MAIN STREET COMMUNITY INITIATIVES: Form 990, tax year 2014

View the entire original 990 at ProPublica ↗

Organization
MAIN STREET COMMUNITY INITIATIVES (EIN 46-1392824)
Tax period
2014-01-01 to 2014-12-31
Filed
2015-11-12
IRS object ID
201543169349305564
Schema version
2014v5.0
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Return2015-11-12T16:31:38-06:00ReturnTs
Tax Period End2014-12-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN350921680PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1CROWE HORWATH LLPBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1750 N St PaulAddressLine1Txt
Address Line2Suite 850AddressLine2Txt
CityDallasCityNm
State AbbreviationTXStateAbbreviationCd
ZIP75201ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2014-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN461392824EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1Texas Children's Health Plan The CenterBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlTEXABusinessNameControlTxt
Phone8328242982PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line16621 FANNIN STREETAddressLine1Txt
CityHOUSTONCityNm
State AbbreviationTXStateAbbreviationCd
ZIP77030ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonBENJAMIN MELSONPersonNm
Person TitleEXECUTIVE VICE PRESIDENT & CFOPersonTitleTxt
Signature2015-11-12SignatureDt
Discuss With Paid PreparerfalseDiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonRACHEL SPURLOCKPreparerPersonNm
PTINP00520729PTIN
Phone2147775200PhoneNum
FieldValueIRS element (for citing)
Tax2014TaxYr
Build TS2016-04-25 22:37:26ZBuildTS

Form 990 IRS990

Doing Business As Name DoingBusinessAsName

FieldValueIRS element (for citing)
Business Name Line1Texas Children's Health Plan-The Center for Children and WomenBusinessNameLine1Txt

