2020-05-15T17:55:43-05:00 2019-06-30 KPMG LLP 550 S Hope St Suite 1500 Los Angeles CA 90071 990 2018-07-01 330528802 CHILDREN'S HOSPITAL AT MISSION % MIKALYN KLUTH CHIL 7149973000 1201 West La Veta Avenue ORANGE CA 92868 KERRI RUPPERT SCHILLER CFO/Assistant Secret 2020-05-15 true Shalini Saidha P01959812 2139724000 2020-05-13 199.207.253.101 95488420201365000022 2020-05-15 P 373382F15624480A8AE70B84D46316B235BED8B4 AFC1CABF2724952AFBFC3879A4882118A11459E7 2018 2021-01-29 14:40:06Z KIMBERLY C CRIPE 1201 West La Veta Avenue ORANGE CA 92868 80430502 false X WWW.CHOC.ORG X 1991 CA TO NURTURE, ADVANCE, & PROTECT THE HEALTH AND WELL-BEING OF CHILDREN. 12 11 149 84 0 0 383610 349767 63320181 79834224 135703 246511 135 0 63839629 80430502 14000000 15071209 0 0 13937219 15960331 0 0 0 41463528 42349650 69400747 73381190 -5561118 7049312 43266840 45044056 15360957 10050750 27905883 34993306 TO NURTURE, ADVANCE, & PROTECT THE HEALTH AND WELL-BEING OF CHILDREN. false false 69746878 15071209 79834224 Facility provides pediatric, young adult, neonatal and care for emergency services. There were 7,804 inpatient care days; 14,593 emergency room visits (including pediatric trauma visits); 630 surgeries and 22,432 outpatient visits. SEE OUR COMPLETE COMMUNITY BENEFIT REPORT ON OUR WEBSITE AT WWW.CHOC.ORG 69746878 true true false true false false false false false false true false false true true true false true false false false false false false false false true true true false true false false false false false false false false false false false false false true true false false false true X 27 0 true 149 true true true false false false false false false false false false false false X 12 11 false false false false true true true true true false false true true true true true true true true false CA X MIKALYN KLUTH 7145094124 1201 WEST LA VETA AVENUE ORANGE CA 928683874 Kimberly Cripe Director/President 2.0 38.0 X X 0 1735119 100124 SAM AURIEMMA Director 1.0 3.0 X 0 0 0 Josh D'Amaro Director 1.0 1.0 X 0 0 0 Janet T Davidson Director 1.0 3.0 X 0 0 0 Chris Furman Director/Chairman 1.0 4.0 X X 0 0 0 Robert Hillyard MD Director 1.0 1.0 X 0 0 0 Joe Kiani Director 1.0 2.0 X 0 0 0 Douglas McCombs Director/Vice Chair 1.0 2.5 X X 0 0 0 Thomas Phelps Director 1.0 1.5 X 0 0 0 Marshall Rowen MD Director 1.0 6.0 X 0 0 0 Kim Sentovich Director 1.0 2.5 X 0 0 0 David Dukes Director (thru 9/2018) 1.0 6.5 X 0 0 0 JEFF ELGHANAYAN DIRECTOR (THU 9/2018) 1.0 2.5 X 0 0 0 MICHAEL COLGLAZIER DIRECTOR (THRU 3/2018) 1.0 2.0 X 0 0 0 Jim Morris Director 0.5 1.0 X 0 0 0 Kerri Ruppert Schiller EVP/CFO/Assistant Secretary 2.0 38.0 X 0 898335 64777 Jay Gabriel Chief Legal Officer/Secretary 2.5 37.5 X 0 871212 65487 Emma Sandhu VICE PRESIDENT/CNO 40.0 0.0 X 212351 0 12557 Matthew Gerlach Exec. Vice President/COO 5.0 35.0 X 0 904067 48980 MARCIA FOLLI VP/CNO (thru 9/2018) 20.0 20.0 X 233783 233782 12631 BONNIE GRAVETT CLINICAL NURSE III 40.0 0.0 X 187979 0 25366 KAREN MCGURK-MISH NURSE MANAGER 40.0 0.0 X 174981 0 23263 EVA ESMAEILI NICU NURSE MANAGER 40.0 0.0 X 163948 0 28666 BRONWYN STACKLEATHER Director, Clinical Services 40.0 0.0 X 164559 0 21633 KRISTY