2018-05-15T11:08:38-05:00 2017-06-30 KPMG LLP 550 S Hope St Suite 1500 Los Angeles CA 90071 990 2016-07-01 330528802 CHILDREN'S HOSPITAL AT MISSION % DONALD NOBLE CHIL 7149973000 1201 West La Veta Avenue ORANGE CA 92868 KERRI RUPPERT SCHILLER CFO/Assistant Secret 2018-05-14 true Valerie J Ball P00178114 2139724000 2018-05-01 2016 2022-09-23 18:48:47Z KIMBERLY C CRIPE 1201 West La Veta Avenue ORANGE CA 92868 67929376 false X WWW.CHOC.ORG X 1991 CA TO NURTURE, ADVANCE, & PROTECT THE HEALTH AND WELL-BEING OF CHILDREN. 10 9 143 76 0 207528 309789 61604433 67386777 182200 232810 7567 0 62001728 67929376 2500000 18000000 0 0 13499591 13669686 0 0 0 39916028 40817310 55915619 72486996 6086109 -4557620 44478870 40644245 6379645 7103690 38099225 33540555 TO NURTURE, ADVANCE, & PROTECT THE HEALTH AND WELL-BEING OF CHILDREN. false false 69228061 18000000 67386777 Facility provides specialized pediatric services for the medical/surgical care of children from birth to age 18. There were 7,929 inpatient care days; 15,365 emergency room visits(including pediatric trauma visits); 671 surgeries and 22,921 outpatient visits. See our complete community benefit report on our website at www.choc.org. 69228061 true true false true false false false false false false true false false false 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 15 0 true 143 true false false false false false false false false false false X 10 9 false false true false true true true true true false false true true true true true true true true false CA X DONALD NOBLE 7145094038 1201 WEST LA VETA AVENUE ORANGE CA 928683874 X Kimberly Cripe Director/President 2.0 38.0 X X 0 1529296 81880 david dukes Director/Chair 2.0 5.5 X X 0 0 0 Sam Auriemma Director/Vice Chair 1.0 3.0 X X 0 0 0 Michael Colglazier Director 1.0 2.0 X 0 0 0 Vijay Dhar MD Director 1.0 1.0 X 0 0 0 Joe Kiani Director 1.0 2.0 X 0 0 0 Marshall Rowen MD Director 1.0 5.5 X 0 0 0 Kim Sentovich Director 1.0 2.0 X 0 0 0 Janet T Davidson Director 1.0 4.5 X 0 0 0 Jeff Elghanayan Director 1.0 3.5 X 0 0 0 Dick Ackerman Director (thru 12/16) 1.0 2.0 X 0 0 0 Douglas McCombs Director (thru 12/16) 1.0 3.0 X 0 0 0 Thomas Tierney Director (thru 12/16) 1.0 1.5 X 0 0 0 Kerri Ruppert Schiller CFO/Assistant Secretary 3.0 37.0 X 0 832951 73542 Jay Gabriel Secretary 4.0 36.0 X 0 624706 93634 Matthew Gerlach Exec. Vice President/COO 5.0 35.0 X 0 1006436 198040 Marcia Folli Vice President/CNO 20.0 20.0 X 216878 216879 26281 Bonni Gravett Clinical Nurse III 40.0 0.0 X 219862 0 25579 Karen McGurk-Mish Nurse MAnager 40.0 0.0 X 171567 0 25579 Emma Sandhu director clinical services 40.0 0.0 X 189843 0 10191 Bronwyn Stackleather nurse manager 40.0 0.0 X 169027 0 15365 Cheryl Peruzzi Clinical Nurse IV 40.0 0.0 X 162436 0 18008 1129613 4210268 568099 42 false true false RightSourcing Inc PO Box 9695 UNIONDALE NY 115559695 Temporary staffing 509759 CERNER CORPORATION PO Box 412702 KANSAS CITY MO 641412702 Patient accounting 267895 DIVERSIFIED HEALTHCARE PO Box 4950 THE WOODLANDS TX 77387 COLLECTION 118709 3 0 309789 309789 NET PATIENT SERVICES 621400 67386777 67386777 67386777 232810 232810 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 67929376 67386777 232810 18000000 18000000 0 0 0 219146 219146 0 10907671 9816904 1090767 370771 333694 37077 1376720 1239048 137672 795378 715840 79538 10974616 9877154 1097462 31416 31416 34000 30600 3400 5870 5870 0 0 1776968 1599271 177697 0 241570 217413 24157 641608 577447 64161 0 1508132 1357319 150813 13633 12270 1363 0 2057 1851 206 0 0 1148814 1033933 114881 234940 211446 23494 PURCHASED SRVS OTHR HOSP. 