COMPLEX CARE MEDICAL SERVICES CORPORATION: Form 990, tax year 2021

View the entire original 990 at ProPublica ↗

Organization
COMPLEX CARE MEDICAL SERVICES CORPORATION (EIN 46-1893597)
Tax period
2021-01-01 to 2021-12-31
Filed
2022-11-15
IRS object ID
202243199349308204
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

FieldValueIRS element (for citing)
Return2022-11-15T10:34:18-06:00ReturnTs
Tax Period End2021-12-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN350921680PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1CROWE LLPBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1750 N St Paul Suite 850AddressLine1Txt
CityDallasCityNm
State AbbreviationTXStateAbbreviationCd
ZIP752013246ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2021-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN461893597EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1Complex Care Medical Services CorporationBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlCOMPBusinessNameControlTxt
Phone2144567000PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line11935 Medical District DriveAddressLine1Txt
CityDallasCityNm
State AbbreviationTXStateAbbreviationCd
ZIP75235ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonRobert FriesPersonNm
Person TitleSenior Vice President, FinancePersonTitleTxt
Phone2144567000PhoneNum
Signature2022-11-15SignatureDt
Discuss With Paid PreparerYes (true)DiscussWithPaidPreparerInd

Signing Officer SigningOfficerGrp

Person Full Name PersonFullName

FieldValueIRS element (for citing)
Person FirstRobertPersonFirstNm
Person LastFriesPersonLastNm
FieldValueIRS element (for citing)
SSN999009999SSN

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonAmy BellancaPreparerPersonNm
PTINP01572961PTIN
Phone2147775200PhoneNum
FieldValueIRS element (for citing)
Tax2021TaxYr
Build TS2022-09-23 18:48:47ZBuildTS

