Children's Medical Center Health Plan: Form 990, tax year 2021
View the entire original 990 at ProPublica ↗
- Organization
- Children's Medical Center Health Plan (EIN 46-2737696)
- Tax period
- 2021-01-01 to 2021-12-31
- Filed
- 2022-11-15
- IRS object ID
- 202203199349307895
- Schema version
- 2021v4.2
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2022-11-15T10:33:22-06:00 | ReturnTs |
| Tax Period End | 2021-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 350921680 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CROWE LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 750 N St Paul Suite 850 | AddressLine1Txt |
| City | Dallas | CityNm |
| State Abbreviation | TX | StateAbbreviationCd |
| ZIP | 752013246 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2021-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 462737696 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Children's Medical Center Health Plan | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | CHIL | BusinessNameControlTxt |
| Phone | 2144567000 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1935 Medical District Drive | AddressLine1Txt |
| City | Dallas | CityNm |
| State Abbreviation | TX | StateAbbreviationCd |
| ZIP | 75235 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Robert Fries | PersonNm |
| Person Title | Senior Vice President, Finance | PersonTitleTxt |
| Phone | 2144567000 | PhoneNum |
| Signature | 2022-11-15 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | Robert | PersonFirstNm |
| Person Last | Fries | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Amy Bellanca | PreparerPersonNm |
| PTIN | P01572961 | PTIN |
| Phone | 2147775200 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2021 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
Principal Ofcr Business Name PrincipalOfcrBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Peter Perialas | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1935 Medical District Drive | AddressLine1Txt |
| City | Dallas | CityNm |
| State Abbreviation | TX | StateAbbreviationCd |
| ZIP | 75235 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $4,939 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | N/A | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2013 | FormationYr |
| Legal Domicile State | TX | LegalDomicileStateCd |
| Activity Or Mission | TO INSURE HEALTH COVERAGE FOR POOR, DISTRESSED, OR UNDERPRIVILEGED CHILDREN & ADULTS. | ActivityOrMissionDesc |
| Voting Members Governing Body | 3 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 0 | VotingMembersIndependentCnt |
| Total Employee | 0 | TotalEmployeeCnt |
| Total Volunteers | 0 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| CY Contributions Grants | $0 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $185,479,133 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $3,646 | CYProgramServiceRevenueAmt |
| PY Investment Income | $300,686 | PYInvestmentIncomeAmt |
| CY Investment Income | $1,293 | CYInvestmentIncomeAmt |
| CY Other Revenue | $0 | CYOtherRevenueAmt |
| PY Total Revenue | $185,779,819 | PYTotalRevenueAmt |
| CY Total Revenue | $4,939 | CYTotalRevenueAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $18,785,455 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $1,403,997 | CYSalariesCompEmpBnftPaidAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $152,743,263 | PYOtherExpensesAmt |
| CY Other Expenses | $1,230,249 | CYOtherExpensesAmt |
| PY Total Expenses | $171,528,718 | PYTotalExpensesAmt |
| CY Total Expenses | $2,634,246 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $14,251,101 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$2,629,307 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $59,551,674 | TotalAssetsBOYAmt |
| Total Assets EOY | $46,883,176 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $10,856,863 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $817,672 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $48,694,811 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $46,065,504 | NetAssetsOrFundBalancesEOYAmt |
| Mission | TO INSURE HEALTH COVERAGE FOR POOR, DISTRESSED, OR UNDERPRIVILEGED CHILDREN & ADULTS IN THE STATE OF TEXAS. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $2,225,644 | ExpenseAmt |
| Revenue | $3,646 | RevenueAmt |
| Desc | To insure poor, distressed, or underprivileged children or adults enrolled in Texas Medicaid (STAR), Children's Health Insurance Program (CHIP), Medicaid recipients on Social Security Administration's Supplemental Security Income (STAR Kids and STAR+PLUS), Medicaid for foster children (STAR health), and Medicare Advantage (covering only those patients that have dual eligibility for Medicaid and Medicare benefits) in the State of Texas. | Desc |
