2025-05-14T15:36:38-05:00 2024-06-30 135565207 KPMG LLP 550 SOUTH HOPE STREET SUITE 1500 LOS ANGELES CA 90071 990 2023-07-01 330528802 CHILDREN'S HOSPITAL AT MISSION CHIL 7149973000 1201 WEST LA VETA AVENUE ORANGE CA 92868 JAMES ULI EVP & CFO 7145098451 2025-05-14 1 0 HOLLY MOEN P01800653 2139724000 2025-04-28 2023 2025-03-06 01:10:19Z KIMBERLY C CRIPE 1201 WEST LA VETA AVENUE ORANGE CA 92868 103759097 0 X WWW.CHOC.ORG X 1991 CA TO NURTURE, ADVANCE, & PROTECT THE HEALTH AND WELL-BEING OF CHILDREN. 12 12 209 76 0 0 231838 117900 110653179 102904977 467993 674448 61137 61772 111414147 103759097 21500000 25000000 0 0 20357567 22660267 0 0 0 63522838 54593406 105380405 102253673 6033742 1505424 80158166 80237078 41090524 39618526 39067642 40618552 TO NURTURE, ADVANCE, & PROTECT THE HEALTH AND WELL-BEING OF CHILDREN. 0 0 94757805 25000000 102942436 CHILDREN'S HOSPITAL AT MISSION (CCMH) PROVIDES SPECIALIZED PEDIATRIC SERVICES FOR THE MEDICAL/SURGICAL CARE OF CHILDREN FROM BIRTH TO AGE 18. THERE WERE 9,220 INPATIENT CARE DAYS; 13,392 EMERGENCY ROOM VISITS; 534 SURGERIES AND 19,628 OUTPATIENT VISITS. SEE OUR COMPLETE COMMUNITY BENEFIT PLAN ON OUR WEBSITE AT HTTPS://WWW.CHOC.ORG/FILES/COMMUNITYBENEFITPLANFY2024CCMH.PDF. 94757805 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 22 0 1 209 1 0 0 0 0 0 0 0 0 0 0 0 0 X 12 12 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 CA X MARY NGUYEN 7145094124 1201 WEST LA VETA AVENUE ORANGE CA 928683874 SAM AURIEMMA DIRECTOR 1.00 3.00 X 0 0 0 CHRIS FURMAN DIRECTOR 1.00 6.00 X 0 0 0 JOE KIANI DIRECTOR 1.00 4.00 X 0 0 0 DOUGLAS MCCOMBS CHAIR 3.00 10.00 X X 0 0 0 MARIA MINON MD DIRECTOR 1.00 4.00 X 0 0 0 JIM MORRIS VICE CHAIR 1.00 8.00 X X 0 0 0 JOE NUZZOLESE DIRECTOR 0.50 2.00 X 0 0 0 KEN POTROCK DIRECTOR 0.50 2.00 X 0 0 0 LINDA ROSE DIRECTOR 1.00 2.50 X 0 0 0 MARSHALL ROWEN MD DIRECTOR 1.00 9.00 X 0 0 0 KIMBERLY SENTOVICH DIRECTOR 0.50 4.00 X 0 0 0 JASJIT SINGH MD DIRECTOR 0.50 2.00 X 0 0 0 KIMBERLY CRIPE PRESIDENT & CEO 2.00 38.00 X 0 2020211 54662 KERRI RUPPERT SCHILLER EXEC VP/CFO/ASST SECRETARY 2.00 38.00 X 0 994430 52057 KIMBERLEY MILSTIEN EXEC VP & COO 6.00 34.00 X 0 807037 16512 JAY GABRIEL CHIEF LEGAL OFFICER & SECRETARY 3.50 36.50 X 0 815827 63146 EMMA SANDHU VP, ADMINISTRATOR/CNO CCMH 40.00 0.00 X 430918 0 7244 BONNIE GRAVETT CLINICAL NURSE IV NICU 40.00 0.00 X 282504 0 29505 MARISA CADWELL CLINICAL NURSE II NICU 40.00 0.00 X 261440 0 34068 KRISTY HAFFAR CHARGE NURSE 40.00 0.00 X 225913 0 27755 ALLISON LEE O'BRIEN CHARGE NURSE 40.00 0.00 X 247013 0 7719 BRONWYN STACKLEATHER DIRECTOR CLINICAL SERVICES 40.00 0.00 X 235344 0 27316 PAUL VAN DOLAH EXEC VP & CTO ( FORMER COO) 3.00 37.00 X 0 928592 25380 1683132 5566097 345364 61 1 1 0 AYA HEALTHCARE INC PO BOX 674907 DALLAS TX 752674907 TEMPORARY STAFFING 3719764 1 117900 117900 PATIENT REVENUE 621400 102904977 102904977 102904977 674448 674448 OTHER REVENUE 621400 61772 37459 24313 61772 103759097 102942436 0 698761 X 25000000 25000000 414982 207491 207491 18399026 16559123 1839903 558373 502536 55837 1959269 1763342 195927 1328617 1195755 132862 11819992 10637993 1181999 5224 4702 522 12593 12593 34578199 31120379 3457820 284258 255832 28426 469027 422124 46903 1869389 1682450 186939 15533 13980 1553 22096 19886 2210 793814 714433 79381 388949 350054 38895 PROVIDER PROGRAM FEE 3942330 3942330 OSHPD FEE 165234 148711 16523 LICENSE AND TAXES 113408 102067 11341 113360 102024 11336 102253673 94757805 7495868 0 5126671 4999983 7699973 6985372 18376908 19718125 317675 338694 22760003 17761845 5371402 4998158 5800679 5800679 37464858 37396067 80158166 80237078 11543423 11367237 117726 117726 29429375 28133563 41090524 39618526 X 38016191 39561410 1051451 1057142 39067642 40618552 80158166 80237078 X 1505424 29102 16384 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 12593 12593 0 PART II-B, LINE 1: GRANTS TO OTHER ORGANIZATIONS FOR LOBBYING PURPOSES FORM 990, SCHEDULE C, PART II-B, LINE 1 DURING FYE 06/30/2024, CHILDREN'S HOSPITAL AT MISSION PAID DUES TO HOSPITAL ASSOCIATION OF SOUTHERN CALIFORNIA, $12,593 OF WHICH SUPPORTED LOBBYING PURPOSES. 