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 750800628 Children's Medical Center of Dallas CHIL 2144567000 1935 Medical District Drive Dallas TX 75235 David Eager SVP, CFO & Treasurer 2144567000 2015-11-09 1 Rebecca Zecha CPA P00648970 2145612300 2014 2016-02-25 16:41:14Z Children's Health Christopher J Durovich 1935 Medical District Dr Dallas TX 75235 1236509771 0 X www.childrens.com X 1947 TX Dedicated to making life better for children 19 18 7092 2500 1626077 136849 28807800 16871919 1029307149 1113687533 27194699 71238833 25898968 34557007 1111208616 1236355292 12400 182000 0 0 503539451 506775200 0 0 0 440969265 483210074 944521116 990167274 166687500 246188018 2410473260 2590186076 645351702 640494477 1765121558 1949691599 X Children's Medical Center of Dallas is dedicated to making life better for children. Children's is committed to carry out this mission through adherence to four guiding principles: quality care; research & innovation; education & advocacy; and excellence & accountability. 0 0 708081307 182000 1141988433 Consistent with its charitable mission, Children's maintains a policy of accepting all patients within its primary service area regardless of ability to pay. The local service regions stretch from the Oklahoma border south to Waco and from Parker County (west of Ft. Worth) east to Wood County. For the fiscal year ended December 31, 2014, Children's absorbed $171 million of uncompensated healthcare services as a result of this open-door charitable policy. Children's participates in applicable government sponsored entitlement programs. For the year ended December 31, 2014, approximately 62% of Children's gross revenue is attributable to patients enrolled in state Medicaid programs.During 2014, Children's served children through more than 760,000 patient encounters. Children's had 47,877 patient admissions resulting in 108,552 patient days, and provided services in 576,870 outpatient visits. In addition, the hospital staff performed 18,624 day surgeries. In recognizing its mission to the community, Children's participates in the Medicaid, Medicare, Children's Health Insurance Program (CHIP), and Children with Special Health Care Needs (CSHCN) government programs. Under an agreement with the Dallas County Hospital District, Children's provides services to the indigent children of Dallas County. 3599451 5805168 Children's is the primary pediatric teaching hospital for the University of Texas Southwestern Medical School at Dallas and has the fifth largest pediatric training program in the country. Currently, there are 100 pediatric residents, three chief residents and approximately 120 pediatric subspecialty residents and fellows enrolled in this training program. Children's offers fellowships/residencies in these pediatric subspecialties, as well as internships and fellowships/residencies in nursing, dentistry, allied health, social sciences and religious studies. In addition to internship and fellowship programs, many students representing a variety of health care professions come to Children's to complete a pediatric rotation as a requisite of their training. 2853585 4602241 Through Children's affiliation with UTSW Medical Center, ongoing research is promoted in many different clinical areas of the hospital. The end goal of this research is the development of newer, more effective diagnostic & treatment methods to meet the health care needs of children. All research involving human subjects is approved by the Institutional Review Board at UTSW. Joint areas of research efforts between UTSW's Department of Pediatrics & Children's are: critical care, immunology, gastroenterology, emergency medicine, radiology, nutrition, endocrinology, psychiatry, cardiology, pharmacology, nephrology, neurology, pulmonology, rheumatology, infectious diseases & hematology/oncology. Many of these clinical studies have been published in medical journals & presented to professional health care societies. 714534343 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 1 1 0 1 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 1 1509 0 1 7092 1 1 1 0 0 0 0 0 0 0 0 0 X 19 18 0 0 0 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 Christopher J Durovich CEO CMC and President/CEO CHST 60.00 X X 2109957 0 115598 Robert A Chereck Chairman & Director 1.00 X X 0 0 0 Richard Knight Jr Vice Chairman & Director 1.00 X X 0 0 0 Richie L Butler Director 1.00 X 0 0 0 John Eagle Director 1.00 X 0 0 0 Jeremy Ford Director 1.00 X 0 0 0 Charles Koetting Director 1.00 X 0 0 0 Tracey Kozmetsky Director 1.00 X 0 0 0 Jeff Lamb Director 1.00 X 0 0 0 CS Lee Director 1.00 X 0 0 0 Thomas A Montgomery Director 1.00 X 0 0 0 Anne Motsenbocker Director 1.00 X 0 0 0 Scott Ozanus Director 1.00 X 0 0 0 Javier Palomarez Director 1.00 X 0 0 0 Robert Peterson Director 1.00 X 0 0 0 Barbara Stuart Director 1.00 X 0 0 0 Mary Suhm Director 1.00 X 0 0 0 Gregg Tanner Director 1.00 X 0 0 0 David Biegler Ex Officio Voting Member 1.00 X 0 0 0 Douglas G Hock President/COO CMC and EVP CHST 55.00 X 918585 0 47571 Michele Chulick EVP Chief Admin Officer 55.00 X 790705 0 10400 Lawrence Foust EVP and Chief Legal Officer 55.00 X 290423 0 7097 W Robert Morrow MD EVP Chief Clinical Officer 55.00 X 519219 0 21858 Kern Wildenthal MD PhD EVP and Pres CMC Foundation 1.00 55.00 X 747216 0 13621 Peter W Roberts EVP PopHealth NetworkDev 55.00 0.00 X 850161 0 23037 Pamela Arora SVP and CIO 55.00 X 558649 0 25614 Cynthia Bassel SVP Foundation 1.00 55.00 X 451107 0 16554 Kimberly Besse SVP Chief HR Officer 55.00 X 437923 0 25868 David G Biggerstaff SVP Svc Line Dev Amb Svc 55.00 X 541398 0 22849 David Eager SVP CFO and Treasurer 55.00 X 516350 0 17481 Mary E Stowe RN SVP and CNO 55.00 X 513110 0 51134 Regina Coggins td 53114 SVP Ext Rel Gen Counsel 55.00 X 975302 0 18938 Ray Dziesinski td 4214 SVP Chief Treasury Officr 55.00 X 1270232 0 19955 Daniel T Carney VP Facilities Dev Ops 50.00 X 395444 0 24407 Kenneth Carr VP Clinical Support Srvcs 50.00 X 230214 0 21924 Joe Don Cavender RN VP and ASSOC CNO 50.00 X 233094 0 21077 Jaquetta Clemons VP Finance 50.00 X 222782 0 5551 Douglas Duwe VP Academic Relations 50.00 X 208896 0 10984 Dorothy Foglia RN VP and ASSOC CNO 50.00 X 242424 0 21481 Michael Hefton RN VP and ASSOC CNO 50.00 X 232958 0 21491 Keri Kaiser VP Marketing and Comm 50.00 X 312823 0 22140 Jerry Lee VP Accounting and Treasury 50.00 X 353382 0 29555 Mitchell Mulvehill VP Finance (td 1/15/14) 50.00 X 369139 0 3405 Rustin Morse MD VP Chief Quality Officer 50.00 X 399336 0 0 Beth Peters VP Corp Compliance and CCO 50.00 X 263491 0 17343 Jeffrey Vawrinek VP Assoc General Counsel 50.00 X 414523 0 8555 Vanessa U Walls VP Regional Specialty Care Svc 50.00 X 438241 0 20131 Mark Ziemianski VP Business Analytics 50.00 X 229435 0 23015 Joseph Egan VP Bus Dev Strat Affiliations 50.00 X 307127 0 2224 Thomas M Zellers MD VP Medical Staff Affairs 50.00 X 150000 0 0 Stephanie K Smith Corporate Secretary 50.00 X 108947 0 10101 Patricia U Winning SVP Strategy Phys Orgs 50.00 X 749005 0 92968 Patricia Sumler td 93014 VP Resource Dev Pop Hlth 50.00 X 409467 0 10504 Stephanie Slaughter VP COO Medicaid HMO 55.00 X 373367 0 19877 Christopher Menzies VP Chief Med Information Offcr 50.00 X 339734 0 11609 Teresa Egan Admin Dir Child Research 50.00 X 312116 0 3747 18786282 0 839664 913 0 1 0 UTSW HI 108 5323 Harry Hines Blvd Dallas TX 753908886 Phys & Medical