2012-05-15T14:05:00-04:00 2011-06-30 KPMG LLP 355 S Grand Ave Suite 2000 Los Angeles CA 90071 990 2010-07-01 952321786 Children's Hospital of Orange County CHIL 7149973000 455 S Main Street Orange CA 928683874 KERRI RUPPERT SCHILLER 2012-05-11 2139724000 2010 2016-02-24 21:20:13Z CHOC CHILDREN'S ORANGE KIMBERLY C CRIPE 455 S MAIN STREET ORANGE CA 928683874 599379069 false X www.choc.org X 1964 CA TO NURTURE, ADVANCE AND PROTECT THE HEALTH AND WELL-BEING OF CHILDREN. 16 13 2529 625 0 0 63114786 115623838 399360759 471618897 959578 1826663 5535802 975074 468970925 590044472 0 11250000 0 0 164218628 171593626 0 0 0 237721998 273740241 401940626 456583867 67030299 133460605 393024980 627851973 156996670 255038207 236028310 372813766 TO NURTURE, ADVANCE AND PROTECT THE HEALTH AND WELL-BEING OF CHILDREN. false false 420826865 11250000 471618897 Children's Hospital of Orange County - Provides specialized pediatric services for the care of children. During this year, there were 59,515 days of inpatient care; 54,553 Emergency room visits; 8,209 surgeries; 1,263 day health visits and 146,425 primary and specialty care clinic visits. see schedule o for additional information. See our complete community benefit report on our website at www.choc.org. 420826865 true true false true false false false false true 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 true false false true X 332 0 true 2529 true false false false false false false false false false false X 16 13 false false true false true true true true true false false true true true true true true true true false CA X DONALD NOBLE 7149973000 455 S MAIN STREET ORANGE CA 928683874 X KIMBERLY C CRIPE 30.0 X X 0 1049159 73291 MEREDITH KHACHIGIAN 1.0 X 0 0 0 JAY KEAR 1.0 X X 0 0 0 DOUGLAS MCCOMBS 1.0 X X 0 0 0 MARSHALL ROWEN MD 1.0 X 0 0 0 MARK STEVENS 4.0 X X 0 0 0 MAUREEN ZEHNTNER 1.0 X 0 0 0 RALPH CLAYMAN MD 2.0 X 0 0 0 JANET T DAVIDSON 2.0 X 0 0 0 DAVID DUKES 1.0 X 0 0 0 JOE DUNN 1.0 X 0 0 0 JEFF ELGHANAYAN 2.0 X X 0 0 0 WILLIAM GURTNER 2.0 X 0 0 0 MUSTAFA KABEER MD 1.0 X 0 0 0 GEORGE KALOGRIDIS 1.0 X 0 0 0 TIM RISTOFF 1.0 X 0 0 0 KERRI RUPPERT SCHILLER 25.0 X 0 563558 99342 DEBRA MATHIAS 35.0 X 0 517130 95474 MARIA E MINON MD 40.0 X 561800 0 45239 MARK L HEADLAND 40.0 X 362066 0 53856 MATTHEW NIEDZWIECKI 40.0 X 281441 0 52689 WALDO ROMERO 40.0 X 333175 0 54294 dana bledsoe 40.0 X 360846 0 8679 MARGARET T CONK 40.0 X 276530 0 2445 JANET R LANSING 40.0 X 298987 0 32356 JAMES P CAPPON MD 40.0 X 283131 0 19966 BETH ROWETT 40.0 X 278739 0 25679 JAY GABRIEL 40.0 X 384570 0 68176 3421285 2129847 631486 245 false true false McCarthy Building Companies 20401 S W Birch St Suite 300 NEWPORT BEACH CA 92660 General Construction 90108579 Pediatric Subspecialty Faculty 455 S Main Street 5th Floor ORANGE CA 92868 Med. Dir. services 6344214 Cerner Corporation 2800 Rockcreek Parkway NORTH KANSAS CITY MO 64117 software services 6027047 FKP Architects Inc 8 Greenway Plaza Suite 300 HOUSTON TX 77046 Architect services 5210444 Schaller Anderson of Arizona 1120 West La Veta Avenue ORANGE CA 92868 health insurance 3401550 45 41806136 72831839 985863 115623838 NET PATIENT REVENUE 900099 397338830 397338830 PREMIUM REVENUE 900099 33610727 33610727 MGMT/OCCUPANCY SERVICES 541610 19737560 19737560 DRUGS/MEDICAL SUPPLIES 446110 8897186 8897186 RESEARCH REVENUE 541700 5133550 5133550 6901044 6901044 471618897 1322202 1322202 0 0 9288 9288 9288 9288 9818264 20794 9285100 49497 533164 -28703 504461 504461 0 0 0 CAFETERIA/CATERING SALES 722320 607007 607007 GIFT SHOP PROCEEDS 453220 284679 284679 VENDING MACHINES 900099 24617 24617 49483 49483 965786 590044472 471618897 0 2801737 11250000 11250000 0 0 0 1653927 1653927 0 0 0 136173900 122556510 13617390 0 3302729 2972456 330273 0 20176284 18158656 2017628 0 10286786 9258107 1028679 0 0 2179691 1961722 217969 0 201837 181653 20184 