2011-11-11T14:19:06-06:00 2010-12-31 Grant Thornton LLP 1717 Main Street Suite 1500 Dallas TX 75201 990 2010-01-01 750800628 Children's Medical Center of Dallas CHIL 2144567000 1935 Medical District Drive Dallas TX 75235 Jerry Lee 2144567000 2011-11-11 1 Kimberly Temple CPA 2145612300 2010 2016-03-07 17:11:31Z Christopher J Durovich 1935 Medical District Dr Dallas TX 75235 972825487 0 X www.childrens.com X 1986 TX Dedicated to making life better for children 20 19 6581 6179 0 0 54647853 27316941 840487339 913627951 3453632 17012282 13445282 14284928 912034106 972242102 88600 80000 0 0 437765386 451773189 0 0 0 392711778 416146571 830565764 867999760 81468342 104242342 1628296383 1773624864 631845174 624316914 996451209 1149307950 X Children's Medical Center of Dallas is dedicated to making life better for children. Children's is committed to carry out this mission through adherence to four guiding principles: quality care; research & innovation; education & advocacy; and excellence & accountability. 0 0 629290228 923540070 Consistent with its charitable mission, Children's maintains a policy of accepting all patients within its primary service area regardless of ability to pay. The local service regions stretch from the Oklahoma border south to Waco and from Parker County (west of Ft. Worth) east to Wood County. For the fiscal year ended December 31, 2010, Children's absorbed $151 million of uncompensated healthcare services as a result of this open-door charitable policy. Children's participates in applicable government sponsored entitlement programs. For the year ended December 31, 2010, 56% of Children's gross revenue is attributable to patients enrolled in state Medicaid programs.During 2010, Children's served 150,000 patients. We had 23,636 patient admissions resulting in 93,361 patient days, and provided services in 448,000 outpatient visits. In addition, the hospital staff performed 17,068 day surgeries. In recognizing its mission to the community, Children's participates in the Medicaid, Medicare, Children's Health Insurance Program (CHIP), Chronically Ill and Disabled Children (CIDC), and Champus government programs. Under an agreement with the Dallas County Hospital District, Children's provides services to the indigent children of Dallas County. 6822459 10012573 Children's is the primary pediatric teaching hospital for the University of Texas Southwestern Medical School at Dallas and has the fifth largest pediatric training program in the country. Currently, there are 92 pediatric residents, three chief residents and approximately 130 pediatric subspecialty residents and fellows enrolled in this training program. Children's offers fellowships/residencies in these pediatric subspecialties, as well as internships and fellowships/residencies in nursing, dentistry, allied health, social sciences and religious studies. In addition to internship and fellowship programs, many students representing a variety of health care professions come to Children's to complete a pediatric rotation as a requisite of their training. 2156971 3165549 Through Children's affiliation with UTSW Medical Center, ongoing research is promoted in many different clinical areas of the hospital. The end goal of this research is the development of newer, more effective diagnostic & treatment methods to meet the health care needs of children. All research involving human subjects is approved by the Institutional Review Board at UTSW. Joint areas of research efforts between UTSW's Department of Pediatrics & Children's are: critical care, immunology, gastroenterology, emergency medicine, radiology, nutrition, endocrinology, psychiatry, cardiology, pharmacology, nephrology, neurology, pulmonology, rheumatology, infectious diseases & hematology/oncology. Many of these clinical studies have been published in medical journals & presented to professional health care societies. 638269658 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 1 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 1243 0 1 6581 1 0 0 0 0 0 0 0 0 0 0 X 20 19 1 0 1 0 1 1 1 1 1 0 1 1 1 1 1 1 1 1 1 1 0 X Stephanie K Smith 2144567040 1935 Medical District Drive Dallas TX 75235 X Thomas Baker 1.00 X X 0 0 0 Robert Chereck 1.00 X X 0 0 0 Christopher J Durovich 60.00 X X 1748887 0 1413633 Ann Goddard Corrigan 1.00 X 0 0 0 Michael Dardick 1.00 X 0 0 0 Richard W Douglas 1.00 X 0 0 0 Gregg L Engles 1.00 X 0 0 0 Sandra Estess 1.00 X 0 0 0 Robert A Estrada 1.00 X 0 0 0 Kathleen Gibson 1.00 X 0 0 0 Richard Knight Jr 1.00 X 0 0 0 Charles Matthews Jr 1.00 X 0 0 0 Connie O'Neill 1.00 X 0 0 0 Marcia Page 1.00 X 0 0 0 Patrick B Shelby 1.00 X 0 0 0 Barbara Stuart 1.00 X 0 0 0 Gifford Touchstone 1.00 X 0 0 0 John F Young 1.00 X 0 0 0 David Biegler 1.00 X 0 0 0 Debbie Scripps 1.00 X 0 0 0 Julio Perez Fontan MD 50.00 X 480000 0 0 Ray R Dziesinski 50.00 X 631945 0 428866 James Herring 50.00 X 1020639 0 454150 Douglas G Hock 50.00 X 708295 0 491637 John P Kline 50.00 X 390849 0 256697 Regina M Coggins 50.00 X 292337 0 170062 Trent C Smith 50.00 X 421447 0 203968 Patricia U Winning 50.00 X 680403 0 474092 Pamela Arora 40.00 X 521855 0 344752 Kimberly Besse 40.00 X 236520 0 106279 David G Biggerstaff 40.00 X 345067 0 235462 Jean Ann Larson 40.00 X 166971 0 45921 Fiona Levy MD 40.00 X 387000 0 0 Justin Lombardo 50.00 X 313834 0 124759 Elizabeth Field MacKay 40.00 X 227097 0 78521 Ronald C Skillens Jr 40.00 X 207201 0 88655 Mary E Stowe 