Principal Ofcr Business Name PrincipalOfcrBusinessName

FieldValueIRS element (for citing)
Business Name Line1Benjamin MelsonBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line16621 FANNIN STREETAddressLine1Txt
CityHOUSTONCityNm
State AbbreviationTXStateAbbreviationCd
ZIP77030ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$47,103,344GrossReceiptsAmt
Group Return For AffiliatesfalseGroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressWWW.TEXASCHILDRENSHEALTHPLAN.ORG/THECENTERWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation2008FormationYr
Legal Domicile StateTXLegalDomicileStateCd
Activity Or MissionTo create a healthier future for children and women throughout our global community by leading in patient care, education, and research.ActivityOrMissionDesc
Voting Members Governing Body5VotingMembersGoverningBodyCnt
Voting Members Independent2VotingMembersIndependentCnt
Total Employee148TotalEmployeeCnt
Total Volunteers0TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$0PYContributionsGrantsAmt
CY Contributions Grants$0CYContributionsGrantsAmt
PY Program Service Revenue$6,673,069PYProgramServiceRevenueAmt
CY Program Service Revenue$47,092,164CYProgramServiceRevenueAmt
PY Investment Income$0PYInvestmentIncomeAmt
CY Investment Income$0CYInvestmentIncomeAmt
PY Other Revenue$320PYOtherRevenueAmt
CY Other Revenue$11,180CYOtherRevenueAmt
PY Total Revenue$6,673,389PYTotalRevenueAmt
CY Total Revenue$47,103,344CYTotalRevenueAmt
PY Grants And Similar Paid$0PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$2,421,160PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$5,516,869CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$4,252,229PYOtherExpensesAmt
CY Other Expenses$41,694,458CYOtherExpensesAmt
PY Total Expenses$6,673,389PYTotalExpensesAmt
CY Total Expenses$47,211,327CYTotalExpensesAmt
PY Revenues Less Expenses$0PYRevenuesLessExpensesAmt
CY Revenues Less Expenses-$107,983CYRevenuesLessExpensesAmt
Total Assets BOY$10,628,744TotalAssetsBOYAmt
Total Assets EOY$32,711,589TotalAssetsEOYAmt
Total Liabilities BOY$2,778,710TotalLiabilitiesBOYAmt
Total Liabilities EOY$8,353,025TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$7,850,034NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$24,358,564NetAssetsOrFundBalancesEOYAmt
MissionTo create a healthier future for children and women throughout our global community by leading in patient care, education, and research.MissionDesc
Significant New Program SrvcfalseSignificantNewProgramSrvcInd
Significant ChangefalseSignificantChangeInd
Expense$44,249,678ExpenseAmt
Revenue$47,092,164RevenueAmt
DescTEXAS CHILDREN'S HEALTH PLAN - THE CENTER FOR CHILDREN AND WOMEN (CCW), IN FULFILLING ITS PURPOSE OF SUPPORTING TEXAS CHILDREN'S HEALTH PLAN, ESTABLISHES PATIENT AND FAMILY-CENTERED MEDICAL HOMES PROVIDING CARE TO PRIMARILY MEDICAID AND CHIP PATIENTS THAT ARE MEMBERS OF TEXAS CHILDREN'S HEALTH PLAN. THE MEDICAL HOMES ARE SPECIFICALLY IN SUPPORT OF TEXAS CHILDREN'S HEALTH PLAN'S MISSION TO PROVIDE CARE THAT IS ACCESSIBLE, COORDINATED, COMPREHENSIVE, CONTINUOUS, CULTURALLY SENSITIVE, COMMUNITY-BASED AND FAMILY-CENTERED.Desc
Total Program Service Expenses$44,249,678TotalProgramServiceExpensesAmt
Described In Section501c3Yes (true)DescribedInSection501c3Ind
Schedule B RequiredfalseScheduleBRequiredInd
Political Campaign ActyfalsePoliticalCampaignActyInd
Lobbying ActivitiesfalseLobbyingActivitiesInd
Donor Advised FundfalseDonorAdvisedFundInd
Conservation EasementsfalseConservationEasementsInd
Collections Of ArtfalseCollectionsOfArtInd
Credit CounselingfalseCreditCounselingInd
Temp Or Permanent EndowmentsfalseTempOrPermanentEndowmentsInd
Report Land Building EquipmentYes (true)ReportLandBuildingEquipmentInd
Report Investments Other SecfalseReportInvestmentsOtherSecInd
Report Program Related InvstfalseReportProgramRelatedInvstInd
Report Other AssetsYes (true)ReportOtherAssetsInd
Report Other LiabilitiesYes (true)ReportOtherLiabilitiesInd
Include FIN48 FootnoteYes (true)IncludeFIN48FootnoteInd
Independent Audit Fincl StmtYes (true)IndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtfalseConsolidatedAuditFinclStmtInd
School OperatingfalseSchoolOperatingInd
Foreign OfficefalseForeignOfficeInd
Foreign ActivitiesfalseForeignActivitiesInd
More Than5000 K To OrgfalseMoreThan5000KToOrgInd
More Than5000 K To IndividualsfalseMoreThan5000KToIndividualsInd
Professional FundraisingfalseProfessionalFundraisingInd
Fundraising ActivitiesfalseFundraisingActivitiesInd
Gaming ActivitiesfalseGamingActivitiesInd
Operate HospitalfalseOperateHospitalInd
Grants To OrganizationsfalseGrantsToOrganizationsInd
Grants To IndividualsfalseGrantsToIndividualsInd
Schedule J RequiredYes (true)ScheduleJRequiredInd
Tax Exempt BondsfalseTaxExemptBondsInd
Engaged In Excess Benefit TransfalseEngagedInExcessBenefitTransInd
PY Excess Benefit TransfalsePYExcessBenefitTransInd
Loan OutstandingfalseLoanOutstandingInd
Grant To Related PersonfalseGrantToRelatedPersonInd
Business Rln With Org MemfalseBusinessRlnWithOrgMemInd
Business Rln With Fam MemfalseBusinessRlnWithFamMemInd
