TY 2021 Form 990

(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)	(E) Reportable compensation from related organizations (W-2/1099-MISC/1099-NEC)
(1) PAUL S VIVIANO...................................................................... DIRECTOR, PRESIDENT AND CEO	55.00 ................. 0.00	X	X	1,693,578	43,321
(2) MARK D KRIEGER MD...................................................................... DIRECTOR, FACULTY PHYSICIAN	20.00 ................. 0.00	X		767,000	0
(3) MATTHEW MATT KEEFER MD...................................................................... DIRECTOR, FACULTY PHYSICIAN	28.00 ................. 0.00	X		374,845	0
(4) ROBERT BOB E SHADDY MD...................................................................... DIRECTOR, FACULTY PHYSICIAN	10.00 ................. 0.00	X		266,750	0
(5) JEFFREY WORTHE...................................................................... DIRECTOR, CHAIR OF BOARD	2.00 ................. 0.00	X	X	0	0
(6) KEVIN H BROGAN...................................................................... DIRECTOR, CHAIR-ELECT OF BOARD	2.00 ................. 0.00	X	X	0	0
(7) ALIA TUTOR...................................................................... DIRECTOR	1.00 ................. 0.00	X		0	0
(8) BURT LEVITCH...................................................................... DIRECTOR	1.00 ................. 0.00	X		0	0
(9) BYRON H POLLITT JR...................................................................... DIRECTOR	1.00 ................. 0.00	X		0	0
(10) CHERYL KUNIN FAIR...................................................................... DIRECTOR	1.00 ................. 0.00	X		0	0
(11) CHRISTOPHER C MARTIN FAIA...................................................................... DIRECTOR	1.00 ................. 0.00	X		0	0
(12) DIANA M BONTA RN DRPH...................................................................... DIRECTOR	1.00 ................. 0.00	X		0	0
(13) ELISABETH BETH HUNT PRICE...................................................................... DIRECTOR	1.00 ................. 0.00	X		0	0
(14) EUGENE MITCH MITCHELL...................................................................... DIRECTOR (BEGIN 10/21)	1.00 ................. 0.00	X		0	0
(15) GEORGE H BROWN...................................................................... DIRECTOR	1.00 ................. 0.00	X		0	0
(16) KIMBERLY KIM SHEPHERD...................................................................... DIRECTOR	1.00 ................. 0.00	X		0	0
(17) LAURENCE LARRY E PAUL MD...................................................................... DIRECTOR	1.00 ................. 0.00	X		0	0

(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)	(E) Reportable compensation from related organizations (W-2/1099-MISC/1099-NEC)	(F) Estimated amount of other compensation from the organization and related organizations
(18) SHERI SANI........................................................................ DIRECTOR	1.00 .......................0.00	X				0	0
(19) TODD E MOLZ........................................................................ DIRECTOR	1.00 .......................0.00	X				0	0
(20) M SCOTT LIEBERENZ........................................................................ SVP, CHIEF FINANCIAL OFFICER	55.00 .......................0.00		X			846,564	117,034
(21) JUDITH M KLINE........................................................................ CORPORATE SECRETARY	55.00 .......................0.00		X			245,168	20,558
(22) JAMES STEIN MD........................................................................ SVP, CHIEF MEDICAL OFFICER	55.00 .......................0.00			X		858,816	77,395
(23) LARA KHOURI........................................................................ SVP, CHIEF STRATEGY OFFICER	55.00 .......................0.00			X		778,055	114,110
(24) NANCY LEE........................................................................ SVP, CHIEF CLINICAL OFFICER	55.00 .......................0.00			X		793,696	31,844
(25) GRACE OH........................................................................ SVP, GENERAL COUNSEL	55.00 .......................0.00			X		614,846	115,540
(26) ALEXANDRA CARTER........................................................................ SVP, CHIEF DEVELOPMENT OFFICER	55.00 .......................0.00			X		606,546	78,125
(27) MAMOON SYED........................................................................ SVP, CHIEF PEOPLE OFFICER	55.00 .......................0.00			X		565,729	92,360
(28) CONRAD BAND........................................................................ SVP, INTERIM CHIEF INFO. OFFICER	55.00 .......................0.00			X		451,917	86,908
(29) STEVE GARSKE........................................................................ SVP, CHIEF INFO. OFFICER (END 07/21)	55.00 .......................0.00			X		478,943	28,826
(30) RHONDA R FOSTER........................................................................ VP, CNO / PATIENT CARE SVCS	55.00 .......................0.00				X	966,523	43,856
(31) RUTH M AREVALO........................................................................ VP, HEALTH SYSTEM DEV & INTEGRATION	55.00 .......................0.00				X	472,843	74,718
(32) JODI SHIRLYN OGDEN RIVERA........................................................................ VP, RESEARCH OPERATIONS	55.00 .......................0.00				X	442,319	79,203
(33) RANDALL W STEWARD........................................................................ VP, ENTERPRISE CONTRACTING	55.00 .......................0.00				X	428,995	88,023
(34) BHAVANA KUMAR ARORA........................................................................ CMO, CHLA HEALTH NETWORK	55.00 .......................0.00				X	442,832	7,807

(A) Name and business address	(B) Description of services	(C) Compensation
SODEXO INC & AFFILIATES 9801 WASHINGTON BLVD GAITHERSBURG,MD20878	FOOD AND HOUSEKEEPING SERVICES	19,148,544
AMN HEALTHCARE INC 12400 HIGH BLUFF DR SAN DIEGO,CA92130	HEALTHCARE WORKFORCE MANAGEMENT	15,545,254
PACIFIC NATIONAL GROUP INC 2392 BATEMAN AVE DUARTE,CA91010	CONSTRUCTION MANAGEMENT	5,830,314
PCAM LLC 3165 GARFIELD AVE LOS ANGELES,CA90040	PARKING SERVICES	5,030,733
BCSP 8 INVESTMENTS LP 200 STATE ST 5TH FL BOSTON,MA02109	RENT	4,273,075
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 163

- TIN:

SCHEDULE A
(Form 990)

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.
right arrow

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

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2021

Open to Public
Inspection

Name of the organization

CHILDREN'S HOSPITAL LOS ANGELES

Employer identification number

95-1690977

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 12, 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 (Form 990).)

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 agricultural research organization described in 170(b)(1)(A)(ix) operated in conjunction with a land-grant college or university or a non-land grant college of agriculture. See instructions. Enter the name, city, and state of the college or university:

An organization that normally receives: (1) more than 33 1/3% 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 33 1/3% 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 on lines 12a through 12d that describes the type of supporting organization and complete lines 12e, 12f, and 12g.

Type I. A supporting organization operated, supervised, or controlled by its supported organization(s), typically by giving the supported organization(s) the power to regularly appoint or elect a majority of the directors or trustees of the supporting organization. You must complete Part IV, Sections A and B.

Type II. A supporting organization supervised or controlled in connection with its supported organization(s), by having control or management of the supporting organization vested in the same persons that control or manage the supported organization(s). You must complete Part IV, Sections A and C.

Type III functionally integrated. A supporting organization operated in connection with, and functionally integrated with, its supported organization(s) (see instructions). You must complete Part IV, Sections A, D, and E.

Type III non-functionally integrated. A supporting organization operated in connection with its supported organization(s) that is not functionally integrated. The organization generally must satisfy a distribution requirement and an attentiveness requirement (see instructions). You must complete Part IV, Sections A and D, and Part V.

Check this box if the organization received a written determination from the IRS that it is a Type I, Type II, Type III functionally integrated, or Type III non-functionally integrated supporting organization.

Enter the number of supported organizations ...............................

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

(i) Name of supported organization	(ii) EIN	(iv) Is the organization listed in your governing document?		(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)
(i) Name of supported organization	(ii) EIN	Yes	No	(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)


Total

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

Cat. No. 11285F

Schedule A (Form 990) 2021

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 failed to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2017	(b) 2018	(c) 2019	(d) 2020	(e) 2021	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") ..
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) 2017	(b) 2018	(c) 2019	(d) 2020	(e) 2021	(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 VI.)..
11	Total support. Add lines 7 through 10

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

First 5 years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here ........................................ right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2021 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2020 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2021. 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—2020. 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—2021. 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 VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization ..................................................... right arrow

10%-facts-and-circumstances test—2020. 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 VI 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) 2021

Page 3

Part III

Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 10 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) 2017	(b) 2018	(c) 2019	(d) 2020	(e) 2021	(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) 2017	(b) 2018	(c) 2019	(d) 2020	(e) 2021	(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 on 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 VI.) ..
13	Total support. (Add lines 9, 10c, 11, and 12.)..

First 5 years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization,
check this box and stop here............................................. right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2021 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2020 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2021 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2020 Schedule A, Part III, line 17 .............

19a

331/3% support tests—2021. 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—2020. 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) 2021

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 12 of Part I. If you checked box 12a, of Part I, complete Sections A and B. If you checked box 12b, of Part I, complete Sections A and C. If you checked box 12c, of Part I, complete Sections A, D, and E. If you checked box12d, of Part I, complete Sections A and D, and complete Part V.)

Section A. All Supporting Organizations

Yes

Are all of the organization’s supported organizations listed by name in the organization’s governing documents?
If "No," describe in Part VI how the supported organizations are designated. If designated by class or purpose,
describe the designation. If historic and continuing relationship, explain.

Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or (2)? If "Yes," explain in Part VI how the organization determined that the supported organization was described in section 509(a)(1) or (2).

Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer lines 3b and 3c below.

Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the public support tests under section 509(a)(2)? If "Yes," describe in Part VI when and how the organization made the determination.

Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) purposes? If "Yes," explain in Part VI what controls the organization put in place to ensure such use.

Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked box 12a or 12b in Part I, answer lines 4b and 4c below.

Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? If “Yes,” describe in Part VI how the organization had such control and discretion despite being controlled or supervised by or in connection with its supported organizations.

Did the organization support any foreign supported organization that does not have an IRS determination under sections 501(c)(3) and 509(a)(1) or (2)? If “Yes,” explain in Part VI what controls the organization used to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B) purposes.

Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer lines 5b and 5c below (if applicable). Also, provide detail in Part VI, including (i) the names and EIN numbers of the supported organizations added, substituted, or removed; (ii) the reasons for each such action; (iii) the authority under the organization's organizing document authorizing such action; and (iv) how the action was accomplished (such as by amendment to the organizing document).

Type I or Type II only. Was any added or substituted supported organization part of a class already designated in the organization's organizing document?

Substitutions only. Was the substitution the result of an event beyond the organization's control?

Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (i) its supported organizations, (ii) individuals that are part of the charitable class benefited by one or more of its supported organizations, or (iii) other supporting organizations that also support or benefit one or more of the filing organization’s supported organizations? If “Yes,” provide detail in Part VI.

Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (defined in section 4958(c)(3)(C)), a family member of a substantial contributor, or a 35% controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990) .

Did the organization make a loan to a disqualified person (as defined in section 4958) not described on line 7? If “Yes,” complete Part I of Schedule L (Form 990).

Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons, as defined in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or (2))? If “Yes,” provide detail in Part VI.

Did one or more disqualified persons (as defined on line 9a) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.

Did a disqualified person (as defined on line 9a) have an ownership interest in, or derive any personal benefit from, assets in which the supporting organization also had an interest? If “Yes,” provide detail in Part VI.

10a

Was the organization subject to the excess business holdings rules of section 4943 because of section 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer line 10b below.

10a

Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to determine whether the organization had excess business holdings).

10b

Schedule A (Form 990) 2021

Page 5

Part IV

Supporting Organizations (continued)

Yes

Has the organization accepted a gift or contribution from any of the following persons?

A person who directly or indirectly controls, either alone or together with persons described on lines 11b and 11c below, the governing body of a supported organization?

11a

A family member of a person described on 11a above?

11b

A 35% controlled entity of a person described on line 11a or 11b above? If “Yes” to 11a, 11b, or 11c, provide detail in Part VI.

11c

Section B. Type I Supporting Organizations

Yes

Did the officers, directors, trustees, or membership of one or more supported organizations have the power to regularly appoint or elect at least a majority of the organization’s directors or trustees at all times during the tax year? If “No,” describe in Part VI how the supported organization(s) effectively operated, supervised, or controlled the organization’s activities. If the organization had more than one supported organization, describe how the powers to appoint and/or remove directors or trustees were allocated among the supported organizations and what conditions or restrictions, if any, applied to such powers during the tax year.

Did the organization operate for the benefit of any supported organization other than the supported organization(s) that operated, supervised, or controlled the supporting organization? If “Yes,” explain in Part VI how providing such benefit carried out the purposes of the supported organization(s) that operated, supervised or controlled the supporting organization.

Section C. Type II Supporting Organizations

Yes

Were a majority of the organization’s directors or trustees during the tax year also a majority of the directors or trustees of each of the organization’s supported organization(s)? If “No,” describe in Part VI how control or management of the supporting organization was vested in the same persons that controlled or managed the supported organization(s).

Section D. All Type III Supporting Organizations

Yes

Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s tax year, (i) a written notice describing the type and amount of support provided during the prior tax year, (ii) a copy of the Form 990 that was most recently filed as of the date of notification, and (iii) copies of the organization’s governing documents in effect on the date of notification, to the extent not previously provided?

Were any of the organization’s officers, directors, or trustees either (i) appointed or elected by the supported organization(s) or (ii) serving on the governing body of a supported organization? If "No," explain in Part VI how the organization maintained a close and continuous working relationship with the supported organization(s).

By reason of the relationship described in line 2 above, did the organization’s supported organizations have a significant voice in the organization’s investment policies and in directing the use of the organization’s income or assets at all times during the tax year? If "Yes," describe in Part VI the role the organization’s supported organizations played in this regard.

Section E. Type III Functionally-Integrated Supporting Organizations

Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):

The organization satisfied the Activities Test. Complete line 2 below.

The organization is the parent of each of its supported organizations. Complete line 3 below.

The organization supported a governmental entity. Describe in Part VI how you supported a government entity (see instructions)

Activities Test. Answer lines 2a and 2b below.

Yes

Did substantially all of the organization’s activities during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was responsive? If "Yes," then in Part VI identify those supported organizations and explain how these activities directly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these activities constituted substantially all of its activities.

Did the activities described on line 2a, above constitute activities that, but for the organization’s involvement, one or more of the organization’s supported organization(s) would have been engaged in? If "Yes," explain in Part VI the reasons for the organization’s position that its supported organization(s) would have engaged in these activities but for the organization’s involvement.

Parent of Supported Organizations. Answer lines 3a and 3b below.

Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations?If "Yes" or "No", provide details in Part VI.

Did the organization exercise a substantial degree of direction over the policies, programs and activities of each of its supported organizations? If "Yes," describe in Part VI. the role played by the organization in this regard.

Schedule A (Form 990) 2021

Page 6

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations

Check here if the organization satisfied the Integral Part Test as a qualifying trust on Nov. 20, 1970 (explain in Part VI). See instructions. All other Type III non-functionally integrated supporting organizations must complete Sections A through E.

	Section A - Adjusted Net Income		(A) Prior Year	(B) Current Year (optional)
1	Net short-term capital gain	1
2	Recoveries of prior-year distributions	2
3	Other gross income (see instructions)	3
4	Add lines 1 through 3	4
5	Depreciation and depletion	5
6	Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions)	6
7	Other expenses (see instructions)	7
8	Adjusted Net Income (subtract lines 5, 6 and 7 from line 4)	8

	Section B - Minimum Asset Amount		(A) Prior Year	(B) Current Year (optional)
1	Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year):	1
a	Average monthly value of securities	1a
b	Average monthly cash balances	1b
c	Fair market value of other non-exempt-use assets	1c
d	Total (add lines 1a, 1b, and 1c)	1d
e	Discount claimed for blockage or other factors (explain in detail in Part VI):
2	Acquisition indebtedness applicable to non-exempt use assets	2
3	Subtract line 2 from line 1d	3
4	Cash deemed held for exempt use. Enter 0.015 of line 3 (for greater amount, see instructions).	4
5	Net value of non-exempt-use assets (subtract line 4 from line 3)	5
6	Multiply line 5 by 0.035	6
7	Recoveries of prior-year distributions	7
8	Minimum Asset Amount (add line 7 to line 6)	8

	Section C - Distributable Amount		Current Year
1	Adjusted net income for prior year (from Section A, line 8, Column A)	1
2	Enter 85% of line 1	2
3	Minimum asset amount for prior year (from Section B, line 8, Column A)	3
4	Enter greater of line 2 or line 3	4
5	Income tax imposed in prior year	5
6	Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions)	6

Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions)

Schedule A (Form 990) 2021

Page 7

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations(continued)

Section D - Distributions		Current Year
1 Amounts paid to supported organizations to accomplish exempt purposes	1
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity	2
3 Administrative expenses paid to accomplish exempt purposes of supported organizations	3
4 Amounts paid to acquire exempt-use assets	4
5 Qualified set-aside amounts (prior IRS approval required - provide details in Part VI)	5
6 Other distributions (describe in Part VI). See instructions	6
7Total annual distributions. Add lines 1 through 6.	7
8 Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions	8
9 Distributable amount for 2021 from Section C, line 6	9
10 Line 8 amount divided by Line 9 amount	10

Section E - Distribution Allocations (see instructions)		(i) Excess Distributions	(ii) Underdistributions Pre-2021	(iii) Distributable Amount for 2021
1 Distributable amount for 2021 from Section C, line 6
2 Underdistributions, if any, for years prior to 2021 (reasonable cause required-- explain in Part VI). See instructions.
3 Excess distributions carryover, if any, to 2021:
a From 2016.......
b From 2017.......
c From 2018.......
d From 2019.......
e From 2020.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2021 distributable amount
i Carryover from 2016 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from line 3f.
4Distributions for 2021 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2021 distributable amount
c Remainder. Subtract lines 4a and 4b from line 4.
5 Remaining underdistributions for years prior to 2021, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions.
6 Remaining underdistributions for 2021. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions.
7 Excess distributions carryover to 2022. Add lines 3j and 4c.
8 Breakdown of line 7:
a Excess from 2017.....
b Excess from 2018.....
c Excess from 2019.....
d Excess from 2020.....
e Excess from 2021.....

Schedule A (Form 990) (2021)

Schedule A (Form 990) 2021

Page 8

Part VI

Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; Part III, line 12; Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11a, 11b, and 11c; Part IV, Section B, lines 1 and 2; Part IV, Section C, line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 1c, 2a, 2b, 3a and 3b; Part V, line 1; Part V, Section B, line 1e; Part V Section D, lines 5, 6, and 8; and Part V, Section E, lines 2, 5, and 6. Also complete this part for any additional information. (See instructions).

Facts And Circumstances Test

Return Reference	Explanation

Schedule A (Form 990) 2021

Additional Data

Software ID:
Software Version:

- TIN:

Schedule B
(Form 990)

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

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

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2021

Name of the organization

CHILDREN'S HOSPITAL LOS ANGELES

Employer identification number

95-1690977

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, contributions totaling $5,000 or more (in money or other property) from any one contributor. Complete Parts I and II. See instructions for determining a contributor's total contributions.

