CHILDRENS HOSPITAL AT MISSION: Form 990, tax year 2020
View the entire original 990 at ProPublica ↗
- Organization
- CHILDRENS HOSPITAL AT MISSION (EIN 33-0528802)
- Tax period
- 2020-07-01 to 2021-06-30
- Filed
- 2022-05-11
- IRS object ID
- 202221319349300227
- Schema version
- 2020v4.2
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule I
- Schedule J
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2022-05-11T08:01:26-05:00 | ReturnTs |
| Tax Period End | 2021-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 135565207 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | KPMG LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 550 SOUTH HOPE STREET | AddressLine1Txt |
| City | LOS ANGELES | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 90071 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2020-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 330528802 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CHILDREN'S HOSPITAL AT MISSION | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | CHIL | BusinessNameControlTxt |
| Phone | 7149973000 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1201 WEST LA VETA AVENUE | AddressLine1Txt |
| City | ORANGE | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 92868 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | KERRI RUPPERT SCHILLER | PersonNm |
| Person Title | EVP/CFO/ASSISTANT SECRETARY | PersonTitleTxt |
| Phone | 7145098451 | PhoneNum |
| Signature | 2022-04-29 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | KERRI | PersonFirstNm |
| Person Last | RUPPERT SCHILLER | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | JAMES R LANCASTER | PreparerPersonNm |
| PTIN | P00742579 | PTIN |
| Phone | 2139724000 | PhoneNum |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 3 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2020 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | KIMBERLY C CRIPE | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1201 WEST LA VETA AVENUE | AddressLine1Txt |
| City | ORANGE | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 92868 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $65,022,734 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.CHOC.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1991 | FormationYr |
| Legal Domicile State | CA | LegalDomicileStateCd |
| Activity Or Mission | TO NURTURE, ADVANCE, & PROTECT THE HEALTH AND WELL-BEING OF CHILDREN. | ActivityOrMissionDesc |
| Voting Members Governing Body | 10 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 9 | VotingMembersIndependentCnt |
| Total Employee | 181 | TotalEmployeeCnt |
| Total Volunteers | 89 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $136,347 | PYContributionsGrantsAmt |
| CY Contributions Grants | $5,235,104 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $78,529,858 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $59,697,246 | CYProgramServiceRevenueAmt |
| PY Investment Income | $133,986 | PYInvestmentIncomeAmt |
| CY Investment Income | $51,095 | CYInvestmentIncomeAmt |
| PY Other Revenue | $5,874 | PYOtherRevenueAmt |
| CY Other Revenue | $39,289 | CYOtherRevenueAmt |
| PY Total Revenue | $78,806,065 | PYTotalRevenueAmt |
| CY Total Revenue | $65,022,734 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $26,000,000 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $16,475,000 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $17,053,701 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $16,112,879 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $42,329,278 | PYOtherExpensesAmt |
| CY Other Expenses | $36,136,706 | CYOtherExpensesAmt |
| PY Total Expenses | $85,382,979 | PYTotalExpensesAmt |
| CY Total Expenses | $68,724,585 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$6,576,914 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$3,701,851 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $40,292,163 | TotalAssetsBOYAmt |
| Total Assets EOY | $55,659,576 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $11,808,760 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $30,637,987 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $28,483,403 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $25,021,589 | NetAssetsOrFundBalancesEOYAmt |
| Mission | TO NURTURE, ADVANCE, & PROTECT THE HEALTH AND WELL-BEING OF CHILDREN. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $65,252,075 | ExpenseAmt |
| Grant | $16,475,000 | GrantAmt |
| Revenue | $59,697,246 | RevenueAmt |
| Desc | CHILDREN'S HOSPITAL AT MISSION (CCMH) PROVIDES SPECIALIZED PEDIATRIC SERVICES FOR THE MEDICAL/SURGICAL CARE OF CHILDREN FROM BIRTH TO AGE 18. THERE WERE 6,791 INPATIENT CARE DAYS; 7,902 EMERGENCY ROOM VISITS; 432 SURGERIES AND 12,566 OUTPATIENT VISITS. SEE OUR COMPLETE COMMUNITY BENEFIT REPORT ON OUR WEBSITE AT WWW.CHOC.ORG. | Desc |
