2014-08-14T15:34:40-05:00 2013-09-30 BKD LLP 2800 Post Oak Blvd Ste 3200 HOUSTON TX 77056 990 2012-10-01 752051646 Cook Children's Medical Center % CORY RHOADES COOK 6828854000 801 Seventh Avenue Suite Fort Worth TX 76104 CORY RHOADES 6828854000 2014-08-15 true M Paige Gerich 7134994600 2012 2015-11-30 17:44:51Z NANCY CYCHOL 801 SEVENTH AVENUE FORT WORTH TX 76104 830443710 false X WWW.COOKCHILDRENS.ORG X 1985 TX KNOWING THAT EVERY CHILD'S LIFE IS SACRED, IT IS THE PROMISE OF COOK CHILDREN'S TO IMPROVE THE HEALTH OF EVERY CHILD IN OUR REGION THROUGH THE PREVENTION AND TREATMENT OF ILLNESS. 13 13 4353 1280 90628 29992 52805990 11605462 768719803 812298871 22895 542569 6070684 3739334 827619372 828186236 41592542 47236427 0 0 270523068 289635935 0 0 0 294897149 330831092 607012759 667703454 220606613 160482782 842018414 854499605 389375498 383129428 452642916 471370177 X KNOWING THAT EVERY CHILD'S LIFE IS SACRED, IT IS THE PROMISE OF COOK CHILDREN'S TO IMPROVE THE HEALTH OF EVERY CHILD IN OUR REGION THROUGH THE PREVENTION AND TREATMENT OF ILLNESS, DISEASE, AND INJURY. false false 493403972 47236427 814930369 Cook Children's Medical Center has nationally respected nursing staff with MAGNET designation by the American Nurses Credentialing Center since 2006 and re-designated in 2011. This recognition of quality patient care and nursing excellence has been achieved by 7 percent of all healthcare organizations nationwide. Cook Children's is known for its nursing excellence and has a distinguished international reputation for providing extraordinary care and achieving positive outcomes in its neurology, neurosurgery, cardiology, cardiothoracic surgery, hematology and oncology, neonatology and pulmonology programs. The medical center accounted for 83 percent of Tarrant County's pediatric admissions in 2011. With the culmination of a historic building initiative that began in 2009, the medical center is now licensed for 457 beds, making it one of the largest children's hospitals in the country. The 530,000 square foot expansion includes a Level IV NICU, more rooms in the Hematology and Oncology unit and the Transitional Care and Rehabilitation Care units, two new helipads, a food court, a patient library with classrooms, a patient business center, an indoor/outdoor playground and 1,300 additional parking spaces. The Dodson Specialty Clinics building houses 18 pediatric subspecialty clinics, including the surgery center, a cancer center, heart center and neurosciences. The Dodson Surgery Center opened in March 2012 and serves pediatric patients needing outpatient procedures such as treating issues with eyes, ear/nose/throat, minor orthopedics and general surgery. It includes: - Six acute beds and 22 prep/recovery beds. - Six state of the art operating suites for outpatient procedures, including two eye surgery suites. - Complimentary valet parking on the day of surgery for the families. In addition to the Dodson Surgery Center, the lower level houses Radiology Outpatient services and the Magnetoencephalography (MEG) technology, which is a noninvasive, state-of-the-art imaging technology. The MEG coupled with Cook Children's MRI and iMRi technology, keeps the medical center at the forefront among the nation's best state-of-the-art facilities. - The first level of the building is the entry point for all clinical services. It includes centralized registration/check-in, Dialysis, Infectious Disease, Nephrology, Orthopedics and Outpatient Lab services. - The second level provides clinic space for patients needing Endocrinology, Gastroenterology and Pulmonology services. - The third level is the home to Cook Children's Heart Center which includes clinics, diagnostics and office space. Pediatric Surgery and NICU offices are on the third floor as well to take advantage of the direct connection to the new NICU space on level 3 of the north tower. - The fourth level is part of the Jane and John Justin Neurosciences Center and includes clinics, diagnostics and office space for Neurology, Neurosurgery, Pain Management, Craniofacial and Cleft Surgery, Rheumatology, Palliative Care and Neuropsychology. - The Neurodiagnostics Center has a dual function as a sleep study center and a direct connection to Transitional Care Unit and Rehabilitation Care Unit beds in the North Tower and North Pavilion. - The fifth level is the Cancer Center. It includes: - An expanded infusion area, dedicated laboratory and dedicated, full-time pharmacy. - Access to Hematology and Oncology inpatient beds through a direct connection to the north tower. - Space for expanded research and participation in more clinical trials. - New, private family spaces for needed breaks. - New meditative garden and family suite for palliative care patients. - Dedicated offices and space to promote collaborative care and comprehensive care. - A telemedicine room for consultations. - State-of-the-art wireless networking infrastructure. Cook Children's is the only pediatric facility in the Southwest to offer I-131 METAIODOBENZYLGUANIDINE (MIBG) therapy. This expansion has positioned Cook Children's to continue to provide the outstanding quality that is the cornerstone of its care, in response to the challenges of an evergrowing population. In addition, Cook Children's Medical Center was selected as a Leapfrog Top Children's Hospital. This distinction is only achieved by an elite group of hospitals that meet the nation's toughest standards for safety and quality. As part of this distinction, Cook Children's was recognized for the implementation of Computerized Provider Order Entry (CPOE) and Bar Coded Medication Administration. The medical center offers advanced technological equipment, leading surgical techniques, rehabilitation facilities and ancillary services designed to meet the special needs of children. Additionally, the campus boasts a professional and highly skilled staff of nurses, technologists, therapists and other clinicians, as well as more than 600 physicians and dentists who provide primary, secondary, tertiary and quaternary levels of pediatric care. Child Life specialists, chaplains, teachers, social services coordinators and translators help patients and families cope with the stresses that accompany a child's hospitalization. The medical center is home to the only EMS-designated, Level II pediatric trauma center in Tarrant County, Texas. In 2012, 127,941 patients were treated in the Emergency Department and Urgent Care Center at Cook Children's. The award-winning Cook Children's