Form 990 IRS990

Principal Ofcr Business Name PrincipalOfcrBusinessName

FieldValueIRS element (for citing)
Business Name Line1Dai ChungBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line11935 Medical District DriveAddressLine1Txt
CityDallasCityNm
State AbbreviationTXStateAbbreviationCd
ZIP75235ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$1,509,802GrossReceiptsAmt
Group Return For AffiliatesfalseGroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressN/AWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation2012FormationYr
Legal Domicile StateTXLegalDomicileStateCd
Activity Or MissionTO SERVE AS THE MEDICAL HOME FOR CHILDREN WITH COMPLEX MEDICAL ILLNESSES.ActivityOrMissionDesc
Voting Members Governing Body3VotingMembersGoverningBodyCnt
Voting Members Independent3VotingMembersIndependentCnt
Total Employee0TotalEmployeeCnt
Total Volunteers4TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$150PYContributionsGrantsAmt
CY Contributions Grants$100CYContributionsGrantsAmt
PY Program Service Revenue$1,472,714PYProgramServiceRevenueAmt
CY Program Service Revenue$1,509,702CYProgramServiceRevenueAmt
CY Investment Income$0CYInvestmentIncomeAmt
CY Other Revenue$0CYOtherRevenueAmt
PY Total Revenue$1,472,864PYTotalRevenueAmt
CY Total Revenue$1,509,802CYTotalRevenueAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$1,477,540PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$1,526,105CYSalariesCompEmpBnftPaidAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$2,109,361PYOtherExpensesAmt
CY Other Expenses$1,818,016CYOtherExpensesAmt
PY Total Expenses$3,586,901PYTotalExpensesAmt
CY Total Expenses$3,344,121CYTotalExpensesAmt
PY Revenues Less Expenses-$2,114,037PYRevenuesLessExpensesAmt
CY Revenues Less Expenses-$1,834,319CYRevenuesLessExpensesAmt
Total Assets BOY$1,724,211TotalAssetsBOYAmt
Total Assets EOY$1,597,419TotalAssetsEOYAmt
Total Liabilities BOY$17,274,838TotalLiabilitiesBOYAmt
Total Liabilities EOY$18,982,365TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY-$15,550,627NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY-$17,384,946NetAssetsOrFundBalancesEOYAmt
MissionTO SERVE AS THE MEDICAL HOME FOR CHILDREN WITH COMPLEX MEDICAL ILLNESSES WHERE A MULTI-DISCIPLINARY TEAM OF CARE GIVERS OVERSEE AND COORDINATE THEIR CARE.MissionDesc
Significant New Program SrvcfalseSignificantNewProgramSrvcInd
Significant ChangefalseSignificantChangeInd
Expense$1,617,812ExpenseAmt
Grant$0GrantAmt
Revenue$1,509,702RevenueAmt
DescTO SERVE AS THE MEDICAL HOME FOR CHILDREN WITH COMPLEX MEDICAL ILLNESSES WHERE A MULTI-DISCIPLINARY TEAM OF CARE GIVERS OVERSEE AND COORDINATE THEIR CARE.Desc
Total Program Service Expenses$1,617,812TotalProgramServiceExpensesAmt
Described In Section501c3Yes (true)DescribedInSection501c3Ind
Schedule B RequiredfalseScheduleBRequiredInd
Political Campaign ActyfalsePoliticalCampaignActyInd
Lobbying ActivitiesfalseLobbyingActivitiesInd
Donor Advised FundfalseDonorAdvisedFundInd
Conservation EasementsfalseConservationEasementsInd
Collections Of ArtfalseCollectionsOfArtInd
Credit CounselingfalseCreditCounselingInd
Donor Rstr Or Quasi EndowmentsfalseDonorRstrOrQuasiEndowmentsInd
Report Land Building EquipmentYes (true)ReportLandBuildingEquipmentInd
Report Investments Other SecfalseReportInvestmentsOtherSecInd
Report Program Related InvstfalseReportProgramRelatedInvstInd
Report Other AssetsfalseReportOtherAssetsInd
Report Other LiabilitiesYes (true)ReportOtherLiabilitiesInd
Include FIN48 FootnoteYes (true)IncludeFIN48FootnoteInd
Independent Audit Fincl StmtfalseIndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (true)ConsolidatedAuditFinclStmtInd
School OperatingfalseSchoolOperatingInd
Foreign OfficefalseForeignOfficeInd
Foreign ActivitiesfalseForeignActivitiesInd
More Than5000 K To OrgfalseMoreThan5000KToOrgInd
More Than5000 K To IndividualsfalseMoreThan5000KToIndividualsInd
Professional FundraisingfalseProfessionalFundraisingInd
Fundraising ActivitiesfalseFundraisingActivitiesInd
Gaming ActivitiesfalseGamingActivitiesInd
Operate HospitalfalseOperateHospitalInd
Grants To OrganizationsfalseGrantsToOrganizationsInd
Grants To IndividualsfalseGrantsToIndividualsInd
Schedule J RequiredYes (true)ScheduleJRequiredInd
Tax Exempt BondsfalseTaxExemptBondsInd
Engaged In Excess Benefit TransfalseEngagedInExcessBenefitTransInd
PY Excess Benefit TransfalsePYExcessBenefitTransInd
Loan OutstandingfalseLoanOutstandingInd
Grant To Related PersonfalseGrantToRelatedPersonInd
Business Rln With Org MemfalseBusinessRlnWithOrgMemInd
Business Rln With Fam MemfalseBusinessRlnWithFamMemInd
Business Rln With35 Ctrl EntfalseBusinessRlnWith35CtrlEntInd
Deductible Non Cash ContrifalseDeductibleNonCashContriInd
Deductible Art ContributionfalseDeductibleArtContributionInd
Terminate OperationsfalseTerminateOperationsInd
Partial LiquidationfalsePartialLiquidationInd
Disregarded EntityfalseDisregardedEntityInd
Related EntityYes (true)RelatedEntityInd
Related Organization Ctrl EntfalseRelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd OrgfalseTrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted PrtshpfalseActivitiesConductedPrtshpInd
Schedule O RequiredYes (true)ScheduleORequiredInd
IRP Document3IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (true)BackupWthldComplianceInd
Employee0EmployeeCnt
Unrelated Bus Incm Over LimitfalseUnrelatedBusIncmOverLimitInd
Foreign Financial AccountfalseForeignFinancialAccountInd
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTransInd
Taxable Party NotificationfalseTaxablePartyNotificationInd
Nondeductible ContributionsfalseNondeductibleContributionsInd
Quid Pro Quo ContributionsfalseQuidProQuoContributionsInd
Form8282 Property Disposed OffalseForm8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft CntrctfalseRcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft CntrctfalsePayPremiumsPrsnlBnftCntrctInd
Indoor Tanning ServicesfalseIndoorTanningServicesInd
Subj To Tax Rmnrtn Ex Prcht PymtfalseSubjToTaxRmnrtnExPrchtPymtInd
Subject To Excs Tax Net Invst IncfalseSubjectToExcsTaxNetInvstIncInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members3GoverningBodyVotingMembersCnt
Independent Voting Member3IndependentVotingMemberCnt
Family Or Business RlnfalseFamilyOrBusinessRlnInd
Delegation Of Mgmt DutiesfalseDelegationOfMgmtDutiesInd
Change To Org DocumentsfalseChangeToOrgDocumentsInd
Material Diversion Or MisusefalseMaterialDiversionOrMisuseInd
Members Or StockholdersYes (true)MembersOrStockholdersInd
Election Of Board MembersYes (true)ElectionOfBoardMembersInd
Decisions Subject To ApprovaYes (true)DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (true)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (true)MinutesOfCommitteesInd
Officer Mailing AddressfalseOfficerMailingAddressInd
Local ChaptersfalseLocalChaptersInd
Form990 Provided To Gvrn BodyfalseForm990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (true)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (true)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (true)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (true)WhistleblowerPolicyInd
Document Retention PolicyYes (true)DocumentRetentionPolicyInd
Compensation Process CEOfalseCompensationProcessCEOInd
Compensation Process OtherfalseCompensationProcessOtherInd
Investment In Joint VenturefalseInvestmentInJointVentureInd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1Amy YeagerBusinessNameLine1Txt
FieldValueIRS element (for citing)
Phone2144567000PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line11935 MEDICAL DISTRICT DRIVEAddressLine1Txt
CityDALLASCityNm
State AbbreviationTXStateAbbreviationCd
ZIP75235ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (8 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtOfficerOfficerIndFormer Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd
Andrew Gelfand MD
Director1.00Yes (X)$0$0$0
John Andersen MD
Director (Term. 8/31/2021)1.00Yes (X)$0$0$0
Patricia Petroff MD
Chairman (Effec. 01/01/2021)1.00Yes (X)$0$0$0
William Scott MD
Director1.00Yes (X)$0$0$0
Dai H Chung MD
President (Effec. 01/01/2021)1.054.0$16,667$900,000$0Yes (X)
Lisa M Frenkel
Secretary1.053.0$0$457,901$65,168Yes (X)
David T Berry
Former Officer0.055.0$0$1,220,782$261,802Yes (X)
Ray Tsai MD
Former Officer0.040.0$0$1,464,945$56,596Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$16,667TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$4,043,628TotReportableCompRltdOrgAmt
Total Other Compensation$383,566TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K0IndivRcvdGreaterThan100KCnt
Former Ofcr Employees ListedYes (true)FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (true)TotalCompGreaterThan150KInd
Compensation From Other SrcsYes (true)CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp

Contractor Name ContractorName

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1UTSWBusinessNameLine1Txt

Contractor Address ContractorAddress

US Address USAddress

FieldValueIRS element (for citing)
Address Line1HI 108 5323 Harry Hines BlvdAddressLine1Txt
CityDallasCityNm
State AbbreviationTXStateAbbreviationCd
ZIP753908886ZIPCd
FieldValueIRS element (for citing)
ServicesPhys & Medical ServicesServicesDesc
Compensation$665,160CompensationAmt
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K1CntrctRcvdGreaterThan100KCnt
Related Organizations$100RelatedOrganizationsAmt
Total Contributions$100TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp

FieldValueIRS element (for citing)
DescNet Patient RevenueDesc
Business621110BusinessCd
Total Revenue Column$1,509,702TotalRevenueColumnAmt
Related Or Exempt Func Income$1,509,702RelatedOrExemptFuncIncomeAmt

Total Oth Program Service Rev TotalOthProgramServiceRevGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt
Related Or Exempt Func Income$0RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$0ExclusionAmt
FieldValueIRS element (for citing)
Total Program Service Revenue$1,509,702TotalProgramServiceRevenueAmt

Rental Income Or Loss RentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Real$0RealAmt
Personal$0PersonalAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Securities$0SecuritiesAmt
Other$0OtherAmt

Miscellaneous Revenue MiscellaneousRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt
Related Or Exempt Func Income$0RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$0ExclusionAmt
FieldValueIRS element (for citing)
Other Revenue Total$0OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$1,509,802TotalRevenueColumnAmt
Related Or Exempt Func Income$1,509,702RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$0ExclusionAmt
FieldValueIRS element (for citing)
Info In Schedule O Part IXYes (X)InfoInScheduleOPartIXInd

