TY 2012 Form 990

(A) Name and business address	(B) Description of services	(C) Compensation
MCCARTHY BUILDING COMPANIES, 20401 S W BIRCH STREET SUITE 300NEWPORT BEACHCA92660	General Construction	72,800,227
PEDIATRIC SUBSPECIALTY FACULTY, 455 S MAIN STREETORANGECA92868	MEDICAL DIR & SERV	49,522,717
COMFORCE TECHNICAL SERVICES, PO BOX 9695UNIONDALENY115559695	TEMP EMPLOYEMENT SER	9,066,379
MICHAEL L DAVIS, 1835 NEWPORT BLVD A109 361COSTA MESACA92627	CONSTRUCTION INSPECT	1,496,441
DGWB ADVERTISING, 217 N MAIN STREET SUITE 200SANTA ANACA92701	ADVERTISING SERVICES	1,427,180
2 Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization 259

Do not include amounts reported on lines 6b, 7b, 8b, 9b, and 10b of Part VIII.	(A) Total expenses	(B) Program service expenses	(C) Management and general expenses	(D) Fundraising expenses
1	Grants and other assistance to governments and organizations in the United States. See Part IV, line 21	0
2	Grants and other assistance to individuals in the United States. See Part IV, line 22	0
3	Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16	0
4	Benefits paid to or for members	0
5	Compensation of current officers, directors, trustees, and key employees ....	1,566,076	1,566,076
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....	479,954	431,959	47,995
7	Other salaries and wages	170,775,350	153,697,815	17,077,535
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	4,133,143	3,719,829	413,314
9	Other employee benefits .......	24,327,270	21,894,543	2,432,727
10	Payroll taxes ...........	11,984,134	10,785,721	1,198,413
11	Fees for services (non-employees):
a	Management ......	13,908,753	12,517,878	1,390,875
b	Legal .........	792,579	713,321	79,258
c	Accounting ...........	207,829	187,046	20,783
d	Lobbying ...........	0
e	Professional fundraising services. See Part IV, line 17	0
f	Investment management fees ......	286,601	257,941	28,660
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) ........	92,613,648	83,352,283	9,261,365
12	Advertising and promotion ....	0
13	Office expenses .......	8,838,634	7,954,771	883,863
14	Information technology ......	0
15	Royalties ..	0
16	Occupancy ...........	8,879,881	7,991,893	887,988
17	Travel ............	634,328	570,895	63,433
18	Payments of travel or entertainment expenses for any federal, state, or local public officials ......	0
19	Conferences, conventions, and meetings ....	649,933	584,940	64,993
20	Interest ...........	8,925,990	8,033,391	892,599
21	Payments to affiliates .......	0
22	Depreciation, depletion, and amortization .....	25,524,499	22,972,049	2,552,450
23	Insurance ..............	8,725,888	7,853,299	872,589
24	Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a	PRCHSD SRVCS FRM OTR HOSP.	55,514,415	55,514,415
b	SUPPLIES	46,785,505	42,106,954	4,678,551
c	DUES & SUBSCRIPTIONS	1,465,627	1,319,064	146,563
d	RECRUITMENT	189,139	170,225	18,914
e	All other expenses	32,565,914	29,242,449	3,323,465
25	Total functional expenses. Add lines 1 through 24e	519,775,090	473,438,757	46,336,333	0
26	Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here if following SOP 98-2 (ASC 958-720).

Part X Balance Sheet Check if Schedule O contains a response to any question in this Part X ...............
	1	Cashnon-interest-bearing .............	68,148,796	1	109,003,634
2	Savings and temporary cash investments .........	201,733,579	2	60,311,263
3	Pledges and grants receivable, net ...........	10,184,726	3	8,303,119
4	Accounts receivable, net .............	102,874,643	4	113,774,764
5	Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of Schedule L ..................
		0	5	0
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L
		0	6	0
7	Notes and loans receivable, net .............	0	7	0
8	Inventories for sale or use ..............	2,321,459	8	8,405,248
9	Prepaid expenses and deferred charges ..........	7,766,068	9	8,918,000
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	924,397,374
b	Less: accumulated depreciation .....	10b	222,651,346	596,254,896	10c	701,746,028
11	Investments—publicly traded securities ..........	0	11	0
12	Investments—other securities. See Part IV, line 11 .....	35,058	12	35,058
13	Investments—program-related. See Part IV, line 11 .....	0	13	0
14	Intangible assets ...............	1,216,000	14	1,216,000
15	Other assets. See Part IV, line 11 ...........	21,039,593	15	41,195,140
16	Total assets. Add lines 1 through 15 (must equal line 34)......	1,011,574,818	16	1,052,908,254
	17	Accounts payable and accrued expenses .........	80,997,492	17	72,703,698
18	Grants payable .................	0	18	0
19	Deferred revenue ................	686,965	19	720,040
20	Tax-exempt bond liabilities .............	366,161,293	20	363,848,347
21	Escrow or custodial account liability. Complete Part IV of Schedule D..	0	21	0
22	Loans and other payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
	persons. Complete Part II of Schedule L..........	0	22	0
23	Secured mortgages and notes payable to unrelated third parties ..	118,989	23	12,731,653
24	Unsecured notes and loans payable to unrelated third parties ....	0	24	0
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D....................	86,159,496	25	62,688,691
26	Total liabilities. Add lines 17 through 25.........	534,124,235	26	512,692,429
		Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets ..............	434,014,107	27	496,842,415
28	Temporarily restricted net assets ...........	42,750,324	28	42,687,258
29	Permanently restricted net assets ...........	686,152	29	686,152
	Organizations that do not follow SFAS 117 (ASC 958), check here and complete lines 30 through 34.
30	Capital stock or trust principal, or current funds ........		30
31	Paid-in or capital surplus, or land, building or equipment fund .....		31
32	Retained earnings, endowment, accumulated income, or other funds		32
33	Total net assets or fund balances ...........	477,450,583	33	540,215,825
34	Total liabilities and net assets/fund balances ........	1,011,574,818	34	1,052,908,254

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SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service

Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.

Attach to Form 990 or Form 990-EZ. right arrow

See separate instructions.

OMB No. 1545-0047

2012

Open to Public
Inspection

Name of the organization

Children's Hospital of Orange County

Employer identification number

95-2321786

Part I

Reason for Public Charity Status (All organizations must complete this part.) See instructions.

The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)

A church, convention of churches, or association of churches described in section 170(b)(1)(A)(i).

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E.)

A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).

A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital's name, city, and state:

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in

section 170(b)(1)(A)(iv). (Complete Part II.)

A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in section 170(b)(1)(A)(vi). (Complete Part II.)

A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)

An organization that normally receives: (1) more than 331/3% of its support from contributions, membership fees, and gross

receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of

its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses

acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)

An organization organized and operated exclusively to test for public safety. See section 509(a)(4).

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box that describes the type of supporting organization and complete lines 11e through 11h.

Type I

Type II

Type III - Functionally integrated

Type III - Non-functionally integrated

By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons other than foundation managers and other than one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2).

If the organization received a written determination from the IRS that it is a Type I, Type II, or Type III supporting organization, check this box ..................................................

Since August 17, 2006, has the organization accepted any gift or contribution from any of the
following persons?

(i) A person who directly or indirectly controls, either alone or together with persons described in (ii)

Yes

and (iii) below, the governing body of the supported organization? ................

11g(i)

(ii) A family member of a person described in (i) above? ......................

11g(ii)

(iii) A 35% controlled entity of a person described in (i) or (ii) above? ................

11g(iii)

Provide the following information about the supported organization(s).

(i) Name of supported organization	(ii) EIN	(iv) Is the organization in col. (i) listed in your governing document?		(v) Did you notify the organization in col. (i) of your support?		(vi) Is the organization in col. (i) organized in the U.S.?		(vii) Amount of monetary support
(i) Name of supported organization	(ii) EIN	Yes	No	Yes	No	Yes	No	(vii) Amount of monetary support


Total

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990EZ.

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2012

Page 2

Part II

Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2008	(b) 2009	(c) 2010	(d) 2011	(e) 2012	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....
2	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......
3	The value of services or facilities furnished by a governmental unit to the organization without charge..
4	Total. Add lines 1 through 3
5	The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
6	Public support. Subtract line 5 from line 4.

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2008	(b) 2009	(c) 2010	(d) 2011	(e) 2012	(f) Total
7	Amounts from line 4..
8	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...
9	Net income from unrelated business activities, whether or not the business is regularly carried on..
10	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)..
11	Total support (Add lines 7 through 10).

Gross receipts from related activities, etc. (see instructions) ..................

First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization, check this box and stop here........................................ right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2012 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2011 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2012. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization ....................... right arrow

33 1/3% support test—2011. If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2012. If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain
in Part IV how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization ..................................................... right arrow

10%-facts-and-circumstances test—2011. If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part IV how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly
supported organization ................................................ right arrow

Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ..................................................... right arrow

Schedule A (Form 990 or 990-EZ) 2012

Page 3

Part III

Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 9 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2008	(b) 2009	(c) 2010	(d) 2011	(e) 2012	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2	Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......
3	Gross receipts from activities that are not an unrelated trade or business under section 513..
4	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5	The value of services or facilities furnished by a governmental unit to the organization without charge..
6	Total. Add lines 1 through 5.
7a	Amounts included on lines 1, 2, and 3 received from disqualified persons...
b	Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c	Add lines 7a and 7b..
8	Public support (Subtract line 7c from line 6.)

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2008	(b) 2009	(c) 2010	(d) 2011	(e) 2012	(f) Total
9	Amounts from line 6...
10a	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b	Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c	Add lines 10a and 10b.
11	Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
12	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.) ..
13	Total support. (Add lines 9, 10c, 11, and 12.)..

First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here............................................. right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2012 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2011 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2012 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2011 Schedule A, Part III, line 17 .............

