2019-11-15T08:32:17-06:00 2018-12-31 350921680 CROWE LLP 750 N St Paul Suite 850 Dallas TX 75201 990 2018-01-01 461893597 Complex Care Medical Services Corporation COMP 2144567000 1935 MEDICAL DISTRICT DRIVE DALLAS TX 75235 Jeremiah Radandt EVP Finance & CFO 2019-11-15 true Rachel Spulock P00520729 2147775200 2018 2020-03-31 21:24:44Z Ray Tsai MD 1935 MEDICAL DISTRICT DRIVE DALLAS TX 75235 1104515 false X N/A X 2012 TX TO SERVE AS THE MEDICAL HOME FOR CHILDREN WITH COMPLEX MEDICAL ILLNESSES. 4 3 20 3 0 0 280 20203 735672 1084312 0 0 0 735952 1104515 0 0 0 1429731 1671057 0 0 0 2235621 1678874 3665352 3349931 -2929400 -2245416 1641942 1554155 9783371 12331680 -8141429 -10777525 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 1817573 0 1084312 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. 1817573 true true false false false false false false false true false false false true false 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 2 0 true 20 true false false false false false false true false false false false false X 4 3 false false false false true true true true true false false false true true true true true false false false X STEPHANIE K SMITH 2144567000 1935 MEDICAL DISTRICT DRIVE DALLAS TX 75235 William R Morrow MD Director and President (until 7/21/2018) 1.0 54.0 X X 0 2248262 115677 John Andersen MD Director 1.0 0 X 0 0 0 Andrew Gelfand MD Director 1.0 13.0 X 0 36745 0 William Scott MD Director 1.0 0 X 0 0 0 Michelle Thomas MD Chair 1.0 0 X 0 0 0 Ray Tsai MD President (CHST SVP Ops) 1.0 54.0 X 0 684614 155384 Tammie L Sibley Treasurer (CHST SVP Finance) 1.0 49.0 X 0 347144 63065 Lisa M Frenkel Secretary 1.0 49.0 X 0 275033 5732 Jerry D Lee Treasurer (until 4/13/2018) 1.0 49.0 X 0 906965 37689 Stephanie K Smith Former Corporate Secretary 0.0 40.0 X 0 162833 4591 0 4661596 382138 0 true true false UTSW HI 108 5323 Harry Hines Blvd Dallas TX 753908886 Phys & Medical Services 1570649 1 20203 20203 Net Patient Revenue 621110 1066783 1066783 Other Medical Service Revenue 621110 17529 17529 0 0 0 0 1084312 0 0 0 0 0 0 0 0 0 1104515 1084312 0 0 X 1303843 666592 637251 77502 39623 37879 193059 98635 94424 96653 49414 47239 694615 694259 356 0 10416 7186 3230 28 28 152232 73715 78517 459 459 3670 1972 1698 114767 114767 Shared Services 627455 627455 Dietary and Food Costs 41505 38801 2704 Medical Surgical Supplies 22949 22949 Provision for Doubtful Accounts 498 498 10280 9162 1118 0 3349931 1817573 1532358 0 10828 37807 0 0 0 0 1969678 453330 1631114 1516348 0 0 0 0 1641942 1554155 1329958 417071 0 0 8453413 11914609 9783371 12331680 -8141429 -10777525 -8141429 -10777525 1641942 1554155 X -2245416 -390680 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1833316 374071 1459245 136362 79259 57103 1516348 LT Advances - Affiliates 11869445 LT Deferred Rent 45164 11914609 true true false false false false false true false William R Morrow MD Director and President (until 7/21/2018) 0 327078 0 471289 0 1449895 0 110636 0 5041 0 2363939 0 0 Stephanie K Smith Former Corporate Secretary 0 128098 0 14598 0 20137 0 0 0 4591 0 167424 0 0 Ray Tsai MD President (CHST SVP Ops) 0 385115 0 240355 0 59144 0 138665 0 16720 0 839998 0 0 Tammie L Sibley Treasurer (CHST SVP Finance) 0 277938 0 67464 0 1742 0 52448 0 10616 0 410209 0 0 Lisa M Frenkel Secretary 0 228264 0 42092 0 4677 0 0 0 5732 0 280765 0 0 Jerry D Lee Treasurer (until 4/13/2018) 0 85821 0 111213 0 709931 0 31756 0 5933 0 944655 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 the CCMSC President's compensation is as follows: The Human Resources Committee (Committee) of the CHST Board is responsible for setting the compensation for the CCMSC President. 