Svcs 74750892 Medline Industries Inc 9303 Stoneview Dr Dallas TX 75237 Medical Supplies 16836807 JE Dunn Construction Co 16000 Dallas Pkwy 500 Dallas TX 75248 Construction Services 15765780 Technologent 5801 Tennyson Pkwy 125 Plano TX 75024 Technology Solutions 10615364 Right Sourcing Inc PO Box 515743 Los Angeles CA 900515118 Staffing/Consulting Svcs 7422210 436 10657557 6214362 16871919 Inpatient Revenue 622110 1380315178 1380315178 Outpatient Revenue 621400 988995816 988995816 Day Surgery Revenue 621400 212013654 212013654 Prov for Dbtful Accts 622110 -34267153 -34267153 Deductions from Rev. 622110 -1433369962 -1433369962 1113687533 71393312 71393312 243956 0 243956 243956 243956 154479 -154479 -154479 -154479 Other Med Svc Revenue 622110 29524533 27898456 1626077 Dietary Revenue 621990 4595491 4595491 Vending Revenue 454210 193027 193027 34313051 1236355292 1146181480 1626077 71675816 X 182000 182000 16994204 3863113 13131091 389663094 305478379 84184715 14624841 11465219 3159622 56492771 44287798 12204973 29000290 22734927 6265363 5151691 186579 4965112 2380789 2380789 423898 1066 422832 157006718 115027709 41979009 13693756 242501 13451255 7821408 2539354 5282054 26866915 969091 25897824 33644724 6235177 27409547 1967807 744413 1223394 3308343 1699992 1608351 17800009 12845019 4954990 56935226 41086164 15849062 3620959 148340 3472619 Med./Surgical Supplies 97377493 96370315 1007178 Community Relations 41124494 41124494 Dietary and Food Costs 4646486 4003546 642940 Special Evnts & Prjcts 3084446 189079 2895367 6354912 3110068 3244844 990167274 714534343 275632931 0 211102906 202842139 246559708 135934761 197587737 180818409 9123939 9827641 22130766 14890158 1373418094 608069007 739221247 765349087 579851888 600400796 404895069 680123085 2410473260 2590186076 205475567 180169849 379526700 365548074 2534057 60349435 92242497 645351702 640494477 X 1439078427 1440397479 241967405 403513990 84075726 105780130 1765121558 1949691599 2410473260 2590186076 X 246188018 -50065762 -11552215 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 163076 163076 0 Part II-B, Line 1: In 2014, CMCD paid membership dues to organizations in which a portion of the membership dues were related to lobbying activities. NACH (National Association of Children's Hospitals), AHA (American Hospital Association), THA (Texas Hospital Association), TAVH (Texas Association of Voluntary Hospitals), THOT (Teaching Hospitals of Texas), and CHAT (Children's Hospital Association of Texas) identifed a portion of their membership dues as being related to lobbying activities. Lobbying percentages were identified by said organizations and applied to 2014 membership dues. 41868946 41868946 790817009 253423960 537393049 14552436 7687518 6864918 455593771 346957529 108636242 70585932 70585932 765349087 Net Assets of Foundation 509266876 Other Assets 10290633 LT Advances to Affiliates 156580891 Professional Risk Liability Deposit - CIC 3984685 680123085 UTSW Phys Guarantees 3396792 Retirement Plan Accr 68404568 Rsv for Professional Liab 7415421 LT Deferred Rent 2840716 LT-Loan Pay-Urban Ventures 10185000 92242497 Part X, Line 2: In 2014, Children's Medical Center of Dallas was not required to have a FIN48 footnote disclosure. 1 1 X 1 X 1 X 1 1 0 1 1 18072352 327991 17744361 0.01790 560218084 480248445 79969639 0.08080 61581457 51717293 9864164 0.01000 639871893 532293729 107578164 0.10870 8982499 689046 8293453 0.00840 35739032 1945764 33793268 0.03410 0 0 6809832 0 6809832 0.00690 2170087 55219 2114868 0.00210 53701450 2690029 51011421 0.05150 693573343 534983758 158589585 0.16020 744704 744704 0.00080 744704 744704 0.00080 1 10823375 1996430 2381629 973394 1408235 X 1 1 1 NONE 2 1 Children's Medical Center of Dallas 1935 Medical District Drive Dallas TX 75235 www.childrens.com 138910807 X X X X X Both Dallas and Plano campuses share a license, A 2 Children's Medical Center of Plano 7601 Preston Road Plano TX 75024 www.childrens.com 138910807 X X X X X EIN, and MCR provider number. A Facility Reporting Group - A 0 0 1 X X X X X X X X X 13 1 0 0 1 X www.childrens.com X X 1 13 1 www.childrens.com 0 0 1 X 200.000000000000 400.000000000000 X X X X 1 1 X X X 1 X X X X 1 X 0 X X X X 1 X 0 0 Part V, Section B Facility Reporting Group A Facility Reporting Group A consists of: - Facility 1: Children's Medical Center of Dallas, - Facility 2: Children's Medical Center of Plano Group A-Facility 1 -- Children's Medical Center of Dallas Part V, Section B, line 5: Each year, Children's recruits a citizen advisory council made up of key stakeholders serving children and knowledgeable in public health. These community leaders meet monthly to discuss children's health care issues and to contribute their experience, insights and expert recommendations for the the Beyond ABC report prepared by Children's. Additionally, the citizen advisory boards for Beyond ABC identify recommendations for advocates and public officials in order to improve the lives and health of children. Recent advisory boards have included city and county officials, former legislators, members of law enforcement, school district administrators, nonprofit organizations' executives, child-advocacy representatives, chambers of commerce and senior staff from corporations and financial institutions.Additionally, as part of the Texas Healthcare Transformation and Quality Improvement Program, the state of Texas has been divided into 20 regions. Hospitals within each region have worked together to develop plans to respond to health needs and transform the health care delivery system. Children's participates in the Regional Healthcare Partnership (RHP) Plans for Regions 9 and 10. Group A-Facility 1 -- Children's Medical Center of Dallas Part V, Section B, line 7d: The current CHNA, Implementaion Strategy, and other community reports may be accessed at the folllowing web address: www.childrens.com/footer/aboutsection/about/reports-and- publications/community-reports Group A-Facility 1 -- Children's Medical Center of Dallas Part V, Section B, line 11: Upon conducting the CHNA and developing the Community Health Implementation Strategy, Children's decided on priority areas of the identified health needs that were reviewed. The priority areas are those areas which Children's has decided to focus its resources and integrate into its strategic and operational plans. Multiple goals were developed for each priority area, along with strategies to accomplish those goals. Children's has implemented and/or is working towards implementation of the strategies for accomplishing the developed goals. Full details of priority areas, goals, and strategies are contained with the publically available CHNA and Community Health Implementation Strategy. Needs Not Addressed:Some issues identified through Children's CHNA have not been addressed in this plan. In initial discussion and subsequent prioritization, Children's Medical Center Needs Assessment Team considered the levels to which some needs were already being addressed in the service area. Additionally, some community needs fall out of the scope of expertise and resources of Children's Medical Center. Children's Community Health Implementation Strategy includes details on Needs Not Addressed. The following are some of the needs identified in the assessment that are addressed by others or in different ways: safe and affordable housing, palliative care capacity/need for increased geriatric/long-term/home care resources, discourage elective deliveries/increase the percentage of women who receive prenatal care, provide comprehensive sexuality education/high incidence of STDs in RHP Region 10, protect green spaces/add bike lanes/improve access to parks. These needs are not being addressed by Children's as our priorities were established based on unmet community health needs that intersect with our mission and key clinical strengths. There are community and state agencies that have greater expertise in housing, palliative care, prenatal care, sex education, and protecting green spaces in our community. At this time, these issues have not been incorporated into our community benefit plan because we do not have the infrastructure, expertise, or funding needed to have a significant impact in these areas. Group A-Facility 1 -- Children's Medical Center of Dallas Part V, Section B, line 13h: Children's uses the Federal Poverty Guidelines to determine eligibility for low income individuals. 