| Total Program Service Expenses | $65,252,075 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | 0 | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (1) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | Yes (1) | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | 0 | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| Info In Schedule O Part V | Yes (X) | InfoInScheduleOPartVInd |
| IRP Document | 34 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 181 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 10 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 9 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | CA | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MARY NGUYEN | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 7145094124 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1201 WEST LA VETA AVENUE | AddressLine1Txt |
| City | ORANGE | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 928683874 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (22 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Key EmployeeKeyEmployeeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|---|
| KIMBERLY CRIPE | |||||||||
| DIRECTOR/PRESIDENT | 2.00 | 38.00 | Yes (X) | Yes (X) | $0 | $1,794,655 | $103,462 | ||
| DOUGLAS MCCOMBS | |||||||||
| DIRECTOR/VICE CHAIR | 1.00 | 4.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| JANET T DAVIDSON | |||||||||
| DIRECTOR | 1.00 | 2.00 | Yes (X) | $0 | $0 | $0 | |||
| MARSHALL ROWEN MD | |||||||||
| DIRECTOR | 1.00 | 3.00 | Yes (X) | $0 | $0 | $0 | |||
| JOE KIANI | |||||||||
| DIRECTOR/VICE CHAIR | 1.00 | 2.00 | Yes (X) | $0 | $0 | $0 | |||
| JIM MORRIS | |||||||||
| DIRECTOR | 1.00 | 2.00 | Yes (X) | $0 | $0 | $0 | |||
| THOMAS PHELPS | |||||||||
| DIRECTOR | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| KEN POTROCK | |||||||||
| DIRECTOR | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| KIMBERLY SENTOVICH | |||||||||
| DIRECTOR | 1.00 | 2.00 | Yes (X) | $0 | $0 | $0 | |||
| MARIA MINON MD | |||||||||
| DIRECTOR (FROM 9/20) | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| CHRIS FURMAN | |||||||||
| CHAIR | 1.00 | 5.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| MATTHEW GERLACH | |||||||||
| EVP/COO (TO 12/20) | 5.00 | 35.00 | Yes (X) | $0 | $922,583 | $80,210 | |||
| KERRI RUPPERT SCHILLER | |||||||||
| EVP/CFO/ASSISTANT SECRETARY | 3.00 | 37.00 | Yes (X) | $0 | $903,062 | $73,762 | |||
| JAY GABRIEL | |||||||||
| CHIEF LEGAL OFFICER/SECRETARY | 3.50 | 36.50 | Yes (X) | $0 | $692,908 | $78,770 | |||
| PAUL VAN DOLAH | |||||||||
| INTERIM EVP/COO (FROM 12/20) | 5.00 | 35.00 | Yes (X) | $0 | $88,116 | $0 | |||
| EMMA SANDHU | |||||||||
| VP, ADMIN/CNO | 40.00 | 0.00 | $355,494 | $0 | $60,195 | Yes (X) | |||
| JAMES CAPPON | |||||||||
| INTERIM CMO | 2.00 | 38.00 | $0 | $580,101 | $60,209 | Yes (X) | |||
| BONNIE GRAVETT | |||||||||
| CLINICAL NURSE IV NICU | 40.00 | 0.00 | $200,177 | $0 | $25,141 | Yes (X) | |||
| KRISTY HAFFAR | |||||||||
| CHARGE NURSE | 40.00 | 0.00 | $182,375 | $0 | $16,626 | Yes (X) | |||
| EVA ESMAEILI | |||||||||
| NURSE MANAGER-NICU | 40.00 | 0.00 | $181,604 | $0 | $30,375 | Yes (X) | |||
| ALLISON LEE O'BRIEN | |||||||||
| CHARGE NURSE | 40.00 | 0.00 | $183,490 | $0 | $14,789 | Yes (X) | |||
| BRONWYN STACKLEATHER | |||||||||
| DIRECTOR, CLINICAL SERVICE | 40.00 | 0.00 | $203,860 | $0 | $23,933 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,307,000 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $4,981,425 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $567,472 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 44 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (2 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| AYA HEALTHCARE INC | |||||
| PO BOX 123519 | DALLAS | TX | 753123519 | TEMPORARY STAFFING | $744,624 |
| CERNER CORPORATION | |||||
| 2800 ROCKCREEK PARKWAY | KANSAS CITY | MO | 64117 | PATIENT ACCOUNTING | $155,291 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 2 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $144,164 | RelatedOrganizationsAmt |
| Government Grants | $5,090,940 | GovernmentGrantsAmt |
| Total Contributions | $5,235,104 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | NET PATIENT SERVICES | Desc |
| Business | 621400 | BusinessCd |
| Total Revenue Column | $59,697,246 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $59,697,246 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $59,697,246 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $51,095 | TotalRevenueColumnAmt |
| Exclusion | $51,095 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | OTHER MISCELLANEOUS RE | Desc |
| Business | 621400 | BusinessCd |
| Total Revenue Column | $39,289 | TotalRevenueColumnAmt |
