DRISCOLL CHILDRENS HEALTH PLAN: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization
DRISCOLL CHILDRENS HEALTH PLAN (EIN 74-2838488)
Tax period
2012-01-01 to 2012-12-31
Filed
2013-10-30
IRS object ID
201343039349300904
Schema version
2012v2.1
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)
Timestamp2013-10-30T10:22:24-05:00Timestamp
Tax Period End Date2012-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1BKD LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line12800 Post Oak Blvd Ste 3200AddressLine1
CityHOUSTONCity
StateTXState
ZIP Code77056ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2012-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN742838488EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1Driscoll Childrens Health PlanBusinessNameLine1
FieldValueIRS element (for citing)
In Care Of Name% RICK VILLARREALInCareOfName
Name ControlDRISNameControl
Phone3616944889Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1615 N Upper Broadway StAddressLine1
Address Line2Suite 1621AddressLine2
CityCorpus ChristiCity
StateTXState
ZIP Code784010746ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameMARY D PETERSONName
TitleCEOTitle
Phone3616946781Phone
Date Signed2012-11-15DateSigned
Authorize Third PartytrueAuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameM Paige GerichName
Phone7134994600Phone
FieldValueIRS element (for citing)
Tax Year2012TaxYear
Build TS2016-02-25 16:41:14ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonDR MARY DALE PETERSONNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1615 N UPPER BROADWAY ST 1621AddressLine1
CityCORPUS CHRISTICity
StateTXState
ZIP Code784010746ZIPCode
FieldValueIRS element (for citing)
Gross Receipts295529666GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.DCHPKIDS.COMWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1997YearFormation
State Legal DomicileTXStateLegalDomicile
Activity Or Mission DescriptionDriscoll Children's Health Plan is committed to providing efficient, cost-effective, quality care through a dedicated and compassionate health care team & respectful collaboration with its provider network.ActivityOrMissionDescription
Nbr Voting Members Governing Body9NbrVotingMembersGoverningBody
Nbr Independent Voting Members4NbrIndependentVotingMembers
Total Nbr Employees108TotalNbrEmployees
Total Gross UBI0TotalGrossUBI
Contributions Grants Prior Year185751ContributionsGrantsPriorYear
Contributions Grants Current Year162643ContributionsGrantsCurrentYear
Program Service Revenue Prior Year150430135ProgramServiceRevenuePriorYear
Program Service Revenue CY290937187ProgramServiceRevenueCY
Investment Income Prior Year679637InvestmentIncomePriorYear
Investment Income Current Year540177InvestmentIncomeCurrentYear
Other Revenue Prior Year0OtherRevenuePriorYear
Other Revenue Current Year0OtherRevenueCurrentYear
Total Revenue Prior Year151295523TotalRevenuePriorYear
Total Revenue Current Year291640007TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year3751231SalariesEtcPriorYear
Salaries Etc Current Year7191751SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year143765392OtherExpensePriorYear
Other Expenses Current Year262482264OtherExpensesCurrentYear
Total Expenses Prior Year147516623TotalExpensesPriorYear
Total Expenses Current Year269674015TotalExpensesCurrentYear
Revenues Less Expenses Prior Year3778900RevenuesLessExpensesPriorYear
Revenues Less Expenses CY21965992RevenuesLessExpensesCY
Total Assets BOY37384603TotalAssetsBOY
Total Assets EOY67073622TotalAssetsEOY
Total Liabilities BOY17744195TotalLiabilitiesBOY
Total Liabilities EOY32854447TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY19640408NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY34219175NetAssetsOrFundBalancesEOY
Mission DescriptionDRISCOLL CHILDREN'S HEALTH PLAN IS COMMITTED TO PROVIDING EFFICIENT, COST-EFFECTIVE, QUALITY CARE THROUGH A DEDICATED & COMPASSIONATE HEALTHCARE TEAM & RESPECTFUL COLLABORATION WITH ITS PROVIDER NETWORK.MissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense244586155Expense
Revenue290937187Revenue
DescriptionSEE SCHEDULE O FOR FULL PROGRAM SERVICE DESCRIPTION.Description
Total Program Service Expense244586155TotalProgramServiceExpense
Described In501 C3trueDescribedIn501C3
Schedule B RequiredtrueScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Lobbying ActivitiestrueLobbyingActivities
