COOK CHILDRENS MEDICAL CENTER: Form 990, tax year 2019

View the entire original 990 at ProPublica ↗

Organization: COOK CHILDRENS MEDICAL CENTER (EIN 75-2051646)
Tax period: 2019-10-01 to 2020-09-30
Filed: 2021-08-12
IRS object ID: 202132249349301023
Schema version: 2019v5.2
Source: Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header
Form 990
Schedule A
Schedule B
Schedule D
Schedule H
Schedule I
Schedule J
Schedule K
Schedule L
Schedule O
Schedule R

Return header ReturnHeader

Field	Value	IRS element (for citing)
Return	2021-08-12T09:25:10-05:00	ReturnTs
Tax Period End	2020-09-30	TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

Preparer Firm Name PreparerFirmName

Field	Value	IRS element (for citing)
Business Name Line1	BKD LLP	BusinessNameLine1Txt

Preparer US Address PreparerUSAddress

Field	Value	IRS element (for citing)
Address Line1	14241 DALLAS PARKWAY SUITE 1100	AddressLine1Txt
City	DALLAS	CityNm
State Abbreviation	TX	StateAbbreviationCd
ZIP	75254	ZIPCd

Field	Value	IRS element (for citing)
Return Type	990	ReturnTypeCd
Tax Period Begin	2019-10-01	TaxPeriodBeginDt

Filer Filer

Field	Value	IRS element (for citing)
EIN	752051646	EIN

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	Cook Children's Medical Center	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
In Care Of	% CORY RHOADES	InCareOfNm
Business Name Control	COOK	BusinessNameControlTxt
Phone	6828854000	PhoneNum

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	801 Seventh Avenue	AddressLine1Txt
City	Fort Worth	CityNm
State Abbreviation	TX	StateAbbreviationCd
ZIP	76104	ZIPCd

Business Officer BusinessOfficerGrp

Field	Value	IRS element (for citing)
Person	CORY R RHOADES	PersonNm
Person Title	CFO & SVP, FINANCE	PersonTitleTxt
Phone	6828854000	PhoneNum
Signature	2021-08-16	SignatureDt
Discuss With Paid Preparer	Yes (true)	DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

Field	Value	IRS element (for citing)
Preparer Person	kevin ensminger	PreparerPersonNm
PTIN	P01310558	PTIN
Phone	9727028262	PhoneNum

Field	Value	IRS element (for citing)
Tax	2019	TaxYr
Build TS	2022-09-23 18:48:47Z	BuildTS

Form 990 IRS990

Field	Value	IRS element (for citing)
Principal Officer	NANCY CYCHOL	PrincipalOfficerNm

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	801 SEVENTH AVENUE	AddressLine1Txt
City	FORT WORTH	CityNm
State Abbreviation	TX	StateAbbreviationCd
ZIP	76104	ZIPCd

Field	Value	IRS element (for citing)
Gross Receipts	$1,314,030,854	GrossReceiptsAmt
Group Return For Affiliates	false	GroupReturnForAffiliatesInd
Organization501c3	Yes (X)	Organization501c3Ind
Website Address	WWW.COOKCHILDRENS.ORG	WebsiteAddressTxt
Type Of Organization Corp	Yes (X)	TypeOfOrganizationCorpInd
Formation	1985	FormationYr
Legal Domicile State	TX	LegalDomicileStateCd
Activity Or Mission	KNOWING THAT EVERY CHILD'S LIFE IS SACRED OUR PROMISE IS TO IMPROVE THE HEALTH OF EVERY CHILD IN OUR REGION THROUGH THE PREVENTION AND TREATMENT OF ILLNESS, DISEASE and INjury.	ActivityOrMissionDesc
Voting Members Governing Body	13	VotingMembersGoverningBodyCnt
Voting Members Independent	12	VotingMembersIndependentCnt
Total Employee	5320	TotalEmployeeCnt
Total Volunteers	666	TotalVolunteersCnt
Total Gross UBI	$10,118	TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm	$125	NetUnrelatedBusTxblIncmAmt
PY Contributions Grants	$12,053,920	PYContributionsGrantsAmt
CY Contributions Grants	$14,081,914	CYContributionsGrantsAmt
PY Program Service Revenue	$1,180,339,581	PYProgramServiceRevenueAmt
CY Program Service Revenue	$1,297,518,713	CYProgramServiceRevenueAmt
PY Investment Income	$166,062	PYInvestmentIncomeAmt
CY Investment Income	$277,208	CYInvestmentIncomeAmt
PY Other Revenue	$1,387,895	PYOtherRevenueAmt
CY Other Revenue	$866,043	CYOtherRevenueAmt
PY Total Revenue	$1,193,947,458	PYTotalRevenueAmt
CY Total Revenue	$1,312,743,878	CYTotalRevenueAmt
PY Grants And Similar Paid	$65,050,938	PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid	$76,066,892	CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members	$0	PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members	$0	CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid	$380,095,875	PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid	$392,525,167	CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns	$0	PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns	$0	CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense	$0	CYTotalFundraisingExpenseAmt
PY Other Expenses	$536,028,942	PYOtherExpensesAmt
CY Other Expenses	$606,849,625	CYOtherExpensesAmt
PY Total Expenses	$981,175,755	PYTotalExpensesAmt
CY Total Expenses	$1,075,441,684	CYTotalExpensesAmt
PY Revenues Less Expenses	$212,771,703	PYRevenuesLessExpensesAmt
CY Revenues Less Expenses	$237,302,194	CYRevenuesLessExpensesAmt
Total Assets BOY	$1,426,284,240	TotalAssetsBOYAmt
Total Assets EOY	$1,804,052,601	TotalAssetsEOYAmt
Total Liabilities BOY	$450,333,040	TotalLiabilitiesBOYAmt
Total Liabilities EOY	$677,130,790	TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY	$975,951,200	NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY	$1,126,921,811	NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part III	Yes (X)	InfoInScheduleOPartIIIInd
Mission	KNOWING THAT EVERY CHILD'S LIFE IS SACRED, OUR PROMISE IS TO IMPROVE THE HEALTH OF EVERY CHILD IN OUR REGION THROUGH THE PREVENTION AND TREATMENT OF ILLNESS, DISEASE AND INJURY.	MissionDesc
Significant New Program Srvc	false	SignificantNewProgramSrvcInd
Significant Change	false	SignificantChangeInd
Expense	$775,855,644	ExpenseAmt
Grant	$76,066,892	GrantAmt
Revenue	$1,298,309,323	RevenueAmt
Desc	Cook Children's Medical Center is the cornerstone of Cook Children's Health Care System. This 444-bed facility is home to top medical minds, advanced technologies, family centered treatments and leading-edge clinical research, all designed to fulfill its Promise to improve the health of every child through the prevention and treatment of illness, disease and injury. Nationally recognized services such as the Level IV Neonatal Intensive Care Unit, the Jane and John Justin Neurosciences Center and the hematology and oncology center are leading the way in providing the highest level of care to families who travel to the medical center from all across Texas and the United States, as well as internationally. From complicated surgeries and level II trauma care to physical therapy and behavioral health services, the medical center offers a variety of services and amenities to meet the unique needs of the families it serves. It is one of only 10 freestanding children's hospitals in the world to achieve Magnet designation from the American Nursing Credentialing Center four years in a row. Fiscal year 2020 was shaping up to be a banner year for Cook Children's Medical Center. Volumes and revenue reached historic highs. The organization strengthened its workforce with an increase in the minimum wage. Several strategic initiatives were launched to improve quality, safety and communication, and patient experience scores were at a positive 86%. Every quality and fiscal metric was on an upward trajectory. Then, five months in, the world changed, and the medical center had to pivot. The global spread of COVID-19 led Cook Children's to open a multidisciplinary crisis command center on March 15, 2020, to coordinate a consistent system-wide response to the ever-changing environment. It quickly became clear this would be a long-haul endeavor and administrators defined three guiding principles to steer every decision and action from that point forward: 1. Zero transmission to staff from patient or caregiver. 2. No patient encounter without the appropriate personal protective equipment (PPE). 3. Have a bed and support for every patient. These principles became the medical center's true north that carried the organization through the challenges of FY2020. Measuring Success Financials play a significant role in the sustainability of any organization, and Cook Children's took several measures to conserve financial resources given the uncertainty of the pandemic's impact on operations and markets. The organization reduced discretionary spending, developed systems to monitor and protect resources and secured available CARES Act funds. These steps, coupled with the medical center's long history of outstanding financial performance, allowed Cook Children's to save and invest its resources to provide financial stability in these uncertain times. The resulting financial strength made it possible for the organization to be patient and measured in its response to the global health and economic crisis. Pandemic Response The medical center had to be nimble, flexible and quick to adjust to changing COVID guidelines. To reduce the spread of illness, the command center instituted policies to limit visitors, greenlit a work-from-home plan for employees and increased bandwidth for telehealth services. In total, 3,000 employees worked from home, and virtual health visits jumped from 316 in February to more than 8,000 in April. By the end of the fiscal year, 57,397 patients had accessed virtual health services. Protecting the workforce became paramount during the pandemic, because healthy and strong employees ensured the continuation of quality patient care. Leadership took several steps to ensure employees were safe and cared for as they navigated working and raising their families in the midst of a global crisis. Most notable, Cook Children's committed to pay employees their full salaries through the end of the fiscal year, even if their positions were temporarily furloughed or reassigned. With schools shuttered, the system activated a crisis care program with its child care partner Bright Horizons so that employees could continue to work knowing their children were cared for. The program provided 10,000 days of child care to 480 employees. During summer, the Cook Children's Child Study Center was repurposed as Camp Cook where 8,500 hours of child-centered activities were provided to employees' children. When the medical center canceled elective surgeries and non-emergency appointments, many impacted employees were redeployed to other areas of the organization and ultimately covered more than 1,000 shifts. A number of operational and facility adjustments had to be made during the pandemic. The medical center repurposed two spaces as dedicated COVID units for a total of 30 beds. Cook Children's offered one of its properties-the former Kindred Hospital building-as an overflow hospital for the community, and 31 nurses volunteered to cross-train to care for COVID patients at Kindred. The medical center's laboratory worked diligently to identify COVID testing platforms and developed in-house testing capabilities, which fielded a total of 18,142 COVID tests. In addition, the lab opened a drive-through testing service for the community and employees and prepared for receiving, storing and administering the anticipated vaccine. Pandemic Inspires Improvement Many of the adjustments were difficult and required sacrifice. Perseverance was necessary as weeks turned into months turned into a year...and counting. But, the lessons learned during the pandemic built a better organization. Moving employees to a work-from-home setting and relying heavily on telehealth required major upgrades in internet bandwidth. The medical center's I.T. professionals worked day and night to make it happen. These improved online capabilities better position the medical center to continue operations in the midst of crisis now and in the future and open up a whole new mode for health care delivery. Personal protective equipment became required gear for every employee. As demand caused resources to wane, innovation and conservation helped protect the supply. To disinfect n95 masks for reuse, a space was converted into an ultraviolet light room. Many clinicians wore face shields fabricated by the Cook Children's Home Health orthotic and prosthetic team using their 3-D printers. Intubation "cubes" were installed to isolate aerosolized respiratory particles during intubation. These innovations not only interrupted the spread of illness, but also preserved PPE supply during high demand. Every employee learned more than ever before about the factors that contribute to illness. Masking, hand washing and social distancing became household terms and were reinforced with outreach and education efforts through the medical center's social media platforms, online newsroom and local news interviews with Cook Children's experts. Fifty Cook Children's physicians worked together to draft back-to-school recommendations and educate 900 school nurses on safe reopening measures. The infection protection strategies learned and shared during the pandemic made the medical center, employees, patients and community safer, healthier and more aware of how to protect themselves and others from illness. Forward Progress By May, the medical center had its hands around how to safely resume full operations and began to bring elective surgeries and other services back online. As a result, volumes improved month over month and the medical center ended its fiscal year just 10% to 20% shy of normal volume levels. But the most significant achievement of the year had nothing to do with volume or revenue, and everything to do with the medical center's COVID-19 guiding principles. Cook Children's stayed true to these principles and attained all three of its goals. Leading with the guiding principles allowed the medical center to not just weather the storm, but to come out on the other side of it with a stronger workforce, a more nimble organization and better positioned to meet the health needs of the community no matter the circumstance.	Desc
Total Program Service Expenses	$775,855,644	TotalProgramServiceExpensesAmt
Described In Section501c3	Yes (true)	DescribedInSection501c3Ind
Schedule B Required	Yes (true)	ScheduleBRequiredInd
Political Campaign Acty	false	PoliticalCampaignActyInd
Lobbying Activities	false	LobbyingActivitiesInd
Subject To Proxy Tax	false	SubjectToProxyTaxInd
Donor Advised Fund	Yes (true)	DonorAdvisedFundInd
Conservation Easements	false	ConservationEasementsInd
Collections Of Art	false	CollectionsOfArtInd
Credit Counseling	false	CreditCounselingInd
Donor Rstr Or Quasi Endowments	Yes (true)	DonorRstrOrQuasiEndowmentsInd
Report Land Building Equipment	Yes (true)	ReportLandBuildingEquipmentInd
Report Investments Other Sec	false	ReportInvestmentsOtherSecInd
Report Program Related Invst	false	ReportProgramRelatedInvstInd
Report Other Assets	Yes (true)	ReportOtherAssetsInd
Report Other Liabilities	Yes (true)	ReportOtherLiabilitiesInd
Include FIN48 Footnote	false	IncludeFIN48FootnoteInd
Independent Audit Fincl Stmt	false	IndependentAuditFinclStmtInd
Consolidated Audit Fincl Stmt	Yes (true)	ConsolidatedAuditFinclStmtInd
School Operating	false	SchoolOperatingInd
Foreign Office	false	ForeignOfficeInd
Foreign Activities	false	ForeignActivitiesInd
More Than5000 K To Org	false	MoreThan5000KToOrgInd
More Than5000 K To Individuals	false	MoreThan5000KToIndividualsInd
Professional Fundraising	false	ProfessionalFundraisingInd
Fundraising Activities	false	FundraisingActivitiesInd
Gaming Activities	false	GamingActivitiesInd
Operate Hospital	Yes (true)	OperateHospitalInd
Audited Financial Stmt Att	Yes (true)	AuditedFinancialStmtAttInd
Grants To Organizations	Yes (true)	GrantsToOrganizationsInd
Grants To Individuals	Yes (true)	GrantsToIndividualsInd
Schedule J Required	Yes (true)	ScheduleJRequiredInd
Tax Exempt Bonds	Yes (true)	TaxExemptBondsInd
Invest Tax Exempt Bonds	false	InvestTaxExemptBondsInd
Escrow Account	false	EscrowAccountInd
On Behalf Of Issuer	false	OnBehalfOfIssuerInd
Engaged In Excess Benefit Trans	false	EngagedInExcessBenefitTransInd
PY Excess Benefit Trans	false	PYExcessBenefitTransInd
Loan Outstanding	false	LoanOutstandingInd
Grant To Related Person	false	GrantToRelatedPersonInd
Business Rln With Org Mem	false	BusinessRlnWithOrgMemInd
Business Rln With Fam Mem	Yes (true)	BusinessRlnWithFamMemInd
Business Rln With35 Ctrl Ent	false	BusinessRlnWith35CtrlEntInd
Deductible Non Cash Contri	false	DeductibleNonCashContriInd
Deductible Art Contribution	false	DeductibleArtContributionInd
Terminate Operations	false	TerminateOperationsInd
Partial Liquidation	false	PartialLiquidationInd
Disregarded Entity	false	DisregardedEntityInd
Related Entity	Yes (true)	RelatedEntityInd
Related Organization Ctrl Ent	Yes (true)	RelatedOrganizationCtrlEntInd
Transaction With Control Ent	Yes (true)	TransactionWithControlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org	false	TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp	false	ActivitiesConductedPrtshpInd
Schedule O Required	Yes (true)	ScheduleORequiredInd
IRP Document	177	IRPDocumentCnt
IRP Document W2 G	0	IRPDocumentW2GCnt
Employee	5320	EmployeeCnt
Employment Tax Returns Filed	Yes (true)	EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over Limit	Yes (true)	UnrelatedBusIncmOverLimitInd
Form990 T Filed	Yes (true)	Form990TFiledInd
Foreign Financial Account	false	ForeignFinancialAccountInd
Prohibited Tax Shelter Trans	false	ProhibitedTaxShelterTransInd
Taxable Party Notification	false	TaxablePartyNotificationInd
Nondeductible Contributions	false	NondeductibleContributionsInd
Quid Pro Quo Contributions	false	QuidProQuoContributionsInd
Form8282 Property Disposed Of	false	Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct	false	RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct	false	PayPremiumsPrsnlBnftCntrctInd
DAF Excess Business Holdings	false	DAFExcessBusinessHoldingsInd
Taxable Distributions	false	TaxableDistributionsInd
Distribution To Donor	false	DistributionToDonorInd
Indoor Tanning Services	false	IndoorTanningServicesInd
Subj To Tax Rmnrtn Ex Prcht Pymt	Yes (true)	SubjToTaxRmnrtnExPrchtPymtInd
Subject To Excs Tax Net Invst Inc	false	SubjectToExcsTaxNetInvstIncInd
Info In Schedule O Part VI	Yes (X)	InfoInScheduleOPartVIInd
Governing Body Voting Members	13	GoverningBodyVotingMembersCnt
Independent Voting Member	12	IndependentVotingMemberCnt
Family Or Business Rln	false	FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties	Yes (true)	DelegationOfMgmtDutiesInd
Change To Org Documents	false	ChangeToOrgDocumentsInd
Material Diversion Or Misuse	false	MaterialDiversionOrMisuseInd
Members Or Stockholders	Yes (true)	MembersOrStockholdersInd
Election Of Board Members	Yes (true)	ElectionOfBoardMembersInd
Decisions Subject To Approva	Yes (true)	DecisionsSubjectToApprovaInd
Minutes Of Governing Body	Yes (true)	MinutesOfGoverningBodyInd
Minutes Of Committees	Yes (true)	MinutesOfCommitteesInd
Officer Mailing Address	false	OfficerMailingAddressInd
Local Chapters	false	LocalChaptersInd
Form990 Provided To Gvrn Body	Yes (true)	Form990ProvidedToGvrnBodyInd
Conflict Of Interest Policy	Yes (true)	ConflictOfInterestPolicyInd
Annual Disclosure Covered Prsn	Yes (true)	AnnualDisclosureCoveredPrsnInd
Regular Monitoring Enfrc	Yes (true)	RegularMonitoringEnfrcInd
Whistleblower Policy	Yes (true)	WhistleblowerPolicyInd
Document Retention Policy	Yes (true)	DocumentRetentionPolicyInd
Compensation Process CEO	Yes (true)	CompensationProcessCEOInd
Compensation Process Other	Yes (true)	CompensationProcessOtherInd
Investment In Joint Venture	Yes (true)	InvestmentInJointVentureInd
Written Policy Or Procedure	Yes (true)	WrittenPolicyOrProcedureInd
Upon Request	Yes (X)	UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Field	Value	IRS element (for citing)
Person	CORY RHOADES	PersonNm
Phone	6828854000	PhoneNum