| Exclusion | $39,289 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $39,289 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $65,022,734 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $59,697,246 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $90,384 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $16,475,000 | TotalAmt |
| Program Services | $16,475,000 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $383,107 | TotalAmt |
| Program Services | $191,554 | ProgramServicesAmt |
| Management And General | $191,553 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $12,320,809 | TotalAmt |
| Program Services | $11,088,728 | ProgramServicesAmt |
| Management And General | $1,232,081 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $455,079 | TotalAmt |
| Program Services | $409,571 | ProgramServicesAmt |
| Management And General | $45,508 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,735,393 | TotalAmt |
| Program Services | $1,561,854 | ProgramServicesAmt |
| Management And General | $173,539 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,218,491 | TotalAmt |
| Program Services | $1,096,642 | ProgramServicesAmt |
| Management And General | $121,849 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $11,453,652 | TotalAmt |
| Program Services | $10,308,287 | ProgramServicesAmt |
| Management And General | $1,145,365 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,129 | TotalAmt |
| Program Services | $5,516 | ProgramServicesAmt |
| Management And General | $613 | ManagementAndGeneralAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,054 | TotalAmt |
| Program Services | $7,054 | ProgramServicesAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $19,092,475 | TotalAmt |
| Program Services | $18,940,070 | ProgramServicesAmt |
| Management And General | $152,405 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $378,823 | TotalAmt |
| Program Services | $340,941 | ProgramServicesAmt |
| Management And General | $37,882 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $709,834 | TotalAmt |
| Program Services | $638,851 | ProgramServicesAmt |
| Management And General | $70,983 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,577,883 | TotalAmt |
| Program Services | $1,420,095 | ProgramServicesAmt |
| Management And General | $157,788 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $971 | TotalAmt |
| Program Services | $874 | ProgramServicesAmt |
| Management And General | $97 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,667 | TotalAmt |
| Program Services | $3,300 | ProgramServicesAmt |
| Management And General | $367 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,019,896 | TotalAmt |
| Program Services | $917,906 | ProgramServicesAmt |
| Management And General | $101,990 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $347,661 | TotalAmt |
| Program Services | $312,895 | ProgramServicesAmt |
| Management And General | $34,766 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (3 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| PROVIDER FEE EXPENSE | $1,481,424 | $1,481,424 | $0 |
| LICENSE AND TAXES | $34,487 | $31,038 | $3,449 |
| OSHPD FEE | $20,672 | $18,605 | $2,067 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,078 | TotalAmt |
| Program Services | $1,870 | ProgramServicesAmt |
| Management And General | $208 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $68,724,585 | TotalAmt |
| Program Services | $65,252,075 | ProgramServicesAmt |
| Management And General | $3,472,510 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $331,714 | BOYAmt |
| EOY | $2,176,082 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,012,551 | BOYAmt |
| EOY | $9,446,177 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,767,618 | BOYAmt |
| EOY | $12,754,451 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,012,707 | BOYAmt |
| EOY | $3,028,013 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $23,968,037 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $17,643,909 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,128,162 | BOYAmt |
| EOY | $6,324,128 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,800,679 | BOYAmt |
| EOY | $5,800,679 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,238,732 | BOYAmt |
| EOY | $16,130,046 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $40,292,163 | BOYAmt |
| EOY | $55,659,576 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,449,530 | BOYAmt |
| EOY | $2,786,021 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,009,170 | BOYAmt |
| EOY | $10,438,011 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,350,060 | BOYAmt |
| EOY | $17,413,955 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,808,760 | BOYAmt |
