COMPLEX CARE MEDICAL SERVICES CORPORATION: Form 990, tax year 2016

View the entire original 990 at ProPublica ↗

Organization
COMPLEX CARE MEDICAL SERVICES CORPORATION (EIN 46-1893597)
Tax period
2016-01-01 to 2016-12-31
Filed
2017-11-13
IRS object ID
201703179349302715
Schema version
2016v3.0
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)
Return2017-11-13T11:01:43-06:00ReturnTs
Tax Period End2016-12-31TaxPeriodEndDt
Return Type990ReturnTypeCd
Tax Period Begin2016-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN461893597EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1Complex Care Medical Services CorporationBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlCOMPBusinessNameControlTxt
Phone2144567000PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line11935 MEDICAL DISTRICT DRIVEAddressLine1Txt
CityDALLASCityNm
State AbbreviationTXStateAbbreviationCd
ZIP75235ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonJERRY LEEPersonNm
Person TitleTREASURERPersonTitleTxt
Signature2017-11-09SignatureDt
FieldValueIRS element (for citing)
Tax2016TaxYr
Build TS2017-02-10 21:41:12ZBuildTS

Form 990 IRS990

Principal Ofcr Business Name PrincipalOfcrBusinessName

FieldValueIRS element (for citing)
Business Name Line1W Robert Morrow MDBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line11935 MEDICAL DISTRICT DRIVEAddressLine1Txt
CityDALLASCityNm
State AbbreviationTXStateAbbreviationCd
ZIP75235ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$172,482GrossReceiptsAmt
Group Return For AffiliatesfalseGroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressN/AWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation2012FormationYr
Legal Domicile StateTXLegalDomicileStateCd
Activity Or MissionTO SERVE AS THE MEDICAL HOME FOR CHILDREN WITH COMPLEX MEDICAL ILLNESSES.ActivityOrMissionDesc
Voting Members Governing Body5VotingMembersGoverningBodyCnt
Voting Members Independent3VotingMembersIndependentCnt
Total Employee10TotalEmployeeCnt
Total Volunteers3TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
CY Contributions Grants$0CYContributionsGrantsAmt
PY Program Service Revenue$121,676PYProgramServiceRevenueAmt
CY Program Service Revenue$172,482CYProgramServiceRevenueAmt
CY Investment Income$0CYInvestmentIncomeAmt
CY Other Revenue$0CYOtherRevenueAmt
PY Total Revenue$121,676PYTotalRevenueAmt
CY Total Revenue$172,482CYTotalRevenueAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$1,386,265PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$731,213CYSalariesCompEmpBnftPaidAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$828,489PYOtherExpensesAmt
CY Other Expenses$1,699,755CYOtherExpensesAmt
PY Total Expenses$2,214,754PYTotalExpensesAmt
CY Total Expenses$2,430,968CYTotalExpensesAmt
PY Revenues Less Expenses-$2,093,078PYRevenuesLessExpensesAmt
CY Revenues Less Expenses-$2,258,486CYRevenuesLessExpensesAmt
Total Assets BOY$3,257,854TotalAssetsBOYAmt
Total Assets EOY$2,184,972TotalAssetsEOYAmt
Total Liabilities BOY$6,211,398TotalLiabilitiesBOYAmt
Total Liabilities EOY$7,397,001TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY-$2,953,544NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY-$5,212,029NetAssetsOrFundBalancesEOYAmt