Special Rules

For an organization described in section 501(c)(3) 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), that checked Schedule A (Form 990 or 990-EZ), Part II, line 13, 16a, or 16b, and that received from any one contributor, during the year, total contributions 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 an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, total contributions of more than $1,000 exclusively for religious, charitable, scientific, literary, or educational purposes, or for the prevention of cruelty to children or animals. Complete Parts I, II, and III.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, contributions exclusively for religious, charitable, etc., purposes, but no such contributions totaled 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. Don't complete any of the parts unless the General Rule applies to this organization because it received nonexclusively religious, charitable, etc., contributions totaling $5,000 or more during the year ......... Arrow Bullet

Caution: An organization that isn't covered by the General Rule and/or the Special Rules doesn't 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 its Form 990PF, Part I, line 2, to certify that it doesn't 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) (2021)

Schedule B (Form 990) (2021) Page 2

Name of organization CHILDREN'S HOSPITAL LOS ANGELES

Part I Contributors	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	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
Schedule B (Form 990) (2021)

Schedule B (Form 990) (2021)

Page 3

Name of organization CHILDREN'S HOSPITAL LOS ANGELES		Employer identification number 95-1690977

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) (2021)

Schedule B (Form 990) (2021)

Page 4


Name of organization CHILDREN'S HOSPITAL LOS ANGELES			Employer identification number 95-1690977
Part III Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year from any one contributor. 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.) $ 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) (2021)

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE C
(Form 990)

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

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2021

Open to Public
Inspection

If the organization answered "Yes" on 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" on 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" on Form 990, Part IV, Line 5 (Proxy Tax) (see separate instructions) or Form 990-EZ, Part V, line 35c (Proxy Tax) (see separate instructions), then
Round Bullet

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

Name of the organization

CHILDREN'S HOSPITAL LOS ANGELES

Employer identification number

95-1690977

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. See instructions for definition of “political campaign activities."

Political campaign activity expenditures. See instructions .................................................................... SchCMd Bullet

Volunteer hours for political campaign activities. See instructions ..................................................................

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-.
1
2
3
4
5
6

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

Cat. No. 50084S

Schedule C (Form 990) 2021

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 separate instructions for lines 2a through 2f.)
Lobbying Expenditures During 4-Year Averaging Period
	Calendar year (or fiscal year beginning in)	(a) 2018	(b) 2019	(c) 2020	(d) 2021	(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) 2021

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 on lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.

(a)

Yes|No

(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

416,058

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

416,058

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

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, lines 1 and 2 (see instructions), and Part ll-B, line 1. Also, complete this part for any additional information.

Return Reference	Explanation
PART II-B, LINE 1:	1. NATIONAL ASSOCIATION OF CHILDREN'S HOSPITALS (NACH) - MEMBERSHIP DUES 2. HOSPITAL ASSOCIATION OF SOUTHERN CALIFORNIA (HASC) - MEMBERSHIP DUES 3. CALIFORNIA CHILDREN'S HOSPITAL ASSOCIATION (CCHA) - MEMBERSHIP DUES 4. CALIFORNIA ASSOCIATION OF HOSPITALS AND HEALTH SYSTEMS (CAHHS) - MEMBERSHIP DUES 5. THE MARGOLIN GROUP, INC. - STATE LOBBYING ACTIVITY 6. ASSOCIATION OF AMERICAN MEDICAL COLLEGES (AAMC) - MEMBERSHIP DUES 7. CALIFORNIA ADVOCACY LLC - STATE LOBBYING ACTIVITY
PART II-B:	CHILDREN'S HOSPITAL LOS ANGELES DOES NOT PARTICIPATE IN OR INTERVENE IN (INCLUDING THE PUBLISHING OR DISTRIBUTING OF STATEMENTS), ANY POLITICAL CAMPAIGN ON BEHALF OF (OR IN OPPOSITION TO) ANY CANDIDATE FOR PUBLIC OFFICE.

Return Reference

Explanation

PART II-B, LINE 1:

1. NATIONAL ASSOCIATION OF CHILDREN'S HOSPITALS (NACH) - MEMBERSHIP DUES 2. HOSPITAL ASSOCIATION OF SOUTHERN CALIFORNIA (HASC) - MEMBERSHIP DUES 3. CALIFORNIA CHILDREN'S HOSPITAL ASSOCIATION (CCHA) - MEMBERSHIP DUES 4. CALIFORNIA ASSOCIATION OF HOSPITALS AND HEALTH SYSTEMS (CAHHS) - MEMBERSHIP DUES 5. THE MARGOLIN GROUP, INC. - STATE LOBBYING ACTIVITY 6. ASSOCIATION OF AMERICAN MEDICAL COLLEGES (AAMC) - MEMBERSHIP DUES 7. CALIFORNIA ADVOCACY LLC - STATE LOBBYING ACTIVITY

PART II-B:

CHILDREN'S HOSPITAL LOS ANGELES DOES NOT PARTICIPATE IN OR INTERVENE IN (INCLUDING THE PUBLISHING OR DISTRIBUTING OF STATEMENTS), ANY POLITICAL CAMPAIGN ON BEHALF OF (OR IN OPPOSITION TO) ANY CANDIDATE FOR PUBLIC OFFICE.

Schedule C (Form 990) 2021

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," on 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

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2021

Open to Public Inspection

Name of the organization

CHILDREN'S HOSPITAL LOS ANGELES

Employer identification number

95-1690977

Part I

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

		(a) Donor advised funds	(b) Funds and other accounts
1	Total number at end of year .........
2	Aggregate value of contributions to (during year)
3	Aggregate value of 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" on 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 7/25/06, 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, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, handling of violations, 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" on Form 990, Part IV, line 8.

If the organization elected, as permitted under FASB 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 FASB 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)

Revenue included on 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 FASB ASC 958 relating to these items:

Revenue included on 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) 2021

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" on 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


b	If "Yes," explain the arrangement in Part XIII and complete the following table:		Amount
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, for escrow or custodial account liability? ...

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" on Form 990, Part IV, line 10.

		(a) Current year	(b) Prior year	(c) Two years back	(d) Three years back	(e) Four years back

1a	Beginning of year balance ....	752,519,746	650,266,946	613,593,715	607,373,502	596,010,538
b	Contributions ...	65,433,713	58,919,128	79,575,519	59,730,321	51,602,973
c	Net investment earnings, gains, and losses	-68,342,348	114,386,968	18,292,383	13,083,122	28,227,452
d	Grants or scholarships ...
e	Other expenditures for facilities and programs ...	85,388,351	71,053,296	61,194,671	66,593,230	68,467,461
f	Administrative expenses ....
g	End of year balance ......	664,222,760	752,519,746	650,266,946	613,593,715	607,373,502

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

Board designated or quasi-endowment SchDMd Bullet

57.210 %

Permanent endowment SchDMd Bullet

Term endowment SchDMd Bullet

42.790 %

The percentages on 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)

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

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

Part VI

Land, Buildings, and Equipment.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11a. See Form 990, Part X, line 10.

Description of property		(a) Cost or other basis (investment)	(b) Cost or other basis (other)	(c) Accumulated depreciation	(d) Book value

1a	Land .....	138,045,594		138,045,594
b	Buildings ....	1,155,643,071	515,181,870	640,461,201
c	Leasehold improvements
d	Equipment ....	619,209,713	504,448,824	114,760,889
e	Other .....	121,989,042		121,989,042
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				1,015,256,726

Schedule D (Form 990) 2021

Page 3

Part VII

Investments - Other Securities.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11b. 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........
(3)Other
(A)
(B)
(C)
(D)
(E)
(F)
(G)
(H)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

Part VIII

Investments - Program Related. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11c. See Form 990, Part X, line 13.

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

(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)

Part IX

Other Assets.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11d. See Form 990, Part X, line 15.

(a) Description				(b) Book value
(1)HOSPITAL FEE PROGRAM RECEIVABLE				169,418,007
(2)CAPITAL ACCUMULATION ACCOUNT				5,167,730
(3)GOLDMAN SACH-SWAP COLLATERAL				1,700,000
(4)RECEIVABLES UNDER GOVERNMENT PROGRAM				25,676,846
(5)RIGHT-OF-USE ASSET				55,693,613
(6)OTHER				4,741,091
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........				262,397,287

Part X

Other Liabilities.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.

1.(a) Description of liability	(b) Book value
(1) Federal income taxes
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	179,790,479
2. Liability for uncertain tax positions. 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) 2021

Page 4

Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total revenue, gains, and other support per audited financial statements .......		1
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains (losses) on investments ....	2a
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d .....................		2e
3	Subtract line 2e from line 1..................		3
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
c	Add lines 4a and 4b....................		4c
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......		5

Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total expenses and losses per audited financial statements ...........		1
2	Amounts included on line 1 but not on Form 990, Part IX, line 25:
a	Donated services and use of facilities .........	2a
b	Prior year adjustments ............	2b
c	Other losses ................	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d....................		2e
3	Subtract line 2e from line 1...................		3
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
c	Add lines 4a and 4b.....................		4c
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......		5

Part XIII

Supplemental Information

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.

Return Reference

Explanation

PART V, LINE 4:

ENDOWMENT FUNDS ARE INTENDED TO BE USED ACCORDING TO THE DONOR'S WISHES WHICH VARY FROM ONGOING PROGRAM SUPPORT, TO SPECIFIC RESEARCH, TO BUILDING OR ASSET ACQUISITION, OR SUPPORT OF ACADEMIC CHAIRS WITHIN THE ORGANIZATION.

PART X, LINE 2:

THE HOSPITAL IS RECOGNIZED BY THE INTERNAL REVENUE SERVICE AS EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(A) OF THE INTERNAL REVENUE CODE AS CHARITABLE ORGANIZATIONS QUALIFYING UNDER SECTION 501(C)(3) AND SIMILAR CALIFORNIA STATUTES. INCOME FROM THE HOSPITAL'S LIMITED LIABILITY CORPORATIONS, CHLA ESBT AND CHLA MEDICAL FOUNDATION (C CORPORATION) ARE TAXABLE TO CHLA. THE INCOME TAX PROVISION IS RECORDED IN OTHER EXPENSES IN THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS AND IS IMMATERIAL FOR THE YEARS ENDED JUNE 30, 2022 AND 2021. THE HOSPITAL ACCOUNTS FOR INCOME TAXES IN ACCORDANCE WITH ASC 740, INCOME TAXES. IT IS THE HOSPITAL'S POLICY TO CLASSIFY THE EXPENSE RELATED TO INTEREST AND PENALTIES, IF ANY, TO BE PAID ON UNDERPAYMENTS OF INCOME TAXES WITHIN OTHER EXPENSES. THE HOSPITAL HAS EVALUATED ITS UNCERTAIN TAX POSITIONS AND THERE WERE NO MATERIAL PENALTIES OR INTEREST RECOGNIZED FOR THE YEARS ENDED JUNE 30, 2022 AND 2021. THE HOSPITAL'S INCOME TAX RETURNS FOR THE YEARS ENDED JUNE 30, 2018, THROUGH JUNE 30, 2022, ARE SUBJECT TO EXAMINATION BY BOTH THE FEDERAL AND STATE TAX JURISDICTIONS.

Schedule D (Form 990) 2021

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE G (Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Information Regarding
Fundraising or Gaming Activities

Complete if the organization answered "Yes" on Form 990, Part IV, lines 17, 18, or 19, or if the organization entered more than $15,000 on Form 990-EZ, line 6a. right arrow

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

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2021

Open to Public Inspection

Name of the organization
CHILDREN'S HOSPITAL LOS ANGELES

Employer identification number

95-1690977

Part I

Fundraising Activities.Complete if the organization answered "Yes" on Form 990, Part IV, line 17.

Form 990-EZ filers are not required to complete this part.

Indicate whether the organization raised funds through any of the following activities. Check all that apply.

a	Mail solicitations	e	Solicitation of non-government grants
b	Internet and email solicitations	f	Solicitation of government grants
c	Phone solicitations	g	Special fundraising events
d	In-person solicitations

Did the organization have a written or oral agreement with any individual (including officers, directors, trustees

or key employees listed in Form 990, Part VII) or entity in connection with professional fundraising services?

YesNo

If "Yes," list the 10 highest paid individuals or entities (fundraisers) pursuant to agreements under which the fundraiser is
to be compensated at least $5,000 by the organization.

(i) Name and address of individual or entity (fundraiser)	(iii) Did fundraiser have custody or control of contributions?
	Yes	No










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

List all states in which the organization is registered or licensed to solicit contributions or has been notified it is exempt from registration or licensing.

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

Cat. No. 50083H

Schedule G (Form 990) 2021

Page 2

Part II

Fundraising Events. Complete if the organization answered "Yes" on Form 990, Part IV, line 18, or reported more than $15,000 of fundraising event contributions and gross income on Form 990-EZ, lines 1 and 6b. List events with gross receipts greater than $5,000.

		(a) Event #1 WALK & PLAY LA (event type)	(d) Total events (add col. (a) through col. (c))
1	Gross receipts . . . . .	299,584	299,584
2	Less: Contributions . . . .	299,584	299,584
3	Gross income (line 1 minus line 2) . . . . . .

4	Cash prizes . . . . .	0
5	Noncash prizes . . . .	11,082	11,082
6	Rent/facility costs . . . .	65,171	65,171
7	Food and beverages . . .	3,889	3,889
8	Entertainment . . . .	43,260	43,260
9	Other direct expenses . . .	82,156	82,156
10	Direct expense summary. Add lines 4 through 9 in column (d) . . . . . . . . . .		205,558
11	Net income summary. Subtract line 10 from line 3, column (d). . . . . . . . . .		-205,558

Part III

Gaming. Complete if the organization answered "Yes" on Form 990, Part IV, line 19, or reported more than $15,000 on Form 990-EZ, line 6a.

		(a) Bingo	(b) Pull tabs/Instant bingo/progressive bingo	(c) Other gaming	(d) Total gaming (add col.(a) through col.(c))
1	Gross revenue . . . . .

2	Cash prizes . . . . .
3	Noncash prizes . . . .
4	Rent/facility costs . . . .
5	Other direct expenses . . .

Volunteer labor . . . .

	Yes %
	No

	Yes %
	No

	Yes %
	No

Direct expense summary. Add lines 2 through 5 in column (d) . . . . . . . . . . right arrow

Net gaming income summary. Subtract line 7 from line 1, column (d). . . . . . . . . right arrow

Enter the state(s) in which the organization conducts gaming activities:

Is the organization licensed to conduct gaming activities in each of these states? . . . . . . . .

YesNo

If "No," explain:

10a

Were any of the organization's gaming licenses revoked, suspended or terminated during the tax year? . . .

YesNo

If "Yes," explain:

Schedule G (Form 990) 2021

Page 3

Does the organization conduct gaming activities with nonmembers? . . . . . . . . . . .

YesNo

Is the organization a grantor, beneficiary or trustee of a trust or a member of a partnership or other entity

formed to administer charitable gaming? . . . . . . . . . . . . . . . . .

YesNo

Indicate the percentage of gaming activity conducted in:

The organization's facility . . . . . . . . . . . . . . . . . .

13a

An outside facility . . . . . . . . . . . . . . . . . . . .

13b

Enter the name and address of the person who prepares the organization's gaming/special events books and records:

Name

Address

15a

Does the organization have a contract with a third party from whom the organization receives gaming

revenue? . . . . . . . . . . . . . . . . . . . . . . . .

YesNo

If "Yes," enter the amount of gaming revenue received by the organization right arrow

$ and the

amount of gaming revenue retained by the third party right arrow

$ .

If "Yes," enter name and address of the third party:

Name

Address

Gaming manager information:

Name

Gaming manager compensation right arrow

Description of services provided right arrow

Director/officer Employee Independent contractor

Mandatory distributions:

Is the organization required under state law to make charitable distributions from the gaming proceeds to

retain the state gaming license? . . . . . . . . . . . . . . . . . . .

YesNo

Enter the amount of distributions required under state law distributed to other exempt organizations or spent

in the organization's own exempt activities during the tax year right arrow

Part IV

Supplemental Information. Provide the explanations required by Part I, line 2b, columns (iii) and (v); and Part III, lines 9, 9b, 10b, 15b, 15c, 16, and 17b, as applicable. Also provide any additional information. See instructions.

Return Reference	Explanation

Schedule G (Form 990) 2021

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" on Form 990, Part IV, question 20.
MediumBullet

Attach to Form 990.
MediumBullet

Go to www.irs.gov/Form990EZ for instructions and the latest information.

OMB No. 1545-0047

2021

Open to Public Inspection

Name of the organization

CHILDREN'S HOSPITAL LOS ANGELES

Employer identification number

95-1690977

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 40000.0000000000 %

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 60000.0000000000 %

If the organization used factors other than FPG in determining eligibility, describe in Part VI the criteria used 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		(a) Number of activities or programs (optional)	(b) Persons served (optional)	(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) . . .	1	241	175,661	0	175,661	0.010 %
b	Medicaid (from Worksheet 3, column a) . . . . .	5	250,325	380,518,063	334,423,679	46,094,384	3.190 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .
d	Total Financial Assistance and Means-Tested Government Programs . . . . .	6	250,566	380,693,724	334,423,679	46,270,045	3.200 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).	14	669,216	9,679,780		9,679,780	0.670 %
f	Health professions education (from Worksheet 5) . . .	8	8,392	69,919,143	31,793,106	38,126,037	2.640 %
g	Subsidized health services (from Worksheet 6) . . . .	1	2,448	5,834,190	0	5,834,190	0.400 %
h	Research (from Worksheet 7) .	1	0	149,781,227	89,981,227	59,800,000	4.140 %
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .	2	170	982,865	0	982,865	0.070 %
j	Total. Other Benefits . .	26	680,226	236,197,205	121,774,333	114,422,872	7.920 %
k	Total. Add lines 7d and 7j .	32	930,792	616,890,929	456,198,012	160,692,917	11.120 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2021

Schedule H (Form 990) 2021

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.

		(a) Number of activities or programs (optional)	(b) Persons served (optional)	(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
4	Environmental improvements
5	Leadership development and training for community members	1	60	77,530		77,530	0.010 %
6	Coalition building
7	Community health improvement advocacy	3	100,000	806,421	219,000	587,421	0.040 %
8	Workforce development	2	32	815,880		815,880	0.060 %
9	Other
10	Total	6	100,092	1,699,831	219,000	1,480,831	0.110 %

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

Did the organization report bad debt expense in accordance with Healthcare 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. ......

36,386,739

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).....

4,549,794

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

4,549,794

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

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) 2021

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?1Name, address, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility)
1	CHILDREN'S HOSPITAL LOS ANGELES 4650 SUNSET BLVD LOS ANGELES,CA900270982 WWW.CHLA.ORG 930000032	X	X	X	X	X	X

Schedule H (Form 990) 2021

Page 4

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 LOS ANGELES
Name of hospital facility or letter of facility reporting group

Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A):

Yes

Community Health Needs Assessment

Was the hospital facility first licensed, registered, or similarly recognized by a state as a hospital facility in the current tax year or the immediately preceding tax year?........................

Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C...............

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 12......................

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 significant 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

The impact of any actions taken to address the significant health needs identified in the hospital facility's prior CHNA(s)

Other (describe in Section C)

Indicate the tax year the hospital facility last conducted a CHNA: 20 21

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

Yes

6 a

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C..................................

Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................

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 (list url): SEE PART V, SECTION C, SUPPLEMENTAL INFORMATION

Other website (list url):

Made a paper copy available for public inspection without charge at the hospital facility

Other (describe in Section C)

Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. ..............

