CHILDRENS HOSPITAL AT MISSION: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- CHILDRENS HOSPITAL AT MISSION (EIN 33-0528802)
- Tax period
- 2012-07-01 to 2013-06-30
- Filed
- 2014-05-15
- IRS object ID
- 201421359349306442
- Schema version
- 2012v2.3
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule D
- Schedule H
- Schedule I
- Schedule J
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2014-05-15T13:21:49-05:00 | Timestamp |
| Tax Period End Date | 2013-06-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | KPMG LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 355 S Grand Ave Suite 2000 | AddressLine1 |
| City | Los Angeles | City |
| State | CA | State |
| ZIP Code | 90071 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2012-07-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 330528802 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CHILDREN'S HOSPITAL AT MISSION | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| In Care Of Name | % DONALD NOBLE | InCareOfName |
| Name Control | CHIL | NameControl |
| Phone | 7149973000 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1201 West La Veta Avenue | AddressLine1 |
| Address Line2 | Suite | AddressLine2 |
| City | ORANGE | City |
| State | CA | State |
| ZIP Code | 92868 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | KERRI SCHILLER | Name |
| Title | SENIOR VP/CFO | Title |
| Phone | 7145094038 | Phone |
| Date Signed | 2014-05-14 | DateSigned |
| Authorize Third Party | true | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 2139724000 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2015-11-30 17:44:51Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Change | X | AddressChange |
| Name Of Principal Officer Person | KIMBERLY C CRIPE | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1201 West La Veta Avenue | AddressLine1 |
| City | ORANGE | City |
| State | CA | State |
| ZIP Code | 92868 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 58509480 | GrossReceipts |
| Group Return For Affiliates | false | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.CHOC.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1991 | YearFormation |
| State Legal Domicile | CA | StateLegalDomicile |
| Activity Or Mission Description | TO NURTURE, ADVANCE, & PROTECT THE HEALTH AND WELL-BEING OF CHILDREN. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 14 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 13 | NbrIndependentVotingMembers |
| Total Nbr Employees | 140 | TotalNbrEmployees |
| Total Nbr Volunteers | 85 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Contributions Grants Prior Year | 80467 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 106887 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 58573208 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 56992833 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 75529 | InvestmentIncomePriorYear |
| Investment Income Current Year | -966 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 67254 | OtherRevenuePriorYear |
| Other Revenue Current Year | 87832 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 58796458 | TotalRevenuePriorYear |
| Total Revenue Current Year | 57186586 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 600000 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 6100000 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 11288076 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 11240340 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 38525431 | OtherExpensePriorYear |
| Other Expenses Current Year | 35900796 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 50413507 | TotalExpensesPriorYear |
| Total Expenses Current Year | 53241136 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 8382951 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 3945450 | RevenuesLessExpensesCY |
| Total Assets BOY | 38403781 | TotalAssetsBOY |
| Total Assets EOY | 42051902 | TotalAssetsEOY |
| Total Liabilities BOY | 6792016 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 6212469 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 31611765 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 35839433 | NetAssetsOrFundBalancesEOY |
| Mission Description | TO NURTURE, ADVANCE, & PROTECT THE HEALTH AND WELL-BEING OF CHILDREN. | MissionDescription |
| Significant New Program Services | false | SignificantNewProgramServices |
| Significant Change | false | SignificantChange |
| Expense | 50613129 | Expense |
| Grants | 6100000 | Grants |
| Revenue | 56992833 | Revenue |
| Description | Facility provides specialized pediatric services for the medical/surgical care of children from birth to age 18. There were 7,821 inpatient care days; 16,804 emergency room visits; 665 surgeries and 5,621 outpatient visits. See our complete community benefit report on our website at www.choc.org. | Description |
| Total Program Service Expense | 50613129 | TotalProgramServiceExpense |
| Described In501 C3 | true | DescribedIn501C3 |
| Schedule B Required | true | ScheduleBRequired |
| Political Activities | false | PoliticalActivities |
| Lobbying Activities | false | LobbyingActivities |
| Subject To Proxy Tax | false | SubjectToProxyTax |
| Donor Advised Funds | false | DonorAdvisedFunds |
| Conservation Easements | false | ConservationEasements |
| Collections Of Art | false | CollectionsOfArt |
| Credit Counseling | false | CreditCounseling |
| Term Or Permanent Endowments | false | TermOrPermanentEndowments |
| Report Land Bldg Equip | true | ReportLandBldgEquip |
| Report Invest Oth Securities | false | ReportInvestOthSecurities |
| Report Prog Rel Invest | false | ReportProgRelInvest |
| Report Other Assets | true | ReportOtherAssets |
| Report Other Liabilities | true | ReportOtherLiabilities |
| Report Fin48 Footnote | true | ReportFin48Footnote |
| Independent Audit Financial Stmt | true | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | true | ConsolidatedAuditFinancialStmt |
| School | false | School |
| Foreign Office | false | ForeignOffice |
| Foreign Activities | false | ForeignActivities |
| More Than5000 K To Organizations | false | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividuals |
| Professional Fundraising | false | ProfessionalFundraising |
| Fundraising Activities | false | FundraisingActivities |
| Gaming | false | Gaming |
| Hospital | true | Hospital |
| Financial Stmt Attached | true | FinancialStmtAttached |
| Grants To Organizations | true | GrantsToOrganizations |
| Grants To Individuals | false | GrantsToIndividuals |
| Schedule J Required | true | ScheduleJRequired |
| Tax Exempt Bonds | false | TaxExemptBonds |
