2021-08-12T09:25:59-05:00 2020-09-30 BKD LLP 14241 DALLAS PARKWAY SUITE 1100 DALLAS TX 75254 990 2019-10-01 752485366 Cook Children's Physician Network % CORY RHOADES COOK 6828854000 801 Seventh Avenue Fort Worth TX 76104 CORY R RHOADES CFO & SVP, FINANCE 6828854000 2021-08-16 true kevin ensminger P01310558 9727028262 2019 2022-09-23 18:48:47Z W BRITT NELSON MD 801 SEVENTH AVE FORT WORTH TX 76104 358671765 false X WWW.COOKCHILDRENS.ORG X 1992 TX KNOWING THAT EVERY CHILD'S LIFE IS SACRED OUR PROMISE IS TO IMPROVE THE HEALTH OF EVERY CHILD IN OUR REGION THROUGH THE PREVENTION AND TREATMENT OF ILLNESS, DISEASE AND INJURY. 13 0 1702 3 0 0 66197090 77555748 269327465 281038830 0 3413 882922 68187 336407477 358666178 0 0 0 0 272600800 286693444 0 0 0 72907943 75852722 345508743 362546166 -9101266 -3879988 28765297 51062651 34931799 61109141 -6166502 -10046490 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 322503951 281038830 Cook Children's Physician Network is the largest pediatric multi-specialty physician group in North Texas. The network includes more than 460 physicians, including 328 employed specialists, 132 primary care specialists and 24 neighborhood clinic doctors. CCPN also employees 300 advanced practitioners. The network's physicians and specialists have offices in Tarrant, Denton and Hood counties and provide a primary care home in economically disadvantaged areas where access to pediatric health care is difficult to obtain. The physician network has increased access to pediatric specialty care through outreach clinics in many communities in North, West, East and Central Texas. Each month, physicians travel to provide services in several markets that are not large enough to support full-time specialty care. Cook Children's offers seven Neighborhood Clinics (five in Fort Worth, one in Arlington and one in Richland Hills) that offer well- and sick-child visits and dental care and provide vaccines. Staff speak both English and Spanish and clinics accept most CHIP, Medicaid and commercial insurance plans. The clinical staff is led by 24 total physicians, 2 dentists and 9 advanced practice providers. Virtual Health The network had been developing and implementing telemedicine capabilities for several years, but the pandemic dramatically accelerated the growth of virtual health services. In 2020, specialists hosted more than 37,000 visits via telemedicine, up from approximately 2,000 virtual visits in 2019. In addition to maintaining continuity of care during the pandemic, telemedicine offers immediate care and patient monitoring, saving hours of travel for patient families. Cook Children's Physician Network telemedicine also supports school based nurses in five local Independent School