2014-11-13T08:35:35-06:00 2013-12-31 366055558 Grant Thornton LLP 1717 Main Street Suite 1500 Dallas TX 75201 990 2013-01-01 752917570 Anesthesiologists For Children ANES 2144567000 1935 Medical District Drive Dallas TX 75235 Jerry Lee Treasurer, VP Acctng & Rev Cycle 2144567000 2014-11-12 1 Kimberly Temple CPA P00669176 2145612300 2013 2015-11-30 17:44:51Z Jerry Lee 1935 Medical District Dr Dallas TX 75235 24741373 0 X N/A X 2000 TX Provide anesthesia services to patients at Children's Medical Center in Dallas, Texas 6 1 34 0 0 0 10800 16915 24409231 24431606 0 14727 281441 278125 24701472 24741373 0 0 0 0 11218129 10007800 0 0 0 14552287 16110854 25770416 26118654 -1068944 -1377281 4898945 6420394 8910641 11809371 -4011696 -5388977 Provide anesthesia services to patients at Children's Medical Center in Dallas, Texas. These services are provided without regard to patient's ability to pay for the services. 0 0 24867363 24709731 Provide anesthesia services to patients at Children's Medical Center inDallas, Texas. These services are provided without regard to thepatient's ability to pay for the services. 24867363 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 21 0 1 34 1 0 0 0 0 0 0 0 0 0 0 X 6 1 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X Stephanie K Smith 2144567000 1935 Medical District Drive Dallas TX 75235 Desmond Henry MD Chairman, President, Dir. 1.00 50.00 X X 0 140000 0 David Bui MD Director, Anesthesiologist 40.00 X 476080 0 18232 Alan Farrow-Gillespie MD Director 1.00 40.00 X 0 50625 0 Robert Foglia MD Director 1.00 50.00 X 0 150000 0 Charles Whitten MD Director 1.00 X 0 0 0 Thomas Zellers MD Director 1.00 50.00 X 0 150000 0 Jerry Lee Treasurer 1.00 50.00 X 0 318998 23640 Stephanie K Smith Corporate Secretary 1.00 40.00 X 0 110048 4796 Christopher Meggyesy MD Anesthesiologist 40.00 X 482428 0 828 Cynthia Gonzales MD Anesthesiologist 40.00 X 480919 0 3781 Jesse Dadson MD Anesthesiologist 40.00 X 491171 0 5054 Kim Lopez MD Anesthesiologist 40.00 X 488929 0 6834 Weiwei Boone MD Anesthesiologist 40.00 X 480868 0 13032 2900395 919671 76197 24 0 1 0 UTSW 5323 Harry Hines Blvd Dallas TX 75390 Anesthesiologist 14670021 Medac Inc 804 Scott Nixon Memorial Dr Augusta GA 30907 Billing & Prac. Mgmt 563674 Mike C Murphy 1813 Creekside Ct Garland TX 75040 Anesthesiologist 420970 Linda Bolanos Diaz 8088 Parklane Apt 613 Dallas TX 75231 Anesthesiologist 159088 Carol Burns 4423 Hollow Oak Dr Dallas TX 75287 Anesthesiologist 121950 5 16915 16915 Professional Svc Rev 621110 18204672 18204672 Coverage Revenue 621110 7164887 7164887 Prov for Dbtful Accts 621110 -937953 -937953 24431606 14727 14727 Chief Stipend 621110 278125 278125 278125 24741373 24709731 0 14727 X 494312 494312 8483322 8027180 456142 273666 259762 13904 409674 388859 20815 346826 329204 17622 713313 713313 12211 12211 14972049 14971604 445 13418 3708 9710 51510 51510 18326 4132 14194 77011 77007 4 215937 215937 Collection Fees 25082 25082 Catering, Meals, Coffee 11257 6665 4592 Patient Dietary 740 190 550 26118654 24867363 1251291 0 2980856 4431784 1752083 1976345 166006 0 12265 0 12265 4898945 6420394 2345349 3913339 6565292 7896032 8910641 11809371 X -4011696 -5388977 -4011696 -5388977 4898945 6420394 -1377281 0 X 0 1 X 1 0 X 33650 30466 10800 16915 91831 40227440 41463061 49455696 49738411 68819857 249704465 40227440 41496711 49486162 49749211 68836772 249796296 0 0 0 249796296 14727 14727 14727 14727 40227440 41496711 49486162 49749211 68851499 249811023 0.99990 1.00000 0.00010 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 12265 12265 12265 LT Advances-AFC 5502808 LT Receivable/Payable-CMC 2393224 7896032 Part X, Line 2 The Anesthesiologists for Children's consolidated financial statements for the year ending December 31, 2013 do not contain a FIN 48 footnote. 0 1 0 0 0 0 0 1 0 David Bui MD Director, Anesthesiologist 456787 0 0 0 19293 0 0 0 18232 0 494312 0 0 0 Jerry Lee Treasurer 0 254661 0 59795 0 4542 0 9352 0 14289 0 342639 0 0 Christopher Meggyesy MD Anesthesiologist 474190 0 0 0 8238 0 0 0 828 0 483256 0 0 0 Cynthia Gonzales MD Anesthesiologist 471237 0 0 0 9682 0 0 0 3781 0 484700 0 0 0 Jesse Dadson MD Anesthesiologist 469965 0 0 0 21206 0 0 0 5054 0 496225 0 0 0 Kim Lopez MD Anesthesiologist 468184 0 0 0 20745 0 0 0 6834 0 495763 0 0 0 Weiwei Boone MD Anesthesiologist 461986 0 0 0 18882 0 0 0 13032 0 493900 0 0 0 Part I, Line 3 The corporation's (AFC) top management official and other officers are employed and compensated by Children's Medical Center of Dallas (Children's). The Children's process is as follows: 1. The Human Resources Committee of the Board is responsible for setting the compensation for executives, except the President and CEO of Children's, which is set by the Board of Directors. The Committee is comprised of independent, non-employee directors with no conflict of interest regarding executive compensation. A written compensation philosophy has been developed by the Human Resources Committee for timeliness and appropriateness. The philosophy defined desired comparator groups for compensation surveys. The comparator groups are from domestic healthcare industry sectors only and do not include any non-healthcare organizations. 