2021-08-12T09:21:44-05:00 2020-09-30 BKD LLP 14241 DALLAS PARKWAY SUITE 1100 DALLAS TX 75254 990 2019-10-01 752051649 WI Cook Foundation Inc % CORY RHOADES WICO 6828854000 801 Seventh Avenue Fort Worth TX 76104 CORY R RHOADES CFO & SVP, FINANCE 2021-08-16 true KEVIN ENSMINGER P01310558 9727028262 2019 2022-09-23 18:48:47Z Cook Children's Health Foundation RICK W MERRILL 801 SEVENTH AVE FORT WORTH TX 76104 664039770 false X WWW.COOKCHILDRENS.ORG X 1985 TX KNOWING THAT EVERY CHILD'S LIFE IS SACRED, OUR PROMISE IS TO IMPROVE THE HEALTH OF EVERY CHILD IN OUR REGION THROUGH PREVENTION AND TREATMENT OF ILLNESS, DISEASE AND INJURY 32 32 49 95 5807233 2552726 20451723 15623049 0 0 54640236 62590818 5279930 9837015 80371889 88050882 16106750 18759173 0 0 5878925 7187089 0 0 5152825 21250461 21346667 43236136 47292929 37135753 40757953 2013556230 2213091555 2643307 2684437 2010912923 2210407118 X KNOWING THAT EVERY CHILD'S LIFE IS SACRED, OUR PROMISE IS TO IMPROVE THE HEALTH OF EVERY CHILD IN OUR REGION THROUGH PREVENTION AND TREATMENT OF ILLNESS, DISEASE, AND INJURY. false false 41489485 18759173 About Cook Children's Health Care System: For more than 100 years Cook Children's Health Care System has worked to fulfill its Promise to improve the health of every child through the prevention and treatment of illness, disease and injury. As a not-for-profit, nationally-recognized and integrated pediatric health care organization based in Fort Worth, Texas, Cook Children's is comprised of 14 entities. They include a medical center, physician network, health plan, home health company, health foundation, a child study center, two surgery centers and more. Cook Children's growing reputation draws patients from near and far. Families travel from across Texas and the United States, as well as internationally, to receive life-saving pediatric care and benefit from the collaboration and vast resources the system offers. In addition to the medical center, a network of more than 60 primary, specialty and urgent care locations provide numerous access points to life-saving pediatric care that's family-centered and built on leading technology, collaboration and a best-in-class patient experience. Cook Children's Health Foundation: Dollars gifted through the Health Foundation impact almost every Cook Children's program and patient. From technology upgrades to research to facility expansions to new services and charity care, running a health system that records more than 1 million patient encounters a year requires a robust philanthropic arm. It can not be done without the support of generous benefactors. Philanthropy impacts Cook Children's patients through three avenues-uncompensated care, clinical advancement and capital growth. A Safety Net For Uncompensated Care: The Health Foundation provides a critical financial safety net for the health system and those it serves. In 2020, that safety net required a much wider cast. A devastating example of the critical need for a safety net is the escalation of acuity among patients seeking help from Cook Children's Behavioral Health