0 0 0 41592 0 41592 0 70229905 63150962 7078943 0 0 9618038 8656234 961804 0 0 0 19782623 17804361 1978262 0 420663 378597 42066 0 0 349249 314324 34925 0 909359 818423 90936 0 0 13858372 12472535 1385837 0 3511341 3160207 351134 0 PRCHSD SRVCS FRM OTR HOSP. 72740343 72740343 0 0 MEDICAL SUPPLIES 45967307 41370576 4596731 LEGAL SETTLEMENT COSTS 16080308 14472277 1608031 0 PROVISION FOR BAD DEBT 14303438 14303438 0 0 DUES & SUBSCRIPTIONS 928728 835855 92873 0 2617447 2355702 261745 0 456583867 420826865 35757002 0 20248476 3870592 56429948 155702262 11100757 8760720 73632451 71069049 3049843 1901751 6597778 10964357 477967633 116341237 209033818 361626396 35058 35058 12896851 13921788 393024980 627851973 57242822 79823192 1170491 19128936 0 43283 98583357 156042796 156996670 255038207 X 189159012 336982336 46183146 35145278 686152 686152 236028310 372813766 393024980 627851973 X 133460605 3324851 X false true true X true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 42723 42723 false grants to other organizations for lobbying purposes form 990, schedule c, part II-B, line 1i during fye 06/30/2011, children's hospital of orange county paid dues, a portion of which supports lobbying purposes to various healthcare associations including: Hospital association of southern california of $37,016 national association of children's hospitals of $5,707 Total dues paid for lobbying purposes: $42,723 3691065 643580 72135 0 0 0 4406780 3339711 351279 1363 0 1288 0 3691065 3076071 262998 11676 0 11034 0 3339711 0.82890 0.15570 0.01540 false true true 406748 271627 135121 52605082 21963022 30642060 131609844 93849299 37760545 293345959 257289 293088670 361626396 0 DEFERRED LEASE OBLIGATION TO CHOCO REALTY 137128152 DUE TO ST. JOSEPH HOSPITAL 3757898 LT WORKERS COMPENSATION 7756773 POST-RETIREMENT BEN OBLIGATION 3066030 LT ACCRUED TAIL COVERAGE 2786674 DUE TO RELATED PARTIES 1338581 CAPITAL LEASE OBLIGATION 172950 OTHER LIABILITIES 35738 156042796 590044472 456583867 133460605 3393354 -2322620 2254117 3324851 136785456 593217270 3393354 2238109 5631463 587585807 41592 2417073 2458665 590044472 456431814 456431814 41592 110461 152053 456583867 fin 48 FootNote form 990, schedule d, Part X U.S. GENERALLY ACCEPTED ACCOUNTING PRINCIPLES REQUIRES THE ORGANIZATION'S MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE ORGANIZATION AND RECOGNIZES A TAX LIABILITY (OR ASSET) 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, 2011, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY (OR ASSET) OR DISCLOSURE IN THE COMBINED FINANCIAL STATEMENTS. RECONCILIATION TO AUDITED FINANCIAL STATEMENTS SCHEDULE D, PART XI, LINE 8 CHANGE IN BENEFICIAL INTEREST IN CHILDREN'S HOSPITAL OF ORANGE COUNTY FOUNDATION $ 2,238,109 ADJ. FOR INCOME FROM INVEST. PARTNERSHIP $ 16,008 --------------- TOTAL $ 2,254,117 RECONCILIATION OF REVENUE PART XII, LINE 2D CHANGE IN BENEFICIAL INTEREST IN CHILDREN'S HOSPITAL OF ORANGE COUNTY FOUNDATION $ 2,238,109 PART XII, LINE 4B RECLASS OF NON-OPERATING EXP. PRIOR PERIOD ADJ. $ 2,322,620 RECLASS FROM REVENUE $ 110,461 ADJ. FOR INCOME FROM INVEST. PARTNERSHIP $ (16,008) --------------- TOTAL $ 2,417,073 RECONCILIATION OF EXPENSES PART XIII, LINE 4B RECLASS OF NON-OPERATING EXPENSES $ 110,461 Use of endowment funds part v, line 4 the endowment fund is used for hospital programs and charity care including research and treatment of children's diseases and disorders. true true X true X true X true true false true true 416079 416079 0.00090 180716833 165537272 15179561 0.03430 181132912 165537272 15595640 0.03520 2964378 2964378 0.00670 9762974 2432997 7329977 0.01660 2383816 2383816 0.00540 15111168 2432997 12678171 0.02870 196244080 167970269 28273811 0.06390 2964378 2964378 0.00670 2964378 2964378 0.00670 false 4535020 0 287433 291879 -4446 X true true 1 1 CHILDREN'S HOSPITAL OF ORANGE COUNTY

