2017-11-13T10:05:08-06:00 2016-12-31 990 2016-01-01 462737696 Children's Medical Center Health Plan CHIL 2144567000 1935 Medical District Drive Dallas TX 75235 Jerry Lee CHST VP, Accounting & Treasury 2017-11-09 2016 2017-02-10 21:41:12Z Doris Hunt 1935 Medical District Drive Dallas TX 75235 38619132 false X N/A X 2013 TX TO INSURE HEALTH COVERAGE FOR POOR, DISTRESSED, OR UNDERPRIVILEGED CHILDREN & ADULTS. 7 0 145 0 0 0 0 38616489 1595 2643 0 1595 38619132 0 0 2290917 8840428 0 0 2337083 43132948 4628000 51973376 -4626405 -13354244 5077374 31785913 779400 21442181 4297974 10343732 TO INSURE HEALTH COVERAGE FOR POOR, DISTRESSED, OR UNDERPRIVILEGED CHILDREN & ADULTS IN THE STATE OF TEXAS. false false 45260561 38616489 To insure poor, distressed, or underprivileged children or adults enrolled in Texas Medicaid (STAR), Children's Health Insurance Program (CHIP), Medicaid recipients on Social Security Administration's Supplemental Security Income (STAR Kids and STAR+PLUS), Medicaid for foster children (STAR health), and Medicare Advantage (covering only those patients that have dual eligibility for Medicaid and Medicare benefits) in the State of Texas. 45260561 true false false false false false false false false false false false false true true false false true false false false false false false false false false false false true false false false false false false false false false false false false false true false false false true 46 0 true 145 true false false false false false false false false false false X 7 0 false false false false true true true true true false false false true true true true true false false false X STEPHANIE K SMITH 2144597000 1935 MEDICAL DISTRICT DRIVE DALLAS TX 75235 Peter Roberts President CMCHP, Pres Population Health CHST 1.0 54.0 X X 0 1108100 27028 Doris Hunt Executive Director CMCHP, SVP Insurance CHST 47.0 3.0 X X 0 538452 20149 Richard Goode Director and Treasurer CMCHP, EVP Chief Financial Officer and Treasurer CHST 1.0 54.0 X X 0 457734 14224 Mary Goessler MD Medical Director CMCHP, VP CHST 1.0 1.0 X X 0 418124 27230 Christopher J Durovich Chairman CMCHP, President CEO CHST 1.0 59.0 X 0 3094791 39495 Ray Tsai MD Director CMCHP, SVP CHST 1.0 54.0 X 0 601337 13404 Lawrence Foust Director CMCHP, EVP Chief Legal Officer and General Counsel CHST 1.0 54.0 X 0 778911 25316 Mark Chulick Secretary CMCHP, Asst General Counsel CHST 1.0 49.0 X 0 211010 11805 Stephanie Smith Former Secretary CMCHP, Sr Legal Counsel CHST 0.0 50.0 X 0 135085 11262 Stephanie Slaughter Former Director/Officer CMCHP, VP CHST 0.0 50.0 X 0 579027 11908 Michele Chulick Former Director/Officer CMCHP, President Venture CHST 0.0 55.0 X 0 1064361 10600 0 8986930 212421 0 true true false HALLE HEALTHCARE INFORMATICS 241 S BEVERLY STREET Chandler AZ 85225 Professional Services 1800757 MEDIWARE INFORMATION SYSTEMS PO BOX 204176 Dallas TX 75230 Professional Services 1100793 BILLY MILLWEE AND ASSOCIATES 1960 Hawthorne Loop Driftwood TX 78619 Professional Services 486953 COPE HEALTH SOLUTIONS 315 W 9TH ST 1001 Los Angeles CA 90015 Professional Services 354708 JOHN SONS PRESS 3300 SOUTH FREEWAY Fort Worth TX 76110 Professional Services 227446 11 0 Premium Revenue 900099 38616489 38616489 0 0 0 0 38616489 2643 2643 0 0 0 0 0 0 0 0 0 38619132 38616489 0 2643 7140576 4427157 2713419 335871 208240 127631 899360 557603 341757 464621 288065 176556 2615958 1621894 994064 0 345624 214287 131337 130373 80831 49542 1043987 647272 396715 103998 64479 39519 57205 35467 21738 378526 234686 143840 Covered Medical Expenses 36158174 