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. When appropriate, an independent compensation consultant may be engaged. COMPENSATION PROGRAM COMPONENTS: The elements of total compensation provided to the CCMSC President includes: - 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 the CCMSC President 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 Severance Payment: *Severance - Jerry Lee - $475,800. Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan Non-Qualified Retirement Plan: * Children's Health Savings Restoration Plan - William Morrow received $12,299 as taxable income from the Savings Restoration Plan. Jerry Lee received $13,682 as taxable income from the Savings Restoration Plan. Employees who participated in the Savings Restoration Plan include Ray Tsai. *Children's Health Executive Defined Contribution Retirement Plan (EDCRP). William Morrow received $503,367 as taxable income from the EDCRP. Jerry Lee received $177,633 as taxable income from the EDCRP. Ray Tsai received $55,523 as taxable income from the EDCRP. Employees who received compensation reported as deferred in column C from the EDCRP include: William Morrow - $99,636, Ray Tsai - $120,550, Tammie Sibley - $41,448, Jerry Lee - $18,351. Schedule J, Part I, Line 7 Non-fixed payments Non-Fixed Payments - The Human Resources Committee of the Board of Directors of Children's Health System of Texas retains the authority to adjust annual payout percentages solely at their discretion. There were no non-fixed payments in 2018. 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 20 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: 691900, Program Service Expense: 691544, Management and General Expenses: 356, Fundraising Expenses: ; Consulting Fees - Total Expense: 2715, Program Service Expense: 2715, Management and General Expenses: , Fundraising Expenses: ; Form 990, Part XI, Line 9 Other changes in net assets or fund balances Company Terminations - -390680; 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 Anesthesiologists for Children 1935 MEDICAL DISTRICT DRIVE DALLAS TX 75235 752917570 PHYSICIANS TX 501(c)(3) 10 CHILDREN'S HEALTH SYSTEM OF TEXAS false Dallas Physician Medical Services for Childrens 1935 MEDICAL DISTRICT DRIVE DALLAS TX 75235 810584868 PHYSICIANS TX 501(c)(3) 3 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 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 CHILDREN'S HEALTH SYSTEM OF TEXAS 1935 MEDICAL DISTRICT DRIVE DALLAS TX 75235 752062019 MANAGEMENT COMPANY TX 501(c)(3) Type II N/A false OCH Holdings 1935 MEDICAL DISTRICT DRIVE DALLAS TX 75235 474837308 Hospital TX 501(c)(3) 3 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 N/A false WOMEN'S AUXILIARY OF CMCD 12720 HILLCREST RD DALLAS TX 75230 752485538 WOMEN'S AUXILIARY TX 501(c)(3) 10 N/A false CHST Physician Group 1 1935 Medical District Drive Dallas TX 75235 813582843 Physician TX 501(c)(3) 10 CHILDREN'S HEALTH SYSTEM OF TEXAS 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 Wellness Innovations LLC 1935 Medical District Drive Dallas TX 75235 475246461 Physicians TX CHST Investment Holdings LLC Unrelated false false 0 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 LTD 878 West Bay Road PO Box 1159 Grand Cayman Grand Cayman CJ KY11202 981318151 Self-insurance CJ NA C Corporation false Wellness Innovations Physician Partners 1935 Medical District Drive Dallas TX 75235 811734937 Physicians TX NA C Corporation false Children's Health 1935 Medical District Drive Dallas TX 75235 833809987 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