2013-05-15T17:15:10-05:00 2012-06-30 KPMG LLP 355 S Grand Ave Suite 2000 Los Angeles CA 90071 990 2011-07-01 330528802 CHILDREN'S HOSPITAL AT MISSION % DONALD NOBLE CHIL 7149973000 455 S MAIN STREET ORANGE CA 928683874 KERRI RUPPERT SCHILLER 2013-05-14 true 2139724000 2011 2016-02-25 16:41:14Z CHOC Children's at Mission Hospital KIMBERLY C CRIPE 455 S MAIN STREET ORANGE CA 928683874 58796458 false X WWW.CHOC.ORG X 1991 CA TO NURTURE, ADVANCE, & PROTECT THE HEALTH AND WELL-BEING OF CHILDREN. 17 16 141 126 0 0 175182 80467 54151956 58573208 43166 75529 328 67254 54370632 58796458 2400000 600000 0 0 11688670 11288076 0 0 0 41693238 38525431 55781908 50413507 -1411276 8382951 38947731 38403781 15785951 6792016 23161780 31611765 TO NURTURE, ADVANCE, & PROTECT THE HEALTH AND WELL-BEING OF CHILDREN. false false 47826854 600000 58573208 Facility provides specialized pediatric services for the medical/surgical care of children from birth to age 18. There were 7,743 inpatient care days; 17,075 emergency room visits; 827 surgeries and 6,566 outpatient visits. See our complete community benefit report on our website at www.choc.org. 47826854 true true false false false false false false false false true false false true true true true true false false false false false false false false true true true false true false false false false false false false false false false false false false true false false false false true X 7 0 true 141 true false false false false false false false false false false X 17 16 false false true false true true true true true false false true true true true true true true true false CA X DONALD NOBLE 7149973000 455 S MAIN STREET ORANGE CA 928683874 X KIMBERLY C CRIPE 2.0 X X 0 1225790 77828 RALPH CLAYMAN MD 1.0 X 0 0 0 JEFF ELGHANAYAN 1.0 X X 0 0 0 WILLIAM GURTNER 1.0 X 0 0 0 MUSTAFA KABEER MD 1.0 X 0 0 0 JAY KEAR 1.0 X X 0 0 0 DOUGLAS MCCOMBS 1.0 X X 0 0 0 MARK STEVENS 1.0 X X 0 0 0 MAUREEN ZEHNTNER 1.0 X 0 0 0 JANET T DAVIDSON 1.0 X 0 0 0 MARSHALL ROWEN MD 1.0 X 0 0 0 DAVID DUKES 1.0 X 0 0 0 JOE DUNN 1.0 X 0 0 0 GEORGE KALOGRIDIS 1.0 X 0 0 0 TIM RISTOFF 1.0 X 0 0 0 vijay Dhar MD 1.0 X 0 0 0 thomas tierney 1.0 X 0 0 0 KERRI RUPPERT SCHILLER 4.0 X 0 593059 109936 DEBRA MATHIAS 4.5 X 0 580844 108489 MARCIA FOLLI 40.0 X 265316 0 45156 BONNIE GRAVETT 40.0 X 164697 0 24507 Elizabeth Drake 40.0 X 133645 0 18701 paula castano 40.0 X 132753 0 17980 Linda Starn 40.0 X 138999 0 9098 Michelle Spensiero 40.0 X 121943 0 10991 957353 2399693 422686 21 false true false PEDIATRIC SUBSPECIALTY FACULTY 455 SOUTH MAIN ST ORANGE CA 92868 Medical Dir & Serv 791107 COMFORCE TECHNICAL SERVICES PO BOX 31001-0893 PASADENA CA 91110 TEMPORARY STAFFING 284635 Pediatric Surgical Associates 1120 W LA VETA AVENUE SUITE 100 ORANGE CA 92868 Medical Dir & Serv 212496 Neurosurgical Specialists Inc 24 Jewel flower IRVINE CA 92603 Medical Dir & Serv 109500 4 80467 80467 NET PATIENT SERVICES 621400 58427946 58427946 CLINIC RENTAL INCOME 900099 145262 145262 58573208 75529 0 75529 0 0 0 0 0 0 MEDICAL STAFF DEPOSITS 900099 62556 62556 MISCELLANEOUS REVENUE 900099 4698 4698 67254 58796458 58573208 0 142783 600000 600000 0 0 0 238032 238032 0 8872232 7985009 887223 298351 268516 29835 1215584 1094026 121558 663877 597489 66388 8873088 7985779 887309 17710 17710 33999 30599 3400 0 0 0 2303327 2072994 230333 0 161512 145361 16151 636122 572510 63612 0 1581901 1423711 158190 13717 12345 1372 0 3386 3047 339 0 0 654758 589282 65476 338781 304903 33878 PURCHASED SRVS OTHR HOSP. 18810362 18810362 PROVISION FOR BAD DEBT 3783561 3783561 LEGAL SETTLEMENT 27215 27215 PROVIDER PROGRAM FEE 1247199 1247199 38793 34914 