| EOY | $30,637,987 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $27,396,716 | BOYAmt |
| EOY | $23,937,610 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,086,687 | BOYAmt |
| EOY | $1,083,979 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $28,483,403 | BOYAmt |
| EOY | $25,021,589 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $40,292,163 | BOYAmt |
| EOY | $55,659,576 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | -$3,701,851 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $240,037 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | VolunteersInd |
| Paid Staff Or Management | 0 | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | 0 | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | 0 | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | Yes (1) | OtherActivitiesInd |
| Other Activities | $7,054 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $7,054 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART II-B, LINE 1: | FormAndLineReferenceDesc |
| Explanation | GRANTS TO OTHER ORGANIZATIONS FOR LOBBYING PURPOSES FORM 990, SCHEDULE C, PART II-B, LINE 1I DURING FYE 06/30/2021, CHILDREN'S HOSPITAL AT MISSION PAID DUES TO HOSPITAL ASSOCIATION OF SOUTHERN CALIFORNIA, $7,054 OF WHICH SUPPORTED LOBBYING PURPOSES. | ExplanationTxt |
Schedule D IRS990ScheduleD
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $14,354,942 | OtherCostOrOtherBasisAmt |
| Depreciation | $10,442,779 | DepreciationAmt |
| Book Value | $3,912,163 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $8,509,275 | OtherCostOrOtherBasisAmt |
| Depreciation | $7,201,130 | DepreciationAmt |
| Book Value | $1,308,145 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,103,820 | OtherCostOrOtherBasisAmt |
| Book Value | $1,103,820 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $6,324,128 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (6 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| OTHER RECEIVABLE | $3,300 |
| PROVIDER FEE PROGRAM RECEIVABLE | $697,994 |
| RECEIVABLES FROM RELATED PARTY | $85,382 |
| OPERATING LEASE ROU ASSETS | $14,491,777 |
| BENEFICIAL INT IN FDN | $41,024 |
| INVESTMENT IN OCMRRG | $810,569 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $16,130,046 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)
| DescDesc | AmtAmt |
|---|---|
| DUE TO RELATED PARTIES | $2,922,178 |
| OPERATING LEASE LIABILITY | $14,491,777 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $17,413,955 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART X, LINE 2: | FormAndLineReferenceDesc |
| Explanation | 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, 2021, 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. | ExplanationTxt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent400 | Yes (X) | Percent400Ind |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | 0 | ExpensesExceedBudgetInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (1) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $24,137 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $24,137 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00040 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $16,537,129 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $8,295,094 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $8,242,035 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.11990 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $16,561,266 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $8,295,094 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $8,266,172 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.12030 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $11,277 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $11,277 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00020 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $11,277 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $11,277 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00020 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $16,572,543 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $8,295,094 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $8,277,449 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.12050 | TotalExpensePct |
Community Support CommunitySupportGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 4 | ActivitiesOrProgramsCnt |
| Total Community Benefit Expns | $37,321 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $600 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $36,721 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00050 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 4 | ActivitiesOrProgramsCnt |