| Excess Benefit Transaction | false | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | false | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | false | LoanToOfficerOrDQP |
| Grant To Related Person | false | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | false | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | false | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | false | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | false | DeductibleNonCashContributions |
| Deductible Contributions Of Art | false | DeductibleContributionsOfArt |
| Terminated | false | Terminated |
| Partial Liquidation | false | PartialLiquidation |
| Disregarded Entity | false | DisregardedEntity |
| Related Entity | true | RelatedEntity |
| Related Org Controlled Entity | true | RelatedOrgControlledEntity |
| Transaction Related Entity | false | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | false | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | false | ActivitiesConductedPartnership |
| Schedule O Required | true | ScheduleORequired |
| Info In Schedule O Part V | X | InfoInScheduleOPartV |
| Number Forms Transmitted With1096 | 11 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | true | ComplianceWithBackupWitholding |
| Number Of Employees | 140 | NumberOfEmployees |
| Employment Tax Returns Filed | true | EmploymentTaxReturnsFiled |
| Unrelated Business Income | false | UnrelatedBusinessIncome |
| Foreign Financial Account | false | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTrans |
| Taxable Party Notification | false | TaxablePartyNotification |
| Non Deductible Contributions | false | NonDeductibleContributions |
| Quid Pro Quo Contributions | false | QuidProQuoContributions |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | false | FundsToPayPremiums |
| Premiums Paid | false | PremiumsPaid |
| Indoor Tanning Services | false | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 14 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 13 | NumberIndependentVotingMembers |
| Family Or Business Relationship | false | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | false | DelegationOfManagementDuties |
| Changes To Organizing Docs | false | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuse |
| Members Or Stockholders | true | MembersOrStockholders |
| Election Of Board Members | true | ElectionOfBoardMembers |
| Decisions Subject To Approval | true | DecisionsSubjectToApproval |
| Minutes Of Governing Body | true | MinutesOfGoverningBody |
| Minutes Of Committees | true | MinutesOfCommittees |
| Officer Mailing Address | false | OfficerMailingAddress |
| Local Chapters | false | LocalChapters |
| Form990 Provided To Governing Body | true | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | true | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | true | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | true | RegularMonitoringEnforcement |
| Whistleblower Policy | true | WhistleblowerPolicy |
| Document Retention Policy | true | DocumentRetentionPolicy |
| Compensation Process CEO | true | CompensationProcessCEO |
| Compensation Process Other | true | CompensationProcessOther |
| Investment In Joint Venture | false | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | CA | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | DONALD NOBLE | NamePerson |
| Telephone Number | 7145094038 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1201 WEST LA VETA AVENUE | AddressLine1 |
| City | ORANGE | City |
| State | CA | State |
| ZIP Code | 928683874 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (22 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Average Hours Per Week RelatedAverageHoursPerWeekRelated | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Key EmployeeKeyEmployee | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|---|---|
| KIMBERLY C CRIPE | |||||||||
| DIRECTOR/PRESIDENT | 2.0 | 38.0 | X | X | 0 | 1220673 | 80318 | ||
| RALPH CLAYMAN MD | |||||||||
| DIRECTOR | 1.0 | 2.5 | X | 0 | 0 | 0 | |||
| JEFF ELGHANAYAN | |||||||||
| DIRECTOR/2ND VICE CHAIR | 1.0 | 5.0 | X | X | 0 | 0 | 0 | ||
| DOUGLAS MCCOMBS | |||||||||
| director/IST VICE CHAIR | 1.0 | 2.0 | X | X | 0 | 0 | 0 | ||
| MARK STEVENS | |||||||||
| DIRECTOR/CHAIR | 1.0 | 6.0 | X | X | 0 | 0 | 0 | ||
| JANET T DAVIDSON | |||||||||
| DIRECTOR | 1.0 | 3.5 | X | 0 | 0 | 0 | |||
| MARSHALL ROWEN MD | |||||||||
| DIRECTOR | 1.0 | 3.5 | X | 0 | 0 | 0 | |||
| DAVID DUKES | |||||||||
| DIRECTOR/SECRETARY | 1.0 | 2.0 | X | X | 0 | 0 | 0 | ||
| TIM RISTOFF | |||||||||
| DIRECTOR | 1.0 | 2.0 | X | 0 | 0 | 0 | |||
| Vijay Dhar MD | |||||||||
| Director | 1.0 | 2.0 | X | 0 | 0 | 0 | |||
| thomas tierney | |||||||||
| director | 1.0 | 2.5 | X | 0 | 0 | 0 | |||
| Dick Ackerman | |||||||||
| Director | 1.0 | 1.0 | X | 0 | 0 | 0 | |||
| Michael Coglazier | |||||||||
| Director | 1.0 | 1.0 | X | 0 | 0 | 0 | |||
| Phillip Richardson MD | |||||||||
| Director | 1.0 | 1.0 | X | 0 | 0 | 0 | |||
| KERRI RUPPERT SCHILLER | |||||||||
| CFO/Assistant Secretary | 4.0 | 36.0 | X | 0 | 611490 | 126779 | |||
| DEBRA MATHIAS | |||||||||
| EXEC. VICE PRESIDENT/COO | 4.5 | 35.5 | X | 0 | 736796 | 17718 | |||
| MARCIA FOLLI | |||||||||
| VICE PRESIDENT/CNO | 40.0 | 276116 | 0 | 49067 | X | ||||
| BONNIE GRAVETT | |||||||||
| Clinical Nurse III | 40.0 | 153216 | 0 | 24396 | X | ||||
| Elizabeth Drake | |||||||||
| Clinical Nurse II | 40.0 | 137261 | 0 | 13735 | X | ||||
| Linda Starn | |||||||||
| Director Patient care services | 40.0 | 158144 | 0 | 9822 | X | ||||
| Karen McGurk-Mish | |||||||||
| NURSE MANAGER | 40.0 | 149071 | 0 | 24275 | X | ||||
| Eva Esmaeili | |||||||||
| NURSE MANAGER | 40.0 | 136138 | 0 | 23173 | X | ||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 1009946 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 2568959 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 369283 | TotalOtherCompensation |
| Number Individuals GT100 K | 16 | NumberIndividualsGT100K |
| Formers Listed | false | FormersListed |
| Total Comp GT150 K | true | TotalCompGT150K |
| Compensation From Other Sources | false | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (4 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| Triage Consulting Group | |||||
| 221 Main Street Suite 1100 | SAN FRANCISCO | CA | 94105 | CONSULTING | 353699 |
| COMFORCE TECHNICAL SERVICES | |||||
| PO Box 9695 | UNIONDALE | NY | 09695 | TEMPORARY STAFFING | 152463 |
| Pediatric Surgical Associates | |||||
| 1120 W LA VETA AVENUE SUITE 100 | ORANGE | CA | 92868 | Medical Dir & Serv | 126906 |
| Neurosurgical Specialists Inc | |||||
| 24 Jewel flower | IRVINE | CA | 92603 | Medical Dir & Serv | 109500 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 4 | NumberOfContractorsGT100K |
