2017-08-10T11:52:53-05:00 2016-09-30 BKD LLP 2800 Post Oak Blvd Ste 3200 HOUSTON TX 77056 990 2015-10-01 752705881 COOK CHILDREN'S HEALTH CARE SYSTEM % CORY RHOADES COOK 6828854000 801 SEVENTH AVENUE FORT WORTH TX 76104 CORY RHOADES SENIOR V.P. 2017-05-15 true Amanda Maya P01067777 7134994600 2015 2021-01-29 14:40:06Z RICK W MERRILL 801 SEVENTH AVE FORT WORTH TX 76104 357899032 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 13 604 24 0 0 1253139 2273667 134752168 156657970 603884 3363833 3945547 3954678 140554738 166250148 402824 600700 0 0 42745855 48795453 0 0 0 95404230 98909526 138552909 148305679 2001829 17944469 191607529 334995116 38725643 48642797 152881886 286352319 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 120668226 600700 160612648 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. 120668226 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 171 0 true 604 true false true CJ false false false false false false false false false X 22 13 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 PETER L PHILPOTT TRUSTEE-CHAIRMAN 2.0 3.0 X X 0 0 0 SANDRA ARCA MD TRUSTEE 1.0 42.0 X 0 279392 47156 MATTHEW DZURIK MD TRUSTEE 1.0 42.0 X 0 448624 31899 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 242606 16510 VANESSA CHARETTE MD TRUSTEE 1.0 41.0 X 0 544406 20387 JERRY R CONATSER TRUSTEE 1.0 4.0 X 0 0 0 JEFFREY H CONNER TRUSTEE-SECRETARY/TREASURER 2.0 2.0 X X 0 0 0 JULIA DAVIDSON TRUSTEE 1.0 1.0 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 326646 20585 SAMUEL KLEINMAN MD TRUSTEE 1.0 40.0 X 0 604125 43619 W M LAWHON TRUSTEE 1.0 1.0 X 0 0 0 G MALCOLM LOUDEN TRUSTEE 1.0 2.0 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 683049 30585 BRIAN C NEWBY TRUSTEE 1.0 3.0 X 0 0 0 BONNIE PETSCHE TRUSTEE 1.0 4.0 X 0 0 0 RAY RHODES MD TRUSTEE 1.0 42.0 X 0 177588 10768 JASON V TERK MD TRUSTEE 1.0 40.0 X 0 339700 43619 LINDA THOMPSON MD TRUSTEE-VICE CHAIRMAN 2.0 42.0 X X 0 285383 17476 JAMES E WEBB TRUSTEE 1.0 2.0 X 0 0 0 TODD WOLF MD TRUSTEE 1.0 42.0 X 0 430781 42807 RICK W MERRILL PRESIDENT AND CEO 17.0 23.0 X 610538 869555 205294 JOANN M SANDERS MD CHIEF QUALITY OFFICER 40.0 0.0 X 526146 0 83622 JAMES C CUNNINGHAM MD EXEC VICE PRESIDENT 40.0 0.0 X 719913 0 38666 ROBERT K FEATHER SR V PRESIDENT PUBLIC POLICY 40.0 0.0 X 473955 0 45770 KEITH HOLTZ CHIEF ADMINISTRATION OFFICER 40.0 0.0 X 526618 0 104219 ERIC H HUBLI MD CHIEF SYS EFFECTIVENESS OFFCR 40.0 0.0 X 629816 0 43294 GREGORY K JIMERSON V PRESIDENT-PAYOR RELATIONS 40.0 0.0 X 278734 0 42399 STEPHEN W KIMMEL CFO 10.0 30.0 X 184268 552805 99556 DAVID F LANCASTER VP-INTERNAL AUDIT & COMPLIANCE 40.0 0.0 X 253982 0 36155 SCOTT LEDDY CHIEF MEDICAL INFO OFFICER 40.0 0.0 X 314193 0 36687 JAMES D MARSHALL MD CHIEF RESEARCH OFFICER 40.0 0.0 X 575695 0 44680 CARA MARTZ SECRETARY/ASST TO PRESIDENT 35.0 5.0 X 139777 0 15489 JOHN W MCNEY SR V PRESIDENT-GEN COUNSEL 40.0 0.0 X 532903 0 37954 THERESA ZAK MEADOWS SR V PRESIDENT-CIO 40.0 0.0 X 500522 0 39966 GEORGE B MONTAGUE V PRESIDENT-REAL ESTATE 36.0 4.0 X 324952 0 43690 CORY RHOADES SR V PRESIDENT-FINANCE 40.0 0.0 X 357242 0 55830 COLEMAN D SKINNER V PRESIDENT-REVENUE CYCLE 40.0 0.0 X 242671 0 43303 JAMES R STALDER V PRES-INFO SYSTEMS & CTO 40.0 0.0 X 319304 0 39143 LARRY L TUBB SR V PRESIDENT-PLANNING 