2018-08-14T15:05:03-05:00 2017-09-30 BKD LLP 2700 Post Oak Blvd Ste 1500 HOUSTON TX 77056 990 2016-10-01 752705881 COOK CHILDREN'S HEALTH CARE SYSTEM % CORY RHOADES COOK 6828854000 801 SEVENTH AVENUE FORT WORTH TX 76104 CORY RHOADES SENIOR V.P. 2018-02-15 true Amanda Maya P01067777 7134994600 2016 2022-09-23 18:48:47Z RICK W MERRILL 801 SEVENTH AVE FORT WORTH TX 76104 306994829 false X WWW.COOKCHILDRENS.ORG X 1996 TX KNOWING THAT EVERY CHILD'S LIFE IS SACRED IT IS OUR PROMISE TO IMPROVE THE HEALTH OF EVERY CHILD IN OUR REGION THROUGH THE PREVENTION AND TREATMENT OF ILLNESS, DISEASE AND INJURY. 22 14 737 24 0 0 2273667 2472065 156657970 166641182 3363833 4113563 3954678 4594607 166250148 177821417 600700 158200 0 0 48795453 42950507 0 0 0 98909526 126440507 148305679 169549214 17944469 8272203 334995116 346897985 48642797 53286182 286352319 293611803 X KNOWING THAT EVERY CHILD'S LIFE IS SACRED, OUR PROMISE IS TO IMPROVE THE HEALTH OF EVERY CHILD IN OUR REGION THROUGH THE PREVENTION AND TREATMENT OF ILLNESS, DISEASE AND INJURY. false false 145447636 158200 171235789 COOK CHILDREN'S HEALTH CARE SYSTEM IS ONE OF THE COUNTRY'S LEADING VERTICALLY INTEGRATED PEDIATRIC HEALTH CARE ORGANIZATIONS. COOK CHILDREN'S REPRESENTS AN AWARD-WINNING, NOT-FOR-PROFIT SYSTEM OF SEAMLESS HEALTH CARE DESIGNED TO FULFILL OUR PROMISE; "KNOWING THAT EVERY CHILD'S LIFE IS SACRED, IT IS THE PROMISE OF COOK CHILDREN'S TO IMPROVE THE HEALTH OF EVERY CHILD IN OUR REGION THROUGH THE PREVENTION AND TREATMENT OF ILLNESS, DISEASE AND INJURY." COOK CHILDREN'S HEALTH CARE SYSTEM IS COMPRISED OF EIGHT ENTITIES- A MEDICAL CENTER, PHYSICIAN NETWORK, HOME HEALTH COMPANY, NORTHEAST HOSPITAL, PEDIATRIC SURGERY CENTER, HEALTH PLAN, HEALTH SERVICES, INC. AND HEALTH FOUNDATION. BASED IN FORT WORTH, TEXAS, COOK CHILDREN'S PRIMARY SERVICE REGION INCLUDES DENTON, HOOD, JOHNSON, PARKER, TARRANT AND WISE COUNTIES, WITH AN ADDITIONAL REFERRAL AREA ENCOMPASSING APPROXIMATELY HALF OF THE STATE. THE INTEGRATED SYSTEM HAS MANY PRIMARY, SPECIALTY AND URGENT CARE OFFICES THROUGHOUT TEXAS AND HAS SERVED HUNDREDS OF INTERNATIONAL PATIENTS, AS WELL AS THOSE FROM ALL 50 STATES. COOK CHILDREN'S SUSTAINABLE HERITAGE DATES BACK TO 1918. SINCE THEN, IT HAS BEEN ESTABLISHED AS A LEADER IN PEDIATRIC HEALTH CARE BY FOSTERING CONTINUAL CHANGE AND ROBUST GROWTH WHILE ALWAYS EMBRACING THE ABIDING PROMISE THAT ALL OF OUR EMPLOYEES COMMIT TO EVERY DAY. COOK CHILDREN'S LIVES UP TO ITS PROMISE BY COMBINING THE ART OF CARING WITH INTEGRITY-LED, INTERDISCIPLINARY COLLABORATION, A COMMITMENT TO EVIDENCE-BASED PRACTICE, THE HIGHEST LEVELS OF SAFETY AND SECURITY, LEADING CLINICAL RESEARCH, STATE-OF-THE-ART TECHNOLOGY, EFFECTIVE FINANCIAL STEWARDSHIP AND THE RE-INVESTMENT OF HUNDREDS OF MILLIONS OF DOLLARS IN COMMUNITY BENEFITS. THE COMMITMENT AND EXPERTISE OF THE SYSTEM'S TRUSTEES, PHYSICIANS AND STAFF, COMBINED WITH COOK CHILDREN'S VAST RESOURCES, ENABLE THIS INSTITUTION TO BE RECOGNIZED AS SUSTAINABLE AND AMONG THE BEST FOR POSITIVE CLINICAL OUTCOMES. AS SUCH, RATING AGENCIES HAVE CITED COOK CHILDREN'S MARKET LEADERSHIP IN TARRANT COUNTY FOR ITS SUCCESSFUL EXPANSION EFFORTS, ROBUST GROWTH IN REVENUE AND LIQUIDITY AND STELLAR OPERATING MARGINS. AT COOK CHILDREN'S, IT'S NOT JUST ABOUT THE BOTTOM LINE. IT'S ABOUT KEEPING OUR PROMISE. AS MUCH AS WE TAKE PRIDE IN THE REWARDS AND RECOGNITION WE RECEIVE FOR OUR WORK, WE MEASURE OUR SUCCESS BY THE IMPROVED HEALTH OF CHILDREN IN OUR REGION. THAT IS WHY OUR TEAM CONTINUES TO WORK COLLABORATIVELY WITH OUR COMMUNITY PARTNERS TO ADDRESS