2011-05-16T14:04:52-05:00 2010-06-30 KPMG LLP 355 S Grand Ave Suite 2000 Los Angeles CA 90071 990 2009-07-01 330528802 Children's Hospital At Mission CHIL 7149973000 455 S Main Street Orange CA 928683874 Kerri Ruppert Schiller 2011-05-13 2139724000 2009 2016-02-24 21:20:13Z CHOC Children's at Mission Hospital KIMBERLY C CRIPE 455 s main street orange CA 928683874 49618562 false X www.choc.org X 1991 CA TO NURTURE, ADVANCE, AND PROTECT THE HEALTH AND WELL-BEING OF CHILDREN. 13 12 149 0 0 0 338873 292391 47454810 49172559 172887 83031 476668 70581 48443238 49618562 5000000 0 0 0 11041162 11214570 0 0 0 36520062 37673518 52561224 48888088 -4117986 730474 32105192 35090109 8362452 10603572 23742740 24486537 TO NURTURE, ADVANCE, AND PROTECT THE HEALTH AND WELL-BEING OF CHILDREN. false false 46383965 49172559 PROVIDES SPECIALIZED PEDIATRIC SERVICES FOR THE MEDICAL/SURGICAL CARE OF CHILDREN FROM BIRTH TO AGE 18. THERE WERE 9,268 DAYS OF INPATIENT CARE; 18,654 EMERGENCY ROOM VISITS; 8,612 OUTPATIENT VISITS; 1,089 SURGERIES WERE PERFORMED DURING THE FISCAL YEAR. 46383965 true true false false false false false false false true true true false false false false false false false false true false false true false false false false false false false false false false false false false true false false false true 29 0 true 149 true false false false false false false false false false 13 12 false false true 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 KIMBERLY C CRIPE 2.0 X X 0 1131003 27090 RALPH CLAYMAN MD 1.0 X 0 0 0 JEFF ELGHANAYAN 2.0 X X 0 0 0 ED GRIER 2.0 X X 0 0 0 WILLIAN GURTNER 2.0 X 0 0 0 MUSTAFA KABEER MD 1.0 X 0 0 0 JAY KEAR 1.0 X 0 0 0 MEREDITH KHACHIGIAN 1.0 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 X 0 0 0 KERRI RUPPERT SCHILLER 3.0 X 0 619500 14603 DEBRA MATHIAS 8.0 X 0 586332 13601 MARCIA FOLLI 40.0 X 290499 0 12417 BONNIE L GRAVETT 40.0 X 150726 0 15550 LAURIE A GAUTHIER 40.0 X 156879 0 21607 ELIZABETH DRAKE 40.0 X 128563 0 19476 LINDA STARN 40.0 X 134326 0 7822 BARBARA SILVERS 40.0 X 135751 0 14128 996744 2336835 146294 34 false true false COMFORCE TECHNICAL SERVICES PO BOX 31001-0893 PASADENA CA 91110 TEMPORARY STAFFING 303865 PEDIATRIC SUBSPECIALTY FACULTY 455 SOUTH MAIN ST ORANGE CA 92868 Medical Dir & Serv 366000 Pediatric Surgical Associates 1120 W LA VETA AVENUE SUITE 100 ORANGE CA 92868 Medical Dir & Serv 214996 West Coast Pediatrics 1010 W La Veta Ave 710 Orange CA 92868 Medical services 109500 4 200887 91504 292391 NET PATIENT SERVICES 621400 49050775 49050775 CLINIC RENTAL INCOME 900099 121784 121784 49172559 83031 83031 0 0 0 0 0 0 MISCELLANEOUS REVENUE 900099 70581 70581 70581 49618562 49172559 0 153612 0 0 0 0 221035 221035 0 8919486 8027537 891949 265036 238532 26504 1118633 1006770 111863 690380 621342 69038 8823088 7940780 882308 17619 17619 12000 10800 1200 0 0 0 1876240 1688618 187622 0 80373 72336 8037 123974 111576 12398 0 1533518 1380166 153352 18527 16674 1853 0 13663 12297 1366 0 0 939880 845892 93988 314597 283137 31460 PURCH. SVC FROM OTHER HOSPITAL 20419357 20419357 PROVISION FOR BAD DEBT 3365023 3365023 MEDICAL SUPPLIES 7436 6692 744 MISCELLANEOUS 103906 93516 10390 TAXES AND LICENSES 24317 21885 2432 48888088 46383965 2504123 0 399340 224560 5056183 9182063 64139 20000 13378366 13182629 394638 407474 13290439 7156976 6482951 6133463 6329575 5939920 32105192 35090109 6558143 8673532 1804309 1930040 8362452 10603572 X 22622723 23439372 1120017 1047165 23742740 24486537 32105192 35090109 X false true true X false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 8448478 3687272 4761206 4841961 3469704 1372257 6133463 GOODWILL NET OF AMORTIZATION 5737500 NICU SUNK COSTS, NET OF AMORT. 