2023-05-10T15:57:39-05:00 2022-06-30 135565207 KPMG LLP 550 SOUTH HOPE STREET SUITE 1500 LOS ANGELES CA 90071 990 2021-07-01 952321786 CHILDREN'S HOSPITAL OF ORANGE COUNTY CHIL 7149973000 1201 WEST LA VETA AVENUE ORANGE CA 92868 KERRI RUPPERT SCHILLER EVP/CFO/ASSISTANT SECRETARY 7149973000 2023-05-10 1 KERRI RUPPERT SCHILLER 999009999 HOLLY MOEN P01800653 2139724000 2023-05-05 3 AAL1 IAL1 2021 2023-04-26 12:10:37Z KIMBERLY C CRIPE 1201 WEST LA VETA AVENUE ORANGE CA 92868 1177249924 0 X WWW.CHOC.ORG X 1964 CA TO NURTURE, ADVANCE AND PROTECT THE HEALTH AND WELL BEING OF CHILDREN. 14 13 5148 474 494888 0 41997311 28446124 879903498 1073426782 3648937 4305049 1962677 3324530 927512423 1109502485 4028521 0 0 0 399343109 478229312 0 0 0 526121891 564003315 929493521 1042232627 -1981098 67269858 1471417883 1524096795 765162187 749757043 706255696 774339752 TO NURTURE, ADVANCE AND PROTECT THE HEALTH AND WELL-BEING OF CHILDREN. 0 0 937990234 1077701993 CHILDREN'S HOSPITAL OF ORANGE COUNTY (CHOC) - PROVIDES SPECIALIZED PEDIATRIC SERVICES FOR THE CARE OF CHILDREN. DURING THIS YEAR, THERE WERE 69,587 DAYS OF INPATIENT CARE; 101,878 EMERGENCY ROOM VISITS (INCLUDING PEDIATRIC TRAUMA VISITS); 11,639 SURGERIES; AND 345,196 PRIMARY AND SPECIALTY CARE CLINIC VISITS. OUR CALIFORNIA MEDICAL FOUNDATION PROVIDED 458,214 PEDIATRIC SUBSPECIALTY SERVICE ENCOUNTERS TO PATIENTS THROUGHOUT ORANGE COUNTY AND BEYOND. SEE OUR COMPLETE COMMUNITY BENEFIT REPORT ON OUR WEBSITE AT HTTPS://WWW.CHOC.ORG/FILES/COMMUNITYBENEFITPLAN.PDF 937990234 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 514 0 1 5148 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 14 13 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 CA X MARY NGUYEN 7145094124 1201 WEST LA VETA AVENUE ORANGE CA 92868 KIMBERLY CRIPE PRESIDENT/CEO 28.50 11.50 X X 0 1766114 103462 SAM AURIEMMA DIRECTOR 1.00 2.00 X 0 0 0 CHRIS FURMAN DIRECTOR 3.00 4.00 X 0 0 0 JOE KIANI VICE CHAIR 2.00 3.00 X X 0 0 0 DOUGLAS MCCOMBS CHAIR 5.00 7.00 X X 0 0 0 MARIA MINON MD DIRECTOR 1.00 1.00 X 0 0 0 JIM MORRIS DIRECTOR 1.00 4.00 X 0 0 0 JOE NUZZOLESE DIRECTOR 1.00 1.00 X 0 0 0 THOMAS PHELPS DIRECTOR 1.00 1.00 X 0 0 0 KEN POTROCK DIRECTOR 1.00 1.00 X 0 0 0 LINDA ROSE DIRECTOR 1.00 1.00 X 0 0 0 KIMBERLY SENTOVICH DIRECTOR 1.00 2.00 X 0 0 0 JASJIT SINGH MD DIRECTOR 1.00 1.00 X 0 0 0 JANET T DAVIDSON DIRECTOR 2.00 2.50 X 0 0 0 KERRI RUPPERT SCHILLER EVP/CFO/ASSISTANT SECRETAR 20.00 20.00 X 0 899653 73762 PAUL VAN DOLAH EVP/COO 34.00 6.00 X 0 714066 0 JAY GABRIEL CHIEF LEGAL OFFICER/SEC 31.00 9.00 X 729962 0 78375 SHAHAB DADJOU SVP/CHIEF STRATEGY OFFICER 36.00 4.00 X 0 946111 44586 SANDIP GODAMBE MD SVP, MED AFFAIRS/CMO 36.00 4.00 X 273547 0 11402 MICHAEL WEISS VP POPULATION HEALTH 40.00 0.00 X 646949 0 55500 HALE KUHLMAN VP, CHOC NETWORK, FINANCE 40.00 0.00 X 415282 0 49761 JASON CULP VP, CHOC CHILDREN'S SPECIALIST 40.00 0.00 X 161155 0 0 MELANIE PATTERSON VP PATIENT CARE SERVICES 40.00 0.00 X 529487 0 52997 MARY ZIMMER VP OPERATIONS 38.00 2.00 X 474084 0 56910 JOHN HENDERSON VP & CHIEF INFO OFFICER 36.00 4.00 X 596511 0 87094 CHARLES GOLDEN MD VP, MEDICAL DIRECTOR PRIMARY CARE 40.00 0.00 X 489590 0 46434 TERENCE SANGER VP, CHIEF SCIENTIFIC OFFICER 40.00 0.00 X 494950 0 42841 WILLIAM FEASTER MD VP, CHIEF HEALTH INFO OFFICER 40.00 0.00 X 552547 0 54273 THOMAS CAPIZZI VP, CHIEF PEOPLE OFFICER 35.00 5.00 X 539186 0 49818 MATTHEW GERLACH FORMER EVP/COO 0.00 0.00 X 0 635843 0 5903250 4961787 807215 986 1 1 0 PEDIATRIC SUBSPECIALTY FACULTY 455 S MAIN STREET ORANGE CA 92868 MEDICAL SERVICES 120899185 REGENTS OF UC 333 CITY BLVD WEST SUITE 8800 ORANGE CA 92868 EDUC & MEDICAL SERVICES 15149410 CERNER CORPORATION PO BOX 412702 KANSAS CITY MO 64141 SOFTWARE SERVICES 14372382 CANNON DESIGN INC DEPARTMENT CHICAGO 19824 PALATINE IL 60055 CONSTRUCTION SERVICES 14048567 JACOBS PROJECT MANAGEMENT 2600 MICHELSON DRIVE IRVINE CA 92612 CONSTRUCTION SERVICES 12153255 195 27538667 907457 28446124 NET PATIENT REVENUE 624100 895449744 895449744 PREMIUM REVENUE 624100 90278368 90278368 MGMT/OCCUPANCY SERVICE 561000 28080580 28080580 DRUGS/MEDICAL SUPPLIES 624100 27303350 27303350 OTHER REVENUE 624100 23744741 23249853 494888 8569999 8569999 1073426782 3629484 3629484 232172 0 232172 232172 232172 68423004 67747439 675565 675565 675565 CAFETERIA 722514 1598672 1598672 GIFT SHOP 453220 570925 570925 PARKING 812930 562501 562501 360260 360260 3092358 1109502485 1072931894 494888 7629579 X 4815949 4334354 481595 384271770 345844593 38427177 9614253 8652828 961425 53421519 48079367 5342152 26105821 23495239 2610582 33809133 30428220 3380913 2094824 1885342 209482 198699 178829 19870 119444 119444 261821 235639 26182 250468112 225421300 25046812 19799021 17819119 1979902 22067653 19860888 2206765 304041 273637 30404 1142016 1027814 114202 8241348 7417213 824135 32105720 28895148 3210572 6988369 6289532 698837 SUPPLIES 143646682 129282014 14364668 QUALITY ASSURANCE FEE 26680522 24012470 2668052 OTHER EXPENSES 12739027 11445994 1293033 DUES & SUBSCRIPTIONS 3336883 2991250 345633 1042232627 937990234 104242393 0 255843098 321613231 196386802 72500631 131670591 197935642 21617666 18045600 36449699 55711256 1222052624 549882633 639099099 672169991 47182938 26856695 1216000 1216000 141951990 158047749 1471417883 1524096795 142546038 170345427 162923658 137737635 298561335 296102232 20160000 161131156 125411749 765162187 749757043 X 637461500 689422665 68794196 84917087 706255696 774339752 1471417883 1524096795 X 67269858 -6116111 6930309 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 119444 119444 0 PART II-B, LINE 1: DURING FYE 06/30/22, CHILDREN'S HOSPITAL OF ORANGE COUNTY PAID DUES, A PORTION OF WHICH SUPPORTS LOBBYING PURPOSES TO VARIOUS HEALTHCARE ASSOCIATIONS: CALIFORNIA CHILDREN'S HOSPITAL ASSOCIATION $52,968 NATIONAL