Districts (ISD). Currently this encompasses 69 campuses. The network anticipates it will support several more independent school districts in the upcoming fiscal year. Patient families have access to 16 specialties via telemedicine: . Cardiology . Care Team . Endocrinology . Gastroenterology . Genetics/Metabolic Genetics . Hematology/Oncology . Infectious Diseases . Neonatology . Nephrology . Neurology . Neuropsychology . Pain Management . Palliative Care . Pediatric surgery . Psychiatry . Physiatry . Psychology . Rheumatology . Urology COVID-19 Coordination Cook Children's Physician Network made a number of adjustments to support its providers and patients as COVID-19 spread throughout the community. In the early days of the pandemic, the network faced the same challenges as health care organizations nationwide with obtaining adequate personal protective equipment and enough COVID-19 tests to meet the demand. To ensure the safety of providers and patients during the pandemic, CCPN implemented safety plans that included new patient flows in all clinics, altered clinic hours, social distancing measures and limits on the number of visitors per patient. Protocols for testing staff and strategies for protecting at-risk staff members and providers were put in place. When vaccines came online, the CCPN offered drive-thru vaccination clinics. Weekly meetings of the CCPN board with key clinical leaders allowed the network to stay up-to-date on ever-changing COVID-19 recommendations. The network's primary care physicians also held weekly virtual meetings to share news and ideas and continue this practice even as the pandemic begins to show signs of containment. As primary and specialty care providers, CCPN physicians, advanced practice providers and neighborhood clinics are often the first line of defense when it comes to protecting the health of the communities they serve. During the pandemic, they played an even more significant and invaluable role in educating the public and keeping families safe and healthy while working tirelessly to adapt and adjust to the ever-changing environment for the benefit of providers and patients. 322503951 true true false false false false false false false true true false false true true false false true false false false false false false false false false false false true false false false false false false true false false false false false false true true true false false true 82 0 1702 true false false false false false false false false false false true false X 13 0 false false false false true true true true true false false true true true true true true true true false X CORY RHOADES 6828854000 801 SEVENTH AVENUE FORT WORTH TX 76104 VINCENT K TAM MD MEDICAL