455 SOUTH MAIN STREET ORANGE CA 92868

X X CHILDREN'S HOSPITAL OF ORANGE COUNTY 1 12 ORANGE PRIMARY CARE CLINIC

455 SOUTH MAIN STREET ORANGE CA 92868

clinic CLINICA CHOC PARA NINOS-SANTA ANA

406 SOUTH MAIN STREET SANTA ANA CA 92701

clinic SANTA ANA BOYS AND GIRLS CLUB

1000 WEST HIGHLAND SANTA ANA CA 92703

clinic ASTHMA BREATHMOBILE

455 SOUTH MAIN STREET ORANGE CA 92868

clinic COSTA MESA CLINIC

136 BROADWAY COSTA MESA CA 92627

clinic GARDEN GROVE CLINIC

10602 CHAPMAN AVENUE GARDEN GROVE CA 92840

clinic CHOC CHILDREN'S ENDOCRINE & DIABETES CTR

520 SUPERIOR AVE SUITE 160 NEWPORT BEACH CA 92663

clinic CHOC CHILDREN'S HOSPITAL

SPECIALTY CLINICS 455 SOUTH MAIN S ORANGE CA 92868

clinics CHOC UROLOGY CENTER SUITE 100

505 S MAIN ST ORANGE CA 92868

clinic PEDIATRIC PSYCHOLOGY

1120 W LA VETA AVENUE SUITE 470 ORANGE CA 92868

CLINIC BLOOD&DONORAPHERESIS

505 SOUTH MAIN STREET SUITE 185 ORANGE CA 92868

CLINIC CHOC NEUROLOGY CENTER

1120 W LA VETA AVENUE SUITE 125 ORANGE CA 92868

CLINIC 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 CHILDREN'S) AND CHOC CHILDREN'S AT MISSION HOSPITAL (CCMH) ANNUALLY AND IS FILED IN ACCORDANCE WITH CALIFORNIA SB697. SCHEDULE H, PART I, LINE 7, COLUMN F THE BAD DEBT EXPENSE INCLUDED IN FORM 990, PART IX, LINE 25 BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $14,303,438. 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. IN JANUARY 2011, THE CMS ISSUED THE FINAL REQUIRED FEDERAL APPROVAL OF CALIFORNIA'S PROGRAM TO IMPOSE A PROVIDER FEE ON HOSPITALS THAT, COMBINED WITH FEDERAL MATCHING FUNDS, HAS BEEN USED TO PROVIDE SUPPLEMENTAL MEDI-CAL PAYMENTS TO HOSPITALS IN THE STATE. THE PROGRAM WAS ENACTED TO PROVIDE SUPPLEMENTAL MEDI-CAL PAYMENTS FOR UP TO 21 MONTHS RETROACTIVE TO APRIL 2009 AND EXPIRING ON DECEMBER 31, 2010. REVENUES UNDER THE PROGRAM OF $61,060,483, AND PROVIDER FEES AND OTHER EXPENSES TOTALING $17,207,806 WERE RECOGNIZED AS NET PATIENT REVENUE AND OPERATING EXPENSES, RESPECTIVELY, IN THE YEAR ENDED June 30, 2011. THE RESULT IS THAT THE UNREIMBURSED MEDI-CAl ON PART 1 LINE 7B IS MUCH LOWER THAN IN THE PRIOR YEAR. SCHEDULE H, PART II COMMUNITY BUILDING ACTIVITIES: COMMUNITY SUPPORT IS DEFINED AS THOSE ACTIVITIES SUPPORTING COMMUNITY LEADERSHIP. THE ORGANIZATION HAS 96 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 BEHAVIORAL HEALTH ACCESS. THROUGH BEHAVIORAL HEALTH ACCESS, THE ORGANIZATION ENHANCES THE COMMUNITY'S ACCESS TO BEHAVIORAL HEALTH INFORMATION AND SOCIAL AND EMOTIONAL SERVICES, TARGETING THE UNDERSERVED. THIS IS ACCOMPLISHED THROUGH MANY COMMUNITY BASED ACTIVITIES INTEGRATED WITH SOCIAL SERVICES PROGRAMS. SCHEDULE H, PART III, LINE 1 THE ORGANIZATION REPORTS BAD DEBT EXPENSE AS AN OPERATING EXPENSE IN ACCORDANCE WITH U.S. GAAP. HFMA Statement no. 115, which requires bad debt to be recognized as a reduction from net patient revenue has been adopted as an accounting standard in the U.S and will be effective with CHOC's 2011 Form 990. SCHEDULE H, PART III, LINE 4 THE ORGANIZATION CHARGES BAD DEBT FOR (A) THE WRITE-OFF OF PATIENT ACCOUNTS WHERE FAMILIES DID NOT COOPERATE WITH CHOC 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. AS A CHILDREN'S HOSPITAL, CHOC IS IN THE UNUSUAL CIRCUMSTANCE OF TREATING PATIENTS WHERE A MAJORITY COULD QUALIFY FOR SOME TYPE OF GOVERNMENT ASSISTANCE OR CHARITY CARE. 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. 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 CHOC'S BEST ESTIMATE OF THE AMOUNT OF PROBABLE CREDIT LOSSES IN CHOC'S EXISTING PATIENT ACCOUNTS RECEIVABLE. CHOC DETERMINES THE ALLOWANCE BASED ON HISTORICAL WRITE-OFF EXPERIENCE. CHOC REVIEWS ITS ALLOWANCE FOR DOUBTFUL ACCOUNTS ON A MONTHLY BASIS AS WELL AS AGE OF ACCOUNTS AND OTHER FACTORS. 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 CASE BEYOND ONE YEAR FROM DATE OF SERVICE. SCHEDULE H, PART III, LINE 8 THE ALLOWABLE COST IS BASED ON A COST TO CHARGE RATIO OF .2654. SHORTFALLS ARE CONSIDERED A COMMUNITY BENEFIT BECAUSE THE DOLLAR VALUE OF BENEFITS PROVIDED BY LEGISLATIVE CATEGORY LINK TO THE DOLLARS IDENTIFIED BY COMMUNITY NEEDS. CHOC REPORTS UNPAID COSTS OF PUBLIC PROGRAMS AS GOVERNMENT PAYOR SHORTFALLS. THE PRINCIPAL MEASURE FOR MONITORING COMMUNITY BENEFIT SERVICES IS THE DOLLAR VALUE OF BENEFITS RETURNED TO THE COMMUNITY PER DOLLAR OF TAX EXEMPTION VALUE RECEIVED. 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 AND IS MAKING EVERY EFFORT TO SETTLE AN OUTSTANDING BILL WITHIN A REASONABLE TIME PERIOD, CHOC 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 CHOC 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 FINANCIAL ASSISTANCE PROGRAM. 