COOK CHILDRENS PHYSICIAN NETWORK: Form 990, tax year 2015

View the entire original 990 at ProPublica ↗

Organization
COOK CHILDRENS PHYSICIAN NETWORK (EIN 75-2485366)
Tax period
2015-10-01 to 2016-09-30
Filed
2017-08-10
IRS object ID
201742229349300809
Schema version
2015v3.0
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)
Return2017-08-10T11:52:51-05:00ReturnTs
Tax Period End2016-09-30TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1BKD LLPBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line12800 Post Oak Blvd Ste 3200AddressLine1Txt
CityHOUSTONCityNm
State AbbreviationTXStateAbbreviationCd
ZIP77056ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2015-10-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN752485366EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1COOK CHILDREN'S PHYSICIAN NETWORKBusinessNameLine1Txt
FieldValueIRS element (for citing)
In Care Of% CORY RHOADESInCareOfNm
Business Name ControlCOOKBusinessNameControlTxt
Phone6828854000PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1801 SEVENTH AVENUEAddressLine1Txt
CityFORT WORTHCityNm
State AbbreviationTXStateAbbreviationCd
ZIP76104ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonCORY RHOADESPersonNm
Person TitleSENIOR VP-FINANCEPersonTitleTxt
Signature2017-05-15SignatureDt
Discuss With Paid PreparerYes (true)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonAmanda MayaPreparerPersonNm
PTINP01067777PTIN
Phone7134994600PhoneNum
FieldValueIRS element (for citing)
Tax2015TaxYr
Build TS2021-01-29 14:40:06ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerW BRITT NELSON MDPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line1801 SEVENTH AVEAddressLine1Txt
CityFORT WORTHCityNm
State AbbreviationTXStateAbbreviationCd
ZIP76104ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$282,819,534GrossReceiptsAmt
Group Return For AffiliatesfalseGroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressWWW.COOKCHILDRENS.ORGWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1992FormationYr
Legal Domicile StateTXLegalDomicileStateCd
Activity Or MissionKNOWING 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.ActivityOrMissionDesc
Voting Members Governing Body13VotingMembersGoverningBodyCnt
Voting Members Independent0VotingMembersIndependentCnt
Total Employee1327TotalEmployeeCnt
Total Volunteers5TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$52,791,690PYContributionsGrantsAmt
CY Contributions Grants$65,674,706CYContributionsGrantsAmt
PY Program Service Revenue$197,526,634PYProgramServiceRevenueAmt
CY Program Service Revenue$216,609,376CYProgramServiceRevenueAmt
PY Investment Income$4,200PYInvestmentIncomeAmt
CY Investment Income-$479CYInvestmentIncomeAmt
PY Other Revenue$121,344PYOtherRevenueAmt
CY Other Revenue$535,452CYOtherRevenueAmt
PY Total Revenue$250,443,868PYTotalRevenueAmt
CY Total Revenue$282,819,055CYTotalRevenueAmt
PY Grants And Similar Paid$3,000PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$197,720,633PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$221,455,035CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$52,542,093PYOtherExpensesAmt
CY Other Expenses$61,629,907CYOtherExpensesAmt
PY Total Expenses$250,265,726PYTotalExpensesAmt
CY Total Expenses$283,084,942CYTotalExpensesAmt
PY Revenues Less Expenses$178,142PYRevenuesLessExpensesAmt
CY Revenues Less Expenses-$265,887CYRevenuesLessExpensesAmt
Total Assets BOY$35,891,473TotalAssetsBOYAmt
Total Assets EOY$39,056,687TotalAssetsEOYAmt
Total Liabilities BOY$27,217,684TotalLiabilitiesBOYAmt
Total Liabilities EOY$30,648,785TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$8,673,789NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$8,407,902NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part IIIYes (X)InfoInScheduleOPartIIIInd
MissionKNOWING 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.MissionDesc
Significant New Program SrvcfalseSignificantNewProgramSrvcInd
Significant ChangefalseSignificantChangeInd
Expense$251,846,394ExpenseAmt
Revenue$217,144,828RevenueAmt