19a

33 1/3% support tests—2012. If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ........ right arrow

33 1/3% support tests—2011. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ..... right arrow

Private foundation. If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions ..... right arrow

Schedule A (Form 990 or 990-EZ) 2012

Page 4

Part IV

Supplemental Information. Complete this part to provide the explanations required by Part II, line 10; Part II, line 17a or 17b; and Part III, line 12. Also complete this part for any additional information. (See instructions).

Facts And Circumstances Test

Explanation

Schedule A (Form 990 or 990-EZ) 2012

Additional Data

Software ID:
Software Version:

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Schedule B
(Form 990, 990-EZ,
or 990-PF)

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

Attach to Form 990, 990-EZ, or 990-PF.

OMB No. 1545-0047

2012

Name of the organization

Children's Hospital of Orange County

Employer identification number

95-2321786

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

4947(a)(1) nonexempt charitable trust not treated as a private foundation

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

4947(a)(1) nonexempt charitable trust treated as a private foundation

501(c)(3) taxable private foundation

Check if your organization is covered by the General Rule or a Special Rule.
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.

General Rule

For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, $5,000 or more (in money or
property) from any one contributor. Complete Parts I and II.

Special Rules

For a section 501(c)(3) organization filing Form 990 or 990-EZ that met the 33¹/3% support test of the regulations
under sections 509(a)(1) and 170(b)(1)(A)(vi) and received from any one contributor, during the year, a contribution of the
greater of (1) $5,000 or (2) 2% of the amount on (i) Form 990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts I and II.

For a section 501(c)(7), (8), or (10) organization filing Form 990 or 990-EZ that received from any one contributor,
during the year, total contributions of more than $1,000 for use exclusively for religious, charitable,
scientific, literary, or educational purposes, or the prevention of cruelty to children or animals. Complete Parts I, II, and
III.

For a section 501(c)(7), (8), or (10) organization filing Form 990 or 990-EZ that received from any one contributor,
during the year, contributions for use exclusively for religious, charitable, etc., purposes, but these contributions did
not total to more than $1,000. If this box is checked, enter here the total contributions that were received during
the year for an exclusively religious, charitable, etc., purpose. Do not complete any of the parts unless the General Rule
applies to this organization because it received nonexclusively religious, charitable, etc., contributions of $5,000 or more
during the year ......................... Arrow Bullet

Caution. An organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2 of its Form 990; or check the box on line H of its
Form 990-EZ or on Part I, line 2 of its Form 990-PF, to certify that it does not meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).

For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.

Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2012)

Schedule B (Form 990, 990-EZ, or 990-PF) (2012)

Page 2

Name of organization Children's Hospital of Orange County

Part I	Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
RESTRICTED	RESTRICTED RESTRICTED RESTRICTED RESTRICTED, RESTRICTED RESTRICTED	$RESTRICTED	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2012)

Schedule B (Form 990, 990-EZ, or 990-PF) (2012)

Page 3

Name of organization Children's Hospital of Orange County

Part II	Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
Schedule B (Form 990, 990-EZ, or 990-PF) (2012)

Schedule B (Form 990, 990-EZ, or 990-PF) (2012)

Page 4

Name of organization
Children's Hospital of Orange County

Employer identification number

95-2321786

Part III

Exclusively religious, charitable, etc., individual contributions to section 501(c)(7), (8), or (10) organizations
that total more than $1,000 for the year. Complete columns (a) through (e) and the following line entry.
For organizations completing Part III, enter the total of exclusively religious, charitable, etc.,
contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet

$
Use duplicate copies of Part III if additional space is needed.

(a) No.
from
Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a) No.
from
Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a) No.
from
Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a) No.
from
Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

Schedule B (Form 990, 990-EZ, or 990-PF) (2012)

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527
SchCMd Bullet

Complete if the organization is described below. SchCMd Bullet

Attach to Form 990 or Form 990-EZ.
SchCMd Bullet

See separate instructions.

OMB No. 1545-0047

2012

Open to Public
Inspection

If the organization answered “Yes” to Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet

Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet

Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet

Section 527 organizations: Complete Part I-A only.
If the organization answered “Yes” to Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet

Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)): Complete Part II-A. Do not complete Part II-B.
Round Bullet

Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered “Yes” to Form 990, Part IV, Line 5 (Proxy Tax) or Form 990-EZ, Part V, line 35c (Proxy Tax), then
Round Bullet

Section 501(c)(4), (5), or (6) organizations: Complete Part III.

Name of the organization

Children's Hospital of Orange County

Employer identification number

95-2321786

Part I-A

Complete if the organization is exempt under section 501(c) or is a section 527 organization.

Provide a description of the organization’s direct and indirect political campaign activities in Part IV.

Political expenditures .................................... SchCMd Bullet

Volunteer hours ........................................

Part I-B

Complete if the organization is exempt under section 501(c)(3).

Enter the amount of any excise tax incurred by the organization under section 4955 ......... SchCMd Bullet

Enter the amount of any excise tax incurred by organization managers under section 4955 ...... SchCMd Bullet

If the organization incurred a section 4955 tax, did it file Form 4720 for this year? ..............

Yes No

Was a correction made? .........................................

Yes No

If "Yes," describe in Part IV.

Part I-C

Complete if the organization is exempt under section 501(c), except section 501(c)(3).

Enter the amount directly expended by the filing organization for section 527 exempt function activities SchCMd Bullet

Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ................................... SchCMd Bullet

Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b.. SchCMd Bullet

Did the filing organization file Form 1120-POL for this year? ..........................

Yes No

Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.

(a) Name	(b) Address	(c) EIN	(d) Amount paid from filing organization's funds. If none, enter -0-.	(e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.

For Paperwork Reduction Act Notice, see the instructions for Form 990 or 990-EZ.

Cat. No. 50084S

Schedule C (Form 990 or 990-EZ) 2012

Page 2

Part II-A

Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).

A Check SchCMd Bullet

if the filing organization belongs to an affiliated group (and list in Part IV each affiliated group member's name, address, EIN, expenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet

if the filing organization checked box A and "limited control" provisions apply.

Limits on Lobbying Expenditures (The term "expenditures" means amounts paid or incurred.)		(b) Affiliated group totals
1a	Total lobbying expenditures to influence public opinion (grass roots lobbying) ......
b	Total lobbying expenditures to influence a legislative body (direct lobbying) .......
c	Total lobbying expenditures (add lines 1a and 1b) ...................
d	Other exempt purpose expenditures ........................
e	Total exempt purpose expenditures (add lines 1c and 1d) ...............
f	Lobbying nontaxable amount. Enter the amount from the following table in both columns.
	If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:
	Not over $500,00020% of the amount on line 1e.
	Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.
	Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.
	Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.
	Over $17,000,000$1,000,000.

g	Grassroots nontaxable amount (enter 25% of line 1f) .................
h	Subtract line 1g from line 1a. If zero or less, enter -0-. ................
i	Subtract line 1f from line 1c. If zero or less, enter -0-. ................
j	If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting section 4911 tax for this year? ......................................	Yes No

4-Year Averaging Period Under Section 501(h) (Some organizations that made a section 501(h) election do not have to complete all of the five columns below. See the instructions for lines 2a through 2f on page 4.)
Lobbying Expenditures During 4-Year Averaging Period
	Calendar year (or fiscal year beginning in)	(a) 2009	(b) 2010	(c) 2011	(d) 2012	(e) Total

2a	Lobbying nontaxable amount

b	Lobbying ceiling amount (150% of line 2a, column(e))

c	Total lobbying expenditures

d	Grassroots nontaxable amount

e	Grassroots ceiling amount (150% of line 2d, column (e))

f	Grassroots lobbying expenditures

Schedule C (Form 990 or 990-EZ) 2012

Page 3

Part II-B

Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).

For each “Yes” response to lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.

(a)

Yes

(b)

Amount

During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:

Volunteers? .........................................

Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ....

Media advertisements? ....................................

Mailings to members, legislators, or the public? .........................

Publications, or published or broadcast statements? .......................

Grants to other organizations for lobbying purposes? .......................

Direct contact with legislators, their staffs, government officials, or a legislative body? ........

Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ......

Other activities? ..........................

Yes

52,984

Total. Add lines 1c through 1i ...............................

52,984

Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....

If "Yes," enter the amount of any tax incurred under section 4912 .................

If "Yes," enter the amount of any tax incurred by organization managers under section 4912 .....

If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? .......

Part III-A

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).

Yes

Were substantially all (90% or more) dues received nondeductible by members? ................

Did the organization make only in-house lobbying expenditures of $2,000 or less? ................

Did the organization agree to carry over lobbying and political expenditures from the prior year? ..........

Part III-B

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2, are answered “No” OR (b) Part III-A, line 3, is answered “Yes."

Dues, assessments and similar amounts from members .....................

Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political
expenses for which the section 527(f) tax was paid).

Current year .........................................

Carryover from last year ....................................

Total ............................................

Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .

If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ................................

Taxable amount of lobbying and political expenditures (see instructions) ..............

Part IV

Supplemental Information

Complete this part to provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; Part II-A (affiliated group list); Part II-A, line 2; and Part ll-B, line 1. Also, complete this part for any additional information.

Identifier	Return Reference	Explanation
grants to other organizations for lobbying purposes	form 990, schedule c, part II-B, line 1i	during fye 06/30/2013, 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 $22,418 national association of children's hospitals $ 7,334 California Children's Hospital Association $23,232 Total dues paid for lobbying purposes: $52,984

Schedule C (Form 990 or 990EZ) 2012

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," to Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b
SchDMd Bullet

Attach to Form 990. SchDMd Bullet

See separate instructions.

OMB No. 1545-0047

2012

Open to Public Inspection

Name of the organization

Children's Hospital of Orange County

Employer identification number

95-2321786

Part I

Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" to Form 990, Part IV, line 6.

		(a) Donor advised funds	(b) Funds and other accounts
1	Total number at end of year .........
2	Aggregate contributions to (during year) ...
3	Aggregate grants from (during year) .....
4	Aggregate value at end of year ........

Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ............

Yes No

Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................

Yes No

Part II

Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.

Purpose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e.g., recreation or education) Preservation of an historically important land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.


a	Total number of conservation easements .......................	2a
b	Total acreage restricted by conservation easements ..................	2b
c	Number of conservation easements on a certified historic structure included in (a) .....	2c
d	Number of conservation easements included in (c) acquired after 8/17/06, and not on a historic structure listed in the National Register ....................	2d

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the tax year SchDMd Bullet

Number of states where property subject to conservation easement is located SchDMd Bullet

Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................

Yes No

Staff and volunteer hours devoted to monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet

Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .......................................

Yes No

In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" to Form 990, Part IV, line 8.

If the organization elected, as permitted under SFAS 116 (ASC 958), not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII, the text of the footnote to its financial statements that describes these items.

If the organization elected, as permitted under SFAS 116 (ASC 958), to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items:

(i)

Revenues included in Form 990, Part VIII, line 1 ........................ SchDMd Bullet

(ii)

Assets included in Form 990, Part X .............................. SchDMd Bullet

If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 (ASC 958) relating to these items:

Revenues included in Form 990, Part VIII, line 1 .......................... SchDMd Bullet

Assets included in Form 990, Part X ............................... SchDMd Bullet

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 52283D

Schedule D (Form 990) 2012

Page 2

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)

Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.

During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?........

Yes No

Part IV

Escrow and Custodial Arrangements. Complete if the organization answered "Yes" to Form 990,
Part IV, line 9, or reported an amount on Form 990, Part X, line 21.

Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................

Yes No

If "Yes," explain the arrangement in Part XIII and complete the following table:


c	Beginning balance .................................	1c
d	Additions during the year ..............................	1d
e	Distributions during the year .............................	1e
f	Ending balance ...................................	1f

Did the organization include an amount on Form 990, Part X, line 21? .....................

Yes No

If “Yes,” explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ........

Part V

Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.

		(a)Current year	(b)Prior year	b (c)Two years back	(d)Three years back	(e)Four years back
1a	Beginning of year balance ....	4,919,888	4,406,780	3,691,065	3,339,711	3,076,071
b	Contributions ........	5,159	584,493	643,580	351,279	262,998
c	Net investment earnings, gains, and losses	61,328	-7,094	72,135	1,363	11,676
d	Grants or scholarships .....		0	0	0	0
e	Other expenditures for facilities and programs ........	54,503	64,290	0	1,288	11,034
f	Administrative expenses ....			0	0	0
g	End of year balance ......	4,931,872	4,919,889	4,406,780	3,691,065	3,339,711

Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:

Board designated or quasi-endowment SchDMd Bullet

86.090 %

Permanent endowment SchDMd Bullet

13.910 %

Temporarily restricted endowment SchDMd Bullet

The percentages in lines 2a, 2b, and 2c should equal 100%.

Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes

(i) unrelated organizations ........................

3a(i)

(ii) related organizations ........................

3a(ii)

Yes

If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........

Yes

Describe in Part XIII the intended uses of the organization's endowment funds.

Part VI

Land, Buildings, and Equipment. See Form 990, Part X, line 10.

Description of property		(b)Cost or other basis (other)	(c) Accumulated depreciation	(d) Book value
1a	Land .................	45,060,833		45,060,833
b	Buildings ................	622,168,864	92,724,431	529,444,433
c	Leasehold improvements ............	13,720,574	9,091,484	4,629,090
d	Equipment ................	228,197,688	120,014,268	108,183,420
e	Other .................	15,249,415	821,163	14,428,252
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......				701,746,028

Schedule D (Form 990) 2012

Page 3

Part VII

InvestmentsOther Securities. See Form 990, Part X, line 12.

(a) Description of security or category (including name of security)		(b)Book value	(c) Method of valuation: Cost or end-of-year market value
(1)Financial derivatives
(2)Closely-held equity interests
Other








Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

Part VIII

InvestmentsProgram Related. See Form 990, Part X, line 13.

(a) Description of investment type		(b) Book value	(c) Method of valuation: Cost or end-of-year market value









Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)

Part IX

Other Assets. See Form 990, Part X, line 15.

(a) Description				(b) Book value









Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........

Part X

Other Liabilities. See Form 990, Part X, line 25.

1.(a) Description of liability		(b) Book value
Federal income taxes		0
DERIVATIVE FINANCIAL INSTRUMENTS		41,949,105
LIABILITY FOR WORKER'S COMP.		7,944,115
PAYABLE TO ST. JOSEPH HOSPITAL		3,046,510
POSTRETIREMENT BENEFIT OBLIGATION		2,892,496
PAYABLE TO RELATED PARTIES		4,465
OTHER LIABILITIES		6,852,000



Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)		62,688,691
2. Fin 48 (ASC 740) Footnote. In Part XIII, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC 740). Check here if the text of the footnote has been provided in Part XIII .....................................................

Schedule D (Form 990) 2012

Page 4

Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return
1	Total revenue, gains, and other support per audited financial statements .......			1	573,511,658
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains on investments ..........	2a	13,502,474
b	Donated services and use of facilities .........	2b	780,000
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIII.) ............	2d	22,092,362
e	Add lines 2a through 2d .....................			2e	36,374,836
3	Subtract line 2e from line 1.....................			3	537,136,822
4	Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b .	4a
b	Other (Describe in Part XIII.) ...........	4b	11,656,280
c	Add lines 4a and 4b.......................			4c	11,656,280
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......			5	548,793,102

Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return
1	Total expenses and losses per audited financial statements ...........			1	508,898,810
2	Amounts included on line 1 but not on Form 990, Part IX, line 25:
a	Donated services and use of facilities ..........	2a	780,000
b	Prior year adjustments ..............	2b
c	Other losses ................	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d......................			2e	780,000
3	Subtract line 2e from line 1.....................			3	508,118,810
4	Amounts included on Form 990, Part IX, line 25, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b ..	4a
b	Other (Describe in Part XIII.) ............	4b	11,656,280
c	Add lines 4a and 4b.......................			4c	11,656,280
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......			5	519,775,090

Part XIII

Supplemental Information

Complete this part to provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b;
Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.

Identifier	Return Reference	Explanation
ORGANIZATION'S LIABILITY FOR UNCERTAIN TAX POSITIONS UNDER ASC 740:		Accounting principles generally accepted in the United States of America require CHOC's management to evaluate tax positions taken by CHOC and recognize a tax liability if CHOC 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 CHOC and has concluded that as of June 30, 2013, there are no uncertain positions taken or expected to be taken that would require recognition of a liability or disclosure in the combined financial statements.
RECONCILIATION OF REVENUE & EXPENSE	PART XI, LINE 2D	CHANGE IN BENEFICIAL INTEREST IN CHOC Foundation for Children - 20,244,756 NET INCOME OF OCMRRG - 1,847,606 ----------- 22,092,362 PART XI AND PART XII, LINE 4B RECLASS OF NON-OPERATING EXPENSES - 11,656,280
Use of endowment funds	part v, line 4	The endowment fund is used to support hospital programs addressing the needs of the underserved, social services to patients and families in need, and research and treatment of children's diseases and disorders.

Schedule D (Form 990) 2012

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE H (Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

Complete if the organization answered "Yes" to Form 990, Part IV, question 20.
MediumBullet

Attach to Form 990. MediumBullet

See separate instructions.

OMB No. 1545-0047

2012

Open to Public Inspection

Name of the organization

Children's Hospital of Orange County

Employer identification number

95-2321786

Part I

Financial Assistance and Certain Other Community Benefits at Cost

Yes

Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a ...

Yes

If "Yes," was it a written policy? .......................

Yes

If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.

Applied uniformly to all hospital facilities Applied uniformly to most hospital facilities Generally tailored to individual hospital facilities

Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.

Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?

If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:

Yes

100% 150% 200% Other %

Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate

which of the following was the family income limit for eligibility for discounted care: .........

Yes

200% 250% 300% 350% 400% Other %

If the organization used factors other than FPG in determining eligibility, describe in Part VI the income based criteria for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.

Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? ..............

Yes

Did the organization budget amounts for free or discounted care provided under its financial assistance policy during the tax year? ............................

Yes

If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? ......

If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? ..............

Did the organization prepare a community benefit report during the tax year? ..........

Yes

If "Yes," did the organization make it available to the public? ..............

Yes

Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.

Financial Assistance and Certain Other Community Benefits at Cost

Financial Assistance and Means-Tested Government Programs		(c) Total community benefit expense	(d) Direct offsetting revenue	(e) Net community benefit expense	(f) Percent of total expense
a	Financial Assistance at cost (from Worksheet 1) ..	949,569		949,569	0.180 %
b	Medicaid (from Worksheet 3, column a) ....	180,283,370	176,297,491	3,985,879	0.760 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) .
d	Total Financial Assistance and Means-Tested Government Programs .	181,232,939	176,297,491	4,935,448	0.940 %
Other Benefits		8,400,300	108,131	8,292,169	1.590 %
e	Community health improvement services and community benefit operations (from Worksheet 4) ..	8,400,300	108,131	8,292,169	1.590 %
f	Health professions education (from Worksheet 5) ..	16,950,032	1,988,410	14,961,622	2.870 %
g	Subsidized health services (from Worksheet 6) ..
h	Research (from Worksheet 7)	2,338,721		2,338,721	0.450 %
i	Cash and in-kind contributions for community benefit (from Worksheet 8)
j	Total. Other Benefits ..	27,689,053	2,096,541	25,592,512	4.910 %
k	Total. Add lines 7d and 7j .	208,921,992	178,394,032	30,527,960	5.850 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2012

Schedule H (Form 990) 2012

Page

Part II

Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.

		(c) Total community building expense	(d) Direct offsetting revenue	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing
2	Economic development
3	Community support	3,328,163	1,500	3,326,663	0.640 %
4	Environmental improvements
5	Leadership development and training for community members
6	Coalition building
7	Community health improvement advocacy
8	Workforce development
9	Other
10	Total	3,328,163	1,500	3,326,663	0.640 %

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................