Donor Advised FundsfalseDonorAdvisedFunds
Conservation EasementsfalseConservationEasements
Collections Of ArtfalseCollectionsOfArt
Credit CounselingfalseCreditCounseling
Term Or Permanent EndowmentsfalseTermOrPermanentEndowments
Report Land Bldg EquiptrueReportLandBldgEquip
Report Invest Oth SecuritiestrueReportInvestOthSecurities
Report Prog Rel InvestfalseReportProgRelInvest
Report Other AssetstrueReportOtherAssets
Report Other LiabilitiestrueReportOtherLiabilities
Report Fin48 FootnotefalseReportFin48Footnote
Independent Audit Financial StmttrueIndependentAuditFinancialStmt
Consolidated Audit Financial StmttrueConsolidatedAuditFinancialStmt
SchoolfalseSchool
Foreign OfficefalseForeignOffice
Foreign ActivitiesfalseForeignActivities
More Than5000 K To OrganizationsfalseMoreThan5000KToOrganizations
More Than5000 K To IndividualsfalseMoreThan5000KToIndividuals
Professional FundraisingfalseProfessionalFundraising
Fundraising ActivitiesfalseFundraisingActivities
GamingfalseGaming
HospitalfalseHospital
Grants To OrganizationsfalseGrantsToOrganizations
Grants To IndividualsfalseGrantsToIndividuals
Schedule J RequiredtrueScheduleJRequired
Tax Exempt BondsfalseTaxExemptBonds
Excess Benefit TransactionfalseExcessBenefitTransaction
Prior Excess Benefit TransactionfalsePriorExcessBenefitTransaction
Loan To Officer Or DQPfalseLoanToOfficerOrDQP
Grant To Related PersonfalseGrantToRelatedPerson
Bsnss Rltnshp With OrganizationfalseBsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family MemberfalseBsnssRltnshpThruFamilyMember
Officer Entity With Bsnss RltnshpfalseOfficerEntityWithBsnssRltnshp
Deductible Non Cash ContributionsfalseDeductibleNonCashContributions
Deductible Contributions Of ArtfalseDeductibleContributionsOfArt
TerminatedfalseTerminated
Partial LiquidationfalsePartialLiquidation
Disregarded EntityfalseDisregardedEntity
Related EntitytrueRelatedEntity
Related Org Controlled EntityfalseRelatedOrgControlledEntity
Transfers To Exempt Non Chrtbl OrgfalseTransfersToExemptNonChrtblOrg
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Number Forms Transmitted With10960NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Number Of Employees108NumberOfEmployees
Employment Tax Returns FiledtrueEmploymentTaxReturnsFiled
Unrelated Business IncomefalseUnrelatedBusinessIncome
Foreign Financial AccountfalseForeignFinancialAccount
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Non Deductible ContributionsfalseNonDeductibleContributions
Quid Pro Quo ContributionsfalseQuidProQuoContributions
Form8282 Property Disposed OffalseForm8282PropertyDisposedOf
Funds To Pay PremiumsfalseFundsToPayPremiums
Premiums PaidfalsePremiumsPaid
Indoor Tanning ServicesfalseIndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members9NbrVotingGoverningBodyMembers
Number Independent Voting Members4NumberIndependentVotingMembers
Family Or Business RelationshipfalseFamilyOrBusinessRelationship
Delegation Of Management DutiesfalseDelegationOfManagementDuties
Changes To Organizing DocsfalseChangesToOrganizingDocs
Material Diversion Or MisusefalseMaterialDiversionOrMisuse
Members Or StockholderstrueMembersOrStockholders
Election Of Board MemberstrueElectionOfBoardMembers
Decisions Subject To ApprovaltrueDecisionsSubjectToApproval
Minutes Of Governing BodytrueMinutesOfGoverningBody
Minutes Of CommitteestrueMinutesOfCommittees
Officer Mailing AddressfalseOfficerMailingAddress
Local ChaptersfalseLocalChapters
Form990 Provided To Governing BodytrueForm990ProvidedToGoverningBody
Conflict Of Interest PolicytrueConflictOfInterestPolicy
Annual Disclosure Covered PersonstrueAnnualDisclosureCoveredPersons
Regular Monitoring EnforcementtrueRegularMonitoringEnforcement
Whistleblower PolicytrueWhistleblowerPolicy
Document Retention PolicytrueDocumentRetentionPolicy
Compensation Process CEOtrueCompensationProcessCEO
Compensation Process OthertrueCompensationProcessOther
Investment In Joint VenturefalseInvestmentInJointVenture
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonRICK VILLARREALNamePerson
Telephone Number3616946781TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1615 N UPPER BROADWAY ST STE 1621AddressLine1
CityCorpus ChristiCity
StateTXState
ZIP Code78401ZIPCode
FieldValueIRS element (for citing)
Info In Schedule O Part VIIXInfoInScheduleOPartVII

