2015-11-12T09:51:46-06:00 2014-12-31 366055558 Grant Thornton LLP 1717 Main Street Suite 1500 Dallas TX 75201 990 2014-01-01 752917570 Anesthesiologists For Children ANES 2144567000 1935 Medical District Drive Dallas TX 75235 Jerry Lee Treasurer, VP Acctng & Treasury 2144567000 2015-11-11 1 Rebecca Zecha CPA P00648970 2145612300 2014 2016-02-25 16:41:14Z Jerry Lee 1935 Medical District Dr Dallas TX 75235 29439135 0 X N/A X 2000 TX Provide anesthesia services to patients at Children's Medical Center in Dallas, Texas 5 1 37 0 0 0 16915 48082 24431606 28916906 14727 12897 278125 461250 24741373 29439135 0 0 0 0 10007800 11716036 0 0 0 16110854 16486770 26118654 28202806 -1377281 1236329 6420394 10812518 11809371 14965166 -5388977 -4152648 Provide anesthesia services to patients at Children's Medical Center in Dallas, Texas. These services are provided without regard to patient's ability to pay for the services. 0 0 26753206 29378156 Provide anesthesia services to patients at Children's Medical Center inDallas, Texas. These services are provided without regard to thepatient's ability to pay for the services. 26753206 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 33 0 1 37 1 0 0 0 0 0 0 0 0 0 0 X 5 1 0 0 1 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X Jeffrey Vawrinek 2144567000 1935 Medical District Drive Dallas TX 75235 Desmond Henry MD Chairman, Pres, Director, Physician 1.00 50.00 X X 0 166563 0 Stephen Hoang MD Anesthesiologist, Director 40.00 0.00 X 476215 0 7306 Ron Mitchell MD Physician, Director 1.00 40.00 X 0 270567 0 Nancy Rollins MD Physician, Director 1.00 40.00 X 0 482266 0 Charles Whitten MD Physician, Director 1.00 0.00 X 0 0 0 Jerry Lee Treasurer 1.00 50.00 X 0 353382 29554 Stephanie Smith Corporate Secretary 1.00 50.00 X 0 108947 10101 Gary Turner MD Anesthesiologist 40.00 0.00 X 491470 0 10837 Christopher Meggyesy MD Anesthesiologist 40.00 0.00 X 486009 0 9979 Hadi Sakhai MD Anesthesiologist 40.00 0.00 X 484873 0 13527 Kim Lopez MD Anesthesiologist 40.00 0.00 X 479348 0 909 Cynthia Gonzales MD Anesthesiologist 40.00 0.00 X 478579 0 6427 2896494 1381725 88640 30 0 1 0 UTSW 5323 Harry Hines Blvd Dallas TX 75390 Anesthesiologist 14218396 Medac Inc 804 Scott Nixon Memorial Dr Augusta GA 30907 Billing & Prac. Mgmt 647759 2 48082 48082 Professional Svc Rev 621110 29274543 29274543 Coverage Revenue 621110 613870 613870 Prov for Dbtful Accts 621110 -971507 -971507 28916906 12897 12897 Chief Stipend 621110 461250 461250 461250 29439135 29378156 0 12897 X 483521 483521 9875124 9403582 471542 377815 360616 17199 587764 561009 26755 391812 373976 17836 875947 875947 22046 22046 15180434 15177492 2942 19936 5861 14075 27263 17461 9802 23003 19344 3659 80488 75488 5000 1752 1662 90 218906 218906 Collection Fees 28317 28317 Catering, Meals, Coffee 8678 3925 4753 28202806 26753206 1449600 0 4431784 8673883 1976345 2128122 12265 1752 12265 10513 6420394 10812518 3913339 5161268 7896032 9803898 11809371 14965166 X -5388977 -4152648 -5388977 -4152648 6420394 10812518 1236329 0 X 0 1 X 1 0 X 33650 30466 10800 16915 48082 139913 41463061 49455696 49738411 68819857 29378156 238855181 41496711 49486162 49749211 68836772 29426238 238995094 0 0 0 238995094 14727 12897 27624 14727 12897 27624 41496711 49486162 49749211 68851499 29439135 239022718 0.99990 0.99990 0.00010 0.00010 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 12265 1752 10513 10513 LT Advances-AFC 5502808 LT Receivable/Payable-CMC 4301090 9803898 Part X, Line 2 The Anesthesiologists for Children's consolidated financial statements for the year ending December 31, 2014 do not contain a FIN 48 footnote. 0 1 0 0 0 0 0 1 0 Desmond Henry MD Chairman, Pres, Director, Physician 0 166563 0 0 0 0 0 0 0 0 0 166563 0 0 Stephen Hoang MD Anesthesiologist, Director 467713 0 0 0 8502 0 0 0 7306 0 483521 0 0 0 Ron Mitchell MD Physician, Director 0 270567 0 0 0 0 0 0 0 0 0 270567 0 0 Nancy Rollins MD Physician, Director 0 482266 0 0 0 0 0 0 0 0 0 482266 0 0 Jerry Lee Treasurer 0 260107 0 88560 0 4715 0 13978 0 15577 0 382937 0 0 Gary Turner MD Anesthesiologist 464182 0 0 0 27288 0 0 0 10837 0 502307 0 0 0 Christopher Meggyesy MD Anesthesiologist 465039 0 0 0 20970 0 0 0 9979 0 495988 0 0 0 Hadi Sakhai MD Anesthesiologist 461491 0 0 0 23382 0 0 0 13527 0 498400 0 0 0 Kim Lopez MD Anesthesiologist 474110 0 0 0 5238 0 0 0 909 0 480257 0 0 0 Cynthia Gonzales MD Anesthesiologist 468592 0 0 0 9987 0 0 0 6427 0 485006 0 0 0 Part I, Line 3 The corporation's (AFC) 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 Savings Restoration Plan - There were no employees that received taxable income from the Savings Restoration Plan. Jerry Lee participated in the Savings Restoration Plan. 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. Form 990, Part VI, Section A, line 4 The organization's by-laws were ammended and approved, during the tax year, to identify the change of sole member of the corporation from the prior sole member as Children's Medical Center of Dallas to Children's Health System of Texas. 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 AFC Board of Directors. Form 990, Part VI, Section A, line 7b Member reserve powers are specified in AFC'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 (AFC) 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. For physicians, AFC retains an outside compensation survey data to provide compensation analysis regarding the fair market value of AFC's salary structure, which is presented to the AFC Board of Directors for approval. 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 Contract Medical: Program service expenses 14,520,535. Management and general expenses 0. Fundraising expenses 0. Total expenses 14,520,535. Consulting & Professional fees: Program service expenses 656,957. Management and general expenses 2,942. Fundraising expenses 0. Total expenses 659,899. 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 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 N/A 0 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 Medical Center Health Plan 1935 Medical District Drive Dallas TX 75235 462737696 HMO TX 501(c)(3) Line 9 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 N/A 0 Women's Auxiliary of CMCD 12720 Hillcrest Rd Dallas TX 75230 752485538 Women's Auxiliary TX 501(c)(3) Line 9 N/A 0 Children's Insurance Company 76 St Paul Street Suite 500 Burlington VT 05401 030328102 Insurance Company VT Children's Health System of Texas C 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 0 0 1 0 1 0 0 0 0 0 0 1 0 1 1 1 1 0 0