22086799 22086799 PROVIDER PROGRAM FEE 2060038 2060038 OSHPD FEE 21350 19215 2135 LICENSE AND TAXES 20740 18666 2074 14759 13283 1476 72486996 69228061 3258935 0 128998 267449 10745477 11433609 0 0 16546388 11186756 0 0 0 0 0 0 0 0 1968365 2302171 21090011 13189451 8711456 7900560 0 0 0 0 0 0 5800679 5800679 577507 1753021 44478870 40644245 2297338 1698887 0 0 792537 0 0 0 0 0 0 0 0 0 0 0 3289770 5404803 6379645 7103690 X 37115987 32551011 983238 989544 0 0 38099225 33540555 44478870 40644245 X -4557620 -1050 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 5870 5870 false Grants to Other Organizations for Lobbying Purposes form 990, schedule c, part II-B, line 1i during fye 06/30/2017, children's hospital at mission paid dues to Hospital Association of Southern California, $5,870 of which supported lobbying purposes. 13633474 7463136 6170338 7456537 5726315 1730222 7900560 0 DUE TO RELATED PARTIES 2341232 LONG TERM ACC TAIL COVERAGE 119000 DUE TO CONTRACTING HOSPITALS 1700071 DUE TO THIRD PARTIES 1244500 5404803 X ASC 740 Form 990, Schedule D, Part X U.S. GENERALLY ACCEPTED ACCOUNTING PRINCIPLES 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, 2017, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY OR DISCLOSURE IN THE FINANCIAL STATEMENTS. true true X true X true X true true false true true 67482 67482 0.00090 21493391 12639346 8854045 0.12210 21560873 12639346 8921527 0.12300 21560873 12639346 8921527 0.12300 true 4485106 true true 1 1 CHILDREN'S HOSPITAL AT MISSION 27700 MEDICAL CENTER ROAD MISSION VIEJO CA 92691 www.choc.org 060000348 X X X CHILDREN'S HOSPITAL AT MISSION 1 false false true X X X X X X X X X 16 true true false true X See Part V, Section C X true 16 true See Part V, Section C false true X 200. 400. X X X true true X X X X true 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 2016, with input and data from numerous authoritative, publicly available sources, a survey of community leaders from various businesses, social service, and public agencies and a survey of the community-at-large. The CHNA report includes both primary and secondary data analyses that focus on the health and social needs of the population in each CHOC Hospital's primary service area. SCHEDULE H, PART V, LINE 6a Children's Hospital of orange county and choc children's at mission together conducted the health needs assessments. Schedule H, Part V, Lines 7 & 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"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 FIVE HIGH-PRIORITY NEEDS: MENTAL HEALTH, PEDIATRIC OBESITY, TIMELY ACCESS TO PEDIATRIC SPECIALTIES/SUBSPECIALTIES, PEDIATRICIAN NEEDS AND RESOURCES FOR CHILDREN WITH AUTISM SPECTRUM DISORDERS. IN 2013, CHOC DEVELOPED ITS SEVEN-YEAR STRATEGIC PLAN CHOC 2020. THIS LONG-RANGE PLAN HAS FIVE GOALS, ONE OF WHICH IS CHOCS PEDIATRIC SYSTEM OF CARE". FOR CHOC, THE PEDIATRIC SYSTEM OF CARE INCLUDES ASSURING ACCESS TO THE FULL CONTNUUM OF HEALTHCARE SERVICES ADDRESSING BOTH THE PHYSICAL AND BEHAVIORAL HEALTH OF CHILDREN WE SERVE; CREATING AN IMPLEMENTING PROCESSES FOR THE SEAMLESS TRANSITIONING OF PATIENTS FROM ONE CARE PROVIDER TO THE NEXT; AND, ACTIVELY ENGAGING PATIENTS AND FAMILIES IN TAKING RESPONSIBILITY FOR THEIR HEALTHCARE. THE FIVE HIGH-PRIORITY NEEDS ARE RECOGNIZED IN CHOC 2020 AS CRITICAL ELEMENTS OF THE CHOC PEDIATRIC SYSTEM OF CARE. SPECIFIC INITIATIVES FOR THE HIGH-PRIORITY NEEDS ARE AS FOLLOWS: PEDIATRIC MENTAL HEALTH CHOC CHIDRENS, IN PARTNERSHIP WITH COMMITTED ORGANIZATIONS AND COMMUNITY GROUPS, ASPIRES TO CREATE AN OUTSTANDING MENTAL HEALTH SYSTEM OF CARE FOR ALL