3879 50413507 47826854 2586653 0 188473 240756 11205876 10392839 0 0 14077894 12276523 0 0 0 0 0 0 0 0 896759 303864 15470046 8325706 6209605 7144340 0 0 0 0 0 0 0 0 6369124 8045459 38947731 38403781 3906214 3564677 0 0 7144624 1239010 0 0 0 0 0 0 0 0 0 0 4735113 1988329 15785951 6792016 X 22089612 30509505 1072168 1102260 0 0 23161780 31611765 38947731 38403781 X 8382951 67034 X false true true X false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 8577508 4284090 4293418 5444555 4041616 1402939 1447983 1447983 7144340 GOODWILL NET OF AMORTIZATION 5737500 RECEIVABLE FROM THIRD-PARTY 1962704 NICU SUNK COSTS, NET OF AMORT. 63179 I/C RECEIVABLE CHOC 2289 BENEFICIAL INT. IN CHOC FND. 20951 INVESTMENT IN OCMRRG 258836 8045459 0 DUE TO CHC 41667 DUE TO CHOC 1711976 LONG TERM ACCRUED TAIL COVERAGE 234686 1988329 58796458 50413507 8382951 69403 -2369 67034 8449985 58863492 69403 69403 58794089 2369 2369 58796458 50413507 50413507 50413507 other changes in net assets form 990, schedule d, part XI, line 8 & part XII, Line 4B Change in beneficial interest in CHOC Foundation (2,369) 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, 2012, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY OR DISCLOSURE IN THE FINANCIAL STATEMENTS. true true X true X true X true true false true true 226871 0 226871 0.00490 15432298 9373110 6059188 0.12990 15659169 9373110 6286059 0.13480 15659169 9373110 6286059 0.13480 7 11987 11987 0.00030 7 11987 11987 0.00030 false 1582169 0 0 0 0 X true true 1 1 CHILDREN'S HOSPITAL AT MISSION

27700 MEDICAL CENTER ROAD MISSION VIEJO CA 92691

X X CHILDREN'S HOSPITAL AT MISSION 1 true true 200. true 400. true X X X true true X X X X true false true X false false 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, COLUMN (F) THE BAD DEBT EXPENSE INCLUDED IN FORM 990, PART IX, LINE 25 BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $3,783,561. 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 of two California programs to impose a provider fee on hospitals that, combined with federal matching funds, has been used to provide supplemental Medi-Cal payments to hospitals in the State. The first program received final approval in December 2011 and was enacted to provide supplemental Medi-Cal payments for up to six months retroactive to January 2011 and expiring on June 30, 2011. Revenues under the program of $1,710,717, and provider fees and other expenses totaling $614,766 were recognized as net patient revenue and operating expenses, respectively, in the year ended June 30, 2012. The CMS also issued final required approval of a second California provider fee program to provide supplemental Medi-Cal payments to hospitals in the State. This program was enacted to provide supplemental Medi-Cal payments for up to 30 months retroactive to July 2011 and expiring on December 31, 2013. Revenues under this program of $1,161,751, and provider fees and other expenses totaling $632,433 were recognized as net patient revenue and operating expenses, respectively, in the year ended June 30, 2012. The result is that the unreimbursed Medi-Cal on Part I Line 7B is lower than in prior years. SCHEDULE H, PART II Community building activities Community support is defined as those activities supporting community leadership. The organization has 95 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 The organization reports bad debt expense as an operating expense in accordance with U.S. GAAP. 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 will be effective with CCMH's 2012 Form 990. SCHEDULE H, PART III, LINE 4 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. 