40.00 X 406866 0 269770 Thomas Zellers MD 40.00 X 113333 0 0 Daniel Carney 50.00 X 206133 0 56240 Jason D White 40.00 X 129290 0 25481 Paul Musgrave hire date Dec 2010 40.00 X 26846 0 4466 Stephanie Gilliard 40.00 X 101282 0 6891 Stephanie K Smith 40.00 X 76686 0 4224 Phyllis Cole 40.00 X 395745 0 51265 Christopher J Dougherty 40.00 X 295936 0 13236 Brett D Lee 40.00 X 225766 0 5544 Christopher Menzies MD 40.00 X 236184 0 7190 Jerry Lee 40.00 X 222007 0 14998 Mary Beth Martin 40.00 X 211788 0 14466 Philip Branson 40.00 X 193066 0 10110 Mazie Jamison 40.00 X 192613 0 2899 Hilda Sallack 40.00 X 184612 0 16645 Candis Posey 40.00 X 182699 0 8283 Jeffrey Vawrinek 40.00 X 182228 0 6692 Deborah Sheppard 40.00 X 178246 0 9499 Denise Claussen 40.00 X 176597 0 3922 Sandra McDermott 40.00 X 173225 0 3373 Michelle Kromelis 40.00 X 172948 0 11985 Jodi Landon 40.00 X 169084 0 6675 Michael Hefton 40.00 X 166718 0 15529 Dorothy Foglia 40.00 X 165981 0 13580 Kaye Schmidt 40.00 X 165620 0 6235 Penny Williams 40.00 X 165128 0 8682 James Adams 40.00 X 164744 0 5250 Karen Cavazos 40.00 X 162228 0 11926 Beth Peters 40.00 X 156079 0 13498 George Combe 40.00 X 203430 0 7587 Brian Sales 40.00 X 196987 0 21832 Stephen Ketner MD 40.00 X 192273 0 14585 Michael Quach 40.00 X 174362 0 9037 Thomas Burt 40.00 X 171724 0 10511 15318801 0 5609560 459 0 1 0 UTSW HI 108 5323 Harry Hines Blvd Dallas TX 753908886 Phys & Medical Svcs 49461116 Cardinal Health PO Box 730112 Dallas TX 753730112 Medical Prod Svcs 17572115 Cerner Corp PO Box 412702 Kansas City MO 64141 Info Tech Services 9429074 Philips Medical Systems PO Box 100355 Atlanta GA 303840355 Medical Prod Svcs 5592259 Epic Systems Corporation PO Box 88314 Milwaukee WI 532880314 Info Tech Services 4776093 316 16794150 10522791 27316941 Inpatient Revenue 622110 1126661264 1126661264 Outpatient Revenue 621400 653593770 653593770 Day Surgery Revenue 621400 157093913 157093913 Deductions from Rev. 622110 -1023720996 -1023720996 913627951 17595667 17595667 168444 168444 168444 168444 583385 -583385 -583385 -583385 Other Med Svc Revenue 622110 8250773 8250773 Dietary Revenue 621990 3628939 3628939 Vending Revenue 454210 77713 77713 2159059 2159059 14116484 972242102 927666722 0 17258439 80000 80000 14066192 3124819 10941373 344161501 280185471 63976030 28527227 22561229 5965998 41180994 31555571 9625423 23837275 18852103 4985172 7580564 1452064 6128500 1884022 1884022 587777 587777 93351265 82348985 11002280 7408948 133489 7275459 6033247 2688219 3345028 18340101 836227 17503874 31257729 5640642 25617087 2075658 1004433 1071225 2699246 770920 1928326 22888458 16830218 6058240 57342706 29675175 27667531 7089852 223026 6866826 Med./Surgical Supplies 84264812 83447452 817360 Prov for Doubtful Accts 50265271 50265271 Consulting & Prof Fees 14238784 967393 13271391 Other Expense 7517676 5626241 1891435 Collection Fees 1320455 710 1319745 867999760 638269658 229730102 0 74939653 172117520 21932215 25000741 135523360 126662831 9399231 9281281 10317206 10377611 1097399624 417883907 696980089 679515717 409980124 456099187 269224505 294569976 1628296383 1773624864 121966783 137333731 95400 95400 392465650 391437356 25040629 13901378 92276712 81549049 631845174 624316914 X 752461429 883570542 202077384 217389413 41912397 48347995 996451209 1149307950 1628296383 1773624864 X 104242342 48614399 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 0 0 0 0 0 0 1 241344 241344 0 Explanation of Other Lobbying Activities: Part II-B, Line 1i: In 2010 CMCD paid membership dues to organizations in which a portion of the membership dues were related to lobbying activities. NACHRI (National Association of Children's Hospitals), AHA, THA, TAVH (Texas Association of Voluntary Hospitals), THOT (Teaching Hospitals of Texas), and CHAT (Children's Hospital Association of Texas) identifed a portion of their membership dues as being related to lobbying activities. Lobbying percentages were identified by said organizations and applied to 2010 membership dues. Additionally, CMCD paid compensation in 2010 to staff for time related to other lobbying activities. 35296376 35296376 663407668 165298358 498109310 9538011 5206184 4331827 362813720 247379365 115434355 26343849 26343849 679515717 Net Assets of Foundation 265710164 Other Assets 18500479 LT Advances to Affiliates 10359333 294569976 UTSW Phys Guarantees 9343245 Retirement Plan Accr 59312528 Rsv for Professional Liab 3294081 Other Liabilities 9599195 81549049 In 2010 Children's Medical Center of Dallas was not required to have a FIN48 footnote disclosure. 1 1 X 1 X 1 X 1 1 0 1 1 19139712 19139712 0.02500 444563951 411469073 33094878 0.04330 0.00000 463703663 411469073 52234590 0.06830 7389780 992728 6397052 0.00840 28183116 2376317 25806799 0.03370 0.00000 4932691 4932691 0.00640 1356366 1356366 0.00180 41861953 3369045 38492908 0.05030 505565616 414838118 90727498 0.11860 236487 236487 0.00030 236487 236487 0.00030 1 21536189 9232650 5891356 1067751 4823605 X 1 1 1 NONE 2 1 Children's Medical Center of Dallas

1935 Medical District Drive Dallas TX 75235

X X X X X Both Dallas and Legacy campuses share a License, 2 Children's Medical Center of Legacy

7601 Preston Road Plano TX 75024