| All Other Contributions | 106887 | AllOtherContributions |
| Total Contributions | 106887 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (2 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| NET PATIENT SERVICES | 621400 | 56851621 | 56851621 |
| CLINIC RENTAL INCOME | 900099 | 141212 | 141212 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 56992833 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 72288 | TotalRevenueColumn |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $72,288 | ExclusionAmount |
Income From Invest Bond Proceeds IncomeFromInvestBondProceeds
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Royalties Revenue RoyaltiesRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 0 | Real |
| Personal | 0 | Personal |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 1249640 | Securities |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 1322894 | Securities |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | -73254 | Securities |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -73254 | TotalRevenueColumn |
| Exclusion | -$73,254 | ExclusionAmount |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Income From Gaming NetIncomeFromGaming
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Income Or Loss NetIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Other Revenue Misc OtherRevenueMisc (2 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | ExclusionExclusionAmount |
|---|---|---|---|
| REIMBURSEMENT FOR IT SERVICES TO AFFILIATE | 900099 | 65832 | $65,832 |
| MEDICAL STAFF DEPOSITS | 900099 | 22000 | $22,000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 87832 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 57186586 | TotalRevenueColumn |
| Related Or Exempt Function Income | 56992833 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $86,866 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 6100000 | Total |
| Program Services | 6100000 | ProgramServices |
Grants To Domestic Individuals GrantsToDomesticIndividuals
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Foreign Grants ForeignGrants
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Benefits To Members BenefitsToMembers
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 279002 | Total |
| Program Services | 279002 | ProgramServices |
Comp Disqual Persons CompDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 8751924 | Total |
| Program Services | 7876732 | ProgramServices |
| Management And General | 875192 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 310304 | Total |
| Program Services | 279274 | ProgramServices |
| Management And General | 31030 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1238893 | Total |
| Program Services | 1115004 | ProgramServices |
| Management And General | 123889 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 660217 | Total |
| Program Services | 594195 | ProgramServices |
| Management And General | 66022 | ManagementAndGeneral |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 9147886 | Total |
| Program Services | 8233097 | ProgramServices |
| Management And General | 914789 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 11881 | Total |
| Management And General | 11881 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 33999 | Total |
| Program Services | 30599 | ProgramServices |
| Management And General | 3400 | ManagementAndGeneral |
Fees For Services Lobbying FeesForServicesLobbying
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2419883 | Total |
| Program Services | 2177895 | ProgramServices |
| Management And General | 241988 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 154094 | Total |
| Program Services | 138685 | ProgramServices |
| Management And General | 15409 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 580406 | Total |
| Program Services | 522365 | ProgramServices |
| Management And General | 58041 | ManagementAndGeneral |
Royalties Royalties
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1574167 | Total |
| Program Services | 1416750 | ProgramServices |
| Management And General | 157417 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 16078 | Total |
| Program Services | 14470 | ProgramServices |
| Management And General | 1608 | ManagementAndGeneral |
Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 6361 | Total |
| Program Services | 5725 | ProgramServices |
| Management And General | 636 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Payments To Affiliates PaymentsToAffiliates
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 912681 | Total |
| Program Services | 821413 | ProgramServices |
| Management And General | 91268 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 315667 | Total |
| Program Services | 284100 | ProgramServices |
| Management And General | 31567 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| PURCHASED SRVS OTHR HOSP. | 17911203 | 17911203 | |
| PROVIDER PROGRAM FEE | 2777794 | 2777794 | |
| OSHPD FEE | 17343 | 15609 | 1734 |
| LICENSE AND TAXES | 16406 | 14765 | 1641 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4947 | Total |
| Program Services | 4452 | ProgramServices |
| Management And General | 495 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 53241136 | Total |
| Program Services | 50613129 | ProgramServices |
| Management And General | 2628007 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 240756 | BOY |
| EOY | 179843 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 10392839 | BOY |
| EOY | 11971575 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 12276523 | BOY |
| EOY | 15209889 | EOY |
Receivables From Officers Etc ReceivablesFromOfficersEtc
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Receivables From Disqual Persons ReceivablesFromDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 303864 | BOY |
| EOY | 303688 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 16933546 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 9098146 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7144340 | BOY |
| EOY | 7835400 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Investments Program Related InvestmentsProgramRelated
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Intangible Assets IntangibleAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 8045459 | BOY |
| EOY | 6551507 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 38403781 | BOY |
| EOY | 42051902 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3564677 | BOY |
| EOY | 3167106 | EOY |
Grants Payable GrantsPayable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Deferred Revenue DeferredRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1239010 | BOY |
| EOY | 1033985 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Escrow Account Liability EscrowAccountLiability
