MAIN STREET COMMUNITY INITIATIVES: Form 990, tax year 2017

View the entire original 990 at ProPublica ↗

Organization
MAIN STREET COMMUNITY INITIATIVES (EIN 46-1392824)
Tax period
2017-01-01 to 2017-12-31
Filed
2018-11-14
IRS object ID
201813189349300831
Schema version
2017v2.2
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Return2018-11-14T09:01:58-06:00ReturnTs
Tax Period End2017-12-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN350921680PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1CROWE LLPBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1750 N St Paul Suite 850AddressLine1Txt
CityDallasCityNm
State AbbreviationTXStateAbbreviationCd
ZIP75201ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2017-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN461392824EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1Texas Children's Health Plan The CenterBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlTEXABusinessNameControlTxt
Phone8328242982PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line16621 FANNIN STREETAddressLine1Txt
CityHOUSTONCityNm
State AbbreviationTXStateAbbreviationCd
ZIP77030ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonWeldon GagePersonNm
Person TitleEXECUTIVE VICE PRESIDENT & CFOPersonTitleTxt
Signature2018-11-14SignatureDt
Discuss With Paid PreparerYes (true)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonRACHEL SPURLOCKPreparerPersonNm
PTINP00520729PTIN
Phone2147775200PhoneNum
FieldValueIRS element (for citing)
Tax2017TaxYr
Build TS2019-02-21 02:37:17ZBuildTS

Form 990 IRS990

Doing Business As Name DoingBusinessAsName

FieldValueIRS element (for citing)
Business Name Line1Texas Children's Health Plan-The Center for Children and WomenBusinessNameLine1Txt

