2024-08-14T09:28:20+00:00 2023-09-30 440160260 Forvis Mazars LLP 14241 Dallas Parkway Ste 1100 Dallas TX 75254 990 2022-10-01 752485366 Cook Children's Physician Network COOK 6828854000 801 Seventh Avenue Fort Worth TX 76104 Matthew Dzurik MD President 6828854000 2024-08-14 true Michael J Engle P00482834 9727028262 2024-08-15 2022 2024-08-08 14:25:15Z Matthew Dzurik MD 801 Seventh Avenue Fort Worth TX 76104 473777698 false X www.cookchildrens.org X 1992 TX KNOWING THAT EVERY CHILD'S LIFE IS SACRED OUR PROMISE IS TO IMPROVE THE HEALTH OF EVERY CHILD IN OUR REGION THROUGH THE PREVENTION AND TREATMENT OF ILLNESS, DISEASE AND INJURY. 13 0 2106 14 0 0 84919803 101950582 340653322 371827116 0 0 46327 -5775 425619452 473771923 0 0 0 0 341151839 394242529 0 0 0 90962115 98098519 432113954 492341048 -6494502 -18569125 71436982 122294316 96905113 166331572 -25468131 -44037256 KNOWING THAT EVERY CHILD'S LIFE IS SACRED, OUR PROMISE IS TO IMPROVE THE HEALTH OF EVERY CHILD IN OUR REGION THROUGH THE PREVENTION AND TREATMENT OF ILLNESS, DISEASE, AND INJURY. false false 445100552 0 371827116 Cook Children's Physician Network is the largest pediatric multi-specialty physician group in North Texas and has grown to include approximately 79 practice locations. CCPN employs approximately 550 physicians and surgeons, including 385 pediatric specialists and 165 primary care pediatricians. The Network also employs 370 advanced practice providers such as nurse practitioners, physician assistants and certified registered nurse anesthetists. These professionals are an integral part of the Cook Children's Health Care System (CCHCS) and help support the system's approximately 1.7 million annual patient encounters. Twenty-five of CCPN's board-certified pediatricians provide care in seven Neighborhood Centers (NHC) located in economically disadvantaged areas within Tarrant County. The Neighborhood Clinics' professional staff also includes two dentists and twelve advanced practice providers. Neighborhood Clinics provide primary care services and serve as medical homes predominantly for children insured under government-funded programs such as the Children's Health Insurance Program (CHIP), Medicaid and Medicaid Managed Care plans. Cook Children's Physician Network is currently in the planning and development phases to add two additional Neighborhood Clinics in Tarrant County. In addition to numerous provider locations in Tarrant, Denton, Hood and Collin counties, CCPN has increased access to pediatric sub-specialty care through outreach in West Texas where specialty care is limited. Each month, numerous CCPN specialty physicians and surgeons travel to seven West Texas markets that lack the full spectrum of pediatric specialty care to serve patients close to their homes. The need for these outreach services in underserved markets is expected to grow as the physician shortage worsens over time. Collaborative Care The Jane and John Justin Institute for Mind Health was created to allow multiple specialties caring for patients with neurological and behavioral health disorders practice in one location. The specialties that make up the Institute for Mind Health include neurology, neurosurgery, developmental pediatrics, developmental psychology, psychology, neuropsychiatry, psychiatry, pain medicine and rehabilitation services. While some programs may hire a provider from another discipline, it is rare to have the entirety of departments working as a unit. Bringing together nine specialties previously located across the campus changes the way we deliver care by providing accessible, comprehensive and well-coordinated care under one roof. This approach will increase collaboration and improve patient outcomes with the amount of cooperative care amongst the multiple departments now working in close proximity to each other. It also drives innovation through research to improve patient outcomes and quality of life. Co-locating these services makes this a one-stop clinical center of care leveraging clinical efficiencies and potentially reducing redundancy in referrals sent to these