36158174 Shared Services 1569769 1569769 Premium Taxes 688625 688625 Transltn & Interprtn Srvc 22478 22478 18231 11303 6928 0 51973376 45260561 6712815 0 3984895 21924294 17 0 0 0 21582 40973 0 0 570897 0 0 0 500000 9820629 5077374 31785913 227732 892135 551668 20550046 779400 21442181 X 4297974 10343732 4297974 10343732 5077374 31785913 X -13354244 19400002 X false true X true false X 0 0 0 0 0 0 0 0 0 38616489 38616489 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 38616489 38616489 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 38616489 0 0 1784 1595 2643 6022 0 0 0 0 0 0 0 1784 1595 2643 6022 0 0 0 0 0 0 0 0 0 0 0 0 0 1784 1595 38619132 38622511 X STATE INSURANCE STATUTORY DEPOSIT 500000 LT Receivable/Payable-CMC 9320629 9820629 LT Advances - Affiliates 21507 LT DEFERRED RENT Accrued Premium Tax Payable HM 688625 HMO IBNR 19839914 20550046 Schedule D, Part X, Line 2 The organization's consolidated financial statements for the year ending December 31, 2016 did not require a FIN 48 footnote. true true false false false false false true false Michele Chulick Former Director/Officer CMCHP, President Venture CHST 0 582817 0 408680 0 72864 0 10600 0 0 0 1074961 0 0 Peter Roberts President CMCHP, Pres Population Health CHST 0 556306 0 391408 0 160386 0 12976 0 14052 0 1135128 0 0 Doris Hunt Executive Director CMCHP, SVP Insurance CHST 0 350945 0 184483 0 3024 0 10600 0 9549 0 558601 0 0 Richard Goode Director and Treasurer CMCHP, EVP Chief Financial Officer and Treasurer CHST 0 356414 0 100000 0 1320 0 7577 0 6647 0 471958 0 0 Mary Goessler MD Medical Director CMCHP, VP CHST 0 309308 0 99334 0 9482 0 10600 0 16630 0 445354 0 0 Christopher J Durovich Chairman CMCHP, President CEO CHST 0 1053808 0 1280410 0 760573 0 18000 0 21495 0 3134286 0 37775 Ray Tsai MD Director CMCHP, SVP CHST 0 375265 0 209366 0 16706 0 0 0 13404 0 614741 0 0 Lawrence Foust Director CMCHP, EVP Chief Legal Officer and General Counsel CHST 0 496421 0 277725 0 4765 0 10600 0 14716 0 804227 0 0 Stephanie Smith Former Secretary CMCHP, Sr Legal Counsel CHST 0 123291 0 10547 0 1247 0 6812 0 4450 0 146347 0 0 Stephanie Slaughter Former Director/Officer CMCHP, VP CHST 0 72023 0 146226 0 360778 0 7956 0 3952 0 590935 0 0 Mark Chulick Secretary CMCHP, Asst General Counsel CHST 0 181977 0 26073 0 2959 0 0 0 11805 0 222814 0 0 Schedule J, Part I, Line 3 Arrangement used to establish the top management official's compensation CHILDREN'S HEALTH SYSTEM OF TEXAS (EIN 75-2062019) IS THE SOLE MEMBER AND COMMON PAYING AGENT FOR CHILDREN'S MEDICAL CENTER HEALTH PLAN (CMCHP). THEREFORE, CMCHP'S TOP MANAGEMENT OFFICIAL, 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 4a Severance or change-of-control payment Severance Payment: *Severance - Stephanie Slaughter - $247,950 Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan Non-Qualified Retirement Plan: Retirement Income Restoration Plan - Christopher J Durovich received $550,086 as taxable income from the Retirement Income restoration Plan in 2016. There are no other employees who participate in the Retirement Income Restoration Plan. * Savings Restoration Plan - Christopher J Durovich received $66,503, and Stephanie Slaughter received $8,395, as taxable income from the Savings Restoration Plan. Additional employees who participated in the Savings Restoration Plan include Peter Roberts, Ray Tsai, Michele Chulick, Lawrence Foust, Richard Goode, Mary Goessler, and Doris Hunt. Schedule J, Part I, Line 7 Non-fixed payments Non-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. Form 990, Part V, Line 