ASSOCIATION OF CHILDREN'S HOSPITAL $15,094 HOSPITAL ASSOCIATION OF SOUTHERN CALLIFORNIA $51382 TOTAL $119,444 21692956 2464552 -164075 23993433 10693187 10980371 302967 283569 21692956 8994369 1698818 49755 49755 10693187 8115982 876326 92033 86972 8997369 7101240 1010740 72655 68653 8115982 0.97820 0.02180 0 1 1 44657164 44657164 712763857 236049681 476714176 20648830 14505053 6143777 348702360 298019515 50682845 95280413 1308384 93972029 672169991 REC FROM RELATED PARTIES 41448178 OTHER RECEIVABLES 6203616 BENEFICIAL INTEREST IN ASSETS OF FOUNDATION 23058283 OPERATING LEASE RIGHT OF USE ASSETS 79931172 LT WORKERS COMP REC 415729 LT PROF LIAB INSURANCE 7551535 INV IN LA PAZ 35058 INV IN OCMRRG -596762 DONATED CEMETARY LOTS 940 158047749 OTHER LIABILITIES 1269711 LT MALPRACTICE LIAB 1637703 POSTRETIREMENT BENEFIT OBLIGAT 3766211 LIABILITY FOR WORKER'S COMP. 4902417 LT PROFESSIONAL LIAB INSURANCE 7551535 PAYABLE TO RELATED PARTIES 24288377 OPERATING LEASE RIGHT OF USE 81995795 125411749 X 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. PART X, LINE 2: U.S. GAAP REQUIRES 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, 2022, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY OR DISCLOSURE IN THE CONSOLIDATED FINANCIAL STATEMENTS. 1 1 X 1 X 1 X 1 1 0 1 1 52716 52716 0.00010 445249206 350261280 94987926 0.09110 445301922 350261280 95040642 0.09120 11969567 282825 11686742 0.01120 18572406 2969131 15603275 0.01500 10650795 10650795 0.01020 41192768 3251956 37940812 0.03640 486494690 353513236 132981454 0.12760 1551062 14298 1536764 0.00150 1551062 14298 1536764 0.00150 1 28754369 74455 122328 -47873 X 1 1 1 1 CHILDREN'S HOSPITAL OF ORANGE COUNTY 1201 WEST LA VETA AVENUE ORANGE CA 92868 WWW.CHOC.ORG 060000011 X X X CHILDREN'S HOSPITAL OF ORANGE COUNTY 0 0 1 X X X X X X X X X 22 1 1 0 1 X SEE PART V, SECTION C X 1 19 1 SEE PART V, SECTION C 0 1 X 200.000000000000 400.000000000000 X X 1 1 X X X X 1 X HTTPS://WWW.CHOC.ORG/PATIENTS-FAMILY/FINANCIAL-RESOURCES/ X HTTPS://WWW.CHOC.ORG/PATIENTS-FAMILY/FINANCIAL-RESOURCES/ X HTTPS://WWW.CHOC.ORG/PATIENTS-FAMILY/FINANCIAL-RESOURCES/ X X X X X X 1 X 0 X 1 X 0 0 CHILDREN'S HOSPITAL OF ORANGE COUNTY PART V, SECTION B, LINE 5: CHOC AND ITS AFFILIATE, CHILDREN'S HOSPITAL AT MISSION (CCMH) CONDUCTED THE CHNA PROCESS INDEPENDENTLY IN THE FALL OF 2022, WITH INPUT AND DATA FROM NUMEROUS AUTHORITATIVE, PUBLICLY AVAILABLE SOURCES, A SURVEY OF COMMUNITY LEADERS FROM VARIOUS BUSINESSES, SOCIAL SERVICE, AND PUBLIC AGENCIES AND A SURVEY OF THE COMMUNITY-AT-LARGE. THE CHNA REPORT INCLUDES BOTH PRIMARY AND SECONDARY DATA ANALYSES THAT FOCUS ON THE HEALTH AND SOCIAL NEEDS OF THE POPULATION IN EACH CHOC HOSPITAL'S PRIMARY SERVICE AREA. CHILDREN'S HOSPITAL OF ORANGE COUNTY PART V, SECTION B, LINE 6A: CHOC AND CCMH TOGETHER CONDUCTED THE HEALTH NEEDS ASSESSMENTS.SCH H, PART V, LINES 7A & 10ATHE COMMUNITY HEALTH NEEDS ASSESSMENT THAT WAS PUBLISHED IN 2022 CAN BE FOUND AT THE FOLLOWING URL: HTTPS://WWW.CHOC.ORG/FILES/CHOC-CHNA-REPORT.PDF. THE MOST RECENT IMPLEMENTATION PLAN PUBLISHED IN 2019 CAN BE FOUND AT THE FOLLOWING URL: HTTPS://WWW.CHOC.ORG/WP/WP-CONTENT/UPLOADS/2020/02/CHNA-IMPLEMENTATION-PLAN_2019.PDF. CHILDREN'S HOSPITAL OF ORANGE COUNTY PART V, SECTION B, LINE 11: ADDRESSING HIGH PRIORITY COMMUNITY HEALTH NEEDSCHOC COORDINATES ITS RESPONSE TO ITS MOST RECENT CHNA WITH ITS AFFILIATE, CHILDREN'S HOSPITAL AT MISSION (CCMH). CHOC'S AND CCMH'S MOST RECENT CHNA IDENTIFIED TWO HIGH-PRIORITY HEALTH NEEDS:CHOC'S AND CCMH'S MOST RECENT CHNA IDENTIFIED TWO HIGH-PRIORITY HEALTH NEEDS: 1) MENTAL HEALTH: THERE HAS BEEN AN INCREASE IN DEPRESSIVE SYMPTOMS AMONG STUDENTS. SECONDLY, THERE HAS BEEN AN INCREASE IN HOSPITALIZATIONS FOR MENTAL ILLNESS IN 2020 DESPITE THE OVERALL DECREASE IN HOSPITALIZATIONS DUE TO COVID-19 PUBLIC HEALTH EMERGENCY. THIRDLY, THERE HAS BEEN A NEED FOR PREVENTION, EARLY INTERVENTION, AND TREATMENT FOR SUBSTANCE USE AMONG YOUTH. 2) ACCESS TO PEDIATRIC HEALTHCARE SERVICES: THERE IS A NEED FOR IMPROVED ACCESS TO PEDIATRIC SERVICES (INCLUDING PEDIATRIC SPECIALISTS) FROM DIVERSE PROVIDERS WHO UNDERSTANDS THE COUNTY'S RACIAL, CULTURAL AND LINGUISTIC NEEDS OF CHILDREN AND FAMILIES AND THERE IS GEOGRAPHIC DISPARITY IN ACCESS TO PEDIATRIC HEALTH CARE.THE ORGANIZATION IS DEVELOPING ADDITIONAL STRATEGIES TO ADDRESS THESE HIGH PRIORITY NEEDS. SOME OF SPECIFIC INITIATIVES PREVIOUSLY IMPLEMENTED BY THE ORGANIZATION FOR THE HIGH-PRIORITY NEEDS ARE AS FOLLOWS:1) MENTAL HEALTH AND AUTISMCHOC, IN PARTNERSHIP WITH COMMITTED ORGANIZATIONS AND COMMUNITY GROUPS, ASPIRES TO CREATE AN OUTSTANDING MENTAL HEALTH SYSTEM OF CARE FOR ALL CHILDREN, TEENS AND YOUNG ADULTS IN ORANGE COUNTY. OUR GOAL IS TO PROVIDE A COMPREHENSIVE APPROACH TO PEDIATRIC MENTAL ILLNESS TO FULFILL THIS INITIATIVE, CHOC BUILT AN INPATIENT CHILDREN'S MENTAL HEALTH CENTER WHICH OPENED IN APRIL 2018. THE CENTER HAS 18 BEDS IN A SECURED AND HEALING ENVIRONMENT, IN ADDITION TO AN OUTDOOR AREA FOR RECREATION. THE CENTER PROVIDES A SAFE, NURTURING PLACE FOR CHILDREN AGES 3 TO 18, AND SPECIALTY PROGRAMMING FOR CHILDREN YOUNGER THAN 12. IN ADDITION, CHOC BUILT THE THOMPSON AUTISM CENTER WHICH OPENED IN JANUARY 2019. THE NEW CENTER IS DEDICATED TO BRINGING THE LATEST TREATMENTS AND RESOURCES TO THE AUTISM COMMUNITY IN ORANGE COUNTY. THROUGH UNIQUE PROGRAMS, CHILDREN HAVE A CENTRALIZED PLACE WHERE THEY CAN RECEIVE EARLY DIAGNOSIS, ADVANCED THERAPY AND THE POSSIBILITY TO REACH THEIR TRUE POTENTIAL. THE OPENING OF THE INPATIENT CENTER AND THE THOMPSON AUTISM CENTER AUGMENTS MENTAL HEALTH SERVICES ALREADY OFFERED BY CHOC. THOSE SERVICES INCLUDE CHOC'S OUTPATIENT EATING DISORDERS PROGRAM, OUTPATIENT PROGRAMS TO KEEP STRUGGLING CHILDREN OUT OF THE HOSPITAL AND ASSISTANCE TO THOSE WHO HAVE BEEN RELEASED, AND MENTAL HEALTH SERVICES FOR