Medical Center is supported by one of the largest pediatric transport programs in the nation, Teddy Bear Transport, which brings more than 2,300 children to the medical center annually, primarily for critical care. Services include ambulance, helicopter and fixed-wing airplane transportation. Cook Children's Teddy Bear Transport staff of 52 neonatal/pediatric nurses, respiratory therapists and paramedics is proud to have more than 400 combined years of transport experience. This team is dedicated to getting the most medically fragile children and neonates to our award-winning medical center quickly and safely. Our transport vehicles include a King Air B200 critical care transport airplane, an American Eurocopter 145 helicopter and four ambulances. Each means of transport is equipped to carry critical care patients and features pediatric-oriented technology. Our team of highly specialized nurses, respiratory therapists and paramedics begin giving care to patients immediately upon arrival to their location. Once they arrive at Cook Children's Medical Center, patients are treated by our board certified physicians and nationally recognized nursing staff. Cook Children's is the only Level IV NICU in Tarrant County, the highest qualification for such programs as established by the American Academy of Pediatrics. Level IV NICUs maintain a full range of pediatric medical and surgical subspecialists and pediatric anesthesiologists on-site. The two-level, all-single-room environment is staffed with a team of neonatologists and specialists who combine expertise with the latest technology to provide the highest level of neonatal care available. Studies show that premature and critically ill infants who are cared for in a single room setting have better long-term outcomes. These tiny patients are shown to grow better, get more oxygen, and go home quicker. Cook Children's all-single room NICU was the largest in the nation at the time of completion, and one of the few that can accommodate twins, triplets and even quads in a single room. Cook Children's designated level II Trauma Center is staffed and equipped to provide comprehensive emergency medical services to patients suffering traumatic injuries 24 hours a day, 7 days a week. Cook Children's opened the Child Life Zone in the medical center on May 15, 2012. Country music legend Garth Brooks and former Dallas Cowboys quarterback and NFL Hall of Famer Troy Aikman were on hand to help with the celebration. They represented the Garth Brooks/Troy Aikman Teammates for Kids Foundation that was a driving force behind the project. The new area within Cook Children's Medical Center was designed to be a place where kids can have fun, hang out with each other and forget about being patients for a while. Teens from the Youth Advisory Council- Patients Advocating for Change (YAC-PAC) were instrumental in helping to design the space. The 4,000-square-foot addition houses a teens-only room with arcade games, pool and foosball tables, a juke box, several gaming systems and more. In addition, the Child Life Zone also consists of the Matustik Family Resource Center, Bomar Library, computers for parents and families and Ray's Place snack bar. However, the main attraction is the recording and broadcast studio, offering the most contemporary technology, where patients can experience healing and escape through music and video creation. 493403972 true true false false false false false false false true true false false false true false false true false false false false false false false false true true true true true true false false false false false false false false false false false false false false false true false false false true 231 0 true 4353 true true true false false false false false false false false false X 13 13 false true false false true true true true true false false true true true true true true true true true true X CORY RHOADES 6828854480 801 SEVENTH AVENUE FORT WORTH TX 76104 JAMES F HERD SR MD 1.0 1.0 X MARSHA HILCHER 2.0 1.0 X X CHRISTOPHER M HUCKABEE 1.0 1.0 X WM MACK LAWHON 1.0 1.0 X ROGER NOBER 1.0 0.0 X BONNIE PETSCHE 1.0 1.0 X PETER L PHILPOTT 1.0 6.0 X JERRY R CONATSER 2.0 1.0 X X ANDREW S WAYNE 1.0 0.0 X JOHN P BOSWELL 2.0 3.0 X X SHARON S MAYES 1.0 0.0 X DANA C KELLY 1.0 1.0 X MICHELLE M MARLOW 1.0 0.0 X JEFF CONNOR 1.0 0.0 X NANCY C CYCHOL 40.0 0.0 X 846145 28021 STANLEY E DAVIS 40.0 0.0 X 308849 30436 RICHARD P GOODE 20.0 20.0 X 422160 439392 32851 CARA MARTZ 1.0 39.0 X 136284 7967 RICK W MERRILL 11.0 29.0 X 574761 1477958 86679 GEORGE B MONTAGUE 2.0 38.0 X 373087 28094 PAULA J WEBB 40.0 0.0 X 368423 21847 TERESA J CLARK 40.0 0.0 X 271429 19494 JACK SOSEBEE 40.0 0.0 X 170590 22005 BARBARA GREER 40.0 0.0 X 191848 18864 DONALD K FAISON 40.0 0.0 X 195982 22490 BRADLEY HORN 40.0 0.0 X 190035 21458 CAROLYN PRESNALL 40.0 0.0 X 227123 19268 ROSANNE THURMAN 40.0 0.0 X 201442 20173 ERIC PRESSON 0.0 0.0 X 154971 5334 4123758 2426721 384981 224 true true false LINBECK GROUP LLC 201 MAIN STREET STE 1801 FORT WORTH TX 76102 CONSTR CONTRACTOR 37321903 MEDTRONIC PO BOX 848086 DALLAS TX 752848086 MED SUPPLY SERVICES 3064237 PROLACTA BIOSCIENCE 757 BALDWIN PARK BLVD CITY OF INDUSTRY CA 91746 NUTRITION SERVICES 735422 PROGRESSIVE PARKING SOLUTIONS 201 W BROADWAY SUITE G-5 N LITTLE ROCK AR 72114 PARKING SERVICES 701539 SPECIALTY CARE CARDIOVASCULAR PO BOX 11407 BIRMINGHAM AL 352461614 SURGICAL SERVICES 685320 23 10327541 364766 913155 11605462 PATIENT SERVICES 621110 753404869 753404869 OTHER OPERATING REVENUE 621110 46418526 46418526 JOINT VENTURE REVENUE 621110 12384848 12384848 LAB REFERRALS 621500 90628 90628 812298871 174031 174031 0 0 2747431 1639595 1107836 0 1107836 1107836 986417 617879 368538 368538 368538 0 0 0 CCIC RETRO PREMIUM 900099 3204929 3204929 LOSS ON DEFEASANCE 900099 -573431 -573431 2631498 828186236 814839741 90628 1650405 47139013 47139013 97414 97414 0 0 2449775 2449775 0 215591401 194602993 20988408 0 71594759 64719575 6875184 0 112259232 3871334 108387898 83327 83327 0 0 0 0 19756103 14742892 5013211 136684 97553 39131 78011575 75675675 2335900 0 0 6065865 4664581 1401284 1134475 962708 171767 0 711473 576416 135057 11053767 10964449 89318 0 37110294 26978995 10131299 2385471 2385471 PHYSICIAN REMUNERATION 10336889 9054539 1282350 BAD DEBT EXPENSE 23992148 23992148 MINOR EQUIPMENT 8913623 1869117 7044506 REPAIRS & MAINTENANCE 6095937 1782142 4313795 12784229 9226957 3557272 667703454 493403972 174299482 0 11899 12260 278158288 269263512 0 0 86434560 74744066 0 0 