200% of the Federal Poverty Guidelines is used for 100% charity adjustment, and 201% to 400% of the Federal Poverty Guidelines is used for a sliding scale adjustment.Children's uses various documents and forms to verify income and expenses when determining the eligibility for financial assistance of a patient and their family. These documents include, but are not limited to, W2 Form, wage and earning statement, pay check remittance, worker's compensation, unemployment compensation determination letters, income tax returns, statement from employer, bank statements, copy of checks, documents of sources of income, telephone verification of gross income with the employer, proof of participation in government assistance programs such as Medicaid, signed affidavit or attestation by patient, and veterans benefit statement. Group A-Facility 1 -- Children's Medical Center of Dallas Part V, Section B, line 16i: In addition to ensuring that the Children's charity care criteria is posted prominently and continuously in common entry points of the facility, a Director of Patient Financial Service ensures that the Children's charity care criteria is published annually in a local newspaper of general circulation in the county. Group A-Facility 1 -- Children's Medical Center of Dallas Part V, Section B, line 22d: Children's determines the maximum amount that can be charged to individuals eligible for financial assistance for emergency or other medically necessary care by calculating the average commercial and government payor amounts received by Children's. Group A-Facility 2 -- Children's Medical Center of Plano Part V, Section B, line 5: Each year, Children's recruits a citizen advisory council made up of key stakeholders serving children and knowledgeable in public health. These community leaders meet monthly to discuss children's health care issues and to contribute their experience, insights and expert recommendations for the the Beyond ABC report prepared by Children's. Additionally, the citizen advisory boards for Beyond ABC identify recommendations for advocates and public officials in order to improve the lives and health of children. Recent advisory boards have included city and county officials, former legislators, members of law enforcement, school district administrators, nonprofit organizations' executives, child-advocacy representatives, chambers of commerce and senior staff from corporations and financial institutions.Additionally, as part of the Texas Healthcare Transformation and Quality Improvement Program, the state of Texas has been divided into 20 regions. Hospitals within each region have worked together to develop plans to respond to health needs and transform the health care delivery system. Children's participates in the Regional Healthcare Partnership (RHP) Plans for Regions 9 and 10. Group A-Facility 2 -- Children's Medical Center of Plano Part V, Section B, line 7d: The current CHNA, Implementaion Strategy, and other community reports may be accessed at the folllowing web address: www.childrens.com/footer/aboutsection/about/reports-and- publications/community-reports Group A-Facility 2 -- Children's Medical Center of Plano Part V, Section B, line 11: Upon conducting the CHNA and developing the Community Health Implementation Strategy, Children's decided on priority areas of the identified health needs that were reviewed. The priority areas are those areas which Children's has decided to focus its resources and integrate into its strategic and operational plans. Multiple goals were developed for each priority area, along with strategies to accomplish those goals. Children's has implemented and/or is working towards implementation of the strategies for accomplishing the developed goals. Full details of priority areas, goals, and strategies are contained with the publically available CHNA and Community Health Implementation Strategy. Needs Not Addressed:Some issues identified through Children's CHNA have not been addressed in this plan. In initial discussion and subsequent prioritization, Children's Medical Center Needs Assessment Team considered the levels to which some needs were already being addressed in the service area. Additionally, some community needs fall out of the scope of expertise and resources of Children's Medical Center. Children's Community Health Implementation Strategy includes details on Needs Not Addressed. The following are some of the needs identified in the assessment that are addressed by others or in different ways: safe and affordable housing, palliative care capacity/need for increased geriatric/long-term/home care resources, discourage elective deliveries/increase the percentage of women who receive prenatal care, provide comprehensive sexuality education/high incidence of STDs in RHP Region 10, protect green spaces/add bike lanes/improve access to parks. These needs are not being addressed by Children's as our priorities were established based on unmet community health needs that intersect with our mission and key clinical strengths. There are community and state agencies that have greater expertise in housing, palliative care, prenatal care, sex education, and protecting green spaces in our community. At this time, these issues have not been incorporated into our community benefit plan because we do not have the infrastructure, expertise, or funding needed to have a significant impact in these areas. Group A-Facility 2 -- Children's Medical Center of Plano Part V, Section B, line 13h: Children's uses the Federal Poverty Guidelines to determine eligibility for low income individuals. 