Form990 Part VII Section A Form990PartVIISectionA (14 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekAverage Hours Per Week RelatedAverageHoursPerWeekRelatedIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationOther CompensationOtherCompensationReportable Comp From Related OrgsReportableCompFromRelatedOrgsKey EmployeeKeyEmployeeHighest Compensated EmployeeHighestCompensatedEmployee
WILLIAM J STERETT
CHAIRMAN OF THE BOARD1.02.0XX00
D ERIC HAMON
SECRETARY/TREASURER1.040.0XX403658194712
C IVAN WILSON
DIRECTOR1.02.0X10000
JOE FULTON
DIRECTOR1.02.0X10000
MARY D PETERSON
PRESIDENT/CEO40.010.0XX35603962406
STEVE WOERNER
DIRECTOR1.040.0X91136843151
S LOYD NEAL JR
DIRECTOR1.02.0X10000
ERNEST BUCK
MEDICAL DIRECTOR40.01.0X22910215508
WILLIAM BRENDEL
ASSOCIATE MEDICAL DIRECTOR40.01.0X1810018022
RICARDO VILLARREAL
VICE PRESIDENT OF FINANCE40.01.020824321958X
JUDITH KRAFT
EXECUTIVE DIRECTOR QUALITY IMP40.01.011869013892X
DON WELLS
CREDENTIAL PROVIDER RELATIONS40.01.01288863869X
HEATHER JOHNSON
DIRECTOR OF UTILIZATION MGMT40.01.011099818928X
MICHAEL P LANCE
VICE PRESIDENT DCHP40.01.01631385485X
FieldValueIRS element (for citing)
Total Reportable Comp From Org1496097TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs1067863TotalReportableCompFrmRltdOrgs
Total Other Compensation644862TotalOtherCompensation
Number Individuals GT100 K8NumberIndividualsGT100K
Formers ListedfalseFormersListed
Total Comp GT150 KtrueTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
VALENCE HEALTH
600 W JACKSON SUITE 800CHICAGOIL60661THIRD PARTY ADMIN10588343
AVANCE RIO GRANDE VALLEY
1205 S Galveston RdMCALLENTX78501PATIENT EDUCATION216265
CORPORATE PRINTING INC
3509 OAK FOREST DRHOUSTONTX77018PRINTING1199242
ALLIED MANAGEMENT GROUP INC
825 N PARKCENTER DR STE 102SANTA ANACA92705SIU SERVICES470089
Sherry Matthews Advocacy Marketing
200 South Congress AvenueAUSTINTX78704ADVERTISING740556
FieldValueIRS element (for citing)
Number Of Contractors GT100 K10NumberOfContractorsGT100K
Government Grants162643GovernmentGrants
Total Contributions162643TotalContributions