IDENTIFIED PEDIATRIC HEALTH NEEDS IN OUR AREA. 145447636 true true false true false false false false false false true false false false false false false true false false true false false false false false false true true true false false false false false false false false false false false false false true true true false false true X 199 0 true 737 true false true CJ false false false false false false false false X 22 14 true false false false true true true true true false false true true true true true true true true false X CORY RHOADES 6828854480 801 SEVENTH AVENUE FORT WORTH TX 76104 X PETER L PHILPOTT TRUSTEE 1.0 3.0 X 0 0 0 SANDRA ARCA MD TRUSTEE 1.0 41.0 X 0 323379 49396 MATTHEW DZURIK MD TRUSTEE-VICE CHAIR 2.0 42.0 X X 0 442913 36818 BRIAN C CRUMLEY TRUSTEE 1.0 1.0 X 0 0 0 BRIAN D BARNARD TRUSTEE 1.0 3.0 X 0 0 0 G THOMAS BOSWELL TRUSTEE 1.0 1.0 X 0 0 0 JOHN P BOSWELL TRUSTEE 1.0 3.0 X 0 0 0 MATTHEW CARROLL MD TRUSTEE 1.0 40.0 X 0 262892 19256 JERRY R CONATSER TRUSTEE-CHAIRMAN 2.0 3.0 X X 0 0 0 JEFFREY H CONNER TRUSTEE-SECRETARY/TREASURER 2.0 2.0 X X 0 0 0 JULIA DAVIDSON TRUSTEE 1.0 2.0 X 0 0 0 JAMES R DUNAWAY JR TRUSTEE 1.0 1.0 X 0 0 0 GRETCHEN EAMES MD TRUSTEE 1.0 40.0 X 0 367991 21087 W M LAWHON TRUSTEE 1.0 1.0 X 0 0 0 G MALCOLM LOUDEN TRUSTEE 1.0 1.0 X 0 0 0 RYAN T MATTHEWS TRUSTEE 1.0 2.0 X 0 0 0 MATTHEW E MAYFIELD MD TRUSTEE 1.0 41.0 X 0 660077 45592 BONNIE PETSCHE TRUSTEE 1.0 4.0 X 0 0 0 RAY RHODES MD TRUSTEE 1.0 42.0 X 0 368420 43053 JASON V TERK MD TRUSTEE 1.0 40.0 X 0 376284 49582 LINDA THOMPSON MD TRUSTEE 1.0 41.0 X 0 421419 18974 JAMES E WEBB TRUSTEE 1.0 2.0 X 0 0 0 TODD WOLF MD TRUSTEE 1.0 41.0 X 0 490836 53210 JOSE IGLESIAS MD TRUSTEE 1.0 42.0 X 0 1033082 48851 SALEEM MALIK TRUSTEE 1.0 40.0 X 0 504828 54492 MARC MAZADE MD TRUSTEE 1.0 42.0 X 0 344123 53384 JONATHAN NEDRELOW MD TRUSTEE 1.0 0.0 X 0 0 0 LINDSAY NEWTON MD TRUSTEE 1.0 42.0 X 0 202008 38317 BILLIE R PUGH JR MD TRUSTEE 1.0 1.0 X 0 0 0 RICK W MERRILL PRESIDENT AND CEO 16.5 23.5 X 653723 931060 207971 JOANN M SANDERS MD CHIEF QUALITY OFFICER 40.0 0.0 X 541503 0 42385 JAMES C CUNNINGHAM MD EXEC VICE PRESIDENT 40.0 0.0 X 737448 0 43238 JOSE GONZALEZ V PRESIDENT-CHILDREN'S HEALTH 20.0 20.0 X 184861 184861 33686 ROBERT K FEATHER SR V PRESIDENT PUBLIC POLICY 40.0 0.0 X 489208 0 53590 KEITH HOLTZ CHIEF ADMINISTRATION OFFICER 40.0 0.0 X 621282 0 40208 ERIC H HUBLI MD CHIEF SYS EFFECTIVENESS OFFCR 40.0 0.0 X 622184 0 48595 GREGORY K JIMERSON V PRESIDENT-PAYOR RELATIONS 40.0 0.0 X 296815 0 51401 STEPHEN W KIMMEL CFO 10.0 30.0 X 191453 574356 111103 DAVID F LANCASTER VP-INTERNAL AUDIT & COMPLIANCE 40.0 0.0 X 255627 0 41504 SCOTT LEDDY CHIEF MEDICAL INFO OFFICER 40.0 0.0 X 374690 0 40250 JAMES D MARSHALL MD CHIEF RESEARCH OFFICER 40.0 1.0 X 621282 0 52080 CARA MARTZ SECRETARY 35.0 5.0 X 129249 0 21196 JOHN W MCNEY SR V PRESIDENT-GEN COUNSEL 40.0 0.0 X 571040 0 43664 THERESA ZAK MEADOWS SR V PRESIDENT-CIO 40.0 0.0 X 528991 0 52059 GEORGE B MONTAGUE V PRESIDENT-REAL ESTATE 36.0 4.0 X 338122 0 46440 CORY RHOADES SR V PRESIDENT-FINANCE 40.0 0.0 X 402363 0 51859 JAMES R STALDER V PRES-INFO SYSTEMS & CTO 40.0 0.0 X 296743 0 46798 LARRY L TUBB SR V PRESIDENT-PLANNING 40.0 0.0 X 410036 0 40800 NATALIE WILKINS CHIEF OF STAFF 40.0 0.0 X 88452 0 7279 LORRAINEA WILLIAMS PAT/MEDICATION SAFETY OFFCR 40.0 0.0 X 236980 0 45205 MAYNARD DYSON MEDICAL DIRECTOR 40.0 0.0 X 222448 0 41062 JODY HAWKINS DIRECTOR OF INFO SECURITY 40.0 0.0 X 224889 0 31206 JOSEPH GALLAHGER DEPUTY GENERAL COUNSEL 40.0 0.0 X 318183 0 50902 KENT SMITH ASSOCIATE GENERAL