HISPANICS ARE 34% OF THE POPULATION. ASIANS/PACIFIC ISLANDERS ARE 19% OF THE TOTAL, AND THE AFRICAN AMERICAN POPULATION REPRESENTS APPROXIMATELY 2% OF THE TOTAL ORANGE COUNTY POPULATION. SOCIOECONOMIC PROFILE THE U.S. CENSUS AMERICAN COMMUNITY SURVEY FOR 2012 INDICATED THAT 17.9% OF CHILDREN UNDER THE AGE OF 18 IN ORANGE COUNTY, 23.8% IN CALIFORNIA, AND 22.6% IN THE U.S. WERE BELOW THE POVERTY LEVEL. THIS SURVEY ALSO INDICATED THAT 12.9% OF THE ORANGE COUNTY POPULATION OF ALL AGES WERE LIVING BELOW THE POVERTY LEVEL. THE U.S. BUREAU OF THE CENSUS ESTIMATED THAT IN 2012, THE COUNTY'S MEDIAN HOUSEHOLD INCOME WAS $71,983. The percentage of the hospital's patients who are uninsured or Medicaid recipients was 59.6%. THERE ARE 31 OTHER HOSPITALS SERVING THE COMMUNITY: ANAHEIM GENERAL HOSPITAL - ANAHEIM, CALIFORNIA ANAHEIM REGIONAL MEDICAL CENTER - ANAHEIM, CALIFORNIA CHAPMAN MEDICAL CENTER - ORANGE, CALIFORNIA CHILDREN'S HOSPITAL AT MISSION - MISSION VIEJO, CALIFORNIA COASTAL COMMUNITIES HOSPITAL - SANTA ANA, CALIFORNIA COLLEGE HOSPITAL COSTA MESA - COSTA MESA, CALIFORNIA FOUNTAIN VALLEY REGIONAL HOSPITAL AND MEDICAL CENTER - FOUNTAIN VALLEY, CALIFORNIA GARDEN GROVE HOSPITAL AND MEDICAL CENTER - GARDEN GROVE, CALIFORNIA HEALTHBRIDGE CHILDREN'S REHABILITATION HOSPITAL - ORANGE, CALIFORNIA HOAG MEMORIAL HOSPITAL PRESBYTERIAN - NEWPORT BEACH, CALIFORNIA HOAG ORTHOPEDIC INSTITUTE - IRVINE - IRVINE, CALIFORNIA HUNTINGTON BEACH HOSPITAL AND MEDICAL CENTER - HUNTINGTON BEACH, CALIFORNIA KAISER FOUNDATION HOSPITAL - ANAHEIM, CALIFORNIA KINDRED HOSPITAL - BREA - BREA, CALIFORNIA KINDRED HOSPITAL - WESTMINSTER - WESTMINSTER, CALIFORNIA LA PALMA INTERCOMMUNITY HOSPITAL - LA PALMA, CALIFORNIA LOS ALAMITOS MEDICAL CENTER - LOS ALAMITOS, CALIFORNIA MISSION HOSPITAL REGIONAL MEDICAL CENTER - MISSION VIE SCHEDULE H, PART VI, LINE 5 PROMOTION OF COMMUNITY HEALTH: CHILDREN'S HEALTHCARE OF CALIFORNIA (CHC) IS THE NOT-FOR-PROFIT, TAX-EXEMPT PARENT CORPORATION OF CHILDREN'S HOSPITAL OF ORANGE COUNTY (CHOC CHILDREN'S) AND CHOC CHILDREN'S AT MISSION HOSPITAL (CCMH). THE HOSPITALS ARE THE PRINCIPAL TERTIARY AND QUATERNARY PEDIATRIC HOSPITALS SERVING ORANGE COUNTY AND ARE THE ONLY HOSPITALS EXCLUSIVELY SERVING INFANTS, CHILDREN AND ADOLESCENTS. THE ORGANIZATION IS COMPRISED OF TWO HOSPITALS; SEVERAL PRIMARY AND SPECIALTY CLINICS, PROGRAMS AND SERVICES; AND FOUR CENTERS OF EXCELLENCE, THE CHOC HEART, NEUROSCIENCE, hyundai cancer institute AND ORTHOPAEDIC INSTITUTES. CHOC ALSO HAS A RESEARCH INSTITUTE PERFORMING BASIC SCIENCE AND CLINICAL RESEARCH. THROUGH ITS JOINT RESIDENCY PROGRAM WITH UC IRVINE, THE ORGANIZATION ALSO TRAINS TOMORROW'S PHYSICIANS. THE COMMUNITY BENEFIT PLAN FOR THE FISCAL YEAR