DescCOOK CHILDREN'S PHYSICIAN NETWORK (CCPN) IS THE LARGEST PEDIATRIC MULTI-SPECIALTY PHYSICIAN GROUP IN NORTH TEXAS. THE NETWORK INCLUDES MORE THAN 387 PHYSICIANS AND 220 MID-LEVEL PROVIDERS IN ADDITION TO THOUSANDS OF OTHER CARING EMPLOYEES. PATIENT FAMILIES HAVE ACCESS TO THE FOLLOWING SPECIALTIES VIA TELEMEDICINE: CARDIOLOGY, CARE TEAM, ENDOCRINOLOGY, GENETICS/METABOLIC GENETICS, HEMATOLOGY/ONCOLOGY, INFECTIOUS DISEASES, NEONATOLOGY, NEPHROLOGY, NEUROLOGY, NEUROPSYCHOLOGY, PEDIATRIC INTENSIVISTS, PSYCHOLOGY, RHEUMATOLOGY AND UROLOGY. THESE SPECIALISTS HOSTED 2,000 VISITS VIA TELEMEDICINE IN 2016 OFFERING IMMEDIATE CARE AND PATIENT MONITORING AS WELL AS SAVING MANY HOURS OF TRAVEL FOR PATIENT FAMILIES. THE NETWORK'S PHYSICIANS AND SPECIALISTS HAVE OFFICES IN TARRANT, DENTON AND HOOD COUNTIES AND PROVIDE A PRIMARY CARE HOME IN ECONOMICALLY DISADVANTAGED AREAS WHERE ACCESS TO PEDIATRIC HEALTH CARE IS DIFFICULT TO OBTAIN. THE PHYSICIAN NETWORK HAS INCREASED ACCESS TO PEDIATRIC SPECIALTY CARE THROUGH OUTREACH CLINICS IN MANY COMMUNITIES IN NORTH, WEST, EAST AND CENTRAL TEXAS. EACH MONTH, PHYSICIANS TRAVEL TO PROVIDE SERVICES IN SEVERAL AREAS THAT ARE NOT LARGE ENOUGH TO SUPPORT FULL-TIME SPECIALTY CARE. COOK CHILDREN'S OFFERS SEVEN NEIGHBORHOOD CLINICS (FIVE IN FORT WORTH, ONE IN ARLINGTON AND ALSO ONE IN RICHLAND HILLS) THAT OFFER WELL- AND SICK-CHILD VISITS, DENTAL CARE AND PROVIDE VACCINES. STAFF SPEAK BOTH ENGLISH AND SPANISH, AND CLINICS ACCEPT MOST CHIP, MEDICAID AND COMMERCIAL INSURANCE PLANS. THE CLINICAL STAFF IS LED BY 21 TOTAL PHYSICIANS, TWO DENTISTS, AND SIX NURSE PRACTITIONERS. EVENING HOURS WILL BE ADDED TO TWO NEIGHBORHOOD CLINICS IN 2017. DURING 2016 CCPN BEGAN PROVIDING TELEMEDICINE SUPPORT TO SCHOOL BASED NURSES IN ONE LOCAL INDEPENDENT SCHOOL DISTRICT (ISD). CURRENTLY THIS ENCOMPASSES TEN ELEMENTARY SCHOOLS, TWO MIDDLE SCHOOLS AND ONE HIGH SCHOOL. CCPN ANTICIPATES IT WILL SUPPORT SEVERAL MORE ISD'S IN THE UPCOMING FISCAL YEAR. PATIENT FAMILIES CONTINUE TO BENEFIT FROM THE AFTER-HOURS CLINIC TIMES AND THE PATIENT PORTAL, MYCOOKCHILDRENS.ORG, WHICH PROVIDES FAMILIES ON-DEMAND ACCESS TO PRIOR VISIT SUMMARIES, MEDICATION LISTS, VACCINE RECORDS, LAB RESULTS AND APPOINTMENT REQUESTS.Desc
Total Program Service Expenses$251,846,394TotalProgramServiceExpensesAmt
Described In Section501c3Yes (true)DescribedInSection501c3Ind
Schedule B RequiredYes (true)ScheduleBRequiredInd
Political Campaign ActyfalsePoliticalCampaignActyInd
Lobbying ActivitiesfalseLobbyingActivitiesInd
Subject To Proxy TaxfalseSubjectToProxyTaxInd
Donor Advised FundfalseDonorAdvisedFundInd
Conservation EasementsfalseConservationEasementsInd
Collections Of ArtfalseCollectionsOfArtInd
Credit CounselingfalseCreditCounselingInd
Temp Or Permanent EndowmentsfalseTempOrPermanentEndowmentsInd
Report Land Building EquipmentYes (true)ReportLandBuildingEquipmentInd
Report Investments Other SecfalseReportInvestmentsOtherSecInd
Report Program Related InvstfalseReportProgramRelatedInvstInd
Report Other 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 MemYes (true)BusinessRlnWithFamMemInd
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 EntYes (true)RelatedOrganizationCtrlEntInd
Transaction With Control EntYes (true)TransactionWithControlEntInd
Trnsfr Exmpt Non Chrtbl Rltd OrgfalseTrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted PrtshpfalseActivitiesConductedPrtshpInd
Schedule O RequiredYes (true)ScheduleORequiredInd
IRP Document82IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (true)BackupWthldComplianceInd
Employee1327EmployeeCnt
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 Members13GoverningBodyVotingMembersCnt
Independent Voting Member0IndependentVotingMemberCnt
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 BodyYes (true)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (true)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (true)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (true)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (true)WhistleblowerPolicyInd
Document Retention PolicyYes (true)DocumentRetentionPolicyInd
Compensation Process CEOYes (true)CompensationProcessCEOInd
Compensation Process OtherYes (true)CompensationProcessOtherInd
Investment In Joint VenturefalseInvestmentInJointVentureInd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

