Children's Medical Center Health Plan: Form 990, tax year 2014
View the entire original 990 at ProPublica ↗
- Organization
- Children's Medical Center Health Plan (EIN 46-2737696)
- Tax period
- 2014-01-01 to 2014-12-31
- Filed
- 2015-11-12
- IRS object ID
- 201503169349301685
- Schema version
- 2014v5.0
- 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2015-11-12T09:51:46-06:00 | ReturnTs |
| Tax Period End | 2014-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 366055558 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Grant Thornton LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1717 Main Street Suite 1500 | AddressLine1Txt |
| City | Dallas | CityNm |
| State Abbreviation | TX | StateAbbreviationCd |
| ZIP | 75201 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2014-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 462737696 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Children's Medical Center Health Plan | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | CHIL | BusinessNameControlTxt |
| Phone | 2144567000 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1935 Medical District Drive | AddressLine1Txt |
| City | Dallas | CityNm |
| State Abbreviation | TX | StateAbbreviationCd |
| ZIP | 75235 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Michele Chulick | PersonNm |
| Person Title | Treasurer and CFO | PersonTitleTxt |
| Phone | 2144567000 | PhoneNum |
| Signature | 2015-11-09 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Rebecca Zecha CPA | PreparerPersonNm |
| PTIN | P00648970 | PTIN |
| Phone | 2145612300 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2014 | TaxYr |
| Build TS | 2016-02-25 16:41:14Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | Peter W Roberts | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1935 Medical District Dr | AddressLine1Txt |
| City | Dallas | CityNm |
| State Abbreviation | TX | StateAbbreviationCd |
| ZIP | 75235 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $1,784 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | N/A | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2013 | FormationYr |
| Legal Domicile State | TX | LegalDomicileStateCd |
| Activity Or Mission | To insure health coverage for poor, distressed, or underpriviledged children & adults. | ActivityOrMissionDesc |
| Voting Members Governing Body | 5 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 0 | VotingMembersIndependentCnt |
| Total Employee | 0 | TotalEmployeeCnt |
| Total Volunteers | 0 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $0 | PYContributionsGrantsAmt |
| CY Contributions Grants | $0 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $0 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $0 | CYProgramServiceRevenueAmt |
| PY Investment Income | $0 | PYInvestmentIncomeAmt |
| CY Investment Income | $1,784 | CYInvestmentIncomeAmt |
| PY Other Revenue | $0 | PYOtherRevenueAmt |
| CY Other Revenue | $0 | CYOtherRevenueAmt |
| PY Total Revenue | $0 | PYTotalRevenueAmt |
| CY Total Revenue | $1,784 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $778,070 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $2,543,912 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $714,724 | PYOtherExpensesAmt |
| CY Other Expenses | $2,465,697 | CYOtherExpensesAmt |
| PY Total Expenses | $1,492,794 | PYTotalExpensesAmt |
| CY Total Expenses | $5,009,609 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$1,492,794 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$5,007,825 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $2,008,332 | TotalAssetsBOYAmt |
| Total Assets EOY | $5,769,480 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $501,126 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $1,495,099 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $1,507,206 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $4,274,381 | NetAssetsOrFundBalancesEOYAmt |
| Mission | To insure health coverage for poor, distressed, or underpriviledged children & adults in the State of Texas. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $3,395,804 | ExpenseAmt |
| Desc | To insure poor, distressed, or underpriviledged 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 are dually eligible for Medicaid and Medicare benefits) in the State of Texas. | Desc |
| Total Program Service Expenses | $3,395,804 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | 0 | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (1) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | 0 | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 5 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 0 | EmployeeCnt |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 5 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 0 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Stephanie K Smith | PersonNm |
| Phone | 2144567000 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1935 Medical District Drive | AddressLine1Txt |
| City | Dallas | CityNm |
| State Abbreviation | TX | StateAbbreviationCd |
| ZIP | 75235 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (7 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt |
|---|---|---|---|---|---|---|---|
| Christopher J Durovich | |||||||
| Chairman & Pres/CEO, CHST | 1.00 | 60.00 | Yes (X) | Yes (X) | $0 | $2,109,957 | $115,598 |
| Michele Chulick | |||||||
| Treas & EVP CAO, CHST | 1.00 | 55.00 | Yes (X) | Yes (X) | $0 | $790,705 | $10,400 |
| Peter W Roberts | |||||||
| Exec Dir/Pres & EVP PopHlth, CHST | 1.00 | 55.00 | Yes (X) | Yes (X) | $0 | $850,161 | $23,037 |
| Denise Levis-Hewson td 42314 | |||||||
| Dir & VP Clin Intg Ntw | 1.00 | 50.00 | Yes (X) | $0 | $187,963 | $8,801 | |
| Ray Tsai MD | |||||||
| Med Dir & Pres/Phys CHPG | 1.00 | 50.00 | Yes (X) | Yes (X) | $0 | $342,714 | $16,846 |
| Stephanie Slaughter | |||||||
| VP COO | 50.00 | 1.00 | Yes (X) | $0 | $373,367 | $19,877 | |
| Stephanie K Smith | |||||||
| Corporate Secretary | 1.00 | 50.00 | Yes (X) | $0 | $108,947 | $10,101 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $0 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $4,763,814 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $204,660 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 0 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (3 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| Health Management Assoc | |||||
| 120 N Washington Sq Ste 705 | Lansing | MI | 48933 | Consulting Services | $221,724 |
| Milliman Inc | |||||
| One Pennsylvania Plaza 38th Floor | New York | NY | 10119 | Actuarial Services | $156,961 |
| The Trizetto Group | |||||
| PO Box 122140 | Dallas | TX | 75312 | IT Solutions | $133,925 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 3 | CntrctRcvdGreaterThan100KCnt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,784 | TotalRevenueColumnAmt |
| Exclusion | $1,784 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,784 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $0 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $1,784 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,976,953 | TotalAmt |
| Program Services | $1,830,032 | ProgramServicesAmt |
| Management And General | $146,921 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $80,746 | TotalAmt |
| Program Services | $74,745 | ProgramServicesAmt |
| Management And General | $6,001 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $354,855 | TotalAmt |
| Program Services | $328,483 | ProgramServicesAmt |
| Management And General | $26,372 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $131,358 | TotalAmt |
| Program Services | $121,596 | ProgramServicesAmt |
| Management And General | $9,762 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $782,354 | TotalAmt |
| Management And General | $782,354 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,079 | TotalAmt |
| Management And General | $1,079 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $706,221 | TotalAmt |
| Program Services | $438,472 | ProgramServicesAmt |
| Management And General | $267,749 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,214 | TotalAmt |
| Program Services | $4,479 | ProgramServicesAmt |
| Management And General | $2,735 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $67,517 | TotalAmt |
| Program Services | $41,919 | ProgramServicesAmt |
| Management And General | $25,598 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $191,329 | TotalAmt |
| Program Services | $118,790 | ProgramServicesAmt |
| Management And General | $72,539 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $651,417 | TotalAmt |
| Program Services | $404,446 | ProgramServicesAmt |
| Management And General | $246,971 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $21,419 | TotalAmt |
| Program Services | $13,299 | ProgramServicesAmt |
| Management And General | $8,120 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $27,213 | TotalAmt |
| Program Services | $16,896 | ProgramServicesAmt |
| Management And General | $10,317 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,263 | TotalAmt |
| Program Services | $2,647 | ProgramServicesAmt |
| Management And General | $1,616 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (2 entries)
| DescDesc | TotalTotalAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|
| Catering, Meals, Coffee | $2,996 | $2,996 |
| Business Relations | $2,675 | $2,675 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,009,609 | TotalAmt |
| Program Services | $3,395,804 | ProgramServicesAmt |
| Management And General | $1,613,805 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,508,332 | BOYAmt |
| EOY | $4,283,646 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $82,406 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $907,691 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $4,263 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $903,428 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $500,000 | BOYAmt |
| EOY | $500,000 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,008,332 | BOYAmt |
| EOY | $5,769,480 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $55,650 | BOYAmt |
| EOY | $32,949 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $445,476 | BOYAmt |
| EOY | $1,462,150 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $501,126 | BOYAmt |
