2011-05-13T16:00:08-05:00 2010-06-30 DELOITTE TAX LLP 655 WEST BROADWAY SUITE 700 SAN DIEGO CA 921018590 990 2009-07-01 951690977 Childrens Hospital Los Angeles CHIL 3236602450 4650 Sunset Boulevard Los Angeles CA 900270982 Diemlan Lannie Tonnu 3233612235 2011-05-13 1 6192326500 2009 2016-02-24 21:20:13Z Diemlan Lannie Tonnu 4650 Sunset Boulevard Los Angeles CA 900270982 1146354056 0 X WWW.CHILDRENSHOSPITALLA.ORG X 1901 CA Promotion and advancement of children's health through patient care, research, and education. 65 41 4738 618 26002 0 126963348 89917517 438494883 463835925 -21056591 5956914 2591857 5077829 546993497 564788185 0 0 296412393 305083062 322112 322112 11483985 300350754 294048506 597085259 599453680 -50091762 -34665495 1397175480 1499431801 639294792 665941137 757880688 833490664 The Hospital's principal mission is to promote and advance the state of children's health, focusing on tertiary and quaternary specialties in patient care, research, and education. 0 0 378767996 440163424 Medical Care provided to childrenIt is the policy of the Hospital to strive to maintain quality health care delivery in a manner that respects the dignity of the individual and family, regardless of the ability to pay. Under the Hospital's policy, medical care may be provided without charge or at amounts less than its established rates to people who are uninsured or underinsured and cannot afford to pay for their own medical care. The Hospital provides additional community support by providing care to patients who participate in programs, like Medi-Cal, that do not pay full charges. Approximately three-fourths of the hospital's patients are covered by Medi-Cal Programs. 40043411 20786987 Graduate Medical Education provides training and education to medical students in Los Angeles County who, in turn, provide services to patients at the hospital. Also, includes Education Revenue from the Residency and Fellowship programs at CHLA. The Hospital subsidizes a large part of the cost of training physicians, allied health professionals, and other health care workers in its emergency room, clinics, inpatient areas, and other parts of its facilities. 59052803 2885514 Research revenues further the exempt purpose of CHLA by providing the patients of CHLA access to new technologies, discoveries and medications for treatment. Results of this research is disseminated through publications in scientific journals and presentations by the principal investigators. The Hospital subsidizes a large part of the cost of medical research taking place in its facilities. 356035 775961 Other program service revenues also include residents housing and miscellaneous tuition and education income. 356035 775961 478220245 1 1 0 1 0 0 0 0 1 1 0 1 0 0 0 0 0 1 1 0 1 0 0 1 1 0 0 0 0 0 1 0 1 1 1 1 0 0 0 0 1 1 0 0 1 662 0 4738 1 1 1 0 0 0 0 1 1 0 0 0 65 41 1 0 1 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 CA X Lawrence Foust 3233612425 4650 Sunset Blvd Los Angeles CA 900270980 Richard Cordova 40.00 X X 782805 0 118289 Arnold Kleiner 10.00 X 0 0 0 Elizabeth Lowe 10.00 X 0 0 0 Cathy Weiss 10.00 X 0 0 0 Marion Anderson 20.00 X 0 0 0 John Jack Pettker 20.00 X 0 0 0 Theodore Samuels 10.00 X 0 0 0 Robert Adler 25.00 X 207829 0 0 Brooke Anderson 2.00 X 0 0 0 CeCe Baise 2.00 X 0 0 0 June Banta 2.00 X 0 0 0 Adele Haggarty Binder 2.00 X 0 0 0 Otis Booth 2.00 X 0 0 0 Patricia A Brown 2.00 X 0 0 0 Alex Chaves 2.00 X 0 0 0 Peggy Tsiang Cherng 2.00 X 0 0 0 Maria Contreras-Sweet 2.00 X 0 0 0 Martha Corbett 2.00 X 0 0 0 John Delfino 2.00 X 0 0 0 Margaret D Eberhardt 2.00 X 0 0 0 Richard Farman 10.00 X 0 0 0 Giselle Fernandez-Farrand 2.00 X 0 0 0 Lynda Boone Fetter 2.00 X 0 0 0 Henri Ford 25.00 X X 745601 0 0 Peggy Galbraith 2.00 X 0 0 0 Herbert Gelfand 2.00 X 0 0 0 Ronald E Gother 2.00 X 0 0 0 Mary Dee Hacker 40.00 X X 263307 0 43969 Mary Hart 2.00 X 0 0 0 Marcia Wilson Hobbs 2.00 X 0 0 0 Linda Joyce Hodge 2.00 X 0 0 0 Gloria Holden 2.00 X 0 0 0 James Hunt 10.00 X 0 0 0 William Hurt 2.00 X 0 0 0 Francine Kaufman 25.00 X 142922 0 0 Robert Kay 25.00 X 175718 0 0 Joseph Lozano 2.00 X 0 0 0 Susan Mallory 2.00 X 0 0 0 Carol Mancino 2.00 X 0 0 0 Gregory Martin 2.00 X 0 0 0 Bonnie Mcclure 30.00 X 64000 0 0 Alex Meneses-Simpson 2.00 X 0 0 0 Caryll Srague Mingst 2.00 X 0 0 0 Mary Adams O'Connell 2.00 X 0 0 0 Chester Chet Pipkin 2.00 X 0 0 0 Brent Polk 30.00 X X 227800 0 0 J Kristoffer Popovich 2.00 X 0 0 0 Ronald Preissman 2.00 X 0 0 0 Carmen Puliafito 2.00 X 0 0 0 Alan Purwin 2.00 X 0 0 0 Dayle Roath 2.00 X 0 0 0 Kathy Luppen Rose 2.00 X 0 0 0 Monica Rosenthal 2.00 X 0 0 0 Cheryl Saban 2.00 X 0 0 0 W Scott Sanford 10.00 X 0 0 0 Paul Schaeffer 10.00 X 0 0 0 Stuart Siegel 25.00 X 390234 0 0 Thomas Simms 10.00 X 0 0 0 Victoria Simms 2.00 X 0 0 0 Susan Smigel 2.00 X 0 0 0 Corinna Smith 2.00 X 0 0 0 Russell Snow 10.00 X 0 0 0 Lisa Stevens 2.00 X 0 0 0 James Terrile 2.00 X 0 0 0 Joyce Bogart Trabulus 2.00 X 0 0 0 Esther Wachtell 2.00 X 0 0 0 Michael Whalen 2.00 X 0 0 0 Roberta Williams 25.00 X 261502 0 0 Alyce Williamson 2.00 X 0 0 0 Alan Wilson 10.00 X 0 0 0 Jeffrey Worthe 10.00 X 0 0 0 Dick Ziegler 2.00 X 0 0 0 Diemlan Lannie Tonnu 40.00 X 812183 0 50356 Lawrence Foust 40.00 X 343852 0 68998 Michelle Cronkhite 40.00 X 63474 0 0 Claudia Looney 40.00 X 314343 0 50833 Rodney Hanners 40.00 X 412058 0 54031 Gail Margolis 40.00 X 267481 0 36361 Steven Garske 40.00 X 262771 0 33388 Kenneth Wildes 40.00 X 481847 0 28453 Charles Krozek 40.00 X 492304 0 47447 Julie Croner 40.00 X 404089 0 25160 Walter Noce 0.00 X 1452140 0 0 8568260 0 557285 458 1 1 1 Zimmer Gunsul Frasca Architects LLP 320 S Oak St Suite 500 Portland OR 97204 Architectural Design 5717152 Cleo Enterprises LLC 34 Calle Castillo San Clemente CA 92673 Construction Mgmt 3387750 Tiller Constructors Partnership LLC 306 W Katella Ave Orange CA 92867 Construction Services 1773615 Triage Consulting Group 221 Main St Suite 1100 San