FieldValueIRS element (for citing)
PersonCORY RHOADESPersonNm
Phone6828854000PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1801 SEVENTH AVENUEAddressLine1Txt
CityFORT WORTHCityNm
State AbbreviationTXStateAbbreviationCd
ZIP76104ZIPCd
FieldValueIRS element (for citing)
Info In Schedule O Part VIIYes (X)InfoInScheduleOPartVIIInd

Form990 Part VII Section A Form990PartVIISectionAGrp (27 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtOfficerOfficerIndHighest Compensated EmployeeHighestCompensatedEmployeeInd
MARK MAZADE MD
TRUSTEE41.00.0Yes (X)$337,058$0$45,792
KENNETH HEYM MD
TRUSTEE41.00.0Yes (X)$315,170$0$42,760
BRADLEY MERCER MD
TRUSTEE41.00.0Yes (X)$449,860$0$46,131
SANDRA ARCA MD
TRUSTEE-TREASURER42.01.0Yes (X)$279,392$0$47,156Yes (X)
BARRY BZOSTEK MD
TRUSTEE41.00.0Yes (X)$199,982$0$12,508
SAM CANTU MD
TRUSTEE41.00.0Yes (X)$410,620$0$41,549
VANESSA CHARETTE MD
TRUSTEE41.01.0Yes (X)$544,406$0$20,387
MATTHEW DZURIK MD
TRUSEE-VICE CHAIR SPLTY CARE42.01.0Yes (X)$448,624$0$31,899Yes (X)
JOSE IGLESIAS MD
TRUSTEE41.00.0Yes (X)$1,002,395$0$40,263
LINDSAY NEWTON MD
TRUSTEE41.00.0Yes (X)$203,522$0$43,223
SANDRA PEAK MD
TRUSTEE41.00.0Yes (X)$333,378$0$35,004
WILFRED RAINE MD
TRUSTEE41.00.0Yes (X)$347,380$0$37,086
RAY RHODES MD
TRUSTEE-VICE CHAIR, PRIM CARE42.01.0Yes (X)$177,588$0$10,768Yes (X)
JUSTIN SMITH MD
TRUSTEE41.00.0Yes (X)$264,772$0$26,801
LINDA THOMPSON MD
TRUSTEE-CHAIRMAN42.02.0Yes (X)$285,383$0$17,476Yes (X)
DEBORAH VERT DO
TRUSTEE41.00.0Yes (X)$522,458$0$27,918
TODD WOLF MD
TRUSTEE-SECRETARY42.01.0Yes (X)$430,781$0$42,807Yes (X)
ROBERT GOODWILL
V PRES-PRIM CARE & SPEC SVCS40.00.0$403,806$0$37,270Yes (X)
SHERI KANTNER
SECRETARY40.00.0$61,995$0$31,663Yes (X)
STEPHEN W KIMMEL
TREASURER4.036.0$81,078$655,995$99,556Yes (X)
JANELL P MASON-BRISCOE
AVP-PRIM CARE & SPLTY SVCS40.00.0$238,465$0$20,424Yes (X)
W BRITT NELSON MD
PRESIDENT40.00.0$755,223$0$47,445Yes (X)
JOHNNIE HONEYCUTT MD
PHYSICIAN40.00.0$1,158,215$0$42,819Yes (X)
CHAD HAMNER MD
PHYSICIAN40.00.0$946,910$0$44,506Yes (X)
MARK PALMER MD
PHYSICIAN40.00.0$1,776,181$0$33,411Yes (X)
VINCENT TAM MD
MEDICAL DIRECTOR40.00.0$2,012,601$0$46,131Yes (X)
JOHN UFFMAN MD
MEDICAL DIRECTOR40.00.0$988,112$0$39,090Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$14,975,355TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$655,995TotReportableCompRltdOrgAmt
Total Other Compensation$1,011,843TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K505IndivRcvdGreaterThan100KCnt
Former Ofcr Employees ListedfalseFormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (true)TotalCompGreaterThan150KInd
Compensation From Other SrcsfalseCompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmt
ATHENAHEALTH
311 ARSENAL STWATERTOWNMA02472CLAIMS PROCESSING$13,125,290
TARRANT CONSTRUCTION SERVICES
2225 W PETERSMITH STFORT WORTHTX76102CONSTRUCTION$1,418,990
MUCKLEROY FALLS
5801 EDWARDS RANCH RD 100FORT WORTHTX76104CONSTRUCTION$297,021
FORT CONSTRUCTION LP
224 E VICKERY BLVDFORT WORTHTX76104CONSTRUCTION$711,819
UNT HEALTH SCIENCE
3500 CAMP BOWIE BLVDFORT WORTHTX76107STAFFING$252,228
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K10CntrctRcvdGreaterThan100KCnt
Related Organizations$65,316,059RelatedOrganizationsAmt
Government Grants$356,147GovernmentGrantsAmt
All Other Contributions$2,500AllOtherContributionsAmt
Total Contributions$65,674,706TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (5 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
NET PATIENT FEES621110$192,897,354$192,897,354
CONTRACTED FEES621110$3,751,083$3,751,083
MANAGEMENT FEES900099$18,659,447$18,659,447
OTHER INCOME621110$1,115,699$1,115,699
RESEARCH900099$185,793$185,793
FieldValueIRS element (for citing)
Total Program Service Revenue$216,609,376TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Royalties Revenue RoyaltiesRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Rental Income Or Loss RentalIncomeOrLossGrp

