4A (Expenses $ 937990234 including grants of $ 0) (Revenue $ 1077701993)
CHILDREN'S HOSPITAL OF ORANGE COUNTY (CHOC) - PROVIDES SPECIALIZED PEDIATRIC SERVICES FOR THE CARE OF CHILDREN. DURING THIS YEAR, THERE WERE 69,587 DAYS OF INPATIENT CARE; 101,878 EMERGENCY ROOM VISITS (INCLUDING PEDIATRIC TRAUMA VISITS); 11,639 SURGERIES; AND 345,196 PRIMARY AND SPECIALTY CARE CLINIC VISITS. OUR CALIFORNIA MEDICAL FOUNDATION PROVIDED 458,214 PEDIATRIC SUBSPECIALTY SERVICE ENCOUNTERS TO PATIENTS THROUGHOUT ORANGE COUNTY AND BEYOND. SEE OUR COMPLETE COMMUNITY BENEFIT REPORT ON OUR WEBSITE AT HTTPS://WWW.CHOC.ORG/FILES/COMMUNITYBENEFITPLAN.PDF

CHILDREN'S HOSPITAL OF ORANGE COUNTY
PART V, SECTION B, LINE 5: CHOC AND ITS AFFILIATE, CHILDREN'S HOSPITAL AT MISSION (CCMH) CONDUCTED THE CHNA PROCESS INDEPENDENTLY IN THE FALL OF 2022, WITH INPUT AND DATA FROM NUMEROUS AUTHORITATIVE, PUBLICLY AVAILABLE SOURCES, A SURVEY OF COMMUNITY LEADERS FROM VARIOUS BUSINESSES, SOCIAL SERVICE, AND PUBLIC AGENCIES AND A SURVEY OF THE COMMUNITY-AT-LARGE. THE CHNA REPORT INCLUDES BOTH PRIMARY AND SECONDARY DATA ANALYSES THAT FOCUS ON THE HEALTH AND SOCIAL NEEDS OF THE POPULATION IN EACH CHOC HOSPITAL'S PRIMARY SERVICE AREA.

CHILDREN'S HOSPITAL OF ORANGE COUNTY
PART V, SECTION B, LINE 6A: CHOC AND CCMH TOGETHER CONDUCTED THE HEALTH NEEDS ASSESSMENTS.SCH H, PART V, LINES 7A & 10ATHE COMMUNITY HEALTH NEEDS ASSESSMENT THAT WAS PUBLISHED IN 2022 CAN BE FOUND AT THE FOLLOWING URL: HTTPS://WWW.CHOC.ORG/FILES/CHOC-CHNA-REPORT.PDF. THE MOST RECENT IMPLEMENTATION PLAN PUBLISHED IN 2019 CAN BE FOUND AT THE FOLLOWING URL: HTTPS://WWW.CHOC.ORG/WP/WP-CONTENT/UPLOADS/2020/02/CHNA-IMPLEMENTATION-PLAN_2019.PDF.