Business Rln With Officer EntfalseBusinessRlnWithOfficerEntInd
Deductible Non Cash ContrifalseDeductibleNonCashContriInd
Deductible Art ContributionfalseDeductibleArtContributionInd
Terminate OperationsfalseTerminateOperationsInd
Partial LiquidationfalsePartialLiquidationInd
Disregarded EntityfalseDisregardedEntityInd
Related EntityYes (true)RelatedEntityInd
Related Organization Ctrl EntfalseRelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd OrgfalseTrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted PrtshpfalseActivitiesConductedPrtshpInd
Schedule O RequiredYes (true)ScheduleORequiredInd
IRP Document0IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Employee148EmployeeCnt
Employment Tax Returns FiledYes (true)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over LimitfalseUnrelatedBusIncmOverLimitInd
Foreign Financial AccountfalseForeignFinancialAccountInd
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTransInd
Taxable Party NotificationfalseTaxablePartyNotificationInd
Nondeductible ContributionsfalseNondeductibleContributionsInd
Quid Pro Quo ContributionsfalseQuidProQuoContributionsInd
Form8282 Property Disposed OffalseForm8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft CntrctfalseRcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft CntrctfalsePayPremiumsPrsnlBnftCntrctInd
Indoor Tanning ServicesfalseIndoorTanningServicesInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members5GoverningBodyVotingMembersCnt
Independent Voting Member2IndependentVotingMemberCnt
Family Or Business RlnfalseFamilyOrBusinessRlnInd
Delegation Of Mgmt DutiesfalseDelegationOfMgmtDutiesInd
Change To Org DocumentsfalseChangeToOrgDocumentsInd
Material Diversion Or MisusefalseMaterialDiversionOrMisuseInd
Members Or StockholdersYes (true)MembersOrStockholdersInd
Election Of Board MembersYes (true)ElectionOfBoardMembersInd
Decisions Subject To ApprovaYes (true)DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (true)MinutesOfGoverningBodyInd
Minutes Of CommitteesfalseMinutesOfCommitteesInd
Officer Mailing AddressfalseOfficerMailingAddressInd
Local ChaptersfalseLocalChaptersInd
Form990 Provided To Gvrn BodyYes (true)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (true)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (true)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (true)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (true)WhistleblowerPolicyInd
Document Retention PolicyYes (true)DocumentRetentionPolicyInd
Compensation Process CEOfalseCompensationProcessCEOInd
Compensation Process OtherfalseCompensationProcessOtherInd
Investment In Joint VenturefalseInvestmentInJointVentureInd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1Anna MatejaBusinessNameLine1Txt
FieldValueIRS element (for citing)
Phone8328281020PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line11919 S Braeswood BlvdAddressLine1Txt
CityHoustonCityNm
State AbbreviationTXStateAbbreviationCd
ZIP77030ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (9 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmt
Michael A Belfort MD PhD
Board Member / Secretary1.003.00Yes (X)Yes (X)$0$254,797$0
Angelo P Giardino MD PHD
Board Member / Chairman / Chief Medical Officer1.0039.00Yes (X)Yes (X)$0$505,930$102,184
Lisa Hollier
Board Member / Medical Director for Obstetrics and Gynecology1.000Yes (X)Yes (X)$0$0$0
Mark W Kline MD
Board Member / Vice Chairman1.003.00Yes (X)Yes (X)$0$237,908$0
Heidi Schwarzwald
Board Member / Pediatric Medical Director1.000Yes (X)Yes (X)$0$0$0
Christopher Born
President1.0039.00Yes (X)$0$653,524$135,213
Anna Mateja
Chief Financial Officer1.0039.00Yes (X)$0$327,381$69,857
Dace Reinholds
Assistant Secretary1.0039.00Yes (X)$0$212,317$26,222
Tangula Taylor
Director of Business Development and Community Initiatives39.001.00Yes (X)$188,381$13,707$30,365
FieldValueIRS element (for citing)
Total Reportable Comp From Org$188,381TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$2,205,563TotReportableCompRltdOrgAmt
Total Other Compensation$363,841TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K1IndivRcvdGreaterThan100KCnt
Former Ofcr Employees ListedfalseFormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (true)TotalCompGreaterThan150KInd
Compensation From Other SrcsfalseCompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (3 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmt
BAYLOR COLLEGE OF MEDICINE
1 BAYLOR PLAZAHOUSTONTX77030PHYSCN & FACULTY SVC$3,572,043
HARVARD MAINTENANCE INC
59 MAIDEN LANENEW YORKNY10038JANITORIAL SERVICES$143,885
COMFORCE TECHNICAL SERVICES INC
PO BOX 9695UNIONDALENY115559695STAFFING SERVICES$101,841
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K3CntrctRcvdGreaterThan100KCnt
Total Contributions$0TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (4 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
PREMIUM REVENUE900099$29,970,222$29,970,222
PROVIDER SUPPORT900099$16,927,063$16,927,063
PROGRAM SERVICE RENTAL INCOME900099$141,926$141,926
NET PATIENT SERVICE REVENUE622310$52,953$52,953