ENDING JUNE 30, 2013, DESCRIBES THE BENEFIT PLANNING PROCESS, THE BENEFITS PROVIDED, AND THE ECONOMIC VALUE OF THE BENEFITS. COMMUNITY BENEFITS ARE FREE OR SUBSIDIZED PROGRAMS AND SERVICES PROVIDED TO MEET IDENTIFIED COMMUNITY NEEDS AND TO SERVE THE PUBLIC INTEREST. THE ORGANIZATION'S COMMUNITY BENEFIT PLAN IS AVAILABLE ONLINE AT: HTTP://WWW.CHOC.ORG/ABOUT/COMMUNITYBENEFITPLAN.PDF. THE MAJORITY OF THE ORGANIZATION'S GOVERNING BODY IS COMPOSED OF PERSONS WHO RESIDE IN THE ORGANIZATION'S PRIMARY SERVICE AREA WHO ARE NEITHER EMPLOYEES NOR CONTRACTORS OF THE ORGANIZATION, NOR FAMILY MEMBERS THEREOF. CLINICAL PRIVILEGES ARE GRANTED TO ALL QUALIFIED PHYSICIANS AS MEMBERS OF THE MEDICAL STAFF. MEDICAL STAFF MEMBERS PROVIDE PATIENT CARE AND HAVE ACCESS TO HOSPITAL RESOURCES (INCLUDING EQUIPMENT, FACILITIES AND PERSONNEL) WHICH ARE NECESSARY TO EFFECTIVELY EXERCISE THEIR PRIVILEGES. PHYSICIANS ARE QUALIFIED TO BE MEMBERS OF THE MEDICAL STAFF IF THEY MEET THE FOLLOWING CRITERIA: ONLY PRACTICING PHYSICIANS, DENTISTS, PSYCHOLOGISTS OR PODIATRISTS SHALL BE DEEMED TO POSSESS BASIC QUALIFICATIONS FOR MEMBERSHIP ON THE MEDICAL STAFF, EXCEPT FOR THE HONORARY AND RETIRED STAFF CATEGORIES IN WHICH CASE THESE CRITERIA SHALL ONLY APPLY AS DEEMED INDIVIDUALLY APPLICABLE BY THE MEDICAL STAFF, AND WHO: (A) DOCUMENT THEIR (1) CURRENT LICENSURE, (2) ADEQUATE EXPERIENCE, EDUCATION, AND TRAINING, (3) CURRENT PROFESSIONAL COMPETENCE, (4) GOOD JUDGMENT, AND (5) CURRENT ADEQUATE PHYSICAL AND MENTAL HEALTH STATUS, SO AS TO DEMONSTRATE TO THE SATISFACTION OF THE MEDICAL STAFF THAT THEY ARE PROFESSIONALLY AND ETHICALLY COMPETENT AND THAT PATIENTS TREATED BY THEM CAN REASONABLY EXPECT TO RECEIVE QUALITY MEDICAL CARE. (B) ARE DETERMINED (1) TO ADHERE TO THE ETHICS OF THEIR RESPECTIVE PROFESSIONS, (2) TO BE ABLE TO WORK COOPERATIVELY WITH OTHERS SO AS NOT TO ADVERSELY AFFECT PATIENT CARE, (3) TO KEEP AS CONFIDENTIAL, AS REQUIRED BY LAW, ALL INFORMATION OR RECORDS RECEIVED IN THE PHYSICIAN-PATIENT RELATIONSHIP, AND (4) TO BE WILLING TO PARTICIPATE IN AND PROPERLY DISCHARGE THOSE RESPONSIBILITIES DETERMINED BY THE MEDICAL STAFF AND BE BOUND BY THE MEDICAL STAFF BYLAWS, RULES AND REGULATIONS, AND POLICIES. (C) WHO MAINTAIN IN FORCE PROFESSIONAL LIABILITY INSURANCE IN NOT LESS THAN THE MINIMUM AMOUNTS JOINTLY DETERMINED BY THE BOARD OF DIRECTORS AND THE MEDICAL EXECUTIVE COMMITTEE, BUT IN NO EVENT LESS THAN $1.0 MILLION PER INCIDENT AND $3.0 MILLION IN THE AGGREGATE IN A POLICY YEAR; PROVIDED, HOWEVER, THAT IN THE EVENT THAT (AND FOR SO LONG AS) SUCH INSURANCE IS NOT AVAILABLE ON COMMERCIALLY REASONABLE TERMS TO PHYSICIANS PRACTICING IN A PARTICULAR SPECIALTY OR SUB-SPECIALTY AREA OF MEDICAL PRACTICE, THE