0 0 0 18870960 6879321 6927758 1104380 838931 694048563 257265535 440570624 436783028 7270941 8009418 0 0 0 0 7424990 7424990 14163411 31624682 842018414 854499605 60728075 63700555 0 0 9529 6832 303309008 295407851 0 0 0 0 0 0 0 0 25328886 24014190 389375498 383129428 X 452642916 471370177 0 0 0 0 452642916 471370177 842018414 854499605 X 160482782 -141755521 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 90534565 29553 9201059 42925787 56839390 82538362 -256157 8800000 547640 90534565 80357260 18935 2595270 433103 82538362 70947601 3803664 5976642 370647 80357260 65867824 7205558 -1698302 427479 70947601 0.23000 0.74000 0.03000 false true true 11234574 11234574 492559194 143664762 348914432 3879041 2472587 1406454 157156470 106567578 50588892 29219284 4580608 24638676 436783028 0 EST. PAYABLE (THIRD PARTY) 24123482 DUE TO/FROM AFFILIATES -109292 24014190 845192419 19875036 19875036 825317383 2868853 2868853 828186236 674652145 31026420 31026420 643625725 24077729 24077729 667703454 SCHEDULE D, PART XI, LINE 2D OTHER CHANGE JOINT VENTURE REVENUE NOT INCLUDED ON 990 $40,513,670 INTEREST RATE SWAP ADJUSTMENT $ 3,808,491 WOMEN'S BOARD NEGATIVE REVENUE ($ 85,581) BAD DEBT DEDUCTION FROM REVENUE ($23,992,148) NE GAIN ON SALE OF ASSET (IN AUDIT EXP) $ 7,396 PLANO GAIN ON SALE OF ASSET (IN AUDIT EXP) ($ 8,254) GAIN ON SALE/DISPOSAL OF ASSET (IN AUDIT EXP) ($ 368,538) ------------- TOTAL OTHER CHANGE $19,875,036 SCHEDULE D, PART XI, LINE 4B OTHER CHANGE CONTRIBUTION FROM HF RECORDED TO NET ASSETS $ 4,508,448 RENT EXPENSE ($ 1,639,595) --------------- TOTAL OTHER CHANGE $ 2,868,853 SCHEDULE D, PART XII, LINE 2D OTHER CHANGE JOINT VENTURE ACCOUNTS NOT INCLUDED ON 990 $40,513,670 MINORITY INTEREST ($10,757,449) RENT EXPENSE $ 1,639,595 GAIN ON SALE/DISPOSAL OF ASSET (IN AUDIT EXP) ($ 368,538) NE GAIN ON SALE OF ASSET (IN AUDIT EXP) $ 7,396 PLANO GAIN ON SALE OF ASSET (IN AUDIT EXP) ($ 8,254) ------------- TOTAL OTHER CHANGE $31,026,420 SCHEDULE D, PART V, QUESTION 4 INTENDED USE OF ENDOWMENT FUNDS COOK CHILDREN'S HAS ADOPTED INVESTMENT AND SPENDING POLICIES FOR ENDOWMENT ASSETS THAT ATTEMPT TO PROVIDE A PREDICTABLE STREAM OF FUNDING TO PROGRAMS AND OTHER ITEMS SUPPORTED BY ITS ENDOWMENT WHILE SEEKING TO MAINTAIN THE PURCHASING POWER OF THE ENDOWMENT. UNDER COOK CHILDREN'S POLICIES, ENDOWMENT ASSETS ARE INVESTED IN A MANNER THAT IS INTENDED TO PRODUCE AN AMOUNT THAT IS EQUAL TO A RETURN HURDLE DEFINED AS THE SPENDING RATE, INFLATION RATE AND THE MANAGEMENT COST OF THE ENDOWMENT ON AN ANNUAL BASIS WHILE ASSUMING A PRUDENT LEVEL OF INVESTMENT RISK. ACTUAL RETURNS IN ANY GIVEN YEAR MAY VARY FROM THIS AMOUNT. TO SATISFY ITS LONG-TERM RATE OF RETURN OBJECTIVES, COOK CHILDREN'S RELIES ON A TOTAL RETURN STRATEGY IN WHICH INVESTMENT RETURNS ARE ACHIEVED THROUGH BOTH CURRENT YIELD (INVESTMENT INCOME SUCH AS DIVIDENDS AND INTEREST) AND CAPITAL APPRECIATION (BOTH REALIZED AND UNREALIZED). COOK CHILDREN'S TARGETS A DIVERSIFIED ASSET ALLOCATION THAT PLACES A GREATER EMPHASIS ON EQUITY-BASED INVESTMENTS TO ACHIEVE ITS LONG-TERM RETURN OBJECTIVES WITHIN PRUDENT RISK CONSTRAINTS. COOK CHILDREN'S HAS A POLICY (THE SPENDING POLICY) OF APPROPRIATING FOR EXPENDITURE EACH YEAR 5% OF THE FOUNDATION'S INVESTMENTS AVERAGE FAIR VALUE OVER THE PRIOR 5 YEARS ENDED JUNE 30 PRECEDING THE YEAR IN WHICH EXPENDITURE IS PLANNED. IN ESTABLISHING THIS POLICY, COOK CHILDREN'S CONSIDERED THE LONG-TERM EXPECTED RETURN ON ITS ENDOWMENT. ACCORDINGLY, OVER THE LONG TERM, COOK CHILDREN'S EXPECTS THE CURRENT SPENDING POLICY TO ALLOW ITS ENDOWMENT TO GROW AT THE RETURN HURDLE. THIS IS CONSISTENT WITH COOK CHILDREN'S OBJECTIVE TO MAINTAIN THE PURCHASING POWER OF ENDOWMENT ASSETS HELD IN PERPETUITY OR FOR A SPECIFIED TERM, AS WELL AS TO PROVIDE ADDITIONAL REAL GROWTH THROUGH NEW GIFTS AND INVESTMENT RETURN. SCHEDULE D, PART XII, LINE 4B OTHER CHANGE WOMAN'S BOARD NEGATIVE REVENUE $ 85,581 BAD DEBT DEDUCTION FROM REVENUE $23,992,148 ----------- TOTAL OTHER CHANGE $24,077,729 true true X true X 400. true X 500. true false true true 4835058 4835058 0.00750 345840737 310725413 35115323 0.05460 350675795 310725413 39950381 0.06210 3468264 42970 3425294 0.00530 384496 142364 242132 0.00040 857205 857205 0.00130 46416839 46416839 0.07210 51126804 185334 50941470 0.07910 401802599 310910747 90891851 0.14120 30000 30000 12709 12709 17723 17723 135408 135408 0.00020 36768 36768 0.00010 232608 232608 0.00030 true 23992148 2029762 3999106 -1969344 X true true CC NORTHEAST HOSP FREESTANDING SURGICAL HOSP 0.56350 0.30380 2 1 COOK CHILDREN'S MEDICAL CENTER

801 SEVENTH AVENUE FORT WORTH TX 76104

X 2 COOK CHILDREN'S NORTHEAST HOSPITAL

6316 PRECINCT LINE RD HURST TX 76054

X COOK CHILDREN'S MEDICAL CENTER 1 true X X X X X X X X X 12 true true true X X X X X X X X X X X true false true true 400. true 500. true X true false X X true false X true X false false COOK CHILDREN'S NORTHEAST HOSPITAL 2 true X X X X X X X X X 12 true true true X X X X X X X X X X X true false true true 400. true 500. true X true false X X true false X true X false false 1 CENTER FOR PEDIATRIC SURGERY

7000 W PLANO PARKWAY STE 100 PLANO TX 75093

AMBULATORY SURGERY CENTER PART I, LINE 3C COOK CHILDREN'S USES FPG TO DETERMINE ELIGIBILTY FOR FREE AND DISCOUNTED CARE. PART I, LINE 6A THE ANNUAL REPORT AND COMMUNITY BENEFITS ARE LOCATED ON THE COOK CHILDREN'S WEB SITE (WWW.COOKCHILDRENS.ORG). A HARD COPY OF THE REPORT IS ALSO AVAILABLE IN THE PUBLICATION "KEEPING OUR PROMISE". PART I, LINE 7G NOT APPLICABLE PART I, LINE 7, COLUMN F BAD DEBT EXPENSE OF $23,992,148 WAS INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT WAS SUBTRACTED FROM TOTAL EXPENSE FOR THE CALCULATION OF "PERCENT OF TOTAL EXPENSE" IN THIS COLUMN. PART I, LINE 7 COSTS FOR LINE 7 WERE CALCULATED USING AN OVERALL COST TO CHARGE RATIO CALCULATED BY THE HOSPITAL'S COST ACCOUNTING SYSTEM. PART III, LINE 2 WE RECORD SELF PAY ACCOUNTS AT THE FULL EXPECTED AMOUNT. EACH ACCOUNT GOES THROUGH THE COLLECTION PROCESS AS NECESSARY. AN ALLOWANCE IS ESTABLISHED BASED ON HISTORICAL EXPERIENCE. AS PATIENTS ARE DETERMINED TO BE ELIGIBLE FOR FINANCIAL ASSISTANCE, THEY ARE NO LONGER CONSIDERED TO BE BAD DEBT. PART III, LINE 4 FOOTNOTE DISCLOSURE REGARDING THE TREATMENT OF BAD DEBTS LOCATED ON PAGES 16 AND 17 OF THE MOST RECENT AUDITED FINANCIAL STATEMENTS. PART III, LINE 3 BAD DEBT, IN WHOLE OR IN PART, SHOULD BE INCLUDED IN COMMUNITY BENEFIT GIVEN THE TANGIBLE AND MEASURABLE BENEFIT OF THE UNDERLYING SERVICES PROVIDED TO, PRIMARILY, UNDERSERVED MEMBERS OF OUR