| Total Community Benefit Expns | $37,321 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $600 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $36,721 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00050 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $3,670,428 | BadDebtExpenseAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CHILDREN'S HOSPITAL AT MISSION | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 27700 MEDICAL CENTER ROAD | AddressLine1Txt |
| City | MISSION VIEJO | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 92691 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.CHOC.ORG | WebsiteAddressTxt |
| State License | 060000348 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| Childrens Hospital | Yes (X) | ChildrensHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CHILDREN'S HOSPITAL AT MISSION | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| CHNA Conducted | 19 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | Yes (1) | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | 0 | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | SEE PART V, SECTION C | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 19 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | SEE PART V, SECTION C | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 200.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 400.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Provided Nonprofit Contact | Yes (X) | ProvidedNonprofitContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | HTTPS://WWW.CHOC.ORG/PATIENTS-FAMILY/PAY-BILL/ | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | HTTPS://WWW.CHOC.ORG/PATIENTS-FAMILY/PAY-BILL/ | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | HTTPS://WWW.CHOC.ORG/PATIENTS-FAMILY/PAY-BILL/ | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Translated | Yes (X) | FAPTranslatedInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Prospective Medicare Medicaid | Yes (X) | ProspectiveMedicareMedicaidInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 2019, 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 SECONDRAY 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 & 10ABOTH THE COMMUNITY HEALTH NEEDS ASSESSMENT AND IMPLEMENTATION STRATEGY CAN BE FOUND AT THE FOLLOWING URL: HTTP://CHOC.ORG/ABOUT BY CLICKING THE LINKS LABELED "COMMUNITY BENEFIT PLAN AND "COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA)". |
| 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 TWELVE HIGH-PRIORITYNEEDS:MENTAL HEALTH AND AUTISM, ACCESS TO PEDIATRIC SPECIALISTS, IMMUNIZATIONS AND INFECTIOUS DISEASES, SUBSTANCE ABUSE, PEDIATRIC OBESITY, RESPIRATORY ILLNESS, ORAL HEALTH, COLLABORATION AND PARTNERSHIPS WITH SCHOOL PROGRAMS, BULLYING AND OTHER STRESSORS IN SCHOOL, PEDIATRIC DIABETES,COST OF CHILD CARE, AND HOUSING AFFORDABILITY. THE LAST TWO PRIORITY NEEDS, COST OF CHILD CARE AND HOUSING AFFORDABILITY, ARE NOT ADDRESSED IN THE IMPLEMENTATION PLAN AS CHOC HAS NEITHER THE RESOURCES OR EXPERTISE TO ADDRESS. OVER THE NEXT THREE YEARS, CHOC IS INVESTING APPROXIMATELY$3.7M, THAT INCLUDES THE HIRING OF APPROXIMATELY 13 FTES, TO ASSIST IN DEVELOPING SCHOOL-BASED INITIATIVES AND PROGRAMS TO HELP ADDRESS THE PRIORITY NEEDS IDENTIFIED. SPECIFIC INITIATIVES 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 PEDIATRC MENTAL ILLNESS.TO FULFILL THIS INITATIVE, CHOC BUILT AN INPATIENT CHILDREN'S MENTAL HEALTH CENTER WHICH OPENED IN APRIL 2018. THE NEW CENTER HAS 18 BEDS IN A SECURED AND HEALING ENVIRONMENT, IN ADDITION TO AN OUTDOOR AREA FOR RECREATION. THE CENTER PROVIDES A SAFE, NUTURING PLACE FOR CHILDREN AGES3 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 NEW CENTER IS DEDICATED TO BRINGING THE LATEST TREATMENTS AND RESOURCES TO THE AUTISM COMMUNITY IN ORANGE COUNTY. THROUGH UNIQUEPROGRAMS, 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) 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 INDICATD 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 270 PROVIDERS AND OFFERS EXPERTISE AND CARE IN OVER 23 PEDIATRIC MEDICAL SPECIALTIES. IN THE PAST YEAR, THE PHYSICIAN GROUP HAS ADDED THE FULL TIME EQUIVALENT OF OVER 17 PROVIDERS.3) IMMUNIZATIONS AND INFECTIOUS DISEASES: CHOC AND CCMH ASPIRE TO IMPROVE OVERALL IMMUNIZATION COMPLETION RATES FOR ORANGE COUNTY CHILDREN, LEADING TO A REDUCTION IN IMMUNIZATION PREVENTABLE DISEASES. CHOC AND CCMH ARE IDENTIFYING OPPORTUNITIES FOR PROVIDING VACCINES AT EVERY PRIMARY CARE VISIT AND IS COORDINATING DIRECT PHYSICIAN-TO-PHYSICIAN DISCUSSIONS TO ENSURE ALL BARRIERS TO COMPLETING IMMUNIZATIONS ARE ADDRESSED. EDUCATIONAL MATERIALS REGARDING THE EFFICACY AND SAFETY OF VACCINES IS MADE AVAILABLE TO ALL CHOC AND CCMH PROVIDERS AND PATIENTS. GREATER EFFORT WILL BE MADE TO INCREASE AVAILABILITY OF MATERIAL TO THE BROADER PUBLIC. CHOC'S AND CCMH'S COMMUNITY EDUCATION DEPARTMENT HAVE IMPLEMENTED PROJECT DULCE THAT PAIRS A FAMILY SPECIALIST WITH