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	801 SEVENTH AVENUE	AddressLine1Txt
City	FORT WORTH	CityNm
State Abbreviation	TX	StateAbbreviationCd
ZIP	76104	ZIPCd

Field	Value	IRS element (for citing)
Info In Schedule O Part VII	Yes (X)	InfoInScheduleOPartVIIInd

Form990 Part VII Section A Form990PartVIISectionAGrp (32 entries)

TitleTitleTxt	Average Hours Per WeekAverageHoursPerWeekRt	Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt	OfficerOfficerInd	Reportable Comp From OrgReportableCompFromOrgAmt	Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt	Other CompensationOtherCompensationAmt	Highest Compensated EmployeeHighestCompensatedEmployeeInd	Key EmployeeKeyEmployeeInd	Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd
RICK w MERILL
CEO	11.0	29.0	Yes (X)	$591,684	$1,521,473	$248,553
STEPHEN w KIMMEL
CFO	16.0	24.0	Yes (X)	$377,483	$566,225	$119,652
NANCY c CYCHOL
PRESIDENT/CHIEF HOSPITAL SVCS	40.0	3.0	Yes (X)	$938,408	$0	$42,263
STANLEY E DAVIS
SR. VICE PRESIDENT, COO	40.0	0.0	Yes (X)	$543,653	$0	$107,996
CHERYL PETERSEN
AVP Nursing, CNO	40.0	0.0	Yes (X)	$401,383	$0	$57,529
JACK SOSEBEE
VICE PRESIDENT	40.0	0.0	Yes (X)	$352,865	$0	$35,316
MATTHEW CARROLL
pediatric hospitalist	40.0	0.0		$318,820	$0	$56,967	Yes (X)
DEBORAH C BOUDREAUX
AVP NURSING	40.0	0.0		$268,307	$0	$52,469		Yes (X)
ORLANDO R CHAPA
AVP NURSING	40.0	0.0		$278,164	$0	$35,404		Yes (X)
ELIA VALENCIA-STOKES
AVP FINANCE	40.0	0.0		$261,276	$0	$39,663		Yes (X)
SPENCER D SEALS
VP CONSTRUCTION & REAL ESTATE	40.0	4.0	Yes (X)	$247,940	$0	$52,417
TAMMY THOMLISION
AVP REVENUE	40.0	0.0		$265,043	$0	$14,097		Yes (X)
OZIOMA N OLOWU
director of pharmacy	40.0	0.0		$205,592	$0	$55,259	Yes (X)
DIANA SHANNON
RNFA, CV SVC COORDINATOR	40.0	0.0		$219,554	$0	$33,290	Yes (X)
JESSACA T SIBR
pharmacist	40.0	0.0		$190,689	$0	$44,321	Yes (X)
MARG DORMAN-O'DONNELL
director, case management	40.0	0.0		$194,669	$0	$27,199		Yes (X)
MARY L HICKS
pharmacist	40.0	0.0		$185,693	$0	$31,012	Yes (X)
MARY CARA MARTZ
SECRETARY	1.0	40.0	Yes (X)	$157,852	$0	$31,463
ANNE CARVALHO
TRUSTEE	1.0	3.0		$0	$0	$0			Yes (X)
R JOHN BATTON
TRUSTEE - SEC/ TREASURER	1.0	2.0	Yes (X)	$0	$0	$0			Yes (X)
JEFF CONNOR
TRUSTEE - CHAIRMAN	2.0	3.0	Yes (X)	$0	$0	$0			Yes (X)
BILLIE R PUGH JR MD
TRUSTEE	1.0	3.0		$0	$0	$0			Yes (X)
JAMES WEBB
TRUSTEE	1.0	5.0		$0	$0	$0			Yes (X)
MICHAEL A LAGATTA
TRUSTEE	1.0	2.0		$0	$0	$0			Yes (X)
FRANK ANDERSON
TRUSTEE	1.0	1.0		$0	$0	$0			Yes (X)
RYAN B DICKERSON
TRUSTEE	1.0	2.0		$0	$0	$0			Yes (X)
DANA C KELLY
TRUSTEE	1.0	1.0		$0	$0	$0			Yes (X)
LEAH KING
TRUSTEE - SEC/TREASURER	2.0	1.0	Yes (X)	$0	$0	$0			Yes (X)
JOSEPH LAMARCA JR
TRUSTEE	1.0	1.0		$0	$0	$0			Yes (X)
JAMES E SENTER
TRUSTEE	1.0	0.0		$0	$0	$0			Yes (X)
ANDREW S WAYNE
TRUSTEE - VICE CHAIRMAN	2.0	2.0	Yes (X)	$0	$0	$0			Yes (X)
JEFFREY L CURETON
TRUSTEE	1.0	3.0		$0	$0	$0			Yes (X)

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	$5,999,075	TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org	$2,087,698	TotReportableCompRltdOrgAmt
Total Other Compensation	$1,084,870	TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K	374	IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed	false	FormerOfcrEmployeesListedInd
Total Comp Greater Than150 K	Yes (true)	TotalCompGreaterThan150KInd
Compensation From Other Srcs	false	CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

Address Line1ContractorAddress/USAddress/AddressLine1Txt	CityContractorAddress/USAddress/CityNm	State AbbreviationContractorAddress/USAddress/StateAbbreviationCd	ZIPContractorAddress/USAddress/ZIPCd	ServicesServicesDesc	CompensationCompensationAmt
LINBECK GROUP LLC
201 MAIN ST STE 1801	FORT WORTH	TX	76102	CONSTR CONTRACTOR	$59,363,865
MEDTRONIC
PO BOX 848086	DALLAS	TX	75284	MED SUPPLY SERVICES	$3,399,500
METRO AVIATION
PO BOX 7008	SHREVEPORT	LA	71137	AIRCRAFT MAINTENANCE	$4,391,939
CONATSER CONSTRUCTION
PO BOX 15448	FORT WORTH	TX	76119	CONSTR CONTRACTOR	$3,491,728
HKS INC
PO BOX 731121	DALLAS	TX	753731121	PROFESSIONAL SVCS	$2,645,616

Field	Value	IRS element (for citing)
Cntrct Rcvd Greater Than100 K	72	CntrctRcvdGreaterThan100KCnt
Related Organizations	$10,434,511	RelatedOrganizationsAmt
Government Grants	$3,647,403	GovernmentGrantsAmt
All Other Contributions	$0	AllOtherContributionsAmt
Total Contributions	$14,081,914	TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (4 entries)