Yes

Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......

18,967,359

Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......

Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.

Section B. Medicare

Enter total revenue received from Medicare (including DSH and IME).....

128,446

Enter Medicare allowable costs of care relating to payments on line 5.....

268,172

Subtract line 6 from line 5. This is the surplus (or shortfall)........

-139,726

Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

Did the organization have a written debt collection policy during the tax year? ..........

Yes

If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI.......................

Yes

Part IV

Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)

(a) Name of entity	(b) Description of primary activity of entity	(c) Organization's profit % or stock ownership %	(d) Officers, directors, trustees, or key employees' profit % or stock ownership %	(e) Physicians' profit % or stock ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13

Schedule H (Form 990) 2012

Page

Part VFacility Information

Section A. Hospital Facilities (list in order of size from largest to smallest—see instructions) How many hospital facilities did the organization operate during the tax year?1 Name, address, and primary website address
1	Children's Hospital of Orange County 455 South Main Street Orange,CA92868	X	X	X

Schedule H (Form 990) 2012

Page

Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)

	Children's Hospital of Orange County
Name of hospital facility or facility reporting group

For single facility filers only: line Number of Hospital Facility (from Schedule H, Part V, Section A)

Yes

Community Health Needs Assessment (Lines 1 through 8c are optional for tax years begining on or before March 23, 2012)

During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 9....................

Yes

If “Yes,” indicate what the CHNA report describes (check all that apply):

A definition of the community served by the hospital facility

Demographics of the community

Existing health care facilities and resources within the community that are available to respond to the health needs of the community

How data was obtained

The health needs of the community

Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups

The process for identifying and prioritizing community health needs and services to meet the community health needs

The process for consulting with persons representing the community’s interests

Information gaps that limit the hospital facility’s ability to assess the community’s health needs

Other (describe in Part VI)

Indicate the tax year the hospital facility last conducted a CHNA: 20 10

In conducting its most recent CHNA, did the hospital facility take into account input from representatives of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted ....................

Yes

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI................................

Yes

Did the hospital facility make its CHNA report widely available to the public? .............

Yes

If “Yes,” indicate how the CHNA report was made widely available (check all that apply):

Hospital facility’s website

Available upon request from the hospital facility

Other (describe in Part VI)

If the hospital facility addressed needs identified in its most recently conducted CHNA, indicate how (check all that apply to date):

Adoption of an implementation strategy that addresses each of the community health needs identified through the CHNA

Execution of the implementation strategy

Participation in the development of a community-wide plan

Participation in the execution of a community-wide plan

Inclusion of a community benefit section in operational plans

Adoption of a budget for provision of services that address the needs identified in the CHNA

Prioritization of health needs in its community

Prioritization of services that the hospital facility will undertake to meet health needs in its community

Other (describe in Part VI)

Did the hospital facility address all of the needs identified in its most recently conducted CHNA? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs ........

Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)? ...........................

If "Yes" to line 8a, did the organization file Form 4720 to report the section 4959 excise tax? ......

If "Yes" to line 8b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $

Schedule H (Form 990) 2012

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Part VFacility Information (continued)

Financial Assistance Policy			Yes	No
9	Did the hospital facility have in place during the tax year a written financial assistance policy that:
	Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care?	9	Yes
10	Used federal poverty guidelines (FPG) to determine eligibility for providing free care?...........	10	Yes
	If "Yes," indicate the FPG family income limit for eligibility for free care: 200.% If "No," explain in Part VI the criteria the hospital facility used.
11	Used FPG to determine eligibility for providing discounted care?.................	11	Yes
	If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 400.% If "No," explain in Part VI the criteria the hospital facility used.
12	Explained the basis for calculating amounts charged to patients?.................	12	Yes
	If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a	Income level
b	Asset level
c	Medical indigency
d	Insurance status
e	Uninsured discount
f	Medicaid/Medicare
g	State regulation
h	Other (describe in Part VI)
13	Explained the method for applying for financial assistance?...................	13	Yes
14	Included measures to publicize the policy within the community served by the hospital facility?.......	14	Yes
	If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a	The policy was posted on the hospital facility’s website
b	The policy was attached to billing invoices
c	The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d	The policy was posted in the hospital facility’s admissions offices
e	The policy was provided, in writing, to patients on admission to the hospital facility
f	The policy was available upon request
g	Other (describe in Part VI)
Billing and Collections
15	Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?.......	15	Yes
16	Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a	Reporting to credit agency
b	Lawsuits
c	Liens on residences
d	Body attachments
e	Other similar actions (describe in Part VI)
17	Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?..........	17		No
	If “Yes,” check all actions in which the hospital facility or a third party engaged:
a	Reporting to credit agency
b	Lawsuits
c	Liens on residences
d	Body attachments
e	Other similar actions (describe in Part VI)

Schedule H (Form 990) 2012

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Part VFacility Information (continued)

Indicate which efforts the hospital facility made before initiating any of the actions listed in line 17 (check all that apply):

Notified individuals of the financial assistance policy on admission

Notified individuals of the financial assistance policy prior to discharge

Notified individuals of the financial assistance policy in communications with the patients regarding the patients’ bills

Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy

Other (describe in Part VI)

Policy Relating to Emergency Medical Care

Yes

Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?..........

Yes

If “No,” indicate why:

The hospital facility did not provide care for any emergency medical conditions

The hospital facility’s policy was not in writing

The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)

Other (describe in Part VI)

Charges to Individuals Eligible for Assistance under the FAP (FAP-Eligible Individuals)

Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.

The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged

The hospital facility used the average of its three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged

The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged

Other (describe in Part VI)

During the tax year, did the hospital facility charge any FAP-eligible individuals to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care? ............................

If “Yes,” explain in Part VI.

During the tax year, did the hospital facility charge any FAP-eligible individuals an amount equal to the gross charge for any service provided to that individual? .........................

If “Yes,” explain in Part VI.

Schedule H (Form 990) 2012

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Part VFacility Information (continued)

Section C. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility (list in order of size, from largest to smallest) How many non-hospital health care facilities did the organization operate during the tax year?23
Name and address		Type of Facility (describe)
1	ORANGE PRIMARY CARE CLINIC 455 SOUTH MAIN STREET ORANGE,CA92868	clinic
2	CLINICA CHOC PARA NINOS-SANTA ANA 406 SOUTH MAIN STREET SANTA ANA,CA92701	clinic
3	SANTA ANA BOYS AND GIRLS CLUB 1000 WEST HIGHLAND SANTA ANA,CA92703	clinic
4	ASTHMA BREATHMOBILE 455 SOUTH MAIN STREET ORANGE,CA92868	clinic
5	COSTA MESA CLINIC 136 BROADWAY COSTA MESA,CA92627	clinic
6	GARDEN GROVE CLINIC 10602 CHAPMAN AVENUE GARDEN GROVE,CA92840	clinic
7	CHOC CHILDREN'S ENDOCRINE & DIABETES CTR 520 SUPERIOR AVE SUITE 160 NEWPORT BEACH,CA92663	clinic
8	CHOC CHILDREN'S HOSPITAL SPECIALTY CLINICS 455 SOUTH MAIN S ORANGE,CA92868	clinics
9	CHOC UROLOGY CENTER SUITE 100 505 S MAIN ST ORANGE,CA92868	clinic
10	PEDIATRIC PSYCHOLOGY 1120 W LA VETA AVENUE SUITE 470 ORANGE,CA92868	CLINIC
11	BLOOD&DONORAPHERESIS 505 SOUTH MAIN STREET SUITE 185 ORANGE,CA92868	CLINIC
12	CHOC NEUROLOGY CENTER 1120 W LA VETA AVENUE SUITE 125 ORANGE,CA92868	CLINIC
13	CORONA CARDIOLOGY & GASTROENTEROLOGY 260 E Ontario Avesuite 204 corona,CA92882	clinic
14	Fountain Valley GASTROENTEROLOGY 11100 Warner Ave suite 252 Fountain Valley,CA92708	CLINIC
15	Irvine CARDIOLOGY 16300 SAND CANYON AVE SUITE 811 IRVINE,CA92618	CLINIC
16	Laguna Niguel OUTPATIENT OFFICE 23521 Paseo de Valencia Suite 200 Laguna Hills,CA92653	CLINIC
17	Mission Viejo CLINIC 27800 Medical Center Road BLDG 2 Mission Viejo,CA92691	CLINIC
18	Newport Beach OTOLARYNGOLOGY 446 Old Newport Blvd Newport Beach,CA92663	CLINIC
19	Children's Specialists Cardiology 505 S Main St Suite 200 ORANGE,CA92868	CLINIC
20	Children's Specialists Pediatric Surgery 505 S Main St Suite 225 Orange,CA92868	CLINIC
21	Batavia Woods Medical Center 725 W La Veta Suite 100 Orange,CA92868	CLINIC
22	Children's Specialists Opthamology 392 S Glassell Suite 100 Orange,CA92866	CLINIC
23	Children's Specialists Otolaryngology 1010 W La Veta Suite 640 ORANGE,CA92868	CLINIC

Schedule H (Form 990) 2012

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Part VI

Supplemental Information

Complete this part to provide the following information.

1	Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II; Part III, lines 4, 8, and 9b; Part V, Section A; and Part V, Section B, lines 1j, 3, 4, 5c, 6i, 7, 10, 11, 12h, 14g, 16e, 17e, 18e, 19c, 19d, 20d, 21, and 22.
2	Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any needs assessments reported in Part V, Section B.
3	Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4	Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5	Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6	Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7	State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.
8	Facility reporting group(s). If applicable, for each hospital facility in a facility reporting group provide the descriptions required for Part V, Section B, lines 1j, 3, 4, 5c, 6i, 7, 10, 11, 12h, 14g, 16e, 17e, 18e, 19c, 19d, 20d, 21, and 22.