Program Service Revenue ProgramServiceRevenue (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
PREMIUM REVENUE524292291064060291064060
Net Reinsurance524292-1230424-1230424
Other Income90009911035511103551
FieldValueIRS element (for citing)
Total Program Service Revenue290937187TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column441183TotalRevenueColumn
Exclusion$441,183ExclusionAmount

Income From Invest Bond Proceeds IncomeFromInvestBondProceeds

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Royalties Revenue RoyaltiesRevenue

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real0Real
Personal0Personal

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities3988653Securities

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities3889659Securities

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities98994Securities

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column98994TotalRevenueColumn
Exclusion$98,994ExclusionAmount

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income From Gaming NetIncomeFromGaming

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Total Revenue Column0TotalRevenueColumn

Net Income Or Loss NetIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn
FieldValueIRS element (for citing)
Total Other Revenue0TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column291640007TotalRevenueColumn
Related Or Exempt Function Income290937187RelatedOrExemptFunctionIncome
Exclusion$540,177ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total0Total

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total0Total

Foreign Grants ForeignGrants

FieldValueIRS element (for citing)
Total0Total

Benefits To Members BenefitsToMembers

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Total0Total

Comp Current Officers Directors CompCurrentOfficersDirectors

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Total1082279Total
Program Services1082279ProgramServices
Fundraising0Fundraising

Comp Disqual Persons CompDisqualPersons

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Total0Total
Fundraising0Fundraising

Other Salaries And Wages OtherSalariesAndWages

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Total4972279Total
Program Services1523214ProgramServices
Management And General3449065ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total161254Total
Program Services28311ProgramServices
Management And General132943ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total578925Total
Program Services219986ProgramServices
Management And General358939ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total397014Total
Program Services166746ProgramServices
Management And General230268ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total12397199Total
Program Services1278085ProgramServices
Management And General11119114ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total100820Total
Management And General100820ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

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Total0Total

Fees For Services Lobbying FeesForServicesLobbying

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Total0Total

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total0Total

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total2000Total
Management And General2000ManagementAndGeneral

Fees For Services Other FeesForServicesOther

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Total3231958Total
Management And General3231958ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total1017532Total
Management And General1017532ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total1465047Total
Management And General1465047ManagementAndGeneral

Information Technology InformationTechnology

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Total309518Total
Management And General309518ManagementAndGeneral

Royalties Royalties

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Total0Total

Occupancy Occupancy

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Total281575Total
Management And General281575ManagementAndGeneral

Travel Travel

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Total161336Total
Management And General161336ManagementAndGeneral

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

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Total0Total

Conferences Meetings ConferencesMeetings

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Total0Total

Interest Interest

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Payments To Affiliates PaymentsToAffiliates

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Total0Total

Depreciation Depletion DepreciationDepletion

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Total62356Total
Management And General62356ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total119642Total
Management And General119642ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesFundraisingFundraisingManagement And GeneralManagementAndGeneral
Medical Expenses2355406822355406820
Premium Taxes51596224746852412770
Member Value Add Expense986382986382
Misc Expense324571324571

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total1322024Total
Management And General1322024ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total269674015Total
Program Services244586155ProgramServices
Management And General25087860ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY3331896BOY
EOY31774595EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

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BOY6808484BOY
EOY4507715EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

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BOY0BOY
EOY0EOY

Accounts Receivable AccountsReceivable

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BOY1766847BOY
EOY4372982EOY

Receivables From Officers Etc ReceivablesFromOfficersEtc

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BOY0BOY
EOY0EOY

Receivables From Disqual Persons ReceivablesFromDisqualPersons

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

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BOY0BOY
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Inventories For Sale Or Use InventoriesForSaleOrUse

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BOY0BOY
EOY0EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

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BOY0BOY
EOY0EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis2625223LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec2523977LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

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BOY169912BOY
EOY101246EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

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BOY0BOY
EOY0EOY

Investments Other Securities InvestmentsOtherSecurities

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BOY25307464BOY
EOY23080468EOY

Investments Program Related InvestmentsProgramRelated

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Intangible Assets IntangibleAssets

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BOY0BOY
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Other Assets Total OtherAssetsTotal

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BOY0BOY
EOY3236616EOY

Total Assets TotalAssets

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BOY37384603BOY
EOY67073622EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

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BOY13847875BOY
EOY27183000EOY

Grants Payable GrantsPayable

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BOY0BOY
EOY0EOY

Deferred Revenue DeferredRevenue

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BOY0BOY
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Tax Exempt Bond Liabilities TaxExemptBondLiabilities

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BOY0BOY
EOY0EOY

Escrow Account Liability EscrowAccountLiability

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EOY0EOY

Loans From Officers Directors LoansFromOfficersDirectors

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

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EOY0EOY

Unsecured Notes Loans Payable UnsecuredNotesLoansPayable

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BOY0BOY
EOY0EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY3896320BOY
EOY5671447EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY17744195BOY
EOY32854447EOY
FieldValueIRS element (for citing)
Do Not Follow SFAS117XDoNotFollowSFAS117

Cap Stck Trst Prin Current Funds CapStckTrstPrinCurrentFunds

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Paid In Cap Srpls Land Bldg Eqp Fund PaidInCapSrplsLandBldgEqpFund