Yes

Indicate the tax year the hospital facility last adopted an implementation strategy: 20 21

Is the hospital facility's most recently adopted implementation strategy posted on a website?.........

Yes

If "Yes" (list url): SEE PART V, SECTION C, SUPPLEMENTAL INFORMATION

If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ......

10b

Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.

12a

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)?...............................

12a

If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........

12b

If "Yes" on line 12b, 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) 2021

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	CHILDREN'S HOSPITAL LOS ANGELES
Name of hospital facility or letter of facility reporting group

Yes

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 included free or discounted care?

Yes

If “Yes,” indicate the eligibility criteria explained in the FAP:

Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of 400.000000000000%
and FPG family income limit for eligibility for discounted care of 600.000000000000%

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

Explained the basis for calculating amounts charged to patients?.................

Yes

Explained the method for applying for financial assistance?...................

Yes

If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):

Described the information the hospital facility may require an individual to provide as part of his or her application

Described the supporting documentation the hospital facility may require an individual to submit as part of his or
her application

Provided the contact information of hospital facility staff who can provide an individual with information about the
FAP and FAP application process

Provided the contact information of nonprofit organizations or government agencies that may be sources of
assistance with FAP applications

Other (describe in Section C)

Was widely publicized within the community served by the hospital facility?........

Yes

If "Yes," indicate how the hospital facility publicized the policy (check all that apply):

The FAP was widely available on a website (list url):

HTTPS://WWW.CHLA.ORG/BILLING-AND-INSURANCE-PAYING-CARE

The FAP application form was widely available on a website (list url):

HTTPS://WWW.CHLA.ORG/BILLING-AND-INSURANCE-PAYING-CARE

A plain language summary of the FAP was widely available on a website (list url):
HTTPS://WWW.CHLA.ORG/BILLING-AND-INSURANCE-PAYING-CARE

The FAP was available upon request and without charge (in public locations in the hospital facility and by mail)

The FAP application form was available upon request and without charge (in public locations in the hospital facility
and by mail)

A plain language summary of the FAP was available upon request and without charge (in public locations in the
hospital facility and by mail)

Individuals were notified about the FAP by being offered a paper copy of the plain language summary of the FAP, by
receiving a conspicuous written notice about the FAP on their billing statements, and via conspicuous public displays or
other measures reasonably calculated to attract patients' attention

Notified members of the community who are most likely to require financial assistance about availability of the FAP

The FAP, FAP application form, and plain language summary of the FAP were translated into the primary language(s)
spoken by LEP populations

Other (describe in Section C)

Schedule H (Form 990) 2021

Page 6

Part VFacility Information (continued)

Billing and Collections

	CHILDREN'S HOSPITAL LOS ANGELES
Name of hospital facility or letter of facility reporting group

Yes

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 all of the actions the hospital facility or other authorized party may take upon nonpayment?..................................

Yes

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 individual’s eligibility under the facility’s FAP:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring, denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

None of these actions or other similar actions were permitted

Did the hospital facility or other authorized party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?............

If "Yes," check all actions in which the hospital facility or a third party engaged:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring , denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 19. (check all that apply):

Provided a written notice about upcoming ECAs (Extraordinary Collection Action) and a plain language summary of the
FAP at least 30 days before initiating those ECAs (if not, describe in Section C)

Made a reasonable effort to orally notify individuals about the FAP and FAP application process (if not, describe in
Section C)

Processed incomplete and complete FAP applications (if not, describe in Section C)

Made presumptive eligibility determinations (if not, describe in Section C)

Other (describe in Section C)

None of these efforts were made

Policy Relating to Emergency Medical Care

Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required 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 Section C)

Other (describe in Section C)

Schedule H (Form 990) 2021

Page 7

Part VFacility Information (continued)

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

	CHILDREN'S HOSPITAL LOS ANGELES
Name of hospital facility or letter of facility reporting group

Yes

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 a look-back method based on claims allowed by Medicare fee-for-service during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicaid, either alone or in combination with
Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month
period

The hospital facility used a prospective Medicare or Medicaid method

During the tax year, did the hospital facility charge any FAP-eligible individual 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 Section C.

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

If "Yes," explain in Section C.

Schedule H (Form 990) 2021

Page 8

Part V

Facility Information (continued)

Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16j, 18e, 19e, 20a, 20b, 20c, 20d, 20e, 21c, 21d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference	Explanation
CHILDREN'S HOSPITAL LOS ANGELES	PART V, SECTION B, LINE 5: THE 2022 COMMUNITY HEALTH NEEDS ASSESSMENT WAS CONDUCTED BY THE CENTER FOR NONPROFIT MANAGEMENT (CNM) AND THE OFFICE OF COMMUNITY AFFAIRS AT CHILDREN'S HOSPITAL LOS ANGELES IN COLLABORATION WITH OTHER INSTITUTIONS, ORGANIZATIONS AND AGENCIES AS WELL AS MEMBERS OF THE CHILDREN'S HOSPITAL COMMUNITY BENEFIT ADVISORY COMMITTEE.THE CNM TEAM HAS EXTENSIVE EXPERIENCE THROUGH BEING INVOLVED IN AND CONDUCTING MORE THAN 30 CHNAS FOR HOSPITALS THROUGHOUT LOS ANGELES COUNTY AND SAN DIEGO COUNTY. THE CNM TEAM CONDUCTED 2019 CHNAS FOR CITRUS VALLEY HEALTH PARTNERS, THE GLENDALE HOSPITALS COLLABORATIVE, CITY OF HOPE, HUNTINGTON HOSPITAL IN PASADENA, CA, AND TWO OF THE LOCAL HOSPITALS WITHIN THE PROVIDENCE HEALTH SYSTEM, AS WELL AS CHLA'S PREVIOUS 2016 & 2019 CHNAS.CHLA HAS CONDUCTED A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) IN AN EFFORT TO UNDERSTAND THE HEALTH AND SOCIAL NEEDS OF THE COMMUNITY AND AS REQUIRED BY STATE AND FEDERAL LAW. THE CHNA IS A PRIMARY TOOL USED BY THE HOSPITAL TO DETERMINE ITS COMMUNITY BENEFIT PLAN. THIS ASSESSMENT INCORPORATES COMPONENTS OF PRIMARY DATA COLLECTION AND SECONDARY DATA ANALYSIS THAT FOCUS ON THE HEALTH AND SOCIAL NEEDS OF THE SERVICE AREA. SOURCES OF DATA INCLUDE THE U.S. CENSUS 2020 DECENNIAL CENSUS AND AMERICAN COMMUNITY SURVEY, CALIFORNIA HEALTH INTERVIEW SURVEY, CALIFORNIA DEPARTMENT OF PUBLIC HEALTH, CALIFORNIA EMPLOYMENT DEVELOPMENT DEPARTMENT, LOS ANGELES COUNTY HEALTH SURVEY, LOS ANGELES HOMELESS SERVICES AUTHORITY, CDC NATIONAL HEALTH STATISTICS, NATIONAL CANCER INSTITUTE, U.S. DEPARTMENT OF EDUCATION, AND OTHERS. WHEN PERTINENT, THESE DATA SETS ARE PRESENTED IN THE CONTEXT OF CALIFORNIA STATE. THE 2022 COMMUNITY HEALTH NEEDS ASSESSMENT METHODOLOGY AND PROCESS INVOLVED THE COLLECTION OF BOTH SECONDARY DATA AND PRIMARY DATA. APPROXIMATELY 300 SECONDARY DATA INDICATORS ON A VARIETY OF HEALTH, SOCIAL, ECONOMIC, AND ENVIRONMENTAL TOPICS WERE COLLECTED BY ZIP CODE, SERVICE PLANNING AREA (SPA), COUNTY, AND STATE LEVELS (AS AVAILABLE). IN ADDITION, PRIMARY DATA COLLECTION INCLUDED AN ONLINE SURVEY, A YOUTH-LED PHOTOVOICE PROJECT WITH YOUTH AND YOUNG ADULT REPRESENTATION FROM ALL OVER LOS ANGELES COUNTY AND A COMMUNITY FORUM WITH INDIVIDUALS WHO REPRESENT THE BROAD INTERESTS OF THE COMMUNITY SERVED BY THE HOSPITAL. ADDITIONALLY, INPUT WAS OBTAINED FROM LOS ANGELES COUNTY DEPARTMENT OF PUBLIC HEALTH OFFICIALS. FOR THE COMMUNITY FORUM, COMMUNITY STAKEHOLDERS IDENTIFIED BY KEY DEPARTMENTS AT CHILDREN'S HOSPITAL LOS ANGELES WERE CONTACTED AND ASKED TO PARTICIPATE IN THE PRIORITIZATION OF NEEDS PROCESS. PARTICIPANTS INCLUDED INDIVIDUALS WHO ARE LEADERS AND REPRESENTATIVES OF MEDICALLY UNDERSERVED, LOW-INCOME, MINORITY AND CHRONIC DISEASE POPULATIONS, OR REGIONAL, STATE OR LOCAL HEALTH OR OTHER DEPARTMENTS OR AGENCIES THAT HAVE CURRENT DATA OR OTHER INFORMATION RELEVANT TO THE HEALTH NEEDS OF THE COMMUNITY SERVED BY THE HOSPITAL FACILITY.A NUMBER OF INSTITUTIONS, ORGANIZATIONS, AND DEPARTMENTS CONTRIBUTED TIME AND RESOURCES TO ASSIST WITH THE ASSESSMENT. THIS LIST WHICH INCLUDED THE LA COUNTY DEPARTMENT OF PUBLIC HEALTH IS FOUND IN APPENDIX C OF THE 2022 CHNA FOUND ON WWW.CHLA.ORG/COMMUNITY.
CHILDREN'S HOSPITAL LOS ANGELES	PART V, SECTION B, LINE 11: AS PART OF THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA), HEALTH AND SOCIAL NEEDS WERE IDENTIFIED THROUGH AN EXAMINATION OF PRIMARY AND SECONDARY DATA AND THEN PRIORITIZED THROUGH A STRUCTURED PROCESS USING THE RELATIVE WORTH METHOD. THE FOLLOWING PRIORITIZED HEALTH NEEDS WERE IDENTIFIED: MENTAL HEALTH, HOMELESSNESS/HOUSING, ECONOMIC SECURITY/POVERTY, COMMUNICABLE/INFECTIOUS DISEASES (INCLUDING COVID-19), PATIENT/FAMILY-CENTERED HEALTH CARE, HEALTH SERVICES COMMUNICATION, OBESITY, AND FOOD SECURITY. TO ADDRESS THESE NEEDS, WE OPERATE THROUGH THE FOLLOWING DOMAINS: 1) HEALTH ACCESS, 2) ECONOMIC ADVANCEMENT AND 3) COMMUNITY GROWTH.1) HEALTH ACCESS DOMAIN: MENTAL HEALTH: -CHLA'S BEHAVIORAL HEALTH INSTITUTE, DEPARTMENT OF PSYCHOLOGY, DIVISION OF DEVELOPMENTAL-BEHAVIORAL PEDIATRICS, DEVELOPMENTAL AND BEHAVIORAL OUTPATIENT CENTER AND OTHER PROGRAMS ARE ADVANCING INITIATIVES THAT IMPROVE THE BEHAVIORAL AND DEVELOPMENTAL HEALTH OF CHILDREN. PATIENT/FAMILY-CENTERED HEALTH CARE: -WE ARE WORKING WITH COMMUNITY HEALTH PROMOTION ORGANIZATIONS AND COMMUNITY HEALTH PROMOTERS TO PARTNER AND CONCEPTUALIZE MODELS THAT INTEGRATE NAVIGATION OF COMMUNITY RESOURCES AND SERVICES INTO THE HEALTH CARE SYSTEM.COMMUNICABLE/INFECTIOUS DISEASES (INCLUDING COVID-19): -CHLA CONTINUES TO HOST ANNUAL COMMUNITY VACCINATION CLINICS FOR INFLUENZA AND HAS HOSTED MULTIPLE COVID-19 VACCINATION CLINICS AT THE HOSPITAL AND VARIOUS COMMUNITY SITES AND WILL CONTINUE TO EXPLORE PARTNERSHIP OPPORTUNITIES TO EXPAND THIS EFFORT. HEALTH SERVICES COMMUNICATION: -WE ARE DEEPENING RELATIONS AND INCREASING PARTNERSHIPS TO EXTEND THE PROVISION OF HEALTH PROMOTION AND RESOURCE INFORMATION TO COMMUNITY MEMBERS AND COMMUNITY ORGANIZATIONS THROUGH MULTIPLE PLATFORMS. -WE ARE ALSO STRENGTHENING OUR EFFORTS TO TRAIN ALL OF OUR TEAM MEMBERS, NO MATTER THEIR AREA OF MEDICAL EXPERTISE, TO ASSESS SOCIAL DETERMINANTS OF HEALTH AND TO ADVANCE HOSPITAL EFFORTS TO HELP FAMILIES IDENTIFY AND NAVIGATE COMMUNITY NETWORKS OF RESOURCES AND SERVICES. OBESITY: -CHLA CONTINUES TO EXPLORE OPPORTUNITIES TO APPLY ITS CLINICAL EXPERTISE AND INITIATIVES TO EXTEND ITS PROGRAMS AND SERVICES TO THE COMMUNITY, INCLUDING BUT NOT LIMITED TO, NUTRITION PROGRAMS, RESEARCH WITHIN THE CHLA DIABETES AND OBESITY PROGRAM TO DEVELOP STRATEGIES TO REDUCE THE BURDEN OF OBESITY AND DIABETES IN CHILDREN AND OTHER CHLA WEIGHT MANAGEMENT PROGRAMS AND CLINICS. 2) ECONOMIC ADVANCEMENT DOMAIN:THE HOSPITAL IS WORKING TO ADVANCE CURRENT EFFORTS TO EXPAND INTERNSHIPS, MENTORSHIPS AND WORK EXPERIENCE OPPORTUNITIES FOR YOUNG ADULTS AND UNEMPLOYED INDIVIDUALS AND WILL COLLABORATE WITH COMMUNITY AND CIVIC STAKEHOLDERS TO MAXIMIZE ECONOMIC OPPORTUNITY STRATEGIES THAT ADDRESS HEALTH DISPARITIES AND THE SOCIAL DETERMINANTS OF HEALTH. TO ADDRESS ECONOMIC SECURITY/POVERTY: -WE ARE ENHANCING OUR SYSTEMS TO ATTRACT CANDIDATES FROM DIVERSE COMMUNITIES FOR EXISTING OPENINGS AND TRAINING PROGRAMS. -WE ARE EXPANDING OUR SUCCESSFUL CAREERS IN HEALTH AND MENTORSHIP (CHAMP) PROGRAM TO INCREASE THE SCOPE OF THE TRAINING PROVIDED FOR INTERNS TO MAXIMIZE THEIR ABILITY TO GAIN EMPLOYMENT FOLLOWING PARTICIPATION IN THE PROGRAM. -WE CONTINUE TO PROVIDE WORKFORCE DEVELOPMENT OPPORTUNITIES TO YOUTH IN DIVERSE COMMUNITIES THROUGH PROGRAMS SUCH AS: LATINO AND AFRICAN AMERICAN HIGH SCHOOL INTERNSHIP PROGRAM (LA HIP) STEM AND HEALTH RESEARCH INTERNSHIPS, PROJECT SEARCH JOB-READINESS PROGRAM FOR YOUTH WITH DEVELOPMENTAL DISABILITIES AND CAMP CHLA- HIGH-SCHOOL HEALTH CAREER EXPLORATION PROGRAM. -THE HOSPITAL IS WORKING TO ADVANCE CURRENT EFFORTS TO EXPAND INTERNSHIPS, MENTORSHIPS AND WORK EXPERIENCE OPPORTUNITIES FOR YOUNG ADULTS AND UNEMPLOYED INDIVIDUALS AND WILL COLLABORATE WITH COMMUNITY AND CIVIC STAKEHOLDERS TO MAXIMIZE ECONOMIC OPPORTUNITY STRATEGIES THAT ADDRESS HEALTH DISPARITIES AND THE SOCIAL DETERMINANTS OF HEALTH.3) COMMUNITY GROWTH DOMAIN:FOOD SECURITY: -WE AIM TO ADDRESS FOOD INSECURITY BY SUPPORTING FOOD RECLAMATION, FRESH PRODUCE DISTRIBUTION AND MEAL PROGRAMS FOR FAMILIES IN NEED, CONDUCTED IN PARTNERSHIP WITH COMMUNITY STAKEHOLDERS. -WE SUPPORT THE DEVELOPMENT OF COMMUNITY GARDENS AND GREEN SPACES. -WE PROVIDE SUPPORT TO LOCAL NONPROFITS ENGAGING IN WORK TO ADVANCE HEALTH EQUITY IN OUR COMMUNITIES. WHILE "HOMELESSNESS/HOUSING" WAS ANOTHER HEALTH AND SOCIAL NEED IDENTIFIED IN PRIORITIZED LIST, THERE ARE OTHER LOCAL AND REGIONAL COMMUNITY ORGANIZATIONS WHOSE MISSION AND RESOURCES ARE WELL-ALIGNED TO ADDRESS THIS NEED THAT HAVE BEEN IDENTIFIED. CHLA WILL STILL CONTINUE TO EXPLORE FUTURE OPPORTUNITIES TO PARTNER OR COLLABORATE REGARDING THIS NEED.
PART V, SECTION B, LINE 7A:	THE COMMUNITY HEALTH NEEDS ASSESSMENT ("CHNA") OF THE HOSPITAL CAN BE LOCATED AT THE FOLLOWING WEB ADDRESS: HTTPS://WWW.CHLA.ORG/COMMUNITY-IMPACT-REPORTS-AND-PUBLICATIONS
PART V, SECTION B, LINE 10A:	THE IMPLEMENTATION STRATEGY OF THE HOSPITAL CAN BE LOCATED AT THE FOLLOWING WEB ADDRESS: HTTPS://WWW.CHLA.ORG/COMMUNITY-IMPACT-REPORTS-AND-PUBLICATIONS

Schedule H (Form 990) 2021

Page 9

Part VFacility Information (continued)

Section D. 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?7
Name and address		Type of Facility (describe)
1	1 - WILSHIRE 3250 WILSHIRE BLVD LOS ANGELES,CA90010	UNIVERSITY CENTER FOR EXCELLENCE IN DEVELOPMENTAL DISABILITIES CLINIC
2	2 - ARCADIA 468 E SANTA CLARA ST ARCADIA,CA91006	OUTPATIENT CLINIC
3	3 - SOUTH BAY 3440 TORRANCE BLVD SUITE 100 TORRANCE,CA90503	OUTPATIENT CLINIC
4	4 - SANTA MONICA 1419 19TH ST SANTA MONICA,CA90404	OUTPATIENT CLINIC
5	5 - VALENCIA 23838 VALENCIA BLVD SUITE 140 VALENCIA,CA91355	OUTPATIENT CLINIC
6	6 - ENCINO 5363 BALBOA BLVD SUITE 121 ENCINO,CA91316	OUTPATIENT CLINIC
7	7 - BAKERSFIELD 9500 STOCKDALE HWY 104 BAKERSFIELD,CA93311	OUTPATIENT CLINIC
8
9
10

Schedule H (Form 990) 2021

Page 10

Part VI

Supplemental Information

Provide the following information.

1	Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2	Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs 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.

