Form 990 for tax year 2022

Revenue

Part VIII, the statement of revenue.

• 1f · All other contributions, gifts and grants

  $253,804

• 2a · Program service revenue: PATIENT REVENUE

  total $11,930,526 · related or exempt $11,930,526

• 3 · Investment income

  total $15,028 · excluded $15,028

• 7a · Gross sales of assets other than inventory

  securities $98,490

• 7b · Less cost or other basis and sales expenses

  securities $96,996

• 7c · Gain or loss

  securities $1,494

• 7d · Net gain or loss

  total $1,494 · excluded $1,494

• 11a · Other revenue: OTHER REVENUE

  total $38,020 · related or exempt $38,020

• 11e · Other revenue, total

  $38,020

Functional expenses

Part IX, the statement of functional expenses.

• 7 · Other salaries and wages

  total $10,790,409 · program services $9,711,368 · management and general $1,079,041

• 8 · Pension plan contributions

  total $145,858 · program services $131,272 · management and general $14,586

• 9 · Other employee benefits

  total $1,279,188 · program services $1,151,269 · management and general $127,919

• 10 · Payroll taxes

  total $799,457 · program services $719,511 · management and general $79,946

• 11f · Fees: investment management

  total $71 · management and general $71

• 12 · Advertising and promotion

  total $1,386 · program services $1,247 · management and general $139

• 13 · Office expenses

  total $205,471 · program services $184,924 · management and general $20,547

• 14 · Information technology

  total $5,130 · program services $4,617 · management and general $513

• 16 · Occupancy

  total $975,028 · program services $877,525 · management and general $97,503

• 17 · Travel

  total $79 · program services $71 · management and general $8

• 20 · Interest

  total $10,493 · program services $9,444 · management and general $1,049

• 22 · Depreciation, depletion and amortization

  total $583,013 · program services $524,712 · management and general $58,301

• 23 · Insurance

  total $11,357 · program services $10,221 · management and general $1,136

• 24a · Other expenses: MEDICAL SUPPLIES

  total $1,464,687 · program services $1,318,218 · management and general $146,469

• 24b · Other expenses: LICENSES & TAXES

  total $13,772 · program services $12,395 · management and general $1,377

• 24c · Other expenses: CONSULTANT

  total $696 · program services $626 · management and general $70

Balance sheet

Part X, book values.

• 1 · Cash, non-interest-bearing

  beginning of year $1,331,180 · end of year $170,687

• 2 · Savings and temporary cash investments

  end of year $871,860

• 4 · Accounts receivable

  beginning of year $2,075,262 · end of year $1,772,531

• 8 · Inventories for sale or use

  beginning of year $27,404 · end of year $44,640

• 9 · Prepaid expenses and deferred charges

  beginning of year $73,619 · end of year $91,498

• 10a · Land, buildings and equipment: cost or other basis

  $11,713,927

• 10b · Land, buildings and equipment: accumulated depreciation

  $1,537,402

• 10c · Land, buildings and equipment, net

  beginning of year $10,031,536 · end of year $10,176,525

• 11 · Investments: publicly traded securities

  end of year $41,104

• 15 · Other assets

  beginning of year $1,320,500 · end of year $719,953

• 17 · Accounts payable and accrued expenses

  beginning of year $1,983,885 · end of year $695,074

• 19 · Deferred revenue

  beginning of year $115,697 · end of year -$3,673

• 25 · Other liabilities

  beginning of year $13,664,732 · end of year $18,187,521

• 27 · Net assets without donor restrictions

  beginning of year -$2,125,640 · end of year -$6,254,466

• 28 · Net assets with donor restrictions

  beginning of year $1,220,827 · end of year $1,264,342

The filer's explanations (Part III)