Services. The Health Foundation has always provided a hefty amount of funding for this service, as the majority of its patients are typically uninsured or underinsured. In 2020, the rate at which children presented with severe anxiety and depression soared. Sadly, 37 children were treated at the medical center for suicide attempts in September, marking the worst month on the hospital's record since at least 2015. Thanks in large part to Health Foundation dollars, children needing mental and emotional care are provided behavioral health services even when their own financial resources are limited. Uncompensated care is more than just charity care. The Health Foundation fully funds a number of non-revenue producing healing programs at Cook Children's that otherwise would not exist. The Sit...Stay...Play therapy dog program is a favorite. After all, nothing can calm an anxious child reeling from a medical crisis like the comfort of a cuddly canine. Similar Child Life department programs such as music therapy, art, camps for children with chronic disease and the Child Life Zone offer a different kind of "medicine" that allows kids to do what kids do best...imagine, create, play and have fun! Meeting the mental, emotional and spiritual needs of patients and their families is just as critical as treating their medical condition, and these services do just that free-of-charge to patients. Innovation Fuels Capital Growth: None of these services would be possible without capital growth. Advanced equipment must be purchased and maintained. Facilities to house these technologies and services where children can access them closer to their homes must be built. Without capital funds children would be deprived of life-changing, life-advancing and life-saving medical care. Recent capital investments include adding facilities in Prosper, Carrollton and Fort Worth's Walsh Ranch. In addition, the NICU was equipped with specialized infant beds, and renovations were made to the Cook Children's Child Study Center. This center provides children with complex developmental and behavioral disabilities the care and education they need to achieve their full potential. The Health Foundation also funds scholarships to this program. All of this, clinical advancement and capital growth-requires the support of the Health Foundation and, by extension, the generosity of donors and community partners. These patrons don't just help us advance our Promise. They become a part of the Promise and impact pediatric health care for generations to come. 41489485 true true false false false false false false false true true false false false true false false true false false true false false false true false false true false true false false false false false false false false true false false false true true true true false false true 41 1 true 49 true true true false false false false true true false false false false true false X 32 32 true false false false false false false true true false false true true true true true true true true false X CORY RHOADES 6828854000 801 SEVENTH