2023-08-15T14:27:20-05:00 2022-09-30 FORVIS LLP 14241 DALLAS PARKWAY STE 1100 DALLAS TX 75254 990 2021-10-01 752485366 Cook Children's Physician Network % CORY RHOADES COOK 6828854000 801 Seventh Avenue Fort Worth TX 76104 CORY R RHOADES CFO, SVP FINANCE 6828854000 2023-08-15 true CORY R RHOADES 999009999 Michael J Engle P00482834 9727028262 2 2021 2023-04-26 12:10:37Z MATTHEW DZURIK MD 801 SEVENTH AVE FORT WORTH TX 76104 425619452 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 2107 0 0 0 74099727 84919803 303602017 340653322 2500 0 43522 46327 377747766 425619452 0 0 0 0 299298636 341151839 0 0 0 87376269 90962115 386674905 432113954 -8927139 -6494502 64106288 71436982 83079917 96905113 -18973629 -25468131 X 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 376122671 340653322 Cook Children's Physician Network is the largest pediatric multi-specialty physician group in North Texas and has grown to include approximately 75 practice locations. CCPN employs approximately 500 physicians and surgeons, including 350 pediatric specialists and 150 primary care pediatricians. The Network also employs 320 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 Clinics (NHC) located in economically disadvantaged areas within Tarrant County. Neighborhood Clinics' professional staff also includes two dentists and nine 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. Virtual Health The pandemic rapidly accelerated the growth and patient adoption of virtual health services. These services greatly improved access to care and continue to be an integral part of how CCPN's physicians and providers care for children. Cook Children's Health Care System and CCPN have been developing and implementing telemedicine capabilities for several years, and defines this service as a live video and audio encounter with a patient/parent who is either in a remote CCPN clinic or simply accessing care from home. Patient families have access to 30 pediatric specialties via telemedicine: Cardiology Craniofacial/Plastics Endocrinology Gastroenterology Clinical Genetics Metabolic Genetics Hematology/Oncology Infectious Disease Neonatology Nephrology Neurology Epileptology Pain Management Palliative Care Pediatric Surgery Psychiatry Physical Medicine (PM&R) Pulmonary Psychology/Neuropsychology Rheumatology Urology CT Surgery Developmental Pediatrics Dermatology ENT Immunology Neurosurgery Orthopedics Sleep Medicine Wound Care Network providers hosted more than 60,000 visits via telemedicine in 2022. Telemedicine offers immediate care and patient monitoring, saving hours of travel for patient families. Cook Children's Physician Network telemedicine also supports school-based nurses in 15 local Independent School Districts (ISD), which includes 99 campuses. Expansion in the Prosper Market In FY22, CCPN developed a larger presence in Plano, Frisco, McKinney, Allen, Aubrey and Prosper, Texas. These markets now include 15 primary care locations with several more under development. In addition, CCPN has approximately 18 pediatric subspecialists working in the Prosper Medical Office Building located on the Cook Children's Medical Center-Prosper campus. When the medical center opens in December 2022, another 17 pediatric specialists will begin working in Prosper on a full-time basis. Physician Wellness Physician burnout has been a growing problem in the United States for the past decade. The COVID-19 pandemic made it worse, putting a significant strain on physician practices and medical providers everywhere. Health