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Loans From Officers Directors LoansFromOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1988329 | BOY |
| EOY | 2011378 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6792016 | BOY |
| EOY | 6212469 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 30509505 | BOY |
| EOY | 34627002 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1102260 | BOY |
| EOY | 1212431 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 31611765 | BOY |
| EOY | 35839433 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 38403781 | BOY |
| EOY | 42051902 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 3945450 | ReconcilationRevenueExpenses |
| Reconciliation Unrealized Invest | 236039 | ReconciliationUnrealizedInvest |
| Reconcilation Other Changes | 46179 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | false | AccountantCompileOrReview |
| FS Audited | true | FSAudited |
FS Audited Basis FSAuditedBasis
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Statement Both | X | FinancialStatementBoth |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | true | AuditCommittee |
| Federal Grant Audit Required | false | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Art Public Exhibition Amts | ArtPublicExhibitionAmts | |
| Held Works Of Art Amts | HeldWorksOfArtAmts | |
| Current Year Minus3 Years | CurrentYearMinus3Years | |
| Current Year Minus4 Years | CurrentYearMinus4Years | |
| Land | Land | |
| Buildings | Buildings |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 10764376 | OtherCostOrOtherBasis |
| Depreciation | 4819432 | Depreciation |
| Book Value | 5944944 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 6113711 | OtherCostOrOtherBasis |
| Depreciation | 4278714 | Depreciation |
| Book Value | 1834997 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 55459 | OtherCostOrOtherBasis |
| Depreciation | 0 | Depreciation |
| Book Value | 55459 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 7835400 | TotalOfBookValueLandBuildings |
Other Assets OtherAssets (6 entries)
| DescriptionDescription | Book ValueBookValue |
|---|---|
| GOODWILL NET OF AMORTIZATION | 5737500 |
| RECEIVABLE FROM THIRD-PARTY | 144883 |
| NICU SUNK COSTS, NET OF AMORT. | 63179 |
| I/C RECEIVABLE CHOC | 3952 |
| BENEFICIAL INT. IN CHOC FND. | 107118 |
| INVESTMENT IN OCMRRG | 494875 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 6551507 | TotalBookValueOtherAssets |
| Federal Income Tax Liability | 0 | FederalIncomeTaxLiability |
Other Liabilities OtherLiabilities (3 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| DUE TO CHC | $41,667 |
| DUE TO CHOC | $1,735,025 |
| LONG TERM ACCRUED TAIL COVERAGE | $234,686 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 2011378 | TotalOfAmounts |
| Footnote In Part XIII | X | FootnoteInPartXIII |
| Tot Revenue Etc Audited Fincl Stmt | 57468804 | TotRevenueEtcAuditedFinclStmt |
| Net Unrealized Gains Investments | 236039 | NetUnrealizedGainsInvestments |
| Other Revenues | 86168 | OtherRevenues |
| Revenue Not Rptd F990 | 322207 | RevenueNotRptdF990 |
| Revenue Subtotal | 57146597 | RevenueSubtotal |
| Other Revenues Not Included | 39989 | OtherRevenuesNotIncluded |
| Revenue Not Rptd On Fin Stmt | 39989 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 57186586 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 53241136 | TotExpensesEtcAuditedFinclStmt |
| Expenses Subtotal | 53241136 | ExpensesSubtotal |
| Total Expenses Per Form990 | 53241136 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIII Form990ScheduleDPartXIII (2 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| other changes in net assets | form 990, schedule d, part XI, Line 2D | Change in beneficial interest in CHOC Foundation - 86,168 form 990, schedule d, part XI, Line 4b Contribution revenue not reported on audited financial statements - 17,989 Medical staff deposit not reported on audited financial statements - 22,000 -------- 39,989 |
| ASC 740 | Form 990, Schedule D, Part X | ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE THE ORGANIZATION'S MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE ORGANIZATION AND RECOGNIZE A TAX LIABILITY IF THE ORGANIZATION HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE INTERNAL REVENUE SERVICE. MANAGEMENT HAS ANALYZED TAX POSITIONS TAKEN BY THE ORGANIZATION AND HAS CONCLUDED THAT AS OF JUNE 30, 2013, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY OR DISCLOSURE IN THE FINANCIAL STATEMENTS. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | true | CharityCarePolicy |
| Written Policy | true | WrittenPolicy |
| Policy Applied To All Hospitals | X | PolicyAppliedToAllHospitals |
| FPG Reference Free Care | true | FPGReferenceFreeCare |
| Pcent200 | X | Pcent200 |
| FPG Reference Discounted Care | true | FPGReferenceDiscountedCare |
| Pcent400 | X | Pcent400 |
| Free Disc Care Medically Indigent | true | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | true | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | false | ExpensesExceededBudget |
| Annual Community Benefit Report | true | AnnualCommunityBenefitReport |
| Report Publically Available | true | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 209034 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 209034 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00390 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 13368400 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 9865381 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 3503019 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.06580 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 13577434 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 9865381 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 3712053 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.06970 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 13577434 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 9865381 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 3712053 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.06970 | PercentOfTotalExpense |
Community Support CommunitySupport
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 9 | NumberOfActivitiesOrPrograms |
| Total Community Building Expense | 8947 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 8947 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00020 | PercentOfTotalExpense |
Total Total
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 9 | NumberOfActivitiesOrPrograms |
| Total Community Building Expense | 8947 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 8947 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00020 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | true | BadDebtExpenseReported |