departments. Expanding Horizons Cook Children's Dodson Specialty Clinics building was expanded to accommodate increased outpatient specialty visit volumes as well as expand future patient access to specialty care. This addition adds 240,000 square feet, making way for six new specialty services to make the Dodson Specialty Clinics building their new home. The expansion, which opened in March 2023, is designed to make visits to one of the more than 35 specialty clinics easier and more convenient for patients and their families. The Dodson expansion places specialty services under one roof, connecting the dots of care, collaboration and convenience for physicians and families. While adding space for clinic growth, the expansion also includes the addition of a Peaks Tech Zone, a sibling center, a cafe, a pharmacy, and other retail space for resources that support the patient experience during their visit with multiple physicians and ancillary services. In FY23, CCPN developed a larger presence in Plano, Frisco, McKinney, Allen, Aubrey and Prosper, Texas, which currently includes 18 primary care locations and 40 general pediatricians. In addition, CCPN has approximately 40 pediatric subspecialists working in the Prosper Medical Office Building and at Cook Children's Medical Center - Prosper. Physician Wellness Physician burnout remains a growing problem. COVID-19 exacerbated the problem by putting a significant strain on physician practices and medical providers everywhere. Since the pandemic, health care's typical seasonality where months of high demand are followed by lulls is a thing of the past. This unremitting toil wears on providers and further worsens the burnout of physicians with poor work/life integration. In 2022, CCPN established an Office of Physician Well-being, staffed by a general pediatrician and a pediatric specialist. Their role is to foster the well-being of physicians, through system-level interventions, addressing activities that contribute to burnout. In 2023, Cook Children's was awarded the bronze level of recognition from the American Medical Association Joy in Medicine Health System Recognition Program based upon these efforts. We continue to strive toward helping our physicians remain connected to the joy and meaning in their work. Top Docs Each year, D Magazine and Fort Worth Top Doctors highlight the region's best physicians as chosen by their peers. Votes are tallied and sorted by the editorial staff, and the remaining votes are vetted by an anonymous panel of esteemed doctors. Sixteen Cook Children's doctors were named to D Magazine's list and 30 were voted Fort Worth Top Doctors for the 2023 Best Doctors and Pediatric Specialists. In 2023, Paul Thornton, M.D., medical director of Diabetes and Endocrinology and world-renowned expert on hyperinsulinism, was awarded the 2023 Global Impact Award. The City of Fort Worth and Fort Worth Sister Cities International bestowed the award for Dr. Thornton's lifelong work in hyperinsulinism, a potentially devastating, rare genetic disease. The award was presented at the Mayor's International Dinner by Fort Worth Mayor Mattie Parker on Nov. 1. This award recognizes Dr. Thornton's tenacity and dedication to helping improve the quality of life for children across the globe with this rare disease. 445100552 true true false true false false false false true true false false true true false false true false false false false false false false false false false false true false false false false false false false false false false false false false true true true false false true 86 0 true 2106 true false false false false false false false false false false true false X 13 0 true false false false true true true true true false false true true true true true true true true false TX X Cory Rhoades 6828854000 801 Seventh Ave Fort Worth TX 76104 Alice W Phillips MD Trustee - Chair End: 05/23 42.0 2.0 X X 377964 0 40360 Anthony Anani MD Trustee - VC/Special Care 42.0 1.0 X X 480665 0 14087 Daphne Shaw MD Trustee - Treasurer 42.0 1.0 X X 357440 0 16554 Deborah Schutte MD Trustee - Chair 