MissionTO SERVE AS THE MEDICAL HOME FOR CHILDREN WITH COMPLEX MEDICAL ILLNESSES WHERE A MULTI-DISCIPLINARY TEAM OF CARE GIVERS OVERSEE AND COORDINATE THEIR CARE.MissionDesc
Significant New Program SrvcfalseSignificantNewProgramSrvcInd
Significant ChangefalseSignificantChangeInd
Expense$1,755,570ExpenseAmt
Revenue$172,482RevenueAmt
DescTO SERVE AS THE MEDICAL HOME FOR CHILDREN WITH COMPLEX MEDICAL ILLNESSES WHERE A MULTI-DISCIPLINARY TEAM OF CARE GIVERS OVERSEE AND COORDINATE THEIR CARE.Desc
Total Program Service Expenses$1,755,570TotalProgramServiceExpensesAmt
Described In Section501c3Yes (true)DescribedInSection501c3Ind
Schedule B RequiredfalseScheduleBRequiredInd
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 AssetsfalseReportOtherAssetsInd
Report Other LiabilitiesYes (true)ReportOtherLiabilitiesInd
Include FIN48 FootnotefalseIncludeFIN48FootnoteInd
Independent Audit Fincl StmtfalseIndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (true)ConsolidatedAuditFinclStmtInd
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 Document2IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (true)BackupWthldComplianceInd
Employee10EmployeeCnt
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 OffalseForm8282PropertyDisposedOfInd
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 Member3IndependentVotingMemberCnt
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 CommitteesYes (true)MinutesOfCommitteesInd
Officer Mailing AddressfalseOfficerMailingAddressInd
Local ChaptersfalseLocalChaptersInd
Form990 Provided To Gvrn BodyfalseForm990ProvidedToGvrnBodyInd
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 Line1STEPHANIE K SMITHBusinessNameLine1Txt
FieldValueIRS element (for citing)
Phone2144567000PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line11935 MEDICAL DISTRICT DRIVEAddressLine1Txt
CityDALLASCityNm
State AbbreviationTXStateAbbreviationCd
ZIP75235ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (11 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtFormer Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd
William Morrow MD
Director/President CCMSC, Pres Phys Orgs Acdmc Rel CCO CHST1.054.0Yes (X)Yes (X)$0$822,400$18,621
Michelle Thomas MD
Chair1.00Yes (X)$0$0$0
John Andersen MD
Director1.00Yes (X)$0$0$0
Andrew Gelfand MD
Director1.06.0Yes (X)$0$18,674$0
William Scott MD
Director1.00Yes (X)$0$0$0
Jerry Lee
Treasurer CCMSC, VP Acctg/Treas CHST1.049.0Yes (X)$0$395,942$32,898
Lisa Frenkel
Secretary CCMSC, Asst Gen Counsel CHST1.049.0Yes (X)$0$217,708$12,255
Peter Roberts
Former President CCMSC, Pres Pop Health CHST0.055.0$0$1,108,100$27,028Yes (X)
Douglas Hock
Former President CCMSC, COO CMC, Pres Clinical Ops CHST0.055.0$0$247,782$856Yes (X)
Stephanie Smith
Former Officer CCMSC, Sr Legal Counsel CHST0.050.0$0$135,085$11,262Yes (X)
Scott Katz MD
Former Director CCMSC, Contract Physician Related Orgs0.05.0$0$10,597$0Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$0TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$2,956,287TotReportableCompRltdOrgAmt
Total Other Compensation$102,920TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K0IndivRcvdGreaterThan100KCnt
Former Ofcr Employees ListedYes (true)FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (true)TotalCompGreaterThan150KInd
Compensation From Other SrcsfalseCompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp

Contractor Name ContractorName

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1UTSWBusinessNameLine1Txt

Contractor Address ContractorAddress

US Address USAddress

FieldValueIRS element (for citing)
Address Line1HI 108 5323 HARRY HINES BLVDAddressLine1Txt
CityDALLASCityNm
State AbbreviationTXStateAbbreviationCd
ZIP75390ZIPCd
FieldValueIRS element (for citing)
ServicesPHYS & MEDICAL SVCSServicesDesc
Compensation$986,778CompensationAmt
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K1CntrctRcvdGreaterThan100KCnt
Total Contributions$0TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp

FieldValueIRS element (for citing)
DescNet Patient RevenueDesc
Business621110BusinessCd
Total Revenue Column$172,482TotalRevenueColumnAmt
Related Or Exempt Func Income$172,482RelatedOrExemptFuncIncomeAmt

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$172,482TotalProgramServiceRevenueAmt

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

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$0OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$172,482TotalRevenueColumnAmt
Related Or Exempt Func Income$172,482RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$0ExclusionAmt
FieldValueIRS element (for citing)
Info In Schedule O Part IXYes (X)InfoInScheduleOPartIXInd

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$526,227TotalAmt
Program Services$526,227ProgramServicesAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$47,624TotalAmt
Program Services$47,624ProgramServicesAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$100,850TotalAmt
Program Services$100,850ProgramServicesAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$56,512TotalAmt
Program Services$56,512ProgramServicesAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$885,157TotalAmt
Program Services$858,438ProgramServicesAmt
Management And General$26,719ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$14,022TotalAmt
Program Services$10,030ProgramServicesAmt
Management And General$3,992ManagementAndGeneralAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$153,487TotalAmt
Program Services$1,260ProgramServicesAmt
Management And General$152,227ManagementAndGeneralAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$1,621TotalAmt
Program Services$1,621ProgramServicesAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$4,325TotalAmt
Program Services$1,603ProgramServicesAmt
Management And General$2,722ManagementAndGeneralAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$112,260TotalAmt
Program Services$112,260ProgramServicesAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtManagement And GeneralManagementAndGeneralAmtProgram ServicesProgramServicesAmt
Shared Services$488,481$488,481
Dietary and Food Costs$13,162$1,257$11,905
Medical Surgical Supplies$12,312$12,312
Transltn & Interprtn Srvc$10,328$10,328

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$4,600TotalAmt
Program Services$4,600ProgramServicesAmt
Management And General$0ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$2,430,968TotalAmt
Program Services$1,755,570ProgramServicesAmt
Management And General$675,398ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$1,446,932BOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$443,972BOYAmt
EOY$439,090EOYAmt

Receivables From Officers Etc ReceivablesFromOfficersEtcGrp

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

Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp

FieldValueIRS element (for citing)
EOY$0EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$1,969,678LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$223,796LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$1,366,950BOYAmt
EOY$1,745,882EOYAmt

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$0BOYAmt
EOY$0EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$3,257,854BOYAmt
EOY$2,184,972EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$1,083,858BOYAmt
EOY$239,268EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$5,127,540BOYAmt
EOY$7,157,733EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$6,211,398BOYAmt
EOY$7,397,001EOYAmt

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY-$2,953,544BOYAmt
EOY-$5,212,029EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY-$2,953,544BOYAmt
EOY-$5,212,029EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$3,257,854BOYAmt
EOY$2,184,972EOYAmt
FieldValueIRS element (for citing)
Info In Schedule O Part XIYes (X)InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss-$2,258,486ReconcilationRevenueExpnssAmt
Other Changes In Net Assets$1OtherChangesInNetAssetsAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or ReviewfalseAccountantCompileOrReviewInd
FS AuditedYes (true)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

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

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
HospitalYes (X)HospitalInd

Schedule D IRS990ScheduleD

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$1,833,316OtherCostOrOtherBasisAmt
Depreciation$190,710DepreciationAmt
Book Value$1,642,606BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$136,362OtherCostOrOtherBasisAmt
Depreciation$33,086DepreciationAmt
Book Value$103,276BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$1,745,882TotalBookValueLandBuildingsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)

DescDescAmtAmt
LT Advances - Affiliates$7,126,961
LT Deferred Rent$30,772
FieldValueIRS element (for citing)
Total Liability$7,157,733TotalLiabilityAmt

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceSchedule D, Part X, Line 2FormAndLineReferenceDesc
ExplanationTHE ORGANIZATION'S CONSOLIDATED FINANCIAL STATEMENTS FOR THE YEAR ENDING DECEMBER 31, 2016 DID NOT REQUIRE A FIN 48 FOOTNOTE.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 PaymentsYes (true)AnyNonFixedPaymentsInd
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
William Morrow MD
Director/President CCMSC, Pres Phys Orgs Acdmc Rel CCO CHST$0$534,242$0$283,208$0$4,950$0$10,600$0$8,021$0$841,021$0$0
Scott Katz MD
Former Director CCMSC, Contract Physician Related Orgs$0$10,597$0$0$0$0$0$0$0$0$0$10,597$0$0
Peter Roberts
Former President CCMSC, Pres Pop Health CHST$0$556,306$0$391,408$0$160,386$0$12,976$0$14,052$0$1,135,128$0$0
Douglas Hock
Former President CCMSC, COO CMC, Pres Clinical Ops CHST$0$22,659$0$154,402$0$70,721$0$0$0$856$0$248,638$0$0
Stephanie Smith
Former Officer CCMSC, Sr Legal Counsel CHST$0$123,291$0$10,547$0$1,247$0$6,812$0$4,450$0$146,347$0$0
Jerry Lee
Treasurer CCMSC, VP Acctg/Treas CHST$0$270,923$0$87,472$0$37,547$0$14,597$0$18,301$0$428,840$0$0
Lisa Frenkel
Secretary CCMSC, Asst Gen Counsel CHST$0$213,182$0$0$0$4,526$0$6,590$0$5,665$0$229,963$0$0