CHILDREN, TEENS AND YOUNG ADULTS IN ORANGE COUNTY. OUR GOAL IS TO PROVIDE A COMPREHENSIVE APPROACH TO PEDIATRIC MENTAL ILLNESS. TO FULFILL THIS INITIATIVE, CHOC IS CURRENTLY BUILDING AN INPATIENT CHILDRENS MENTAL HEALTH CENTER. ORANGE COUNTY CURRENTLY HAS ONLY 32 INPATIENT ADOLESCENT PSYCHIATRIC BEDS FOR A POPULATION OF ROUGHLY 3 MILLION, AND NOT A SINGLE BED FOR CHILDREN UNDER THE AGE OF 12. THE NEW CENTER WILL HAVE 18 BEDS IN A SECURED AND HEALING ENVIRONMENT, IN ADDITION TO AN OUTDOOR AREA FOR RECREATION. THE CENTER WILL PROVIDE A SAFE, NURTURING PLACE FOR CHILDREN AGES 3 TO 18, AND SPECIALTY PROGRAMMING FOR CHILDREN YOUNGER THAN 12. THE CENTER WILL BE OPENING IN SPRING 2018. THE OPENING OF THE INPATIENT CENTER WILL AUGMENT MENTAL HEALTH SERVICES ALREADY OFFERED BY CHOC. - IN 2015, CHOC EXPANDED MENTAL HEALTH SERVICES FOR CHOC PATIENTS BEING TREATED FOR SERIOUS/CHRONIC ILLNESSES (THESE CHILDREN ARE MORE LIKELY TO HAVE MENTAL HEALTH PROBLEMS, SUCH AS DEPRESSION AND SEVERE ANXIETY, THAN THEIR HEALTHIER PEERS). - IN 2016, CHCOC OPENED AN INTENSIVE OUTPATIENT PROGRAM TO KEEP STRUGGLING CHILDREN OUT OF THE HOSPITAL AND ASSIST THOSE WHO HAVE BEEN RELEASED. - EXPANDED, ALSO IN 2016, CHOCS OUTPATIENT EATING DISORDERS PROGRAM 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. PEDIATRIC SPECIALISTS NEEDS 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 INDICATED AS A HIGH PRIORITY IN THE MOST RECENTLY COMPLETED COMMUNITY NEEDS ASSESSMENT. THE SPECIALTY PHYSICIAN GROUP THAT HAS CONTRACTED WITH CHOC TO PROVIDE THE SERVICES HAS GROWN TO A TOTAL OF 199 PHYSICIANS AND OFFERS EXPERTISE AND CARE IN OVER 20 PEDIATRIC MEDICAL SPECIALTIES. IN THE PAST YEAR, THE PHYSICIAN GROUP HAS ADDED THE FULL TIME EQUIVALENT OF OVER 14 PHYSICIANS. PEDIATRICIAN NEEDS TO MEET THE GROWING NEED FOR PEDIATRIC CARE, CHOCS STRATEGIC INITIATIVE IS TO CREATE AND BUILD A PEDIATRIC SYSTEM OF CARE. SINCE JANUARY 2016, CHOC HAS BEEN BUILDING A COMMUNITY BASED SYSTEM THAT IS AIMED AT MEETING THIS NEED AS PRIORITIZED IN THE CHNA. FROM THAT TIME UNTIL JUNE 2017, CHOC HAS ADDED SEVERAL PEDIATRIC PRACTICES TO ITS MEDICAL FOUNDATION, WITH MORE TO BE ADDED IN THE NEAR FUTURE. AS OF JUNE 2017, CHOCS PEDIATRIC SYSTEM OF CARE INCLUDES ORANGE COMMUNITY CLINIC, CLINICA CHOC PARA NINOS-SANTA ANA, SANTA ANA BOYS AND GIRLS CLUB, ASTHMA BREATHMOBILE, GARDEN GROVE CLINIC, SEA VIEW PEDATRICS (FOUR SITES), SOUTH ORANGE COUNTY PEDATRIC ASSOCIATES (FOUR SITES) AND PEDATRIC AND ADULT MEDICINE. THESE PRACTICE SITES COVER THE MAJORITY OF CHOCS AND CHOC CHILDRENS AT MISSIONS SERVICE AREAS AND PROVIDE BASIC PEDATRIC HEALTH CARE TO UNDERSERVED AREAS WITHIN ORANGE COUNTY. ADDITIONAL PRACTICES ARE SCHEDULED TO BE ADDED IN FY 2018 AND BEYOND. DEVELOPMENTAL DISABILITIES, SPECIFICALLY AUTISM RECOGNIZING THE PERVASIVENESS OF AUTISM IN THE ORANGE COUNTY PEDIATRIC POPULATION, CHOC HAS ACTIVELY SUPPORTED FOR OC KIDS, AN ORGANIZATION THAT DIAGNOSES AND TREATS CHILDREN UP TO SIX YEARS OF AGE. MORE RECENTLY, CHOC HAS ENGAGED IN A PARTNERSHIP WITH THE CHILDRENS AND FAMILY COMMISSION OF ORANGE COUNTY, THE UNIVERSITY OF CALIFORNIA IRVINE, CHAPMAN UNIVERSITY AND THE THOMPSON CENTER FOR AUTISM (COLUMBIA, MO) TO ESTABLISH THE CENTER FOR AUTISM AND NEURODEVELOPMENT DISORDERS IN SANTA ANA. CHOC IS PROVIDING FINANCIAL SUPPORT FOR AN ADDITIONAL NEURO-DEVELOPMENTAL PEDIATRICIAN, PSYCHOLOGY AND PHYSICAL THERAPY SERVICES TO EXPAND ACCESS TO THE SERVICES FOR A GREATER NUMBER OF ORANGE COUNTY CHILDREN INCLUDING THOSE OVER EIGHT YEARS OLD. THERE WERE NO SIGNIFICANT NEEDS IDENTIFIED BUT NOT ADDRESSED FROM THE MOST RECENTLY CONDUCTED CHNA. Schedule H, Part V, Lines 16A & 16B The FAP and the FAP application are included in Appendix A of the Community Benefit Report posted at www.choc.org/about, and by clicking on the link to view our community benefit plan. 