COMMUNITY. FOR INSTANCE, WE HAVE A SIGNIFICANT NON-INSURED, UNDOCUMENTED WORKER POPULATION THAT MAY NOT PARTICIPATE IN THE CHARITY OR MEDICAL INDIGENT DISCOUNT QUALIFICATION PROCESS DUE TO CONCERNS ABOUT THEIR IMMIGRATION STATUS. WE PROVIDE CRITICAL INPATIENT, EMERGENCY ROOM, AND OUTPATIENT SERVICES TO THIS DEMOGRAPHIC FOR LITTLE OR NO REIMBURSEMENT AND WITHOUT REGARD FOR THEIR ABILITY TO PAY, BUT RECEIVE NO COMMUNITY BENEFIT CONSIDERATION. AT MINIMUM, HOSPITALS SHOULD HAVE THE OPPORTUNITY TO DELINEATE HOW MUCH BAD DEBT STEMS FROM NON INSURED PATIENTS AND THEN BE GIVEN COMMUNITY BENEFIT CONSIDERATION FOR THE COST BURDEN ASSOCIATED WITH PROVIDING THESE NEEDED SERVICES KNOWING THAT WE HAVE ALREADY DONE ALL WE CAN WITH REGARD TO SCREENING PATIENTS FOR CHARITY AND MEDICAL INDIGENT DISCOUNTS AND WRITTEN THE PATIENTS' BALANCES OFF AS SUCH. DISCOUNTS AND WRITTEN THE PATIENTS' BALANCES OFF AS SUCH. PART III, LINE 8 THE MEDICARE SHORTFALL SHOULD BE CONSIDERED COMMUNITY BENEFIT SINCE IT IS REPRESENTATIVE OF THE NON-COVERED COST OF PATIENT CARE THAT HOSPITALS ARE USING TO JUSTIFY THE NEED FOR THEIR TAX EXEMPT STATUS. PRESENTING THE MEDICARE SHORTFALL IN THE COMMUNITY BENEFIT SECTION ALLOWS REGULATORS AND THE PUBLIC TO SEE THE UNFUNDED COSTS OF SERVICES THAT HOSPITALS PROVIDE TO COMMUNITY MEMBERS. THIS PRESENTATION WOULD HELP THE COMMUNITY BETTER UNDERSTAND THAT IN THE ABSENCE OF A TAX EXEMPT STATUS (WHICH IN EFFECT IS GRANTED TO THEM BY THE PUBLIC), THE HOSPITALS WOULD HAVE TO LOOK TO THE COMMUNITY TO FUND THE SHORTFALL OR RISK LOSING VALUED HOSPITAL SERVICES. THE RATIO OF COST TO CHARGES USED IN THE CALCULATION OF COSTS FOR MEDICARE WAS TAKEN FROM THE MEDICARE COST REPORT. PART III, LINE 9B THE HOSPITAL DOES NOT PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE. NEEDS ASSESSMENT THERE ARE NO NEEDS ASSESSMENTS RELEVANT TO THE CHILD POPULATION IN OUR COMMUNITY THAT WOULD BE IN ADDITION TO THE ONE ALREADY REPORTED. PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE English and Spanish versions of a one-page document explaining the charity care offered at Cook Children's are posted in each of the patient registration areas, the Emergency Room, night clinic, and Medical Office Building. This document includes information on the following: 1)how one might qualify for financial assistance 2)explains qualification is determined by family size and income, and 3)guides families to contact the Patient Accounting department to apply for financial assistance. In all areas of Patient Registration, registration clerks offer a Medicaid application to all self pay registrations. Patient Registration staff will assist the family with the application for Medicaid, and then Charity if Medicaid is denied. Patient Representatives and Case Management personnel also direct families to the Patient Registration staff when they need financial assistance. In addition, the financial assistance policy, explanation of amounts generally billed and the charity application are posted on the Cook Children's website at www.cookchildrens.org. The charity application is posted in both English and Spanish versions. COMMUNITY INFORMATION COOK CHILDREN'S HEALTH CARE SYSTEM IS THE COUNTRY'S LEADING INTEGRATED PEDIATRIC HEALTH CARE DELIVERY NETWORK. BASED IN FORT WORTH, TEXAS, THE NOT-FOR-PROFIT ORGANIZATION INCLUDES A MEDICAL CENTER (430 BEDS), PHYSICIAN NETWORK (297 PEDIATRIC SPECIALISTS), NORTHEAST HOSPITAL, PEDIATRIC SURGERY CENTER, HOME HEALTH COMPANY, HEALTH PLAN (110,046 MEDICAID AND CHIP COVERED LIVES) AND HEALTH FOUNDATION. THE SYSTEM HAS A SIX-COUNTY PRIMARY SERVICE AREA THAT REPRESENTS 86% OF ITS TOTAL VOLUME COVERING 4,711 MILES. IT ALSO PROVIDES TERTIARY AND QUATERNARY PEDIATRIC MEDICAL CARE TO 122 COUNTIES IN WEST AND NORTH CENTRAL TEXAS, COVERING 257,086 MILES AND TO OUT-OF-STATE PATIENTS. THE SYSTEM HAS MORE THAN 1.2 MILLION PATIENT ENCOUNTERS PER YEAR ACROSS THE CONTINUUM OF PEDIATRIC CARE. COOK CHILDREN'S HEALTH PLAN COVERS 110,046 MEDICAID AND CHIP LIVES WITHIN THE TARRANT SERVICE AREA. THE SYSTEM PROVIDED $5.9 MILLION IN TRUE CHARITY CARE IN 2011. 57.4% OF THE SYSTEM'S PATIENT CARE IS PROVIDED TO MEDICAID, MEDICAID MANAGED CARE AND CHIP BENEFICIARIES. DEMOGRAPHICS OF THE COMMUNITY THE SIX-COUNTY PRIMARY SERVICE AREA CONSISTS OF DENTON, HOOD, JOHNSON, PARKER, TARRANT AND WISE COUNTIES IN TEXAS. THAT AREA IS HOME TO 681,440 CHILDREN AGES BIRTH TO 14 YEARS WHO REPRESENT 22.7% OF THE TOTAL POPULATION AND WHOSE NUMBERS ARE EXPECTED TO GROW TO 722,528 BY 2018 OR A 5-YEAR GROWTH RATE OF 6.0%. THERE ARE 1,090,620 HOUSEHOLDS WITHIN THAT GEOGRAPHY WITH 20.3% HAVING INCOME AT OR BELOW THE FEDERAL POVERTY LEVEL; BUT THERE IS WIDE VARIATION AMONG COMMUNITIES WITHIN THOSE GEOGRAPHIC BOUNDS. SIMILARLY WIDE VARIATION EXISTS IN RACE AND ETHNICITY AMONG DIFFERENT COMMUNITIES; BUT THE ENTIRE AREA'S POPULATION OF 2,999,116 PEOPLE CONSISTS OF 56.8% WHITE NON-HISPANIC, 24.5% HISPANIC, 11.5% BLACK NON-HISPANIC AND 4.9% ASIAN AND PACIFIC ISLANDERS. PROMOTION OF COMMUNITY HEALTH: Cook Children's maintains an open medical staff and the governing bodies of the various companies are made up (unless constrained by the Texas Medical Practice Act) of voluntary community members along with physicians. The organization cares for all children regardless of their ability to pay and proactively seeks to enroll all eligible children into appropriate programs to improve access to care. AFFILIATED HEALTH CARE SYSTEM ROLES Cook Children's also operates five Neighborhood Clinics providing primary care to underserved populations around the city's perimeter and inner city to help assure care is provided in the most appropriate setting. Both preventive and therapeutic dental health care are provided to underserved populations. Mental and behavioral health is provided in both inpatient and outpatients settings subsidized by Cook Children's. Cook Children's Health Plan is a contracted intermediary for Medicaid Managed Care and sCHIP, providing an open provider panel for all eligible children in the six-county primary service area. Cook Children's offers pediatric specific home care to assure care is provided in the most appropriate and lowest cost setting. ALL STATES WHICH ORGANIZATION FILES A COMMUNITY BENEFIT REPORT TX COMMUNITY BUILDING ACTIVITIES PART II PHYSICAL IMPROVEMENTS AND HOUSING: COOK CHILDREN'S IS LOCATED IN THE NEAR SOUTH SIDE OF FORT WORTH WHICH INCLUDES THE MEDICAL DISTRICT AS WELL AS A DIVERSE MIX OF RESIDENTIAL NEIGHBORHOODS. TO ADDRESS NEIGHBORHOOD IMPROVEMENT NEEDS, COOK CHILDREN'S