Supplemental Information Detail SupplementalInformationDetail (3 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Schedule J, Part I, Line 3 Arrangement used to establish the top management official's compensationCHILDREN'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, OTHER OFFICERS, AND KEY EMPLOYEES ARE 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. COMPENSATION PROGRAM COMPONENTS: The elements of total compensation provided to CHST executives include: - Cash compensation (i.e., base salary, short-term and long-term incentive compensation, and/or other cash compensation), determined in consideration of competitive market practices, organizational and individual performance, recruitment and retention considerations, and other relevant factors. - Standard benefits, assisting in each executive's medical, dental, disability, life insurance, time off, and retirement needs, reflective of the employment status (i.e., full or part time) of the executive. - Supplemental benefits, including supplemental insurance, retirement benefits, and/or other supplemental benefits determined by the Committee to be appropriate and reasonable in relation to marketplace practices. Compensation and benefits decisions are made in consideration of each executive's position, responsibilities, skills, effort, and performance, in relation to documented practices within the appropriate comparator group(s). PEER GROUP: The Committee has defined its primary peer group for executives as not-for-profit health care organizations similar in size, structure, and complexity. This group will include leading pediatric health systems as well as integrated health systems and academic medical centers. - Data will be compiled in a manner consistent with the IRS Intermediate Sanctions rules of federal tax law, to reflect what is "ordinarily paid to like executives by like enterprises under like circumstances." - In certain circumstances, market data from additional comparator groups (e.g., research institutions, insurance industry, and general industry companies) may also be referenced. - The specific nature of the role at CHST will be considered when adding comparator groups outside of the primary peer group, and the Committee will discuss and agree on the appropriateness of adding comparator groups whenever the specific nature of the CHST role requires additional comparator groups to be used.
Schedule J, Part I, Line 4b Supplemental nonqualified retirement planNon-Qualified Retirement Plan: * Children's Health Savings Restoration Plan - There were no employees that received taxable income from the Savings Restoration Plan in 2016. Dr. William Morrow, Douglas Hock, Peter Roberts, and Jerry Lee participated in the Savings Restoration Plan.
Schedule J, Part I, Line 7 Non-fixed paymentsNon-Fixed Payments - The Human Resources Committee of the Board of Directors retains the authority to adjust annual payout percentages solely at their discretion. There were no non-fixed payments in 2016.

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (10 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Form 990, Part V, Line 2aCHILDREN'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 10 EMPLOYEES.
Form 990, Part VI, Line 15a PROCESS TO ESTABLISH COMPENSATION OF TOP MANAGEMENT OFFICIALCHILDREN'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, OTHER OFFICERS, AND KEY EMPLOYEES ARE 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. 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.
Form 990, Part VI, Line 6 Classes of members or stockholdersChildren's Health System of Texas (CHST) is the sole member.
Form 990, Part VI, Line 7a Members or stockholders electing members of governing bodyDirectors 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 stockholdersMember 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 bodyComplex 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 policyOfficers, directors, and key employees received a copy of the Statement of Interest form to execute. Disclosures made are reviewed by the CHST Executive Vice President, Chief Legal Officer and General Counsel and the Chief Compliance Officer and discussed as necessary at the appropriate Board meeting to determine if further action is needed.
Form 990, Part VI, Line 19 Required documents available to the publicCertificate of Formation and Consolidated Financial Statements are publicly available. The conflict of interest policy is made available to the public upon request.
Form 990, Part IX, Line 11g Other FeesConsulting & Professional Fees - Total Expense: 7097, Program Service Expense: , Management and General Expenses: 7097, Fundraising Expenses: ; Contract Medical - Total Expense: 878060, Program Service Expense: 858438, Management and General Expenses: 19622, Fundraising Expenses: ;
Form 990, Part XI, Line 9 Other changes in net assets or fund balancesRounding - 1;