| Total Program Service Expenses | $2,225,644 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | false | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | false | LobbyingActivitiesInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | false | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (true) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | false | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (true) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (true) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | false | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (true) | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | false | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | false | OperateHospitalInd |
| Grants To Organizations | false | GrantsToOrganizationsInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Schedule J Required | Yes (true) | ScheduleJRequiredInd |
| Tax Exempt Bonds | false | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | false | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | false | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | false | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | false | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | false | DisregardedEntityInd |
| Related Entity | Yes (true) | RelatedEntityInd |
| Related Organization Ctrl Ent | false | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 26 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 0 | EmployeeCnt |
| Unrelated Bus Incm Over Limit | false | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | false | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | false | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | false | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 3 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 0 | IndependentVotingMemberCnt |
| Family Or Business Rln | false | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | false | DelegationOfMgmtDutiesInd |
| Change To Org Documents | false | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (true) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (true) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (true) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (true) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (true) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (true) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (true) | DocumentRetentionPolicyInd |
| Compensation Process CEO | false | CompensationProcessCEOInd |
| Compensation Process Other | false | CompensationProcessOtherInd |
| Investment In Joint Venture | false | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Amy Yeager | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 2144567000 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1935 MEDICAL DISTRICT DRIVE | AddressLine1Txt |
| City | DALLAS | CityNm |
| State Abbreviation | TX | StateAbbreviationCd |
| ZIP | 75235 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (8 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt |
|---|---|---|---|---|---|---|---|
| Doris E Hunt | |||||||
| Dir. and VP/Executive Director | 1.0 | 54.0 | Yes (X) | Yes (X) | $0 | $1,152,930 | $190,990 |
| Peter C Perialas Jr | |||||||
| Director & President | 1.0 | 54.0 | Yes (X) | Yes (X) | $0 | $1,548,349 | $327,607 |
| Christopher J Durovich | |||||||
| Chairman/CHST President & CEO | 1.0 | 59.0 | Yes (X) | $0 | $3,389,547 | $62,242 | |
| Kenneth Stewart | |||||||
| Director (Term 01/03/2021) | 1.0 | 54.0 | Yes (X) | $0 | $709,660 | $1,018 | |
| Ray Tsai MD | |||||||
| Director (Term. 3/13/2021) | 0.0 | 40.0 | Yes (X) | $0 | $1,464,945 | $56,596 | |
| Amy Yeager | |||||||
| Secretary (Effec. 4/1/2021) | 1.0 | 54.0 | Yes (X) | $0 | $762,030 | $211,728 | |
| Jeremiah Radandt | |||||||
| Treasurer (Term. 11/06/2021) | 1.0 | 54.0 | Yes (X) | $0 | $2,912,736 | $248,161 | |
| Mark Chulick | |||||||
| Secretary (Term 3/31/2021) | 1.0 | 0.0 | Yes (X) | $0 | $359,921 | $25,025 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $0 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $12,300,118 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $1,123,367 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 0 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | Yes (true) | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (2 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| VIVA MEDICAL GROUP LLC | |||||
| 275 W CAMPBELL ROAD | RICHARDSON | TX | 75080 | NURSING AND THERAPY SERVICES | $265,000 |
| COGNIZANT TRIZETTO SOFTWARE GR | |||||
| 9655 Maroon Circle | Engleweood | CO | 80112 | Professional Services | $163,136 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 2 | CntrctRcvdGreaterThan100KCnt |
| Total Contributions | $0 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Premium Revenue | Desc |