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

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

FieldValueIRS element (for citing)
Other$479OtherAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Other-$479OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column-$479TotalRevenueColumnAmt
Exclusion-$479ExclusionAmt

Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Net Income From Gaming NetIncomeFromGamingGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Net Income Or Loss NetIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Other Revenue Misc OtherRevenueMiscGrp

FieldValueIRS element (for citing)
DescOTHER INCOMEDesc
Business900099BusinessCd
Total Revenue Column$535,452TotalRevenueColumnAmt
Related Or Exempt Func Income$535,452RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Other Revenue Total$535,452OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$282,819,055TotalRevenueColumnAmt
Related Or Exempt Func Income$217,144,828RelatedOrExemptFuncIncomeAmt
Exclusion-$479ExclusionAmt

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Grants To Domestic Individuals GrantsToDomesticIndividualsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Foreign Grants ForeignGrantsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Benefits To Members BenefitsToMembersGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$9,173,583TotalAmt
Program Services$7,580,290ProgramServicesAmt
Management And General$1,593,293ManagementAndGeneralAmt

Comp Disqual Persons CompDisqualPersonsGrp

FieldValueIRS element (for citing)
Total$210,834TotalAmt
Program Services$210,834ProgramServicesAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$183,667,010TotalAmt
Program Services$177,320,585ProgramServicesAmt
Management And General$6,346,425ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$28,403,608TotalAmt
Program Services$26,538,928ProgramServicesAmt
Management And General$1,864,680ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Services Management FeesForServicesManagementGrp

FieldValueIRS element (for citing)
Total$4,616,583TotalAmt
Management And General$4,616,583ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Services Lobbying FeesForServicesLobbyingGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$2,759,196TotalAmt
Program Services$1,761,889ProgramServicesAmt
Management And General$997,307ManagementAndGeneralAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$111,953TotalAmt
Program Services$47,952ProgramServicesAmt
Management And General$64,001ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$583,640TotalAmt
Program Services$683,449ProgramServicesAmt
Management And General-$99,809ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Royalties RoyaltiesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$6,939,113TotalAmt
Program Services$6,696,474ProgramServicesAmt
Management And General$242,639ManagementAndGeneralAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$311,026TotalAmt
Program Services$274,310ProgramServicesAmt
Management And General$36,716ManagementAndGeneralAmt

Pymt Travel Entrtnmnt Pub Ofcl PymtTravelEntrtnmntPubOfclGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$103,882TotalAmt
Program Services$7,728ProgramServicesAmt
Management And General$96,154ManagementAndGeneralAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$1,262TotalAmt
Program Services$1,262ProgramServicesAmt

Payments To Affiliates PaymentsToAffiliatesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$1,910,381TotalAmt
Program Services$1,561,322ProgramServicesAmt
Management And General$349,059ManagementAndGeneralAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$1,860,372TotalAmt
Program Services$1,858,986ProgramServicesAmt
Management And General$1,386ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
MEDICAL SUPPLIES$18,563,341$18,596,539-$33,198
COLLECTION EXPENSE$14,100,847$38,164$14,062,683
BAD DEBT EXPENSE$6,980,545$6,980,545
MINOR EQUIPMENT EXPENSE$1,319,120$581,127$737,993

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$1,468,646TotalAmt
Program Services$1,106,010ProgramServicesAmt
Management And General$362,636ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$283,084,942TotalAmt
Program Services$251,846,394ProgramServicesAmt
Management And General$31,238,548ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$10,686BOYAmt
EOY$11,245EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$10,916,858BOYAmt
EOY$11,266,320EOYAmt

Pledges And Grants Receivable PledgesAndGrantsReceivableGrp

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

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$9,613,513BOYAmt
EOY$11,882,535EOYAmt

Receivables From Officers Etc ReceivablesFromOfficersEtcGrp

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

Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp

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

Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp

FieldValueIRS element (for citing)
BOY$131,838BOYAmt
EOY$107,263EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$1,179,125BOYAmt
EOY$1,499,995EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$172,050BOYAmt
EOY$250,342EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$17,775,287LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$7,212,185LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$9,848,130BOYAmt
EOY$10,563,102EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

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

Investments Other Securities InvestmentsOtherSecuritiesGrp

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

Investments Program Related InvestmentsProgramRelatedGrp

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

Intangible Assets IntangibleAssetsGrp

FieldValueIRS element (for citing)
BOY$1,560,000BOYAmt
EOY$1,560,000EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$2,459,273BOYAmt
EOY$1,915,885EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$35,891,473BOYAmt
EOY$39,056,687EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$6,954,131BOYAmt
EOY$8,135,432EOYAmt

