2012-11-14T16:19:20-06:00 2011-12-31 366055558 Grant Thornton LLP 1717 Main Street Suite 1500 Dallas TX 75201 990 2011-01-01 752917570 Anesthesiologists For Children ANES 2144567000 1935 Medical District Drive Dallas TX 75235 Jerry Lee 2144567000 2012-11-14 1 Kimberly Temple CPA P00669176 2145612300 2011 2016-02-24 21:20:13Z X Ray Dziesinski 1935 Medical District Dr Dallas TX 75235 25426234 0 X N/A X 2000 TX To provide anesthesia services to patients at Children's Medical Center of Dallas 7 3 31 0 0 0 33650 30466 17960879 25164293 0 0 5799961 231475 23794490 25426234 0 0 0 0 11023316 11404880 0 0 0 12960517 14722705 23983833 26127585 -189343 -701351 4476322 5113435 6717724 8056187 -2241402 -2942752 To provide anesthesia services to patients at Children's Medical Center in Dallas, Texas. These services are provided without regard to the patient's ability to pay for the services. 0 0 24687982 25395768 Provide anesthesia services to patients at Children's Medical Center in Dallas, Texas. These services are provided without regard to the patient's ability to pay for the services. 24687982 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 0 1 16 0 1 31 1 0 0 0 0 0 0 0 0 0 0 X 7 3 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 X Julio Perez Fontan MD 1.00 X X 0 480000 0 Desmond Henry MD 1.00 X X 0 137225 0 Jerry Lee 1.00 X 0 233606 4053 Stephanie K Smith 1.00 X 0 80872 663 David Bui MD 1.00 X 468866 0 11258 Alan Farrow-Gillespie MD 1.00 X 0 0 0 Robert Foglia MD 1.00 X 0 0 0 Charles Whitten MD 1.00 X 0 0 0 Thomas Zellers MD 1.00 X 0 150000 0 Christopher Meggyesy MD 40.00 X 541183 0 3276 Vera Barbosa MD 40.00 X 499377 0 10085 Shannon Roden MD 40.00 X 498448 0 4179 Stephen Hoang MD 40.00 X 496462 0 3326 Hadi Sakhai MD 40.00 X 495084 0 6632 2999420 1081703 43472 24 0 1 0 UTSW 5323 Harry Hines Blvd Dallas TX 753908886 Anesthesiologist 9554726 ABEO 4100 International Plaza Ste 600 Ft Worth TX 76109 Physician Services 608095 Mike C Murphy 1813 Creekside Ct Garland TX 75040 Anesthesiologist 604939 Summit Healthcare Mgmt 4916 Overton Plaza Ft Worth TX 76109 Billing Services 334468 Medical Protective Co 23289 Network Place Chicago IL 606731232 Risk Mgmt, Insurance 237209 7 30466 30466 Professional Svc Rev 621110 17482746 17482746 Coverage Revenue 621110 7681547 7681547 25164293 Chief Stipend 621110 231475 231475 231475 25426234 25395768 0 0 137225 137225 10410778 10239014 171764 247986 243948 4038 273131 269007 4124 335760 330292 5468 425348 425348 11811054 11811054 29017 23530 5487 3566 3050 516 86 86 22225 21117 1108 65352 65065 287 266637 266637 Prov for Doubtful Accts 1274222 1274222 Consulting Fees 820578 820578 4620 3821 799 26127585 24687982 1439603 0 1908504 2225822 2344589 2681862 135 0 223094 205751 4476322 5113435 1075584 2330151 5642140 5726036 6717724 8056187 X -2241402 -2942752 -2241402 -2942752 4476322 5113435 -701351 0 X 0 1 1 X 0 X 33650 30466 64116 19001080 32691710 40227440 41463061 49455696 182838987 19001080 32691710 40227440 41496711 49486162 182903103 0 0 0 182903103 19001080 32691710 40227440 41496711 49486162 182903103 1.00000 0.99980 0.00000 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 LT Advances - AFC 5502808 LT Receivables/Payable-CMC 223228 5726036 Description of Uncertain Tax Positions Under FIN 48: Part X: The Anesthesiologists for Children's consolidated financial statements for the year ending December 31, 2011 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 Jerry Lee 0 186551 0 26186 0 20869 0 0 0 4053 0 237659 0 0 David Bui MD 463760 0 0 0 5106 0 0 0 11258 0 480124 0 0 0 Christopher Meggyesy MD 471743 0 0 0 69440 0 0 0 3276 0 544459 0 0 0 Vera Barbosa MD 464933 0 0 0 34444 0 0 0 10085 0 509462 0 0 0 Shannon Roden MD 470840 0 0 0 27608 0 0 0 4179 0 502627 0 0 0 Stephen Hoang MD 471692 0 0 0 24770 0 0 0 3326 0 499788 0 0 0 Hadi Sakhai MD 468386 0 0 0 26698 0 0 0 6632 0 501716 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 soley 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 Anesthesiologists For Children Board of Directors. Form 990, Part VI, Section A, line 7b Sole member reserve powers are specified in Anesthesiologists For Children bylaws and represent those actions by the organization which require sole member approval to be effective. These powers generally encompass specific 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 its treasurer at either a scheduled meeting or sent electronically for board review before being filed with the IRS. Form 990, Part VI, Section B, line 12c Directors execute a conflict of interest disclosure statement every year at the annual meeting of the 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 Governing documents, conflict of interest policy, and financial statements are made available to the public upon request. Form 990, Part VII - Section A Avg Hrs per Week for Related Organization Average hours per week have been identified as 60 hours/week for the CEO as there are numerous offsite community events which involve weekend, breakfast, and evening meetings. Average hours per week for Senior Vice Presidents have been identified as 55 hours per week as they are involved with limited offsite community events. Average hours per week for Vice Presidents have been identified as 50 hours per week as they have some involvement with offsite community events. Key Employees and Highest Compensated Employees have been identified as 40 hours per week. Children's Medical Center of Dallas 1935 Medical District Drive Dallas TX 75235 750800628 Hospital TX 501 (c)(3) Line 3 Children's Health Svcs of Texas 0 Dallas Physician Medical Services 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 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 Health Services of Texas 1935 Medical District Drive Dallas TX 75235 752062019 Management company TX 501 (c)(3) Line 11a, I N/A 0 Children's Med Ctr Foundation 1935 Medical District Drive Dallas TX 75235 752062015 Foundation TX 501 (c)(3) Line 11a, I Children's Health Svcs of Texas 0 Children's Med Ctr Research Institute at UTSWMC 1935 Medical District Drive Dallas TX 75235 Research Institute TX Pending Pending N/A 0 Southwestern Medical District 5323 Harry Hines Blvd Dallas TX 75390 204101612 Medical District TX 501 (c)(3) Line 11a, I N/A 0 Women's Auxiliary to CMC 12720 Hillcrest Road Dallas TX 75230 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 VT N/A C Alternative Care Systems 1935 Medical District Drive Dallas TX 75235 752244475 Other Medical Svcs TX N/A C 0 0 0 0 1 0 0 0 0 0 1 0 1 1 0 1 0 1