CHILDREN'S HOSPITAL OF ORANGE COUNTY
PART V, SECTION B, LINE 11: ADDRESSING HIGH PRIORITY COMMUNITY HEALTH NEEDSCHOC COORDINATES ITS RESPONSE TO ITS MOST RECENT CHNA WITH ITS AFFILIATE, CHILDREN'S HOSPITAL AT MISSION (CCMH). CHOC'S AND CCMH'S MOST RECENT CHNA IDENTIFIED TWO HIGH-PRIORITY HEALTH NEEDS:CHOC'S AND CCMH'S MOST RECENT CHNA IDENTIFIED TWO HIGH-PRIORITY HEALTH NEEDS: 1) MENTAL HEALTH: THERE HAS BEEN AN INCREASE IN DEPRESSIVE SYMPTOMS AMONG STUDENTS. SECONDLY, THERE HAS BEEN AN INCREASE IN HOSPITALIZATIONS FOR MENTAL ILLNESS IN 2020 DESPITE THE OVERALL DECREASE IN HOSPITALIZATIONS DUE TO COVID-19 PUBLIC HEALTH EMERGENCY. THIRDLY, THERE HAS BEEN A NEED FOR PREVENTION, EARLY INTERVENTION, AND TREATMENT FOR SUBSTANCE USE AMONG YOUTH. 2) ACCESS TO PEDIATRIC HEALTHCARE SERVICES: THERE IS A NEED FOR IMPROVED ACCESS TO PEDIATRIC SERVICES (INCLUDING PEDIATRIC SPECIALISTS) FROM DIVERSE PROVIDERS WHO UNDERSTANDS THE COUNTY'S RACIAL, CULTURAL AND LINGUISTIC NEEDS OF CHILDREN AND FAMILIES AND THERE IS GEOGRAPHIC DISPARITY IN ACCESS TO PEDIATRIC HEALTH CARE.THE ORGANIZATION IS DEVELOPING ADDITIONAL STRATEGIES TO ADDRESS THESE HIGH PRIORITY NEEDS. SOME OF SPECIFIC INITIATIVES PREVIOUSLY IMPLEMENTED BY THE ORGANIZATION FOR THE HIGH-PRIORITY NEEDS ARE AS FOLLOWS:1) MENTAL HEALTH AND AUTISMCHOC, IN PARTNERSHIP WITH COMMITTED ORGANIZATIONS AND COMMUNITY GROUPS, ASPIRES TO CREATE AN OUTSTANDING MENTAL HEALTH SYSTEM OF CARE FOR ALL CHILDREN, TEENS AND YOUNG ADULTS IN ORANGE COUNTY. OUR GOAL IS TO PROVIDE A COMPREHENSIVE APPROACH TO PEDIATRIC MENTAL ILLNESS TO FULFILL THIS INITIATIVE, CHOC BUILT AN INPATIENT CHILDREN'S MENTAL HEALTH CENTER WHICH OPENED IN APRIL 2018. THE CENTER HAS 18 BEDS IN A SECURED AND HEALING ENVIRONMENT, IN ADDITION TO AN OUTDOOR AREA FOR RECREATION. THE CENTER PROVIDES A SAFE, NURTURING PLACE FOR CHILDREN AGES 3 TO 18, AND SPECIALTY PROGRAMMING FOR CHILDREN YOUNGER THAN 12. IN ADDITION, CHOC BUILT THE THOMPSON AUTISM CENTER WHICH OPENED IN JANUARY 2019. THE NEW CENTER IS DEDICATED TO BRINGING THE LATEST TREATMENTS AND RESOURCES TO THE AUTISM COMMUNITY IN ORANGE COUNTY. THROUGH UNIQUE PROGRAMS, CHILDREN HAVE A CENTRALIZED PLACE WHERE THEY CAN RECEIVE EARLY DIAGNOSIS, ADVANCED THERAPY AND THE POSSIBILITY TO REACH THEIR TRUE POTENTIAL. THE OPENING OF THE INPATIENT CENTER AND THE THOMPSON AUTISM CENTER AUGMENTS MENTAL HEALTH SERVICES ALREADY OFFERED BY CHOC. THOSE SERVICES INCLUDE CHOC'S OUTPATIENT EATING DISORDERS PROGRAM, OUTPATIENT PROGRAMS TO KEEP STRUGGLING CHILDREN OUT OF THE HOSPITAL AND ASSISTANCE TO THOSE WHO HAVE BEEN RELEASED, AND MENTAL HEALTH SERVICES FOR CHOC PATIENTS BEING TREATED FOR SERIOUS/CHRONIC ILLNESSES.2) SUBSTANCE ABUSE CHOC IS INCREASING EDUCATION TO PROVIDE ADDITIONAL TREATMENT OPTIONS TO LOCAL PROVIDERS, INCLUDING INCREASED OUTREACH TO LOCAL SCHOOLS AND COMMUNITIES. CHOC'S EMERGENCY DEPARTMENT SCREENS CHILDREN 11 AND OLDER WHO PRESENT FOR AN EMERGENCY PSYCHIATRIC CONCERN TO DETERMINE LEVEL OF CONCERNING SUBSTANCE USE AND PROVIDE BRIEF ALCOHOL AND OTHER DRUG EDUCATION AS WELL AS REFERRALS FOR TREATMENT IF CONCERNING LEVELS ARE IDENTIFIED. THESE STRATEGIES WILL INDUCE PREVENTION AS WELL AS ALLOWING FOR EARLIER IDENTIFICATION OF SUBSTANCE USE IN CONJUNCTION WITH MENTAL HEALTH DISORDERS FOR EARLY LINKAGE TO SERVICES.3) ACCESS TO PEDIATRIC SPECIALTIES/SUBSPECIALTIESCHOC RECOGNIZES THE COMMUNITY NEED FOR ACCESS TO PEDIATRIC SPECIALISTS/SUBSPECIALISTS AND CONTINUES TO BUILD THE RESOURCES AVAILABLE THROUGHOUT THE COMMUNITIES SERVED BY CHOC. CHOC'S MEDICAL FOUNDATION WAS CREATED IN 2011, AND SINCE THAT TIME HAS CONTINUED TO GROW TO PROVIDE THE SPECIALTY SERVICES SOUGHT BY THE COMMUNITY AND INDICATED AS A HIGH PRIORITY IN THE MOST RECENTLY COMPLETED COMMUNITY NEEDS ASSESSMENT. THE SPECIALTY PHYSICIAN GROUPS THAT HAVE CONTRACTED WITH CHOC TO PROVIDE THE SERVICES HAS GROWN TO A TOTAL OF 262 PROVIDERS AND OFFERS EXPERTISE AND CARE IN OVER 25 PEDIATRIC MEDICAL SPECIALTIES.THE PRIMARY CARE NETWORK, PART OF CHOC'S MEDICAL FOUNDATION, WAS ESTABLISHED IN 2016 AND HAS GROWN TO 134 PEDIATRIC PROVIDERS ACROSS 11 PRACTICES THAT SPAN 21 LOCATIONS AROUND ORANGE COUNTY AND LA COUNTY, PROVIDING GENERAL PEDIATRICS AND ADOLESCENT MEDICINE. ADDITIONALLY, THE PRIMARY CARE NETWORK AND STAFFS PEDIATRICIANS AT 6 ADDITIONAL URGENT CARE LOCATIONS ACROSS ORANGE AND LA COUNTIES. 4) COLLABORATION AND PARTNERSHIPS WITH SCHOOL PROGRAMS COLLABORATION AND PARTNERSHIPS WITH SCHOOL PROGRAMS IS A WAY TO OVERCOME BARRIERS WHEN ADDRESSING OTHER CRITICAL ISSUES IDENTIFIED IN THE CHNA. CHOC WILL COLLABORATE WITH THE ORANGE COUNTY DEPARTMENT OF EDUCATION TO ENHANCE THE PHYSICAL, MENTAL, EMOTIONAL, AND EDUCATIONAL HEALTH OF THE CHILDREN IN ORANGE COUNTY. CHOC'S ASTHMA OUTREACH PROGRAM PROVIDES EDUCATION, DIAGNOSIS AND TREATMENT VIA THE BREATHMOBILE AND THROUGH THE LUNCH AND LEARN PROGRAM TO SCHOOL PERSONNEL AND TO CHILDREN WITH ASTHMA. THE BREATHMOBILE PROGRAM HAS AGREEMENTS WITH VARIOUS LOCATIONS THROUGHOUT THE COUNTY TO PROVIDE ACCESS TO CARE.5) BULLYING AND OTHER STRESSORS IN SCHOOLBULLYING AND OTHER STRESSORS IN SCHOOL CAN CAUSE CHRONIC ABSENTEEISM AND CAN EXACERBATE OTHER CRITICAL HEALTH ISSUES SUCH AS MENTAL HEALTH, OBESITY, AND HUNGER. TO REDUCE THESE STRESSORS, CHOC HAS IMPLEMENTED UNIVERSAL SCREENING ACROSS ALL ORANGE COUNTY PRIMARY CARE PEDIATRIC OFFICES. CHOC HEALTH ALLIANCE, WITH OVERSIGHT OF 150,000 OF THE MOST VULNERABLE CHILDREN IN ORANGE COUNTY, WILL ALIGN ITS INCENTIVE PROGRAM WITH COMPLETION OF SCREENING TO HELP PRACTICES OPERATIONALIZE SCREENING COMPLETION. SCREENING WILL AID IN THE EARLY IDENTIFICATION AND REFERRAL OF AT-RISK YOUTH TO COMMUNITY, SOCIAL AND MENTAL/BEHAVIORAL HEALTH SERVICES AND WILL ULTIMATELY REDUCE SCHOOL ABSENTEEISM, IMPROVEMENT IN GRADE PROGRESSION, AND REDUCTION IN SUICIDE/VIOLENT EVENTS.