X X X X X EIN,and MCR provider number. _ Not Required per IRS Anouncement 2011-37 1 Not Required per IRS Anouncement 2011-37 2 Part I, Line 3c: Children's uses the Federal Poverty Guidelines to determine eligibility for low income individuals. 200% of the Federal Poverty Guidelines is used for 100% charity adjustment, and 201% to 400% of the Federal Poverty Guidelines is used for a sliding scale adjustment. Part I, Line 6a: Children's Community Benefit Report is prepared by our Public Relations department with collaboration from numerous departments within the hospital. Part I, Line 7: Total expenses for Schedule H purposes are calculated using Worksheet 2 from the Form 990 Schedule H guidelines. Part II: Children's is passionate about maintaining a vocal presence in legislative affairs on the local, state and federal levels and are at the forefront of governmental efforts that affect the community at large, from booster seat and car safety measures to critical funding initiatives. Additionally, Children's collaborates extensively with the Children's Hospital Association of Texas (CHAT) to advocate the development of an effective, comprehensive and appropriately funded children's health care delivery system within Texas. Part III, Line 4: Children's maintains allowances for doubtful accounts to reserve for potential write-offs relating to a patient's inability to make payments on an account. Accounts are written off as a bad debt when collection efforts have been exhausted following guidelines established by Healthcare Financial Management Association Statement No. 15. Children's routinely monitors its accounts receivable balances and utilizes historical collection experience to support the basis for its estimates of the provision for doubtful accounts. Children's uses Worksheet A guidelines from the Form 990 Schedule H guidelines and Worksheet 2 instructions to calculate the bad debt expense and ratio of patient care cost to charges, respectively. Part III, Line 8: Children's uses the As Filed Medicare Cost Report and Worksheet B from the IRS Schedule H Instructions to determine medicare allowable costs. Part III, Line 9b: and Part VI, Line 3: Children's has written debt collection policies which identify collection practices to be followed. The collection practices determine for what financial assistance a patient qualifies, and if a patient does not qualify for financial assistance, Children's also has written collection practices to be followed to determine if a patient qualifies for charity care. As part of the collection practice, Childrens' financial counselors review with the patient and their family the various state and federal programs available to them. Part VI, Line 2: Community Needs AssessmentSince 1994, Children's has produced a comprehensive quality-of-life report on area children, Beyond ABC: Growing Up in Dallas County. Beginning in 2008, a separate study has been published to focus on youth in Collin County as well. These biennial reports provide 10 years of trended data on the many factors facing children in our community. Beyond ABC analyzes more than 50 indicators of well-being with respect to health, education, safety and security for the more than 900,000 children that call those areas home.Children's has taken on the task of preparing Beyond ABC and distributing it to child advocates, service agencies, community leaders and lawmakers because of the presence the hospital holds in the community. In turn, these community leaders and organizations as well as Children's use the report to help determine how best to employ their resources each year. Part VI, Line 4: Children's is well known for bringing exceptional medical and surgical care to the children of North Texas. Through community events, child-specific initiatives and organizational affiliations, the hospital invests in prevention, research, education, clinical excellence and advocacy to benefit all children. Through its academic affiliation with UT Southwestern Medical Center, faculty physician scientists conduct research that is instrumental in developing treatments, therapies and greater understanding of pediatric diseases. More than 120 pediatric residents and 70 fellows train here annually. Many of the more than 50 subspecialty programs of Children's have received national and international recognition, confirming a reputation for Children's and UT Southwestern as one of the finest pediatric healthcare providers in the U.S. Part VI, Line 5: Texas ranks 6th highest in the nation for obesity in 10-17 year olds, and the problem is even more pressing in Dallas County. Nearly four of ten (38.3 percent) Dallas Independent School District students are obese or overweight as compared to 31.5 percent in Texas and 28.8 percent nationally. In addition, only 1 in 5 Dallas Independent School District 3rd graders passed the Texas mandated school Fitnessgram assessment compared to about 1 in 3 statewide. At Children's, we provide services to 7,500 patients each year with diagnoses that research shows to be obesity related. These include cardiology, endocrine, gastrointestinal, pulmonary and psychiatry.The Dallas Area Coalition to Prevent Childhood ObesityChildren's Medical Center sponsors the Dallas Area Coalition to Prevent Childhood Obesity (DACPCO), an alliance of 140 organizations representing health and human service providers, businesses, government, schools, civic and service organizations, and faith-based groups. Both the U.S. Surgeon General's Plan to Address Childhood Obesity and the Strategic Plan for Prevention of Obesity in Texas: 2005-2010 recommended the establishment of broad and deep collaborations of