| Bad Debt Expense | $5,333,168 | BadDebtExpenseAmount |
| Amount Attributable To | 0 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 0 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 0 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | 0 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | X | CostToChargeRatio |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | true | WrittenDebtCollectionPolicy |
| Provision For Charity Care | true | ProvisionForCharityCare |
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CHILDREN'S HOSPITAL AT MISSION | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 27700 MEDICAL CENTER ROAD | AddressLine1 |
| City | MISSION VIEJO | City |
| State | CA | State |
| ZIP Code | 92691 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| Childrens Hospital | X | ChildrensHospital |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CHILDREN'S HOSPITAL AT MISSION | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| CHNA Conducted | true | CHNAConducted |
| Community Definition | X | CommunityDefinition |
| Community Demographics | X | CommunityDemographics |
| Existing Resources | X | ExistingResources |
| How Data Obtained | X | HowDataObtained |
| Community Health Needs | X | CommunityHealthNeeds |
| Other Health Issues | X | OtherHealthIssues |
| Identifying Process | X | IdentifyingProcess |
| Consulting Process | X | ConsultingProcess |
| Information Gaps | X | InformationGaps |
| Needs Assessment Conducted | 10 | NeedsAssessmentConducted |
| Take Into Account | true | TakeIntoAccount |
| Other Facilities | true | OtherFacilities |
| CHNA Widely Available | true | CHNAWidelyAvailable |
| Own Website | X | OwnWebsite |
| On Request | X | OnRequest |
| Adopt Implement Strategy | X | AdoptImplementStrategy |
| Execute Implement Strategy | X | ExecuteImplementStrategy |
| Adopt Budget | X | AdoptBudget |
| Prioritize Health Needs | X | PrioritizeHealthNeeds |
| Prioritize Services | X | PrioritizeServices |
| All Needs Addressed | false | AllNeedsAddressed |
| Organization Incur Excise Tax | false | OrganizationIncurExciseTax |
| Eligibility Criteria Explained | true | EligibilityCriteriaExplained |
| Uses FPG Free | true | UsesFPGFree |
| FPG Free Percent | 200. | FPGFreePercent |
| Uses FPG Discounted | true | UsesFPGDiscounted |
| FPG Discount Percent | 400. | FPGDiscountPercent |
| Explains Basis | true | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Asset Level | X | AssetLevel |
| Medical Indigency | X | MedicalIndigency |
| Explains Application Method | true | ExplainsApplicationMethod |
| Includes Publicity Measures | true | IncludesPublicityMeasures |
| Posted On Website | X | PostedOnWebsite |
| Posted In Emergency Room | X | PostedInEmergencyRoom |
| Posted In Admission Office | X | PostedInAdmissionOffice |
| Provided On Admission | X | ProvidedOnAdmission |
| Available On Request | X | AvailableOnRequest |
| Actions On Nonpayment | true | ActionsOnNonpayment |
| Collection Activities | false | CollectionActivities |
| Notify Upon Admission | X | NotifyUponAdmission |
| Notify Before Discharge | X | NotifyBeforeDischarge |
| Notified All Patients | X | NotifiedAllPatients |
| Documented Determination | X | DocumentedDetermination |
| Nondiscrim Emergency Care Policy | true | NondiscrimEmergencyCarePolicy |
| Used Other Method | X | UsedOtherMethod |
| Amounts Generally Billed | false | AmountsGenerallyBilled |
| Gross Charges | false | GrossCharges |
Form990 Schedule H Part VI Form990ScheduleHPartVI (10 entries)
| IdentifierIdentifier | ExplanationExplanation | Return ReferenceReturnReference |
|---|---|---|
| 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) 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, CCMH recognized revenues under this program of $1,162,000 and Provider Fees and other expenses totaling $632,000. 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. CCMH recognized revenues of $1,971,000 for each of the 12 month periods for a total revenue of $3,942,000 and Provider Fees and other expenses of $1,072,000 for each 12 month period for total expenses of $2,144,000. 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. The result is that the unreimbursed Medi-Cal of Part I, line 7B is lower than in prior years. | |
| SCHEDULE H, PART II | 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. | Community building activities |
| 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 CCMH'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 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 CCMH'S BEST ESTIMATE OF THE AMOUNT OF PROBABLE CREDIT LOSSES IN CCMH'S EXISTING PATIENT ACCOUNTS RECEIVABLE. CCMH DETERMINES THE ALLOWANCE BASED ON HISTORICAL WRITE-OFF EXPERIENCE. CCMH REVIEWS ITS ALLOWANCE FOR DOUBTFUL ACCOUNTS ON A MONTHLY BASIS. 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 INCREASE 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 CASES BEYOND ONE YEAR FROM DATE OF SERVICE. | |
| SCHEDULE H, PART III, LINE 8 | AS A CHILDREN'S HOSPITAL, CCMH MEDICARE ALLOWABLE COSTS ARE ZERO. THEREFORE THERE IS NO AMOUNT ENTERED ON LINE PART III LINE 6 AND NO MEDICARE SHORTFALL REPORTED ON LINE 7. 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, CCMH 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 CCMH 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, CCMH WILL NOT USE WAGE GARNISHMENTS OR LIENS ON PATIENT'S OR PATIENT FAMILY'S PRIMARY RESIDENCE AS A MEANS OF COLLECTING UNPAID CCMH BILLS. THIS REQUIREMENT DOES NOT PRECLUDE CCMH 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 5A 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". CCMH's core mission is the provision of health care to the pediatric population; while CCMH did not explicitly develop plans to address child health and academic achievement, per se, CCMH 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 the fee-for-service Medi-Cal rate. The rate is determined annually by the allowable cost-to-charge ratio as determined by the annual Medi-Cal cost report. | |
| SCHEDULE H, PART VI, LINE 2 | IN ADDITION TO THE TRI-ANNUAL COMMUNITY HEALTH NEEDS ASSESSMENT, CCMH 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, CCMH 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. | Needs Assessment: |
| SCHEDULE H, PART VI, LINE 3 | 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. | PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE: |