care has always been a 24/7 business, but the profession's typical seasonality-where months of high demand are followed by a lull-is a thing of the past since the pandemic. As a result, many providers are weary under the weight of a serious lack of work-life balance and burnout. This year, to help ease the strain, CCPN developed the Office of Physician Well-being-a physician wellness program led by one pediatric specialist and one primary care pediatrician. Their role is to identify the activities that contribute to burnout and determine practical solutions to address those issues. Top Docs Each year, D Magazine highlights 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 of 2022 Best Doctors and Pediatric Specialists. 376122671 true true false true false 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 74 0 true 2107 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 AVENUE FORT WORTH TX 76104 X RICK W MERRILL CEO 4.0 36.0 X 264861 2142971 255556 Vincent Tam Medical Director 40.0 0.0 X 2111861 0 55683 Johnnie Honeycutt MD Physician 40.0 0.0 X 1249542 0 57468 Richard Roberts MD PHYSICIAN 40.0 0.0 X 1195028 0 55989 Stephen W Kimmel Treasurer 4.0 36.0 X 114694 927975 162506 John Uffman MD PHYSICIAN 40.0 0.0 X 1142704 0 54169 Thomas Rothenbach MD PHYSICIAN 40.0 0.0 X 1142169 0 53221 Justin Smith MD Trustee End: 05/22 41.0 0.0 X 940288 0 50143 MICHELLE MARCINCUK MD Trustee - Secretary End: 05/22 42.0 1.0 X X 640810 0 55055 MATTHEW DZURIK MD PRESIDENT 42.0 0.0 X 606173 0 73544 Robert Goodwill VP Primary Care & Splty Svcs 40.0 0.0 X 566910 0 110933 DEBORAH SCHUTTE MD Trustee - VC/Special Care 42.0 1.0 X X 585177 0 58794 DIANE ARNAOUT MD Trustee 41.0 0.0 X 525576 0 46427 M SCOTT PERRY MD Trustee 41.0 2.0 X 424042 0 52551 CORWIN WARMINK MD Trustee 41.0 1.0 X 390844 0 51433 ERIK TEMPLETON MD Trustee 41.0 0.0 X 349317 0 56867 Mary Kathleen Powderly MD Trustee Start: 06/22 41.0 0.0 X 338972 0 55574 Anthony Anani MD Secretary Start: 06/22 42.0 1.0 X 359739 0 22732 ALICE W PHILLIPS MD Trustee - Chair 42.0 2.0 X X 306629 0 45959 Kevin Briscoe Assistant VP 40.0 0.0 X 318628 0 33442 Lindsay Huggins MD Trustee End: 05/22 41.0 0.0 X 308984 0 33926 W BRITT NELSON MD FORMER PRESIDENT 40.0 0.0 X 292009 0 34197 JULEE S MORROW MD Trustee - VC/Primary Care 42.0 3.0 X X 295402 0 17578 WHITNEY JOHANNESSEN AVP Advance Practice 40.0 0.0 X 254330 0 56302 Linda Thompson MD Trustee 41.0 0.0 X 275212 0 22922 ALMA TOLLEY AVP Primary Care & Specialty 40.0 0.0 X 242270 0 45907 Heather Miller MD Trustee Start: 06/22 41.0 0.0 X 218409 0 43014 BIANKA SORIA-OLMOS DO Trustee - Treasurer 42.0 1.0 X X 211051 0 45276 Teresa Baker AVP, PRIMARY/SPEC SERVICES 40.0 0.0 X 204769 0 41768 Tara Allen AVP, PRIMARY/SPEC SERVICES 40.0 0.0 X 214640 0 20645 DAPHNE SHAW MD Trustee - Treasurer 42.0 1.0 X X 176711 0 12958 Sheri Kantner Secretary 40.0 0.0 X 74319 0 29671 14999901 3070946 1572971 711 true true false CREDIT SYSTEMS INTERNATIONAL 1277 COUNTRY CLUB LN FORT WORTH TX 76112 CLAIM COLLECTION 356377 REGIONAL ADJUSTMENT BUREAU INC 3310 KELLER SPRINGS RD CARROLLTON TX 75006 CLAIM COLLECTION 366119 SUNDOWN JANITORIAL MAINTENANCE 1413 HEIDI CT FORT WORTH TX 76108 JANITORIAL SERVICES 248901 SKILES GROUP LLC 1810 N GREENVILLE AVE RICHARDSON TX 75081 CONSTRUCTION 298828 STRATUS VIDEO LLC 33 N GARDEN AVE CLEARWATER FL 33755 INTERPRETATION 247611 35 83786303 1133500 84919803 NET PATIENT FEES 621110 267521603 267521603 CONTRACTED FEES 621110 5304597 5304597 MANAGEMENT FEES 900099 63351901 63351901 OTHER OPERATING