| Business | 900099 | BusinessCd |
| Total Revenue Column | $3,646 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $3,646 | RelatedOrExemptFuncIncomeAmt |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $0 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $0 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $3,646 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,293 | TotalRevenueColumnAmt |
| Exclusion | $1,293 | ExclusionAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
| Personal | $0 | PersonalAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $0 | SecuritiesAmt |
| Other | $0 | OtherAmt |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $0 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $0 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $0 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $4,939 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $3,646 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $1,293 | ExclusionAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,159,167 | TotalAmt |
| Program Services | $1,119,160 | ProgramServicesAmt |
| Management And General | $40,007 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $122,264 | TotalAmt |
| Program Services | $118,044 | ProgramServicesAmt |
| Management And General | $4,220 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $59,501 | TotalAmt |
| Program Services | $57,448 | ProgramServicesAmt |
| Management And General | $2,053 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $63,065 | TotalAmt |
| Program Services | $60,888 | ProgramServicesAmt |
| Management And General | $2,177 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $154,409 | TotalAmt |
| Management And General | $154,409 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $174,713 | TotalAmt |
| Program Services | $0 | ProgramServicesAmt |
| Management And General | $174,713 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,670 | TotalAmt |
| Program Services | $5,474 | ProgramServicesAmt |
| Management And General | $196 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $285,529 | TotalAmt |
| Program Services | $275,674 | ProgramServicesAmt |
| Management And General | $9,855 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $282,798 | TotalAmt |
| Program Services | $273,038 | ProgramServicesAmt |
| Management And General | $9,760 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $25 | TotalAmt |
| Program Services | $24 | ProgramServicesAmt |
| Management And General | $1 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $324,829 | TotalAmt |
| Program Services | $313,618 | ProgramServicesAmt |
| Management And General | $11,211 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Premium Taxes | Desc |
| Total | $2,276 | TotalAmt |
| Program Services | $2,276 | ProgramServicesAmt |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
| Program Services | $0 | ProgramServicesAmt |
| Management And General | $0 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,634,246 | TotalAmt |
| Program Services | $2,225,644 | ProgramServicesAmt |
| Management And General | $408,602 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $54,477,480 | BOYAmt |
| EOY | $41,908,755 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,117,832 | BOYAmt |
| EOY | $2,118,280 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $184,316 | BOYAmt |
| EOY | $0 | EOYAmt |
Receivables From Officers Etc ReceivablesFromOfficersEtcGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $116,119 | BOYAmt |
| EOY | $8,528 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $3,424,539 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $1,594,977 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,154,392 | BOYAmt |
| EOY | $1,829,562 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $501,535 | BOYAmt |
| EOY | $1,018,051 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $59,551,674 | BOYAmt |
| EOY | $46,883,176 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,408,453 | BOYAmt |
| EOY | $295,558 | EOYAmt |
Loans From Officers Directors LoansFromOfficersDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,448,410 | BOYAmt |
| EOY | $522,114 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,856,863 | BOYAmt |
| EOY | $817,672 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $48,694,811 | BOYAmt |
| EOY | $46,065,504 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $48,694,811 | BOYAmt |
| EOY | $46,065,504 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $59,551,674 | BOYAmt |
| EOY | $46,883,176 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | -$2,629,307 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | Yes (true) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (true) | AuditCommitteeInd |