FOREGOING REQUIREMENTS MAY BE MODIFIED OR WAIVED WITH RESPECT TO ALL PHYSICIANS PRACTICING IN SUCH SPECIALTY OR SUB-SPECIALTY AREA, SUBJECT TO THE APPROVAL OF THE BOARD OF DIRECTORS UPON REQUEST OF THE MEDICAL EXECUTIVE COMMITTEE. ADMINISTRATIVE STAFF AND MEMBERS ON A LEAVE OF ABSENCE DO NOT NEED TO SHOW EVIDENCE OF INSURANCE. (D) IF BOARD CERTIFICATION IS AVAILABLE IN THEIR RESPECTIVE SPECIALTIES, ARE BOARD CERTIFIED OR BOARD ADMISSIBLE, OR IN THE ALTERNATIVE, CAN DEMONSTRATE TO THE REASONABLE SATISFACTION OF THE MEDICAL EXECUTIVE COMMITTEE, A COMPARABLE LEVEL OF TRAINING, EXPERIENCE AND SKILL. LIMITED privileges ARE PROVIDED TO PHYSICIANS LICENSED BY THE STATE OF CALIFORNIA WHO ARE ENROLLED IN AN ACCREDITED PEDIATRIC RESIDENCY TRAINING PROGRAM AND WHO ARE PROVIDING MEDICAL HEALTH-RELATED SERVICES TO PATIENTS INDEPENDENT OF THE HOSPITAL RESIDENCY PROGRAM. THE ORGANIZATION APPLIES ITS SURPLUS FUNDS TO IMPLEMENT IMPROVEMENTS IN PATIENT CARE, MEDICAL EDUCATION AND RESEARCH. DURING THE REPORTING YEAR ENDED JUNE 30, 2013, THE ORGANIZATION COMPLETED THE CONSTRUCTION OF A STATE-OF-THE-ART $552 MILLION HOSPITAL TOWER ON ITS MAIN CAMPUS IN THE CITY OF ORANGE. CONSTRUCTION OF THE 7 STORY BUILDING STARTED IN 2009 AND OPENED ITS DOORS TO PATIENTS IN 2013. THE NEW TOWER INCLUDEs INPATIENT AND OUTPATIENT CARE FOR CHILDREN, WITH EMERGENCY DEPARTMENT, OPERATING ROOMS, A MEDICAL LABORATORY, PATHOLOGY DEPARTMENT AND IMAGING AND RADIOLOGY SERVICES. THERE IS ALSO A LARGE CONFERENCE AREA TO ACCOMMODATE AND SUPPORT SOME OF THE ORGANIZATION'S TEACHING ACTIVITIES. THE CHOC ENDOWMENT FUNDS ARE IN PART USED TO FUND MEDICAL RESEARCH, CLINICAL PROGRAMS AND SERVICES, AND TO RECRUIT AND RETAIN DOCTORS WHO ARE THE BEST IN THEIR FIELDS. SCHEDULE H, PART VI, LINE 6 AFFILIATED HEALTH CARE SYSTEM: CHOC HAS EVOLVED FROM A COMMUNITY HOSPITAL TO A WORLD-CLASS, INTEGRATED PEDIATRIC HEALTH CARE SYSTEM AFFILIATED WITH THE UNIVERSITY OF CALIFORNIA, IRVINE (UC IRVINE). THE ORGANIZATION IS STEADFASTLY COMMITTED TO THE TENS OF THOUSANDS OF CHILDREN AND FAMILIES WHO DEPEND ON CHOC FOR CARE, AS WELL AS LEADING THE CHARGE IN ADVANCING PEDIATRIC MEDICINE ON A NATIONAL LEVEL. CHOC'S NEW BRAND IDENTITY - CHOC CHILDREN'S - ASSERTS THE INSTITUTION'S POSITION IN THE COMMUNITY AND NATIONALLY. CHOC'S LEGAL NAME (CHILDREN'S HOSPITAL OF ORANGE COUNTY) WILL REMAIN. THE ECONOMIC VALUE OF THE 88 BENEFIT SERVICES PROVIDED BY CHOC AND CCMH IN FISCAL YEAR 2013 IS $41.6 MILLION. OF THESE DOLLARS, 31.3% ($13 MILLION) SERVED THE ECONOMICALLY DISADVANTAGED. THE ECONOMIC VALUE OF SAVINGS FROM NOT-FOR-PROFIT STATUS IS $ 22.6 MILLION. THUS, THE HOSPITALS RETURN $1.85 IN COMMUNITY BENEFITS FOR EACH $1 SAVED FROM TAX-EXEMPT STATUS. IN ADDITION