Francisco CA 94105 Billing Recovery 972901 USC Cardiothoracic Surgeons Inc PO Box 50590 Pasadena CA 911150590 Professional Services 711792 41 169839 39398355 50349323 2791932 89917517 Patient Revenue 621110 440163424 440163424 Graduate Medical Educa 900099 11629487 11629487 Education Revenue 900099 9157500 9157500 Research Revenue 900099 2885514 2885514 463835925 -4617291 7849 -4625140 883371 883371 592139284 792 581228504 337367 10910780 -336575 10574205 10574205 4452 169839 4452 4452 Parking Garage 812930 1981380 1981380 Child Development Cent 624410 1103947 1103947 Resident's Housing 900099 511642 511642 593037 264319 18153 310565 4190006 564788185 464611886 26002 10232780 2770410 301239 2119259 349912 254871062 199336086 49589789 5945187 4856764 4299619 416895 140250 24134824 20990471 2457632 686721 18450002 13986315 4002933 460754 921410 921410 643758 210137 433621 808618 808618 46205 46205 322112 322112 1060492 1060492 100499311 68166326 30854163 1478822 1157203 1157203 85766523 81094603 4187728 484192 24584409 18495100 5434034 655275 347738 347738 4802670 2016591 2707907 78172 1878630 1296256 473857 108517 931703 387270 419981 124452 13914305 13189370 724935 25383590 24316626 1066964 3096291 2934974 161317 Provision for bad debts 9291252 9291252 0 0 Utilities 6970873 6614662 354505 1706 Minor equipment 2706653 2580342 115415 10896 Licenses and taxes 1189485 1141150 46400 1935 Dues and subscription 1127456 260898 753210 113348 6919931 5806017 592180 521734 599453680 478220245 109749450 11483985 5000 5000 11425103 4275951 64856451 47769406 91828385 94519047 135446 112872 246787 1208161 6033419 6432437 5811079 5979943 1235793683 437369307 720692846 798424376 466849541 493314392 3826449 3769305 25464974 43620911 1397175480 1499431801 73701573 74307552 498154732 517257301 67438487 74376284 639294792 665941137 X 498558348 579056991 118339899 111388079 140982441 143045594 757880688 833490664 1397175480 1499431801 X 0 1 1 X 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 46205 46205 478174040 478220245 1000000 250000 0 0 1000000 1000000 1000000 1000000 4000000 6000000 173028 47525 129415 46205 396173 250000 250000 250000 250000 1000000 1500000 471858453 30649271 45036808 52496127 495048405 592416535 32922898 -81655753 71825227 471858453 0.67000 0.30000 0.03000 0 0 13097826 13097826 386722556 202663757 184058799 268112547 231313074 36799473 567860754 3392476 564468278 798424376 Payable under Securities Lending Agreement 18160700 Loan Payable 15000000 CIP Retention 14881306 Interest Rate Swap 8900863 Workers Compensation Insurance Reserve 6749599 Accrued Executive Benefits 4124967 Malpractice Tail Reserve 3500000 Other 3058849 74376284 Part V, Line 4: Description of Intended Use of Endowment Funds: Endowment funds are intended to be used according to the donor's wishes which vary from ongoing program support, to specific research, to building or asset acquisition, or support of academic chairs within the organization. Part X: Description of Uncertain Tax Positions Under FIN 48: The Hospital accounts for income taxes in accordance with FASB ASC 740, Income Taxes. FASB ASC 740 prescribes a comprehensive model for how a company should recognize, measure, present, and disclose in its consolidated financial statements uncertain tax positions that the company has taken or expects to take on a tax return. During the years ended June 30, 2010 and 2009, the Hospital did not record any liability for unrecognized tax benefits. X X X X X X X 1 Children's Miracle Network General fundraising 0 2267459 322112 1945347 2267459 322112 1945347 CA Piolin Radio 100959 96507 4452 Kids on the Run 59377 59377 1 13955 13955 174291 169839 4452 4452 1 1 1 X 1 X 1 1 0 1 1 1 2838239 2838239 0.00470 1 291534063 215938730 75595333 0.12610 1 3 294372302 215938730 78433572 0.13080 58 3393659 4014827 4014827 0.00670 10 1524 69454744 43018369 26436375 0.04410 2 4845 4047000 4047000 0.00680 3 88293697 62479219 25814478 0.04310 7 82064 332754 332754 0.00060 80 3482092 166143022 105497588 60645434 0.10130 83 3482092 460515324 321436318 139079006 0.23210 1 7495 7495 0.00000 6 6597 173492 173492 0.00030 7 6597 180987 180987 0.00030 1 9291252 928660 928660 X 1 1 Childrens Hospital Los Angeles

4650 Sunset Blvd Los Angeles CA 90027

X X X X X X Part I, Line 3c: Part III, Line 4: Bad debts are NOT included as community benefits and contain -0- charity cost. Bad debts are calculated based on uncollectible accounts net of contractuals. Part III, Line 8: CHLA is not including any Medicare shortfall as part of its community benefit. Further, CHLA uses federal Medicare cost allocation methodology, as reported in its Medicare Cost report, to determine the allowable costs of care relating to Medicare payments received. Part III, Line 9b: The hospital's policy states that if the patient/guarantor is unable to pay for services due to their current financial situation, they could be eligible for uncompensated care, in which case the hospital's applicable policy and procedure is further referenced. If the patient/guarantor does not qualify, the hospital follows all applicable federal and state guidelines for debt collection, including the requirement of fair treatment, the prohibition of making false statements and restrictions on the time of day that debt collectors may contact the debtor. Part VI, Line 2: Community NeedsLos Angeles County is the most populous county in the United States, with close to 10 million people residing in dense urban communities, suburban towns and rural neighborhoods stretched across 4,752 square miles. The county is divided into eight Service Planning Areas (SPA) for health care delivery and planning purposes. Childrens Hospital Los Angeles is a regional, tertiary health care facility that serves patients throughout L.A. County and beyond. Childrens Hospital Los Angeles recognizes the importance of knowing and understanding the key indicators