diverse stakeholders to leverage resources and touch more community members.The mission of the Dallas Area Coalition to Prevent Childhood Obesity (DACPCO) is to promote healthy lifestyles in Dallas children through physical activity and nutrition. Since its launch in 2005, Children's has provided leadership and staffing for monthly meetings, member correspondence and strategic coalition initiatives.The coalition focuses on five primary strategies which include expanding community resources, providing education to children and families, mobilizing grassroots support on public policy issues related to childhood obesity, collaborating on a focused intervention in a low-income neighborhood, and exposing low-income children and families to opportunities for free and healthy lifestyle activities.Dental OutreachAlthough effective methods exist to prevent tooth decay, cavities remain the most prevalent chronic condition among children - five times more common than asthma and seven times more common than hay fever. Inpartnership with UT Southwestern, a grant has been obtained so that children from the continuity clinics and ARCH (at-risk children) clinic who are identified as at-risk are now provided oral health education and fluoride varnish to reduce their risk of cavities every three months.Children's websiteOur hospital Web site, www.childrens.com, empowers parents with the latest information about childhood illnesses, prevention, treatment and services available at the hospital. More than 1,300 common pediatric topics are addressed on the Web site. Also available are interactive guides promoting healthy living that target both children and their parents. The site also offers a free subscription to a monthly electronic newsletter that connects our community to the amazing things that take place at Children's every day.Reaching out to support the families of our communities is at the heart of the Children's mission. The challenge of ensuring the safety and well-being of all children is a driving force for the hospital, its employees and its medical staff. Assessing how many lives our services touch requires a look into our community, where the Children's influence has impact far beyond the hospital's walls.Disease Management and WellnessThe Disease Management and Wellness Department at Children's improves quality of life and decreases the use of healthcare services through education and pro-active self-management. Children's has six disease-specific certifications, the most of any pediatric center in the United States. The programs offer access to evidence-based care and support that is needed for the management of conditions like asthma, diabetes and obesity.The disease management initiative is part of the hospital's ongoingefforts to reduce emergency department use, decrease admissions, curtail healthcare costs and ultimately, improve the quality of life for children with chronic conditions. Each program provides a family-centered environment that focuses on providing quality care to patients and overall increased disease awareness. Children's is committed to educating coaches, parents and young athletes on the importance of sports injury prevention. The hospital has a presence at dozens of coaches' clinics each year at facilities such as the Plano Sports Authority and Dallas Baseball Academy of Texas. During the clinics, Children's provides sports-specific injury-prevention cards and clipboards to thousands of coaches each year. So far, we have impacted the health and safety of 400,000 young athletes. Children's has also worked with companies such as Kohl's Corporation and their Sports Health and Wellness Outreach Program, to further support community outreach efforts. Spreading a message of water safetyDrowning is the second-leading cause of injury-related deaths among American children under age 14. The Know Before You Go Program spreads the message that every drowning is preventable when parents take appropriate precautions. The program includes distributing water safety materials, providing demonstrations on proper water rescue techniques and the use and proper fit of Coast Guard approved flotation devices. In 2009 almost 78,000 children and adults were educated in water safety through the Know Before You Go program.Working to reduce preventable injuriesMore than a decade ago, Children's formed the Safe Kids Dallas Area Coalition - the local chapter of Safe Kids Worldwide - to prevent childhood injuries. Traumatic injuries are the leading cause of death in Texas in children ages 1 to 14, and preventing these injuries is imperative at Children's - the first Level I trauma center in Texas (and one of only two in the state) that is solely dedicated to treating pediatric patients. Since 2002, the number of patients hospitalized because of motor vehicle crashes has steadily risen. Children's Injury Prevention Program has expanded its outreach efforts accordingly to bring car seat safety education and installation services to the community in an effort to reduce the number of children injured in car crashes. A specific initiative within the Safe Kids Dallas program is our car-seat safety inspection project. The project offers child safety-seat inspections by certified car seat technicians at Children's Dallas and Legacy campus so parents can learn to buckle up their children appropriately. In 2009, Children's Injury Prevention program provided over 1200 free