| Federal Grant Audit Required | false | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Publicly Supported Org509a2 | Yes (X) | PubliclySupportedOrg509a2Ind |
Gifts Grants Contris Rcvd509 GiftsGrantsContrisRcvd509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $0 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $0 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $0 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $0 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $0 | CurrentTaxYearAmt |
| Total | $0 | TotalAmt |
Gross Receipts Admissions GrossReceiptsAdmissionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $245,065,321 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $266,099,546 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $272,136,229 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $185,479,133 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $3,646 | CurrentTaxYearAmt |
| Total | $968,783,875 | TotalAmt |
Gross Receipts Non Unrlt Bus GrossReceiptsNonUnrltBusGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $0 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $0 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $0 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $0 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $0 | CurrentTaxYearAmt |
| Total | $0 | TotalAmt |
Tax Rev Levied Orgnztnl Bnft509 TaxRevLeviedOrgnztnlBnft509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $0 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $0 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $0 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $0 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $0 | CurrentTaxYearAmt |
| Total | $0 | TotalAmt |
Govt Furn Srvc Fclts Vl509 GovtFurnSrvcFcltsVl509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $0 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $0 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $0 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $0 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $0 | CurrentTaxYearAmt |
| Total | $0 | TotalAmt |
Total509 Total509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $245,065,321 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $266,099,546 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $272,136,229 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $185,479,133 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $3,646 | CurrentTaxYearAmt |
| Total | $968,783,875 | TotalAmt |
Amounts Rcvd Dsqlfy Person AmountsRcvdDsqlfyPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $0 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $0 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $0 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $0 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $0 | CurrentTaxYearAmt |
| Total | $0 | TotalAmt |
Substantial Contributors Amt SubstantialContributorsAmtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $0 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $0 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $0 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $0 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $0 | CurrentTaxYearAmt |
| Total | $0 | TotalAmt |
Subst And Dsqlfy Prsns Tot SubstAndDsqlfyPrsnsTotGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $0 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $0 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $0 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $0 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $0 | CurrentTaxYearAmt |
| Total | $0 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total509 | $968,783,875 | PublicSupportTotal509Amt |
Gross Investment Income509 GrossInvestmentIncome509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $36,023 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $40,069 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $1,662,727 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $300,686 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $1,293 | CurrentTaxYearAmt |
| Total | $2,040,798 | TotalAmt |
Post1975 UBTI Post1975UBTIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $0 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $0 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $0 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $0 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $0 | CurrentTaxYearAmt |
| Total | $0 | TotalAmt |
Investment Income And UBTI InvestmentIncomeAndUBTIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $36,023 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $40,069 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $1,662,727 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $300,686 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $1,293 | CurrentTaxYearAmt |