IS A MEMBER OF FORT WORTH SOUTH, INC., A NONPROFIT ORGANIZATION THAT PARTNERS WITH THE CITY OF FORT WORTH AND OTHER COMMUNITY ORGANIZATIONS TO ADVANCE EDUCATIONAL INITIATIVES, PUBLIC POLICIES, AND COMMUNITY PROGRAMS THAT FOSTER A REVITALIZED AND SAFE CENTRAL CITY. STRATEGIC PLANNING HAS RESULTED IN IMPROVED SECURITY, CODE ENFORCEMENT, AND TRANSPORTATION FOR RESIDENTS AND EMPLOYEES WHO WORK IN THIS AREA. COMMUNITY SUPPORT: COOK CHILDREN'S STAFF PARTICIPATED IN THE JUNIOR ACHIEVEMENT PROGRAM AS MENTORS AT A NEARBY ELEMENTARY SCHOOL. THESE EMPLOYEES SPENT TIME DURING WORK HOURS TEACHING CLASSES TO HELP INSPIRE THE STUDENTS TO DREAM BIG AND REACH THEIR POTENTIAL. THIS PROGRAM DEVELOPS AND STRENGTHENS THE YOUTHS' ASSETS AS THE STUDENTS LEARN KEY CONCEPTS RELATED TO WORK READINESS, ENTREPRENEURSHIP AND FINANCIAL LITERACY. COALITION BUILDING: COOK CHILDREN'S IS A CO-FOUNDING MEMBER OF THE INFANT MORTALITY NETWORK ORGANIZED TO ADDRESS THE HIGH RATES OF INFANT MORTALITY IN THE COUNTY. THE NETWORK HAS RAISED COMMUNITY AWARENESS OF THE PROBLEM AND WORKED WITH LEGISLATORS TO CREATE PUBLIC POLICY TO HELP ADDRESS THE PROBLEM. COOK CHILDREN'S IS ALSO AN ACTIVE MEMBER OF THE HEALTHY TARRANT COUNTY COLLABORATION - A HEALTH PROMOTION NETWORK OF NON-PROFIT HOSPITALS, PUBLIC HEALTH AND LOCAL UNIVERSITIES. THE COLLABORATION EFFORTS INCLUDE HEALTH EDUCATION AT A SUMMER CAMP FOR UNDERSERVED CHILDREN. COMMUNITY HEALTH IMPROVEMENT ADVOCACY: ADVOCACY EFFORTS BY COOK CHILDREN'S ARE ENHANCED THROUGH MEMBERSHIP IN VARIOUS LOCAL, STATE, AND NATIONAL ORGANIZATIONS. ASSESSMENT OF COMMUNITY NEEDS, ACCESS TO HEALTH CARE AND INSURANCE FOR UNDERSERVED POPULATIONS AND ADVOCACY ON SPECIFIC HEALTH ISSUES SUCH AS CHILD ABUSE AND NEGLECT AND PREVENTABLE INJURIES ARE AMONG THE ISSUES ADDRESSED. WORKFORCE DEVELOPMENT: COOK CHILDREN'S HAS REPRESENTATION ON THE TEXAS NURSES' ASSOCIATION BOARD OF DIRECTORS. PART V, LINE 12, COOK CHILDREN'S MEDICAL CENTER BASIS FOR CALCULATING AMOUNTS CHARGED TO PATIENTS THE HOSPITAL FACILITY USED FEDERAL POVERTY GUIDELINES AND A SLIDING SCALE DISCOUNT TO DETERMINE AMOUNTS DUE DURING THE TAX YEAR. HOUSEHOLD GROSS INCOME AND FAMILY SIZE ARE CONSIDERED IN DETERMINING ELIGIBILITY FOR FINANCIAL ASSISTANCE. DURING 2013 A REVISED POLICY WAS APPROVED WHICH STATES AND USES THE FOLLOWING DEFINITION TO DETERMINE AMOUNTS THAT CAN BE CHARGED TO FAP-ELIGIBLE INDIVIDUALS: FOLLOWING A DETERMINATION OF FINANCIAL-ASSISTANCE ELIGIBILITY, AN INDIVIDUAL WILL NOT BE CHARGED MORE THAN THE AMOUNTS GENERALLY BILLED (AGB) FOR EMERGENCY OR OTHER MEDICAL CARE PROVIDED TO INDIVIDUALS WITH INSURANCE COVERING THAT CARE. AT COOK CHILDREN'S THE AGB IS DETERMINED THROUGH THE "LOOK-BACK METHOD" WHICH IS CALCULATED AS FOLLOWS: 1. THE AGB IS CALCULATED BY REVIEWING ALL PAST CLAIMS THAT HAVE BEEN PAID IN FULL TO THE HOSPITAL FACILITY FOR MEDICALLY NECESSARY CARE BY MEDICARE FEE-FOR-SERVICE TOGETHER WITH ALL PRIVATE HEALTH INSURERS PAYING CLAIMS TO THE HOSPITAL IN A PRIOR 12-MONTH PERIOD. THIS AMOUNT CAN INCLUDE COINSURANCE, COPAYMENTS AND DEDUCTIBLES. 2. THE AGB FOR EMERGENCY OR MEDICALLY NECESSARY CARE PROVIDED TO A FINANCIAL ASSISTANCE-ELIGIBLE INDIVIDUAL IS DETERMINED BY MULTIPLYING GROSS CHARGES FOR THAT CARE BY ONE OR MORE PERCENTAGES OF GROSS CHARGES (CALLED "AGB PERCENTAGES"). A. THE PERCENTAGES ARE CALCULATED AT LEAST ANNUALLY BY DIVIDING THE SUM OF CERTAIN CLAIMS PAID TO THE HOSPITAL FACILITY BY THE SUM OF THE ASSOCIATED GROSS CHARGES FOR THOSE CLAIMS. B. MULTIPLE AGB PERCENTAGES MAY BE CALCULATED FOR SEPARATE CATEGORIES OF CARE (FOR EXAMPLE, IN-PATIENT VERSES OUT-PATIENT CARE; OR CARE PROVIDED BY DIFFERENT DEPARTMENTS) OR FOR SEPARATE ITEMS OR SERVICES. 3. THE PERCENTAGES ARE APPLIED BY THE 45TH DAY AFTER THE END OF THE 12-MONTH PERIOD THE HOSPITAL FACILITY USED IN CALCULATING THE AGB PERCENTAGE(S). PART V, LINE 14, COOK CHILDREN'S MEDICAL CENTER MEASURES USED TO PUBLICIZE THE POLICY ALTHOUGH THE POLICY DID NOT SPECIFICALLY STATE HOW THE POLICY WOULD BE PUBLICIZED WITHIN THE COMMUNITY DURING THE TAX YEAR, THE FOLLOWING PROCESS HAS BEEN FOLLOWED. ENGLISH AND SPANISH VERSIONS OF A ONE-PAGE DOCUMENT EXPLAINING THE CHARITY CARE OFFERED AT COOK CHILDREN'S ARE POSTED IN EACH OF THE PATIENT REGISTRATION AREAS, THE EMERGENCY ROOM, NIGHT CLINIC, AND MEDICAL OFFICE BUILDING. THIS DOCUMENT INCLUDES INFORMATION ON THE FOLLOWING: 1) HOW ONE MIGHT QUALIFY FOR FINANCIAL ASSISTANCE 2) EXPLAINS QUALIFICATION IS DETERMINED BY FAMILY SIZE AND INCOME, AND 3) GUIDES FAMILIES TO CONTACT THE PATIENT ACCOUNTING DEPARTMENT TO APPLY FOR FINANCIAL ASSISTANCE. IN ALL AREAS OF PATIENT REGISTRATION, REGISTRATION CLERKS OFFER A MEDICAID APPLICATION TO ALL SELF-PAY REGISTRATIONS. PATIENT REGISTRATION STAFF WILL ASSIST THE FAMILY WITH THE APPLICATION FOR MEDICAID, AND THEN CHARITY IF MEDICAID IS DENIED. PATIENT REPRESENTATIVES AND CASE MANAGEMENT PERSONNEL ALSO DIRECT FAMILIES TO THE PATIENT REGISTRATION STAFF WHEN THEY NEED FINANCIAL ASSISTANCE. IN ADDITION, THE FINANCIAL ASSISTANCE POLICY, EXPLANATION OF AMOUNTS GENERALLY BILLED AND THE CHARITY APPLICATION ARE NOW POSTED ON THE COOK CHILDREN'S WEBSITE AT WWW.COOKCHILDRENS.ORG. THE CHARITY APPLICATION IS POSTED IN BOTH ENGLISH AND SPANISH VERSIONS. PART V, LINE 20, COOK CHILDREN'S MEDICAL CENTER MAXIMUM AMOUNTS CHARGEABLE TO FAP-ELIGIBLE PATIENTS FOR EMERGENCY CARE SEE RESPONSE TO SCHEDULE H, PART V, LINE 12. PART V, LINE 12, COOK CHILDREN'S NORTHEAST HOSPITAL BASIS FOR CALCULATING AMOUNTS CHARGED TO PATIENTS THE HOSPITAL FACILITY USED FEDERAL POVERTY GUIDELINES AND A SLIDING SCALE DISCOUNT TO DETERMINE AMOUNTS DUE DURING THE TAX YEAR. HOUSEHOLD GROSS INCOME AND FAMILY SIZE ARE CONSIDERED IN DETERMINING ELIGIBILITY FOR FINANCIAL ASSISTANCE. DURING 2013 A REVISED POLICY WAS APPROVED WHICH STATES AND USES THE FOLLOWING DEFINITION TO DETERMINE AMOUNTS THAT CAN BE CHARGED TO FAP-ELIGIBLE INDIVIDUALS: FOLLOWING A DETERMINATION OF FINANCIAL-ASSISTANCE ELIGIBILITY, AN INDIVIDUAL WILL NOT BE CHARGED MORE THAN THE AMOUNTS GENERALLY BILLED (AGB) FOR EMERGENCY OR OTHER MEDICAL CARE PROVIDED TO INDIVIDUALS WITH INSURANCE COVERING THAT CARE. AT COOK CHILDREN'S THE AGB IS DETERMINED THROUGH THE "LOOK-BACK METHOD" WHICH IS CALCULATED AS FOLLOWS: 1. THE AGB IS CALCULATED BY REVIEWING ALL PAST CLAIMS THAT HAVE BEEN PAID IN FULL TO THE HOSPITAL FACILITY FOR MEDICALLY NECESSARY CARE BY MEDICARE FEE-FOR-SERVICE TOGETHER WITH ALL PRIVATE HEALTH INSURERS PAYING CLAIMS TO THE HOSPITAL IN A PRIOR 12-MONTH PERIOD. THIS AMOUNT CAN INCLUDE COINSURANCE, COPAYMENTS AND DEDUCTIBLES. 