TO THE $41.6 MILLION IN BENEFITS PROVIDED FOR BY THE HOSPITALS REFERENCED ABOVE, BOARD MEMBERS, PHYSICIANS, EMPLOYEES AND VOLUNTEERS CONTRIBUTED 43,000 HOURS OF VOLUNTEER SERVICE TO THE COMMUNITY. SCHEDULE H PART VI, LINE 7 STATE FILING OF COMMUNITY BENEFIT REPORT: A COMMUNITY BENEFIT REPORT IS FILED ANNUALLY IN THE STATE OF CALIFORNIA. X X X X true true false false false false false false false KIMBERLY C CRIPE 0 751203 0 236120 0 233350 0 57454 0 22864 0 1300991 0 78602 DEBRA MATHIAS 0 436877 0 117998 0 181921 0 6145 0 11573 0 754514 0 80355 KERRI RUPPERT SCHILLER 0 456740 0 101469 0 53281 0 103915 0 22864 0 738269 0 79435 Matthew E Niedzwiecki 235643 0 53528 0 32446 0 46468 0 16059 0 384144 0 39241 0 Jay Gabriel 317869 0 65438 0 40981 0 58572 0 22829 0 505689 0 47725 0 MARK L HEADLAND 279667 0 51277 0 82624 0 27980 0 6104 0 447652 0 51042 0 Waldo Romero 266622 0 55913 0 39409 0 50609 0 11668 0 424221 0 41995 0 Hale Kuhlman 215483 0 35077 0 18120 0 22861 0 16059 0 307600 0 0 0 Susan Burrows 250174 0 53667 0 35393 0 47641 0 16466 0 403341 0 37187 0 JANET LANSING 222871 0 41135 0 69451 0 22218 0 11634 0 367309 0 18132 0 Maria Minon MD 436368 87107 113146 34200 8138 678959 34260 Louise White 260532 0 38802 0 32450 0 46497 0 11668 0 389949 0 0 0 SEVERANCE ARRANGEMENTS,PART I, LINE 4A Part I, Line 4a Some of 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. Unpaid severance under the separation agreements for current key employees were reported at their full value in a previous tax year. One executive listed on schedule J, part II, received severance payments in calender 2012. the payment was received by Debra Mathias ($125,969). SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN Part I, Line 4b 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 individuals received payments from the Plan during calendar year 2012: Ms. Cripe ($149,013), Dr. Minon ($64,921), Mr. Headland ($41,299), and Ms. Lansing ($33,912). Compensation from an affiliated organization 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. DEBRA MATHIAS 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 AND CHILDREN'S HOSPITAL AT MISSION (BOTH IRC SECTION 501(C)(3) AFFILIATES). MS. MATHIAS DEVOTES APPROXIMATELY 88% OF HER TIME EACH WEEK TO CHILDREN'S HOSPITAL OF ORANGE COUNTY RESPONSIBILITIES WITH THE BALANCE OF HER TIME BEING SPENT ON CHILDREN'S HOSPITAL AT MISSION BUSINESS AFFAIRS. A CALIFORNIA HEALTH FACILITIES FINANCING AUTHORITY 521643828 13033LBP1 2009-06-30 137686600 CONSTRUCT A HOSPITAL false false false B CALIFORNIA HEALTH FACILITIES FINANCING AUTHORITY 521643828 13033LBT3 2009-06-30 127800000 CONSTRUCT A HOSPITAL false false false C CALIFORNIA HEALTH FACILITIES FINANCING AUTHORITY 