AVENUE FORT WORTH TX 76104 X RICK W MERRILL PRESIDENT & CEO 9.0 31.0 X 464895 1648262 248553 B ANTHONY BAGWELL CIIO 40.0 1.0 X 1189038 0 99630 STEPHEN KIMMEL CFO 2.0 38.0 X 47185 896522 119652 STANLEY E DAVIS SR. VP, COO 0.0 40.0 X 0 543653 107996 GRANT W HARRIS SVP CHIEF DEVELOPMENT OFFICER 40.0 0.0 X 434907 0 93274 KYLE DALEY INVESTMENT MANAGER 40.0 0.0 X 280277 0 44340 CHRISTOPHER TINDELL INVESTMENT MANAGER 40.0 0.0 X 272833 0 48946 SPENCER D SEALS VP CONSTRUCTION & REAL ESTATE 2.0 38.0 X 0 247940 52417 JENNIFER JOHNSON AVP DONOR RELATIONS 40.0 0.0 X 208162 0 14358 KIMBERLY A MCGINNIS ASSISTANT VICE PRESIDENT 40.0 0.0 X 161676 0 42782 JON R JOHNSON DIRECTOR 40.0 0.0 X 0 159792 31873 CARA MARTZ SECRETARY 1.0 39.0 X 0 157852 31463 AMANDA K LEWIS DIRECTor 40.0 0.0 X 134297 0 46532 DAYLE LOWRY INVESTMENT OPERATIONS MANAGER 40.0 0.0 X 145731 0 24710 MARTHA MATTOX DIRECTOR PHILANTHROPY 40.0 0.0 X 129083 0 24122 ASHLI BLUMENFELD TRUSTEE 1.0 0.0 X 0 0 0 TERESA BROWNLIE TRUSTEE 1.0 0.0 X 0 0 0 CARIE BURNETTe TRUSTEE 1.0 0.0 X 0 0 0 JERRY R CONATSER TRUSTEE 1.0 6.0 X X 0 0 0 BRIAN CRUMLEY TRUSTEE - SEC/TREASURER 2.0 2.0 X X 0 0 0 LEZLIE P DAVIS TRUSTEE 1.0 0.0 X 0 0 0 MICHAEL DIKE TRUSTEE 1.0 2.0 X 0 0 0 CLARABELE PIT DODSON TRUSTEE - EMERITUS 1.0 0.0 X 0 0 0 JAMES R DUNAWAY JR TRUSTEE 1.0 1.0 X 0 0 0 RICHARD DYESS TRUSTEE - VICE CHAIR 2.0 2.0 X 0 0 0 ROSALIND EVANS TRUSTEE 1.0 1.0 X 0 0 0 JAY L FIERKE MD TRUSTEE 1.0 1.0 X 0 0 0 KENT HORST TRUSTEE 1.0 0.0 X 0 0 0 R KYLE KIGHT TRUSTEE 1.0 0.0 X 0 0 0 ANDREW P LOMBARDI TRUSTEE 1.0 0.0 X 0 0 0 G MALCOLM LOUDEN TRUSTEE 1.0 0.0 X 0 0 0 ROGER P MARCINCUK JR TRUSTEE 1.0 0.0 X 0 0 0 RYAN T MATTHEWS TRUSTEE 1.0 2.0 X 0 0 0 RUSSELL MORTON TRUSTEE- CHAIRMAN 2.0 0.0 X 0 0 0 BRYAN NEWBY TRUSTEE 1.0 1.0 X 0 0 0 ANDREW ROSELL TRUSTEE 1.0 3.0 X 0 0 0 RICK SORENSON TRUSTEE 1.0 1.0 X 0 0 0 JAMES WEBB TRUSTEE 1.0 5.0 X 0 0 0 WILLIAM JACKSON RATTIKIN III TRUSTEE 1.0 1.0 X 0 0 0 WM LAWHON TRUSTEE 1.0 1.0 X 0 0 0 MICHAEL R PAVELL TRUSTEE 1.0 1.0 X 0 0 0 BELEN M GARREN TRUSTEE 1.0 0.0 X 0 0 0 WILLIE HOUSTON III TRUSTEE 1.0 0.0 X 0 0 0 LISA H JAMIESON TRUSTEE 1.0 1.0 X 0 0 0 JAMES MATTHEW JOHNSON TRUSTEE 1.0 0.0 X 0 0 0 FROST R PRIOLEAU TRUSTEE 1.0 1.0 X 0 0 0 RACHEL R WERNER TRUSTEE 1.0 1.0 X 0 0 0 JON S BRUMLEY JONNY TRUSTEE 1.0 0.0 X 0 0 0 LARRY G AUTREY TRUSTEE - END: 06/2020 1.0 0.0 X 0 0 0 REBECCA STUPFEL TRUSTEE - END 1.0 0.0 X 0 0 0 PETER PHILPOTT TRUSTEE - END: 06/2020 1.0 3.0 X 0 0 0 KATHRYN FARMER TRUSTEE - END: 06/2020 1.0 0.0 X 0 0 0 CYNTHIA PRINCE TRUSTEE - END: 06/2020 1.0 0.0 X 0 0 0 3468084 3654021 1030648 10 false true false WCM INVESTMENT MANAGEMENT 281 BROOKS STREET LAGUNA BEACH CA 92651 INVESTMENT MGMT SVCS 776035 LAZARD 30 ROCKEFELLER PLAZA NEW YORK NY 10112 INVESTMENT MGMT SVCS 585030 SILCHESTER INTERNATIONAL 1 BRUTON STREET 5TH FLOOR LONDON 0 UK W1J 6TL INVESTMENT MGMT SVCS 549788 GARDNER RUSSO GARDNER LLC 223 EAST CHESTNUT STREET LANCASTER PA 17602 INVESTMENT MGMT SVCS 546699 BNY MELLON 240 GREENWICH STREET NEW YORK NY 10286 TRUSTEE/CUSTODIAN 512509 16 498087 15124962 109086 15623049 0 15754922 5807233 