2013-05-15T15:08:41-05:00 2012-06-30 KPMG LLP 355 S Grand Ave Suite 2000 Los Angeles CA 90071 990 2011-07-01 956097416 CHOC Foundation % DONALD NOBLE CHOC 7149973000 455 S Main Street Orange CA 928683874 KERRI RUPPERT SCHILLER 2013-05-14 true 2139724000 2011 2016-02-24 21:20:13Z CHOC CHILDREN'S FOUNDATION kimberly c cripe 455 s main street orange CA 928683874 35938247 false X www.choc.org X 1964 CA SUPPORTING CLINICAL AND NONCLINICAL SERVICES, MEDICAL EDUCATION, RESEARCH AND ALLIED FIELDS OF PEDIATRICS AT CHILDREN'S HOSPITAL OF ORANGE COUNTY,CHILDREN'S HOSPITAL AT MISSION AND ITS AFFILIATES. 19 18 27 0 0 0 48406024 20654820 0 0 607634 586407 0 0 49013658 21241227 41981317 15591850 0 0 2810348 2270742 0 0 2612814 2682729 2881275 47474394 20743867 1539264 497360 36350124 38208879 711659 1073633 35638465 37135246 CHOC FOUNDATION WAS FORMED TO HELP SUPPORT CLINICAL AND NONCLINICAL SERVICES, MEDICAL EDUCATION, RESEARCH AND ALLIED FIELDS OF PEDIATRICS AT CHILDREN'S HOSPITAL OF ORANGE COUNTY, CHILDREN'S HOSPITAL AT MISSION AND TO SUPPORT ITS AFFILIATES. false false 15499528 15499528 0 Children's Hospital of Orange County - Provides specialized pediatric services for the care of children. During this year, there were 59,397 days of inpatient care; 50,992 Emergency room visits; 8,247 surgeries; 1,523 day health visits and 142,863 primary and specialty care clinic visits. Funds raised helps to offset cost of services provided to indigent families. 92322 92322 0 Children Hospital at Mission - Funds support affiliated acute care pediatric hospital. Facility provides pediatric, neonatal, and care for emergency services. There were 7,743 inpatient care days; 17,075 Emergency room visits; 827 surgeries and 6,566 outpatient visits. 98708 0 0 CHOC Foundation program service expenses. 15690558 true true false false false false false false false true true false false false true true true true false false false false false false true false false true false true false false false false false false true false true false false false false true false false false false true X 80 0 true 27 true false false false false false true true false false false false X 19 18 false false false false true true true true true false false true true true true true true true false false CA X DONALD NOBLE 7149973000 455 S MAIN STREET ORANGE CA 928683874 X KIMBERLY CCRIPE 4.0 X X 0 1225790 77828 JANET DAVIDSON 1.0 X 0 0 0 CHRIS FURMAN 2.0 X X 0 0 0 HEATHER MADDEN 1.0 X X 0 0 0 SAM AURIEMMA 1.0 X X 0 0 0 TERRY ADAMS 1.0 X 0 0 0 JERRY FLANNERY 1.0 X 0 0 0 CHRISTINE BREN 1.0 X 0 0 0 DELPHINE LEE 1.0 X 0 0 0 ADRIENNE MATROS 1.0 X 0 0 0 BARRY RYAN 1.0 X 0 0 0 KEN VENNER 1.0 X 0 0 0 Allen Fazio 1.0 X 0 0 0 STEPHANIE ARGYROS 1.0 X 0 0 0 JOHN CARPINO 1.0 X 0 0 0 ALI KAVANIAN MD 1.0 X 0 0 0 JASON KNIGHT MD 1.0 X 0 0 0 CAROLINE MARCHANT 1.0 X 0 0 0 STEVE SOLOMON 1.0 X KERRI RUPPERT SCHILLER 4.0 X 0 593059 109936 BETH BRADLEY 40.0 X 151835 0 10153 Heather Inch-Desuta 40.0 X 238642 0 18237 PATRICE POIDMORE 40.0 X 171245 0 1423 Zachariah Moonitz 40.0 X 117347 0 13519 Dolores Korf 40.0 X 123554 0 8490 TANYA LIEBER X 259277 0 10732 1061900 1818849 250318 7 true true false 0 3800104 500000 16354716 152079 20654820 0 329296 329296 0 0 13989928 13732817 257111 257111 257111 964203 3800104 964203 0 0 0 0 21241227 0 586407 15591850 15591850 0 0 0 308633 0 256556 52077 0 1594910 43112 388541 1163257 28649 887 6006 21756 198542 4511 53071 140960 140008 3194 42928 93886 1266803 1468 1118808 146527 22149 6681 15468 0 0 0 61798 61798 557235 9122 160967 387146 86303 186 12279 73838 24883 12434 12449 126939 107686 19253 0 375345 160969 214376 28961 9461 19500 0 7319 884 6435 0 0 25066 25066 6570 6570 DUES 201485 36228 8086 157171 PROVISION FOR UNCOLLECTIBLE 70000 70000 TAXES & LICENSES 20419 1704 18715 20743867 15690558 2440495 2612814 1279013 1688399 6361886 2995464 7114174 6188884 0 0 0 0 0 0 0 0 0 0 166909 78923 399099 282309 141855 116790 19529438 26009598 0 0 0 0 0 0 1756849 1130821 36350124 38208879 372159 92096 0 0 0 0 0 0 0 0 0 0 0 0 0 0 339500 981537 711659 1073633 X 12516370 12398091 12297740 10661852 10824355 14075303 35638465 37135246 36350124 38208879 X 497360 999421 X false true true X false X 15602800 13561991 18351396 48406024 20654820 116577031 15602800 13561991 18351396 48406024 20654820 116577031 30310055 86266976 556256 479980 155902 423050 329296 1944484 1204491 748754 611425 932335 