of its community's health and the issues that affect patients, parents, and community organizations. The Community Needs Assessment serves as the basis for the planning of programs and services that promote the well-being of our surrounding communities. Childrens Hospital Los Angeles works collaboratively on the assessment with four other area hospitals: California Hospital Medical Center, Good Samaritan Hospital, Kaiser Permanente Los Angeles Medical Center and St. Vincent's Medical Center. Childrens Hospital Los Angeles is located within SPA 4-Metro, home to 331,217 children and adolescents. SPA 4 Source: Nielsen Claritas Part VI, Line 3: Access to CareWith the recent economic volatility, the number of uninsured continues to rise. Lack of adequate, affordable health insurance coverage has been identified as the single most important barrier to accessing quality health care services for children in Los Angeles. Childrens Hospital Los Angeles recognizes the importance of health insurance coverage for children and works with local community coalitions to get the word out about various health access initiatives and programs. Program Application Assistance The Office of Community Affairs helps families access available health insurance coverage by assisting with applications for health programs and referrals to other community health resources. In FY 2010, more than 190 children accessed new health insurance coverage, and more than 10,000 families were reached through awareness campaigns. Statewide Pediatrics Advocacy Collaborative General pediatric residents at Childrens Hospital Los Angeles participate in a statewide pediatrics advocacy collaborative. In 2010, 28 pediatric residents and faculty visited local city, state and federal legislative offices advocating for children's health issues, including access to vaccines, health insurance coverage and obesity prevention programs. The advocacy work brings together residents and practicing pediatricians from throughout Los Angeles County to promote access to quality health care. Childrens Hospital Los Angeles is a partner in the Healthy City Project. Through its online portal, HealthyCity.org, this program provides the community with information regarding access to services and community health data. Part VI, Line 4: Community InformationLos Angeles County is the most populous county in the United States, with close to 10 million people residing in dense urban communities, suburban towns and rural neighborhoods stretched across 4,752 square miles. The county is divided into eight Service Planning Areas (SPA) for health care delivery and planning purposes. Childrens Hospital Los Angeles is a regional, tertiary health care facility that serves patients throughout L.A. County and beyond and is the only level 1 trauma center between San Francisco and San Diego. Part VI, Line 5: Healthy CommunitiesAt Childrens Hospital Los Angeles, providing health care to patients and their families doesn't stop at the hospital's walls. Reaching out to communities through education, outreach and advocacy is a priority for the hospital. The staff is actively engaged within the community, providing preventive services and access to health care. Emergency Medicine and Transport The Division of Emergency Medicine and Transport at Childrens Hospital Los Angeles is an invaluable resource for families and community physicians throughout the region. As the only freestanding Level I Pediatric Trauma Center in L.A. County approved by the County Department of Health Services and accredited by the Committee on Trauma of the American College of Surgeons, Childrens Hospital Los Angeles provides the highest level of emergency care for children. The Emergency Transport Program is a life-saving resource for children throughout Southern California and beyond. In addition, Kids Care/Urgent Care, a fast-track clinic for children with acute but non-emergent conditions, expands access to care for children during evenings and weekends. The Emergency Department at Childrens Hospital Los Angeles sees more than 66,000 infants, children and adolescents a year. Other Departments and Divisions The Division of Cardiology at Childrens Hospital, in partnership with the Chad Foundation for Athletes and Artists, conducted heart screenings for 45 student athletes in 2010 to promote early diagnosis of heart disease and heart-muscle abnormalities. The Division of Dentistry and Orthodontics' Oral Health Program provided 80 children with access to appropriate dental care in FY 2010. The Children's Orthopaedic Center conducted scoliosis screenings at more than 135 schools in FY 2010. The Vision Center provided eye screenings and educational information at several community sites. Through the Department of Patient Care Services, 602 nurses participated in various community services in FY 2010. Their efforts reached more than 6,000 children and families.The Baby Sound Check initiative, through the Division of General Pediatrics, screened 2,167 infants and toddlers for hearing loss in FY 2010.Educating CommunitiesChildrens Hospital Los Angeles is committed to educating and empowering members of the communities it serves. Informed patients and families are more likely to make healthier decisions. This is especially true when it comes to keeping up-to-date with immunizations, general health, nutrition and physical fitness. Childrens Hospital Los Angeles conducts community outreach throughout the region to educate and inform residents on issues affecting their health and health care choices. Parent University Childrens Hospital Los Angeles' Parent University provides education and empowers parents about matters concerning their child's health. Classes are held, free-of-charge, on an assortment of topics, from nutrition to child safety to talking with adolescents. Each session is offered in English and Spanish and is available to