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 19D, 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 NEEDS ASSESSMENT: THE HOSPITAL PLAYED A LEADERSHIP ROLE IN THE ORANGE COUNTY HEALTH NEEDS ASSESSMENT (OCHNA). OCHNA was A COMMUNITY-BASED, NOT-FOR-PROFIT PROJECT CREATED AND DESIGNED TO MEET THE REQUIREMENTS OF SB697 FOR ALL HEALTHCARE ASSOCIATION OF SOUTHERN CALIFORNIA (HASC) MEMBER HOSPITALS IN ORANGE COUNTY,TO PRODUCE A COMPREHENSIVE, COUNTYWIDE ANALYSIS OF HEALTH NEEDS AND SERVICES. THE OCHNA PROJECT WAS A COLLABORATIVE EFFORT AND WAS JOINTLY FUNDED BY THE COUNTY OF ORANGE HEALTHCARE AGENCY AND 27 FOR-PROFIT AND NOT-FOR-PROFIT HOSPITALS, AND OTHER ORGANIZATIONS AND PROVIDERS. ITS GOAL WAS TO ACHIEVE MAXIMUM, VALID AND RELIABLE INFORMATION THAT CAN BE ANALYZED BY ZIP CODE, IN ORDER TO PROVIDE HOSPITALS WITH DATA SIGNIFICANT TO THEIR SERVICE AREAS. IN ADDITION, THIS PROCESS WAS THE BASIS OF THE COUNTYWIDE REPORT THAT WAS MADE AVAILABLE TO THE LARGER COMMUNITY OF HEALTH AND HUMAN SERVICES PROVIDERS. OCHNA STARTED DATA COLLECTION FOR ITS HEALTH ASSESSMENT IN 1997. THE LATEST SURVEY RESULTS FOR ORANGE COUNTY WERE FOR 2010 AND PUBLISHED IN THE "HEALTH NEEDS ASSESSMENT". OCHNA WAS AN ONGOING PROCESS WITH PARTICIPATION AND SUPPORT FROM HEALTHCARE PROVIDERS AND GOVERNMENT AGENCIES. THE HOSPITAL'S EXECUTIVE MANAGEMENT UTILIZED THE OCHNA HEALTH NEEDS FINDINGS TO DEVELOP THE HOSPITALS' GOALS FOR MEETING THE NEEDS INDENTIFIED IN SIX BROAD AREAS: HEALTHCARE ACCESS - INCREASE ACCESS TO QUALITY PEDIATRIC HEALTHCARE RESOURCES AND INFORMATION TO FAMILIES, ESPECIALLY LOW-INCOME AND MEDICALLY UNDERSERVED, THROUGHOUT ORANGE COUNTY. BEHAVIORAL HEALTH ACCESS - ENHANCE THE COMMUNITY'S ACCESS TO BEHAVIORAL HEALTH INFORMATION AND SERVICES, TARGETING THE UNDERSERVED. DISEASE PREVENTION - INCREASE AWARENESS OF DISEASE PREVENTION AND PROMOTE EARLY INTERVENTION OF MAJOR DISEASES THAT AFFECT THE COMMUNITY. INFORMATION RESOURCE - PROVIDE THE COMMUNITY WITH RESOURCES FOR INFORMATION AND EDUCATION OF HEALTH RISK BEHAVIORS. INJURY PREVENTION - ACTIVELY CONTRIBUTE TO REDUCING THE NUMBER OF UNINTENTIONAL INJURIES TO YOUNG CHILDREN, ESPECIALLY TARGETING LOW-INCOME, DIVERSE AND MEDICALLY UNDERSERVED POPULATIONS. COMMUNITY ACTION - ACTIVELY RECRUITS, RECOGNIZE AND ADVOCATE FOR THE IMPORTANCE OF VOLUNTEER LEADERSHIP AND COMMUNITY ASSISTANCE IN PROVIDING CARE FOR CHILDREN. 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 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. COMMUNITY CHARACTERISTICS: POPULATION AND SOCIOECONOMIC DATA PROJECTIONS FOR 2012 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 CHM. TOTAL POPULATION OF THE COUNTY WAS 3.04 MILLION, ACCORDING TO 2012 ESTIMATES, MAKING IT THE THIRD LARGEST COUNTY IN CALIFORNIA. THE MEDIAN AGE IS 35.7, AND CHILDREN UP TO 17 YEARS OF AGE MAKE UP 24.9% OF THE TOTAL POPULATION. THE LARGEST RACE/ETHNICITY SUBGROUP IS WHITE, AT 43%. LATINOS/HISPANICS ARE 34% OF THE POPULATION. ASIANS/PACIFIC ISLANDERS ARE 18% 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 2007-11 INDICATED THAT 14.6% OF CHILDREN UNDER THE AGE OF 18 IN ORANGE COUNTY, 19.9% IN CALIFORNIA, AND 22.5% IN THE U.S. WERE BELOW THE POVERTY LEVEL. THIS SURVEY ALSO INDICATED THAT 14.4% 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 $71,312. THE PERCENTAGE OF THE HOSPITAL'S PATIENTS WHO ARE UNINSURED OR MEDICAID RECIPIENTS WAS 56.8%. THERE ARE 32 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 - LAGUNA HILLS, CALIFORNIA SADDLEBACK MEMORIAL 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 WEST ANAHEIM MEDICAL CENTER - ANAHEIM, 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. 