| Total | $2,040,798 | TotalAmt |
Net Income From Other UBI NetIncomeFromOtherUBIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $0 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $0 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $0 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $0 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $0 | CurrentTaxYearAmt |
| Total | $0 | TotalAmt |
Other Income509 OtherIncome509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $0 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $0 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $0 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $0 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $0 | CurrentTaxYearAmt |
| Total | $0 | TotalAmt |
Total Support Calendar Year TotalSupportCalendarYearGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $245,101,344 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $266,139,615 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $273,798,956 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $185,779,819 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $4,939 | CurrentTaxYearAmt |
| Total | $970,824,673 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support CY509 | 0.9979 | PublicSupportCY509Pct |
| Public Support PY509 | 0.9980 | PublicSupportPY509Pct |
| Investment Income CY | 0 | InvestmentIncomeCYPct |
| Investment Income PY | 0.0 | InvestmentIncomePYPct |
| Thirty Thr Pct Suprt Tests CY509 | Yes (X) | ThirtyThrPctSuprtTestsCY509Ind |
Schedule D IRS990ScheduleD
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,463,291 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,407,595 | DepreciationAmt |
| Book Value | $1,055,696 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $187,382 | OtherCostOrOtherBasisAmt |
| Depreciation | $187,382 | DepreciationAmt |
| Book Value | $0 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $773,866 | OtherCostOrOtherBasisAmt |
| Book Value | $773,866 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $1,829,562 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | INTERCOMPANY LIABILITY | Desc |
| Amt | $522,114 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $522,114 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Schedule D, Part X, Line 2 FIN 48 (ASC 740) footnote | FormAndLineReferenceDesc |
| Explanation | Children's Medical Center Health Plan's financial information is included in the consolidated audited financial statements of Children's Health System of Texas, a related organization. Children's Health System of Texas's FIN 48 (ASC 740) footnote for the year ended December 31, 2021, reads as follows: "The authoritative guidance in ASC 740 Income Taxes, creates a single model to address uncertainty in tax positions and clarifies the accounting for income taxes by prescribing the minimum recognition threshold a tax position is required to meet before being recognized in the financial statements. Management annually reviews its tax positions and has determined that there are no material uncertain tax positions that require recognition in the accompanying consolidated balance sheets. The statute of limitations remains open for tax years 2018 through 2021 in Children's Health main taxing jurisdictions." | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | Yes (true) | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (true) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | false | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | false | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | false | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | false | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | false | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | false | AnyNonFixedPaymentsInd |
| Initial Contract Exception | false | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (8 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Doris E Hunt | ||||||||||||||
| Dir. and VP/Executive Director | $0 | $444,281 | $0 | $356,250 | $0 | $352,399 | $0 | $160,788 | $0 | $30,202 | $0 | $1,343,920 | $0 | $0 |
| Peter C Perialas Jr | ||||||||||||||
| Director & President | $0 | $911,324 | $0 | $489,187 | $0 | $147,838 | $0 | $294,900 | $0 | $32,707 | $0 | $1,875,956 | $0 | $0 |
| Christopher J Durovich | ||||||||||||||
| Chairman/CHST President & CEO | $0 | $1,595,313 | $0 | $1,734,814 | $0 | $59,420 | $0 | $19,530 | $0 | $42,712 | $0 | $3,451,789 | $0 | $0 |
| Kenneth Stewart | ||||||||||||||
| Director (Term 01/03/2021) | $0 | $23,077 | $0 | $317,310 | $0 | $369,273 | $0 | $923 | $0 | $95 | $0 | $710,678 | $0 | $0 |
| Ray Tsai MD | ||||||||||||||
| Director (Term. 3/13/2021) | $0 | $89,812 | $0 | $250,098 | $0 | $1,125,035 | $0 | $45,481 | $0 | $11,115 | $0 | $1,521,541 | $0 | $0 |
| Mark Chulick | ||||||||||||||