Principal Ofcr Business Name PrincipalOfcrBusinessName

FieldValueIRS element (for citing)
Business Name Line1Weldon GageBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line16621 FANNIN STREETAddressLine1Txt
CityHoustonCityNm
State AbbreviationTXStateAbbreviationCd
ZIP77030ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$121,679,237GrossReceiptsAmt
Group Return For AffiliatesfalseGroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressWWW.JOINTHECENTER.ORGWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation2008FormationYr
Legal Domicile StateTXLegalDomicileStateCd
Activity Or MissionTO CREATE A HEALTHIER FUTURE FOR CHILDREN AND WOMEN THROUGHOUT OUR GLOBAL COMMUNITY BY LEADING IN PATIENT CARE, EDUCATION, AND RESEARCH.ActivityOrMissionDesc
Voting Members Governing Body5VotingMembersGoverningBodyCnt
Voting Members Independent2VotingMembersIndependentCnt
Total Employee198TotalEmployeeCnt
Total Volunteers0TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
CY Contributions Grants$621,374CYContributionsGrantsAmt
PY Program Service Revenue$96,188,779PYProgramServiceRevenueAmt
CY Program Service Revenue$120,983,120CYProgramServiceRevenueAmt
CY Investment Income$0CYInvestmentIncomeAmt
PY Other Revenue$3,039PYOtherRevenueAmt
CY Other Revenue$74,743CYOtherRevenueAmt
PY Total Revenue$96,191,818PYTotalRevenueAmt
CY Total Revenue$121,679,237CYTotalRevenueAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$11,978,130PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$12,336,874CYSalariesCompEmpBnftPaidAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$84,213,688PYOtherExpensesAmt
CY Other Expenses$109,342,363CYOtherExpensesAmt
PY Total Expenses$96,191,818PYTotalExpensesAmt
CY Total Expenses$121,679,237CYTotalExpensesAmt
PY Revenues Less Expenses$0PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$0CYRevenuesLessExpensesAmt
Total Assets BOY$35,419,475TotalAssetsBOYAmt
Total Assets EOY$36,180,944TotalAssetsEOYAmt
Total Liabilities BOY$8,931,183TotalLiabilitiesBOYAmt
Total Liabilities EOY$9,692,652TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$26,488,292NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$26,488,292NetAssetsOrFundBalancesEOYAmt
MissionTO CREATE A HEALTHIER FUTURE FOR CHILDREN AND WOMEN THROUGHOUT OUR GLOBAL COMMUNITY BY LEADING IN PATIENT CARE, EDUCATION, AND RESEARCH.MissionDesc
Significant New Program SrvcfalseSignificantNewProgramSrvcInd
Significant ChangefalseSignificantChangeInd
Expense$118,328,017ExpenseAmt
Revenue$120,983,120RevenueAmt
DescTEXAS CHILDREN'S HEALTH PLAN - THE CENTER FOR CHILDREN AND WOMEN (CCW), IN FULFILLING ITS PURPOSE OF SUPPORTING TEXAS CHILDREN'S HEALTH PLAN, ESTABLISHES PATIENT AND FAMILY-CENTERED MEDICAL HOMES PROVIDING CARE TO PRIMARILY MEDICAID AND CHIP PATIENTS THAT ARE MEMBERS OF TEXAS CHILDREN'S HEALTH PLAN. THE MEDICAL HOMES ARE SPECIFICALLY IN SUPPORT OF TEXAS CHILDREN'S HEALTH PLAN'S MISSION TO PROVIDE CARE THAT IS ACCESSIBLE, COORDINATED, COMPREHENSIVE, CONTINUOUS, CULTURALLY SENSITIVE, COMMUNITY-BASED AND FAMILY-CENTERED.Desc
Total Program Service Expenses$118,328,017TotalProgramServiceExpensesAmt
Described In Section501c3Yes (true)DescribedInSection501c3Ind
Schedule B RequiredYes (true)ScheduleBRequiredInd
Political Campaign ActyfalsePoliticalCampaignActyInd
Lobbying ActivitiesfalseLobbyingActivitiesInd
Subject To Proxy TaxfalseSubjectToProxyTaxInd
Donor Advised FundfalseDonorAdvisedFundInd
Conservation EasementsfalseConservationEasementsInd
Collections Of ArtfalseCollectionsOfArtInd
Credit CounselingfalseCreditCounselingInd
Temp Or Permanent EndowmentsfalseTempOrPermanentEndowmentsInd
Report Land Building EquipmentYes (true)ReportLandBuildingEquipmentInd
Report Investments Other SecfalseReportInvestmentsOtherSecInd
Report Program Related InvstfalseReportProgramRelatedInvstInd
Report Other AssetsYes (true)ReportOtherAssetsInd
Report Other LiabilitiesYes (true)ReportOtherLiabilitiesInd
Include FIN48 FootnoteYes (true)IncludeFIN48FootnoteInd
Independent Audit Fincl StmtYes (true)IndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtfalseConsolidatedAuditFinclStmtInd
School OperatingfalseSchoolOperatingInd
Foreign OfficefalseForeignOfficeInd
Foreign ActivitiesfalseForeignActivitiesInd
More Than5000 K To OrgfalseMoreThan5000KToOrgInd
More Than5000 K To IndividualsfalseMoreThan5000KToIndividualsInd
Professional FundraisingfalseProfessionalFundraisingInd
Fundraising ActivitiesfalseFundraisingActivitiesInd
Gaming ActivitiesfalseGamingActivitiesInd
Operate HospitalfalseOperateHospitalInd
Grants To OrganizationsfalseGrantsToOrganizationsInd
Grants To IndividualsfalseGrantsToIndividualsInd
Schedule J RequiredYes (true)ScheduleJRequiredInd
Tax Exempt BondsfalseTaxExemptBondsInd
Engaged In Excess Benefit TransfalseEngagedInExcessBenefitTransInd
PY Excess Benefit TransfalsePYExcessBenefitTransInd
Loan OutstandingfalseLoanOutstandingInd
Grant To Related PersonfalseGrantToRelatedPersonInd
Business Rln With Org MemfalseBusinessRlnWithOrgMemInd
Business Rln With Fam MemfalseBusinessRlnWithFamMemInd
Business Rln With Officer EntfalseBusinessRlnWithOfficerEntInd
Deductible Non Cash ContrifalseDeductibleNonCashContriInd
Deductible Art ContributionfalseDeductibleArtContributionInd
Terminate OperationsfalseTerminateOperationsInd
Partial LiquidationfalsePartialLiquidationInd
Disregarded EntityfalseDisregardedEntityInd
Related EntityYes (true)RelatedEntityInd
Related Organization Ctrl EntfalseRelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd OrgfalseTrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted PrtshpfalseActivitiesConductedPrtshpInd
Schedule O RequiredYes (true)ScheduleORequiredInd
IRP Document28IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (true)BackupWthldComplianceInd
Employee198EmployeeCnt
Employment Tax Returns FiledYes (true)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over LimitfalseUnrelatedBusIncmOverLimitInd
Foreign Financial AccountfalseForeignFinancialAccountInd
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTransInd
Taxable Party NotificationfalseTaxablePartyNotificationInd
Nondeductible ContributionsfalseNondeductibleContributionsInd
Quid Pro Quo ContributionsfalseQuidProQuoContributionsInd
Form8282 Property Disposed OfYes (true)Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft CntrctfalseRcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft CntrctfalsePayPremiumsPrsnlBnftCntrctInd
Indoor Tanning ServicesfalseIndoorTanningServicesInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members5GoverningBodyVotingMembersCnt
Independent Voting Member2IndependentVotingMemberCnt
Family Or Business RlnfalseFamilyOrBusinessRlnInd
Delegation Of Mgmt DutiesfalseDelegationOfMgmtDutiesInd
Change To Org DocumentsfalseChangeToOrgDocumentsInd
Material Diversion Or MisusefalseMaterialDiversionOrMisuseInd
Members Or StockholdersYes (true)MembersOrStockholdersInd
Election Of Board MembersYes (true)ElectionOfBoardMembersInd
Decisions Subject To ApprovaYes (true)DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (true)MinutesOfGoverningBodyInd
Minutes Of CommitteesfalseMinutesOfCommitteesInd
Officer Mailing AddressfalseOfficerMailingAddressInd
Local ChaptersfalseLocalChaptersInd
Form990 Provided To Gvrn BodyYes (true)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (true)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (true)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (true)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (true)WhistleblowerPolicyInd
Document Retention PolicyYes (true)DocumentRetentionPolicyInd
Compensation Process CEOfalseCompensationProcessCEOInd
Compensation Process OtherfalseCompensationProcessOtherInd
Investment In Joint VenturefalseInvestmentInJointVentureInd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1Anna MatejaBusinessNameLine1Txt
FieldValueIRS element (for citing)
Phone8328281020PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line11919 S Braeswood BlvdAddressLine1Txt
CityHoustonCityNm
State AbbreviationTXStateAbbreviationCd
ZIP77030ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (16 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtHighest Compensated EmployeeHighestCompensatedEmployeeInd
Michael A Belfort MD PhD
Board Member / Secretary1.03.0Yes (X)Yes (X)$0$37,790$0
Angelo P Giardino MD PHD
Board Member / Chairman / Chief Medical Officer1.039.0Yes (X)Yes (X)$0$593,925$105,249
Lisa Hollier
Board Member / Medical Director for Obstetrics and Gynecology1.01.0Yes (X)Yes (X)$0$0$0
Mark W Kline MD
Board Member / Vice Chairman1.04.0Yes (X)Yes (X)$0$40,122$0
Heidi Schwarzwald
Board Member / Pediatric Medical Director1.01.0Yes (X)Yes (X)$0$0$0
Lucio Fragoso
Schedule O1.039.0Yes (X)$0$371,184$79,394
Aisha Jamal
Schedule O1.039.0Yes (X)$0$150,982$23,582
Anna Mateja
Chief Financial Officer1.039.0Yes (X)$0$381,856$121,273
Dace Reinholds
Schedule O1.039.0Yes (X)$0$124,894$15,111
Tangula Taylor
Director of Business Development and Community Initiatives40.00.0Yes (X)$218,973$0$39,600
Randy Wright
Schedule O1.039.0Yes (X)$0$203,983$3,576
Toronda Baker
Education Coordinator - TCHP/TCHPC40.00$109,483$0$19,536Yes (X)
Kristine Barton
Director of Business development / strategic planning40.00$133,845$0$24,486Yes (X)
Sydnee Lucas
NURSE PRACTITIONER40.00$103,885$0$14,891Yes (X)
Ijeoma Opara
Nurse Practitioner40.00$106,545$0$12,978Yes (X)
Victoria Taiwo
Nurse Practitioner40.00$102,449$0$14,139Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$775,180TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$1,904,736TotReportableCompRltdOrgAmt
Total Other Compensation$473,815TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K6IndivRcvdGreaterThan100KCnt
Former Ofcr Employees ListedfalseFormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (true)TotalCompGreaterThan150KInd
Compensation From Other SrcsfalseCompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmtAddress Line2ContractorAddress/USAddress/AddressLine2Txt
THE UNIVERSITY OF TEXAS HEALTH SCIENCE CENTER AT HOUSTON
PO BOX 301365DALLASTX753031365STAFFING SERVICES$470,871
PHYSICIAN RESOURCES INC
1818 MEMORIAL DRIVEHOUSTONTX77007PHYSICIAN STAFFING$152,031200
STRATUS VIDEO LLC
PO BOX 674954DETROITMI482674954INTERPRETING SERVICES$118,760
OMNINET SWCC LP
9420 Wilshire Boulevard 4th FloorBEVERLY HILLSCA90212PROPERTY MANAGEMENT$110,586
LANGUAGE LINE SERVICES INC
1 LOWER RAGSDALE DRIVE BUILDING 2MONTEREYCA93940INTERPRETING SERVICES$108,262
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K5CntrctRcvdGreaterThan100KCnt
Government Grants$609,923GovernmentGrantsAmt
All Other Contributions$11,451AllOtherContributionsAmt
Total Contributions$621,374TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (4 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
PREMIUM REVENUE900099$120,218,471$120,218,471
NET PATIENT SERVICE REVENUE622310$529,904$529,904
PROGRAM SERVICE RENTAL900099$185,019$185,019
CMS Incentives900099$49,726$49,726