car seats to the community across 112 Dallas county zip codes.A voice for childrenAt Children's we consider it a privilege and responsibility to serve as ardent advocates for children.We work tenaciously to influence health and public policies. Through a combination of programmatic initiatives, organizational affiliations and community events, Children's spreads its influence into the region and provides area children much-needed access to a better quality of life. Whether that means establishing programs to increase services to the area's underserved children or fostering partnerships with existing organizations, Children's is committed to connecting families to the services they need.Coalition for North Texas Children Children's is the founding member and sponsor of the Coalition for North Texas Children, a nonpartisan alliance of more than 100 non-profit organizations. The coalition is devoted to keeping children's issues a priority among policy makers and the public they serve. In addition, the Advocacy staff at Children's participates in community initiatives focused on public policy, including those sponsored by the United Way of Metropolitan Dallas, the Texas Children's Health Insurance Program Coalition, the Greater Dallas Chamber of Commerce, the Partnership for a Healthier Texas, March of Dimes of Texas and the Asthma Coalition of Texas.Children First! Collin County CoalitionChildren's is the founding member and sponsor of the Children First! Collin County Coalition, a nonpartisan alliance of more than 80 non-profit organizations. The coalition works to improve the quality of life of children through the development of initiatives related to public policy, advocacy, public awareness and community programs. The coalition's five work groups focus on economic security, education, family strengthening, health and safety. Community Outreach Through the efforts of the Advocacy staff at Children's, more area children who are eligible for Medicaid or the Children's Health Insurance Program (CHIP) are receiving coverage. One in three children living in Dallas County is uninsured. Lack of health insurance leads to poorer health in childhood, greater rates of avoidable hospitalizations and higher childhood mortality. Uninsured children are 8 times more likely to have delayed care and 12 times more likely to have an unmet medical need than children with private insurance.Children's is committed to helping families obtain health insurance, an important factor in the health and well-being for our entire community. Children's has a vision to help address the shortage of primary pediatric medical care for families with limited resources.Dallas CHIP CoalitionChildren's founded and sponsors the Dallas Children's Health Insurance Program Coalition, an alliance of more than 90 organizations focused on helping families of uninsured children apply for CHIP or Medicaid. In addition, the coalition provides community leadership on public policy issues that affect the crisis of uninsured children in our community. MEDICAID/CHIP Outreach EventsAnnually, Children's coordinates two large community outreach events targeting the families of uninsured children. Working with the Dallas Children's Health Insurance Program Coalition, these events are promoted through school flyers and the media. Since 2005, these events have helped more than 12,000 families apply for coverage for more than 24,000 children. The coalition has trained more than 250 volunteers to assist families with applications for CHIP or Medicaid. School Based Medicaid/Chip Outreach Children's outreach team conducts Medicaid/Children's Health Insurance Program outreach at 7 area school districts with a combined enrollment of more than 350,000. Each student's family receives at least four communications during a school year with information on the importance of health insurance and the tools to apply for CHIP/Medicaid. In nine years, Children's has gained buy-in from 7 school districts, trained more than 2,500 school staff and volunteers, completed more than 55,000 applications for Medicaid/CHIP and participated in 700 special events. Children's serves as a liasion with the state for families who could not successfully navigate the state's eligibility system. Public Health Task Force Children's Director of Advocacy serves as the advisor on child health issues for the Dallas County District 3 Public Health Task Force which focuses on the most impoverished, isolated and underserved area of Dallas County. The task force works to bring more public and private health and human services resources to this area and to connect the residents to the resources. Part VI, Line 6: Children's is not part of an affiliated health care system.Part VI, Line 7: Children's files a Community Benefits Plan with the State of Texas as required by Senate Bill 427. 