200% of the Federal Poverty Guidelines is used for 100% charity adjustment, and 201% to 400% of the Federal Poverty Guidelines is used for a sliding scale adjustment.Children's uses various documents and forms to verify income and expenses when determining the eligibility for financial assistance of a patient and their family. These documents include, but are not limited to, W2 Form, wage and earning statement, pay check remittance, worker's compensation, unemployment compensation determination letters, income tax returns, statement from employer, bank statements, copy of checks, documents of sources of income, telephone verification of gross income with the employer, proof of participation in government assistance programs such as Medicaid, signed affidavit or attestation by patient, and veterans benefit statement. Group A-Facility 2 -- Children's Medical Center of Plano Part V, Section B, line 16i: In addition to ensuring that the Children's charity care criteria is posted prominently and continuously in common entry points of the facility, a Director of Patient Financial Service ensures that the Children's charity care criteria is published annually in a local newspaper of general circulation in the county. Group A-Facility 2 -- Children's Medical Center of Plano Part V, Section B, line 22d: Children's determines the maximum amount that can be charged to individuals eligible for financial assistance for emergency or other medically necessary care by calculating the average commercial and government payor amounts received by Children's. 6 Ambulatory Care Pavilion Dallas 2350 Stemmons Fwy Dallas TX 75207 Outpatient Care Specialty Center Southlake 470 E State Hwy 114 Southlake TX 76092 Outpatient Specialty Care Center Specialty Center Mesquite 1675 Republic Pkwy Suite 190 Mesquite TX 75150 Outpatient Specialty Care Center Specialty Center Rockwall 890 Rockwall Parkway Suite 100 Rockwall TX 75032 Outpatient Specialty Care Center Specialty Center Bass Center 6300 Harry Hines Blvd Dallas TX 75235 Outpatient Specialty Care Center Specialty Center Park Cities 8160 Walnut Hill Lane Dallas TX 75231 Outpatient Specialty Care Center Part I, Line 3c: Children's uses the Federal Poverty Guidelines to determine eligibility for low income individuals. 200% of the Federal Poverty Guidelines is used for 100% charity adjustment, and 201% to 400% of the Federal Poverty Guidelines is used for a sliding scale adjustment. Part I, Line 6a: Children's Community Benefit Report is prepared by our Public Relations department with collaboration from numerous departments within the hospital. Part I, Line 7: Children's uses Worksheet 2 from the Form 990 Schedule H instructions to calculate the costs for Part I, Line 7 and ratio of patient care cost to charges attributable to community benefits. Part I, Line 7g: Not applicable Part I, Ln 7 Col(f): Children's recorded $34,267,153 in bad debt expense for the year. The bad debt expense recorded was excluded from the calculation of community benefit expense. Part II, Community Building Activities: Children's is passionate about maintaining a vocal presence in legislative affairs on the local, state and federal levels and is at the forefront of governmental efforts that affect the community at large, from booster seat and car safety measures to critical funding initiatives. Additionally, Children's collaborates extensively with our partners in coalitions such as the Children's Hospital Association of Texas (CHAT) and the Texas Hospital Association (THA) at the state level, as well as the Children's Hospital Association (formerly the National Association of Children's Hospitals and Related Institutions). Children's President and Chief Executive Officer also serves on the Board of Trustees for the American Hospital Association. Through these affiliations, Children's is better able to advocate the development of an effective, comprehensive and appropriately funded children's health care system in Texas and across the country. Part III, Line 2: Children's uses Worksheet 2 from the Form 990 Schedule H instructions to calculate the bad debt expense and ratio of patient care cost to charges attributable to community benefits. Part III, Line 3: Children's uses its cost accounting system and the actual costs that are written off by patient accounts to calculate the bad debt expense attributable to patients eligible under the organization's charity care policy. Children's rationale for including a portion of bad debt as community benefit is that, bad debt expense should be treated as a community benefit as it is similar to other unreimbursed financial assistance, as reported in Part I, Line 7a, but for a different population (namely, those patients who would qualify for charity care if they completed the financial assistance application). Part III, Line 4: The following is the footnote disclosure related to the Allowance for Doubtful Accounts, provided with Children's Audited Financial Statements. Children's maintains allowances for doubtful accounts to reserve for potential write-offs relating to a patient's inability to make payments on an account. Accounts are written off when collection efforts have been exhausted. Children's routinely monitors its accounts receivable balances and utilizes historical collection experience to support the basis for its estimates of the provision for doubtful accounts. Part III, Line 8: Children's uses Worksheet A from the As Filed Medicare Cost Report and the IRS Schedule H Instructions to determine Medicare allowable costs. Part III, Line 9b: Children's has written debt collection policies which identify collection practices to be followed. The collection practices determine for what financial assistance a patient qualifies, and if a patient does not qualify for financial assistance, Children's also has written collection practices to be followed to determine if a patient qualifies for charity care. As part of the collection practice, Childrens' financial counselors review with the patient and their family the various state and federal programs available to them. Part VI, Line 2: In addition to the 2013 Community Health Needs Assessment, Children's has produced a comprehensive quality-of-life report on area children, Beyond ABC: Growing Up in Dallas County, since 1994. Beginning in 2008, a separate study has been published to focus on youth in Collin County as well. These biennial reports provide 10 years of trended data on the many factors facing children in our community. Beyond ABC analyzes more than 50 indicators of well-being with respect to health, education, safety and security for the more than 900,000 children that call those areas home.Children's has taken on the task of preparing Beyond ABC and distributing it to child advocates, service agencies, community leaders and lawmakers because of the presence the hospital holds in the community. In turn, these community leaders and organizations as well as Children's use the report to help determine how best to employ their resources each year. Part VI, Line 3: Children's Financial Counselors or Customer Service Representatives work with patients' guardians/guarantors to ensure that all public and voluntary assistance programs are fully explored.Children's has a financial program for patients who are considered indigent and do not qualify for a federal or state program. The eligibility criteria for financial assistance is based upon Federal Poverty Guidelines published annually. Patients eligible for financial assistance will have charges reduced to the lowest level charged to individuals who have insurance covering such care. Gross charges will not be used to calculate patient's bills.Children's will inform prospective patients of Children's charity care criteria by posting this information in common entry points and annually publishing this information in the community newspaper. Part VI, Line 4: Community Served by Children's Medical Center - Children's main campus is located at 1935 Medical District Drive, Dallas, Texas. The city of Dallas is the county seat of Dallas County. The city of Dallas is one of the most populous cities in Texas, as