Grants Payable GrantsPayableGrp

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

Deferred Revenue DeferredRevenueGrp

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

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

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

Escrow Account Liability EscrowAccountLiabilityGrp

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

Loans From Officers Directors LoansFromOfficersDirectorsGrp

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

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

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

Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp

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

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$20,263,553BOYAmt
EOY$22,513,353EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$27,217,684BOYAmt
EOY$30,648,785EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY$8,673,789BOYAmt
EOY$8,407,902EOYAmt

Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp

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

Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp

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

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$8,673,789BOYAmt
EOY$8,407,902EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$35,891,473BOYAmt
EOY$39,056,687EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss-$265,887ReconcilationRevenueExpnssAmt
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 B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Total ContributionsRESTRICTEDTotalContributionsAmt

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Art Public Exhibition AmountsArtPublicExhibitionAmountsGrp
Held Works ArtHeldWorksArtGrp
CY Minus3 Yr Endwmt FundCYMinus3YrEndwmtFundGrp
CY Minus4 Yr Endwmt FundCYMinus4YrEndwmtFundGrp
LandLandGrp

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$6,677,359OtherCostOrOtherBasisAmt
Depreciation$1,411,852DepreciationAmt
Book Value$5,265,507BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$5,701,126OtherCostOrOtherBasisAmt
Depreciation$3,205,596DepreciationAmt
Book Value$2,495,530BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$4,588,321OtherCostOrOtherBasisAmt
Depreciation$2,542,261DepreciationAmt
Book Value$2,046,060BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$808,481OtherCostOrOtherBasisAmt
Depreciation$52,476DepreciationAmt
Book Value$756,005BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$10,563,102TotalBookValueLandBuildingsAmt
Federal Income Tax Liability$0FederalIncomeTaxLiabilityAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (8 entries)

DescDescAmtAmt
ACCRUED PAYROLL$2,466,102
ACCRUED PHYSICIAN RECONS$10,145,848
DUE TO AFFILIATES$4,514,570
ACCRUED PTO LIABILITY$2,805,984
ACCRUED EXECUTIVE BONUS$585,218
CAPITAL LEASE OBLIGATION$8,240
ACCRUED COMP BONUS-CARE SHARE$540,469
ACCRUED PHYSICIAN BONUS-PERC$1,446,922
FieldValueIRS element (for citing)
Total Liability$22,513,353TotalLiabilityAmt
Total Rev Etc Audited Fincl Stmt$275,577,586TotalRevEtcAuditedFinclStmtAmt
Other Revenue-$6,980,545OtherRevenueAmt
Revenue Not Reported-$6,980,545RevenueNotReportedAmt
Revenue Subtotal$282,558,131RevenueSubtotalAmt
Investment Expenses Not Incld$260,924InvestmentExpensesNotIncldAmt
Revenue Not Reported Fincl Stmt$260,924RevenueNotReportedFinclStmtAmt
Total Revenue Per Form990$282,819,055TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt$276,104,876TotExpnsEtcAuditedFinclStmtAmt
Losses Reported$479LossesReportedAmt
Expenses Not Reported$479ExpensesNotReportedAmt
Expenses Subtotal$276,104,397ExpensesSubtotalAmt
Other Expenses Not Included$6,980,545OtherExpensesNotIncludedAmt
Expenses Not Rpt Fincl Stmt$6,980,545ExpensesNotRptFinclStmtAmt
Total Expenses Per Form990$283,084,942TotalExpensesPerForm990Amt

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART XI, LINES 2D & 4BRECONCILIATION OF REVENUE FINANCIAL STATEMENTS TO FORM 990 BAD DEBT EXPENSE: ($ 6,980,545) LOSS ON DISPOSAL OF ASSETS: ( $ 479) CONTRIBUTION FROM CCHF RECORDED TO NET ASSETS: 261,430 ----------- TOTAL $ 260,924
PART XII, LINES 2D & 4BRECONCILIATION OF EXPENSES FINANCIAL STATEMENTS TO FORM 990 LOSS ON DISPOSAL OF ASSETS: $ 479 BAD DEBT EXPENSE: $ 6,980,545