DIRECTOR 40.0 0.0 X 2217512 0 1656736 RICK W MERRILL CEO 4.0 36.0 X 232448 1880710 248553 JOHNNIE H HONEYCUTT MD PHYSICIAN 40.0 0.0 X 1435519 0 54665 RICHARD A ROBERTS MD PHYSICIAN 40.0 0.0 X 1412609 0 57937 DANIEL HANSEN MD PHYSICIAN 40.0 0.0 X 1389118 0 45274 DAVID J DONAHUE MD PHYSICIAN 40.0 0.0 X 1190238 0 43765 JOSE IGLESIAS MD TRUSTEE 41.0 1.0 X 1013904 0 51156 STEPHEN W KIMMEL TREASUER 4.0 36.0 X 103808 839899 119652 DIANE ARNAOUT MD TRUSTEE 41.0 0.0 X 790241 0 99695 w BRITT NELSON MD PRESIDENT 40.0 0.0 X 799076 0 57530 MICHELLE MARCINCUK MD TRUSTEE - SECRETARY 42.0 0.0 X X 644503 0 48900 JUSTIN R SMITH MD TRUSTEE 41.0 0.0 X 623003 0 34887 MATTHEW DZURIK MD TRUSTEE-CHAIRMAN 42.0 2.0 X X 573046 0 45883 ROBERT C GOODWILL VP PRIMARY CARE & SPLTY SVCS 40.0 0.0 X 504101 0 94953 BRADLEY S MERCER MD TRUSTEE 41.0 0.0 X 478655 0 57821 M SCOTT PERRY MD TRUSTEE 41.0 3.0 X 475586 0 51774 SAMSON CANTU MD TRUSTEE-VICE CHAIR SPEC. 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BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE FINANCIAL STATEMENTS. SCHEDULE D, PART XI, LINE 2D RECONCILIATION OF REVENUES PER AUDITED FINANCIALS TO RETURN: BAD DEBT EXPENSE $(7,856,488) SCHEDULE D, PART XII, LINE 4B RECONCILIATION OF REVENUES PER AUDITED FINANCIALS TO RETURN: GAIN ON DISPOSITION OF ASSETS $3,413 NET ASSETS RELEASED FROM RESTRICTIONS $123,183 -------- TOTAL $126,596 Schedule D, Part XII, Line 2D RECONCILIATION OF EXPENSES PER AUDITED FINANCIALS TO RETURN: Gain on Disposition of assets $(3,413) SCHEDULE D, PART XII, LINE 4B RECONCILIATION OF EXPENSES PER AUDITED FINANCIALS TO RETURN: BAD DEBT EXPENSE $7,856,488 SCHEDULE D, PART V, LINE 4 INTENDED USE OF ENDOWMENT FUNDS: COOK CHILDREN'S HAS ADOPTED INVESTMENT AND SPENDING POLICIES FOR ENDOWMENT ASSETS THAT ATTEMPT TO PROVIDE A PREDICTABLE STREAM OF FUNDING TO PROGRAMS AND OTHER ITEMS SUPPORTED BY ITS ENDOWMENT WHILE SEEKING TO MAINTAIN THE PURCHASING POWER OF THE ENDOWMENT. UNDER COOK CHILDREN'S POLICIES, ENDOWMENT ASSETS ARE INVESTED IN A MANNER THAT IS INTENDED TO PRODUCE AN AMOUNT THAT IS EQUAL TO A RETURN HURDLE DEFINED AS THE SPENDING RATE, INFLATION RATE AND THE MANAGEMENT COST OF THE ENDOWMENT ON AN ANNUAL BASIS WHILE ASSUMING A PRUDENT LEVEL OF INVESTMENT RISK. ACTUAL RETURNS IN ANY GIVEN YEAR MAY VARY FROM THIS AMOUNT. TO SATISFY ITS LONG-TERM RATE OF RETURN OBJECTIVES, COOK CHILDREN'S RELIES ON A TOTAL RETURN STRATEGY IN WHICH INVESTMENT RETURNS ARE ACHIEVED THROUGH BOTH CURRENT YIELD (INVESTMENT INCOME SUCH AS DIVIDENDS AND INTEREST) AND CAPITAL APPRECIATION (BOTH REALIZED AND UNREALIZED). COOK CHILDREN'S TARGETS A DIVERSIFIED ASSET ALLOCATION THAT PLACES A GREATER EMPHASIS ON EQUITY-BASED INVESTMENTS TO ACHIEVE ITS LONG-TERM RETURN