42.0 1.0 X X 632640 0 61055 Jason V Terk MD Trustee - VC/Primary Care 42.0 1.0 X X 339768 0 43488 Kara Starnes DO Trustee - Secretary 42.0 1.0 X X 363110 0 39878 Bianka Soria-Olmos DO Trustee 41.0 0 X 338908 0 51805 Corwin Warmink MD Trustee End: 05/23 41.0 0 X 455010 0 57746 Diane Arnaout MD Trustee 41.0 0 X 621333 0 52278 Erik Templeton MD Trustee 41.0 0 X 377918 0 57324 Heather Miller MD Trustee 41.0 0 X 252676 0 45385 Jeff Pugach MD Trustee 41.0 0 X 1622975 0 37952 Julee S Morrow MD Trustee 41.0 3.0 X 356943 0 22294 Linda Thompson MD Trustee End: 05/23 41.0 0 X 200941 0 18410 M Scott Perry MD Trustee 41.0 0.0 X 507354 0 52715 Mary Kathleen Powderly MD Trustee 41.0 0 X 346035 0 56835 Matthew Dzurik MD President 42.0 0 X 787215 0 138460 Rick W Merrill CEO 4.0 38.0 X 385420 3118397 182676 Robert Goodwill VP Primary Care & Splty Svcs 40.0 0 X 664702 0 121955 Sheri Kantner Secretary 40.0 0 X 82472 0 30189 Stephen W Kimmel EVP, SYS FINANCE 4.0 38.0 X 120960 978680 170569 Alma Tolley VP Primary Care & Specialty 40.0 0 X 322161 0 60005 Kevin Briscoe VP, CCPN Finance 40.0 0 X 382935 0 60792 Matthew Carroll MD VP, Associate Chief Quality Officer 40.0 0 X 538230 0 75154 Tara Allen AVP, Primary/Spec Services 40.0 0 X 242735 0 22403 Teresa Baker AVP, Primary/Spec Services 40.0 0 X 255504 0 42196 Whitney Johannessen AVP Advance Practice 40.0 0 X 268140 0 49795 Daniel Hansen Medical Director, Neuro-Trauma 40.0 0 X 1209559 0 48261 Johnnie Honeycutt Physician 40.0 0 X 1428465 0 57255 Jonathan Kaye MD Medical Director 40.0 0 X 1994446 0 45415 Kirk Pinto Physician, OP/C 40.0 0 X 1921687 0 46595 Vincent Tam Medical Director 40.0 0 X 2214470 0 58777 20450781 4097077 1878663 778 false true false Hill & Wilkerson Construction Group Ltd 2703 Telecome Pkwy Ste 120 Richardson TX 75082 Construction Services 1758722 Skiles Group LLC 1810 N Greenville Ave Richardson TX 75081 Construction Services 1571429 Vaughn Construction 10355 Westpark Dr Houston TX 77042 Construction Services 1390049 Royer & Schutts Inc 200 Bailey Ave Ste 300 Fort Worth TX 76107 Construction Services 559890 Michael Walker Construction 14901 Quorum Dr Ste 475 Dallas TX 75254 Construction Services 193228 11 101950582 101950582 Net Patient Fees 621110 282042593 282042593 Contracted Fees 621110 6262662 6262662 Management Fees 900099 78585321 78585321 Other Operating Income 621110 4936540 4936540 0 0 0 0 371827116 5775 -5775 0 -5775 -5775 0 0 0 0 0 0 0 473771923 371827116 0 -5775 12401366 8591725 3809641 324368113 311472245 12895868 14981071 14071862 909209 25661846 21363443 4298403 16830133 16119495 710638 21679360 21679360 4845666 4523692 321974 0 50177 38948 11229 908860 797866 110994 15100455 14048579 1051876 513313 444971 68342 203180 36941 166239 465316 464441 875 2661531 2659594 1937 3394321 3394321 Medical Supplies 36325735 36325735 Minor/Computer Equipment 979124 970579 8545 Bad Debt Expense 8767081 8767081 Collection Expense 1072147 1072147 1132253 1009034 123219 0 492341048 445100552 47240496 0 13659 41992 14968917 18958915 0 0 0 2863199 2985615 80840 123555 38836761 22343818 10615880 16492943 0 0 1248000 1170000 41646487 82521296 71436982 122294316 15629362 31061903 0 81275751 135269669 96905113 166331572 X -25468131 -44037256 -25468131 -44037256 71436982 122294316 -18569125 0 X false true X true false X 0 0 0 0 0 0 Schedule A, Part I, Line 3 REASON FOR PUBLIC CHARITY STATUS: COOK CHILDREN'S PHYSICIAN NETWORK IS CLASSIFIED AS A HOSPITAL FOR EXEMPT PURPOSES ONLY. THE ORGANIZATION IS NOT A LICENSED HOSPITAL UNDER TEXAS STATE LAW AND THEREFORE NOT REQUIRED TO COMPLETE SCHEDULE H. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED X 0 0 0 249880 0 249880 492341048 3466979764 492341048 3467229644 1000000 1000000 250000 250000 0 0 0 0 1000000 1000000 1000000 3000000 4500000 0 203050 249880 452930 250000 250000 250000 750000 1125000 0 0 0 0 365010 7956 15426 357540 369834 0 10915 15739 365010 102871 190213 92180 15430 369834 101112 0 4206 2447 102871 0 100000 1112 101112 0.0 0.6621 0.3379 false true true 4619505 3505697 1113808 22345092 11355312 10989780 11325065 7482809 3842256 547099 547099 16492943 Other Receivables 1376517 Right of Use Asset 53160205 Intercompany Receivables 27984574 82521296 Due to Affiliates 47774473 Accrued Liabilities 33827679 Right of Use Liabilities 53667517 135269669 464749324 -8767081 -8767081 473516405 255518 255518 473771923 483573967 0 0 483573967 8767081 8767081 492341048 Schedule D, Part X, Line 2 ASC 740 Footnote MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE FINANCIAL STATEMENTS. Schedule D, Part V, Line 4 Intended uses of endowment funds COOK CHILDREN'S HAS ADOPTED INVESTMENT AND SPENDING POLICIES FOR ENDOWMENT ASSETS THAT ATTEMPT TO PROVIDE A PREDICTABLE STREAM OF FUNDING TO PROGRAMS AND OTHER ITEMS SUPPORTED BY ITS ENDOWMENT WHILE SEEKING TO MAINTAIN THE PURCHASING POWER OF THE ENDOWMENT. UNDER COOK CHILDREN'S POLICIES, ENDOWMENT ASSETS ARE INVESTED IN A MANNER THAT IS INTENDED TO PRODUCE AN AMOUNT THAT IS EQUAL TO A RETURN HURDLE DEFINED AS THE SPENDING RATE, INFLATION RATE AND THE MANAGEMENT COST OF THE ENDOWMENT ON AN ANNUAL BASIS WHILE ASSUMING A PRUDENT LEVEL OF INVESTMENT RISK. ACTUAL RETURNS IN ANY GIVEN YEAR MAY VARY FROM THIS AMOUNT. TO SATISFY ITS LONG-TERM RATE OF RETURN OBJECTIVES, COOK CHILDREN'S RELIES ON A TOTAL RETURN STRATEGY IN WHICH INVESTMENT RETURNS ARE ACHIEVED THROUGH BOTH CURRENT YIELD (INVESTMENT INCOME SUCH AS DIVIDENDS AND INTEREST) AND CAPITAL APPRECIATION (BOTH REALIZED AND UNREALIZED). COOK CHILDREN'S TARGETS A DIVERSIFIED ASSET ALLOCATION THAT PLACES A GREATER EMPHASIS ON EQUITY-BASED INVESTMENTS TO ACHIEVE ITS LONG-TERM RETURN OBJECTIVES WITHIN PRUDENT RISK CONSTRAINTS. COOK CHILDREN'S HAS A POLICY (THE SPENDING POLICY) OF APPROPRIATING FOR EXPENDITURE EACH YEAR OF UP TO 5% OF THE FOUNDATION'S INVESTMENTS AVERAGE FAIR VALUE OVER THE PRIOR 5 YEARS ENDED JUNE 30 PRECEDING THE YEAR IN WHICH EXPENDITURE IS PLANNED AND/OR ACCORDING TO THE DONOR REQUIREMENTS AS SET FORTH IN EACH ENDOWMENT DOCUMENT. IN ESTABLISHING THIS POLICY, COOK CHILDREN'S CONSIDERED THE LONG-TERM EXPECTED RETURN ON ITS ENDOWMENT. ACCORDINGLY, OVER THE LONG TERM, COOK CHILDREN'S EXPECTS THE CURRENT SPENDING POLICY TO ALLOW ITS ENDOWMENT TO GROW AT THE RETURN HURDLE. THIS IS CONSISTENT WITH COOK CHILDREN'S OBJECTIVE TO MAINTAIN THE PURCHASING POWER OF ENDOWMENT ASSETS HELD IN PERPETUITY OR FOR A SPECIFIED TERM, AS WELL AS TO PROVIDE ADDITIONAL REAL GROWTH THROUGH NEW GIFTS AND INVESTMENT RETURN. Schedule D, Part XI, Line 2(d) Other revenues in audited financial statements not in form 990 Bad Debt Expense - -8767081 Schedule D, Part XI, Line 4(b) Other revenues in form 990 not in audited financial statements Net Assets Released from Restrictions - 255518 Schedule D, Part XII, Line 4(b) Other expenses in form 990 not in audited financial statements Bad Debt Expense - 8767081 X X false true false true false false false false false false false Anthony Anani MD Trustee - VC/Special Care 436206 0 21385 0 23074 0 12200 0 1887 0 494752 0 0 0 Alice W Phillips MD Trustee - Chair End: 05/23 322588 0 7594 0 47782 0 14953 0 25407 0 418324 0 0 0 Deborah Schutte MD Trustee - Chair 581969 0 12736 0 37935 0 22875 0 38180 0 693695 0 0 0 Daphne Shaw MD Trustee - Treasurer 329000 0 11034 0 17406 0 15649 0 905 0 373994 0 0 0 Kara Starnes DO Trustee - Secretary 313967 0 40549 0 8594 0 19061 0 20817 0 402988 0 0 0 Jason V Terk MD Trustee - VC/Primary Care 318329 0 7897 0 13542 0 20500 0 22988 0 383256 0 0 0 Diane Arnaout MD Trustee 597966 0 12919 0 10448 0 19063 0 33215 0 673611 0 0 0 Heather Miller MD Trustee 203197 0 42911 0 6568 0 10358 0 35027 0 298061 0 0 0 Julee S Morrow MD Trustee 317865 0 8350 0 30728 0 0 0 22294 0 379237 0 0 0 M Scott Perry MD Trustee 434946 0 61801 0 10607 0 19500 0 33215 0 560069 0 0 0 Mary Kathleen Powderly MD Trustee 328023 0 8887 0 9125 0 22875 0 33960 0 402870 0 0 0 Jeff Pugach MD Trustee 1296637 0 303989 0 22349 0 8936 0 29016 0 1660927 0 0 0 Bianka Soria-Olmos DO Trustee 315394 0 8662 0 14852 0 19063 0 32742 0 390713 0 0 0 Erik Templeton MD Trustee 333279 0 37169 0 7470 0 22875 0 34449 0 435242 0 0 0 Linda Thompson MD Trustee End: 05/23 180995 0 6976 0 12970 0 14272 0 