Form and Line Reference	Explanation
PART I, LINE 6A:	CHLA HAS PREPARED A COMMUNITY IMPACT REPORT AND IT CAN BE FOUND ON OUR WEBSITE AT THE FOLLOWING LINK: HTTPS://WWW.CHLA.ORG/COMMUNITY-IMPACT-REPORTS-AND-PUBLICATIONS
PART I, LINE 7:	THE ORGANIZATION USES THE COST-TO-CHARGE RATIO METHODOLOGY TO DETERMINE UNREIMBURSED COST OF CARE PROVIDED TO MEDI-CAL PATIENTS. ALL OTHER COSTS ARE ACCOUNTED FOR USING AN INTERNAL SOFTWARE CALLED CBISA (COMMUNITY BENEFIT INVENTORY FOR SOCIAL ACCOUNTABILITY), WHICH FEATURES A BLEND OF BOTH STATISTICAL AND NARRATIVE INFORMATION. IN OCTOBER 2010, CMS APPROVED LEGISLATION ENACTED BY THE STATE OF CALIFORNIA THAT PROVIDED FOR SUPPLEMENTAL MEDI-CAL PAYMENTS TO BE PAID TO CERTAIN HOSPITALS FROM FUNDS COLLECTED FROM PARTICIPATING HOSPITALS UNDER THE STATE'S QUALITY ASSURANCE FEE PROGRAM. SUCH AMOUNTS WERE ALLOCATED AND PAID TO CHLA BASED ON PRIOR YEAR PATIENT DATA, WHICH INCLUDES MEDI-CAL PATIENTS.
PART II, COMMUNITY BUILDING ACTIVITIES:	THE HOSPITAL SPONSORS VARIOUS COMMUNITY SERVICES TO BENEFIT THE PHYSICALLY, MENTALLY, AND GENETICALLY DISABLED AS PART OF ITS CHARITABLE MISSION. THESE SERVICES INCLUDE PARENTAL COUNSELING, EDUCATIONAL SEMINARS, FAMILY SUPPORT GROUPS, AND AN OUTREACH ORGANIZATION FOR FAMILIES ADMINISTERED BY THE HOSPITAL IN AN AGENCY RELATIONSHIP AND FUNDED BY THE STATE OF CALIFORNIA. ADDITIONALLY, A LARGE NUMBER OF HEALTH-RELATED EDUCATIONAL PROGRAMS ARE PROVIDED FOR THE BENEFIT OF THE COMMUNITY, INCLUDING HEALTH ENHANCEMENTS AND WELLNESS, TELEPHONE INFORMATION SERVICES, AND PROGRAMS DESIGNED TO IMPROVE THE GENERAL STANDARDS OF THE HEALTH OF THE COMMUNITY. CHILDREN'S HOSPITAL LOS ANGELES OFFERS MANY COMMUNITY SERVICES AND PROGRAMS IN RESPONSE TO THE NEEDS OF CHILDREN, YOUTH AND FAMILIES. COMMUNITY BENEFIT SERVICES AND ACTIVITIES ARE DESIGNED TO PROVIDE TREATMENT AND PROMOTE HEALTH AS A RESPONSE TO IDENTIFIED COMMUNITY NEEDS. OUR OBJECTIVES ARE TO IMPROVE ACCESS TO HEALTH CARE SERVICES, ENHANCE PUBLIC HEALTH OF THE COMMUNITY, ADVANCE MEDICAL OR HEALTH CARE KNOWLEDGE THAT PROVIDES PUBLIC BENEFIT, AND RELIEVE OR REDUCE THE BURDEN OF GOVERNMENT OR OTHER COMMUNITY EFFORTS.THE CHLA COMMUNITY HEALTH OUTREACH NETWORK - DUE TO CHANGING COVID-19 RESTRICTIONS, CHLA COMMUNITY HEALTH OUTREACH NETWORK IN-PERSON OUTREACH HAS BEEN LIMITED AND HAS REMAINED PRIMARILY IN A VIRTUAL FORMAT. CHLA'S OFFICE OF COMMUNITY AFFAIRS CONTINUED TO UTILIZE THE COMMUNITY IMPACT VIRTUAL SERIES TO VIRTUALLY PROVIDE HEALTH EDUCATION AND HEALTH PROMOTION INFORMATION TO THE COMMUNITY ORGANIZATION AND COMMUNITY MEMBERS INCLUDING TOPICS SUCH AS NUTRITION FOR HEALTHY KIDS, HOW TO TALK TO OUR KIDS ABOUT TRAUMATIC EVENTS, THE DANGERS OF FENTANYL, SCHOOL IMMUNIZATIONS REACHING OVER 400 INDIVIDUALS INCLUDING REPRESENTATIVES FROM COMMUNITY ORGANIZATIONS, COMMUNITY MEMBERS AND FAMILIES VIA 13 VIRTUAL SESSIONS.CAREERS IN HEALTH AND MENTORSHIP PROGRAM (CHAMP) CHLA'S CHAMP PROVIDES UNDERREPRESENTED ADULTS FROM THE LOS ANGELES COMMUNITY THE OPPORTUNITY TO PARTICIPATE IN A SERIES OF COMPREHENSIVE JOB READINESS AND LEADERSHIP DEVELOPMENT WORKSHOPS THAT ARE LED BY CHLA STAFF AND HOSPITAL PARTNERS. SINCE ITS INCEPTION, OVER 250 YOUNG ADULTS ENTERED THE CHLA CHAMP. AFTER SUCCESSFULLY COMPLETING THE WORKSHOP SERIES, "CHAMPERS" ARE PLACED IN NONCLINICAL, PROJECT-BASED INTERNSHIPS IN PARTICIPATING HOSPITAL DEPARTMENTS. STUDENTS ENGAGED WITH MANY DEPARTMENTS INCLUDING INNOVATIONS, COMMUNITY AFFAIRS, THE SABAN RESEARCH INSTITUTE, DIVERSITY, EQUITY & INCLUSION AND PATIENT EXPERIENCE.CAMP CHLA, A HEALTH CAREERS EXPLORATION PROGRAM, PROVIDES HIGH SCHOOL STUDENTS A FIRSTHAND LOOK INTO THE DAILY LIVES OF HEALTH CARE PROFESSIONALS. SINCE ITS INCEPTION IN 2006, OVER 1,000 STUDENTS FROM OUR COMMUNITY HAVE HAD THE OPPORTUNITY TO: JOB-SHADOW HEALTH CARE PROFESSIONALS, PARTICIPATE IN HANDS-ON SKILLS LABS, GAIN EXPOSURE TO DIFFERENT HEALTH CAREER PATHS AND SHARE THEIR EXPERIENCES WITH OTHER CAMPERS. TWO SESSIONS OF 60 STUDENTS RETURNED TO AN IN-PERSON FORMAT. STUDENTS ENGAGED WITH MANY PEDIATRIC DEPARTMENTS INCLUDING GENERAL PEDIATRICS, ED, NEONATOLOGY, HEMATOLOGY/ONCOLOGY, ORTHOPEDICS, SURGERY AND REHABILITATION.CHLA CONTINUES TO DEEPEN ITS COMMITMENT TO THE COMMUNITY AT LARGE THROUGH THE INNOVATION AND IMPLEMENTATION OF ITS COMMUNITY SERVICES AND PROGRAMS TO IMPROVE THE COMMUNITY'S HEALTH AND SAFETY. THROUGH OUR COMMUNITY BENEFIT PROCESS WE WILL GAIN A BETTER UNDERSTANDING OF THE SOCIAL DETERMINANTS OF HEALTH; AND INNOVATE AND IMPLEMENT SERVICES AND PROGRAMS TO IMPROVE THE HEALTH AND SAFETY OF THE COMMUNITY.
PART III, LINE 2:	THE HOSPITAL RECOGNIZES PATIENT SERVICE REVENUE ON THE BASIS OF CONTRACTUAL RATES FOR THE SERVICES RENDERED FOR THOSE PATIENTS WHO HAVE THIRD-PARTY PAYOR COVERAGE. FOR UNINSURED PATIENTS WHO DO NOT QUALIFY FOR CHARITY CARE, THE HOSPITAL RECOGNIZES REVENUE ON THE BASIS OF ITS STANDARD RATES (OR ON THE BASIS OF DISCOUNTED RATES, IF NEGOTIATED OR PROVIDED BY POLICY). PATIENTS COVERED BY INSURANCE, BUT REQUIRED TO PAY DEDUCTIBLES OR COPAYMENTS, ARE CONSIDERED TO BE UNINSURED FOR THOSE PORTIONS. BASED ON HISTORICAL EXPERIENCE, THE HOSPITAL BELIEVES THAT A SIGNIFICANT PORTION OF ITS PATIENT ACCOUNTS WILL BE UNCOLLECTIBLE. THUS, IT RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS RELATED TO PATIENT ACCOUNTS IN THE PERIOD THE SERVICES ARE PROVIDED.BAD DEBTS ARE NOT INCLUDED AS COMMUNITY BENEFITS AND CONTAIN -0- CHARITY COST. BAD DEBTS ARE CALCULATED BASED ON UNCOLLECTIBLE ACCOUNTS NET OF CONTRACTUALS. THE METHODOLOGY USED TO ARRIVE AT THE BAD DEBT REPORTED FOR THE FISCAL YEAR IS DERIVED FROM INCREMENTAL RESERVE INCREASES BASED ON THE AGE OF BILLED ACCOUNTS, PAYOR, AND PATIENT TYPE.
PART III, LINE 3:	THE HOSPITAL RECOGNIZES PATIENT SERVICE REVENUE ON THE BASIS OF CONTRACTUAL RATES FOR THE SERVICES RENDERED FOR THOSE PATIENTS WHO HAVE THIRD-PARTY PAYOR COVERAGE. FOR UNINSURED PATIENTS WHO DO NOT QUALIFY FOR CHARITY CARE, THE HOSPITAL RECOGNIZES REVENUE ON THE BASIS OF ITS STANDARD RATES (OR ON THE BASIS OF DISCOUNTED RATES, IF NEGOTIATED OR PROVIDED BY POLICY). PATIENTS COVERED BY INSURANCE, BUT REQUIRED TO PAY DEDUCTIBLES OR COPAYMENTS, ARE CONSIDERED TO BE UNINSURED FOR THOSE PORTIONS. BASED ON HISTORICAL EXPERIENCE, THE HOSPITAL BELIEVES THAT A SIGNIFICANT PORTION OF ITS PATIENT ACCOUNTS WILL BE UNCOLLECTIBLE. THUS, IT RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS RELATED TO PATIENT ACCOUNTS IN THE PERIOD THE SERVICES ARE PROVIDED. BAD DEBTS ARE NOT INCLUDED AS COMMUNITY BENEFITS AND CONTAIN -0- CHARITY COST. BAD DEBTS ARE CALCULATED BASED ON UNCOLLECTIBLE ACCOUNTS NET OF CONTRACTUALS.
PART III, LINE 4:	FOOTNOTE 1: NET PATIENT SERVICE REVENUE IS REPORTED AT THE ESTIMATED NET REALIZABLE AMOUNTS FROM PATIENTS, THIRD-PARTY PAYORS, AND OTHERS, INCLUDING ESTIMATED VARIABLE CONSIDERATION FOR RETROACTIVE ADJUSTMENTS DUE TO TERMS UNDER REIMBURSEMENT AGREEMENTS WITH THIRD-PARTY PAYORS, SETTLEMENT OF AUDITS, REVIEWS, AND INVESTIGATIONS. RETROACTIVE ADJUSTMENTS ARE ESTIMATED AND ACCRUED IN THE PERIOD IN WHICH THE RELATED SERVICES ARE RENDERED AND ADJUSTED IN FUTURE PERIODS AS FINAL SETTLEMENTS ARE DETERMINED.THE HOSPITAL DETERMINES PERFORMANCE OBLIGATIONS BASED ON THE NATURE OF THE SERVICES PROVIDED. PATIENT SERVICE REVENUE IS RECOGNIZED FOR PERFORMANCE OBLIGATIONS SATISFIED OVER TIME BASED ON ACTUAL CHARGES INCURRED IN RELATION TO TOTAL EXPECTED CHARGES. THE HOSPITAL BELIEVES THAT THIS METHOD PROVIDES A FAITHFUL DEPICTION OF THE TRANSFER OF SERVICES OVER THE TERM OF PERFORMANCE OBLIGATIONS BASED ON THE INPUTS NEEDED TO SATISFY THE OBLIGATIONS. GENERALLY, PERFORMANCE OBLIGATIONS SATISFIED OVER TIME RELATE TO PATIENTS IN THE HOSPITAL RECEIVING INPATIENT ACUTE CARE SERVICES. PERFORMANCE OBLIGATIONS ARE MEASURED FROM ADMISSION TO THE POINT WHEN THERE ARE NO FURTHER SERVICES REQUIRED FOR THE PATIENT, WHICH IS GENERALLY THE TIME OF DISCHARGE. REVENUE IS RECOGNIZED FOR PERFORMANCE OBLIGATIONS SATISFIED AT A POINT IN TIME, WHICH GENERALLY RELATE TO PATIENTS RECEIVING OUTPATIENT SERVICES, WHEN (1) SERVICES ARE PROVIDED AND (2) THE HOSPITAL DOES NOT BELIEVE THE PATIENT REQUIRES ADDITIONAL SERVICES. BECAUSE THE PATIENT SERVICE PERFORMANCE OBLIGATIONS RELATE TO CONTRACTS WITH A DURATION OF LESS THAN ONE YEAR, THE HOSPITAL HAS ELECTED TO APPLY THE OPTIONAL EXEMPTION PROVIDED IN FINANCIAL ACCOUNTING STANDARDS BOARD (FASB) ACCOUNTING STANDARDS CODIFICATION (ASC) 606-10-50-14(A), REVENUE FROM CONTRACTS WITH CUSTOMERS (TOPIC 606), AND, THEREFORE, THE HOSPITAL IS NOT REQUIRED TO DISCLOSE THE AGGREGATE AMOUNT OF THE TRANSACTION PRICE ALLOCATED TO PERFORMANCE OBLIGATIONS THAT ARE UNSATISFIED OR PARTIALLY UNSATISFIED AT THE END OF THE REPORTING PERIOD. THE UNSATISFIED OR PARTIALLY UNSATISFIED PERFORMANCE OBLIGATIONS REFERRED TO ABOVE ARE PRIMARILY RELATED TO INPATIENT ACUTE CARE SERVICES AT THE END OF THE REPORTING PERIOD. THE PERFORMANCE OBLIGATIONS FOR THESE CONTRACTS ARE GENERALLY COMPLETED WHEN THE PATIENTS ARE DISCHARGED, WHICH GENERALLY OCCURS WITHIN DAYS OR WEEKS OF THE END OF THE REPORTING PERIOD, EXCEPT FOR CERTAIN PATIENTS WHO MAY HAVE MUCH LONGER LENGTHS OF STAY.THE HOSPITAL DETERMINES THE TRANSACTION PRICE, WHICH INVOLVES SIGNIFICANT ESTIMATES AND JUDGEMENT, BASED ON GROSS CHARGES UTILIZING STANDARD BILLING RATES FOR SERVICES PROVIDED, REDUCED BY CONTRACTUAL ADJUSTMENTS PROVIDED TO THIRD-PARTY PAYERS, DISCOUNTS PROVIDED TO UNINSURED PATIENTS, AND IMPLICIT PRICE CONCESSIONS PROVIDED PRIMARILY TO UNINSURED OR UNDERINSURED PATIENTS. THE HOSPITAL DETERMINES ITS ESTIMATES OF CONTRACTUAL ADJUSTMENTS AND DISCOUNTS BASED ON CONTRACTUAL AGREEMENTS, ITS DISCOUNT POLICY, AND HISTORICAL EXPERIENCE. THE HOSPITAL DETERMINES ITS ESTIMATE OF IMPLICIT PRICE CONCESSIONS BASED ON HISTORICAL COLLECTION EXPERIENCE WITH THESE CLASSES OF PATIENTS USING A PORTFOLIO APPROACH AS A PRACTICAL EXPEDIENT TO ACCOUNT FOR PATIENT CONTRACTS AS COLLECTIVE GROUPS RATHER THAN ON AN INDIVIDUAL CONTRACT BASIS. THE FINANCIAL STATEMENT EFFECTS OF USING THIS PRACTICAL EXPEDIENT ARE NOT MATERIALLY DIFFERENT FROM AN INDIVIDUAL CONTRACT APPROACH.REVENUES UNDER THE TRADITIONAL FEE-FOR-SERVICE MEDICAID PROGRAMS, INCLUDING CALIFORNIA'S MEDICAID PROGRAM ("MEDI-CAL"), ARE BASED PRIMARILY ON PROSPECTIVE PAYMENT SYSTEMS, PLUS AN OUTLIER PAYMENT FOR INDIVIDUAL PATIENTS WHOSE MEDICAL CONDITIONS ARE COSTLIER TO TREAT THAN THOSE OF PATIENTS WITH THE SAME DIAGNOSIS.SETTLEMENTS WITH THIRD-PARTY PAYERS FOR RETROACTIVE REVENUE ADJUSTMENTS DUE TO AUDITS, REVIEWS, OR INVESTIGATIONS ARE CONSIDERED VARIABLE CONSIDERATION AND ARE INCLUDED IN THE DETERMINATION OF THE ESTIMATED TRANSACTION PRICE FOR PROVIDING PATIENT CARE USING THE MOST LIKELY OUTCOME METHOD. THESE SETTLEMENTS ARE ESTIMATED BASED ON THE TERMS OF THE PAYMENT AGREEMENT WITH THE PAYER, CORRESPONDENCE FROM THE PAYER, AND HISTORICAL SETTLEMENT ACTIVITY, INCLUDING AN ASSESSMENT TO ENSURE THAT IT IS PROBABLE THAT A SIGNIFICANT REVERSAL IN THE AMOUNT OF CUMULATIVE REVENUE RECOGNIZED WILL NOT OCCUR WHEN THE UNCERTAINTY ASSOCIATED WITH THE RETROACTIVE ADJUSTMENT IS SUBSEQUENTLY RESOLVED. ESTIMATED SETTLEMENTS ARE ADJUSTED IN FUTURE PERIODS AS ADJUSTMENTS BECOME KNOWN (THAT IS, NEW INFORMATION BECOMES AVAILABLE), OR AS YEARS ARE SETTLED OR ARE NO LONGER SUBJECT TO SUCH AUDITS, REVIEWS, OR INVESTIGATIONS.REVENUES UNDER MANAGED CARE PLANS ARE BASED PRIMARILY ON PAYMENT TERMS INVOLVING PREDETERMINED RATES PER DIAGNOSIS, PER DIEM RATES, DISCOUNTED FEE-FOR-SERVICE RATES, AND/OR OTHER SIMILAR CONTRACTUAL ARRANGEMENTS. THESE REVENUES ARE ALSO SUBJECT TO REVIEW AND POSSIBLE AUDIT BY THE PAYERS, WHICH CAN TAKE SEVERAL YEARS BEFORE THEY ARE COMPLETELY RESOLVED. THE PAYERS ARE BILLED FOR PATIENT SERVICES ON AN INDIVIDUAL PATIENT BASIS. AN INDIVIDUAL PATIENT'S BILL IS SUBJECT TO ADJUSTMENT ON A PATIENT-BY-PATIENT BASIS IN THE ORDINARY COURSE OF BUSINESS BY THE PAYERS FOLLOWING THEIR REVIEW AND ADJUDICATION OF EACH PARTICULAR BILL. THE HOSPITAL ESTIMATES