HAFFAR CHARGE NURSE 40.0 0.0 X 154921 0 24624 1292522 4642515 428108 39 false true false RightSourcing Inc PO Box 515743 LOS ANGELES CA 900515118 Temporary staffing 692347 CERNER CORPORATION 2800 Rockcreek Parkway KANSAS CITY MO 64117 Patient accounting 357032 AIM HEALTHCARE SERVICE PO BOX 415000 NASHVILLE TN 372410833 Claims management 355491 3 191720 158047 349767 NET PATIENT SERVICES 621400 79834224 79834224 79834224 246511 246511 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 80430502 79834224 246511 15071209 15071209 0 0 0 302557 302557 0 12676388 11408749 1267639 434906 391415 43491 1628551 1465696 162855 917929 826136 91793 11184708 10066237 1118471 33589 33589 24772 22295 2477 8588 8588 0 0 1895787 1706208 189579 0 339504 305554 33950 701686 631517 70169 0 1569491 1412542 156949 10493 9444 1049 0 16628 14965 1663 0 0 1198644 1078780 119864 291077 261969 29108 0 PURCHASED SRVS OTHR HOSP. 20429062 20429062 PROVIDER PROGRAM FEE 4554523 4554523 LICENSE AND TAXES 51523 46371 5152 OSHPD FEE 30410 27369 3041 9165 8249 916 73381190 69746878 3634312 0 114741 160506 11176613 8371686 0 0 11626506 16992621 0 0 0 0 0 0 0 0 3714612 2050570 22484684 15540824 7582564 6943860 0 0 0 0 0 0 5800679 5800679 3251125 4724134 43266840 45044056 1896217 2153495 0 0 8209774 4250747 0 0 0 0 0 0 0 0 0 0 5254966 3646508 15360957 10050750 X 26893346 34051978 1012537 941328 0 0 27905883 34993306 43266840 45044056 7049312 38111 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 8588 8588 false Grants to Other Organizations for Lobbying Purposes form 990, schedule c, part II-B, line 1i during fye 06/30/2019, children's hospital at mission paid dues to Hospital Association of Southern California, $8,588 of which supported lobbying purposes. X 14354943 9014430 5340513 8098741 6526394 1572347 31000 31000 6943860 OTHER RECEIVABLE 3032110 PROVIDER FEE PROG RECEIVABLE 1068125 RECEIVABLES FROM RELATED PARTY 56476 INVESTMENT IN OCMRRG 503522 BENEFICIAL INT IN FDN 63901 4724134 0 DUE TO RELATED PARTIES 1783250 LONG TERM ACC TAIL COVERAGE 184000 DUE TO CONTRACTING HOSPITALS 1129258 DUE TO THIRD PARTIES 550000 3646508 X ASC 740 Form 990, Schedule D, Part X US GAAP require 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, 2019 there are no uncertain tax positions taken or expected to be taken that would require recognition of a liability or disclosure in the consolidated financial statements. true true X true X true X true true false true true 168504 168504 0.00230 25706802 17122263 8584539 0.11710 25875306 17122263 8753043 0.11940 25875306 17122263 8753043 0.11940 5 7154 7154 0.00010 5 7154 7154 0.00010 true 5457803 true true 1 1 CHILDREN'S HOSPITAL AT MISSION 27700 MEDICAL CENTER ROAD MISSION VIEJO CA 92691 www.choc.org X X X CHILDREN'S HOSPITAL AT MISSION 1 false false true X X X X X X X X X 19 true true false true X See Part V, Section C X true 19 true See Part V, Section C false true X 200. 