964203 4461208 122982723 0.70146 0.68586 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 19886776 3708846 -372491 0 418237 22804894 17504600 1121168 1645508 0 384500 0 19886776 15437152 2824539 127384 0 3247 881228 17504600 14147708 1358552 27794 0 91902 5000 15437152 0.37680 0.61720 0.00600 false false 157875 66305 91570 241224 216004 25220 116790 0 PAYABLE TO AFFILIATES 981537 981537 21241227 20743867 497360 -642651 1650000 -7928 999421 1496781 22240648 -642651 1650000 -7928 999421 21241227 21241227 20743867 20743867 20743867 ORGANIZATION'S LIABILITY FOR UNCERTAIN TAX POSITIONS UNDER ASC 740: 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 UNCERTIAN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY OR DISCLOSURE IN THE FINANCIAL STATEMENTS. OTHER CHANGES IN NET ASSETS PART XI, LINE 8 & PART XII, LINE 2D CHANGE IN VALUE OF SPLIT-INTEREST AGREEMENTS - $(7,928). Schedule D, Part V, Line 4 The endowment fund is used to support hospital programs addressing the needs of the underserved, social services to patients and families in need, and research and treatment of children's diseases and disorders. none false CHOC Walk 1796344 1569678 226666 44184 72000 7076 1214 102195 Guild events 1272364 1170064 102300 102301 4 1695599 1060362 635237 6995 184986 9267 5610 428375 4764307 3800104 964203 51179 256986 16343 6824 632871 964203 true CHILDREN'S HOSPITAL OF ORANGE COUNTY 455 SOUTH MAIN STREET ORANGE CA 928683874 952321786 501(c)(3) 15499528 n/a n/a HOSPITAL OPERATIONS AND CHARITABLE CARE CHILDREN'S HOSPITAL AT MISSION 455 SOUTH MAIN STREET ORANGE CA 928683874 330528802 501(c)(3) 92322 n/a n/a HOSPITAL OPERATIONS AND CHARITABLE CARE 2 0 PROCEDURE FOR MONITORING THE USE OF GRANT FUNDS - PART I, LINE 1 CHOC Foundation receives contributions on behalf of CHOC and Children's Hospital at Mission, both affiliated 501(c)(3) organizations. Donations are generally restricted or designated by donors for various purposes at inception. The funds are then distributed to the appropriate organization according to donor stipulations for medical programs or for the new tower construction as designated. X X X X true true false false false false false false false KIMBERLY CCRIPE 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 TANYA LIEBER 236403 0 0 0 22874 0 2307 0 8425 0 270009 0 0 0 BETH BRADLEY 131841 0 9027 0 10967 0 3396 0 6757 0 161988 0 0 0 Heather Inch-Desuta 200094 0 25114 0 13434 0 4271 0 13966 0 256879 0 0 0 PATRICE POIDMORE 147911 0 11840 0 11494 0 1423 0 0 0 172668 0 0 0 Schedule J, Line 4a Some of the organization's personnel listed on form 990 Part VII and Schedule J participate in a separation arrangement that provides for a portion of the employee's annual salary based on their position in the organization. For the senior executive level, the amount is based on years of service up to a maximum number of months. Unpaid severance under the separation agreements for current key employees were reported at their full value in a previous tax year. one executive listed on Schedule J, Part II, received severance payments in calendar year 2011. The payment was received by Tanya Lieber ($139,290). Compensation from an Affiliated Organization KIMBERLY 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 10% OF HER TIME EACH WEEK TO CHOC FOUNDATION 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 CHOC FOUNDATION RESPONSIBILITIES WITH THE BALANCE OF HER TIME BEING SPENT ON THE OTHER RELATED ORGANIZATIONS' BUSINESS affairs. 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). chad lieber family member of key emp. 105183 payment of compensation false X 10 152079 average market value false true false SCHEDULE M, PART I, COLUMN B THE NUMBER LISTED IN PART I, LINE 9 COLUMN (B) WAS DETERMINED BASED ON THE NUMBER OF CONTRIBUTIONS RECEIVED. Information Regarding Common Paymaster 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 CHOC Foundation. CHOC Foundation has 27 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 CHOC Foundation. members or stockholders Form 990, Part VI, Section A, Line 6 The sole member of CHOC Foundation is Children's HealthCare of California (CHC). persons who may elect members of the governing body Form 990, Part VI, Section A, Line 7a Directors of CHOC Foundation shall be elected annually by the Member, based on the nomination(s) provided by CHOC Foundation'S Board of Directors. the governing body's