Identifier	ReturnReference	Explanation
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		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 fiscal year 2012, the CMS issued final required federal approval for the fee for service portion of a 30 month California Provider Fee Program that, combined with federal matching funds, has been used to provide supplemental Medi-Cal payments to hospitals in the state. In fiscal year 2013, CHOC recognized revenues under this program of $24,911,000 and Provider Fees and other expenses totaling $8,866,000. The CMS also issued final approval in fiscal 2013 for the managed care portion of this 30 month Provider Fee program. The approvals were in May 2013 for the period July 1, 2011 to June 30, 2012 and in June 2013 for the period July 1, 2012 to June 30, 2013. CHOC recognized revenues of $26,368,000 for each of the 12 month periods for a total revenue of $52,736,000 and Provider Fees and other expenses of $9,385,000 for each 12 month period for total expenses of $18,770,000. All of the amounts RELATED TO THE TWO YEAR PERIOD above were recognized as net patient revenue and operating expenses, respectively, in the year ended June 30, 2013 RESULTING IN LESS UNREIMBURSED MEDI-CAL THAN IN PREVIOUS YEARS.
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 88 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 1		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 IS effective with CHOC's 2012 Form 990. SCHEDULE H, PART III, LINE 2 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. 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 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 .2382. 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 (FAP) 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 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, 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 V, LINE 3 The Community Benefits Key Informant Survey, which was conducted in September 2010 and updated in 2013, targeted local health care leaders to determine community opinions on the health needs in Orange County, as well as the barriers faced by patients in accessing health care. Those who completed the survey included 21 persons from Health Provider Community Benefit Organizations, 14 from County or City Governments, 13 from hospitalS, 11 from Community Clinics/ FQHC's, and 8 from Health Advocacy/Education Organizations. The SURVEY also included health care providers, educators, and researchers. SCHEDULE H, PART V, LINE 4 The september 2010 Health Needs Assessment was conducted in collaboration with nine Orange County not-for-profit hospitals, including Hoag Memorial Hospital Presbyterian, St. Joseph Hospital, Mission Hospital, St. Jude Hospital, Kaiser Foundation Hospital, University of California Irvine Medical Center, CHOC Children's (Orange) and CHOC Children's at Mission Hospital. SCHEDULE H, PART V, LINE 5 THE CHNA REPORT IS AVAILABLE AT HTTP://WWW.CHOC.ORG/ABOUT/ SCHEDULE H, PART V, LINE 7 One of the seven areas of high priority need identified in the CHNA was "Child Health and Academic Achievement". CHOC's core mission is the provision of health care to the pediatric population; while CHOC did not explicitly develop plans to address child health and academic achievement, per se, CHOC does provide services that impact a child's academic achievement. 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 a blended Medi-Cal rate. This rate is the percentage of charges based on the contracted Medi-Cal reimbursement rate plus the additional disproportionate share (DSH) reimbursement received by the facility. The total reimbursement is compared to gross charges and the percentage of overall reimbursement is the maximum charged to FAP-eligible individuals. SCHEDULE H PART VI LINE 2 NEEDS ASSESSMENT: IN ADDITION TO THE TRI-ANNUAL COMMUNITY HEALTH NEEDS ASSESSMENT, CHOC 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, CHOC 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, 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 73% 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. 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 3.12 MILLION, ACCORDING TO 2013 ESTIMATES, MAKING IT THE THIRD LARGEST COUNTY IN CALIFORNIA. THE MEDIAN AGE IS 36.8, AND CHILDREN UP TO 17 YEARS OF AGE MAKE UP 23.8% OF THE TOTAL POPULATION. THE LARGEST RACE/ETHNICITY SUBGROUP IS WHITE, AT 43%. LATINOS/HISPANICS ARE 34% OF THE POPULATION. ASIANS/PACIFIC ISLANDERS ARE 19% OF THE TOTAL, AND THE AFRICAN AMERICAN POPULATION REPRESENTS APPROXIMATELY 2% OF THE TOTAL ORANGE COUNTY POPULATION. SOCIOECONOMIC PROFILE THE U.S. CENSUS AMERICAN COMMUNITY SURVEY FOR 2012 INDICATED THAT 17.9% OF CHILDREN UNDER THE AGE OF 18 IN ORANGE COUNTY, 23.8% IN CALIFORNIA, AND 22.6% IN THE U.S. WERE BELOW THE POVERTY LEVEL. THIS SURVEY ALSO INDICATED THAT 12.9% OF THE ORANGE COUNTY POPULATION OF ALL AGES WERE LIVING BELOW THE POVERTY LEVEL. THE U.S. BUREAU OF THE CENSUS ESTIMATED THAT IN 2012, THE COUNTY'S MEDIAN HOUSEHOLD INCOME WAS $71,983. The percentage of the hospital's patients who are uninsured or Medicaid recipients was 59.6%. THERE ARE 31 OTHER HOSPITALS SERVING THE COMMUNITY: ANAHEIM GENERAL HOSPITAL - ANAHEIM, CALIFORNIA ANAHEIM REGIONAL MEDICAL CENTER - ANAHEIM, CALIFORNIA CHAPMAN MEDICAL CENTER - ORANGE, CALIFORNIA CHILDREN'S HOSPITAL AT MISSION - MISSION VIEJO, 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 - 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 VIE
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 OF EXCELLENCE, THE CHOC HEART, NEUROSCIENCE, hyundai cancer institute AND ORTHOPAEDIC INSTITUTES. CHOC ALSO HAS A RESEARCH INSTITUTE PERFORMING BASIC SCIENCE AND CLINICAL RESEARCH. THROUGH ITS JOINT RESIDENCY PROGRAM WITH UC IRVINE, THE ORGANIZATION ALSO TRAINS TOMORROW'S PHYSICIANS. THE COMMUNITY BENEFIT PLAN FOR THE FISCAL YEAR ENDING JUNE 30, 2013, 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. DURING THE REPORTING YEAR ENDED JUNE 30, 2013, THE ORGANIZATION COMPLETED 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 OPENED ITS DOORS TO PATIENTS IN 2013. THE NEW TOWER INCLUDEs INPATIENT AND OUTPATIENT CARE FOR CHILDREN, WITH EMERGENCY DEPARTMENT, OPERATING ROOMS, A MEDICAL LABORATORY, PATHOLOGY DEPARTMENT AND IMAGING AND RADIOLOGY SERVICES. THERE IS ALSO A LARGE CONFERENCE AREA TO ACCOMMODATE AND SUPPORT SOME OF THE ORGANIZATION'S TEACHING ACTIVITIES. THE CHOC ENDOWMENT FUNDS ARE IN PART 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 88 BENEFIT SERVICES PROVIDED BY CHOC AND CCMH IN FISCAL YEAR 2013 IS $41.6 MILLION. OF THESE DOLLARS, 31.3% ($13 MILLION) SERVED THE ECONOMICALLY DISADVANTAGED. THE ECONOMIC VALUE OF SAVINGS FROM NOT-FOR-PROFIT STATUS IS $ 22.6 MILLION. THUS, THE HOSPITALS RETURN $1.85 IN COMMUNITY BENEFITS FOR EACH $1 SAVED FROM TAX-EXEMPT STATUS. IN ADDITION TO THE $41.6 MILLION IN BENEFITS PROVIDED FOR BY THE HOSPITALS REFERENCED ABOVE, BOARD MEMBERS, PHYSICIANS, EMPLOYEES AND VOLUNTEERS CONTRIBUTED 43,000 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 ANNUALLY IN THE STATE OF CALIFORNIA.

Schedule H (Form 990) 2012

Additional Data

Software ID:
Software Version:

- TIN:

Schedule J
(Form 990)

Department of the Treasury
Internal Revenue Service

Compensation Information

For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet

Complete if the organization answered "Yes" to Form 990,
Part IV, question 23.
SchJMediumBullet

Attach to Form 990. SchJMediumBullet

See separate instructions.

OMB No. 1545-0047

2012

Open to Public Inspection

Name of the organization

Children's Hospital of Orange County

Employer identification number

95-2321786

Part I

Questions Regarding Compensation

Yes

Check the appropiate box(es) if the organization provided any of the following to or for a person listed in Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.

First-class or charter travel Housing allowance or residence for personal use

Travel for companions Payments for business use of personal residence

Tax idemnification and gross-up payments Health or social club dues or initiation fees

Discretionary spending account Personal services (e.g., maid, chauffeur, chef)

If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain....

Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all officers,
directors, trustees, and the CEO/Executive Director, regarding the items checked in line 1a? .......

Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

Form 990 of other organizations Approval by the board or compensation committee

During the year, did any person listed in Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:

Receive a severance payment or change-of-control payment? ................

Yes

Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........

Yes

Participate in, or receive payment from, an equity-based compensation arrangement? .........

If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.

Only 501(c)(3) and 501(c)(4) organizations only must complete lines 5-9.

For persons listed in Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:

The organization? ...........................

Any related organization? .........................

If "Yes," to line 5a or 5b, describe in Part III.

For persons listed in Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:

The organization? ...........................

Any related organization? .........................

If "Yes," to line 6a or 6b, describe in Part III.

For persons listed in Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............

Were any amounts reported in Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................

If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50053T

Schedule J (Form 990) 2012

Page 2

Part II

Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.

For each individual whose compensation must be reported in Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions, on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.
Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.