521643828 13033LRT6 2011-11-03 105003490 CONSTRUCT A HOSPITAL false false false A 0 0 137800764 10852054 12342642 0 1838778 0 0 17244250 107849999 0 2013 false true false true B 0 0 128231052 0 15470246 0 1382488 0 0 126850189 0 0 2013 false false false true C 0 0 105081393 0 7460489 0 0 0 0 105081328 0 0 2013 false false false true A false false true true false 0 false false false true B false false true true false 0 false false false true C false false true true false 0 false false false true A false false false true false false 0 false 0 false true B false false false true true true MORGAN STANLEY 30. false false false 0 false true C false false false true false false 0 false 0 false true A true B true C true PART II, LINE 3 0 CUMULATIVE INTEREST EARNED ON ISSUE A: 114,164 CUMULATIVE INTEREST EARNED ON ISSUE B: 431,052 CUMULATIVE INTEREST EARNED ON ISSUE C: 77,903 part iv, line 2c 0 date rebate computation was performed: report dated 8/27/13 as of 6/30/13. MORAN ROWEN AND DORSEY INC MARSHALL ROWEN M.D., BOD 260000 MEDICAL SERVICES false Allied Anesthesia PHILLIP RICHARDSON, M.D. 479954 MEDICAL SERVICES false PEDIATRIC SUBSPECIALTY FACULTY INC VIJAY DHAR M.D. 49522717 SEE PART V false SCHEDULE L, PART IV BUSINESS TRANSACTION WITH INTERESTED PERSON Dr. Vijay Dahr, a board member of the hospital, is also an officer of Pediatric Subspecialty Faculty, Inc. (PSF). PSF provides professional and administrative services to CHOC's medical and research foundation and to the hospital. CHOC's medical and research foundation includes 21 medical and surgical sub-specialties and operates as a division of CHOC. FORM 990, PART I, LINE 5 AND PART V, LINE 2 INFORMATION REGARDING CHOC AS THE COMMON PAYMASTER: Children's Hospital of Orange County is the common paymaster of the following: CHILDREN'S HEALTHCARE OF CALIFORNIA CHILDREN'S HOSPITAL AT MISSION CHOC FOUNDATION All wages and employee specific information, including volunteers, are retained with Children's Hospital of Orange County. FORM 990, PART III, LINE 4A COMMUNITY BENEFIT REPORT HIGHLIGHTS: CHOC IS DEDICATED TO PROVIDING THE HIGHEST QUALITY TERTIARY, QUATERNARY INPATIENT CARE AS WELL AS SPECIALTY AND PRIMARY CARE TO CHILDREN IN A FAMILY CENTERED ENVIRONMENT. ACCESS TO QUALITY PEDIATRIC HEALTHCARE RESOURCES AND INFORMATION TO FAMILIES, INCLUDING LOW-INCOME AND MEDICALLY UNDERSERVED, THROUGHOUT ORANGE AND CONTIGUOUS COUNTIES, IS ACCOMPLISHED BY OFFERING: (1) PEDIATRIC INTENSIVE CARE UNIT (PICU). THE 30 BED PICU AT CHOC IS STAFFED BY INTENSIVISTS AND CLINICIAN STAFF AND IS EQUIPPED WITH ADVANCED COMPUTERIZED MONITORING SYSTEMS AND OFFERS CARE TO CRITICALLY ILL OR INJURED CHILDREN WITH LIFE-THREATENING DISORDERS. (2) ONCOLOGY