OBJECTIVES WITHIN PRUDENT RISK CONSTRAINTS. COOK CHILDREN'S HAS A POLICY (THE SPENDING POLICY) OF APPROPRIATING FOR EXPENDITURE EACH YEAR OF UP TO 5% OF THE FOUNDATION'S INVESTMENTS AVERAGE FAIR VALUE OVER THE PRIOR 5 YEARS ENDED JUNE 30 PRECEDING THE YEAR IN WHICH EXPENDITURE IS PLANNED AND/OR ACCORDING TO THE DONOR REQUIREMENTS AS SET FORTH IN EACH ENDOWMENT DOCUMENT. IN ESTABLISHING THIS POLICY, COOK CHILDREN'S CONSIDERED THE LONG-TERM EXPECTED RETURN ON ITS ENDOWMENT. ACCORDINGLY, OVER THE LONG TERM, COOK CHILDREN'S EXPECTS THE CURRENT SPENDING POLICY TO ALLOW ITS ENDOWMENT TO GROW AT THE RETURN Hurdle. THIS IS CONSISTENT WITH COOK CHILDREN'S OBJECTIVE TO MAINTAIN THE PURCHASING POWER OF ENDOWMENT ASSETS HELD IN PERPETUITY OR FOR A SPECIFIED TERM, AS WELL AS TO PROVIDE ADDITIONAL REAL GROWTH THROUGH NEW GIFTS AND INVESTMENT RETURN. X X false true X X X X X false true false false false false false false false ALICE PHILIPS MD TRUSTEE- V. CHAIR PRIMARY CARE 317133 0 24058 0 10022 0 21000 0 37089 0 409302 0 0 0 ALMA V TOLLEY AVP Primary Care & Specialty 157349 0 36473 0 8286 0 15504 0 25874 0 243486 0 0 0 beau d mcneff AVP Primary/Specialty Services 154963 0 36473 0 2821 0 8061 0 36550 0 238868 0 0 0 BRADLEY S MERCER MD TRUSTEE 468033 0 500 0 10122 0 21000 0 36821 0 536476 0 0 0 CORWIN A WARMINK MD TRUSTEE 344151 0 100690 0 8810 0 19731 0 34335 0 507717 0 0 0 DANIEL HANSEN MD PHYSICIAN 1358992 0 18500 0 11626 0 11200 0 34074 0 1434392 0 0 0 DAPHNE N SHAW MD TRUSTEE 338000 0 250 0 3100 0 9656 0 0 0 351006 0 0 0 DAVID J DONAHUE MD PHYSICIAN 1134760 0 21637 0 33841 0 21000 0 22765 0 1234003 0 0 0 DIANE ARNAOUT MD TRUSTEE 766846 0 9600 0 13795 0 31466 0 68229 0 889936 0 0 0 JOHNNIE H HONEYCUTT MD PHYSICIAN 1333044 0 86253 0 16222 0 21000 0 33665 0 1490184 0 0 0 JOSE IGLESIAS MD TRUSTEE 951938 0 43944 0 18022 0 17500 0 33656 0 1065060 0 0 0 JULEE MORROW MD TRUSTEE 283358 0 500 0 13124 0 11736 0 34574 0 343292 0 0 0 JUSTIN R SMITH MD TRUSTEE 566189 0 50500 0 6314 0 14000 0 20887 0 657890 0 0 0 KEVIN L BRISCOE Assistant VP 191488 0 43401 0 11153 0 7693 0 8622 0 262357 0 0 0 LINDSAY NEWTON MD TRUSTEE - TREASURER 209208 0 39225 0 5859 0 9878 0 28300 0 292470 0 0 0 M SCOTT PERRY MD TRUSTEE 463296 0 500 0 11790 0 17500 0 34274 0 527360 0 0 0 MARIA D PEREZ TRUSTEE 293078 0 500 0 10238 0 15877 0 34133 0 353826 0 0 0 MATTHEW DZURIK MD TRUSTEE-CHAIRMAN 527433 0 36803 0 8810 0 21000 0 24883 0 618929 0 0 0 MICHELLE MARCINCUK MD TRUSTEE - SECRETARY 637147 0 500 0 6856 0 11200 0 37700 0 693403 0 0 0 RICHARD A ROBERTS MD PHYSICIAN 1395887 0 500 0 16222 0 21000 0 36937 0 1470546 0 0 0 STEPHEN W KIMMEL TREASUER 62687 507196 28303 228995 12818 103708 9821 79465 3340 27026 116969 946390 0 66071 RICK W MERRILL CEO 132837 