| SCHEDULE H, PART VI, LINE 4 | COMMUNITY INFORMATION: THE HOSPITAL SERVES ALL OF ORANGE COUNTY AND A LIMITED 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 SOUTHERN PORTION OF ORANGE COUNTY, AND IS THE SOURCE OF APPROXIMATELY 86% OF ITS PATIENTS. SIGNIFICANT CITIES IN THIS AREA ARE: MISSION VIEJO, SAN CLEMENTE, SAN JUAN CAPISTRANO, LAGUNA NIGUEL, AND ALISO VEIJO. 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 48.1%. 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 OF ORANGE COUNTY - ORANGE, 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, 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 VIEJO, CALIFORNIA MISSION HOSPITAL - LAGUNA BEACH - LAGUNA BEACH, CALIFORNIA NEWPORT BAY HOSPITAL - NEWPORT BEACH, CALIFORNIA NEWPORT SPECIALTY HOSPITAL - TUSTIN, CALIFORNIA ORANGE COAST MEMORIAL MEDICAL CENTER - FOUNTAIN VALLEY, CALIFORNIA PLACENTIA-LINDA COMMUNITY HOSPITAL - PLACENTIA, CALIFORNIA SADDLEBACK MEMORIAL MEDICAL CENTER - SAN CLEMENTE, CALIFORNIA SAN CLEMENTE HOSPITAL AND MEDICAL CENTER - SAN CLEMENTE, CALIFORNIA ST. JOSEPH HOSPITAL - ORANGE, CALIFORNIA ST. JUDE MEDICAL CENTER - FULLERTON, CALIFORNIA TUSTIN REHABILITATION HOSPITAL - TUSTIN, CALIFORNIA UNIVERSITY OF CALIFORNIA, IRVINE MEDICAL CENTER - ORANGE, CALIFORNIA WESTERN MEDICAL CENTER - ANAHEIM, CALIFORNIA WESTERN MEDICAL CENTER - SANTA ANA, CALIFORNIA | |
| 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. CCMH ALSO OFFERS PEDIATRIC TRAUMA SERVICES TO THE COMMUNITY. THE ORGANIZATION IS COMPRISED OF TWO HOSPITALS; SEVERAL PRIMARY AND SPECIALTY CLINICS, PROGRAMS AND SERVICES; AND FOUR CENTERS OF EXCELLENCE, THE CHOC HEART, NEUROSCIENCE, ONCOLOGY AND ORTHOPAEDIC INSTITUTES. CHOC ALSO HAS A RESEARCH INSTITUTE PERFORMING BASIC SCIENCE AND CLINICAL RESEARCH. THROUGH ITS RESIDENCY PROGRAM, 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: SECTION 1. NATURE OF MEDICAL STAFF MEMBERSHIP MEMBERSHIP ON THE MEDICAL STAFF OF CHOC CHILDREN'S AT MISSION HOSPITAL IS A PRIVILEGE THAT SHALL BE EXTENDED ONLY TO PROFESSIONALLY COMPETENT PRACTITIONERS WHO CONTINUOUSLY MEET THE QUALIFICATIONS, STANDARDS AND REQUIREMENTS SET FORTH IN THESE BYLAWS. A PRACTITIONER MAY ADMIT OR PROVIDE SERVICES TO PATIENTS IN THE HOSPITAL ONLY IF THE PRACTITIONER IS A MEMBER OF THE MEDICAL STAFF OR HAS BEEN GRANTED TEMPORARY PRIVILEGES IN ACCORDANCE WITH THE BYLAWS, RULES AND REGULATIONS. APPOINTMENT TO THE MEDICAL STAFF SHALL CONFER ONLY SUCH CLINICAL PRIVILEGES AND PREROGATIVES AS HAVE BEEN GRANTED IN ACCORDANCE WITH THESE BYLAWS. SECTION 2. QUALIFICATIONS FOR MEMBERSHIP A. ONLY PRACTITIONERS WHO HOLD AN UNRESTRICTED LICENSE TO PRACTICE MEDICINE, DENTISTRY, PODIATRY OR CLINICAL PSYCHOLOGY IN THE STATE OF CALIFORNIA, WHO CAN DOCUMENT THE FOLLOWING WITH SUFFICIENT ADEQUACY TO ASSURE THE MEDICAL STAFF AND THE GOVERNING BODY THAT ANY PATIENT TREATED BY THEM IN THE HOSPITAL WILL RECEIVE CARE OF THE GENERALLY RECOGNIZED PROFESSIONAL LEVEL AND EFFICIENCY ESTABLISHED BY THE MEDICAL STAFF AND HOSPITAL, SHALL BE QUALIFIED FOR MEMBERSHIP ON THE MEDICAL STAFF THEIR BACKGROUND; EDUCATION; EXPERIENCE; JUDGMENT; TRAINING; DEMONSTRATED CURRENT COMPETENCE; ABILITY TO COMMUNICATE INCLUDING A DEMONSTRATED PROFICIENCY IN THE ENGLISH LANGUAGE SUCH THAT THERE IS REASONABLE ASSURANCE THAT THERE WILL BE NO RISK OF MISUNDERSTANDING IN COMMUNICATION WITH ENGLISH SPEAKING COLLEAGUES, PATIENTS AND HEALTH CARE WORKERS; PHYSICAL AND MENTAL HEALTH STATUS; ADHERENCE TO THE ETHICS OF THEIR PROFESSION; GOOD REPUTATION; AND ABILITY TO WORK WITH OTHERS. NO PRACTITIONER SHALL BE ENTITLED TO MEMBERSHIP ON THE MEDICAL STAFF OR TO THE EXERCISE OF PARTICULAR CLINICAL PRIVILEGES IN THE HOSPITAL MERELY BECAUSE HE IS DULY LICENSED TO PRACTICE MEDICINE, DENTISTRY, CLINICAL PSYCHOLOGY OR PODIATRY IN THIS OR IN ANY OTHER STATE, HOLDS A CERTAIN DEGREE, IS CERTIFIED BY ANY CLINICAL BOARD, OR THAT HE IS A MEMBER OF SOME PROFESSIONAL ORGANIZATION, OR THAT HE HAD IN THE PAST, OR PRESENTLY HAS SUCH PRIVILEGES AT ANOTHER HOSPITAL INCLUDING BUT NOT LIMITED TO MISSION HOSPITAL OR CHOC CHILDREN'S (CHOC). NO APPLICANT SHALL BE DENIED MEMBERSHIP ON THE BASIS OF SEX, SEXUAL ORIENTATION, RACE, RELIGION, ANCESTRY, AGE, CREED, COLOR, NATIONAL ORIGIN, MARITAL STATUS, HANDICAP OR DISABILITY (EXCEPT TO THE EXTENT THE HANDICAP OR DISABILITY PREVENTS THE PRACTITIONER FROM PERFORMING ESSENTIAL FUNCTIONS OR POSES A HEALTH OR SAFETY RISK TO THE PRACTITIONER OR OTHERS AND THE HANDICAP OR DISABILITY CANNOT BE REASONABLY ACCOMMODATED OR ON THE BASIS OF ANY OTHER CRITERION THAT IS NOT RELATED TO AN INDIVIDUAL'S PROFESSIONAL CAPABILITIES (CHOC CHILDREN'S AT MISSION HOSPITAL MEDICAL STAFF BYLAWS (2/23/09), PAGE 6 ). B. ONLY PRACTITIONERS WHO MAINTAIN IN FORCE PROFESSIONAL LIABILITY INSURANCE IN NOT LESS THAN THE MINIMUM AMOUNTS JOINTLY DETERMINED BY THE GOVERNING BODY AND THE MEDICAL STAFF EXECUTIVE COMMITTEE, BUT IN NO EVENT LESS THAN $1.0 MILLION PER INCIDENT AND $3.0 MILLION IN THE AGGREGATE IN A POLICY YEAR, SHALL BE QUALIFIED FOR MEMBERSHIP ON THE MEDICAL STAFF. THE INSURANCE MUST COVER ALL PRIVILEGES THE PRACTITIONER IS GRANTED BY THE GOVERNING BODY. A CARRIER ADMITTED TO DO BUSINESS IN CALIFORNIA OR A MUTUAL COOPERATIVE TRUST MUST PROVIDE THE INSURANCE. INFORMATION REGARDING EACH APPLICANT'S AND MEMBER'S INSURANCE COVERAGE MUST BE PROVIDED IN THE FORM OF A CURRENT CERTIFICATE OF INSURANCE WHICH SHALL BE MAINTAINED IN EACH PRACTITIONER'S CREDENTIALS FILE. INFORMATION REGARDING INSURANCE COVERAGE MUST BE PROVIDED AT THE TIME OF APPOINTMENT AND REAPPOINTMENT AND IMMEDIATELY UPON RECEIPT OF EACH ANNUAL RENEWAL CERTIFICATE. EACH MEMBER SHALL REPORT TO THE MEDICAL STAFF SERVICES OFFICE ANY REDUCTION, RESTRICTION, CLAIMS, CANCELLATION OR TERMINATION OF THE REQUIRED PROFESSIONAL LIABILITY INSURANCE OR CHANGE IN CARRIER IMMEDIATELY UPON THE NOTICE OF ACTION OR CHANGE. C. ACCEPTANCE OF MEMBERSHIP ON THE MEDICAL STAFF SHALL CONSTITUTE THE STAFF MEMBER'S CERTIFICATION THAT HE HAS IN THE PAST, AND HIS AGREEMENT THAT HE WILL IN THE FUTURE, BEHAVE ACCORDING TO ETHICAL PRINCIPLES APPLICABLE TO HIS PROFESSION, AND WILL ABIDE BY ALL STATE AND FEDERAL LAWS AND REGULATIONS GOVERNING THE PROFESSION, INCLUDING, BUT NOT LIMITED TO, MEDICARE/MEDICAID LAWS AND REGULATIONS. FURTHER, ALL MEMBERS OF THE MEDICAL STAFF SHALL PLEDGE THAT THEY WILL NOT RECEIVE FROM, OR PAY TO ANOTHER PHYSICIAN, DENTIST, CLINICAL PSYCHOLOGIST OR PODIATRIST, EITHER DIRECTLY OR INDIRECTLY, ANY PART OF A FEE RECEIVED FOR PROFESSIONAL SERVICES AND THEY WILL NOT DECEIVE A PATIENT AS TO THE IDENTITY OF AN OPERATING SURGEON, OR ANY OTHER MEDICAL PRACTITIONER PROVIDING TREATMENT. D. A PRACTITIONER APPLYING FOR APPOINTMENT TO THE MEDICAL STAFF AND FOR THE GRANTING OR EXTENSION OF CLINICAL PRIVILEGES MUST HAVE BEEN OR BECOME, WHICHEVER IS APPROPRIATE, CERTIFIED BY THE NATIONAL SPECIALTY BOARD PERTAINING TO THE PRACTITIONER'S CLINICAL PRIVILEGES OF THE AMERICAN BOARD OF MEDICAL SPECIALTIES, THE AMERICAN OSTEOPATHIC ASSOCIATION, OR THE