2. THE AGB FOR EMERGENCY OR MEDICALLY NECESSARY CARE PROVIDED TO A FINANCIAL ASSISTANCE-ELIGIBLE INDIVIDUAL IS DETERMINED BY MULTIPLYING GROSS CHARGES FOR THAT CARE BY ONE OR MORE PERCENTAGES OF GROSS CHARGES (CALLED "AGB PERCENTAGES"). A. THE PERCENTAGES ARE CALCULATED AT LEAST ANNUALLY BY DIVIDING THE SUM OF CERTAIN CLAIMS PAID TO THE HOSPITAL FACILITY BY THE SUM OF THE ASSOCIATED GROSS CHARGES FOR THOSE CLAIMS. B. MULTIPLE AGB PERCENTAGES MAY BE CALCULATED FOR SEPARATE CATEGORIES OF CARE (FOR EXAMPLE, IN-PATIENT VERSES OUT-PATIENT CARE; OR CARE PROVIDED BY DIFFERENT DEPARTMENTS) OR FOR SEPARATE ITEMS OR SERVICES. 3. THE PERCENTAGES ARE APPLIED BY THE 45TH DAY AFTER THE END OF THE 12-MONTH PERIOD THE HOSPITAL FACILITY USED IN CALCULATING THE AGB PERCENTAGE(S). PART V, LINE 14, COOK CHILDREN'S NORTHEAST HOSPITAL MEASURES USED TO PUBLICIZE THE POLICY ALTHOUGH THE POLICY DID NOT SPECIFICALLY STATE HOW THE POLICY WOULD BE PUBLICIZED WITHIN THE COMMUNITY DURING THE TAX YEAR, THE FOLLOWING PROCESS HAS BEEN FOLLOWED. ENGLISH AND SPANISH VERSIONS OF A ONE-PAGE DOCUMENT EXPLAINING THE CHARITY CARE OFFERED AT COOK CHILDREN'S ARE POSTED IN EACH OF THE PATIENT REGISTRATION AREAS, THE EMERGENCY ROOM, NIGHT CLINIC, AND MEDICAL OFFICE BUILDING. THIS DOCUMENT INCLUDES INFORMATION ON THE FOLLOWING: 1) HOW ONE MIGHT QUALIFY FOR FINANCIAL ASSISTANCE 2) EXPLAINS QUALIFICATION IS DETERMINED BY FAMILY SIZE AND INCOME, AND 3) GUIDES FAMILIES TO CONTACT THE PATIENT ACCOUNTING DEPARTMENT TO APPLY FOR FINANCIAL ASSISTANCE. IN ALL AREAS OF PATIENT REGISTRATION, REGISTRATION CLERKS OFFER A MEDICAID APPLICATION TO ALL SELF-PAY REGISTRATIONS. PATIENT REGISTRATION STAFF WILL ASSIST THE FAMILY WITH THE APPLICATION FOR MEDICAID, AND THEN CHARITY IF MEDICAID IS DENIED. PATIENT REPRESENTATIVES AND CASE MANAGEMENT PERSONNEL ALSO DIRECT FAMILIES TO THE PATIENT REGISTRATION STAFF WHEN THEY NEED FINANCIAL ASSISTANCE. IN ADDITION, THE FINANCIAL ASSISTANCE POLICY, EXPLANATION OF AMOUNTS GENERALLY BILLED AND THE CHARITY APPLICATION ARE NOW POSTED ON THE COOK CHILDREN'S WEBSITE AT WWW.COOKCHILDRENS.ORG. THE CHARITY APPLICATION IS POSTED IN BOTH ENGLISH AND SPANISH VERSIONS. PART V, LINE 20, COOK CHILDREN'S NORTHEAST HOSPITAL MAXIMUM AMOUNTS CHARGEABLE TO FAP-ELIGIBLE PATIENTS FOR EMERGENCY CARE SEE RESPONSE TO SCHEDULE H, PART V, LINE 12. IMPLEMENTATION STRATEGY PART V, LINE 6A THE ORGANIZATION'S IMPLEMENTATION STRATEGY IS LOCATED AT THE FOLLOWING WEBSITE: http://www.cookchildrens.org/SiteCollectionDocuments/AboutUs/CHNA-Implemen tation-Strategies.pdf PART V, SECTION B, LINE 4 COOK CHILDREN'S MEDICAL CENTER COOK CHILDREN'S MEDICAL CENTER HAS A NATIONALLY RECOGNIZED, AWARD WINNING FACILITY. MAGNET DESIGNATED, LICENSED BY THE STATE OF TEXAS IT IS ACCREDITED BY THE JOINT COMMISSION. COOK CHILDREN'S IS KNOWN NATION-WIDE FOR ITS EXCELLENCE IN QUALITY AND SAFETY AND HAS A DISTINGUISHED REPUTATION FOR PROVIDING EXTRAORDINARY CARE AND ACHIEVING POSITIVE OUTCOMES IN ITS NEUROLOGY, NEUROSURGERY, CARDIOLOGY, CARDIOTHORACIC SURGERY, HEMATOLOGY AND ONCOLOGY, NEONATOLOGY, AND PULMONOLOGY PROGRAMS. THE MEDICAL CENTER IS LICENSED FOR 430 BEDS, MAKING IT ONE OF THE LARGEST CHILDREN'S HOSPITALS IN THE COUNTRY. CCMC OFFERS ADVANCED TECHNOLOGICAL EQUIPMENT, LEADING SURGICAL TECHNIQUES, REHABILITATION FACILITIES AND ANCILIARY SERVICES DESIGNED TO MEET THE SPECIAL NEEDS OF CHILDREN INCLUDING A LEVEL IV NICU STAFFED WITH A TEAM OF NEONATOLOGISTS AND SPECIALISTS COMBINING EXPERTISE WITH THE LATEST TECHNOLOGY TO PROVIDE THE HIGHEST LEVEL OF NEONATAL CARE AVAILABLE. ADDITIONALLY, THE CAMPUS BOASTS A PROFESSIONAL AND HIGHLY SKILLED STAFF OF NURSES, TECHNOLOGISTS, THERAPISTS, AND OTHER CLINICIANS, AS WELL AS MORE THAN 600 PHYSICIANS AND DENTISTS WHO PROVIDE PRIMARY, SECONDARY, TERTIARY AND QUATERNARY LEVELS OF PEDIATRIC CARE. CHILD LIFE SPECIALISTS, CHAPLAINS, TEACHERS, SOCIAL SERVICES COORDINATORS AND TRANSLATORS HELP PATIENTS AND FAMILIES COPE WITH THE STRESSORS THAT ACCOMPANY A CHILD'S HOSPITALIZATION. COOK CHILDREN'S DESIGNATED LEVEL II TRAUMA CENTER IS STAFFED AND EQUIPPED TO PROVIDE COMPREHENSIVE EMERGENCY MEDICAL SERVICES TO PATIENTS SUFFERING TRAUMATIC INJURIES 24 HOURS A DAY, 7 DAYS A WEEK. COOK CHILDREN'S NORTHEAST HOSPITAL COOK CHILDREN'S NORTHEAST HOSPITAL IS LOCATED IN NORTHEAST TARRANT COUNTY AND PROVIDES CONVENIENT AND COMPREHENSIVE MEDICAL CARE FOR CHILDREN AND ADOLESCENTS REQUIRING URGENT CARE, DIAGNOSTIC IMAGING (INCLUDING MRI AND CT) AND DAY SURGERY WITH OVERNIGHT STAYS AVAILABLE. IN 2013, THE NORTHEAST HOSPITAL SAW MORE THAN 37,000 PATIENTS COMPARED TO APPROXIMATELY 35,000 ITS FIRST YEAR OPERATING AS A HOSPITAL. THE HOSPITAL HAS A GROWING LIST OF SURGICAL SERVICES THAT MEET BOTH INPATIENT AND OUTPATIENT NEEDS, AND ALL SURGICAL SERVICES ARE PERFORMED BY PEDIATRIC-TRAINED DOCTORS. THIS CHILD-FRIENDLY FACILITY INCLUDES A DEDICATED CHILD LIFE SPECIALIST. COOK CHILDREN'S NORTHEAST HOSPITAL IS LICENSED BY THE STATE OF TEXAS AND ACCREDITED BY THE JOINT COMMISSION. PART V, SECTION B, LINE 3 COOK CHILDREN'S COMMUNITY-WIDE CHILDREN'S HEALTH ASSESSMENT AND PLANNING SURVEY (CCHAPS) CONDUCTED IN 2008-2009 INCLUDED A HOUSEHOLD SURVEY OF THE STATUS OF CHILDREN'S HEALTH AGES 0-14 (7,439 COMPLETED SURVEYS), A COMMUNITY LEADER SURVEY, SECONDARY DATA REVIEW, AND MULTIPLE FOCUS GROUPS WITH COMMUNITY LEADERS, 20 COMMUNITY GROUP/COALITION MEETINGS, 12 LISTENING SESSIONS AND 7 INTERNAL MEETINGS; ALL TO OBTAIN FEEDBACK FROM APPROXIMATELY 486 EXTERNAL COMMUNITY MEMBERS AND 59 INTERNAL COMMUNITY MEMBERS. FEEDBACK FROM GROUP MEETINGS WAS OBTAINED THROUGH DISCUSSION AND A WRITTEN SURVEY. A SECOND CCHAPS WAS CONDUCTED IN 2011-2012 TO UPDATE THE ORIGINAL DATA AND INCLUDED A PARENT SURVEY (8,394 COMPLETED SURVEYS) AND ONE-ON-ONE SURVEY INTERVIEWS WITH PARENTS WHO ARE HOMELESS OR WHO HAVE AT LEAST ONE UNDOCUMENTED FAMILY MEMBER. THE RESULTS OF THE SURVEY WERE COMPARED TO THE 2008 DATA TO SEE HOW CHILDREN'S HEALTH IN THE REGION CHANGED. DISCUSSION GROUPS WERE CONDUCTED WITH THE CHILDREN OF PARENTS WHO PARTICIPATED IN THE SURVEY TO PROVIDE FURTHER INFORMATION ABOUT SURVEY FINDINGS IN PARTNERSHIP WITH COOK CHILDREN'S CHILD LIFE SPECIALISTS. A COMMUNITY LEADER SURVEY AND SPECIAL REPORTS ON PARENTING PRACTICES IN HOOD AND WISE COUNTIES BASED ON ADDITIONAL CCHAPS SURVEYS WERE CONDUCTED IN 2012 AND 2013. PART V, SECTION B, LINE 5C IN ADDITION TO BEING AVAILABLE ON THE HOSPITALS WEBSITE AT WWW.COOKCHILDRENS.ORG AND UPON REQUEST FROM THE HOSPITAL'S FACILITY, THE CHNA REPORT IS ALSO AVAILABLE AT