well as the United States.Children's also has an inpatient facility located at a second campus in Plano, Texas. Plano is in Collin County; which is also home to fast-growing cities like Frisco, Allen, McKinney and Prosper.Identification and Description of Geographical Community - The city of Dallas is the third largest city in Texas. The city of Dallas is accessible from I-30, I-35E, I-45 and I-635. Patients primarily originate from Texas (94.8 percent). Nearly 50 percent (48.8 percent) ofChildren's discharges originate in Dallas County, Texas.Collin County is one of the fastest growing areas in the United States, with its population between 2000 and 2010 growing from 491,000 to over 782,000. Community Population and Demographics - The U.S. Bureau of Census has compiled population and demographic data based on the 2010 census. The Nielsen Company, a firm specializing in the analysis of demographic data, has extrapolated this data to estimate population trends from 2013 through 2018. Based on the data, the overall population for Children's service area is projected to increase over the five-year period from 3,320,715 to 3,608,755. The age categories that represent youth and adolescents (0-14 and 15-20) is projected to increase 7.0 percent and 8.9 percent,respectively.According to the American Community Survey, 670,217 children under the age of 18 lived in Dallas County in 2012. Nearly 54 percent of all the children in Dallas County were Caucasian compared to approximately 67percent in Collin County.In terms of race, nearly 54 percent of all children in Dallas County were Caucasian, followed by 23 percent African-American. Although more than half of the children in Dallas County are Caucasian, only 35 percent of the Caucasian child population is non-Hispanic. Moreover, Hispanic children make up more than 52 percent of the child population of Dallas County.Service to the Community - Children's is well known for bringing exceptional medical and surgical care to the children of North Texas. Through community events, child-specific initiatives and organizational affiliations, the hospital invests in prevention, research, education, clinical excellence and advocacy to benefit all children.Children's devotes itself solely to caring for the complex medical needs of children. Children's provides patient care ranging from simple eye exams to specialized treatment in areas such as heart disease, hematology-oncology and cystic fibrosis. In addition, Children's is a major pediatric kidney, liver, intestine and heart transplant center. Through its established injury prevention, advocacy program and disease management programs, the hospital works diligently to educate the community so that no child has to ever come through our doors.Children's is licensed for 595 beds and has more than 50 subspecialty programs spanning two campuses the main hospital in Dallas and a second full-service hospital in Plano. Children's was the first pediatric hospital in Dallas designated as a Level I Trauma Center. Children's is a private, not-for-profit hospital system that does not receive local tax dollars to offer the care provided. Children's is philanthropically supported in its efforts to provide care for every child who comes to us, regardless of their family's ability to pay. Donors also play a significant part in our ability to conduct research, education and advocacy.Combined, the two Children's facilities serve children through more than 677,000 patient encounters annually. But that doesn't prevent the offering of an elite level of individual care and attention to each family. As the primary pediatric teaching facility for the UT Southwestern Medical Center at Dallas, ("UTSW"), Children's is the only full-service, academic-affiliated pediatric hospital in North Texas. Through this academic affiliation, the Children's medical staff conducts research that is instrumental in developing treatments, therapies, and greater understanding of pediatric diseases and trains more than 200 pediatric residents and fellows annually. Part VI, Line 5: Children's mission is to make life better for children. We consider it our privilege and our responsibility to serve as ardent advocates for kids in Texas and across the country. To that end, we work tirelessly to ensure that children's voices are heard and that their needs are met. Our efforts to influence public policies that impact children's health are comprehensive and ongoing. Through programmatic initiatives, organizational partnerships and community events, Children's spreads its influence throughout the region and provides area children with much-needed access to a better quality of life. Whether that means establishing programs to increase services to the area's underserved children or fostering partnerships with existing organizations, Children's is committed to connecting families to the services they need.Children First! Collin County CoalitionChildren's is the founding member and sponsor of the Children First! Collin County Coalition, a nonpartisan alliance of more than 80 non-profit organizations. The coalition works to improve the quality of life of children through the development of initiatives related to public policy, advocacy, public awareness and community programs. The coalition's five work groups focus on economic security, education, family strengthening, health and safety. Community Outreach Through the efforts of the Community Relations staff at Children's, more area children who are eligible for Medicaid or the Children's Health Insurance Program (CHIP) are receiving coverage. Almost 18 percent of the children living in Dallas County are uninsured. Lack of health insurance leads to poorer health in childhood, greater rates of avoidable hospitalizations and higher childhood mortality. Uninsured children are 8 times more likely to have delayed care and 12 times more likely to have an unmet medical need than children with private insurance.Children's is committed to helping families obtain health insurance, an important factor in the health and well-being for our entire community. Children's has a vision to help address the shortage of primary pediatric medical care for families with limited resources.Dallas CHIP CoalitionChildren's founded and sponsors the Dallas Children's Health Insurance Program Coalition, an alliance of more than 90 organizations focused on helping families of uninsured children apply for CHIP or Medicaid. In addition, the coalition provides community leadership on public policy issues that affect the crisis of uninsured children in our community. MEDICAID/CHIP Outreach EventsAnnually, Children's coordinates two large community outreach events targeting the families of uninsured children. Working with the Dallas Children's Health Insurance Program Coalition, these events are promoted through school flyers and the media. Since 2005, these events have helped more than 12,000 families apply for coverage for more than 24,000 children. The coalition has trained more than 250 volunteers to assist families with applications for CHIP or Medicaid. School Based Medicaid/Chip Outreach Children's outreach team conducts Medicaid/Children's Health Insurance Program outreach at area school districts with a combined enrollment of more than 350,000. Each student's family receives communications during a school year with information on the importance of