2020-11-16T08:31:12-06:00 2019-12-31 350921680 CROWE LLP 750 N St Paul Suite 850 Dallas TX 75201 990 2019-01-01 461893597 Complex Care Medical Services Corporation COMP 2144567000 1935 Medical District Drive Dallas TX 75235 Robert Fries Senior Vice President, Finance 2020-11-16 true Rachel Spulock P00520729 2147775200 2019 2022-09-23 18:48:47Z Ray Tsai MD 1935 Medical District Drive Dallas TX 75235 1051546 false X N/A X 2012 TX TO SERVE AS THE MEDICAL HOME FOR CHILDREN WITH COMPLEX MEDICAL ILLNESSES. 4 4 28 4 0 0 20203 150 1084312 1051396 0 0 0 0 1104515 1051546 0 0 0 1671057 1436672 0 0 0 1678874 2273939 3349931 3710611 -2245416 -2659065 1554155 1864275 12331680 15300865 -10777525 -13436590 TO SERVE AS THE MEDICAL HOME FOR CHILDREN WITH COMPLEX MEDICAL ILLNESSES WHERE A MULTI-DISCIPLINARY TEAM OF CARE GIVERS OVERSEE AND COORDINATE THEIR CARE. false false 1735377 0 1051396 TO SERVE AS THE MEDICAL HOME FOR CHILDREN WITH COMPLEX MEDICAL ILLNESSES WHERE A MULTI-DISCIPLINARY TEAM OF CARE GIVERS OVERSEE AND COORDINATE THEIR CARE. 1735377 true false false false false false false false false true false false false true true false true false false false false false false false false false false false true false false false false false false false false false false false false false true false false false true X 5 0 true 28 true false false false false false false false false false false false false X 4 4 false false false false true true true true true false false false true true true true true false false false X Amy Yeager 2144567000 1935 MEDICAL DISTRICT DRIVE DALLAS TX 75235 Andrew Gelfand MD Director 1.0 0.0 X 0 0 0 John Andersen MD Director 1.0 0 X 0 0 0 Michelle Thomas MD Chair 1.0 0 X 0 0 0 William Scott MD Director 1.0 0 X 0 0 0 Lisa M Frenkel Secretary 1.0 5.0 X 0 318389 6579 Ray Tsai MD President (CHST SVP Ops) 1.0 54.0 X 0 812977 161690 Tammie L Sibley Treasurer (CHST SVP Finance) (Until 11/6/19) 1.0 49.0 X 0 1152385 67689 Stephanie K Smith Former Corporate Secretary 0.0 40.0 X 0 154475 4593 0 2438226 240551 0 true true false UTSW HI 108 5323 Harry Hines Blvd Dallas TX 753908886 Phys & Medical Services 997400 1 150 150 Net Patient Revenue 621110 1049229 1049229 Other Medical Service Revenue 621110 2167 2167 0 0 0 0 1051396 0 0 0 0 0 0 0 0 0 1051546 1051396 0 0 X 1092906 505714 587192 65795 27748 38047 198509 96286 102223 79462 36343 43119 223 223 732506 732506 0 0 306 306 5557 5557 403 403 155153 2929 152224 1693 900 793 265103 265103 Shared Services 1049857 1049857 Dietary and Food Costs 39602 38658 944 Medical Surgical Supplies 20326 20326 Miscellaneous expenses 3210 2681 529 0 0 0 0 3710611 1735377 1975234 0 37807 17917 0 0 0 0 2564791 718433 1516348 1846358 0 0 0 0 1554155 1864275 417071 141283 0 0 11914609 15159582 12331680 15300865 -10777525 -13436590 -10777525 -13436590 1554155 1864275 -2659065 0 X false true X true false X 2428181 616946 1811235 136362 101487 34875 248 0 248 1846358 LT Advances - Affiliates 15113706 LT Deferred Rent 45876 15159582 X Schedule D, Part X, Line 2 FIN 48 (ASC 740) footnote Complex 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, 2019, 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 2016 through 2019 in Children's Health main taxing jurisdictions." true true false false false false false false false Stephanie K Smith Former Corporate Secretary 0 132475 0 20759 0 1241 0 0 0 4593 0 159068 0 0 Lisa M Frenkel Secretary 0 257119 0 51226 0 10044 0 0 0 6579 0 324968 0 0 Tammie L Sibley Treasurer (CHST SVP Finance) (Until 11/6/19) 0 272798 0 257450 0 622137 0 54936 0 12753 0 1220074 0 0 Ray Tsai MD President (CHST SVP Ops) 0 393135 0 295959 0 123883 0 142652 0 19038 0 974667 0 0 Schedule J, Part I, Line 3 Arrangement used to establish the top management official's compensation CHILDREN'S HEALTH SYSTEM OF TEXAS (EIN 75-2062019) IS THE SOLE MEMBER AND COMMON PAYING AGENT FOR COMPLEX CARE MEDICAL SERVICES CORPORATION (CCMSC). THEREFORE, CCMSC'S TOP MANAGEMENT OFFICIAL, THE PRESIDENT, IS COMPENSATED BY CHILDREN'S HEALTH SYSTEM OF TEXAS (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 Tammie Sibley - $472,500. Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan Savings Restoration Plan: Ray Tsai participated in the Savings Restoration Plan; however, no payments were received in 2019. Executive Defined Contribution Retirement Plan (EDCRP): Employees who received taxable income from the EDCRP include: Ray Tsai - $72,007 and Tammie Sibley - $119,039. Employees who participated in and have contributions to the EDCRP include: Ray Tsai - $123,652 and Tammie Sibley - $44,538. Form 990, Part V, Line 2a CHILDREN'S HEALTH SYSTEM OF TEXAS (CHST) EIN 75-2062019 IS THE COMMON PAYING AGENT FOR COMPLEX CARE MEDICAL SERVICES CORPORATION (CCMSC) THEREFORE, ALL APPLICABLE IRS TAX COMPLIANCE FILINGS ARE REPORTED BY CHST ON BEHALF OF CCMSC. CCMSC HAS APPROXIMATELY 28 EMPLOYEES. Form 990, Part VI, Line 15a PROCESS TO ESTABLISH COMPENSATION OF TOP MANAGEMENT OFFICIAL CHILDREN'S HEALTH SYSTEM OF TEXAS (EIN 75-2062019) IS THE SOLE MEMBER AND COMMON PAYING AGENT FOR COMPLEX CARE MEDICAL SERVICES CORPORATION (CCMSC). THEREFORE, CCMSC'S TOP MANAGEMENT OFFICIAL IS EMPLOYED AND COMPENSATED BY CHILDREN'S HEALTH SYSTEM OF TEXAS (CHST). Compensation setting takes place at the related entity Children's Health System of Texas (CHST). 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 15b PROCESS TO ESTABLISH COMPENSATION OF OFFICERS AND OTHER KEY EMPLOYEES Line 15b is answered no in accordance with the IRS Form 990 instructions because salary is paid and determined by a related party, Children's Health System of Texas (CHST). CHST is the sole member and officers are employed and paid by CHST. 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 Directors 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 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, 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 body Complex 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 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. Form 990, Part IX, Line 11g Other Fees Contract Medical - Total Expense: 731606, Program Service Expense: 731606, Management and General Expenses: , Fundraising Expenses: ; Consulting Fees - Total Expense: 900, Program Service Expense: 900, Management and General Expenses: , Fundraising Expenses: ; 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 CHILDREN'S MEDICAL CENTER HEALTH PLAN 1935 MEDICAL DISTRICT DRIVE DALLAS TX 75235 462737696 HMO TX 501(c)(3) 10 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 CHST Physician Group 2 1935 Medical District Drive Dallas TX 75235 813679995 Physician TX 501(c)(3) 10 CHILDREN'S HEALTH SYSTEM OF TEXAS false CHST Physician Group 3 1935 Medical District Drive Dallas TX 75235 813691209 Physician TX 501(c)(3) 10 CHILDREN'S HEALTH SYSTEM OF TEXAS false CHST Physician Group 4 1935 Medical District Drive Dallas TX 75235 814577909 Physician TX 501(c)(3) 10 CHILDREN'S HEALTH SYSTEM OF TEXAS false CHST Physician Group 5 1935 Medical District Drive Dallas TX 75235 814848085 Physician TX 501(c)(3) 10 CHILDREN'S HEALTH SYSTEM OF TEXAS false CHST Physician Group 6 1935 Medical District Drive Dallas TX 75235 814865847 Physician TX 501(c)(3) 10 CHILDREN'S HEALTH SYSTEM OF TEXAS 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 Legacy Trail Surgery Center LLC dba Live Oak Surgery Center 7211 Preston Rd Ste 2100 Plano TX 750240258 822278618 Surgery Center TX NA N/A 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 CJ NA C Corporation false Children's Health 1935 Medical District Drive Dallas TX 75235 833809987 Other Medical Services TX NA C Corporation false CHST Physician Group 1 1935 Medical District Drive Dallas TX 75235 813582843 Physician 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 false false true false true false false false false false false true false true true false false false false