40.0 0.0 X 397832 0 35145 NATALIE WILKINS CHIEF OF STAFF 40.0 0.0 X 0 0 0 LORRAINEA WILLIAMS PAT/MEDICATION SAFETY OFFCR 40.0 0.0 X 231647 0 13532 DEBORAH RUBINSON AVP-EDUCATION 40.0 0.0 X 208195 0 12353 JOSEPH GALLAHGER DEPUTY GENERAL COUNSEL 40.0 0.0 X 311692 0 37714 BETH SCHMIDT AVP-HUMAN RESOURCES 40.0 0.0 X 213134 0 29945 KENT SMITH ASSOCIATE GENERAL COUNSEL 40.0 0.0 X 276995 0 22710 KAREN WARDELL ASSOCIATE GENERAL COUNSEL 40.0 0.0 X 276659 0 33168 9427383 5784660 1565695 134 false true false GENERAL DATATECH DEPT D8014 PO BOX 650002 DALLAS TX 75265 SOFTWARE SERVICES 3291628 MICROSOFT 1950 N STEMMONS FWY STE 5010 DALLAS TX 75207 SOFTWARE SERVICES 662191 MCKESSON TECHNOLOGIES INC 22423 NETWORK PLACE CHICAGO IL 60673 CONSULTING/ANALYTICS 770027 AXISPOINT HEALTH MAIL CODE 5199 PO BOX 660367 DALLAS TX 752660367 SOFTWARE SERVICES 587496 CLOUDWAVE DEPT CH 19800 PALATINE IL 600559800 PROFESSIONAL SVCS 570750 31 687138 1024469 562060 2273667 SHARED SERVICES 900099 140104132 140104132 HUMAN RESOURCES 900099 8867559 8867559 RENT 900099 3048785 3048785 COMMUNITY HEALTH OUTREACH 900099 3744713 3744713 RESEARCH 900099 169541 169541 723240 723240 156657970 3455400 3455400 0 0 0 0 0 191552817 4500 191520270 128614 32547 -124114 -91567 -91567 0 0 0 REBATE 900099 3802406 3802406 CONCIERGE 900099 136796 136796 OTHER REVENUE 900099 15476 15476 3954678 166250148 160612648 3363833 550700 550700 50000 50000 0 0 8432445 1817791 6614654 0 0 28736113 21226895 7509218 0 11626895 9204959 2421936 0 0 720522 97365 623157 361873 361873 150577 150577 0 167388 167388 8203835 7278196 925639 4014200 449069 3565131 802846 474211 328635 55504212 55504212 0 2790478 2790478 1022720 831369 191351 0 300148 248646 51502 193624 1976 191648 0 8659033 8659033 1635707 1635707 MINOR EQUIPMENT 4284048 4283982 66 PHYSICIAN REMUNERATION 7290966 2738153 4552813 DUES & SUBSCRIPTIONS 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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 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; 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 150577 150577 148155102 148305679 1000000 250000 false 1000000 1000000 1000000 1000000 4000000 6000000 131959 143972 169449 150577 595957 250000 250000 250000 250000 1000000 1500000 33385887 33385887 34197460 8759309 25438151 872461 753954 118507 71098408 38658696 32439712 796637 464325 332312 91714569 168260881 485199 1568809 2054008 166206873 167389 -124114 43275 166250148 149707099 1568809 1568809 148138290 167389 167389 148305679 SCHEDULE D, PART XI, LINE 2D OTHER CHANGE: MANAGEMENT FEE REDUCTION $1,568,809 SCHEDULE D, PART XII, LINE 2D OTHER CHANGE: MANAGEMENT FEE REDUCTION $1,568,809 SCHEDULE D, PART XI, LINE 4B LOSS ON ASSET DISPOSITION ($124,114) Central America and the Caribbean Investments 5288763 5288763 5288763 true false true false false false true UNT HEALTH SCIENCE CENTER 3500 CAMP BOWIE BLVD FT WORTH TX 76107 756064033 501(C)3 500000 1 SCHOLARSHIPS FOR INDIVIDUALS 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 & 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 false true false false false false false false false RICK W MERRILL PRESIDENT AND CEO 352666 502284 181547 258566 76325 108705 73657 104906 11026 15705 695221 990166 0 0 SANDRA ARCA MD