65637 65637 49198 8709 40489 15022702 12088564 2934138 7591064 5664572 1926492 31402 31402 4998158 OTHER RECEIVABLE 3300 PROVIDER FEE PROGRAM RECEIVABLE 10553996 RECEIVBLES FROM RELATED PARTY 878119 OPERATING LEASE ROU ASSETS 24983281 BENEFICIAL INT IN FDN 74518 INVESTMENT IN OCMRRG 900853 OTHER ASSETS 2000 37396067 DUE TO RELATED PARTIES 3547319 OPERATING LEASE LIABILITY 24586244 28133563 X 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, 2024, 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 23147 23147 0.00020 32285745 20222245 12063500 0.11800 32308892 20222245 12086647 0.11820 194973 7785 187188 0.00180 194973 7785 187188 0.00180 32503865 20230030 12273835 0.12000 1 7143504 X 1 1 1 1 CHILDREN'S HOSPITAL AT MISSION 27700 MEDICAL CENTER ROAD MISSION VIEJO CA 92691 WWW.CHOC.ORG 060000348 X X X CHILDREN'S HOSPITAL AT MISSION 1 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 22 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/PATIENTS-FAMILY/PAY-BILL/ X HTTPS://CHOC.ORG/PATIENTS-FAMILY/PAY-BILL X HTTPS://CHOC.ORG/WP-CONTENT/UPLOADS/2018/06/FAP-ENGLISH-SUMMARY.PDF X X X X X X 1 X 0 X X X X 1 X 0 0 CHILDREN'S HOSPITAL AT MISSION PART V, SECTION B, LINE 5: CHILDREN'S HOSPITAL AT MISSION (CCMH) AND ITS AFFILIATE, CHILDREN'S HOSPITAL OF ORANGE COUNTY (CHOC) CONDUCTED THE CHNA PROCESS 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 AT MISSION PART V, SECTION B, LINE 6A: CHOC AND CCMH TOGETHER CONDUCTED THE HEALTH NEEDS ASSESSMENTS.SCHEDULE 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-COMMUNITY-HEALTH-NEEDS-ASSESSMENT.PDF. THE MOST RECENT IMPLEMENTATION PLAN PUBLISHED IN 2022 CAN BE FOUND AT THE FOLLOWING URL: HTTPS://WWW.CHOC.ORG/WP-CONTENT/UPLOADS/2023/08/CHNA-IMPLEMENTATION-PLAN_2023.PDF CHILDREN'S HOSPITAL AT MISSION PART V, SECTION B, LINE 11: ADDRESSING HIGH PRIORITY COMMUNITY HEALTH NEEDS CCMH COORDINATES ITS RESPONSE TO ITS MOST RECENT CHNA WITH ITS LARGER AFFILIATE, CHOC.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, INCREASE IN HOSPITALIZATIONS FOR MENTAL ILLNESS IN 2020, DESPITE THE OVERALL DECREASE IN HOSPITALIZATIONS DUE TO COVID-19 PUBLIC HEALTH EMERGENCY AND 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 STRATEGIC PLANS 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 AND CCMH, 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 AND CCMH BUILT THE THOMPSON AUTISM CENTER WHICH OPENED IN JANUARY 2019. THE AUTISM 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 AND CCMH. THOSE SERVICES INCLUDE CHOC'S AND CCMH'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 AND CCMH PATIENTS BEING TREATED FOR SERIOUS/CHRONIC ILLNESSES.2) SUBSTANCE ABUSECHOC AND CCMH ARE INCREASING EDUCATION TO PROVIDE ADDITIONAL TREATMENT OPTIONS TO LOCAL PROVIDERS, INCLUDING INCREASED OUTREACH TO LOCAL SCHOOLS AND COMMUNITIES. CHOC'S AND CCMH'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/SUBSPECIALTIES CHOC AND CCMH RECOGNIZE THE COMMUNITY NEED FOR ACCESS TO PEDIATRIC SPECIALISTS/SUBSPECIALISTS AND CONTINUES TO BUILD THE RESOURCES AVAILABLE THROUGHOUT THE COMMUNITIES SERVED BY CHOC AND CCMH. 