all parents and parents-to-be. - Ninety six parents and parents-to-be attended Parent University classes in FY 2010. The Office of Community Affairs The Office of Community Affairs works in collaboration with local organizations to improve the health of children and families. - Through outreach, education and advocacy services, 54,913 children and families were reached at 123 events in FY 2010. Outreach Highlights - One hundred seventeen Childrens Hospital nurses participated in community education programs, reaching 1,170 people. - The Literally Healing Program distributed books at no cost to 25,000 families and children. - The HOPE Portal, an online educational resource for children with cancer and their families, was accessed by more than 126,000 users. - The Blood Donor Center reached 7,200 people with outreach and education through its mobile blood unit, nicknamed "the MaxMobile." - Clinical dietitians reached more than 7,800 people with nutritional outreach and education. - The Center for Endocrinology, Diabetes and Metabolism hosts College Night for young adults with Type 1 diabetes and their families. The sessions offer education and preparation for applying and transitioning to college. In addition to test preparation materials, presentations from a Childrens Hospital Los Angeles staff member and a current college student with Type 1 diabetes address various aspects of college life. Other Educational Efforts Many Childrens Hospital Los Angeles physicians, nurses and other health care professionals give lectures and presentations at Los Angeles Unified School District schools and universities, as well as at professional conferences. In addition, Childrens Hospital Los Angeles is well represented at health fairs and community events all over L.A. County. Part VI, Line 6: CEO LetterThroughout our history, the staff at Childrens Hospital Los Angeles has been recognized for providing state-of-the-art care to children from all walks of life. As we prepare to celebrate our 110th anniversary, I have never been more energized about the positive impact our collaborative efforts are having on the health and well-being of the children in our community. Our commitment to our patients and their families extends well beyond the walls of our hospital. We are actively involved in efforts to improve the quality of life for the communities we serve, and nowhere is that passion and commitment to continuous improvement more visible than in this Community Benefit Report. This year, our programs and initiatives served thousands of children in our communities through outreach, education, and advocacy. From community health improvement services to education and research-at Childrens Hospital Los Angeles, we work with families, civic and community organizations, government agencies, educators, researchers, child advocates and policymakers to improve the health of the children and adolescents in our local communities and across the region. I invite you to review this report and learn more about the important work Childrens Hospital Los Angeles is doing to improve the lives of children and their families. As we transform our hospital in preparation for the next 110 years and beyond, our commitment to the diverse communities we serve remains a priority - as well as a great source of pride for me and the rest of the staff at Childrens Hospital Los Angeles.Sincerely, Richard D. Cordova, FACHE President and Chief Executive Officer Childrens Hospital Los AngelesAdditional information on the organizations programs is provided in the community benefit report (which is available upon request) and includes detailed information on the following programs:A New Era of CareResearch Access to CareChildren with Special NeedsSafe ChildrenHealthy TeensHealthy CommunitiesHealthy FamiliesFuture ProvidersEducating CommunitiesDeveloping Youth Our NeighborhoodsCommunity Partners CA X X 1 1 X X X X X X 1 1 0 0 0 0 0 1 0 Richard Cordova 663521 0 0 0 119284 0 112547 0 5742 0 901094 0 88689 0 Robert Adler 207829 0 0 0 0 0 0 0 0 0 207829 0 0 0 Henri Ford 624195 0 0 0 121406 0 0 0 0 0 745601 0 0 0 Mary Dee Hacker 236463 0 0 0 26844 0 24826 0 19143 0 307276 0 0 0 Robert Kay 175718 0 0 0 0 0 0 0 0 0 175718 0 0 0 Brent Polk 227800 0 0 0 0 0 0 0 0 0 227800 0 0 0 Stuart Siegel 390234 0 0 0 0 0 0 0 0 0 390234 0 0 0 Roberta Williams 261502 0 0 0 0 0 0 0 0 0 261502 0 0 0 Diemlan (Lannie) Tonnu 343366 0 405365 0 63452 0 37656 0 12700 0 862539 0 444593 0 Lawrence Foust 327352 0 0 0 16500 0 52591 0 16407 0 412850 0 0 0 Claudia Looney 297843 0 0 0 16500 0 30903 0 19930 0 365176 0 0 0 Rodney Hanners 393240 0 0 0 18818 0 38949 0 15082 0 466089 0 0 0 Gail Margolis 246822 0 0 0 20659 0 31523 0 4838 0 303842 0 0 0 Steven Garske 231907 0 0 0 30864 0 26581 0 6807 0 296159 0 30864 0 Kenneth Wildes 387627 0 0 0 94220 0 24632 0 3821 0 510300 0 26010 0 Charles Krozek 369746 0 78600 0 43958 0 39300 0 8147 0 539751 0 0 0 Julie Croner 147855 0 0 0 256234 0 23006 0 2154 0 429249 0 23131 0 Walter Noce 0 0 0 0 1452140 0 0 0 0 0 1452140 0 1452140 0 Part I, Line 1a Henri Ford received a housing allowance of $121,406 which was treated as taxable compensation and reported on his 2009 Form W-2. Richard Cordova has a discretionary spending account of $36,000 for calendar year 2009, which is to be used for CHLA business activities in his role as CEO. This amount was reported as taxable income on his Form W-2. Part I, Line 4a Julie Croner received a severance payment of $198,248 during calendar year 2009. Ken Wildes received a severance payment of $30,000 during calendar year 2009. Part I, Line 4b: The following individuals participated in CHLA's 457(f) plan, a supplemental nonqualified retirement plan. Amounts deferred under Section 457(f) plan are subject to substantial risk of forfeiture. These amounts will be reported as compensation for the year paid. Amounts recognized as taxable compensation