Total Oth Program Service Rev TotalOthProgramServiceRevGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt
Related Or Exempt Func Income$0RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$0ExclusionAmt
FieldValueIRS element (for citing)
Total Program Service Revenue$47,092,164TotalProgramServiceRevenueAmt

Rental Income Or Loss RentalIncomeOrLossGrp

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

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Securities$0SecuritiesAmt
Other$0OtherAmt

Other Revenue Misc OtherRevenueMiscGrp

FieldValueIRS element (for citing)
DescOTHER REVENUEDesc
Business900099BusinessCd
Total Revenue Column$11,180TotalRevenueColumnAmt
Exclusion$11,180ExclusionAmt

Miscellaneous Revenue MiscellaneousRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt
Related Or Exempt Func Income$0RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$0ExclusionAmt
FieldValueIRS element (for citing)
Other Revenue Total$11,180OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$47,103,344TotalRevenueColumnAmt
Related Or Exempt Func Income$47,092,164RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$11,180ExclusionAmt
FieldValueIRS element (for citing)
Info In Schedule O Part IXYes (X)InfoInScheduleOPartIXInd

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$217,161TotalAmt
Management And General$217,161ManagementAndGeneralAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$4,318,227TotalAmt
Program Services$3,790,384ProgramServicesAmt
Management And General$527,843ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$124,397TotalAmt
Program Services$48,042ProgramServicesAmt
Management And General$76,355ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$514,178TotalAmt
Program Services$463,898ProgramServicesAmt
Management And General$50,280ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$342,906TotalAmt
Program Services$300,133ProgramServicesAmt
Management And General$42,773ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$5,511,288TotalAmt
Program Services$5,004,080ProgramServicesAmt
Management And General$507,208ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$1,730TotalAmt
Program Services$1,442ProgramServicesAmt
Management And General$288ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$75,868TotalAmt
Program Services$65,112ProgramServicesAmt
Management And General$10,756ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$12,337TotalAmt
Program Services$10,165ProgramServicesAmt
Management And General$2,172ManagementAndGeneralAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$1,595,096TotalAmt
Program Services$1,283,286ProgramServicesAmt
Management And General$311,810ManagementAndGeneralAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$10,893TotalAmt
Program Services$6,760ProgramServicesAmt
Management And General$4,133ManagementAndGeneralAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$15,047TotalAmt
Program Services$13,274ProgramServicesAmt
Management And General$1,773ManagementAndGeneralAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$2,431,129TotalAmt
Program Services$2,087,278ProgramServicesAmt
Management And General$343,851ManagementAndGeneralAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$134,578TotalAmt
Program Services$123,977ProgramServicesAmt
Management And General$10,601ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
MEDICAL EXPENSE PER PROVIDER AGREEMENT$29,121,730$29,121,730
VENDED SERVICES FROM TCH AND TCHP$2,034,929$1,200,025$834,904
MEDICAL SUPPLIES$695,596$695,596
EDUCATIONAL MATERIAL$30,456$11,438$19,018

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$23,781TotalAmt
Program Services$23,058ProgramServicesAmt
Management And General$723ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$47,211,327TotalAmt
Program Services$44,249,678ProgramServicesAmt
Management And General$2,961,649ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$556,826BOYAmt
EOY$367,469EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$136BOYAmt
EOY$4,778EOYAmt

Receivables From Officers Etc ReceivablesFromOfficersEtcGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt

Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$17,167BOYAmt
EOY$17,167EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$24,623,731LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$3,131,448LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$9,650,588BOYAmt
EOY$21,492,283EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt

Investments Program Related InvestmentsProgramRelatedGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$404,027BOYAmt
EOY$10,829,892EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$10,628,744BOYAmt
EOY$32,711,589EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$1,783,431BOYAmt
EOY$3,878,076EOYAmt

Deferred Revenue DeferredRevenueGrp

FieldValueIRS element (for citing)
EOY$6,202EOYAmt

Loans From Officers Directors LoansFromOfficersDirectorsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$995,279BOYAmt
EOY$4,468,747EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$2,778,710BOYAmt
EOY$8,353,025EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY$7,850,034BOYAmt
EOY$24,358,564EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$7,850,034BOYAmt
EOY$24,358,564EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$10,628,744BOYAmt
EOY$32,711,589EOYAmt
FieldValueIRS element (for citing)
Info In Schedule O Part XIYes (X)InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss-$107,983ReconcilationRevenueExpnssAmt
Other Changes In Net Assets$16,616,513OtherChangesInNetAssetsAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or ReviewfalseAccountantCompileOrReviewInd
FS AuditedYes (true)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Separate Basis Fincl StmtYes (X)SeparateBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (true)AuditCommitteeInd
Federal Grant Audit RequiredfalseFederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Supporting Organization509a3Yes (X)SupportingOrganization509a3Ind
Supporting Org Type1Yes (X)SupportingOrgType1Ind
IRS Written DeterminationYes (X)IRSWrittenDeterminationInd
Supported Organizations1SupportedOrganizationsCnt

Supported Org Information SupportedOrgInformationGrp

Supported Organization Name SupportedOrganizationName

FieldValueIRS element (for citing)
Business Name Line1TEXAS CHILDREN'S HEALTH PLANBusinessNameLine1Txt
FieldValueIRS element (for citing)
EIN760486264EIN
Organization Type9OrganizationTypeDesc
Governing Document ListedYes (true)GoverningDocumentListedInd
Support$44,249,678SupportAmt
Other Support$0OtherSupportAmt
FieldValueIRS element (for citing)
Supported Organizations Total1SupportedOrganizationsTotalCnt
Support Sum$44,249,678SupportSumAmt

Form990 Sch A Supporting Org Form990SchASupportingOrgGrp

FieldValueIRS element (for citing)
Listed By Name Governing DocYes (true)ListedByNameGoverningDocInd
Suprt Org No IRS DeterminationfalseSuprtOrgNoIRSDeterminationInd
Supported Org Section C456falseSupportedOrgSectionC456Ind
Supported Org Not Organized USfalseSupportedOrgNotOrganizedUSInd
Organization Change Suprt OrgfalseOrganizationChangeSuprtOrgInd
Support Non Supported OrgfalseSupportNonSupportedOrgInd
Payment Substantial ContribtrfalsePaymentSubstantialContribtrInd
Loan Disqualified PersonfalseLoanDisqualifiedPersonInd
Controlled Disqualified PrsnfalseControlledDisqualifiedPrsnInd
Disqualified Prsn Controll IntfalseDisqualifiedPrsnControllIntInd
Disqualified Prsn Ownr IntfalseDisqualifiedPrsnOwnrIntInd
Excess Business Holdings RulesfalseExcessBusinessHoldingsRulesInd
Contribution ControllerfalseContributionControllerInd
Contribution FamilyfalseContributionFamilyInd
Contribution35 ControlledfalseContribution35ControlledInd