THE DISCOUNTS FOR CONTRACTUAL ALLOWANCES. AT THE END OF EACH MONTH, THE HOSPITAL ESTIMATES ITS EXPECTED REIMBURSEMENT FOR PATIENTS OF MANAGED CARE PLANS BASED ON THE APPLICABLE CONTRACT TERMS. CONTRACTUAL ALLOWANCE ESTIMATES ARE PERIODICALLY REVIEWED FOR ACCURACY BY TAKING INTO CONSIDERATION KNOWN CONTRACT TERMS, AS WELL AS PAYMENT HISTORY. THE HOSPITAL BELIEVES THAT THE ESTIMATION AND REVIEW PROCESS ENABLES THEM TO IDENTIFY INSTANCES ON A TIMELY BASIS WHERE SUCH ESTIMATES NEED TO BE REVISED. THE HOSPITAL DOES NOT BELIEVE THERE WERE ANY ADJUSTMENTS TO ESTIMATES OF PATIENT BILLS THAT WERE MATERIAL TO REVENUES.GENERALLY, PATIENTS WHO ARE COVERED BY THIRD-PARTY PAYERS ARE RESPONSIBLE FOR RELATED COPAYS, COINSURANCE, AND DEDUCTIBLES, WHICH VARY IN AMOUNT. THE HOSPITAL ALSO PROVIDES SERVICES TO UNINSURED PATIENTS AND OFFER UNINSURED PATIENTS A DISCOUNT FROM STANDARD CHARGES. THE HOSPITAL ESTIMATES THE TRANSACTION PRICE FOR PATIENTS WITH COPAYS, COINSURANCE, AND DEDUCTIBLES AND FOR THOSE WHO ARE UNINSURED BASED ON HISTORICAL COLLECTION EXPERIENCE AND CURRENT MARKET CONDITIONS. UNDER THE HOSPITAL'S UNINSURED DISCOUNT PROGRAMS, THE DISCOUNT OFFERED TO CERTAIN UNINSURED PATIENTS IS RECOGNIZED AS A POLICY DISCOUNT, WHICH REDUCES NET OPERATING REVENUES AT THE TIME THE SELF-PAY ACCOUNTS ARE RECORDED. THE UNINSURED PATIENT ACCOUNTS, NET OF POLICY DISCOUNTS RECORDED, ARE FURTHER REDUCED TO THEIR NET REALIZABLE VALUE AT THE TIME THEY ARE RECORDED THROUGH IMPLICIT PRICE CONCESSIONS BASED ON HISTORICAL COLLECTION TRENDS FOR SELF-PAY ACCOUNTS AND OTHER FACTORS THAT AFFECT THE ESTIMATION PROCESS. SUBSEQUENT CHANGES TO THE ESTIMATE OF THE TRANSACTION PRICE ARE GENERALLY RECORDED AS ADJUSTMENTS TO NET PATIENT SERVICE REVENUES IN THE PERIOD OF THE CHANGE. ALTHOUGH OUTCOMES VARY, THE HOSPITAL'S POLICY IS TO ATTEMPT TO COLLECT AMOUNTS DUE FROM PATIENTS, INCLUDING COPAYS, COINSURANCE, AND DEDUCTIBLES DUE FROM PATIENTS WITH INSURANCE, AT THE TIME OF SERVICE WHILE COMPLYING WITH ALL FEDERAL AND STATE STATUTES AND REGULATIONS.THE HOSPITAL'S CHARITY CARE AND UNINSURED DISCOUNT POLICIES REMAINED UNCHANGED DURING THE YEARS 2022 AND 2021 (SEE NOTE 5).
PART III, LINE 8:	CHLA IS NOT INCLUDING ANY MEDICARE SHORTFALL AS PART OF ITS COMMUNITY BENEFIT. FURTHER, CHLA USES FEDERAL MEDICARE COST ALLOCATION METHODOLOGY, AS REPORTED IN ITS MEDICARE COST REPORT, TO DETERMINE THE ALLOWABLE COSTS OF CARE RELATING TO MEDICARE PAYMENTS RECEIVED.
PART III, LINE 9B:	THE HOSPITAL'S POLICY STATES THAT IF THE PATIENT/GUARANTOR IS UNABLE TO PAY FOR SERVICES DUE TO THEIR CURRENT FINANCIAL SITUATION, THEY COULD BE ELIGIBLE FOR UNCOMPENSATED OR DISCOUNTED CARE, IN WHICH CASE THE HOSPITAL'S APPLICABLE POLICY AND PROCEDURE IS FURTHER REFERENCED. IF THE PATIENT/GUARANTOR DOES NOT QUALIFY, THE HOSPITAL FOLLOWS ALL APPLICABLE FEDERAL AND STATE GUIDELINES FOR DEBT COLLECTION, INCLUDING THE REQUIREMENT OF FAIR TREATMENT, THE PROHIBITION OF MAKING FALSE STATEMENTS AND RESTRICTIONS ON THE TIME OF DAY THAT DEBT COLLECTORS MAY CONTACT THE DEBTOR.
PART VI, LINE 2:	CHLA CONTINUES ITS COMMITMENT TO THE CHILDREN AND FAMILIES OF THE LOS ANGELES AREA THROUGH ITS COMMUNITY BENEFIT ACTIVITIES WHICH ENSURE THAT OUR HOSPITAL WILL REMAIN RESPONSIVE TO THE NEEDS OF THE COMMUNITY. CHILDREN'S HOSPITAL LOS ANGELES STRIVES TO ACCOMPLISH OUR GOALS THROUGH OUR STRATEGIC PLAN, DEVELOPED IN ACCORDANCE WITH THE 2022 COMMUNITY HEALTH NEEDS ASSESSMENT. 2022 COMMUNITY HEALTH NEEDS ASSESSMENT GOALS INCLUDE: -EXPAND ACCESS TO PEDIATRIC HEALTH, BEHAVIORAL HEALTH, AND PREVENTATIVE SERVICES -INCREASE AWARENESS OF PEDIATRIC AND FAMILY HEALTH CARE RESOURCES AND INFORMATION -EXPAND WORKFORCE PIPELINE PROGRAMS FOR YOUTH AND YOUNG ADULTS -EXPAND SUPPORT OF LOCAL ECONOMIC INCLUSION INITIATIVES -SPUR LOCAL ECONOMIC GROWTH AND CHAMPION ENVIRONMENTAL SUSTAINABILITY. CHLA COMPLETED 2022 COMMUNITY HEALTH NEEDS ASSESSMENT AND CONTINUES TO STRENGTHEN ITS COMMITMENT TO UNDERSTANDING THE HEALTH NEEDS OF THE COMMUNITIES IT SERVES.
PART VI, LINE 3:	EVERY PATIENT OR HIS OR HER REPRESENTATIVE SHALL, UPON ADMISSION AS AN INPATIENT, RECEIVE A WRITTEN NOTICE CONTAINING INFORMATION ABOUT THE AVAILABILITY OF CHARITY CARE AND DISCOUNT CARE. THE NOTICE SHALL INCLUDE INFORMATION ABOUT THIS POLICY, AS WELL AS CONTACT INFORMATION FOR A HOSPITAL EMPLOYEE OR OFFICE FROM WHICH THE PATIENT OR REPRESENTATIVE MAY OBTAIN FURTHER INFORMATION ABOUT THIS POLICY. THIS SAME NOTICE SHALL BE GIVEN TO PATIENTS WHO RECEIVE EMERGENCY OR OUTPATIENT CARE, AND WHO MAY RECEIVE A BILL FOR SUCH CARE, BUT WHO WERE NOT ADMITTED. THE NOTICE SHALL BE PROVIDED IN ENGLISH AND IN THE LANGUAGE SPOKEN BY THE PATIENT'S FAMILY IF AVAILABLE. NOTICES REGARDING THIS POLICY WILL BE CLEARLY AND CONSPICUOUSLY POSTED IN LOCATIONS VISIBLE TO THE PUBLIC INCLUDING, BUT NOT LIMITED TO, ALL OF THE FOLLOWING: THE EMERGENCY DEPARTMENT, BILLING OFFICE, ADMISSIONS OFFICE, AND OUTPATIENT SETTINGS. THESE POSTED NOTICES WILL EXPLAIN THAT CHLA HAS A VARIETY OF OPTIONS AVAILABLE, INCLUDING FINANCIAL ASSISTANCE, TO INDIVIDUALS WHO ARE UNINSURED OR UNDERINSURED. THESE NOTICES WILL INCLUDE A CONTACT OFFICE AND TELEPHONE NUMBER AN INDIVIDUAL CAN CALL TO OBTAIN MORE INFORMATION ABOUT THIS FINANCIAL ASSISTANCE POLICY AND TO APPLY FOR FINANCIAL ASSISTANCE.
PART VI, LINE 4:	OUR HOSPITAL SERVICES REACH THOUSANDS ACROSS SOUTHERN CALIFORNIA, WITH A PRIMARY SERVICE AREA OF LOS ANGELES COUNTY--A REGION THAT SPANS 4,057 SQUARE MILES AND INCLUDES VAST URBAN COMMUNITIES, SUBURBAN AREAS AND RURAL NEIGHBORHOODS AND INCLUDES 8 SERVICE PLANNING AREAS (SPAS) AS DESIGNATED BY THE LOS ANGELES COUNTY HEALTH DEPARTMENT. APPROXIMATELY 85% OF THE HOSPITAL'S PATIENTS ORIGINATE FROM L.A. COUNTY. LOS ANGELES COUNTY IS HOME TO MORE THAN 10 MILLION RESIDENTS--APPROXIMATELY 27 PERCENT OF THE STATE'S POPULATION. IT IS THE MOST POPULOUS COUNTY IN THE NATION, AND ONE OF THE MOST ETHNICALLY AND RACIALLY DIVERSE AS WELL.CHILDREN (AGES 0-14) REPRESENTED 18.2% OF THE POPULATION IN LOS ANGELES COUNTY, WHILE ADOLESCENTS (AGES 15-17) REPRESENTED 3.8%. LOS ANGELES COUNTY IS VERY DIVERSE. APPROXIMATELY HALF OF THE POPULATIONIDENTIFIES AS HISPANIC OR LATINO (50%); A LITTLE OVER A QUARTER IDENTIFIED AS WHITE (26.2%); 13.3% IDENTIFIED AS ASIAN, AND 7.9% IDENTIFIED AS BLACK OR AFRICAN AMERICAN. IN LA COUNTY, 57% OF THE POPULATION SPEAKS A LANGUAGE OTHER THAN ENGLISH AT HOME AND 22% ARE LINGUISTICALLY ISOLATED. IN LOS ANGELES COUNTY, 16.7% OF THE POPULATION LIVED AT OR BELOW 100% OF THE FPL. FURTHERMORE, IN LOS ANGELES COUNTY, 16.7% OF CHILDREN, UNDER AGE 18 YEARS, LIVED IN POVERTY.
PART VI, LINE 5:	CHILDREN'S HOSPITAL LOS ANGELES OFFERS MANY COMMUNITY SERVICES AND PROGRAMS IN RESPONSE TO THE NEEDS OF CHILDREN, YOUTH AND FAMILIES. COMMUNITY BENEFIT SERVICES AND ACTIVITIES ARE DESIGNED TO PROVIDE TREATMENT AND PROMOTE HEALTH AS A RESPONSE TO IDENTIFIED COMMUNITY NEEDS. OUR OBJECTIVES ARE TO IMPROVE ACCESS TO HEALTH CARE SERVICES, ENHANCE PUBLIC HEALTH OF THE COMMUNITY, ADVANCE MEDICAL OR HEALTH CARE KNOWLEDGE THAT PROVIDES PUBLIC BENEFIT, AND RELIEVE OR REDUCE THE BURDEN OF GOVERNMENT OR OTHER COMMUNITY EFFORTS AND HAVE INCLUDED PROGRAMS SUCH AS THE FOLLOWING:SAMUELS FAMILY LATINO AND AFRICAN AMERICAN HIGH SCHOOL INTERNSHIP PROGRAM (LA-HIP):THE OVERALL GOAL OF THE SAMUELS FAMILY LA-HIP IS TO PROVIDE LATINO AND AFRICAN AMERICAN PUBLIC HIGH SCHOOL STUDENTS THAT HAVE A GENUINE INTEREST IN SCIENCE, TECHNOLOGY, ENGINEERING AND MATH (STEM) WITH THE OPPORTUNITY TO LEARN HANDS-ON LABORATORY-BASED RESEARCH AND TO SUPPORT THEM IN THEIR QUEST TO BECOME SCIENTISTS OR PHYSICIAN SCIENTISTS. LA-HIP WAS FOUNDED 17 YEARS AGO AND HAS TRAINED OVER 200 HIGH SCHOOL STUDENTS FROM THE LOS ANGELES AREA. LA-HIP IS A COMPREHENSIVE YEARLONG INTERNSHIP PROGRAM THAT COMBINES BIOMEDICAL RESEARCH WITH COLLEGE READINESS WORKSHOPS, ACADEMIC ENHANCEMENT, AND SAT PREPARATORY CURRICULUM. THIS 2022 CLASS OF 16 OUTSTANDING STUDENTS IN THE PROGRAM, ALL OF WHOM UNDERTOOK ORIGINAL RESEARCH PROJECTS WORKING WITH FACULTY, FELLOWS, AND GRADUATE STUDENT MENTORS IN THE SABAN RESEARCH INSTITUTE. CAREERS IN HEALTH AND MENTORSHIP PROGRAM (CHAMP):CHLA'S CHAMP PROVIDES UNDERREPRESENTED ADULTS FROM THE LOS ANGELES COMMUNITY THE OPPORTUNITY TO PARTICIPATE IN A SERIES OF COMPREHENSIVE JOB READINESS, LEADERSHIP DEVELOPMENT WORKSHOPS AND INTERNSHIPS. OVER 280 YOUNG ADULTS LIVING WITHIN THE LOS ANGELES COMMUNITY HAVE BEEN PROVIDED THE OPPORTUNITY TO STRENGTHEN THEIR CAREER PATHWAYS BY GAINING UNIQUE WORK EXPERIENCES AND MENTORSHIP BY OUR HOSPITAL'S LEADERS THAT ARE AFFILIATED WITH NON-CLINICAL SYSTEMS. THE STUDENTS APPLYING CAME FROM VARIOUS EDUCATIONAL INSTITUTIONS INCLUDING TRADE TECHS, COMMUNITY COLLEGES, UNIVERSITIES (UNDERGRADUATE AND GRADUATE), AND PRIVATE PROFESSIONAL ORGANIZATIONS, MANY FROM UNDERSERVED AREAS IN LOS ANGELES COUNTY AND ACROSS THE COUNTRY. CHAMPERS ARE PAIRED WITH DEPARTMENTS ACROSS THE ORGANIZATION THAT HAVE INCLUDED AREAS SUCH AS AMBULATORY OPERATIONS, FOUNDATION, IT, RESEARCH, FACILITIES, ACADEMIC AFFAIRS, ETC. APPROXIMATELY 50% HAVE BEEN OFFERED A POSITION, IN A HEALTHCARE SETTING INCLUDING BUT NOT LIMITED TO CHLA, CEDARS SINAI, THE UCLA HEALTH SYSTEM, THE KAISER SYSTEM, AND USC AND MORE THAN 75% OF THE STUDENTS WENT ON TO CONTINUE TO PURSUE HIGHER EDUCATION INCLUDING PROGRAMS FOR DEGREES SUCH AS MASTER'S IN BUSINESS ADMINISTRATION (MBA), MASTER'S IN PUBLIC HEALTH (MPH), MASTER'S IN HEALTH ADMINISTRATION (MHA), TO NAME A FEW. BOTH COHORTS RETURNED TO IN-PERSON SESSIONS.PROJECT SEARCH:CHILDREN'S HOSPITAL LOS ANGELES LAUNCHED THE NATIONALLY RECOGNIZED PROJECT SEARCH PROGRAM IN COLLABORATION WITH THE LOS ANGELES UNIFIED SCHOOL DISTRICT, PATHPOINT, LANTERNMAN REGIONAL CENTER, AND SOUTH-CENTRAL LOS ANGELES REGIONAL CENTER THIS YEAR. THIS PROGRAM PROVIDES INTERNSHIP OPPORTUNITIES TO PREPARE YOUNG PEOPLE WITH SIGNIFICANT DISABILITIES FOR SUCCESS IN INTEGRATED, COMPETITIVE EMPLOYMENT. BY PLACING YOUNG ADULT INTERNS THROUGHOUT VARIOUS DEPARTMENTS AT CHLA. THE PROGRAM PROVIDES REAL-LIFE WORK EXPERIENCE COMBINED WITH SKILLS TRAINING, CAREER EXPLORATION, AND INDEPENDENT-LIVING SKILLS. WE RECRUITED 5 NEW STUDENTS FOR THE 2022 PROJECT SEARCH COHORT.COVID 19 COMMUNITY VACCINES:DURING THE PANDEMIC, CHILDREN'S HOSPITAL LOS ANGELES BECAME AN OFFICIAL COUNTY "POINT OF DISPENSING" SITE FOR COVID-19 VACCINES, SETTING UP A REGULAR FRIDAY-SATURDAY-SUNDAY CLINIC IN A HOSPITAL CONFERENCE ROOM. THE CLINIC, WHICH IS ONGOING, IS BY APPOINTMENT ONLY THROUGH CALIFORNIA'S MY TURN WEBSITE. IN ADDITION, THE HOSPITAL WORKED CLOSELY WITH LOS ANGELES COUNTY TO IDENTIFY NEIGHBORHOODS AND GROUPS IN NEED OF BETTER ACCESS TO COVID-19 VACCINES. FROM SOUTH L.A. TO PALMDALE, CHILDREN'S HOSPITAL LOS ANGELES PROVIDED OVER 9,700 SHOTS AND COUNTING.FOOD INSECURITY INITIATIVES:TO ADDRESS FOOD INSECURITY IN ITS LOCAL COMMUNITY, CHILDREN'S HOSPITAL SPONSORED AND PROVIDED VOLUNTEERS FOR OVER 45 PRODUCE BOX GIVEAWAY EVENTS IN THE EAST HOLLYWOOD/VIRGIL VILLAGE NEIGHBORHOOD NEAR THE HOSPITAL. IN PARTNERSHIP WITH THE EAST HOLLYWOOD NEIGHBORHOOD COUNCIL, THE OFFICE OF COUNCILMEMBER MITCH O'FARRELL AND RICK'S PRODUCE MARKET, MORE THAN 1,400 BOXESABOUT 35,000 POUNDS OF FRESH PRODUCEHAVE BEEN GIVEN TO FAMILIES AND INDIVIDUALS FACING FOOD INSECURITY. ADDITIONALLY, CHLA MOBILIZED EMPLOYEE VOLUNTEERS FROM THE HOSPITAL'S COMMUNITY IMPACT CHAMPIONS NETWORK (CICN) TO SUPPORT ADDITIONAL FOOD DISTRIBUTION EVENTS TO PROVIDE AN ADDITIONAL 1,100 BOXES TO THE COMMUNITY, RAISING THE OVERALL TOTAL TO MORE THAN 2,500 BOXES OR 50,000 POUNDS OF FOOD. CHILDREN'S HOSPITAL ALSO SEEDED AND SPONSORED THE CITY'S GARDEN AT LOS ANGELES CITY COLLEGE (LACC). EMPLOYEE VOLUNTEERS FROM THE CICN HAVE BEEN BUSY HELPING TO PLANT AND SEED THE GARDEN, WHICH WILL PROVIDE LACC STUDENTS AND THE COMMUNITY WITH A PLACE TO COME TOGETHER, GROW THEIR OWN FRESH PRODUCE, AND LEARN ABOUT NUTRITION AND DIVERSE CUISINES.
PART VI, LINE 7, REPORTS FILED WITH STATES	CA