on the employee's 2009 Form W-2 reflect payments received by the employee during calendar year 2009 that were previously reported as deferred compensation in prior year Form 990s: Richard Cordova - $88,689 Diemlan (Lannie) Tonnu - $39,228 Steve Garske - $30,864 Walter Noce - $1,120,117 Kenneth Wildes - $26,010 Julie Croner - $23,131 Part I, Line 7 CHLA maintains an executive bonus program that awards incentive compensation based upon achievement of organizational objectives including health outcomes, quality improvement, level of community benefit provided and other measures as determined annually by the Compensation Committee. Although the amount of bonus incentives that each employee may be granted is based on a fixed formula, the Compensation Committee has the discretion to determine the extent of the goals that have been met by each employee. However, no award is payable under this program unless designated minimum operating margin levels are achieved by the Hospital. Supplemental Information Part III Part VII, Line 5: Pursuant to the affiliate agreement with the University of Southern California ("USC"), an unrelated organization, the following compensation amounts were paid to the following listed individuals by USC. USC was subsequently reimbursed by CHLA for the amounts: Robert Adler M.D. - $207,829 Henri R. Ford M.D. - $624,195 Francine Kaufman M.D. - $74,299 Brent Polk, M.D. - $227,800 Stuart E. Siegel M.D. - $390,234 Roberta G. Williams - $261,502 Additionally, CHLA paid housing relocation costs of $121,406 to Dr. Henri Ford to fulfill his administrative duties. CHLA directly paid $68,623 to Dr. Francine Kaufman as inventor royalties pursuant to the Hospital's intellectual property policy. Mrs. Bonnie McClure is the director of Associates & Affiliates Group that supports and is involved in fund raising programs to generate revenue support for CHLA. She was compensated $64,000 for the services, for which she received Form 1099. Mr. Walter Noce, Jr. retired on December 31, 2007 as President of CHLA, after 12 years of service. During his tenure, Mr. Noce participated in CHLA's 457(f) plan, a supplemental nonqualified retirement plan, which was subject to substantial risk of forfeiture. Mr. Noce was also involved in a split-dollar life insurance policy with CHLA. The amount reported in Schedule J-1, Part I, column (B)(iii) reflects both the calendar year 2009 payout of the $1,120,117 balance that had accumulated in Mr. Noce's 457(f) plan as well as the amount taxable to Mr. Noce during calendar year 2009 as related to his split-dollar life insurance policy. Both of these amounts have already been reported as deferred compensation on CHLA's prior year Form 990s. Part II, Column B (ii) for Lannie Tonnu: The amount reported in Column B(ii) represents a one-time mandatory pay-out of a retention bonus established in 2004 that would be paid out if the participating employee remains employed with CHLA for 5 subsequent years. The Retention Plan consisted of a Retention Bonus to be paid if Ms. Tonnu was still employed by CHLA at the vesting date of December 31, 2008. Prior to the 2009 tax year, the Retention Bonus deferral amounts were subject to substantial risk of forfeiture and have been reported as deferred compensation on CHLA's Form 990. Ms. Tonnu received the Retention Bonus in 2009 after 18 years of service with CHLA and, hence, the amounts are being reported as compensation to the employee. California Statewide Communities Development Authority 680164610 130795CQ8 2007-04-24 170792342 Financed the Costs of Major Expansion and Modernization of the Hospital 0 0 California Statewide Communities Development Authority 680164610 2009-12-18 29865000 Refund bonds issued 7/24/2008 0 0 California Health Facilities Financing Authority 521643828 13033LHC4 2010-05-20 186024080 Refund bonds issued 5/26/99, 9/8/04 and 7/24/08 0 0 170792342 1500000 9301225 159991117 2009 0 0 0 1 29865000 2010 1 0 1 1 186024080 7858221 2011 1 0 0 1 0 0 0 0 0 0.00000 0.00000 0.00000 1 0 0 0 0 0 0.00000 0.00000 0.00000 1 0 0 0 0 0 0.00000 0.00000 0.00000 1 0 0 1 Goldman Sachs & Co 0.100000000000 1 AIG Matched Funding Corp 1.400000000000 1 0 1 0 1 0 0 0 1 0 1 0 0 0 1 Henri Ford Housing assistance X 237495 112872 0 1 1 112872 Mr William H Hurt Trustee Chairman of Capital Strategy Research, Inc. (an affiliate of CGT) 348644 The Hospital has investment accounts with Capital Guardian Trust (CGT). 0 Mr Alan Purwin Trustee President of Helinet Aviation 153501 Provides transportation services for patients of the Hospital. 0 Mr Alex Chaves Sr Trustee Owner of Parking Company of America 3390278 Provides parking services for the Hospital. 0 Robert Adler MD Trustee President for Children's Hospital Los Angeles Medical Group ("CHLAMG") 5235357 CHLAMG is the pediatric faculty physician plan for the University of Southern California at CHLA. Payment is for administrative and coverage services provided by faculty physicians. 0 Francine Kaufman MD Trustee Key employee of Children's Hospital Los Angeles Medical Group ("CHLAMG") 5235357 CHLAMG is the pediatric faculty physician plan for the University of Southern California at CHLA. Payment is for administrative and coverage services provided by faculty physicians. 0 Henri R Ford MD Trustee Director for Children's Hospital Los Angeles Medical Group ("CHLAMG") 5235357 CHLAMG is the pediatric faculty physician plan for the University of Southern California at CHLA. Payment is for administrative and coverage services provided by faculty physicians. 0 Arnold J Kleiner Trustee President of local ABC affiliate 203150 CHLA purchased advertisements on ABC radio stations as well as on ABC local affiliate TV stations. 0 Theodore R Samuels Trustee Sr. VP and Director of Capital Guardian Trust Co. 348644 Payment for investment services to the Hospital. 