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (26 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtPublic Charity StatusPublicCharityStatusTxtBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtControlled OrganizationControlledOrganizationIndDirect Controlling NADirectControllingNACd
Children's Medical Center of Dallas
1935 MEDICAL DISTRICT DRIVEDALLASTX75235750800628HospitalTX501(c)(3)3CHILDREN'S HEALTH SYSTEM OF TEXASfalse
Children's Medical Center Foundation
1935 MEDICAL DISTRICT DRIVEDALLASTX75235752062015FoundationTX501(c)(3)7CHILDREN'S HEALTH SYSTEM OF TEXASfalse
Anesthesiologists for Children
1935 MEDICAL DISTRICT DRIVEDALLASTX75235752917570PHYSICIANSTX501(c)(3)10CHILDREN'S HEALTH SYSTEM OF TEXASfalse
Dallas Physician Medical Services for Childrens
1935 MEDICAL DISTRICT DRIVEDALLASTX75235810584868PHYSICIANSTX501(c)(3)3CHILDREN'S HEALTH SYSTEM OF TEXASfalse
Physicians for Children
1935 MEDICAL DISTRICT DRIVEDALLASTX75235752854505PHYSICIANSTX501(c)(3)3CHILDREN'S HEALTH SYSTEM OF TEXASfalse
CHILDREN'S MEDICAL CENTER HEALTH PLAN
1935 MEDICAL DISTRICT DRIVEDALLASTX75235462737696HMOTX501(c)(3)10CHILDREN'S HEALTH SYSTEM OF TEXASfalse
CHILDREN'S MED CTR RESEARCH INST AT UTSWMC
1935 MEDICAL DISTRICT DRIVEDALLASTX75235433462044RESEARCH INSTITUTETX501(c)(3)Type ICHILDREN'S HEALTH SYSTEM OF TEXASfalse
PEDIATRIC PARTNERS
1935 MEDICAL DISTRICT DRIVEDALLASTX75235461917702CLINICALLY INTEGRATED NETWORKTX501(c)(3)Type ICHILDREN'S HEALTH SYSTEM OF TEXASfalse
CHILDREN'S MEDICAL CENTER SERVICES
1935 MEDICAL DISTRICT DRIVEDALLASTX75235461934007MEDICAL SERVICESTX501(c)(3)10CHILDREN'S HEALTH SYSTEM OF TEXASfalse
CHILDREN'S POPULATION HEALTH
1935 MEDICAL DISTRICT DRIVEDALLASTX75235463104601POPULATION HEALTHTX501(c)(3)Type ICHILDREN'S HEALTH SYSTEM OF TEXASfalse
CHILDREN'S HEALTH SYSTEM OF TEXAS
1935 MEDICAL DISTRICT DRIVEDALLASTX75235752062019MANAGEMENT COMPANYTX501(c)(3)Type IIfalseN/A
OCH Holdings
1935 MEDICAL DISTRICT DRIVEDALLASTX75235474837308HospitalTX501(c)(3)3CHILDREN'S HEALTH SYSTEM OF TEXASfalse
SPECIALISTS FOR CHILDREN
1935 MEDICAL DISTRICT DRIVEDALLASTX75235463110125PHYSICIANSTX501(c)(3)10CHILDREN'S HEALTH SYSTEM OF TEXASfalse
PHYSICIANS QUALITY ALLIANCE OF NORTH TEXAS
1935 MEDICAL DISTRICT DRIVEDALLASTX75235464049491PHYSICIANSTX501(c)(3)Type ICHILDREN'S HEALTH SYSTEM OF TEXASfalse
COMMUNITY PROVIDERS FOR CHILDREN
1935 MEDICAL DISTRICT DRIVEDALLASTX75235463675742PHYSICIANSTX501(c)(3)Type ICHILDREN'S HEALTH SYSTEM OF TEXASfalse
SOUTHWESTERN MEDICAL DISTRICT
1935 MEDICAL DISTRICT DRIVEDALLASTX75235204101612MEDICAL DISTRICTTX501(c)(3)Type IfalseN/A
WOMEN'S AUXILIARY OF CMCD
12720 HILLCREST RDDALLASTX75230752485538WOMEN'S AUXILIARYTX501(c)(3)10falseN/A
THE HEALTH AND WELLNESS ALLIANCE FOR CHILDREN
1935 MEDICAL DISTRICT DRIVEDALLASTX75235463080586PHYSICIANSTX501(c)(3)Type ICHILDREN'S HEALTH SYSTEM OF TEXASfalse
Children's BMG dba One Care Domain
1935 Medical District DriveDallasTX75235475057374PhysicianTX501(c)(3)3CHILDREN'S HEALTH SYSTEM OF TEXASfalse
Wellness Innovations Physician Partners
1935 Medical District DriveDallasTX75235811734937PhysicianTX501(c)(3)3Wellness Innovations LLCfalse
CHST Physician Group 1
1935 Medical District DriveDallasTX75235813582843PhysicianTX501(c)(3)10CHILDREN'S HEALTH SYSTEM OF TEXASfalse
CHST Physician Group 2
1935 Medical District DriveDallasTX75235813679995PhysicianTX501(c)(3)10CHILDREN'S HEALTH SYSTEM OF TEXASfalse
CHST Physician Group 3
1935 Medical District DriveDallasTX75235813691209PhysicianTX501(c)(3)10CHILDREN'S HEALTH SYSTEM OF TEXASfalse
CHST Physician Group 4
1935 Medical District DriveDallasTX75235814577909PhysicianTX501(c)(3)10CHILDREN'S HEALTH SYSTEM OF TEXASfalse
CHST Physician Group 5
1935 Medical District DriveDallasTX75235814848085PhysicianTX501(c)(3)10CHILDREN'S HEALTH SYSTEM OF TEXASfalse
CHST Physician Group 6
1935 Medical District DriveDallasTX75235814865847PhysicianTX501(c)(3)10CHILDREN'S HEALTH SYSTEM OF TEXASfalse

Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp

Related Organization Name RelatedOrganizationName

FieldValueIRS element (for citing)
Business Name Line1Wellness Innovations LLCBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line11935 Medical District DriveAddressLine1Txt
CityDallasCityNm
State AbbreviationTXStateAbbreviationCd
ZIP75235ZIPCd
FieldValueIRS element (for citing)
EIN475246461EIN
Primary ActivitiesPhysiciansPrimaryActivitiesTxt
Legal Domicile StateTXLegalDomicileStateCd

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1CHST Investment Holdings LLCBusinessNameLine1Txt
FieldValueIRS element (for citing)
Predominant Income TypeUnrelatedPredominantIncomeTypeTxt
Disproportionate AllocationsfalseDisproportionateAllocationsInd
General Or Managing PartnerfalseGeneralOrManagingPartnerInd
Ownership0OwnershipPct

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (5 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtEntity TypeEntityTypeTxtOwnershipOwnershipPctControlled OrganizationControlledOrganizationIndAddress Line1ForeignAddress/AddressLine1TxtAddress Line2ForeignAddress/AddressLine2TxtCityForeignAddress/CityNmCountryForeignAddress/CountryCdForeign PostalForeignAddress/ForeignPostalCdLegal Domicile Foreign CountryLegalDomicileForeignCountryCd
CHILDREN'S INSURANCE COMPANY
76 ST PAUL STREET SUITE 500BURLINGTONVT05401030328102INSURANCE COMPANYVTCHILDREN'S HEALTH SYSTEM OF TEXASC Corporation0false
ALTERNATIVE CARE SYSTEMS
1935 MEDICAL DISTRICT DRIVEDALLASTX75235752244475OTHER MEDICAL SERVICESTXCHILDREN'S HEALTH SYSTEM OF TEXASC Corporation0false
NTPSS INC
1935 MEDICAL DISTRICT DRIVEDALLASTX75235471036641PHYSICIAN SOLUTIONSTXPediatric PartnersC Corporation0false
Texas Bluebonnet Insurance Company
1935 Medical District DriveDallasTX75235475032893Insurance CompanyTXChildren's Health System of TexasC Corporation0false
TEXAS TRINITY RIVER ASSURANCE COMPANY LTD
981318151Self-insuranceChildren's Health System of TexasC Corporation0false878 West Bay RoadPO Box 1159Grand CaymanCJKY11202CJ
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 OrgYes (true)LoansOrGuaranteesFromOthOrgInd
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 OrgYes (true)PerformOfServicesForOthOrgInd
Perform Of Services By Other OrgfalsePerformOfServicesByOtherOrgInd
Sharing Of FacilitiesYes (true)SharingOfFacilitiesInd
Paid Employees SharingYes (true)PaidEmployeesSharingInd
Reimbursement Paid To Other OrgfalseReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other OrgfalseReimbursementPaidByOtherOrgInd
Transfer To Other OrgfalseTransferToOtherOrgInd
Transfer From Other OrgfalseTransferFromOtherOrgInd

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