CHOC PATIENTS BEING TREATED FOR SERIOUS/CHRONIC ILLNESSES.2) SUBSTANCE ABUSE CHOC IS INCREASING EDUCATION TO PROVIDE ADDITIONAL TREATMENT OPTIONS TO LOCAL PROVIDERS, INCLUDING INCREASED OUTREACH TO LOCAL SCHOOLS AND COMMUNITIES. CHOC'S EMERGENCY DEPARTMENT SCREENS CHILDREN 11 AND OLDER WHO PRESENT FOR AN EMERGENCY PSYCHIATRIC CONCERN TO DETERMINE LEVEL OF CONCERNING SUBSTANCE USE AND PROVIDE BRIEF ALCOHOL AND OTHER DRUG EDUCATION AS WELL AS REFERRALS FOR TREATMENT IF CONCERNING LEVELS ARE IDENTIFIED. THESE STRATEGIES WILL INDUCE PREVENTION AS WELL AS ALLOWING FOR EARLIER IDENTIFICATION OF SUBSTANCE USE IN CONJUNCTION WITH MENTAL HEALTH DISORDERS FOR EARLY LINKAGE TO SERVICES.3) ACCESS TO PEDIATRIC SPECIALTIES/SUBSPECIALTIESCHOC RECOGNIZES THE COMMUNITY NEED FOR ACCESS TO PEDIATRIC SPECIALISTS/SUBSPECIALISTS AND CONTINUES TO BUILD THE RESOURCES AVAILABLE THROUGHOUT THE COMMUNITIES SERVED BY CHOC. CHOC'S MEDICAL FOUNDATION WAS CREATED IN 2011, AND SINCE THAT TIME HAS CONTINUED TO GROW TO PROVIDE THE SPECIALTY SERVICES SOUGHT BY THE COMMUNITY AND INDICATED AS A HIGH PRIORITY IN THE MOST RECENTLY COMPLETED COMMUNITY NEEDS ASSESSMENT. THE SPECIALTY PHYSICIAN GROUPS THAT HAVE CONTRACTED WITH CHOC TO PROVIDE THE SERVICES HAS GROWN TO A TOTAL OF 262 PROVIDERS AND OFFERS EXPERTISE AND CARE IN OVER 25 PEDIATRIC MEDICAL SPECIALTIES.THE PRIMARY CARE NETWORK, PART OF CHOC'S MEDICAL FOUNDATION, WAS ESTABLISHED IN 2016 AND HAS GROWN TO 134 PEDIATRIC PROVIDERS ACROSS 11 PRACTICES THAT SPAN 21 LOCATIONS AROUND ORANGE COUNTY AND LA COUNTY, PROVIDING GENERAL PEDIATRICS AND ADOLESCENT MEDICINE. ADDITIONALLY, THE PRIMARY CARE NETWORK AND STAFFS PEDIATRICIANS AT 6 ADDITIONAL URGENT CARE LOCATIONS ACROSS ORANGE AND LA COUNTIES. 4) COLLABORATION AND PARTNERSHIPS WITH SCHOOL PROGRAMS COLLABORATION AND PARTNERSHIPS WITH SCHOOL PROGRAMS IS A WAY TO OVERCOME BARRIERS WHEN ADDRESSING OTHER CRITICAL ISSUES IDENTIFIED IN THE CHNA. CHOC WILL COLLABORATE WITH THE ORANGE COUNTY DEPARTMENT OF EDUCATION TO ENHANCE THE PHYSICAL, MENTAL, EMOTIONAL, AND EDUCATIONAL HEALTH OF THE CHILDREN IN ORANGE COUNTY. CHOC'S ASTHMA OUTREACH PROGRAM PROVIDES EDUCATION, DIAGNOSIS AND TREATMENT VIA THE BREATHMOBILE AND THROUGH THE LUNCH AND LEARN PROGRAM TO SCHOOL PERSONNEL AND TO CHILDREN WITH ASTHMA. THE BREATHMOBILE PROGRAM HAS AGREEMENTS WITH VARIOUS LOCATIONS THROUGHOUT THE COUNTY TO PROVIDE ACCESS TO CARE.5) BULLYING AND OTHER STRESSORS IN SCHOOLBULLYING AND OTHER STRESSORS IN SCHOOL CAN CAUSE CHRONIC ABSENTEEISM AND CAN EXACERBATE OTHER CRITICAL HEALTH ISSUES SUCH AS MENTAL HEALTH, OBESITY, AND HUNGER. TO REDUCE THESE STRESSORS, CHOC HAS IMPLEMENTED UNIVERSAL SCREENING ACROSS ALL ORANGE COUNTY PRIMARY CARE PEDIATRIC OFFICES. CHOC HEALTH ALLIANCE, WITH OVERSIGHT OF 150,000 OF THE MOST VULNERABLE CHILDREN IN ORANGE COUNTY, WILL ALIGN ITS INCENTIVE PROGRAM WITH COMPLETION OF SCREENING TO HELP PRACTICES OPERATIONALIZE SCREENING COMPLETION. SCREENING WILL AID IN THE EARLY IDENTIFICATION AND REFERRAL OF AT-RISK YOUTH TO COMMUNITY, SOCIAL AND MENTAL/BEHAVIORAL HEALTH SERVICES AND WILL ULTIMATELY REDUCE SCHOOL ABSENTEEISM, IMPROVEMENT IN GRADE PROGRESSION, AND REDUCTION IN SUICIDE/VIOLENT EVENTS. 46 1 - ALLEVATO PEDIATRICS 431 S BATAVIA STREET SUITE 203 ORANGE CA 92866 PHYSICIAN PRACTICE / CLINIC 2 - CHOC CLINIC - SPECIALTY CARE 1201 W LA VETA AVE ORANGE CA 92868 PHYSICIAN PRACTICE / CLINIC 3 - CHOC CLINIC -SANTA ANA BOYS & GIRLS CLUB 1000 WEST HIGHLAND SANTA ANA CA 92703 PHYSICIAN PRACTICE / CLINIC 4 - CHOC ENDOCRINE & DIABETES CENTER 520 SUPERIOR AVE SUITE 160 NEWPORT BEACH CA 92663 PHYSICIAN PRACTICE / CLINIC 5 - CHOC HEALTH CENTER 26691 PLAZA SUITE 130 MISSION VIEJO CA 92691 PHYSICIAN PRACTICE / CLINIC 6 - CHOC HEALTH CENTER CENTRUM 1120 WEST LA VETA AVENUE SUITE 125 ORANGE CA 92868 PHYSICIAN PRACTICE / CLINIC 7 - CHOC HEALTH CENTER CORONA 845 MAGNOLIA SUITE 101 CORONA CA 92879 PHYSICIAN PRACTICE / CLINIC 8 - CHOC HEALTH CENTER GARDEN GROVE 10602 CHAPMAN AVENUE SUITE 100 GARDEN GROVE CA 92840 PHYSICIAN PRACTICE / CLINIC 9 - CHOC HEALTH CENTER HUNTINGTON BEACH 19582 BEACH BLVD SUITE 380 HUNTINGTON BEACH CA 92648 PHYSICIAN PRACTICE / CLINIC 10 - CHOC OUTPATIENT HEART CENTER 505 S MAIN STREET SUITE 600 ORANGE CA 92868 PHYSICIAN PRACTICE / CLINIC 11 - CHOC OUTPATIENT REHABILITATION SERVICES 3745 W CHAPMAN AVE SUITE 200 ORANGE CA 92868 REHAB CLINIC 12 - CHOC PRIMARY CARE CLINIC 3745 W CHAPMAN AVE ORANGE CA 92868 PHYSICIAN PRACTICE / CLINIC 13 - CHOC SLEEP CENTER 530 S MAIN STREET SUITE 100 ORANGE CA 92868 OUTPATIENT CLINIC 14 - CHOC SPECIALISTS ALLERGY AND IMMUNOLOGY 725 WEST LA VETA SUITE 100 ORANGE CA 92868 PHYSICIAN PRACTICE / CLINIC 15 - CHOC SPECIALISTS CARDIOLOGY 505 SOUTH MAIN STREET SUITE 600 ORANGE CA 92868 PHYSICIAN PRACTICE / CLINIC 16 - CHOC SPECIALISTS NEUROSURGERY 505 SOUTH MAIN STREET SUITE 300 ORANGE CA 92868 PHYSICIAN PRACTICE / CLINIC 17 - CHOC SPECIALISTS OPTHALMOLOGY 1120 W LA VETA SUITE 100 ORANGE CA 92868 PHYSICIAN PRACTICE / CLINIC 18 - CHOC SPECIALISTS OTOLARYNGOLOGY 466 OLD NEWPORT BLVD NEWPORT BEACH CA 92663 PHYSICIAN PRACTICE / CLINIC 19 - CHOC SPECIALISTS OTOLARYNGOLOGY 1010 WEST LA VETA SUITE 710 ORANGE CA 92868 PHYSICIAN PRACTICE / CLINIC 20 - CHOC SPECIALISTS OTOLARYNGOLOGY 770 PACIFIC COAST HWY SEAL BEACH CA 90740 PHYSICIAN PRACTICE / CLINIC 21 - CHOC SPECIALISTS OTOLARYNGOLOGY 250 E YALE LOOP SUITE 200 IRVINE CA 92604 PHYSICIAN PRACTICE / CLINIC 22 - CHOC SPEC PED GENERAL & THORACIC SURG 505 SOUTH MAIN STREET SUITE 225 ORANGE CA 92868 PHYSICIAN PRACTICE / CLINIC 23 - CHOC SPECIALISTS PHYSICIAN OFFICE 505 SOUTH MAIN STREET SUITE 350 ORANGE CA 92868 PHYSICIAN PRACTICE / CLINIC 24 - CHOC SPECIALISTS PSYCHIATRY 1120 WEST LA VETA AVENUE SUITE 470 ORANGE CA 92868 PHYSICIAN PRACTICE / CLINIC 25 - CHOC SPECIALTY CENTER NEWPORT BEACH 500 