9947689 0 557551 557551 949806 949806 0 949806 949806 622781238 575945342 46835896 46835896 46835896 0 498087 43546 -43546 -43546 0 0 0 0 0 0 KINDRED REVENUE 532000 8373204 8373204 8373204 88050882 5807233 66620600 18759173 18759173 0 0 0 2830211 1276208 540068 1013935 0 3261096 1095147 2165949 69820 -3254 73074 737429 226390 511039 288533 89999 198534 109936 109936 13750 13750 0 0 0 5536398 5536398 2362379 2256241 106138 503767 503767 84537 11553 72984 0 0 82636 82636 43143 25427 17716 0 960 345 615 0 0 1989785 1989083 702 0 Physician Remuneration 10108618 10108618 Dues & subscriptions 249967 2859 247108 Federal tax 81796 100631 -18835 . 0 178995 917 178078 47292929 41489485 650619 5152825 0 0 147447834 175707064 12919244 1051685 0 9089 0 0 0 0 0 0 0 0 0 0 1250512 42440 1067128 1208072 1836462000 2020432887 0 0 0 0 0 0 15660024 14682758 2013556230 2213091555 1393309 1809976 0 0 316602 0 0 0 0 0 0 0 0 0 0 0 933396 874461 2643307 2684437 X 1868808639 2072850841 142104284 137556277 2010912923 2210407118 2013556230 2213091555 X 40757953 75701592 83034650 X false true X true false X 28260763 19160053 19321032 20451723 15623049 102816620 0 0 28260763 19160053 19321032 20451723 15623049 102816620 9273080 93543540 10618098 18591817 23990105 28817719 11541667 93559406 2553726 2553726 14113042 8373204 22486246 221415998 0.42248 0.45050 X SCHEDULE A, PART II UNUSUAL GRANTS THE ORGANIZATION RECEIVED THE FOLLOWING UNUSUAL GRANT IN 2017, WHICH WAS NOT INCLUDED IN THE PUBLIC SUPPORT CALCULATION IN PART II, COLUMN (E). UNUSUAL GRANT #1 $20,000,025 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 140163649 9193123 5976208 3974295 151358685 134782310 545733 6377720 1542114 140163649 95010517 32237997 9352630 1818834 134782310 76556166 11777744 7575568 898961 95010517 71855341 190488 4883138 372801 76556166 0.29200 0.61480 0.09320 false false 1058330 1058330 17562 14050 3512 28390 28390 0 146230 146230 1208072 0 FUNDS HELD FOR AFFILIATES 540013 GIFT ANNUITIES 334448 874461 139588242 71437208 -4811117 66626091 72962151 5544092 9544639 15088731 88050882 18072508 43546 43546 18028962 5544092 23719875 29263967 47292929 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. SCHEDULE D, PART X, LINE 2 ASC 740 FOOTNOTE: MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE FINANCIAL STATEMENTS. SCHEDULE D, PART XI, LINE 2D RECONCILIATION OF REVENUE PER AUDITED FINANCIALS TO TAX RETURN: KINDRED BUILDING AMORTIZATION (1,984,500) RECLASS OF INVESTMENT DEPT EXPENSES (2,826,617) ---------------- Total $(4,811,117) SCHEDULE D, PART XI, LINE 4B RECONCILIATION OF REVENUE PER AUDITED FINANCIALS TO TAX RETURN: CONTRIBUTIONS IN RESTRICTED TO NET ASSETS $ 9,588,185 DIRECT FUNDRAISING EXPENSES (43,546) ------------- TOTAL $ 9,544,639 SCHEDULE D, PART XII, LINE 2D RECONCILIATION OF EXPENSES PER AUDITED FINANCIALS TO TAX RETURN: DIRECT FUNDRAISING EXPENSES $43,546 SCHEDULE D, PART XII, LINE 4B RECONCILIATION OF EXPENSES PER AUDITED FINANCIALS TO TAX RETURN: KINDRED BUILDING AMORTIZATION $ 1,984,500 DONATIONS FROM NET ASSETS 18,908,758 RECLASS OF INVESTMENT DEPT EXPENSES 2,826,617 ------------- TOTAL $ 23,719,875 Central America and the Caribbean INVESTMENTS 339211056 Europe (Including Iceland and Greenland) INVESTMENTS 108432383 Sub-Saharan Africa INVESTMENTS 42727874 South Asia INVESTMENTS 9580490 499951803 499951803 true false true true true false STELTER COMPANY CONSULTATIO false M GALE ASSOCIATES CONSULTATIO false THE ADVISORY BOARD RESEARCH false BUXTON CONSULTATIO false LEXIS NEXIS RESEARCH false PICKIN' FOR PRE 289312 289312 0 5000 THE BLAST 141096 141096 0 33181 1 67679 67679 0 5365 498087 498087 0 43546 43546 -43546 true COOK CHILDREN'S MEDICAL CENTER 801 SEVENTH AVE FORT WORTH TX 76104 752051646 501(C)(3) 9634042 FINANCIAL ASSISTANCE COOK CHILDREN'S PHYSICIAN NETWORK 801 SEVENTH AVE FORT WORTH TX 76104 752575366 501(C)(3) 1715765 FINANCIAL ASSISTANCE COOK CHILDREN'S HEALTH CARE SYSTEM 801 SEVENTH AVE FORT WORTH TX 76104 752705881 501(C)(3) 5919869 FINANCIAL ASSISTANCE COOK CHILDREN'S HOME HEALTH 801 SEVENTH AVE FORT WORTH TX 76104 752896983 501(C)(3) 16412 FINANCIAL ASSISTANCE CHILD STUDY CENTER 801 SEVENTH AVE FORT WORTH TX 76104 751099536 501(C)(3) 1469585 FINANCIAL ASSISTANCE 5 SCHEDULE I, PART I, LINE 2 PROCEDURES FOR MONITORING THE USE OF GRANT FUNDS: FUNDS ARE PLACED IN THE APPROPRIATE DESIGNATED ACCOUNTS WITH NOTIFICATION FROM DEVELOPMENT STAFF TO THE AUTHORIZED SIGNER. AUTHORIZED SIGNERS AND OTHER APPROPRIATE INDIVIDUALS ARE NOTIFIED OF ANY RESTRICTIONS ON THE FUNDS. DEVELOPMENT STAFF FOLLOW UP WITH AUTHORIZED SIGNERS TO OBTAIN INFORMATION ON THE USE OF FUNDS AND THE IMPACT MADE TO THE PROGRAM. IMPACT REPORTS ARE THEN PREPARED BY DEVELOPMENT STAFF AND SENT TO THE DONOR ON AN ANNUAL BASIS OR AS REQUIRED BY THE DONOR AGREEMENT. X false true false true false false false false false false false RICK W MERRILL PRESIDENT & CEO 265674 941933 140975 499821 58246 206508 47740 169260 6942 24611 519577 1842133 0 0 STEPHEN KIMMEL CFO 28494 541389 12865 244433 5826 110700 4464 84822 1518 28848 53167 1010192 0 66071 GRANT W HARRIS SVP CHIEF DEVELOPMENT OFFICER 290773 0 120383 0 23751 0 55721 0 37553 0 528181 0 0 0 SPENCER D SEALS VP CONSTRUCTION & REAL ESTATE 0 181402 0 53900 0 12638 0 15880 0 36537 0 300357 0 0 CARA MARTZ SECRETARY 0 121670 0 31749 0 4433 0 7704 0 23759 0 189315 0 0 B ANTHONY BAGWELL CIIO 397616 0 740226 0 51196 0 76122 0 23508 0 1288668 0 0 0 KYLE DALEY INVESTMENT MANAGER 168265 0 108760 0 3252 0 7616 0 36724 0 324617 0 0 0 CHRISTOPHER TINDELL INVESTMENT MANAGER 162964 0 106639 0 3230 0 11200 0 37746 0 321779 0 0 0 JENNIFER JOHNSON AVP DONOR RELATIONS 167221 0 36287 0 4654 0 11083 0 3275 0 222520 0 0 0 DAYLE LOWRY INVESTMENT OPERATIONS MANAGER 107298 0 35315 0 3118 0 9050 0 15660 0 170441 0 0 0 MARTHA MATTOX DIRECTOR PHILANTHROPY 110943 0 15717 0 2423 0 5220 0 18902 0 153205 0 0 0 AMANDA K LEWIS DIRECTor 114330 0 17675 0 2292 0 5849 0 40683 0 180829 0 0 0 KIMBERLY A MCGINNIS ASSISTANT VICE PRESIDENT 126916 0 32396 0 2364 0 4279 0 38503 0 204458 0 0 0 JON R JOHNSON DIRECTOR 0 133908 0 17817 0 8067 0 8376 0 23497 0 191665 0 0 STANLEY E DAVIS SR. VP, COO 0 365484 0 152013 0 26156 0 68188 0 39808 0 