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, CHOC WILL NOT USE WAGE GARNISHMENTS OR LIENS ON PATIENT'S OR PATIENT FAMILY'S PRIMARY RESIDENCE AS A MEANS OF COLLECTING UNPAID CHOC BILLS. THIS REQUIREMENT DOES NOT PRECLUDE CHOC FROM PURSUING REIMBURSEMENT FROM THIRD PARTY LIABILITY SETTLEMENTS. SCHEDULE H PART VI LINE 2 NEEDS ASSESSMENT: THE HOSPITAL PLAYS A LEADERSHIP ROLE IN THE ORANGE COUNTY HEALTH NEEDS ASSESSMENT (OCHNA). OCHNA IS A COMMUNITY-BASED, NOT-FOR-PROFIT PROJECT CREATED AND DESIGNED TO MEET THE REQUIREMENTS OF SB697 FOR ALL HEALTHCARE ASSOCIATION OF SOUTHERN CALIFORNIA (HASC) MEMBER HOSPITALS IN ORANGE COUNTY, TO PRODUCE A COMPREHENSIVE, COUNTYWIDE ANALYSIS OF HEALTH NEEDS AND SERVICES. THE OCHNA PROJECT IS A COLLABORATIVE EFFORT AND IS JOINTLY FUNDED BY THE COUNTY OF ORANGE HEALTHCARE AGENCY AND 27 FOR-PROFIT AND NOT-FOR-PROFIT HOSPITALS, AND OTHER ORGANIZATIONS AND PROVIDERS. ITS GOAL IS TO ACHIEVE MAXIMUM, VALID AND RELIABLE INFORMATION THAT CAN BE ANALYZED BY ZIP CODE, IN ORDER TO PROVIDE HOSPITALS WITH DATA SIGNIFICANT TO THEIR SERVICE AREAS. IN ADDITION, THIS PROCESS IS THE BASIS OF THE COUNTYWIDE REPORT THAT WAS MADE AVAILABLE TO THE LARGER COMMUNITY OF HEALTH AND HUMAN SERVICES PROVIDERS. OCHNA STARTED DATA COLLECTION FOR ITS HEALTH ASSESSMENT IN 1997. THE LATEST SURVEY RESULTS FOR ORANGE COUNTY WERE FOR 2010 AND PUBLISHED IN THE "Health Needs Assessment". OCHNA IS AN ONGOING PROCESS WITH PARTICIPATION AND SUPPORT FROM HEALTHCARE PROVIDERS AND GOVERNMENT AGENCIES. THE HOSPITAL'S EXECUTIVE MANAGEMENT UTILIZED THE OCHNA HEALTH NEEDS FINDINGS TO DEVELOP THE HOSPITALS' GOALS FOR MEETING THE NEEDS INDENTIFIED IN SIX BROAD AREAS: HEALTHCARE ACCESS - INCREASE ACCESS TO QUALITY PEDIATRIC HEALTHCARE RESOURCES AND INFORMATION TO FAMILIES, ESPECIALLY LOW-INCOME AND MEDICALLY UNDERSERVED, THROUGHOUT ORANGE COUNTY. BEHAVIORAL HEALTH ACCESS - ENHANCE THE COMMUNITY'S ACCESS TO BEHAVIORAL HEALTH INFORMATION AND SERVICES, TARGETING THE UNDERSERVED. DISEASE PREVENTION - INCREASE AWARENESS OF DISEASE PREVENTION AND PROMOTE EARLY INTERVENTION OF MAJOR DISEASES THAT AFFECT THE COMMUNITY. INFORMATION RESOURCE - PROVIDE THE COMMUNITY WITH RESOURCES FOR INFORMATION AND EDUCATION OF HEALTH RISK BEHAVIORS. INJURY PREVENTION - ACTIVELY CONTRIBUTE TO REDUCING THE NUMBER OF UNINTENTIONAL INJURIES TO YOUNG CHILDREN, ESPECIALLY TARGETING LOW-INCOME, DIVERSE AND MEDICALLY UNDERSERVED POPULATIONS. COMMUNITY ACTION - ACTIVELY RECRUITS, RECOGNIZE AND ADVOCATE FOR THE IMPORTANCE OF VOLUNTEER LEADERSHIP AND COMMUNITY ASSISTANCE IN PROVIDING CARE FOR CHILDREN. 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. COMMUNITY INFORMATION - THE HOSPITAL SERVES ALL OF ORANGE COUNTY AND A LIMITED, ALTHOUGH SIGNIFICANT, 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 CENTRAL-NORTHERN PORTION OF ORANGE COUNTY, AND IS THE SOURCE OF APPROXIMATELY 71% OF ITS PATIENTS. SIGNIFICANT CITIES IN THIS AREA ARE: SANTA ANA, ANAHEIM, FULLERTON, ORANGE, AND GARDEN GROVE. THE SECONDARY SERVICE AREA INCLUDES ALL THE OTHER ORANGE COUNTY CITIES AND UNINCORPORATED AREAS. COMMUNITY CHARACTERISTICS - POPULATION AND SOCIOECONOMIC DATA PROJECTIONS FOR 2010 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 CHM. TOTAL POPULATION OF THE COUNTY WAS 3.01 MILLION, ACCORDING TO 2010 ESTIMATES, MAKING IT THE THIRD LARGEST COUNTY IN CALIFORNIA. THE MEDIAN AGE IS 36.1, AND CHILDREN UP TO 17 YEARS OF AGE MAKE UP 25% OF THE TOTAL POPULATION. THE LARGEST RACE/ETHNICITY SUBGROUP IS WHITE, AT 45%. LATINOS/HISPANICS ARE 34% OF THE POPULATION. ASIANS/PACIFIC ISLANDERS ARE 17% 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 2005-07 INDICATED THAT 12.0% (92,520) OF CHILDREN UNDER THE AGE OF 18 IN ORANGE COUNTY, 17.7% IN CALIFORNIA, AND 18.0% IN THE U.S. WERE BELOW THE POVERTY LEVEL. THIS SURVEY ALSO INDICATED THAT 9.7% (288,346) OF THE ORANGE COUNTY POPULATION OF ALL AGES WERE LIVING BELOW THE POVERTY LEVEL. THE U.S. BUREAU OF THE CENSUS ESTIMATED THAT IN 2009, THE COUNTY'S MEDIAN HOUSEHOLD INCOME WAS $70,751. The percentage of the hospital's and the community's patients who are uninsured or Medicaid recipients was 45.8%. THERE ARE 32 OTHER HOSPITALS SERVING THE COMMUNITY: ANAHEIM GENERAL HOSPITAL - ANAHEIM, CALIFORNIA ANAHEIM REGIONAL MEDICAL CENTER - ANAHEIM, CALIFORNIA CHAPMAN MEDICAL CENTER - 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 HOSPITAL - IRVINE - 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 - NEWPORT BEACH, CALIFORNIA ORANGE COAST MEMORIAL MEDICAL CENTER - FOUNTAIN VALLEY, CALIFORNIA PLACENTIA-LINDA COMMUNITY HOSPITAL - PLACENTIA, CALIFORNIA ROYALE MISSION VIEJO HEALTH - MISSION VIEJO, CALIFORNIA SADDLEBACK MEMORIAL MEDICAL CENTER - SAN CLEMENTE, CALIFORNIA SAN CLEMENTE HOSPITAL AND MEDICAL CENTER - SAN CLEMENTE, CALIFORNIA ST. JOSEPH HOSPITAL - ORANGE, CALIFORNIA ST. JUDE MEDICAL CENTER - FULLERTON, CALIFORNIA TUSTIN REHABILITATION HOSPITAL - TUSTIN, CALIFORNIA UNIVERSITY OF 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. THE ORGANIZATION IS COMPRISED OF TWO HOSPITALS; SEVERAL PRIMARY AND SPECIALTY CLINICS, PROGRAMS AND SERVICES; AND FOUR CENTERS OFEXCELLENCE, THE CHOC HEART, NEUROSCIENCE, hyundai cancer institute 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, 2011, 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/COMMUNITYBENEFITPLAN.PDF. 