2012-08-14T18:39:06-05:00 2011-09-30 BKD LLP 2800 Post Oak Blvd Ste 3200 HOUSTON TX 77056 990 2010-10-01 752485366 COOK CHILDREN'S PHYSICIAN NETWORK COOK 6828854000 801 SEVENTH AVENUE FORT WORTH TX 76104 Cory Rhoades 2012-08-15 M Paige Gerich 7134994600 2010 2016-02-24 21:20:13Z W BRITT NELSON MD 801 SEVENTH AVE FORT WORTH TX 76104 187896083 false X WWW.COOKCHILDRENS.ORG X 1992 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, DISEASE, AND INJURY. 13 0 1009 7 1328048 926339 36923232 42965376 144011559 143331135 -842 0 1195673 1599572 182129622 187896083 0 0 0 0 139963262 145972094 0 0 0 41386606 41801348 181349868 187773442 779754 122641 29725077 34104541 17562758 21819581 12162319 12284960 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 166298030 143602659 Cook Children's Physician Network is the largest pediatric multi-specialty physician group in North Texas. The network includes more than 300 physicians and thousands of other caring employees who provide medical care in 60 locations to more than 30 primary care and subspecialty practices. Continued on Schedule O. 166298030 true true false false false false false false false true false false false true true false true false false false false false false false false false false false true false false false false false false true false false false false false false true false false false false true 82 0 true 1009 true true true false false false false false false false false false X 13 0 false false false false true true true true true false false true true true true true true true true false X CORY RHOADES 6828854480 801 SEVENTH AVENUE FORT WORTH TX 76104 X NANCY N DAMBRO MD 41.0 X 331290 0 20814 CLIVE G DANIELS MD 41.0 X 521313 0 22886 MICHAEL J DEITCHMAN MD 42.0 X X 276938 0 11026 HOWARD M KELFER MD 41.0 X 518629 0 34075 M PILAR LEVY MD 41.0 X 228604 0 9138 FRANK MCGEHEE MD 41.0 X X 582973 0 30848 JAMES P MILLER MD 41.0 X 901864 0 31511 TOM T ROGERS JR MD 41.0 X 105456 0 8171 DEBORAH SCHUTTE MD 42.0 X X 454764 0 27149 JASON V TERK MD 41.0 X 328221 0 29011 JAMES C WHEELER MD 41.0 X 463827 0 37805 M SUZANNE WHITWORTH MD 42.0 X X 147956 0 11045 KEVIN D WYLIE DO 42.0 X X 224015 0 30834 SANDRA ARCA MD 41.0 X 218507 0 40367 VANESSA CHARETTE MD 41.0 X 222508 0 17845 LINDA M THOMPSON MD 41.0 X 301787 0 14975 TODD WOLF MD 41.0 X 411612 0 31886 RYAN CHAMPLIN 40.0 X 353143 0 30928 JANELL MASON-BRISCOE 2.0 X 0 167751 11196 THEODORE MATTHEWS 40.0 X 205533 0 32803 W BRITT NELSON MD 40.0 X 458085 0 33271 MITCHELL WILLIAMS 40.0 X 149641 0 9339 RICHARD P GOODE 4.0 X 61092 494292 30985 RICK W MERRILL 4.0 X 135472 1096095 156115 CONNIE EDWARDS 40.0 X 0 0 0 ELDAD EREZ 40.0 X 839737 0 27329 DAVID H GOFF MD 40.0 X 738438 0 26247 NICHOLAS A OGUNMOLA MD 40.0 X 763261 0 30349 VINCENT TAM MD 40.0 X 1264746 0 31886 JOSE L IGLESIAS MD 40.0 X 710405 0 20713 11919817 1758138 850547 351 false true false TARRANT CONSTRUCTION SERVICES CONSTRUCTION SERVICE 676560 FORT CONSTRUCTION LP CONSTRUCTION SERVICE 546986 ABEO ANESTHESIA BILLING 313500 RECALL TOTAL INFORMATION PATIENT RECORD SVCS 234642 SUNDOWN JANITORIAL JANITORIAL SERVICES 133575 6 42697005 223915 44456 42965376 NET PATIENT FEES 