Schedule H (Form 990) 2021

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Schedule I
(Form 990)

Department of the Treasury
Internal Revenue Service

Grants and Other Assistance to Organizations,
Governments and Individuals in the United States

Complete if the organization answered "Yes," on Form 990, Part IV, line 21 or 22.
lBullet

Attach to Form 990.
lBullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2021

Open to Public
Inspection

Name of the organization
CHILDREN'S HOSPITAL LOS ANGELES

Employer identification number
95-1690977

Part I

General Information on Grants and Assistance

Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ........................

Yes No

Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.

Part II

Grants and Other Assistance to Domestic Organizations and Domestic Governments. Complete if the organization answered "Yes" on Form 990, Part IV, line 21, for any recipient

that received more than $5,000. Part II can be duplicated if additional space is needed.

(a) Name and address of organization or government	(b) EIN	(c) IRC section (if applicable)	(d) Amount of cash grant	(h) Purpose of grant or assistance
(1) CALIFORNIA HEALTH FOUNDATION AND TRUST 1215 K STREET SUITE 800 SACRAMENTO,CA95814	94-1498687	501(C)(3)	1,242,631	SUPPORT CHARITABLE ACTIVITIES AT HOSPITALS AND HEALTH SYSTEMS IN CALIFORNIA
(2) RONALD MCDONALD HOUSE CHARITIES OF SOUTHERN CALIFORNIA 4650 FOUNTAIN AVENUE LOS ANGELES,CA90029	95-3167869	501(C)(3)	500,000	DONATION
(3) NATIONAL MEDICAL FELLOWSHIPS INC 347 FIFTH AVENUE SUITE 510 NEW YORK,NY10016	01-0963657	501(C)(3)	144,500	PRIMARY CARE LEADERSHIP PROGRAM SUPPORT
(4) PARTNERS IN CARE FOUNDATION INC 732 MOTT STREET SUITE 150 SAN FERNANDO,CA91340	95-3954057	501(C)(3)	50,000	22ND ANNUAL TRIBUTE DINNER
(5) THE UCLA FOUNDATION 10889 WILSHIRE BLVD SUITE 1500 LOS ANGELES,CA90024	95-2250801	501(C)(3)	25,000	UCLA HPMAA ANNUAL AWARDS DINNER 2022
(6) THE CONFERENCE BOARD INC 845 THIRD AVENUE NEW YORK,NY100226600	13-1624108	501(C)(3)	25,000	SUPPORT FOR CED AND TCB INDEPENDENT RESEARCH AND OUTREACH PROGRAMS
(7) GREATER LOS ANGELES AFRICAN AMERICAN 5120 W GOLDLEAF CIRCLE SUITE 230 LOS ANGELES,CA90056	95-4357302	501(C)(6)	20,000	ANNUAL ECONOMICS AWARDS DINNER
(8) HOLLYWOOD CHAMBER OF COMMERCE COMMUNITY 6255 SUNSET BLVD SUITE 150 HOLLYWOOD,CA90028	95-4557923	501(C)(3)	24,600	VARIOUS SPONSORSHIPS
(9) ROMAN CATHOLIC ARCHBISHOP OF LOS ANGELES 3424 WILSHIRE BLVD LOS ANGELES,CA90010	95-1642382	501(C)(3)	10,000	CARDINAL'S AWARDS DINNER
(10) EAST LOS ANGELES COLLEGE FOUNDATION 1301 AVENIDA CESAR CHAVEZ MONTEREY PARK,CA91754	33-0034221	501(C)(3)	10,000	ELAC FOUNDATION 2022 PRESIDENT'S GALA
(11) HATHAWAY-SYCAMORES CHILD & FAMILY SVCS 100 W WALNUT STREET SUITE 375 PASADENA,CA91124	95-1691005	501(C)(3)	10,000	2022 SPRING GALA
(12) RICK'S PRODUCE MARKET 755 N VIRGIL AVE LOS ANGELES,CA90029	82-1841207		25,000	EAST HOLLYWOOD COMMUNITY PRODUCE BOXES
(13) LOS ANGELES AREA CHAMBER OF COMMERCE 350 S BIXEL ST NO 201 LOS ANGELES,CA90017	95-0947860	501(C)(6)	10,000	2022 INAUGURAL DINNER SPONSORSHIP
(14) FRIENDS OF THE LOS ANGELES FREE CLINIC 8405 BEVERLY BLVD LOS ANGELES,CA90048	95-3433824	501(C)(3)	10,000	ANNUAL DINNER GALA
(15) VALLEY PRESBYTERIAN HOSPITAL 15107 VANOWEN ST VAN NUYS,CA91405	95-1945832	501(C)(3)	7,500	2021 GOLF CLASSIC SPONSORSHIP
(16) SOUTH LA COMMUNITY FOUNDATION 1847 BROWNING BLVD LOS ANGELES,CA90062	85-3084715	501(C)(3)	6,500	SPONSORSHIP
(17) JVS SOCAL 6505 WILSHIRE BLVD SUITE 200 LOS ANGELES,CA90048	95-1643388	501(C)(3)	12,500	JVS TABLE SPONSORSHIP
(18) UNITE LA INC 350 S BIXEL STREET LOS ANGELES,CA90017	82-0576380	501(C)(3)	15,000	SPONSORSHIPS
(19) PLAYFLY HOLDINGS LLC 22 CASSATT AVE BERWYN,PA19312	85-1210887		50,000	SPONSORSHIP

Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image

Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image

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

Cat. No. 50055P

Schedule I (Form 990) 2021

Page 2

Part III

Grants and Other Assistance to Domestic Individuals. Complete if the organization answered "Yes" on Form 990, Part IV, line 22.
Part III can be duplicated if additional space is needed.

(a) Type of grant or assistance	(b) Number of recipients	(c) Amount of cash grant	(d) Amount of noncash assistance	(e) Method of valuation (book, FMV, appraisal, other)	(f) Description of noncash assistance

(1)
(2)
(3)
(4)
(5)
(6)
(7)

Part IV

Supplemental Information. Provide the information required in Part I, line 2; Part III, column (b); and any other additional information.

Return Reference	Explanation
PART I, LINE 2:	CHLA AWARDS GRANTS TO VARIOUS ORGANIZATIONS FOR PURPOSES THAT ARE CONSISTENT WITH OUR MISSION AND VALUES. IN ADDITION, DUE DILIGENCE IS PERFORMED TO ENSURE THE FUNDS ARE USED FOR THEIR INTENDED PURPOSES.

Schedule I (Form 990) 2021

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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" on Form 990, Part IV, line 23.
SchJMediumBullet

Attach to Form 990.
SchJMediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2021

Open to Public Inspection

Name of the organization

CHILDREN'S HOSPITAL LOS ANGELES

Employer identification number

95-1690977

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 on 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 on 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
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked on 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 on 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), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.

For persons listed on 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," on line 5a or 5b, describe in Part III.

For persons listed on 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," on line 6a or 6b, describe in Part III.

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

Yes

Were any amounts reported on 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" on 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) 2021

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 on 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, 1099-MISC compensation, and/or 1099-NEC			(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation in column (B) reported as deferred on 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)
1PAUL S VIVIANO DIRECTOR, PRESIDENT AND CEO	(i) (ii)	1,074,555 ------------- 0	384,201 ------------- 0	234,822 ------------- 0	4,350 ------------- 0	38,971 ------------- 0	1,736,899 ------------- 0	207,630 ------------- 0
2RHONDA R FOSTER VP, CNO / PATIENT CARE SVCS	(i) (ii)	221,490 ------------- 0	0 ------------- 0	745,033 ------------- 0	25,004 ------------- 0	18,852 ------------- 0	1,010,379 ------------- 0	0 ------------- 0
3M SCOTT LIEBERENZ SVP, CHIEF FINANCIAL OFFICER	(i) (ii)	618,133 ------------- 0	123,816 ------------- 0	104,615 ------------- 0	87,340 ------------- 0	29,694 ------------- 0	963,598 ------------- 0	80,432 ------------- 0
4JAMES STEIN MD SVP, CHIEF MEDICAL OFFICER	(i) (ii)	590,965 ------------- 0	109,942 ------------- 0	157,909 ------------- 0	75,474 ------------- 0	1,921 ------------- 0	936,211 ------------- 0	133,789 ------------- 0
5LARA KHOURI SVP, CHIEF STRATEGY OFFICER	(i) (ii)	549,848 ------------- 0	132,747 ------------- 0	95,460 ------------- 0	77,148 ------------- 0	36,962 ------------- 0	892,165 ------------- 0	63,637 ------------- 0
6NANCY LEE SVP, CHIEF CLINICAL OFFICER	(i) (ii)	554,684 ------------- 0	115,820 ------------- 0	123,192 ------------- 0	4,350 ------------- 0	27,494 ------------- 0	825,540 ------------- 0	99,312 ------------- 0
7MARK D KRIEGER MD DIRECTOR, FACULTY PHYSICIAN	(i) (ii)	693,750 ------------- 0	73,250 ------------- 0	0 ------------- 0	0 ------------- 0	0 ------------- 0	767,000 ------------- 0	0 ------------- 0
8GRACE OH SVP, GENERAL COUNSEL	(i) (ii)	456,625 ------------- 0	85,795 ------------- 0	72,426 ------------- 0	61,630 ------------- 0	53,910 ------------- 0	730,386 ------------- 0	50,267 ------------- 0
9ALEXANDRA CARTER SVP, CHIEF DEVELOPMENT OFFICER	(i) (ii)	427,662 ------------- 0	83,599 ------------- 0	95,285 ------------- 0	58,711 ------------- 0	19,414 ------------- 0	684,671 ------------- 0	58,916 ------------- 0
10MAMOON SYED SVP, CHIEF PEOPLE OFFICER	(i) (ii)	376,594 ------------- 0	75,527 ------------- 0	113,608 ------------- 0	54,609 ------------- 0	37,751 ------------- 0	658,089 ------------- 0	54,970 ------------- 0
11RUTH M AREVALO VP, HEALTH SYSTEM DEV & INTEGRATION	(i) (ii)	327,279 ------------- 0	63,638 ------------- 0	81,926 ------------- 0	53,758 ------------- 0	20,960 ------------- 0	547,561 ------------- 0	61,072 ------------- 0
12CONRAD BAND SVP, INTERIM CHIEF INFO. OFFICER	(i) (ii)	364,058 ------------- 0	79,944 ------------- 0	7,915 ------------- 0	53,327 ------------- 0	33,581 ------------- 0	538,825 ------------- 0	0 ------------- 0
13JODI SHIRLYN OGDEN RIVERA VP, RESEARCH OPERATIONS	(i) (ii)	312,801 ------------- 0	60,994 ------------- 0	68,524 ------------- 0	51,431 ------------- 0	27,772 ------------- 0	521,522 ------------- 0	46,429 ------------- 0
14RANDALL W STEWARD VP, ENTERPRISE CONTRACTING	(i) (ii)	319,063 ------------- 0	59,264 ------------- 0	50,668 ------------- 0	49,524 ------------- 0	38,499 ------------- 0	517,018 ------------- 0	48,147 ------------- 0
15STEVE GARSKE SVP, CHIEF INFO. OFFICER (END 07/21)	(i) (ii)	237,691 ------------- 0	0 ------------- 0	241,252 ------------- 0	14,222 ------------- 0	14,604 ------------- 0	507,769 ------------- 0	76,571 ------------- 0
16BHAVANA KUMAR ARORA CMO, CHLA HEALTH NETWORK	(i) (ii)	388,759 ------------- 0	54,073 ------------- 0	0 ------------- 0	4,350 ------------- 0	3,457 ------------- 0	450,639 ------------- 0	0 ------------- 0
17MATTHEW MATT KEEFER MD DIRECTOR, FACULTY PHYSICIAN	(i) (ii)	374,845 ------------- 0	0 ------------- 0	0 ------------- 0	0 ------------- 0	0 ------------- 0	374,845 ------------- 0	0 ------------- 0
18ROBERT BOB E SHADDY MD DIRECTOR, FACULTY PHYSICIAN	(i) (ii)	266,750 ------------- 0	0 ------------- 0	0 ------------- 0	0 ------------- 0	0 ------------- 0	266,750 ------------- 0	0 ------------- 0
19JUDITH M KLINE CORPORATE SECRETARY	(i) (ii)	244,168 ------------- 0	1,000 ------------- 0	0 ------------- 0	3,728 ------------- 0	16,830 ------------- 0	265,726 ------------- 0	0 ------------- 0

Schedule J (Form 990) 2021

Page 3

Part III

Supplemental Information

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.

Return Reference	Explanation
PART I, LINE 4A:	THE FOLLOWING INDIVIDUALS RECEIVED SEVERANCE IN CALENDAR YEAR 2021, WHICH WAS TREATED AS TAXABLE COMPENSATION: RHONDA R. FOSTER - $700,000 STEVE GARSKE - $100,000
PART I, LINE 4B:	THE FOLLOWING INDIVIDUALS PARTICIPATED IN CHLA'S 457(F) PLAN FOR EXECUTIVE DEFERRED COMPENSATION (EDCP), A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN. AMOUNTS DEFERRED UNDER SECTION 457(F) PLAN ARE SUBJECT TO SUBSTANTIAL RISK OF FORFEITURE. THESE AMOUNTS WILL BE REPORTED AS COMPENSATION FOR THE YEAR PAID. AMOUNTS RECOGNIZED AS TAXABLE COMPENSATION ON THE EMPLOYEES 2020 FORM W-2 (EXCEPT PAUL VIVIANO - DEFERRED COMPENSATION) REFLECT PAYMENTS RECEIVED BY THE EMPLOYEE DURING CALENDAR YEAR 2021 THAT WERE PREVIOUSLY REPORTED AS DEFERRED COMPENSATION IN PRIOR YEAR FORM 990S: PAUL S. VIVIANO - $207,630 M. SCOTT LIEBERENZ - $80,432 ALEXANDRA CARTER - $58,916 STEVE GARSKE - $76,571 LARA KHOURI - $63,637 NANCY LEE - $99,312 GRACE OH - $50,267 JAMES STEIN, M.D. - $133,789 MAMOON SYED - $54,970 JODI SHIRLYN ODEN RIVERA - $46,429 RANDALL W. STEWARD - $48,147 RUTH AREVALO - $61,072
PART I, LINE 7	CHLA MAINTAINS AN ENTERPRISE INCENTIVE PROGRAM (THE PLAN) THAT AWARDS INCENTIVE COMPENSATION BASED UPON ACHIEVEMENT OF ORGANIZATIONAL OBJECTIVES AS DETERMINED ANNUALLY BY THE BOARD OF DIRECTORS. ALTHOUGH THE AMOUNT OF INCENTIVE THAT EACH PARTICIPANT MAY BE AWARDED IS BASED ON A FIXED FORMULA, THE PRESIDENT AND CHIEF EXECUTIVE OFFICER AND BOARD OF DIRECTORS HAS THE FULL DISCRETION AND AUTHORITY TO DETERMINE QUESTIONS CONCERNING THE INTERPRETATION OR ADMINISTRATION OF THE PLAN, INCLUDING, WITHOUT LIMITATION, ALL QUESTIONS RELATING TO PLAN ELIGIBILITY, FINANCIAL FUNDING, PERFORMANCE GOALS AND RESULTS, AND APPROPRIATE PAYMENTS, AND THE DETERMINATIONS OF THE PRESIDENT AND CHIEF EXECUTIVE OFFICER AND BOARD OF DIRECTORS IS CONCLUSIVE AND BINDING AS TO ALL PERSONS AND FOR ALL PURPOSES.
PART VII, SECTION A, LINE 5	PURSUANT TO THE AFFILIATE AGREEMENT WITH THE UNIVERSITY OF SOUTHERN CALIFORNIA (USC), AN UNRELATED ORGANIZATION, THE FOLLOWING COMPENSATION AMOUNTS WERE PAID TO THE FOLLOWING LISTED INDIVIDUALS BY USC. USC WAS SUBSEQUENTLY REIMBURSED BY CHLA FOR THE AMOUNTS: MARK D. KRIEGER, M.D. - $767,000 MATTHEW KEEFER, M.D. - $374,845 ROBERT E. SHADDY, M.D. - $266,750 JAMES STEIN, M.D. - $67,337

Schedule J (Form 990) 2021

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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 Ⅵ, line 24a. Provide descriptions,
explanations, and any additional information in Part Ⅵ.
SchKMediumBullet

Attach to Form 990.
SchKMediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2021

Open to Public
Inspection

Name of the organization
CHILDREN'S HOSPITAL LOS ANGELES

Employer identification number
95-1690977

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	13033LB22	08-15-2012	182,930,717	SEE PART VI		X		X		X
B	CALIFORNIA HEALTH FACILITIES FINANCING AUTHORITY	52-1643828	13032UNH7	06-06-2017	295,974,620	SEE PART VI		X		X		X
C	CALIFORNIA HEALTH FACILITIES FINANCING AUTHORITY	52-1643828	13032UNJ3	06-06-2017	52,180,000	SEE PART VI		X		X		X

Part Ⅱ

Proceeds

	A		B		C		D
	1 Amount of bonds retired ..................	61,620,000
2 Amount of bonds legally defeased ..............
3 Total proceeds of issue ..................	182,930,717		296,178,058		52,180,000
4 Gross proceeds in reserve funds .............
5 Capitalized interest from proceeds .............
6 Proceeds in refunding escrows ...............
7 Issuance costs from proceeds ...............	2,310,722		2,528,240		494,240
8 Credit enhancement from proceeds .............
9 Working capital expenditures from proceeds .............
10 Capital expenditures from proceeds .............			33,225,192
11 Other spent proceeds .............	180,619,995		260,424,626		51,685,760
12 Other unspent proceeds .............
13 Year of substantial completion .............			2018
	Yes	No	Yes	No	Yes	No	Yes	No
14 Were the bonds issued as part of a current refunding issue of tax-exempt bonds (or, if issued prior to 2020, a current refunding issue)? ........	X		X		X
15 Were the bonds issued as part of an advance refunding issue of taxable bonds (or, if issued prior to 2020, 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

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

Cat. No. 50193E

Schedule K (Form 990) 2021

Page 2

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
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?
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 .........	0 %		0 %		0 %
6 Total of lines 4 and 5 .............	0 %		0 %		0 %
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? .............
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, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate? ...		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 "Yes" to 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

Schedule K (Form 990) 2021

Page 3

Part Ⅳ

Arbitrage (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
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 ..........					GOLDMAN SACHS
c Term of hedge .........					1300.0000000000 %
d Was the hedge superintegrated? ......						X
e Was the hedge terminated? ........						X
5a Were gross proceeds invested in a guaranteed investment contract (GIC)?		X		X		X
b Name of provider ..........
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
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. Provide additional information for responses to questions on Schedule K. (See instructions).

Return Reference	Explanation
DATE REBATE COMPUTATION PERFORMED	ISSUER NAME: CALIFORNIA HEALTH FACILITIES FINANCING AUTHORITY DATE THE REBATE COMPUTATION WAS PERFORMED: 07/01/2022
SCHEDULE K, PART I, BOND ISSUES:	PART I(F): THE CURRENT REFUNDING OF THE SERIES 1999 BONDS (ISSUED ON 05/26/1999), SERIES 2009 BONDS (ISSUED ON 12/18/2009) AND SERIES 2010B BONDS (ISSUED ON 05/20/2010).
SCHEDULE K, PART I, BOND ISSUES:	PART I(F): THE SERIES 2017A BONDS WERE ISSUED TO FINANCE HOSPITAL PROJECTS; THE ADVANCE REFUNDING OF THE BORROWER'S SERIES 2010A BONDS (ISSUED ON 05/20/2010); AND THE CURRENT REFUNDING OF THE BORROWER'S SERIES 2007 BONDS (ISSUED ON 04/24/2007) AND SERIES 2012B BONDS (ISSUED ON 08/15/2012).
SCHEDULE K, PART I, BOND ISSUES:	PART I(F): THE CURRENT REFUNDING OF THE SERIES 2007 BONDS (ISSUED ON 04/24/2007) AND THE SERIES 2012B BONDS (ISSUED ON 08/15/2012).
PART IV, LINE 2B, COLUMN A:	BOND A: THE 2012 BONDS MET THE 6 MONTH EXCEPTION TO REBATE.
PART IV, LINE 6, COLUMN B:	THIS QUESTION IS BEING ANSWERED WITHOUT REGARD TO A YIELD-RESTRICTED ADVANCE REFUNDING ESCROW FINANCED WITH PROCEEDS OF THE BONDS.
PART VI:	DIFFERENCES BETWEEN THE ISSUE PRICE (PART I) AND TOTAL PROCEEDS (PART II, LINE 3) ARE DUE TO INVESTMENT EARNINGS.

Schedule K (Form 990) 2021

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Schedule L
(Form 990)

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

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2021

Open to Public Inspection

Name of the organization

CHILDREN'S HOSPITAL LOS ANGELES

Employer identification number

95-1690977

Part I

Excess Benefit Transactions (section 501(c)(3), section 501(c)(4), and section 501(c)(29) 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 the 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 Benefiting 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) 2021

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) MARTHA GARSKE	MARTHA GARSKE IS THE WIFE OF STEVE GARSKE (KEY EMPLOYEE)	78,256	EMPLOYMENT		No

Part V

Supplemental Information
Provide additional information for responses to questions on Schedule L (see instructions).

Return Reference	Explanation

Schedule L (Form 990) 2021

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SCHEDULE M
(Form 990)

Department of the Treasury

Internal Revenue Service

Noncash Contributions

Complete if the organizations answered "Yes" on Form 990, Part IV, lines 29 or 30.
Right pointing arrow large image

Attach to Form 990.
Right pointing arrow large image

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2021

Open to Public Inspection

Name of the organization

CHILDREN'S HOSPITAL LOS ANGELES

Employer identification number

95-1690977

Part I

Types of Property

	(a) Check if applicable	(b) Number of contributions or items contributed	(c) Noncash contribution amounts reported on Form 990, Part VIII, line 1g	(d) Method of determining noncash contribution amounts
1 Art—Works of art ....	X	1	38,000	FAIR MARKET VALUE
2 Art—Historical treasures .
3 Art—Fractional interests ..
4 Books and publications ..	X		52,182	FAIR MARKET VALUE
5 Clothing and household goods .......	X		201,879	FAIR MARKET VALUE
6 Cars and other vehicles ..
7 Boats and planes ....
8 Intellectual property ...
9 Securities—Publicly traded .	X	227	2,748,436	COST OR SELLING PRICE
10 Securities—Closely held stock .
11 Securities—Partnership, LLC, or trust interests ....
12 Securities—Miscellaneous ..
13 Qualified conservation contribution—Historic structures .....
14 Qualified conservation contribution—Other ...
15 Real estate—Residential .	X	1	4,035,000	APPRAISED VALUE
16 Real estate—Commercial ..
17 Real estate—Other ...
18 Collectibles .....
19 Food inventory ...	X	8	10,822	FAIR MARKET VALUE
20 Drugs and medical supplies .
21 Taxidermy ......
22 Historical artifacts ....
23 Scientific specimens ..
24 Archeological artifacts ...
25 Other ( OTHER IN-KIND )	X	25	709,543	FAIR MARKET VALUE
26 Other ( PERSONAL PROTECTIVE EQUIPMENT )	X	5	151,149	FAIR MARKET VALUE
27 Other ( AIRLINE TICKETS/HOTEL )	X	1	24,000	FAIR MARKET VALUE
28 Other ( GIFT CARDS )	X	5	20,850	FAIR MARKET VALUE

Number of Forms 8283 received by the organization during the tax year for contributions
for which the organization completed Form 8283, Part IV, Donee Acknowledgement

Yes

30a

During the year, did the organization receive by contribution any property reported in Part I, lines 1 through 28, that it must hold for at least three years from the date of the initial contribution, and which isn't required to be used for exempt purposes for the entire holding period? ...................

30a

If "Yes," describe the arrangement in Part II.

Does the organization have a gift acceptance policy that requires the review of any nonstandard contributions?

Yes

32a

Does the organization hire or use third parties or related organizations to solicit, process, or sell noncash

contributions? ..........................

32a

If "Yes," describe in Part II.

If the organization didn't report an amount in column (c) for a type of property for which column (a) is checked,

describe in Part II.

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

Cat. No. 51227J

Schedule M (Form 990) (2021)

Page 2

Part IISupplemental Information. Provide the information required by Part I, lines 30b, 32b, and 33, and whether the organization is reporting in Part I, column (b), the number of contributions, the number of items received, or a combination of both. Also complete this part for any additional information.

Return Reference	Explanation
PART I, COLUMN (B):	THE HOSPITAL IS REPORTING THE NUMBER OF CONTRIBUTIONS.

Schedule M (Form 990) (2021)

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SCHEDULE O
(Form 990)

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 990-EZ or to provide any additional information.
MediumBullet

Attach to Form 990 or 990-EZ.
MediumBullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2021

Open to Public
Inspection

Name of the organization

CHILDREN'S HOSPITAL LOS ANGELES

Employer identification number

95-1690977

Return Reference	Explanation
FORM 990, PART III, LINE 1	WE CREATE HOPE AND BUILD HEALTHIER FUTURES. AS A LEADING ACADEMIC CHILDREN'S HOSPITAL, WE FULFILL OUR MISSION BY: CARING FOR CHILDREN, ADOLESCENTS, YOUNG ADULTS, FAMILIES AND EACH OTHER; ADVANCING KNOWLEDGE; PREPARING FUTURE GENERATIONS; BUILDING OUR FINANCIAL STRENGTH.
FORM 990, PART VI, SECTION A, LINE 4	THE FOURTH AMENDED AND RESTATED BYLAWS WERE EFFECTIVE JUNE 12, 2020 TO JANUARY 26, 2022. THE FIFTH AMENDED AND RESTATED BYLAWS BECAME EFFECTIVE ON JANUARY 26, 2022 AND REMAIN EFFECTIVE THROUGH THE PRESENT. SUMMARY OF CHANGES: THE BYLAWS WERE AMENDED TO ADD PROVISIONS REGARDING THE GOVERNING BOARD'S AUTHORITY TO ACT IN THE EVENT THAT AN EMERGENCY (SUCH AS A PANDEMIC) RENDERS THE BOARD UNABLE TO CONVENE A QUORUM OF THE BOARD AND/OR OF A STANDING COMMITTEE OF THE BOARD; AND IN COMPLIANCE WITH CALIFORNIA ASSEMBLY BILL 663 EFFECTIVE AS OF JANUARY 1, 2022.
FORM 990, PART VI, SECTION B, LINE 11B	THE FORM 990 IS PREPARED BY DELOITTE TAX LLP, WORKING IN CONJUNCTION WITH CHLA'S FINANCE DEPARTMENT. CHLA'S DIRECTOR OF FINANCE AND CONTROLLER HAS DIRECT RESPONSIBILITY FOR THIS EFFORT, SUBJECT TO SUPERVISION BY THE CHIEF FINANCIAL OFFICER. AFTER AN INITIAL DRAFT OF THE FORM 990 IS PREPARED, IT IS CIRCULATED FOR REVIEW AND COMMENT BY RELEVANT MEMBERS OF THE EXECUTIVE TEAM WHO HAVE RESPONSIBILITY AND/OR KNOWLEDGE ABOUT THE VARIOUS MATTERS DISCLOSED AND/OR DESCRIBED IN THE FORM. THE CHIEF FINANCIAL OFFICER AND GENERAL COUNSEL, IN PARTICULAR, REVIEW THE FORM 990 AND ENSURE ACCURACY OF DESCRIPTIONS AND THAT DISCLOSURE IS COMPLETE. THE DRAFT FORM 990 IS REVIEWED BY THE AUDIT COMMITTEE OF CHLA, ACTING ON BEHALF OF THE BOARD OF DIRECTORS OF CHLA. ONCE THE DRAFT FORM 990 HAS BEEN REVIEWED AND DISCUSSED BY THE AUDIT COMMITTEE, ANY CHANGES RESULTING FROM THEIR REVIEW IS INCORPORATED INTO THE FINAL DRAFT OF THE FORM 990. THE FINAL DRAFT OF THE FORM 990 IS THEN DISTRIBUTED TO THE BOARD OF DIRECTORS VIA A SECURE WEB SITE FOR THEIR REVIEW AND COMMENTS PRIOR TO THE FILING OF THE FORM 990.
FORM 990, PART VI, SECTION B, LINE 12C	CHLA MONITORS AND ENFORCES COMPLIANCE WITH ITS CONFLICT OF INTEREST POLICY THROUGH ANNUAL CIRCULATION OF A CONFLICT OF INTEREST QUESTIONNAIRE WHICH IS TO BE ANSWERED BY MEMBERS OF ITS BOARD OF DIRECTORS AND BOARD OF TRUSTEES, OFFICERS, MEDICAL STAFF MEMBERS, AND CERTAIN KEY EMPLOYEES. FURTHERMORE, INDIVIDUALS COVERED BY THE POLICY ARE REQUIRED TO DISCLOSE ANY PERSONAL INTERESTS THAT COULD CREATE A CONFLICT OF INTEREST ON A CONTINUOUS BASIS THROUGHOUT THE YEAR. ANY DISCLOSURES PRESENTING A CONFLICT OF INTEREST ARE EVALUATED BY A COMBINATION OF CHLA'S CONFLICT OF INTEREST COMMITTEE, GENERAL COUNSEL, CHIEF COMPLIANCE OFFICER, CHIEF EXECUTIVE OFFICER, CHIEF MEDICAL OFFICER, RESEARCH COMPLIANCE AND INTEGRITY OFFICER, AND BOARD OF DIRECTORS AND ITS AUDIT COMMITTEE, DEPENDING ON THE INDIVIDUAL MAKING THE DISCLOSURE. DISCLOSURES WILL BE INITIALLY ASSESSED BY CHLA'S OFFICE OF COMPLIANCE AND PRIVACY AND, IF A CONFLICT EXISTS, IT WILL BE REFERRED TO CHLA'S CONFLICT OF INTEREST COMMITTEE FOR FURTHER EVALUATION. IF A CONFLICT EXISTS INVOLVING A CHLA BOARD MEMBER, THE BOARD OF DIRECTORS IS RESPONSIBLE FOR REVIEWING THE CONFLICT AND DETERMINING THE CONFLICT RESOLUTION, WHICH MAY INCLUDE, BUT IS NOT LIMITED TO, A CONFLICT MANAGEMENT STIPULATION REQUIRING THE BOARD MEMBER'S RECUSAL FROM CERTAIN CHLA MATTERS.
FORM 990, PART VI, SECTION B, LINE 15	THE PROCESS FOR DETERMINING THE COMPENSATION OF THE CHIEF EXECUTIVE OFFICER OF CHLA IS CONDUCTED BY THE BOARD OF DIRECTORS OF CHLA. IN DETERMINING THE CHIEF EXECUTIVE OFFICER'S COMPENSATION DURING THE TAX PERIOD OF THIS INFORMATION RETURN THE BOARD WORKED WITH AND RELIED UPON THE COUNSEL AND EXPERTISE OF SULLIVAN, COTTER AND ASSOCIATES, INC., A FIRM WITH EXPERIENCE AND EXPERTISE IN THE AREA OF NON-PROFIT ORGANIZATION EXECUTIVE COMPENSATION. SULLIVAN COTTER PROVIDED REPORTS TO THE BOARD, WHICH FURNISHED THE BASIS FOR THE ESTABLISHMENT OF THE CHIEF EXECUTIVE OFFICER'S COMPENSATION PACKAGE. THEIR REPORTS WERE BASED ON A REVIEW OF THE EXECUTIVE COMPENSATION PRACTICES OF A VARIETY OF HOSPITALS AND HEALTHCARE SYSTEMS THAT ARE CONSIDERED COMPARABLE TO CHLA BASED ON VARIOUS METRICS SUCH AS HOSPITAL TYPE AND REVENUE. THE BOARD DELIBERATED ON THE ISSUE OF THE CHIEF EXECUTIVE OFFICER'S COMPENSATION PACKAGE IN LIGHT OF THESE REPORTS AND SULLIVAN COTTER WERE AVAILABLE TO ANSWER ANY QUESTIONS REGARDING SUCH REPORTS AND OTHER RELEVANT MATTERS. BASED ON SUCH DELIBERATIONS, BOARD NEGOTIATED A WRITTEN CONTRACT WITH THE CHIEF EXECUTIVE OFFICER. THE PROCESS FOR DETERMINING THE COMPENSATION OF OFFICERS AND OTHER KEY EMPLOYEES OF CHLA IS CONDUCTED BY THE BOARD OF DIRECTORS OF CHLA, WITH SUPPORT AND GUIDANCE FROM THE CHIEF EXECUTIVE OFFICER AND HUMAN RESOURCES DEPARTMENT. IN DETERMINING SUCH EMPLOYEE'S COMPENSATION, DURING THE COMPENSATION SEASON THE HUMAN RESOURCES DEPARTMENT AND THE BOARD WORKED WITH AND RELIED UPON THE COUNSEL AND EXPERTISE OF SULLIVAN COTTER, A FIRM WITH EXPERIENCE AND EXPERTISE IN THE AREA OF NON-PROFIT ORGANIZATION EXECUTIVE COMPENSATION, INCLUDING PEDIATRIC SYSTEMS. SULLIVAN COTTER PROVIDED AN EXECUTIVE COMPENSATION REPORT TO THE HUMAN RESOURCES DEPARTMENT AND THE BOARD WHICH FURNISHED THE BASIS FOR THE ESTABLISHMENT OF SUCH EMPLOYEE'S COMPENSATION PACKAGE DURING THE FOLLOWING YEAR. SULLIVAN COTTERS REPORT WAS BASED ON A REVIEW OF EXECUTIVE COMPENSATION PRACTICES OF A VARIETY OF HOSPITALS AND HEALTHCARE SYSTEMS THAT ARE CONSIDERED COMPARABLE TO CHLA BASED ON VARIOUS METRICS SUCH AS HOSPITAL TYPE AND REVENUE. IN ADDITION, THE CHIEF EXECUTIVE OFFICER MADE A RECOMMENDATION TO THE BOARD WITH RESPECT TO EACH OF SUCH EMPLOYEE'S COMPENSATION PACKAGE IN LIGHT OF THE SULLIVAN COTTER REPORT AND IN LIGHT OF THE EXECUTIVE'S PERFORMANCE. AT THE BOARD MEETING ADDRESSING SUCH MATTERS, SULLIVAN COTTER WERE AVAILABLE TO ANSWER ANY QUESTIONS REGARDING SUCH REPORT AND OTHER RELEVANT MATTERS, AND RECOMMENDATIONS FROM THE CHIEF EXECUTIVE OFFICER WERE REQUESTED BY AND PROVIDED TO THE BOARD. BASED ON SUCH DELIBERATIONS, THE BOARD MADE A DECISION REGARDING THE COMPENSATION PACKAGE FOR SUCH EMPLOYEES FOR THE FOLLOWING YEAR.
FORM 990, PART VI, SECTION C, LINE 19	CHLA DOES NOT MAKE ITS GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY AVAILABLE TO THE PUBLIC. CHLA'S FINANCIAL STATEMENTS ARE CONTAINED IN ITS FORM 990, WHICH IS AVAILABLE FOR PUBLIC INSPECTION DURING BUSINESS HOURS.
FORM 990, PART IX, LINE 11G	PROFESSIONAL MEDICAL FEES: PROGRAM SERVICE EXPENSES 121,353,661. MANAGEMENT AND GENERAL EXPENSES 27,083,399. FUNDRAISING EXPENSES 537,003. TOTAL EXPENSES 148,974,063. MEDICAL-RELATED SERVICES: PROGRAM SERVICE EXPENSES 10,626,280. MANAGEMENT AND GENERAL EXPENSES 47,177. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 10,673,457. OTHER PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 24,001,865. MANAGEMENT AND GENERAL EXPENSES 44,725,544. FUNDRAISING EXPENSES 2,831,567. TOTAL EXPENSES 71,558,976.
FORM 990, PART XI, LINE 9:	CHANGE IN VALUE OF SPLIT INTEREST AGREEMENTS 1,079,384. TRANSFERS AND OTHERS -1,318,664. CHANGE IN SWAP MARK TO MARKET 6,292,801.