2. The compensation philosophy also defines target levels relative to the marketplace comparator groups for base pay, base pay plus incentive pay, and fringe benefits provided to Children's executives. A third-party consultant, Sullivan Cotter, is engaged by the Human Resources Committee and provides independent, expert consulting services in the area of executive compensation market surveying, pay and benefits program design, and administrative services. Salaries for Children's executives (except for the President and CEO) are set by comparing the salaries paid for comparable positions in integrated systems, academic medical centers, and children's hospitals in similar size and scope of services to Children's. 3. The salary for the President and CEO is set in reference to salaries paid for Presidents and CEOs of children's hospitals in similar size and scope of services to Children's. The data is compiled by Sullivan Cotter and they develop and update annually salary ranges unique to each executive position. The Human Resources Committee approves base pay for each executive (except the President and CEO, whose base pay is approved by the Board of Directors) aimed in the aggregate at approximately the middle of executive pay ranges. 4. For other officers and key employees, Children's uses a combination of job evaluation and survey data to determine the market pay range. Part I, Line 4b Non-Qualified Retirement Plan: * Children's Medical Center of Dallas Savings Restoration Plan - There were no employees that received taxable income from the Savings Restoration Plan. Jerry Lee participated in the Savings Restoration Plan. Part I, Line 7 Non-Fixed Payments - The Human Resources Committee of the Board of Directors retains the authority to adjust annual payout percentages solely at their discretion. Form 990, Part VI, Section A, line 6 Children's Medical Center of Dallas (Children's) is the sole member. Form 990, Part VI, Section A, line 7a Directors are appointed by the sole member and approved by the current AFC Board of Directors. Form 990, Part VI, Section A, line 7b Sole member reserve powers are specified in AFC's bylaws and represent actions by the organization which require sole member approval. These powers generally include specified financial decisions, appointment of directors, and strategic planning. Form 990, Part VI, Section B, line 11 The draft Form 990 is presented to the Board of Directors by their treasurer at either a scheduled meeting or sent electronically for their review. Form 990, Part VI, Section B, line 12c Directors execute a conflict of interest disclosure statement each year at the annual meeting of the AFC Board of Directors. Any disclosures made in the statements are presented to the Board of Directors for discussion and review at that time. Form 990, Part VI, Section B, line 15 The corporation's (AFC) top management official and other officers are employed and compensated by Children's Medical Center of Dallas (Children's). The Children's process is as follows: 1. The Human Resources Committee of the Board is responsible for setting the compensation for executives, except the President and CEO of Children's, which is set by the Board of Directors. The Committee is comprised of independent, non-employee directors with no conflict of interest regarding executive compensation. A written compensation philosophy has been developed by the Human Resources Committee for timeliness and appropriateness. The philosophy defined desired comparator groups for compensation surveys. The comparator groups are from domestic healthcare industry sectors only and do not include any non-healthcare organizations. 