621110 129737938 129737938 CONTRACTED FEES 621110 2626913 2626913 MANAGEMENT FEES 900099 9878323 9878323 OTHER INCOME 621110 869638 869638 RESEARCH 900099 218323 218323 143331135 0 0 0 0 0 0 0 GROUP PURCH SALES 561439 1328048 1328048 OTHER INCOME 900099 271524 271524 1599572 187896083 143602659 1328048 0 0 0 0 8300429 6543342 1757087 0 121016925 117331751 3685174 0 16654740 15495898 1158842 0 11726685 11726685 122219 400 121819 0 0 0 0 1989886 1488193 501693 135373 56412 78961 12388114 11676618 711496 0 0 5656060 4943456 712604 312204 264316 47888 0 113313 96447 16866 0 0 431882 388083 43799 1970858 1970224 634 0 BAD DEBT 3075499 3075499 PHYSICIAN EXPENSES 980499 977843 2656 COLLECTION EXPENSE 1180438 527834 652604 MINOR EQUIPMENT 424796 291828 132968 TELEPHONE TRIAGE 378230 378230 915292 791656 123636 187773442 166298030 21475412 0 10011 10012 17965415 19724374 8010373 10231799 848725 846566 1555199 1223540 5111096 3285877 1247854 1825219 87500 243031 29725077 34104541 2891332 3276455 14671426 18543126 17562758 21819581 X 12162319 12284960 12162319 12284960 29725077 34104541 122641 X false true true X false X false false false RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1127557 1104508 23049 1602771 567166 1035605 2368605 1614203 754402 12163 0 12163 1825219 0 ACCRUED PAYROLL 947699 ACCRUED PHYSICIAN RECONS 6864898 DUE TO AFFILIATES 4207047 ACCRUED PTO LIABILITY 2539983 ACCRUED EXECUTIVE BONUS 218642 ACCRUED EIB LIABILITY 3459172 OTHER ACCRUED LIABILITIES 305685 18543126 187896083 187773442 122641 122641 187896083 187896083 187896083 187773442 187773442 187773442 UNCERTAIN TAX POSITION UNDER FIN 48 SCHEDULE D, PART X, LINE 2 MANAGEMENT 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. X X X X X X false true false false false false false false false NANCY N DAMBRO MD 328661 0 0 0 2629 0 18375 0 2439 0 352104 0 0 0 CLIVE G DANIELS MD 520470 0 -833 0 1676 0 12250 0 10636 0 544199 0 0 0 MICHAEL J DEITCHMAN MD 275578 0 0 0 1360 0 0 0 11026 0 287964 0 0 0 HOWARD M KELFER MD 514165 0 0 0 4464 0 18375 0 15700 0 552704 0 0 0 M PILAR LEVY MD 228451 0 0 0 153 0 9138 0 0 0 237742 0 0 0 FRANK MCGEHEE MD 572961 0 2000 0 8012 0 18375 0 12473 0 613821 0 0 0 JAMES P MILLER MD 884122 0 0 0 17742 0 18375 0 13136 0 933375 0 0 0 DEBORAH SCHUTTE MD 453054 0 0 0 1710 0 15313 0 11836 0 481913 0 0 0 JASON V TERK MD 326781 0 0 0 1440 0 18375 0 10636 0 357232 0 0 0 JAMES C WHEELER MD 462387 0 0 0 1440 0 18375 0 19430 0 501632 0 0 0 M SUZANNE WHITWORTH MD 146512 0 200 0 1244 0 9303 0 1742 0 159001 0 0 0 KEVIN D WYLIE DO 184767 0 38453 0 795 0 15970 0 14864 0 254849 0 0 0 RYAN CHAMPLIN 253325 0 76178 0 23640 0 15313 0 15615 0 384071 0 0 0 JANELL MASON-BRISCOE 0 166210 0 0 0 1541 0 6679 0 4517 0 178947 0 0 THEODORE MATTHEWS 156888 0 40347 0 8298 0 15580 0 17223 0 238336 0 0 0 W BRITT NELSON MD 389091 0 14097 0 54897 0 18375 0 14896 0 491356 0 0 0 MITCHELL WILLIAMS 118417 0 29786 0 1438 0 0 0 9339 0 158980 0 0 0 RICHARD P GOODE 38315 310003 12180 98551 10597 85738 1451 11742 1956 15836 64499 521870 0 0 RICK W MERRILL 73382 593737 41761 337886 20329 164472 15598 126202 1574 12741 152644 1235038 14520 117480 ELDAD EREZ 838027 0 0 0 1710 