(A) Name and Title		(B) Breakdown of W-2 and/or 1099-MISC compensation			(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation reported as deferred in prior Form 990
(A) Name and Title		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation reported as deferred in prior Form 990
(1)KIMBERLY C CRIPEDirector/President	(i) (ii)	0 751,203	0 236,120	0 233,350	0 57,454	0 22,864	0 1,300,991	0 78,602
(2)DEBRA MATHIASEVP/COO	(i) (ii)	0 436,877	0 117,998	0 181,921	0 6,145	0 11,573	0 754,514	0 80,355
(3)KERRI RUPPERT SCHILLERCFO/Assistant Secretary	(i) (ii)	0 456,740	0 101,469	0 53,281	0 103,915	0 22,864	0 738,269	0 79,435
(4)Matthew E NiedzwieckiVP ANCILLARY/SUPPORT SERVICE	(i) (ii)	235,643 0	53,528 0	32,446 0	46,468 0	16,059 0	384,144 0	39,241 0
(5)Jay GabrielGENERAL COUNSEL	(i) (ii)	317,869 0	65,438 0	40,981 0	58,572 0	22,829 0	505,689 0	47,725 0
(6)MARK L HEADLANDVP/CHIEF INFORMATION OFFICER	(i) (ii)	279,667 0	51,277 0	82,624 0	27,980 0	6,104 0	447,652 0	51,042 0
(7)Waldo RomeroVP FACILITIES DESIGN/CONSTR.	(i) (ii)	266,622 0	55,913 0	39,409 0	50,609 0	11,668 0	424,221 0	41,995 0
(8)Hale Kuhlmanv.p., speciality physician srv	(i) (ii)	215,483 0	35,077 0	18,120 0	22,861 0	16,059 0	307,600 0	0 0
(9)Susan BurrowsVP HUMAN RESOURCES	(i) (ii)	250,174 0	53,667 0	35,393 0	47,641 0	16,466 0	403,341 0	37,187 0
(10)JANET LANSINGVP MARKETING/COMMUNICATIONS	(i) (ii)	222,871 0	41,135 0	69,451 0	22,218 0	11,634 0	367,309 0	18,132 0
(11)Maria Minon MDVP/CMO	(i) (ii)	436,368	87,107	113,146	34,200	8,138	678,959	34,260
(12)Louise WhiteVP & CNO	(i) (ii)	260,532 0	38,802 0	32,450 0	46,497 0	11,668 0	389,949 0	0 0

Schedule J (Form 990) 2012

Page 3

Part III

Supplemental Information

Complete this part to provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II.
Also complete this part for any additional information.

Identifier	Return Reference	Explanation
SEVERANCE ARRANGEMENTS,PART I, LINE 4A	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 calender 2012. the payment was received by Debra Mathias ($125,969).
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 2012: Ms. Cripe ($149,013), Dr. Minon ($64,921), Mr. Headland ($41,299), and Ms. Lansing ($33,912).
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 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, CRC Real Estate Corporation and Children's Hospital at Mission (all IRC Section 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 IRC SECTION 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 BUSINESS AFFAIRS.

Schedule J (Form 990) 2012

Additional Data

Software ID:
Software Version:

- TIN:

Schedule K
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Information on Tax Exempt Bonds

Complete if the organization answered "Yes" to Form 990, Part IV, line 24a. Provide descriptions,
explanations, and any additional information in Part VI.
SchKMediumBullet

Attach to Form 990. SchKMediumBullet

See separate instructions.

OMB No. 1545-0047

2012

Open to Public
Inspection

Name of the organization
Children's Hospital of Orange County

Employer identification number
95-2321786

Part I

Bond Issues

(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	(g) Defeased		(h) On behalf of issuer		(i) Pool financing
(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	Yes	No	Yes	No	Yes	No
A	CALIFORNIA HEALTH FACILITIES FINANCING AUTHORITY	52-1643828	13033LBP1	06-30-2009	137,686,600	CONSTRUCT A HOSPITAL		X		X		X
B	CALIFORNIA HEALTH FACILITIES FINANCING AUTHORITY	52-1643828	13033LBT3	06-30-2009	127,800,000	CONSTRUCT A HOSPITAL		X		X		X
C	CALIFORNIA HEALTH FACILITIES FINANCING AUTHORITY	52-1643828	13033LRT6	11-03-2011	105,003,490	CONSTRUCT A HOSPITAL		X		X		X

Part II

Proceeds

	A		B		C		D
	1 Amount of bonds retired . . . . . . . . . . . . . .	0		0		0
2 Amount of bonds legally defeased . . . . . . . . . . .	0		0		0
3 Total proceeds of issue . . . . . . . . . . . . . .	137,800,764		128,231,052		105,081,393
4 Gross proceeds in reserve funds . . . . . . . . . . . .	10,852,054		0		0
5 Capitalized interest from proceeds . . . . . . . . . . .	12,342,642		15,470,246		7,460,489
6 Proceeds in refunding escrows . . . . . . . . . . . .	0		0		0
7 Issuance costs from proceeds . . . . . . . . . . . .	1,838,778		1,382,488		0
8 Credit enhancement from proceeds . . . . . . . . . . .	0		0		0
9 Working capital expenditures from proceeds . . . . . . . . .	0		0		0
10 Capital expenditures from proceeds . . . . . . . . . . .	17,244,250		126,850,189		105,081,328
11 Other spent proceeds . . . . . . . . . . . . . .	107,849,999		0		0
12 Other unspent proceeds . . . . . . . . . . . . . .	0		0		0
13 Year of substantial completion . . . . . . . . . . . .	2013		2013		2013
	Yes	No	Yes	No	Yes	No	Yes	No
14 Were the bonds issued as part of a current refunding issue? . . . . .		X		X		X
15 Were the bonds issued as part of an advance refunding issue? . . . . .	X			X		X
16 Has the final allocation of proceeds been made? . . . . . . . .		X		X		X
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? . . . . . . . . . . . . . .	X		X		X

Part III

Private Business Use

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? . . . . . . .		X		X		X
2 Are there any lease arrangements that may result in private business use of bond-financed property? . . . . . . . . .		X		X		X

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50193E

Schedule K (Form 990) 2012

Page 2

Part III

Private Business Use (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
3a Are there any management or service contracts that may result in private business use of bond-financed property? . . . . . . . . . . . .	X		X		X
b If "Yes" to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property? . . . . . . . . . . . . . . . .	X		X		X
c Are there any research agreements that may result in private business use of bond-financed property? . . . . . . . . . . . . . . .		X		X		X
d If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property? .
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government . .	0%		0%		0%		%
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government . . . . . . .	%		%		%		%
6 Total of lines 4 and 5 . . . . . . . . . . . . . . .	%		%		%		%
7 Does the bond issue meet the private security or payment test? . . . . .		X		X		X
8a Has there been a sale or disposition of any of the bond financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were issued?. . . . . . . . . . . . . . . . .		X		X		X
b If “Yes” to line 8a, enter the percentage of bond-financed property sold or disposed of.	%		%		%		%
c If “Yes” to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? . . . . . . . . . . . . .		X		X		X
9 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under Regulations sections 1.141-12 and 1.145-2?	X		X		X

Part IV

Arbitrage

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Has the issuer filed Form 8038-T? . . . . .		X		X		X
2 If "No" to line 1, did the following apply? . . . .
a Rebate not due yet? . . . . . . . .		X		X		X
b Exception to rebate? . . . . . . . .		X		X		X
c No rebate due? . . . . . . . . . .	X		X		X
If you checked "No rebate due" in line 2c, provide in Part VI the date the rebate computation was performed
3 Is the bond issue a variable rate issue? . . . .		X	X			X
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?		X	X			X
b Name of provider . . . . . . . . .	0		MORGAN STANLEY		0
c Term of hedge . . . . . . . . . .	30.		30.
d Was the hedge superintegrated? . . . . . .		X		X
e Was a hedge terminated? . . . . . . .		X		X

Schedule K (Form 990) 2012

Page 3

Part IV

Arbitrage (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
5a Were gross proceeds invested in a guaranteed investment contract (GIC)? . . . . . . . . .		X		X		X
b Name of provider . . . . . . . . .	0		0		0
c Term of GIC . . . . . . . . . .
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? . . . . .
6 Were any gross proceeds invested beyond an available temporary period? . . . . . . . .		X		X		X
7 Has the organization established written procedures to monitor the requirements of section 148? . . .	X		X		X

Part V

Procedures To Undertake Corrective Action

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations?	X		X		X

Part VI

Supplemental Information. Complete this part to provide additional information for responses to questions on Schedule K (see instructions).

Identifier	Return Reference	Explanation
PART II, LINE 3	0	CUMULATIVE INTEREST EARNED ON ISSUE A: 114,164 CUMULATIVE INTEREST EARNED ON ISSUE B: 431,052 CUMULATIVE INTEREST EARNED ON ISSUE C: 77,903
part iv, line 2c	0	date rebate computation was performed: report dated 8/27/13 as of 6/30/13.

Schedule K (Form 990) 2012

Additional Data

Software ID:
Software Version:

- TIN:

Schedule L
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Transactions with Interested Persons

Complete if the organization answered
"Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c,
or Form 990-EZ, Part V, line 38a or 40b.
MediumBullet

Attach to Form 990 or Form 990-EZ. MediumBullet

See separate instructions.

OMB No. 1545-0047

2012

Open to Public Inspection

Name of the organization

Children's Hospital of Orange County

Employer identification number

95-2321786

Part I

Excess Benefit Transactions (section 501(c)(3) and section 501(c)(4) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.

1(a) Name of disqualified person	(c) Description of transaction	(d) Corrected?
1(a) Name of disqualified person	(c) Description of transaction	Yes	No

Enter the amount of tax incurred by organization managers or disqualified persons during the year under section 4958. ........................... Bullet Image

Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ....... Bullet Image

Part II

Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990-EZ, Part V, line 38a, or Form 990, Part IV, line 26; or if the organization reported an amount on Form 990, Part X, line 5, 6, or 22

(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	(d) Loan to or from the organization?		(e)Original principal amount	(f)Balance due	(g) In default?		(h) Approved by board or committee?		(i)Written agreement?
(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	To	From	(e)Original principal amount	(f)Balance due	Yes	No	Yes	No	Yes	No






Total ...... $

Part III

Grants or Assistance Benefitting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of assistance	(d) Type of assistance	(e) Purpose of assistance

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 50056A

Schedule L (Form 990 or 990-EZ) 2012

Page 2

Part IV

Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of transaction	(d) Description of transaction	(e) Sharing of organization's revenues?
(a) Name of interested person		(c) Amount of transaction	(d) Description of transaction	Yes	No
(1) MORAN ROWEN AND DORSEY INC	MARSHALL ROWEN M.D., BOD	260,000	MEDICAL SERVICES		No
(2) Allied Anesthesia	PHILLIP RICHARDSON, M.D.	479,954	MEDICAL SERVICES		No
(3) PEDIATRIC SUBSPECIALTY FACULTY INC	VIJAY DHAR M.D.	49,522,717	SEE PART V		No

Part V

Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule L (see instructions).