Total Oth Program Service Rev TotalOthProgramServiceRevGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt
Related Or Exempt Func Income$0RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$0ExclusionAmt
FieldValueIRS element (for citing)
Total Program Service Revenue$120,983,120TotalProgramServiceRevenueAmt

Rental Income Or Loss RentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Real$0RealAmt
Personal$0PersonalAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Securities$0SecuritiesAmt
Other$0OtherAmt

Other Revenue Misc OtherRevenueMiscGrp

FieldValueIRS element (for citing)
DescNon-patient revenueDesc
Business900099BusinessCd
Total Revenue Column$74,743TotalRevenueColumnAmt
Exclusion$74,743ExclusionAmt

Miscellaneous Revenue MiscellaneousRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt
Related Or Exempt Func Income$0RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$0ExclusionAmt
FieldValueIRS element (for citing)
Other Revenue Total$74,743OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$121,679,237TotalRevenueColumnAmt
Related Or Exempt Func Income$120,983,120RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$74,743ExclusionAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$258,573TotalAmt
Management And General$258,573ManagementAndGeneralAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$9,362,090TotalAmt
Program Services$8,779,549ProgramServicesAmt
Management And General$582,541ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$495,426TotalAmt
Program Services$187,751ProgramServicesAmt
Management And General$307,675ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$1,464,210TotalAmt
Program Services$1,391,954ProgramServicesAmt
Management And General$72,256ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$756,575TotalAmt
Program Services$691,806ProgramServicesAmt
Management And General$64,769ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$10,522,513TotalAmt
Program Services$10,488,360ProgramServicesAmt
Management And General$34,153ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$276TotalAmt
Program Services$269ProgramServicesAmt
Management And General$7ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$129,931TotalAmt
Program Services$125,244ProgramServicesAmt
Management And General$4,687ManagementAndGeneralAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$1,767,529TotalAmt
Program Services$1,629,313ProgramServicesAmt
Management And General$138,216ManagementAndGeneralAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$6,586TotalAmt
Program Services$4,199ProgramServicesAmt
Management And General$2,387ManagementAndGeneralAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$15,949TotalAmt
Program Services$15,275ProgramServicesAmt
Management And General$674ManagementAndGeneralAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$2,198,889TotalAmt
Program Services$1,838,081ProgramServicesAmt
Management And General$360,808ManagementAndGeneralAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$324,717TotalAmt
Program Services$320,638ProgramServicesAmt
Management And General$4,079ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
MEDICAL EXPENSE PER PROVIDER AGREEMENT$87,160,775$87,160,775
VENDED SERVICES FROM TCH$3,551,973$3,312,365$239,608
MEDICAL SUPPLIES$2,318,977$2,318,977
VENDED SERVICES FROM TCHP$1,271,499$1,271,499