400. X X true true X X X X true X See Part V X See Part V X SEE PART V X X X X X X true X false X X X X true X false false Schedule H, Part V Additional Information SCHEDULE H, PART V, LINE 5 CCMH AND CHOC CONDUCTED THE CHNA PROCESS INDEPENDENTLY 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 HOSPITALS PRIMARY SERVICE AREA. SCHEDULE H, PART V, LINE 6A CHILDRENS HOSPITAL OR ORANGE COUNTY AND CHOC CHILDRENS AT MISSION TOGETHER CONDUCTED THE HEALTH NEEDS ASSESSMENTS. SCHEDULE H, PART V, LINES 7A & 10A BOTH THE COMMUNITY HEALTH NEEDS ASSESSMENT AND IMPLEMENTATION STRATEGY CAN BE FOUND AT THE FOLLOWING URL: HTTP://CHOC.ORG/ABOUT BY CLICKING THE LINKS LABELED VIEW OUR COMMUNITY BENEFIT PLAN AND VIEW OUR COMMUNITY HEALTH NEEDS ASSESSMENT. SCHEDULE H, PART V, LINE 11 ADDRESSING HIGH PRIORITY COMMUNITY HEALTH NEEDS CHOC CHILDRENS HOSPITAL AT MISSION (CCMH) COORDINATES ITS RESPONSE TO ITS MOST RECENT CHNA WITH ITS LARGER AFFILIATE, CHILDRENS HOSPITAL OF ORANGE COUNTY (CHOC). CHOCS AND CCMHS MOST RECENT CHNA IDENTIFIED TWELVE HIGH-PRIORITY NEEDS: 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 AUTISM CHOC CHILDRENS, 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 CHILDRENS 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 AGES 3 TO 18, AND SPECIALTY PROGRAMMING FOR CHILDREN YOUNGER THAN 12. IN ADDITION, CHOC BUILT THE THOMPSON AUTISM CENTER WHICH OPENED IN JANUARY 2019. THE NEW CENTER IS DEDICATED TO BRINGING THE LATEST TREATMENTS AND RESOURCES TO THE AUTISM COMMUNITY IN ORANGE COUNTY. THROUGH UNIQUE PROGRAMS, CHILDREN HAVE A CENTRALIZED PLACE WHERE THEY CAN RECEIVE EARLY DIAGNOSIS, ADVANCED THERAPY AND THE POSSIBILITY TO REACH THEIR TRUE POTENTIAL. THE OPENING OF THE INPATIENT CENTER AND THE THOMPSON AUTISM CENTER AUGMENTS MENTAL HEALTH SERVICES ALREADY OFFERED BY CHOC. THOSE SERVICES INCLUDE CHOCS OUTPATIENT EATING DISORDERS PROGRAM, OUTPATIENT PROGRAMS TO KEEP STRUGGLING CHILDREN OUT OF THE HOSPITAL AND ASSISTANCE TO THOSE WHO HAVE BEEN RELEASED, AND MENTAL HEALTH SERVICES FOR CHOC PATIENTS BEING TREATED FOR SERIOUS/CHRONIC ILLNESSES. 2) ACCESS TO PEDIATRIC SPECIALTIES/SUBSPECIALTIES CHOC RECOGNIZES THE COMMUNITY NEED FOR ACCESS TO PEDIATRIC SPECIALISTS/SUBSPECIALISTS AND CONTINUES TO BUILD THE RESOURCES AVAILABLE THROUGHOUT THE COMMUNITIES SERVED BY CHOC. CHOCS 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 TO PROVIDE THE SERVICES HAS 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 ASPIRES TO IMPROVE OVERALL IMMUNIZATION COMPLETION RATES FOR ORANGE COUNTY CHILDREN, LEADING TO A REDUCTION IN IMMUNIZATION PREVENTABLE DISEASES. CHOC IS 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 PROVIDERS AND PATIENTS. GREATER EFFORT WILL BE MADE TO INCREASE AVAILABILITY OF MATERIAL TO THE BROADER PUBLIC. CHOCS COMMUNITY EDUCATION DEPARTMENT HAS 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 ABUSE CHOC IS INCREASING EDUCATION TO PROVIDE ADDITIONAL TREATMENT OPTIONS TO LOCAL PROVIDERS, INCLUDING INCREASED OUTREACH TO LOCAL SCHOOLS AND COMMUNITIES. CHOCS 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 HAS 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 CHILDS NORMAL GROWTH AND DEVELOPMENT. CHOC CHILDRENS 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 ILLNESS RESPIRATORY ILLNESS IS A CRITICAL CONCERN IN ORANGE COUNTY AS NEARLY 14% OF ORANGE COUNTYS PEDIATRIC POPULATION HAVE BEEN DIAGNOSED WITH ASTHMA. 