2013-11-13T09:05:11-06:00 2012-12-31 366055558 Grant Thornton LLP 1717 Main Street Suite 1500 Dallas TX 75201 990 2012-01-01 752917570 Anesthesiologists For Children ANES 2144567000 1935 Medical District Drive Dallas TX 75235 Jerry Lee 2144567000 2013-11-13 1 Kimberly Temple CPA P00669176 2145612300 2012 2016-02-24 21:20:13Z Jerry Lee 1935 Medical District Dr Dallas TX 75235 24701472 0 X N/A X 2000 TX Provide anesthesia services to patients at Children's Medical Center in Dallas, Texas 7 2 33 0 0 0 30466 10800 25164293 24409231 0 0 231475 281441 25426234 24701472 0 0 0 0 11404880 11218129 0 0 0 14722705 14552287 26127585 25770416 -701351 -1068944 5113435 4898945 8056187 8910641 -2942752 -4011696 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 24831298 24690672 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. 24831298 1 1 0 0 0 0 0 0 0 0 0 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 24 0 1 33 1 0 0 0 0 0 0 0 0 0 0 X 7 2 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 1 0 X Stephanie K Smith 2144567000 1935 Medical District Drive Dallas TX 75235 Julio Perez-Fontan MD 1.00 55.00 X X 0 480000 0 Desmond Henry MD 1.00 40.00 X X 0 151875 0 David Bui MD 40.00 0.00 X 470358 0 11638 Alan Farrow-Gillespie MD 1.00 0.00 X 0 0 0 Charles Whitten MD 1.00 0.00 X 0 0 0 Robert Foglia MD 1.00 40.00 X 0 150000 0 Thomas Zellers MD 1.00 50.00 X 0 150000 0 Jerry Lee 1.00 50.00 X 0 291531 13939 Stephanie K Smith 1.00 40.00 X 0 102713 744 Christopher Meggyesy MD 40.00 0.00 X 557819 0 3537 Shannon Roden MD 40.00 0.00 X 512577 0 4673 Stephen Hoang MD 40.00 0.00 X 504326 0 3534 Jesse Dadson MD 40.00 0.00 X 500885 0 16051 Hadi Sakhai MD 40.00 0.00 X 500523 0 8287 3046488 1326119 62403 25 0 1 0 UTSW 5323 Harry Hines Blvd Dallas TX 75390 Anesthesiologist 11668062 Mike C Murphy 1813 Creekside Ct Garland TX 75040 Anesthesiologist 583123 Medac Inc 804 Scott Nixon Memorial Dr Augusta GA 30907 Billing & Prac. Mgmt 547112 Medical Pro 23257 Network Place Chicago IL 60673 Risk Mgmt Insurance 180429 Carol Burns MD 4423 Hollow Oak Dr Dallas TX 75287 Anesthesiologist 142450 7 10800 10800 Professional Svc Rev 621110 17026891 17026891 Coverage Revenue 621110 8503085 8503085 Prov for Dbtful Accts 621110 -1120745 -1120745 24409231 Chief Stipend 621110 281441 281441 281441 24701472 24690672 0 0 X 481997 481997 9711404 9465002 246402 284415 277540 6875 376664 367579 9085 363649 354859 8790 648538 648538 2500 2500 13456622 13456622 22465 15542 6923 14908 14908 419 419 20806 11278 9528 76291 75925 366 264150 264150 Collection Fees 37269 37269 Catering, Meals, Coffee 4790 2627 2163 Business Relations 3529 3500 29 25770416 24831298 939118 0 2225822 2980856 2681862 1752083 205751 166006 5113435 4898945 2330151 2345349 5726036 6565292 8056187 8910641 X -2942752 -4011696 -2942752 -4011696 5113435 4898945 -1068944 0 X 0 1 X 1 0 X 33650 30466 10800 74916 32691710 40227440 41463061 49455696 49738411 213576318 32691710 40227440 41496711 49486162 49749211 213651234 0 0 0 213651234 32691710 40227440 41496711 49486162 49749211 213651234 1.00000 1.00000 0.00000 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 LT Advances-AFC 5502808 LT Receivable/Payable-CMC 1062484 6565292 Part X, Line 2: The Anesthesiologists for Children's consolidated financial statements for the year ending December 31, 2012 do not contain a FIN 48 footnote. 0 0 0 0 0 0 0 1 0 Julio Perez-Fontan MD 0 480000 0 0 0 0 0 0 0 0 0 480000 0 0 Desmond Henry MD 0 151875 0 0 0 0 0 0 0 0 0 151875 0 0 David Bui MD 463380 0 0 0 6978 0 0 0 11638 0 481996 0 0 0 Jerry Lee 0 247110 0 40688 0 3733 0 9529 0 4410 0 305470 0 0 Christopher Meggyesy MD 471482 0 0 0 86337 0 0 0 3537 0 561356 0 0 0 Shannon Roden MD 470346 0 0 0 42231 0 0 0 4673 0 517250 0 0 0 Stephen Hoang MD 471484 0 0 0 32842 0 0 0 3534 0 507860 0 0 0 Jesse Dadson MD 458967 0 0 0 41918 0 0 0 16051 0 516936 0 0 0 Hadi Sakhai MD 466731 0 0 0 33792 0 0 0 8287 0 508810 0 0 0 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 Children's 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 15b The top management official and officers of Anesthesiologists For Children (AFC) receive no compensation from AFC. For physicians, AFC obtains an outside consulting company to provide compensation analysis regarding the fair market value of AFC's salary structure, which is presented to the 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. Other Fees Form 990, Part IX, line 11g Contract Medical: Program service expenses 12,993,575. Management and general expenses 0. Fundraising expenses 0. Total expenses 12,993,575. Consulting & Professional fees: Program service expenses 463,047. Management and general expenses 0. Fundraising expenses 0. Total expenses 463,047. 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 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 Dallas Phys Medical Svs for Children 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 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 Children's Med Ctr Research Inst at UTSWMC 1935 Medical District Drive Dallas TX 75235 433462044 Research Institute TX Pending Pending Children's Hlth Svc of TX 0 Complex Care Medical Services 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 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 N/A C 0 Alternative Care Systems 1935 Medical District Drive Dallas TX 75235 752244475 Other Medical Services TX N/A C 0 0 0 0 0 1 0 0 0 0 0 0 1 0 1 1 1 0 0 1