2019-11-15T08:30:42-06:00 2018-12-31 350921680 CROWE LLP 750 N St Paul Suite 850 Dallas TX 75201 990 2018-01-01 462737696 Children's Medical Center Health Plan CHIL 2144567000 1935 Medical District Drive Dallas TX 75235 Jeremiah Radandt EVP Finance & CFO 2019-11-15 true Rachel Spurlock P00520729 2147775200 2018 2020-03-31 21:24:44Z Peter Perialas 1935 Medical District Drive Dallas TX 75235 266612021 false X N/A X 2013 TX TO INSURE HEALTH COVERAGE FOR POOR, DISTRESSED, OR UNDERPRIVILEGED CHILDREN & ADULTS. 5 0 208 0 0 0 0 0 245065321 266571952 36023 40069 0 0 245101344 266612021 0 0 0 18431810 19725222 0 0 0 302712062 300630459 321143872 320355681 -76042528 -53743660 42916565 104165538 53515363 60307996 -10598798 43857542 TO INSURE HEALTH COVERAGE FOR POOR, DISTRESSED, OR UNDERPRIVILEGED CHILDREN & ADULTS IN THE STATE OF TEXAS. false false 304334412 0 266571952 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. 304334412 true false 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 59 0 true 208 true false false false false false false true 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 STEPHANIE K SMITH 2144567000 1935 MEDICAL DISTRICT DRIVE DALLAS TX 75235 Peter C Perialas Director & President (CHST EVP & CSO) 1.0 54.0 X X 0 712037 156697 Richard P Goode Director and Treasurer 1.0 54.0 X X 0 1029022 418477 Doris E Hunt Dir. and VP/Executive Director 53.0 2.0 X X 0 597546 135774 Christopher J Durovich Chairman (CHST Pres. & CEO) 1.0 59.0 X 0 3556525 200803 Ray Tsai MD Director (CHST SVP Ops) 1.0 54.0 X 0 684614 155384 Lawrence L Foust Director (until 2/20/2018) 1.0 54.0 X 0 1580407 43617 Mark Chulick Secretary (CHST Asst. 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Counsel) 1.0 49.0 X 0 231619 12174 Stephanie K Smith Former Corporate Secretary 0.0 40.0 X 0 162833 4591 Michele Chulick Former Director and Officer 0.0 0.0 X 0 548268 0 0 9102871 1127517 0 true true false HMS Inc 5615 High Point Drive Ste 100 Irving TX 75038 Professional Services 1004127 COGNIZANT TRIZETTO SOFTWARE GR 9655 Maroon Circle Engleweood CO 80112 Professional Services 844626 Wellsky 11711 W 79TH ST Lenexa KS 66214 Professional Services 491792 Invidasys Inc 2500 S Power Road Suite 215 Mesa AZ 85209 Professional Services 350762 JOHN SONS PRESS 3300 SOUTH FREEWAY Ft Worth TX 76110 Professional Services 308504 10 0 Premium Revenue 900099 266099546 266099546 Insurance Recoveries 900099 472406 472406 0 0 0 0 266571952 40069 40069 0 0 0 0 0 0 0 0 0 266612021 266571952 0 40069 15914931 10617594 5297337 736049 491053 244996 2071650 1382095 689555 1002592 668876 333716 60000 60000 5497770 146743 5351027 0 303980 253727 50253 151752 61650 90102 1030470 800 1029670 1992413 1992413 214821 137778 77043 162432 16870 145562 362306 362306 Medical Claims Expense 285829675 285829675 Premium Taxes 4655975 4655975 Shared Services 276016 276016 Transltn & Interprtn Srvc 77182 69311 7871 15667 2265 13402 0 320355681 304334412 16021269 0 36614436 96122190 2030159 2063117 251362 2318185 0 0 0 935454 309926 3413270 561150 2585154 2852120 0 0 500000 500000 42916565 104165538 26272842 25441362 0 27242521 34866634 53515363 60307996 X -10598798 43857542 -10598798 43857542 42916565 104165538 X -53743660 108200000 X false true X true false X 0 0 0 0 0 0 0 0 38616489 245065321 266099546 549781356 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 38616489 245065321 266099546 549781356 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 549781356 1784 1595 2643 36023 40069 82114 0 0 0 0 0 0 1784 1595 2643 36023 40069 82114 0 0 0 0 0 0 0 0 0 0 0 0 1784 1595 38619132 245101344 266139615 549863470 X 2463291 433106 2030185 187382 128044 59338 762597 762597 2852120 LT Advances - Affiliates 3183724 LT DEFERRED RENT Accrued Premium Tax Payable HM 394162 HMO IBNR 31288748 Premium Deficiency Reserve 34866634 true true false false false false false true false Michele Chulick Former Director and Officer 0 0 0 548268 0 0 0 0 0 0 0 548268 0 0 Peter C Perialas Director & President (CHST EVP & CSO) 0 434648 0 223604 0 53784 0 144926 0 11771 0 868733 0 0 Richard P Goode Director and Treasurer 0 716612 0 310110 0 2300 0 408147 0 10330 0 1447500 0 0 Doris E Hunt Dir. and VP/Executive Director 0 372046 0 175843 0 49657 0 125651 0 10123 0 733320 0 0 Christopher J Durovich Chairman (CHST Pres. & CEO) 0 1132271 0 1262355 0 1161899 0 175306 0 25497 0 3757328 0 0 Ray Tsai MD Director (CHST SVP Ops) 0 385115 0 240355 0 59144 0 138665 0 16720 0 839998 0 0 Lawrence L Foust Director (until 2/20/2018) 0 77211 0 322689 0 1180507 0 35406 0 8211 0 1624024 0 0 Stephanie K Smith Former Corporate Secretary 0 128098 0 14598 0 20137 0 0 0 4591 0 167424 0 0 Mark Chulick Secretary (CHST Asst. Gen. Counsel) 0 190948 0 36786 0 3885 0 0 0 12174 0 243793 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. When appropriate, an independent compensation consultant may be engaged. 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 Severance Payment: *Severance - Lawrence Foust - $793,200 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 $647,485 of taxable income during 2018. * Savings Restoration Plan: Christopher J Durovich received $352,127 of taxable income from the Savings Restoration Plan during 2018. Additional employees who participated in the Savings Restoration Plan include Ray Tsai. *Executive Defined Contribution Retirement Plan (EDCRP): Employees who received taxable income from the EDCRP include: Christopher J Durovich - $141,304, Peter Perialas - $50,265, Ray Tsai - $55,523, Doris Hunt - $46,197, Lawrence Foust - $349,857. Employees who received compensation reported as deferred in column C from the EDCRP include: Christopher J Durovich - $157,922, Doris Hunt - $114,651, Richard Goode - $400,183, Peter Perialas - $133,926, Ray Tsai - $120,500, Lawrence Foust - $24,406. 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 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 208 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 - 108200000; 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. 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 COMPLEX CARE MED SVC CORP 1935 MEDICAL DISTRICT DRIVE DALLAS TX 75235 461893597 MEDICAL SERVICES TX 501(c)(3) 3 CHILDREN'S HEALTH SYSTEM OF TEXAS false CHILDREN'S MED CTR RESEARCH INST AT UTSWMC 1935 MEDICAL DISTRICT DRIVE DALLAS TX 75235 433462044 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 NA N/A false false 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 false true false false false false