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$1,176,795TotalAmt
Program Services$551,586ProgramServicesAmt
Management And General$625,209ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$72,446TotalAmt
Program Services$33,957ProgramServicesAmt
Management And General$38,489ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$194,365TotalAmt
Program Services$91,102ProgramServicesAmt
Management And General$103,263ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$82,499TotalAmt
Program Services$38,669ProgramServicesAmt
Management And General$43,830ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$668,146TotalAmt
Program Services$668,146ProgramServicesAmt
Management And General$0ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$386TotalAmt
Management And General$386ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$8,017TotalAmt
Program Services$3,758ProgramServicesAmt
Management And General$4,259ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$1,679TotalAmt
Program Services$787ProgramServicesAmt
Management And General$892ManagementAndGeneralAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$148,579TotalAmt
Program Services$69,642ProgramServicesAmt
Management And General$78,937ManagementAndGeneralAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$126,128TotalAmt
Program Services$59,118ProgramServicesAmt
Management And General$67,010ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (2 entries)

DescDescTotalTotalAmtManagement And GeneralManagementAndGeneralAmtProgram ServicesProgramServicesAmt
Shared Services$764,034$764,034
Medical Surgical Supplies$101,047$101,047

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt
Program Services$0ProgramServicesAmt
Management And General$0ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$3,344,121TotalAmt
Program Services$1,617,812ProgramServicesAmt
Management And General$1,726,309ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$100BOYAmt
EOY$100EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$12,203BOYAmt
EOY$11,538EOYAmt

Receivables From Officers Etc ReceivablesFromOfficersEtcGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$2,564,543LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$978,762LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$1,711,908BOYAmt
EOY$1,585,781EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt

Investments Program Related InvestmentsProgramRelatedGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$1,724,211BOYAmt
EOY$1,597,419EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$72,996BOYAmt
EOY$124,281EOYAmt

Loans From Officers Directors LoansFromOfficersDirectorsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$17,201,842BOYAmt
EOY$18,858,084EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$17,274,838BOYAmt
EOY$18,982,365EOYAmt
FieldValueIRS element (for citing)
Organization Follows FASB117Yes (X)OrganizationFollowsFASB117Ind

No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY-$15,550,627BOYAmt
EOY-$17,384,946EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY-$15,550,627BOYAmt
EOY-$17,384,946EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$1,724,211BOYAmt
EOY$1,597,419EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss-$1,834,319ReconcilationRevenueExpnssAmt
Other Changes In Net Assets$0OtherChangesInNetAssetsAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or ReviewfalseAccountantCompileOrReviewInd
FS AuditedYes (true)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Consolidated Basis Fincl StmtYes (X)ConsolidatedBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (true)AuditCommitteeInd
Federal Grant Audit RequiredfalseFederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
HospitalYes (X)HospitalInd

Schedule D IRS990ScheduleD

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$2,428,181OtherCostOrOtherBasisAmt
Depreciation$859,793DepreciationAmt
Book Value$1,568,388BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$136,362OtherCostOrOtherBasisAmt
Depreciation$118,969DepreciationAmt
Book Value$17,393BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$1,585,781TotalBookValueLandBuildingsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)

DescDescAmtAmt
LT Advances - Affiliates$18,822,386
LT Deferred Rent$35,698
FieldValueIRS element (for citing)
Total Liability$18,858,084TotalLiabilityAmt
Footnote TextYes (X)FootnoteTextInd

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceSchedule D, Part X, Line 2 FIN 48 (ASC 740) footnoteFormAndLineReferenceDesc
ExplanationComplex Care Medical Services'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

FieldValueIRS element (for citing)
Severance PaymentYes (true)SeverancePaymentInd
Supplemental Nonqual Rtr PlanYes (true)SupplementalNonqualRtrPlanInd
Equity Based Comp ArrngmfalseEquityBasedCompArrngmInd
Comp Based On Revenue Of Flng OrgfalseCompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related OrgsfalseCompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng OrgfalseCompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd OrgsfalseCompBsdNetEarnsRltdOrgsInd
Any Non Fixed PaymentsfalseAnyNonFixedPaymentsInd
Initial Contract ExceptionfalseInitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (4 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Filing OrganizationBonusFilingOrganizationAmountBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Filing OrgOtherCompensationFilingOrgAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtComp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmtComp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
David T Berry
Former Officer$0$639,433$0$349,623$0$231,726$0$227,356$0$34,446$0$1,482,584$0$0
Ray Tsai MD
Former Officer$0$89,812$0$250,098$0$1,125,035$0$45,481$0$11,115$0$1,521,541$0$0
Dai H Chung MD
President (Effec. 01/01/2021)$16,667$900,000$0$0$0$0$0$0$0$0$16,667$900,000$0$0
Lisa M Frenkel
Secretary$0$310,557$0$99,513$0$47,831$0$48,721$0$16,447$0$523,069$0$0