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: ONLY PRACTICING PHYSICIANS, DENTISTS, PSYCHOLOGISTS OR PODIATRISTS SHALL BE DEEMED TO POSSESS BASIC QUALIFICATIONS FOR MEMBERSHIP ON THE MEDICAL STAFF, EXCEPT FOR THE HONORARY AND RETIRED STAFF CATEGORIES IN WHICH CASE THESE CRITERIA SHALL ONLY APPLY AS DEEMED INDIVIDUALLY APPLICABLE BY THE MEDICAL STAFF, AND WHO: (A) DOCUMENT THEIR (1) CURRENT LICENSURE, (2) ADEQUATE EXPERIENCE, EDUCATION, AND TRAINING, (3) CURRENT PROFESSIONAL COMPETENCE, (4) GOOD JUDGMENT, AND (5) CURRENT ADEQUATE PHYSICAL AND MENTAL HEALTH STATUS, SO AS TO DEMONSTRATE TO THE SATISFACTION OF THE MEDICAL STAFF THAT THEY ARE PROFESSIONALLY AND ETHICALLY COMPETENT AND THAT PATIENTS TREATED BY THEM CAN REASONABLY EXPECT TO RECEIVE QUALITY MEDICAL CARE. (B) ARE DETERMINED (1) TO ADHERE TO THE ETHICS OF THEIR RESPECTIVE PROFESSIONS, (2) TO BE ABLE TO WORK COOPERATIVELY WITH OTHERS SO AS NOT TO ADVERSELY AFFECT PATIENT CARE, (3) TO KEEP AS CONFIDENTIAL, AS REQUIRED BY LAW, ALL INFORMATION OR RECORDS RECEIVED IN THE PHYSICIAN-PATIENT RELATIONSHIP, AND (4) TO BE WILLING TO PARTICIPATE IN AND PROPERLY DISCHARGE THOSE RESPONSIBILITIES DETERMINED BY THE MEDICAL STAFF AND BE BOUND BY THE MEDICAL STAFF BYLAWS, RULES AND REGULATIONS, AND POLICIES. (C) WHO MAINTAIN IN FORCE PROFESSIONAL LIABILITY INSURANCE IN NOT LESS THAN THE MINIMUM AMOUNTS JOINTLY DETERMINED BY THE BOARD OF DIRECTORS AND THE MEDICAL EXECUTIVE COMMITTEE, BUT IN NO EVENT LESS THAN $1.0 MILLION PER INCIDENT AND $3.0 MILLION IN THE AGGREGATE IN A POLICY YEAR; PROVIDED, HOWEVER, THAT IN THE EVENT THAT (AND FOR SO LONG AS) SUCH INSURANCE IS NOT AVAILABLE ON COMMERCIALLY REASONABLE TERMS TO PHYSICIANS PRACTICING IN A PARTICULAR SPECIALTY OR SUB-SPECIALTY AREA OF MEDICAL PRACTICE, THE FOREGOING REQUIREMENTS MAY BE MODIFIED OR WAIVED WITH RESPECT TO ALL PHYSICIANS PRACTICING IN SUCH SPECIALTY OR SUB-SPECIALTY AREA, SUBJECT TO THE APPROVAL OF THE BOARD OF DIRECTORS UPON REQUEST OF THE MEDICAL EXECUTIVE COMMITTEE. ADMINISTRATIVE STAFF AND MEMBERS ON A LEAVE OF ABSENCE DO NOT NEED TO SHOW EVIDENCE OF INSURANCE. (D) IF BOARD CERTIFICATION IS AVAILABLE IN THEIR RESPECTIVE SPECIALTIES, ARE BOARD CERTIFIED OR BOARD ADMISSIBLE, OR IN THE ALTERNATIVE, CAN DEMONSTRATE TO THE REASONABLE SATISFACTION OF THE MEDICAL EXECUTIVE COMMITTEE, A COMPARABLE LEVEL OF TRAINING, EXPERIENCE AND SKILL. LIMITED privileges ARE PROVIDED TO PHYSICIANS LICENSED BY THE STATE OF CALIFORNIA WHO ARE ENROLLED IN AN ACCREDITED PEDIATRIC RESIDENCY TRAINING PROGRAM AND WHO ARE PROVIDING MEDICAL HEALTH-RELATED SERVICES TO PATIENTS INDEPENDENT OF THE HOSPITAL RESIDENCY PROGRAM. THE ORGANIZATION APPLIES ITS SURPLUS FUNDS TO IMPLEMENT IMPROVEMENTS IN PATIENT CARE, MEDICAL EDUCATION AND RESEARCH. THE ORGANIZATION IS CURRENTLY EMBARKING ON THE CONSTRUCTION OF A STATE-OF-THE-ART $552 MILLION HOSPITAL TOWER ON ITS MAIN CAMPUS IN THE CITY OF ORANGE. CONSTRUCTION OF THE 7 STORY BUILDING STARTED IN 2009 AND WILL OPEN ITS DOORS TO PATIENTS IN 2013. THE NEW TOWER SHALL INCLUDE INPATIENT AND OUTPATIENT CARE FOR CHILDREN, WITH EMERGENCY DEPARTMENT, OPERATING ROOMS, A MEDICAL LABORATORY, PATHOLOGY DEPARTMENT AND IMAGING AND RADIOLOGY SERVICES. THERE SHALL ALSO BE A LARGE CONFERENCE AREA TO ACCOMMODATE SOME OF THE ORGANIZATION'S TEACHING RESPONSIBILITIES. THE CHOC ENDOWMENT FUNDS ARE USED TO FUND MEDICAL RESEARCH, CLINICAL PROGRAMS AND SERVICES, AND TO RECRUIT AND RETAIN DOCTORS WHO ARE THE BEST IN THEIR FIELDS. SCHEDULE H, PART VI, LINE 6 AFFILIATED HEALTH CARE SYSTEM: CHOC HAS EVOLVED FROM A COMMUNITY HOSPITAL TO A WORLD-CLASS, INTEGRATED PEDIATRIC HEALTH CARE SYSTEM AFFILIATED WITH THE UNIVERSITY OF CALIFORNIA, IRVINE (UC IRVINE). THE ORGANIZATION IS STEADFASTLY COMMITTED TO THE TENS OF THOUSANDS OF CHILDREN AND FAMILIES WHO DEPEND ON CHOC FOR CARE, AS WELL AS LEADING THE CHARGE IN ADVANCING PEDIATRIC MEDICINE ON A NATIONAL LEVEL. CHOC'S NEW BRAND IDENTITY - CHOC CHILDREN'S - ASSERTS THE INSTITUTION'S POSITION IN THE COMMUNITY AND NATIONALLY. CHOC'S LEGAL NAME (CHILDREN'S HOSPITAL OF ORANGE COUNTY) WILL REMAIN. THE ECONOMIC VALUE OF THE 96 BENEFIT SERVICES PROVIDED BY CHOC AND CCMH IN FISCAL YEAR 2011 IS $39 MILLION. OF THESE DOLLARS, 60.2% ($23 