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$72,749TotalAmt
Program Services$63,461ProgramServicesAmt
Management And General$9,288ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$121,679,237TotalAmt
Program Services$118,328,017ProgramServicesAmt
Management And General$3,351,220ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$12,588,445BOYAmt
EOY$13,881,329EOYAmt

Receivables From Officers Etc ReceivablesFromOfficersEtcGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp

FieldValueIRS element (for citing)
EOY$0EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$129,833BOYAmt
EOY$143,296EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$26,519,132LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$13,561,743LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$15,164,321BOYAmt
EOY$12,957,389EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt

Investments Program Related InvestmentsProgramRelatedGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$7,536,876BOYAmt
EOY$9,198,930EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$35,419,475BOYAmt
EOY$36,180,944EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$3,157,468BOYAmt
EOY$4,583,653EOYAmt

Deferred Revenue DeferredRevenueGrp

FieldValueIRS element (for citing)
BOY$44,378BOYAmt
EOY$49,613EOYAmt

Loans From Officers Directors LoansFromOfficersDirectorsGrp

FieldValueIRS element (for citing)
EOY$0EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$5,729,337BOYAmt
EOY$5,059,386EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$8,931,183BOYAmt
EOY$9,692,652EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY$26,488,292BOYAmt
EOY$26,488,292EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$26,488,292BOYAmt
EOY$26,488,292EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$35,419,475BOYAmt
EOY$36,180,944EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss$0ReconcilationRevenueExpnssAmt
Other Changes In Net Assets$0OtherChangesInNetAssetsAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or ReviewfalseAccountantCompileOrReviewInd
FS AuditedYes (true)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Separate Basis Fincl StmtYes (X)SeparateBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (true)AuditCommitteeInd
Federal Grant Audit RequiredfalseFederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Supporting Organization509a3Yes (X)SupportingOrganization509a3Ind
Supporting Org Type1Yes (X)SupportingOrgType1Ind
IRS Written DeterminationYes (X)IRSWrittenDeterminationInd
Supported Organizations1SupportedOrganizationsCnt

Supported Org Information SupportedOrgInformationGrp

Supported Organization Name SupportedOrganizationName

FieldValueIRS element (for citing)
Business Name Line1TEXAS CHILDREN'S HEALTH PLANBusinessNameLine1Txt
FieldValueIRS element (for citing)
EIN760486264EIN
Organization Type9OrganizationTypeCd
Governing Document ListedYes (true)GoverningDocumentListedInd
Support$118,328,017SupportAmt
Other Support$0OtherSupportAmt
FieldValueIRS element (for citing)
Supported Organizations Total1SupportedOrganizationsTotalCnt
Support Sum$118,328,017SupportSumAmt
Other Support Sum$0OtherSupportSumAmt

Form990 Sch A Supporting Org Form990SchASupportingOrgGrp

FieldValueIRS element (for citing)
Listed By Name Governing DocYes (true)ListedByNameGoverningDocInd
Suprt Org No IRS DeterminationfalseSuprtOrgNoIRSDeterminationInd
Supported Org Section C456falseSupportedOrgSectionC456Ind
Supported Org Not Organized USfalseSupportedOrgNotOrganizedUSInd
Organization Change Suprt OrgfalseOrganizationChangeSuprtOrgInd
Support Non Supported OrgfalseSupportNonSupportedOrgInd
Payment Substantial ContribtrfalsePaymentSubstantialContribtrInd
Loan Disqualified PersonfalseLoanDisqualifiedPersonInd
Controlled Disqualified PrsnfalseControlledDisqualifiedPrsnInd
Disqualified Prsn Controll IntfalseDisqualifiedPrsnControllIntInd
Disqualified Prsn Ownr IntfalseDisqualifiedPrsnOwnrIntInd
Excess Business Holdings RulesfalseExcessBusinessHoldingsRulesInd
Contribution ControllerfalseContributionControllerInd
Contribution FamilyfalseContributionFamilyInd
Contribution35 ControlledfalseContribution35ControlledInd

Form990 Sch A Type1 Suprt Org Form990SchAType1SuprtOrgGrp

FieldValueIRS element (for citing)
Power Appoint Majority Dir TrstYes (true)PowerAppointMajorityDirTrstInd
Operate Benefit Non Suprt OrgfalseOperateBenefitNonSuprtOrgInd

Schedule B IRS990ScheduleB

Schedule D IRS990ScheduleD

Leasehold Improvements LeaseholdImprovementsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$18,508,910OtherCostOrOtherBasisAmt
Depreciation$6,568,428DepreciationAmt
Book Value$11,940,482BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$8,010,222OtherCostOrOtherBasisAmt
Depreciation$6,993,315DepreciationAmt
Book Value$1,016,907BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$12,957,389TotalBookValueLandBuildingsAmt