1 May Smith Scholars Program 9 45000 Women's Auxiliary Education Assistance Program 22 30000 University of Texas at Arlington 1 5000 Other Information: Part IV: May Smith Scholars Program The May Smith Scholars program provides both financial assistance and practical clinical experience for students interested in pediatric nursing. The scholarship program is named for May Forster Smith, who began an open-air clinic for infants in 1913 in Dallas. Sophomore and junior undergraduate students are eligible to apply to receive $5,000 each year for up to two years. Recipients of the scholarships must work at Children's as nurse externs for at least 400 hours during their undergraduate program. After graduation, recipients will be offered employment as registered nurses in one of the Children's Nurse Internship Tracts: Critical Care, Emergency, General Pediatrics, Hematology-Oncology, or Perioperative Services. Women's Auxiliary Educational Assistance Program The Women's Auxiliary to Children's offers educational support to nursing and allied health students who are registered for or currently enrolled in an accredited program through the Educational Assistance program for Nursing and Allied Health Students. Students who qualify may receive up to $1000 per semester. Educational assistance is granted and paid on a per-semester basis. Students or prospective students of accredited nursing or allied health programs may apply if they: Are junior or senior level students enrolled full or part time in an accredited undergraduate or graduate nursing program. Maintain an overall grade point average of 3.0 on a 4.0 scale, or cumulative 3.0 prior to being accepted into an accredited program. Students are asked to sign agreements to work full time for 12 months at Children's for each academic year they receive education assistance or six months for each semester. If the students are offered employment with Children's but decline the offer, they will be obligated to repay the full amount plus interest calculated at the current prime interest rate at the time the offer is declined. Pediatric Post-Masters Certificate Program The University of Texas at Arlington School of Nursing and Children's Medical Center Dallas offer an Acute Care Pediatric Nurse Practitioner Post-Masters Certificate Program that consists of 31 credit hours. The program prepares students to serve in advanced practice leadership roles with infants, children and adolescents who have acute and chronic health care needs. Requirements include: an MSN from an NLN-accredited program 3.0 GPA on a 4.0 scale for the MSN, Registered Nurse Licensure in Texas, Physical Assessment content within the past three years, and Two years' experience in Pediatric Acute Care nursing recommended. X X X X X 1 1 X X X X 1 1 0 0 0 0 0 0 0 Christopher J Durovich 736892 0 803990 0 208005 0 1396525 0 17108 0 3162520 0 912140 0 Julio Perez Fontan MD 480000 0 0 0 0 0 0 0 0 0 480000 0 0 0 Ray R Dziesinski 313124 0 254741 0 64080 0 417990 0 10876 0 1060811 0 297324 0 James Herring 307952 0 587643 0 125044 0 454102 0 48 0 1474789 0 636702 0 Douglas G Hock 343363 0 290631 0 74301 0 479000 0 12637 0 1199932 0 336895 0 John P Kline 256792 0 125000 0 9057 0 238489 0 18208 0 647546 0 125000 0 Regina M Coggins 220496 0 46519 0 25322 0 156558 0 13504 0 462399 0 46519 0 Trent C Smith 286225 0 53293 0 81929 0 199193 0 4775 0 625415 0 53293 0 Patricia U Winning 331832 0 277759 0 70812 0 467924 0 6168 0 1154495 0 334972 0 Pamela Arora 279858 0 178110 0 63887 0 340610 0 4142 0 866607 0 228035 0 Kimberly Besse 219648 0 10000 0 6872 0 100927 0 5352 0 342799 0 0 0 David G Biggerstaff 181846 0 116865 0 46356 0 223308 0 12154 0 580529 0 151728 0 Jean Ann Larson 87983 0 15000 0 63988 0 39269 0 6652 0 212892 0 0 0 Fiona Levy MD 387000 0 0 0 0 0 0 0 0 0 387000 0 0 0 Justin Lombardo 244278 0 15000 0 54556 0 119037 0 5722 0 438593 0 0 0 Elizabeth Field MacKay 149465 0 52674 0 24958 0 65986 0 12535 0 305618 0 64533 0 Ronald C Skillens Jr 173984 0 27130 0 6087 0 80639 0 8016 0 295856 0 27130 0 Mary E Stowe 227128 0 135782 0 43956 0 262898 0 6872 0 676636 0 168605 0 Daniel Carney 141973 0 20000 0 44160 0 54464 0 1776 0 262373 0 0 0 Jason D White 60594 0 25000 0 43696 0 25435 0 46 0 154771 0 0 0 Phyllis Cole 129552 0 14248 0 251945 0 40137 0 11128 0 447010 0 40091 0 Christopher J Dougherty 108604 0 139347 0 47985 0 10590 0 2646 0 309172 0 164579 0 Brett D Lee 74366 0 122500 0 28900 0 4031 0 1513 0 231310 0 149673 0 Christopher Menzies MD 214948 0 0 0 21236 0 6753 0 437 0 243374 0 0 0 Jerry Lee 172590 0 28500 0 20917 0 10674 0 4324 0 237005 0 0 0 Mary Beth Martin 130206 0 18382 0 63200 0 6787 0 7679 0 226254 0 0 0 Philip Branson 95150 0 14745 0 83171 0 6782 0 3328 0 203176 0 0 0 Mazie Jamison 31521 0 22956 0 138136 0 2599 0 300 0 195512 0 0 0 Hilda Sallack 135461 0 23342 0 25809 0 3810 0 12835 0 201257 0 0 0 Candis Posey 168710 0 0 0 13989 0 6723 0 1560 0 190982 0 0 0 Jeffrey Vawrinek 159231 0 15000 0 7997 0 6692 0 0 0 188920 0 0 0 Deborah Sheppard 141936 0 17767 0 18543 0 649 0 8850 0 187745 0 0 0 Denise Claussen 137144 0 18762 0 20691 0 966 0 2956 0 180519 0 0 0 Sandra McDermott 132722 0 15440 0 25063 0 3373 0 0 0 176598 0 0 0 Michelle Kromelis 123081 0 18648 0 31219 0 3352 0 8633 0 184933 0 0 0 Jodi Landon 132741 0 20366 0 15977 0 3299 0 3376 0 175759 0 0 0 Michael Hefton 131893 0 15207 0 19618 0 9688 0 5841 0 182247 0 0 0 Dorothy Foglia 122077 0 14600 0 29304 0 3758 0 9822 0 179561 0 0 0 Kaye Schmidt 135263 0 15163 0 15194 0 3692 0 2543 0 171855 0 0 0 Penny Williams 124888 0 14967 0 25273 0 3374 0 5308 0 173810 0 0 0 James Adams 124325 0 16564 0 23855 0 3144 0 2106 0 169994 0 0 0 Karen Cavazos 127733 0 13278 0 21217 0 3432 0 8494 0 174154 0 0 0 Beth Peters 113991 0 18242 0 23846 0 7856 0 5642 0 169577 0 0 0 George Combe 90559 0 82832 0 30039 0 3780 0 3807 0 211017 0 0 0 Brian Sales 90873 0 72179 0 33935 0 15016 0 6816 0 218819 0 0 0 Stephen Ketner MD 141239 0 19860 0 31174 0 6901 0 7684 0 206858 0 0 0 Michael Quach 109707 0 44698 0 