1074770 70488 570309 29123 235631 23870 193130 3471 28082 259789 2101922 0 0 ROBERT C GOODWILL VP PRIMARY CARE & SPLTY SVCS 333525 0 136577 0 33999 0 59339 0 35614 0 599054 0 16829 0 SAMSON CANTU MD TRUSTEE-VICE CHAIR SPEC. CARE 461863 0 500 0 5460 0 17500 0 41504 0 526827 0 0 0 VIDA AMIN MD TRUSTEE 223101 0 26500 0 6938 0 5463 0 29593 0 291595 0 0 0 VINCENT K TAM MD MEDICAL DIRECTOR 2195588 0 500 0 21424 0 1619799 0 36937 0 3874248 0 0 0 WHITNEY JOHANNESSEN AVP ADVANCE PRACTICE 193743 0 44259 0 5795 0 18819 0 97781 0 360397 0 0 0 w BRITT NELSON MD PRESIDENT 498949 0 202096 0 98031 0 21000 0 36530 0 856606 0 0 0 SPENCER D SEALS VP CONSTRUCTION/ REAL ESTATE 0 181402 0 53900 0 12638 0 15880 0 36537 0 300357 0 0 SCHEDULE J, PART I, LINE 1A GENERAL GROSS UP PAYMENTS: DIANE ARNAOUT $110 SHERI KANTNER $220 CME GROSS UP PAYMENTS: JOHNNIE HONEYCUTT $13,000 RICHARD ROBERTS $13,000 VINCENT TAM $13,000 JOSE IGLESIAS $14,500 MATTHEW DZURIK $6,500 LINDSAY NEWTON $4,875 VIDA AMIN $5,308 SAMSON CANTU $3,900 M SCOTT PERRY $9,750 MICHELLE MARCINCUK $5,000 MARIA PEREZ $6,500 ALICE PHILIPS $6,500 DIANE ARNAOUT $11,375 JULEE MORROW $5,000 BRADLEY MERCER $6,500 JUSTIN SMITH $5,000 ERRIN NEWMAN MD $5,000 DAVID J DONAHUE $18,785 DANIEL HANSEN $10,000 WHITNEY JOHANNESSEN $2,600 DAPHNE N. SHAW $2,500 CORWIN A WARMINK $6,500 SCHEDULE J, PART I, LINE 1B GENERAL GROSS UP PAYMENTS DISCLOSURE: THERE IS NO WRITTEN POLICY REGARDING PAYMENT OR REIMBURSEMENT OF TAX INDEMNIFICATION AND GROSS-UP PAYMENTS BECAUSE THE COMPANY DOES NOT GENERALLY ALLOW FOR GROSS-UP PAYMENTS EXCEPT IN SPECIFIC CIRCUMSTANCES AND THEN ONLY IF APPROVED BY SENIOR MANAGEMENT FOLLOWED BY REVIEW OF THE COMPANY'S COMPLIANCE AND LEGAL DEPARTMENTS. THESE TYPE OF REIMBURSEMENTS GENERALLY RELATE TO TAXES OWED BY INDIVIDUALS WHO RECEIVE NOMINAL INCENTIVE PAYMENTS FOR SERVICE AWARDS OR QUALITY IMPROVEMENT PROGRAMS, AND THE GROSS-UP PAYMENTS USUALLY ARE IMMATERIAL, $250 OR LESS. CME GROSS UPS PAYMENTS DISCLOSURE: IN ADDITION TO THE GIFT CARD AND INCENTIVE BONUSES DESCRIBED ABOVE, THERE IS NO WRITTEN POLICY REGARDING PAYMENT OR REIMBURSEMENT OF TAX INDEMNIFICATION AND GROSS-UP PAYMENTS FOR CONTINUING MEDICAL EDUCATION ALLOWANCES PAID TO EMPLOYED PHYSICIANS OF COOK CHILDREN'S PHYSICIAN NETWORK. THESE TYPE OF EXPENSES ARE USUALLY HANDLED AS NON TAXABLE ACCOUNTABLE PLAN BUSINESS EXPENSES UNDER THE INTERNAL REVENUE CODE, BUT THE COMPANY HAS ELECTED TO TREAT THESE PAYMENTS AND THE GROSS-UP PAYMENTS AS TAXABLE INCOME TO THE AFFECTED INDIVIDUALS. THESE PAYMENTS ARE APPROVED IN ADVANCE BY SENIOR MANAGEMENT AND REVIEWED BY THE COMPANY'S COMPLIANCE AND LEGAL DEPARTMENTS. FURTHER, THESE EXPENSES ARE INCLUDED IN THE BENEFITS CALCULATION FOR SUCH PHYSICIANS WHICH ARE REVIEWED