Other Assets Org OtherAssetsOrgGrp (2 entries)

DescDescBook ValueBookValueAmt
MISCELLANEOUS RECEIVABLE$9,198,930
DUE FROM AFFILIATES
FieldValueIRS element (for citing)
Total Book Value Other Assets$9,198,930TotalBookValueOtherAssetsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)

DescDescAmtAmt
DEFERRED RENT$4,300,176
DUE TO AFFILIATES$759,210
FieldValueIRS element (for citing)
Total Liability$5,059,386TotalLiabilityAmt
Footnote TextYes (X)FootnoteTextInd
Total Rev Etc Audited Fincl Stmt$121,679,237TotalRevEtcAuditedFinclStmtAmt
Other Revenue$0OtherRevenueAmt
Revenue Not Reported$0RevenueNotReportedAmt
Revenue Subtotal$121,679,237RevenueSubtotalAmt
Other Revenues Not Included$0OtherRevenuesNotIncludedAmt
Revenue Not Reported Fincl Stmt$0RevenueNotReportedFinclStmtAmt
Total Revenue Per Form990$121,679,237TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt$121,679,237TotExpnsEtcAuditedFinclStmtAmt
Other Expenses Included$0OtherExpensesIncludedAmt
Expenses Not Reported$0ExpensesNotReportedAmt
Expenses Subtotal$121,679,237ExpensesSubtotalAmt
Other Expenses Not Included$0OtherExpensesNotIncludedAmt
Expenses Not Rpt Fincl Stmt$0ExpensesNotRptFinclStmtAmt
Total Expenses Per Form990$121,679,237TotalExpensesPerForm990Amt

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceSchedule D, Part X, Line 2 FIN 48 (ASC 740) footnoteFormAndLineReferenceDesc
ExplanationMANAGEMENT ANNUALLY REVIEWS ITS TAX POSITIONS AND HAS DETERMINED THAT THERE ARE NO MATERIAL UNCERTAIN TAX POSITIONS THAT REQUIRE RECOGNITION ON THE ACCOMPANYING BALANCE SHEETS AS OF DECEMBER 31, 2017 OR 2016.ExplanationTxt

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Severance PaymentfalseSeverancePaymentInd
Supplemental Nonqual Rtr PlanYes (true)SupplementalNonqualRtrPlanInd
Equity Based Comp ArrngmfalseEquityBasedCompArrngmInd
Comp Based On Revenue Of Flng OrgfalseCompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related OrgsfalseCompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng OrgfalseCompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd OrgsfalseCompBsdNetEarnsRltdOrgsInd
Any Non Fixed PaymentsfalseAnyNonFixedPaymentsInd
Initial Contract ExceptionfalseInitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (7 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Filing OrganizationBonusFilingOrganizationAmountBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Filing OrgOtherCompensationFilingOrgAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtComp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmtComp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
Angelo P Giardino MD PHD
Board Member / Chairman / Chief Medical Officer$0$481,709$0$33,075$0$79,141$0$92,350$0$12,899$0$699,174$0$57,233
Lucio Fragoso
Schedule O$0$331,547$0$19,600$0$20,037$0$66,900$0$12,494$0$450,578$0$0
Aisha Jamal
Schedule O$0$147,677$0$2,225$0$1,080$0$11,140$0$12,442$0$174,564$0$0
Anna Mateja
Chief Financial Officer$0$306,573$0$14,225$0$61,058$0$105,255$0$16,018$0$503,129$0$41,562
Tangula Taylor
Director of Business Development and Community Initiatives$208,698$0$9,275$0$1,000$0$16,009$0$23,591$0$258,573$0$0$0
Randy Wright
Schedule O$0$116,001$0$0$0$87,982$0$2,596$0$980$0$207,559$0$0
Kristine Barton
Director of Business development / strategic planning$132,272$0$1,416$0$157$0$5,330$0$19,156$0$158,331$0$0$0