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 AND CCMH TO PROVIDE THE SERVICES HAVE GROWN TO A TOTAL OF 262 PROVIDERS AND OFFERS EXPERTISE AND CARE IN OVER 25 PEDIATRIC MEDICAL SPECIALTIES.4) COLLABORATION AND PARTNERSHIPS WITH SCHOOL PROGRAMSCOLLABORATION AND PARTNERSHIPS WITH SCHOOL PROGRAMS IS A WAY TO OVERCOME BARRIERS WHEN ADDRESSING OTHER CRITICAL ISSUES IDENTIFIED IN THE CHNA. CHOC AND CCMH 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 AND CCMH'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 AND CCMH WILL IMPLEMENT 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. PART I, LINE 6A: THE ORGANIZATION'S COMMUNITY BENEFIT PLAN 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 PROGRAMCCMH RECOGNIZED REVENUES FOR THE FEE FOR SERVICE AND MANAGED CARE PORTIONS OF THE FOLLOWING PROGRAMS:1) QAF 6 - 24-MONTH PROGRAM ENDED DECEMBER 31, 2021 - $453,000. 2) QAF 7 - 12 MONTH PROGRAM ENDED DECEMBER 31, 2022- $781,000 3) QAF 8 - 12 MONTH PROGRAM ENDED DECEMBER 31, 2023 - $8,758,000. CCMH RECOGNIZED TOTAL PROVIDER FEES AND OTHER EXPENSES OF $3,942,000. THE AMOUNTS WERE RECOGNIZED AS NET PATIENT REVENUE AND OPERATING EXPENSES, RESPECTIVELY, IN THE FISCAL YEAR ENDED JUNE 30, 2024. 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. PART III, LINE 2: THE ORGANIZATION CHARGES BAD DEBT FOR (A) THE WRITE-OFF OF PATIENT ACCOUNTS WHERE FAMILIES DID NOT COOPERATE IN THE COMPLETION OF MEDI-CAL OR CHARITY CARE APPLICATIONS AND WHERE INSUFFICIENT INFORMATION COULD BE OBTAINED REGARDING THE FINANCIAL STATUS OF THE FAMILY, AND (B) A PROVISION FOR OUTSTANDING ACCOUNTS RECEIVABLE FROM SELF-PAY (INCLUDING PENDING MEDI-CAL AND PENDING CHARITY) ACCOUNTS. UNDER NEW REVENUE RECOGNITION CRITERIA, ACCOUNTS PREVIOUSLY WRITTEN OFF AS BAD DEBT ARE NOW RECORDED AS DEDUCTIONS FROM REVENUE.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: AUDITED FINANCIAL STATEMENT FOOTNOTE: PATIENT ACCOUNTS RECEIVABLE ARE RECORDED AT THE INVOICED AMOUNT, NET OF ANY EXPECTED CONTRACTUAL ADJUSTMENTS AND DO NOT BEAR INTEREST. THE 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: AS A CHILDREN'S HOSPITAL, CCMH MEDICARE ALLOWABLE COSTS ARE ZERO. THEREFORE, THERE IS NO AMOUNT ENTERED ON PART III LINE 6 AND NO MEDICARE SHORTFALL REPORTED ON LINE 7. PART III, LINE 9B: THE HOSPITAL'S WRITTEN BAD-DEBT COLLECTION POLICY STATES THE FOLLOWING:1. IF A PATIENT QUALIFIES FOR ASSISTANCE UNDER THE FINANCIAL ASSISTANCE PROGRAM (FAP) AND IS MAKING EVERY EFFORT TO SETTLE AN OUTSTANDING BILL WITHIN A REASONABLE TIME PERIOD, CCMH OR ITS AGENT WILL NOT SEND, NOR INTIMATE THAT IT WILL SEND, THE UNPAID ACCOUNT TO AN OUTSIDE AGENCY IF DOING SO MAY NEGATIVELY IMPACT A PATIENT'S CREDIT. IF CCMH IS FORCED TO SEND THE ACCOUNT TO AN OUTSIDE COLLECTION AGENCY, THE AMOUNT REFERRED TO THE AGENCY WILL REFLECT THE REDUCED PAYMENT LEVEL FOR WHICH THE PATIENT WAS ELIGIBLE UNDER THE FAP. AT NO TIME WILL A PATIENT ACCOUNT BE REFERRED TO AN OUTSIDE COLLECTION AGENCY IF THE ACCOUNT IS LESS THAN 150 DAYS FROM ORIGINAL BILLING.2. IN DEALING WITH IDENTIFIED UNINSURED PATIENTS AT OR BELOW 400% OF THE FEDERAL POVERTY LEVEL, CCMH WILL NOT USE WAGE GARNISHMENTS OR LIENS ON PATIENT'S OR PATIENT FAMILY'S PRIMARY RESIDENCE AS A MEANS OF COLLECTING UNPAID CCMH BILLS. THIS REQUIREMENT DOES NOT PRECLUDE CCMH FROM PURSUING REIMBURSEMENT FROM THIRD PARTY LIABILITY SETTLEMENTS. PART VI, LINE 2: NEEDS ASSESSMENT:IN ADDITION TO THE TRI-ANNUAL COMMUNITY HEALTH NEEDS ASSESSMENT, CCMH 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, CCMH 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 THE FOLLOWING URL: HTTPS://CHOC.ORG/FILES/CHOC-COMMUNITY-HEALTH-NEEDS-ASSESSMENT.PDF AND HTTPS://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: PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE:PATIENTS ARE INFORMED OF THEIR