WWW.CENTERFORCHILDRENSHEALTH.ORG. PART V, SECTION B, LINE 18 THE HOSPITAL FACILITY DID NOT TAKE ANY OF THE ACTIONS LISTED ON LINE 17. true COOK CHILDREN'S PHYSICIAN NETWORK 801 SEVENTH AVENUE FORT WORTH TX 76104 752485366 501(C)(3) 46108155 subsidize operations MENTAL HEALTH CONNECTION OF TARRANT COUNTY 3131 SANGUINET ST FORT WORTH TX 76107 752659610 501(C)(3) 20000 SPONSOR THE WARM PLACE 809 LIPSCOMB ST FORT WORTH TX 76104 752220859 501(C)(3) 20000 SPONSOR AMERICAN HEART ASSOCIATION 2630 W FREEWAY 250 FORT WORTH TX 76102 135613797 501(C)(3) 25000 SPONSOR CAREITY FOUNDATION PO BOX 126038 FORT WORTH TX 76126 061704800 501(C)(3) 10000 SPONSOR JUVENILE DIABETES RESEARCH FUND 3601 HULEN ST STE 102 FORT WORTH TX 76107 231907729 501(C)(3) 6000 SPONSOR JUNIOR LEAGUE OF FORT WORTH 255 BAILEY AVE FORT WORTH TX 76107 756022377 501(C)(3) 25000 SPONSOR RONALD MCDONALD HOUSE 1001 8TH AVE FORT WORTH TX 76104 751754490 501(C)(3) 880720 FMV LAND DONATION PURSUIT OF MISSION MARCH OF DIMES 6815 MANHATTAN BLVD 102 FORT WORTH TX 76120 131846366 501(C)(3) 15000 SPONSOR FOUND NATIONAL STUDENT NURSES ASSOCIATION 45 MAIN ST 606 BROOKLYN NY 11201 133123125 501(C)(3) 7500 SPONSOR 10 MEDICATIONS 1047 84780 TRANSPORTATION 106 24334 UTILITIES 11 3454 LODGING 69 27775 FUNERAL 6 4535 MEDICAL EQUIPMENT 4 4516 LAB WORK 3 3286 BABY ITEMS 8 2351 OTHER 5 1199 PROCEDURES FOR MONITORING THE USE OF THE GRANT FUNDS IN THE US SCHEDULE I PART I QUESTION 2 THE ORGANIZATION USES PUBLIC AND PRIVATE DATA TO MONITOR THE USE OF FUNDS, AS NEEDED. X false true true true false false false false false false false NANCY C CYCHOL 377073 333529 135543 18750 9271 874166 STANLEY E DAVIS 178110 121378 9361 14415 16021 339285 RICHARD P GOODE 179869 187210 166015 172792 76276 79390 7656 7969 8441 8785 438257 456146 RICK W MERRILL 198283 509870 110181 283323 266297 684765 19950 51299 4320 11110 599031 1540367 116200 298800 GEORGE B MONTAGUE 210560 141220 21307 15893 12201 401181 PAULA J WEBB 218513 145842 4068 12752 9095 390270 TERESA J CLARK 165664 93373 12392 9930 9564 290923 ERIC PRESSON 90626 57752 6593 2223 3111 160305 BARBARA GREER 147389 41070 3389 12773 6091 210712 JACK SOSEBEE 129593 39718 1279 13125 8880 192595 DONALD K FAISON 144114 37656 14212 14779 7711 218472 BRADLEY HORN 178304 11731 11685 9773 211493 CAROLYN PRESNALL 98285 18596 110242 8682 10586 246391 ROSANNE THURMAN 145564 43137 12741 8211 11962 221615 PARTICIPATION IN A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN PART I, QUESTION 4B PARTICIPANTS IN SERP REPORTED IN W-2 DEFERRED COMPENSATION -------------------- --------------- --------------------- RICK W. MERRILL $ 755,000 $ 61,249 ALLOCATION OF CEO AND CFO SALARIES PART II SALARIES FOR THE CEO AND CFO ARE ALLOCATED PRO-RATA BASED ON THE AMOUNT OF TIME THEY SPEND WITH EACH OF THE FOLLOWING COMPANIES: COOK CHILDREN'S MEDICAL CENTER COOK CHILDREN'S PHYSICIAN NETWORK COOK CHILDREN'S HEALTH FOUNDATION COOK CHILDREN'S HOME HEALTH COOK CHILDREN'S HEALTH CARE SYSTEM COOK CHILDREN'S HEALTH PLAN RECEIVED SEVERANCE PAYMENTS PART I, QUESTION 4A NAME AMOUNT --------------- --------- CAROLYN PRESNALL $ 65,250 TAX INDEMNIFICATION AND GROSS-UP PAYMENTS PART I, QUESTIONS 1A & 1B THERE IS NO WRITTEN POLICY REGARDING PAYMENT OR REIMBURSEMENT OF TAX INDEMNIFICATION AND GROSS-UP PAYMENTS BECAUSE THE COMPANY DOES NOT GENERALLY ALLOW FOR GROSS-UPS IN TAX PAYMENTS EXCEPT IN UNUSUAL CIRCUMSTANCES AND ONLY THEN IF APPROVED BY SENIOR MANAGEMENT. IN THIS CASE, $500.00 GIFT CARDS WERE DISTRIBUTED AT CHRISTMAS TO NON-EXECUTIVE EMPLOYEES. THE SENIOR VICE PRESIDENT OF HUMAN RESOURCES APPROVED THE GROSS-UP OF $125.00 PER CARD SO THAT EMPLOYEES WOULD RECEIVE THE FULL STATED BENEFIT OF THE GIFT CARD. METHODS USED BY CCHCS TO ESTABLISH COMPENSATION OF THE CEO/EXEC DIRECTOR PART I, QUESTION 3 COMPENSATION COMMITTEE INDEPENDENT COMPENSATION CONSULTANT WRITTEN EMPLOYMENT CONTRACT COMPENSATION SURVEY OR STUDY APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE A TARRANT COUNTY HEALTH FACILITIES DEVELOPMENT 751881060 875906MV8 2007-06-27 52156976 REFUNDING BONDS 2000 & 2005 false false false B BELL COUNTY HEALTH FACILITIES DEVELOPMENT CORP 742218760 078027HW2 2007-06-27 17523594 REFUNDING BONDS ISSUED 7/19/2000 false false false C TARRANT COUNTY HEALTH FACILITIES DEVELOPMENT 751881060 875906NY1 2010-02-04 231948097 DEVELOPMENT, CONSTR, EQUIPMENT COS false false false D TARRANT COUNTY CULTURAL EDUCATION FACILITIES FINAN 043833551 87638QJC4 2013-08-01 71222592 REFUNDING PORTION OF 2010 BOND SER false false false A 0 0 52156976 0 0 50833752 672932 650292 0 0 0 0 2007 true false true true B 0 0 17523594 0 0 17116642 229475 177477 0 0 0 0 2007 false true true true C 70110000 0 232805916 0 0 0 2686446 0 0 230119470 0 0 2011 false false true true D 0 0 71222592 0 0 70145033 1077553 0 0 0 0 0 2013 true false true true A false false false false 0 false false true B false false false false 0 false false true C false true false false 0.00260 0.00260 true false false true D false false false false 0.00080 0.00000 0.00080 true false false true A false true false false 0 false 0 false true B false true false false 0 false 0 false true C false true true false 0 false 0 false true D false true false false 0 false 0 false true A true B true C true D true TOTAL PROCEEDS OF ISSUE PART II, COLUMN C, LINE 3 TOTAL PROCEEDS INCLUDE INVESTMENT EARNINGS. NO REBATE DUE PART IV, COLUMN A & B, LINE 2C THE REBATE COMPUTATION WAS PERFORMED AS OF 6/27/12. NO REBATE DUE PART IV, COLUMN C, LINE 2C THE REBATE COMPUTATION WAS PERFORMED AS OF 2/4/14. PRIVATE SECURITY/PAYMENT TEST PART III, LINE 7, COLUMNS C & D FOR PURPOSES OF CALCULATING THE PRIVATE SECURITY OR PAYMENT TEST, COOK CHILDREN'S MEDICAL CENTER (CCMC) HAS INCLUDED GROSS RECEIPTS FROM CERTAIN ACTIVITIES THAT CCMC HAS CONCLUDED GENERATE PRIVATE PAYMENTS. CALCULATED IN THAT MANNER, CCMC HAS CONCLUDED THAT THE PRIVATE PAYMENT TEST HAS BEEN MET WITH RESPECT TO THE BOND ISSUES DESCRIBED IN COLUMNS C & D. HOWEVER, THE AMOUNT OF PRIVATE BUSINESS USE WITH RESPECT TO THE BOND ISSUES DESCRIBED IN COLUMNS C & D IS LESS THAN 5%, IN EACH CASE, SO THAT EACH OF THOSE BOND ISSUES FAILS THE PRIVATE BUSINESS USE TEST AND CONTINUES TO MEET THE REQUIREMENTS IMPOSED ON "QUALIFIED 501(C)(3) BONDS." SOLE MEMBER FORM 990 PART VI, QUESTION 6 COOK CHILDREN'S HEALTH CARE SYSTEM, A TEXAS NON-PROFIT CORPORATION, IS THE SOLE MEMBER OF THE ORGANIZATION. MEMBER ELECTION ABILITIES FORM 990 PART VI, QUESTION 7A AS THE SOLE MEMBER OF THE ORGANIZATION COOK CHILDREN'S HEALTH CARE SYSTEM HAS THE POWER TO