Form990 Sch A Type1 Suprt Org Form990SchAType1SuprtOrgGrp

FieldValueIRS element (for citing)
Power Appoint Majority Dir TrstYes (true)PowerAppointMajorityDirTrstInd
Operate Benefit Non Suprt OrgfalseOperateBenefitNonSuprtOrgInd

Schedule D IRS990ScheduleD

Leasehold Improvements LeaseholdImprovementsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$17,859,934OtherCostOrOtherBasisAmt
Depreciation$1,214,519DepreciationAmt
Book Value$16,645,415BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$6,616,462OtherCostOrOtherBasisAmt
Depreciation$1,916,929DepreciationAmt
Book Value$4,699,533BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$147,335OtherCostOrOtherBasisAmt
Book Value$147,335BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$21,492,283TotalBookValueLandBuildingsAmt

Other Assets Org OtherAssetsOrgGrp (3 entries)

DescDescBook ValueBookValueAmt
DUE FROM AFFILIATES$9,052,138
MISCELLANEOUS RECEIVABLE$5,281
TENANT IMPROVEMENTS REIMBURSEMENT RECEIVABLE$1,772,473
FieldValueIRS element (for citing)
Total Book Value Other Assets$10,829,892TotalBookValueOtherAssetsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp

FieldValueIRS element (for citing)
DescDEFERRED RENTDesc
Amt$4,468,747Amt
FieldValueIRS element (for citing)
Total Liability$4,468,747TotalLiabilityAmt
Footnote TextYes (X)FootnoteTextInd
Total Rev Etc Audited Fincl Stmt$47,103,344TotalRevEtcAuditedFinclStmtAmt
Other Revenue$0OtherRevenueAmt
Revenue Not Reported$0RevenueNotReportedAmt
Revenue Subtotal$47,103,344RevenueSubtotalAmt
Other Revenues Not Included$0OtherRevenuesNotIncludedAmt
Revenue Not Reported Fincl Stmt$0RevenueNotReportedFinclStmtAmt
Total Revenue Per Form990$47,103,344TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt$47,211,327TotExpnsEtcAuditedFinclStmtAmt
Other Expenses Included$0OtherExpensesIncludedAmt
Expenses Not Reported$0ExpensesNotReportedAmt
Expenses Subtotal$47,211,327ExpensesSubtotalAmt
Other Expenses Not Included$0OtherExpensesNotIncludedAmt
Expenses Not Rpt Fincl Stmt$0ExpensesNotRptFinclStmtAmt
Total Expenses Per Form990$47,211,327TotalExpensesPerForm990Amt

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceSchedule D, Part X, Line 2 FIN 48 (ASC 740) footnoteFormAndLineReferenceDesc
ExplanationMANAGEMENT ANNUALLY REVIEWS ITS TAX POSITIONS AND DETERMINED THAT THERE ARE NO MATERIAL UNCERTAIN TAX POSITIONS THAT REQUIRE RECOGNITION IN THE ACCOMPANYING COMBINED BALANCE SHEETS AS OF DECEMBER 31, 2014.ExplanationTxt

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Severance PaymentfalseSeverancePaymentInd
Supplemental Nonqual Rtr PlanYes (true)SupplementalNonqualRtrPlanInd
Equity Based Comp ArrngmfalseEquityBasedCompArrngmInd
Comp Based On Revenue Of Flng OrgfalseCompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related OrgsfalseCompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng OrgfalseCompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd OrgsfalseCompBsdNetEarnsRltdOrgsInd
Any Non Fixed PaymentsfalseAnyNonFixedPaymentsInd
Initial Contract ExceptionfalseInitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (7 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Filing OrganizationBonusFilingOrganizationAmountBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Filing OrgOtherCompensationFilingOrgAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtComp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmtComp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
Michael A Belfort MD PhD
Board Member / Secretary$0$0$0$254,797$0$0$0$0$0$0$0$254,797$0$0
Angelo P Giardino MD PHD
Board Member / Chairman / Chief Medical Officer$0$381,141$0$104,400$0$20,389$0$91,194$0$10,990$0$608,114$0$0
Mark W Kline MD
Board Member / Vice Chairman$0$0$0$237,908$0$0$0$0$0$0$0$237,908$0$0
Christopher Born
President$0$473,955$0$97,900$0$81,669$0$111,041$0$24,172$0$788,737$0$60,531
Anna Mateja
Chief Financial Officer$0$226,615$0$40,000$0$60,766$0$45,004$0$24,853$0$397,238$0$40,175
Dace Reinholds
Assistant Secretary$0$183,808$0$19,658$0$8,851$0$17,048$0$9,174$0$238,539$0$0
Tangula Taylor
Director of Business Development and Community Initiatives$173,330$13,643$14,268$0$783$64$13,974$352$14,806$1,233$217,161$15,292$14,218$0