health insurance and the tools to apply for CHIP/Medicaid. Children's serves as a liasion with the state for families who could not successfully navigate the state's eligibility system.Tackling an epidemic Texas ranks sixth in the nation for obesity in 10 to 17 year-olds, and the problem is even more pressing in Dallas County. More than one-third (36.1 percent) of Dallas Independent School District high-school students are obese or overweight, almost double the national average, according to the Department of State Health Services. In 2008, only one in five Dallas ISD third-graders passed the Texas-mandated school Fitnessgram assessment, compared to about one in three statewide. At Children's, we provide services to 7,500 patients each year with diagnoses that research shows to be obesity-related. These include cardiology, endocrine, gastrointestinal, pulmonary and psychiatric diagnoses. Dental OutreachAlthough effective methods exist to prevent tooth decay, cavities remain the most prevalent chronic condition among children-five times more common than asthma and seven times more common than hay fever. Inpartnership with UT Southwestern Medical Center at Dallas, a grant has been obtained so that children from the continuity clinics and ARCH (At-Risk Children) clinic who are identified as at-risk are now provided oral health education and fluoride varnish every three months to reduce their risk of cavities.Children's websiteOur hospital web site, www.childrens.com, empowers parents with the latest information about childhood illnesses, prevention, treatment and services available at the hospital. More than 1,300 common pediatric topics are addressed on the Web site. Also available are interactive guides promoting healthy living that target both children and their parents. The site also offers a free subscription to a monthly electronic newsletter that connects our community to the amazing things that take place at Children's every day.Reaching out to support the families of our communities is at the heart of the Children's mission. The challenge of ensuring the safety and well-being of all children is a driving force for the hospital, its employees and its medical staff. Assessing how many lives our services touch requires a look into our community, where the Children's influence has impact far beyond the hospital's walls.Disease Management and WellnessThe Disease Management and Wellness Department at Children's improves quality of life and decreases the use of healthcare services through education and pro-active self-management. Children's has seven disease-specific certifications, the most of any pediatric center in the United States. The programs offer access to evidence-based care and support that is needed for the management of conditions like asthma, diabetes and obesity.The disease management initiative is part of the hospital's ongoingefforts to reduce emergency department use, decrease admissions, curtail healthcare costs and ultimately, improve the quality of life for children with chronic conditions. Each program provides a family-centered environment that focuses on providing quality care to patients and overall increased disease awareness.Coaching coaches, athletes and parentsChildren's is committed to educating coaches, parents and young athletes on the importance of sports injury prevention. The hospital has a presence at dozens of coaches' clinics each year at facilities such as the Plano Sports Authority and Dallas Baseball Academy of Texas. During the clinics, Children's provides sports-specific injury-prevention cards and clipboards to thousands of coaches each year. So far, we have impacted the health and safety of 400,000 young athletes. Children's has also worked with companies such as Kohl's Corporation and their Sports Health and Wellness Outreach Program, to further support community outreach efforts. Spreading a message of water safetyDrowning is the second-leading cause of unintentional injury-related deaths among American children ages 1 to 14. The Know Before You Go Program spreads the message that every drowning is preventable when parents take appropriate precautions. The program includes distributing water safety materials, providing demonstrations on proper water rescue techniques and the use and proper fit of Coast Guard approved flotation devices. Working to reduce preventable injuriesMore than a decade ago, Children's formed the Safe Kids Dallas Area Coalition - the local chapter of Safe Kids Worldwide - to prevent childhood injuries. Traumatic injuries are the leading cause of death in Texas in children ages 1 to 14, and preventing these injuries is imperative at Children's - the first Level I trauma center in Texas (and one of only two in the state) that is solely dedicated to treating pediatric patients. Since 2002, the number of patients hospitalized because of motor vehicle crashes has steadily risen. Children's Injury Prevention Program has expanded its outreach efforts accordingly to bring car seat safety education and installation services to the community in an effort to reduce the number of children injured in car crashes. A specific initiative within the Safe Kids Dallas program is our car-seat safety inspection project. The project offers child safety-seat inspections by certified car seat technicians at Children's Dallas and Legacy campus so parents can learn to buckle up their children appropriately. Part VI, Line 6: Children's Medical Center is a part of Children's Health System of Texas. Children's Health System of Texas is the leading pediatric health care system in North Texas, the seventh largest pediatric health care provider in the nation (according to Modern Healthcare 2014), and the second busiest in terms of admissions and pediatric Emergency Department visits. A private, not-for-profit organization, Children's Health is anchored by two full-service hospitals and encompasses a full range of pediatric health, wellness and acute care services for children from birth to age 18, including specialty care, primary care, home health, a pediatric research institute and community outreach services, among other forms of health care delivery. Part VI, Line 7: Children's files a Community Benefit Plan with the State of Texas as required by Senate Bill 427. 