2022-08-05T16:46:19-05:00 2021-09-30 FORVIS LLP 14241 DALLAS PARKWAY SUITE 1100 DALLAS TX 75254 990 2020-10-01 752896983 Cook Children's Home Health % CORY RHOADES COOK 6828854000 801 Seventh Avenue Fort Worth TX 76104 CORY R RHOADES CFO AND SVP, FINANCE 6828854480 2022-08-15 true CORY R RHOADES 999009999 Michael J Engle P00482834 9727028262 3 2020 2022-09-23 18:48:47Z MIKE SIMMONS 801 SEVENTH AVE FORT WORTH TX 76104 62388186 false X WWW.COOKCHILDRENS.ORG X 2000 TX KNOWING THAT EVERY CHILD'S LIFE IS SACRED OUR PROMISE IS TO IMPROVE THE HEALTH OF EVERY CHILD IN OUR REGION THROUGH PREVENTION AND TREATMENT OF ILLNESS, DISEASE AND INJURY 8 5 279 6 0 0 16412 0 57550813 62316906 44209 63220 0 0 57611434 62380126 2215 0 0 0 18142870 19333151 0 0 0 36711069 40225002 54856154 59558153 2755280 2821973 22356314 25340426 8190751 8352890 14165563 16987536 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 45164348 62316906 Children and families all across northeast and southeast Texas rely on Cook Children's Home Health for in-home medical care including: Skilled nursing Respiratory therapy Physical therapy Occupational therapy Speech therapy Orthotics and prosthetic Custom mobility equipment Pharmaceutical infusion Specialty drug therapy In FY21, CCHH's four locations in Fort Worth, Dallas, Austin and San Antonio served more than 76,000 patients. As with many businesses across the country, CCHH was forced during COVID-19 to make adjustments to its operations. Telehealth became a critical tool. By reducing the amount of time that CCHH employees spent in patient homes, virtual interaction limited opportunities for virus exposure for both employees and patients. Home Health's nursing and rehabilitation services transitioned to a virtual platform as much as possible to safely provide care for its home-based patients. Nursing and rehabilitation services logged more than 3,000 skilled nursing visits and more than 24,000 rehabilitative visits, either virtually or in person, in FY21. Home Health continued to deliver life-enhancing and life-sustaining durable medical equipment to patients' homes during the pandemic. Rather than spend time inside homes training families to use the equipment, delivery personnel met online with equipment users. More than 68,000 patients received durable medical equipment products and services in FY21. Delivery personnel traveled more than 785,000 miles to complete deliveries. In addition, respiratory care and services were provided to 147 homebound patients on ventilators. Despite the challenges of operating during a pandemic, CCHH continued to innovate and diversify its services. The company expanded its newest division of custom mobility equipment. Every child is different. So are their needs when it comes to keeping them outfitted with equipment that allows them to be as active as possible. That's where CCHH's talented engineers and fabricators come in. Similar to orthotics and prosthetics, they work with both patients and families in the field and with physicians and therapists in the clinics at Cook Children's Medical Center to customize equipment that keep kids on the move. This new division serviced 119 patients during FY21, providing everything from custom gait trainers to motorized custom wheelchairs, along with various types of adaptive devices. 