Identifier	Return Reference	Explanation
SCHEDULE L, PART IV	BUSINESS TRANSACTION WITH INTERESTED PERSON	Dr. Vijay Dahr, a board member of the hospital, is also an officer of Pediatric Subspecialty Faculty, Inc. (PSF). PSF provides professional and administrative services to CHOC's medical and research foundation and to the hospital. CHOC's medical and research foundation includes 21 medical and surgical sub-specialties and operates as a division of CHOC.

Schedule L (Form 990 or 990-EZ) 2012

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
MediumBullet

Attach to Form 990 or 990-EZ.

OMB No. 1545-0047

2012

Open to Public
Inspection

Name of the organization

Children's Hospital of Orange County

Employer identification number

95-2321786

Identifier	Return Reference	Explanation
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, WHICH INCLUDES A 28-BED HEMATOLOGY/ONCOLOGY UNIT. THE UNIT OFFERS THE LATEST IN MEDICAL AND SURGICAL ONCOLOGY INCLUDING CHEMOTHERAPY, RADIOTHERAPY AND BLOOD AND MARROW TRANSPLANTATION. IN ADDITION, CHOC OFFERS A 22 CHAIR OUTPATIENT INFUSION CENTER. (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 66-BED NICU AT CHOC INCLUDES TWO EIGHT-BED NURSERIES, TWO NINE-BED NURSERIES, SIX ISOLATION ROOMS, 12 BEDS THAT PROVIDE PRIVATE ROOMING, A TWO-BED EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO) UNIT AND A 12-BED MOTHER-BABY UNTI WITHIN SAINT JOSEPH HOSPITAL OF ORANGE. 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 HAS A DESIGNATED SMALL BABY UNIT OF 12 BEDS THAT 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 INCLUDES TWO SPECIAL PROCEDURE TREATMENT ROOMS THAT ENABLE PHYSICIANS TO PERFORM SURGERY ON CHILDREN WHO OTHERWISE COULD NOT BE TRANSPORTED OUT OF THE UNIT AND INTO THE OPERATING ROOMS. ALL OF THE CVICU ROOMS ARE OUTFITTED WITH TECHNOLOGY TO MONITOR CHILDREN AFTER COMPLEX OPERATIONS AND SURGICAL PROCEDURES. (5) IN MARCH 2013, CHOC COMPLETED AND OPENED SERVICES IN A NEW STATE-OF-THE-ART PATIENT TOWER. ALL INPATIENT AND OUTPATIENT ANCILLARY SERVICES PREVIOUSLY PURCHASED FROM SAINT JOSEPH HOSPITAL OF ORANGE ARE NOW AVAILABLE WITHIN CHOC'S FACILITIES. THE SERVICES INCLUDE FULL CLINICAL LABORATORY SERVICES, AN EMERGENCY DEPARTMENT DEDICATED SOLELY TO PEDIATRIC CARE, FULL IMAGING SERVICES AND SURGICAL SERVICES, INCLUDING CATH LAB AND FULL CARDIAC CARE. THESE DEDICATED SERVICES HAVE GREATLY ENHANCED THE TOTAL CARE GIVEN TO CHOC'S PATIENTS. (6) 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 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 NIOS 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 BREATH MOBILES 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 11b - 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. 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 closed sessions with no staff members present. This review was last performed in 2013. 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 IX, LINE 11G	OTHER FEES FOR SERVICES	TOTAL PROGRAM MANAGEMENT SERVICE Physician Services 54,289,765 48,860,789 5,428,976 Medical Services 17,161,963 15,445,766 1,764,191 Collection Agency fees 1,168,296 1,051,467 116,829 Misc Purchased Services 15,318,040 13,786,237 1,531,803 Other Professional Fees 4,290,699 3,861,630 429,069 Janitorial services 33,837 30,454 3,383 Security Services 297,037 267,334 29,703 Courier Services 54,010 48,605 5,405
RECONCILIATION OF NET ASSETS	FORM 990, PART XI, LINE 5	CHANGE IN BENEFICIAL INTEREST IN CHOC FOUNDATION $ 20,244,756

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2012

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

Complete if the organization answered "Yes" to Form 990, Part IV, line 33, 34, 35, 36, or 37.
MediumBullet

Attach to Form 990. MediumBullet

See separate instructions.

OMB No. 1545-0047

2012

Open to Public Inspection

Name of the organization

Children's Hospital of Orange County

Employer identification number

95-2321786

Part I

Identification of Disregarded Entities (Complete if the organization answered "Yes" to Form 990, Part IV, line 33.)

(a) Name, address, and EIN (if applicable) of disregarded entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Total income	(e) End-of-year assets	(f) Direct controlling entity

Part II

Identification of Related Tax-Exempt Organizations (Complete if the organization answered "Yes" to Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.)

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No
(1) CHILDREN'S HEALTHCARE OF CALIFORNIA(CHC) 1201 West La Veta Avenue ORANGE,CA92868 33-0265266	HEALTH CARE	CA	501(c)(3)	7	NA		No
(2) Children's Hospital at Mission 1201 West La Veta Avenue ORANGE,CA92868 33-0528802	HEALTH CARE	CA	501(c)(3)	3	CHC		No
(3) CHOC FOUNDATION 455 S MAIN STREET ORANGE,CA92868 95-6097416	Fund Raising	CA	501(c)(3)	7	CHC		No
(4) CRC REAL ESTATE CORPORATION 455 S MAIN STREET ORANGE,CA92868 33-0612565	REAL ESTATE	CA	501(c)(3)	11	CHC		No
(5) CHOC Thrift Stores Inc 455 S MAIN STREET orange,CA92868 33-0266422	Fund Raising	CA	501(c)(3)	9	CHC		No

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50135Y

Schedule R (Form 990) 2012

Page 2

Part III

Identification of Related Organizations Taxable as a Partnership (Complete if the organization answered "Yes" to Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.)

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

Part IV

Identification of Related Organizations Taxable as a Corporation or Trust (Complete if the organization answered "Yes" to Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.)

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(h) Percentage ownership	(i) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets		Yes	No
(1) ORANGE COUNTY MEDICAL RECIPROCAL INS CO 2999 North 4th Street Suite 250 phoenix,AZ85108 20-1620666	insurance	AZ	na	c corp	54,452	3,049,467	50.000 %	Yes

Schedule R (Form 990) 2012

Page 3

Part V

Transactions With Related Organizations (Complete if the organization answered "Yes" to Form 990, Part IV, line 34, 35b, or 36.)

Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.

Yes

1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?

a Receipt of (i) interest (ii) annuities (iii) royalties or (iv) rent from a controlled entity . . . . . . . . . . . . . . . . . . . . . . .

b Gift, grant, or capital contribution to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

c Gift, grant, or capital contribution from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

d Loans or loan guarantees to or for related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

e Loans or loan guarantees by related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

f Dividends from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

g Sale of assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

h Purchase of assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

i Exchange of assets with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

j Lease of facilities, equipment, or other assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .

k Lease of facilities, equipment, or other assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

l Performance of services or membership or fundraising solicitations for related organization(s) . . . . . . . . . . . . . . . . . . . .

m Performance of services or membership or fundraising solicitations by related organization(s) . . . . . . . . . . . . . . . . . . . .

Yes

n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) . . . . . . . . . . . . . . . . . . . . .

o Sharing of paid employees with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

p Reimbursement paid to related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

q Reimbursement paid by related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

r Other transfer of cash or property to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

s Other transfer of cash or property from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.

(a) Name of other organization	(b) Transaction type (a-s)	(c) Amount involved	(d) Method of determining amount involved
(1) ORANGE COUNTY MEDICAL RECIPROCAL INS CO	K	948,657	PER AGREEMENT

Schedule R (Form 990) 2012

Page 4

Part VI

Unrelated Organizations Taxable as a Partnership (Complete if the organization answered "Yes" to Form 990, Part IV, line 37.)

Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.

(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(e) Are all partners section 501(c)(3) organizations?		(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

Schedule R (Form 990) 2012

Page 5

Part VII

Supplemental Information

Complete this part to provide additional information for responses to questions on Schedule R (see instructions).

Identifier	Return Reference	Explanation
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.

