2020-11-16T08:03:25-06:00 2019-12-31 350921680 CROWE LLP 750 N St Paul Suite 850 Dallas TX 75201 990 2019-01-01 462737696 Children's Medical Center Health Plan CHIL 2144567000 1935 Medical District Drive Dallas TX 75235 Robert Fries Senior Vice President, Finance 2020-11-16 true Rachel Spurlock P00520729 2147775200 2019 2021-01-29 14:40:06Z Peter Perialas 1935 Medical District Drive Dallas TX 75235 273798956 false X N/A X 2013 TX TO INSURE HEALTH COVERAGE FOR POOR, DISTRESSED, OR UNDERPRIVILEGED CHILDREN & ADULTS. 5 0 209 0 0 0 0 0 266571952 272136229 40069 1662727 0 0 266612021 273798956 0 0 0 19725222 30545013 0 0 0 300630459 262667775 320355681 293212788 -53743660 -19413832 104165538 86317957 60307996 51874247 43857542 34443710 X TO INSURE HEALTH COVERAGE FOR POOR, DISTRESSED, OR UNDERPRIVILEGED CHILDREN & ADULTS IN THE STATE OF TEXAS. false true 267887285 0 272136229 To insure poor, distressed, or underprivileged children or adults enrolled in Texas Medicaid (STAR), Children's Health Insurance Program (CHIP), Medicaid recipients on Social Security Administration's Supplemental Security Income (STAR Kids and STAR+PLUS), Medicaid for foster children (STAR health), and Medicare Advantage (covering only those patients that have dual eligibility for Medicaid and Medicare benefits) in the State of Texas. 267887285 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 46 0 true 209 true false false false false false false false false false false false false X 5 0 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 Doris E Hunt Dir. and VP/Executive Director 53.0 1.0 X X 0 724027 139188 Peter C Perialas Director & President (CHST EVP & CSO) 1.0 54.0 X X 0 1013454 275752 Richard P Goode Director and Treasurer (until 9/23/19) 1.0 54.0 X X 0 1076840 191178 Christopher J Durovich Chairman (CHST Pres. & CEO) 1.0 59.0 X 0 3413104 207572 Kenneth Stewart Director 1.0 54.0 X 0 585142 197709 Ray Tsai MD Director (CHST SVP Ops) 1.0 54.0 X 0 812977 161690 Jeremiah Radandt Treasurer 1.0 54.0 X 0 620876 149591 Mark Chulick Secretary (CHST Asst. Gen. Counsel) 1.0 0.0 X 0 245287 11961 Stephanie K Smith Former Corporate Secretary 0.0 40.0 X 0 154475 4593 0 8646182 1339234 0 true true false HMS Inc 5615 High Point Drive Ste 100 Irving TX 75038 Professional Services 736555 COGNIZANT TRIZETTO SOFTWARE GR 9655 Maroon Circle Engleweood CO 80112 Professional Services 694528 Wellsky 11711 W 79TH ST Lenexa KS 66214 Professional Services 481770 Invidasys Inc 2500 S Power Road Suite 215 Mesa AZ 85209 Professional Services 334938 JOHN SONS PRESS 3300 SOUTH FREEWAY Ft Worth TX 76110 Professional Services 263325 7 0 Premium Revenue 900099 272136229 272136229 0 0 0 0 272136229 1662727 1662727 0 0 0 0 0 0 0 0 0 273798956 272136229 0 1662727 25641997 10887303 14754694 742490 418428 324062 2315018 1755377 559641 1845508 786627 1058881 75000 75000 4889752 166925 4722827 0 1000885 926988 73897 1119133 3183 1115950 2259680 563995 1695685 206880 143029 63851 129776 2185 127591 362306 362306 307469 307469 Medical Claims Expense 246879063 246879063 Premium Taxes 4752101 4752101 Shared Services 374949 374949 Printing 208355 203584 4771 102426 91028 11398 0 293212788 267887285 25325503 0 96122190 80717496 2063117 2107310 2318185 208960 0 0 0 0 309926 283108 3424539 923456 2852120 2501083 0 0 500000 500000 104165538 86317957 25441362 23848187 0 0 34866634 28026060 60307996 51874247 X 43857542 34443710 43857542 34443710 104165538 86317957 X -19413832 10000000 X false true X true false X 0 0 0 0 0 0 38616489 245065321 266099546 272136229 821917585 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 38616489 245065321 266099546 272136229 821917585 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 821917585 1595 2643 36023 40069 0 80330 0 0 0 0 0 0 1595 2643 36023 40069 0 80330 0 0 0 0 0 0 0 0 0 0 0 0 1595 38619132 245101344 266139615 272136229 821997915 0.9999 0.0001 X 2463291 757936 1705355 187382 165520 21862 773866 773866 2501083 LT Advances - Affiliates 1812437 Accrued Premium Tax Payable HM HMO IBNR 21268393 LT Non-Qualified Plan 4945230 28026060 X Schedule D, Part X, Line 2 FIN 48 (ASC 740) footnote Children's Medical Center Health Plan's financial information is included in the consolidated audited financial statements of Children's Health System of Texas, a related organization. Children's Health System of Texas's FIN 48 (ASC 740) footnote for the year ended December 31, 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." false true false false false false false false false Richard P Goode Director and Treasurer (until 9/23/19) 0 562462 0 451779 0 62599 0 182532 0 8646 0 1268018 0 0 Doris E Hunt Dir. and VP/Executive Director 0 381906 0 253325 0 88796 0 128868 0 10320 0 863215 0 0 Peter C Perialas Director & President (CHST EVP & CSO) 0 521612 0 391823 0 100019 0 269545 0 6207 0 1289206 0 0 Christopher J Durovich Chairman (CHST Pres. & CEO) 0 1193522 0 1531410 0 688172 0 184839 0 22733 0 3620676 0 0 Kenneth Stewart Director 0 575276 0 0 0 9866 0 186831 0 10878 0 782851 0 0 Ray Tsai MD Director (CHST SVP Ops) 0 393135 0 295959 0 123883 0 142652 0 19038 0 974667 0 0 Stephanie K Smith Former Corporate Secretary 0 132475 0 20759 0 1241 0 0 0 4593 0 159068 0 0 Mark Chulick Secretary (CHST