651649 0 0 SCHEDULE J, PART I, LINE 1A 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 EXTREMELY UNUSUAL CIRCUMSTANCES AND THEN ONLY IF APPROVED BY SENIOR MANAGEMENT FOLLOWED BY REVIEW OF THE COMPANY'S COMPLIANCE AND LEGAL DEPARTMENTS. THESE TYPES OF REIMBURSEMENTS GENERALLY RELATE TO TAXES OWED BY INDIVIDUALS WHO RECEIVE NOMINAL INCENTIVE PAYMENTS FOR SERVICE AWARDS OR QUALITY IMPROVEMENT PROGRAMS, AND THE GROSS-UP PAYMENTS USUALLY ARE IMMATERIAL, $250 OR LESS. CY 2019 GROSS UP PAYMENTS KYLE DALEY $230 AMANDA LEWIS $110 CHRISTOPHER TINDELL $230 DAYLE LOWRY $230 MARTHA MATTOX $110 B. ANTHONY BAGWELL $7,960 JON R. JOHNSON $110 CARA MARTZ $220 SCHEDULE J, PART I, LINE 4B PARTICIPATION IN A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN: PARTICIPANTS IN SERP IN W-2 DEF COMP PAID BY -------------------- --------- --------- ------- RICK W. MERRILL 140,060 196,000 CCHCS STEPHEN W. KIMMEL 66,071 75,286 CCHCS STANLEY E. DAVIS none 47,188 CCMC B. ANTHONY Bagwell NONE 64,922 CCHF GRANT HARRIS NONE 37,890 CCHF SCHEDULE J, PART I, LINE 3 METHODS USED BY CCHCS TO ESTABLISH COMPENSATION OF THE CEO/EXEC DIRECTOR: COMPENSATION COMMITTEE INDEPENDENT COMPENSATION CONSULTANT WRITTEN EMPLOYMENT CONTRACT COMPENSATION SURVEY OR STUDY APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE SCHEDULE J, PART II ALLOCATION OF CEO AND CFO SALARIES: SALARIES FOR THE CEO AND CFO ARE ALLOCATED PRO-RATA BASED ON THE AMOUNT OF TIME THEY SPEND WITH EACH OF THE FOLLOWING COMPANIES: COOK CHILDREN'S MEDICAL CENTER COOK CHILDREN'S PHYSICIAN NETWORK COOK CHILDREN'S HEALTH FOUNDATION COOK CHILDREN'S HOME HEALTH COOK CHILDREN'S HEALTH CARE SYSTEM COOK CHILDREN'S HEALTH PLAN CHILD STUDY CENTER X 6 109086 AVG HIGH/LOW FOR DAY false true false SCHEDULE M, PART 1, COLUMN B NUMBER OF CONTRIBUTIONS OR NUMBER OF ITEMS RECEIVED: THE AMOUNTS REPORTED IN THIS COLUMN REFLECT THE NUMBER OF CONTRIBUTIONS RECEIVED. FORM 990, PART VI, SECTION A, LINE 2 OFFICER, DIRECTOR, TRUSTEE, OR KEY EMPLOYEE FAMILY/BUSINESS RELATIONSHIPS: RICK SORENSON AND JAMES WEBB HAVE A BUSINESS RELATIONSHIP. R. KYLE KIGHT AND JON BRUMLEY HAVE A BUSINESS RELATIONSHIP. LISA JAMIESON AND JERRY CONATSER HAVE A BUSINESS RELATIONSHIP. FORM 990, PART VI, SECTION B, LINE 11B REVIEW PROCESS FOR FORM 990: THE ORGANIZATION ENGAGES AN OUTSIDE INDEPENDENT ACCOUNTING FIRM TO ASSIST IN THE PREPARATION OF THE FORM 990 AND RELATED FILINGS. ALL INFORMATION PROVIDED TO THE OUTSIDE ACCOUNTING FIRM IS GATHERED BY KEY COMPANY EMPLOYEES AND EXECUTIVES. ONCE THE FORM 990 IS PREPARED, IT IS REVIEWED BY COMPANY FINANCE, LEGAL AND COMPLIANCE STAFF AND THEN PROVIDED TO THE BOARD OF TRUSTEES FOR REVIEW AND COMMENT. IN ADDITION, IT IS 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 CONFLICT OF INTEREST: 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 REVIEW AND APPROVAL OF COMPENSATION: COOK CHILDREN'S HEALTH CARE SYSTEM HAS ESTABLISHED A COMPENSATION COMMITTEE WITH OVERSIGHT OF EXECUTIVE AND PHYSICIAN COMPENSATION, WHICH INCLUDES THE ORGANIZATION'S CEO AND OTHER OFFICERS AND KEY EMPLOYEES OF THE ORGANIZATION. THE COMPENSATION COMMITTEE APPROVES COMPENSATION ARRANGEMENTS IN ADVANCE, WHICH INCLUDES A REVIEW AND APPROVAL BY INDEPENDENT COMMITTEE MEMBERS, USING COMPARABLE MARKET DATA RELATING TO COMPENSATION, WHICH IS PROVIDED BY SULLIVAN COTTER AND ASSOCIATES, INC. FOR EXECUTIVE COMPENSATION AND 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 PROCESS OF MAKING GOVERNING DOCUMENTS AVAILABLE TO THE PUBLIC: THE ORGANIZATION DOES NOT MAKE ITS GOVERNING DOCUMENTS OR CONFLICT OF INTEREST POLICY AVAILABLE TO THE PUBLIC, EXCEPT TO THE EXTENT THEY ARE ON FILE WITH THE SECRETARY OF STATE OF TEXAS. THE CONFLICT OF INTEREST POLICY IS POSTED ON THE ORGANIZATION'S INTERNAL WEBSITE AND AVAILABLE TO ALL EMPLOYEES AND BOARD MEMBERS OF COOK CHILDREN'S HEALTH CARE SYSTEM ENTITIES. CONSOLIDATED FINANCIAL STATEMENTS ARE REPORTED ELECTRONICALLY FOR ALL COOK CHILDREN'S HEALTH CARE SYSTEM ENTITIES VIA THE ELECTRONIC MUNICIPAL MARKET ACCESS (EMMA) WEB SITE. FORM 990, PART XI, LINE 9 OTHER CHANGES TO NET ASSETS: CHANGE IN BENEFICIAL INTEREST IN TRUSTS $ 508,183 TRANSFER FROM CCMC $ 85,000,000 TRANSFER TO CCHS $ (2,473,533) ------------- TOTAL $ 83,034,650 JEFFERSON STREET INVESTORS BLUE LLC 801 SEVENTH AVE FORT WORTH TX 76104 830910401 INVEST TX 0 9976859 CCHF COOK CHILDREN'S HEALTH PLAN 801 SEVENTH AVE FORT WORTH TX 76104 760585240 INSURANCE TX 501(C)(3) 10 CCHCS true COOK CHILDREN'S HEALTH CARE SYSTEM 801 SEVENTH AVE FORT WORTH TX 76104 752705881 HLTH CARE SUP TX 501(C)(3) 12C CCHF true COOK CHILDREN'S PHYSICIAN NETWORK 801 SEVENTH AVE FORT WORTH TX 76104 752485366 PHYSICIAN SVC TX 501(C)(3) 3 CCHCS true 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 AVE FORT WORTH TX 76104 752896983 HEALTHCARE TX 501(C)(3) 10 CCHCS true ROSEDALE OFFICE BUILDING INC 1500 W ROSEDALE FORT WORTH TX 76104 461866421 TITLE HOLDING TX 501(C)(2) N/A CCHF true CHILD STUDY CENTER 1300 W LANCASTER FORT WORTH TX 76102 751099536 HLTHCARE SRVC TX 501(C)(3) 7 CCMC true COOK CHILDREN'S HEALTH ENTERPRISES 801 SEVENTH AVE FORT WORTH TX 76104 842625990 SUPPORT TX 501(C)(3) 12B CCHF true COOK CHILDREN'S MEDICAL CENTER PROSPER 801 SEVENTH AVE FORT WORTH TX 76104 852354189 HEALTHCARE SV TX 501(C)(3) 3 CCHCS true SPLIT INTEREST TRUSTS (2) PO BOX 830269 DALLAS TX 75283 SPLIT INT TRUST TX NA TRUST false COOK CHILDREN'S HEALTH SERVICES INC 801 7TH AVENUE FORT WORTH TX 76104 454024843 HEALTH SERVICE TX CCHCS C CORPORATION true SPLIT INTEREST TRUST 270 PARK AVE NEW YORK NY 100172014 SPLIT INT TRUST TX NA TRUST false false true false false false false true false false false false false false false true true true true true COOK CHILDREN'S MEDICAL CENTER B 9634042 FMV COOK CHILDREN'S PHYSICIAN NETWORK B 1715765 FMV COOK CHILDREN'S HEALTH CARE SYSTEM B 5919869 FMV CHILD CARE STUDY CENTER B 1469585 FMV COOK CHILDREN'S HEALTH CARE SYSTEM G 10335895 FMV COOK CHILDREN'S PHYSICIAN NETWORK P 10108618 FMV COOK CHILDREN'S HEALTH CARE SYSTEM P 3890083 FMV COOK CHILDREN'S HEALTH CARE SYSTEM Q 58677 FMV COOK CHILDREN'S MEDICAL CENTER R 256054 FMV COOK CHILDREN'S HEALTH CARE SYSTEM R 3045741 FMV COOK CHILDREN'S MEDICAL CENTER S 85000000 FMV