0 Lisa Stevens Trustee Executive VP and Regional President of Wells Fargo Bank 271145 Payment for banking services as well as repayment of housing mortgage. 0 James Terrile Trustee Sr. VP of Capital Research Global Investors 348644 Payment for investment services to the Hospital. 0 Alan J Willson Trustee Sr. VP of Capital Guardian Trust Company 348644 Payment for investment services to the Hospital. 0 Richard Zeigler Trustee Sr. VP of Investment Services of Bank of America 1816927 Payment for banking services to the Hospital and fees for letters of credit provided to the hospital. 0 Stuart E Siegel MD Trustee Key employee of Children's Hospital Los Angeles Medical Group ("CHLAMG") 5235357 CHLAMG is the pediatric faculty physician plan for the University of Southern California at CHLA. Payment is for administrative and coverage services provided by faculty physicians. 0 Roberta G Williams Trustee Key employee of Children's Hospital Los Angeles Medical Group ("CHLAMG") 5235357 CHLAMG is the pediatric faculty physician plan for the University of Southern California at CHLA. Payment is for administrative and coverage services provided by faculty physicians. 0 J Kristoffer Popovich His wife is a trustee of University of Southern California 0 Reimbursement of Faculty salaries to USC by CHLA. Zero amount reflects reimbursement nature of transaction, rather than sales of service. 0 Robert Kay Trustee Key Employee of Children's Hospital Los Angeles Medical Group ("CHLAMG") 5235357 CHLAMG is the pediatric faculty physician plan for the University of Southern California at CHLA. Payment is for administrative and coverage services provided by faculty physicians. 0 Susan Mallory President of Southern California and Nevada for Northern Trust 426532 Payment for banking services. 0 Jeff Worthe Owner of Worthe Real Estate Group 133175 Payment for real estate commission. 0 Elizabeth Lowe Husband operates Terranea Resort in Palo Verdes 178126 Payment for retreat/hotel services. 0 Martha Corbett Partner at Price Waterhouse Coopers 1331733 Payment for consulting services related to revenue enhancements. 0 Carmen Puliafito Key Employee of University of Southern California 0 Reimbursement of Faculty salaries to USC by CHLA. Zero amount reflects reimbursement nature of transaction, rather than sales of service. 0 X 1 OTHER X 57 2791932 Cost or Selling Price 1 0 1 1 Third Party Use: Part I, Line 32b: The hospital uses brokerage houses to sell non-cash contributions. Non Reporting of Revenue: Part I, Line 33: The hospital received an oil painting valued by the donor at $19,000, but will not include it in income until it is sold. Form 990, Part VI, Section A, line 1 The Executive Committee consists of only active, voting members of the Board of Trustees and is composed of the Co-Chairpersons of the Board; the Vice Chairpersons of the Board; the President and Chief Executive Officer of the Hospital; the Chairpersons of the Board's Finance; Audit; Safety, Quality and Service; Compensation; Government Relations; Investment; Governance; Nominating; and Research Institute Committees and several other Trustees elected by the Board of Trustees. The Executive Committee may act with the full authority of the Board of Trustees except on those matters that are required by law or the Bylaws to be decided by the full Board of Trustees. All actions of the Executive Committee are reflected in minutes of the Committee, contemporaneously documented and reported to both the Executive Committee and the full Board of Trustees at their next meetings. Form 990, Part VI, Section A, line 2 Francine Kaufman, MD (Trustee) - business relationship with Cathy Weiss (Trustee) Alan Wilson (Trustee) - business relationships among Ted Samuels (Trustee), Bill Hurt (Trustee), and James Terrile (Trustee) Form 990, Part VI, Section A, line 4 During the fiscal year ended June 30, 2010 CHLA made changes to its organizational documents. CHLA amended its bylaws and made the following significant changes: - To reduce the required number of members of the Government Relations Committee to 5 from 10 - To amend the name of the Professional Affairs Committee to the Safety, Quality and Service Committee - To alter the reference to the University Childrens Medical Group to the Childrens Hospital Los Angeles Medical Group - To clarify that the five term limit for elected members of the Board shall be counted from a trustee's first full term to begin on or after February 11, 2003 - To delete the concept of "independence" from the Bylaws, administer it as a function of the Governance and Nominating Committees, and update the definition to current IRS and California state law standards. Form 990, Part VI, Section B, line 11 The Form 990 is prepared by Deloitte Tax LLP, working in conjunction with CHLA's finance department. CHLA's Director of Accounting has direct responsibility for this effort, subject to supervision by the Chief Financial Officer. After an initial draft of the Form 990 is prepared, it is circulated for review and comment by relevant members of the executive team who have responsibility and/or knowledge about the various matters disclosed and/or described in the Form. The Chief Financial Officer and General Counsel, in particular, review the Form 990 and ensures accuracy of descriptions and that disclosure is complete. The draft Form 990 is reviewed by the Audit Committee of CHLA, acting on behalf of the Board of Trustees of CHLA. Once the draft Form 990 has been reviewed and discussed by the Audit Committee, any changes resulting from their review is incorporated into the final draft of the Form 990. The final draft of the Form 990 is then distributed to the Board of Trustees via a secure web site for their review and comments prior to the filing of the Form 990. Form 990, Part VI, Section B, line 12c CHLA regularly and consistently monitors and enforces compliance with its conflict of interest policy through annual circulation of a conflict of