4138 0 219351 0 0 0 Corwin Warmink MD Trustee End: 05/23 353433 0 90618 0 10959 0 25288 0 32458 0 512756 0 0 0 Stephen W Kimmel EVP, SYS FINANCE 73122 591623 32965 266720 14873 120337 15368 124337 3395 27469 139723 1130486 10967 88735 Rick W Merrill CEO 148238 1199379 86334 698519 150848 1220499 15961 129138 4133 33444 405514 3280979 107800 872200 Matthew Dzurik MD President 543721 0 218830 0 24664 0 110011 0 28449 0 925675 0 0 0 Robert Goodwill VP Primary Care & Splty Svcs 362384 0 226344 0 75974 0 86571 0 35384 0 786657 0 55465 0 Tara Allen AVP, Primary/Spec Services 189473 0 45726 0 7536 0 8895 0 13508 0 265138 0 0 0 Teresa Baker AVP, Primary/Spec Services 180762 0 70740 0 4002 0 6847 0 35349 0 297700 0 0 0 Kevin Briscoe VP, CCPN Finance 266910 0 90858 0 25167 0 23554 0 37238 0 443727 0 0 0 Matthew Carroll MD VP, Associate Chief Quality Officer 354111 0 88359 0 95760 0 34687 0 40467 0 613384 0 0 0 Whitney Johannessen AVP Advance Practice 203728 0 52376 0 12036 0 20864 0 28931 0 317935 0 0 0 Alma Tolley VP Primary Care & Specialty 206416 0 77108 0 38637 0 32969 0 27036 0 382166 0 0 0 Johnnie Honeycutt Physician 1372496 0 37900 0 18069 0 22875 0 34380 0 1485720 0 0 0 Jonathan Kaye MD Medical Director 1663399 0 311890 0 19157 0 12200 0 33215 0 2039861 0 0 0 Kirk Pinto Physician, OP/C 1574521 0 322195 0 24971 0 10302 0 36293 0 1968282 0 0 0 Vincent Tam Medical Director 2141191 0 43054 0 30225 0 22875 0 35902 0 2273247 0 0 0 Daniel Hansen Medical Director, Neuro-Trauma 1115104 0 80807 0 13648 0 15250 0 33011 0 1257820 0 0 0 Schedule J, Part I, Line 1a First-class or charter travel AIR TRAVEL FOR M. SCOTT PERRY MD, MATTHEW DZURIK MD AND DEBORAH SCHUTTE MD WAS PROVIDED TO PROVIDE MEDICAL SERVICES IN THEIR CAPACITIES AS PHYSICIANS FOR COOK CHILDREN'S PHYSICIAN NETWORK. THIS IS NOT INCLUDED IN THEIR W-2 TAXABLE COMPENSATION AS IT IS 100% BUSINESS RELATED. Schedule J, Part I, Line 1a Tax indemnification and gross-up payments THE FOLLOWING INDIVIDUALS RECEIVED CME AND OTHER GROSS UP PAYMENTS IN THEIR W-2 AS TAXABLE WAGES: Tara Allen, Anthony Anani MD, Diane Arnaout MD, Teresa Baker, Kevin Briscoe, Matthew Carroll MD, Matthew Dzurik MD, Daniel Hansen, Johnnie Honeycutt, Whitney Johannessen, Heather Miller MD, Julee S. Morrow MD, M. Scott Perry MD, Alice W. Phillips MD, Kirk Pinto, Mary Kathleen Powderly MD, Deborah Schutte MD, Bianka Soria-Olmos DO, Erik Templeton MD, Jason V. Terk MD, Linda Thompson MD, Alma Tolley Schedule J, Part I, Line 1b Written policy regarding payment or reimbursement of expenses THERE IS NO WRITTEN POLICY REGARDING PAYMENT OR REIMBURSEMENT OF TAX INDEMNIFICATION AND GROSS-UP PAYMENTS BECAUSE THE COMPANY DOES NOT GENERALLY ALLOW FOR GROSS-UP PAYMENTS EXCEPT IN SPECIFIC CIRCUMSTANCES AND THEN ONLY IF APPROVED BY SENIOR MANAGEMENT FOLLOWED BY REVIEW OF THE COMPANY'S COMPLIANCE AND LEGAL DEPARTMENTS. THESE TYPE OF REIMBURSEMENTS GENERALLY RELATE TO TAXES OWED BY INDIVIDUALS WHO RECEIVE NOMINAL INCENTIVE PAYMENTS FOR SERVICE AWARDS OR QUALITY IMPROVEMENT PROGRAMS, AND THE GROSS-UP PAYMENTS USUALLY ARE IMMATERIAL, $250 OR LESS. IN ADDITION TO THE GIFT CARD AND INCENTIVE BONUSES DESCRIBED ABOVE, THERE IS NO WRITTEN POLICY REGARDING PAYMENT OR REIMBURSEMENT OF TAX INDEMNIFICATION AND GROSS-UP PAYMENTS FOR CONTINUING MEDICAL EDUCATION ALLOWANCES PAID TO EMPLOYED PHYSICIANS OF COOK CHILDREN'S PHYSICIAN NETWORK. THESE TYPE OF EXPENSES ARE USUALLY HANDLED AS NON TAXABLE ACCOUNTABLE PLAN BUSINESS EXPENSES UNDER THE INTERNAL REVENUE CODE, BUT THE COMPANY HAS ELECTED TO TREAT THESE PAYMENTS AND THE GROSS-UP PAYMENTS AS TAXABLE INCOME TO THE AFFECTED INDIVIDUALS. THESE PAYMENTS ARE APPROVED IN ADVANCE BY SENIOR MANAGEMENT AND REVIEWED BY THE COMPANY'S COMPLIANCE AND LEGAL DEPARTMENTS. FURTHER, THESE EXPENSES ARE INCLUDED IN THE BENEFITS CALCULATION FOR SUCH PHYSICIANS WHICH ARE REVIEWED BY THE COMPANY'S COMPENSATION COMMITTEE TO VERIFY THAT SUCH PAYMENTS ARE PAID AT FAIR MARKET VALUE AND COMMERCIALLY REASONABLE. Schedule J, Part I, Line 3 Arrangement used to establish the top management official's compensation METHODS USED BY CCHCS TO