DescDesc	BusinessBusinessCd	Total Revenue ColumnTotalRevenueColumnAmt	Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt	Unrelated Business RevenueUnrelatedBusinessRevenueAmt
Patient Services	621110	$1,202,036,781	$1,202,036,781
Other Operating Revenue	621110	$87,357,121	$87,357,121
JOINT VENTURE REVENUE	621110	$8,114,693	$8,114,693
LAB REFERRALS	621500	$10,118		$10,118

Field	Value	IRS element (for citing)
Total Program Service Revenue	$1,297,518,713	TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$242,196	TotalRevenueColumnAmt
Exclusion	$242,196	ExclusionAmt

Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$0	TotalRevenueColumnAmt

Royalties Revenue RoyaltiesRevenueGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$0	TotalRevenueColumnAmt

Gross Rents GrossRentsGrp

Field	Value	IRS element (for citing)
Real	$1,359,436	RealAmt

Less Rental Expenses LessRentalExpensesGrp

Field	Value	IRS element (for citing)
Real	$1,284,003	RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

Field	Value	IRS element (for citing)
Real	$75,433	RealAmt
Personal	$0	PersonalAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$75,433	TotalRevenueColumnAmt
Exclusion	$75,433	ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

Field	Value	IRS element (for citing)
Other	$37,985	OtherAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

Field	Value	IRS element (for citing)
Other	$2,973	OtherAmt

Gain Or Loss GainOrLossGrp

Field	Value	IRS element (for citing)
Other	$35,012	OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$35,012	TotalRevenueColumnAmt
Exclusion	$35,012	ExclusionAmt

Field	Value	IRS element (for citing)
Fundraising Gross Income	$0	FundraisingGrossIncomeAmt
Fundraising Direct Expenses	$0	FundraisingDirectExpensesAmt

Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$0	TotalRevenueColumnAmt

Field	Value	IRS element (for citing)
Gaming Gross Income	$0	GamingGrossIncomeAmt
Gaming Direct Expenses	$0	GamingDirectExpensesAmt

Net Income From Gaming NetIncomeFromGamingGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$0	TotalRevenueColumnAmt

Field	Value	IRS element (for citing)
Gross Sales Of Inventory	$0	GrossSalesOfInventoryAmt
Cost Of Goods Sold	$0	CostOfGoodsSoldAmt

Net Income Or Loss NetIncomeOrLossGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$0	TotalRevenueColumnAmt

Other Revenue Misc OtherRevenueMiscGrp (2 entries)

DescDesc	BusinessBusinessCd	Total Revenue ColumnTotalRevenueColumnAmt	Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
CCIC Retro Premium	621110	$698,726	$698,726
GAIN ON DEFEASANCE	621110	$91,884	$91,884

Field	Value	IRS element (for citing)
Other Revenue Total	$790,610	OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$1,312,743,878	TotalRevenueColumnAmt
Related Or Exempt Func Income	$1,298,299,205	RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue	$10,118	UnrelatedBusinessRevenueAmt
Exclusion	$352,641	ExclusionAmt

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

Field	Value	IRS element (for citing)
Total	$75,660,445	TotalAmt
Program Services	$75,660,445	ProgramServicesAmt

Grants To Domestic Individuals GrantsToDomesticIndividualsGrp

Field	Value	IRS element (for citing)
Total	$406,447	TotalAmt
Program Services	$406,447	ProgramServicesAmt

Foreign Grants ForeignGrantsGrp

Field	Value	IRS element (for citing)
Total	$0	TotalAmt

Benefits To Members BenefitsToMembersGrp

Field	Value	IRS element (for citing)
Total	$0	TotalAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

Field	Value	IRS element (for citing)
Total	$5,962,666	TotalAmt
Program Services	$935,390	ProgramServicesAmt
Management And General	$5,027,276	ManagementAndGeneralAmt

Comp Disqual Persons CompDisqualPersonsGrp

Field	Value	IRS element (for citing)
Total	$83,258	TotalAmt
Program Services	$83,258	ProgramServicesAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

Field	Value	IRS element (for citing)
Total	$291,154,413	TotalAmt
Program Services	$259,409,845	ProgramServicesAmt
Management And General	$31,744,568	ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

Field	Value	IRS element (for citing)
Total	$14,144,242	TotalAmt
Program Services	$12,841,151	ProgramServicesAmt
Management And General	$1,303,091	ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

Field	Value	IRS element (for citing)
Total	$59,852,682	TotalAmt
Program Services	$53,654,589	ProgramServicesAmt
Management And General	$6,198,093	ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

Field	Value	IRS element (for citing)
Total	$21,327,906	TotalAmt
Program Services	$19,195,316	ProgramServicesAmt
Management And General	$2,132,590	ManagementAndGeneralAmt

Fees For Services Management FeesForServicesManagementGrp

Field	Value	IRS element (for citing)
Total	$178,151,805	TotalAmt
Program Services	$2,743,006	ProgramServicesAmt
Management And General	$175,408,799	ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

Field	Value	IRS element (for citing)
Total	$1,361,133	TotalAmt
Management And General	$1,361,133	ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

Field	Value	IRS element (for citing)
Total	$0	TotalAmt

Fees For Services Lobbying FeesForServicesLobbyingGrp

Field	Value	IRS element (for citing)
Total	$0	TotalAmt

Fees For Services Prof Fundraising FeesForServicesProfFundraising

Field	Value	IRS element (for citing)
Total	$0	TotalAmt

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

Field	Value	IRS element (for citing)
Total	$0	TotalAmt

Fees For Services Other FeesForServicesOtherGrp

Field	Value	IRS element (for citing)
Total	$28,065,716	TotalAmt
Program Services	$22,205,519	ProgramServicesAmt
Management And General	$5,860,197	ManagementAndGeneralAmt

Advertising AdvertisingGrp

Field	Value	IRS element (for citing)
Total	$24,746	TotalAmt
Program Services	$18,243	ProgramServicesAmt
Management And General	$6,503	ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

Field	Value	IRS element (for citing)
Total	$8,645,496	TotalAmt
Program Services	$3,231,425	ProgramServicesAmt
Management And General	$5,414,071	ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

Field	Value	IRS element (for citing)
Total	$0	TotalAmt

Royalties RoyaltiesGrp

Field	Value	IRS element (for citing)
Total	$0	TotalAmt

Occupancy OccupancyGrp

Field	Value	IRS element (for citing)
Total	$42,634,026	TotalAmt
Program Services	$7,570,214	ProgramServicesAmt
Management And General	$35,063,812	ManagementAndGeneralAmt

Travel TravelGrp

Field	Value	IRS element (for citing)
Total	$1,025,095	TotalAmt
Program Services	$924,956	ProgramServicesAmt
Management And General	$100,139	ManagementAndGeneralAmt

Pymt Travel Entrtnmnt Pub Ofcl PymtTravelEntrtnmntPubOfclGrp

Field	Value	IRS element (for citing)
Total	$0	TotalAmt

Conferences Meetings ConferencesMeetingsGrp

Field	Value	IRS element (for citing)
Total	$266,667	TotalAmt
Program Services	$213,979	ProgramServicesAmt
Management And General	$52,688	ManagementAndGeneralAmt

Interest InterestGrp

Field	Value	IRS element (for citing)
Total	$13,690,820	TotalAmt
Program Services	$13,671,091	ProgramServicesAmt
Management And General	$19,729	ManagementAndGeneralAmt

Payments To Affiliates PaymentsToAffiliatesGrp

Field	Value	IRS element (for citing)
Total	$0	TotalAmt

Depreciation Depletion DepreciationDepletionGrp

Field	Value	IRS element (for citing)
Total	$57,041,338	TotalAmt
Program Services	$41,807,803	ProgramServicesAmt
Management And General	$15,233,535	ManagementAndGeneralAmt

Insurance InsuranceGrp

Field	Value	IRS element (for citing)
Total	$1,975,565	TotalAmt
Program Services	$1,975,565	ProgramServicesAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDesc	TotalTotalAmt	Program ServicesProgramServicesAmt	Management And GeneralManagementAndGeneralAmt
MEDICAL SUPPLIES	$121,698,161	$121,698,161
BAD DEBT	$88,233,720	$88,233,720
PHYSICIAN RENUMERATION	$35,312,357	$34,816,174	$496,183
EQUIPMENT AND REPAIRS	$8,517,327	$3,708,667	$4,808,660

All Other Expenses AllOtherExpensesGrp

Field	Value	IRS element (for citing)
Total	$20,205,653	TotalAmt
Program Services	$10,850,680	ProgramServicesAmt
Management And General	$9,354,973	ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

Field	Value	IRS element (for citing)
Total	$1,075,441,684	TotalAmt
Program Services	$775,855,644	ProgramServicesAmt
Management And General	$299,586,040	ManagementAndGeneralAmt
Fundraising	$0	FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

Field	Value	IRS element (for citing)
BOY	$16,607	BOYAmt
EOY	$16,543	EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

Field	Value	IRS element (for citing)
BOY	$532,777,239	BOYAmt
EOY	$786,959,319	EOYAmt

Pledges And Grants Receivable PledgesAndGrantsReceivableGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt
EOY	$0	EOYAmt

Accounts Receivable AccountsReceivableGrp

Field	Value	IRS element (for citing)
BOY	$146,128,634	BOYAmt
EOY	$164,582,071	EOYAmt

Receivables From Officers Etc ReceivablesFromOfficersEtcGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt
EOY	$0	EOYAmt

Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt
EOY	$0	EOYAmt

Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp

Field	Value	IRS element (for citing)
BOY	$30,559,237	BOYAmt
EOY	$31,257,963	EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

Field	Value	IRS element (for citing)
BOY	$10,825,408	BOYAmt
EOY	$11,592,250	EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

Field	Value	IRS element (for citing)
BOY	$710,640	BOYAmt
EOY	$260,793	EOYAmt

Field	Value	IRS element (for citing)
Land Bldg Equip Cost Or Other Bss	$1,180,285,145	LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec	$569,716,039	LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

Field	Value	IRS element (for citing)
BOY	$657,389,206	BOYAmt
EOY	$610,569,106	EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

Field	Value	IRS element (for citing)
BOY	$7,976,148	BOYAmt
EOY	$5,394,772	EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt
EOY	$0	EOYAmt

Investments Program Related InvestmentsProgramRelatedGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt
EOY	$0	EOYAmt

Intangible Assets IntangibleAssetsGrp

Field	Value	IRS element (for citing)
BOY	$7,424,990	BOYAmt
EOY	$7,424,990	EOYAmt

Other Assets Total OtherAssetsTotalGrp

Field	Value	IRS element (for citing)
BOY	$32,476,131	BOYAmt
EOY	$185,994,794	EOYAmt

Total Assets TotalAssetsGrp

Field	Value	IRS element (for citing)
BOY	$1,426,284,240	BOYAmt
EOY	$1,804,052,601	EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

Field	Value	IRS element (for citing)
BOY	$78,358,680	BOYAmt
EOY	$89,450,188	EOYAmt

Grants Payable GrantsPayableGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt
EOY	$0	EOYAmt

Deferred Revenue DeferredRevenueGrp

Field	Value	IRS element (for citing)
BOY	$171,751	BOYAmt
EOY	$56,012,015	EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$366,450,710	BOYAmt
EOY	$511,829,817	EOYAmt

Escrow Account Liability EscrowAccountLiabilityGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt
EOY	$0	EOYAmt

Loans From Officers Directors LoansFromOfficersDirectorsGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt
EOY	$0	EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt
EOY	$0	EOYAmt

Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt
EOY	$0	EOYAmt

Other Liabilities OtherLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$5,351,899	BOYAmt
EOY	$19,838,770	EOYAmt

Total Liabilities TotalLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$450,333,040	BOYAmt
EOY	$677,130,790	EOYAmt

Field	Value	IRS element (for citing)
Organization Follows FASB117	Yes (X)	OrganizationFollowsFASB117Ind

No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$975,951,200	BOYAmt
EOY	$1,126,921,811	EOYAmt

Donor Restriction Net Assets DonorRestrictionNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt
EOY	$0	EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$975,951,200	BOYAmt
EOY	$1,126,921,811	EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$1,426,284,240	BOYAmt
EOY	$1,804,052,601	EOYAmt

Field	Value	IRS element (for citing)
Info In Schedule O Part XI	Yes (X)	InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss	$237,302,194	ReconcilationRevenueExpnssAmt
Other Changes In Net Assets	-$86,331,583	OtherChangesInNetAssetsAmt
Method Of Accounting Accrual	Yes (X)	MethodOfAccountingAccrualInd
Accountant Compile Or Review	false	AccountantCompileOrReviewInd
FS Audited	Yes (true)	FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