INCOME 621110 4475221 4475221 340653322 0 0 0 46327 46327 0 46327 46327 0 0 0 0 0 0 0 0 0 0 0 425619452 340653322 46327 0 0 0 0 11667284 7905879 3761405 0 282457133 263707525 18749608 12746480 11879411 867069 19891388 16974674 2916714 14389554 13388737 1000817 21353688 21353688 0 0 0 0 0 3550456 2452069 1098387 38666 35360 3306 786321 727622 58699 0 0 13713192 10427184 3286008 444053 371720 72333 0 119961 2496 117465 0 0 2701572 1333352 1368220 2673582 2670932 2650 MEDICAL SUPPLIES 33848057 33848057 BAD DEBT EXPENSE 9186639 9186639 COLLECTION EXPENSE 766619 766619 MINOR EQUIPMENT EXPENSE 519552 320103 199449 1259757 890911 368846 432113954 376122671 55991283 0 13501 13659 0 0 0 0 15446491 14968917 0 0 0 0 0 0 2633504 2863199 30337 80840 30361984 19746104 10502417 10615880 0 0 0 0 0 0 1404000 1248000 34076038 41646487 64106288 71436982 9542195 15629362 0 0 0 0 0 0 0 0 0 0 0 0 0 0 73537722 81275751 83079917 96905113 X -18973629 -25468131 0 0 -18973629 -25468131 64106288 71436982 -6494502 X false true X true false X 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. 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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 XI, LINE 2D RECONCILIATION OF REVENUES PER AUDITED FINANCIALS TO RETURN: BAD DEBT EXPENSE $(9,186,639) SCHEDULE D, PART XI, LINE 4B RECONCILIATION OF REVENUES PER AUDITED FINANCIALS TO RETURN: NET ASSETS RELEASED FROM RESTRICTIONS $35,654 SCHEDULE D, PART XII, LINE 4B RECONCILIATION OF EXPENSES PER AUDITED FINANCIALS TO RETURN: BAD DEBT EXPENSE $9,186,639 SCHEDULE D, PART V, LINE 4 INTENDED USE 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. X X false true false true false false false false false false false Tara Allen AVP, PRIMARY/SPEC SERVICES 170202 0 38910 0 5528 0 8143 0 12502 0 235285 0 0 0 Anthony Anani MD Secretary Start: 06/22 352308 0 1000 0 6431 0 11600 0 11132 0 382471 0 0 0 DIANE ARNAOUT MD Trustee 515489 0 1000 0 9087 0 13863 0 32564 0 572003 0 0 0 Teresa Baker AVP, PRIMARY/SPEC SERVICES 162990 0 39368 0 2411 0 7242 0 34526 0 246537 0 0 0 Kevin Briscoe Assistant VP 239996 0 63114 0 15518 0 9156 0 24286 0 352070 0 0 0 Robert Goodwill VP Primary Care & Splty Svcs 351617 0 152225 0 63068 0 75070 0 35863 0 677843 0 47043 0 Johnnie Honeycutt MD Physician 1166263 0 66044 0 17235 0 21750 0 35718 0 1307010 0 0 0 WHITNEY JOHANNESSEN AVP Advance Practice 192724 0 50351 0 11255 0 20220 0 36082 0 310632 0 0 0 Stephen W Kimmel Treasurer 69112 559178 32839 265698 12743 103099 14454 116948 3421 27683 132569 1072606 0 82928 MICHELLE MARCINCUK MD Trustee - Secretary End: 05/22 602959 0 1000 0 36851 0 18125 0 36930 0 695865 0 0 0 Heather Miller MD Trustee Start: 06/22 169414 0 41000 0 7995 0 8901 0 34113 0 261423 0 0 0 JULEE S MORROW MD Trustee - VC/Primary Care 270899 0 1000 0 23503 0 0 0 17578 0 312980 0 0 0 Lindsay Huggins MD Trustee End: 05/22 270160 0 26751 0 12073 0 10226 0 23700 0 342910 0 0 0 M SCOTT PERRY MD Trustee 412105 0 1000 0 10937 0 20205 0 32346 0 476593 0 0 0 ALICE W PHILLIPS MD Trustee - Chair 266582 0 1000 0 39047 0 15995 0 29964 0 352588 0 0 0 Mary Kathleen Powderly MD Trustee Start: 06/22 330272 0 1000 0 7700 0 21750 0 33824 0 394546 0 0 0 Richard Roberts MD PHYSICIAN 1131522 0 46332 0 17174 0 20893 0 35096 0 1251017 0 0 0 Thomas Rothenbach MD PHYSICIAN 1126995 0 1000 0 14174 0 18125 0 35096 0 1195390 0 0 0 DEBORAH SCHUTTE MD Trustee - VC/Special Care 557083 0 1000 0 27094 0 21750 0 37044 0 643971 0 0 0 DAPHNE SHAW MD Trustee - Treasurer 172269 0 500 0 3942 0 12958 0 0 0 189669 0 0 0 