MILLION) SERVED THE ECONOMICALLY DISADVANTAGED. THE ECONOMIC VALUE OF SAVINGS FROM NOT-FOR-PROFIT STATUS IS $ 31.8 MILLION. THUS, THE HOSPITALS RETURN $1.23 IN COMMUNITY BENEFITS FOR EACH $1 SAVED FROM TAX-EXEMPT STATUS. IN ADDITION TO THE $39 MILLION IN BENEFITS PROVIDED FOR BY THE HOSPITALS REFERENCED ABOVE, BOARD MEMBERS, PHYSICIANS, EMPLOYEES AND VOLUNTEERS CONTRIBUTED 59058 HOURS OF VOLUNTEER SERVICE TO THE COMMUNITY. SCHEDULE H PART VI, LINE 7 STATE FILING OF COMMUNITY BENEFIT REPORT: A COMMUNITY BENEFIT REPORT IS FILED IN THE STATE OF CALIFORNIA. true CHOCO REALTY CORPORATION 455 S MAIN STREET ORANGE CA 92868 330011853 501(C)(3) 11250000 0 N/A N/A SUPPORT 1 0 PROCEDURE FOR MONITORING THE USE OF GRANT FUNDS - PART I, LINE 2 CHOC transfers funds to CHOCO Realty Corporation, pursuant to the bylaws of CHOC. X X X X true true false false false false false false false KIMBERLY C CRIPE 0 710811 0 169688 0 168660 0 54579 0 18712 0 1122450 0 0 KERRI RUPPERT SCHILLER 0 419474 0 80404 0 63680 0 80630 0 18712 0 662900 0 0 DEBRA MATHIAS 0 396210 0 71257 0 49663 0 76762 0 18712 0 612604 0 0 MARIA E MINON MD 415641 0 56075 0 90084 0 32797 0 12442 0 607039 0 0 0 MARGARET T CONK 79550 0 0 196980 0 2305 0 140 0 278975 0 0 0 MARK L HEADLAND 260877 0 36733 0 64456 0 49042 0 4814 0 415922 0 0 0 JANET R LANSING 189808 0 31575 0 77604 0 20476 0 11880 0 331343 0 0 0 JAMES P CAPPON MD 255220 0 13569 0 14342 0 1254 0 18712 0 303097 0 0 0 MATTHEW NIEDZWIECKI 221413 0 28974 0 31054 0 39598 0 13091 0 334130 0 0 0 BETH ROWETT 195533 0 27897 0 55309 0 12188 0 13491 0 304418 0 0 0 WALDO ROMERO 251976 0 42910 0 38289 0 44751 0 9543 0 387469 0 0 0 JAY GABRIEL 294204 0 50968 0 39398 0 49502 0 18674 0 452746 0 0 0 dana bledsoe 258717 0 45133 0 56996 0 8604 0 75 0 369525 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. Unpaid severance under the separation agreements for current key employees were reported at their full value in a previous tax year. ONE EXECUTIVE LISTED ON SCHEDULE J, PART II RECEIVED SEVERANCE PAYMENTS IN FISCAL YEAR 2011. THE PAYMENT WAS RECEIVED BY MARGARET T. CONK ($180,665). 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) 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 2010: Ms. Cripe ($100,765), Ms. Rowett ($20,355), Dr. Minon ($44,638) and Ms. Lansing ($20,639). As stated in previous filings, in December 2008, the CHOC Executive Compensation Committee dissolved the previous non-qualified retirement plan and all assets were disbursed involuntarily to the participants. The following individuals listed on Schedule J received payments from the dissolution of the plan in calendar 2010, which are included as a component of the amount reported on Schedule J, Part II, column B: Ms. Bledsoe ($19,079); Ms. Schiller ($11,923); Mr. Headland ($25,413) and Ms. Lansing ($22,640). 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, CHOCO Realty Corporation, CRC Real Estate Corporation and Children's Hospital at Mission (all 501(c)(3) affiliates). Ms. Cripe devotes approximately 75% of her time each week to Children's Hospital of Orange County 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, CHOCO Realty Corporation, CRC Real Estate Corporation and Children's Hospital at Mission (all 501(c)(3) affiliates). Ms. Schiller devotes approximately 63% of her time each week to Children's Hospital of Orange County responsibilities with the balance of her time being spent on the other related organizations' business affairs. Debra Mathias 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 and Children's Hospital at Mission (both 501(c)(3) affiliates). Ms. Mathias devotes approximately 88% of her time each week to Children's Hospital of Orange County responsibilities with the balance of her time being spent on Children's Hospital at Mission's business affairs. MORAN ROWEN AND DORSEY INC MARSHALL ROWEN M.D., BOD 260000 MEDICAL SERVICES false Pediatric Surgical Associates MUSTAFA KABEER, M.D., BOD 656246 medical services false form 990, PART I, LINE 5 AND PART V, LINE 2 INFORMATION REGARDING CHOC AS THE COMMON PAYMASTER: Children's Hospital of Orange County is the common paymaster of the following: CHILDREN'S HEALTHCARE OF CALIFORNIA CHILDREN'S HOSPITAL AT MISSION CHOC FOUNDATION All wages and employee specific information, including volunteers, are retained with Children's Hospital of Orange County. FORM 990, PART III, LINE 4A Community Benefit Report Highlights: CHOC is dedicated to providing the highest quality tertiary, quaternary inpatient care as well as specialty and primary care to children in a family centered environment. Access to quality pediatric healthcare resources and information to families, including low-income and medically underserved, throughout