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

Cat. No. 51056K

Schedule O (Form 990) 2021

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" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBullet

Attach to Form 990.
MediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2021

Open to Public Inspection

Name of the organization

CHILDREN'S HOSPITAL LOS ANGELES

Employer identification number

95-1690977

Part I

Identification of Disregarded Entities. Complete if the organization answered "Yes" on 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	(f) Direct controlling entity
(1) CHLA HOLDINGS LLC 4650 SUNSET BLVD LOS ANGELES,CA90027 27-3653228	INVESTMENT VEHICLE	CA	45,344	CHILDREN'S HOSPITAL LOS ANGELES
(2) CHILDREN'S HEALTH SYSTEM OF LOS ANGELES LLC 4650 SUNSET BLVD LOS ANGELES,CA90027 95-1690977	HEALTHCARE SERVICES	CA	0	CHILDREN'S HOSPITAL LOS ANGELES
(3) CHLA HEALTH NETWORK LLC 4650 SUNSET BLVD LOS ANGELES,CA90027 95-1690977	HEALTHCARE SERVICES	CA	0	CHILDREN'S HOSPITAL LOS ANGELES
(4) CHLA INTERNATIONAL LLC 4650 SUNSET BLVD LOS ANGELES,CA90027 47-1738947	HEALTHCARE SERVICES	CA	0	CHILDREN'S HOSPITAL LOS ANGELES
(5) CHLA TEACHING CLINICS LLC 4650 SUNSET BLVD LOS ANGELES,CA90027 82-0677283	HEALTHCARE SERVICES	CA	0	CHILDREN'S HOSPITAL LOS ANGELES
(6) CHLA FOUNDATION LLC 4650 SUNSET BLVD LOS ANGELES,CA90027 95-1690977	HEALTHCARE SERVICES	CA	0	CHILDREN'S HOSPITAL LOS ANGELES
(7) 4520 SUNSET BLVD LLC 4650 SUNSET BLVD LOS ANGELES,CA90027 83-3837347	REAL ESTATE HOLDING	CA	1,256,700	CHILDREN'S HOSPITAL LOS ANGELES
(8) 4470 SUNSET BLVD LLC 4650 SUNSET BLVD LOS ANGELES,CA90027 87-2150138	REAL ESTATE HOLDING	CA	450,634	CHILDREN'S HOSPITAL LOS ANGELES

Part II

Identification of Related Tax-Exempt Organizations. Complete if the organization answered "Yes" on 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)ANTELOPE VALLEY GUILD 4650 SUNSET BLVD MS 4 LOS ANGELES,CA90027 95-6118987	FUNDRAISING	CA	501(C)(3)	LINE 12D, III-O	N/A		No
(2)CENTENNIAL GUILD 4650 SUNSET BLVD MS 4 LOS ANGELES,CA90027 14-1878642	FUNDRAISING	CA	501(C)(3)	LINE 12D, III-O	N/A		No
(3)CHILDRENS CHAIN 4650 SUNSET BLVD MS 4 LOS ANGELES,CA90027 95-4559789	FUNDRAISING	CA	501(C)(3)	LINE 12D, III-O	N/A		No
(4)DELTA DELTA DELTA 4650 SUNSET BLVD MS 4 LOS ANGELES,CA90027 23-7294093	FUNDRAISING	CA	501(C)(3)	LINE 12D, III-O	N/A		No
(5)EL SEGUNDO AUXILIARY 4650 SUNSET BLVD MS 4 LOS ANGELES,CA90027 95-6118991	FUNDRAISING	CA	501(C)(3)	LINE 12D, III-O	N/A		No
(6)FLINTRIDGE GUILD 4650 SUNSET BLVD MS 4 LOS ANGELES,CA90027 95-6118993	FUNDRAISING	CA	501(C)(3)	LINE 12D, III-O	N/A		No
(7)HEALING ARTS REACHING KIDS 4650 SUNSET BLVD MS 4 LOS ANGELES,CA90027 20-4459362	FUNDRAISING	CA	501(C)(3)	LINE 12D, III-O	N/A		No
(8)LA PROVIDENCIA GUILD 4650 SUNSET BLVD MS 4 LOS ANGELES,CA90027 95-6128178	FUNDRAISING	CA	501(C)(3)	LINE 12D, III-O	N/A		No
(9)LAS MADRINAS INC 4650 SUNSET BLVD MS 4 LOS ANGELES,CA90027 95-1959907	FUNDRAISING	CA	501(C)(3)	LINE 12D, III-O	N/A		No
(10)MARY DUQUE JUNIORS 4650 SUNSET BLVD MS 4 LOS ANGELES,CA90027 95-3786303	FUNDRAISING	CA	501(C)(3)	LINE 12D, III-O	N/A		No
(11)MEN'S GUILD 4650 SUNSET BLVD MS 4 LOS ANGELES,CA90027 26-0109744	FUNDRAISING	CA	501(C)(3)	LINE 12D, III-O	N/A		No
(12)MONROVIA GUILD 4650 SUNSET BLVD MS 4 LOS ANGELES,CA90027 95-6121929	FUNDRAISING	CA	501(C)(3)	LINE 12D, III-O	N/A		No
(13)PASADENA GUILD 4650 SUNSET BLVD MS 4 LOS ANGELES,CA90027 95-6121932	FUNDRAISING	CA	501(C)(3)	LINE 12D, III-O	N/A		No
(14)PENINSULA COMMITTEE 4650 SUNSET BLVD MS 4 LOS ANGELES,CA90027 23-7091175	FUNDRAISING	CA	501(C)(3)	LINE 12D, III-O	N/A		No
(15)SANTA MONICA BAY AUXILIARY 4650 SUNSET BLVD MS 4 LOS ANGELES,CA90027 23-7293607	FUNDRAISING	CA	501(C)(3)	LINE 12D, III-O	N/A		No
(16)SOUTH BAY AUXILIARY 4650 SUNSET BLVD MS 4 LOS ANGELES,CA90027 95-6118996	FUNDRAISING	CA	501(C)(3)	LINE 12D, III-O	N/A		No
(17)SPIRITUAL CARE 4650 SUNSET BLVD MS 4 LOS ANGELES,CA90027 20-0872821	FUNDRAISING	CA	501(C)(3)	LINE 12D, III-O	N/A		No
(18)TOLUCA GUILD 4650 SUNSET BLVD MS 4 LOS ANGELES,CA90027 95-6098666	FUNDRAISING	CA	501(C)(3)	LINE 12D, III-O	N/A		No
(19)WESTSIDE GUILD 4650 SUNSET BLVD MS 4 LOS ANGELES,CA90027 95-6059321	FUNDRAISING	CA	501(C)(3)	LINE 12D, III-O	N/A		No
(20)YOUNG PROFESSIONALS COUNCIL 4650 SUNSET BLVD MS 4 LOS ANGELES,CA90027 46-1301196	FUNDRAISING	CA	501(C)(3)	LINE 12D, III-O	N/A		No

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

Cat. No. 50135Y

Schedule R (Form 990) 2021

Page 2

Part III

Identification of Related Organizations Taxable as a Partnership. Complete if the organization answered "Yes" on 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	(e) Predominant income(related, unrelated, excluded from tax under sections 512-514)	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?		(k) Percentage ownership
(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 V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No	(k) Percentage ownership
(1) VIRTUAL PICU SYSTEMS LLC 4470 W SUNSET BLVD STE 440 LOS ANGELES,CA90027 20-1414664	HEALTHCARE SERVICES	CA	CHILDREN'S HOSPITAL LOS ANGELES	RELATED	-845,050	-44,174		No		Yes		98.330 %

Part IV

Identification of Related Organizations Taxable as a Corporation or Trust. Complete if the organization answered "Yes" on 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	(h) Percentage ownership	Yes	No
(1) CHLA ESBT 4650 SUNSET BLVD LOS ANGELES,CA90027 20-3115169	INVESTMENT	CA	CHILDREN'S HOSPITAL LOS ANGELES	T	146,900		100.000 %	Yes
(2) CHLA MEDICAL FOUNDATION 4650 SUNSET BLVD LOS ANGELES,CA90027 82-4816550	HEALTHCARE SERVICES	CA	CHILDREN'S HOSPITAL LOS ANGELES	C			100.000 %	Yes
(3) CHARITABLE REMAINDER TRUST (6) 99-9999999	CHARITABLE TRUST	CA	CHILDREN'S HOSPITAL LOS ANGELES	T					No

Schedule R (Form 990) 2021

Page 3

Part V

Transactions With Related Organizations. Complete if the organization answered "Yes" on 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) ............................

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

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

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

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) ......................

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) .................

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) ............................

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 related organization	(b) Transaction type (a-s)	(c) Amount involved	(d) Method of determining amount involved

Schedule R (Form 990) 2021

Page 4

Part VI

Unrelated Organizations Taxable as a Partnership. Complete if the organization answered "Yes" on 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 V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?		(k) Percentage ownership
(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 V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No	(k) Percentage ownership

Schedule R (Form 990) 2021

Page 5

Part VII

Supplemental Information

Provide additional information for responses to questions on Schedule R. See instructions.

Return Reference	Explanation

Schedule R (Form 990) 2021

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: PROMOTION AND ADVANCEMENT OF CHILDREN'S HEALTH THROUGH PATIENT CARE, RESEARCH, AND EDUCATION.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	19
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	15
5	Total number of individuals employed in calendar year 2021 (Part V, line 2a) ......	5	7,624
6	Total number of volunteers (estimate if necessary) .............	6	516
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	34,968
b	Net unrelated business taxable income from Form 990-T, Part I, line 11 .........	7b	179

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	261,581,920	265,364,863
9	Program service revenue (Part VIII, line 2g) .........	1,056,282,434	1,156,935,400
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	27,161,039	37,331,036
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	13,687,063	15,692,189
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	1,358,712,456	1,475,323,488
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	1,816,033	2,251,232
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)	684,895,147	763,094,721
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 18,750,805
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	646,906,479	679,834,432
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	1,333,617,659	1,445,180,385
19	Revenue less expenses. Subtract line 18 from line 12.......	25,094,797	30,143,103
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	2,698,695,774	2,607,463,497
21	Total liabilities (Part X, line 26).............	880,084,234	871,839,461
22	Net assets or fund balances. Subtract line 21 from line 20.....	1,818,611,540	1,735,624,036

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 920,759,914 including grants of $ 2,251,232 ) (Revenue $ 1,119,143,501 )
	MEDICAL CARE PROVIDED TO CHILDREN: IT IS THE POLICY OF THE HOSPITAL TO STRIVE TO MAINTAIN QUALITY HEALTH CARE DELIVERY IN A MANNER THAT RESPECTS THE DIGNITY OF THE INDIVIDUAL AND FAMILY, REGARDLESS OF THE ABILITY TO PAY. UNDER THE HOSPITAL'S POLICY, MEDICAL CARE MAY BE PROVIDED WITHOUT CHARGE OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATES TO PEOPLE WHO ARE UNINSURED OR UNDERINSURED AND CANNOT AFFORD TO PAY FOR THEIR OWN MEDICAL CARE. THE HOSPITAL PROVIDES ADDITIONAL COMMUNITY SUPPORT BY PROVIDING CARE TO PATIENTS WHO PARTICIPATE IN PROGRAMS, LIKE MEDI-CAL, THAT DO NOT PAY FULL CHARGES. APPROXIMATELY THREE-FOURTHS OF THE HOSPITAL'S PATIENTS ARE COVERED BY MEDI-CAL PROGRAMS.

4b	(Code: ) (Expenses $ 62,942,140 including grants of $ ) (Revenue $ 21,348,728 )
	GRADUATE MEDICAL EDUCATION PROVIDES TRAINING AND EDUCATION TO MEDICAL STUDENTS IN LOS ANGELES COUNTY WHO, IN TURN, PROVIDE SERVICES TO PATIENTS AT THE HOSPITAL. ALSO, INCLUDES EDUCATION REVENUE FROM THE RESIDENCY AND FELLOWSHIP PROGRAMS AT CHLA. THE HOSPITAL SUBSIDIZES A LARGE PART OF THE COST OF TRAINING PHYSICIANS, ALLIED HEALTH PROFESSIONALS, AND OTHER HEALTH CARE WORKERS IN ITS EMERGENCY ROOM, CLINICS, INPATIENT AREAS, AND OTHER PARTS OF ITS FACILITIES.

4c	(Code: ) (Expenses $ 147,769,836 including grants of $ ) (Revenue $ 16,443,170 )
	RESEARCH REVENUES FURTHER THE EXEMPT PURPOSE OF CHLA BY PROVIDING THE PATIENTS OF CHLA ACCESS TO NEW TECHNOLOGIES, DISCOVERIES AND MEDICATIONS FOR TREATMENT. RESULTS OF THIS RESEARCH IS DISSEMINATED THROUGH PUBLICATIONS IN SCIENTIFIC JOURNALS AND PRESENTATIONS BY THE PRINCIPAL INVESTIGATORS. THE HOSPITAL SUBSIDIZES A LARGE PART OF THE COST OF MEDICAL RESEARCH TAKING PLACE IN ITS FACILITIES.

	(Code: ) (Expenses $ 4,193,795 including grants of $ ) (Revenue $ 4,294,192 )
	OTHER PROGRAM SERVICE REVENUES ALSO INCLUDE RESIDENTS HOUSING AND MISCELLANEOUS TUITION AND EDUCATION INCOME.

4d	Other program services (Describe in Schedule O.)
	(Expenses $ 4,193,795 including grants of $ ) (Revenue $ 4,294,192 )
4e	Total program service expenses1,135,665,685

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	12,095,965	0	1,099,628

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c	299,584
d	Related organizations		1d
e	Government grants (contributions)		1e	149,963,305

f	All other contributions, gifts, grants, and similar amounts not included above		1f	115,101,974

g	Noncash contributions included in lines 1a - 1f:$		1g	7,991,861

h Total. Add lines 1a-1f.......		265,364,863

		Business Code
2a	PATIENT REVENUE	621110	1,119,143,501	1,119,143,501
b	RESEARCH REVENUE	900099	16,443,170	16,443,170
c	GRADUATE MEDICAL EDU.	900099	15,461,057	15,461,057
d	EDUCATION REVENUE	900099	5,887,672	5,887,672
e
f	All other program service revenue.
g	Total. Add lines 2a–2f .....		1,156,935,400

3 Investment income (including dividends, interest, and othersimilar amounts) ......			28,378,470		34,968	28,343,502
4 Income from investment of tax-exempt bond proceeds
5 Royalties...........			172,004			172,004
		(ii) Personal	(i) Real
6a	Gross rents		3,099,942	6a
b	Less: rental expenses		0	6b
c	Rental income or (loss)		3,099,942	6c
d	Net rental income or (loss).......			3,099,942			3,099,942
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory		255,038,059	7a
b	Less: cost or other basis and sales expenses	-400	246,085,893	7b
c	Gain or (loss)	400	8,952,166	7c
d	Net gain or (loss).........			8,952,566			8,952,566
8a	Gross income from fundraising events (not including $ 299,584of contributions reported on line 1c). See Part IV, line 18 ....
			8a	0
b	Less: direct expenses ...		8b	205,558
c	Net income or (loss) from fundraising events..			-205,558			-205,558
9a	Gross income from gaming activities. See Part IV, line 19 ...
			9a
b	Less: direct expenses ...		9b
c	Net income or (loss) from gaming activities..
10a	Gross sales of inventory, less returns and allowances ..
			10a
b	Less: cost of goods sold ..		10b
c	Net income or (loss) from sales of inventory..
Business Code			Miscellaneous Revenue
11a	CAFETERIA		722514	3,805,461			3,805,461
b	JV INCOME		900099	3,427,216	3,427,216
c	PARKING GARAGE		812930	3,081,029			3,081,029
d	All other revenue ....			2,312,095	866,975		1,445,120
e	Total. Add lines 11a–11d ......			12,625,801
12	Total revenue. See instructions.....			1,475,323,488	1,161,229,591	34,968	48,694,066

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 ....	2,251,232	2,251,232
2	Grants and other assistance to domestic individuals. See Part IV, line 22 ...........
3	Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16. .............
4	Benefits paid to or for members .......
5	Compensation of current officers, directors, trustees, and key employees ...........	7,725,469	1,460,810	5,772,692	491,967
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .........	78,256	78,256
7	Other salaries and wages........	638,697,453	496,999,916	131,243,018	10,454,519
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	13,239,965	10,509,307	2,472,762	257,896
9	Other employee benefits .......	59,372,047	49,002,445	9,309,498	1,060,104
10	Payroll taxes ...........	43,981,531	34,428,473	8,838,174	714,884
11	Fees for services (non-employees):
a	Management ......	2,822,197	1,200	2,820,997
b	Legal .........	1,778,450	179,505	1,598,945
c	Accounting ...........	604,079		604,079
d	Lobbying ...........	416,058		416,058
e	Professional fundraising services. See Part IV, line 17
f	Investment management fees ......	1,064,908		1,064,908
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	231,206,496	155,981,806	71,856,120	3,368,570
12	Advertising and promotion ....	6,069,720	6,062,119		7,601
13	Office expenses .......	190,842,628	178,383,932	12,234,878	223,818
14	Information technology ......	41,093,782	33,631,313	6,993,422	469,047
15	Royalties ..	259,202	259,202
16	Occupancy ...........	18,206,343	15,648,050	2,558,293
17	Travel ............	1,506,889	750,170	717,285	39,434
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .
19	Conferences, conventions, and meetings ....	1,992,059	1,516,656	432,229	43,174
20	Interest ...........	19,365,035	18,345,092	1,019,943
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization ..	61,271,323	58,432,001	2,839,322
23	Insurance ...	6,246,149	4,783,016	1,394,009	69,124
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	QUALITY ASSURANCE FEES	54,501,817	54,501,817	0	0
b	LEASE EXPENSE	11,268,335	4,673,543	6,594,792	0
c	TAXES AND LICENSES	5,007,912	647,679	4,360,233	0
d	DUES AND SUBSCRIPTIONS	4,154,310	717,881	2,239,333	1,197,096
e	All other expenses	20,156,740	6,420,264	13,382,905	353,571
25	Total functional expenses. Add lines 1 through 24e	1,445,180,385	1,135,665,685	290,763,895	18,750,805
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).

1	Cash–non-interest-bearing ........			6,000	1	9,200
2	Savings and temporary cash investments .........			104,424,094	2	71,706,472
3	Pledges and grants receivable, net ......			83,885,912	3	111,740,446
4	Accounts receivable, net .............			234,372,466	4	252,747,517
5	Loans and other receivables from any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .......
				0	5	0
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), and persons described in section 4958(c)(3)(B) ...
					6
7	Notes and loans receivable, net ...........			626,915	7	500,000
8	Inventories for sale or use ............			13,361,298	8	16,054,558
9	Prepaid expenses and deferred charges ......			24,481,587	9	13,125,821
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	2,034,887,420
b	Less: accumulated depreciation	10b	1,019,630,694	991,353,749	10c	1,015,256,726
11	Investments—publicly traded securities .			1,026,904,435	11	858,165,115
12	Investments—other securities. See Part IV, line 11 .....			4,135,712	12	5,760,355
13	Investments—program-related. See Part IV, line 11 ..				13
14	Intangible assets ...............				14
15	Other assets. See Part IV, line 11 ...........			215,143,606	15	262,397,287
16	Total assets. Add lines 1 through 15 (must equal line 33)...			2,698,695,774	16	2,607,463,497

17	Accounts payable and accrued expenses .....	221,574,470	17	218,665,778
18	Grants payable ...		18
19	Deferred revenue .........	18,146,710	19	19,511,917
20	Tax-exempt bond liabilities .........	456,731,185	20	453,871,287
21	Escrow or custodial account liability. Complete Part IV of Schedule D		21
22	Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .........
			22
23	Secured mortgages and notes payable to unrelated third parties ..		23
24	Unsecured notes and loans payable to unrelated third parties ..		24
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	183,631,869	25	179,790,479
26	Total liabilities. Add lines 17 through 25..	880,084,234	26	871,839,461

	Organizations that follow FASB ASC 958, check here and complete lines 27, 28, 32, and 33.
27	Net assets without donor restrictions ..........	1,280,373,261	27	1,175,779,719
28	Net assets with donor restrictions ...........	538,238,279	28	559,844,317
	Organizations that do not follow FASB ASC 958, check here and complete lines 29 through 33.
29	Capital stock or trust principal, or current funds .....		29
30	Paid-in or capital surplus, or land, building or equipment fund ...		30
31	Retained earnings, endowment, accumulated income, or other funds		31
32	Total net assets or fund balances ...........	1,818,611,540	32	1,735,624,036
33	Total liabilities and net assets/fund balances ........	2,698,695,774	33	2,607,463,497