DETERMINE THE NUMBER OF MEMBERS OF THE BOARD OF TRUSTEES AND TO ELECT THE MEMBERS OF THE BOARD OF TRUSTEES. MEMBER DECISION ABILITIES FORM 990 PART VI, QUESTION 7B As the sole member of the organization, Cook Children's Health Care System has the exclusive power to do any of the following: a. Amend, alter or repeal the bylaws; b. Amend the certificate of formation of the organization; c. Determine the number of members of the Board of Trustees and to elect the members of the Board of Trustees; d. Approve any merger, acquisition, liquidation, winding up, termination or consolidation of the organization; e. Approve the sale, gift or other disposition of all or substantially all of the property of the organization; and f. Approve the creation of, or investment in, any subsidiary entity. REVIEW PROCESS FOR FORM 990 FORM 990 PART VI, QUESTION 11B The organization engages an outside accounting firm to assist in the preparation of the Form 990 and related filings. All information provided to the outside accounting firm is gathered by key company employees and executives. Once the Form 990 is prepared, it is reviewed by company Finance, Legal and Compliance staff and then provided to the Board of Trustees for review. In addition, it is presented to the Cook Children's Health Care System Audit Committee for review. Subsequent to Audit Committee review, the Form 990 is filed with the Internal Revenue Service and made available to the public for review. REVIEW AND APPROVAL OF COMPENSATION FORM 990 PART VI, QUESTION 15A & 15B Cook Children's Health Care System has established a Compensation Committee with oversight of executive and physician compensation. The Compensation Committee approves compensation arrangements in advance, which includes a review and approval by independent persons, using comparable market data relating to compensation, which is provided by Sullivan Cotter and Associates, Inc., an independent, nationally recognized compensation consultant. The Compensation Committee documents the basis for its determinations following contemporaneous substantiation of the Compensation Committee's deliberation and decision. The Compensation Committee requires the compensation consultant to update market data periodically, usually every two years, with interim reviews being conducted as needed. With regard to physician compensation, the Compensation Committee also retains the law firm of McDermott, Will & Emery of Chicago, Illinois, to issue a reasonableness opinion covering the physician compensation plan for Cook Children's Physician Network. PROCESS OF MAKING GOVERNING DOCUMENTS AVAILABLE TO THE PUBLIC FORM 990 PART VI, QUESTION 19 THE ORGANIZATION DOES NOT MAKE ITS GOVERNING DOCUMENTS OR CONFLICT OF INTEREST POLICY AVAILABLE TO THE PUBLIC, EXCEPT TO THE EXTENT THEY ARE ON FILE WITH THE SECRETARY OF STATE OF TEXAS. THE CONFLICT OF INTEREST POLICY IS POSTED ON THE ORGANIZATION'S INTERNAL WEBSITE AND AVAILABLE TO ALL EMPLOYEES AND BOARD MEMBERS OF COOK CHILDREN'S HEALTH CARE SYSTEM ENTITIES. CONSOLIDATED FINANCIAL STATEMENTS ARE REPORTED ELECTRONICALLY FOR ALL COOK CHILDREN'S HEALTH CARE SYSTEM ENTITIES VIA THE ELECTRONIC MUNICIPAL MARKET ACCESS ("EMMA") WEB SITE. DELEGATION OF CONTROL OVER MANAGEMENT FORM 990 PART VI QUESTION 3 A MANAGEMENT COMPANY MANAGES THE DAY TO DAY OPERATIONS OF BOTH OF OUR JOINT VENTURES. WRITTEN CONFLICT OF INTEREST POLICY FORM 990 PART VI, QUESTION 12C Every year the Legal Department of the Cook Children's Health Care System ("System") sends out a Form 990 Questionnaire/Conflict of Interest Disclosure Statement to officers, directors, trustees and key employees of all System companies. The responses are reviewed by the Legal, Finance, and Compliance Departments. Follow up and/or corrective action is taken as needed with respect to responses that indicate the existence of actual or potential conflicts of interest. The responses to the questionnaires and follow-up information are provided to the System Audit Committee for review and follow-up. Further, the Audit Committee of Cook Children's Health Care System is responsible for monitoring the implementation and enforcement of the Conflict of Interest Policy in force for all affiliated companies of the Cook Children's Health Care System. The Audit Committee is also responsible for oversight of the Compliance Department of Cook Children's Health Care System. The Compliance Department maintains a hot-line to receive reports of inappropriate activities including activities that might constitute a conflict of interest. Internal Audit and Compliance also conduct random audits of corporate activities such as expense reimbursements and accounts payable to determine if any inappropriate payments are being made to individuals, some of which could be evidence of a conflict of interest. Any corrective action related to conflicts of interest would be reported to the Audit Committee for review, approval, and modification, as necessary. OTHER CHANGES IN NET ASSETS FORM 990, PART XI, LINE 5 TRANSFERS BETWEEN AFFILIATES ($145,564,012) INTEREST RATE SWAP ADJUSTMENT 3,808,491 -------------- ($141,755,521) COOK CHILDREN'S PHYSICIAN NETWORK 801 SEVENTH AVE FORT WORTH TX 76104 752485366 PHYSICIAN SVC TX 501(C)(3) 3 CCHCS false WI COOK FOUNDATION 801 SEVENTH AVE FORT WORTH TX 76104 752056149 FUNDRAISING TX 501(C)(3) 11D NA false COOK CHILDREN'S HOME HEALTH 801 SEVENTH AVE HOUSTON TX 76104 752896983 HEALTHCARE TX 501(C)(3) 11C CCHCS false COOK CHILDREN'S HEALTH CARE SYSTEM 801 SEVENTH AVE FORT WORTH TX 76104 752705881 HLTH CARE SUP TX 501(C)(3) 11C CCHF false COOK CHILDREN'S HEALTH PLAN 801 SEVENTH AVE FORT WORTH TX 76104 760585240 INSURANCE TX 501(C)(3) 11C CCHCS false ROSEDALE OFFICE BUILDING INC 1500 W ROSEDALE FORT WORTH TX 76104 460866421 TITLE HOLDING TX 501(C)(2) N/A CCHF false COOK CHILDREN'S NORTHEAST HOSPITAL 801 SEVENTH AVE FORT WORTH TX 76104 205227064 HOSPITAL TX NA RELATED 5983072 6410818 false 0 true 0.55135 CENTER FOR PEDIATRIC SURGERY 801 SEVENTH AVE FORT WORTH TX 76104 470871715 ASC TX NA RELATED 7167463 13010179 false 0 false 0.52319 CPS PEDIATRICS LLC 11221 ROE AVE SUITE 320 LEAWOOD KS 66211 470871718 ASC TX NA RELATED 36118 105135 false 0 true 0.52565 COOK CHILDREN'S HEALTH SERVICES INC 801 7TH AVENUE FORT WORTH TX 76104 454024843 HEALTHCARE TX CCHCS C CORPORATION false true false true false true true false false true true true false true false true true true true true COOK CHILDREN'S NORTHEAST HOSPITAL LLC R 6064864 FMV CENTER FOR PEDIATRIC SURGERY LTD R 6943285 FMV