interest questionnaire which is required to be answered by all members of the Board of Trustees and officers. These annual disclosures are reviewed by a combination of CHLA's General Counsel, Compliance Officer, Chief Executive Officer, Governance Committee of the Board and the full Board of Trustees, depending on the individual making the disclosure. Additionally, the Legal Department of CHLA reviews contractual relationships entered into by CHLA. Furthermore, Board members and officers are asked to disclose any potential conflicts of interest on a continuous basis throughout the year. This request is reinforced at the beginning of each board or committee meeting. If a potential conflict exists, the board or committee determines whether the board member or officer should be excluded from voting on that particular matter. Form 990, Part VI, Section B, line 15 15. a. The process for determining the compensation of the Chief Executive Officer of CHLA is conducted by the Compensation Committee of the Board of Trustees of CHLA, acting on behalf of the Board of Trustees of the organization. The Compensation Committee reported its deliberations and decisions to the Executive Committee of the Board of Trustees. In determining the Chief Executive Officer's compensation during the tax period of this information return the Compensation Committee worked with and relied upon the counsel and expertise of Integrated Healthcare Services and Mercer Consulting, firms with experience and expertise in the area of non-profit organization executive compensation. These consultants provided reports to the Compensation Committee, which furnished the basis for the establishment of the Chief Executive Officer's compensation package. Their reports were based on a review of the executive compensation practices of a variety of organizations that are considered comparable to CHLA based on various metrics such as hospital type and revenue. The Compensation Committee deliberated on the issue of the Chief Executive Officer's compensation package in light of these reports and questions were asked of, and answered by, Integrated Healthcare Services and Mercer regarding such reports and other relevant matters. Based on such deliberations, the Compensation Committee negotiated a written contract with the CEO. 15. b. The process for determining the compensation of officers and other key employees of CHLA is conducted by the Human Resources Department of CHLA, and the Compensation Committee of the Board of Trustees of CHLA, acting on behalf of the Board of Trustees of the organization. In determining such employee's compensation, during the 2009 compensation season the Human Resources Department and Compensation Committee worked with and relied upon the counsel and expertise of Mercer Consulting, a firm with experience and expertise in the area of non-profit organization executive compensation. Mercer provided an executive compensation report to the Human Resources Department and Compensation Committee which furnished the basis for the establishment of such employees' compensation package during the following year. Mercer's report was based on a review of executive compensation practices of a variety of organizations that are considered comparable to CHLA based on various metrics such as hospital type and revenue. In addition, the Chief Executive Officer made a recommendation to the Compensation Committee with respect to each of such employees' compensation package in light of the Mercer report and in light of the executive's performance. At the Compensation Committee meeting addressing such matters, questions were asked of, and answered by, Mercer regarding such report and other relevant matters. Based on such deliberations, the Compensation Committee made a decision regarding the compensation package for such employees for the following year. Form 990, Part VI, Section C, line 19 Form 990, Part VI, Section C, Line 19: CHLA does not make its governing documents and conflict of interest policy available to the public. CHLA's financial statements are contained in its Form 990, which is available for public inspection during business hours. Schedule G, Part I, Line 2b, Column (v) Explanation of Fundraising Payments Funds submitted directly to Children's Miracle Network by sponsor partners are remitted to member hospitals on a quarterly basis by Children's Miracle Network. Funds remitted directly to member hospitals as a result of a Children's Miracle Network fundraising program are reported back to Children's Miracle Network for the purposes tracking fundraising results but those funds are deposited directly by the member hospital. Member hospitals pay an annual membership fee, which differs for each member hospital and depends largely on its market territory population. These fees are analogous to franchise fees, where hospitals "own" market territory in which they fundraise using the Children's Miracle Network brand. Children's Miracle Network furnishes fundraising materials that are essential to the campaigns. Such materials include the paper icons, collateral materials, and coin canisters. Materials are sent directly to locations of sponsor partners (such as an individual Costco warehouse). It is the responsibility of each hospital to pay for the cost of these materials. Materials costs are billed separate from the annual membership fee and are sent intermittently depending on the frequency of the campaigns. Schedule K Supplental Information Part III, line 3c: While CHLA does not routinely engage bond counsel or other outside counsel to review any contracts or agreements relating to tax-exempt bond-financed property, CHLA utilizes its full- time in-house legal department to review any such contracts. CHLA's General Counsel's office has developed internal procedures for reviewing contracts relating to tax-exempt bond financed properties to ensure compliance