| Secretary (Term 3/31/2021) | $0 | $56,375 | $0 | $186,637 | $0 | $116,909 | $0 | $15,972 | $0 | $9,053 | $0 | $384,946 | $0 | $0 |
| Jeremiah Radandt | ||||||||||||||
| Treasurer (Term. 11/06/2021) | $0 | $650,988 | $0 | $396,638 | $0 | $1,865,110 | $0 | $210,639 | $0 | $37,522 | $0 | $3,160,897 | $0 | $0 |
| Amy Yeager | ||||||||||||||
| Secretary (Effec. 4/1/2021) | $0 | $494,517 | $0 | $256,916 | $0 | $10,597 | $0 | $162,960 | $0 | $48,768 | $0 | $973,758 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Schedule J, Part I, Line 3 Arrangement used to establish the top management official's compensation | Children's Medical Center Health Plan (The "Corporation") has no employees. Certain individuals identified herein as Director or Officers of the Corporation are employed and compensated by a related organization, Children's Health System of Texas (CHST). The Individuals perform services for the Corporation, and in some cases other related organizations, by arrangement between CHST and such organization(s). Therefore, Compensation decisions for the officers were determined by the related organization following CHST compensation's policy. In their duties as Officers of the Corporation, they have no influence over the compensation process performed by CHST. The CHST process for determining executive compensation is as follows: The Human Resources Committee (Committee) of the CHST Board is responsible for setting the compensation for executives. The Committee is comprised of independent, non-employee directors. A written compensation philosophy has been developed by the Human Resources Committee for timeliness and appropriateness and defines the desired peer groups for compensation surveys. The HR Committee engages the services of an independent compensation consultant for executive compensation. COMPENSATION PROGRAM COMPONENTS: The elements of total compensation provided to CHST executives include: - Cash compensation (i.e., base salary, short-term and long-term incentive compensation, and/or other cash compensation), determined in consideration of competitive market practices, organizational and individual performance, recruitment and retention considerations, and other relevant factors. - Standard benefits, assisting in each executive's medical, dental, disability, life insurance, time off, and retirement needs, reflective of the employment status (i.e., full or part time) of the executive. - Supplemental benefits, including supplemental insurance, retirement benefits, and/or other supplemental benefits determined by the Committee to be appropriate and reasonable in relation to marketplace practices. Compensation and benefits decisions are made in consideration of each executive's position, responsibilities, skills, effort, and performance, in relation to documented practices within the appropriate comparator group(s). PEER GROUP: The Committee has defined its primary peer group for executives as not-for-profit health care organizations similar in size, structure, and complexity. This group will include leading pediatric health systems as well as integrated health systems and academic medical centers. - Data will be compiled in a manner consistent with the IRS Intermediate Sanctions rules of federal tax law, to reflect what is "ordinarily paid to like executives by like enterprises under like circumstances." - In certain circumstances, market data from additional comparator groups (e.g., research institutions, insurance industry, and general industry companies) may also be referenced. - The specific nature of the role at CHST will be considered when adding comparator groups outside of the primary peer group, and the Committee will discuss and agree on the appropriateness of adding comparator groups whenever the specific nature of the CHST role requires additional comparator groups to be used. |
| Schedule J, Part I, Line 4a Severance or change-of-control payment | Jeremiah Radandt - $1,125,000 Ray Tsai - $627,450 Mark Chulick - $87,771 |
| Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan | Executive Defined Contribution Retirement Plan (EDCRP): Employees who received taxable income from the EDCRP include: Christopher J. Durovich - $13,569 Jeremiah Radandt - $736,271 Peter Perialas - $137,823 Ray Tsai - $439,738 Doris Hunt - $325,530 Kenneth Stewart - $368,871 Employees who participated in and have contributions to the EDCRP include: Jeremiah Radandt - $199,039 Peter Perialas - $277,500 Ray Tsai - $24,133 Doris Hunt - $179,771 Amy Yeager - $151,360 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part VI, Line 15 PROCESS TO ESTABLISH COMPENSATION OF TOP MANAGEMENT OFFICIAL AND OFFICERS | CHILDREN'S MEDICAL CENTER HEALTH PLAN (The "Corporation") has no employees. Certain individuals identified herein as Officers of the Corporation are employed and compensated by a related organization, Children's Health System of Texas (CHST). The Individuals perform services for the Corporation, and in some cases other related organizations, by arrangement between CHST and such organization(s). As set forth in the Schedule R, the Corporation and CHST are related organizations. In their duties as Officers of the Corporation, they have no influence over the compensation process performed by CHST, which is explained in Schedule J, Part I, Line 3. |