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Schedule J, Part I, Line 3 Arrangement used to establish the top management official's compensationCOMPENSATION FOR THE ORGANIZATION'S TOP MANAGEMENT OFFICIAL IS ESTABLISHED BY TEXAS CHILDREN'S AND TEXAS CHILDREN'S HOSPITAL, USING THE FOLLOWING METHODS: *COMPENSATION COMMITTEE *INDEPENDENT COMPENSATION CONSULTANT *COMPENSATION SURVEY OR STUDY *APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE
Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan457 (F) PLAN: PAID/DEFERRED CHRISTOPHER BORN 158,431 / 90,491 ANGELO P. GIARDINO, MD, PHD 104,400 / 67,894 ANNA MATEJA 80,175 / 24,998 DIRECTOR INCENTIVE PLAN: PAID/DEFERRED DACE REINHOLDS 19,608 / 0 TANGULA TAYLOR 14,218 / 0 457(F): THE 457(F) PLAN IS A DEFERRED COMPENSATION PLAN THAT ALLOWS ELIGIBLE EXECUTIVES, FROM THE ASSISTANT VICE PRESIDENT LEVEL TO CHIEF EXECUTIVE OFFICER, TO CONTRIBUTE MONEY ON A PRE-TAX BASIS. FUNDS MAY BE DEFERRED INTO THIS ACCOUNT FROM ANY OF FOUR SOURCES: BASE SALARY, ANNUAL INCENTIVE PLAN, LONG-TERM INCENTIVE PLAN, AND CAPITAL ACCUMULATION ACCOUNT FROM A FLEXIBLE BENEFIT ACCOUNT SURPLUS. THESE VEST AFTER THREE YEARS IN THE 457(F) WITH THE EXCEPTION OF THE CAPITAL ACCUMULATION ACCOUNT WHICH VESTS AFTER FIVE YEARS IN THE 457(F) PLAN. DIRECTOR INCENTIVE PLAN: THE DIRECTOR INCENTIVE PLAN IS AN ANNUAL INCENTIVE PLAN IN WHICH ELIGIBLE DIRECTORS PARTICIPATE. THE PLAN SHARES GOALS WITH THE EXECUTIVE ANNUAL INCENTIVE PLAN, FOCUSING ON FACTORS SUCH AS FINANCIAL PERFORMANCE, QUALITY GOALS, AND PATIENT SATISFACTION. IN ADDITION, THERE ARE INDIVIDUAL COMPONENTS FOR EACH DIRECTOR WHICH VARY DEPENDING ON THE EXPECTED OUTCOMES FOR THAT AREA AND/OR YEAR.