BY THE COMPANY'S COMPENSATION COMMITTEE TO VERIFY THAT SUCH PAYMENTS ARE PAID AT FAIR MARKET VALUE AND COMMERCIALLY REASONABLE. AIR TRAVEL: MATTHEW DZURIK, MD, M. SCOTT PERRY, MD AND DANIEL HANSEN, MD ALL HAD CHARTER AIR TRAVEL PROVIDED IN THEIR CAPACITY AS PHYSICIANS FOR COOK CHILDREN'S PHYSICIAN NETWORK. SCHEDULE J, PART I, LINE 3 METHODS USED BY CCHCS TO ESTABLISH COMPENSATION OF THE COMPANY'S PRESIDENT: COMPENSATION COMMITTEE INDEPENDENT COMPENSATION CONSULTANT WRITTEN EMPLOYMENT CONTRACT COMPENSATION SURVEY OR STUDY APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE SCHEDULE J, PART I, LINE 4B PARTICIPATION IN A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN: PARTICIPANTS IN SERP IN W-2 DEF COMP PAID BY -------------------- -------- -------- -------- ROBERT C. GOODWILL 16,829 41,839 CCPN STEPHEN W. KIMMEL 66,071 75,286 CCHCS W. BRITT NELSON 59,348 NONE CCPN RICK W. MERRILL 140,060 196,000 CCHCS VINCENT K. TAM, MD NONE 1,598,799 CCPN KEVIN BRISCOE J. MASON-BRISCOE SPOUSE 246043 COMPENSATION false YVETTE DZURIK M. DZURIK SPOUSE 152462 COMPENSATION false FORM 990, PART VI, SECTION A, LINE 6 SOLE MEMBER: COOK CHILDREN'S HEALTH CARE SYSTEM, A TEXAS NON-PROFIT CORPORATION, IS THE SOLE MEMBER OF THE ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7A MEMBER ELECTION ABILITIES: AS THE SOLE MEMBER OF THE ORGANIZATION, COOK CHILDREN'S HEALTH CARE SYSTEM HAS THE ABSOLUTE RIGHT TO APPOINT OR APPROVE MEMBERSHIP ON THE BOARD OF DIRECTORS OF THE ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7B MEMBER DECISION ABILITIES: AS THE SOLE MEMBER OF THE ORGANIZATION, COOK CHILDREN'S HEALTH CARE SYSTEM HAS THE EXCLUSIVE AND RESERVED POWER TO DO ANY OF THE FOLLOWING: A. APPROVE THE ANNUAL OPERATING AND CAPITAL BUDGETS OF THE ORGANIZATION AND THE LONG-RANGE FINANCIAL AND STRATEGIC PLANS FOR THE CORPORATION; B. APPROVE DEVIATIONS FROM ANNUAL OPERATING AND CAPITAL BUDGETS IN EXCESS OF SUCH LIMITS AS ESTABLISHED BY THE MEMBER; C. APPROVE THE PURCHASE OR ACQUISITION OF ANY PROPERTY, REAL, PERSONAL, OR MIXED, BY THE ORGANIZATION IN EXCESS OF SUCH LIMITS AS ESTABLISHED BY THE MEMBER; D. APPROVE THE SALE, GIFT OR OTHER DISPOSITION OF ALL OR SUBSTANTIALLY ALL OF THE PROPERTY OF THE ORGANIZATION; E. APPROVE THE MORTGAGE OR OTHER ENCUMBRANCE OF ANY PROPERTY, REAL, PERSONAL, OR MIXED, OF THE ORGANIZATION IN EXCESS OF SUCH LIMITS AS ESTABLISHED BY THE MEMBER; F. APPROVE THE ACQUISITION, LIQUIDATION, MERGER, WINDING UP, TERMINATION, OR CONSOLIDATION OF THE ORGANIZATION; G. APPROVE THE CREATION OF, OR INVESTMENT IN, ANY SUBSIDIARY ENTITY, JOINT VENTURE, ACCOUNTABLE CARE ORGANIZATION OR SIMILAR ENTITIES; H. APPROVE THE ADOPTION, AMENDMENT OR REPEAL OF THE CERTIFICATE OF FORMATION OF THE ORGANIZATION AND