TRUSTEE 0 268854 0 1819 0 8719 0 18462 0 28694 0 326548 0 0 MATTHEW DZURIK MD TRUSTEE 0 415767 0 5833 0 27024 0 16563 0 15336 0 480523 0 0 JOANN M SANDERS MD CHIEF QUALITY OFFICER 346380 0 112760 0 67006 0 62766 0 20856 0 609768 0 0 0 DEBORAH RUBINSON AVP-EDUCATION 164080 0 34161 0 9954 0 11395 0 958 0 220548 0 0 0 JAMES C CUNNINGHAM MD EXEC VICE PRESIDENT 430678 0 170008 0 119227 0 19875 0 18791 0 758579 0 0 0 MATTHEW CARROLL MD TRUSTEE 0 220428 0 18700 0 3478 0 7086 0 9424 0 259116 0 0 VANESSA CHARETTE MD TRUSTEE 0 528236 0 10000 0 6170 0 19875 0 512 0 564793 0 0 GRETCHEN EAMES MD TRUSTEE 0 307215 0 5500 0 13931 0 19875 0 710 0 347231 0 0 SAMUEL KLEINMAN MD TRUSTEE 0 591823 0 0 0 12302 0 19875 0 23744 0 647744 0 0 MATTHEW E MAYFIELD MD TRUSTEE 0 671909 0 0 0 11140 0 10600 0 19985 0 713634 0 0 RAY RHODES MD TRUSTEE 0 121095 0 50000 0 6493 0 5100 0 5668 0 188356 0 0 JASON V TERK MD TRUSTEE 0 330590 0 0 0 9110 0 19875 0 23744 0 383319 0 0 LINDA THOMPSON MD TRUSTEE-VICE CHAIRMAN 0 250431 0 25000 0 9952 0 16563 0 913 0 302859 0 0 TODD WOLF MD TRUSTEE 0 287284 0 135857 0 7640 0 16563 0 26244 0 473588 0 0 ROBERT K FEATHER SR V PRESIDENT PUBLIC POLICY 275494 0 113133 0 85328 0 19875 0 25895 0 519725 0 0 0 KEITH HOLTZ CHIEF ADMINISTRATION OFFICER 347681 0 140332 0 38605 0 77483 0 26736 0 630837 0 0 0 ERIC H HUBLI MD CHIEF SYS EFFECTIVENESS OFFCR 523512 0 70310 0 35994 0 16563 0 26731 0 673110 0 0 0 GREGORY K JIMERSON V PRESIDENT-PAYOR RELATIONS 197601 0 79237 0 1896 0 16423 0 25976 0 321133 0 0 0 STEPHEN W KIMMEL CFO 121376 364131 47886 143658 15006 45016 18436 55308 6454 19358 209158 627471 0 0 DAVID F LANCASTER VP-INTERNAL AUDIT & COMPLIANCE 185856 0 55907 0 12219 0 19134 0 17021 0 290137 0 0 0 SCOTT LEDDY CHIEF MEDICAL INFO OFFICER 254216 0 51347 0 8630 0 10600 0 26087 0 350880 0 0 0 JAMES D MARSHALL MD CHIEF RESEARCH OFFICER 485723 0 66123 0 23849 0 19875 0 24805 0 620375 0 0 0 CARA MARTZ SECRETARY/ASST TO PRESIDENT 106020 0 22753 0 11004 0 7162 0 8327 0 155266 0 0 0 JOHN W MCNEY SR V PRESIDENT-GEN COUNSEL 319141 0 128801 0 84961 0 19875 0 18079 0 570857 0 0 0 THERESA ZAK MEADOWS SR V PRESIDENT-CIO 310354 0 126366 0 63802 0 13250 0 26716 0 540488 0 0 0 GEORGE B MONTAGUE V PRESIDENT-REAL ESTATE 238575 0 71405 0 14972 0 19788 0 23902 0 368642 0 0 0 CORY RHOADES SR V PRESIDENT-FINANCE 262054 0 81570 0 13618 0 29240 0 26590 0 413072 0 0 0 COLEMAN D SKINNER V PRESIDENT-REVENUE CYCLE 184355 0 56388 0 1928 0 17073 0 26230 0 285974 0 0 0 JAMES R STALDER V PRES-INFO SYSTEMS & CTO 218967 0 99197 0 1140 0 12669 0 26474 0 358447 0 0 0 LARRY L TUBB SR V PRESIDENT-PLANNING 250586 0 95324 0 51922 0 19875 0 15270 0 432977 0 0 0 LORRAINEA WILLIAMS PAT/MEDICATION SAFETY OFFCR 184225 0 39816 0 7606 0 11633 0 1899 0 245179 0 0 0 JOSEPH GALLAHGER DEPUTY GENERAL COUNSEL 234629 0 70151 0 6912 0 19875 0 17839 0 349406 0 0 0 BETH SCHMIDT AVP-HUMAN RESOURCES 173070 0 36744 0 3320 0 15514 0 14431 0 243079 0 0 0 KENT SMITH ASSOCIATE GENERAL COUNSEL 205798 0 60904 0 10293 0 8047 0 14663 0 299705 0 0 0 KAREN WARDELL ASSOCIATE GENERAL COUNSEL 206814 0 62931 0 6914 0 15384 0 17784 0 309827 0 0 0 SCHEDULE J, PART I, LINE 1A JAMES C CUNNINGHAM $31 GROSS-UP CARA MARTZ $113 GROSS-UP JOANN SANDERS $31 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 EXTREMELY UNUSUAL 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 2015 CME GROSS UP AMOUNTS SANDRA ARCA, MD $1,500.00 VANESSA CHARETTE, MD $1,125.00 JAMES C. CUNNINGHAM, MD $3,375.00 MATTHEW DZURIK, MD $1,500.00 GRETCHEN EAMES, MD $2,250.00 ERIC H. HUBLI, MD $3,375.00 SAMUEL E. KLEINMAN, MD $1,500.00 JAMES D. MARSHALL, MD $4,725.00 MATT MAYFIELD, MD $2,100.00 JOANN M. SANDERS, MD $5,062.50 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. 