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 In 2016, CMS issued final required federal approval for the fee for service portion of the 36 month California Provider Fee Program. This approval covered the 12 month period from July 1, 2015-June 30, 2016 and the 6 months ended December 31, 2016. In fiscal year 2017, CCMH recognized revenues under these periods of the fee for service portion of the program of $1,029,000 and Provider Fees and other expenses of $420,000. In addition, CMS issued final approval in 2016 of the Managed Care portion of the 36 month program for the 12 months ended June 30, 2015. Under this portion of the program, CCMH recognized revenues of $4,034,000 and Provider Fee and other expenses of $1,647,000. The amounts were recognized as net patient revenue and operating expenses, respectively, in the year ended June 30, 2017. 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 ALLOWANCE FOR DOUBTFUL ACCOUNTS IS CCMH'S BEST ESTIMATE OF THE AMOUNT OF PROBABLE CREDIT LOSSES IN CCMH'S EXISTING PATIENT ACCOUNTS RECEIVABLE. CCMH DETERMINES THE ALLOWANCE BASED ON HISTORICAL WRITE-OFF EXPERIENCE. CCMH REVIEWS ITS ALLOWANCE FOR DOUBTFUL ACCOUNTS ON A MONTHLY BASIS. PAST-DUE BALANCES OVER 90 DAYS AND OVER A SPECIFIED AMOUNT ARE REVIEWED INDIVIDUALLY FOR COLLECTABILITY. THERE ARE OTHER FACTORS THAT CAN IMPACT COLLECTIONS, SUCH AS CHANGES IN THE ECONOMY, WHICH IN TURN HAVE AN IMPACT ON UNEMPLOYMENT RATES AND THE NUMBER OF UNINSURED AND UNDERINSURED PATIENTS, THE INCREASED BURDEN OF CO-PAYMENTS TO BE MADE BY PATIENTS WITH INSURANCE AND BUSINESS PRACTICES RELATED TO COLLECTION EFFORTS. THESE FACTORS CONTINUOUSLY CHANGE AND CAN HAVE AN IMPACT ON COLLECTION TRENDS AND THE ESTIMATION PROCESS. ACCOUNT BALANCES ARE CHARGED OFF AGAINST THE ALLOWANCE AFTER ALL MEANS OF COLLECTION HAVE BEEN EXHAUSTED AND THE POTENTIAL FOR RECOVERY IS REMOTE, BUT IN NO CASES BEYOND ONE YEAR FROM DATE OF SERVICE. 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 www.choc.org 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 2016-2017 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 3.2 MILLION, ACCORDING TO 2016 ESTIMATES, MAKING IT THE THIRD LARGEST COUNTY IN CALIFORNIA. THE MEDIAN AGE IS 36.4, AND CHILDREN UP TO 18 YEARS OF AGE MAKE UP 25% OF THE TOTAL POPULATION. THE LARGEST RACE/ETHNICITY SUBGROUP IS WHITE, AT 43%. LATINOS/HISPANICS ARE 34% OF THE POPULATION. ASIANS/PACIFIC ISLANDERS ARE 19% OF THE TOTAL, AND THE AFRICAN AMERICAN POPULATION REPRESENTS APPROXIMATELY 2% OF THE TOTAL ORANGE COUNTY POPULATION. SOCIOECONOMIC PROFILE THE U.S. CENSUS AMERICAN COMMUNITY SURVEY FOR 2016 INDICATED THAT 17.6% OF CHILDREN UNDER THE AGE OF 18 IN ORANGE COUNTY, 23% IN CALIFORNIA, AND 22.0% IN THE U.S. WERE BELOW THE POVERTY LEVEL. THE COUNTY'S MEDIAN HOUSEHOLD INCOME iS $74,163. THE PERCENTAGE OF THE HOSPITAL'S PATIENTS WHO ARE UNINSURED OR MEDICAID RECIPIENTS WAS 41.9%. 