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (11 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Form 990, Part VI, Line 6 Classes of members or stockholdersTEXAS CHILDREN'S HEALTH PLAN IS THE SOLE CORPORATE MEMBER OF TEXAS CHILDREN'S HEALTH PLAN - THE CENTER
Form 990, Part VI, Line 7a Members or stockholders electing members of governing bodyTEXAS CHILDREN'S HEALTH PLAN, AS THE SOLE MEMBER CORPORATION, HAS THE AUTHORITY TO ELECT THE BOARD OF DIRECTORS OF THE ORGANIZATION.
Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholdersPER THE ORGANIZATION'S BYLAWS THE MEMBER HAS CERTAIN RESERVED POWERS: -Approve, interpret or change the purpose of the Corporation. -Fix the number of Directors and appoint or remove, with or without cause, any Director of the Corporation. -Approve the merger, dissolution or consolidation, or reorganization of the Corporation. -Approve the acquisition, sale, lease, transfer or other alienation of property of the Corporation, other than in the usual and regular course of the Corporation's business, when such acquisition, sale, lease, transfer or other alienation is above specified financial levels set in accordance with policies established from time to time by the Member. -Approve capital and operating budgets of the Corporation. -Adoption or amendment of salaries or other compensation (including the awarding of any incentive compensation) of the officers of the Corporation, physician employees of the Corporation, if any, and physicians who are independent contractors to the Corporation, if any. -Approve debt incurred by the Corporation, which is in excess of such limits as are established by the Member. -Approve the disposition of assets of the Corporation at the time of its dissolution. -Approve any long-range financial and strategic plans for the Corporation. -Selection of the Corporation's auditors and legal counsel. -Creation or sale of any subsidiaries of the Corporation. -Any affiliation, joint venture, contract, employment, retention, indemnification, or other arrangements between the Corporation and any insurer, health maintenance organization, preferred provider organization, medical school, hospital, clinic, pharmacy, physician, Texas Children's Health Plan affiliate, or other provider of health or related services, including, without limitation, all service terms and compensation arrangements. -Establishment by the Corporation of any training or residency program. -The giving, seeking, or receiving of grants. -Adoption or amendment of any indemnification rights, obligations, or agreements affecting the Corporation. -Purchase, adoption, amendment, cancellation, or replacement of any insurance coverage for the Corporation or its Directors, officers and agents, as well as copies of any notices of cancellation received by the Corporation. -The commencement of litigation or the settlement of litigation or other claims. -Approval of the adoption or amendment of fee schedules relating to patient services. -Designation of additional or successor Member(s). -Take any action which would be consistent with the governing documents or policies of the member.
Form 990, Part VI, Line 8b Documentation of meetings held by committees of governing bodyNO SUCH COMMITTEES EXIST.
Form 990, Part VI, Line 11b Review of form 990 by governing bodyPER A RESOLUTION APPROVED BY THE MEMBER'S BOARD OF TRUSTEES, THE MEMBER BOARD'S AUDIT & COMPLIANCE COMMITTEE HAS DELEGATED AUTHORITY TO REVIEW THE ORGANIZATION'S COMPLETED FORM 990 PRIOR TO FILING. FOLLOWING THE COMMITTEE'S REVEW, THE COMPLETED FORM 990 IS DISTRIBUTED TO THE MEMBERS OF THE ORGANIZATION'S BOARD OF DIRECTORS PRIOR TO FILING WITH THE IRS.
Form 990, Part VI, Line 12c Conflict of interest policyTHE ORGANIZATION CONSISTENTLY MONITORS AND ENFORCES THE CONFLICT OF INTEREST POLICY THROUGH TWO SEPARATE PROCESSES, ONE THAT APPLIES TO THE BOARD MEMBERS, AND A SECOND THAT APPLIES TO OFFICERS AND KEY EMPLOYEES. 1) BOARD MEMBERS: PER THE ORGANIZATION'S BOARD-APPROVED CONFLICTS REVIEW PROCESS, RESPONSES TO THE ANNUAL CONFLICTS QUESTIONNAIRE ARE REVIEWED BY THE MEMBER'S BOARD LEADERSHIP AND PRESENTED TO THE MEMBER'S AUDIT & COMPLIANCE COMMITTEE. IF THE COMMITTEE DEEMS THERE ARE ANY SIGNIFICANT ISSUES, THE RESPONSES ARE THEN REVIEWED BY THE MEMBER BOARD'S EXECUTIVE COMMITTEE AND ANY REQUIRED ACTION (RECUSEMENT FROM BOARD DELIBERATIONS RELATED TO THE CONFLICT, ETC.) IS TAKEN IN ACCORDANCE WITH THE ORGANIZATION'S BOARD-APPROVED CODE OF CONDUCT. 2) OFFICERS / KEY EMPLOYEES: PER THE ORGANIZATION'S BOARD APPROVED CONFLICTS REVIEW PROCESS, RESPONSES TO THE ANNUAL CONFLICTS QUESTIONNAIRE ARE REVIEWED BY THE COMPLIANCE SERVICES DEPARTMENT. IF THE DEPARTMENT DEEMS THERE ARE ANY SIGNIFICANT ISSUES, REQUIRED ACTION IS TAKEN IN ACCORDANCE WITH THE ORGANIZATION'S BOARD-APPROVED CODE OF CONDUCT AND THE BOARD IS NOTIFIED OF SUCH ACTIONS.
Form 990, Part VI, Line 19 Required documents available to the publicTHE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE MADE AVAILABLE UPON REQUEST.
Form 990, Part VII, Section A INCENTIVE COMPENSATIONDRS. BELFORT AND KLINE, WHILE EMPLOYED BY BAYLOR COLLEGE OF MEDICINE, SERVE AS IN-CHIEFS DIRECTING PATIENT CARE AT TEXAS CHILDREN'S HOSPITAL. DUE TO THEIR SENIOR LEADERSHIP ROLES, THEY ARE ELIGIBLE FOR INCENTIVE COMPENSATION BASED ON THEIR CONTRIBUTIONS TO ACHIEVING THE ORGANIZATION'S STRATEGIC GOALS. ALL COMPENSATION IS EARNED IN THEIR CAPACITY AS PHYSICIAN LEADERS.
Form 990, Part IX, Line 11g Other FeesHEALTHCARE PROFESSIONAL SERVICES - Total Expense: 5511288, Program Service Expense: 5004080, Management and General Expenses: 507208, Fundraising Expenses: ;
Form 990, Part XI, Line 9 Other changes in net assets or fund balancesCONTRIBUTED CAPITAL - 16616513;
SCHEDULE O FORM 5471 DISCLOSURE STATEMENTUNDER THE CONSTRUCTIVE OWNERSHIP RULES OF IRC SECTIONS 958(A) AND (B), THE TAXPAYER IS REQUIRED TO FILE FORMS 5471, INFORMATION RETURN OF U.S. PERSONS WITH RESPECT TO CERTAIN FOREIGN CORPORATIONS, AS A CATEGORY 5 FILER WITH RESPECT TO CERTAIN CONTROLLED FOREIGN CORPORATIONS (CFCS). THESE FILING REQUIREMENTS ARE OR WILL BE SATISFIED THROUGH THE FILING OF FORMS 5471 FOR THESE CFCS BY OTHER U.S. TAXPAYERS IDENTIFIED BELOW WHO HAVE THE SAME FILING REQUIREMENT: -TEXAS CHILDREN'S HOSPITAL FOUNDATION EIN:20-2380599 6621 FANNIN ST HOUSTON, TX 77030 TEXAS CHILDREN'S EIN: 76-0461578 1919 S. BRAESWOOD BLVD, 4TH FL HOUSTON, TX 77030