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Schedule J, Part I, Line 3 Arrangement used to establish the top management official's compensationCOMPENSATION FOR THE ORGANIZATION'S TOP MANAGEMENT OFFICIAL IS ESTABLISHED BY TEXAS CHILDREN'S AND TEXAS CHILDREN'S HOSPITAL, USING THE FOLLOWING METHODS: *COMPENSATION COMMITTEE *INDEPENDENT COMPENSATION CONSULTANT *COMPENSATION SURVEY OR STUDY *APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE
Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan457 (F) PLAN: PAID/DEFERRED LUCIO FRAGOSO 19,600 / 51,000 ANGELO P. GIARDINO, MD, PHD 90,308 / 71,000 ANNA MATEJA 55,787 / 83,905 RANDY WRIGHT 77,544 / 0 TANGULA TAYLOR 9,275 / 0 DIRECTOR INCENTIVE PLAN: PAID/DEFERRED AISHA JAMAL 2,225 / 0 457(F): THE 457(F) PLAN IS A NON-QUALIFIED DEFERRED COMPENSATION PLAN THAT ALLOWS ELIGIBLE EXECUTIVES, FROM THE ASSISTANT VICE PRESIDENT LEVEL TO CHIEF EXECUTIVE OFFICER, TO RECEIVE SUPPLEMENT EXECUTIVE RETIREMENT INCOME. FUNDS MAY BE CREDITED INTO THIS ACCOUNT FROM AN EMPLOYER CONTRIBUTION, CALCULATED BASED ON AN INDIVIDUAL'S TITLE AND BASE SALARY AS OF JANUARY 1. THESE EMPLOYER FUNDED CONTRIBUTIONS VEST THE EARLIER OF FIVE YEARS, OR THE ATTAINMENT OF AGE 60 AND 75-POINTS DETERMINED AS OF THEIR AGE AND YEARS OF SERVICE. THE 457(F) PLAN ALSO CONTAINS RESIDUAL LONG-TERM INCENTIVE PLAN CONTRIBUTIONS AND CAPITAL ACUMULATION CONTRIBUTIONS FROM A FLEXILBE BENEFIT ACCOUNT SURPLUS. THE LONG-TERM INCENTIVE CONTRIBUTIONS VEST AFTER THREE YEARS AND THE CAPITAL ACCUMULATION CONRIBUTIONS VEST AFTER 5 YEARS IN THE PLAN. DIRECTOR INCENTIVE PLAN: THE DIRECTOR INCENTIVE PLAN IS AN ANNUAL INCENTIVE PLAN IN WHICH ELIGIBLE DIRECTORS PARTICIPATE. THE PLAN SHARES GOALS WITH THE EXECUTIVE ANNUAL INCENTIVE PLAN, FOCUSING ON FACTORS SUCH AS FINANCIAL PERFORMANCE, QUALITY GOALS, AND PATIENT SATISFACTION. IN ADDITION, THERE ARE INDIVIDUAL COMPONENTS FOR EACH DIRECTOR WHICH VARY DEPENDING ON THE EXPECTED OUTCOMES FOR THAT AREA AND/OR YEAR.