0 9800 0 17529 0 867066 0 0 0 DAVID H GOFF MD 720498 0 0 0 17940 0 18375 0 7872 0 764685 0 0 0 NICHOLAS A OGUNMOLA MD 745001 0 320 0 17940 0 15313 0 15036 0 793610 0 0 0 VINCENT TAM MD 1242604 0 20000 0 2142 0 18375 0 13511 0 1296632 0 0 0 SANDRA ARCA MD 215933 0 1200 0 1374 0 17637 0 22730 0 258874 0 0 0 VANESSA CHARETTE MD 222286 0 0 0 222 0 12875 0 4970 0 240353 0 0 0 LINDA M THOMPSON MD 301581 0 0 0 206 0 9800 0 5175 0 316762 0 0 0 TODD WOLF MD 186479 0 224754 0 379 0 12250 0 19636 0 443498 0 0 0 JOSE L IGLESIAS MD 692510 0 0 0 17895 0 9800 0 10913 0 731118 0 0 0 NAMES, AMOUNTS, AND DETAILS OF ARRANGEMENTS PART I, QUESTION 4B RICK W. MERRILL PARTICIPATES, BUT RECEIVED 0 PAYMENT DURING CALENDAR YEAR 2010. ALLOCATION OF CEO AND CFO SALARIES SCHEDULE J, PART II COOK CHILDREN'S HEALTH CARE SYSTEM IS COMPRISED OF 9 COMPANIES, INCLUDING A MEDICAL CENTER, PHYSICIAN NETWORK, HEALTH PLAN, HOME HEALTH COMPANY, INDEMNITY COMPANY, HEALTH FOUNDATION, NORTHEAST HOSPITAL, PEDIATRIC SURGERY CENTER, AND HEALTH CARE SYSTEM COMPANY. THE CEO AND CFO ARE RESPONSIBLE FOR THE OVERSIGHT OF ALL AFOREMENTIONED COMPANIES. AS A RESULT, THEIR SALARIES ARE ALLOCATED PRO-RATA, BASED ON THE AMOUNT OF TIME THEY SPEND WITH EACH COMPANY. AUDREY ROGERS MD TOM ROGERS' DAUGTER-IN-LA 272151 COMPENSATION false MEMBERS OR STOCKHOLDERS FORM 990, PART VI, QUESTION 6 COOK CHILDREN'S HEALTH CARE SYSTEM, A TEXAS NON-PROFIT CORPORATION, IS THE SOLE MEMBER OF THE ORGANIZATION. ELECTION OF MEMBERS 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. DECISIONS OF GOVERNING BODY 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 corporation; c, Approve any merger, acquisition, liquidation, winding up, termination or consolidation of the corporation; d. Approve the persons who are to be elected by the corporation to fill any vacancies on the board of trustees; e. Approve the sale, gift or other disposition of all or substantially all of the property of the corporation; f. Approve the creation of, or investment in, any subsidiary entity; and g. Approve the removal of a member of the board of trustees. PROCESS FOR REVIEW OF THE 990 FORM 990, PART VI, QUESTION 11 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 FORMS ARE PREPARED, THEY ARE REVIEWED BY COMPANY EXECUTIVES AND THEN PROVIDED TO THE BOARD OF TRUSTEES FOR REVIEW. IN ADDITION, THEY ARE PRESENTED TO THE BOARD AUDIT COMMITTEE FOR REVIEW. SUBSEQUENT TO AUDIT COMMITTEE REVIEW, THE FORMS ARE FILED WITH THE INTERNAL REVENUE SERVICE AND MADE AVAILABLE TO THE PUBLIC FOR REVIEW. WRITTEN CONFLICT OF INTEREST POLICY FORM 990, PART VI, QUESTION 12C EVERY YEAR THE LEGAL DEPARTMENT SENDS OUT A FORM 990 QUESTIONNAIRE TO OFFICERS, DIRECTORS, TRUSTEES AND KEY EMPLOYEES. 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 ARE PROVIDED TO THE 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 entities 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. 