2012-11-14T10:18:55-06:00 2011-12-31 BKD LLP 2800 Post Oak Blvd Ste 3200 HOUSTON TX 77056 990 2011-01-01 742838488 Driscoll Childrens Health Plan % RICK VILLARREAL DRIS 3616944889 615 N Upper Broadway St Corpus Christi TX 784010746 MARY D PETERSON 2012-11-15 true M Paige Gerich 7134994600 2011 2016-02-24 21:20:13Z DR MARY DALE PETERSON 615 N UPPER BROADWAY ST 1621 CORPUS CHRISTI TX 784010746 151295523 false X WWW.DCHPKIDS.COM X 1997 TX Driscoll 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. 9 4 67 0 0 423224 185751 152114133 150430135 388164 679637 0 0 152925521 151295523 0 0 0 0 3218625 3751231 0 0 0 139470472 143765392 142689097 147516623 10236424 3778900 45253813 37384603 19923766 17744195 25330047 19640408 X DRISCOLL 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. false false 133140755 150430135 SEE SCHEDULE O FOR FULL PROGRAM SERVICE DESCRIPTION. 133140755 true true false true false false false false false true true false false true false true true false false false false false false false false false false false true false false false false false false false false false false false false false true false false false false true 0 0 67 true false false false false false false false false false false X 9 4 false false false false true true true true true false false true true true true true true true true false X RICK VILLARREAL 3616946781 615 N UPPER BROADWAY ST STE 1621 Corpus Christi TX 78401 X WILLIAM J STERETT 1.0 X X D ERIC HAMON 1.0 X X 207838 403084 C IVAN WILSON 1.0 X 0 10000 0 JOE FULTON 1.0 X 0 10000 0 MARY D PETERSON 40.0 X X 343557 52136 STEVE WOERNER 1.0 X 551082 399033 S LOYD NEAL JR 1.0 X 0 10000 0 ERNEST BUCK 40.0 X WILLIAM BRENDEL 40.0 X RICARDO VILLARREAL 40.0 X 167774 18792 MIGUEL PEREZ III 40.0 X 134950 22763 JUDITH KRAFT 40.0 X 116718 13076 DON WELLS 40.0 X 118464 2219 HEATHER JOHNSON 40.0 X 105971 12107 987434 788920 923210 6 false true false VALENCE HEALTH 600 W JACKSON SUITE 800 CHICAGO IL 60661 THIRD PARTY ADMIN 7120355 EVERGREEN RE 940 GOLF HOUSE RD W STE 300 WHITSETT NC 27377 REINSURANCE BROKER 1383442 CORPORATE PRINTING INC 3509 OAK FOREST DR HOUSTON TX 77018 PRINTING 603188 PORTER ROGERS DAHLMAN GORDON 800 N Shoreline Suite 800 S CORPUS CHRISTI TX 784013708 Legal 224416 ALLIED MANAGEMENT GROUP INC 825 N PARKCENTER DR STE 102 SANTA ANA CA 92705 SIU SERVICES 377740 11 185751 185751 Preimum Revenue 524292 149886214 149886214 Net Reinsurance 524292 -839199 -839199 Other Income 900099 1383120 1383120 150430135 525837 525837 0 0 153800 153800 153800 153800 0 0 0 0 151295523 150430135 679637 0 0 0 0 582258 582258 0 2526113 723257 1802856 190165 79869 110296 245221 102993 142228 207474 87139 120335 6858319 735845 6122474 350159 350159 0 0 0 2000 2000 2979587 2979587 270175 270175 840216 840216 327142 327142 0 152849 152849 76892 76892 0 0 0 0 76971 76971 73022 73022 Medical Expenses 128264930 128264930 Premium Taxes 2787461 2564464 222997 Member Value Add Expense 202733 202733 SPECIAL FEES 131050 131050 371886 371886 147516623 133140755 14375868 0 16098120 3331896 6768108 6808484 0 0 2930723 1766847 0 0 0 0 0 0 0 0 0 0 2631534 2461622 175865 169912 0 0 19280997 25307464 0 0 0 0 0 0 45253813 37384603 17836492 13847875 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2087274 3896320 19923766 17744195 X 0 0 0 0 25330047 19640408 25330047 19640408 45253813 37384603 X 3778900 -9468539 X false true false X true true X 103906 357701 423224 185751 1070582 103906 357701 423224 185751 1070582 1070582 336324 254370 362081 525837 1478612 56299110 134848007 152114133 150430135 493691385 496240579 491300955 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false true 77899 false false false 77899 false 2631534 2461622 169912 169912 VANGUARD- MUTUAL FUNDS 25307464 F 25307464 0 Rebate Liability 3545036 Due to CPSST 21960 Due to Affiliate 329324 3896320 151295523 147516623 3778900 3778900 149694765 149694765 1600758 1600758 151295523 145915866 145915866 1600757 1600757 147516623 RECONCILIATION OF AUDIT REPORT REVENUE/EXPENSES TO FORM 990 SCH D, PARTS XII & XIII LINE 4B INCOME ON RETURN, NOT ON BOOKS: AUDIT EXPENSES NETTED WITH INCOME ON 990 $1,600,758 EXPENSE ON RETURN, NOT ON BOOKS: AUDIT EXPENSES NETTED WITH INCOME ON 990 $1,600,757 