Field	Value	IRS element (for citing)
Consolidated Basis Fincl Stmt	Yes (X)	ConsolidatedBasisFinclStmtInd

Field	Value	IRS element (for citing)
Audit Committee	Yes (true)	AuditCommitteeInd
Federal Grant Audit Required	false	FederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

Field	Value	IRS element (for citing)
Hospital	Yes (X)	HospitalInd

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

Field	Value	IRS element (for citing)
Contributor	RESTRICTED	ContributorNum

Contributor Business Name ContributorBusinessName

Field	Value	IRS element (for citing)
Business Name Line1	RESTRICTED	BusinessNameLine1

Contributor US Address ContributorUSAddress

Field	Value	IRS element (for citing)
Address Line1	RESTRICTED	AddressLine1
Address Line2	RESTRICTED	AddressLine2
City	RESTRICTED	City
State	RESTRICTED	State
ZIP Code	RESTRICTED	ZIPCode

Field	Value	IRS element (for citing)
Total Contributions	RESTRICTED	TotalContributionsAmt

Schedule D IRS990ScheduleD

Field	Value	IRS element (for citing)
Donor Advised Funds Held	1	DonorAdvisedFundsHeldCnt
Donor Advised Funds Vl EOY	$190,684	DonorAdvisedFundsVlEOYAmt
Funds And Other Accounts Vl EOY	$111,066,541	FundsAndOtherAccountsVlEOYAmt
Disclosed Org Leg Ctrl	Yes (true)	DisclosedOrgLegCtrlInd
Disclosed For Charitable Prps	Yes (true)	DisclosedForCharitablePrpsInd
Art Public Exhibition Amounts		ArtPublicExhibitionAmountsGrp
Held Works Art		HeldWorksArtGrp

CY Endwmt Fund CYEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$116,417,669	BeginningYearBalanceAmt
Contributions	$1,190,873	ContributionsAmt
Investment Earnings Or Losses	$4,368,488	InvestmentEarningsOrLossesAmt
Other Expenditures	$10,719,805	OtherExpendituresAmt
End Year Balance	$111,257,225	EndYearBalanceAmt

CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$111,568,298	BeginningYearBalanceAmt
Contributions	$545,683	ContributionsAmt
Investment Earnings Or Losses	$5,290,113	InvestmentEarningsOrLossesAmt
Other Expenditures	$986,425	OtherExpendituresAmt
End Year Balance	$116,417,669	EndYearBalanceAmt

CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$95,010,517	BeginningYearBalanceAmt
Contributions	$9,396,884	ContributionsAmt
Investment Earnings Or Losses	$8,367,517	InvestmentEarningsOrLossesAmt
Other Expenditures	$1,206,620	OtherExpendituresAmt
End Year Balance	$111,568,298	EndYearBalanceAmt

CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$76,556,166	BeginningYearBalanceAmt
Contributions	$11,777,744	ContributionsAmt
Investment Earnings Or Losses	$7,575,568	InvestmentEarningsOrLossesAmt
Other Expenditures	$898,961	OtherExpendituresAmt
End Year Balance	$95,010,517	EndYearBalanceAmt

CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$71,855,341	BeginningYearBalanceAmt
Contributions	$190,488	ContributionsAmt
Investment Earnings Or Losses	$4,883,138	InvestmentEarningsOrLossesAmt
Other Expenditures	$372,801	OtherExpendituresAmt
End Year Balance	$76,556,166	EndYearBalanceAmt

Field	Value	IRS element (for citing)
Board Designated Balance EOY	0.34740	BoardDesignatedBalanceEOYPct
Prmnnt Endowment Balance EOY	0.04760	PrmnntEndowmentBalanceEOYPct
Term Endowment Balance EOY	0.60500	TermEndowmentBalanceEOYPct
Endowments Held Unrelated Org	false	EndowmentsHeldUnrelatedOrgInd
Endowments Held Related Org	Yes (true)	EndowmentsHeldRelatedOrgInd
Related Org List Sch R	Yes (true)	RelatedOrgListSchRInd

Land LandGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$16,793,324	OtherCostOrOtherBasisAmt
Book Value	$16,793,324	BookValueAmt

Buildings BuildingsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$853,014,972	OtherCostOrOtherBasisAmt
Depreciation	$356,043,730	DepreciationAmt
Book Value	$496,971,242	BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$4,939,316	OtherCostOrOtherBasisAmt
Depreciation	$0	DepreciationAmt
Book Value	$4,939,316	BookValueAmt

Equipment EquipmentGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$257,430,979	OtherCostOrOtherBasisAmt
Depreciation	$203,387,622	DepreciationAmt
Book Value	$54,043,357	BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$48,106,554	OtherCostOrOtherBasisAmt
Depreciation	$10,284,687	DepreciationAmt
Book Value	$37,821,867	BookValueAmt

Field	Value	IRS element (for citing)
Total Book Value Land Buildings	$610,569,106	TotalBookValueLandBuildingsAmt

Other Assets Org OtherAssetsOrgGrp (4 entries)

DescDesc	Book ValueBookValueAmt
Assets Limited to Use	$137,748,002
Other Receivables	$22,653,178
SUPPLEMENTAL PMT RECEIVABLE	$21,606,275
RIGHT OF USE ASSETS	$3,987,339

Field	Value	IRS element (for citing)
Total Book Value Other Assets	$185,994,794	TotalBookValueOtherAssetsAmt
Federal Income Tax Liability	$0	FederalIncomeTaxLiabilityAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (3 entries)

DescDesc	AmtAmt
INTERCOMPANY PAYABLES	-$17,500
EST DUE TO THIRD PARTIES	$16,917,975
RIGHT OF USE LIABILITIES	$2,938,295

Field	Value	IRS element (for citing)
Total Liability	$19,838,770	TotalLiabilityAmt
Total Rev Etc Audited Fincl Stmt	$1,244,135,981	TotalRevEtcAuditedFinclStmtAmt
Other Revenue	-$67,767,528	OtherRevenueAmt
Revenue Not Reported	-$67,767,528	RevenueNotReportedAmt
Revenue Subtotal	$1,311,903,509	RevenueSubtotalAmt
Other Revenues Not Included	$840,369	OtherRevenuesNotIncludedAmt
Revenue Not Reported Fincl Stmt	$840,369	RevenueNotReportedFinclStmtAmt
Total Revenue Per Form990	$1,312,743,878	TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt	$1,003,845,511	TotExpnsEtcAuditedFinclStmtAmt
Other Expenses Included	$16,637,547	OtherExpensesIncludedAmt
Expenses Not Reported	$16,637,547	ExpensesNotReportedAmt
Expenses Subtotal	$987,207,964	ExpensesSubtotalAmt
Other Expenses Not Included	$88,233,720	OtherExpensesNotIncludedAmt
Expenses Not Rpt Fincl Stmt	$88,233,720	ExpensesNotRptFinclStmtAmt
Total Expenses Per Form990	$1,075,441,684	TotalExpensesPerForm990Amt

Supplemental Information Detail SupplementalInformationDetail (6 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
SCHEDULE D, PART V, LINE 4	INTENDED USE OF ENDOWMENT FUNDS: COOK CHILDREN'S HAS ADOPTED INVESTMENT AND SPENDING POLICIES FOR ENDOWMENT ASSETS THAT ATTEMPT TO PROVIDE A PREDICTABLE STREAM OF FUNDING TO PROGRAMS AND OTHER ITEMS SUPPORTED BY ITS ENDOWMENT WHILE SEEKING TO MAINTAIN THE PURCHASING POWER OF THE ENDOWMENT. UNDER COOK CHILDREN'S POLICIES, ENDOWMENT ASSETS ARE INVESTED IN A MANNER THAT IS INTENDED TO PRODUCE AN AMOUNT THAT IS EQUAL TO A RETURN HURDLE DEFINED AS THE SPENDING RATE, INFLATION RATE AND THE MANAGEMENT COST OF THE ENDOWMENT ON AN ANNUAL BASIS WHILE ASSUMING A PRUDENT LEVEL OF INVESTMENT RISK. ACTUAL RETURNS IN ANY GIVEN YEAR MAY VARY FROM THIS AMOUNT. TO SATISFY ITS LONG-TERM RATE OF RETURN OBJECTIVES, COOK CHILDREN'S RELIES ON A TOTAL RETURN STRATEGY IN WHICH INVESTMENT RETURNS ARE ACHIEVED THROUGH BOTH CURRENT YIELD (INVESTMENT INCOME SUCH AS DIVIDENDS AND INTEREST) AND CAPITAL APPRECIATION (BOTH REALIZED AND UNREALIZED). COOK CHILDREN'S TARGETS A DIVERSIFIED ASSET ALLOCATION THAT PLACES A GREATER EMPHASIS ON EQUITY-BASED INVESTMENTS TO ACHIEVE ITS LONG-TERM RETURN OBJECTIVES WITHIN PRUDENT RISK CONSTRAINTS. COOK CHILDREN'S HAS A POLICY (THE SPENDING POLICY) OF APPROPRIATING FOR EXPENDITURE EACH YEAR UP TO 5% OF THE FOUNDATION'S INVESTMENTS AVERAGE FAIR VALUE OVER THE PRIOR 5 YEARS ENDED JUNE 30 PRECEDING THE YEAR IN WHICH EXPENDITURE IS PLANNED. IN ESTABLISHING THIS POLICY, COOK CHILDREN'S CONSIDERED THE LONG-TERM EXPECTED RETURN ON ITS ENDOWMENT. ACCORDINGLY, OVER THE LONG TERM, COOK CHILDREN'S EXPECTS THE CURRENT SPENDING POLICY TO ALLOW ITS ENDOWMENT TO GROW AT THE RETURN HURDLE. THIS IS CONSISTENT WITH COOK CHILDREN'S OBJECTIVE TO MAINTAIN THE PURCHASING POWER OF ENDOWMENT ASSETS HELD IN PERPETUITY OR FOR A SPECIFIED TERM, AS WELL AS TO PROVIDE ADDITIONAL REAL GROWTH THROUGH NEW GIFTS AND INVESTMENT RETURN.
Schedule D, Part XI, Line 2D	Reconciliation of audited revenue to form 990 revenue: Bad Debt expense: (88,233,720) Joint Venture Revenue not on 990: 21,625,055 Interest Rate SWAP Adjustment: (1,148,663) Women's Board Loss: (10,200) --------------- (67,767,528)
Schedule D, Part XI, Line 4b	RECONCILIATION OF AUDITED revenue to form 990 revenue: Additional Gain on Disposal of Asset: 35,012 Additional Contributions from Foundation: 2,089,360 Direct Rent Expenses: (1,284,003) ------------ 840,369
Schedule D, Part XII, Line 2D	Reconciliation of audited expenses to form 990 expenses: direct rent expenses: 1,284,003 Women's Board Loss: 10,200 Joint Venture Expenses not on 990: 15,378,356 Additional gain on Disposal of Asset (35,012) --------------------- 16,637,547
SCHEDULE D, PART XII, LINE 4B	Reconciliation of audited expenses to form 990 expenses: Bad Debt Expense 88,233,720
Schedule D, Part X, Line 2	ASC 740 Footnote: 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.