| EOY | $1,495,099 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,507,206 | BOYAmt |
| EOY | $4,274,381 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,507,206 | BOYAmt |
| EOY | $4,274,381 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,008,332 | BOYAmt |
| EOY | $5,769,480 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$5,007,825 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $7,775,000 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Publicly Supported Org509a2 | Yes (X) | PubliclySupportedOrg509a2Ind |
| Public Support Total509 | $0 | PublicSupportTotal509Amt |
Gross Investment Income509 GrossInvestmentIncome509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year | $1,784 | CurrentTaxYearAmt |
| Total | $1,784 | TotalAmt |
Investment Income And UBTI InvestmentIncomeAndUBTIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year | $1,784 | CurrentTaxYearAmt |
| Total | $1,784 | TotalAmt |
Total Support Calendar Year TotalSupportCalendarYearGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year | $1,784 | CurrentTaxYearAmt |
| Total | $1,784 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| First5 Years509 | Yes (X) | First5Years509Ind |
Schedule D IRS990ScheduleD
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $869,217 | OtherCostOrOtherBasisAmt |
| Depreciation | $3,622 | DepreciationAmt |
| Book Value | $865,595 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $38,474 | OtherCostOrOtherBasisAmt |
| Depreciation | $641 | DepreciationAmt |
| Book Value | $37,833 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $903,428 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | State Insurance Statutory Deposit | Desc |
| Book Value | $500,000 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $500,000 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)
| DescDesc | AmtAmt |
|---|---|
| LT Receivable/Payable-CMC | $1,299,188 |
| LT Deferred Rent | $162,962 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $1,462,150 | TotalLiabilityAmt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part X, Line 2 | FormAndLineReferenceDesc |
| Explanation | The organization's consolidated financial statements for the year ending December 31, 2014 did not require a FIN 48 footnote. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (1) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | Yes (1) | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (6 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Christopher J Durovich | ||||||||||||||
| Chairman & Pres/CEO, CHST | $0 | $978,719 | $0 | $998,539 | $0 | $132,699 | $0 | $93,691 | $0 | $21,907 | $0 | $2,225,555 | $0 | $306,546 |
| Michele Chulick | ||||||||||||||
| Treas & EVP CAO, CHST | $0 | $522,268 | $0 | $264,252 | $0 | $4,185 | $0 | $10,400 | $0 | $0 | $0 | $801,105 | $0 | $0 |
| Peter W Roberts | ||||||||||||||
| Exec Dir/Pres & EVP PopHlth, CHST | $0 | $519,240 | $0 | $305,471 | $0 | $25,450 | $0 | $10,400 | $0 | $12,637 | $0 | $873,198 | $0 | $0 |
| Denise Levis-Hewson td 42314 | ||||||||||||||
| Dir & VP Clin Intg Ntw | $0 | $103,683 | $0 | $70,732 | $0 | $13,548 | $0 | $7,510 | $0 | $1,291 | $0 | $196,764 | $0 | $0 |
| Ray Tsai MD | ||||||||||||||
| Med Dir & Pres/Phys CHPG | $0 | $280,608 | $0 | $59,050 | $0 | $3,056 | $0 | $0 | $0 | $16,846 | $0 | $359,560 | $0 | $0 |
| Stephanie Slaughter | ||||||||||||||
| VP COO | $0 | $254,251 | $0 | $115,957 | $0 | $3,159 | $0 | $9,651 | $0 | $10,226 | $0 | $393,244 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, Line 3 | The corporation's (CMCHP) top management official and other officers are employed and compensated by Children's Medical Center of Dallas (Children's). The Children's process is as follows: 1. The Human Resources Committee of the Board is responsible for setting the compensation for executives, except the President and CEO of Children's, which is set by the Board of Directors. The Committee is comprised of independent, non-employee directors with no conflict of interest regarding executive compensation. A written compensation philosophy has been developed by the Human Resources Committee for timeliness and appropriateness. The philosophy defined desired comparator groups for compensation surveys. The comparator groups are from domestic healthcare industry sectors only and do not include any non-healthcare organizations. 2. The compensation philosophy also defines target levels relative to the marketplace comparator groups for base pay, base pay plus incentive pay, and fringe benefits provided to Children's executives. A third-party consultant, Sullivan Cotter, is engaged by the Human Resources Committee and provides independent, expert consulting services in the area of executive compensation market surveying, pay and benefits program design, and administrative services. Salaries for Children's executives (except for the President and CEO) are set by comparing the salaries paid for comparable positions in integrated systems, academic medical centers, and children's hospitals in similar size and scope of services to Children's. 3. The salary for the President and CEO is set in reference to salaries paid for Presidents and CEOs of children's hospitals in similar size and scope of services to Children's. The data is compiled by Sullivan Cotter and they develop and update annually salary ranges unique to each executive position. The Human Resources Committee approves base pay for each executive (except the President and CEO, whose base pay is approved by the Board of Directors) aimed in the aggregate at approximately the middle of executive pay ranges. 4. For other officers and key employees, Children's uses a combination of job evaluation and survey data to determine the market pay range. |