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 committee approves compensation arrangements in advance, relying upon comparable market data relating to compensation, which is provided by Mercer & Associates (executive compensation) and Sullivan Cotter (physician compensation), both independent, nationally recognized compensation consultants. The committee documents the basis for its determinations, and requires the compensation consultants to update market data periodically, usually every two years, with interim reviews being conducted as needed. With regard to physician compensation, the 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. MAKING GOVERNING DOCUMENTS 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 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. PROGRAM SERVICE ACCOMPLISHMENTS FORM 990, PART III, LINE 4A The network includes primary care physicians and pediatric specialists with offices in Tarrant, Denton, and Hood counties and established physician offices in several medically underserved, economically disadvantaged neighborhoods. The physician network has increased access to pediatric specialty care through outreach clinics in many communities in North and West Texas. Each month, physicians travel to provide services in several areas not large enough to support full-time specialty care. HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:MICHAEL J. DEITCHMAN, MD TITLE:TRUSTEE-VICE CHAIRMAN HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:HOWARD M. KELFER, MD TITLE:TRUSTEE HOURS:2 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:M. PILAR LEVY, MD TITLE:TRUSTEE HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:FRANK MCGEHEE, MD TITLE:TRUSTEE-TREASURER HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:JAMES P. MILLER, MD TITLE:TRUSTEE HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:DEBORAH SCHUTTE, MD TITLE:TRUSTEE-VICE CHAIRMAN HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:JASON V. TERK, MD TITLE:TRUSTEE HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:M. SUZANNE WHITWORTH, MD TITLE:TRUSTEE-CHAIRMAN HOURS:3 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:KEVIN D. WYLIE, DO TITLE:TRUSTEE-SECRETARY HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:VANESSA CHARETTE, MD TITLE:TRUSTEE HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:LINDA M. THOMPSON, MD TITLE:TRUSTEE HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:TODD WOLF, MD TITLE:TRUSTEE HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:JANELL MASON-BRISCOE TITLE:VP, OPERATIONS HOURS:38 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:RICHARD P. GOODE TITLE:CHIEF FINANCIAL OFFICER HOURS:36 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:RICK W. MERRILL TITLE:CHIEF EXECUTIVE OFFICER HOURS:36 COOK CHILDREN'S MEDICAL CENTER 801 SEVENTH AVE FORT WORTH TX 76104 752051646 HOSPITAL TX 501(c)(3) 3 NA WI COOK FOUNDATION 801 SEVENTH AVENUE FORT WORTH TX 76104 752051649 FUNDRAISING TX 501(c)(3) 11D NA COOK CHILDREN'S HOME HEALTH 801 SEVENTH AVENUE FORT WORTH TX 76104 752896983 HEALTHCARE TX 501(c)(3) 11C NA COOK CHILDREN'S HEALTH CARE SYSTEM 801 SEVENTH AVE FORT WORTH TX 76104 752705881 SUPPORT TX 501(c)(3) 11C NA COOK CHILDREN'S HEALTH PLAN 801 SEVENTH AVE FORT WORTH TX 76104 760585240 INSURANCE TX 501(c)(3) 11C NA false false true false false false false false true true false false false false true true true true