NEWBORNS THROUGH AGE 6 MONTHS AND THEIR FAMILIES AT THE SANTA ANA BOYS AND GIRLS CLINIC AND CLINICA CHOC PARA NINOS. THE FAMILY SPECIALIST ENSURES FAMILIES ARE KEEPING AND ATTENDING ALL VISITS AND MAINTAINING COMPLIANCE WITH VISIT RECOMMENDATIONS INCLUDING VACCINATIONS.4) 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.5) OBESITY CHOC AND CCMH HAVE CONVENED A MULTI-DISCIPLINARY COALITION OF COMMUNITY MEMBERS TO WORK ON THE ISSUE OF OBESITY. THIS TASK FORCE INCLUDES REPRESENTATIVES FROM THE HEALTH CARE COMMUNITY (PHYSICIANS, DIETICIANS AND PSYCHOLOGISTS), THE UNIVERSITY OF CALIFORNIA - IRVINE, ORANGE COUNTY SOCIAL SERVICES AND THE SCHOOL DISTRICTS THROUGHOUT THE COMMUNITY. EFFORTS TO DATE INCLUDE OFFERING CLASSES AND EDUCATIONAL MATERIALS AND A KIDS FIT CLUB. ADEQUATE AND PROPER NUTRITION IS IMPORTANT FOR A CHILD'S NORMAL GROWTH AND DEVELOPMENT. CHOC'S AND CCMH'S CLINICAL NUTRITION AND LACTATION SERVICES AIM TO BE A RELIABLE SOURCE OF NUTRITION AND LACTATION INFORMATION FOR OUR PATIENTS, FAMILIES AND COMMUNITY. WE ARE HERE TO HELP PATIENTS WITH GROWTH AND DEVELOPMENT, WHILE GIVING THEM A FOUNDATION FOR LIFELONG HEALTH AND WELLNESS. WE PROVIDE FAMILY-CENTERED, CULTURALLY SENSITIVE CARE THAT IS CUSTOMIZED FOR EVERY INDIVIDUAL, USING EVIDENCE-BASED TECHNIQUES AND BEST PRACTICES WITH A MULTI-DISCIPLINARY APPROACH.6) RESPIRATORY ILLNESSRESPIRATORY ILLNESS IS A CRITICAL CONCERN IN ORANGE COUNTY AS NEARLY 14% BARRIERS TO ADDRESSING RESPIRATORY ILLNESSES INCLUDE LACK OF ACCESS TO PEDIATRIC SUBSPECIALISTS, AND LANGUAGE AND CULTURAL PERSPECTIVES TO UNDERSTANDING AND MANAGING RESPIRATORY DISEASES. THROUGH USE OF THE BREATHMOBILE AND THE DEVELOPMENT OF SCHOOL-BASED WELLNESS CENTERS IN PARTNERSHIP WITH THE ORANGE COUNTY DEPARTMENT OF EDUCATION, CHOC WILL ENGAGE CHILDREN AND FAMILIES IN THE COMMUNITY, IN A CULTURALLY AND LINGUISTICALLY COMPETENT MANNER. THIS, ALONG WITH EFFORTS TO ASSURE FRONTLINE PROVIDERS ARE USING STATE OF THE ART APPROACHES TO CARE, WILL IMPROVE CONTROL OF ASTHMA SYMPTOMS WITH CONCURRENT REDUCTIONS IN EMERGENCY DEPARTMENT UTILIZATION, HOSPITAL ADMISSIONS, AND SCHOOL ABSENTEEISM. ORANGE COUNTY'S PEDIATRIC POPULATION HAVE BEEN DIAGNOSED WITH ASTHMA. CARE WILL BE BROUGHT TO CHILDREN BY CONTINUING TO DEPLOY THE BREATHMOBILE UNIT TO SCHOOLS AND COMMUNITIES AS WELL AS DEVELOPING SCHOOL BASED WELLNESS CENTERS IN PARTNERSHIP WITH THE ORANGE COUNTY DEPARTMENT OF EDUCATION.7) ORAL HEALTHCHOC AND CCMH SEEK TO ENHANCE ACCESS TO DENTAL PREVENTATIVE CARE SERVICES AND IMPROVE THE PREVENTION OF DENTAL CAVITIES IN THE BROADER POPULATION OF CHILDREN, WHICH WILL REDUCE DENTAL DISEASE AND COMPLICATIONS. CHOC AND CCMH WILL EXPAND TELEDENTISTRY SERVICES TO INCLUDE MORE WEEKDAY AND WEEKEND HOURS IN CHOC'S AND CCMH'S PRACTICE LOCATIONS. CHOC AND CCMH WILL ALSO INCREASE DISTRIBUTION AND EDUCATION FOR TOPICAL FLUORIDE APPLICATION AT PRIMARY CARE WELL-VISITS FOR ALL PATIENTS IN THE CHOC HEALTH ALLIANCE NETWORK. CHOC AND CCMH WILL CONTINUE TO PROVIDE SCREENING SERVICES AND MORE EDUCATION TO FAMILIES REGARDING DENTAL HEALTH.8) 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. |
| SCHEDULE H, PART V, LINE 11 - CONTINUED | 9) BULLYING AND OTHER STRESSORS IN SCHOOL BULLYING 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 UNIVERAL SCREENING ACROSS ALL ORANGE COUNTY PRIMARY CARE PEDIATRIC OFFICES. CHOC HEALTH ALLIANCE, WIITH 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.10) PEDIATRIC DIABETESOBESITY AND DIABETES ARE MAJOR CONTRIBUTORS TO THE LEADING CAUSES OF DEATH INCLUDING HEART DISEASE, STROKE, AND CERTAIN CANCERS.CHALLENGES TO ADDRESSING DIABETES INLCUDE A LACK OF ACCESS TO HEALTHY FOODS, LACK OF PARTNERSHIPS AND COLLABORATIONS WITH OTHER AGENCIES, INCREASED SOCIAL MEDIA EXPOSURE AND SCREEN TIME AND DECREASED PHYSICAL ACTIVITY. CHOC SEEKS TO REDUCE THE RATE OF PEDIATRIC DIABETES IN THE COMMUNITY THROUGH THE IDENTIFICATION OF CHILDREN WITH ELEVATED BMI VALUES, INCREASING ACCESS TO PROGRAMS SUCH AS PODER (PREVENTION OF OBESITY AND DIABETES THROUGH EDUCATION AND RESOURCES), AND ENSURING THAT PRIMARY CARE PHYSICIANS IN CHOC'S NETWORK HAVE ACCESS TO SPECIFIC DIABETES SCREENING GUIDLEINES TO IDENTIFY HIGH-RISK CHILDREN. THESE STRATEGIES WILL LEAD TO EARLIER INSTITUTION OF MEDICAL AND LIFESTYLE INTERVENTIONS. |
Supplemental Information Detail SupplementalInformationDetail (13 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
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| 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 PROGRAMCCMH RECOGNIZED REVENUES FOR THE 6-MONTH PROGRAM OF $2,184,000 AND PROVIDER FEES AND OTHER EXPENSES OF $729,000. IN ADDITION, CMS ISSUED FINAL APPROVAL DURING FY2021 OF THE FEE FOR SERVICE PORTION OF THE 30 MONTH PROGRAM ENDED JUNE 30, 2021. UNDER THIS PORTION OF THE PROGRAM, CCMH RECOGNIZED REVENUES OF $3,194,000 AND PROVIDER FEES AND OTHER EXPENSES OF $1,930,000. THE AMOUNTS WERE RECOGNIZED AS NET PATIENT REVENUE AND OPERATING EXPENSES, REPSECTIVELY, IN THE FISCAL YEAR ENDED JUNE 30, 2021. |