decisions subject to approval Form 990, Part VI, Section A, Line 7b The approval of the Member shall be required with respect to any of the following actions: (1) Changing the purposes and powers of CHOC Foundation; (2) Obligating CHOC Foundation to undertake any capital expenditure in excess of $1,000,000; (3) Adopting CHOC Foundation'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 $1,000,000; (7) Obligating CHOC Foundation to act as guarantor with respect to any debt of any person or other entity; (8) Accepting any donation which is conditioned upon CHOC Foundation's undertaking any unbudgeted capital expenditure in excess of $1,000,000 or any unbudgeted expenditure in excess of $1,000,000; (9) Entering into any contract which involves any of the following: (a) any financial obligation on the part of CHOC Foundation in an amount in excess of $1,000,000, (b) any purpose or activity which is outside the scope of CHOC Foundation's ordinary course of business, or (c) a term in excess of five years (unless the contract is terminable at will); (10) involving CHOC Foundation in any merger, acquisition, corporate restructuring, or formal affiliation; (11) Involving CHOC Foundation as a member, shareholder, or partner in any new corporation, partnership, or other legal entity; (12) Dissolving CHOC Foundation; (13) Entering into any transaction involving the sale, lease, conveyance, exchange, transfer or other disposition of all or substantially all of CHOC Foundation's assets; (14) Amending CHOC Foundation'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. PROCESS OF REVIEW Form 990, Part VI, Section B, Line 11A Prior to filing, the tax return and related schedules are provided to the 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 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 May 2013 board of directors meeting. MONITORNING AND ENFORCING COMPLIANCE OF CONFLICT INTEREST POLICY FORM 990, PART VI, SECTION B, LINE 12C 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). 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 contacted via written communication. The procedures for addressing any conflict of interest may include but are 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 conflict, the substance of the transaction or the arrangement being considered; (3)the person with the conflict of interest is excluded from any discussion or approval of such transaction; (4)if applicable alternatives to the proposed transaction are investigated, competitive bids or comparable valuations are obtained; and (5)the transaction or action must be approved by a majority of disinterested persons. PROCESS OF DETERMINING COMPENSATION OF THE CEO AND OFFICERS FORM 990, PART VI, SECTION B, LINE 15 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 and Kerri Ruppert Schiller 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. disclosure copy - FORM 990, PART VI, SECTION C, LINE 19 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 $ (642,651) Change in value of Split-Interest Agreement ( 7,928) Donated services/use of facilities 1,650,000 ------------ Total change in Net Assets $ 999,421 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:KIMBERLY C.CRIPE TITLE:DIRECTOR/PRESIDENT HOURS:36 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:JANET DAVIDSON TITLE:DIRECTOR HOURS:5 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:SAM AURIEMMA TITLE:DIRECTOR/CHAIR HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Allen Fazio TITLE:Director HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:KERRI RUPPERT SCHILLER TITLE:CFO/ASSISTANT SECRETARY HOURS:36 CHILDREN'S HEALTHCARE OF CALIFORNIA(CHC) 455 S MAIN STREET ORANGE CA 92868 330265266 HEALTH CARE CA 501(C)(3) 7 NA false CHILDREN'S HOSPITAL OF ORANGE COUNTY 455 S MAIN STREET ORANGE CA 92868 952321786 HEALTH CARE CA 501(C)(3) 3 CHC false CHILDREN'S HOSPITAL AT MISSION 455 S MAIN STREET ORANGE CA 92686 330528802 HEALTH CARE CA 501(C)(3) 3 CHC false CRC REAL ESTATE CORPORATION 455 S MAIN STREET ORANGE CA 92868 330612565 real estate CA 501(C)(3) 11a CHC false CHOCO REALTY CORPORATION 455 S MAIN STREET ORANGE CA 92868 330011853 real estate CA 501(C)(3) 11A CHC false choc Thrift Stores Inc 455 S MAIN STREET orange CA 92868 330266422 fund raising CA 501(C)(3) 9 CHC false false true true false false false false false false true true true false false false false false false