Schedule H IRS990ScheduleH

Field	Value	IRS element (for citing)
Financial Assistance Policy	Yes (true)	FinancialAssistancePolicyInd
Written Policy	Yes (true)	WrittenPolicyInd
All Hospitals Policy	Yes (X)	AllHospitalsPolicyInd
FPG Reference Free Care	Yes (true)	FPGReferenceFreeCareInd

Free Care Oth Percentage FreeCareOthPercentageGrp

Field	Value	IRS element (for citing)
Other	Yes (X)	OtherInd
Free Care Other	400.	FreeCareOtherPct

Field	Value	IRS element (for citing)
FPG Reference Discounted Care	Yes (true)	FPGReferenceDiscountedCareInd

Discounted Care Oth Percentage DiscountedCareOthPercentageGrp

Field	Value	IRS element (for citing)
Other	Yes (X)	OtherInd
Discounted Care Other	500.	DiscountedCareOtherPct

Field	Value	IRS element (for citing)
Free Care Medically Indigent	Yes (true)	FreeCareMedicallyIndigentInd
Financial Assistance Budget	false	FinancialAssistanceBudgetInd
Annual Community Bnft Report	Yes (true)	AnnualCommunityBnftReportInd
Report Publically Available	false	ReportPublicallyAvailableInd

Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$16,174,237	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$16,174,237	NetCommunityBenefitExpnsAmt
Total Expense	0.01640	TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$499,275,465	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$402,248,265	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$97,027,200	NetCommunityBenefitExpnsAmt
Total Expense	0.09830	TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$515,449,702	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$402,248,265	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$113,201,437	NetCommunityBenefitExpnsAmt
Total Expense	0.11470	TotalExpensePct

Community Health Services CommunityHealthServicesGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$5,041,023	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$60,481	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$4,980,542	NetCommunityBenefitExpnsAmt
Total Expense	0.00500	TotalExpensePct

Health Professions Education HealthProfessionsEducationGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$212,319	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$181,356	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$30,963	NetCommunityBenefitExpnsAmt

Research ResearchGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$303,383	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$288,613	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$14,770	NetCommunityBenefitExpnsAmt

Cash And In Kind Contributions CashAndInKindContributionsGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$75,743,717	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$0	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$75,743,717	NetCommunityBenefitExpnsAmt
Total Expense	0.07670	TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$81,300,442	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$530,450	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$80,769,992	NetCommunityBenefitExpnsAmt
Total Expense	0.08170	TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$596,750,144	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$402,778,715	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$193,971,429	NetCommunityBenefitExpnsAmt
Total Expense	0.19640	TotalExpensePct

Physical Imprv And Housing PhysicalImprvAndHousingGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$20,000	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$20,000	NetCommunityBenefitExpnsAmt

Coalition Building CoalitionBuildingGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$60,872	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$60,872	NetCommunityBenefitExpnsAmt
Total Expense	0.00010	TotalExpensePct

Health Improvement Advocacy HealthImprovementAdvocacyGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$191,781	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$191,781	NetCommunityBenefitExpnsAmt
Total Expense	0.00020	TotalExpensePct

Total Communtity Building Acty TotalCommuntityBuildingActyGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$272,653	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$272,653	NetCommunityBenefitExpnsAmt
Total Expense	0.00030	TotalExpensePct

Field	Value	IRS element (for citing)
Bad Debt Expense Reported	Yes (true)	BadDebtExpenseReportedInd
Bad Debt Expense	$88,233,720	BadDebtExpenseAmt
Reimbursed By Medicare	$6,499,967	ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr	$8,559,295	CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall	-$2,059,328	MedicareSurplusOrShortfallAmt

Costing Methodology Used CostingMethodologyUsedGrp

Field	Value	IRS element (for citing)
Cost To Charge Ratio	Yes (X)	CostToChargeRatioInd

Field	Value	IRS element (for citing)
Written Debt Collection Policy	Yes (true)	WrittenDebtCollectionPolicyInd
Financial Assistance Prvsn	Yes (true)	FinancialAssistancePrvsnInd

Management Co And Jnt Ventures ManagementCoAndJntVenturesGrp (2 entries)

Primary ActivitiesPrimaryActivitiesTxt	Org Profit Or OwnershipOrgProfitOrOwnershipPct	Physicians Profit Or OwnershipPhysiciansProfitOrOwnershipPct
CC Surgery Center
SURGERY CENTER	0.6	0.30151
CC Pediatric Surgery
surgery center	0.55201	0.06982

Field	Value	IRS element (for citing)
Hospital Facilities	1	HospitalFacilitiesCnt

Hospital Facilities HospitalFacilitiesGrp

Field	Value	IRS element (for citing)
Facility	1	FacilityNum

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	COOK CHILDREN'S MEDICAL CENTER	BusinessNameLine1Txt

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	801 SEVENTH AVE	AddressLine1Txt
City	FORT WORTH	CityNm
State Abbreviation	TX	StateAbbreviationCd
ZIP	76104	ZIPCd

Field	Value	IRS element (for citing)
Website Address	WWW.COOKCHILDRENS.ORG	WebsiteAddressTxt
State License	000332	StateLicenseNum
Childrens Hospital	Yes (X)	ChildrensHospitalInd

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp

Hospital Facility Name HospitalFacilityName

Field	Value	IRS element (for citing)
Business Name Line1	COOK CHILDREN'S MEDICAL CENTER	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Facility	1	FacilityNum
First Licensed CY Or PY	false	FirstLicensedCYOrPYInd
Tax Exempt Hospital CY Or PY	false	TaxExemptHospitalCYOrPYInd
CHNA Conducted	Yes (true)	CHNAConductedInd
Community Definition	Yes (X)	CommunityDefinitionInd
Community Demographics	Yes (X)	CommunityDemographicsInd
Existing Resources	Yes (X)	ExistingResourcesInd
How Data Obtained	Yes (X)	HowDataObtainedInd
Community Health Needs	Yes (X)	CommunityHealthNeedsInd
Other Health Issues	Yes (X)	OtherHealthIssuesInd
Community Hlth Needs Id Process	Yes (X)	CommunityHlthNeedsIdProcessInd
Consulting Process	Yes (X)	ConsultingProcessInd
Prior CHNA Impact	Yes (X)	PriorCHNAImpactInd
CHNA Conducted	18	CHNAConductedYr
Take Into Account Others Input	Yes (true)	TakeIntoAccountOthersInputInd
CHNA Conducted With Other Fclts	false	CHNAConductedWithOtherFcltsInd
CHNA Conducted With Non Fclts	false	CHNAConductedWithNonFcltsInd
CHNA Report Widely Available	Yes (true)	CHNAReportWidelyAvailableInd
Rpt Available On Own Website	Yes (X)	RptAvailableOnOwnWebsiteInd
Own Website URL	SEE PART V, SECTION C	OwnWebsiteURLTxt
Other Website	Yes (X)	OtherWebsiteInd
Other Website URL	WWW.CENTERFORCHILDRENSHEALTH.ORG	OtherWebsiteURLTxt
Paper Copy Public Inspection	Yes (X)	PaperCopyPublicInspectionInd
Implementation Strategy Adopt	Yes (true)	ImplementationStrategyAdoptInd
Implementation Strategy Adpt	18	ImplementationStrategyAdptYr
Strategy Posted Website	Yes (true)	StrategyPostedWebsiteInd
Strategy Website URL	SEE PART V, SECTION C	StrategyWebsiteURLTxt
Organization Incur Excise Tax	false	OrganizationIncurExciseTaxInd
Elig Criteria Explained	Yes (true)	EligCriteriaExplainedInd
FPG Family Incm Lmt Free Dscnt	Yes (X)	FPGFamilyIncmLmtFreeDscntInd
FPG Family Incm Lmt Free Care	400.	FPGFamilyIncmLmtFreeCarePct
FPG Family Incm Lmt Dscnt Care	500.	FPGFamilyIncmLmtDscntCarePct
Asset Level Criteria	Yes (X)	AssetLevelCriteriaInd
Medical Indigency Criteria	Yes (X)	MedicalIndigencyCriteriaInd
Insurance Status Criteria	Yes (X)	InsuranceStatusCriteriaInd
Underinsurance Stat Criteria	Yes (X)	UnderinsuranceStatCriteriaInd
Residency Criteria	Yes (X)	ResidencyCriteriaInd
Explained Basis	Yes (true)	ExplainedBasisInd
App Financial Asst Expln	Yes (true)	AppFinancialAsstExplnInd
Described Info	Yes (X)	DescribedInfoInd
Described Suprt Doc	Yes (X)	DescribedSuprtDocInd
Provided Hospital Contact	Yes (X)	ProvidedHospitalContactInd
Includes Publicity Measures	Yes (true)	IncludesPublicityMeasuresInd
FAP Available On Website	Yes (X)	FAPAvailableOnWebsiteInd
FAP Available On Website URL	SEE PART V, SECTION C	FAPAvailableOnWebsiteURLTxt
FAP App Available On Website	Yes (X)	FAPAppAvailableOnWebsiteInd
FAP App Available On Website URL	SEE PART V, SECTION C	FAPAppAvailableOnWebsiteURLTxt
FAP Summary On Website	Yes (X)	FAPSummaryOnWebsiteInd
FAP Summary On Website URL	SEE PART V, SECTION C	FAPSummaryOnWebsiteURLTxt
FAP Avlbl On Request No Charge	Yes (X)	FAPAvlblOnRequestNoChargeInd
FAP App Avlbl On Request No Chrg	Yes (X)	FAPAppAvlblOnRequestNoChrgInd
FAP Sum Avlbl On Request No Chrg	Yes (X)	FAPSumAvlblOnRequestNoChrgInd
Notified FAP Copy Bill Display	Yes (X)	NotifiedFAPCopyBillDisplayInd
Communtity Notified FAP	Yes (X)	CommuntityNotifiedFAPInd
FAP Translated	Yes (X)	FAPTranslatedInd
FAP Actions On Nonpayment	Yes (true)	FAPActionsOnNonpaymentInd
Permit No Actions	Yes (X)	PermitNoActionsInd
Collection Activities	false	CollectionActivitiesInd
Provided Written Notice	Yes (X)	ProvidedWrittenNoticeInd
Made Effort Orally Notify	Yes (X)	MadeEffortOrallyNotifyInd
Processed FAP Application	Yes (X)	ProcessedFAPApplicationInd
Made Presumptive Elig Determ	Yes (X)	MadePresumptiveEligDetermInd
Nondis Emergency Care Policy	Yes (true)	NondisEmergencyCarePolicyInd
Look Back Medicaid Medcr Prvt	Yes (X)	LookBackMedicaidMedcrPrvtInd
Amounts Generally Billed	false	AmountsGenerallyBilledInd
Gross Charges	false	GrossChargesInd