2a CHILDREN'S HEALTH SYSTEM OF TEXAS (CHST) EIN 75-2062019 IS THE COMMON PAYING AGENT FOR CHILDREN'S MEDICAL CENTER HEALTH PLAN (CMCHP) THEREFORE, ALL APPLICABLE IRS TAX COMPLIANCE FILINGS ARE REPORTED BY CHST ON BEHALF OF CMCHP. CMCHP HAS APPROXIMATELY 145 EMPLOYEES. Form 990, Part VI, Line 15a PROCESS TO ESTABLISH COMPENSATION OF TOP MANAGEMENT OFFICIAL CHILDREN'S HEALTH SYSTEM OF TEXAS (EIN 75-2062019) IS THE SOLE MEMBER AND COMMON PAYING AGENT FOR CHILDREN'S MEDICAL CENTER HEALTH PLAN (CMCHP). THEREFORE, CMCHP'S TOP MANAGEMENT OFFICIAL, 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 stockholders Children's Health System of Texas (CHST) is the sole member. Form 990, Part VI, Line 7a Members or stockholders electing members of governing body CHST elects all members of the organization's Board of Directors. Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders Member reserve powers are specified in the organization's Bylaws and represent those actions by the organization which require member approval. These powers generally encompass changes in the mission of the organization, addition of new members, specified financial matters, amendments to the organization's Certificate of Formation and Bylaws, and appointment of directors. Form 990, Part VI, Line 11b Review of form 990 by governing body Children's Medical Center Health Plan has delegated its oversight and review of the Form 990 to the Board of Directors of Children's Health System of Texas (CHST), its Sole Member. A draft of the Form 990 is presented to the CHST Audit Committee for review prior to filing. A copy of the Final Form 990 is made available to the CHST directors through our Board portal before it is filed. Form 990, Part VI, Line 12c Conflict of interest policy Officers, directors, and key employees 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 public Certificate 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 XI, Line 9 Other changes in net assets or fund balances CHST Paid-in Capital - 19400000; Rounding - 2; Children's Medical Center of Dallas 1935 MEDICAL DISTRICT DRIVE DALLAS TX 75235 750800628 Hospital TX 501(c)(3) 3 CHILDREN'S HEALTH SYSTEM OF TEXAS false Children's Medical Center Foundation 1935 MEDICAL DISTRICT DRIVE DALLAS TX 75235 752062015 Foundation TX 501(c)(3) 7 CHILDREN'S HEALTH SYSTEM OF TEXAS false Anesthesiologists for Children 1935 MEDICAL DISTRICT DRIVE DALLAS TX 75235 752917570 PHYSICIANS TX 501(c)(3) 10 CHILDREN'S HEALTH SYSTEM OF TEXAS false Dallas Physician Medical Services for Childrens 1935 MEDICAL DISTRICT DRIVE DALLAS TX 75235 810584868 PHYSICIANS TX 501(c)(3) 3 CHILDREN'S HEALTH SYSTEM OF TEXAS false Physicians for Children 1935 MEDICAL DISTRICT DRIVE DALLAS TX 75235 752854505 PHYSICIANS TX 501(c)(3) 3 CHILDREN'S HEALTH SYSTEM OF TEXAS false COMPLEX CARE MED SVC CORP 1935 MEDICAL DISTRICT DRIVE DALLAS TX 75235 461893597 MEDICAL SERVICES TX 501(c)(3) 3 CHILDREN'S HEALTH SYSTEM OF TEXAS false CHILDREN'S MEDICAL CENTER HEALTH PLAN 1935 MEDICAL DISTRICT DRIVE DALLAS TX 75235 462737696 HMO TX 501(c)(3) 10 CHILDREN'S HEALTH SYSTEM OF TEXAS false CHILDREN'S MED CTR RESEARCH INST AT UTSWMC 1935 MEDICAL DISTRICT DRIVE DALLAS TX 75235 433462044 RESEARCH INSTITUTE TX 501(c)(3) Type I CHILDREN'S HEALTH SYSTEM OF TEXAS false PEDIATRIC PARTNERS 1935 MEDICAL DISTRICT DRIVE DALLAS TX 75235 461917702 CLINICALLY INTEGRATED NETWORK TX 501(c)(3) Type I CHILDREN'S HEALTH SYSTEM OF TEXAS false CHILDREN'S MEDICAL CENTER SERVICES 1935 MEDICAL DISTRICT DRIVE DALLAS TX 75235 461934007 MEDICAL SERVICES TX 501(c)(3) 