with proper safe harbors. Schedule K, Part II, line 5, column C: Of the $7,858,221 shown, $2,644,798 is costs of issuance and $5,213,423 is credit enhancement costs. Schedule K, Part IV, line 4c, column A: There were two contracts with the provider, one with a term of 1.3 years, the other with a term of 2.3 years. Schedule G, Part II: For its 2009 Form 990, CHLA adopted an updated interpretation of the definition of what constitutes a "Fundraising Event" for Form 990 reporting purposes, pursuant to guidelines provided by the Form's instructions. CHLA is reporting "Revenue from Fundraising Events" solely from events where CHLA had an active involvement in the production and administration of the event, rather than just the dedicated beneficiary of the event's donations. Accordingly, there was a decline in the number of "CHLA Fundraising Events" being reported on CHLA's 2009 Form 990 as compared to its 2008 Form 990. These events, while operated by CHLA, did not incur any direct expenses. Part VII, column B: The hours reported for each of the faculty physicians relates only to their administrative time and does not include clinical time. Versant Advantage Inc 4650 Sunset Blvd MS 70 Los Angeles CA 90027 731718240 Nurse residency training CA 501(C)(3) 2 N/A Anchors Guild of Children's Hospital Los Angeles 4650 Sunset Blvd MS 4 Los Angeles CA 90027 956118986 Fundraising CA 501(C)(3) 11d N/A Antelope Valley Guild of Children's Hospital Los Angeles 4650 Sunset Blvd MS 4 Los Angeles CA 90027 956118987 Fundraising CA 501(C)(3) 11d N/A BelAir Guild of Children's Hospital Los Angeles 4650 Sunset Blvd MS 4 Los Angeles CA 90027 956118835 Fundraising CA 501(C)(3) 11d N/A Centennial Guild of Children's Hospital Los Angeles 4650 Sunset Blvd MS 4 Los Angeles CA 90027 141878642 Fundraising CA 501(C)(3) 11d N/A Children's Chain of Children's Hospital Los Angeles 4650 Sunset Blvd MS 4 Los Angeles CA 90027 954559789 Fundraising CA 501(C)(3) 11d N/A Della Robbia Guild of Children's Hospital Los Angeles 4650 Sunset Blvd MS 4 Los Angeles CA 90027 956118990 Fundraising CA 501(C)(3) 11d N/A Delat Delta Delta for Children's Hospital Los Angeles 4650 Sunset Blvd MS 4 Los Angeles CA 90027 237294093 Fundraising CA 501(C)(3) 11d N/A El Segundo Auxiliary of Children's Hospital Los Angeles 4650 Sunset Blvd MS 4 Los Angeles CA 90027 956118991 Fundraising CA 501(C)(3) 11d N/A Flintridge Guild of Children's Hospital Los Angeles 4650 Sunset Blvd MS 4 Los Angeles CA 90027 956118993 Fundraising CA 501(C)(3) 11d N/A FOCUS 4650 Sunset Blvd MS 4 Los Angeles CA 90027 800290181 Fundraising CA 501(C)(3) 11d N/A Friends of Childrens Hospital Los Angeles 4650 Sunset Blvd MS 4 Los Angeles CA 90027 141878647 Fundraising CA 501(C)(3) 11d N/A Glendale Auxiliary of Childrens Hospital Los Angeles 4650 Sunset Blvd MS 4 Los Angeles CA 90027 956118994 Fundraising CA 501(C)(3) 11d N/A Green House 4650 Sunset Blvd MS 4 Los Angeles CA 90027 237215226 Fundraising CA 501(C)(3) 11d N/A Healing Arts Reaching Kids (HARK) 4650 Sunset Blvd MS 4 Los Angeles CA 90027 204459362 Fundraising CA 501(C)(3) 11d N/A La Providencia Guild of Childrens Hospital Los Angeles 4650 Sunset Blvd MS 4 Los Angeles CA 90027 956128178 Fundraising CA 501(C)(3) 11d N/A Las Hermanas Guild of Childrens Hospital Los Angeles 4650 Sunset Blvd MS 4 Los Angeles CA 90027 956128176 Fundraising CA 501(C)(3) 11d N/A Las Madrinas Inc 4650 Sunset Blvd MS 4 Los Angeles CA 90027 951959907 Fundraising CA 501(C)(3) 11d N/A Las Primeras Guild of Childrens Hospital Los Angeles 4650 Sunset Blvd MS 4 Los Angeles CA 90027 956121928 Fundraising CA 501(C)(3) 11d N/A Mary Duque of Childrens Hospital Los Angeles 4650 Sunset Blvd MS 4 Los Angeles CA 90027 956121921 Fundraising CA 501(C)(3) 11d N/A Mary Duque Juniors of Childrens Hospital Los Angeles 4650 Sunset Blvd MS 4 Los Angeles CA 90027 953786303 Fundraising CA 501(C)(3) 11d N/A Men's Guild of Childrens Hospital Los Angeles 4650 Sunset Blvd MS 4 Los Angeles CA 90027 260109744 Fundraising CA 501(C)(3) 11d N/A Monrovia Guild of Childrens Hospital Los Angeles 4650 Sunset Blvd MS 4 Los Angeles CA 90027 956121929 Fundraising CA 501(C)(3) 11d N/A Northridge Guild of Childrens Hospital Los Angeles 4650 Sunset Blvd MS 4 LOs Angeles CA 90027 956121930 Fundraising CA 501(C)(3) 11d N/A Pasadena Guild of Childrens Hospital Los Angeles 4650 Sunset Blvd MS 4 Los Angeles CA 90027 956121932 Fundraising CA 501(C)(3) 11d N/A Peninsula Committee 4650 Sunset Blvd MS 4 Los Angeles CA 90027 237091175 Fundraising CA 501(C)(3) 11d N/A Project CHLA 4650 Sunset Blvd MS 4 Los Angeles CA 90027 954524737 Fundraising CA 501(C)(3) 11d N/A San Antonio Guild of Childrens Hospital Los Angeles 4650 Sunset Blvd MS 4 Los Angeles CA 90027 956121934 Fundraising CA 501(C)(3) 11d N/A Santa Monica Bay Auxiliary of Childrens Hospital Los Angeles 4650 Sunset Blvd MS 4 Los Angeles CA 90027 237293607 Fundraising CA 501(C)(3) 11d N/A Sierra Guild of Childrens Hospital Los Angeles 4650 Sunset Blvd MS 4 Los Angeles CA 90027 956121935 Fundraising CA 501(C)(3) 11d N/A South Bay Auxiliary of Childrens Hospital Los Angeles 4650 Sunset Blvd MS 4 Los Angeles CA 90027 956118996 Fundraising CA 501(C)(3) 11d N/A Spiritual Care of Childrens Hospital Los Angeles 4650 Sunset Blvd MS 4 Los Angeles CA 90027 200872821 Fundraising CA 501(C)(3) 11d N/A This Little Light of Childrens Hospital Los Angeles 4650 Sunset Blvd MS 4 Los Angeles CA 90027 954445549 Fundraising CA 501(C)(3) 11d N/A Toluca Guild of Childrens Hospital Los Angeles 4650 Sunset Blvd MS 4 Los Angeles CA 90027 956098666 Fundraising CA 501(C)(3) 11d N/A Westside Guild of Childrens Hospital Los Angeles 4650 Sunset Blvd MS 4 Los Angeles CA 90027 956059321 Fundraising CA 501(C)(3) 11d N/A Whittier Guild of Childrens Hospital Los Angeles 4650 Sunset Blvd MS 4 Los Angeles CA 90027 956121939 Fundraising CA 501(C)(3) 11d N/A 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0