Supplemental Information SupplementalInformationGrp (6 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
SCHEDULE H, PART V, SECTION B, LINE 5	input from representatives of the community: The initial Cook Children's Community-Wide Children's Health Assessment and Planning Survey (CCHAPS) was conducted in 2009 and every three years thereafter (2012, 2015, and 2018). Our methodology varies slightly among assessment years but always includes gathering data from multiple sources representing our community. Methodology includes a survey of parents of children ages 0-14, a community leader survey, and focus groups. We also gather feedback from community coalition members through facilitated discussions at regular meetings and at six child health summits that we host to present the data to our various communities. In addition, Cook Children's collects data from publicly available sources to supplement perceptions of children's health obtained through the parent and community leader surveys, focus groups and/or community meetings. The 2018 household survey was administered through an outside vendor (ETC Institute) to a statistically representative sample of parents with children ages 0-14 living in our primary service region (Denton, Hood, Johnson, Parker, Tarrant, and Wise counties). The large sample size (8,249 completed surveys) provides statistically representative results applicable to all six counties individually and collectively with a low margin of error (+/- 5%). The survey is administered through mail and telephone and ETC monitors responses to ensure that representation is similar to general population demographics in terms of total population in each geographic area, race/ethnicity, income, and education level. In order to assess the health of children living in families that are traditionally underrepresented in mail and telephone surveys, a research team from the Evaluation and Outcomes Division of My Health My Resources of Tarrant County (MHMRTC) conducted intercept surveys with parents living with a child or children in one of several Tarrant County homeless shelters (209 completed surveys). ETC Institute also conducted a survey with community leaders to obtain their feedback about the status of children's health. Surveys were mailed to 1,156 community leaders representing city and county governments, public agencies, not-for-profit organizations, independent school districts, faith based/clergy, elected officials, and health care professionals. We received 301 responses (26% response rate). A complete list of who received the opportunity to participate in the leader survey is available upon request. Based on the 2009 initial assessment results, Cook Children's Board of Trustees prioritized children's health issues identified by parents and community leaders and findings from subsequent CCHAPS processes in 2012, 2015, and 2018 confirmed the importance of these issues for continuing focused intervention: - Child Abuse & Neglect - Dental Health - Wellness - Access to Health Care - Asthma - Mental Health - General Health: Childhood Obesity - General Health: Parenting Support - Injury Prevention - Child Passenger Safety - Drowning Prevention - Poison Prevention - Gun Safety Cook Children's continues to use the 2018 CCHAPS findings to assess parent and community leader perceptions of children's health needs and to inform our community health outreach and community engagement efforts.
Schedule H, Part V, Section B, Line 6B	Other Organizations other than Hospital Facilities: External vendors used to conduct the CCHAPS surveys included ETC Institute, Inc. and My Health My Resources of Tarrant County. No other organizations were involved other than these contracted surveyor entities and no other organizations are able to use this assessment to fulfill CHNA requirements.
SCHEDULE H, PART V, SECTION B, LINE 11	How we are addressing significant needs: Cook Children's created the Center for Children's Health in 2011 to provide an infrastructure for using children's health assessment data to guide community programs and stakeholder collaborations that prevent illness, disease and injuries for children. The center oversees a regular community health needs assessment, community research and community health outreach. All three categories of Center activities are focused on increasing access to preventive services for underserved populations. The Center for Children's Health develops strategies for addressing targeted children's health priorities through research and an infrastructure that supports effective delivery of community and family services. Our services are data driven, evidence-informed and provided using high standards of community practice and service delivery. Recognizing that Cook Children's cannot solve complex children's health needs alone, we lead coalitions in every county within our primary service region to involve community partners in identifying health needs, and developing and implementing sustainable solutions. Collaborations are structured according to principles that research indicates are effective characteristics for successful community collaborations, including a commitment to using strategic plans to guide implementation of strategies, diverse representation within each community, and facilitating decisions guided by members according to formal coalition bylaws and meeting guidelines. Collaborations led by the Center for Children's Health include: - ACES Task Force - Children's Oral Health Coalition - Drowning Prevention Campaign - Healthy Children Coalition of Parker County - Hood County for Healthy Children - Johnson County Alliance for Healthy Kids - Safe Baby Sleep Council - Safe Kids North Texas - Save a Smile - Wise Coalition for Healthy Children - Wellness Alliance for Total Children's Health of Denton County CCHAPS 2018 findings support Cook Children's continued focus on family outreach programs that address the children's health issues identified in our initial CCHAPS process in 2009. The family services addressing priority children's health needs are provided using evidence-based/informed practices, including strict adherence to regulatory requirements, implementing proven program designs, obtaining appropriate staff certifications or licensures, providing adequate supervision, practicing accurate and confidential record-keeping, and conducting ongoing formal evaluation. Recognizing the need to improve access to care for vulnerable populations, the Center for Children's Health focuses all programming listed in the following sections to families identified as high-risk either due to low income or high prevalence of health risk factors. Community Strategy: Prevent child abuse and neglect The Center for Prevention of Child Abuse and Neglect is housed within Cook Children's Center for Children's Health to lead initiatives targeting child abuse prevention. These include a county-wide Adverse Childhood Experiences (ACEs) Task Force working to develop and implement multiple strategies for reducing the impact of ACEs on children's health; ACEs child abuse reporting and caregiver support trainings and presentations provided by staff; an evidence-informed training for medical professionals and first responders to recognize the signs of child abuse and know how to respond appropriately; and a website support product for survivors of abuse. The center also works with a larger Cook Children's Health Care System team to expand a predictive mapping project to better focus on resource allocation. Community Strategy: Improve child oral health The Center for Children's Health leads the Children's Oral Health Coalition (COHC), a county-wide collaborative effort to address dental care needs for underserved children. COHC focuses on providing education and oral hygiene kits to families in priority zip codes and hosts Train the Trainer events -- 4-hour workshops for community professionals that teach them how to train parents they regularly serve on proper oral health care for infants and children ages 0-4 years old. COHC works to improve community collaboration around oral health care by bringing together those organizations in Tarrant County conducting limited oral exams in the school setting to reduce overlap, discuss common obstacles and promote best practices. COHC also supports collaboration with community partners to work with pregnant women and young children to improve overall health. And the coalition's Legislative Advocacy committee monitors state and national legislative issues, especially those supporting expanded access to dental care for low-income children. The Center is also home to Save a Smile, an innovative and award-winning program that partners with schools to provide preventive and restorative treatment to children with serious dental disease. Approximately 7,000+ children in targeted Title I schools are screened and assigned an oral health status to determine which children need treatment provided by volunteer dentists. Community health workers work under the supervision of a licensed social worker provide social services that facilitate treatment completion for those children with serious dental disease. Save a Smile also provides oral health classroom education to children to promote good oral health. Community Strategy: Improve control of childhood asthma The Center for Children's Health implements a Healthy Homes program designed to mitigate asthma triggers in the home for families of children seen in the Cook Children's Medical Center ER for asthma three or more times in a 12-month period. Healthy Homes uses trained community health staff to assess homes for asthma triggers and offers remediation of those triggers to reduce asthma episodes requiring ER visits. Cook Children's is also a key partner in community efforts to address asthma, including the Asthma 411 Consortium. Through the Asthma 411 Consortium, Cook Children's provides support to equip school nurses with appropriate tools and knowledge of rescue meds to quickly respond to a child in respiratory distress. Community Strategy: Increase access to mental health services Cook Children's is a founding partner of the Mental Health Connection (MHC) and continues to support this group financially and through staff participation. MHC is a partnership of health and social service organizations that works to improve mental health services in Tarrant County through collaboration. In addition, the Center for Children's Health leads the Wellness Alliance for Total Children's Health of Denton County, a coalition working to increase awareness of and access to mental health services through maintaining a resource website (watchdenton.org), facilitating educational events for professionals, hosting an annual children's art expression initiative, and strengthening collaboration between mental health service providers. Community Strategy: Increase access to wellness activities for children Coalitions led by the Center for Children's Health in Johnson and Parker Counties work with schools and community organizations to implement a school-based wellness education program centered on evidence-based approaches (5-2-1-0 Let's Go! and Coordinated Approach to Child Health, or CATCH). The program includes four education sessions during the school year to teach 3rd-4th grade children to eat five servings of fruits/vegetables per day, spend no more than two hours of recreation screen time per day, engage in physical activity for at least one hour per day and drink less sugary beverages and more water. Children are also taught about "Go" foods (good to eat almost anytime), "Slow" foods (can be eaten a few times per week) and "Whoa" foods (may be eaten up to a few times per month). Volunteer facilitators lead the sessions and in some sites facilitate school-based gardens. Cook Children's also promotes physical activity through offering GoNoodle to all school districts within our service region. GoNoodle provides teachers access to online videos to promote physical activity in the classroom. Community Strategy: Increase support network for parents and families through community partnerships Coalitions led by the Center for Children's Health in Hood and Wise Counties work to promote healthy parenting practices by offering Parent Cafs using a curriculum based on Nurturing Parenting and other evidence-informed parenting programs. The goal of the Parent Caf is to engage parents in building a support network which is one of the protective factors needed to promote healthy outcomes for their children. Volunteers are trained by licensed professionals on how to successfully facilitate parent discussions. The coalitions developed comprehensive toolkits for Parent Caf facilitators that include key messages for 14 parenting lessons, discussion questions, handouts, sign-in s
Schedule H, Part V, Section B, lines 7a & 10a	CHNA & Implementation Strategy availability: The CHNA and implementation strategy are available upon request and at the following address: www.cookchildrens.org/about/community-outreach/Pages/Community-Health-Need s-Assessment.aspx
Schedule H, Part V, Section B, lines 16a, 16b & 16c	Financial Assistance Documents: The financial assistance policy, application and plain language summary are available at the following address: https://www.cookchildrens.org/patients/billing-insurance/Pages/financial-a ssistance.aspx
Schedule H, Part V, Section B, line 3	board approval of chna: The deadline for presenting and obtaining board approval of the Community Health Needs Assessment for tax year 2018 was September 30, 2019, and all work had been completed on the assessment prior to that date to make it ready for approval. Due to an administrative oversight in finalizing the agenda for the September 30, 2019 Board meeting, consideration and approval of the Community Health Needs Assessment for tax year 2018 was inadvertently postponed to the next Board meeting. The Community Health Needs Assessment was posted for public comment on November 5, 2019 and subsequently approved at the next scheduled Board meeting, December 3, 2019. The Implementation Strategies for the tax year 2018 CHNA were also approved at that meeting in a separate motion. Because the Community Health Needs Assessment was approved prior to the deadline for implementation (i.e., prior to February 15, 2020), and the Implementation Strategies were timely approved, this minor and inadvertent error in timing had no impact on the community we serve. In addition, governance staff who manage the Board agenda have been educated as to the appropriate timeline for approval of future Community Health Needs Assessments and the hospital is reviewing its policies and procedures for other advisable improvements.

Field	Value	IRS element (for citing)
Facility	2	FacilityNum

Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp

Oth Hlth Care Fclts OthHlthCareFcltsGrp (2 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	FacilityFacilityTxt
CENTER FOR PEDIATRIC SURGERY
4200 W UNIVERSITY DRIVE STE 110	PROSPER	TX	75078	AMBULATORY SURGERY CENTER
COOK CHILDREN'S Surgery Center
6313 PRECINCT LINE RD	HURST	TX	76054	AMBULATORY SURGERY CENTER