63179 I/C RECEIVABLE CHOC 33007 I/C RECEIVABLE CHOC FOUNDATION 7061 OTHER ASSETS 99173 5939920 0 DUE TO CHILDREN'S HEALTHCARE OF CALIFORNIA 43410 DUE TO CHILDREN'S HOSPITAL OF ORANGE COUNTY 1651944 OTHER LIABILITIES 234686 1930040 49618562 48888088 730474 57462 -44139 13323 743797 49631885 57462 57462 49574423 44139 44139 49618562 48888088 48888088 48888088 Reconciliation of Change in Net Assets form 990, schedule d, part XI, line 8 Change in beneficial interest in CHOC Foundation ($44,139) Contributions ($45,000) Auditors year end adjustment $861 Total ($44,139) Other Revenue on Return but not on financial statements FORM 990, SCHEDULE D, PART XII, LINE 4B Change in beneficial interest in CHOC Foundation $44,139 Contributions $45,000 Auditor's year end adjustment ($861) Total $44,139 FIN 48 Form 990, Schedule D, Part X Children's Healthcare of California ("CHC") and Affiliates adopted the provisions of FASB Interpretation No. 48 ("FIN 48") effectively on July 01, 2007. This adoption did not result in any material impact on the combined financial statements of CHC and Affiliates. true true X true X true X true true false true true 249385 0 249385 0.00550 13236729 4353773 8882956 0.19510 13486114 4353773 9132341 0.20060 13486114 4353773 9132341 0.20060 4 19925 19925 0.00040 4 19925 19925 0.00040 false 806865 0 0 0 0 X true true CHILDREN'S HOSPITAL AT MISSION

27700 MEDICAL CENTER ROAD MISSION VIEJO CA 92691

X X The organization uses the Federal Poverty Guidlines (FPG) to determine eligibility for providing free and discounted care to low income individuals. In doing so, the organization follows methodologies recommended by the American Hospital Association. 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. The organization did not include subsidized health services costs attributable to a physician clinic in the table in Part I, line 7g. The bad debt expense included in Form 990, Part IX, Line 25 but subtracted for purposes of calculating the percentage in this column is $3,365,023. 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. PART III, LINE 1 THE ORGANIZATION REPORTS BAD DEBT EXPENSE AS AN OPERATING EXPENSE IN ACCORDANCE WITH US GAAP. HFMA STATEMENT NO. 15, WHICH REQUIRES BAD DEBT TO BE RECOGNIZED AS A REDUCTION FROM NET PATIENT REVENUE, HAS NOT YET BEEN ADOPTED AS AN ACCOUNTING STANDARD IN THE US. X X X X false true false false false false false false false KIMBERLY C CRIPE 0 712995 0 207305 0 210703 0 14743 0 12347 0 1158093 0 0 KERRI RUPPERT SCHILLER 0 405686 0 101481 0 112333 0 7393 0 7210 0 634103 0 0 DEBRA MATHIAS 0 378088 0 98285 0 109959 0 1254 0 12347 0 599933 0 0 MARCIA FOLLI 186056 0 44282 0 60161 0 12417 0 0 0 302916 0 0 0 BONNIE L GRAVETT 139599 0 0 0 11127 0 3241 0 12309 0 166276 0 0 0 LAURIE A GAUTHIER 133483 0 12056 0 11340 0 9260 0 12347 0 178486 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. UNPAID SEVERANCE UNDER THE SEPARATION AGREEMENTS FOR CURRENT KEY EMPLOYEES WERE REPORTED AT THEIR FULL VALUE IN A PREVIOUS TAX YEAR. IN THE CURRENT YEAR THERE WERE NO INCREASES ATTRIBUTABLE TO THE SEPARATION AGREEMENT FOR ANY PERSONS LISTED ON THIS RETURN. Supplemental Nonqualified Retirement Plan Part I, Line 4B Children's Hospital of Orange County (CHOC) established a nonqualified deferred compensation plan in 2002 in which certain individuals listed on the Form 990, Part VII and Schedule J are participants. Under the plan, a grantor trust was established for which CHOC is the grantor. The principal of the trust and any earnings thereon are held separate and apart from other funds of CHOC and are to be used exclusively for the uses and purposes of plan participants and CHOC's general creditors. The company established a capital accumulation account on its books for each plan participant for each election of benefits accrued under the plan. The capital accumulation account is utilized solely as a device for the measurement and determination of the amounts to be paid to the participants under the plan. The participant is a general unsecured creditor of the company for the payment of capital accumulation account benefits. CHOC contributed to the trust such money or other assets in the amounts and at the times determined in its sole discretion. The participant is entitled to his/her capital accumulation account benefit under the earliest of (1) remaining employed by the company to the deferred vesting for the account; (2) disability; (3) 24 months following involuntary separation from service without reasonable cause; or (4) following a voluntary separation from service if certain non-compete stipulations are met. In December 2008, the CHOC compensation committee dissolved this plan and all assets were disbursed involuntarily to the participants. The following individuals received payments from the dissolution of this supplemental non-qualified retirement plan during calendar year 2009: Kimberly C. Cripe ($159,223); Kerri Ruppert Schiller ($79,208); Ms. Foli ($38,564). 