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, 2012, 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 CHOC CHILDREN'S AT MISSION HOSPITAL MEDICAL STAFF BYLAWS (2/23/09) PAGE 6 BE REASONABLY ACCOMMODATED) OR ON THE BASIS OF ANY OTHER CRITERION THAT IS NOT RELATED TO AN INDIVIDUAL'S PROFESSIONAL CAPABILITIES. 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. true CHILDREN'S HEALTHCARE OF CALIFORNIA 455 s main street orange CA 928683874 330265266 501(c)(3) 600000 N/A N/A Support 1 0 Procedure for monitoring the use of grant funds - part i, line 2 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. In addition, CHOC has an A-133 audit performed each year by its independent audit firm. X X X X false true false false false false false false false KIMBERLY C CRIPE 0 726625 0 196891 0 302274 0 55927 0 21901 0 1303618 0 38625 KERRI RUPPERT SCHILLER 0 443436 0 96396 0 53227 0 88035 0 21901 0 702995 0 0 DEBRA MATHIAS 0 425653 0 101338 0 53853 0 86588 0 21901 0 689333 0 0 MARCIA FOLLI 197741 0 35558 0 32017 0 45156 0 0 0 310472 0 0 0 BONNIE GRAVETT 153295 0 114 0 11288 0 9006 0 15501 0 189204 0 0 0 Elizabeth Drake 123157 0 114 0 10374 0 7428 0 11273 0 152346 0 0 0 paula castano 122018 0 432 0 10303 0 2479 0 15501 0 150733 0 0 0 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. 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) 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 2011: Ms. Cripe ($159,816). As stated in previous filings, in December 2008, the CHOC executive compensation committee dissolved the previous non-qualified retirement plan and all assets were disbursed involuntarily to the participants. The following individual listed on schedule J received payments from the dissolution of the plan in calendar 2011, which are included as a component of the amount reported on schedule J, Part II, column B: Ms. Cripe ($64,984). 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, CHOCO Realty Corporation, 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, CHOCO Realty Corporation, 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 Section 501(c)(3) affiliates). Ms. Mathias devotes 11% of her time to Children's Hospital at Mission responsibilities with the balance of her time being spent on Children's Hospital of Orange County business affairs. 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 141 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 4 - CHANGES TO BYLAWS 1. Increased the authorized number of directors from "thirteen (13) to sixteen (16)" to "Thirteen (13) to seventeen (17)". 2. Reduced the percentage of authorized directors who can be members of the hospital's medical staff from twenty-five percent (25%) to twenty percent (20%). Line 11a - 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. The Form 990 is also a scheduled agenda item at the April 2013 Board of Directors meeting. 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 15A - Compensation Determination Process - Top Management Official: An independent Board committee, 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 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 executive sessions with no staff members present. All comparative salary data is well documented and there are minutes from these meetings that document the members present and voting, the comparative data used 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. Line 15B - Compensation Determination Process - Other Officers and Key Employees: The Organization has no other officers or key employees. Kimberly C. Cripe, Kerri Ruppert Schiller, and Debra Mathias are employees of Children's