2. The compensation philosophy also defines target levels relative to the marketplace comparator groups for base pay, base pay plus incentive pay, and fringe benefits provided to Children's executives. A third-party consultant, Sullivan Cotter, is engaged by the Human Resources Committee and provides independent, expert consulting services in the area of executive compensation market surveying, pay and benefits program design, and administrative services. Salaries for Children's executives (except for the President and CEO) are set by comparing the salaries paid for comparable positions in integrated systems, academic medical centers, and children's hospitals in similar size and scope of services to Children's. 3. The salary for the President and CEO is set in reference to salaries paid for Presidents and CEOs of children's hospitals in similar size and scope of services to Children's. The data is compiled by Sullivan Cotter and they develop and update annually salary ranges unique to each executive position. The Human Resources Committee approves base pay for each executive (except the President and CEO, whose base pay is approved by the Board of Directors) aimed in the aggregate at approximately the middle of executive pay ranges. 4. For other officers and key employees, Children's uses a combination of job evaluation and survey data to determine the market pay range. For physicians, AFC retains an outside compensation survey data to provide compensation analysis regarding the fair market value of AFC's salary structure, which is presented to the AFC Board of Directors for approval. Form 990, Part VI, Section C, line 19 The governing documents, conflict of interest policy, and financial statements are made available to the public when they are requested. Form 990, Part IX, line 11g Contract Medical: Program service expenses 14,392,574. Management and general expenses 0. Fundraising expenses 0. Total expenses 14,392,574. Consulting & Professional fees: Program service expenses 579,030. Management and general expenses 445. Fundraising expenses 0. Total expenses 579,475. Children's Medical Center of Dallas 1935 Medical District Drive Dallas TX 75235 750800628 Hospital TX 501(c)(3) Line 3 Children's Hlth Svc of TX 0 Children's Medical Center Foundation 1935 Medical District Drive Dallas TX 75235 752062015 Foundation TX 501(c)(3) Line 7 Children's Hlth Svc of TX 0 Dallas Phys Med Svcs Inc 1935 Medical District Drive Dallas TX 75235 810584868 Physicians TX 501(c)(3) Line 9 Children's Medical Center of Dallas 0 Children's Health Svc of Texas 1935 Medical District Drive Dallas TX 75235 752062019 Management Company TX 501(c)(3) Line 11a, I N/A 0 Physicians For Children 1935 Medical District Drive Dallas TX 75235 752854505 Physicians TX 501(c)(3) Line 9 Children's Medical Center of Dallas 0 Children's Med Ctr Research Inst at UTSWMC 1935 Medical District Drive Dallas TX 75235 433462044 Research Institute TX 501(c)(3) Line 11a, I Children's Hlth Svc of TX 0 Complex Care Med Svcs Corp 1935 Medical District Drive Dallas TX 75235 461893597 Medical Services TX Pending Pending Children's Medical Center of Dallas 0 Pediatric Partners For Children 1935 Medical District Drive Dallas TX 75235 461917702 Clinically Integrated Network TX Pending Pending Children's Medical Center of Dallas 0 Children's Medical Center Services 1935 Medical District Drive Dallas TX 75235 461934007 Medical Services TX Pending Pending Children's Medical Center of Dallas 0 Children's Medical Center Health Plan 1935 Medical District Drive Dallas TX 75235 462737696 HMO TX Pending Pending Children's Hlth Svc of TX 0 Children's Population Health 1935 Medical District Drive Dallas TX 75235 463104601 Population Health TX Pending Pending Children's Hlth Svc of TX 0 The Health and Wellness Alliance For Children 1935 Medical District Drive Dallas TX 75235 463080586 Physicians TX 501(c)(3) Line 11a, I Children's Hlth Svc of TX 0 Specialists For Children 1935 Medical District Drive Dallas TX 75235 463110125 Physicians TX Pending Pending Children's Medical Center of Dallas 0 Physicians Quality Alliance of North Texas 1935 Medical District Drive Dallas TX 75235 464049491 Physicians TX Pending Pending Children's Hlth Svc of TX 0 Community Providers for Children 1935 Medical District Drive Dallas TX 75235 463675742 Physicians TX Pending Pending Children's Hlth Svc of TX 0 Southwestern Medical District 1935 Medical District Drive Dallas TX 75235 204101612 Medical District TX 501(c)(3) Line 11a, I N/A 0 Women's Auxiliary of CMCD 1935 Medical District Drive Dallas TX 75235 752485538 Women's Auxiliary TX 501(c)(3) Line 9 N/A 0 Children's Insurance Company 76 St Paul Street Suite 500 Burlington VT 05401 030328102 Insurance Company VT Children's Medical Center of Dallas C 0 Alternative Care Systems 1935 Medical District Drive Dallas TX 75235 752244475 Other Medical Services TX Children's Hlth Svc of TX C 0 0 0 1 0 1 0 0 0 0 0 0 1 0 1 1 1 0 0 0