19957 0 8082 0 955 0 183399 0 0 0 Thomas Burt 132763 0 21728 0 17233 0 7523 0 2988 0 182235 0 0 0 Part I, Line 1a * Children's written policy on business and educational travel prohibits first class travel except when approved in advance by the CEO or by the Board Chair. * Companion travel is prohibited except when it is deemed to further Children's business activities and must be approved in advance by the CEO or Board Chair. Approved companion travel is included as taxable income in 2010 for Christopher J Durovich, Trent C Smith, Daniel Carney, and Jason D White. * Compensation is grossed up in limited circumstances with prior approval of the appropriate board committee. Approved grossed up compensation has been included as 2010 taxable income for Christopher J Durovich, Trent C Smith, Justin Lombardo, Daniel Carney, Jean Ann Larson, and Jason D White. * Children's offers, to promote health and wellness consistent with Children's mission, a limited monthly allowance as a taxable benefit to employees for health club membership dues. In 2010 Health Club membership dues were included as taxable income for Kimberly Besse, David G Biggerstaff, Regina M Coggins, Christopher J Dougherty, Christopher J Durovich, James Herring, Douglas G Hock, Jean Ann Larson, Justin Lombardo, Ronald C Skillens, Jr, and Patricia U Winning. * In an effort to continue to attract quality leadership, Children's provides temporary housing allowances as a taxable benefit to executives and other key employees relocating to Dallas. Temporary housing allowances were provided in 2010 for Daniel Carney, Jean Ann Larson, Justin Lombardo, Trent C Smith, and Jason D White Part I, Lines 4a-b Severance Payment and Non-Qualified Retirement Plan: * Severance - Phyllis Cole - $190,000 * Severance - Philip Branson - $55,166 * Severance - Mazie Jamison - $117,075 * Retirement Income Restoration Plan - James Herring received $51,289.69 as taxable income from the Retirement Income Restoration Plan as he is over the age of 65. Additional employees who participate in the Retirement Income Restoration Plan are Christopher J Durovich, Douglas G Hock, Mary E Stowe, and Patricia U Winning. * Savings Restoration Plan - James Herring received $3,499.57 as taxable income from the Savings Restoration Plan as he is over the age of 65. Additional employees who participate in the Savings Restoration Plan are Christopher J Durovich, Douglas G Hock, Mary E Stowe, Patricia U Winning, Pamela Arora, David G Biggerstaff, Regina M Coggins, Ray R Dziesinski, John P Kline, Justin Lombardo, and Trent C Smith. N Central Tx Hlth Fac Dev Corp Hosp 521304502 65854RAL4 2009-07-01 193697772 Reimburse Construction Costs 0 0 0 193697772 2819039 190566160 312573 2009 0 0 0 1 0 0 1 0 0 0.00590 0.00590 1 0 0 0 0 0 0 Schedule K Supplental Information Although facility does not routinely engage bond counsel to review management or service contracts, facility did contract with Ernst and Young to review the 2009 management services contracts and research agreements for potential private business use of bond financed space. Ernst & Young also conducted a site review to verify the use of bond financed space. Form 990, Part VI, Section A, line 2 Michael Dardick: Business relationship Richard Douglas: Business relationship Gregg Engles: Business relationship Robert Estrada: Business relationship Richard Knight, Jr.: Business relationship John Young: Business relationship Form 990, Part VI, Section A, line 4 The sole member reserve powers were amended to remove the requirement for sole member approval for investment policies or changes in investment policies of Children's Medical Center of Dallas. Form 990, Part VI, Section A, line 6 Children's Health Services of Texas ("CHST"), a Texas non-profit corporation, is the sole member of the corporation. Form 990, Part VI, Section A, line 7a CHST elects all members of the organization's Board of Directors. Form 990, Part VI, Section A, line 7b A list of decisions requiring approval by the member is as follows: a) Any change in the mission or purpose of the Corporation; b) Any amendment to the Articles of Incorporation or Bylaws of the Corporation; c) Any addition of new Members; d) Any purchase or acquisition, sale, gift, lease, disposition of, mortgage or other encumbrance of any property, real, personal, or mixed by the Corporation, excluding routine expenditures, the value of which in the aggregate exceeds five percent (5%) of the total assets of the Corporation; e) Selling, exchanging, or otherwise disposing of all or substantially all of the Corporation's assets; f) Any incurrence or guarantee of indebtedness by the Corporation that in the aggregate exceeds five percent (5%) of the total assets of the Corporation; g) Any merger, acquisition, or consolidation of the Corporation or entering into any joint business venture with any other person, corporation or other legal entity that exceeds five percent (5%) of the total assets of the Corporation; h) Any dissolution of the Corporation; i) Any proposed amendments to the affiliation agreement between the Corporation and The UTSW Medical School (Medical School); j) In the event the Member merges or consolidates with another member or another entity, any proposed contract between such new organization and the Corporation; k) Create, acquire, or dispose of any subsidiary or affiliated entity the value of which in the aggregate exceeds five percent (5%) of