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BOY0BOY
EOY0EOY

Retained Earnings Endowment Etc RetainedEarningsEndowmentEtc

FieldValueIRS element (for citing)
BOY19640408BOY
EOY34219175EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY19640408BOY
EOY34219175EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY37384603BOY
EOY67073622EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses21965992ReconcilationRevenueExpenses
Reconciliation Unrealized Invest115567ReconciliationUnrealizedInvest
Reconcilation Other Changes-7502792ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedtrueFSAudited

FS Audited Basis FSAuditedBasis

FieldValueIRS element (for citing)
Financial Statement BothXFinancialStatementBoth
FieldValueIRS element (for citing)
Audit CommitteefalseAuditCommittee
Federal Grant Audit RequiredtrueFederalGrantAuditRequired
Federal Grant Audit PerformedtrueFederalGrantAuditPerformed

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org509a2XPubliclySupportedOrg509a2

Gifts Grants Contrib Received509 GiftsGrantsContribReceived509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years103906CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years357701CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years423224CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year185751CurrentTaxYearMinus1Year
Current Tax Year162643CurrentTaxYear
Total1233225Total

Gross Receipts From Admissions GrossReceiptsFromAdmissions

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years56299110CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years134848007CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years152114133CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year150430135CurrentTaxYearMinus1Year
Current Tax Year290937187CurrentTaxYear
Total784628572Total

Gross Receipts From Non UBI GrossReceiptsFromNonUBI

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Total0Total

Tax Rev Levied For Org Benefit509 TaxRevLeviedForOrgBenefit509

FieldValueIRS element (for citing)
Total0Total

Value Of Svcs Fclts Furnishd By Govt ValueOfSvcsFcltsFurnishdByGovt

FieldValueIRS element (for citing)
Total0Total

Total509 Total509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years56403016CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years135205708CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years152537357CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year150615886CurrentTaxYearMinus1Year
Current Tax Year291099830CurrentTaxYear
Total785861797Total

Amts Recd From Disqual Persons AmtsRecdFromDisqualPersons

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Total0Total

Amts From Subst Contributors AmtsFromSubstContributors

FieldValueIRS element (for citing)
Total0Total

Support From DQ Ps Etc SupportFromDQPsEtc

FieldValueIRS element (for citing)
Total0Total
FieldValueIRS element (for citing)
Public Support Total509785861797PublicSupportTotal509

Gross Investment Income509 GrossInvestmentIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years336324CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years254370CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years362081CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year525837CurrentTaxYearMinus1Year
Current Tax Year441183CurrentTaxYear
Total1919795Total

Post1975 UBTI Post1975UBTI

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Total0Total

Investment Income And UBTI InvestmentIncomeAndUBTI

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years336324CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years254370CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years362081CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year525837CurrentTaxYearMinus1Year
Current Tax Year441183CurrentTaxYear
Total1919795Total

Net Income From Other UBI NetIncomeFromOtherUBI

FieldValueIRS element (for citing)
Total0Total

Other Income509 OtherIncome509

FieldValueIRS element (for citing)
Total0Total

Total Support Total TotalSupportTotal

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years56739340CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years135460078CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years152899438CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year151141723CurrentTaxYearMinus1Year
Current Tax Year291541013CurrentTaxYear
Total787781592Total
FieldValueIRS element (for citing)
First5 Years509XFirst5Years509
Public Support Percentage5090.00000PublicSupportPercentage509