Orange and contiguous counties, is accomplished by offering: (1) Pediatric Intensive Care Unit (PICU). The 30 bed PICU at CHOC is staffed by intensivists and clinician staff and is equipped with advanced computerized monitoring systems and offers care to critically ill or injured children with life-threatening disorders. (2) Oncology Unit staffed by specialists trained to treat the complex conditions that accompany pediatric cancers. This includes a 28-bed hematology/oncology unit and a 12-bed oncology intensive care unit (OICU). The unit offers the latest in medical and surgical oncology including chemotherapy, radiotherapy and blood and marrow transplantation. CHOC also opened a 22 chair outpatient infusion center in 2008. (3) CHOC's neonatal intensive care unit (NICU) takes care of infants who need critical care (most often premature babies suffering from respiratory and circulatory problems as well as congenital anomalies requiring surgery) that can be admitted to the NICU within minutes of birth. The 54-bed NICU at CHOC includes two eight-bed nurseries, two nine-bed nurseries, six isolation rooms, 12 beds that provide private rooming and a two-bed extracorporeal membrane oxygenation (ECMO) unit. CHOC's ECMO unit is the only one of its kind in Orange County and one of only 72 in the United States. CHOC also has Southern California's only ECMO transport unit. CHOC designated a small baby unit of 12 beds in March 2010. The unit cares for babies that weigh less than 1,000 grams at birth or 27 weeks or less gestation period. (4) CHOC's cardiovascular intensive care unit (CVICU) meets the growing need for specialized heart services in Orange County. This 12-bed unit was opened in October 2007. It includes two special procedure treatment rooms that enable physicians to perform surgery on children who otherwise could not be transported out of the unit. All of the CVICU rooms are outfitted with technology to monitor children after complex operations and surgical procedures. (5) The CHOC Cancer, Neuroscience, Heart and Orthopaedic Institutes offer innovative advanced models of care in the evaluation, management and treatment of the most complex pediatric and adolescent conditions. CHOC provides and enhances the community's access to behavioral health information and social and emotional services, targeting the underserved. CHOC offers outpatient specialty care in multiple specialties through clinics in Orange and Newport Beach. CHOC actively supports community action and leadership. CHOC actively recruits, recognizes and advocates for the importance of volunteer leadership and community assistance in providing care for children. CHOC provides community-wide education and health information access using programs including disease prevention education, information resources and injury prevention. In addition, CHOC offers services through its outreach clinics that serve surrounding communities to provide preventative and primary care in low-income, high risk areas where children have limited access to care. CHOC's outreach clinics include the CHOC Orange Community Clinic, Clinica Para Ninos in Santa Ana, the CHOC Clinic at Santa Ana Boys and Girls Club, CHOC Costa Mesa Clinic and CHOC Garden Grove Clinic. CHOC also provides care through mobile clinics, including Breathmobiles and Asthma care. See our Community Benefits Report on our website at www.choc.org LINES 6 & 7A - ORGANIZATION MEMBER INFORMATION THE SOLE MEMBER OF CHILDREN'S HOSPITAL OF ORANGE COUNTY (CHOC) 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 CHOC; (2) OBLIGATING CHOC TO UNDERTAKE ANY CAPITAL EXPENDITURE IN EXCESS OF $5,000,000; (3) ADOPTING CHOC'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 CHOC TO ACT AS GUARANTOR WITH RESPECT TO ANY DEBT OF ANY PERSON OR OTHER ENTITY; (8) ACCEPTING ANY DONATION WHICH IS CONDITIONED UPON CHOC'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 CHOC IN AN AMOUNT IN EXCESS OF $5,000,000, (B) ANY PURPOSE OR ACTIVITY WHICH IS OUTSIDE THE SCOPE OF CHOC'S ORDINARY COURSE OF BUSINESS, OR (C) A TERM IN EXCESS OF FIVE YEARS (UNLESS THE CONTRACT IS TERMINABLE AT WILL); (10) INVOLVING CHOC IN ANY MERGER, ACQUISITION, CORPORATE RESTRUCTURING, OR FORMAL AFFILIATION; (11) INVOLVING CHOC AS A MEMBER, SHAREHOLDER, OR PARTNER IN ANY NEW CORPORATION, PARTNERSHIP, OR OTHER LEGAL ENTITY; (12) DISSOLVING CHOC; (13) ENTERING INTO ANY TRANSACTION INVOLVING THE SALE, LEASE, CONVEYANCE, EXCHANGE, TRANSFER OR OTHER DISPOSITION OF ALL OR SUBSTANTIALLY ALL OF CHOC'S ASSETS; (14) AMENDING CHOC'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, SECTION B LINE 11A - REVIEW OF FORM 990: 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. The Form 990 is also