Supplemental Information Detail SupplementalInformationDetail (15 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
SCHEDULE H, PART III, SECTION A, LINE 2	BAD DEBT EXPENSE: WE RECORD SELF-PAY ACCOUNTS AT THE FULL EXPECTED AMOUNT. EACH ACCOUNT GOES THROUGH THE COLLECTION PROCESS AS NECESSARY. AN ALLOWANCE IS ESTABLISHED BASED ON HISTORICAL EXPERIENCE.
SCHEDULE H, PART III, SECTION A, LINE 3	BAD DEBT AS A COMMUNITY BENEFIT: BAD DEBT, IN WHOLE OR IN PART, SHOULD BE INCLUDED IN COMMUNITY BENEFIT GIVEN THE TANGIBLE AND MEASURABLE BENEFIT OF THE UNDERLYING SERVICES PROVIDED TO, PRIMARILY, UNDERSERVED MEMBERS OF OUR COMMUNITY. FOR INSTANCE, WE HAVE A SIGNIFICANT NON-INSURED, UNDOCUMENTED WORKER POPULATION THAT MAY NOT PARTICIPATE IN THE CHARITY OR MEDICALLY INDIGENT DISCOUNT QUALIFICATION PROCESS DUE TO CONCERNS ABOUT THEIR IMMIGRATION STATUS. WE PROVIDE CRITICAL INPATIENT, EMERGENCY ROOM, AND OUTPATIENT SERVICES TO THIS DEMOGRAPHIC FOR LITTLE OR NO REIMBURSEMENT AND WITHOUT REGARD FOR THEIR ABILITY TO PAY, BUT RECEIVE NO COMMUNITY BENEFIT CONSIDERATION. AT A MINIMUM, HOSPITALS SHOULD HAVE THE OPPORTUNITY TO DELINEATE HOW MUCH BAD DEBT STEMS FROM NON-INSURED PATIENTS AND THEN BE GIVEN COMMUNITY BENEFIT CONSIDERATION FOR THE COST BURDEN ASSOCIATED WITH PROVIDING THESE NEEDED SERVICES KNOWING THAT WE HAVE ALREADY DONE ALL WE CAN WITH REGARD TO SCREENING PATIENTS FOR CHARITY AND MEDICALLY INDIGENT DISCOUNTS AND WRITTEN THE PATIENTS' BALANCES OFF AS SUCH.
SCHEDULE H, PART III, SECTION A, LINE 4	BAD DEBT FOOTNOTE: FOOTNOTE DISCLOSURE REGARDING THE TREATMENT OF BAD DEBTS IS LOCATED ON PAGE 10 OF THE MOST RECENT AUDITED FINANCIAL STATEMENTS ATTACHED TO THIS FORM.
SCHEDULE H, PART III, SECTION B, LINE 8	MEDICARE SHORTFALL AND COST REPORTED: THE MEDICARE SHORTFALL SHOULD BE CONSIDERED COMMUNITY BENEFIT SINCE IT IS REPRESENTATIVE OF THE NON-COVERED COST OF PATIENT CARE THAT HOSPITALS ARE USING TO JUSTIFY THE NEED FOR THEIR TAX EXEMPT STATUS. PRESENTING THE MEDICARE SHORTFALL IN THE COMMUNITY BENEFIT SECTION ALLOWS REGULATORS AND THE PUBLIC TO SEE THE UNFUNDED COSTS OF SERVICES THAT HOSPITALS PROVIDE TO COMMUNITY MEMBERS. THIS PRESENTATION WOULD HELP THE COMMUNITY BETTER UNDERSTAND THAT IN THE ABSENCE OF A TAX EXEMPT STATUS (WHICH IN EFFECT IS GRANTED TO THEM BY THE PUBLIC), THE HOSPITALS WOULD HAVE TO LOOK TO THE COMMUNITY TO FUND THE SHORTFALL OR RISK LOSING VALUED HOSPITAL SERVICES. THE RATIO OF COST TO CHARGES USED IN THE CALCULATION OF COSTS FOR MEDICARE WAS TAKEN FROM THE MEDICARE COST REPORT.
SCHEDULE H, PART III, SECTION C, LINE 9B	COLLECTION PRACTICES: THE HOSPITAL DOES NOT PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE.
SCHEDULE H, PART VI, LINE 2	NEEDS ASSESSMENT: ALTHOUGH VARIOUS DEPARTMENTS WITHIN COOK CHILDREN'S PERIODICALLY CONDUCT PATIENT NEEDS ASSESSMENTS FOR SPECIFIC MEDICAL SPECIALITIES, THE COMMUNITY-WIDE CHILDREN'S HEALTH ASSESSMENT AND PLANNING SURVEY (CCHAPS) AS REPORTED IN PART V, SECTION B IS THE ONLY COMMUNITY-WIDE CHILDREN'S HEALTH NEEDS ASSESSMENT CONDUCTED BY OUR HEALTH SYSTEM.
SCHEDULE H, PART VI, LINE 3	PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE: ENGLISH AND SPANISH VERSIONS OF A ONE-PAGE DOCUMENT EXPLAINING THE CHARITY CARE OFFERED AT COOK CHILDREN'S ARE POSTED IN EACH OF THE PATIENT REGISTRATION AREAS, THE EMERGENCY ROOM, URGENT CARE, AND MEDICAL OFFICE BUILDING. THIS DOCUMENT INCLUDES INFORMATION ON THE FOLLOWING: 1. HOW ONE MIGHT QUALIFY FOR FINANCIAL ASSISTANCE; 2. EXPLAINS QUALIFICATION IS DETERMINED BY FAMILY SIZE AND INCOME; AND, 3. GUIDES FAMILIES TO CONTACT THE PATIENT ACCOUNTING DEPARTMENT TO APPLY FOR FINANCIAL ASSISTANCE. A FINANCIAL COUNSELOR WILL ASSIST ALL SELF-PAY INPATIENTS, OBSERVATION STAYS AND SCHEDULED PROCEDURES, SCREENING THEM FOR VARIOUS GOVERNMENT PROGRAMS, SUCH AS MEDICAID AND CHIP. IN ADDITION, A FINANCIAL COUNSELOR WILL ASSIST ANY PATIENT THAT PRESENTS TO REGISTRATION FOR FINANCIAL ASSISTANCE, PROVIDING THEM WITH A MEDICAID APPLICATION AND REVIEWING THE CHARITY POLICY. PATIENT REPRESENTATIVES AND CASE MANAGEMENT PERSONNEL ALSO DIRECT FAMILIES TO THE PATIENT REGISTRATION STAFF WHEN THEY NEED FINANCIAL ASSISTANCE. IN ADDITION, THE FINANCIAL ASSISTANCE POLICY, EXPLANATION OF AMOUNTS GENERALLY BILLED AND THE CHARITY APPLICATION ARE POSTED ON THE COOK CHILDREN'S WEBSITE at www.cookchildrens.org. the charity application is posted in both english and spanish versions.
SCHEDULE H, PART VI, LINE 4	COMMUNITY INFORMATION: The Cook Childrens six-county service region is based in North Central Texas and comprises Tarrant, Denton, Johnson, Parker, Wise, and Hood Counties. Cook Childrens evaluates the statistics describing our community and representing our population served with every Community Health Needs Assessment (CHNA); thus, the statistics described in this section reflect those reported in our most recent CHNA, which is 2018. The US Census Bureau classifies these counties as follows: Tarrant County (mostly urban, 1% rural), Denton County (mostly urban, 7% rural), Johnson County (mostly urban, 38% rural), Parker County (rural 56%), Wise County (mostly rural 72%), and Hood County (mostly urban, 33% rural). Overall, the six-county region is home to a diverse population of 3,382,569 people, and 720,697 (21%) are children under 14 years of age. Of those 720,697 children ages 0-14, there are 456,492 children living in Tarrant; 174,406 in Denton County; 36,881 in Johnson County; 28,296 in Parker County; 13,906 in Wise County; and 10,716 in Hood County. The annual median income for families with children under age 18 ranges between $63,702 in Wise County to $99,763 in Denton County. Of the 834,108 children under age 18 living in the region, 151,931 (16%) live in households with income below the poverty level, and between 28.9%-52.5% of those living in poverty reside in female householder, no husband present households. Of the 834,108 children under age 18 living in the region, between 13%-38% live in households that receive Supplemental Security Income (SSI), cash public assistance, or Food Stamps/SNAP benefits. The information below reflects race and ethnicity by county within our region.
SCHEDULE H, PART VI, LINE 5	PROMOTION OF COMMUNITY HEALTH: COOK CHILDREN'S MAINTAINS AN OPEN MEDICAL STAFF, AND THE GOVERNING BODIES OF THE VARIOUS COMPANIES ARE MADE UP (UNLESS CONSTRAINED BY THE TEXAS MEDICAL PRACTICE ACT) OF VOLUNTARY COMMUNITY MEMBERS ALONG WITH PHYSICIANS. THE ORGANIZATION CARES FOR ALL CHILDREN REGARDLESS OF THEIR ABILITY TO PAY, AND PROACTIVELY SEEKS TO ENROLL ALL ELIGIBLE CHILDREN IN APPROPRIATE PROGRAMS TO IMPROVE THEIR ACCESS TO CARE. In FY20, the Center for Childrens Health led 625 health outreach events serving over 20,000 children, families, and community partners. These outreach events include education or activities around the prioritized health issues identified in the findings from CCHAPS, which include: - CHILD ABUSE & NEGLECT - DENTAL HEALTH - WELLNESS - ACCESS TO HEALTH CARE - ASTHMA - MENTAL HEALTH - GENERAL HEALTH: CHILDHOOD OBESITY - INJURY PREVENTION - CHILD PASSENGER SAFETY - DROWNING PREVENTION - POISON PREVENTION - GUN SAFETY Through our coalitions and collaborations we engage community partners and volunteers to help us reach children and families in need through outreach activities that support sustainable solutions within the community. In FY2020 our community partners and volunteers gave over 4,700 hours of volunteer support to the Center for Childrens Health, totaling a value of $152,300. Out of our 625 health outreach events, over 400 were coalition, workgroup, and stakeholder meetings that we led through our collaborations below: - Childrens Oral Health Coalition - Drowning Prevention Campaign - Healthy Children Coalition of Parker County - Hood County for Healthy Children - Johnson County Alliance for Healthy Kids - Safe Kids North Texas - Save a Smile - Wise Coalition for Healthy Children - Wellness Alliance for Total Childrens Health of Denton County Selected highlights of our work in FY2020 to improve the health of children and families in the community include: - Over 7,000 children received a limited oral health evaluation and nearly 2,000 dental procedures were provided to children with dental disease for a total value of $566,330. - Provided 4,909 support services and 799 community referrals to families, meeting needs for food, rent and utilities assistance, technology support for virtual learning, school supplies, and mental health. - Distributed 351,283 prevention and educational resources at a value of $378,802 to families and community partners. - Educated over 6,950 children and adults on drowning prevention by the Lifeguard Your Child campaign partners across eight counties. - Engaged over 700 children in learning proper nutrition and healthy lifestyles information.
SCHEDULE H, PART VI, LINE 6	AFFILIATED HEALTH CARE SYSTEM: COOK CHILDREN'S ALSO OPERATES SEVEN NEIGHBORHOOD CLINICS PROVIDING PRIMARY CARE TO UNDERSERVED POPULATIONS AROUND THE CITY'S PERIMETER AND INNER CITY TO HELP ASSURE CARE IS PROVIDED IN THE MOST APPROPRIATE SETTING. BOTH PREVENTIVE AND THERAPEUTIC DENTAL HEALTH CARE ARE PROVIDED TO UNDERSERVED POPULATIONS. MENTAL AND BEHAVIORAL HEALTH IS PROVIDED IN BOTH INPATIENT AND OUTPATIENT SETTINGS SUBSIDIZED BY COOK CHILDREN'S. COOK CHILDREN'S HEALTH PLAN IS A CONTRACTED INTERMEDIARY FOR MEDICAID MANAGED CARE AND SCHIP, PROVIDING AN OPEN PROVIDER PANEL FOR ALL ELIGIBLE CHILDREN IN THE SIX-COUNTY PRIMARY SERVICE AREA. COOK CHILDREN'S HOME HEALTH OFFERS PEDIATRIC-SPECIFIC HOME CARE TO ASSURE CARE IS PROVIDED IN THE MOST APPROPRIATE AND LOWEST COST SETTING.
SCHEDULE H, PART VI, LINE 7	STATE FILING OF COMMUNITY BENEFIT REPORT: Texas
Schedule H, Part I, Line 7, Column (F)	Bad Debt Expense of $88,233,720 was included on form 990, Part IX, Line 25, Column (A), but was subtracted from total expense for the calculation of "percent of total expense" in this column.
Schedule H, Part II, Lines 1-10	COMMUNITY BUILDING PHYSICAL IMPROVEMENTS AND HOUSING: COOK CHILDREN'S IS LOCATED IN THE NEAR SOUTH SIDE OF FORT WORTH WHICH INCLUDES THE MEDICAL DISTRICT AS WELL AS A DIVERSE MIX OF RESIDENTIAL NEIGHBORHOODS. TO ADDRESS NEIGHBORHOOD IMPROVEMENT NEEDS, COOK CHILDREN'S IS A MEMBER OF FORT WORTH SOUTH, INC., A NONPROFIT ORGANIZATION THAT PARTNERS WITH THE CITY OF FORT WORTH AND OTHER COMMUNITY ORGANIZATIONS TO ADVANCE EDUCATIONAL INITIATIVES, PUBLIC POLICIES, AND COMMUNITY PROGRAMS THAT FOSTER A REVITALIZED AND SAFE CENTRAL CITY. STRATEGIC PLANNING HAS RESULTED IN IMPROVED SECURITY, CODE ENFORCEMENT, AND TRANSPORTATION FOR RESIDENTS AND EMPLOYEES WHO WORK IN THE AREA. COALITION BUILDING: COOK CHILDREN'S IS THE LEAD ORGANIZATION FOR THE WELLNESS ALLIANCE FOR TOTAL CHILDREN'S HEALTH OF DENTON COUNTY ("WATCH"). WATCH OF DENTON COUNTY IS A COLLABORATION OF BOTH PUBLIC AND PRIVATE ORGANIZATIONS AND INDIVIDUALS WHO ARE INVESTED IN THE TOTAL WELLNESS OF DENTON COUNTY'S CHILDREN. WATCH CURRENTLY WORKS TO INCREASE AWARENESS OF AND ACCESS TO MENTAL HEALTH SERVICES IN DENTON COUNTY. COOK CHILDREN'S IS ALSO A PARTICIPANT IN THE DENTON COUNTY BEHAVIORAL HEALTH LEADERSHIP TEAM WHICH ADVOCATES AND FACILITATES A COLLABORATIVE PERSON-CENTERED BEHAVIORAL HEALTH SYSTEM TO REPAIR AND RESTORE LIVES BY ENSURING BEHAVIORAL HEALTH SERVICES ARE AVAILABLE TO MEET THE NEEDS OF ALL, ASSESSING DATA FOR CONTINUOUS OUTCOME MEASUREMENTS, PRIORITIZING DATA DRIVEN RECOMMENDATIONS, AND PROVIDING A CONTINUUM OF CARE IN DENTON COUNTY. COOK CHILDREN'S IS ALSO A PARTICIPANT IN THE INTELLECTUAL AND DEVELOPMENTAL DISABILITIES COUNCIL OF TARRANT COUNTY WHICH IS A COMMUNITY COALITION OF PROVIDERS, PUBLIC OFFICIALS, FAMILIES, AND SELF-ADVOCATES WHO HAVE COME TOGETHER TO INCREASE OPPORTUNITIES FOR PEOPLE WITH INTELLECTUAL DISABILITIES IN OUR COMMUNITY. COMMUNITY HEALTH IMPROVEMENT ADVOCACY: ADVOCACY EFFORTS BY COOK CHILDREN'S ARE ENHANCED THROUGH MEMBERSHIP IN VARIOUS LOCAL, STATE, AND NATIONAL ORGANIZATIONS. ISSUES ADDRESSED INCLUDE COMMUNITY NEEDS ASSESSMENT, ACCESS TO HEALTH CARE AND INSURANCE FOR UNDERSERVED POPULATIONS, AND ADVOCACY FOR SPECIFIC HEALTH ISSUES SUCH AS CHILD ABUSE AND NEGLECT AND PREVENTABLE INJURIES. OVER 700 HOURS WERE CONTRIBUTED TO MULTIPLE COALITIONS FOR FYE 2020.
Schedule H, Part I, Line 7	financial assistance & certain community benefits at cost: Line 7a is calculated using worksheet 1 and the cost to charge ratio. Line 7b medicaid shortfall is calculated using worksheet 3 and the cost to charge ratio. Lines 7e - i are calculated using the hospital's internal activity reports.
Schedule H, Part I, Line 3C	COOK CHILDREN'S ALSO USES ASSET LEVEL, MEDICAL INDIGENCY, INSURANCE STATUS, UNDERINSURANCE STATUS AND RESIDENCY IN DETERMINING ELIGIBILITY FOR FREE OR DISCOUNTED CARE.