Asst. Gen. Counsel) 0 195224 0 44720 0 5343 0 0 0 11961 0 257248 0 0 Jeremiah Radandt Treasurer 0 400899 0 212365 0 7612 0 135652 0 13939 0 770467 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 CHILDREN'S MEDICAL CENTER HEALTH PLAN (CMCHP). THEREFORE, CMCHP'S TOP MANAGEMENT OFFICIAL IS EMPLOYED AND 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 4b Supplemental nonqualified retirement plan Retirement Income Restoration Plan: Christopher J. Durovich participated in the Retirement Income Restoration Plan and received $315,458 of taxable income during 2019. Savings Restoration Plan: Christopher J. Durovich received $200,478 of taxable income from the Savings Restoration Plan during 2019. Additional employees who participated in the Savings Restoration Plan include Ray Tsai; however, no payments were received in 2019. Executive Defined Contribution Retirement Plan (EDCRP): Employees who received taxable income from the EDCRP include: Christopher J. Durovich - $150,116, Peter Perialas - $56,527, Ray Tsai - $72,007, Doris Hunt - $55,317, and Richard Goode - $53,248. Employees who participated in and have contributions to the EDCRP include: Christopher J. Durovich - $165,839, Richard Goode - $171,332, Peter Perialas - $258,345, Ray Tsai - $123,652, Doris Hunt - $117,668, Jeremiah Radandt - $124,452, and Kenneth Stewart - $180,000. Form 990, Part III, Line 3 Significant changes in program services Children's Medical Center Health Plan (CMCHP) notified HHSC and the Texas Department of Insurance that Children's Health will exit the STAR Kids program as of September 30, 2020 due to historical losses in the product. HHSC has agreed with this date and CMCHP does not foresee any factors to prevent the entity from fulfilling its contractual obligations with HHSC. Form 990, Part V, Line 2a CHILDREN'S HEALTH SYSTEM OF TEXAS (CHST) EIN 75-2062019 IS THE COMMON PAYING AGENT FOR CHILDREN'S MEDICAL CENTER HEALTH PLAN (CMCHP) THEREFORE, ALL APPLICABLE IRS TAX COMPLIANCE FILINGS ARE REPORTED BY CHST ON BEHALF OF CMCHP. CMCHP HAS APPROXIMATELY 209 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 CHILDREN'S MEDICAL CENTER HEALTH PLAN (CMCHP). THEREFORE, CMCHP'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 6 Classes of members or stockholders Children's Health System of Texas (CHST) is the sole member. Form 990, Part VI, Line 7a Members or stockholders electing members of governing body CHST elects all members of the organization's Board of Directors. Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders Member reserve powers are specified in the organization's Bylaws and represent those actions by the organization which require member approval. These powers generally encompass changes in the mission of the organization, addition of new members, specified financial matters, amendments to the organization's Certificate of Formation and Bylaws, and appointment of directors. Form 990, Part VI, Line 11b Review of form 990 by governing body Children's Medical Center Health Plan has delegated its oversight and review of the Form 990 to the Board of Directors of Children's Health System of Texas (CHST), its Sole Member. A draft of the Form 990 is presented to the CHST Audit Committee for review prior to filing. A copy of the Final Form 990 is made available to the CHST directors through our Board portal before it is filed. Form 990, Part VI, Line 12c Conflict of interest policy Officers, directors, and key employees receive annually a copy of the Children's Health Statement of Interest form to complete. Disclosures made are reviewed by the CHST Legal Department and the Chief Compliance Officer, who are authorized under the Children's Health Conflict of Interest Policy to make determinations under the Policy regarding persons who are medical staff members or employees of Children's Health and its affiliates. Disclosures made by senior officers (as defined in the Policy) are reviewed by the Compliance Officer, the Chief Legal Officer, and CHST's President and Chief Executive Officer to determine if a conflict exists. Disclosures made by directors of CHST and its affiliates, as well as by the President and Chief Executive Officer of CHST, are discussed as necessary with the appropriate delegated Board Committee and, if required pursuant to the Policy, by the appropriate Board of Directors at meetings to determine if further action is needed. A Statement of Interest must be completed annually and Board members are requested to report changes if they occur. A Committee or Board member with a potential conflict is prohibited from participating in deliberations regarding the transaction in question and will recuse themselves from voting. Form 990, Part VI, Line 19 Required documents available to the public IRC section 6104 does not require disclosure of the financial statements, conflict of interest policy and governing documents. The Certificate of Formation, Consolidated Financial Statements, and the conflict of interest policy are made available upon request. Form 990, Part XI, Line 9 Other changes in net assets or fund balances CHST Paid-in Capital - 10000000; 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. 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