| Form 990, Part VI, Line 8b Committees | Children's Health System of Texas has established seven standing Committees of the Board, which have the authority to act for and on behalf of CHST, Children's Health Clinical Operations, Children's Medical Center Foundation, and their affiliates, operating divisions and division facilities to fulfill the responsibilities designated in the respective Committee charters. Written minutes are prepared and maintained for all formal meetings of each Committee. Actions by Written Consent are also prepared and maintained as they occur. |
| Form 990, Part VI, Line 6 Classes of members or stockholders | Children's Health System of Texas (CHST) is the sole member. |
| Form 990, Part VI, Line 7a Members or stockholders electing members of governing body | CHST elects all members of the organization's Board of Directors. |
| Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders | Member reserve powers are specified in the organization's Bylaws and represent those actions by the organization which require member approval. These powers generally encompass changes in the mission of the organization, addition of new members, specified financial matters, amendments to the organization's Certificate of Formation and Bylaws, and appointment of directors. |
| Form 990, Part VI, Line 11b Review of form 990 by governing body | Children's Medical Center Health Plan has delegated its oversight and review of the Form 990 to the Board of Directors of Children's Health System of Texas (CHST), its Sole Member. A draft of the Form 990 is presented to the CHST Audit Committee for review prior to filing. A copy of the Final Form 990 is made available to the CHST directors through our Board portal before it is filed. |
| Form 990, Part VI, Line 12c Conflict of interest policy | Officers, directors, and key employees receive annually a copy of the Children's Health Statement of Interest form to complete. Disclosures made are reviewed by the CHST Legal Department and the Chief Compliance Officer, who are authorized under the Children's Health Conflict of Interest Policy to make determinations under the Policy regarding persons who are medical staff members or employees of Children's Health and its affiliates. Disclosures made by senior officers (as defined in the Policy) are reviewed by the Compliance Officer, the Chief Legal Officer, and CHST's President and Chief Executive Officer to determine if a conflict exists. Disclosures made by directors of CHST and its affiliates, as well as by the President and Chief Executive Officer of CHST, are discussed as necessary with the appropriate delegated Board Committee and, if required pursuant to the Policy, by the appropriate Board of Directors at meetings to determine if further action is needed. A Statement of Interest must be completed annually and Board members are requested to report changes if they occur. A Committee or Board member with a potential conflict is prohibited from participating in deliberations regarding the transaction in question and will recuse themselves from voting. |
| Form 990, Part VI, Line 19 Required documents available to the public | IRC section 6104 does not require disclosure of the financial statements, conflict of interest policy and governing documents. The Certificate of Formation, Consolidated Financial Statements, and the conflict of interest policy are made available upon request. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (16 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|---|
| Children's Health Clinical Operations | ||||||||||
| 1935 MEDICAL DISTRICT DRIVE | DALLAS | TX | 75235 | 750800628 | Hospital | TX | 501(c)(3) | 3 | CHILDREN'S HEALTH SYSTEM OF TEXAS | false |
| CHILDREN'S MEDICAL CENTER FOUNDATION | ||||||||||
| 1935 MEDICAL DISTRICT DRIVE | DALLAS | TX | 75235 | 752062015 | FOUNDATION | TX | 501(c)(3) | 7 | CHILDREN'S HEALTH SYSTEM OF TEXAS | false |
| PHYSICIANS FOR CHILDREN | ||||||||||
| 1935 MEDICAL DISTRICT DRIVE | DALLAS | TX | 75235 | 752854505 | PHYSICIANS | TX | 501(c)(3) | 3 | CHILDREN'S HEALTH SYSTEM OF TEXAS | false |
| DALLAS PHYS MED SVCS FOR CHILDREN INC | ||||||||||
| 1935 MEDICAL DISTRICT DRIVE | DALLAS | TX | 75235 | 810584868 | PHYSICIANS | TX | 501(c)(3) | 3 | CHILDREN'S HEALTH SYSTEM OF TEXAS | false |
| COMPLEX CARE MED SVC CORP | ||||||||||