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Idemnification Gross Up PmtsYes (X)IdemnificationGrossUpPmtsInd
Written Policy Ref T And E ExpnssfalseWrittenPolicyRefTAndEExpnssInd
Substantiation RequiredYes (true)SubstantiationRequiredInd
Severance PaymentfalseSeverancePaymentInd
Supplemental Nonqual Rtr PlanYes (true)SupplementalNonqualRtrPlanInd
Equity Based Comp ArrngmfalseEquityBasedCompArrngmInd
Comp Based On Revenue Of Flng OrgfalseCompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related OrgsfalseCompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng OrgfalseCompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd OrgsfalseCompBsdNetEarnsRltdOrgsInd
Any Non Fixed PaymentsfalseAnyNonFixedPaymentsInd
Initial Contract ExceptionfalseInitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (26 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
MARK MAZADE MD
TRUSTEE$326,142$0$0$0$10,916$0$19,875$0$25,917$0$382,850$0$0$0
KENNETH HEYM MD
TRUSTEE$298,909$0$5,500$0$10,761$0$16,562$0$26,198$0$357,930$0$0$0
BRADLEY MERCER MD
TRUSTEE$439,838$0$0$0$10,022$0$19,875$0$26,256$0$495,991$0$0$0
JOHNNIE HONEYCUTT MD
PHYSICIAN$1,125,316$0$0$0$32,899$0$16,563$0$26,256$0$1,201,034$0$0$0
SANDRA ARCA MD
TRUSTEE-TREASURER$268,854$0$1,819$0$8,719$0$18,462$0$28,694$0$326,548$0$0$0
BARRY BZOSTEK MD
TRUSTEE$173,546$0$15,500$0$10,936$0$0$0$12,508$0$212,490$0$0$0
SAM CANTU MD
TRUSTEE$404,442$0$0$0$6,178$0$10,600$0$30,949$0$452,169$0$0$0
VANESSA CHARETTE MD
TRUSTEE$528,236$0$10,000$0$6,170$0$19,875$0$512$0$564,793$0$0$0
MATTHEW DZURIK MD
TRUSEE-VICE CHAIR SPLTY CARE$415,767$0$5,833$0$27,024$0$16,563$0$15,336$0$480,523$0$0$0
JOSE IGLESIAS MD
TRUSTEE$957,535$0$4,750$0$40,110$0$16,563$0$23,700$0$1,042,658$0$0$0
LINDSAY NEWTON MD
TRUSTEE$179,947$0$18,938$0$4,637$0$10,919$0$32,304$0$246,745$0$0$0
SANDRA PEAK MD
TRUSTEE$328,151$0$0$0$5,227$0$17,957$0$17,047$0$368,382$0$0$0
WILFRED RAINE MD
TRUSTEE$332,456$0$0$0$14,924$0$19,875$0$17,211$0$384,466$0$0$0
RAY RHODES MD
TRUSTEE-VICE CHAIR, PRIM CARE$121,095$0$50,000$0$6,493$0$5,100$0$5,668$0$188,356$0$0$0
JUSTIN SMITH MD
TRUSTEE$198,679$0$59,564$0$6,529$0$10,537$0$16,264$0$291,573$0$0$0
LINDA THOMPSON MD
TRUSTEE-CHAIRMAN$250,431$0$25,000$0$9,952$0$16,563$0$913$0$302,859$0$0$0
DEBORAH VERT DO
TRUSTEE$516,873$0$0$0$5,585$0$19,259$0$8,659$0$550,376$0$0$0
TODD WOLF MD
TRUSTEE-SECRETARY$287,284$0$135,857$0$7,640$0$16,563$0$26,244$0$473,588$0$0$0
ROBERT GOODWILL
V PRES-PRIM CARE & SPEC SVCS$307,628$0$92,255$0$3,923$0$10,600$0$26,670$0$441,076$0$0$0
STEPHEN W KIMMEL
TREASURER$53,405$432,102$21,070$170,474$6,603$53,419$8,112$65,632$2,839$22,973$92,029$744,600$0$0
JANELL P MASON-BRISCOE
AVP-PRIM CARE & SPLTY SVCS$195,739$0$41,060$0$1,666$0$10,233$0$10,191$0$258,889$0$0$0
W BRITT NELSON MD
PRESIDENT$456,536$0$175,519$0$123,168$0$19,875$0$27,570$0$802,668$0$0$0
CHAD HAMNER MD
PHYSICIAN$924,586$0$0$0$22,324$0$13,250$0$31,256$0$991,416$0$0$0
MARK PALMER MD
PHYSICIAN$1,765,679$0$0$0$10,502$0$16,563$0$16,848$0$1,809,592$0$0$0
VINCENT TAM MD
MEDICAL DIRECTOR$1,683,799$0$310,000$0$18,802$0$19,875$0$26,256$0$2,058,732$0$0$0
JOHN UFFMAN MD
MEDICAL DIRECTOR$949,508$0$0$0$38,604$0$10,600$0$28,490$0$1,027,202$0$0