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (10 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Form 990, Part VI, Line 6 Classes of members or stockholdersTEXAS CHILDREN'S HEALTH PLAN IS THE SOLE CORPORATE MEMBER OF TEXAS CHILDREN'S HEALTH PLAN - THE CENTER.
Form 990, Part VI, Line 7a Members or stockholders electing members of governing bodyTEXAS CHILDREN'S HEALTH PLAN, AS THE SOLE MEMBER CORPORATION, HAS THE AUTHORITY TO ELECT THE BOARD OF DIRECTORS OF THE ORGANIZATION.
Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholdersPER THE ORGANIZATION'S BYLAWS THE MEMBER HAS CERTAIN RESERVED POWERS: -APPROVE, INTERPRET OR CHANGE THE PURPOSE OF THE CORPORATION. -FIX THE NUMBER OF DIRECTORS AND APPOINT OR REMOVE, WITH OR WITHOUT CAUSE, ANY DIRECTOR OF THE CORPORATION. -APPROVE THE MERGER, DISSOLUTION OR CONSOLIDATION, OR REORGANIZATION OF THE CORPORATION. -APPROVE THE ACQUISITION, SALE, LEASE, TRANSFER OR OTHER ALIENATION OF PROPERTY OF THE CORPORATION, OTHER THAN IN THE USUAL AND REGULAR COURSE OF THE CORPORATION'S BUSINESS, WHEN SUCH ACQUISITION, SALE, LEASE, TRANSFER OR OTHER ALIENATION IS ABOVE SPECIFIED FINANCIAL LEVELS SET IN ACCORDANCE WITH POLICIES ESTABLISHED FROM TIME TO TIME BY THE MEMBER. -APPROVE CAPITAL AND OPERATING BUDGETS OF THE CORPORATION. -ADOPTION OR AMENDMENT OF SALARIES OR OTHER COMPENSATION (INCLUDING THE AWARDING OF ANY INCENTIVE COMPENSATION) OF THE OFFICERS OF THE CORPORATION, PHYSICIAN EMPLOYEES OF THE CORPORATION, IF ANY, AND PHYSICIANS WHO ARE INDEPENDENT CONTRACTORS TO THE CORPORATION, IF ANY. -APPROVE DEBT INCURRED BY THE CORPORATION, WHICH IS IN EXCESS OF SUCH LIMITS AS ARE ESTABLISHED BY THE MEMBER. -APPROVE THE DISPOSITION OF ASSETS OF THE CORPORATION AT THE TIME OF ITS DISSOLUTION. -APPROVE ANY LONG-RANGE FINANCIAL AND STRATEGIC PLANS FOR THE CORPORATION. -SELECTION OF THE CORPORATION'S AUDITORS AND LEGAL COUNSEL. -CREATION OR SALE OF ANY SUBSIDIARIES OF THE CORPORATION. -ANY AFFILIATION, JOINT VENTURE, CONTRACT, EMPLOYMENT, RETENTION, INDEMNIFICATION, OR OTHER ARRANGEMENTS BETWEEN THE CORPORATION AND ANY INSURER, HEALTH MAINTENANCE ORGANIZATION, PREFERRED PROVIDER ORGANIZATION, MEDICAL SCHOOL, HOSPITAL, CLINIC, PHARMACY, PHYSICIAN, TEXAS CHILDREN'S HEALTH PLAN AFFILIATE, OR OTHER PROVIDER OF HEALTH OR RELATED SERVICES, INCLUDING, WITHOUT LIMITATION, ALL SERVICE TERMS AND COMPENSATION ARRANGEMENTS. -ESTABLISHMENT BY THE CORPORATION OF ANY TRAINING OR RESIDENCY PROGRAM. -THE GIVING, SEEKING, OR RECEIVING OF GRANTS. -ADOPTION OR AMENDMENT OF ANY INDEMNIFICATION RIGHTS, OBLIGATIONS, OR AGREEMENTS AFFECTING THE CORPORATION. -PURCHASE, ADOPTION, AMENDMENT, CANCELLATION, OR REPLACEMENT OF ANY INSURANCE COVERAGE FOR THE CORPORATION OR ITS DIRECTORS, OFFICERS AND AGENTS, AS WELL AS COPIES OF ANY NOTICES OF CANCELLATION RECEIVED BY THE CORPORATION. -THE COMMENCEMENT OF LITIGATION OR THE SETTLEMENT OF LITIGATION OR OTHER CLAIMS. -APPROVAL OF THE ADOPTION OR AMENDMENT OF FEE SCHEDULES RELATING TO PATIENT SERVICES. -DESIGNATION OF ADDITIONAL OR SUCCESSOR MEMBER(S). -TAKE ANY ACTION WHICH WOULD BE CONSISTENT WITH THE GOVERNING DOCUMENTS OR POLICIES OF THE MEMBER.
Form 990, Part VI, Line 8b Documentation of meetings held by committees of governing bodyNO SUCH COMMITTEES EXIST.
Form 990, Part VI, Line 11b Review of form 990 by governing bodyPER A RESOLUTION APPROVED BY THE MEMBER'S BOARD OF TRUSTEES, THE MEMBER BOARD'S AUDIT & COMPLIANCE COMMITTEE HAS DELEGATED AUTHORITY TO REVIEW THE ORGANIZATION'S COMPLETED FORM 990 PRIOR TO FILING. FOLLOWING THE COMMITTEE'S REVEW, THE COMPLETED FORM 990 IS DISTRIBUTED TO THE MEMBERS OF THE ORGANIZATION'S BOARD OF DIRECTORS PRIOR TO FILING WITH THE IRS.
Form 990, Part VI, Line 12c Conflict of interest policyTHE ORGANIZATION CONSISTENTLY MONITORS AND ENFORCES THE CONFLICT OF INTEREST POLICY THROUGH TWO SEPARATE PROCESSES, ONE THAT APPLIES TO THE BOARD MEMBERS, AND A SECOND THAT APPLIES TO OFFICERS AND KEY EMPLOYEES. 1) BOARD MEMBERS: PER THE ORGANIZATION'S BOARD-APPROVED CONFLICTS REVIEW PROCESS, RESPONSES TO THE ANNUAL CONFLICTS QUESTIONNAIRE ARE REVIEWED BY THE MEMBER'S BOARD LEADERSHIP AND PRESENTED TO THE MEMBER'S AUDIT & COMPLIANCE COMMITTEE. IF THE COMMITTEE DEEMS THERE ARE ANY SIGNIFICANT ISSUES, THE RESPONSES ARE THEN REVIEWED BY THE MEMBER BOARD'S EXECUTIVE COMMITTEE AND ANY REQUIRED ACTION (RECUSEMENT FROM BOARD DELIBERATIONS RELATED TO THE CONFLICT, ETC.) IS TAKEN IN ACCORDANCE WITH THE ORGANIZATION'S BOARD-APPROVED CODE OF CONDUCT. 2) OFFICERS / KEY EMPLOYEES: PER THE ORGANIZATION'S BOARD APPROVED CONFLICTS REVIEW PROCESS, RESPONSES TO THE ANNUAL CONFLICTS QUESTIONNAIRE ARE REVIEWED BY THE COMPLIANCE SERVICES DEPARTMENT. IF THE DEPARTMENT DEEMS THERE ARE ANY SIGNIFICANT ISSUES, REQUIRED ACTION IS TAKEN IN ACCORDANCE WITH THE ORGANIZATION'S BOARD-APPROVED CODE OF CONDUCT AND THE BOARD IS NOTIFIED OF SUCH ACTIONS.
Form 990, Part VI, Line 19 Required documents available to the publicTHE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE MADE AVAILABLE UPON REQUEST.
Form 990, Part VII, Section A INCENTIVE COMPENSATIONDRS. BELFORT AND KLINE, WHILE EMPLOYED BY BAYLOR COLLEGE OF MEDICINE, SERVE AS IN-CHIEFS DIRECTING PATIENT CARE AT TEXAS CHILDREN'S HOSPITAL. DUE TO THEIR SENIOR LEADERSHIP ROLES, THEY ARE ELIGIBLE FOR INCENTIVE COMPENSATION BASED ON THEIR CONTRIBUTIONS TO ACHIEVING THE ORGANIZATION'S STRATEGIC GOALS. ALL COMPENSATION IS EARNED IN THEIR CAPACITY AS PHYSICIAN LEADERS.
Form 990, Part VII, Section A TITLESLUCIO FRAGOSO: PRESIDENT STARTING 3/1/17 AISHA JAMAL: ASSISTANT SECRETARY STARTING 6/1/17 DACE REINHOLDS: ASSISTANT SECRETARY THROUGH 6/1/17 RANDY WRIGHT: PRESIDENT THROUGH 3/1/17
SCHEDULE O FORM 5471 DISCLOSURE STATEMENTUNDER THE CONSTRUCTIVE OWNERSHIP RULES OF IRC SECTIONS 958(A) AND (B), THE TAXPAYER IS REQUIRED TO FILE FORMS 5471, INFORMATION RETURN OF U.S. PERSONS WITH RESPECT TO CERTAIN FOREIGN CORPORATIONS, AS A CATEGORY 5 FILER WITH RESPECT TO CERTAIN CONTROLLED FOREIGN CORPORATIONS (CFCS). THESE FILING REQUIREMENTS ARE OR WILL BE SATISFIED THROUGH THE FILING OF FORMS 5471 FOR THESE CFCS BY OTHER U.S. TAXPAYERS IDENTIFIED BELOW WHO HAVE THE SAME FILING REQUIREMENT: -TEXAS CHILDREN'S HOSPITAL FOUNDATION EIN:20-2380599 6621 FANNIN ST HOUSTON, TX 77030 -TEXAS CHILDREN'S EIN: 76-0461578 1919 S. BRAESWOOD BLVD, 4TH FL HOUSTON, TX 77030