| Part I, Line 4b | Non-Qualified Retirement Plan: * Children's Medical Center of Dallas Retirement Income Restoration Plan - There were no employees that received taxable income from the Retirement Income Restoration Plan in 2014. Christopher J Durovich participated in the Retirement Income Restoration Plan. * Children's Medical Center of Dallas Savings Restoration Plan - There were no employees that received taxable income from the Savings Restoration Plan in 2014. Employees who participate in the Savings Restoration Plan are Christopher J Durovich, Michele Chulick, Peter W Roberts, and Ray Tsai. |
| Part I, Line 7 | Non-Fixed Payments - The Human Resources Committee of the Board of Directors retains the authority to adjust annual payout percentages solely at their discretion. |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (9 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part VI, Section A, line 6 | Children's Health System of Texas (CHST) is the sole member. |
| Form 990, Part VI, Section A, line 7a | Directors are appointed by the sole member and approved by the current CMCHP Board of Directors. |
| Form 990, Part VI, Section A, line 7b | Member reserve powers are specified in CMCHP's Bylaws and represent those actions by the organization which require member approval. These powers generally encompass changes in the mission of the organization, addition of new members, certain dispositions of assets, amendments to the organization's Certificate of Formation and Bylaws, and appointment of directors. |
| Form 990, Part VI, Section B, line 11 | A draft of the Form 990 is presented to the CHST Audit Committee, which has certain delineated authority for the organization, for review with discussion of the draft led by the CHST Chief Financial Officer. A copy of the Form 990 is made available to the directors through our board portal before it is filed. |
| Form 990, Part VI, Section B, line 12c | The Board members, including any director, officer, or member of a committee with Board delegated powers, receive a copy of the policy, along with a Statement of Interest form to complete, with their annual Board appointment letter. All disclosures made are reviewed by the Chief Compliance Officer and Vice President, Associate General Counsel and Secretary, and discussed as necessary at the appropriate Board meeting to determine if further action is required. Any individual with a perceived or potential conflict is prohibited from voting or participating in the decision making process regarding such transaction or arrangement. |
| Form 990, Part VI, Section B, line 15 | The corporation's (CMCHP) top management official and other officers are employed and compensated by Children's Medical Center of Dallas (Children's). The Children's process is as follows: 1. The Human Resources Committee of the Board is responsible for setting the compensation for executives, except the President and CEO of Children's, which is set by the Board of Directors. The Committee is comprised of independent, non-employee directors with no conflict of interest regarding executive compensation. A written compensation philosophy has been developed by the Human Resources Committee for timeliness and appropriateness. The philosophy defined desired comparator groups for compensation surveys. The comparator groups are from domestic healthcare industry sectors only and do not include any non-healthcare organizations. 2. The compensation philosophy also defines target levels relative to the marketplace comparator groups for base pay, base pay plus incentive pay, and fringe benefits provided to Children's executives. A third-party consultant, Sullivan Cotter, is engaged by the Human Resources Committee and provides independent, expert consulting services in the area of executive compensation market surveying, pay and benefits program design, and administrative services. Salaries for Children's executives (except for the President and CEO) are set by comparing the salaries paid for comparable positions in integrated systems, academic medical centers, and children's hospitals in similar size and scope of services to Children's. 3. The salary for the President and CEO is set in reference to salaries paid for Presidents and CEOs of children's hospitals in similar size and scope of services to Children's. The data is compiled by Sullivan Cotter and they develop and update annually salary ranges unique to each executive position. The Human Resources Committee approves base pay for each executive (except the President and CEO, whose base pay is approved by the Board of Directors) aimed in the aggregate at approximately the middle of executive pay ranges. 4. For other officers and key employees, Children's uses a combination of job evaluation and survey data to determine the market pay range. |