AMERICAN BOARD OF DENTISTRY WITHIN FIVE (5) YEARS FROM THE COMPLETION OF THE PRACTITIONER'S TRAINING PROGRAM. BOARD CERTIFICATION MUST CORRESPOND TO THE CLINICAL PRIVILEGES REQUESTED AND PROGRAM COMPLETED. AN EXTENSION OF THIS TIME PERIOD OR EXEMPTION FROM THESE REQUIREMENTS WILL BE GRANTED ONLY UNDER EXTRAORDINARY CIRCUMSTANCES AND FOR DEMONSTRATED GOOD CAUSE AS DETERMINED SOLELY AT THE DISCRETION OF THE MEDICAL STAFF EXECUTIVE COMMITTEE AND THE GOVERNING BODY. IF THE MEDICAL STAFF APPLICANT OR MEMBER IS REQUIRED BY THE SPECIALTY BOARD TO RE-CERTIFY IN ORDER TO MAINTAIN BOARD CERTIFICATION, THE PRACTITIONER MUST BECOME RE-CERTIFIED IN ORDER TO OBTAIN AND/OR MAINTAIN MEDICAL STAFF MEMBERSHIP AND CLINICAL PRIVILEGES UNLESS EXEMPTED BY THE ABOVE PARAGRAPH. CURRENT MEMBERS OF THE MEDICAL STAFF WHO WERE NOT, AS OF DATE OF ADOPTION OF THIS AMENDMENT, BOARD CERTIFIED OR PROGRESSING TOWARD BOARD CERTIFICATION, AND WHO CANNOT REASONABLY BE EXPECTED TO PURSUE BOARD CERTIFICATION, MAY BE CONSIDERED FOR RENEWAL OF MEDICAL STAFF MEMBERSHIP IF THEY CAN DOCUMENT SUFFICIENT TRAINING, EXPERIENCE, AND COMPETENCE, AND OTHERWISE MEET THE REQUIREMENTS OF MEDICAL STAFF MEMBERSHIP. E. PHYSICIANS WHO ARE RESIDENTS OR FELLOWS IN GRADUATE MEDICAL EDUCATION PROGRAMS AND WHO ARE ASSIGNED TO RESIDENCY OR FELLOWSHIP ROTATIONS AT CHOC CHILDREN'S AT MISSION HOSPITAL OR MISSION HOSPITAL SHALL NOT BY VIRTUE OF SUCH ASSIGNMENT BE CONSIDERED MEMBERS OF THE MEDICAL STAFF WHILE FUNCTIONING IN THEIR ROLES AS RESIDENTS OR FELLOWS. THE ORGANIZATION APPLIES ITS SURPLUS FUNDS TO PLANNED CAPITAL PROJECTS TO FURTHER COMMUNITY ACCESS TO HEALTH CARE. EXCESS FUNDS, IF ANY, ARE TRANSFERRED TO CHC, THE SOLE MEMBER OF THE CORPORATION, IN ACCORDANCE WITH THE ORGANIZATION'S BYLAWS. | |
| SCHEDULE H, PART VI, LINE 6 | AFFILIATED HEALTH CARE SYSTEM: CCMH AND CHOC ARE MEMBERS OF A TWO-HOSPITAL SYSTEM. BOTH HOSPITALS HAVE A SOLE CORPORATE MEMBER, CHILDREN'S HEALTHCARE OF CALIFORNIA, THAT PROVIDES MANAGEMENT SERVICES TO BOTH HOSPITALS. THE HOSPITALS SHARE A COMMON MISSION AND ARE STRATEGICALLY ALIGNED IN THEIR EFFORT TO MEET THE HEALTHCARE NEEDS OF THE COMMUNITY. SCHEDULE H, PART VI, LINE 7 A COMMUNITY BENEFIT REPORT IS FILED ANNUALLY IN THE STATE OF CALIFORNIA. |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | true | RecordsMaintained |
Recipient Table RecipientTable
Recipient Name Business RecipientNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CHILDREN'S HEALTHCARE OF CALIFORNIA | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1201 West La Veta Avenue | AddressLine1 |
| City | orange | City |
| State | CA | State |
| ZIP Code | 92868 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN Of Recipient | 330265266 | EINOfRecipient |
| IRC Section | 501(c)(3) | IRCSection |
| Amount Of Cash Grant | 6100000 | AmountOfCashGrant |
| Method Of Valuation | N/A | MethodOfValuation |
| Description Of Non Cash Assistance | N/A | DescriptionOfNonCashAssistance |
| Purpose Of Grant | Support | PurposeOfGrant |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Nbr Of501 C3 And Govt Grants | 1 | TotalNbrOf501C3AndGovtGrants |
Form990 Schedule I Part IV Form990ScheduleIPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Procedure for monitoring the use of grant funds - part i, line 2 | Identifier |
| Explanation | Grant funds are monitored for appropriate use per the specific grant agreements. The grant expenditures are consistently tracked and reconciled per existing policies and procedures. | Explanation |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | X | CompensationCommittee |
| Independent Consultant | X | IndependentConsultant |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | true | SeverancePayment |
| Supplemental Nonqual Retire Plan | true | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | false | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | false | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | false | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | false | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | false | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | false | AnyNonFixedPayments |
| Initial Contract Exception | false | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (9 entries)
| TitleTitle | Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| KIMBERLY C CRIPE | ||||||||||||||
| DIRECTOR/PRESIDENT | 0 | 751203 | 0 | 236120 | 0 | 233350 | 0 | 57454 | 0 | 22864 | 0 | 1300991 | 0 | 78602 |
| KERRI RUPPERT SCHILLER | ||||||||||||||
| CFO/Assistant Secretary | 0 | 456740 | 0 | 101469 | 0 | 53281 | 0 | 103915 | 0 | 22864 | 0 | 738269 | 0 | 79435 |
| DEBRA MATHIAS | ||||||||||||||
| EXEC. VICE PRESIDENT/COO | 0 | 436877 | 0 | 117998 | 0 | 181921 | 0 | 6145 | 0 | 11573 | 0 | 754514 | 0 | 80355 |
| MARCIA FOLLI | ||||||||||||||
| VICE PRESIDENT/CNO | 207627 | 0 | 36303 | 0 | 32186 | 0 | 49067 | 0 | 0 | 0 | 325183 | 0 | 32042 | 0 |
| BONNIE GRAVETT | ||||||||||||||
| Clinical Nurse III | 142298 | 0 | 0 | 0 | 10918 | 0 | 8337 | 0 | 16059 | 0 | 177612 | 0 | 0 | 0 |
| Elizabeth Drake | ||||||||||||||
| Clinical Nurse II | 126547 | 0 | 202 | 0 | 10512 | 0 | 7631 | 0 | 6104 | 0 | 150996 | 0 | 0 | 0 |
| Linda Starn | ||||||||||||||
| Director Patient care services | 135887 | 0 | 11133 | 0 | 11124 | 0 | 3752 | 0 | 6070 | 0 | 167966 | 0 | 0 | 0 |
| Karen McGurk-Mish | ||||||||||||||
| NURSE MANAGER | 136294 | 0 | 2000 | 0 | 10777 | 0 | 8216 | 0 | 16059 | 0 | 173346 | 0 | 0 | 0 |
| Eva Esmaeili | ||||||||||||||
| NURSE MANAGER | 125700 | 0 | 0 | 0 | 10438 | 0 | 7580 | 0 | 15593 | 0 | 159311 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII (3 entries)
| IdentifierIdentifier | ExplanationExplanation | Return ReferenceReturnReference |
|---|---|---|
| Severance Arrangements, 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. One executive listed on schedule J, part II, received severance payments in calendar year 2012. The payment was received by Debra Mathias ($125,969). | |
| Supplemental Nonqualified Retirement Plan | Children's Hospital of Orange County (CHOC or the Company) established a nonqualified deferred compensation plan effective January 1, 2010 in which certain individuals listed on the form 990, Part VII and Schedule J are participants. Under the established Supplemental Executive Retirement Plan (the Plan) or serp, for each Plan year that begins prior to the participant's cash date, CHOC shall create a new SERP account on its books for the Participant and shall credit to such account at times specified. The participants of the plan are general creditors of the company. The participant's SERP account shall be utilized solely as a device for the measurement and determination of the amounts to be paid to the participant under this plan. The participant is entitled to his/her SERP benefit amount upon the earliest of (1) remaining employed with the Company to the third anniversary of the first day of the Plan Year for which the SERP account was created; (2) remaining employed with the Company to the Participant's 60th birthday; (3) remaining employed with the Company to the date the Participant has both attained at least age 55 and has completed at least 10 years of service; (4) disability; (5) involuntary separation from service without reasonable cause; (6) voluntary separation from service for good reason or (7) death. The following individual received payments from the Plan during calendar year 2012: Ms. Cripe ($149,013). | Part I, Line 4B |