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, 2017, 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) 18000000 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 false true false false false false false false false Kimberly Cripe Director/President 0 883801 0 370786 0 274709 0 61495 0 20385 0 1611176 0 46284 Kerri Ruppert Schiller CFO/Assistant Secretary 0 516920 0 167817 0 148214 0 47660 0 25882 0 906493 0 22838 Jay Gabriel Secretary 0 411755 0 111028 0 101923 0 67728 0 25906 0 718340 0 54574 Matthew Gerlach Exec. Vice President/COO 0 504428 0 167413 0 334595 0 181562 0 16478 0 1204476 0 174966 Marcia Folli Vice President/CNO 138598 138598 37955 37955 40325 40326 13140 13141 0 0 230018 230020 0 11069 Bonni Gravett Clinical Nurse III 206413 0 0 0 13449 0 12136 0 16494 0 248492 0 0 0 Karen McGurk-Mish Nurse MAnager 151254 0 8307 0 12006 0 9101 0 16478 0 197146 0 0 0 Emma Sandhu director clinical services 158915 0 18371 0 12557 0 9424 0 767 0 200034 0 0 0 Bronwyn Stackleather nurse manager 142155 14978 0 11894 0 141 0 15224 0 184392 0 0 0 Cheryl Peruzzi Clinical Nurse IV 150659 0 0 0 11777 0 8312 0 9696 0 180444 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. No payments were made in 2016. 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 2016: Ms. Cripe $179,253, Ms. Schiller $87,664 , Ms. Folli ($42,804) , and Mr. Gerlach ($263,241). 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 8% 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 Secion 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 devots 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 143 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. Part VI, Line 4 Changes to Bylaws included the following below: Number of Directors: The Authorized number of directors has been changed to include 9 to 15 individuals. Preapproval of expenditures: the provision allowing the board committees to spend up to $50,000 without prior approval has been removed. Part VI, Lines 6 & 7a - Organization Member Information The sole member of Children's Hospital at Mission (CHM) is Children's HealthCare of California (CHC). Part VI, 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 CCMH; (2) Obligating CCMH to undertake any capital expenditure in excess of $5,000,000; (3) Adopting CCMH's annual operating and capital budgets; (4) Adopting a long-term capital budget; (5) Buying, selling, mortgaging, pledging, or otherwise hypothecating any real property; (6) Incurring any indebtedness in excess of $5,000,000; (7) Obligating CCMH to act as guarantor with respect to any debt of any person or other entity; (8) Accepting any donation which is conditioned upon CCMH'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 any of the following: (a) any financial obligation on the part of CCMH in an amount in excess of $5,000,000, or (b) any purpose or activity which is outside the scope of CCMH's ordinary course of business; (10) involving CCMH in any merger, acquisition, corporate restructuring, or formal affiliation; (11) Involving CCMH as a member, shareholder, or partner in any new corporation, partnership, or other legal entity; (12) Dissolving CCMH; (13) Entering into any transaction involving the sale, lease, conveyance, exchange, transfer or other disposition of all or substantially all of CCMH's assets; (14) Amending CCMH'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 2016. 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 Line 19 - DISCLOSURE POLICY Federal tax laws do not mandate that the 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. FORM 990, PART XI, LINE 5 Other Changes in Fund Balance $(1,050) 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 choc thrift stores inc 455 S MAIN STREET orange CA 92868 330266422 Fund Raising CA 501(c)(3) 9 CHC false Orange County MEDICAL RECIPROCAL INS CO 2999 North 4th Street Suite 250 phoenix AZ 85108 201620666 Insurance AZ CHOC C Corp 37608 2919944 0.50000 false false true true false false false false false false false false true false false false false false false