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 false true false false false false false false false D ERIC HAMON 97010 94328 16500 391319 11765 610922 0 MARY D PETERSON 270850 67600 5107 45774 6362 395693 0 STEVE WOERNER 355512 179070 16500 389394 9639 950115 0 RICARDO VILLARREAL 131786 31826 4162 12436 6356 186566 0 MIGUEL PEREZ III 117226 17724 0 11899 10864 157713 0 PARTICIPANTS IN/PAYMENT FROM SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN PART I, QUESTION 4B THE FOLLOWING INDIVIDUALS PARTICIPATED IN A 457(F) SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN: NAME DEFERRAL AMOUNT D. ERIC HAMON $329,904 STEVE WOERNER $310,284 NO PAYMENTS WERE RECEIVED. PROGRAM SERVICE ACCOMPLISHMENT FORM 990, PART III, QUESTION 4A DRISCOLL 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 58,721 AND 56,216 AT DECEMBER 31, 2011 AND 2010, RESPECTIVELY. CLASSES OF MEMBERS OR STOCKHOLDERS Form 990, Part IV, Question 6 Driscoll Children's Hospital is the sole member of Driscoll Children's Health Plan. CLASS OF PERSONS AND NATURE OF THEIR RIGHTS Form 990, Part IV, Question 7a Any 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 RIGHTS Form 990, Part IV, Question 7b The 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 BODY form 990, part VI, question 11 THE 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 OFFICIAL FORM 990, PART VI, QUESTION 15A BOARD 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 EMPLOYEES FORM 990, PART VI, QUESTION 15B MANAGEMENT REVIEWS APPLICABLE MARKET DATA AND SLOTS THE SALARY ACCORDING TO APPROPRIATE MARKET DATA. Organizational documents made available to public form 990, part VI, question 19 The organization does not make its governing documents, policies, and financial statements available to the public. ORGANIZATION'S PRACTICE FOR MONITORING COMPLIANCE WITH POLICY FORM 990, PART VI, QUESTION 12C ANNUALLY, 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 ASSETS FORM 990, PART XI, LINE 5 Transfer to Driscoll Children's Hospital $ (10,000,000) Unrealized Gain/Loss $ 531,462 ---------- OTHER CHANGES TOTAL $ (9,468,539) HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:WILLIAM J STERETT TITLE:CHAIRMAN OF THE BOARD HOURS:2 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:D. ERIC HAMON TITLE:SECRETARY/TREASURER HOURS:40 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:C. IVAN WILSON TITLE:DIRECTOR HOURS:2 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:JOE FULTON TITLE:DIRECTOR HOURS:2 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:MARY D PETERSON TITLE:PRESIDENT/CEO HOURS:10 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:STEVE WOERNER TITLE:DIRECTOR HOURS:40 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:S LOYD NEAL JR TITLE:DIRECTOR HOURS:2 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:ERNEST BUCK TITLE:MEDICAL DIRECTOR HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:WILLIAM BRENDEL TITLE:ASSOCIATE MEDICAL DIRECTOR HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:RICARDO VILLARREAL TITLE:VICE PRESIDENT OF FINANCE HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:MIGUEL PEREZ III TITLE:CHIEF INFORMATION OFFICER HOURS:1 Driscoll Children's Hospital 3533 South Alameda Corpus Christi TX 78411 742577746 Hospital TX 501(c)(3) 3 na false DCH Holding Company 3533 South Alameda Corpus Christi TX 78411 743011381 Holding Co. TX 501(c)(3) N/A DCH false Driscoll Physician's Group 3533 South Alameda Corpus Christi TX 78411 742988134 Hospital TX 501(c)(3) 3 DCH false Driscoll Valley Physicians Group 3533 South Alameda Corpus Christi TX 78411 201234322 Hospital TX 501(c)(3) 3 DCH false Driscoll Maternal & Fetal Physician's Gr 3533 South Alameda Corpus Christi TX 78411 201234461 Health Care TX 501(c)(3) 7 DCH false Childrens Physician Services of South TX 3533 South Alameda Corpus Christi TX 78411 742620408 Hospital TX 501(c)(3) 3 DCH false Driscoll Foundation 615 North Upper Broadway ste 1635 Corpus Christi TX 78401 741170270 Char. Trust TX 501(c)(3) 11a NA false Driscoll Healthcare Services 3533 south alameda corpus christi TX 78411 010962276 health care TX 501(c)(3) 11a dch false false false false false false false false false false true false true true true true true false false