| 1935 MEDICAL DISTRICT DRIVE | DALLAS | TX | 75235 | 461893597 | MEDICAL SERVICES | TX | 501(c)(3) | 3 | CHILDREN'S HEALTH SYSTEM OF TEXAS | false |
| CHILDREN'S MED CTR RESEARCH INST AT UTSWMC | ||||||||||
| 1935 MEDICAL DISTRICT DRIVE | DALLAS | TX | 75235 | 453462044 | RESEARCH INSTITUTE | TX | 501(c)(3) | Type I | CHILDREN'S HEALTH SYSTEM OF TEXAS | false |
| PEDIATRIC PARTNERS | ||||||||||
| 1935 MEDICAL DISTRICT DRIVE | DALLAS | TX | 75235 | 461917702 | CLINICALLY INTEGRATED NETWORK | TX | 501(c)(3) | Type I | CHILDREN'S HEALTH SYSTEM OF TEXAS | false |
| ANESTHESIOLOGISTS FOR CHILDREN | ||||||||||
| 1935 MEDICAL DISTRICT DRIVE | DALLAS | TX | 75235 | 752917570 | PHYSICIANS | TX | 501(c)(3) | 10 | CHILDREN'S HEALTH SYSTEM OF TEXAS | false |
| PHYSICIANS QUALITY ALLIANCE OF NORTH TEXAS | ||||||||||
| 1935 MEDICAL DISTRICT DRIVE | DALLAS | TX | 75235 | 464049491 | PHYSICIANS | TX | 501(c)(3) | Type I | CHILDREN'S HEALTH SYSTEM OF TEXAS | false |
| SOUTHWESTERN MEDICAL DISTRICT | ||||||||||
| 1935 MEDICAL DISTRICT DRIVE | DALLAS | TX | 75235 | 204101612 | MEDICAL DISTRICT | TX | 501(c)(3) | Type I | NA | false |
| WOMEN'S AUXILIARY TO THE CHILDREN'S MEDICAL CENTER | ||||||||||
| 2777 N STEMMONS FWY 700 | DALLAS | TX | 75207 | 752485538 | WOMEN'S AUXILIARY | TX | 501(c)(3) | 10 | CHILDREN'S MEDICAL CENTER FOUNDATION | false |
| OCH Holdings | ||||||||||
| 1935 Medical District Drive | Dallas | TX | 75235 | 474837308 | Hospital | TX | 501(c)(3) | 3 | Children's Health Clinical Operations | false |
| CHILDREN'S HEALTH SYSTEM OF TEXAS | ||||||||||
| 1935 MEDICAL DISTRICT DRIVE | DALLAS | TX | 75235 | 752062019 | MANAGEMENT COMPANY | TX | 501(c)(3) | Type II | NA | false |
| Bradford Memorial Hospital for Babies | ||||||||||
| 1935 MEDICAL DISTRICT DRIVE | DALLAS | TX | 75235 | 756067819 | Hospital | TX | 501(c)(3) | 3 | CHILDREN'S HEALTH SYSTEM OF TEXAS | false |
| The Children's Hospital of Texas | ||||||||||
| 1935 MEDICAL DISTRICT DRIVE | DALLAS | TX | 75235 | 756081004 | Hospital | TX | 501(c)(3) | 3 | CHILDREN'S HEALTH SYSTEM OF TEXAS | false |
| Richmond Freeman Memorial Clinic | ||||||||||
| 1935 MEDICAL DISTRICT DRIVE | DALLAS | TX | 75235 | 237079698 | Hospital | TX | 501(c)(3) | 3 | CHILDREN'S HEALTH SYSTEM OF TEXAS | false |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (7 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Entity TypeEntityTypeTxt | Controlled OrganizationControlledOrganizationInd | Legal Domicile Foreign CountryLegalDomicileForeignCountryCd |
|---|---|---|---|---|---|---|---|---|---|---|
| ALTERNATIVE CARE SYSTEMS | ||||||||||
| 1935 MEDICAL DISTRICT DRIVE | DALLAS | TX | 75235 | 752244475 | OTHER MEDICAL SERVICES | TX | NA | C Corporation | false | |
| NTPSS INC | ||||||||||
| 1935 MEDICAL DISTRICT DRIVE | DALLAS | TX | 75235 | 471036641 | PHYSICIAN SOLUTIONS | TX | NA | C Corporation | false | |
| Texas Bluebonnet Insurance Company | ||||||||||
| 1935 Medical District Drive | Dallas | TX | 75235 | 475032893 | Insurance Company | TX | NA | C Corporation | false | |
| Texas Trinity River Assurance Company | ||||||||||
| 981318151 | Self-insurance | NA | C Corporation | false | CJ | |||||
| Children's Health | ||||||||||
| 1935 Medical District Drive | Dallas | TX | 75235 | 833809987 | Other Medical Services | TX | NA | C Corporation | false | |
| CHFH Inc | ||||||||||
| 1935 Medical District Drive | Dallas | TX | 75235 | 831336111 | OTHER MEDICAL SERVICES | TX | NA | C Corporation | false | |
| CHILDREN'S HEALTH CARE NETWORK | ||||||||||
| 1935 MEDICAL DISTRICT DRIVE | DALLAS | TX | 75235 | 834560427 | OTHER MEDICAL SERVICES | TX | NA | C Corporation | false | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | false | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | false | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (true) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | false | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | false | DivRelatedOrganizationInd |
| Asset Sale To Other Org | false | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | false | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | false | AssetExchangeInd |
| Rental Of Facilities To Oth Org | false | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | false | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | Yes (true) | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | false | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | false | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (true) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | false | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | false | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | false | TransferToOtherOrgInd |
| Transfer From Other Org | false | TransferFromOtherOrgInd |
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