UNIT STAFFED BY SPECIALISTS TRAINED TO TREAT THE COMPLEX CONDITIONS THAT ACCOMPANY PEDIATRIC CANCERS, WHICH INCLUDES A 28-BED HEMATOLOGY/ONCOLOGY UNIT. THE UNIT OFFERS THE LATEST IN MEDICAL AND SURGICAL ONCOLOGY INCLUDING CHEMOTHERAPY, RADIOTHERAPY AND BLOOD AND MARROW TRANSPLANTATION. IN ADDITION, CHOC OFFERS A 22 CHAIR OUTPATIENT INFUSION CENTER. (3) CHOC'S NEONATAL INTENSIVE CARE UNIT (NICU) TAKES CARE OF INFANTS WHO NEED CRITICAL CARE (MOST OFTEN PREMATURE BABIES SUFFERING FROM RESPIRATORY AND CIRCULATORY PROBLEMS AS WELL AS CONGENITAL ANOMALIES REQUIRING SURGERY) THAT CAN BE ADMITTED TO THE NICU WITHIN MINUTES OF BIRTH. THE 66-BED NICU AT CHOC INCLUDES TWO EIGHT-BED NURSERIES, TWO NINE-BED NURSERIES, SIX ISOLATION ROOMS, 12 BEDS THAT PROVIDE PRIVATE ROOMING, A TWO-BED EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO) UNIT AND A 12-BED MOTHER-BABY UNTI WITHIN SAINT JOSEPH HOSPITAL OF ORANGE. CHOC'S ECMO UNIT IS THE ONLY ONE OF ITS KIND IN ORANGE COUNTY AND ONE OF ONLY 72 IN THE UNITED STATES. CHOC ALSO HAS SOUTHERN CALIFORNIA'S ONLY ECMO TRANSPORT UNIT. CHOC HAS A DESIGNATED SMALL BABY UNIT OF 12 BEDS THAT CARES FOR BABIES THAT WEIGH LESS THAN 1,000 GRAMS AT BIRTH OR 27 WEEKS OR LESS GESTATION PERIOD. (4) CHOC'S CARDIOVASCULAR INTENSIVE CARE UNIT (CVICU) MEETS THE GROWING NEED FOR SPECIALIZED HEART SERVICES IN ORANGE COUNTY. THIS 12-BED UNIT INCLUDES TWO SPECIAL PROCEDURE TREATMENT ROOMS THAT ENABLE PHYSICIANS TO PERFORM SURGERY ON CHILDREN WHO OTHERWISE COULD NOT BE TRANSPORTED OUT OF THE UNIT AND INTO THE OPERATING ROOMS. ALL OF THE CVICU ROOMS ARE OUTFITTED WITH TECHNOLOGY TO MONITOR CHILDREN AFTER COMPLEX OPERATIONS AND SURGICAL PROCEDURES. (5) IN MARCH 2013, CHOC COMPLETED AND OPENED SERVICES IN A NEW STATE-OF-THE-ART PATIENT TOWER. ALL INPATIENT AND OUTPATIENT ANCILLARY SERVICES PREVIOUSLY PURCHASED FROM SAINT JOSEPH HOSPITAL OF ORANGE ARE NOW AVAILABLE WITHIN CHOC'S FACILITIES. THE SERVICES INCLUDE FULL CLINICAL LABORATORY SERVICES, AN EMERGENCY DEPARTMENT DEDICATED SOLELY TO PEDIATRIC CARE, FULL IMAGING SERVICES AND SURGICAL SERVICES, INCLUDING CATH LAB AND FULL CARDIAC CARE. THESE DEDICATED SERVICES HAVE GREATLY ENHANCED THE TOTAL CARE GIVEN TO CHOC'S PATIENTS. (6) THE CHOC CANCER, NEUROSCIENCE, HEART AND ORTHOPAEDIC INSTITUTES OFFER INNOVATIVE ADVANCED MODELS OF CARE IN THE EVALUATION, MANAGEMENT AND TREATMENT OF THE MOST COMPLEX PEDIATRIC AND ADOLESCENT CONDITIONS. CHOC PROVIDES AND ENHANCES THE COMMUNITY'S ACCESS TO BEHAVIORAL HEALTH INFORMATION AND SOCIAL AND EMOTIONAL SERVICES, TARGETING THE UNDERSERVED. CHOC OFFERS OUTPATIENT SPECIALTY CARE IN MULTIPLE SPECIALTIES THROUGH CLINICS IN ORANGE AND NEWPORT BEACH. CHOC ACTIVELY SUPPORTS COMMUNITY