ELIGIBILITY FOR ASSISTANCE UNDER FEDERAL, STATE, OR LOCAL GOVERNMENT PROGRAMS AND UNDER THE HOSPITAL'S CHARITY CARE POLICY IN OUR FINANCIAL ASSISTANCE AND DISCOUNT PROGRAM POLICY. THIS INFORMATION, EITHER IN FULL OR IN SUMMARY, IS POSTED IN ALL OF THE HIGH TRAFFIC PATIENT AREAS: ADMITTING, EMERGENCY ROOM, CLINIC AND THE BUSINESS OFFICE. THE PATIENTS ARE ALSO INFORMED IF THERE IS A FINANCIAL NEED IDENTIFIED BY THE HOSPITAL FINANCIAL COUNSELORS WHEN SPEAKING TO THE FAMILIES ABOUT THEIR INSURANCE OR LACK OF INSURANCE. PATIENTS ARE PROVIDED A COPY OF THE HOSPITAL'S PATIENT FINANCIAL ASSISTANCE AND DISCOUNT PAYMENT PROGRAM POLICY. FAMILIES ARE ALSO NOTIFIED ON EVERY PATIENT STATEMENT THAT IF THERE IS A FINANCIAL NEED, THEY SHOULD CALL THE DESIGNATED PHONE NUMBER FOR MORE INFORMATION AND ASSISTANCE. FINANCIAL ASSISTANCE COMMUNICATION: AS PART OF THE HOSPITALS' ONGOING PUBLIC AWARENESS CAMPAIGNS, THE MISSION STATEMENTS (INCLUDING THE FINANCIAL ASSISTANCE POLICY) ARE INCLUDED WHEREVER POSSIBLE ON PROGRAM BROCHURES, FACILITY BROCHURES, MEDICAL EDUCATION INFORMATION, COMMUNITY EDUCATION MATERIALS, CONFERENCE INVITATIONS AND ADMISSION MATERIALS. ADDITIONALLY, THE HOSPITALS' FINANCIAL ASSISTANCE POLICY IS EMPHASIZED IN PUBLIC RELATIONS AND MEDIA RELATIONS EFFORTS, FOUNDATION CAMPAIGNS, AND SELECTED MARKETING CAMPAIGNS. THE FINANCIAL ASSISTANCE POLICY IS ALSO INCLUDED AS PART OF THE ANNUAL COMMUNITY BENEFIT PLAN. THE FINANCIAL ASSISTANCE POLICY IS AVAILABLE IN ENGLISH AND SPANISH. PART VI, LINE 4: THE HOSPITAL SERVES ALL OF ORANGE COUNTY AND A LIMITED NUMBER OF PATIENTS FROM THE WESTERN RIM OF RIVERSIDE COUNTY, THE NORTHERN PORTION OF SAN DIEGO COUNTY AND SOUTHEAST AREAS OF LOS ANGELES COUNTY. THE PRIMARY SERVICE AREA IS ORANGE COUNTY AND IS THE SOURCE OF APPROXIMATELY 85% OF ITS PATIENTS. THE COMMUNITY SERVED BY THE HOSPITAL INCLUDES FEDERALLY DESIGNATED MEDICALLY UNDERSERVED AREAS AND POPULATIONS.COMMUNITY 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 2022-2024 COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) REPORT, THE MOST RECENTLY AVAILABLE. ORANGE COUNTY'S POPULATION IS OVER 3 MILLION, MAKING IT THE THIRD MOST POPULOUS COUNTY IN CALIFORNIA. THE MEDIAN AGE IS 38.1, AND CHILDREN UP TO 19 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. IN ORANGE COUNTY, BIPOC (BLACK, INDIGENOUS, PEOPLE OF COLOR) CHILREN REPRESENT 44% OF THE POPULATION UNDER AGE 18. PART VI, LINE 5: PROMOTION OF COMMUNITY HEALTHCHILDREN'S HEALTHCARE OF CALIFORNIA (CHC) IS THE NOT-FOR-PROFIT, TAX-EXEMPT PARENT CORPORATION OF CHOC AND 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. CCMH ALSO OFFERS PEDIATRIC TRAUMA SERVICES TO THE COMMUNITY. THE ORGANIZATION IS COMPRISED OF TWO HOSPITALS, SEVERAL PRIMARY AND SPECIALTY CLINICS, PROGRAMS AND SERVICES; AND FOUR CENTERS OF EXCELLENCE, THE CHOC HEART, NEUROSCIENCE, ONCOLOGY AND ORTHOPEDIC INSTITUTES. CHOC ALSO HAS A RESEARCH INSTITUTE PERFORMING BASIC SCIENCE AND CLINICAL RESEARCH. THROUGH ITS RESIDENCY PROGRAM, THE ORGANIZATION ALSO TRAINS TOMORROW'S PHYSICIANS. THE COMMUNITY BENEFIT PLAN FOR THE FISCAL YEAR ENDING JUNE 30, 2024, 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/COMMUNITYBENEFITPLANFY2024CCMH.PDFTHE MAJORITY OF THE ORGANIZATION'S GOVERNING BODY IS COMPOSED OF PERSONS WHO RESIDE IN THE ORGANIZATION'S PRIMARY SERVICE AREA WHO ARE NEITHER EMPLOYEES NOR CONTRACTORS OF THE ORGANIZATION, NOR FAMILY MEMBERS THEREOF.CLINICAL PRIVILEGES ARE GRANTED TO ALL QUALIFIED PHYSICIANS AS MEMBERS OF THE MEDICAL STAFF. MEDICAL STAFF MEMBERS PROVIDE PATIENT CARE AND HAVE ACCESS TO HOSPITAL RESOURCES (INCLUDING EQUIPMENT, FACILITIES AND PERSONNEL) WHICH ARE NECESSARY TO EFFECTIVELY EXERCISE