Supplemental Information Detail SupplementalInformationDetail (4 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Schedule J, Part I, Line 3 Arrangement used to establish the top management official's compensationComplex Care Medical Services Corporation (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). 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 paymentRay Tsai - $627,450
Schedule J, Part I, Line 4b Supplemental nonqualified retirement planExecutive Defined Contribution Retirement Plan (EDCRP): Employees who received taxable income from the EDCRP include: Ray Tsai - $439,738 David Berry- $193,414 Employees who participated in and have contributions to the EDCRP include: Ray Tsai - $24,133 Lisa Frenkel - $37,777 David Berry - $202,340
Schedule J, Part II COMPENSATION FROM AN UNRELATED ORGANIZATION OR INDIVIDUALNAME - DAI H. CHUNG, MD, COMPENSATION FROM UNRELATED ORGANIZATION - 16667.000000, NAME OF UNRELATED ORGANIZATION - UT SOUTHWESTERN MEDICAL CENTER, TYPE OF COMPENSATION - COMPENSATION FOR SERVICES PROVIDED TO CHILDREN'S HEALTH ENTITIES AS PART OF A MSA BETWEEN THE ORGANIZATIONS.

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (9 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Form 990, Part VI, Line 15 PROCESS TO ESTABLISH COMPENSATION OF TOP MANAGEMENT OFFICIAL AND OFFICERSCOMPLEX CARE MEDICAL SERVICES CORPORATION (CCMSC) (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 CommitteesChildren'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 stockholdersChildren's Health System of Texas (CHST) is the sole member.
Form 990, Part VI, Line 7a Members or stockholders electing members of governing bodyDirectors are appointed by the sole member and approved by the current CCMSC Board of Directors.
Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholdersMember 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, certain dispositions of assets, 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 bodyComplex Care Medical Services Corporation 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 policyOfficers, 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 publicIRC 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.
Form 990, Part IX, Line 11g Other FeesContract Medical - Total Expense: 668146, Program Service Expense: 668146, Management and General Expenses: , Fundraising Expenses: ;