ACTION AND LEADERSHIP. CHOC ACTIVELY RECRUITS, RECOGNIZES AND ADVOCATES FOR THE IMPORTANCE OF VOLUNTEER LEADERSHIP AND COMMUNITY ASSISTANCE IN PROVIDING CARE FOR CHILDREN. CHOC PROVIDES COMMUNITY-WIDE EDUCATION AND HEALTH INFORMATION RESOURCES AND INJURY PREVENTION. IN ADDITION, CHOC OFFERS SERVICES THROUGH ITS OUTREACH CLINICS THAT SERVE SURROUNDING COMMUNITIES TO PROVIDE PREVENTATIVE AND PRIMARY CARE IN LOW-INCOME, HIGH RISK AREAS WHERE CHILDREN HAVE LIMITED ACCESS TO CARE. CHOC'S OUTREACH CLINICS INCLUDE THE CHOC ORANGE COMMUNITY CLINIC, CLINICA PARA NIOS IN SANTA ANA, THE CHOC CLINIC AT SANTA ANA BOYS AND GIRLS CLUB, CHOC COSTA MESA CLINIC AND CHOC GARDEN GROVE CLINIC. CHOC ALSO PROVIDES CARE THROUGH MOBILE CLINICS, INCLUDING BREATH MOBILES AND ASTHMA CARE. SEE OUR COMMUNITY BENEFITS REPORT ON OUR WEBSITE AT WWW.CHOC.ORG. LINES 6 & 7A - ORGANIZATION MEMBER INFORMATION THE SOLE MEMBER OF CHILDREN'S HOSPITAL OF ORANGE COUNTY (CHOC) IS CHILDREN'S HEALTHCARE OF CALIFORNIA (CHC). LINE 7B - ORGANIZATION MEMBER INFORMATION THE APPROVAL OF THE MEMBER SHALL BE REQUIRED WITH RESPECT TO ANY OF THE FOLLOWING ACTIONS: (1) CHANGING THE PURPOSES AND POWERS OF CHOC; (2) OBLIGATING CHOC TO UNDERTAKE ANY CAPITAL EXPENDITURE IN EXCESS OF $5,000,000; (3) ADOPTING CHOC'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 TO ACT AS GUARANTOR WITH RESPECT TO ANY DEBT OF ANY PERSON OR OTHER ENTITY; (8) ACCEPTING ANY DONATION WHICH IS CONDITIONED UPON CHOC'S UNDERTAKING ANY UNBUDGETED CAPITAL EXPENDITURE IN EXCESS OF $2,000,000 OR ANY UNBUDGETED EXPENDITURE IN EXCESS OF $2,000,000; (9) ENTERING INTO ANY CONTRACT WHICH INVOLVES ANY OF THE FOLLOWING: (A) ANY FINANCIAL OBLIGATION ON THE PART OF CHOC IN AN AMOUNT IN EXCESS OF $5,000,000, (B) ANY PURPOSE OR ACTIVITY WHICH IS OUTSIDE THE SCOPE OF CHOC'S ORDINARY COURSE OF BUSINESS, OR (C) A TERM IN EXCESS OF FIVE YEARS (UNLESS THE CONTRACT IS TERMINABLE AT WILL); (10) INVOLVING CHOC IN ANY MERGER, ACQUISITION, CORPORATE RESTRUCTURING, OR FORMAL AFFILIATION; (11) INVOLVING CHOC AS A MEMBER, SHAREHOLDER, OR PARTNER IN ANY NEW CORPORATION, PARTNERSHIP, OR OTHER LEGAL ENTITY; (12) DISSOLVING CHOC; (13) ENTERING INTO ANY TRANSACTION INVOLVING THE SALE, LEASE, CONVEYANCE, EXCHANGE, TRANSFER OR OTHER DISPOSITION OF ALL OR SUBSTANTIALLY ALL OF CHOC'S ASSETS; (14) AMENDING CHOC'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 - REVIEW OF FORM 990: PRIOR TO FILING, THE TAX RETURN AND RELATED SCHEDULES ARE PROVIDED TO THE CHOC EXECUTIVE COMPENSATION COMMITTEE, AN EMPOWERED BOARD COMMITTEE DELEGATED WITH THIS AUTHORITY. THE CHIEF FINANCIAL OFFICER REVIEWS THE REPORT 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 SENT ELECTRONICALLY TO 