45164348 true false false true false false false false false false 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 19 0 true 279 true false false false false false false false false false false true false X 8 5 true false false false true true true true true false false true true true true true true true true false X CORY RHOADES 6828854480 801 SEVENTH AVENUE FORT WORTH TX 76104 X RICK W MERRILL CEO 1.0 39.0 X 47688 2336699 255387 STEPHEN W KIMMEL TREASURER 2.0 38.0 X 50632 962007 129999 JASON KENNEDY MD TRUSTEE 1.0 40.0 X 0 683603 52244 MICHAEL R SIMMONS PRESIDENT & CFO 40.0 0.0 X 521931 0 52321 M SCOTT PERRY MD TRUSTEE - VICE CHAIRMAN 2.0 42.0 X X 0 478891 53931 MICHAEL E GENDKE VP - OPERATIONS 40.0 0.0 X 316676 0 41535 SANDRA MANNING AVP CLINICAL & PHARMACY OPS 40.0 0.0 X 220440 0 50506 CAROLYN BRUNO AVP FINANCE 40.0 0.0 X 227514 0 40359 DIONNE R CRIGLER DIRECTOR - PHARMACY 40.0 0.0 X 196290 0 41859 VICKY TALAMO-GUERVARA MD TRUSTEE END: 06/2021 1.0 40.0 X 0 217433 20605 SHANNON ROGERS SUPERVISOR, PHARMACY 40.0 0.0 X 172490 0 46022 JON JOHNSON DIRECTOR CLINICAL OUTCOMES O&P 40.0 0.0 X 167827 0 35519 KRISTEN TAYLOR MD TRUSTEE 1.0 40.0 X 0 178384 21093 VINH PHAN PHARMACIST 40.0 0.0 X 158449 0 35785 MARY CARA MARTZ SECRETARY 1.0 39.0 X 0 165987 24953 DONYA FRONK DIRECTOR, HH REHAB SERVICES 40.0 0.0 X 153525 0 34851 RICHARD W DYESS TRUSTEE - CHAIRMAN 2.0 5.0 X X 0 0 0 ROSALIND EVANS TRUSTEE 1.0 1.0 X 0 0 0 ANNE M CARVALHO TRUSTEE 1.0 3.0 X 0 0 0 FROST R PRIOLEAU TRUSTEE 1.0 1.0 X 0 0 0 WILLIAM JACKSON RATTIKIN III TRUSTEE 1.0 1.0 X 0 0 0 2233462 5023004 936969 20 false true false MIG RE INVESTORS I PO BOX 741496 LOS ANGELES CA 90074 TEMPORARY STAFFING 114878 CHANGE HEALTHCARE LLC PO BOX 403421 ATLANTA GA 30384 TEMPORARY STAFFING 123401 2 0 Net Patient Service Revenue 621110 59175172 59175172 Management Fee Revenue 900099 3133019 3133019 Other Department Revenue 900099 8715 8715 62316906 0 0 0 0 0 0 71280 8060 63220 63220 63220 0 0 0 0 0 0 0 0 0 0 62380126 62316906 63220 0 0 0 0 1593292 1593292 0 13483000 8000183 5482817 627182 306535 320647 2591235 1389428 1201807 1038442 583516 454926 3003588 3003588 0 0 0 0 0 975721 208526 767195 22809 22809 774123 540941 233182 0 0 1283088 401297 881791 399177 382983 16194 0 16821 4890 11931 0 0 645767 529140 116627 0 Medical Supplies 26726413 26706514 19899 Bad Debt Expense 3990429 3990429 Minor Equipment 1625688 1585870 39818 Repairs & Maintenance 495985 477494 18491 265393 56602 208791 59558153 45164348 14393805 0 1550 1550 10111076 10197399 0 0 4089034 6108714 0 0 0 0 0 0 1647150 2074530 49171 54359 5838315 3531318 2109481 2306997 0 0 0 0 0 0 0 0 4348852 4596877 22356314 25340426 3829903 3736870 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4360848 4616020 8190751 8352890 X 14165563 16987536 0 0 14165563 16987536 22356314 25340426 2821973 X false true X true false X 17032 18085 17973 16412 0 69502 49003668 48636430 50275874 57550813 62316906 267783691 0 0 0 49020700 48654515 50293847 57567225 62316906 267853193 0 4097353 2759099 4649497 5059794 3716890 20282633 4097353 2759099 4649497 5059794 3716890 20282633 247570560 0 0 0 0 0 49020700 48654515 50293847 57567225 62316906 267853193 0.92428 0.91870 0.00000 0.00000 X X 0 0 0 298322 0 298322 59558153 2601131028 59558153 2601429350 1000000 7362790 250000 1840698 1000000 1000000 1500000 0 0 250000 250000 375000 0 0 41632 1388 40244 366297 282591 83706 4984021 3123266 1860755 446365 124073 322292 2306997 Right-of-Use Assets 4596877 4596877 0 LT Lease Obligation - Current 865020 LT LEASE OBLIGATION - LONG TERM 3751000 4616020 58326477 -3990429 -3990429 62316906 63220 63220 62380126 55504504 -63220 -63220 55567724 3990429 3990429 59558153 SCHEDULE D, PART XI, LINE 4B RECONCILIATION OF EXPENSES FINANCIAL STATEMENTS TO FORM 990 GAIN ON DISPOSAL OF ASSETS: $ 63,220 SCHEDULE D, PART XI, LINE 2D RECONCILIATION OF REVENUE PER AUDITED FINANCIAL STATEMENTS WITH RETURN: BAD DEBT TOTAL: $(3,990,429) SCHEDULE D, PART XII, LINE 2D RECONCILIATION OF REVENUE PER AUDITED FINANCIAL STATEMENTS WITH RETURN: GAIN ON DISPOSAL OF ASSETS: $(63,220) SCHEDULE D, PART XII, LINE 4B RECONCILIATION OF REVENUE PER AUDITED FINANCIAL STATEMENTS WITH RETURN: BAD DEBT TOTAL: $3,990,429 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. X