THEIR PRIVILEGES. PHYSICIANS ARE QUALIFIED TO BE MEMBERS OF THE MEDICAL STAFF IF THEY MEET THE FOLLOWING CRITERIA: SECTION 1. NATURE OF MEDICAL STAFF MEMBERSHIP ON THE MEDICAL STAFF OF CCMH IS A PRIVILEGE THAT SHALL BE EXTENDED ONLY TO PROFESSIONALLY COMPETENT PRACTITIONERS WHO CONTINUOUSLY MEET THE QUALIFICATIONS, STANDARDS AND REQUIREMENTS SET FORTH IN THESE BYLAWS. A PRACTITIONER MAY ADMIT OR PROVIDE SERVICES TO PATIENTS IN THE HOSPITAL ONLY IF THE PRACTITIONER IS A MEMBER OF THE MEDICAL STAFF OR HAS BEEN GRANTED TEMPORARY PRIVILEGES IN ACCORDANCE WITH THE BYLAWS, RULES AND REGULATIONS. APPOINTMENT TO THE MEDICAL STAFF SHALL CONFER ONLY SUCH CLINICAL PRIVILEGES AND PREROGATIVES AS HAVE BEEN GRANTED IN ACCORDANCE WITH THESE BYLAWS. SECTION 2. QUALIFICATIONS FOR MEMBERSHIP A. ONLY PRACTITIONERS WHO HOLD AN UNRESTRICTED LICENSE TO PRACTICE MEDICINE, DENTISTRY, PODIATRY OR CLINICAL PSYCHOLOGY IN THE STATE OF CALIFORNIA, WHO CAN DOCUMENT THE FOLLOWING WITH SUFFICIENT ADEQUACY TO ASSURE THE MEDICAL STAFF AND THE GOVERNING BODY THAT ANY PATIENT TREATED BY THEM IN THE HOSPITAL WILL RECEIVE CARE OF THE GENERALLY RECOGNIZED PROFESSIONAL LEVEL AND EFFICIENCY ESTABLISHED BY THE MEDICAL STAFF AND HOSPITAL, SHALL BE QUALIFIED FOR MEMBERSHIP ON THE MEDICAL STAFF THEIR BACKGROUND; EDUCATION; EXPERIENCE; JUDGMENT; TRAINING; DEMONSTRATED CURRENT COMPETENCE; ABILITY TO COMMUNICATE INCLUDING A DEMONSTRATED PROFICIENCY IN THE ENGLISH LANGUAGE SUCH THAT THERE IS REASONABLE ASSURANCE THAT THERE WILL BE NO RISK OF MISUNDERSTANDING IN COMMUNICATION WITH ENGLISH SPEAKING COLLEAGUES, PATIENTS AND HEALTH CARE WORKERS; PHYSICAL AND MENTAL HEALTH STATUS; ADHERENCE TO THE ETHICS OF THEIR PROFESSION; GOOD REPUTATION; AND ABILITY TO WORK WITH OTHERS. NO PRACTITIONER SHALL BE ENTITLED TO MEMBERSHIP ON THE MEDICAL STAFF OR TO THE EXERCISE OF PARTICULAR CLINICAL PRIVILEGES IN THE HOSPITAL MERELY BECAUSE HE IS DULY LICENSED TO PRACTICE MEDICINE, DENTISTRY, CLINICAL PSYCHOLOGY OR PODIATRY IN THIS OR IN ANY OTHER STATE, HOLDS A CERTAIN DEGREE, IS CERTIFIED BY ANY CLINICAL BOARD, OR THAT HE IS A MEMBER OF SOME PROFESSIONAL ORGANIZATION, OR THAT HE HAD IN THE PAST, OR PRESENTLY HAS SUCH PRIVILEGES AT ANOTHER HOSPITAL INCLUDING BUT NOT LIMITED TO MISSION HOSPITAL OR CHOC. NO APPLICANT SHALL BE DENIED MEMBERSHIP ON THE BASIS OF SEX, SEXUAL ORIENTATION, RACE, RELIGION, ANCESTRY, AGE, CREED, COLOR, NATIONAL ORIGIN, MARITAL STATUS, HANDICAP OR DISABILITY (EXCEPT TO THE EXTENT THE HANDICAP OR DISABILITY PREVENTS THE PRACTITIONER FROM PERFORMING ESSENTIAL FUNCTIONS OR POSES A HEALTH OR SAFETY RISK TO THE PRACTITIONER OR OTHERS AND THE HANDICAP OR DISABILITY CANNOT BE REASONABLY ACCOMMODATED OR ON THE BASIS OF ANY OTHER CRITERION THAT IS NOT RELATED TO AN INDIVIDUAL'S PROFESSIONAL CAPABILITIES (CCMH MEDICAL STAFF BYLAWS). B. ONLY PRACTITIONERS WHO MAINTAIN IN FORCE PROFESSIONAL LIABILITY INSURANCE IN NOT LESS THAN THE MINIMUM AMOUNTS JOINTLY DETERMINED BY THE GOVERNING BODY AND THE MEDICAL STAFF EXECUTIVE COMMITTEE, BUT IN NO EVENT LESS THAN $1.0 MILLION PER INCIDENT AND $3.0 MILLION IN THE AGGREGATE IN A POLICY YEAR, SHALL BE QUALIFIED FOR MEMBERSHIP ON THE MEDICAL STAFF. THE INSURANCE MUST COVER ALL PRIVILEGES THE PRACTITIONER IS GRANTED BY THE BODY. A CARRIER ADMITTED DOING BUSINESS IN CALIFORNIA OR A MUTUAL COOPERATIVE TRUST MUST PROVIDE THE INSURANCE. INFORMATION REGARDING EACH APPLICANT'S AND MEMBER'S INSURANCE COVERAGE MUST BE PROVIDED IN THE FORM OF A CURRENT CERTIFICATE OF INSURANCE WHICH SHALL BE MAINTAINED IN EACH PRACTITIONER'S CREDENTIALS FILE. INFORMATION REGARDING INSURANCE COVERAGE MUST BE PROVIDED AT THE TIME OF APPOINTMENT AND REAPPOINTMENT AND IMMEDIATELY UPON RECEIPT OF EACH ANNUAL RENEWAL CERTIFICATE. EACH MEMBER SHALL REPORT TO THE MEDICAL STAFF SERVICES OFFICE ANY REDUCTION, RESTRICTION, CLAIMS, CANCELLATION OR TERMINATION OF THE REQUIRED PROFESSIONAL LIABILITY INSURANCE OR CHANGE IN CARRIER IMMEDIATELY UPON THE NOTICE OF ACTION OR CHANGE. C. ACCEPTANCE OF MEMBERSHIP ON THE MEDICAL STAFF SHALL CONSTITUTE THE STAFF MEMBER'S CERTIFICATION THAT HE HAS IN THE PAST, AND HIS AGREEMENT THAT HE WILL IN THE FUTURE, BEHAVE ACCORDING TO ETHICAL PRINCIPLES APPLICABLE TO HIS PROFESSION, AND WILL ABIDE BY ALL STATE AND FEDERAL LAWS AND REGULATIONS GOVERNING THE PROFESSION, INCLUDING, BUT NOT LIMITED TO, MEDICARE/MEDICAID LAWS AND REGULATIONS. FURTHER, ALL MEMBERS OF THE MEDICAL STAFF SHALL PLEDGE THAT THEY WILL NOT RECEIVE FROM, OR PAY TO ANOTHER PHYSICIAN, DENTIST, CLINICAL PSYCHOLOGIST OR PODIATRIST, EITHER DIRECTLY OR INDIRECTLY, ANY PART OF A FEE RECEIVED FOR PROFESSIONAL SERVICES AND THEY WILL NOT DECEIVE A PATIENT AS TO THE IDENTITY OF AN OPERATING SURGEON, OR ANY OTHER MEDICAL PRACTITIONER PROVIDING TREATMENT. PART VI, LINE 6: AFFILIATED HEALTH CARE SYSTEM: CCMH AND CHOC ARE MEMBERS OF A TWO-HOSPITAL SYSTEM. BOTH HOSPITALS HAVE A SOLE CORPORATE MEMBER, CHILDREN'S HEALTHCARE OF CALIFORNIA (CHC), THAT PROVIDES MANAGEMENT SERVICES TO BOTH HOSPITALS. THE HOSPITALS SHARE A COMMON MISSION AND ARE STRATEGICALLY ALIGNED IN THEIR EFFORT TO MEET THE HEALTHCARE NEEDS OF THE COMMUNITY. PART VI, LINE 7, REPORTS FILED WITH STATES CA 1 CHILDREN'S HEALTHCARE OF CALIFORNIA 1201 WEST LA VETA AVENUE ORANGE CA 92868 330265266 501(C)3 25000000 0 N/A N/A SUPPORT 1 0 PART I, LINE 2: PROCEDURE FOR MONITORING THE USE OF GRANT FUNDS THE GRANT FROM CCMH TO CHC WAS IN ACCORDANCE WITH THE BYLAWS OF BOTH ORGANIZATIONS. X X X X 0 1 0 0 0 0 0 0 0 KIMBERLY CRIPE PRESIDENT & CEO 0 1194041 0 534395 0 291775 0 20477 0 34185 0 2074873 0 62896 KERRI RUPPERT SCHILLER EXEC VP/CFO/ASST SECRETARY 0 679655 0 160870 0 153905 0 21857 0 30200 0 1046487 0 26918 PAUL VAN DOLAH EXEC VP & CTO ( FORMER COO) 0 678221 0 145018 0 105353 0 25380 0 0 0 953972 0 27092 JAY GABRIEL CHIEF LEGAL OFFICER & SECRETARY 0 568337 0 131237 0 116253 0 19618 0 43528 0 878973 0 18560 KIMBERLEY MILSTIEN EXEC VP & COO 0 610743 0 118024 0 78270 0 1500 0 15012 0 823549 0 0 EMMA SANDHU VP, ADMINISTRATOR/CNO CCMH 301898 0 54683 0 74337 0 6574 0 670 0 438162 0 45529 0 BONNIE GRAVETT CLINICAL NURSE IV NICU 251062 0 24057 0 7385 0 15307 0 14198 0 312009 0 0 0 MARISA CADWELL CLINICAL NURSE II NICU 215832 0 39794 0 5814 0 13430 0 20638 0 295508 0 0 0 BRONWYN STACKLEATHER DIRECTOR CLINICAL SERVICES 215447 0 19897 0 0 0 6678 0 20638 0 262660 0 0 0 ALLISON LEE O'BRIEN CHARGE NURSE 213804 0 25657 0 7552 0 0 0 7719 0 254732 0 0 0 KRISTY HAFFAR CHARGE NURSE 205573 0 12738 0 7602 0 12590 0 15165 0 253668 0 0 0 PART I, LINE 4B SCHEDULE J: PART I, LINE 4B SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN CHILDREN'S HOSPITAL OF ORANGE COUNTY (CHOC) 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. MS. CRIPE ($235,026), MS. SCHILLER ($100,584), MR. GABRIEL ($69,286), AND MR. VAN DOLAH ($101,234) AND MS. SANDHU ($45,529). THE COMPANY PROVIDES AN INCENTIVE PLAN TO ALL ELIGIBLE MEMBERS OF MANAGEMENT, INCLUDING CERTAIN INDIVIDUALS LISTED IN PART II OF SCHEDULE J. INCENTIVES ARE EARNED BASED ON ACHIEVEMENT OF ORGANIZATION AND INDIVIDUAL GOALS TYPICALLY RELATED TO QUALITY, PATIENT SAFETY, OPERATING, AND FINANCIAL PERFORMANCE AS WELL AS OTHER SIGNIFICANT CLINICAL, QUALITY, AND STRATEGIC ACHIEVEMENTS. THE COMPANY MAINTAINS A CORPORATE MEMBERSHIP IN A SOCIAL CLUB THAT IS UTILIZED FOR BUSINESS PURPOSES BY ITS EXECUTIVES, INCLUDING CERTAIN INDIVIDUALS LISTED IN PART II OF SCHEDULE J. USE OF THE CLUB AND PAYMENTS TO THE CLUB FOR BUSINESS-RELATED EXPENSES ARE SUBJECT TO THE COMPANY'S WRITTEN POLICIES AND PROCEDURES THAT INCLUDE A REQUIREMENT TO DOCUMENT THE PURPOSE AND ATTENDEES OF THE BUSINESS MEETING PRIOR TO PAYMENT. 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 5% OF HER TIME EACH WEEK TO CHILDREN'S HOSPITAL AT MISSION RESPONSIBILITIES WITH THE BALANCE OF HER TIME BEING SPENT ON THE OTHER RELATED ORGANIZATIONS' BUSINESS AFFAIRS. KERRI RUPPERT SCHILLER IS COMPENSATED THROUGH CHILDREN'S HEALTHCARE OF CALIFORNIA (CHC), HOWEVER, IN ADDITION TO HER RESPONSIBILITIES FOR CHC, SHE ALSO SERVES AS AN OFFICER OF CHILDREN'S HOSPITAL OF ORANGE COUNTY, CHOC FOUNDATION, CRC REAL ESTATE CORPORATION AND CHILDREN'S HOSPITAL AT MISSION (ALL IRC SECTION 501(C)(3) AFFILIATES). MS. SCHILLER DEVOTES APPROXIMATELY 5% OF HER TIME EACH WEEK TO CHILDREN'S HOSPITAL AT MISSION RESPONSIBILITIES WITH THE BALANCE OF HER TIME BEING SPENT ON THE OTHER RELATED ORGANIZATIONS' BUSINESS AFFAIRS. KIM MILSTEIN 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, CHILDREN'S HOSPITAL AT MISSION AND CRC REAL ESTATE CORPORATION (ALL IRC SECTION 501(C)(3) AFFILIATES). MS. MILSTIEN DEVOTES APPROXIMATELY 16% OF HER TIME EACH WEEK TO CHILDREN'S HOSPITAL AT MISSION RESPONSIBILITIES WITH THE BALANCE OF HER TIME BEING SPENT ON CHILDREN'S HOSPITAL OF ORANGE COUNTY BUSINESS AFFAIRS. FORM 990, PART I, LINE 5 AND PART V, LINE 2 CHILDREN'S HOSPITAL OF ORANGE COUNTY (CHOC) ACTS AS A COMMON PAYMASTER, ISSUING FORMS W-2 AND 1099 ON BEHALF OF CHILDREN'S HOSPITAL AT MISSION. CHILDREN'S HOSPITAL AT MISSION HAS 209 EMPLOYEES, HOWEVER BECAUSE OF THE COMMON PAYMASTER ARRANGEMENT RESULTING IN THE FORMS W-2 BEING ISSUED UNDER CHOC'S EMPLOYER IDENTIFICATION NUMBER, THERE ARE NO W-2S ISSUED DIRECTLY BY CHILDREN'S HOSPITAL AT MISSION. FORM 990, PART VI, SECTION A, LINE 6 ORGANIZATION MEMBER INFORMATION THE SOLE MEMBER OF CHILDREN'S HOSPITAL AT MISSION (CHM) IS CHILDREN'S HEALTHCARE OF CALIFORNIA (CHC). EFFECTIVE JANUARY 1, 2025, THE PARENT COMPANY OF THIS FILER MERGED WITH THE PARENT COMPANY OF RADY CHILDREN'S HOSPITAL OF ORANGE COUNTY. THE SURVIVING PARENT CORPORATION WAS RENAMED RADY CHILDREN'S HEALTH. FORM 990, PART VI, SECTION A, LINE 7A PLEASE SEE THE EXPLANATION FOR LINE 7B. FORM 990, PART VI, SECTION A, LINE 7B ORGANIZATION MEMBER INFORMATION THE APPROVAL OF THE MEMBER SHALL BE REQUIRED WITH RESPECT TO ANY OF THE FOLLOWING ACTIONS: (1) CHANGING THE PURPOSES AND POWERS OF CHM; (2) OBLIGATING CHM TO UNDERTAKE ANY CAPITAL EXPENDITURE IN EXCESS OF $5,000,000; (3) ADOPTING CHM'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 CHM TO ACT AS GUARANTOR WITH RESPECT TO ANY DEBT OF ANY PERSON OR OTHER ENTITY; (8) ACCEPTING ANY DONATION WHICH IS CONDITIONED UPON CHM'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 CHM IN AN AMOUNT IN EXCESS OF $5,000,000 OR (B) ANY PURPOSE OR ACTIVITY WHICH IS OUTSIDE THE SCOPE OF CHM'S ORDINARY COURSE OF BUSINESS. (10) INVOLVING CHM IN ANY MERGER, ACQUISITION, CORPORATE RESTRUCTURING, OR FORMAL AFFILIATION; (11) INVOLVING CHM AS A MEMBER, SHAREHOLDER, OR PARTNER IN ANY NEW CORPORATION, PARTNERSHIP, OR OTHER LEGAL ENTITY; (12) DISSOLVING CHM; (13) ENTERING INTO ANY TRANSACTION INVOLVING THE SALE, CONVEYANCE, EXCHANGE, TRANSFER OR OTHER DISPOSITION OF ALL OR SUBSTANTIALLY ALL OF CHM'S ASSETS; (14) AMENDING CHM'S ARTICLES OF INCORPORATION; (15) ADOPTING NEW BYLAWS OR AMENDING EXISTING BYLAWS. FORM 990, PART VI, SECTION B, LINE 11B PROCESS OF REVIEW BEFORE FILING, THE TAX RETURN AND SCHEDULES ARE REVIEWED BY THE AUDIT AND COMPLIANCE COMMITTEE OF RADY CHILDREN'S HEALTH'S