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. LINE 12C - CONFLICT OF INTEREST COMPLIANCE: 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 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 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. LINE 15 - COMPENSATION DETERMINATION: An independent Board Committee of THE ORGANIZATION 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 firm to provide relevant comparability data and other compensation studies. The CEO, officers and executive management salaries and incentives, 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 review was last performed in 2013. All comparative salary data, such as annual compensation survey comprising 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 Board of Directors. FORM 990, PART VI, SECTION C line 19 - disclosure policy FEDERAL TAX LAWS DO NOT MANDATE THAT THE ORGANIZATION'S GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY BE MADE AVAILABLE FOR PUBLIC INSPECTION. FORM 990 AND THE COPY OF AUDITED FINANCIAL STATEMENTS ATTACHED TO IT ARE MADE AVAILABLE UPON REQUEST. FORM 990, PART IX, LINE 11G OTHER FEES FOR SERVICES TOTAL PROGRAM MANAGEMENT SERVICE Physician Services 54,289,765 48,860,789 5,428,976 Medical Services 17,161,963 15,445,766 1,764,191 Collection Agency fees 1,168,296 1,051,467 116,829 Misc Purchased Services 15,318,040 13,786,237 1,531,803 Other Professional Fees 4,290,699 3,861,630 429,069 Janitorial services 33,837 30,454 3,383 Security Services 297,037 267,334 29,703 Courier Services 54,010 48,605 5,405 RECONCILIATION OF NET ASSETS FORM 990, PART XI, LINE 5 CHANGE IN BENEFICIAL INTEREST IN CHOC FOUNDATION $ 20,244,756 CHILDREN'S HEALTHCARE OF CALIFORNIA(CHC) 1201 West La Veta Avenue ORANGE CA 92868 330265266 HEALTH CARE CA 501(c)(3) 7 NA false Children's Hospital at Mission 1201 West La Veta Avenue ORANGE CA 92868 330528802 HEALTH CARE CA 501(c)(3) 3 CHC false CHOC FOUNDATION 455 S MAIN STREET ORANGE CA 92868 956097416 Fund Raising CA 501(c)(3) 7 CHC false CRC REAL ESTATE CORPORATION 455 S MAIN STREET ORANGE CA 92868 330612565 REAL ESTATE CA 501(c)(3) 11 CHC false CHOC Thrift Stores Inc 455 S MAIN STREET orange CA 92868 330266422 Fund Raising CA 501(c)(3) 9 CHC false ORANGE COUNTY MEDICAL RECIPROCAL INS CO 2999 North 4th Street Suite 250 phoenix AZ 85108 201620666 insurance AZ na c corp 54452 3049467 0.50000 true false true true false true false false false false false true false true false false false false false true ORANGE COUNTY MEDICAL RECIPROCAL INS CO K 948657 PER AGREEMENT PART V, LINE 2, COLUMN(C) OCMRRG PROVIDES MEDICAL PROFESSIONAL LIABILITY AND GENERAL LIABILITY COVERAGE OF UP TO $250,000 PER CLAIM ON A CLAIMS-MADE BASIS TO CHOC.