Supplemental Information Detail SupplementalInformationDetail (4 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
SCHEDULE J, PART I, LINE 1ASHERI KANTNER $188 GROSS-UP JOHN UFFMAN, MD $14 GROSS-UP
SCHEDULE J, PART I, LINE 1BGENERAL GROSS UP PAYMENTS DISCLOSURE: 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 BARRY BZOSTEK, MD $ 1,500.00 SAM CANTU, MD $ 900.00 VANESSA CHARETTE, MD $ 1,125.00 MATTHEW DZURIK, MD $ 1,500.00 CHAD HAMNER, MD $ 4,500.00 KENNETH HEYM, MD $ 2,250.00 JOHNNIE HONEYCUTT, MD $ 3,000.00 JOSE L. IGLESIAS, MD $ 4,500.00 MARK MAZADE, MD $ 2,100.00 BRADLEY MERCER, MD $ 1,500.00 W. BRITT NELSON, MD $ 4,725.00 LINDSAY HUGGINS NEWTON, MD $ 975.00 SANDRA PEAK, MD $ 900.00 WILFRED L. RAINE, MD $ 1,500.00 VINCENT TAM, MD $ 3,000.00 LINDA THOMPSON, MD $ 2,100.00 JOHN UFFMAN, MD $ 4,500.00 DEBORAH VERT, DO $ 750.00 TODD WOLF, MD $ 1,500.00 CME GROSS UPS PAYMENTS DISCLOSURE: 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 I, LINE 3METHODS USED BY CCHCS TO ESTABLISH COMPENSATION OF THE COMPANY'S PRESIDENT: COMPENSATION COMMITTEE INDEPENDENT COMPENSATION CONSULTANT WRITTEN EMPLOYMENT CONTRACT COMPENSATION SURVEY OR STUDY APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE
SCHEDULE J, PART I, LINE 4BPARTICIPATION IN A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN: PARTICIPANTS IN SERP IN W-2 DEF COMP PAID BY -------------------- -------- -------- -------- MATTHEW DZURIK, MD 18,000 NONE CCPN JOHNNIE HONEYCUTT, MD 18,000 NONE CCPN JOSE L. IGLESIAS, MD 18,000 NONE CCPN W. BRITT NELSON, MD 71,187 NONE CCPN JOHN UFFMAN, MD 18,000 NONE CCPN STEPHEN KIMMEL 18,000 63,144 CCHS

Schedule L IRS990ScheduleL

FieldValueIRS element (for citing)
Total Balance Due$0TotalBalanceDueAmt

Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (2 entries)

Relationship DescriptionRelationshipDescriptionTxtTransactionTransactionAmtTransactionTransactionDescSharing Of RevenuesSharingOfRevenuesInd
TOM ROGERS JR MD
A. ROGERS FATHER-IN-LAW$64,665COMPENSATIONfalse
YVETTE DZURIK MD
M.DZURIK SPOUSE$146,169COMPENSATIONfalse

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (7 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART VI, QUESTION 6SOLE MEMBER: COOK CHILDREN'S HEALTH CARE SYSTEM, A TEXAS NON-PROFIT CORPORATION, IS THE SOLE MEMBER OF THE ORGANIZATION.
FORM 990, PART VI, QUESTION 7AMEMBER ELECTION ABILITIES: AS THE SOLE MEMBER OF THE ORGANIZATION, COOK CHILDREN'S HEALTH CARE SYSTEM HAS THE ABSOLUTE RIGHT TO APPOINT OR APPROVE MEMBERSHIP ON THE BOARD OF DIRECTORS OF THE ORGANIZATION.
FORM 990, PART VI, QUESTION 7BMEMBER DECISION ABILITIES: AS THE SOLE MEMBER OF THE ORGANIZATION, COOK CHILDREN'S HEALTH CARE SYSTEM HAS THE EXCLUSIVE AND RESERVED POWER TO DO ANY OF THE FOLLOWING: A. APPROVE THE ANNUAL OPERATING AND CAPITAL BUDGETS OF THE ORGANIZATION AND THE LONG-RANGE FINANCIAL AND STRATEGIC PLANS FOR THE CORPORATION; B. APPROVE DEVIATIONS FROM ANNUAL OPERATING AND CAPITAL BUDGETS IN EXCESS OF SUCH LIMITS AS ESTABLISHED BY THE MEMBER; C. APPROVE THE PURCHASE OR ACQUISITION OF ANY PROPERTY, REAL, PERSONAL, OR MIXED, BY THE ORGANIZATION IN EXCESS OF SUCH LIMITS AS ESTABLISHED BY THE MEMBER; D. APPROVE THE SALE, GIFT OR OTHER DISPOSITION OF ALL OR SUBSTANTIALLY ALL OF THE PROPERTY OF THE ORGANIZATION; E. APPROVE THE MORTGAGE OR OTHER ENCUMBRANCE OF ANY PROPERTY, REAL, PERSONAL, OR MIXED, OF THE ORGANIZATION IN EXCESS OF SUCH LIMITS AS ESTABLISHED BY THE MEMBER; F. APPROVE THE ACQUISITION, LIQUIDATION, MERGER, WINDING UP, TERMINATION, OR CONSOLIDATION OF THE ORGANIZATION; G. APPROVE THE CREATION OF, OR INVESTMENT IN, ANY SUBSIDIARY ENTITY, JOINT VENTURE, ACCOUNTABLE CARE ORGANIZATION OR SIMILAR ENTITIES; H. APPROVE THE ADOPTION, AMENDMENT OR REPEAL OF THE CERTIFICATE OF FORMATION OF THE ORGANIZATION AND THESE BYLAWS; I. APPROVE INCURRING DEBT WHICH WOULD EXCEED SUCH LIMITS ESTABLISHED BY THE MEMBER; J. APPROVE THE SETTLEMENT OF CLAIMS AND LITIGATION OF THE ORGANIZATION; AND K. SUBSEQUENT TO THE ORGANIZING AND INCORPORATING PHYSICIAN'S SELECTION OF THE INITIAL BOARD OF DIRECTORS, APPROVE THE APPOINTMENT OR ELECTION OF DIRECTORS IN ACCORDANCE WITH SECTION 3.2 OF THE ORGANIZATION'S BYLAWS.
FORM 990, PART VI, SECTION B, LINE 11BPROCESS FOR REVIEW OF THE 990: THE ORGANIZATION ENGAGES AN OUTSIDE 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 12CWRITTEN 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, QUESTION 15A & 15BREVIEW 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 PRESIDENT 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 19MAKING GOVERNING DOCUMENTS 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.