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 135,821 162,000 CCHS JAMES C. CUNNINGHAM, MD 79,840 NONE CCHS ROBERT K. FEATHER 58,366 NONE CCHS KEITH HOLTZ 18,000 66,883 CCHS ERIC H. HUBLI, MD 18,000 NONE CCHS STEPHEN KIMMEL 18,000 63,144 CCHS JOHN W. MCNEY 58,984 NONE CCHS THERESA ZAK MEADOWS 51,931 NONE CCHS CORY RHOADES 8,848 13,437 CCHS JOANN SANDERS, MD 18,000 42,891 CCHS LARRY L. TUBB 33,410 NONE CCHS MATTHEW DZURIK, MD 18,000 NONE CCPN FORM 990 PART VI, QUESTION 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, QUESTION 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, QUESTION 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, QUESTION 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, QUESTION 15A & 15B REVIEW AND APPROVAL OF COMPENSATION: COOK CHILDREN'S HEALTH CARE SYSTEM HAS ESTABLISHED A COMPENSATION 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., AN INDEPENDENT, NATIONALLY RECOGNIZED COMPENSATION CONSULTANT. THE COMPENSATION COMMITTEE DOCUMENTS THE BASIS FOR ITS DETERMINATIONS FOLLOWING CONTEMPORANEOUS SUBSTANTIATION OF THE COMPENSATION COMMITTEE'S DELIBERATIONS AND DECISIONS. THE COMPENSATION COMMITTEE REQUIRES THE COMPENSATION CONSULTANT TO UPDATE MARKET DATA PERIODICALLY, USUALLY EVERY TWO YEARS, WITH 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, QUESTION 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") WEB SITE. FORM 990 PART VI QUESTION 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 XI, LINE 9 OTHER CHANGES IN NET ASSETS OF FUND BALANCES: TRANSFER FROM HF 40,765 TRANSFER FROM CCMC 115,000,000 --------------- $115,040,765 FORM 990, PART VI, QUESTION 2 BONNIE PETSCHE HAS A FAMILY RELATIONSHIP WITH JULIA DAVIDSON. COOK CHILDREN'S HEALTH PLAN 801 SEVENTH AVE FORT WORTH TX 76104 760585240 INSURANCE TX 501(C)(3) 9 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) 9 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 800617 2726815 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 B 961085 FMV COOK CHILDREN'S MEDICAL CENTER O 62993 FMV COOK CHILDREN'S MEDICAL CENTER P 133494 FMV COOK CHILDREN'S MEDICAL CENTER Q 183063005 FMV COOK CHILDREN'S MEDICAL CENTER S 115000000 FMV COOK CHILDREN'S PHYSICIAN NETWORK A 1594199 FMV COOK CHILDREN'S PHYSICIAN NETWORK B 540616 FMV COOK CHILDREN'S PHYSICIAN NETWORK O 8229231 FMV COOK CHILDREN'S PHYSICIAN NETWORK P 110000 FMV COOK CHILDREN'S PHYSICIAN NETWORK Q 18109609 FMV COOK CHILDREN'S HOME HEALTH A 659578 FMV COOK CHILDREN'S HOME HEALTH Q 5131470 FMV COOK CHILDREN'S HEALTH PLAN A 447276 FMV COOK CHILDREN'S HEALTH PLAN B 120677 FMV COOK CHILDREN'S HEALTH PLAN O 188847 FMV COOK CHILDREN'S HEALTH PLAN Q 6367810 FMV COOK CHILDREN'S HEALTH SERVICES Q 231189 FMV ROSEDALE OFFICE BUILDING O 98887 FMV ROSEDALE OFFICE BUILDING P 2346386 FMV ROSEDALE OFFICE BUILDING K 1250561 FMV