the total assets of the Corporation; l) Approval of the annual budget for the Corporation; and m) Any single transaction resulting in a five percent (5%) or more deviation from the annual budget. Form 990, Part VI, Section B, line 11 A draft of the Form 990 is presented to the corporation's Audit Committee one week before the meeting. At the meeting, the Chief Financial Officer proivdes a detailed review of the Form 990 and answers questions presented by the Committee members. The Committee votes to approve or disapprove the release of the Form 990 for filing. Form 990, Part VI, Section B, line 12c The Board members receive a copy of the policy, along with a Disclosure of Possible Conflict of Interests Form to complete, with their Board appointment letter. Additionally, compliance training is provided annually at a designated Board meeting, as well as during the annual Board orientation. Lastly, all disclosures made are reviewed by the Chief Compliance Officer and discussed at the member Board of Directors meeting to determine if further action is required. Form 990, Part VI, Section B, line 15 The corporation's CEO, President, other officers, and key employees are employed and compensated by Children's Medical Center of Dallas ("Children's"). The Children's process is as follows: 1. The Human Resources Committee of the Board is responsible for setting the compensation for executives, except for the President and CEO which is set by the Board. The Committee is comprised of independent, non-employee directors with no conflict of interest regarding executive compensation. A written compensation philosophy has been developed by the Human Resources Committee and is formally reviewed on an annual basis by the Committee for timeliness and appropriateness. The philosophy defines desired comparator groups for compensation surveys. The comparator groups are from domestic healthcare industry sectors only and do not include any non-healthcare organizations. 2. The compensation philosophy also defines target levels relative to the marketplace comparator groups for base pay, base pay plus incentive pay and fringe benefits provided to Children's executives. A third-party consultant, Sullivan Cotter, is engaged by the Human Resources Committee and provides independent, expert consulting services in the area of executive compensation market surveying, pay and benefits program design, and administrative services. Salaries for Children's executives (except for the President and CEO) are set by comparing the salaries paid for comparable positions in integrated systems, academic medical centers and children's hospitals similar in size and scope of services to Children's. 3. The salary for the President and CEO is set in reference to salaries paid for Presidents and CEOs of children's hospitals similar in size and scope of services to Children's. The data is compiled by Sullivan Cotter and they develop and update annually salary ranges unique to each executive position. The Human Resources Committee approves base pay for each executive (except for the President and CEO, whose base pay is approved by the full Board of Directors) aimed in the aggregate at approximately the middle of executive pay ranges. 4. For other officers and key employees, Children's uses a combination of job evaluation (Hay Guide Chart-Profile Method of Position Evaluation) and survey data to determine the market pay range. Form 990, Part VI, Section C, line 19 Governing documents, conflict of interest policy and financial statements are made available upon request. 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 50 hours per week as they are involved with limited offsite community events. Average hours per week for all Vice Presidents, key employees, and highest compensated employees have been identified as 40 hours per week. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 5: Net unrealized gains on investments: 28,911,311. Prior period adjustments: 19,703,088. Total to Form 990, Part XI, Line 5: 48,614,399. Children's Health Svcs of TX 1935 Medical District Drive Dallas TX 75235 752062019 Management 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 7 Children's Health Svcs of TX 1 Dallas Phys Medical Svcs for Children Inc 1935 Medical District Drive Dallas TX 75235 810584868 Physicians TX 501(c)(3) Line 9 Children's Medical Ctr of Dallas 1 Physicians for Children 1935 Medical District Drive Dallas TX 75235 752854505 Physicians TX 501(c)(3) Line 9 Children's Medical Ctr of Dallas 1 Anesthesiologists for Children 1935 Medical District Drive Dallas TX 75235 752917570 Physicians TX 501(c)(3) Line 9 Children's Medical Ctr of Dallas 1 Southwestern Medical District 5323 Harry Hines Blvd Dallas TX 75390 204101612 Management 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 Alternative Care Systems 1935 Medical District Drive Dallas TX 75235 752244475 Other Medical Svcs TX N/A C Children's Insurance Co 76 St Paul Street Suite 500 Burlington VT 05401 030328102 Insurance VT N/A C 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 1 0 0 Anesthesiologist for Children D 5055027 actual cost Anesthesiologist for Children P 325008 actual cost Physicians for Children D 6123147 actual cost Physicians for Children P 81804 actual cost Dallas Phys Medical Svcs for Children Inc E 1013144 actual cost Children's Health Svcs of TX D 194305 actual cost Children's Med Ctr Foundation P 7931666 actual cost