COUNSEL 40.0 0.0 X 283533 0 28662 KAREN WARDELL ASSOCIATE GENERAL COUNSEL 40.0 0.0 X 285648 0 40590 COLEMAN D SKINNER V PRESIDENT-REVENUE CYCLE 40.0 0.0 X 156672 0 45723 10083425 7488529 1891468 147 true true false FPI BUILDERS LLC 2116 WENNECA AVE FORT WORTH TX 76102 CONSTRUCTION SERVICE 7066745 TARRANT CONSTRUCTION SVCS 2225 W PETERSMITH ST FT WORTH TX 76102 CONSTRUCTION SERVICE 6670418 EPIC SYSTEMS CORP PO BOX 88314 MILWAUKEE WI 53288 SOFTWARE SERVICES 2456894 APEX SYSTEMS INC 3750 COLLECTIONS CENTER DR CHICAGO IL 60693 CONTRACT LABOR 1787455 GENERAL DATATECH DEPT D8014 PO BOX 650002 DALLAS TX 75265 SOFTWARE SERVICES 1598984 39 991500 1480565 2472065 SHARED SERVICES 900099 148736527 148736527 HUMAN RESOURCES 900099 8382276 8382276 RENT 900099 4607341 4607341 COMMUNITY HEALTH OUTREACH 900099 4275960 4275960 REAL ESTATE MANAGEMENT 900099 428270 428270 210808 210808 166641182 4771027 4771027 0 0 0 0 0 128443473 129100937 -657464 -657464 -657464 0 0 0 0 0 0 0 0 0 REBATE 900099 4456183 4456183 CONCIERGE 900099 120972 120972 OTHER REVENUE 900099 17452 17452 4594607 177821417 171235789 4113563 108200 108200 50000 50000 0 0 9457293 2002217 7455076 0 28682623 22978520 5704103 0 4810591 1921622 2888969 0 0 1239938 288583 951355 368282 368282 169000 169000 0 198805 198805 9372493 8650730 721763 3940609 569180 3371429 544579 473625 70954 76497280 76497280 0 2798919 2798919 1087448 875243 212205 0 313254 237290 75964 200622 4511 196111 0 10346690 10346690 1791983 1791983 0 PHYSICIAN REMUNERATION 9328388 7698937 1629451 MINOR EQUIPMENT 4542841 4542841 DUES & SUBSCRIPTIONS 1299852 550124 749728 RECRUITMENT 1067351 1067351 1332173 1257703 74470 169549214 145447636 24101578 0 9550 9950 17736045 5392329 432420 557593 2353381 2671604 0 0 0 0 0 0 4130 9236 592858 2597416 169791715 58986193 91714569 110805522 217867413 219354079 0 0 0 0 0 0 4284750 5500256 334995116 346897985 48177870 52606436 0 0 464927 679746 0 0 0 0 0 0 0 0 0 0 0 0 48642797 53286182 X 286352319 293611803 0 0 0 0 286352319 293611803 334995116 346897985 X 8272203 -1096316 83597 X false true X true false X X 1 CC MEDICAL CENTER 752051646 3 true 145447636 0 1 145447636 true false false false false false false false false false false false false false false true true false X true true SCHEDULE A, PART IV, SECTION E, LINE 3A THE ORGANIZATION IS THE SOLE MEMBER OF THE SUPPORTED ORGANIZATION, COOK CHILDREN'S MEDICAL CENTER, AND AS SUCH HAS THE POWER TO DETERMINE THE NUMBER OF MEMBERS OF THE BOARD OF TRUSTEES AND TO ELECT THE MEMBERS OF THE BOARD OF TRUSTEES OF THE SUPPORTED ORGANIZATION. SCHEDULE A, PART IV, SECTION E, LINE 3B THE ORGANIZATION IS THE SOLE MEMBER OF THE SUPPORTED ORGANIZATION, COOK CHILDREN'S MEDICAL CENTER, AND AS SUCH HAS THE EXCLUSIVE POWER AND RESERVED POWER TO DO ANY OF THE FOLLOWING: A. AMEND, ALTER OR REPEAL THE BYLAWS; B. AMEND THE CERTIFICATE OF FORMATION OF THE ORGANIZAITON; C. DETERMINE THE NUMBER OF MEMBERS OF THE BOARD OF TRUSTEES AND TO ELECT THE MEMBERS OF THE BOARD OF TRUSTEES; D. APPROVE ANY MERGER, ACQUISITION, LIQUIDATION, WINDING UP, TERMINATION OR CONSOLIDATION OF THE ORGANIZATION; E. APPROVE THE SALE, GIFT OR OTHER DISPOSITION OF ALL OR SUBSTANTIALLY ALL OF THE PROPERTY OF THE ORGANIZATION; AND, F. APPROVE THE CREATION OF, OR INVESTMENT IN, ANY SUBSIDIARY ENTITY. THE ORGANIZATION IS ALSO RESPONSIBLE FOR IMPLEMENTATION AND ENFORCEMENT OF VARIOUS POLICIES AND PROCEDURES OF THE SUPPORTED ORGANIZATION INCLUDING THE CONFLICT OF INTEREST POLICY AND COMPENSATION ARRANGEMENTS. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 177550 177550 169452689 169630239 1000000 250000 false 1000000 1000000 1000000 1000000 4000000 6000000 143972 169449 150577 177550 641548 250000 250000 250000 250000 1000000 1500000 34397040 34397040 50753616 11545161 39208455 872461 773302 99159 82249999 46094972 36155027 1518599 572758 945841 110805522 178683348 -1096316 2157052 1060736 177622612 198805 198805 177821417 171507461 2157052 2157052 169350409 198805 198805 169549214 SCHEDULE D, PART XI, LINE 2D OTHER CHANGE: MANAGEMENT FEE REDUCTION $2,157,052 SCHEDULE D, PART XII, LINE 2D OTHER CHANGE: MANAGEMENT FEE REDUCTION $2,157,052 Central America and the Caribbean Investments 5248113 5248113 5248113 true false true false false false true COWTOWN MARATHON INC 2617 WHITMORE FORT WORTH TX 76107 752198418 501(C)(3) 20000 SPONSORSHIP DFW HOSPITAL COUNCIL FOUNDATION 300 DECKER DR STE 300 IRVING TX 75062 237004426 501(C)(3) 6000 SPONSORSHIP WARM PLACE 809 LIPSCOMB ST FORT WORTH TX 76104 752220859 501(C)(3) 10000 SPONSORSHIP UNITED WAY OF TARRANT CO 1500 N MAIN ST 200 FT WORTH TX 76164 750858360 501(C)(3) 25000 SPONSORSHIP 4 SCHOLARSHIPS FOR INDIVIDUAL 10 50000 SCHEDULE I, PART I, LINE 2 PROCEDURE FOR MONITORING THE USE OF GRANT FUNDS IN THE UNITED STATES: THE ORGANIZATION USES PUBLIC AND PRIVATE DATA TO MONITOR THE USE OF FUNDS, AS NEEDED. IN ORDER TO BE ELIGIBLE FOR THE PRESIDENT'S SCHOLARSHIP AWARD THE APPLICANTS MUST MEET THE FOLLOWING REQUIREMENTS: 1) BE A CHILD OF A FULL TIME EMPLOYEE WITH ONE YEAR FULL TIME EXPERIENCE, 2) BE A FULL TIME STUDENT IN A BACCALAUREATE PROGRAM AND 3) PURSUING A DEGREE APPLICABLE TO THE HEALTHCARE WORKFORCE. THE SCHOLARSHIP RECIPIENTS ARE SELECTED BY THE SCHOLARSHIP COMMITTEE. THE SELECTION IS BASED ON ESSAYS SUBMITTED BY THE APPLICANTS, AS WELL AS GRADES. THE MINIMUM AWARD IS $5,000 FOR FIRST TIME RECIPIENTS AND $2,500 FOR REPEAT RECIPIENTS. SCHOLARSHIP PAYMENTS ARE ISSUED DIRECTLY TO THE UNIVERSITIES. X false true X X X X X true true false false false false false false false RICK W MERRILL PRESIDENT AND CEO 348869 496875 214934 306118 89920 128067 73657 104905 12131 17278 739511 1053243 0 0 SANDRA ARCA MD TRUSTEE 0 312752 0 5579 0 5048 0 18479 0 30917 0 372775 0 0 MATTHEW DZURIK MD TRUSTEE-VICE CHAIR 0 424845 0 10000 0 8068 0 16563 0 20255 0 479731 0 0 JOANN M SANDERS MD CHIEF QUALITY OFFICER 361962 0 132411 0 47130 0 19875 0 22510 0 583888 0 0 0 JAMES C CUNNINGHAM MD EXEC VICE PRESIDENT 434967 0 200693 0 101788 0 19875 0 23363 0 780686 0 0 0 MATTHEW CARROLL MD TRUSTEE 0 240239 0 18975 0 3678 0 7836 0 11420 0 282148 0 0 MAYNARD DYSON MEDICAL DIRECTOR 211950 0 0 0 10498 0 8775 0 32287 0 263510 0 0 0 GRETCHEN EAMES MD TRUSTEE 0 344339 0 16500 0 7152 0 19875 0 1212 0 389078 0 0 JOSE GONZALEZ V PRESIDENT-CHILDREN'S HEALTH 131496 131496 46865 46865 6500 6500 5300 5300 11543 11543 201704 201704 0 0 MATTHEW E MAYFIELD MD TRUSTEE 0 654495 0 0 0 5582 0 13250 0 32342 0 705669 0 0 JODY HAWKINS DIRECTOR OF INFO SECURITY 123122 0 22583 0 79184 0 0 0 31206 0 256095 0 0 0 RAY RHODES MD TRUSTEE 0 346517 0 5833 0 16070 0 19875 0 23178 0 411473 0 0 JASON V TERK MD TRUSTEE 0 370549 0 1000 0 4735 0 19875 0 29707 0 425866 0 0 LINDA THOMPSON MD TRUSTEE 0 396419 0 25000 0 0 0 16563 0 2411 0 440393 0 0 TODD WOLF MD TRUSTEE 0 311281 0 179555 0 0 0 18341 0 34869 0 544046 0 0 ROBERT K FEATHER SR V PRESIDENT PUBLIC POLICY 273072 0 133942 0 82194 0 19875 0 33715 0 542798 0 0 0 KEITH HOLTZ CHIEF ADMINISTRATION OFFICER 354432 0 232436 0 34414 0 4711 0 35497 0 661490 0 0 0 ERIC H HUBLI MD CHIEF SYS EFFECTIVENESS OFFCR 516291 0 79741 0 26152 0 