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Political Expenditures0PoliticalExpenditures
Amt Of4955 Tax0AmtOf4955Tax
Total Grassroots LobbyingTotalGrassrootsLobbying
Total Direct LobbyingTotalDirectLobbying
Total Lobbying ExpendituresTotalLobbyingExpenditures
Other Exempt Purpose ExpendituresOtherExemptPurposeExpenditures
Total Exempt Purpose ExpendituresTotalExemptPurposeExpenditures
Lobbying NontaxableLobbyingNontaxableAmount
Grassroots NontaxableGrassrootsNontaxableAmount
Tot Lobbying Grassroot Minus Non TxTotLobbyingGrassrootMinusNonTx
Tot Lobby Expend Mns Lobbying NontxTotLobbyExpendMnsLobbyingNontx
VolunteersfalseVolunteers
Paid Staff Or ManagementfalsePaidStaffOrManagement
Media AdvertisementsfalseMediaAdvertisements
Mailings MembersfalseMailingsMembers
Publications Or BroadcastfalsePublicationsOrBroadcast
Grants Other OrganizationstrueGrantsOtherOrganizations
Grants Other Organizations$89,912GrantsOtherOrganizationsAmount
Direct Contact LegislatorsfalseDirectContactLegislators
Rallies DemonstrationsfalseRalliesDemonstrations
Other ActivitiesfalseOtherActivities
Total Lobbying Expenditures IIB89912TotalLobbyingExpendituresIIB
Not Described In501c3falseNotDescribedIn501c3
Amount To Be Carried Over0AmountToBeCarriedOver

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Art Public Exhibition AmtsArtPublicExhibitionAmts
Held Works Of Art AmtsHeldWorksOfArtAmts
Current Year Minus3 YearsCurrentYearMinus3Years
Current Year Minus4 YearsCurrentYearMinus4Years
LandLand
BuildingsBuildings
Leasehold ImprovementsLeaseholdImprovements

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis2625223OtherCostOrOtherBasis
Depreciation2525977Depreciation
Book Value101246BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis0OtherCostOrOtherBasis
Depreciation0Depreciation
Book Value0BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings101246TotalOfBookValueLandBuildings
Financial DerivativesFinancialDerivatives
Closely Held Equity InterestsCloselyHeldEquityInterests

Other Securities OtherSecurities

FieldValueIRS element (for citing)
DescriptionVANGUARD - MUTUAL FUNDSDescription
Book Value23080468BookValue
Method Of ValuationFMethodOfValuation
FieldValueIRS element (for citing)
Total Of Book Value Securities23080468TotalOfBookValueSecurities

Other Assets OtherAssets (2 entries)

DescriptionDescriptionBook ValueBookValue
Due from Driscoll Health Sys1971616
DEPOSITS1265000
FieldValueIRS element (for citing)
Total Book Value Other Assets3236616TotalBookValueOtherAssets
Federal Income Tax Liability0FederalIncomeTaxLiability

Other Liabilities OtherLiabilities (3 entries)

DescriptionDescriptionAmountAmount
Rebate Liability$5,604,817
DUE TO DVPG$29,392
Due to Affiliate$37,238
FieldValueIRS element (for citing)
Total Of Amounts5671447TotalOfAmounts
Tot Revenue Etc Audited Fincl Stmt290555674TotRevenueEtcAuditedFinclStmt
Revenue Subtotal290555674RevenueSubtotal
Other Revenues Not Included1084333OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt1084333RevenueNotRptdOnFinStmt
Total Revenue Per Form990291640007TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt268589682TotExpensesEtcAuditedFinclStmt
Expenses Subtotal268589682ExpensesSubtotal
Other Expenses Not Included1084333OtherExpensesNotIncluded
Expenses Not Rptd On Fin Stmt1084333ExpensesNotRptdOnFinStmt
Total Expenses Per Form990269674015TotalExpensesPerForm990

Form990 Schedule D Part XIII Form990ScheduleDPartXIII (2 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
RECONCILIATION OF AUDIT REPORT REVENUE/EXPENSES TO FORM 990SCH D, PARTS XI & XII LINE 4BINCOME ON RETURN, NOT ON BOOKS: AUDIT EXPENSES NETTED WITH INCOME ON 990 $1,084,333 EXPENSE ON RETURN, NOT ON BOOKS: AUDIT EXPENSES NETTED WITH INCOME ON 990 $1,084,333.
FIN 48SCHEDULE D, PART X, LINE 2MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE FINANCIAL STATEMENTS.