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. 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 HEALTH CHOC SEEKS 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 WILL EXPAND TELEDENTISTRY SERVICES TO INCLUDE MORE WEEKDAY AND WEEKEND HOURS IN CHOC CHILDRENS PRACTICE LOCATIONS. CHOC 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 WILL CONTINUE TO PROVIDE SCREENING SERVICES AND MORE EDUCATION TO FAMILIES REGARDING DENTAL HEALTH. 8) COLLABORATION AND PARTNERSHIPS WITH SCHOOL PROGRAMS COLLABORATION AND PARTNERSHIPS WITH SCHOOL PROGRAMS IS A WAY TO OVERCOME BARRIERS WHEN ADDRESSING OTHER CRITICAL ISSUES IDENTIFIED IN THE CHNA. CHOC WILL COLLABORATE WITH THE ORANGE COUNTY DEPARTMENT OF EDUCATION TO ENHANCE THE PHYSICAL, MENTAL, EMOTIONAL, AND EDUCATIONAL HEALTH OF THE CHILDREN IN ORANGE COUNTY. CHOCS ASTHMA OUTREACH PROGRAM PROVIDES EDUCATION, DIAGNOSIS AND TREATMENT VIA THE BREATHMOBILE AND THROUGH THE LUNCH AND LEARN PROGRAM TO SCHOOL PERSON SCHEDULE H, PART I, LINE 6A THE ORGANIZATION'S COMMUNITY BENEFIT REPORT IS CONTAINED IN A REPORT PREPARED BY CHILDREN'S HOSPITAL OF ORANGE COUNTY (CHOC) AND CHOC CHILDREN'S AT MISSION HOSPITAL (CCMH) ANNUALLY AND IS FILED IN ACCORDANCE WITH CALIFORNIA SB697. SCHEDULE H, 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 Program DURING FY2019, CMS ISSUED FINAL REQUIRED APPROVAL FOR THE MANAGED CARE PORTION OF THE 36 MONTH PROVIDER FEE PROGRAM ENDED DECEMBER 2016. CCMH RECOGNIZED REVENUES FOR THE PROGRAM OF $8,795,000 AND PROVIDER FEES AND OTHER EXPENSES OF $3,564,000. IN ADDITION, CMS ISSUED FINAL APPROVAL DURING FY2019 OF THE FEE FOR SERVICE PORTION OF THE 30 MONTH PROGRAM ENDED JUNE 30, 2019. UNDER THIS PORTION OF THE PROGRAM, CCMH RECOGNIZED REVENUES OF $2,751,000 AND PROVIDER FEES AND OTHER EXPENSES OF $991,000. THE AMOUNTS WERE RECOGNIZED AS NET PATIENT REVENUE AND OPERATING EXPENSES, REPSECTIVELY, IN THE YEAR ENDED JUNE 30, 2019. SCHEDULE H, 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. SCHEDULE H, 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. 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. SCHEDULE H, 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. SCHEDULE H, 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. SCHEDULE H, 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. SCHEDULE H, 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. SCHEDULE H, 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. SCHEDULE H, 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 REPORT. The financial assistance policy is available in english and spanish. SCHEDULE H, 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 FOR 2018-2019 HAVE BEEN COLLECTED FROM A VARIETY OF LOCAL COUNTY AND STATE SOURCES REPRESENTING DEMOGRAPHIC ANALYSIS OF ORANGE COUNTY, INCLUDING THE COMBINED SERVICE AREAS OF BOTH HOSPITALS CHOC AND CCMH. TOTAL POPULATION OF THE COUNTY WAS 3.3 MILLION, ACCORDING TO 2018 ESTIMATES, MAKING IT THE THIRD LARGEST COUNTY IN CALIFORNIA. THE MEDIAN AGE IS 37.4, AND CHILDREN UP TO 18 YEARS OF AGE MAKE UP 22% OF THE TOTAL POPULATION. THE LARGEST RACE SUBGROUP IS WHITE, AT 49%. ASIANS/PACIFIC ISLANDERS ARE 18% OF THE TOTAL, AND THE AFRICAN AMERICAN POPULATION REPRESENTS APPROXIMATELY 2% OF THE TOTAL ORANGE COUNTY POPULATION. 