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (8 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtPublic Charity StatusPublicCharityStatusTxtBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtControlled OrganizationControlledOrganizationIndAddress Line2USAddress/AddressLine2Txt
TEXAS CHILDREN'S
1919 S BRAESWOOD BLVD 4TH FLOORHOUSTONTX77030760461578PARENTTX501(c)(3Type IINAfalse
TEXAS CHILDREN'S PHYSICIAN GROUP INC
6621 FANNIN STREETHOUSTONTX77030260834681HEALTH CARETX501(c)(39TEXAS CHILDREN'Sfalse
TEXAS CHILDREN'S WOMEN'S SPECIALISTS
PO BOX 300630HOUSTONTX77230261482195HEALTH CARETX501(c)(3Type IITEXAS CHILDREN'Sfalse
TEXAS CHILDREN'S HOSPITAL
6621 FANNIN STREETHOUSTONTX77030741100555HOSPITALTX501(c)(33TEXAS CHILDREN'Sfalse
TEXAS CHILDREN'S HOSPITAL FOUNDATION
6621 FANNIN STREETHOUSTONTX77030202380599SUPPORTING ORGTX501(c)(3Type IITEXAS CHILDREN'Sfalse
TCH PEDIATRIC ASSOCIATES
PO BOX 300630HOUSTONTX77230760460242HEALTH CARETX501(c)(39TEXAS CHILDREN'Sfalse
TEXAS CHILDREN'S HEALTH PLAN
2450 HOLCOMBE SUITE 34LHOUSTONTX77021760486264HEALTH CARETX501(c)(39TEXAS CHILDREN'Sfalse
TEXAS CHILDREN'S URGENT CARE
1919 S BRAESWOOD BLVDHOUSTONTX77030472029489HEALTH CARETX501(c)(3Type ITCH PEDIATRIC ASSOCIATESfalse4TH FLOOR

Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp

Related Organization Name RelatedOrganizationName

FieldValueIRS element (for citing)
Business Name Line1QUINTANA ENERGY FUND I COINVESTOR-PRZ LPBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1601 JEFFERSON STREET SUITE 3600AddressLine1Txt
CityHOUSTONCityNm
State AbbreviationTXStateAbbreviationCd
ZIP77002ZIPCd
FieldValueIRS element (for citing)
EIN263190589EIN
Primary ActivitiesINVESTMENTPrimaryActivitiesTxt
Legal Domicile StateTXLegalDomicileStateCd

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1NABusinessNameLine1Txt
FieldValueIRS element (for citing)
Predominant Income TypeN/APredominantIncomeTypeTxt
Disproportionate AllocationsfalseDisproportionateAllocationsInd
General Or Managing PartnerfalseGeneralOrManagingPartnerInd

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (2 entries)

Address Line1ForeignAddress/AddressLine1TxtProvince Or StateForeignAddress/ProvinceOrStateNmCountryForeignAddress/CountryCdForeign PostalForeignAddress/ForeignPostalCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile Foreign CountryLegalDomicileForeignCountryCdBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtEntity TypeEntityTypeTxtControlled OrganizationControlledOrganizationIndCityForeignAddress/CityNm
TCH INSURANCE COMPANY LTD
23 LIME BAY AVENUEGRAND CAYMANCJKY11102980176652INSURANCECJNAC Corporationfalse
CVI GVF HOLDINGS 3 LTD
UGLAND HOUSE SOUTH CHURCH STREETCJKY11104981078282INVESTMENTCJNAC CorporationfalseGEORGE TOWN

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