ESTABLISH COMPENSATION OF THE COMPANY'S PRESIDENT: COMPENSATION COMMITTEE INDEPENDENT COMPENSATION CONSULTANT WRITTEN EMPLOYMENT CONTRACT COMPENSATION SURVEY OR STUDY APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan Rick W Merrill - Paid by System - $122,224 Deferred, $980,000 W-2 Stephen W Kimmel - Paid by System - $120,643 Deferred, $99,702 W-2 Robert C Goodwill - Paid by CCPN - $67,509 Deferred, $55,465 W-2 Kevin Briscoe - Paid by CCPN - $11,696 Deferred, $0 W-2 Matthew Carroll - Paid by CCPN - $15,624 Deferred, $0 W-2 Matthew Dzurik - Paid by CCPN - $87,135 Deferred, $0 W-2 Alma Tolley - Paid by CCPN - $10,094 Deferred, $0 W-2 Corwin Warmink - Paid by CCPN - $4,021 Deferred, $0 W-2 Schedule J, Part II ALLOCATION OF CEO & CFO SALARIES: SALARIES FOR THE CEO AND EVP, SYSTEM FINANCE ARE ALLOCATED PRO-RATA BASED ON THE AMOUNT OF TIME THEY SPEND WITH EACH OF THE FOLLOWING COMPANIES: COOK CHILDREN'S MEDICAL CENTER COOK CHILDREN'S HEALTH FOUNDATION COOK CHILDREN'S HOME HEALTH COOK CHILDREN'S HEALTH CARE SYSTEM COOK CHILDREN'S HEALTH PLAN COOK CHILDREN'S PHYSICIAN NETWORK COOK CHILDREN'S MEDICAL CENTER - PROSPER CHILD STUDY CENTER Form 990, Part VI, Line 2 Family/business relationships amongst interested persons VARIOUS TRUSTEES & OFFICERS EMPLOYED OR SERVING BOARDS WITHIN THE SYSTEM - Business relationship Form 990, Part VI, Line 6 Classes of members or stockholders COOK CHILDREN'S HEALTH CARE SYSTEM, A TEXAS NON-PROFIT CORPORATION, IS THE SOLE MEMBER OF THE ORGANIZATION. Form 990, Part VI, Line 7a Members or stockholders electing members of governing body AS THE SOLE MEMBER OF THE ORGANIZATION, COOK CHILDREN'S HEALTH CARE SYSTEM HAS THE ABSOLUTE RIGHT TO APPOINT OR APPROVE MEMBERSHIP ON THE BOARD OF DIRECTORS OF THE ORGANIZATION. Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders AS THE SOLE MEMBER OF THE ORGANIZATION, COOK CHILDREN'S HEALTH CARE SYSTEM HAS THE EXCLUSIVE AND RESERVED POWER TO DO ANY OF THE FOLLOWING: A. APPROVE THE ANNUAL OPERATING AND CAPITAL BUDGETS OF THE ORGANIZATION AND THE LONG-RANGE FINANCIAL AND STRATEGIC PLANS FOR THE CORPORATION; B. APPROVE DEVIATIONS FROM ANNUAL OPERATING AND CAPITAL BUDGETS IN EXCESS OF SUCH LIMITS AS ESTABLISHED BY THE MEMBER; C. APPROVE THE PURCHASE OR ACQUISITION OF ANY PROPERTY, REAL, PERSONAL, OR MIXED, BY THE ORGANIZATION IN EXCESS OF SUCH LIMITS AS ESTABLISHED BY THE MEMBER; D. APPROVE THE SALE, GIFT OR OTHER DISPOSITION OF ALL OR SUBSTANTIALLY ALL OF THE PROPERTY OF THE ORGANIZATION; E. APPROVE THE MORTGAGE OR OTHER ENCUMBRANCE OF ANY PROPERTY, REAL, PERSONAL, OR MIXED, OF THE ORGANIZATION IN EXCESS OF SUCH LIMITS AS ESTABLISHED BY THE MEMBER; F. APPROVE THE ACQUISITION, LIQUIDATION, MERGER, WINDING UP, TERMINATION, OR CONSOLIDATION OF THE ORGANIZATION; G. APPROVE THE CREATION OF, OR INVESTMENT IN, ANY SUBSIDIARY ENTITY, JOINT VENTURE, ACCOUNTABLE CARE ORGANIZATION OR SIMILAR ENTITIES; H. APPROVE THE ADOPTION, AMENDMENT OR REPEAL OF THE CERTIFICATE OF FORMATION OF THE ORGANIZATION AND THESE BYLAWS; I. APPROVE INCURRING DEBT WHICH WOULD EXCEED SUCH LIMITS ESTABLISHED BY THE MEMBER; J. APPROVE THE SETTLEMENT OF CLAIMS AND LITIGATION OF THE ORGANIZATION; AND K. SUBSEQUENT TO THE ORGANIZING AND INCORPORATING PHYSICIAN'S SELECTION OF THE INITIAL BOARD OF DIRECTORS, APPROVE THE APPOINTMENT OR ELECTION OF DIRECTORS IN ACCORDANCE WITH SECTION 3.2 OF THE ORGANIZATION'S BYLAWS. Form 990, Part VI, Line 11b Review of form 990 by governing body THE ORGANIZATION ENGAGES AN OUTSIDE INDEPENDENT ACCOUNTING FIRM TO ASSIST IN THE PREPARATION OF THE FORM 990 AND RELATED FILINGS. ALL INFORMATION PROVIDED TO THE OUTSIDE ACCOUNTING FIRM IS GATHERED BY KEY COMPANY EMPLOYEES AND EXECUTIVES. ONCE THE FORM 990 IS PREPARED, IT IS REVIEWED BY COMPANY FINANCE, LEGAL AND COMPLIANCE STAFF AND THEN PROVIDED TO THE BOARD OF TRUSTEES FOR REVIEW AND COMMENT. IN ADDITION, IT IS PROVIDED TO THE COOK CHILDREN'S HEALTH CARE SYSTEM AUDIT COMMITTEE FOR REVIEW AND COMMENT. SUBSEQUENT TO THE BOARD AND AUDIT COMMITTEE REVIEW, THE FORM 990 IS FILED WITH THE INTERNAL REVENUE SERVICE AND MADE AVAILABLE TO THE PUBLIC FOR