1 May Smith Scholars Program 6 30000 Women's Auxiliary Education Assistance Program 1 2000 James J. Farnsworth Health Care Scholarship Program 1 1000 Grace Lee Scholarship for Clinical Education 3 9000 Nursing Division Tuition Assistance Program 76 140000 Part I, Line 2 May Smith Scholars Program The heritage of nursing is rich at Children's, which traces its roots back to a clinic started by nurse May Forster Smith. This scholarship is named for Smith, who began an open-air clinic for infants in 1913. That pioneering spirit continues in the 21st century. The May Smith Scholars Program provides financial assistance for baccalaureate students interested in pediatric nursing. Eligibility Applicants must meet all of the following criteria to be eligible to apply for this scholarship: *Be a current sophomore or junior undergraduate baccalaureate nursing student. *Have a cumulative 3.0 GPA on a 4.0 scale. Award Details *A limited number of scholarships in the amount of $5,000 will be awarded each year. *Students may reapply each year as long as they continue to meet the eligibility criteria. *The scholarships will be applied to tuition, fees, books, supplies and equipment required for course load at accredited, nonprofit four-year colleges/universities in the United States. *Students may transfer from one institution to another and retain the award. Women's Auxiliary Educational Assistance Program The Women's Auxiliary to Children's offers educational support to nursing and allied health students who are registered for, or currently enrolled in, an accredited program through the Educational Assistance program for Nursing and Allied Health Students. Eligibility Applicants must meet all of the following criteria to be eligible to apply for this scholarship: *Be a current junior, senior or graduate student enrolled full or part-time in an accredited undergraduate, or graduate, nursing or allied health program. *Have a cumulative 3.0 GPA on a 4.0 scale. Award Details *A limited number of scholarships in the amount of $2,000 will be awarded each year. *Students may reapply each year as long as they continue to meet the eligibility criteria. *The scholarships will be applied to tuition, fees, books, supplies and equipment required for course load at accredited, nonprofit four-year colleges/universities in the United States. *Students may transfer from one institution to another and retain the award. James J. Farnsworth Health Career Scholarship Program The James J. Farnsworth Health Career Scholarship offers educational support to students planning careers in pediatric healthcare. The scholarship is named in honor of James J. Farnsworth and was established from gifts to endowments made in tribute to Mr. Farnsworth by his friends and colleagues. Mr. Farnsworth served as president of Children's Medical Center Dallas for more than 30 years and was a fellow in the College of Healthcare Executives. Eligibility Applicants must meet all of the following criteria to be eligible to apply for this scholarship: *Be a current sophomore, junior, senior or graduate student, planning a career in pediatric healthcare. *Preference will be given to students who fall into the following categories: -Former patients of Children's -Current full or part-time employees -Former or current volunteers at Children's -Parent is employed at Children's -Parent is a volunteer at Children's -Students demonstrating strong academic achievement Award Details *A limited number of scholarships in the amount of $1,000 will be awarded each year. *Students may reapply each year as long as they continue to meet the eligibility criteria. *The scholarships will be applied to tuition, fees, books, supplies and equipment required for course load at accredited, nonprofit four-year colleges/universities in the United States. *Students may transfer from one institution to another and retain the award. Grace Lee Scholarship for Clinical Education The Grace Lee Scholarship for Clinical Education recently was established in honor of Grace Lee, a former patient at Children's and in recognition of the exemplary care provided by clinical staff members who contributed to her comprehensive care. The scholarship will provide financial assistance for the continuing education of clinical employees who are direct caregivers at Children's. Eligibility Applicants must meet all of the following criteria to be eligible to apply for this scholarship: *Be a full-time clinical employee of Children's with two years of continuous employment at Children's as of the application deadline. *Be enrolled in or accepted into an accredited healthcare education program. *Be recommended by an immediate supervisor or department director. *Have a cumulative 3.0 GPA on a 4.0 scale. Award Details *A limited number of scholarships in the amount of $3,000 will be awarded each year. *Students may reapply each year as long as they continue to meet the eligibility criteria. *The scholarships will be applied to tuition, fees, books, supplies and equipment required for course load at accredited, nonprofit two or four-year colleges/universities in the United States. *Students may transfer from one institution to another and retain the award. Nursing Division Tuition Assistance Program The Nursing Division is offering scholarships to full- and part-time RN staff enrolled in an accredited BSN program, up to $2,000 per nurse for full-time employment and $1000 for part-time employment. The Nursing Division can award up to $140,000. These scholarships support the Nursing Division's goal for all bedside nurses to have a BSN degree by 2020. Eligibility Applicants must meet all of the following criteria to be eligible to apply for this scholarship: *Be a full-time clinical employee of Children's in good standing. *Confirm proof of enrollment in an accredited BSN nursing program. Award Details *A limited number of scholarships in the amount of $1,000-2,000 will be awarded each year. *Students may reapply each year as long as they continue to meet the eligibility criteria. *The tuition assistance will be applied to tuition, fees, books, supplies and equipment required for course load at accredited, nonprofit two or four-year colleges/universities in the United States. *Students may transfer from one institution to another and retain the award. X X X X 1 1 X X X X 1 1 0 0 0 0 0 1 0 Christopher J Durovich CEO CMC and President/CEO CHST 978719 0 998539 0 132699 0 93691 0 21907 0 2225555 0 306546 0 Douglas G Hock President/COO CMC and EVP CHST 502423 0 348733 0 67429 0 29813 0 17758 0 966156 0 98201 0 Michele Chulick EVP Chief Admin Officer 522268 0 264252 0 4185 0 10400 0 0 0 801105 0 0 0 Lawrence Foust EVP and Chief Legal Officer 134857 0 125000 0 30566 0 3825 0 3272 0 297520 0 0 0 W Robert Morrow MD EVP Chief Clinical Officer 472101 0 30000 0 17118 0 10400 0 11458 0 541077 0 0 0 Kern Wildenthal MD PhD EVP and Pres CMC Foundation 518271 0 217281 0 11664 0 10400 0 3221 0 760837 0 0 0 Peter W Roberts EVP PopHealth NetworkDev 519240 0 305471 0 25450 0 10400 0 12637 0 873198 0 0 0 Pamela Arora SVP and CIO 336607 0 182652 0 39390 0 15600 0 10014 0 584263 0 70850 0 Cynthia Bassel SVP Foundation 303163 0 140594 0 7350 0 10400 0 6154 0 467661 0 0 0 Kimberly Besse SVP Chief HR Officer 301137 0 97107 0 39679 0 9409 0 16459 0 463791 0 0 0 David G Biggerstaff SVP Svc Line Dev Amb Svc 304784 0 209141 0 27473 0 12862 0 9987 0 564247 0 58148 0 David Eager SVP CFO and Treasurer 470061 0 42318 0 3971 0 10400 0 7081 0 533831 0 0 0 Mary E Stowe RN SVP and CNO 299870 0 178676 0 34564 0 41173 0 9961 0 564244 0 77609 0 Regina Coggins td 53114 SVP Ext Rel Gen Counsel 132494 0 172351 0 670457 0 9779 0 9159 0 994240 0 0 0 Ray Dziesinski td 4214 SVP Chief Treasury Officr 101545 0 304527 0 864160 0 15600 0 4355 0 1290187 0 90000 0 Daniel T Carney VP Facilities Dev Ops 267909 0 88263 0 39272 0 10400 0 14007 0 419851 0 0 0 Kenneth Carr VP Clinical Support Srvcs 200624 0 26577 0 3013 0 13541 0 8383 0 252138 0 0 0 Joe Don Cavender RN VP and ASSOC CNO 207495 0 22837 0 2762 0 11455 0 9622 0 254171 0 0 0 Jaquetta Clemons VP Finance 171654 0 50000 0 1128 0 5084 0 467 0 228333 0 0 0 Douglas Duwe VP Academic Relations 178781 0 11933 0 18182 0 7758 0 3226 0 219880 0 0 0 Dorothy Foglia RN VP and ASSOC CNO 211993 0 24462 0 5969 0 9256 0 12225 0 263905 0 0 0 Michael Hefton RN VP and ASSOC CNO 206302 0 24232 0 2424 0 9998 0 11493 0 254449 0 0 0 Keri Kaiser VP Marketing and Comm 236016 0 73830 0 2977 0 10400 0 11740 0 334963 0 0 0 