| Form 990, Part VI, Section C, line 19 | Certificate of Formation is publically available and the conflict of interest policy is made available upon request. Financial statements are available upon request. |
| Form 990, Part IX, line 11g | Consulting & Professional Fees: Program service expenses 438,472. Management and general expenses 267,749. Fundraising expenses 0. Total expenses 706,221. |
| Form 990, Part XI, line 9: | CHST Paid-in Capital 7,775,000. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (17 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Children's Medical Center of Dallas | |||||||||||
| 1935 Medical District Drive | Dallas | TX | 75235 | 750800628 | Hospital | TX | 501(c)(3) | Line 3 | Children's Health System of Texas | 0 | |
| Children's Medical Center Foundation | |||||||||||
| 1935 Medical District Drive | Dallas | TX | 75235 | 752062015 | Foundation | TX | 501(c)(3) | Line 7 | Children's Health System of Texas | 0 | |
| Anesthesiologists For Children | |||||||||||
| 1935 Medical District Drive | Dallas | TX | 75235 | 752917570 | Physicians | TX | 501(c)(3) | Line 9 | Children's Health System of Texas | 0 | |
| Dallas Phys Med Svcs for Children Inc | |||||||||||
| 1935 Medical District Drive | Dallas | TX | 75235 | 810584868 | Physicians | TX | 501(c)(3) | Line 3 | Children's Health System of Texas | 0 | |
| Children's Health System of Texas | |||||||||||
| 1935 Medical District Drive | Dallas | TX | 75235 | 752062019 | Management Company | TX | 501(c)(3) | Line 11b, II | 0 | N/A | |
| Physicians For Children | |||||||||||
| 1935 Medical District Drive | Dallas | TX | 75235 | 752854505 | Physicians | TX | 501(c)(3) | Line 3 | Children's Health System of Texas | 0 | |
| Children's Med Ctr Research Inst at UTSWMC | |||||||||||
| 1935 Medical District Drive | Dallas | TX | 75235 | 433462044 | Research Institute | TX | 501(c)(3) | Line 11a, I | Children's Health System of Texas | 0 | |
| Complex Care Med Svc Corp | |||||||||||
| 1935 Medical District Drive | Dallas | TX | 75235 | 461893597 | Medical Services | TX | 501(c)(3) | Line 3 | Children's Health System of Texas | 0 | |
| Pediatric Partners For Children | |||||||||||
| 1935 Medical District Drive | Dallas | TX | 75235 | 461917702 | Clinically Integrated Network | TX | 501(c)(3) | Line 11a, I | Children's Health System of Texas | 0 | |
| Children's Medical Center Services | |||||||||||
| 1935 Medical District Drive | Dallas | TX | 75235 | 461934007 | Medical Services | TX | Pending | Pending | Children's Health System of Texas | 0 | |
| Children's Population Health | |||||||||||
| 1935 Medical District Drive | Dallas | TX | 75235 | 463104601 | Population Health | TX | 501(c)(3) | Line 11a, I | Children's Health System of Texas | 0 | |
| The Health and Wellness Alliance For Children | |||||||||||
| 1935 Medical District Drive | Dallas | TX | 75235 | 463080586 | Physicians | TX | 501(c)(3) | Line 11a, I | Children's Health System of Texas | 0 | |
| Specialists For Children | |||||||||||
| 1935 Medical District Drive | Dallas | TX | 75235 | 463110125 | Physicians | TX | Pending | Pending | Children's Health System of Texas | 0 | |
| Physicians Quality Alliance of North Texas | |||||||||||
| 1935 Medical District Drive | Dallas | TX | 75235 | 464049491 | Physicians | TX | 501(c)(3) | Line 11a, I | Children's Health System of Texas | 0 | |
| Community Providers for Children | |||||||||||
| 1935 Medical District Drive | Dallas | TX | 75235 | 463675742 | Physicians | TX | 501(c)(3) | Line 11a, I | Children's Health System of Texas | 0 | |
| Southwestern Medical District | |||||||||||
| 5323 Harry Hines Dr | Dallas | TX | 75390 | 204101612 | Medical District | TX | 501(c)(3) | Line 11a, I | 0 | N/A | |
| Women's Auxiliary of CMCD | |||||||||||
| 12720 Hillcrest Rd | Dallas | TX | 75230 | 752485538 | Women's Auxiliary | TX | 501(c)(3) | Line 9 | 0 | N/A | |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (4 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Entity TypeEntityTypeTxt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|
| Children's Insurance Company | |||||||||
| 76 St Paul Street Suite 500 | Burlington | VT | 05401 | 030328102 | Insurance Company | VT | Children's Health System of Texas | C | 0 |
| Alternative Care Systems | |||||||||
| 1935 Medical District Drive | Dallas | TX | 75235 | 752244475 | Other Medical Services | TX | Children's Health System of Texas | C | 0 |
| NTPSS Inc | |||||||||
| 1935 Medical District Drive | Dallas | TX | 75235 | 471036641 | Physician Solutions | TX | Children's Health System of Texas | C | 0 |
| Texas Bluebonnet Health Plan | |||||||||
| 1935 Medical District Drive | Dallas | TX | 75235 | 472252673 | Health Plan | TX | Children's Health System of Texas | C | 0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | Yes (1) | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | Yes (1) | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | Yes (1) | TransferFromOtherOrgInd |