SUPERIOR AVE SUITE 140 NEWPORT BEACH CA 92868 PHYSICIAN PRACTICE / CLINIC 26 - CLINICA CHOC PARA NINOS 406 S MAIN ST SANTA ANA CA 92701 PHYSICIAN PRACTICE / CLINIC 27 - EDINGER PEDIATRICS 9900 TALBERT AVE SUITE 201 FOUNTAIN VALLEY CA 92708 PHYSICIAN PRACTICE / CLINIC 28 - FETAL CARE CENTER OF SOUTHERN CALIFORNIA 505 S MAIN STREET SUITE 650 ORANGE CA 92868 PHYSICIAN PRACTICE / CLINIC 29 - LOS ALAMITOS PEDIATRICS 10861 CHERRY STREET SUITE 305 LOS ALAMITOS CA 90720 PHYSICIAN PRACTICE / CLINIC 30 - ORANGE DOCTORS OF KIDS AND TEENS 1310 W STEWART DR SUITE 506 ORANGE CA 92868 PHYSICIAN PRACTICE / CLINIC 31 - PEDIATRIC AND ADULT MEDICINE 18102 IRVINE BLVD SUITES 103 105 TUSTIN CA 92780 PHYSICIAN PRACTICE / CLINIC 32 - POMONA PEDIATRICS 250 W BONITA AVENUE SUITE 200 POMONA CA 91767 PHYSICIAN PRACTICE / CLINIC 33 - PREMIER PEDIATRICS 15825 LAGUNA CANYON RD SUITE 102 IRVINE CA 92618 PHYSICIAN PRACTICE / CLINIC 34 - SEAVIEW PEDIATRICS - ALISO VIEJO 2 JOURNEY SUITE 100 ALISO VIEJO CA 92656 PHYSICIAN PRACTICE / CLINIC 35 - SEAVIEW PEDIATRICS - IRVINE 15785 LAGUNA CANYON ROAD SUITE 120 IRVINE CA 92618 PHYSICIAN PRACTICE / CLINIC 36 - SEAVIEW PEDIATRICS - LAGUNA HILLS 23521 PASEO DE VALENCIA SUITE 200 LAGUNA HILLS CA 92653 PHYSICIAN PRACTICE / CLINIC 37 - SEAVIEW PEDIATRICS - SAN CLEMENTE 1031 AVENIDA PICO SUITE 106 SAN CLEMENTE CA 92673 PHYSICIAN PRACTICE / CLINIC 38 - SOCPA - LADERA RANCH 777 CORPORATE DRIVE SUITE 250 LADERA RANCH CA CA 92694 PHYSICIAN PRACTICE / CLINIC 39 - SOCPA - LAKE FOREST 23321 EL TORO ROAD SUITES F G LAKE FOREST CA 92630 PHYSICIAN PRACTICE / CLINIC 40 - SOCPA - RSM 30212 TOMAS SUITE 220 RANCHO SANTA MARGARI CA 92688 PHYSICIAN PRACTICE / CLINIC 41 - SOCPA - SAN CLEMENTE 1300 AVENIDA VISTA HERMOSA SUITE 200 SAN CLEMENTE CA 92673 PHYSICIAN PRACTICE / CLINIC 42 - TOTAL PEDIATRICS OF ORANGE COUNTY 1640 NEWPORT BLVD SUITE 360 COSTA MESA CA 92627 PHYSICIAN PRACTICE / CLINIC 43 - CHOC SPECIALISTS PHYSICIAN OFFICE 505 SOUTH MAIN STREET SUITE 350 ORANGE CA 92868 PHYSICIAN PRACTICE / CLINIC 44 - CHOC NEUROSCIENCE INSTITUTE OP CENTER 505 SOUTH MAIN STREET SUITE 350 ORANGE CA 92868 PHYSICIAN PRACTICE / CLINIC 45 - CHOC PEDIATRIC PSYCHOLOGY 1120 WEST LA VETA AVENUE SUITE 470 ORANGE CA 92868 PHYSICIAN PRACTICE / CLINIC 46 - CHOC UROLOGY CENTER 505 S MAIN STREET SUITE 100 ORANGE CA 92868 PHYSICIAN PRACTICE / CLINIC PART I, LINE 6A: THE ORGANIZATION'S COMMUNITY BENEFIT REPORT IS CONTAINED IN A REPORT PREPARED BY CHOC AND CCMH ANNUALLY AND IS FILED IN ACCORDANCE WITH CALIFORNIA SB697. 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.PROVIDER FEE PROGRAMTHE STATE OF CALIFORNIA HAS A PROVIDER FEE PROGRAM THAT, COMBINED WITH FEDERAL MATCHING FUNDS, HAS PROVIDED SUPPLEMENTAL MEDI-CAL PAYMENTS TO HOSPITALS IN THE STATE.CHOC RECOGNIZED REVENUES FOR THE MANAGED CARE PORTION OF THE 30-MONTH PROGRAM ENDED JUNE 30, 2019 OF $105,512,000 AND PROVIDER FEES AND OTHER EXPENSES OF $19,235,000. IN ADDITION, CHOC RECOGNIZED REVENUES RELATED TO THE FEE FOR SERVICE PORTION OF THE 24 MONTH PROGRAM ENDED JUNE 30, 2021 OF $29,624,000 AND PROVIDER FEES AND OTHER EXPENSES OF $7,446,000. THE AMOUNTS WERE RECOGNIZED AS NET PATIENT REVENUE AND OPERATING EXPENSES, RESPECTIVELY, IN THE FISCAL YEAR ENDED JUNE 30, 2022. PART II, COMMUNITY BUILDING ACTIVITIES: COMMUNITY SUPPORT IS BEST EXEMPLIFIED BY THE ORGANIZATION'S INCREASED EMPHASIS ON COMMUNITY OUTREACH AND COMMUNITY EDUCATION, WHICH INCLUDES INJURY PREVENTION, SAFETY AND WELLNESS. THE ORGANIZATION HAS 84 DIFFERENT COMMUNITY BENEFIT PROGRAMS CATEGORIZED ACCORDING TO THE CALIFORNIA COMMUNITY BENEFITS LAW, SB697. WITHIN THESE CATEGORIES, THE CATEGORY WHICH MOST CLOSELY CORRELATES TO LINE 3, COMMUNITY SUPPORT, IS HEALTHCARE ACCESS. THROUGH HEALTHCARE ACCESS, THE ORGANIZATION INCREASES ACCESS TO QUALITY PEDIATRIC HEALTHCARE RESOURCES AND INFORMATION TO FAMILIES, ESPECIALLY LOW-INCOME AND MEDICALLY UNDERSERVED, THROUGHOUT ORANGE COUNTY. THIS IS ACCOMPLISHED THROUGH COMMUNITY OUTREACH CLINICS AND EDUCATION.COMMUNITY BENEFIT REPORT HIGHLIGHTS:CHOC IS EXCLUSIVELY COMMITTED TO IMPROVING THE HEALTH AND WELL-BEING OF CHILDREN THROUGH CLINICAL EXPERTISE, ADVOCACY, OUTREACH, EDUCATION AND RESEARCH. AFFILIATED WITH THE UNIVERSITY OF CALIFORNIA, IRVINE, CHOC'S HEALTHCARE SYSTEM INCLUDES TWO STATE-OF-THE-ART PEDIATRIC HOSPITALS IN ORANGE AND MISSION VIEJO, TWO TRAUMA CENTERS, MANY PRIMARY AND SPECIALTY CARE OUTPATIENT CLINICS, A MENTAL HEALTH INPATIENT CENTER, AND FOUR CLINICAL CENTERS OF EXCELLENCE - CHOC HEART, NEUROSCIENCE, ORTHOPAEDIC AND HYUNDAI CANCER INSTITUTES.THE CHOC INSTITUTES PROVIDE COMPREHENSIVE MULTIDISCIPLINARY CARE FOR SOME OF THE MOST SERIOUS PEDIATRIC AND ADOLESCENT ILLNESSES AND INJURIES. PATIENTS BENEFIT FROM INNOVATIVE AND SPECIALIZED PROGRAMS, SUCH AS THE ADOLESCENT AND YOUNG ADULT CANCER TREATMENT PROGRAM. ONE OF THE ONLY PROGRAMS OF ITS KIND IN THE NATION, IT OFFERS CANCER-SPECIFIC TREATMENT WHILE ALSO ADDRESSING THE UNIQUE PSYCHO-SOCIAL NEEDS OF TEENS AND YOUNG ADULTS.OFFERING ACCESS TO CUTTING-EDGE CLINICAL TRIALS THAT CAN'T BE FOUND ANYWHERE ELSE, CHOC'S RESEARCH INSTITUTE HAS MORE THAN 350 RESEARCH STUDIES IN MORE THAN 30 SPECIALTIES. SCIENTISTS TRANSLATE THE LATEST ADVANCES IN MOLECULAR PROFILING, INCLUDING WHOLE GENOME SEQUENCING, TO MEET THE INDIVIDUALIZED NEEDS OF PATIENTS AT EVERY STAGE OF THEIR YOUNG LIVES, FROM INFANCY THROUGH ADOLESCENCE.DEDICATED TO ENSURING CHILDREN HAVE ACCESS TO THE RIGHT CARE AT THE RIGHT TIME AND PLACE, CHOC'S DIVISION OF POPULATION HEALTH PARTNERS WITH PRIMARY AND SPECIALTY CARE PEDIATRICIANS TO HELP THEM BETTER COORDINATE CARE FOR PATIENTS AND TO IMPROVE OUTCOMES. NEW TOOLS, INCLUDING EVIDENCE-BASED GUIDELINES AND DISEASE-SPECIFIC PATIENT REGISTRIES, AND ENHANCED TECHNOLOGY REDUCE VARIATIONS IN CARE, IMPROVING QUALITY. AN ADVOCATE FOR CHILDREN