Jerry Lee VP Accounting and Treasury 260107 0 88560 0 4715 0 13978 0 15577 0 382937 0 0 0 Mitchell Mulvehill VP Finance (td 1/15/14) 11755 0 52415 0 304969 0 2860 0 545 0 372544 0 0 0 Rustin Morse MD VP Chief Quality Officer 399336 0 0 0 0 0 0 0 0 0 399336 0 0 0 Beth Peters VP Corp Compliance and CCO 216216 0 45724 0 1551 0 9426 0 7917 0 280834 0 0 0 Jeffrey Vawrinek VP Assoc General Counsel 257525 0 154773 0 2225 0 8555 0 0 0 423078 0 0 0 Vanessa U Walls VP Regional Specialty Care Svc 239352 0 178644 0 20245 0 10173 0 9958 0 458372 0 0 0 Mark Ziemianski VP Business Analytics 199544 0 27889 0 2002 0 9633 0 13382 0 252450 0 0 0 Joseph Egan VP Bus Dev Strat Affiliations 270036 0 34496 0 2595 0 0 0 2224 0 309351 0 0 0 Patricia U Winning SVP Strategy Phys Orgs 379514 0 310294 0 59197 0 76887 0 16081 0 841973 0 85405 0 Patricia Sumler td 93014 VP Resource Dev Pop Hlth 143702 0 41261 0 224504 0 7901 0 2603 0 419971 0 0 0 Stephanie Slaughter VP COO Medicaid HMO 254251 0 115957 0 3159 0 9651 0 10226 0 393244 0 0 0 Christopher Menzies VP Chief Med Information Offcr 302736 0 35126 0 1872 0 9827 0 1782 0 351343 0 0 0 Teresa Egan Admin Dir Child Research 249402 0 60265 0 2449 0 0 0 3747 0 315863 0 0 0 Part I, Line 1a * Children's written policy on business and educational travel prohibits first class travel except when approved in advance by the CEO or by the Board Chair. * Companion travel is prohibited except when it is deemed to further Children's business activities and must be approved in advance by the CEO or Board Chair. There were no employees that received taxable income as a result of companion travel in 2014. * Compensation is grossed up in limited circumstances with prior approval of the appropriate board committee. Approved one-time, grossed up compensation has been included as 2014 taxable income for W Robert Morrow, Lawrence Foust, and Douglas Duwe. * In an effort to continue to attract quality leadership, Children's provides temporary housing allowances as a taxable benefit to executives and other key employees relocating to Dallas. Part I, Lines 4a-b Severance Payment and Non-Qualified Retirement Plan: * Severance - Regina Coggins - $463,575 * Severance - Ray Dziesinski - $545,813 * Severance - Mitchell Mulvehill - $246,000 * Severance - Patricia Sumler - $178,500 * Retirement Income Restoration Plan - There were no employees that received taxable income from the Retirement Income Restoration Plan in 2014. Employees who participated in the Retirement Income Restoration Plan are Christopher J Durovich, Douglas G Hock, Mary E Stowe, and Patricia U Winning. * Savings Restoration Plan - Kern Wildenthal, MD, Phd received $5,536 as taxable income from the Savings Restoration Plan. Regina Coggins received $33,693 as taxable income from the Savings Restoration Plan, as a result of a Qualifying Termination under the severance plan. Ray Dziesinski received $109,937 as taxable income from the Savings Restoration Plan, as a result of a Qualifying Termination under the severance plan. Mitchell Mulvehill received $2,271 as taxable income from the Savings Restoration Plan, as a result of a Qualifying Termination under the severance plan. Additional employees who participate in the Savings Restoration Plan are Christopher J Durovich, Peter Roberts, Patricia U Winning, Douglas G Hock, Ray Tsai, Michele Chulick, Jeffrey Vawrinek, Pamela Arora, Vanessa U Walls, David G Biggerstaff, Mary E Stowe, Daniel T Carney, Jerry Lee, Kimberly Besse. 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. A N Central Tx Hlth Fac Dev Corp Hosp 521304502 65854RAL4 2009-07-01 193697772 Reimburse Construction Cost 0 0 0 B N Central Tx Hlth Fac Dev Corp Hosp 521304502 65854RBD1 2012-08-15 183637368 Refund Series 2002 Bonds 0 0 0 A 193697772 2819039 190566160 312573 2009 0 0 0 1 B 183637368 2020125 1 0 1 1 A 0 0 1 0 0 0.00260 0.00260 0 0 1 A 0 0 0 0 0 0 0 0 1 B 0 0 0 0 0 0 0 0 1 A 1 B 1 Schedule K, Part I, Line B Series 2012 Bonds were issued for the purpose of currently refunding the Issuer's Hospital Revenue Bonds (Children's Medical Center of Dallas Project) Series 2002 (original issue date prior to December 31, 2002). Teresa Egan See Part V 315863 Employment 0 Part IV, Line 1 Teresa Egan has a family relationship with Joseph Egan, VP Business Development. Form 990, Part VI, Section A, line 1 Children's Board membership includes six ex officio non voting members. Form 990, Part VI, Section A, line 6 Children's Health System of Texas ("CHST"), a Texas non-profit corporation, is the sole member of the corporation. Form 990, Part VI, Section A, line 7a CHST elects all members of the organization's Board of Directors. Form 990, Part VI, Section A, line 7b A list of decisions requiring approval by the member is as follows: a) Any change in the mission or purpose of the Corporation; b) Any amendment to the Articles of Incorporation or Bylaws of the Corporation; c) Any addition of new Members; d) Any purchase or acquisition, sale, gift, lease, disposition of, mortgage or other encumbrance of any property, real, personal, or mixed by the Corporation, excluding routine expenditures, the value of which in the aggregate exceeds five percent (5%) of the total assets of the Corporation; e) Selling, exchanging, or otherwise disposing of all or substantially all of the Corporation's assets; f) Any incurrence or guarantee of indebtedness by the Corporation that in the aggregate exceeds five percent (5%) of the total assets of the Corporation; g) Any merger, acquisition, or consolidation of the Corporation or entering into any joint business venture with any other person, corporation or other legal entity that exceeds five percent (5%) of the total assets of the Corporation; h) Any dissolution of the Corporation; i) Any proposed amendments to the affiliation agreement between the Corporation and The UTSW Medical School (Medical School); (j) Appointment and removal of directors in accordance with Article 3 of these Bylaws; (k) Creation, acquisition, or disposition of any subsidiary or affiliated entity of the Corporation, the value of which in the aggregate exceeds five percent (5%) of the total assets of the Corporation; and (l) Approval of the annual budget for the Corporation. Form 990, Part VI, Section B, line 11 A draft of the Form 990 is presented to the CHST Audit Committee, which has delineated authority for the organization, for review with discussion of the draft led by the 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 CEO, President, other officers, and key employees 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 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 and attached to this return. Form 990, Part IX, line 11g Consulting & Professional fees: Program service expenses 2,347,805. Management and general expenses 23,630,034. Fundraising expenses 0. Total expenses 25,977,839. Contract Medical: Program service expenses 112,679,904. Management and general expenses 18,348,975. Fundraising expenses 0. Total expenses 131,028,879. Form 990, Part XI, line 9: Acc Pens Liab-OCI -44,803,202. Net Assets-CMCF-Unrest&Temp Rest 161,546,585. Net Assets-CMCF-Endowment 21,704,404. Transfer to Children's Medical Center Foundation -150,000,000. Rounding Adjustment -2. 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 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 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0