REVIEW. Form 990, Part VI, Line 12c Conflict of interest policy EVERY YEAR THE LEGAL DEPARTMENT OF THE COOK CHILDREN'S HEALTH CARE SYSTEM (SYSTEM) SENDS OUT A FORM 990 QUESTIONNAIRE/CONFLICT OF INTEREST DISCLOSURE STATEMENT TO OFFICERS, DIRECTORS, TRUSTEES AND KEY EMPLOYEES OF ALL SYSTEM COMPANIES, AS WELL AS CERTAIN OTHER EMPLOYEES, INCLUDING PHYSICIANS, WHO ARE DETERMINED TO BE EMPLOYED IN POSITIONS THAT MIGHT BE SUBJECT TO THE SYSTEM'S CONFLICT OF INTEREST POLICY. THE RESPONSES ARE REVIEWED BY THE LEGAL, FINANCE, AND COMPLIANCE DEPARTMENTS. FOLLOW UP AND/OR CORRECTIVE ACTION IS TAKEN AS NEEDED WITH RESPECT TO RESPONSES THAT INDICATE THE EXISTENCE OF ACTUAL OR POTENTIAL CONFLICTS OF INTEREST. A SUMMARY OF THE RESPONSES TO THE QUESTIONNAIRES AND FOLLOW-UP INFORMATION IS PROVIDED TO THE SYSTEM AUDIT COMMITTEE FOR REVIEW AND FOLLOW-UP. FURTHER, THE AUDIT COMMITTEE OF COOK CHILDREN'S HEALTH CARE SYSTEM IS RESPONSIBLE FOR MONITORING THE IMPLEMENTATION AND ENFORCEMENT OF THE CONFLICT OF INTEREST POLICY THAT IS APPLICABLE TO ALL AFFILIATED COMPANIES OF THE COOK CHILDREN'S HEALTH CARE SYSTEM. THE AUDIT COMMITTEE IS ALSO RESPONSIBLE FOR OVERSIGHT OF THE COMPLIANCE DEPARTMENT OF COOK CHILDREN'S HEALTH CARE SYSTEM. THE COMPLIANCE DEPARTMENT MAINTAINS A HOTLINE TO RECEIVE REPORTS OF INAPPROPRIATE ACTIVITIES INCLUDING ACTIVITIES THAT MIGHT CONSTITUTE A CONFLICT OF INTEREST. INTERNAL AUDIT AND COMPLIANCE ALSO CONDUCT RANDOM AUDITS OF CORPORATE ACTIVITIES SUCH AS EXPENSE REIMBURSEMENTS AND ACCOUNTS PAYABLE TO DETERMINE IF ANY INAPPROPRIATE PAYMENTS ARE BEING MADE TO INDIVIDUALS, SOME OF WHICH COULD BE EVIDENCE OF A CONFLICT OF INTEREST. ANY CORRECTIVE ACTION RELATED TO CONFLICTS OF INTEREST WOULD BE REPORTED TO THE AUDIT COMMITTEE FOR REVIEW, APPROVAL, AND MODIFICATION, AS NECESSARY, WITH FURTHER REPORTING TO THE SYSTEM BOARD OF TRUSTEES AS APPROPRIATE. Form 990, Part VI, Line 15a Process to establish compensation of top management official COOK CHILDREN'S HEALTH CARE SYSTEM HAS ESTABLISHED A COMPENSATION COMMITTEE WITH OVERSIGHT OF THE CEO. THE COMPENSATION COMMITTEE APPROVES COMPENSATION ARRANGEMENT IN ADVANCE, WHICH INCLUDES A REVIEW AND APPROVAL BY INDEPENDENT COMMITTEE MEMBERS, USING COMPARABLE MARKET DATA RELATING TO COMPENSATION, WHICH IS PROVIDED BY SULLIVAN COTTER AND ASSOCIATES, INC. , WHICH IS AN INDEPENDENT, NATIONALLY RECOGNIZED COMPENSATION CONSULTANT. THE COMPENSATION COMMITTEE DOCUMENTS THE BASIS FOR ITS DETERMINATIONS FOLLOWING CONTEMPORANEOUS SUBSTANTIATION OF THE COMPENSATION COMMITTEE'S DELIBERATIONS AND DECISIONS. THE COMPENSATION COMMITTEE REQUIRES THE COMPENSATION CONSULTANT TO UPDATE MARKET DATA PERIODICALLY, USUALLY EVERY TWO YEARS, WITH INTERIM REVIEWS BEING CONDUCTED AS NEEDED. Form 990, Part VI, Line 15b Process to establish compensation of other employees COOK CHILDREN'S HEALTH CARE SYSTEM HAS ESTABLISHED A COMPENSATION COMMITTEE WITH OVERSIGHT OF THE COMPENSATION OF THE OTHER OFFICERS AND KEY EMPLOYEES OF THE ORGANIZATION. THE COMPENSATION COMMITTEE APPROVES COMPENSATION ARRANGEMENTS IN ADVANCE, WHICH INCLUDES A REVIEW AND APPROVAL BY INDEPENDENT COMMITTEE MEMBERS, USING COMPARABLE MARKET DATA RELATING TO COMPENSATION, WHICH IS PROVIDED BY SULLIVAN COTTER AND ASSOCIATES, INC. FOR EXECUTIVE COMPENSATION AND PHYSICIAN COMPENSATION, WHICH IS AN INDEPENDENT, NATIONALLY RECOGNIZED COMPENSATION CONSULTANT. THE COMPENSATION COMMITTEE DOCUMENTS THE BASIS FOR ITS DETERMINATIONS FOLLOWING CONTEMPORANEOUS SUBSTANTIATION OF THE COMPENSATION COMMITTEE'S DELIBERATIONS AND DECISIONS. THE COMPENSATION COMMITTEE REQUIRES THE COMPENSATION CONSULTANT TO UPDATE MARKET DATA PERIODICALLY, USUALLY EVERY TWO YEARS, WITH INTERIM REVIEWS BEING CONDUCTED AS NEEDED. WITH REGARD TO PHYSICIAN COMPENSATION, THE COMPENSATION COMMITTEE ALSO RETAINS THE LAW FIRM OF MCDERMOTT, WILL & EMERY OF CHICAGO, ILLINOIS, TO ISSUE A REASONABLENESS OPINION COVERING THE PHYSICIAN COMPENSATION PLAN FOR COOK CHILDREN'S PHYSICIAN NETWORK. Form 990, Part VI, Line 19 Required documents available to the public THE ORGANIZATION DOES NOT MAKE ITS GOVERNING DOCUMENTS OR CONFLICT