Additional Data

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1	Briefly describe the organization’s mission or most significant activities: TO NURTURE, ADVANCE AND PROTECT THE HEALTH AND WELL-BEING OF CHILDREN.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	14
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	10
5	Total number of individuals employed in calendar year 2011 (Part V, line 2a) ......	5	2,962
6	Total number of volunteers (estimate if necessary) .............	6	1,010
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	128,409
b	Net unrelated business taxable income from Form 990-T, line 34 .........	7b	22,107

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	24,244,487	21,994,560
9	Program service revenue (Part VIII, line 2g) .........	495,929,988	521,014,460
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	2,436,624	3,629,775
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	1,251,846	2,154,307
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)...................	523,862,945	548,793,102
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	27,220,000	0
14	Benefits paid to or for members (Part IX, column (A), line 4).....	0	0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	185,063,132	213,265,927
16a	Professional fundraising fees (Part IX, column (A), line 11e).....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	285,831,348	306,509,163
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	498,114,480	519,775,090
19	Revenue less expenses. Subtract line 18 from line 12.......	25,748,465	29,018,012
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	1,011,574,818	1,052,908,254
21	Total liabilities (Part X, line 26).............	534,124,235	512,692,429
22	Net assets or fund balances. Subtract line 21 from line 20.....	477,450,583	540,215,825

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 473,438,757 including grants of $ ) (Revenue $ 521,014,460 )
	CHILDREN'S HOSPITAL OF ORANGE COUNTY - PROVIDES SPECIALIZED PEDIATRIC SERVICES FOR THE CARE OF CHILDREN. DURING THIS YEAR, THERE WERE 58,087 DAYS OF INPATIENT CARE; 52,338 EMERGENCY ROOM VISITS; 7,916 SURGERIES;1,713 DAY HEALTH VISITS AND 135,957 PRIMARY AND SPECIALTY CARE CLINIC VISITS.OUR CALIFORNIA MEDICAL FOUNDATION PROVIDED 279,511 PEDIATRIC SUBSPECIALTY SERVICE ENCOUNTERS TO PATIENTS THROUGHOUT ORANGE COUNTY AND BEYOND. SEE SCHEDULE O FOR ADDITIONAL INFORMATION.SEE OUR COMPLETE COMMUNITY BENEFIT REPORT ON OUR WEBSITE AT WWW.CHOC.ORG.

4b	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4c	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4d	Other program services (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses473,438,757

(A) Name and Title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)			(D) Reportable compensation from the organization (W- 2/1099-MISC)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(A) Name and Title
(1) KIMBERLY C CRIPE........................................................................ Director/President	30.0 .......................10.0	X	X		0	1,220,673	80,318
(2) VIJAY DHAR MD........................................................................ DIRECTOR	2.0 .......................1.0	X
(3) David Dukes........................................................................ DIRECTOR/SECRETARY	2.0 .......................1.0	X	X		0	0	0
(4) Tim Ristoff........................................................................ DIRECTOR	1.0 .......................2.0	X
(5) MARSHALL ROWEN MD........................................................................ DIRECTOR	1.5 .......................3.0	X
(6) MARK STEVENS........................................................................ DIRECTOR/CHAIR	4.0 .......................3.0	X	X
(7) Thomas Tierney........................................................................ DIRECTOR	2.0 .......................1.5	X			0	0	0
(8) Dick Ackerman........................................................................ DIRECTOR	1.0 .......................1.0	X			0	0	0
(9) Ralph Clayman MD........................................................................ DIRECTOR	2.0 .......................1.5	X			0	0	0
(10) MICHAEL COGLAZIER........................................................................ DIRECTOR	1.0 .......................1.0	X			0	0	0
(11) Janet T Davidson........................................................................ DIRECTOR	2.0 .......................2.5	X			0	0	0
(12) JEFF ELGHANAYAN........................................................................ DIRECTOR/2ND VICE CHAIR	2.5 .......................3.5	X	X
(13) DOuglas McCombs........................................................................ DIRECTOR/1ST VICE CHAIR	1.5 .......................1.5	X	X
(14) PHILLIP RICHARDSON MD........................................................................ DIRECTOR	1.0 .......................1.0	X			0	0	0
(15) DEBRA MATHIAS........................................................................ EVP/COO	35.0 .......................5.0		X		0	736,796	17,718
(16) KERRI RUPPERT SCHILLER........................................................................ CFO/Assistant Secretary	25.0 .......................15.0		X		0	611,490	126,779
(17) Matthew E Niedzwiecki........................................................................ VP ANCILLARY/SUPPORT SERVICE	40.0 .......................			X	321,617	0	62,527

(A) Name and Title	(B) Average hours per week (list any hours for related organizations below dotted line)			(D) Reportable compensation from the organization (W- 2/1099-MISC)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(A) Name and Title
(18) Hale Kuhlman........................................................................ v.p., speciality physician srv	40.0 .......................	X		268,680	0	38,920
(19) Maria Minon MD........................................................................ VP/CMO	40.0 .......................	X		636,621		42,338
(20) Louise White........................................................................ VP & CNO	40.0 .......................	X		331,784	0	58,165
(21) Jay Gabriel........................................................................ GENERAL COUNSEL	40.0 .......................		X	424,288	0	81,401
(22) MARK L HEADLAND........................................................................ VP/CHIEF INFORMATION OFFICER	40.0 .......................		X	413,568	0	34,084
(23) Waldo Romero........................................................................ VP FACILITIES DESIGN/CONSTR.	40.0 .......................		X	361,944	0	62,277
(24) Susan Burrows........................................................................ VP HUMAN RESOURCES	40.0 .......................		X	339,234	0	64,107
(25) JANET LANSING........................................................................ VP MARKETING/COMMUNICATIONS	40.0 .......................		X	333,457	0	33,852

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)............	3,431,193	2,568,959	702,486

				(A) Total revenue	(B) Related or exempt function revenue	(C) Unrelated business revenue	(D) Revenue excluded from tax under sections 512, 513, or 514
1a	Federated campaigns..1a
b	Membership dues....1b
c	Fundraising events....1c
d	Related organizations...1d		19,230,147
e	Government grants (contributions)1e		1,722,413

f	All other contributions, gifts, grants, and similar amounts not included above1f		1,042,000

g	Noncash contributions included in lines 1a-1f:$
h	Total. Add lines 1a-1f.......			21,994,560
			Business Code
2a	NET PATIENT REVENUE		900099	440,685,427	440,685,427
b	PREMIUM REVENUE		900099	39,294,993	39,294,993
c	MGMT/OCCUPANCY SERVICES		900099	9,829,460	9,829,460
d	DRUGS/MEDICAL SUPPLIES SOLD		900099	10,190,131	10,190,131
e	COVERAGE FEE REVENUE		900099	4,431,356	4,431,356
f	All other program service revenue .			16,583,093	16,454,684	128,409
g	Total. Add lines 2a–2f........			521,014,460
3	Investment income (including dividends, interest, and other similar amounts).......			1,405,451			1,405,451
4	Income from investment of tax-exempt bond proceeds..			0
5	Royalties...........			0
		(i) Real	(ii) Personal
6a	Gross rents	199,566
b	Less: rental expenses
c	Rental income or (loss)	199,566	0
d	Net rental income or (loss).......			199,566			199,566
		(i) Securities	(ii) Other
7a	Gross amount from sales of assets other than inventory	37,703,682
b	Less: cost or other basis and sales expenses	35,479,358
c	Gain or (loss)	2,224,324
d	Net gain or (loss)..........			2,224,324			2,224,324
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ..
	a
b	Less: direct expenses ...b
c	Net income or (loss) from fundraising events..			0
9a	Gross income from gaming activities. See Part IV, line 19 ...
	a
b	Less: direct expenses ...b
c	Net income or (loss) from gaming activities...			0
10a	Gross sales of inventory, less returns and allowances .
	a
b	Less: cost of goods sold ..b
c	Net income or (loss) from sales of inventory..			0
Miscellaneous Revenue			Business Code
11a	CAFETERIA/CATERING SALES		900099	1,031,730			1,031,730
b	GIFT SHOP PROCEEDS		900099	247,142			247,142
c	PARKING		900099	128,877			128,877
d	All other revenue ....			546,992			546,992
e	Total. Add lines 11a–11d ......			1,954,741
12	Total revenue. See Instructions......			548,793,102	520,886,051	128,409	5,784,082


				(A) Beginning of year		(B) End of year
1	Cashnon-interest-bearing .............			68,148,796	1	109,003,634
2	Savings and temporary cash investments .........			201,733,579	2	60,311,263
3	Pledges and grants receivable, net ...........			10,184,726	3	8,303,119
4	Accounts receivable, net .............			102,874,643	4	113,774,764
5	Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of Schedule L ..................
				0	5	0
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L
				0	6	0
7	Notes and loans receivable, net .............			0	7	0
8	Inventories for sale or use ..............			2,321,459	8	8,405,248
9	Prepaid expenses and deferred charges ..........			7,766,068	9	8,918,000
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	924,397,374
b	Less: accumulated depreciation .....	10b	222,651,346	596,254,896	10c	701,746,028
11	Investments—publicly traded securities ..........			0	11	0
12	Investments—other securities. See Part IV, line 11 .....			35,058	12	35,058
13	Investments—program-related. See Part IV, line 11 .....			0	13	0
14	Intangible assets ...............			1,216,000	14	1,216,000
15	Other assets. See Part IV, line 11 ...........			21,039,593	15	41,195,140
16	Total assets. Add lines 1 through 15 (must equal line 34)......			1,011,574,818	16	1,052,908,254
17	Accounts payable and accrued expenses .........			80,997,492	17	72,703,698
18	Grants payable .................			0	18	0
19	Deferred revenue ................			686,965	19	720,040
20	Tax-exempt bond liabilities .............			366,161,293	20	363,848,347
21	Escrow or custodial account liability. Complete Part IV of Schedule D..			0	21	0
22	Loans and other payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
	persons. Complete Part II of Schedule L..........			0	22	0
23	Secured mortgages and notes payable to unrelated third parties ..			118,989	23	12,731,653
24	Unsecured notes and loans payable to unrelated third parties ....			0	24	0
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D....................			86,159,496	25	62,688,691
26	Total liabilities. Add lines 17 through 25.........			534,124,235	26	512,692,429
	Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets ..............			434,014,107	27	496,842,415
28	Temporarily restricted net assets ...........			42,750,324	28	42,687,258
29	Permanently restricted net assets ...........			686,152	29	686,152
	Organizations that do not follow SFAS 117 (ASC 958), check here and complete lines 30 through 34.
30	Capital stock or trust principal, or current funds ........				30
31	Paid-in or capital surplus, or land, building or equipment fund .....				31
32	Retained earnings, endowment, accumulated income, or other funds				32
33	Total net assets or fund balances ...........			477,450,583	33	540,215,825
34	Total liabilities and net assets/fund balances ........			1,011,574,818	34	1,052,908,254