AND FAMILIES, CHOC IS ADDRESSING THE LACK OF PEDIATRIC MENTAL HEALTH SERVICES IN THE REGION WITH THE CREATION OF A COMPREHENSIVE MODEL OF CARE. THE MENTAL HEALTHINPATIENT CENTER, PROVIDING A SAFE, NURTURING ENVIRONMENT FOR CHILDREN AGES 3 TO 18 AND SPECIALTY PROGRAMMING FOR CHILDREN YOUNGER THAN 12, OPENED IN 2018. IN ADDITION TO INPATIENT SERVICES, CHOC OFFERS OUTPATIENT BEHAVIORAL SERVICES AND LEADS A COUNTY-WIDE TASK FORCE FOCUSED ON ENSURING EVERY CHILD AND ADULT IN ORANGE COUNTY WHO NEED MENTAL HEALTH TREATMENT RECEIVE HIGH QUALITY SERVICES WITHOUT STIGMA OR BARRIERS TO ACCESS. CHOC'S MENTAL HEALTH SYSTEM OF CARE STRIVES TO BE A NATIONAL MODEL, BENEFITTING CHILDREN ACROSS THE UNITED STATES.THE THOMPSON AUTISM CENTER AT CHOC OPENED IN EARLY 2020, EXPANDING THE REGION'S CAPACITY TO SERVE THE INCREASING NUMBER OF CHILDREN WITH AUTISM SPECTRUM DISORDER (ASD) AND RELATED NEURODEVELOPMENTAL CONDITIONS.SEE OUR COMMUNITY BENEFIT REPORTS ON OUR WEBSITE AT HTTPS://WWW.CHOC.ORG/FILES/COMMUNITYBENEFITPLAN.PDF. PART III, LINE 2: THE ORGANIZATION CHARGES BAD DEBT FOR (A) THE WRITE-OFF OF PATIENT ACCOUNTS WHERE FAMILIES DID NOT COOPERATE WITH CHOC 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. PART III, LINE 3: THE HOSPITAL FOLLOWS HFMA STATEMENT 15 AND THEREFORE NO PART OF BAD DEBT, AS DEFINED BY STATEMENT 15, REPRESENTS AMOUNTS ATTRIBUTABLE TO PATIENTS ELIGIBLE TO RECEIVE FINANCIAL ASSISTANCE. PART III, LINE 4: PATIENT ACCOUNTS RECEIVABLE ARE RECORDED AT THE INVOICED AMOUNT, NET OF ANY EXPECTED CONTRACTUAL ADJUSTMENTS AND DO NOT BEAR INTEREST. THE ORGANIZATION HAS AGREEMENTS WITH THIRD-PARTY PAYORS THAT PROVIDE FOR PAYMENTS AT AMOUNTS DIFFERENT FROM THE ESTABLISHED RATES. PAYMENT ARRANGEMENTS INCLUDE PROSPECTIVELY DETERMINED RATES PER DISCHARGE, REIMBURSED COSTS, DISCOUNTED CHARGES, AND PER DIEM PAYMENTS. PATIENT SERVICES REVENUES ARE REPORTED AT THE ESTIMATED NET REALIZABLE AMOUNTS FROM PATIENTS, THIRD-PARTY PAYORS, AND OTHERS FOR SERVICES RENDERED. CONTRACTUAL ADJUSTMENTS ARISING UNDER REIMBURSEMENT ARRANGEMENTS WITH THIRD-PARTY PAYORS ARE ACCRUED ON AN ESTIMATED BASIS IN THE PERIOD THE RELATED SERVICES ARE RENDERED AND ARE ADJUSTED IN FUTURE PERIODS AS FINAL SETTLEMENTS ARE DETERMINED. IMPLICIT PRICE CONCESSIONS ARE TAKEN BASED ON HISTORICAL COLLECTION EXPERIENCE AND REFLECT THE ESTIMATED AMOUNTS THE ORGANIZATION EXPECTS TO COLLECT. PART III, LINE 8: THE ALLOWABLE COST IS BASED ON A COST TO CHARGE RATIO OF .2054 AS DETERMINED BY THE ORGANIZATION'S FILED MEDICARE COST REPORT. SHORTFALLS ARE CONSIDERED A COMMUNITY BENEFIT BECAUSE THE DOLLAR VALUE OF BENEFITS PROVIDED BY LEGISLATIVE CATEGORY LINK TO THE DOLLARS IDENTIFIED BY COMMUNITY NEEDS. CHOC REPORTS UNPAID COSTS OF PUBLIC PROGRAMS AS GOVERNMENT PAYOR SHORTFALLS. THE PRINCIPAL MEASURE FOR MONITORING COMMUNITY BENEFIT SERVICES IS THE DOLLAR VALUE OF BENEFITS RETURNED TO THE COMMUNITY PER DOLLAR OF TAX EXEMPTION VALUE RECEIVED. 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, CHOC 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 CHOC 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, CHOC WILL NOT USE WAGE GARNISHMENTS OR LIENS ON PATIENT'S OR PATIENT FAMILY'S PRIMARY RESIDENCE AS A MEANS OF COLLECTING UNPAID CHOC BILLS. THIS REQUIREMENT DOES NOT PRECLUDE CHOC FROM PURSUING REIMBURSEMENT FROM THIRD PARTY LIABILITY SETTLEMENTS. PART VI, LINE 2: NEEDS ASSESSMENT:IN ADDITION TO THE TRI-ANNUAL COMMUNITY HEALTH NEEDS ASSESSMENT, CHOC REGULARLY TRACKS KEY DEMOGRAPHIC CHANGES IN THE PEDIATRIC POPULATION OF ITS COMMUNITY AND THE UTILIZATION OF KEY SERVICES DELIVERED AND EVALUATES THE PROGRAMS IT PROVIDES TO MEET IDENTIFIED NEEDS. THROUGH CONSTANT CONTACT WITH A VARIETY OF COMMUNITY CONSTITUENTS, CHOC IS ABLE TO LEARN ABOUT EMERGING TRENDS AND NEEDS. IT THEN EVALUATES OPTIONS TO MEET THOSE NEEDS, EITHER ALONE OR IN COLLABORATION WITH OTHERS IN THE COMMUNITY.ALL OF THE PROGRAMS ASSOCIATED WITH THE COMMUNITY HEALTH NEEDS ASSESSMENT ARE AVAILABLE IN THE REPORT ON THE HOSPITAL'S WEBSITE AT HTTPS://WWW.CHOC.ORG/FILES/CHOC-CHNA-REPORT.PDF AS WELL AS A PAPER COPY THAT IS AVAILABLE UPON REQUEST FOR PUBLIC INSPECTION. PART VI, LINE 3: PATIENTS ARE INFORMED OF THEIR ELIGIBILITY FOR ASSISTANCE UNDER FEDERAL, STATE, OR LOCAL GOVERNMENT PROGRAMS AND UNDER THE HOSPITAL'S CHARITY CARE POLICY IN OUR FINANCIAL ASSISTANCE AND DISCOUNT PROGRAM POLICY. THIS INFORMATION, EITHER IN FULL OR IN SUMMARY, IS POSTED IN ALL OF THE HIGH TRAFFIC PATIENT AREAS: ADMITTING, EMERGENCY ROOM, CLINIC AND THE BUSINESS OFFICE. THE PATIENTS ARE ALSO INFORMED IF THERE IS A FINANCIAL NEED IDENTIFIED BY THE HOSPITAL FINANCIAL COUNSELORS WHEN SPEAKING TO THE FAMILIES ABOUT THEIR INSURANCE OR LACK OF INSURANCE. PATIENTS ARE PROVIDED A COPY OF THE HOSPITAL'S PATIENT FINANCIAL ASSISTANCE AND DISCOUNT PAYMENT PROGRAM POLICY. FAMILIES ARE ALSO NOTIFIED ON EVERY PATIENT STATEMENT THAT IF THERE IS A FINANCIAL NEED THEY SHOULD CALL THE DESIGNATED PHONE NUMBER FOR MORE INFORMATION AND ASSISTANCE.FINANCIAL ASSISTANCE COMMUNICATION - AS PART OF THE HOSPITAL'S 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 HOSPITAL'S 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. THE FINANCIAL ASSISTANCE POLICY IS AVAILABLE IN ENGLISH AND SPANISH. PART VI, LINE 4: COMMUNITY INFORMATION - THE HOSPITAL SERVES ALL OF ORANGE COUNTY AND A LIMITED, ALTHOUGH SIGNIFICANT, NUMBER OF PATIENTS FROM THE WESTERN RIM OF RIVERSIDE AND SAN BERNARDINO COUNTIES, THE NORTHERN PORTION OF SAN DIEGO COUNTY AND SOUTHEAST AREAS OF LOS ANGELES COUNTY. THE PRIMARY SERVICE AREA IS THE CENTRAL-NORTHERN PORTION OF ORANGE COUNTY, AND IS THE SOURCE OF APPROXIMATELY 85% OF ITS PATIENTS. SIGNIFICANT CITIES IN THIS AREA ARE: SANTA ANA, ANAHEIM, FULLERTON, ORANGE, AND GARDEN GROVE. THE SECONDARY SERVICE AREA INCLUDES ALL THE OTHER ORANGE COUNTY