PART I, LINES 4A-B

SEVERANCE ARRANGEMENTS: PART I, LINE 4A SOME OF THE ORGANIZATION'S PERSONNEL LISTED ON FORM 990 PART VII AND SCHEDULE J PARTICIPATE IN A SEPARATION ARRANGEMENT THAT PROVIDES FOR A PORTION OF THE EMPLOYEE'S ANNUAL SALARY BASED ON THEIR POSITION IN THE ORGANIZATION. FOR THE SENIOR EXECUTIVE LEVEL, THE AMOUNT IS BASED ON YEARS OF SERVICE UP TO A MAXIMUM NUMBER OF MONTHS. UNPAID SEVERANCE UNDER THE SEPARATION AGREEMENTS FOR CURRENT KEY EMPLOYEES WERE REPORTED AT THEIR FULL VALUE IN A PREVIOUS TAX YEAR. IN 2022 SHAHAB DADJOU RECEIVED A SEVERANCE PAYMENT OF $392,881. SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN: PART I, LINE 4B CHILDREN'S HOSPITAL OF ORANGE COUNTY (CHOC OR THE COMPANY) ESTABLISHED A NONQUALIFIED DEFERRED COMPENSATION PLAN EFFECTIVE JANUARY 1, 2010 IN WHICH CERTAIN INDIVIDUALS LISTED ON THE FORM 990, PART VII AND SCHEDULE J ARE PARTICIPANTS. UNDER THE ESTABLISHED SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (THE PLAN), OR SERP, FOR EACH PLAN YEAR THAT BEGINS PRIOR TO THE PARTICIPANT'S CASH DATE, CHOC SHALL CREATE A NEW SERP ACCOUNT ON ITS BOOKS FOR THE PARTICIPANT AND SHALL CREDIT TO SUCH ACCOUNT AT TIMES SPECIFIED. THE PARTICIPANTS OF THE PLAN ARE GENERAL CREDITORS OF THE COMPANY. THE PARTICIPANT'S SERP ACCOUNT SHALL BE UTILIZED SOLELY AS A DEVICE FOR THE MEASUREMENT AND DETERMINATION OF THE AMOUNTS TO BE PAID TO THE PARTICIPANT UNDER THIS PLAN. THE PARTICIPANT IS ENTITLED TO HIS/HER SERP BENEFIT AMOUNT UPON THE EARLIEST OF (1) REMAINING EMPLOYED WITH THE COMPANY TO THE THIRD ANNIVERSARY OF THE FIRST DAY OF THE PLAN YEAR FOR WHICH THE SERP ACCOUNT WAS CREATED; (2) REMAINING EMPLOYED WITH THE COMPANY TO THE PARTICIPANT'S 60TH BIRTHDAY; (3) REMAINING EMPLOYED WITH THE COMPANY TO THE DATE THE PARTICIPANT HAS BOTH ATTAINED AT LEAST AGE 55 AND HAS COMPLETED AT LEAST 10 YEARS OF SERVICE; (4) DISABILITY; (5) INVOLUNTARY SEPARATION FROM SERVICE WITHOUT REASONABLE CAUSE; (6) VOLUNTARY SEPARATION FROM SERVICE FOR GOOD REASON OR (7) DEATH. THE FOLLOWING INDIVIDUALS RECEIVED PAYMENTS FROM THE PLAN DURING CALENDAR YEAR 2022: MS. SCHILLER ($101,580), MR. GABRIEL ($76,697), MS. ZIMMER ($44,669), AND MR. VAN DOLAH ($102,255). THE COMPANY PROVIDES AN INCENTIVE PLAN TO ALL ELIGIBLE MEMBERS OF MANAGEMENT, INCLUDING CERTAIN INDIVIDUALS LISTED IN PART II OF SCHEDULE J. INCENTIVES ARE EARNED BASED ON ACHIEVEMENT OF ORGANIZATION AND INDIVIDUAL GOALS TYPICALLY RELATED TO QUALITY, PATIENT SAFETY, OPERATING, AND FINANCIAL PERFORMANCE AS WELL AS OTHER SIGNIFICANT CLINICAL, QUALITY, AND STRATEGIC ACHIEVEMENTS. THE COMPANY MAINTAINS A CORPORATE MEMBERSHIP IN A SOCIAL CLUB THAT IS UTILIZED FOR BUSINESS PURPOSES BY ITS EXECUTIVES, INCLUDING CERTAIN INDIVIDUALS LISTED IN PART