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 461893597 Complex Care Medical Services Corporation COMP 2144567000 1935 Medical District Drive Dallas TX 75235 Jerry Lee Treasurer, VP Acctng & Tresury 2144567000 2015-11-11 1 Rebecca Zecha CPA P00648970 2145612300 2014 2016-02-25 16:41:14Z Jerry Lee 1935 Medical District Drive Dallas TX 75235 1770185 0 X N/A X 2012 TX To serve as the medical home for children with complex medical illnesses. 3 2 0 2 0 0 0 0 32162 1770185 0 0 0 0 32162 1770185 0 0 0 0 191802 398699 0 0 0 48999 2023311 240801 2422010 -208639 -651825 1507 3323468 210146 4183932 -208639 -860464 To serve as the medical home for children with complex medical illnesses where a multi-disciplinary team of care givers oversee and coordinate their care. 0 0 1781218 1770185 To serve as the medical home for children with complex medical illnesses where a multi-disciplinary team of care givers oversee and coordinate their care. 1781218 1 0 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 1 0 1 0 0 0 0 0 0 0 0 0 0 0 X 3 2 1 0 1 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X Stephanie K Smith 2144567000 1935 Medical District Drive Dallas TX 75235 Michelle Thomas MD Chair 1.00 0.00 X X 0 0 0 John Anderson MD Director 1.00 0.00 X 0 0 0 Andy Gelfand MD Director & Physician, CMC 1.00 5.00 X 0 17250 0 Douglas G Hock Pres & Pres/COO, CMC and EVP, CHST 1.00 55.00 X 0 918585 47571 Jerry Lee Treas & VP Acctng/Treas, CHST 1.00 50.00 X 0 353382 29554 Stephanie K Smith Corporate Secretary 1.00 50.00 X 0 108947 10101 0 1398164 87226 0 0 1 0 UTSW HI 108 5323 Harry Hines Blvd Dallas TX 753908886 Phys & Medical Svcs 219195 1 DSRIP 621110 1758486 1758486 Outpatient 621110 11699 11699 1770185 1770185 1770185 0 0 285680 201295 84385 12143 8556 3587 80272 56561 23711 20604 14518 6086 506773 506773 222368 222368 6718 4186 2532 1886 1886 307079 307027 52 5500 5500 7562 1282 6280 6699 6699 Community Relations 944506 944506 Translation Srvcs 11270 11270 Nutrition Support 1850 1850 Patient Parking 1100 1100 2422010 1781218 640792 0 0 83877 1507 1767804 1478486 6699 0 1471787 1507 3323468 219195 210146 3964737 210146 4183932 X -208639 -860464 -208639 -860464 1507 3323468 -651825 0 X 0 1 X 1 0 X 1406298 5860 1400438 72188 839 71349 1471787 LT Receivable/Payable-CMC 3964737 3964737 Part X, Line 2 The organization's consolidated financial statements for the year ending December 31, 2014 did not require a FIN 48 footnote. 0 1 0 0 0 0 0 1 0 Douglas G Hock Pres & Pres/COO, CMC and EVP, CHST 0 502423 0 348733 0 67429 0 29813 0 17758 0 966156 0 0 Jerry Lee Treas & VP Acctng/Treas, CHST 0 260107 0 88560 0 4715 0 13978 0 15577 0 382937 0 0 Part I, Line 3 The corporation's (CCMSC) 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. Douglas G Hock 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. Employees who participate in the Savings Restoration Plan are Douglas G Hock and Jerry Lee. 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 2 Michelle Thomas, M.D. John Anderson, M.D., Andy Gelfand, M.D. - business relationship Form 990, Part VI, Section A, line 4 During the tax year and by board approval and resolution, the sole member of the corporation was changed from Children's Medical Center of Dallas to Children's Health System of Texas. The organization's by-laws were amended to reflect this change. 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 CCMSC Board of Directors. Form 990, Part VI, Section A, line 7b Member reserve powers are specified in CCMSC'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 (CCMSC) 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, CCMSC retains an outside compensation survey data to provide compensation analysis regarding the fair market value of CCMSC's salary structure, which is presented to the CCMSC 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. 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 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 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 0 0 1 0 0 0 0 0 0 1 0 1 1 1 1 0 0