CITIES AND UNINCORPORATED AREAS. THE COMMUNITY SERVED BY THE HOSPITAL INCLUDES FEDERALLY-DESIGNATED MEDICALLY UNDERSERVED AREAS AND POPULATIONS.COMMUNITY CHARACTERISTICSCOMMUNITY CHARACTERISTICS: POPULATION AND SOCIOECONOMIC DATA PROJECTIONS HAVE BEEN COLLECTED FROM A VARIETY OF LOCAL COUNTY AND STATE SOURCES REPRESENTING COMMUNITY DEMOGRAPHIC, SOCIAL AND ECONOMIC FACTORS, HEALTH ACCESS AND UTILIZATION, AND RESOURCES AVAILABLE IN THE COMMUNITY FOR THE 2022 COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) REPORT, THE MOST RECENTLY AVAILABLE. ORANGE COUNTY'S POPULATION IS 3,203,504, MAKING IT THE THIRD MOST POPULOUS COUNTY IN CALIFORNIA. THE MEDIAN AGE IS 38.1, AND CHILDREN UP TO 18 YEARS OF AGE MAKE UP 24% OF THE TOTAL POPULATION. IN THE CHOC SERVICE AREA. 17.1% OF CHILDREN UNDER THE AGE OF 18 LIVE IN POVERTY, COMPARED TO 21.1% OF CALIFORNIA'S CHILDREN. ORANGE COUNTY'S POPULATION IS DIVERSE, WITH 49.9% OF THE POPULATION BEING WHITE; 2.1% BEING BLACK/AFRICAN AMERICAN; .4% BEING AMERICAN INDIAN/ALASKA NATIVE; 14.9% BEING ASIAN; .6% BEING PACIFIC ISLANDER; 5.5% IDENTIFYING AS MULTIPLE RACES; AND 26.6% AS OTHER. OF THE TOTAL ORANGE COUNTY POPULATION, 34.1% IDENTIFY AS HISPANIC ETHNICITY. PART VI, LINE 5: CHILDREN'S HEALTHCARE OF CALIFORNIA (CHC) IS THE NOT-FOR-PROFIT, TAX-EXEMPT PARENT CORPORATION OF CHILDREN'S HOSPITAL OF ORANGE COUNTY (CHOC) AND CHILDREN'S HOSPITAL 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; A NUMBER OF PRIMARY AND SPECIALTY CLINICS THROUGHOUT ORANGE AND RIVERSIDE COUNTIES, PROGRAMS AND SERVICES; AND FOUR CENTERS OF EXCELLENCE, THE CHOC HEART, NEUROSCIENCE, HYUNDAI CANCER INSTITUTE AND ORTHOPAEDIC INSTITUTES. CHOC ALSO HAS A RESEARCH INSTITUTE PERFORMING BASIC SCIENCE AND CLINICAL RESEARCH. THROUGH ITS JOINT RESIDENCY PROGRAM WITH UC IRVINE, THE ORGANIZATION ALSO TRAINS TOMORROW'S PHYSICIANS. THE COMMUNITY BENEFIT PLAN FOR THE FISCAL YEAR ENDING JUNE 30, 2022, 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: HTTPS://WWW.CHOC.ORG/FILES/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:ONLY PRACTICING PHYSICIANS, DENTISTS, PSYCHOLOGISTS OR PODIATRISTS SHALL BE DEEMED TO POSSESS BASIC QUALIFICATIONS FOR MEMBERSHIP ON THE MEDICAL STAFF, EXCEPT FOR THE HONORARY AND RETIRED STAFF CATEGORIES IN WHICH CASE THESE CRITERIA SHALL ONLY APPLY AS DEEMED INDIVIDUALLY APPLICABLE BY THE MEDICAL STAFF, AND WHO:(A) DOCUMENT THEIR (1) CURRENT LICENSURE, (2) ADEQUATE EXPERIENCE, EDUCATION, AND TRAINING, (3) CURRENT PROFESSIONAL COMPETENCE, (4) GOOD JUDGMENT, AND (5) CURRENT ADEQUATE PHYSICAL AND MENTAL HEALTH STATUS, SO AS TO DEMONSTRATE TO THE SATISFACTION OF THE MEDICAL STAFF THAT THEY ARE PROFESSIONALLY AND ETHICALLY COMPETENT AND THAT PATIENTS TREATED BY THEM CAN REASONABLY EXPECT TO RECEIVE QUALITY MEDICAL CARE.(B) ARE DETERMINED (1) TO ADHERE TO THE ETHICS OF THEIR RESPECTIVE PROFESSIONS, (2) TO BE ABLE TO WORK COOPERATIVELY WITH OTHERS SO AS NOT TO ADVERSELY AFFECT PATIENT CARE, (3) TO KEEP AS CONFIDENTIAL, AS REQUIRED BY LAW, ALL INFORMATION OR RECORDS RECEIVED IN THEPHYSICIAN-PATIENT RELATIONSHIP, AND (4) TO BE WILLING TO PARTICIPATE IN AND PROPERLY DISCHARGE THOSE RESPONSIBILITIES DETERMINED BY THE MEDICAL STAFF AND BE BOUND BY THE MEDICAL STAFF BYLAWS, RULES AND REGULATIONS, AND POLICIES.(C) WHO MAINTAIN IN FORCE PROFESSIONAL LIABILITY INSURANCE IN NOT LESS THAN THE MINIMUM AMOUNTS JOINTLY DETERMINED BY THE BOARD OF DIRECTORS AND THE MEDICAL EXECUTIVE COMMITTEE, BUT IN NO EVENT LESS THAN $1.0 MILLION PER INCIDENT AND $3.0 MILLION IN THE AGGREGATE IN A POLICY YEAR; PROVIDED, HOWEVER, THAT IN THE EVENT THAT (AND FOR SO LONG AS) SUCH INSURANCE IS NOT AVAILABLE ON COMMERCIALLY REASONABLE TERMS TO PHYSICIANS PRACTICING IN A PARTICULAR SPECIALTY OR SUB-SPECIALTY AREA OF MEDICAL PRACTICE, THE FOREGOING REQUIREMENTS MAY BE MODIFIED OR WAIVED WITH RESPECT TO ALL PHYSICIANS PRACTICING IN SUCH SPECIALTY OR SUB-SPECIALTY AREA, SUBJECT TO THE APPROVAL OF THE BOARD OF DIRECTORS UPON REQUEST OF THE MEDICAL EXECUTIVE COMMITTEE. ADMINISTRATIVE STAFF AND MEMBERS ON A LEAVE OF ABSENCE DO NOT NEED TO SHOW EVIDENCE OF INSURANCE.THE ORGANIZATION APPLIES ITS SURPLUS FUNDS TO IMPLEMENT IMPROVEMENTS IN PATIENT CARE, MEDICAL EDUCATION, RESEARCH AND IN CONSTRUCTION PROJECTS RELATED TO THE ENTERPRISE MASTER PLAN (EMP). IN RECENT YEARS, THE ORGANIZATION HAS COMMENCED CONSTRUCTION ON A NEW AMBULATORY CARE TOWER, ADDITIONAL OPERATING ROOMS, A MATERNAL FETAL MEDICINE SUITE INCLUSIVE OF A SPECIAL DELIVERY UNIT, PRIVATE ROOM INTENSIVE CARE ROOM EXPANSIONS, AND AN EXPANDED EMERGENCY DEPARTMENT. THE CHOC ENDOWMENT FUNDS ARE IN PART USED TO FUND MEDICAL RESEARCH, CLINICAL PROGRAMS AND SERVICES, AND TO RECRUIT AND RETAIN DOCTORS WHO ARE THE BEST IN THEIR FIELDS. PART VI, LINE 6: AFFILIATED HEALTH CARE SYSTEM:FOR OVER 50 YEARS, CHOC HAS BEEN STEADFASTLY COMMITTED TO PROVIDING THE HIGHEST QUALITY MEDICAL CARE TO CHILDREN. AFFILIATED WITH THE UNIVERSITY OF CALIFORNIA, IRVINE, OUR REGIONAL PEDIATRIC HEALTHCARE NETWORK INCLUDES A STATE-OF-THE ART 334 BED HOSPITAL IN THE CITY OF ORANGE AND A HOSPITAL-WITHIN-A-HOSPITAL IN MISSION VIEJO. CHOC ALSO OFFERS MANY PRIMARY AND SPECIALTY CARE CLINICS, MORE THAN 89 ADDITIONAL PROGRAMS AND SERVICES, A PEDIATRIC RESIDENCY PROGRAM, AND FOUR CENTERS OF EXCELLENCE - CHOC HEART, NEUROSCIENCE, ORTHOPAEDIC, AND HYUNDAI CANCER INSTITUTES. THE ECONOMIC VALUE OF THE 73 BENEFIT SERVICES PROVIDED BY CHOC IN FISCAL YEAR 2022 IS $143.2 MILLION. OF THESE DOLLARS, 72.8% ($104.2 MILLION) SERVED THE ECONOMICALLY DISADVANTAGED. THE ECONOMIC VALUE OF SAVINGS FROM NOT-FOR-PROFIT STATUS IS $22.9 MILLION. THUS, THE HOSPITALS RETURN $6.25 IN COMMUNITY BENEFITS FOR EACH $1 SAVED FROM TAX-EXEMPT STATUS. IN ADDITION TO THE $143.2 MILLION IN BENEFITS PROVIDED FOR BY THE HOSPITALS REFERENCED ABOVE, BOARD