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (6 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtPublic Charity StatusPublicCharityStatusTxtBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtControlled OrganizationControlledOrganizationInd
COOK CHILDREN'S MEDICAL CENTER
801 SEVENTH AVEFORT WORTHTX76104752051646HOSPITALTX501(C)(3)3CCHCSYes (true)
WI COOK FOUNDATION
801 SEVENTH AVENUEFORT WORTHTX76104752051649FUNDRAISINGTX501(C)(3)7NAfalse
COOK CHILDREN'S HOME HEALTH
801 SEVENTH AVENUEFORT WORTHTX76104752896983HEALTHCARETX501(C)(3)9CCHCSYes (true)
COOK CHILDREN'S HEALTH CARE SYSTEM
801 SEVENTH AVEFORT WORTHTX76104752705881HLTH CARE SUPTX501(C)(3)11CCCHFfalse
COOK CHILDREN'S HEALTH PLAN
801 SEVENTH AVEFORT WORTHTX76104760585240INSURANCETX501(C)(3)9CCHCSYes (true)
ROSEDALE OFFICE BUILDING INC
1500 W ROSEDALEFORT WORTHTX76104460866421TITLE HOLDINGTX501(C)(2)N/ACCHFfalse

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp

Related Organization Name RelatedOrganizationName

FieldValueIRS element (for citing)
Business Name Line1COOK CHILDREN'S HEALTH SERVICESBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1801 7TH AVENUEAddressLine1Txt
CityFORT WORTHCityNm
State AbbreviationTXStateAbbreviationCd
ZIP76104ZIPCd
FieldValueIRS element (for citing)
EIN454024843EIN
Primary ActivitiesHEALTHCAREPrimaryActivitiesTxt
Legal Domicile StateTXLegalDomicileStateCd

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1CCHCSBusinessNameLine1Txt
FieldValueIRS element (for citing)
Entity TypeC CORPORATIONEntityTypeTxt
Controlled OrganizationYes (true)ControlledOrganizationInd
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts RyltsYes (true)ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth OrgYes (true)GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth OrgYes (true)GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth OrgfalseLoansOrGuaranteesFromOthOrgInd
Div Related OrganizationfalseDivRelatedOrganizationInd
Asset Sale To Other OrgfalseAssetSaleToOtherOrgInd
Asset Purchase From Other OrgfalseAssetPurchaseFromOtherOrgInd
Asset ExchangeYes (true)AssetExchangeInd
Rental Of Facilities To Oth OrgYes (true)RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth OrgYes (true)RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth OrgfalsePerformOfServicesForOthOrgInd
Perform Of Services By Other OrgfalsePerformOfServicesByOtherOrgInd
Sharing Of FacilitiesfalseSharingOfFacilitiesInd
Paid Employees SharingYes (true)PaidEmployeesSharingInd
Reimbursement Paid To Other OrgYes (true)ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other OrgYes (true)ReimbursementPaidByOtherOrgInd
Transfer To Other OrgYes (true)TransferToOtherOrgInd
Transfer From Other OrgYes (true)TransferFromOtherOrgInd

Transactions Related Org TransactionsRelatedOrgGrp (7 entries)

Transaction TypeTransactionTypeTxtInvolvedInvolvedAmtMethod Of Amount DeterminationMethodOfAmountDeterminationTxt
COOK CHILDREN'S MEDICAL CENTER
O$6,932,979FMV
COOK CHILDREN'S MEDICAL CENTER
R$2,045,910FMV
COOK CHILDREN'S MEDICAL CENTER
Q$425,522FMV
COOK CHILDREN'S MEDICAL CENTER
A$1,017,120FMV
COOK CHILDREN'S MEDICAL CENTER
C$64,491,429FMV
COOK CHILDREN'S HEALTH PLAN
O$333,767FMV
COOK CHILDREN'S HEALTH PLAN
R$14,713,363FMV

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