THESE BYLAWS; I. APPROVE INCURRING DEBT WHICH WOULD EXCEED SUCH LIMITS ESTABLISHED BY THE MEMBER; J. APPROVE THE SETTLEMENT OF CLAIMS AND LITIGATION OF THE ORGANIZATION; AND K. SUBSEQUENT TO THE ORGANIZING AND INCORPORATING PHYSICIAN'S SELECTION OF THE INITIAL BOARD OF DIRECTORS, APPROVE THE APPOINTMENT OR ELECTION OF DIRECTORS IN ACCORDANCE WITH SECTION 3.2 OF THE ORGANIZATION'S BYLAWS. FORM 990, PART VI, SECTION B, LINE 11B PROCESS FOR REVIEW OF THE 990: THE ORGANIZATION ENGAGES AN OUTSIDE 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 PRESENTED TO THE COOK CHILDREN'S HEALTH CARE SYSTEM AUDIT COMMITTEE FOR REVIEW AND COMMENT. SUBSEQUENT TO AUDIT COMMITTEE REVIEW, THE FORM 990 IS FILED WITH THE INTERNAL REVENUE SERVICE AND MADE AVAILABLE TO THE PUBLIC FOR REVIEW. FORM 990, PART VI, SECTION B, LINE 12C WRITTEN CONFLICT OF INTEREST POLICY: EVERY YEAR THE LEGAL DEPARTMENT OF THE COOK CHILDREN'S HEALTH CARE SYSTEM (SYSTEM) SENDS OUT A FORM 990 QUESTIONNAIRE/CONFLICT OF INTEREST DISCLOSURE STATEMENT TO OFFICERS, DIRECTORS, TRUSTEES AND KEY EMPLOYEES OF ALL SYSTEM COMPANIES, AS WELL AS CERTAIN OTHER EMPLOYEES, INCLUDING PHYSICIANS, WHO ARE DETERMINED TO BE EMPLOYED IN POSITIONS THAT MIGHT BE SUBJECT TO THE SYSTEM'S CONFLICT OF INTEREST POLICY. THE RESPONSES ARE REVIEWED BY THE LEGAL, FINANCE, AND COMPLIANCE DEPARTMENTS. FOLLOW UP AND/OR CORRECTIVE ACTION IS TAKEN AS NEEDED WITH RESPECT TO RESPONSES THAT INDICATE THE EXISTENCE OF ACTUAL OR POTENTIAL CONFLICTS OF INTEREST. A SUMMARY OF THE RESPONSES TO THE QUESTIONNAIRES AND FOLLOW-UP INFORMATION IS PROVIDED TO THE SYSTEM AUDIT COMMITTEE FOR REVIEW AND FOLLOW-UP. FURTHER, THE AUDIT COMMITTEE OF COOK CHILDREN'S HEALTH CARE SYSTEM IS RESPONSIBLE FOR MONITORING THE IMPLEMENTATION AND ENFORCEMENT OF THE CONFLICT OF INTEREST POLICY THAT IS APPLICABLE TO ALL AFFILIATED COMPANIES OF THE COOK CHILDREN'S HEALTH CARE SYSTEM. THE AUDIT COMMITTEE IS ALSO RESPONSIBLE FOR OVERSIGHT OF THE COMPLIANCE DEPARTMENT OF COOK CHILDREN'S HEALTH CARE SYSTEM. THE COMPLIANCE DEPARTMENT MAINTAINS A HOTLINE TO RECEIVE REPORTS OF INAPPROPRIATE ACTIVITIES INCLUDING ACTIVITIES THAT MIGHT CONSTITUTE A CONFLICT OF INTEREST. INTERNAL AUDIT AND COMPLIANCE ALSO CONDUCT RANDOM AUDITS OF CORPORATE ACTIVITIES SUCH AS EXPENSE REIMBURSEMENTS AND ACCOUNTS PAYABLE TO DETERMINE IF ANY INAPPROPRIATE PAYMENTS ARE BEING MADE TO INDIVIDUALS, SOME OF WHICH COULD BE EVIDENCE OF A CONFLICT OF INTEREST. ANY CORRECTIVE ACTION RELATED TO CONFLICTS OF INTEREST WOULD BE REPORTED TO THE AUDIT COMMITTEE FOR REVIEW, APPROVAL, AND MODIFICATION, AS NECESSARY, WITH FURTHER REPORTING TO THE SYSTEM BOARD OF TRUSTEES AS APPROPRIATE. FORM 990, PART VI, SECTION B, LINE 15A & 15b REVIEW AND APPROVAL OF COMPENSATION: COOK CHILDREN'S HEALTH CARE SYSTEM HAS ESTABLISHED A COMPENSATION COMMITTEE WITH OVERSIGHT OF EXECUTIVE AND PHYSICIAN COMPENSATION, WHICH INCLUDES THE ORGANIZATION'S PRESIDENT 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 BY ECG MANAGEMENT CONSULTANTS FOR PHYSICIAN COMPENSATION, BOTH OF WHICH ARE INDEPENDENT, NATIONALLY RECOGNIZED COMPENSATION CONSULTANTS. 