2012-11-14T16:22:48-06:00 2011-12-31 366055558 Grant Thornton LLP 1717 Main Street Suite 1500 Dallas TX 75201 990 2011-01-01 752854505 Physicians For Children PHYS 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 MyChildren's Ray Dziesinski 1935 Medical District Dr Dallas TX 75235 5671231 0 X N/A X 1999 TX To deliver Primary Care to children in underserved areas of North Central Texas 6 6 110 0 0 0 3750 750000 4195381 4918768 0 -22284 2657 0 4201788 5646484 0 0 0 0 4380373 6192511 0 0 0 2419577 3720897 6799950 9913408 -2598162 -4266924 3688289 4653351 9938927 15170913 -6250638 -10517562 Physicians For Children delivers primary care to children in critically underserved areas of the North Central Texas community in a private physician office setting. Of the 78,901 total patient encounters in 2011, 90% or 71,011 were Medicaid patients. 0 0 7753693 4918768 Physicians For Children delivers primary care to children in critically underserved areas of the North Central Texas community in a private physician office setting. Of the 78,901 total patient encounters in 2011, 90% or 71,011 were Medicaid patients. Physicians For Children also provides discounted medical care for cash patients not covered by insurance. 7753693 1 1 0 0 0 0 0 0 0 0 1 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 85 0 1 110 1 0 0 0 0 0 0 0 0 0 0 X 6 6 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X Stephanie K Smith 2144567000 1935 Medical District Drive Dallas TX 75235 X Ernesto Fernandez MD 1.00 X X 0 0 0 Michael Brown MD 1.00 X X 0 0 0 Debra Burns MD 1.00 X 0 0 0 Richard Daniel MD 1.00 X 0 0 0 Larry Gray MD 1.00 X 0 0 0 Frank Lieu MD 1.00 X 0 0 0 Trent C Smith 1.00 X 0 593441 37330 Jerry Lee 1.00 X 0 233606 4053 Stephanie K Smith 1.00 X 0 80872 663 Ray Tsai MD 40.00 X 208303 0 23400 Daria Alexandrova MD 40.00 X 173788 0 1465 Maryam Saifi MD 40.00 X 152049 0 1360 Yvette Almendarez MD 40.00 X 149889 0 13410 Rekha Sivadasan MD 40.00 X 142131 0 37760 826160 907919 119441 16 0 1 0 PHYSICIAN SALES AND SERVICE 4345 SOUTHPOINT BLVD JACKSONVILLE TX 32216 Medical Supplies 370434 SCHERER INVESTMENTS INC 4800 HEDGCOXE RD SUITE 100 PLANO TX 75024 Property Rental 207566 AON RISK SERVICES OF TX INC PO BOX 847174 DALLAS TX 752847174 Risk Management 139182 THE CABRAL FAMILY TRUST 3610 W PIONEER PARKWAY STE 109 ARLINGTON TX 76013 Property Rental 133103 COMFORCE TECHNICAL SERVICES PO BOX 9695 UNIONDALE NY 115559695 Info.Technology 111584 6 750000 750000 Professional Svc Rev 621110 4918768 4918768 4918768 2463 2463 24747 -24747 -24747 -24747 5646484 4918768 0 -22284 5215241 4065038 1150203 26791 20882 5909 601546 466809 134737 348933 271977 76956 472411 472411 337812 311852 25960 38466 34646 3820 203650 153760 49890 34593 27942 6651 1172702 1089943 82759 29292 22788 6504 622157 498326 123831 191752 185560 6192 Medical Surg Suppl 472980 472201 779 Dues and Subscriptions 67896 56700 11196 Prov for Doubtful Accts 64756 63970 786 Miscellaneous expenses 12430 11299 1131 9913408 7753693 2159715 0 438710 473737 1138266 990025 162654 176475 4463616 1450502 1948659 3013114 3688289 4653351 241195 223374 9697732 14947539 9938927 15170913 X -6250638 -10517562 -6250638 -10517562 3688289 4653351 -4266924 0 X 0 1 1 X 0 X 100000 100000 3750 750000 953750 3259486 8524982 9638731 9889623 13463421 44776243 3259486 8624982 9738731 9893373 14213421 45729993 0 0 0 45729993 2463 2463 2463 2463 3259486 8624982 9738731 9893373 14215884 45732456 0.99990 1.00000 0.00010 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 4036269 1195684 2840585 427347 254818 172529 3013114 LT Advances - PFC 7288801 LT Receivable/Payable-CMC 7307342 LT Deferred Rent 351396 14947539 Description of Uncertain Tax Positions Under FIN 48: Part X: The Physicians For Children's consolidated financial statements for the year ending December 31, 2011 do not contain a FIN 48 footnote. 0 1 0 0 0 0 0 1 0 Trent C Smith 0 295574 0 163928 0 133939 0 32904 0 4426 0 630771 0 182083 Jerry Lee 0 186551 0 26186 0 20869 0 0 0 4053 0 237659 0 0 Ray Tsai MD 208303 0 0 0 0 0 0 0 23400 0 231703 0 0 0 Daria Alexandrova MD 173788 0 0 0 0 0 0 0 1465 0 175253 0 0 0 Maryam Saifi MD 152049 0 0 0 0 0 0 0 1360 0 153409 0 0 0 Yvette Almendarez MD 149889 0 0 0 0 0 0 0 13410 0 163299 0 0 0 Rekha Sivadasan MD 142131 0 0 0 0 0 0 0 37760 0 179891 0 0 0 Part I, Line 4b Trent C Smith participates in the Savings Restoration Plan 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. Supplemental Information Part III Schedule J, Part II, Column F - The compensation reported in Column F has been prepared using the FY2011 Form 990 (clarifying) instructions. The 2008, 2009, and 2010 Form 990s will be revised and refiled to maintain consistent compensation reporting in Column F across all four periods. 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 Board of Directors. Form 990, Part VI, Section A, line 7b Sole member reserve powers are specified in Physicians For Children's bylaws and represent those actions by the organization which require sole member approval. These powers generally encompass 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 the treasurer at either a scheduled meeting or sent electronically for board review. 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 15 The top management official and officers of Physicians For Children (PFC) are not employees of the corporation and receive no compensation from PFC. For physicians, PFC obtains outside compensation survey data to provide compensation analysis regarding the fair market value of PFC's salary structure, which is presented to the PFC Board of Directors for approval. Form 990, Part VI, Section C, line 19 Governing documents, conflict of interest policy, and financial statements for Physicians For Children are made available to the public when a formal request has been made. Form 990, Part VII, Section A - Average Hours per Week 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 TX 0 Anesthesiologists For Children 1935 Medical District Drive Dallas TX 75235 752917570 Physicians TX 501(c)(3) Line 9 Children's Medical Center of Dallas 0 Dallas Physician Medical Services for Children 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 Svcs of TX 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 Health Svcs of TX 0 Children's Med Ctr Research Institute at UTSWMC 1935 Medical District Drive Dallas TX 75235 453462044 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 CMCD 12720 Hillcrest Road Dallas TX 75230 752485538 Women's Auxiliary TX 501(c)(3) Line 9 N/A 0 Children's Insurance Company (CIC) 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 1 0 1 0 0 0 0 0 1 0 0 0 0 1 0 1