Justin Smith MD Trustee End: 05/22 881760 0 51000 0 7528 0 18125 0 32018 0 990431 0 0 0 BIANKA SORIA-OLMOS DO Trustee - Treasurer 193072 0 1000 0 16979 0 13370 0 31906 0 256327 0 0 0 Vincent Tam Medical Director 2088485 0 1000 0 22376 0 21750 0 33933 0 2167544 0 0 0 ERIK TEMPLETON MD Trustee 314684 0 28254 0 6379 0 21750 0 35117 0 406184 0 0 0 Linda Thompson MD Trustee 262102 0 1000 0 12110 0 19898 0 3024 0 298134 0 0 0 ALMA TOLLEY AVP Primary Care & Specialty 168466 0 66737 0 7067 0 18060 0 27847 0 288177 0 0 0 John Uffman MD PHYSICIAN 1124412 0 1000 0 17292 0 18125 0 36044 0 1196873 0 0 0 CORWIN WARMINK MD Trustee 329083 0 51132 0 10629 0 19500 0 31933 0 442277 0 0 0 RICK W MERRILL CEO 140481 1136623 81310 657873 43070 348475 23953 193797 4159 33647 292973 2370415 0 0 MATTHEW DZURIK MD PRESIDENT 506452 0 67724 0 31997 0 52631 0 20913 0 679717 0 0 0 W BRITT NELSON MD FORMER PRESIDENT 236236 0 0 0 55773 0 18809 0 15388 0 326206 0 0 0 SCHEDULE J, PART I, LINE 3 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 PARTICIPATION IN A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN: PARTICIPANTS IN SERP IN W-2 DEF COMP PAID BY -------------------- -------- -------- -------- ROBERT C. GOODWILL 47,043 56,945 CCPN STEPHEN W. KIMMEL 82,928 113,277 SYSTEM Rick W. Merrill NONE 196,000 SYSTEM Schedule J, Part I, Line 1a THE FOLLOWING INDIVIDUALS RECEIVED CME and other GROSS UP PAYMENTS IN THEIR W-2 AS TAXABLE WAGES: Diane Arnaout MD Michelle Marcincuk MD M Scott Perry MD Deborah Schutte MD Julee S Morrow MD Daphne Shaw MD Justin Smith MD Johnnie Honeycutt MD BiankA Soria-Olmos DO Vincent Tam MD Erik Templeton MD Corwin Warmink MD Alice Phillips MD Anthony Anani, MD Kevin Briscoe Lindsay Higgins, MD Heather Miller, MD Mary Kathleen Powderly, MD Richard Roberts, MD Thomas Rothenbach, MD John Uffman, MD Schedule J, Part I, Line 1b GENERAL GROSS UP PAYMENTS DISCLOSURE: 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. CME GROSS UPS PAYMENTS DISCLOSURE: 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. Air 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 II ALLOCATION OF CEO AND CFO SALARIES: SALARIES FOR THE CEO AND CFO 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 CHILD STUDY CENTER FORM 990, PART VI, SECTION A, LINE 2 BUSINESS RELATIONSHIPS: VARIOUS OFFICERS AND TRUSTEES HAVE A BUSINESS RELATIONSHIP WITH EACH OTHER DUE TO THEIR EMPLOYMENT OR BOARD SERVICE WITH OTHER ORGANIZATIONS WITHIN THE SYSTEM. FORM 990, PART VI, SECTION A, LINE 6 SOLE MEMBER: COOK CHILDREN'S HEALTH CARE SYSTEM, A TEXAS NON-PROFIT CORPORATION, IS THE SOLE MEMBER OF THE ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7A MEMBER ELECTION ABILITIES: 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, SECTION A, LINE 7B MEMBER DECISION ABILITIES: 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, SECTION B, LINE 11B PROCESS FOR REVIEW OF THE 990: 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, SECTION B, LINE 12C WRITTEN 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, SECTION B, LINE 15A & 15b REVIEW AND APPROVAL OF COMPENSATION: Cook Children's Health Care System has established a Compensation Committee with oversight of executive and physician compensation, which includes the organization's CEO and 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 RETAINED SULLIVAN COTTER AND ASSOCIATES, INC. IN 2022 to issue a reasonableness opinion covering the physician compensation plan for Cook Children's Physician Network. FORM 990, PART VI, SECTION C, LINE 19 MAKING GOVERNING DOCUMENTS 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 SECRETARY OF STATE OF TEXAS. 