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 AND 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 MAKING GOVERNING DOCUMENTS PUBLIC: THE ORGANIZATION DOES NOT MAKE ITS GOVERNING DOCUMENTS OR CONFLICT OF INTEREST POLICY AVAILABLE TO THE PUBLIC, EXCEPT TO THE EXTENT THEY ARE ON FILE WITH THE SECRETARY OF STATE OF TEXAS. THE CONFLICT OF INTEREST POLICY IS POSTED ON THE ORGANIZATION'S INTERNAL WEBSITE AND AVAILABLE TO ALL EMPLOYEES AND BOARD MEMBERS OF COOK CHILDREN'S HEALTH CARE SYSTEM ENTITIES. CONSOLIDATED FINANCIAL STATEMENTS ARE REPORTED ELECTRONICALLY FOR ALL COOK CHILDREN'S HEALTH CARE SYSTEM ENTITIES VIA THE ELECTRONIC MUNICIPAL MARKET ACCESS (EMMA) WEB SITE. COOK CHILDREN'S MEDICAL CENTER 801 SEVENTH AVE FORT WORTH TX 76104 752051646 HOSPITAL TX 501(C)(3) 3 CCHCS true COOK CHILDREN'S HOME HEALTH 801 SEVENTH AVENUE FORT WORTH TX 76104 752896983 HEALTHCARE TX 501(C)(3) 10 CCHCS true WI COOK FOUNDATION 801 SEVENTH AVENUE FORT WORTH TX 76104 752051649 FUNDRAISING TX 501(C)(3) 7 NA false COOK CHILDREN'S HEALTH CARE SYSTEM 801 SEVENTH AVE FORT WORTH TX 76104 752705881 HLTH CARE SUP TX 501(C)(3) 12C CCHF false COOK CHILDREN'S HEALTH PLAN 801 SEVENTH AVE FORT WORTH TX 76104 760585240 INSURANCE TX 501(C)(3) 10 CCHCS true ROSEDALE OFFICE BUILDING INC 1500 W ROSEDALE FORT WORTH TX 76104 460866421 TITLE HOLDING TX 501(C)(2) N/A CCHF false CHILD STUDY CENTER 1300 W LANCASTER FORT WORTH TX 76102 751099536 HLTHCARE SRVC TX 501(C)(3) 7 CCMC true COOK CHILREN'S HEALTH ENTERPRISES 801 SEVENTH AVE FORT WORTH TX 76104 842625990 SUPPORT TX 501(C)(3) 12B CCHF false COOK CHILDRENS MEDICAL CENTER PROSPER 801 SEVENTH AVE FORT WORTH TX 76104 852354189 HEALTHCARE SV TX 501(C)(3) 3 CCHCS true COOK CHILDREN'S HEALTH SERVICES 801 7TH AVENUE FORT WORTH TX 76104 454024843 HEALTHCARE TX CCHCS C CORPORATION true false false true false false false false false false false true false false false true true true true true COOK CHILDREN'S MEDICAL CENTER O 32774515 FMV COOK CHILDREN'S MEDICAL CENTER C 75625445 FMV COOK CHILDREN'S MEDICAL CENTER R 539689 FMV COOK CHILDREN'S MEDICAL CENTER Q 375466 FMV COOK CHILDREN'S MEDICAL CENTER P 334809 FMV COOK CHILDREN'S MEDICAL CENTER K 1702303 FMV Cook Children's Health Care System O 26372288 FMV Cook Children's Health Plan O 1022396 FMV Cook Children's Health Plan S 18158140 FMV CHILD STUDY CENTER O 602353 FMV