16563 0 32032 0 670779 0 0 0 GREGORY K JIMERSON V PRESIDENT-PAYOR RELATIONS 203943 0 91300 0 1572 0 16563 0 34838 0 348216 0 0 0 STEPHEN W KIMMEL CFO 123920 371759 56694 170080 10839 32517 19167 57503 8608 25825 219228 657684 0 0 DAVID F LANCASTER VP-INTERNAL AUDIT & COMPLIANCE 177344 0 66190 0 12093 0 19246 0 22258 0 297131 0 0 0 SCOTT LEDDY CHIEF MEDICAL INFO OFFICER 273692 0 98782 0 2216 0 10600 0 29650 0 414940 0 0 0 JAMES D MARSHALL MD CHIEF RESEARCH OFFICER 534163 0 79922 0 7197 0 19875 0 32205 0 673362 0 0 0 CARA MARTZ SECRETARY 101407 0 25956 0 1886 0 7106 0 14090 0 150445 0 0 0 JOHN W MCNEY SR V PRESIDENT-GEN COUNSEL 330883 0 162452 0 77705 0 19875 0 23789 0 614704 0 0 0 THERESA ZAK MEADOWS SR V PRESIDENT-CIO 309250 0 149610 0 70131 0 16563 0 35496 0 581050 0 0 0 GEORGE B MONTAGUE V PRESIDENT-REAL ESTATE 237303 0 84535 0 16284 0 19778 0 26662 0 384562 0 0 0 CORY RHOADES SR V PRESIDENT-FINANCE 250448 0 124160 0 27755 0 16563 0 35296 0 454222 0 0 0 COLEMAN D SKINNER V PRESIDENT-REVENUE CYCLE 132803 0 0 0 23869 0 12159 0 33564 0 202395 0 0 0 JAMES R STALDER V PRES-INFO SYSTEMS & CTO 216928 0 78682 0 1133 0 11723 0 35075 0 343541 0 0 0 LARRY L TUBB SR V PRESIDENT-PLANNING 297182 0 112854 0 0 0 19875 0 20925 0 450836 0 0 0 LORRAINEA WILLIAMS PAT/MEDICATION SAFETY OFFCR 189842 0 47138 0 0 0 11998 0 33207 0 282185 0 0 0 JOSEPH GALLAHGER DEPUTY GENERAL COUNSEL 228509 0 83050 0 6624 0 19875 0 31027 0 369085 0 0 0 JOSE IGLESIAS MD TRUSTEE 0 1005618 0 0 0 27464 0 16563 0 32288 0 1081933 0 0 KENT SMITH ASSOCIATE GENERAL COUNSEL 200726 0 72101 0 10706 0 8037 0 20625 0 312195 0 0 0 KAREN WARDELL ASSOCIATE GENERAL COUNSEL 211144 0 74504 0 0 0 18551 0 22039 0 326238 0 0 0 SALEEM MALIK TRUSTEE 0 497614 0 0 0 7214 0 19585 0 34907 0 559320 0 0 MARC MAZADE MD TRUSTEE 0 337821 0 1000 0 5302 0 19875 0 33509 0 397507 0 0 LINDSAY NEWTON MD TRUSTEE 0 121494 0 72418 0 8096 0 11325 0 26992 0 240325 0 0 SCHEDULE J, PART I, LINE 1A SANDRA ARCA $125 GROSS-UP MATTHEW CARROLL, MD $125 GROSS-UP JAMES C CUNNINGHAM $5 GROSS-UP MAYNARD DYSON $125 GROSS-UP MATTHEW DZURIK, MD $125 GROSS-UP GRETCHEN EAMES, MD $125 GROSS-UP MATTHEW E MAYFIELD, MD $125 GROSS-UP JOSE IGLESIAS, MD $125 GROSS-UP SALEEM MALIK $125 GROSS-UP JAMES D MARSHALL, MD $5 GROSS-UP CARA MARTZ ($113) GROSS-UP MARC MAZADE, MD $125 GROSS-UP JOHN W MCNEY $2.50 GROSS-UP RICK W. MERRILL $10 GROSS-UP LINDSAY NEWTON, MD $125 GROSS-UP RAY RHODES, MD $125 GROSS-UP JOANN SANDERS, MD $2.50 GROSS-UP JASON V TERK, MD $125 GROSS-UP LINDA THOMPSON, MD $125 GROSS-UP TODD WOLF, MD $125 GROSS-UP STEPHEN KIMMEL $5 GROSS-UP SCHEDULE J, PART I, LINE 1A & 1B GENERAL GROSS UP PAYMENTS: THERE IS NO WRITTEN POLICY REGARDING PAYMENT OR REIMBURSEMENT OF TAX INDEMNIFICATION AND GROSS-UP PAYMENTS BECAUSE THE COMPANY DOES NOT GENERALLY ALLOW FOR GROSS-UP PAYMENTS EXCEPT IN SPECIFIC CIRCUMSTANCES AND THEN ONLY IF APPROVED BY SENIOR MANAGEMENT FOLLOWED BY REVIEW OF THE COMPANY'S COMPLIANCE AND LEGAL DEPARTMENTS. THESE TYPE OF REIMBURSEMENTS GENERALLY RELATE TO TAXES OWED BY INDIVIDUALS WHO RECEIVE NOMINAL INCENTIVE PAYMENTS FOR SERVICE AWARDS OR QUALITY IMPROVEMENT PROGRAMS, AND THE GROSS-UP PAYMENTS USUALLY ARE IMMATERIAL, $250 OR LESS. CY 2016 CME GROSS UP AMOUNTS SANDRA ARCA, MD $1,500.00 ERIC HUBLI $3,250.00 JAMES C. CUNNINGHAM, MD $3,250.00 MAYNARD DYSON $1,125.00 MATTHEW DZURIK, MD $1,500.00 GRETCHEN EAMES, MD $2,250.00 JOSE L. IGLESIAS, MD $4,500.00 SALEEM MALIK, MD $2,250.00 JAMES D. MARSHALL, MD $4,550.00 MATT E. MAYFIELD, MD $2,100.00 MARC MAZADE, MD $2,100.00 LINDSAY NEWTON, MD $1,125.00 JOANN M. SANDERS, MD $4,875.00 JASON V. TERK, MD $1,500.00 LINDA THOMPSON, MD $2,100.00 TODD WOLF, MD $1,500.00 CME GROSS UPS PAYMENTS IN ADDITION TO THE GIFT CARD AND INCENTIVE BONUSES DESCRIBED ABOVE, THERE IS NO WRITTEN POLICY REGARDING PAYMENT OR REIMBURSEMENT OF TAX INDEMNIFICATION AND GROSS-UP PAYMENTS FOR CONTINUING MEDICAL EDUCATION ALLOWANCES PAID TO EMPLOYED PHYSICIANS OF COOK CHILDREN'S PHYSICIAN NETWORK. THESE TYPE OF EXPENSES ARE USUALLY HANDLED AS NON-TAXABLE ACCOUNTABLE PLAN BUSINESS EXPENSES UNDER THE INTERNAL REVENUE CODE, BUT THE COMPANY HAS ELECTED TO TREAT THESE PAYMENTS AND THE GROSS-UP PAYMENTS AS TAXABLE INCOME TO THE AFFECTED INDIVIDUALS. THESE PAYMENTS ARE APPROVED IN ADVANCE BY SENIOR MANAGEMENT AND REVIEWED BY THE COMPANY'S COMPLIANCE AND LEGAL DEPARTMENTS. FURTHER, THESE EXPENSES ARE INCLUDED IN THE BENEFITS CALCULATION FOR SUCH PHYSICIANS WHICH ARE REVIEWED BY THE COMPANY'S COMPENSATION COMMITTEE TO VERIFY THAT SUCH PAYMENTS ARE PAID AT FAIR MARKET VALUE AND COMMERCIALLY REASONABLE. PAYMENTS ARE APPROVED IN ADVANCE BY SENIOR MANAGEMENT AND REVIEWED BY THE COMPANY'S COMPLIANCE AND LEGAL DEPARTMENTS. FURTHER, THESE EXPENSES ARE INCLUDED IN THE BENEFITS CALCULATION FOR SUCH PHYSICIANS WHICH ARE REVIEWED BY THE COMPANY'S COMPENSATION COMMITTEE TO VERIFY THAT SUCH PAYMENTS ARE PAID AT FAIR MARKET VALUE AND COMMERCIALLY REASONABLE. SCHEDULE J, PART II ALLOCATION OF CEO AND CFO SALARIES: SALARIES FOR THE CEO AND CFO ARE ALLOCATED PRO-RATA BASED ON THE AMOUNT OF TIME THEY SPEND WITH EACH OF THE FOLLOWING COMPANIES: COOK CHILDREN'S MEDICAL CENTER COOK CHILDREN'S HEALTH FOUNDATION COOK CHILDREN'S HOME HEALTH COOK CHILDREN'S HEALTH CARE SYSTEM COOK CHILDREN'S HEALTH PLAN SCHEDULE J, PART I, QUESTION 4B PARTICIPATION IN A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN PARTICIPANTS IN SERP IN W-2 DEF COMP PAID BY -------------------- -------- ---------- --------- RICK W. MERRILL 134,409 162,000 CCHS MATTHEW CARROLL, MD 2,393 NONE CCPN JAMES C. CUNNINGHAM, MD 72,776 NONE CCHS ROBERT K. FEATHER 55,038 NONE CCHS KEITH HOLTZ 18,000 67,922 CCHS ERIC H. HUBLI, MD 18,000 NONE CCHS JOSE IGLESIAS, MD 18,000 NONE CCPN STEPHEN W. KIMMEL 18,000 66,070 CCHS JOHN W. MCNEY 59,737 NONE CCHS THERESA ZAK MEADOWS 58,316 NONE CCHS LINDSAY NEWTON, MD 5,811 NONE CCPN CORY RHOADES 18,000 34,905 CCHS JOANN SANDERS, MD 18,000 39,374 CCHS LARRY L. TUBB 48,412 NONE CCHS MATTHEW DZURIK, MD 3,386 NONE CCPN SCHEDULE J, PART I, LINE 4A SEVERANCE PAYMENT: JODY HAWKINS RECEIVED A SEVERANCE PAYMENT OF $62,622 IN CALENDAR YEAR 2016. FORM 990, PART VI, SECTION A, LINE 2 BONNIE PETSCHE HAS A FAMILY RELATIONSHIP AND BUSINESS RELATIONSHIP WITH JULIA DAVIDSON. FORM 990, PART VI, SECTION A, LINE 6 SOLE MEMBER: W. I. COOK FOUNDATION, INC., D/B/A COOK CHILDREN'S HEALTH FOUNDATION, A TEXAS NON-PROFIT CORPORATION, IS THE SOLE MEMBER OF THE ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7A MEMBER ELECTION ABILITIES: AS THE SOLE MEMBER OF THE ORGANIZATION, W.I. COOK FOUNDATION, INC., HAS THE POWER TO DETERMINE THE NUMBER OF MEMBERS OF THE BOARD OF TRUSTEES AND TO ELECT THE MEMBERS OF THE BOARD OF TRUSTEES. FORM 990, PART VI, SECTION A, LINE 7B MEMBER DECISION ABILITIES: AS THE SOLE MEMBER OF THE ORGANIZATION, W.I. COOK FOUNDATION, INC., HAS THE EXCLUSIVE POWER TO DO ANY OF THE FOLLOWING: A. AMEND, ALTER OR REPEAL THE BYLAWS; B. AMEND THE CERTIFICATE OF FORMATION OF THE ORGANIZATION; C. DETERMINE THE NUMBER OF MEMBERS OF THE BOARD OF TRUSTEES AND TO ELECT THE MEMBERS OF THE BOARD OF TRUSTEES; D. APPROVE ANY