false true false true false false false false false false false MICHAEL R SIMMONS PRESIDENT & CFO 282387 0 130432 0 109112 0 21375 0 30946 0 574252 0 0 0 M SCOTT PERRY MD TRUSTEE - VICE CHAIRMAN 0 465811 0 500 0 12580 0 19500 0 34431 0 532822 0 0 MICHAEL E GENDKE VP - OPERATIONS 202836 0 71890 0 41950 0 18315 0 23220 0 358211 0 0 0 STEPHEN W KIMMEL TREASURER 29460 559747 14961 284257 6211 118003 4938 93818 1562 29681 57132 1085506 0 68837 MARY CARA MARTZ SECRETARY 0 127943 0 32854 0 5190 0 7972 0 16981 0 190940 0 0 RICK W MERRILL CEO 24824 1216375 15351 752194 7513 368130 4348 213027 760 37252 52796 2586978 0 0 SANDRA MANNING AVP CLINICAL & PHARMACY OPS 160798 0 44158 0 15484 0 8889 0 41617 0 270946 0 0 0 SHANNON ROGERS SUPERVISOR, PHARMACY 153915 0 15400 0 3175 0 11373 0 34649 0 218512 0 0 0 JASON KENNEDY MD TRUSTEE 0 667843 0 500 0 15260 0 17813 0 34431 0 735847 0 0 CAROLYN BRUNO AVP FINANCE 177597 0 45963 0 3954 0 13338 0 27021 0 267873 0 0 0 DIONNE R CRIGLER DIRECTOR - PHARMACY 160222 0 26352 0 9716 0 14992 0 26867 0 238149 0 0 0 DONYA FRONK DIRECTOR, HH REHAB SERVICES 125019 0 20250 0 8256 0 9868 0 24983 0 188376 0 0 0 JON JOHNSON DIRECTOR CLINICAL OUTCOMES O&P 136338 0 20717 0 10772 0 10723 0 24796 0 203346 0 0 0 VINH PHAN PHARMACIST 139842 0 15400 0 3207 0 7329 0 28456 0 194234 0 0 0 VICKY TALAMO-GUERVARA MD TRUSTEE END: 06/2021 0 210519 0 500 0 6414 0 4299 0 16306 0 238038 0 0 KRISTEN TAYLOR MD TRUSTEE 0 170025 0 500 0 7859 0 6969 0 14124 0 199477 0 0 SCHEDULE J, PART I, Line 3 METHODS USED BY CCHCS TO ESTABLISH COMPENSATION OF THE CEO/EXEC DIRECTOR: 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 -------------------- -------- ---------- --------- STEPHEN W. KIMMEL 68,837 80,943 SYSTEM Rick W. Merrill 167,069 196,000 SYSTEM Michael R. Simmons 35,548 NONE CCHH Schedule J, Part I, Line 1a GROSS UP PAYMENTS INCLUDED IN W-2 TAXABLE COMPENSATION: DIONNE CRIGLER VINH PHAN DONYA FRONK JON JOHNSON Schedule J, Part I, Line 1b GROSS UP 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 TYPES 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. 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 POWER TO DETERMINE THE NUMBER OF MEMBERS OF THE BOARD OF TRUSTEES AND TO ELECT THE MEMBERS OF THE BOARD OF TRUSTEES. 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 POWER AND RESERVED POWER TO DO ANY OF THE FOLLOWING: A. AMEND, ALTER OR REPEAL THE BYLAWS; B. AMEND THE CERTIFICATE OF FORMATION OF THE ORGANIZATION; C. DETERMINE THE NUMBER OF MEMBERS OF THE BOARD OF TRUSTEES AND TO ELECT THE MEMBERS OF THE BOARD OF TRUSTEES; D. APPROVE ANY MERGER, ACQUISITION, LIQUIDATION, WINDING UP, TERMINATION OR CONSOLIDATION OF THE ORGANIZATION; E. APPROVE THE SALE, GIFT OR OTHER DISPOSITION OF ALL OR SUBSTANTIALLY ALL OF THE PROPERTY OF THE ORGANIZATION; F. APPROVE THE CREATION OF, OR INVESTMENT IN, ANY SUBSIDIARY ENTITY; G. APPROVE CAPITAL AND OPERATING BUDGETS OF THE ORGANIZATION; H. APPROVE DEBT TO BE INCURRED BY THE ORGANIZATION WHICH WOULD EXCEED SUCH LIMITS AS ESTABLISHED BY THE SOLE MEMBER; AND, I. APPROVE THE LONG-RANGE FINANCIAL AND STRATEGIC PLANS FOR THE ORGANIZATION. FORM 990, PART VI, SECTION B, LINE 11B REVIEW PROCESS FOR FORM 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 ARE 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 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, SECTION C, LINE 19 PROCESS OF MAKING GOVERNING 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 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. FORM 990, PART VI, SECTION A, LINE 2 BUSINESS RELATIONSHIPS: VARIOUS OFFICERS AND TRUSTEES HAVE A BUSINESS RELATIONSHIP WITH EACHOTHER DUE TO THEIR EMPLOYMENT OR BOARD SERVICE WITH OTHER ORGANIZATIONS WITHIN THE SYSTEM. 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