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 752062015 Children's Medical Center Foundation CHIL 2144567000 1935 Medical District Drive Dallas TX 75235 Jerry Lee 2144567000 2011-11-11 1 Kimberly Temple CPA 2145612300 2010 2016-02-24 21:20:13Z J Peter Kline 1935 Medical Distr Dr Dallas TX 75235 30760534 0 X www.childrens.com X 1985 TX To provide financial support for CMC to enable the hospital to accomplish its mission. 18 13 0 1202 0 0 14371441 22099020 0 0 2354340 7174978 488636 -497053 17214417 28776945 18153264 16895978 0 0 5081608 5179300 0 0 2783981 1767128 2535933 25002000 24611211 -7787583 4165734 253295335 286105114 9329903 20394949 243965432 265710165 To provide financial support for CMC to enable the hospital to accomplish its mission to make life better for children. To accomplish this, the foundation is committed to supporting the guiding principles of CMCD. 0 0 17714647 16895978 162350 Children's Medical Center Foundation is an organization devoted to raising money in support of Children's Medical Center of Dallas, a 501(c)(3) organization. To accomplish this purpose, the foundation, like the hospital, is committed to supporting the guiding principles: quality care, research and innovation, education and advocacy, excellence and accountability. 17714647 1 1 0 0 0 0 0 0 1 1 0 0 0 1 0 1 0 0 0 0 0 0 0 1 0 0 1 1 1 0 0 0 0 0 0 0 0 1 1 0 0 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 0 0 X 18 13 1 1 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 Debbie Scripps 1.00 X X 0 0 0 Christopher J Durovich 60.00 X X 0 1748887 1413633 John P Kline 50.00 X X 0 390849 256697 Ray R Dziesinski 50.00 X X 0 631945 428866 Stephanie J Gilliard 40.00 X X 0 101282 6891 Stephanie K Smith 40.00 X 0 76686 4224 Katherine Friend 40.00 X 0 201768 3821 Michele Whitsett 40.00 X 0 156729 1219 William Braem 40.00 X 0 153480 1798 Lori Waggoner 40.00 X 0 152977 973 Olivia Davidson 40.00 X 0 138286 11177 Carol Mann-Bieler 40.00 X 0 116179 1279 Carol Schauer 40.00 X 0 113088 936 0 3982156 2131514 0 0 1 0 0 59250 1237085 20802685 396287 22099020 868187 868187 4659925 2682151 731960 303325 3927965 2378826 6306791 6306791 288901 1237085 948304 -659403 -659403 Other Revenue 900099 162350 162350 162350 28776945 162350 0 6515575 16891978 16891978 4000 4000 664954 664954 3541870 1858495 1683375 308440 48754 136263 123423 420872 66525 185933 168414 243164 38436 107425 97303 391800 391800 51368 51368 408581 358445 50136 347655 196069 151586 598841 191275 407566 18461 18461 408380 408380 43975 23760 20215 27954 27954 Other Expense 191923 118298 73625 Dues and Subscriptions 46995 38657 8338 24611211 17714647 4112583 2783981 26856644 24780717 17654661 17200255 25000 12834170 285129 103547 19157677 232293 21566134 18925384 181213893 206664374 5718874 5571667 253295335 286105114 3080355 88820 4976062 7385038 9865218 1273486 3055873 9329903 20394949 X 119826848 134442188 82226187 82919982 41912397 48347995 243965432 265710165 253295335 286105114 X 4165734 17578999 X 0 1 1 X 0 X 19378518 29412086 21344153 14371441 21388136 105894334 19378518 29412086 21344153 14371441 21388136 105894334 105894334 18688201 8286349 5517933 2345340 7174978 42012801 25670 10951 152057 18012 162350 369040 148276175 2893756 0.71420 X Schedule A, Part II, Line 10, Explanation of Other Income: Other income for year-end 12/31/2006 Other income for year-end 12/31/2007 Other income for year-end 12/31/2008 Proceeds from Haltine Seminar for year-end 12/31/2009 Other income for year-end 12/31/2010 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 41912397 812733 5622864 48347994 39929360 1180734 802303 41912397 38556230 2095272 -722142 39929360 1.00000 0 0 18925384 18925384 232293 232293 0 18925384 Annuities and Trust Payable 1802073 Other LT Liabilities 1253800 3055873 28776945 24611211 4165734 17578999 17578999 21744733 46355943 17578998 17578998 28776945 0 28776945 24611211 0 24611211 0 24611211 Part X, Line 2 The Children's Medical Center Foundation audited financial statements for the year ending December 31, 2010 do not contain a FIN 48 footnote. Part V, Line 4 The Foundation's endowment fund earnings, depending on the donor's designation, are used for patient care, education, and research. If an endowment is designated as unrestricted, management may determine how the earnings are used. Parade 675285 408497 266788 361 3095 755387 Tennis Tournament 178153 156040 22113 666 200 400 53238 2 146347 146347 56931 110 3798 74118 999785 710884 288901 57597 671 7293 882743 948304 -659403 1 Children's Medical Center Dallas 1935 Medical District Drive Dallas TX 75235 750800628 501( c) (3) 16794150 N/A N/A Program Operations & Capital UT Southwestern Medical 5323 Harry Hines Blvd Dallas TX 75390 752556007 501( c) (3) 35000 N/A N/A Research Salary Support UT Southwestern Medical 5323 Harry Hines Blvd Dallas TX 75390 752556007 501( c) (3) 6928 N/A N/A Lectureship PIBDNet Inc