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (9 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtPublic Charity StatusPublicCharityStatusTxtBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtControlled OrganizationControlledOrganizationIndAddress Line2USAddress/AddressLine2Txt
TEXAS CHILDREN'S
1919 S BRAESWOOD BLVD 4TH FLOORHOUSTONTX77030760461578PARENTTX501(c)(3)Type IINAfalse
TEXAS CHILDREN'S PHYSICIAN GROUP
6621 FANNIN STREETHOUSTONTX77030260834681HEALTH CARETX501(c)(3)10TEXAS CHILDREN'Sfalse
TEXAS CHILDREN'S WOMEN'S SPECIALISTS
PO BOX 300630HOUSTONTX77230261482195HEALTH CARETX501(c)(3)Type IITEXAS CHILDREN'Sfalse
TEXAS CHILDREN'S HOSPITAL
6621 FANNIN STREETHOUSTONTX77030741100555HOSPITALTX501(c)(3)3TEXAS CHILDREN'Sfalse
TEXAS CHILDREN'S HOSPITAL FOUNDATION
6621 FANNIN STREETHOUSTONTX77030202380599SUPPORTING ORGTX501(c)(3)Type IITEXAS CHILDREN'Sfalse
TCH PEDIATRIC ASSOCIATES INC
PO BOX 300630HOUSTONTX77230760460242HEALTH CARETX501(c)(3)10TEXAS CHILDREN'Sfalse
TEXAS CHILDREN'S HEALTH PLAN
6330 WEST LOOP SOUTH SUITE 800HOUSTONTX77401760486264HEALTH CARETX501(c)(3)10TEXAS CHILDREN'Sfalse8TH FLOOR
TEXAS CHILDREN'S URGENT CARE
1919 S BRAESWOOD BLVD 4TH FLOORHOUSTONTX77030472029489HEALTH CARETX501(c)(3)10TCH PEDIATRIC ASSOCIATES INCfalse
THE GORDON AND MARY CAIN PEDIATRIC NEUROLOGY RESEARCH FOUNDATION
9 GREENWAY PLAZAHOUSTONTX77046760246858SUPPORTING ORGTX501(c)(3)Type ITEXAS CHILDREN'S HOSPITALfalse

Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp

Related Organization Name RelatedOrganizationName

FieldValueIRS element (for citing)
Business Name Line1CORDILLERA PRIMARY WAVE CO-INVESTMENT FUND LPBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line13000 SAND HILL RDAddressLine1Txt
Address Line2BLDG 3 STE 100AddressLine2Txt
CityMENLO PARKCityNm
State AbbreviationCAStateAbbreviationCd
ZIP94025ZIPCd
FieldValueIRS element (for citing)
EIN821568240EIN
Primary ActivitiesINVESTMENTPrimaryActivitiesTxt
Legal Domicile StateCALegalDomicileStateCd

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1NABusinessNameLine1Txt
FieldValueIRS element (for citing)
Predominant Income TypeN/APredominantIncomeTypeTxt

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (2 entries)

Address Line1ForeignAddress/AddressLine1TxtProvince Or StateForeignAddress/ProvinceOrStateNmCountryForeignAddress/CountryCdForeign PostalForeignAddress/ForeignPostalCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile Foreign CountryLegalDomicileForeignCountryCdBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtEntity TypeEntityTypeTxtControlled OrganizationControlledOrganizationInd
TCH INSURANCE COMPANY LTD
23 LIME BAY AVENUEGRAND CAYMANCJKY11102980176652INSURANCECJNAC Corporationfalse
CVI GVF HOLDINGS 3 LTD
981078282INVESTMENTCJNAC Corporationfalse
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts RyltsfalseReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth OrgfalseGiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth OrgfalseGiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth OrgfalseLoansOrGuaranteesFromOthOrgInd
Div Related OrganizationfalseDivRelatedOrganizationInd
Asset Sale To Other OrgfalseAssetSaleToOtherOrgInd
Asset Purchase From Other OrgfalseAssetPurchaseFromOtherOrgInd
Asset ExchangefalseAssetExchangeInd
Rental Of Facilities To Oth OrgfalseRentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth OrgfalseRentalOfFcltsFromOthOrgInd
Perform Of Services For Oth OrgfalsePerformOfServicesForOthOrgInd
Perform Of Services By Other OrgYes (true)PerformOfServicesByOtherOrgInd
Sharing Of FacilitiesfalseSharingOfFacilitiesInd
Paid Employees SharingfalsePaidEmployeesSharingInd
Reimbursement Paid To Other OrgfalseReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other OrgfalseReimbursementPaidByOtherOrgInd
Transfer To Other OrgYes (true)TransferToOtherOrgInd
Transfer From Other OrgfalseTransferFromOtherOrgInd

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