II OF SCHEDULE J. USE OF THE CLUB AND PAYMENTS TO THE CLUB FOR BUSINESS-RELATED EXPENSES ARE SUBJECT TO THE COMPANY'S WRITTEN POLICIES AND PROCEDURES THAT INCLUDE A REQUIREMENT TO DOCUMENT THE PURPOSE AND ATTENDEES OF THE BUSINESS MEETING PRIOR TO PAYMENT. COMPENSATION FROM AN AFFILIATED ORGANIZATION KERRI RUPPERT SCHILLER IS COMPENSATED THROUGH CHILDREN'S HEALTHCARE OF CALIFORNIA (CHC), HOWEVER, IN ADDITION TO HER RESPONSIBILITIES FOR CHC, SHE ALSO SERVES AS AN OFFICER OF CHILDREN'S HOSPITAL OF ORANGE COUNTY, CHOC FOUNDATION, CRC REAL ESTATE CORPORATION AND CHILDREN'S HOSPITAL AT MISSION (ALL IRC SECTION 501(C)(3) AFFILIATES). MS. SCHILLER DEVOTES APPROXIMATELY 50% OF HER TIME EACH WEEK TO CHILDREN'S HOSPITAL OF ORANGE COUNTY RESPONSIBILITIES WITH THE BALANCE OF HER TIME BEING SPENT ON THE OTHER RELATED ORGANIZATIONS' BUSINESS AFFAIRS. JAY GABRIEL IS COMPENSATED THROUGH CHILDREN'S HOSPITAL OF ORANGE COUNTY (CHOC), HOWEVER, IN ADDITION TO HIS RESPONSIBILITIES FOR CHOC, HE ALSO SERVES AS AN OFFICER OF CHILDREN'S HEALTHCARE OF CALIFORNIA (CHC), CRC REAL ESTATE CORPORATION, CHILDREN'S HOSPITAL AT MISSION (CCMH) AND PROVIDENCE ESTATE CORPORATION, CHILDREN'S HOSPITAL AT MISSION (CCMH) AND PROVIDENCE SPEECH AND HEARING CENTER (PSHC) (ALL IRC SECTION 501(C)(3) AFFILIATES). MR. GABRIEL DEVOTES APPROXIMATELY 44% OF HIS TIME EACH WEEK TO CHOC RESPONSIBILITIES WITH THE BALANCE OF HIS TIME BEING SPENT ON THE OTHER RELATED ORGANIZATIONS' BUSINESS AFFAIRS. PAUL VAN DOLAH IS COMPENSATED THROUGH CHILDREN'S HEALTHCARE OF CALIFORNIA (CHC), HOWEVER, IN ADDITION TO HIS RESPONSIBILITIES FOR CHC, HE ALSO SERVES AS AN OFFICER OF CHILDREN'S HOSPITAL OF ORANGE COUNTY, CRC REAL ESTATE CORPORATION, CHILDREN'S HOSPITAL AT MISSION AND PROVIDENCE SPEECH AND HEARING CENTER (PSHC) (ALL IRC SECTION 501(C)(3) AFFILIATES). MR. VAN DOLAH DEVOTES APPROXIMATELY 84% OF HIS TIME EACH WEEK TO CHOC RESPONSIBILITIES WITH THE BALANCE OF HIS TIME BEING SPENT ON THE OTHER RELATED ORGANIZATIONS' BUSINESS AFFAIRS. MARY ZIMMER IS COMPENSATED THROUGH CHILDREN'S HOSPITAL OF ORANGE COUNTY (CHOC), HOWEVER, IN ADDITION TO HER RESPONSIBILITIES FOR CHOC, SHE ALSO SERVES AS DIRECTOR OF PROVIDENCE SPEECH AND HEARING CENTER (PSHC). MS. ZIMMER DEVOTES APPROXIMATELY 95% OF HER TIME EACH WEEK TO CHOC RESPONSIBILITIES WITH THE BALANCE OF HER TIME BEING SPENT ON PSHC BUSINESS AFFAIRS.

Disregarded entities

Part I: entities that legally are the filer and file no return of their own.

• NEWPORT LANGUAGE SPEECH & AUD

  HEARING ASSISTANCE · CA · income $0 · assets $0

  Directly controlled by PSHC

Related corporations and trusts

Part IV: related organizations taxable as a corporation or trust.

• ORANGE COUNTY MEDICAL RECIPROCAL INSURANCE

  C · INSURANCE · AZ