MERGER, ACQUISITION, LIQUIDATION, WINDING UP, TERMINATION OR CONSOLIDATION OF THE ORGANIZATION; E. APPROVE THE SALE, GIFT OR OTHER DISPOSITION OF ALL OR SUBSTANTIALLY ALL OF THE PROPERTY OF THE ORGANIZATION; F. APPROVE THE CREATION OF, OR INVESTMENT IN, ANY SUBSIDIARY ENTITY; G. APPROVE THE REMOVAL OF A MEMBER OF THE BOARD OF TRUSTEES OF THE ORGANIZATION; AND H. APPROVE THE PERSONS WHO ARE TO BE ELECTED BY THE ORGANIZATION TO FILL ANY VACANCIES ON THE BOARD OF TRUSTEES OR BOARD OF DIRECTORS, AS APPLICABLE, OF (1) COOK CHILDREN'S MEDICAL CENTER, (2) COOK CHILDREN'S PHYSICIAN NETWORK, (3) COOK CHILDREN'S HOME HEALTH, (4) COOK CHILDREN'S HEALTH PLAN, (5) COOK CHILDREN'S INDEMNITY COMPANY; AND (6) ANY OTHER SUBSIDIARY CORPORATION AFFILIATED WITH OR CONTROLLED BY THE ORGANIZATION (INCLUDING ANY VACANCIES ARISING FROM THE EXPIRATION OF THE TERMS OF ANY OF THE TRUSTEES OR DIRECTORS). FORM 990, PART VI, SECTION B, LINE 11B REVIEW PROCESS FOR FORM 990: THE ORGANIZATION ENGAGES AN OUTSIDE INDEPENDENT ACCOUNTING FIRM TO ASSIST IN THE PREPARATION OF THE FORM 990 AND RELATED FILINGS. ALL INFORMATION PROVIDED TO THE OUTSIDE ACCOUNTING FIRM IS GATHERED BY KEY COMPANY EMPLOYEES AND EXECUTIVES. ONCE THE FORM 990 IS PREPARED, IT IS REVIEWED BY COMPANY FINANCE, LEGAL AND COMPLIANCE STAFF AND THEN PROVIDED TO THE BOARD OF TRUSTEES FOR REVIEW AND COMMENT. IN ADDITION, IT IS PRESENTED TO THE COOK CHILDREN'S HEALTH CARE SYSTEM AUDIT COMMITTEE FOR REVIEW AND COMMENT. SUBSEQUENT TO AUDIT COMMITTEE REVIEW, THE FORM 990 IS FILED WITH THE INTERNAL REVENUE SERVICE AND MADE AVAILABLE TO THE PUBLIC FOR REVIEW. FORM 990, PART VI, SECTION B, LINE 12C WRITTEN CONFLICT OF INTEREST POLICY: EVERY YEAR THE LEGAL DEPARTMENT OF THE COOK CHILDREN'S HEALTH CARE SYSTEM (SYSTEM) SENDS OUT A FORM 990 QUESTIONNAIRE/CONFLICT OF INTEREST DISCLOSURE STATEMENT TO OFFICERS, DIRECTORS, TRUSTEES AND KEY EMPLOYEES OF ALL SYSTEM COMPANIES, AS WELL AS CERTAIN OTHER EMPLOYEES, INCLUDING PHYSICIANS, WHO ARE DETERMINED TO BE EMPLOYED IN POSITIONS THAT MIGHT BE SUBJECT TO THE SYSTEM'S CONFLICT OF INTEREST POLICY. THE RESPONSES ARE REVIEWED BY THE LEGAL, FINANCE, AND COMPLIANCE DEPARTMENTS. FOLLOW UP AND/OR CORRECTIVE ACTION IS TAKEN AS NEEDED WITH RESPECT TO RESPONSES THAT INDICATE THE EXISTENCE OF ACTUAL OR POTENTIAL CONFLICTS OF INTEREST. THE RESPONSES TO THE QUESTIONNAIRES AND FOLLOW-UP INFORMATION ARE PROVIDED TO THE SYSTEM AUDIT COMMITTEE FOR REVIEW AND FOLLOW-UP. FURTHER, THE AUDIT COMMITTEE OF COOK CHILDREN'S HEALTH CARE SYSTEM IS RESPONSIBLE FOR MONITORING THE IMPLEMENTATION AND ENFORCEMENT OF THE CONFLICT OF INTEREST POLICY THAT IS APPLICABLE TO ALL AFFILIATED COMPANIES OF THE COOK CHILDREN'S HEALTH CARE SYSTEM. THE AUDIT COMMITTEE IS ALSO RESPONSIBLE FOR OVERSIGHT OF THE COMPLIANCE DEPARTMENT OF COOK CHILDREN'S HEALTH CARE SYSTEM. THE COMPLIANCE DEPARTMENT MAINTAINS A HOT-LINE TO RECEIVE REPORTS OF INAPPROPRIATE ACTIVITIES INCLUDING ACTIVITIES THAT MIGHT CONSTITUTE A CONFLICT OF INTEREST. INTERNAL AUDIT AND COMPLIANCE ALSO CONDUCT RANDOM AUDITS OF CORPORATE ACTIVITIES SUCH AS EXPENSE REIMBURSEMENTS AND ACCOUNTS PAYABLE TO DETERMINE IF ANY INAPPROPRIATE PAYMENTS ARE BEING MADE TO INDIVIDUALS, SOME OF WHICH COULD BE EVIDENCE OF A CONFLICT OF INTEREST. ANY CORRECTIVE ACTION RELATED TO CONFLICTS OF INTEREST WOULD BE REPORTED TO THE AUDIT COMMITTEE FOR REVIEW, APPROVAL, AND MODIFICATION, AS NECESSARY, WITH FURTHER REPORTING TO THE SYSTEM BOARD OF TRUSTEES AS APPROPRIATE. FORM 990, PART VI, SECTION B, LINE 15A & 15B REVIEW AND APPROVAL OF COMPENSATION: COOK CHILDRENS HEALTH CARE SYSTEM HAS ESTABLISHED A COMPENSAITON COMMITTEE WITH OVERSIGHT OF EXECUTIVE AND PHYSICIAN COMPENSATION, WHICH INCLUDES THE ORGANIZATION'S CEO AND OTHER OFFICERS AND KEY EMPLOYEES OF THE ORGANIZATION. THE COMPENSATION COMMITTEE APPROVES COMPENSATION ARRANGEMENTS IN ADVANCE, WHICH INCLUDES A REVIEW AND APPROVAL BY INDEPENDENT COMMITTEE MEMBERS, USING COMPARABLE MARKET DATA RELATING TO COMPENSATION, WHICH IS PROVIDED BY SULLIVAN COTTER AND ASSOCIATES, INC. FOR EXECUTIVE COMPENSATION, AND BY ECG MANAGEMENT CONSULTANTS FOR PHYSICIAN COMPENSATION, BOTH OF WHICH ARE INDEPENDENT, NATIONALLY RECOGNIZED COMPENSATION CONSULTANTS. THE COMPENSATION COMMITTEE DOCUMENTS THE BASIS FOR ITS DETERMINATIONS AND DECISIONS. THE COMPENSATION COMMITTEE REQUIRES THE COMPENSATION CONSULTANT TO UPDATE MARKET DATA PERIODICALLY, USUALLY EVERY TWO YEARS, THE INTERIM REVIEWS BEING CONDUCTED AS NEEDED. WITH REGARD TO PHYSICIAN COMPENSATION, THE COMPENSATION COMMITTEE ALSO RETAINS THE LAW FIRM OF MCDERMOTT, WILL & EMERY OF CHICAGO, ILLINOIS, TO ISSUE A REASONABLENESS OPINION COVERING THE PHYSICIAN COMPENSATION PLAN FOR COOK CHILDREN'S PHYSICIAN NETWORK. FORM 990, PART VI, SECTION C, LINE 19 PROCESS OF MAKING GOVERNING DOCUMENTS AVAILABLE TO THE PUBLIC: THE ORGANIZATION DOES NOT MAKE ITS GOVERNING DOCUMENTS OR CONFLICT OF INTEREST POLICY AVAILABLE TO THE PUBLIC, EXCEPT TO THE EXTENT THEY ARE ON FILE WITH THE SECRETARY OF STATE OF TEXAS. THE CONFLICT OF INTEREST POLICY IS POSTED ON THE ORGANIZATION'S INTERNAL WEBSITE AND AVAILABLE TO ALL EMPLOYEES AND BOARD MEMBERS OF COOK CHILDREN'S HEALTH CARE SYSTEM ENTITIES. CONSOLIDATED FINANCIAL STATEMENTS ARE REPORTED ELECTRONICALLY FOR ALL COOK CHILDREN'S HEALTH CARE SYSTEM ENTITIES VIA THE ELECTRONIC MUNICIPAL MARKET ACCESS (EMMA) WEBSITE. FORM 990, PART XI, LINE 9 TRANSFER FROM CCHF $83,597 COOK CHILDREN'S HEALTH PLAN 801 SEVENTH AVE FORT WORTH TX 76104 760585240 INSURANCE TX 501(C)(3) 10 CCHCS true COOK CHILDREN'S PHYSICIAN NETWORK 801 SEVENTH AVE FORT WORTH TX 76104 752485366 PHYSICIAN SVC TX 501(C)(3) 3 CCHCS true WI COOK FOUNDATION 801 SEVENTH AVE FORT WORTH TX 76104 752051649 FUNDRAISING TX 501(C)(3) 7 NA false COOK CHILDREN'S MEDICAL CENTER 801 SEVENTH AVE FORT WORTH TX 76104 752051646 HOSPITAL TX 501(C)(3) 3 CCHCS true COOK CHILDREN'S HOME HEALTH 801 SEVENTH AVE FORT WORTH TX 76104 752896983 HEALTHCARE TX 501(C)(3) 10 CCHCS true ROSEDALE OFFICE BUILDING INC 801 SEVENTH AVE FORT WORTH TX 76104 460866421 TITLE HOLDING TX 501(C)(2) N/A CCHF true COOK CHILDREN'S HEALTH SERVICES INC 801 7TH AVENUE FORT WORTH TX 76104 454024843 HEALTHCARE TX CCHCS C CORPORATION 847319 3517814 1.00000 true true true false false false false false false false false true false false false true true true false true COOK CHILDREN'S MEDICAL CENTER A 561171 FMV COOK CHILDREN'S MEDICAL CENTER B 1214591 FMV COOK CHILDREN'S MEDICAL CENTER O 72103 FMV COOK CHILDREN'S MEDICAL CENTER Q 195687577 FMV COOK CHILDREN'S PHYSICIAN NETWORK A 1996340 FMV COOK CHILDREN'S PHYSICIAN NETWORK B 544794 FMV COOK CHILDREN'S PHYSICIAN NETWORK O 10154339 FMV COOK CHILDREN'S PHYSICIAN NETWORK P 449248 FMV COOK CHILDREN'S PHYSICIAN NETWORK Q 19532461 FMV COOK CHILDREN'S HOME HEALTH A 880405 FMV COOK CHILDREN'S HOME HEALTH Q 4704669 FMV COOK CHILDREN'S HEALTH PLAN A 771302 FMV COOK CHILDREN'S HEALTH PLAN O 243821 FMV COOK CHILDREN'S HEALTH PLAN Q 9530323 FMV COOK CHILDREN'S HEALTH SERVICES Q 220132 FMV ROSEDALE OFFICE BUILDING K 1275574 FMV ROSEDALE OFFICE BUILDING O 80668 FMV ROSEDALE OFFICE BUILDING P 1565418 FMV