| PART II, COMMUNITY BUILDING ACTIVITIES: | COMMUNITY BUILDING ACTIVITIESCOMMUNITY 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: HTTP://CHOC.ORG/ABOUT 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 ANDDISCOUNT 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 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 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 THE SOUTHERN PORTION OF ORANGE COUNTY, AND IS THE SOURCE OF APPROXIMATELY 84% OF ITS PATIENTS. SIGNIFICANT CITIES IN THIS AREA ARE: MISSION VIEJO, SAN CLEMENTE, SAN JUAN CAPISTRANO, LAGUNA NIGUEL, RANCHO SANTA MARGARITA, LAGUNA HILLS, AND LAKE FOREST. 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 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 2019 COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) REPORT, THE MOST RECENTLY AVAILABLE. ORANGE COUNTY'S POPULATION IS 3,252,459, MAKING IT THE THIRD MOST POPULOUS COUNTY IN CALIFORNIA. THE MEDIAN AGE IS 37.4, AND CHILDREN UP TO 18 YEARS OF AGE MAKE UP 22.1% OF THE TOTAL POPULATION. THE MEDIAN FAMILY INCOME IN THE COUNTY IS APPROXITMATELY $88,453. IN THE CHOC SERVICE AREA. 16.4% OF CHILDREN UNDER THE AGE OF 18 LIVE IN POVERTY, COMPARED TO 20.8% OF CALIFORNIA'S CHILDREN. THIS INDICATOR VARIES ACROSS THE COUNTY, WITH 24.7% OF CHILDREN IN SANTA ANA LIVING IN POVERTY COMPARED TO 1.7% OF CHILDREN IN YORBA LINDA. CHILDREN OF LOW INCOME FAMILIES WILL BE ELIGIBLE FOR MEDI-CAL AND POTENTIALLY CCS (CALIFORNIA CHILDREN'S SERVICES) IF THEY HAVE A QUALIFING CONDITION. ORANGE COUNTY'S POPULATION IS DIVERSE, WITH 49.2% OF THE POPUATION BEING WHITE; 1.8% BEING BLACK/AFRICAN AMERICAN; .6% BEING AMERICAN INDIAN/ALASKA NATIVE; 18.1% BEING ASIAN; .3% BEING PACIFIC ISLANDER; 8.8% IDENTIFYING AS MULTIPLE RACES; AND 21.2% AS OTHER. OF THE TOTAL ORANGE COUNTY POPULLATION, 48.7% IDENTIFY AS HISPANIC ETHNICITY. |
| 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 ORTHOPAEDIC 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, 2021, 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: HTTP://WWW.CHOC.ORG/ABOUT.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: 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 TO DO 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.SCHEDULE H, PART VI, LINE 7A COMMUNITY BENEFIT REPORT IS FILED ANNUALLY IN THE STATE OF CALIFORNIA. |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable
Recipient Business Name RecipientBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CHILDREN'S HEALTHCARE OF CALIFORNIA | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1201 WEST LA VETA AVENUE | AddressLine1Txt |
| City | ORANGE | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 92868 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Recipient EIN | 330265266 | RecipientEIN |
| IRC Section | 501(C)(3) | IRCSectionDesc |
| Cash Grant | $16,475,000 | CashGrantAmt |
| Valuation Method Used | N/A | ValuationMethodUsedDesc |
| Non Cash Assistance | N/A | NonCashAssistanceDesc |
| Purpose Of Grant | SUPPORT | PurposeOfGrantTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 1 | Total501c3OrgCnt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 2: | FormAndLineReferenceDesc |
| Explanation | PROCEDURE FOR MONITORING THE USE OF GRANT FUNDS THE GRANT FROM CCMH TO CHC WAS IN ACCORDANCE WITH THE BYLAWS OF BOTH ORGANIZATIONS. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Independent Consultant | Yes (X) | IndependentConsultantInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (1) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (11 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| KIMBERLY CRIPE | ||||||||||||||
| DIRECTOR/PRESIDENT | $0 | $1,106,414 | $0 | $397,073 | $0 | $291,168 | $0 | $68,315 | $0 | $35,147 | $0 | $1,898,117 | $0 | $49,744 |
| MATTHEW GERLACH | ||||||||||||||
| EVP/COO (TO 12/20) | $0 | $641,030 | $0 | $141,983 | $0 | $139,570 | $0 | $37,846 | $0 | $42,364 | $0 | $1,002,793 | $0 | $25,431 |
| KERRI RUPPERT SCHILLER | ||||||||||||||
| EVP/CFO/ASSISTANT SECRETARY | $0 | $603,953 | $0 | $147,954 | $0 | $151,155 | $0 | $44,383 | $0 | $29,379 | $0 | $976,824 | $0 | $23,844 |
| JAY GABRIEL | ||||||||||||||
| CHIEF LEGAL OFFICER/SECRETARY | $0 | $500,216 | $0 | $100,072 | $0 | $92,620 | $0 | $36,419 | $0 | $42,351 | $0 | $771,678 | $0 | $16,777 |
| JAMES CAPPON | ||||||||||||||
| INTERIM CMO | $0 | $431,800 | $0 | $85,603 | $0 | $62,698 | $0 | $17,845 | $0 | $42,364 | $0 | $640,310 | $0 | $13,772 |
| EMMA SANDHU | ||||||||||||||
| VP, ADMIN/CNO | $282,000 | $0 | $57,185 | $0 | $16,309 | $0 | $59,527 | $0 | $668 | $0 | $415,689 | $0 | $0 | $0 |