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 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 AVENUE FORT WORTH TX 76104 752896983 HEALTHCARE TX 501(C)(3) 10 CCHCS true WI COOK FOUNDATION 801 SEVENTH AVENUE FORT WORTH TX 76104 752051649 FUNDRAISING TX 501(C)(3) 7 NA false COOK CHILDREN'S HEALTH CARE SYSTEM 801 SEVENTH AVE FORT WORTH TX 76104 752705881 HLTH CARE SUP TX 501(C)(3) 12C CCHF true COOK CHILDREN'S HEALTH PLAN 801 SEVENTH AVE FORT WORTH TX 76104 760585240 INSURANCE TX 501(C)(3) 10 CCHCS true ROSEDALE OFFICE BUILDING INC 1500 W ROSEDALE FORT WORTH TX 76104 460866421 TITLE HOLDING TX 501(C)(2) N/A CCHF true CHILD STUDY CENTER 1300 W LANCASTER FORT WORTH TX 76102 751099536 HLTHCARE SRVC TX 501(C)(3) 7 CCMC true COOK CHILREN'S HEALTH ENTERPRISES 801 SEVENTH AVE FORT WORTH TX 76104 842625990 HLTH CARE SUP TX 501(C)(3) 12B CCHCS true COOK CHILDRENS MEDICAL CENTER PROSPER 801 SEVENTH AVE FORT WORTH TX 76104 852354189 HOSPITAL TX 501(C)(3) 3 CCHCS true CPS PEDIATRICS LLC 11221 ROE AVE SUITE 320 LEAWOOD KS 66211 470871718 ASC TX NA N/A COOK CHILDREN'S SURGERY CENTER 11221 ROE AVE SUITE 320 LEAWOOD KS 66211 205227064 ASC TX NA N/A CENTER FOR PEDIATRIC SURGERY 11221 ROE AVE SUITE 320 LEAWOOD KS 66211 470871715 ASC TX NA N/A COOK CHILDREN'S HEALTH SERVICES 801 7TH AVENUE FORT WORTH TX 76104 454024843 HEALTHCARE TX CCHCS C CORPORATION true COOK CHILDREN'S INDEMNITY COMPANY 878 WEST BAY RD GRAND CAYMAN CJ KY1-1102 980424041 SELF INSURANCE CJ cchcs C CORPORATION true false false true false false false false false false false true false false true true true true true true COOK CHILDREN'S HEALTH CARE SYSTEM k 5964813 FMV COOK CHILDREN'S HEALTH CARE SYSTEM C 280780 FMV COOK CHILDREN'S MEDICAL CENTER C 82531217 FMV COOK CHILDREN'S MEDICAL CENTER K 1732721 FMV COOK CHILDREN'S HEALTH ENTERPRISES N 1000074 FMV COOK CHILDREN'S MEDICAL CENTER O 113890220 FMV COOK CHILDREN'S HEALTH CARE SYSTEM O 22860937 FMV COOK CHILDREN'S MEDICAL CENTER - PROSPER O 6319473 FMV CHILD STUDY CENTER O 504517 FMV COOK CHILDREN'S MEDICAL CENTER P 193974 FMV COOK CHILDREN'S HEALTH CARE SYSTEM P 41723700 FMV COOK CHILDREN'S MEDICAL CENTER Q 387116 FMV COOK CHILDREN'S HEALTH CARE SYSTEM R 74782 FMV COOK CHILDREN'S HEALTH PLAN S 23820258 FMV COOK CHILDREN'S MEDICAL CENTER S 332540 FMV COOK CHILDREN'S PHYSICIAN NE 801 SEVENTH AVE FORT WORTH TX 76104 752485366 X 0 0 0 432113954 432113954 1000000 250000 0 0 0 COOK CHILDREN'S HEALTH PLAN 801 SEVENTH AVE FORT WORTH TX 76104 760585240 0 22478 22478 840298549 840321027 1000000 250000 0 0 0 COOK CHILDREN'S HEALTH CARE 801 SEVENTH AVE FORT WORTH TX 76104 752705881 X 0 180572 180572 287722338 287902910 1000000 250000 0 0 0 WI COOK FOUNDATION 801 SEVENTH AVE FORT WORTH TX 76104 752051649 0 0 0 0 0 0 0 0 0 0 COOK CHILDREN'S MEDICAL CENT 801 SEVENTH AVE FORT WORTH TX 76104 752051646 X 0 0 0 0 0 0 0 0 0 0 COOK CHILDREN'S HOME HEALTH 801 SEVENTH AVE FORT WORTH TX 76104 752896983 X 0 0 0 68024379 68024379 1000000 250000 0 0 0 CHILD STUDY CENTER 801 SEVENTH AVE FORT WORTH TX 76104 751099536 0 0 0 9401256 9401256 620063 155016 0 0 0 ROSEDALE OFFICE BUILDING 1500 W ROSEDALE FORT WORTH TX 76104 460866421 0 0 0 2316032 2316032 265802 66451 0 0 0 COOK CHILDREN'S HEALTH ENTER 801 SEVENTH AVE FORT WORTH TX 76104 842625990 0 0 0 7200844 7200844 510042 127511 0 0 0 COOK CHILDREN'S MEDICAL CENT 801 SEVENTH AVE FORT WORTH TX 76104 852354189 0 0 0 13552732 13552732 827637 206909 0 0 0