PART I, LINE 6A:
THE ORGANIZATION'S COMMUNITY BENEFIT REPORT IS CONTAINED IN A REPORT PREPARED BY CHOC AND CCMH ANNUALLY AND IS FILED IN ACCORDANCE WITH CALIFORNIA SB697.

PART I, LINE 7:
THE ORGANIZATION USES THE COST-TO-CHARGE RATIO METHODOLOGY TO DETERMINE THE COST OF CHARITY CARE AND UNREIMBURSED COST OF CARE PROVIDED TO MEDI-CAL PATIENTS. COSTS ARE ACCOUNTED FOR USING AN INTERNAL DECISION SUPPORT SYSTEM. THE COST-TO-CHARGE RATIO FOLLOWS THE METHOD DEFINED BY THE MEDICARE COST REPORT AND IS UPDATED MONTHLY USING THE MOST RECENT ORGANIZATIONAL INFORMATION.PROVIDER FEE PROGRAMTHE STATE OF CALIFORNIA HAS A PROVIDER FEE PROGRAM THAT, COMBINED WITH FEDERAL MATCHING FUNDS, HAS PROVIDED SUPPLEMENTAL MEDI-CAL PAYMENTS TO HOSPITALS IN THE STATE.CHOC RECOGNIZED REVENUES FOR THE MANAGED CARE PORTION OF THE 30-MONTH PROGRAM ENDED JUNE 30, 2019 OF $105,512,000 AND PROVIDER FEES AND OTHER EXPENSES OF $19,235,000. IN ADDITION, CHOC RECOGNIZED REVENUES RELATED TO THE FEE FOR SERVICE PORTION OF THE 24 MONTH PROGRAM ENDED JUNE 30, 2021 OF $29,624,000 AND PROVIDER FEES AND OTHER EXPENSES OF $7,446,000. THE AMOUNTS WERE RECOGNIZED AS NET PATIENT REVENUE AND OPERATING EXPENSES, RESPECTIVELY, IN THE FISCAL YEAR ENDED JUNE 30, 2022.

PART II, COMMUNITY BUILDING ACTIVITIES:
COMMUNITY SUPPORT IS BEST EXEMPLIFIED BY THE ORGANIZATION'S INCREASED EMPHASIS ON COMMUNITY OUTREACH AND COMMUNITY EDUCATION, WHICH INCLUDES INJURY PREVENTION, SAFETY AND WELLNESS. THE ORGANIZATION HAS 84 DIFFERENT COMMUNITY BENEFIT PROGRAMS CATEGORIZED ACCORDING TO THE CALIFORNIA COMMUNITY BENEFITS LAW, SB697. WITHIN THESE CATEGORIES, THE CATEGORY WHICH MOST CLOSELY CORRELATES TO LINE 3, COMMUNITY SUPPORT, IS HEALTHCARE ACCESS. THROUGH HEALTHCARE ACCESS, THE ORGANIZATION INCREASES ACCESS TO QUALITY PEDIATRIC HEALTHCARE RESOURCES AND INFORMATION TO FAMILIES, ESPECIALLY LOW-INCOME AND MEDICALLY UNDERSERVED, THROUGHOUT ORANGE COUNTY. THIS IS ACCOMPLISHED THROUGH COMMUNITY OUTREACH CLINICS AND EDUCATION.COMMUNITY BENEFIT REPORT HIGHLIGHTS:CHOC IS EXCLUSIVELY COMMITTED TO IMPROVING THE HEALTH AND WELL-BEING OF CHILDREN THROUGH CLINICAL EXPERTISE, ADVOCACY, OUTREACH, EDUCATION AND RESEARCH. AFFILIATED WITH THE UNIVERSITY OF CALIFORNIA, IRVINE, CHOC'S HEALTHCARE SYSTEM INCLUDES TWO STATE-OF-THE-ART PEDIATRIC HOSPITALS IN ORANGE AND MISSION VIEJO, TWO TRAUMA CENTERS, MANY PRIMARY AND SPECIALTY CARE OUTPATIENT CLINICS, A MENTAL HEALTH INPATIENT CENTER, AND FOUR CLINICAL CENTERS OF EXCELLENCE - CHOC HEART, NEUROSCIENCE, ORTHOPAEDIC AND HYUNDAI CANCER INSTITUTES.THE CHOC INSTITUTES PROVIDE COMPREHENSIVE MULTIDISCIPLINARY CARE FOR SOME OF THE MOST SERIOUS PEDIATRIC AND ADOLESCENT ILLNESSES AND INJURIES. PATIENTS BENEFIT FROM INNOVATIVE AND SPECIALIZED PROGRAMS, SUCH AS THE ADOLESCENT AND YOUNG ADULT CANCER TREATMENT PROGRAM. ONE OF THE ONLY PROGRAMS OF ITS KIND IN THE NATION, IT OFFERS CANCER-SPECIFIC TREATMENT WHILE ALSO ADDRESSING THE UNIQUE PSYCHO-SOCIAL NEEDS OF TEENS AND YOUNG ADULTS.OFFERING ACCESS TO CUTTING-EDGE CLINICAL TRIALS THAT CAN'T BE FOUND ANYWHERE ELSE, CHOC'S RESEARCH INSTITUTE HAS MORE THAN 350 RESEARCH STUDIES IN MORE THAN 30 SPECIALTIES. SCIENTISTS TRANSLATE THE LATEST ADVANCES IN MOLECULAR PROFILING, INCLUDING WHOLE GENOME SEQUENCING, TO MEET THE INDIVIDUALIZED NEEDS OF PATIENTS AT EVERY STAGE OF THEIR YOUNG LIVES, FROM INFANCY THROUGH ADOLESCENCE.DEDICATED TO ENSURING CHILDREN HAVE ACCESS TO THE RIGHT CARE AT THE RIGHT TIME AND PLACE, CHOC'S DIVISION OF POPULATION HEALTH PARTNERS WITH PRIMARY AND SPECIALTY CARE PEDIATRICIANS TO HELP THEM BETTER COORDINATE CARE FOR PATIENTS AND TO IMPROVE OUTCOMES. NEW TOOLS, INCLUDING EVIDENCE-BASED GUIDELINES AND DISEASE-SPECIFIC PATIENT REGISTRIES, AND ENHANCED TECHNOLOGY REDUCE VARIATIONS IN CARE, IMPROVING QUALITY. AN ADVOCATE FOR CHILDREN AND FAMILIES, CHOC IS ADDRESSING THE LACK OF PEDIATRIC MENTAL HEALTH SERVICES IN THE REGION WITH THE CREATION OF A COMPREHENSIVE MODEL OF CARE. THE MENTAL HEALTHINPATIENT CENTER, PROVIDING A SAFE, NURTURING ENVIRONMENT FOR CHILDREN AGES 3 TO 18 AND SPECIALTY PROGRAMMING FOR CHILDREN YOUNGER THAN 12, OPENED IN 2018. IN ADDITION TO INPATIENT SERVICES, CHOC OFFERS OUTPATIENT BEHAVIORAL SERVICES AND LEADS A COUNTY-WIDE TASK FORCE FOCUSED ON ENSURING EVERY CHILD AND ADULT IN ORANGE COUNTY WHO NEED MENTAL HEALTH TREATMENT RECEIVE HIGH QUALITY SERVICES WITHOUT STIGMA OR BARRIERS TO ACCESS. CHOC'S MENTAL HEALTH SYSTEM OF CARE STRIVES TO BE A NATIONAL MODEL, BENEFITTING CHILDREN ACROSS THE UNITED STATES.THE THOMPSON AUTISM CENTER AT CHOC OPENED IN EARLY 2020, EXPANDING THE REGION'S CAPACITY TO SERVE THE INCREASING NUMBER OF CHILDREN WITH AUTISM SPECTRUM DISORDER (ASD) AND RELATED NEURODEVELOPMENTAL CONDITIONS.SEE OUR COMMUNITY BENEFIT REPORTS ON OUR WEBSITE AT HTTPS://WWW.CHOC.ORG/FILES/COMMUNITYBENEFITPLAN.PDF.

PART III, LINE 2:
THE ORGANIZATION CHARGES BAD DEBT FOR (A) THE WRITE-OFF OF PATIENT ACCOUNTS WHERE FAMILIES DID NOT COOPERATE WITH CHOC IN THE COMPLETION OF MEDI-CAL OR CHARITY CARE APPLICATIONS AND WHERE INSUFFICIENT INFORMATION COULD BE OBTAINED REGARDING THE FINANCIAL STATUS OF THE FAMILY, AND (B)A PROVISION FOR OUTSTANDING ACCOUNTS RECEIVABLE FROM SELF-PAY (INCLUDING PENDING MEDI-CAL AND PENDING CHARITY) ACCOUNTS. THE ORGANIZATION APPLIES ITS CHARITY CARE POLICY TO DETERMINE ELIGIBILITY BASED ON FAMILIES' SATISFYING THE APPLICATION REQUIREMENTS AND THE ORGANIZATION'S ELIGIBILITY CRITERIA. THE ORGANIZATION DOES, HOWEVER, HAVE FAMILIES WHO FAIL TO COMPLETE THE REQUIRED PAPERWORK DESPITE THE ORGANIZATION'S EFFORTS TO EDUCATE ALL FAMILIES OF THE CHARITY CARE OPTIONS. IN THESE CASES, AN ASSESSMENT OF CHARITY CARE ELIGIBILITY IS MADE BASED ON KNOWN INFORMATION.

PART III, LINE 3:
THE HOSPITAL FOLLOWS HFMA STATEMENT 15 AND THEREFORE NO PART OF BAD DEBT, AS DEFINED BY STATEMENT 15, REPRESENTS AMOUNTS ATTRIBUTABLE TO PATIENTS ELIGIBLE TO RECEIVE FINANCIAL ASSISTANCE.

PART III, LINE 8:
THE ALLOWABLE COST IS BASED ON A COST TO CHARGE RATIO OF .2054 AS DETERMINED BY THE ORGANIZATION'S FILED MEDICARE COST REPORT. SHORTFALLS ARE CONSIDERED A COMMUNITY BENEFIT BECAUSE THE DOLLAR VALUE OF BENEFITS PROVIDED BY LEGISLATIVE CATEGORY LINK TO THE DOLLARS IDENTIFIED BY COMMUNITY NEEDS. CHOC REPORTS UNPAID COSTS OF PUBLIC PROGRAMS AS GOVERNMENT PAYOR SHORTFALLS. THE PRINCIPAL MEASURE FOR MONITORING COMMUNITY BENEFIT SERVICES IS THE DOLLAR VALUE OF BENEFITS RETURNED TO THE COMMUNITY PER DOLLAR OF TAX EXEMPTION VALUE RECEIVED.

PART VI, LINE 2:
NEEDS ASSESSMENT:IN ADDITION TO THE TRI-ANNUAL COMMUNITY HEALTH NEEDS ASSESSMENT, CHOC REGULARLY TRACKS KEY DEMOGRAPHIC CHANGES IN THE PEDIATRIC POPULATION OF ITS COMMUNITY AND THE UTILIZATION OF KEY SERVICES DELIVERED AND EVALUATES THE PROGRAMS IT PROVIDES TO MEET IDENTIFIED NEEDS. THROUGH CONSTANT CONTACT WITH A VARIETY OF COMMUNITY CONSTITUENTS, CHOC IS ABLE TO LEARN ABOUT EMERGING TRENDS AND NEEDS. IT THEN EVALUATES OPTIONS TO MEET THOSE NEEDS, EITHER ALONE OR IN COLLABORATION WITH OTHERS IN THE COMMUNITY.ALL OF THE PROGRAMS ASSOCIATED WITH THE COMMUNITY HEALTH NEEDS ASSESSMENT ARE AVAILABLE IN THE REPORT ON THE HOSPITAL'S WEBSITE AT HTTPS://WWW.CHOC.ORG/FILES/CHOC-CHNA-REPORT.PDF AS WELL AS A PAPER COPY THAT IS AVAILABLE UPON REQUEST FOR PUBLIC INSPECTION.

PART VI, LINE 7, REPORTS FILED WITH STATES
CA

PART III, LINE 4:
PATIENT ACCOUNTS RECEIVABLE ARE RECORDED AT THE INVOICED AMOUNT, NET OF ANY EXPECTED CONTRACTUAL ADJUSTMENTS AND DO NOT BEAR INTEREST. THE ORGANIZATION HAS AGREEMENTS WITH THIRD-PARTY PAYORS THAT PROVIDE FOR PAYMENTS AT AMOUNTS DIFFERENT FROM THE ESTABLISHED RATES. PAYMENT ARRANGEMENTS INCLUDE PROSPECTIVELY DETERMINED RATES PER DISCHARGE, REIMBURSED COSTS, DISCOUNTED CHARGES, AND PER DIEM PAYMENTS. PATIENT SERVICES REVENUES ARE REPORTED AT THE ESTIMATED NET REALIZABLE AMOUNTS FROM PATIENTS, THIRD-PARTY PAYORS, AND OTHERS FOR SERVICES RENDERED. CONTRACTUAL ADJUSTMENTS ARISING UNDER REIMBURSEMENT ARRANGEMENTS WITH THIRD-PARTY PAYORS ARE ACCRUED ON AN ESTIMATED BASIS IN THE PERIOD THE RELATED SERVICES ARE RENDERED AND ARE ADJUSTED IN FUTURE PERIODS AS FINAL SETTLEMENTS ARE DETERMINED. IMPLICIT PRICE CONCESSIONS ARE TAKEN BASED ON HISTORICAL COLLECTION EXPERIENCE AND REFLECT THE ESTIMATED AMOUNTS THE ORGANIZATION EXPECTS TO COLLECT.

PART III, LINE 9B:
THE HOSPITAL'S WRITTEN BAD-DEBT COLLECTION POLICY STATES THE FOLLOWING:1. IF A PATIENT QUALIFIES FOR ASSISTANCE UNDER THE FINANCIAL ASSISTANCE PROGRAM (FAP) AND IS MAKING EVERY EFFORT TO SETTLE AN OUTSTANDING BILL WITHIN A REASONABLE TIME PERIOD, CHOC OR ITS AGENT WILL NOT SEND, NOR INTIMATE THAT IT WILL SEND, THE UNPAID ACCOUNT TO AN OUTSIDE AGENCY IF DOING SO MAY NEGATIVELY IMPACT A PATIENT'S CREDIT. IF CHOC IS FORCED TO SEND THE ACCOUNT TO AN OUTSIDE COLLECTION AGENCY, THE AMOUNT REFERRED TO THE AGENCY WILL REFLECT THE REDUCED PAYMENT LEVEL FOR WHICH THE PATIENT WAS ELIGIBLE UNDER THE FAP. AT NO TIME WILL A PATIENT ACCOUNT BE REFERRED TO AN OUTSIDE COLLECTION AGENCY IF THE ACCOUNT IS LESS THAN 150 DAYS FROM ORIGINAL BILLING.2. IN DEALING WITH IDENTIFIED UNINSURED PATIENTS AT OR BELOW 400% OF THE FEDERAL POVERTY LEVEL, CHOC WILL NOT USE WAGE GARNISHMENTS OR LIENS ON PATIENT'S OR PATIENT FAMILY'S PRIMARY RESIDENCE AS A MEANS OF COLLECTING UNPAID CHOC BILLS. THIS REQUIREMENT DOES NOT PRECLUDE CHOC FROM PURSUING REIMBURSEMENT FROM THIRD PARTY LIABILITY SETTLEMENTS.

PART VI, LINE 3:
PATIENTS ARE INFORMED OF THEIR ELIGIBILITY FOR ASSISTANCE UNDER FEDERAL, STATE, OR LOCAL GOVERNMENT PROGRAMS AND UNDER THE HOSPITAL'S CHARITY CARE POLICY IN OUR FINANCIAL ASSISTANCE AND DISCOUNT PROGRAM POLICY. THIS INFORMATION, EITHER IN FULL OR IN SUMMARY, IS POSTED IN ALL OF THE HIGH TRAFFIC PATIENT AREAS: ADMITTING, EMERGENCY ROOM, CLINIC AND THE BUSINESS OFFICE. THE PATIENTS ARE ALSO INFORMED IF THERE IS A FINANCIAL NEED IDENTIFIED BY THE HOSPITAL FINANCIAL COUNSELORS WHEN SPEAKING TO THE FAMILIES ABOUT THEIR INSURANCE OR LACK OF INSURANCE. PATIENTS ARE PROVIDED A COPY OF THE HOSPITAL'S PATIENT FINANCIAL ASSISTANCE AND DISCOUNT PAYMENT PROGRAM POLICY. FAMILIES ARE ALSO NOTIFIED ON EVERY PATIENT STATEMENT THAT IF THERE IS A FINANCIAL NEED THEY SHOULD CALL THE DESIGNATED PHONE NUMBER FOR MORE INFORMATION AND ASSISTANCE.FINANCIAL ASSISTANCE COMMUNICATION - AS PART OF THE HOSPITAL'S ONGOING PUBLIC AWARENESS CAMPAIGNS, THE MISSION STATEMENTS (INCLUDING THE FINANCIAL ASSISTANCE POLICY) ARE INCLUDED WHEREVER POSSIBLE ON PROGRAM BROCHURES, FACILITY BROCHURES, MEDICAL EDUCATION INFORMATION, COMMUNITY EDUCATION MATERIALS, CONFERENCE INVITATIONS AND ADMISSION MATERIALS. ADDITIONALLY, THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY IS EMPHASIZED IN PUBLIC RELATIONS AND MEDIA RELATIONS EFFORTS, FOUNDATION CAMPAIGNS, AND SELECTED MARKETING CAMPAIGNS. THE FINANCIAL ASSISTANCE POLICY IS ALSO INCLUDED AS PART OF THE ANNUAL COMMUNITY BENEFIT REPORT. THE FINANCIAL ASSISTANCE POLICY IS AVAILABLE IN ENGLISH AND SPANISH.

PART VI, LINE 4:
COMMUNITY INFORMATION - THE HOSPITAL SERVES ALL OF ORANGE COUNTY AND A LIMITED, ALTHOUGH SIGNIFICANT, NUMBER OF PATIENTS FROM THE WESTERN RIM OF RIVERSIDE AND SAN BERNARDINO COUNTIES, THE NORTHERN PORTION OF SAN DIEGO COUNTY AND SOUTHEAST AREAS OF LOS ANGELES COUNTY. THE PRIMARY SERVICE AREA IS THE CENTRAL-NORTHERN PORTION OF ORANGE COUNTY, AND IS THE SOURCE OF APPROXIMATELY 85% OF ITS PATIENTS. SIGNIFICANT CITIES IN THIS AREA ARE: SANTA ANA, ANAHEIM, FULLERTON, ORANGE, AND GARDEN GROVE. THE SECONDARY SERVICE AREA INCLUDES ALL THE OTHER ORANGE COUNTY CITIES AND UNINCORPORATED AREAS. THE COMMUNITY SERVED BY THE HOSPITAL INCLUDES FEDERALLY-DESIGNATED MEDICALLY UNDERSERVED AREAS AND POPULATIONS.COMMUNITY CHARACTERISTICSCOMMUNITY CHARACTERISTICS: POPULATION AND SOCIOECONOMIC DATA PROJECTIONS HAVE BEEN COLLECTED FROM A VARIETY OF LOCAL COUNTY AND STATE SOURCES REPRESENTING COMMUNITY DEMOGRAPHIC, SOCIAL AND ECONOMIC FACTORS, HEALTH ACCESS AND UTILIZATION, AND RESOURCES AVAILABLE IN THE COMMUNITY FOR THE 2022 COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) REPORT, THE MOST RECENTLY AVAILABLE. ORANGE COUNTY'S POPULATION IS 3,203,504, MAKING IT THE THIRD MOST POPULOUS COUNTY IN CALIFORNIA. THE MEDIAN AGE IS 38.1, AND CHILDREN UP TO 18 YEARS OF AGE MAKE UP 24% OF THE TOTAL POPULATION. IN THE CHOC SERVICE AREA. 17.1% OF CHILDREN UNDER THE AGE OF 18 LIVE IN POVERTY, COMPARED TO 21.1% OF CALIFORNIA'S CHILDREN. ORANGE COUNTY'S POPULATION IS DIVERSE, WITH 49.9% OF THE POPULATION BEING WHITE; 2.1% BEING BLACK/AFRICAN AMERICAN; .4% BEING AMERICAN INDIAN/ALASKA NATIVE; 14.9% BEING ASIAN; .6% BEING PACIFIC ISLANDER; 5.5% IDENTIFYING AS MULTIPLE RACES; AND 26.6% AS OTHER. OF THE TOTAL ORANGE COUNTY POPULATION, 34.1% IDENTIFY AS HISPANIC ETHNICITY.

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CHILDREN'S HEALTHCARE OF CALIFORNIA (CHC) IS THE NOT-FOR-PROFIT, TAX-EXEMPT PARENT CORPORATION OF CHILDREN'S HOSPITAL OF ORANGE COUNTY (CHOC) AND CHILDREN'S HOSPITAL AT MISSION HOSPITAL (CCMH). THE HOSPITALS ARE THE PRINCIPAL TERTIARY AND QUATERNARY PEDIATRIC HOSPITALS SERVING ORANGE COUNTY AND ARE THE ONLY HOSPITALS EXCLUSIVELY SERVING INFANTS, CHILDREN AND ADOLESCENTS. THE ORGANIZATION IS COMPRISED OF TWO HOSPITALS; A NUMBER OF PRIMARY AND SPECIALTY CLINICS THROUGHOUT ORANGE AND RIVERSIDE COUNTIES, PROGRAMS AND SERVICES; AND FOUR CENTERS OF EXCELLENCE, THE CHOC HEART, NEUROSCIENCE, HYUNDAI CANCER INSTITUTE AND ORTHOPAEDIC INSTITUTES. CHOC ALSO HAS A RESEARCH INSTITUTE PERFORMING BASIC SCIENCE AND CLINICAL RESEARCH. THROUGH ITS JOINT RESIDENCY PROGRAM WITH UC IRVINE, THE ORGANIZATION ALSO TRAINS TOMORROW'S PHYSICIANS. THE COMMUNITY BENEFIT PLAN FOR THE FISCAL YEAR ENDING JUNE 30, 2022, DESCRIBES THE BENEFIT PLANNING PROCESS, THE BENEFITS PROVIDED, AND THE ECONOMIC VALUE OF THE BENEFITS. COMMUNITY BENEFITS ARE FREE OR SUBSIDIZED PROGRAMS AND SERVICES PROVIDED TO MEET IDENTIFIED COMMUNITY NEEDS AND TO SERVE THE PUBLIC INTEREST. THE ORGANIZATION'S COMMUNITY BENEFIT PLAN IS AVAILABLE ONLINE AT: HTTPS://WWW.CHOC.ORG/FILES/COMMUNITYBENEFITPLAN.PDF.THE MAJORITY OF THE ORGANIZATION'S GOVERNING BODY IS COMPOSED OF PERSONS WHO RESIDE IN THE ORGANIZATION'S PRIMARY SERVICE AREA WHO ARE NEITHER EMPLOYEES NOR CONTRACTORS OF THE ORGANIZATION, NOR FAMILY MEMBERS THEREOF.CLINICAL PRIVILEGES ARE GRANTED TO ALL QUALIFIED PHYSICIANS AS MEMBERS OF THE MEDICAL STAFF. MEDICAL STAFF MEMBERS PROVIDE PATIENT CARE AND HAVE ACCESS TO HOSPITAL RESOURCES (INCLUDING EQUIPMENT, FACILITIES AND PERSONNEL) WHICH ARE NECESSARY TO EFFECTIVELY EXERCISE THEIR PRIVILEGES.PHYSICIANS ARE QUALIFIED TO BE MEMBERS OF THE MEDICAL STAFF IF THEY MEET THE FOLLOWING CRITERIA:ONLY PRACTICING PHYSICIANS, DENTISTS, PSYCHOLOGISTS OR PODIATRISTS SHALL BE DEEMED TO POSSESS BASIC QUALIFICATIONS FOR MEMBERSHIP ON THE MEDICAL STAFF, EXCEPT FOR THE HONORARY AND RETIRED STAFF CATEGORIES IN WHICH CASE THESE CRITERIA SHALL ONLY APPLY AS DEEMED INDIVIDUALLY APPLICABLE BY THE MEDICAL STAFF, AND WHO:(A) DOCUMENT THEIR (1) CURRENT LICENSURE, (2) ADEQUATE EXPERIENCE, EDUCATION, AND TRAINING, (3) CURRENT PROFESSIONAL COMPETENCE, (4) GOOD JUDGMENT, AND (5) CURRENT ADEQUATE PHYSICAL AND MENTAL HEALTH STATUS, SO AS TO DEMONSTRATE TO THE SATISFACTION OF THE MEDICAL STAFF THAT THEY ARE PROFESSIONALLY AND ETHICALLY COMPETENT AND THAT PATIENTS TREATED BY THEM CAN REASONABLY EXPECT TO RECEIVE QUALITY MEDICAL CARE.(B) ARE DETERMINED (1) TO ADHERE TO THE ETHICS OF THEIR RESPECTIVE PROFESSIONS, (2) TO BE ABLE TO WORK COOPERATIVELY WITH OTHERS SO AS NOT TO ADVERSELY AFFECT PATIENT CARE, (3) TO KEEP AS CONFIDENTIAL, AS REQUIRED BY LAW, ALL INFORMATION OR RECORDS RECEIVED IN THEPHYSICIAN-PATIENT RELATIONSHIP, AND (4) TO BE WILLING TO PARTICIPATE IN AND PROPERLY DISCHARGE THOSE RESPONSIBILITIES DETERMINED BY THE MEDICAL STAFF AND BE BOUND BY THE MEDICAL STAFF BYLAWS, RULES AND REGULATIONS, AND POLICIES.(C) WHO MAINTAIN IN FORCE PROFESSIONAL LIABILITY INSURANCE IN NOT LESS THAN THE MINIMUM AMOUNTS JOINTLY DETERMINED BY THE BOARD OF DIRECTORS AND THE MEDICAL EXECUTIVE COMMITTEE, BUT IN NO EVENT LESS THAN $1.0 MILLION PER INCIDENT AND $3.0 MILLION IN THE AGGREGATE IN A POLICY YEAR; PROVIDED, HOWEVER, THAT IN THE EVENT THAT (AND FOR SO LONG AS) SUCH INSURANCE IS NOT AVAILABLE ON COMMERCIALLY REASONABLE TERMS TO PHYSICIANS PRACTICING IN A PARTICULAR SPECIALTY OR SUB-SPECIALTY AREA OF MEDICAL PRACTICE, THE FOREGOING REQUIREMENTS MAY BE MODIFIED OR WAIVED WITH RESPECT TO ALL PHYSICIANS PRACTICING IN SUCH SPECIALTY OR SUB-SPECIALTY AREA, SUBJECT TO THE APPROVAL OF THE BOARD OF DIRECTORS UPON REQUEST OF THE MEDICAL EXECUTIVE COMMITTEE. ADMINISTRATIVE STAFF AND MEMBERS ON A LEAVE OF ABSENCE DO NOT NEED TO SHOW EVIDENCE OF INSURANCE.THE ORGANIZATION APPLIES ITS SURPLUS FUNDS TO IMPLEMENT IMPROVEMENTS IN PATIENT CARE, MEDICAL EDUCATION, RESEARCH AND IN CONSTRUCTION PROJECTS RELATED TO THE ENTERPRISE MASTER PLAN (EMP). IN RECENT YEARS, THE ORGANIZATION HAS COMMENCED CONSTRUCTION ON A NEW AMBULATORY CARE TOWER, ADDITIONAL OPERATING ROOMS, A MATERNAL FETAL MEDICINE SUITE INCLUSIVE OF A SPECIAL DELIVERY UNIT, PRIVATE ROOM INTENSIVE CARE ROOM EXPANSIONS, AND AN EXPANDED EMERGENCY DEPARTMENT. THE CHOC ENDOWMENT FUNDS ARE IN PART USED TO FUND MEDICAL RESEARCH, CLINICAL PROGRAMS AND SERVICES, AND TO RECRUIT AND RETAIN DOCTORS WHO ARE THE BEST IN THEIR FIELDS.