| BRONWYN STACKLEATHER | ||||||||||||||
| DIRECTOR, CLINICAL SERVICE | $186,123 | $0 | $17,712 | $0 | $25 | $0 | $3,850 | $0 | $20,083 | $0 | $227,793 | $0 | $0 | $0 |
| BONNIE GRAVETT | ||||||||||||||
| CLINICAL NURSE IV NICU | $191,080 | $0 | $3,008 | $0 | $6,089 | $0 | $11,328 | $0 | $13,813 | $0 | $225,318 | $0 | $0 | $0 |
| EVA ESMAEILI | ||||||||||||||
| NURSE MANAGER-NICU | $171,983 | $0 | $9,596 | $0 | $25 | $0 | $10,305 | $0 | $20,070 | $0 | $211,979 | $0 | $0 | $0 |
| KRISTY HAFFAR | ||||||||||||||
| CHARGE NURSE | $172,111 | $0 | $4,500 | $0 | $5,764 | $0 | $4,934 | $0 | $11,692 | $0 | $199,001 | $0 | $0 | $0 |
| ALLISON LEE O'BRIEN | ||||||||||||||
| CHARGE NURSE | $170,077 | $0 | $7,500 | $0 | $5,913 | $0 | $0 | $0 | $14,789 | $0 | $198,279 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 4B | FormAndLineReferenceDesc |
| Explanation | 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. SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN PART I, LINE 4B 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 2021. MS. CRIPE ($216,367), MS. SCHILLER ($103,710), MR. GABRIEL ($73,241), MR. GERLACH ($110,616), AND MR. CAPPON ($61,513.) 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. MATTHEW GERLACH 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 CORPORTATION (ALL IRC SECTION 501(C)(3) AFFILIATES). MR. GERLACH DEVOTES APPROXIMATELY 13% OF HIS TIME EACH WEEK TO CHILDREN'S HOSPITAL AT MISSION RESPONSIBILITIES WITH THE BALANCE OF HIS TIME BEING SPENT ON CHILDREN'S HOSPITAL OF ORANGE COUNTY BUSINESS AFFAIRS. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (9 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 153 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). |
| 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 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 | 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 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 | 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 125,075. MANAGEMENT AND GENERAL EXPENSES 13,897. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 138,972. MEDICAL PHYSICIANS: PROGRAM SERVICE EXPENSES 6,748. MANAGEMENT AND GENERAL EXPENSES 750. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 7,498. 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 25,380. MANAGEMENT AND GENERAL EXPENSES 2,820. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 28,200. 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 526,199. MANAGEMENT AND GENERAL EXPENSES 58,467. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 584,666. DR-COVERG-SURGERY GENERAL: PROGRAM SERVICE EXPENSES 158,374. MANAGEMENT AND GENERAL EXPENSES 17,597. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 175,971. COLLECTION AGENCY SERV FEES: PROGRAM SERVICE EXPENSES 201,761. MANAGEMENT AND GENERAL EXPENSES 22,418. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 224,179. OTHER MISC PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 53,040. MANAGEMENT AND GENERAL EXPENSES 5,893. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 58,933. MISC PURCH SVCS - COVID 19: PROGRAM SERVICE EXPENSES 117. MANAGEMENT AND GENERAL EXPENSES 13. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 130. MEDICAL SERVICES: PROGRAM SERVICE EXPENSES 17,568,426. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 17,568,426. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (4 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|---|---|---|---|
| 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 11 | CHC | 0 | |
| CHILDREN'S HEALTHCARE OF CALIFORNIA(CHC) | |||||||||||
| 1201 WEST LA VETA AVENUE | ORANGE | CA | 92868 | 330265266 | HEALTHCARE | CA | 501(C)(3) | LINE 7 | 0 | N/A | |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ORANGE COUNTY MEDICAL RECIPROCAL INS CO | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2999 NORTH 4TH STREET SUITE 250 | AddressLine1Txt |
| City | PHOENIX | CityNm |
| State Abbreviation | TX | StateAbbreviationCd |
| ZIP | 85108 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 201620666 | EIN |
| Primary Activities | INSURANCE | PrimaryActivitiesTxt |
| Legal Domicile State | AZ | LegalDomicileStateCd |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CHOC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Entity Type | C | EntityTypeTxt |
| Share Of Total Income | $35,291 | ShareOfTotalIncomeAmt |
| Share Of EOY Assets | $3,602,306 | ShareOfEOYAssetsAmt |
| Ownership | 0.50000 | OwnershipPct |
| Controlled Organization | 0 | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | Yes (1) | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (1) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (1) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | 0 | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |