2015-05-15T15:11:14-05:00 2014-06-30 KPMG LLP 550 S Hope St Suite 1500 Los Angeles CA 90071 990 2013-07-01 330528802 CHILDREN'S HOSPITAL AT MISSION % DONALD NOBLE CHIL 7149973000 1201 West La Veta Avenue Suite ORANGE CA 92868 KERRI SCHILLER SENIOR VP/CFO 2139724000 2015-05-12 true REGINA L PRINCE P00576936 2139724000 2015-05-11 2013 2016-02-25 16:41:14Z KIMBERLY C CRIPE 1201 West La Veta Avenue ORANGE CA 92868 49478000 false X WWW.CHOC.ORG X 1991 CA TO NURTURE, ADVANCE, & PROTECT THE HEALTH AND WELL-BEING OF CHILDREN. 14 12 140 84 0 106887 240693 56992833 49022146 -966 85890 87832 129271 57186586 49478000 6100000 8500000 0 0 11240340 11970283 0 0 0 35900796 34889945 53241136 55360228 3945450 -5882228 42051902 36792045 6212469 6700454 35839433 30091591 TO NURTURE, ADVANCE, & PROTECT THE HEALTH AND WELL-BEING OF CHILDREN. false false 52439937 8500000 49022146 Facility provides specialized pediatric services for the medical/surgical care of children from birth to age 18. There were 7,604 inpatient care days; 15,759 emergency room visits; 746 surgeries and 7,527 outpatient visits. See our complete community benefit report on our website at www.choc.org. 52439937 true true false true false false false false false false true false false false true true true true false false false false false false false false true true true false true false false false false false false false true false false false false false true true false false false true 20 0 true 140 true false false false false false false false false false false X 14 12 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 C CRIPE DIRECTOR/PRESIDENT 2.0 38.0 X X 0 1288268 81839 RALPH CLAYMAN MD DIRECTOR 1.0 2.5 X 0 0 0 JEFF ELGHANAYAN DIRECTOR/2ND VICE CHAIR 1.0 5.0 X X 0 0 0 DOUGLAS MCCOMBS director/IST VICE CHAIR 1.0 3.0 X X 0 0 0 MARK STEVENS DIRECTOR/CHAIR 1.0 7.0 X X 0 0 0 JANET T DAVIDSON DIRECTOR 1.0 3.5 X 0 0 0 MARSHALL ROWEN MD DIRECTOR 1.0 4.5 X 0 0 0 DAVID DUKES DIRECTOR/SECRETARY 1.0 2.0 X X 0 0 0 TIM RISTOFF DIRECTOR 1.0 2.0 X 0 0 0 Vijay Dhar MD Director 1.0 1.0 X 0 0 0 thomas tierney director 1.0 2.5 X 0 0 0 Dick Ackerman Director 1.0 1.0 X 0 0 0 Michael Coglazier Director 1.0 1.0 X 0 0 0 Phillip Richardson MD Director 1.0 1.0 X 0 0 0 KERRI RUPPERT SCHILLER CFO/Assistant Secretary 4.0 36.0 X 0 747883 47913 Matthew Gerlach Exec. Vice President/COO 6.0 34.0 X 0 192513 36240 MARCIA FOLLI VICE PRESIDENT/CNO 40.0 0.0 X 326735 0 17241 BONNIE GRAVETT Clinical Nurse III 40.0 0.0 X 172214 0 24818 Cindy Yeley Clinical Nurse II 40.0 0.0 X 141857 0 13947 Linda Starn Director Patient care services 40.0 0.0 X 162705 0 10439 Karen McGurk-Mish NURSE MANAGER 40.0 0.0 X 160173 0 24485 Eva Esmaeili NURSE MANAGER 40.0 0.0 X 147442 0 23849 DEBRA MATHIAS EXEC. VICE PRESIDENT/COO X 0 470371 0 1111126 2699035 280771 27 true true false SIEMENS MEDICAL SOLUTIONS USA P O BOX 120001 DEPT 0733 DALLAS TX 753120733 HEALTHCARE IT SERVIC 461496 MILES KELLEY CONSTRUCTION CO 1102 EAST VALENCIA DRIVE FULLERTON CA 92831 CONSTRUCTION 392534 TRIAGE CONSULTING GROUP 221 MAIN STREET SUITE 1100 SAN FRANCISCO CA 94105 CONSULTING 117334 NEUROSURGICAL SPECIALISTS INC 24 JEWEL FLOWER IRVINE CA 92603 MED DIR AND SERVICE 100375 4 200460 40233 240693 NET PATIENT SERVICES 621400 48876598 48876598 CLINIC RENTAL INCOME 900099 145548 145548 49022146 85890 85890 0 0 0 0 0 0 0 0 0 REIMBURSEMENT FOR IT SERVICES TO AFFILIATE 900099 129271 129271 129271 49478000 49022146 215161 8500000 8500000 0 0 0 264944 264944 0 9390253 8451228 939025 321307 289176 32131 1294900 1165410 129490 698879 628991 69888 11167884 10051096 1116788 15193 15193 34400 30960 3440 26160 26160 0 0 2438396 2218100 220296 0 194712 175241 19471 629601 566641 62960 0 0 1591896 1432706 159190 21114 19003 2111 0 6696 6026 670 0 0 920499 828449 92050 271249 244124 27125 PURCHASED SRVS OTHR HOSP. 17212897 17212897 PROVIDER PROGRAM FEE 316212 316212 OSHPD FEE 14022 12620 1402 LICENSE AND TAXES 15553 13998 1555 13461 12115 1346 55360228 52439937 2920291 0 179843 296330 11971575 9296089 0 0 15209889 11660759 0 0 0 0 0 0 0 0 303688 843300 18144384 9993596 7835400 8150788 0 0 0 0 0 0 5800679 5800679 750828 744100 42051902 36792045 3167106 2441273 0 0 1033985 1358818 0 0 0 0 0 0 0 0 0 0 2011378 2900363 6212469 6700454 X 34627002 29063322 1212431 1028269 0 0 35839433 30091591 42051902 36792045 X -5882228 113439 20947 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED true 26160 26160 Grants to Other Organizations for Lobbying Purposes form 990, schedule c, part II-B, line 1i during fye 06/30/2014, children's hospital at mission paid dues, a portion of which supports lobbying purposes to various healthcare associations: Healthcare Associations $26,160 11014087 5379408 5634679 6247118 4614187 1632931 883179 883179 8150789 0 DUE TO RELATED PARTIES 2665677 LONG TERM ACCRUED TAIL COVERAG 234686 2900363 X 49612386 113439 20947 134386 49478000 49478000 55360228 55360228 55360228 other changes in net assets form 990, schedule d, part XI, Line 2D Change in beneficial interest in CHOC Foundation - 20,947 ASC 740 Form 990, Schedule D, Part X ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA 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, 2014, 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 160799 160799 0.00290 16129836 10533594 5596242 0.10110 16290635 10533594 5757041 0.10400 16290635 10533594 5757041 0.10400 9 33007 33007 0.00060 9 33007 33007 0.00060 true 4605333 true true 1 1 CHILDREN'S HOSPITAL AT MISSION 27700 MEDICAL CENTER ROAD MISSION VIEJO CA 92691 www.choc.org 060000348 X X CHILDREN'S HOSPITAL AT MISSION 1 true X X X X X X X X X 13 true true true X SEE PART V SECTION C X X X X X X true false true true 200. true 400. true X X X true true X X X X X true false X X X X true X false false Schedule H, Part V Additional Information SCHEDULE H, PART V, LINE 3 Focus groups and interviews were used to gather opinions and impressions from people who represent the broad interests of the community. Thirty people participated in these groups and interviews in october 2013. included were people from health provider community benefit organizations, county and city governments, hospitals, community clinics/fhqc's and health advocacy education organizations. SCHEDULE H, PART V, LINE 4 Children's Hospital of orange county and choc children's at mission together conducted the health needs assessments. SCHEDULE H, PART V, LINE 5A The CHNA report is available at http://www.choc.org/about SCHEDULE H, PART V, LINE 20D, OTHER The maximum amounts that may be charged to FAP-eligible individuals for emergency or other medically necessary services are determined by the fee-for-service Medi-Cal rate. The rate is determined annually by the allowable cost-to-charge ratio as determined by the annual Medi-Cal cost report. 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. The state of California has a provider fee program that, combined with federal matching funds, has provided supplemental medi-cal payments to hospitals in the state. In 2012, the Centers for Medicare and Medicaid Services (CMS) issued final required federal approval for the fee for service portion of the 30 month California Provider Fee Program. In fiscal year 2014, CCMH recognized revenues under this program of $581,000 and Provider Fees and other expenses totaling $316,000 for the final six month fee-for-service portion of the 30 month program. The amounts were recognized as net patient revenue and operating expenses, respectively, in the year ended June 30, 2014. 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 100 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 LINE 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. 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, AND ALISO VEIJO. 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 2013 ARE PROVIDED BY CLARITAS, A THIRD-PARTY VENDOR THAT MAKES PROJECTIONS BASED ON DEMOGRAPHIC ANALYSIS OF ORANGE COUNTY, INCLUDING THE COMBINED SERVICE AREAS OF BOTH HOSPITALS CHOC AND CCMH. TOTAL POPULATION OF THE COUNTY WAS 3.1 MILLION, ACCORDING TO 2013 ESTIMATES, MAKING IT THE THIRD LARGEST COUNTY IN CALIFORNIA. THE MEDIAN AGE IS 36.2, AND CHILDREN UP TO 17 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 13% OF THE TOTAL, AND THE AFRICAN AMERICAN POPULATION REPRESENTS APPROXIMATELY 6.3% OF THE TOTAL ORANGE COUNTY POPULATION. SOCIOECONOMIC PROFILE THE U.S. CENSUS AMERICAN COMMUNITY SURVEY FOR 2013 INDICATED THAT 14.6% OF CHILDREN UNDER THE AGE OF 18 IN ORANGE COUNTY, 23% IN CALIFORNIA, AND 22.6% IN THE U.S. WERE BELOW THE POVERTY LEVEL. THIS SURVEY ALSO INDICATED THAT 14.6% OF THE ORANGE COUNTY POPULATION OF ALL AGES WERE LIVING BELOW THE POVERTY LEVEL. THE U.S. BUREAU OF THE CENSUS ESTIMATED THAT IN 2013, THE COUNTY'S MEDIAN HOUSEHOLD INCOME WAS $56,867. THE PERCENTAGE OF THE HOSPITAL'S PATIENTS WHO ARE UNINSURED OR MEDICAID RECIPIENTS WAS 33%. THERE ARE 29 OTHER HOSPITALS SERVING THE COMMUNITY: ANAHEIM REGIONAL MEDICAL CENTER - ANAHEIM, CALIFORNIA CHAPMAN MEDICAL CENTER - ORANGE, CALIFORNIA CHILDREN'S HOSPITAL OF ORANGE COUNTY - ORANGE, CALIFORNIA COASTAL COMMUNITIES HOSPITAL - SANTA ANA, CALIFORNIA COLLEGE HOSPITAL COSTA MESA - COSTA MESA, CALIFORNIA FOUNTAIN VALLEY REGIONAL HOSPITAL AND MEDICAL CENTER - FOUNTAIN VALLEY, CALIFORNIA GARDEN GROVE HOSPITAL AND MEDICAL CENTER - GARDEN GROVE, CALIFORNIA HEALTHBRIDGE CHILDREN'S REHABILITATION HOSPITAL - ORANGE, CALIFORNIA HOAG MEMORIAL HOSPITAL PRESBYTERIAN - NEWPORT BEACH, CALIFORNIA HOAG ORTHOPEDIC INSTITUTE - IRVINE, CALIFORNIA HUNTINGTON BEACH HOSPITAL AND MEDICAL CENTER - HUNTINGTON BEACH, CALIFORNIA KAISER FOUNDATION HOSPITAL - ANAHEIM, CALIFORNIA KINDRED HOSPITAL - BREA - BREA, CALIFORNIA KINDRED HOSPITAL - WESTMINSTER - WESTMINSTER, CALIFORNIA LA PALMA INTERCOMMUNITY HOSPITAL - LA PALMA, CALIFORNIA LOS ALAMITOS MEDICAL CENTER - LOS ALAMITOS, CALIFORNIA MISSION HOSPITAL REGIONAL MEDICAL CENTER - MISSION VIEJO, CALIFORNIA MISSION HOSPITAL - LAGUNA BEACH - LAGUNA BEACH, CALIFORNIA NEWPORT BAY HOSPITAL - NEWPORT BEACH, CALIFORNIA NEWPORT SPECIALTY HOSPITAL - TUSTIN, CALIFORNIA ORANGE COAST MEMORIAL MEDICAL CENTER - FOUNTAIN VALLEY, CALIFORNIA PLACENTIA-LINDA COMMUNITY HOSPITAL - PLACENTIA, CALIFORNIA SADDLEBACK MEMORIAL MEDICAL CENTER - SAN CLEMENTE, CALIFORNIA ST. JOSEPH HOSPITAL - ORANGE, CALIFORNIA ST. JUDE MEDICAL CENTER - FULLERTON, CALIFORNIA TUSTIN REHABILITATION HOSPITAL - TUSTIN, CALIFORNIA UNIVERSITY OF CALIFORNIA, IRVINE MEDICAL CENTER - ORANGE, CALIFORNIA WESTERN MEDICAL CENTER - ANAHEIM, CALIFORNIA WESTERN MEDICAL CENTER - SANTA ANA, CALIFORNIA 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, 2014, 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. D. A PRACTITIONER APPLYING FOR APPOINTMENT TO THE MEDICAL STAFF AND FOR THE GRANTING OR EXTENSION OF CLINICAL PRIVILEGES MUST HAVE BEEN OR BECOME, WHICHEVER IS APPROPRIATE, CERTIFIED BY THE NATIONAL SPECIALTY BOARD PERTAINING TO THE PRACTITIONER'S CLINICAL PRIVILEGES OF THE AMERICAN BOARD OF MEDICAL SPECIALTIES, THE AMERICAN OSTEOPATHIC ASSOCIATION, OR THE AMERICAN BOARD OF DENTISTRY WITHIN FIVE (5) YEARS FROM THE COMPLETION OF THE PRACTITIONER'S TRAINING PROGRAM. BOARD CERTIFICATION MUST CORRESPOND TO THE CLINICAL PRIVILEGES REQUESTED AND PROGRAM COMPLETED. AN EXTENSION OF THIS TIME PERIOD OR EXEMPTION FROM THESE REQUIREMENTS WILL BE GRANTED ONLY UNDER EXTRAORDINARY CIRCUMSTANCES AND FOR DEMONSTRATED GOOD CAUSE AS DETERMINED SOLELY AT THE DISCRETION OF THE MEDICAL STAFF EXECUTIVE COMMITTEE AND THE GOVERNING BODY. IF THE MEDICAL STAFF APPLICANT OR MEMBER IS REQUIRED BY THE SPECIALTY BOARD TO RE-CERTIFY IN ORDER TO MAINTAIN BOARD CERTIFICATION, THE PRACTITIONER MUST BECOME RE-CERTIFIED IN ORDER TO OBTAIN AND/OR MAINTAIN MEDICAL STAFF MEMBERSHIP AND CLINICAL PRIVILEGES UNLESS EXEMPTED BY THE ABOVE PARAGRAPH. CURRENT MEMBERS OF THE MEDICAL STAFF WHO WERE NOT, AS OF DATE OF ADOPTION OF THIS AMENDMENT, BOARD CERTIFIED OR PROGRESSING TOWARD BOARD CERTIFICATION, AND WHO CANNOT REASONABLY BE EXPECTED TO PURSUE BOARD CERTIFICATION, MAY BE CONSIDERED FOR RENEWAL OF MEDICAL STAFF MEMBERSHIP IF THEY CAN DOCUMENT SUFFICIENT TRAINING, EXPERIENCE, AND COMPETENCE, AND OTHERWISE MEET THE REQUIREMENTS OF MEDICAL STAFF MEMBERSHIP. E. PHYSICIANS WHO ARE RESIDENTS OR FELLOWS IN GRADUATE MEDICAL EDUCATION PROGRAMS AND WHO ARE ASSIGNED TO RESIDENCY OR FELLOWSHIP ROTATIONS AT CHOC CHILDREN'S AT MISSION HOSPITAL OR MISSION HOSPITAL SHALL NOT BY VIRTUE OF SUCH ASSIGNMENT BE CONSIDERED MEMBERS OF THE MEDICAL STAFF WHILE FUNCTIONING IN THEIR ROLES AS RESIDENTS OR FELLOWS. THE ORGANIZATION APPLIES ITS SURPLUS FUNDS TO PLANNED CAPITAL PROJECTS TO FURTHER COMMUNITY ACCESS TO HEALTH CARE. EXCESS FUNDS, IF ANY, ARE TRANSFERRED TO CHC, THE SOLE MEMBER OF THE CORPORATION, IN ACCORDANCE WITH THE ORGANIZATION'S BYLAWS. 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. Additional Information: The hospital is in compliance with the statutory requirements of Section 501(r) However, since the 2013 Form 990 Schedule H does not require the hospital to describe how it is addressing the needs identified in its community health needs assessment, the hospital did not prepare a report describing them. The organization will provide as required by the 2014 Form 990 Schedule H. The Hospital's Implementation Strategy is included at the end of the CHNA located at http://www.choc.org/about. true CHILDREN'S HEALTHCARE OF CALIFORNIA 1201 West La Veta Avenue orange CA 92868 330265266 501(c)(3) 8500000 Support 1 Procedure for monitoring the use of grant funds - part i, line 2 Grant funds are monitored for appropriate use per the specific grant agreements. The grant expenditures are consistently tracked and reconciled per existing policies and procedures. X X X X true true false false false false false false false KIMBERLY C CRIPE DIRECTOR/PRESIDENT 0 773753 0 273755 0 240760 0 58990 0 22849 0 1370107 0 41205 KERRI RUPPERT SCHILLER CFO/Assistant Secretary 0 470448 0 139073 0 138362 0 25064 0 22849 0 795796 0 88870 DEBRA MATHIAS EXEC. VICE PRESIDENT/COO 0 0 0 0 0 470371 0 0 0 0 0 470371 0 0 MARCIA FOLLI VICE PRESIDENT/CNO 213843 0 46068 0 66824 0 16990 0 251 0 343976 0 35379 0 BONNIE GRAVETT Clinical Nurse III 160366 0 167 0 11681 0 8774 0 16044 0 197032 0 0 0 Cindy Yeley Clinical Nurse II 130828 0 167 0 10862 0 2583 0 11364 0 155804 0 0 0 Linda Starn Director Patient care services 136403 0 14990 0 11312 0 4340 0 6099 0 173144 0 0 0 Karen McGurk-Mish NURSE MANAGER 140055 0 8802 0 11316 0 8441 0 16044 0 184658 0 0 0 Eva Esmaeili NURSE MANAGER 129453 0 7031 0 10958 0 7805 0 16044 0 171291 0 0 0 Matthew Gerlach Exec. Vice President/COO 0 172127 0 0 0 20386 0 30686 0 5554 0 228753 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. One executive listed on schedule J, part II, received severance payments in calendar year 2013. The payment was received by Debra Mathias ($450,133). Supplemental Nonqualified Retirement Plan Part I, Line 4B Children's Hospital of Orange County (CHOC or the Company) established a nonqualified deferred compensation plan effective January 1, 2010 in which certain individuals listed on the form 990, Part VII and Schedule J are participants. Under the established Supplemental Executive Retirement Plan (the Plan) or serp, for each Plan year that begins prior to the participant's cash date, CHOC shall create a new SERP account on its books for the Participant and shall credit to such account at times specified. The participants of the plan are general creditors of the company. The participant's SERP account shall be utilized solely as a device for the measurement and determination of the amounts to be paid to the participant under this plan. The participant is entitled to his/her SERP benefit amount upon the earliest of (1) remaining employed with the Company to the third anniversary of the first day of the Plan Year for which the SERP account was created; (2) remaining employed with the Company to the Participant's 60th birthday; (3) remaining employed with the Company to the date the Participant has both attained at least age 55 and has completed at least 10 years of service; (4) disability; (5) involuntary separation from service without reasonable cause; (6) voluntary separation from service for good reason or (7) death. The following individuals received payments from the Plan during calendar year 2013: Ms. Cripe ($153,515), Ms. Schiller ($80,973), and Ms. Folli ($32,556). 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 10% 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 and Children's Hospital at Mission (both IRC Secion 501(c)(3) affiliates). Mr. Gerlach devotes approximately 15% 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. Pediatric Subspecialty Faculty Inc Vijay Dhar, M.D. 626004 see part v false Business Transaction with Interested Person Dr. Vijay Dhar, a board member of the hospital, is also an officer of pediatric subspecialty faculty, Inc. (PSF). PSF provides professional and administrative services to the hospital. 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 140 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 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 $2,000,000 or any unbudgeted expenditure in excess of $2,000,000; (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, (b) any purpose or activity which is outside the scope of CCMH's ordinary course of business, or (c) a term in excess of ten years (unless the contract is terminable at will); (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, in the event that such action would affect any of the Member's rights under the bylaws or as provided by applicable law. Form 990, Part VI Line 4 - SIGNIFICANT CHANGES TO GOVERNING DOCUMENTS - The following changes were made to the organization's bylaws: 1. CHC is not required to approve an action on behalf of CCMH to lease real property. 2. Changed the requirement for CHC to approve a contract based on contracts with terms in excess of ten years (previously in excess of five years). 3. Qualifications of directors - deleted reference that an individual may not be a director if a relative is employed by organization or by any of its affiliates. 4. The Chief Legal Officer may attend mettings of the Board and participate in meetings without voting privileges if he or she is the Secretary. 5. If the Secretary is also the Chief Legal OFficer or another employee of CCMH or its affiliates, he or she may not fill a position on the Executive Committee. 6. The required members of the Nominating Committee decreased from five to four. 7. The Executive Vice President and Chief Operating Officer was added as an Officer whose services are obtained from CHC pursuant to the Executive Management Agreement, or if such agreement is not in effect, may be appointed by the President and Chief Executive OFficer. 8. The Secretary shall be appointed in accordance with Section 5.12 of the bylaws. 9. The Secretary may be a board member or the Chief Legal Officer if appointed by the President and Chief Executive Officer. Previously the Secretary could only be a volunteer board member. 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. 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 2014. 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 Change in Beneficial interest in CHOC FND - $ 20,947 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 455 S MAIN STREET ORANGE CA 92868 956097416 FUND RAISING CA 501(c)(3) 7 CHC false CRC REAL ESTATE CORPORATION 455 S MAIN STREET 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 106823 3500588 0.50000 true false true false false false false false false false false false false true false false false false false false