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 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 501(c)(3) affiliates). Ms. Schiller devotes approximately 8% 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 501(c)(3) affiliates). Ms. Mathias devotes 20% 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 149 employees, however because of the common paymaster arrangement resulting in the forms W-2 being issued under CHOC's employer identified number, there are no W-2s issued directly by Children's Hospital at Mission. Form 990, Part VI, Section A: Line 4 - Changes to Organization's Documents: As of August 2009, the BY-Laws of CHOC Children's at Mission Hospital (CCMH) were amended to change the composition of the Board of Directors. The number of Directors comprising the Board will not be less than 13 and not more than 16 (formerly 9 and 13). In addition, the Board of CCMH shall be comprised of the same individuals who serve as the members of the Board of Directors of Children's Hospital of Orange County and for the same terms and/or periods of qualifications. 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 CHOC; (2) Obligating CHOC to undertake any capital expenditure in excess of $5,000,000; (3) Adopting CHOC's annual operating and capital budgets; (4) Adopting a long-term capital budget; (5) Buying, selling, leasing, mortgaging, pledging, or otherwise hypothecating any real property; (6) Incurring any indebtedness in excess of $5,000,000; (7) Obligating CHOC to act as guarantor with respect to any debt of any person or other entity; (8) Accepting any donation which is conditioned upon CHOC's undertaking any unbudgeted capital expenditure in excess of $2,000,000 or any unbudgeted expenditure in excess of $2,000,000; (9) Entering into any contract which involves any of the following: (a) any financial obligation on the part of CHOC in an amount in excess of $5,000,000, (b) any purpose or activity which is outside the scope of CHOC's ordinary course of business, or (c) a term in excess of five years (unless the contract is terminable at will); (10) involving CHOC in any merger, acquisition, corporate restructuring, or formal affiliation; (11) Involving CHOC as a member, shareholder, or partner in any new corporation, partnership, or other legal entity; (12) Dissolving CHOC; (13) Entering into any transaction involving the sale, lease, conveyance, exchange, transfer or other disposition of all or substantially all of CHOC's assets; (14) Amending CHOC's articles of Incorporation; (15) Adopting new bylaws or amending existing bylaws, in the event that such action would affect any of the Member's rights under the bylaws or as provided by applicable law. Form 990, Part VI, Section B noLine 11a - PROCESS OF REVIEW Prior to filing, the tax return and related schedules are provided to the organization's executive review committee, an empowered board committee delegated with this authority. The Chief Financial Officer reviewed the report with the committee prior to filing the final return. The final return is provided to the board of directors at its May 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 Director 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. CHILDREN'S HOSPITAL OF ORANGE COUNTY 455 S MAIN STREET ORANGE CA 928683874 952321786 HEALTH CARE CA 501(c)(3) 3 NA CHOC FOUNDATION 455 S MAIN STREET ORANGE CA 928683874 956097416 FUND RAISING CA 501(c)(3) 7 NA CHOCO REALTY CORPORATION 455 S MAIN STREET ORANGE CA 928683874 330011853 REAL ESTATE CA 501(c)(3) 11 NA CRC REAL ESTATE CORPORATION 455 S MAIN STREET ORANGE CA 928683874 330612565 REAL ESTATE CA 501(c)(3) 11 NA CHILDREN'S HEALTHCARE OF CALIFORNIA 455 S MAIN STREET ORANGE CA 928683874 330265266 HEALTH CARE CA 501(c)(3) 3 NA choc thrift stores inc 455 S MAIN STREET orange CA 928683874 330266422 Fund Raising CA 501(c)(3) 9 na OCMRRG 2999 North 4th Street Suite 250 phoenix AZ 85108 201620666 insurance AZ na C Corp 8978 1896316 0.50000 false false true false false false false false false false false true false false false false false false