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AFFILIATED HEALTH CARE SYSTEM:FOR OVER 50 YEARS, CHOC HAS BEEN STEADFASTLY COMMITTED TO PROVIDING THE HIGHEST QUALITY MEDICAL CARE TO CHILDREN. AFFILIATED WITH THE UNIVERSITY OF CALIFORNIA, IRVINE, OUR REGIONAL PEDIATRIC HEALTHCARE NETWORK INCLUDES A STATE-OF-THE ART 334 BED HOSPITAL IN THE CITY OF ORANGE AND A HOSPITAL-WITHIN-A-HOSPITAL IN MISSION VIEJO. CHOC ALSO OFFERS MANY PRIMARY AND SPECIALTY CARE CLINICS, MORE THAN 89 ADDITIONAL PROGRAMS AND SERVICES, A PEDIATRIC RESIDENCY PROGRAM, AND FOUR CENTERS OF EXCELLENCE - CHOC HEART, NEUROSCIENCE, ORTHOPAEDIC, AND HYUNDAI CANCER INSTITUTES. THE ECONOMIC VALUE OF THE 73 BENEFIT SERVICES PROVIDED BY CHOC IN FISCAL YEAR 2022 IS $143.2 MILLION. OF THESE DOLLARS, 72.8% ($104.2 MILLION) SERVED THE ECONOMICALLY DISADVANTAGED. THE ECONOMIC VALUE OF SAVINGS FROM NOT-FOR-PROFIT STATUS IS $22.9 MILLION. THUS, THE HOSPITALS RETURN $6.25 IN COMMUNITY BENEFITS FOR EACH $1 SAVED FROM TAX-EXEMPT STATUS. IN ADDITION TO THE $143.2 MILLION IN BENEFITS PROVIDED FOR BY THE HOSPITALS REFERENCED ABOVE, BOARD MEMBERS, PHYSICIANS, EMPLOYEES AND VOLUNTEERS CONTRIBUTED APPROXIMATELY 57,519 HOURS OF VOLUNTEER SERVICE TO THE COMMUNITY.