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (16 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtPublic Charity StatusPublicCharityStatusTxtBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtControlled OrganizationControlledOrganizationInd
Children's Health Clinical Operations
1935 MEDICAL DISTRICT DRIVEDALLASTX75235750800628HospitalTX501(c)(3)3CHILDREN'S HEALTH SYSTEM OF TEXASfalse
CHILDREN'S MEDICAL CENTER FOUNDATION
1935 MEDICAL DISTRICT DRIVEDALLASTX75235752062015FOUNDATIONTX501(c)(3)7CHILDREN'S HEALTH SYSTEM OF TEXASfalse
PHYSICIANS FOR CHILDREN
1935 MEDICAL DISTRICT DRIVEDALLASTX75235752854505PHYSICIANSTX501(c)(3)3CHILDREN'S HEALTH SYSTEM OF TEXASfalse
DALLAS PHYS MED SVCS FOR CHILDREN INC
1935 MEDICAL DISTRICT DRIVEDALLASTX75235810584868PHYSICIANSTX501(c)(3)3CHILDREN'S HEALTH SYSTEM OF TEXASfalse
CHILDREN'S MEDICAL CENTER HEALTH PLAN
1935 MEDICAL DISTRICT DRIVEDALLASTX75235462737696HMOTX501(c)(3)10CHILDREN'S HEALTH SYSTEM OF TEXASfalse
CHILDREN'S MED CTR RESEARCH INST AT UTSWMC
1935 MEDICAL DISTRICT DRIVEDALLASTX75235453462044RESEARCH INSTITUTETX501(c)(3)Type ICHILDREN'S HEALTH SYSTEM OF TEXASfalse
PEDIATRIC PARTNERS
1935 MEDICAL DISTRICT DRIVEDALLASTX75235461917702CLINICALLY INTEGRATED NETWORKTX501(c)(3)Type ICHILDREN'S HEALTH SYSTEM OF TEXASfalse
ANESTHESIOLOGISTS FOR CHILDREN
1935 MEDICAL DISTRICT DRIVEDALLASTX75235752917570PHYSICIANSTX501(c)(3)10CHILDREN'S HEALTH SYSTEM OF TEXASfalse
PHYSICIANS QUALITY ALLIANCE OF NORTH TEXAS
1935 MEDICAL DISTRICT DRIVEDALLASTX75235464049491PHYSICIANSTX501(c)(3)Type ICHILDREN'S HEALTH SYSTEM OF TEXASfalse
SOUTHWESTERN MEDICAL DISTRICT
1935 MEDICAL DISTRICT DRIVEDALLASTX75235204101612MEDICAL DISTRICTTX501(c)(3)Type INAfalse
WOMEN'S AUXILIARY TO THE CHILDREN'S MEDICAL CENTER
2777 N STEMMONS FWY 700DALLASTX75207752485538WOMEN'S AUXILIARYTX501(c)(3)10CHILDREN'S MEDICAL CENTER FOUNDATIONfalse
OCH Holdings
1935 Medical District DriveDallasTX75235474837308HospitalTX501(c)(3)3Children's Health Clinical Operationsfalse
CHILDREN'S HEALTH SYSTEM OF TEXAS
1935 MEDICAL DISTRICT DRIVEDALLASTX75235752062019MANAGEMENT COMPANYTX501(c)(3)Type IINAfalse
Bradford Memorial Hospital for Babies
1935 MEDICAL DISTRICT DRIVEDALLASTX75235756067819HospitalTX501(c)(3)3CHILDREN'S HEALTH SYSTEM OF TEXASfalse
The Children's Hospital of Texas
1935 MEDICAL DISTRICT DRIVEDALLASTX75235756081004HospitalTX501(c)(3)3CHILDREN'S HEALTH SYSTEM OF TEXASfalse
Richmond Freeman Memorial Clinic
1935 MEDICAL DISTRICT DRIVEDALLASTX75235237079698HospitalTX501(c)(3)3CHILDREN'S HEALTH SYSTEM OF TEXASfalse

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (7 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtEntity TypeEntityTypeTxtControlled OrganizationControlledOrganizationIndLegal Domicile Foreign CountryLegalDomicileForeignCountryCd
ALTERNATIVE CARE SYSTEMS
1935 MEDICAL DISTRICT DRIVEDALLASTX75235752244475OTHER MEDICAL SERVICESTXNAC Corporationfalse
NTPSS INC
1935 MEDICAL DISTRICT DRIVEDALLASTX75235471036641PHYSICIAN SOLUTIONSTXNAC Corporationfalse
Texas Bluebonnet Insurance Company
1935 Medical District DriveDallasTX75235475032893Insurance CompanyTXNAC Corporationfalse
Texas Trinity River Assurance Company
981318151Self-insuranceNAC CorporationfalseCJ
Children's Health
1935 Medical District DriveDallasTX75235833809987Other Medical ServicesTXNAC Corporationfalse
CHFH Inc
1935 Medical District DriveDallasTX75235831336111Other Medical ServicesTXNAC Corporationfalse
CHILDREN'S HEALTH CARE NETWORK
1935 MEDICAL DISTRICT DRIVEDALLASTX75235834560427OTHER MEDICAL SERVICESTXNAC Corporationfalse
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts RyltsfalseReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth OrgfalseGiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth OrgYes (true)GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth OrgfalseLoansOrGuaranteesFromOthOrgInd
Div Related OrganizationfalseDivRelatedOrganizationInd
Asset Sale To Other OrgfalseAssetSaleToOtherOrgInd
Asset Purchase From Other OrgfalseAssetPurchaseFromOtherOrgInd
Asset ExchangefalseAssetExchangeInd
Rental Of Facilities To Oth OrgfalseRentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth OrgfalseRentalOfFcltsFromOthOrgInd
Perform Of Services For Oth OrgYes (true)PerformOfServicesForOthOrgInd
Perform Of Services By Other OrgfalsePerformOfServicesByOtherOrgInd
Sharing Of FacilitiesYes (true)SharingOfFacilitiesInd
Paid Employees SharingYes (true)PaidEmployeesSharingInd
Reimbursement Paid To Other OrgfalseReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other OrgfalseReimbursementPaidByOtherOrgInd
Transfer To Other OrgfalseTransferToOtherOrgInd
Transfer From Other OrgfalseTransferFromOtherOrgInd

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