| 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 5% of her time each week to Children's Hospital at Mission 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 10% of her time each week to Children's Hospital at Mission 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 Secion 501(c)(3) affiliates). Ms. Mathias devotes approximately 11% of her time each week to Children's Hospital at Mission responsibilities with the balance of her time being spent on Children's Hospital of Orange County business affairs. |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (3 entries)
| IdentifierIdentifier | ExplanationExplanation |
|---|---|
| Form 990, Part I, Line 5 and Part V, Line 2 | Children's Hospital of Orange County (CHOC) acts as a common paymaster, issuing forms W-2 and 1099 on behalf of Children's Hospital at Mission. Children's Hospital at Mission has 140 employees, however because of the common paymaster arrangement resulting in the forms W-2 being issued under CHOC's employer identification number, there are no W-2s issued directly by Children's Hospital at Mission. Lines 6 & 7a - Organization Member Information The sole member of Children's Hospital at Mission (CHM) 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 CCMH; (2) Obligating CCMH to undertake any capital expenditure in excess of $5,000,000; (3) Adopting CCMH'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 CCMH to act as guarantor with respect to any debt of any person or other entity; (8) Accepting any donation which is conditioned upon CCMH'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 CCMH in an amount in excess of $5,000,000, (b) any purpose or activity which is outside the scope of CCMH's ordinary course of business, or (c) a term in excess of five years (unless the contract is terminable at will); (10) involving CCMH in any merger, acquisition, corporate restructuring, or formal affiliation; (11) Involving CCMH as a member, shareholder, or partner in any new corporation, partnership, or other legal entity; (12) Dissolving CCMH; (13) Entering into any transaction involving the sale, lease, conveyance, exchange, transfer or other disposition of all or substantially all of CCMH's assets; (14) Amending CCMH'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 | Line 11B - PROCESS OF REVIEW 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 - MONITORING/ENFORCING COMPLIANCE OF CONFLICT OF INTEREST POLICY The Compliance Officer is charged with monitoring proposed or ongoing transactions for conflicts of interest and addressing any potential or actual conflicts. Pursuant to the conflict of interest policy, an annual conflict of interest questionnaire, aimed at determining any family and business relationships and transactions or other transactions that may pose a potential conflict, is distributed to all covered persons (i.e., board members, officers and executive leadership or key employees). Covered persons are required to disclose real or potential 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 CHOC 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 XI, Line 5 Change in Beneficial interest in CHOC FND - $ 86,168 Contribution revenue not reported on audited financial statements - (17,989) Medical staff deposit not reported on audited financial statements - (22,000) -------- $ 46,179 |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (5 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Controlled OrgControlledOrg |
|---|---|---|---|---|---|---|---|---|---|---|
| CHILDREN'S HOSPITAL OF ORANGE COUNTY | ||||||||||
| 1201 West La Veta Avenue | ORANGE | CA | 92868 | 952321786 | 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 |
| CHILDREN'S HEALTHCARE OF CALIFORNIA(CHC) | ||||||||||
| 1201 West La Veta Avenue | ORANGE | CA | 92868 | 330265266 | HEALTH CARE | CA | 501(c)(3) | 7 | NA | false |
| choc thrift stores inc | ||||||||||
| 455 S MAIN STREET | orange | CA | 92868 | 330266422 | Fund Raising | CA | 501(c)(3) | 9 | CHC | false |
Form990 Schedule R Part IV Form990ScheduleRPartIV
Name Of Related Org NameOfRelatedOrg
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Orange County MEDICAL RECIPROCAL INS CO | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2999 North 4th Street Suite 250 | AddressLine1 |
| City | phoenix | City |
| State | AZ | State |
| ZIP Code | 85108 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 201620666 | EIN |
| Primary Activity | Insurance | PrimaryActivity |
| Legal Domicile State | AZ | LegalDomicileState |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CHOC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Type Of Entity | C Corp | TypeOfEntity |
| Share Of Total Income | 54452 | ShareOfTotalIncome |
| Share Of EOY Assets | 3049467 | ShareOfEOYAssets |
| Percentage Ownership | 0.50000 | PercentageOwnership |
| Controlled Org | true | ControlledOrg |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | false | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | true | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | false | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | false | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | false | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | false | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | false | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | false | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | false | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | false | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | true | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | false | SharingOfFacilities |
| Sharing Of Paid Employees | false | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | false | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | false | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | false | OtherTransferToOtherOrg |
| Other Transfer From Other Org | false | OtherTransferFromOtherOrg |
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