E203 Given Medical Bldg University of Vermont Burlington VT 05405 203200488 501( c) (3) 18500 N/A N/A IBD Collaboration Support Anesthesiologists for Children 1935 Medical District Drive Dallas TX 75235 752917570 501( c) (3) 33650 N/A N/A Program Operations & Capital 4 Employee Care Fund 2 3000 N/A Continuing Education Speaker Fee for the Paul P. Taylor Association of Pediatrics 1 1000 N/A Procedure for Monitoring Grants in the U.S.: Part I, Line 2: Schedule I, Part I, Line 2: Transfer of funds by the Foundation to Children's Medical Center and its affiliates as well as to UTSW are to reimburse them for expenditures that are to be covered by Foundation donated funds. X X X X 0 0 0 0 0 0 0 0 0 Christopher J Durovich 0 736892 0 803990 0 208005 0 1396525 0 17108 0 3162520 0 912140 John P Kline 0 256792 0 125000 0 9057 0 238489 0 18208 0 647546 0 125000 Ray R Dziesinski 0 313124 0 254741 0 64080 0 417990 0 10876 0 1060811 0 297324 Katherine Friend 0 164515 0 13816 0 23437 0 0 0 3821 0 205589 0 0 Michele Whitsett 0 143751 0 0 0 12978 0 0 0 1219 0 157948 0 0 William Braem 0 139121 0 0 0 14359 0 0 0 1798 0 155278 0 0 Lori Waggoner 0 121452 0 10829 0 20696 0 0 0 973 0 153950 0 0 X 1 35000 Opinions of Experts X 3 346487 Opinions of Experts X Grand Piano 1 14800 Opinions of Experts 0 1 0 Form 990, Part VI, Section A, line 2 Peter Kline, Foundation President, and Caren Kline, Foundation Board member -family relationship David Beuerlein and Sheila Beuerlein, Foundation Board members - family relationship Debbie Scripps and Ric Scripps, Foundation Board members - family relationship; Sharon Worrell and Terry Worrell, Foundation Board members - family relationship Form 990, Part VI, Section A, line 3 All management duties are performed by employees of the organization's affiliate, Children's Medical Center of Dallas ("Children's"). A contract between the organization and Children's covers all services provided. 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 for the corporation. 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 Matters Requiring Approval of the Member. (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) Implementing the annual budget for the Corporation; (e) Acquiring, selling, leasing, disposing of or mortgaging any real estate; (f) Selling, exchanging, or otherwise disposing of all or substantially all of the Corporation's assets; (g) Making expenditures of the Corporation's funds in excess of an amount which is established by CHST from time to time or which represent a significant departure from established policies or objectives of the Corporation; (h) Guaranteeing the debts of others; (i) Merging, consolidating, or entering into any joint business venture with any other person, corporation, or other legal entity; (j) Transferring any portion of the Corporation's assets to another person or legal entity other than pursuant to Article 2.05(f) above, or to the annual budget or approved policies of the Corporation governing the Corporation's support of Children's and its affiliates; or (k) Taking any action where the Board of Directors has received notice that such prior approval is required. Form 990, Part VI, Section B, line 11 A draft of the Form 990 is presented to the Audit Committee one week before the Committee meeting. At the meeting, the Chief Financial Officer provides a detailed overview of the Form 990 and answers any questions the Committee members may have. The Committee then 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. All disclosures made are reviewed by the corporation's Chief Compliance Officer and discussed at the sole 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. It defines desired comparator groups for compensation surveys. The comparator groups are from domestic healthcare industry sectors only and include no non-healthcare for-profit or not-for-profit 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. These data are 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. Form 990, Part VI, Section C, line 19 Governing documents, the 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: 17,578,999. 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 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 1 Dallas Phys Med Svcs Inc 1935 Medical District Drive Dallas TX 75235 810584868 Physicians TX 501(c)(3) Line 9 Children's Medical Center of Dallas 1 Physicians For Children 1935 Medical District Drive Dallas TX 75235 752854505 Physicians TX 501(c)(3) Line 9 Children's Medical Center of Dallas 1 Anesthesiologists for Children 1935 Medical District Drive Dallas TX 75235 752917570 Physicians TX 501(c)(3) Line 9 Children's Medical Center 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 Management TX N/A C Children's Insurance Co 76 St Paul Street Suite 500 Burlington VT 05401 030328102 Insurance VT N/A C 0 1 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0