a scheduled agenda item at the May 2012 Board of Directors meeting. LINE 12C - CONFLICT OF INTEREST COMPLIANCE: The 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 executive sessions with no staff members present. All comparative salary data is well documented and there are minutes from these meetings that document the members present and voting, the comparative data used 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 WHILE FEDERAL TAX LAWS DO NOT MANDATE THAT THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS BE MADE AVAILABLE FOR PUBLIC INSPECTION, THE ORGANIZATION MAKES ITS FINANCIAL STATEMENTS AVAILABLE UPON REQUEST. RECONCILIATION OF NET ASSETS FORM 990, PART XI, LINE 5 NET UNREALIZED GAINS ON INVESTMENT $ 3,393,354 CHANGE IN BENEFICIAL INTEREST IN CHOC FOUNDATION 2,238,109 Adjustment for Income from Investment Partnerships 16,008 Prior period adjustment (2,322,620) ------------- $ 3,324,851 CHANGES TO BYLAWS FORM 990, PART VI, LINE 4 Purposes and Powers: Revised name of corporation to Children's Hospital of Orange County, d.b.a. CHOC Children's Orange. Qualifications of Directors: Updated title to Vice President of Medical Affiars/Chief Medical Officer (the "VPMA/CMO") Advisory Committees: Deleted Physician Agreements Committee and Corporate Compliance Committee as Advisory Committees. Planning Committee: Removed "campus master planning" from responsibilities because this will be handled by the Construction Committee. Physician Agreements Committee: Removed Physician Agreement Committee as an Advisory Committee of the Corporation because the Internal Compliance Oversight committee will take over these responsiblities. Corporate Compliance Committee: Removed Corporate Compliance Committee because this moved to CHC as the Audit and Compliance Committee. Quality: Revised duties of the Quality committee. Deleted "consistently improving care, treatment, and services that address the needs of patients, families and the community." HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:KIMBERLY C. CRIPE TITLE:DIRECTOR / PRESIDENT HOURS:10 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:MEREDITH KHACHIGIAN TITLE:DIRECTOR HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:JAY KEAR TITLE:DIRECTOR / FIRST VICE CHAIR HOURS:2 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:DOUGLAS MCCOMBS TITLE:DIRECTOR / SECRETARY HOURS:2 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:MARSHALL ROWEN, M.D. TITLE:DIRECTOR HOURS:3 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:MARK STEVENS TITLE:DIRECTOR / CHAIR HOURS:3 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:MAUREEN ZEHNTNER TITLE:DIRECTOR HOURS:2 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:RALPH CLAYMAN M.D. TITLE:DIRECTOR HOURS:2 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:JANET T. DAVIDSON TITLE:DIRECTOR HOURS:4 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:DAVID DUKES TITLE:DIRECTOR HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:JOE DUNN TITLE:DIRECTOR HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:JEFF ELGHANAYAN TITLE:DIRECTOR / 2ND VICE CHAIR HOURS:2 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:WILLIAM GURTNER TITLE:DIRECTOR HOURS:2 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:MUSTAFA KABEER, M.D. TITLE:DIRECTOR HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:GEORGE KALOGRIDIS TITLE:DIRECTOR HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:TIM RISTOFF TITLE:DIRECTOR HOURS:2 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:KERRI RUPPERT SCHILLER TITLE:SR. VICE PRESIDENT & CFO HOURS:15 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:DEBRA MATHIAS TITLE:EXEC. VICE PRESIDENT / COO HOURS:5 CHILDREN'S HEALTHCARE OF CALIFORNIA(CHC) 455 S MAIN STREET ORANGE CA 92868 330265266 HEALTH CARE CA 501(c)(3) 7 NA Children's Hospital at Mission 455 S MAIN STREET ORANGE CA 92868 330528802 HEALTH CARE CA 501(C)(3) 3 CHC CHOC FOUNDATION 455 S MAIN STREET ORANGE CA 92868 956097416 Fund Raising CA 501(C)(3) 7 CHC CHOCO REALTY CORPORATION 455 S MAIN STREET ORANGE CA 92868 330011853 REAL ESTATE CA 501(C)(3) 11 CHC CRC REAL ESTATE CORPORATION 455 S MAIN STREET ORANGE CA 92868 330612565 REAL ESTATE CA 501(C)(3) 11 CHC CHOC Thrift Stores Inc 455 S MAIN STREET orange CA 92868 330266422 Fund Raising CA 501(C)(3) 9 CHC ocmrrg 2999 North 4th Street Suite 250 phoenix AZ 85108 201620666 insurance AZ na c corp 42277 2381834 0.50000 false true true false true false false false false true false true true false false false false false ocmrrg l 1032337 part v, line 2, column(c) OCMRRG provides medical professional liability and general liability coverage of up to $250,000 per claim on a claims-made basis to CHOC.