MEMBERS, PHYSICIANS, EMPLOYEES AND VOLUNTEERS CONTRIBUTED APPROXIMATELY 57,519 HOURS OF VOLUNTEER SERVICE TO THE COMMUNITY. PART VI, LINE 7, REPORTS FILED WITH STATES CA X X X X 1 1 0 0 0 0 0 0 0 KIMBERLY CRIPE PRESIDENT/CEO 0 1071266 0 430240 0 264608 0 68315 0 35147 0 1869576 0 58318 SHAHAB DADJOU SVP/CHIEF STRATEGY OFFICER 0 579049 0 151737 0 215325 0 33430 0 11156 0 990697 0 27630 KERRI RUPPERT SCHILLER EVP/CFO/ASSISTANT SECRETAR 0 587246 0 160933 0 151474 0 44383 0 29379 0 973415 0 27953 JAY GABRIEL CHIEF LEGAL OFFICER/SEC 500430 0 114068 0 115464 0 36024 0 42351 0 808337 0 20609 0 PAUL VAN DOLAH EVP/COO 0 605535 0 104694 0 3837 0 0 0 0 0 714066 0 0 MICHAEL WEISS VP POPULATION HEALTH 455623 0 104402 0 86924 0 26534 0 28966 0 702449 0 18574 0 JOHN HENDERSON VP & CHIEF INFO OFFICER 432557 0 86256 0 77698 0 65706 0 21388 0 683605 0 59906 0 MATTHEW GERLACH FORMER EVP/COO 0 0 0 29815 0 606028 0 0 0 0 0 635843 0 29815 WILLIAM FEASTER MD VP, CHIEF HEALTH INFO OFFICER 391096 0 93995 0 67456 0 24894 0 29379 0 606820 0 16194 0 THOMAS CAPIZZI VP, CHIEF PEOPLE OFFICER 379112 0 84377 0 75697 0 20439 0 29379 0 589004 0 15596 0 MELANIE PATTERSON VP PATIENT CARE SERVICES 376448 0 78619 0 74420 0 29362 0 23635 0 582484 0 15338 0 TERENCE SANGER VP, CHIEF SCIENTIFIC OFFICER 399850 0 92500 0 2600 0 17400 0 25441 0 537791 0 0 0 CHARLES GOLDEN MD VP, MEDICAL DIRECTOR PRIMARY CARE 394301 0 92683 0 2606 0 4083 0 42351 0 536024 0 0 0 MARY ZIMMER VP OPERATIONS 331167 0 74387 0 68530 0 14559 0 42351 0 530994 0 13767 0 HALE KUHLMAN VP, CHOC NETWORK, FINANCE 291295 0 62085 0 61902 0 28084 0 21677 0 465043 0 12113 0 SANDIP GODAMBE MD SVP, MED AFFAIRS/CMO 203536 0 50000 0 20011 0 0 0 11402 0 284949 0 0 0 JASON CULP VP, CHOC CHILDREN'S SPECIALIST 10578 0 150000 0 577 0 0 0 0 0 161155 0 0 0 PART I, LINES 4A-B 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. IN 2021 SHAHAB DADJOU RECEIVED A SEVERANCE PAYMENT IN THE AMOUNT OF $95,543 AND MATTHEW GERLACH RECEIVED A SEVERANCE PAYMENT IN THE AMOUNT OF $606,028. 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), OR SERP, FOR EACH PLAN YEAR THAT BEGINS PRIOR TO THE PARTICIPANT'S CASH DATE, CHOC SHALL CREATE A NEW SERP ACCOUNT ON ITS BOOKS FOR THE PARTICIPANT AND SHALL CREDIT TO SUCH ACCOUNT AT TIMES SPECIFIED. THE PARTICIPANTS OF THE PLAN ARE GENERAL CREDITORS OF THE COMPANY. THE PARTICIPANT'S SERP ACCOUNT SHALL BE UTILIZED SOLELY AS A DEVICE FOR THE MEASUREMENT AND DETERMINATION OF THE AMOUNTS TO BE PAID TO THE PARTICIPANT UNDER THIS PLAN. THE PARTICIPANT IS ENTITLED TO HIS/HER SERP BENEFIT AMOUNT UPON THE EARLIEST OF (1) REMAINING EMPLOYED WITH THE COMPANY TO THE THIRD ANNIVERSARY OF THE FIRST DAY OF THE PLAN YEAR FOR WHICH THE SERP ACCOUNT WAS CREATED; (2) REMAINING EMPLOYED WITH THE COMPANY TO THE PARTICIPANT'S 60TH BIRTHDAY; (3) REMAINING EMPLOYED WITH THE COMPANY TO THE DATE THE PARTICIPANT HAS BOTH ATTAINED AT LEAST AGE 55 AND HAS COMPLETED AT LEAST 10 YEARS OF SERVICE; (4) DISABILITY; (5) INVOLUNTARY SEPARATION FROM SERVICE WITHOUT REASONABLE CAUSE; (6) VOLUNTARY SEPARATION FROM SERVICE FOR GOOD REASON OR (7) DEATH. THE FOLLOWING INDIVIDUALS RECEIVED PAYMENTS FROM THE PLAN DURING CALENDAR YEAR 2021: MS. CRIPE ($233,272), MS. SCHILLER ($103,827), MR. GABRIEL ($76,932), MR. GERLACH ($29,815), MR. KUHLMAN ($44,990), MR. WEISS ($68,989), MS. PATTERSON ($56,970), MR. CAPIZZI ($58,218), MS. ZIMMER ($51,343), MR. HENDERSON ($59,906), MR. FEASTER ($60,149), AND MR. DADJOU ($102,624). COMPENSATION FROM AN AFFILIATED ORGANIZATION KIMBERLY C. CRIPE IS COMPENSATED THROUGH CHILDREN'S HEALTHCARE OF CALIFORNIA (CHC), HOWEVER, IN ADDITION TO HER RESPONSIBILITIES FOR CHC, SHE ALSO SERVES AS AN OFFICER OF CHILDREN'S HOSPITAL OF ORANGE COUNTY, CHOC FOUNDATION, CRC REAL ESTATE CORPORATION AND CHILDREN'S HOSPITAL AT MISSION (ALL IRC SECTION 501(C)(3) AFFILIATES). MS. CRIPE DEVOTES APPROXIMATELY 71% OF HER TIME EACH WEEK TO CHILDREN'S HOSPITAL OF ORANGE COUNTY RESPONSIBILITIES WITH THE BALANCE OF HER TIME BEING SPENT ON THE OTHER RELATED ORGANIZATIONS' BUSINESS AFFAIRS. KERRI RUPPERT SCHILLER IS COMPENSATED THROUGH CHILDREN'S HEALTHCARE OF CALIFORNIA (CHC), HOWEVER, IN ADDITION TO HER RESPONSIBILITIES FOR CHC, SHE ALSO SERVES AS AN OFFICER OF CHILDREN'S HOSPITAL OF ORANGE COUNTY, CHOC FOUNDATION, CRC REAL ESTATE CORPORATION AND CHILDREN'S HOSPITAL AT MISSION (ALL IRC SECTION 501(C)(3) AFFILIATES). MS. SCHILLER DEVOTES APPROXIMATELY 50% OF HER TIME EACH WEEK TO CHILDREN'S HOSPITAL OF ORANGE COUNTY RESPONSIBILITIES WITH THE BALANCE OF HER TIME BEING SPENT ON THE OTHER RELATED ORGANIZATIONS' BUSINESS AFFAIRS. PAUL VAN DOLAH IS COMPENSATED THROUGH CHILDREN'S HEALTHCARE OF CALIFORNIA (CHC), HOWEVER, IN ADDITION TO HIS RESPONSIBILITIES FOR CHC, HE ALSO SERVES AS AN OFFICER OF CHILDREN'S HOSPITAL OF ORANGE COUNTY, CHILDREN'S HOSPITAL AT MISSION AND CRC REAL ESTATE CORPORATION (ALL IRC SECTION 501(C)(3) AFFILIATES). MR. VAN DOLAH DEVOTES APPROXIMATELY 84% OF HIS TIME EACH WEEK TO CHILDREN'S HOSPITAL OF ORANGE COUNTY RESPONSIBILITIES WITH THE BALANCE OF HIS TIME BEING SPENT ON CHILDREN'S HOSPITAL AT MISSION'S BUSINESS AFFAIRS. A CALIFORNIA HEALTH FACILITIES FINANCING AUTHORITY 521643828 13032UTU2 2019-08-06 107712910 DEFEASE CUSIP # 13033LBP1 0 0 0 B CALIFORNIA HEALTH FACILITIES FINANCING AUTHORITY 521643828 13032UZN1 2021-08-03 105675069 DEFEASE CUSIP # 13033LRT6 0 0 0 C CALIFORNIA HEALTH FACILITIES FINANCING AUTHORITY 521643828 13032UA40 2021-08-03 103213988 DEFEASE CUSIP # 13033LBT3 0 0 0 A 11955000 107717747 1146097 106571553 2019 1 0 1 1 B 260000 105685561 1020677 106034249 2021 1 0 1 1 C 103214040 714086 102500000 2021 1 0 1 1 A 0 0 1 1 0 0 0 1 B 0 0 1 1 0 0 0 1 C 0 0 1 1 0 0 0 1 A 0 1 0 0 0 0 0 0 1 B 0 1 0 0 0 0 0 0 1 C 0 1 0 0 0 0 0 0 1 A 1 B 1 C 1 PART II LINE 3, PART VI THE DIFFERENCE BETWEEN THE