10 CHILDREN'S HEALTH SYSTEM OF TEXAS false CHILDREN'S POPULATION HEALTH 1935 MEDICAL DISTRICT DRIVE DALLAS TX 75235 463104601 POPULATION HEALTH TX 501(c)(3) Type I CHILDREN'S HEALTH SYSTEM OF TEXAS false CHILDREN'S HEALTH SYSTEM OF TEXAS 1935 MEDICAL DISTRICT DRIVE DALLAS TX 75235 752062019 MANAGEMENT COMPANY TX 501(c)(3) Type II N/A false OCH Holdings 1935 MEDICAL DISTRICT DRIVE DALLAS TX 75235 474837308 Hospital TX 501(c)(3) 3 CHILDREN'S HEALTH SYSTEM OF TEXAS false SPECIALISTS FOR CHILDREN 1935 MEDICAL DISTRICT DRIVE DALLAS TX 75235 463110125 PHYSICIANS TX 501(c)(3) 10 CHILDREN'S HEALTH SYSTEM OF TEXAS false PHYSICIANS QUALITY ALLIANCE OF NORTH TEXAS 1935 MEDICAL DISTRICT DRIVE DALLAS TX 75235 464049491 PHYSICIANS TX 501(c)(3) Type I CHILDREN'S HEALTH SYSTEM OF TEXAS false COMMUNITY PROVIDERS FOR CHILDREN 1935 MEDICAL DISTRICT DRIVE DALLAS TX 75235 463675742 PHYSICIANS TX 501(c)(3) Type I CHILDREN'S HEALTH SYSTEM OF TEXAS false SOUTHWESTERN MEDICAL DISTRICT 1935 MEDICAL DISTRICT DRIVE DALLAS TX 75235 204101612 MEDICAL DISTRICT TX 501(c)(3) Type I N/A false WOMEN'S AUXILIARY OF CMCD 12720 HILLCREST RD DALLAS TX 75230 752485538 WOMEN'S AUXILIARY TX 501(c)(3) 10 N/A false THE HEALTH AND WELLNESS ALLIANCE FOR CHILDREN 1935 MEDICAL DISTRICT DRIVE DALLAS TX 75235 463080586 PHYSICIANS TX 501(c)(3) Type I CHILDREN'S HEALTH SYSTEM OF TEXAS false Children's BMG dba One Care Domain 1935 Medical District Drive Dallas TX 75235 475057374 Physician TX 501(c)(3) 3 CHILDREN'S HEALTH SYSTEM OF TEXAS false Wellness Innovations Physician Partners 1935 Medical District Drive Dallas TX 75235 811734937 Physician TX 501(c)(3) 3 Wellness Innovations LLC false CHST Physician Group 1 1935 Medical District Drive Dallas TX 75235 813582843 Physician TX 501(c)(3) 10 CHILDREN'S HEALTH SYSTEM OF TEXAS false CHST Physician Group 2 1935 Medical District Drive Dallas TX 75235 813679995 Physician TX 501(c)(3) 10 CHILDREN'S HEALTH SYSTEM OF TEXAS false CHST Physician Group 3 1935 Medical District Drive Dallas TX 75235 813691209 Physician TX 501(c)(3) 10 CHILDREN'S HEALTH SYSTEM OF TEXAS false CHST Physician Group 4 1935 Medical District Drive Dallas TX 75235 814577909 Physician TX 501(c)(3) 10 CHILDREN'S HEALTH SYSTEM OF TEXAS false CHST Physician Group 5 1935 Medical District Drive Dallas TX 75235 814848085 Physician TX 501(c)(3) 10 CHILDREN'S HEALTH SYSTEM OF TEXAS false CHST Physician Group 6 1935 Medical District Drive Dallas TX 75235 814865847 Physician TX 501(c)(3) 10 CHILDREN'S HEALTH SYSTEM OF TEXAS false Wellness Innovations LLC 1935 Medical District Drive Dallas TX 75235 475246461 Physicians TX CHST Investment Holdings LLC Unrelated false false 0 CHILDREN'S INSURANCE COMPANY 76 ST PAUL STREET SUITE 500 BURLINGTON VT 05401 030328102 INSURANCE COMPANY VT CHILDREN'S HEALTH SYSTEM OF TEXAS C Corporation 0 false ALTERNATIVE CARE SYSTEMS 1935 MEDICAL DISTRICT DRIVE DALLAS TX 75235 752244475 OTHER MEDICAL SERVICES TX CHILDREN'S HEALTH SYSTEM OF TEXAS C Corporation 0 false NTPSS INC 1935 MEDICAL DISTRICT DRIVE DALLAS TX 75235 471036641 PHYSICIAN SOLUTIONS TX Pediatric Partners C Corporation 0 false Texas Bluebonnet Insurance Company 1935 Medical District Drive Dallas TX 75235 475032893 Insurance Company TX Children's Health System of Texas C Corporation 0 false TEXAS TRINITY RIVER ASSURANCE COMPANY LTD 878 West Bay Road PO Box 1159 Grand Cayman CJ KY11202 981318151 Self-insurance CJ Children's Health System of Texas C Corporation 0 false false false true false true false false false false false false true false false true false false false false