BOARD. THE CFO REVIEWS THE MATERIALS WITH THE COMMITTEE. A COMPLETE COPY IS ALSO SHARED WITH ALL BOARD MEMBERS PRIOR TO FILING USING ELECTRONIC COMMUNICATION SYSTEMS. FORM 990, PART VI, SECTION B, LINE 12C MONITORING/ENFORCING COMPLIANCE OF CONFLICT OF INTEREST POLICY 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 COMPENSATION COMMITTEE, WHOSE MEMBERS ARE DISINTERESTED AND INDEPENDENT, IS IN PLACE WITH A WRITTEN COMPENSATION COMMITTEE CHARTER. THIS COMMITTEE ANNUALLY RETAINS AN INDEPENDENT HEALTHCARE COMPENSATION 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 COMPENSATION COMMITTEE MEMBERS, IN PERSON, IN CLOSED SESSIONS WITH NO STAFF MEMBERS PRESENT. THIS ANNUAL REVIEW WAS LAST PERFORMED IN OCTOBER 2024. 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 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 NURSING REGISTRY PERSONNEL: PROGRAM SERVICE EXPENSES 2,012,225. MANAGEMENT AND GENERAL EXPENSES 223,580. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,235,805. DR-DIRECT-INFECTION CONTROL: PROGRAM SERVICE EXPENSES 10,800. MANAGEMENT AND GENERAL EXPENSES 1,200. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 12,000. DR-DIRECT-OPHTHALMOLOGY: PROGRAM SERVICE EXPENSES 32,400. MANAGEMENT AND GENERAL EXPENSES 3,600. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 36,000. DR-COVERG-CHILD PSYCHIATRY: PROGRAM SERVICE EXPENSES 192,370. MANAGEMENT AND GENERAL EXPENSES 21,374. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 213,744. DR-COVERG-NEUROLOGICAL SURG: PROGRAM SERVICE EXPENSES 98,550. MANAGEMENT AND GENERAL EXPENSES 10,950. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 109,500. DR-COVERG-NEUROLOGY: PROGRAM SERVICE EXPENSES 90,000. MANAGEMENT AND GENERAL EXPENSES 10,000. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 100,000. DR-COVERG-NICU: PROGRAM SERVICE EXPENSES 75,600. MANAGEMENT AND GENERAL EXPENSES 8,400. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 84,000. DR-COVERG-PICU: PROGRAM SERVICE EXPENSES 861,119. MANAGEMENT AND GENERAL EXPENSES 95,679. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 956,798. DR-COVERG-SURGERY GENERAL: PROGRAM SERVICE EXPENSES 158,047. MANAGEMENT AND GENERAL EXPENSES 17,561. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 175,608. MEDICAL THERAPISTS/TECHNICIANS: PROGRAM SERVICE EXPENSES 12,778. MANAGEMENT AND GENERAL EXPENSES 1,419. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 14,197. MEDICAL SERV-CONTRACTED HOSP: PROGRAM SERVICE EXPENSES 26,336,150. MANAGEMENT AND GENERAL EXPENSES 2,926,242. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 29,262,392. MEDICAL SERVICES-SSA: PROGRAM SERVICE EXPENSES 859,020. MANAGEMENT AND GENERAL EXPENSES 95,447. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 954,467. COLLECTION AGENCY SERV FEES: PROGRAM SERVICE EXPENSES 303,176. MANAGEMENT AND GENERAL EXPENSES 33,686. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 336,862. OTHER MISC PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 78,144. MANAGEMENT AND GENERAL EXPENSES 8,682. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 86,826. FORM 990, PART XI, LINE 9: OTHER TRANSFER 16,384. CHILDREN'S HOSPITAL OF ORANGE COUNTY 1201 WEST LA VETA AVENUE ORANGE CA 92868 952321786 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 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 PROVIDENCE SPEECH AND HEARING CENTER 1301 PROVIDENCE AVENUE ORANGE CA 92868 956154473 HEALTHCARE CA 501(C)(3) LINE 7 CHOC 0 ORANGE COUNTY MEDICAL RECIPROCAL INS CO 7400 E GAINEY CLUB DR 111 SCOTTSDALE AZ 85258 201620666 INSURANCE AZ N/A C 107620 3833300 0.50000 0 0 1 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0