ISSUE PRICE AND THE PROCEEDS OF THE ISSUE IS THE CUMULATIVE INTEREST EARNED AS FOLLOWS: CUMMULATIVE INTEREST EARNED ON ISSUE A $4,836 CUMMULATIVE INTEREST EARNED ON ISSUE B $10,492 CUMMULATIVE INTEREST EARNED ON ISSUE C $51 FORM 990, PART I, LINE 5 AND PART V, LINE 2 INFORMATION REGARDING CHOC AS THE COMMON PAYMASTER: CHILDREN'S HOSPITAL OF ORANGE COUNTY IS THE COMMON PAYMASTER OF THE FOLLOWING: CHILDREN'S HEALTHCARE OF CALIFORNIA CHILDREN'S HOSPITAL AT MISSION CHOC FOUNDATION PROVIDENCE SPEECH AND HEARING CENTER ALL WAGES AND EMPLOYEE SPECIFIC INFORMATION, INCLUDING VOLUNTEERS, ARE RETAINED WITH CHILDREN'S HOSPITAL OF ORANGE COUNTY. FORM 990, PART VI, SECTION A, LINE 6 ORGANIZATION MEMBER INFORMATION THE SOLE MEMBER OF CHILDREN'S HOSPITAL OF ORANGE COUNTY (CHOC) IS CHILDREN'S HEALTHCARE OF CALIFORNIA (CHC). FORM 990, PART VI, SECTION A, LINE 7A PLEASE SEE THE EXPLANATION FOR LINE 7B. 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; (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 $5,000,000 OR ANY UNBUDGETED EXPENDITURE IN EXCESS OF $5,000,000; (9) ENTERING INTO ANY CONTRACT WHICH INVOLVES THE FOLLOWING: (A) ANY FINANCIAL OBLIGATION ON THE PART OF CHOC IN AN AMOUNT IN EXCESS OF $5,000,000 OR (B) ANY PURPOSE OR ACTIVITY WHICH IS OUTSIDE THE SCOPE OF CHOC'S ORDINARY COURSE OF BUSINESS. (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, CONVEYANCE, OF CHOC'S ASSETS; (14) AMENDING CHOC'S ARTICLES OF INCORPORATION; (15) ADOPTING NEW BYLAWS OR AMENDING EXISTING BYLAWS. FORM 990, PART VI, SECTION B, LINE 11B REVIEW OF FORM 990 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 MATERIALS 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 SHARED ELECTRONICALLY WITH 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. FORM 990, PART VI, SECTION B, LINE 12C CONFLICT OF INTEREST COMPLIANCE THE CHIEF 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. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION DETERMINATION AN INDEPENDENT BOARD COMMITTEE OF THE ORGANIZATION CHARGED WITH THE DUTIES OF THE EXECUTIVE COMPENSATION COMMITTEE, WHOSE MEMBERS ARE DISINTERESTED AND INDEPENDENT, IS IN PLACE WITH A WRITTEN COMMITTEE CHARTER. THIS COMMITTEE ANNUALLY RETAINS AN INDEPENDENT HEALTHCARE COMPENSATION CONSULTING FIRM TO PROVIDE RELEVANT COMPARABILITY DATA AND OTHER COMPENSATION STUDIES. THE CEO, OFFICERS AND EXECUTIVE MANAGEMENT SALARIES, INCENTIVES AND BENEFITS, AS WELL AS OVERALL COMPENSATION PHILOSOPHY AND POLICIES, ARE DISCUSSED WITH THE INDEPENDENT CONSULTANT REPRESENTATIVES AND THE EXECUTIVE COMPENSATION COMMITTEE MEMBERS, IN PERSON, IN CLOSED SESSIONS WITH NO STAFF MEMBERS PRESENT. THIS ANNUAL REVIEW WAS LAST PERFORMED IN OCTOBER 2021. ALL COMPARATIVE MARKET DATA, SUCH AS ANNUAL COMPENSATION SURVEY COMPRISED OF A PEER GROUP OF COMPARABLY-SIZED PEDIATRIC HOSPITALS, IS WELL DOCUMENTED AND THERE ARE MINUTES FROM THESE MEETINGS THAT DOCUMENT THE MEMBERS PRESENT AND VOTING, THE COMPARATIVE DATA USED AND HOW IT WAS OBTAINED AND THE DELIBERATIONS AND DECISIONS OF THE COMMITTEE. THE RESULTS AND RECOMMENDATIONS FROM THE COMMITTEE ARE SHARED IN AN EXECUTIVE SESSION WITH THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION C, LINE 19 DISCLOSURE POLICY FEDERAL TAX LAWS DO NOT MANDATE THAT THE ORGANIZATION'S GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE MADE AVAILABLE FOR PUBLIC INSPECTION. FORM 990 AND THE COPY OF AUDITED FINANCIAL STATEMENTS ATTACHED TO IT ARE MADE AVAILABLE UPON REQUEST. FORM 990, PART IX, LINE 11G PHYSICIAN SERVICES: PROGRAM SERVICE EXPENSES 128,507,653. MANAGEMENT AND GENERAL EXPENSES 14,278,628. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 142,786,281. MEDICAL SERVICES: PROGRAM SERVICE EXPENSES 32,655,068. MANAGEMENT AND GENERAL EXPENSES 3,628,341. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 36,283,409. COLLECTION AGENCY FEES: PROGRAM SERVICE EXPENSES 1,945,904. MANAGEMENT AND GENERAL EXPENSES 216,212. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,162,116. OTHER PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 22,320,317. MANAGEMENT AND GENERAL EXPENSES 2,480,035. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 24,800,352. JANITORIAL SERVICES: PROGRAM SERVICE EXPENSES 86,598. MANAGEMENT AND GENERAL EXPENSES 9,622. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 96,220. SECURITY SERVICES: PROGRAM SERVICE EXPENSES 2,280,393. MANAGEMENT AND GENERAL EXPENSES 253,377. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,533,770. COURIER SERVICES: PROGRAM SERVICE EXPENSES 7,215. MANAGEMENT AND GENERAL EXPENSES 802. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 8,017. OTHER PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 37,618,152. MANAGEMENT AND GENERAL EXPENSES 4,179,795. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 41,797,947. FORM 990, PART XI, LINE 9: NET UNREALIZED LOSS ON INEFFECTIVE SWAP AGREEMENTS -971,680. CHANGE IN BENEFICIAL INTEREST IN NET ASSETS OF FOUNDATION 5,443,438. RELEASE OF NET ASSETS FROM CHOC FOUNDATION 2,458,551. CHILDREN'S HEALTHCARE OF CALIFORNIA (CHC) 1201 WEST LA VETA AVENUE ORANGE CA 92868 330265266 HEALTHCARE CA 501 (C) (3) LINE 12A, I N/A 0 CHILDREN'S HOSPITAL AT MISSION 1201 WEST LA VETA AVENUE ORANGE CA 92868 330528802 HEALTHCARE CA 501 (C) (3) LINE 3 CHC 0 CHOC FOUNDATION 1201 WEST LA VETA AVENUE ORANGE CA 92868 956097416 FUNDRAISING CA 501 (C) (3) LINE 7 CHC 0 CRC REAL ESTATE CORPORATION 1201 WEST LA VETA AVENUE ORANGE CA 92868 330612565 REAL ESTATE CA 501 (C) (3) LINE 12B, II CHC 0 PROVIDENCE SPEECH AND HEARING CENTER 1301 W PROVIDENCE AVENUE ORANGE CA 92868 956154473 HEALTHCARE CA 501 (C) (3) LINE 7 CHOC 1 ORANGE COUNTY MEDICAL RECIPROCAL INS CO 2999 NORTH 4TH ST 250 PHOENIX AZ 85108 201620666 INSURANCE AZ N/A C 90430 3737564 0.50000 0 0 0 1 0 0 0 0 0 0 0 1 1 1 0 0 0 0 0 0