OF INTEREST POLICY AVAILABLE TO THE PUBLIC, EXCEPT TO THE EXTENT THEY ARE ON FILE WITH THE TEXAS SECRETARY OF STATE. THE CONFLICT-OF-INTEREST POLICY IS POSTED ON THE ORGANIZATION'S INTERNAL WEBSITE AND AVAILABLE TO ALL EMPLOYEES AND BOARD MEMBERS OF COOK CHILDREN'S HEALTH CARE SYSTEM ENTITIES. CONSOLIDATED FINANCIAL STATEMENTS ARE REPORTED ELECTRONICALLY FOR ALL COOK CHILDREN'S HEALTH CARE SYSTEM ENTITIES VIA THE ELECTRONIC MUNICIPAL MARKET ACCESS ("EMMA") WEB SITE. Cook Children's Health Care System 801 Seventh Ave Fort Worth TX 76104 752705881 Health Care Support TX 501(c)(3) Type III-FI CCHF true ROSEDALE OFFICE BUILDING 1500 W ROSEDALE Fort Worth TX 76104 460866421 TITLE HOLDING TX 501(c)(2) CCHF true WI COOK FOUNDATION dba Cook Children's Health Foundation 801 Seventh Ave Fort Worth TX 76104 752051649 Fundraising TX 501(c)(3) 7 NA false COOK CHILDREN'S MEDICAL CENTER 801 Seventh Ave Fort Worth TX 76104 752051646 Hospital TX 501(c)(3) 3 CCHCS true COOK CHILDREN'S HOME HEALTH 801 Seventh Ave Fort Worth TX 76104 752896983 Healthcare TX 501(c)(3) 10 CCHCS true COOK CHILDREN'S HEALTH PLAN 801 Seventh Ave Fort Worth TX 76104 760585240 Insurance TX 501(c)(3) 10 CCHCS true CHILD STUDY CENTER 1300 West Lancaster Fort Worth TX 76102 751099536 Healthcare Services TX 501(c)(3) 7 CCMC true COOK CHILDREN'S HEALTH ENTERPRISES 801 Seventh Ave Fort Worth TX 76104 842625990 Healthcare Services TX 501(c)(3) Type II CCHCS true COOK CHILDREN'S MEDICAL CENTER PROSPER 801 Seventh Ave Fort Worth TX 76104 852354189 Hospital TX 501(c)(3) 3 CCHCS true CPS Pediatrics LLC 340 Seven Springs Way Ste 600 Brentwood TN 37027 470871718 ASC TX NA N/A Cook Children's Surgery Center 340 Seven Springs Way Ste 600 Brentwood TN 37027 205227064 ASC TX NA N/A Center for Pediatric Surgery 340 Seven Springs Way Ste 600 Brentwood TN 37027 470871715 ASC TX NA N/A Cook Children's Health Services 801 Seventh Ave Fort Worth TX 76104 454024843 Healthcare TX CCHCS C Corporation true Cook Children's Indemnity Company 878 West Bay Road PO Box 1159 Grand Cayman Grand Cayman CJ KY1110 980424041 Self Insurance CJ CCHCS C Corporation true false false true false false false false false false false true false true true true true false true COOK CHILDREN'S HEALTH CARE SYSTEM K 3936002 FMV COOK CHILDREN'S HEALTH CARE SYSTEM C 304863 FMV COOK CHILDREN'S MEDICAL CENTER C 92789588 FMV COOK CHILDREN'S MEDICAL CENTER K 1732636 FMV COOK CHILDREN'S HEALTH ENTERPRISES N 1086293 FMV COOK CHILDREN'S MEDICAL CENTER O 48259858 FMV COOK CHILDREN'S HEALTH CARE SYSTEM O 19410027 FMV COOK CHILDREN'S MEDICAL CENTER - PROSPER O 7858647 FMV CHILD STUDY CENTER O 718949 FMV COOK CHILDREN'S MEDICAL CENTER - PROSPER C 7197667 FMV COOK CHILDREN'S HEALTH CARE SYSTEM P 41471222 FMV COOK CHILDREN'S MEDICAL CENTER Q 371312 FMV COOK CHILDREN'S HEALTH PLAN S 25011805 FMV COOK CHILDREN'S MEDICAL CENTER S 88920 FMV Cook Children's Physician Network 801 Seventh Avenue Fort Worth TX 76104 752485366 X 0 0 0 492341048 492341048 1000000 250000 0 0 0 COOK CHILDREN'S HEALTH PLAN 801 SEVENTH AVE FORT WORTH TX 76104 760585240 X 0 24784 24784 887415572 887440356 1000000 250000 0 0 0 COOK CHILDREN'S HEALTH CARE SYSTEM 802 SEVENTH AVE FORT WORTH TX 76104 752705881 X 0 225096 225096 333532587 333757683 1000000 250000 0 0 0 COOK CHILDREN'S MEDICAL CENTER 804 SEVENTH AVE FORT WORTH TX 76104 752051646 X 0 0 0 1521897393 1521897393 1000000 250000 0 0 0 WI COOK FOUNDATION 805 SEVENTH AVE FORT WORTH TX 76104 752051649 0 0 0 44775655 44775655 1000000 250000 0 0 0 COOK CHILDREN'S HOME HEALTH 806 SEVENTH AVE FORT WORTH TX 76104 752896983 X 0 0 0 73515122 73515122 1000000 250000 0 0 0 ROSEDALE OFFICE BUILDING 807 SEVENTH AVE FORT WORTH TX 76104 460866421 0 0 0 2286663 2286663 264333 66083 0 0 0 CHILD STUDY CENTER 808 SEVENTH AVE FORT WORTH TX 76104 751099536 0 0 0 10861711 10861711 693086 173271 0 0 0 COOK CHILDREN'S HEALTH ENTERPRISES 809 SEVENTH AVE FORT WORTH TX 76104 842625990 0 0 0 7377384 7377384 518869 129717 0 0 0 COOK CHILDREN'S MEDICAL CENTER PROSPER 810 SEVENTH AVE FORT WORTH TX 76104 852354189 0 0 0 92976629 92976629 1000000 250000 0 0 0