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Independent ConsultantXIndependentConsultant
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance PaymentfalseSeverancePayment
Supplemental Nonqual Retire PlantrueSupplementalNonqualRetirePlan
Equity Based Comp ArrangementfalseEquityBasedCompArrangement
Comp Based On Revenue Of Filing OrgfalseCompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related OrgsfalseCompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing OrgfalseCompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate OrgsfalseCompBasedNetEarningsRelateOrgs
Any Non Fixed PaymentsfalseAnyNonFixedPayments
Initial Contract ExceptionfalseInitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (7 entries)

TitleTitleComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Related OrgsBonusRelatedOrgsOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Related OrgsTotalCompensationRelatedOrgsBase Compensation Filing OrgBaseCompensationFilingOrgBonus Filing OrgBonusFilingOrgOther Compensation Filing OrgOtherCompensationFilingOrgDeferred Comp Filing OrgDeferredCompFilingOrgNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgTotal Compensation Filing OrgTotalCompensationFilingOrg
D ERIC HAMON
SECRETARY/TREASURER582261121052438138752316135598370
MARY D PETERSON
PRESIDENT/CEO26941169628170004991312493418445
STEVE WOERNER
DIRECTOR610969215182170008094910187934287
RICARDO VILLARREAL
VICE PRESIDENT OF FINANCE16824340000149097049230201
ERNEST BUCK
MEDICAL DIRECTOR2008721456813662313612372244610
WILLIAM BRENDEL
ASSOCIATE MEDICAL DIRECTOR168953120488022189023
MICHAEL P LANCE
VICE PRESIDENT DCHP137845252935485168623

Form990 Schedule J Part III Form990ScheduleJPartIII

FieldValueIRS element (for citing)
IdentifierPARTICIPANTS IN/PAYMENT FROM SUPPLEMENTAL NONQUALIFIED RETIREMENT PLANIdentifier
Return ReferencePART I, QUESTION 4BReturnReference
ExplanationTHE FOLLOWING INDIVIDUALS PARTICIPATED IN A 457(F) SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN: NAME DEFERRAL AMOUNT D. ERIC HAMON $324,815 NO PAYMENTS WERE RECEIVED.Explanation

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (10 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
PROGRAM SERVICE ACCOMPLISHMENTFORM 990, PART III, QUESTION 4ADRISCOLL CHILDREN'S HEALTH PLAN IS THE CONTRACTOR FOR THE CHILDREN'S HEALTH INSURANCE PROGRAM (CHIP) THIS SERVICE AREA INCLUDES 14 COUNTIES COMPRISED OF ARANSAS, BEE, BROOKS, CALHOUN, GOLIAD, JIM WELLS, KARNES, KENEDY, KLEBERG, LIVE OAK, NUECES, REFUGIO, SAN PATRICIO, AND VICTORIA. THE PLAN ALSO PROVIDES HEALTH BENEFITS FOR CHILDREN ENROLLED IN THE STATE OF TEXAS ACCESS REFORM (STAR) PROGRAM FOR 24 COUNTIES. THE PLAN IS A HEALTH MAINTENANCE ORGANIZATION (HMO) COMMITTED TO PROVIDING ITS MEMBERS A NETWORK OF HEALTH SERVICE PROVIDERS. ITS AFFILIATION WITH DRISCOLL CHILDREN'S HOSPITAL (DCH), THE SOLE CORPORATE MEMBER, LENDS TO THE PLAN'S SUCCESS BY OFFERING ITS MEMBERS DCH'S EXTENSIVE NETWORK INCLUDING PHYSICIANS, HOSPITAL, AND SERVICES IN ITS TOTAL EXPANDED SERVICE AREA, THUS OFFERING CHIP AND STAR MEMBERS WHO LIVE IN THE ADJACENT COUNTIES A FULL CONTINUUM OF QUALITY SERVICES TAILORED TO MEET THE NEEDS OF THE CHIP AND STAR POPULATION. THE PLAN'S ENROLLMENT WAS 106,041 AND 58,721 AT DECEMBER 31, 2012 AND 2011, RESPECTIVELY.
CLASSES OF MEMBERS OR STOCKHOLDERSForm 990, Part IV, Question 6Driscoll Children's Hospital is the sole member of Driscoll Children's Health Plan.
CLASS OF PERSONS AND NATURE OF THEIR RIGHTSForm 990, Part IV, Question 7aAny vacancy occurring in the board of directors shall be filled in accordance with the following procedure: the Member shall elect and appoint a candidate to fill the vacancy.
CLASS OF THE PERSON, DECISIONS THAT REQUIRE APPROVAL, AND VOTING RIGHTSForm 990, Part IV, Question 7bThe following matters are reserved to the member and shall require the affirmative action of the member to be effective: A. annual operating & capital budgets of the corporation; B. Merger, acquisition or consolidation of the corporation; c. borrowing or lending of money or the creation of indebtedness through the guarantee of another debt or similar action; and d. appointment & removal of directors in accordance with the by-laws.
FORM 990 PROVIDED TO GOVERNING BODYform 990, part VI, question 11THE ORGANIZATION ENGAGES AN OUTSIDE ACCOUNTING FIRM TO PREPARE FORM 990. ONCE PREPARED, THE FORM IS REVIEWED BY THE ORGANIZATION'S INTERNAL ACCOUNTANTS AND DISTRIBUTED TO THE GOVERNING BODY PRIOR TO FILING.
COMPENSATION REVIEW OF CEO, EXECUTIVE DIRECTOR, OR TOP MANAGEMENT OFFICIALFORM 990, PART VI, QUESTION 15ABOARD OF DIRECTORS REVIEW THE APPLICABLE MARKETING DATA PROVIDED BY A THRID PARTY COMPENSATION FIRM AND MATCHES THE PRESIDENT/CEO SALARY TO THE APPROPRIATE MARKET RATE FOR THE DUTIES. SULLIVAN COTTER REVIEWED 2011.
COMPENSATION REVIEW OF OFFICERS OR KEY EMPLOYEESFORM 990, PART VI, QUESTION 15BMANAGEMENT REVIEWS APPLICABLE MARKET DATA AND SLOTS THE SALARY ACCORDING TO APPROPRIATE MARKET DATA.
Organizational documents made available to publicform 990, part VI, question 19The organization does not make its governing documents, policies, and financial statements available to the public.
ORGANIZATION'S PRACTICE FOR MONITORING COMPLIANCE WITH POLICYFORM 990, PART VI, QUESTION 12CANNUALLY, ALL DIRECTORS, OFFICERS, AND KEY PERSONNEL FILL OUT A CONFLICT OF INTEREST FORM. STAFF MAKES SURE ALL CONFLICT OF INTEREST FORMS ARE TURNED IN AND REVIEWED ANNUALLY.
OTHER CHANGES IN NET ASSETSFORM 990, PART XI, LINE 9Transfer to Driscoll Children's Hospital $ (7,502,792)