Healthcare of California (CHC) and are compensated by CHC. An independent Board Committee of CHC charged with the duties of the compensation committee, whose members are disinterested and independent, is in place with a written compensation committee charter. This Committee annually retains an independent healthcare compensation firm to provide relevant comparability data and other compensation studies. The officers and key employees of CHC 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. All comparative salary data is well documented and there are minutes from these meetings that document the members present and voting, the comparative data used and the deliberations and decisions of the committee. The results and recommendations from the committee are shared in a closed session with the Board of Directors. Form 990, Part VI, Section C Line 19 - DISCLOSURE POLICY While federal tax laws do not mandate that the organization's governing documents, conflict of interest policy and financial statements be made available for public inspection, the organization makes its financial statements available upon request. Form 990, Part XI, Line 5 Unrealized Gains $69,403. Change in Beneficial interest in CHOC FND $(2,369) ----------- Total Changes 67,034 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:KIMBERLY C. CRIPE TITLE:DIRECTOR/PRESIDENT HOURS:38 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:RALPH CLAYMAN, M.D. TITLE:DIRECTOR HOURS:3 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:JEFF ELGHANAYAN TITLE:DIRECTOR/2ND VICE CHAIR HOURS:4 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:WILLIAM GURTNER TITLE:DIRECTOR HOURS:3 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:MUSTAFA KABEER, M.D. TITLE:DIRECTOR HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:JAY KEAR TITLE:DIRECTOR/FIRST VICE CHAIR HOURS:2 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:DOUGLAS MCCOMBS TITLE:DIRECTOR / SECRETARY HOURS:2 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:MARK STEVENS TITLE:DIRECTOR/CHAIR HOURS:6 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:MAUREEN ZEHNTNER TITLE:DIRECTOR HOURS:2 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:JANET T. DAVIDSON TITLE:DIRECTOR HOURS:5 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:MARSHALL ROWEN, M.D. TITLE:DIRECTOR HOURS:3 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:DAVID DUKES TITLE:DIRECTOR HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:JOE DUNN TITLE:DIRECTOR HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:GEORGE KALOGRIDIS TITLE:DIRECTOR HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:TIM RISTOFF TITLE:DIRECTOR HOURS:2 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:vijay Dhar, M.D. TITLE:director HOURS:2 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:thomas tierney TITLE:director HOURS:2 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:KERRI RUPPERT SCHILLER TITLE:CFO/Assistant Secretary HOURS:36 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:DEBRA MATHIAS TITLE:EXEC. VICE PRESIDENT / COO HOURS:36 CHILDREN'S HOSPITAL OF ORANGE COUNTY 455 S MAIN STREET 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 CHOCO REALTY CORPORATION 455 S MAIN STREET ORANGE CA 92868 330011853 REAL ESTATE CA 501(c)(3) 11 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) 455 S MAIN STREET 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 OCMRRG 2999 North 4th Street Suite 250 phoenix AZ 85108 201620666 Insurance AZ CHOC C Corp 42633 2621196 0.50000 false true false false false false false false false false false true false false false false false false