48% OF THE TOTAL ORANGE COUNTY POPULATION IDENTIFY AS HISPANIC IN ETHNICITY. SOCIOECONOMIC PROFILE: IN THE CHOC SERVICE AREA, 16.4% OF CHILDREN UNDER AGE 18 LIVE IN POVERTY, COMPARED TO 20.8% OF CALIFORNIAS CHILDREN. THE COUNTY'S MEDIAN HOUSEHOLD INCOME iS $88,453. THE PERCENTAGE OF THE HOSPITAL'S PATIENTS WHO ARE UNINSURED OR MEDICAID RECIPIENTS WAS 41%. THERE ARE 29 OTHER HOSPITALS SERVING THE COMMUNITY. SCHEDULE H, PART VI, LINE 5 PROMOTION OF COMMUNITY HEALTH: CHILDREN'S HEALTHCARE OF CALIFORNIA (CHC) IS THE NOT-FOR-PROFIT, TAX-EXEMPT PARENT CORPORATION OF CHILDREN'S HOSPITAL OF ORANGE COUNTY (CHOC CHILDREN'S) AND CHOC CHILDREN'S AT MISSION HOSPITAL (CCMH). THE HOSPITALS ARE THE PRINCIPAL TERTIARY AND QUATERNARY PEDIATRIC HOSPITALS SERVING ORANGE COUNTY AND ARE THE ONLY HOSPITALS EXCLUSIVELY SERVING INFANTS, CHILDREN AND ADOLESCENTS. 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, 2019, 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 MEMBERSHIP ON THE MEDICAL STAFF OF CHOC CHILDREN'S AT MISSION HOSPITAL 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 CHILDREN'S (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 (CHOC CHILDREN'S AT MISSION HOSPITAL 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 GOVERNING 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. SCHEDULE H, 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, 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 7 A COMMUNITY BENEFIT REPORT IS FILED ANNUALLY IN THE STATE OF CALIFORNIA. true CHILDREN'S HEALTHCARE OF CALIFORNIA 1201 WEST LA VETA AVENUE ORANGE CA 92868 330265266 501(C)(3) 15071209 N/A N/A Support 1 Procedure for monitoring the use of grant funds - part i, line 2 The grant from CCMH to CHC was in accordance with the bylaws of both organizations. X X X X true true false false false false false false false Kimberly Cripe Director/President 0 1005715 0 445347 0 284057 0 66845 0 33279 0 1835243 0 48531 Emma Sandhu VICE PRESIDENT/CNO 192862 0 15412 0 4077 0 11572 0 985 0 224908 0 0 0 Kerri Ruppert Schiller EVP/CFO/Assistant Secretary 0 550926 0 198605 0 148804 0 37056 0 27721 0 963112 0 23262 Matthew Gerlach Exec. Vice President/COO 0 587624 0 174681 0 141762 0 29715 0 19265 0 953047 0 24811 Jay Gabriel Chief Legal Officer/Secretary 0 444369 0 142577 0 284266 0 25598 0 39889 0 936699 0 15967 MARCIA FOLLI VP/CNO (thru 9/2018) 105085 105084 30098 30097 98600 98601 6305 6305 11 10 240099 240097 0 0 BONNIE GRAVETT CLINICAL NURSE III 182142 0 500 0 5337 0 10929 0 14437 0 213345 0 0 0 KAREN MCGURK-MISH NURSE MANAGER 165982 0 8910 0 89 0 9959 0 13304 0 198244 0 0 0 EVA ESMAEILI NICU NURSE MANAGER 156898 0 6961 0 89 0 9414 0 19252 0 192614 0 0 0 BRONWYN STACKLEATHER Director, Clinical Services 156285 0 8185 0 89 0 3126 0 18507 0 186192 0 0 0 KRISTY HAFFAR CHARGE NURSE 148931 0 500 0 5490 0 2196 0 22428 0 179545 0 0 0 Severance Arrangements, PART I, LINE 4A Some of the organization's personnel listed on form 990 Part VII and Schedule J participate in a separation arrangement that provides for a portion of the employee's annual salary based on their position in the organization. For the senior executive level, the amount is based on years of service up to a maximum number of months. PAYMENT IN THE AMOUNT OF $129,314 WAS MADE TO MS. FOLLI DURING CALENDAR YEAR 2018. 