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (7 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Controlled OrgControlledOrg
Driscoll Children's Hospital
3533 South AlamedaCorpus ChristiTX78411742577746HospitalTX501(C)(3)3nafalse
Driscoll Physician's Group
3533 South AlamedaCorpus ChristiTX78411742988134HospitalTX501(C)(3)3DCHfalse
Driscoll Valley Physicians Group
3533 South AlamedaCorpus ChristiTX78411201234322HospitalTX501(C)(3)3DCHfalse
Driscoll Maternal & Fetal Physician's Gr
3533 South AlamedaCorpus ChristiTX78411201234461Health CareTX501(C)(3)7DCHfalse
Childrens Physician Services of South TX
3533 South AlamedaCorpus ChristiTX78411742620408HospitalTX501(C)(3)3DCHfalse
Driscoll Foundation
615 North Upper Broadway ste 1635Corpus ChristiTX78401741170270Char. TrustTX501(C)(3)11aNAfalse
Driscoll Healthcare Services
3533 south alamedacorpus christiTX78411010962276health careTX501(C)(3)11adchfalse
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents RoyaltiesfalseReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other OrgfalseGiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other OrgfalseGiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other OrgfalseLoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other OrgfalseSaleOfAssetsToOtherOrg
Purchase Of Assets From Other OrgfalsePurchaseOfAssetsFromOtherOrg
Exchange Of AssetsfalseExchangeOfAssets
Rental Of Facilities To Other OrgsfalseRentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other OrgstrueRentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other OrgsfalsePerformOfServicesForOtherOrgs
Perform Of Services By Other OrgstruePerformOfServicesByOtherOrgs
Sharing Of FacilitiestrueSharingOfFacilities
Sharing Of Paid EmployeestrueSharingOfPaidEmployees
Reimbursement Paid To Other OrgtrueReimbursementPaidToOtherOrg
Reimbursement Paid By Other OrgtrueReimbursementPaidByOtherOrg
Other Transfer To Other OrgfalseOtherTransferToOtherOrg
Other Transfer From Other OrgfalseOtherTransferFromOtherOrg

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