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 2019: MS. CRIPE ($198,229), MS. SCHILLER ($95,139), MS. FOLLI ($53,448), Mr. Gabriel ($241,739) AND MR. GERLACH ($101,292) 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. Marcia Folli is compensated through Children's Hospital at Mission; however, in addition to her responsibilities for Children's Hospital at Mission, she also serves as VP of Ancillary Services at Children's Hospital of Orange COunty, an IRC Section 501(c)(3) affiliate. Ms Folli devotes approximately 50% of her time to Children's Hospital at Mission 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 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. LINES 6 & 7A - ORGANIZATION MEMBER INFORMATION THE SOLE MEMBER OF CHILDREN'S HOSPITAL AT MISSION(CHM) IS CHILDREN'S HEALTHCARE OF CALIFORNIA (CHC). LINE 7B - ORGANIZATION MEMBER INFORMATION THE APPROVAL OF THE MEMBER SHALL BE REQUIRED WITH RESPECT TO ANY OF THE FOLLOWING ACTIONS: (1) CHANGING THE PURPOSES AND POWERS OF 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. Part VI, 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 report 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 sent electronically to 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. Part VI, 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. 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 firm to provide relevant comparability data and other compensation studies. The CEO, officers and executive management salaries and incentives, as well as overall compensation philosophy and policies, are discussed with the independent consultant representatives and the compensation committee members, in person, in closed sessions with no staff members present. This review was last performed in october 2018. All comparative salary data, such as annual compensation survey comprising 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 organization's governing documents and conflict of interest policy be made available for public inspection. Form 990 and the copy of audited financial statements attached to it are made available upon request. CHILDREN'S HOSPITAL OF ORANGE COUNTY 1201 West La Veta Avenue ORANGE CA 92868 952321786 HEALTH CARE CA 501(c)(3) 3 CHC false CHOC FOUNDATION 1201 West La Veta Avenue ORANGE CA 92868 956097416 FUND RAISING CA 501(c)(3) 7 CHC false CRC REAL ESTATE CORPORATION 1201 West La Veta Avenue ORANGE CA 92868 330612565 REAL ESTATE CA 501(c)(3) 11 CHC false CHILDREN'S HEALTHCARE OF CALIFORNIA(CHC) 1201 West La Veta Avenue ORANGE CA 92868 330265266 HEALTH CARE CA 501(c)(3) 7 NA false Orange County MEDICAL RECIPROCAL INS CO 2999 North 4th Street Suite 250 phoenix AZ 85108 201620666 Insurance AZ CHOC C Corp 216512 3028651 0.50000 false false true true false false false false false false false false false true false false false false false false