Schedule I IRS990ScheduleI

Field	Value	IRS element (for citing)
Grant Records Maintained	Yes (true)	GrantRecordsMaintainedInd

Recipient Table RecipientTable (4 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	Recipient EINRecipientEIN	IRC SectionIRCSectionDesc	Cash GrantCashGrantAmt	Purpose Of GrantPurposeOfGrantTxt
COOK CHILDREN'S PHYSICIAN NETWORK
801 SEVENTH AVENUE	FORT WORTH	TX	76104	752485366	501(C)(3)	$75,625,445	SUBSIDIZE OPERATIONS
WARM PLACE
809 LIPSCOMB STREET	FORT WORTH	TX	76104	752220859	501(C)(3)	$10,000	SPONSOR
MARCH OF DIMES
555 HEMPHILL ST	FORT WORTH	TX	76104	131846366	501(C)(3)	$10,000	SPONSOR
WINDSONG RANCH COMMUNITY
1001 WINDSONG PRKWY STH	PROSPER	TX	75078	465352001	n/a	$15,000	SPONSOR

Field	Value	IRS element (for citing)
Total501c3 Org	3	Total501c3OrgCnt
Total Other Org	1	TotalOtherOrgCnt

Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp (11 entries)

Grant TypeGrantTypeTxt	RecipientRecipientCnt	Cash GrantCashGrantAmt
Medication	2219	$111,185
Transportation	1512	$41,792
LODGING	531	$98,439
Gift Cards	254	$11,018
UTILITIES	17	$4,906
MEALS	585	$44,794
MEDICAL EQUIPMENT	9	$9,971
INSURANCE	1	$1,468
BABY SUPPLIES	290	$15,156
Funeral	99	$67,080
OTHER	1	$638

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	SCHEDULE I, PART I, LINE 2	FormAndLineReferenceDesc
Explanation	PROCEDURES FOR MONITORING THE USE OF THE GRANT FUNDS IN THE US: THE ORGANIZATION USES PUBLIC AND PRIVATE DATA TO MONITOR THE USE OF FUNDS, AS NEEDED.	ExplanationTxt

Schedule J IRS990ScheduleJ

Field	Value	IRS element (for citing)
Idemnification Gross Up Pmts	Yes (X)	IdemnificationGrossUpPmtsInd
Written Policy Ref T And E Expnss	false	WrittenPolicyRefTAndEExpnssInd
Substantiation Required	Yes (true)	SubstantiationRequiredInd
Severance Payment	false	SeverancePaymentInd
Supplemental Nonqual Rtr Plan	Yes (true)	SupplementalNonqualRtrPlanInd
Equity Based Comp Arrngm	false	EquityBasedCompArrngmInd
Comp Based On Revenue Of Flng Org	false	CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related Orgs	false	CompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng Org	false	CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd Orgs	false	CompBsdNetEarnsRltdOrgsInd
Any Non Fixed Payments	false	AnyNonFixedPaymentsInd
Initial Contract Exception	false	InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (18 entries)

TitleTitleTxt	Base Compensation Filing OrgBaseCompensationFilingOrgAmt	Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt	Bonus Filing OrganizationBonusFilingOrganizationAmount	Bonus Related OrganizationsBonusRelatedOrganizationsAmt	Other Compensation Filing OrgOtherCompensationFilingOrgAmt	Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt	Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt	Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt	Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt	Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt	Total Compensation Filing OrgTotalCompensationFilingOrgAmt	Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt	Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt	Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
RICK w MERILL
CEO	$338,130	$869,477	$179,423	$461,374	$74,131	$190,622	$60,760	$156,240	$8,835	$22,718	$661,279	$1,700,431	$0	$0
STEPHEN w KIMMEL
CFO	$227,953	$341,930	$102,919	$154,379	$46,611	$69,916	$35,714	$53,572	$12,146	$18,220	$425,343	$638,017	$0	$66,071
NANCY c CYCHOL
PRESIDENT/CHIEF HOSPITAL SVCS	$561,783	$0	$250,634	$0	$125,991	$0	$21,000	$0	$21,263	$0	$980,671	$0	$0	$0
STANLEY E DAVIS
SR. VICE PRESIDENT, COO	$365,484	$0	$152,013	$0	$26,156	$0	$68,188	$0	$39,808	$0	$651,649	$0	$0	$0
CHERYL PETERSEN
AVP Nursing, CNO	$297,991	$0	$96,255	$0	$7,137	$0	$19,000	$0	$38,529	$0	$458,912	$0	$0	$0
JACK SOSEBEE
VICE PRESIDENT	$265,540	$0	$82,623	$0	$4,702	$0	$21,000	$0	$14,316	$0	$388,181	$0	$0	$0
MATTHEW CARROLL
pediatric hospitalist	$262,938	$0	$46,345	$0	$9,537	$0	$12,875	$0	$44,092	$0	$375,787	$0	$0	$0
DEBORAH C BOUDREAUX
AVP NURSING	$206,223	$0	$48,080	$0	$14,004	$0	$13,090	$0	$39,379	$0	$320,776	$0	$0	$0
ORLANDO R CHAPA
AVP NURSING	$217,842	$0	$48,687	$0	$11,635	$0	$20,079	$0	$15,325	$0	$313,568	$0	$0	$0
ELIA VALENCIA-STOKES
AVP FINANCE	$207,121	$0	$48,395	$0	$5,760	$0	$0	$0	$39,663	$0	$300,939	$0	$0	$0
SPENCER D SEALS
VP CONSTRUCTION & REAL ESTATE	$181,402	$0	$53,900	$0	$12,638	$0	$15,880	$0	$36,537	$0	$300,357	$0	$0	$0
TAMMY THOMLISION
AVP REVENUE	$211,091	$0	$46,752	$0	$7,200	$0	$10,314	$0	$3,783	$0	$279,140	$0	$0	$0
OZIOMA N OLOWU
director of pharmacy	$175,885	$0	$26,291	$0	$3,416	$0	$11,978	$0	$43,281	$0	$260,851	$0	$0	$0
DIANA SHANNON
RNFA, CV SVC COORDINATOR	$215,519	$0	$1,000	$0	$3,035	$0	$4,471	$0	$28,819	$0	$252,844	$0	$0	$0
JESSACA T SIBR
pharmacist	$186,771	$0	$1,000	$0	$2,918	$0	$11,394	$0	$32,927	$0	$235,010	$0	$0	$0
MARG DORMAN-O'DONNELL
director, case management	$159,268	$0	$22,142	$0	$13,259	$0	$10,910	$0	$16,289	$0	$221,868	$0	$0	$0
MARY L HICKS
pharmacist	$176,245	$0	$1,000	$0	$8,448	$0	$13,737	$0	$17,275	$0	$216,705	$0	$0	$0
MARY CARA MARTZ
SECRETARY	$121,670	$0	$31,749	$0	$4,433	$0	$7,704	$0	$23,759	$0	$189,315	$0	$0	$0

Supplemental Information Detail SupplementalInformationDetail (5 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
SCHEDULE J, PART I, LINE 1A	TAX GROSS UP PAYMENTS: MARG DORMAN-O'DONNELL $110 GROSS UP, MARY L. HICKS $220 GROSS UP, OZIOMA OLOWU $110 GROSS UP, DIANA SHANNON $220 GROSS UP, JESSACA T. SIBR $220 GROSS UP, ELIA VALENCIA-STOKES $9 GROSS UP, MARY CARA MARTZ $220 GROSS UP
SCHEDULE J, PART I, LINE 1B	GENERAL GROSS UP PAYMENTS DISCLOSURE: THERE IS NO WRITTEN POLICY REGARDING PAYMENT OR REIMBURSEMENT OF TAX INDEMNIFICATION AND GROSS-UP PAYMENTS BECAUSE THE COMPANY DOES NOT GENERALLY ALLOW FOR GROSS-UP PAYMENTS EXCEPT IN SPECIFIC CIRCUMSTANCES AND THEN ONLY IF APPROVED BY SENIOR MANAGEMENT FOLLOWED BY REVIEW OF THE COMPANY'S COMPLIANCE AND LEGAL DEPARTMENTS. THESE TYPE OF REIMBURSEMENTS GENERALLY RELATE TO TAXES OWED BY INDIVIDUALS WHO RECEIVE NOMINAL INCENTIVE PAYMENTS FOR SERVICE AWARDS OR QUALITY IMPROVEMENT PROGRAMS, AND THE GROSS-UP PAYMENTS USUALLY ARE IMMATERIAL, $250 OR LESS.
SCHEDULE J, PART I, LINE 4B	PARTICIPATION IN A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN: PARTICIPANTS IN SERP IN W-2 DEF COMP PAID BY ----------------------- --------- ------------ ------------ RICK W. MERRILL 140,060 196,000 CCHCS STEPHEN W. KIMMEL 66,071 75,286 CCHCS Nancy C. Cychol 69,761 None CCMC Stanley Davis none 47,188 ccmc
SCHEDULE J, PART I, LINE 3	METHODS USED BY CCHCS TO ESTABLISH COMPENSATION OF THE CEO/EXEC DIRECTOR:cOMPENSATION COMMITTEE INDEPENDENT COMPENSATION CONSULTANT COMPENSATION SURVEY OR STUDY WRITTEN EMPLOYMENT CONTRACT APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE
Schedule J, Part II	ALLOCATION OF CEO AND CFO SALARIES: SALARIES FOR THE CEO AND CFO ARE ALLOCATED PRO-RATA BASED ON THE AMOUNT OF TIME THEY SPEND WITH EACH OF THE FOLLOWING COMPANIES: COOK CHILDREN'S MEDICAL CENTER COOK CHILDREN'S HEALTH FOUNDATION COOK CHILDREN'S HOME HEALTH COOK CHILDREN'S HEALTH CARE SYSTEM COOK CHILDREN'S HEALTH PLAN COOK CHILDREN'S PHYSICIAN NETWORK CHILD STUDY CENTER

Schedule K IRS990ScheduleK

Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp (4 entries)

Bond ReferenceBondReferenceCd	Bond Issuer EINBondIssuerEIN	CUSIPCUSIPNum	Bond IssuedBondIssuedDt	Issue PriceIssuePriceAmt	PurposePurposeDesc	DefeasedDefeasedInd	On Behalf Of IssuerOnBehalfOfIssuerInd	Pool FinancingPoolFinancingInd
TARRANT COUNTY HEALTH FACILITIES DEVELOPMENT
A	751181060	875906NY1	2010-02-24	$231,948,097	DEVELOPMENT, CONST, EQUIPMENT	false	false	false
Tarrant County Cultural Education Facilities
B	043833551	87638QJC4	2013-08-01	$71,222,592	REFUNDING PORTION OF 2010 BOND	false	false	false
Tarrant County Cultural Education Facilities
C	043833551	87638QKX6	2014-02-02	$176,767,688	CONSTRUCTION & EQUIPMENT COSTS	false	false	false
Tarrant County Cultural Education Facilities Finan
D	043833551	87638QQq5	2020-02-25	$241,629,204	REFUNDING AND CONSTRUCTION AND EQU	false	false	false

Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp (4 entries)

Bond ReferenceBondReferenceCd	RetiredRetiredAmt	Bond DefeasedBondDefeasedAmt	Total ProceedsTotalProceedsAmt	In Reserve FundInReserveFundAmt	Capitalized InterestCapitalizedInterestAmt	Refunding EscrowRefundingEscrowAmt	Issuance Costs From ProceedsIssuanceCostsFromProceedsAmt	Credit EnhancementCreditEnhancementAmt	Working Capital ExpendituresWorkingCapitalExpendituresAmt	Capital ExpendituresCapitalExpendituresAmt	Other Spent ProceedsOtherSpentProceedsAmt	UnspentUnspentAmt	Substantial CompletionSubstantialCompletionYr	Refunding Tax Exempt BondsRefundingTaxExemptBondsInd	Refunding Taxable BondsRefundingTaxableBondsInd	Final Allocation MadeFinalAllocationMadeInd	Adequate Books And Rec MaintAdequateBooksAndRecMaintInd
A	$199,770,000	$0	$232,805,916	$0	$0	$0	$2,686,446	$0	$0	$230,119,470	$0	$0	2011	false	false	Yes (true)	Yes (true)
B	$0	$0	$71,222,592	$0	$0	$70,145,003	$1,077,553	$0	$0	$0	$0	$0	2013	Yes (true)	false	Yes (true)	Yes (true)
C	$15,570,000	$0	$177,571,254	$0	$0	$0	$1,755,350	$0	$0	$176,023,031	$0	$0	2016	false	false	Yes (true)	Yes (true)
D	$0	$0	$241,629,204	$0	$0	$90,712,257	$2,221,088	$0	$0	$13,000,000	$0	$137,022,858		Yes (true)	false	false	Yes (true)

Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp (4 entries)

Bond ReferenceBondReferenceCd	Owning Bond Financed PropertyOwningBondFinancedPropertyInd	Any Lease ArrangementsAnyLeaseArrangementsInd	Mgmt Contract Bond Fincd PropMgmtContractBondFincdPropInd	Any Research AgreementsAnyResearchAgreementsInd	Private Bus Use By OthersPrivateBusUseByOthersPct	Total Private Business UseTotalPrivateBusinessUsePct	Bond Iss Meet Prvt Sec Pymt TestBondIssMeetPrvtSecPymtTestInd	Change In Use Bond Financed PropChangeInUseBondFinancedPropInd	Remedial Action TakenRemedialActionTakenInd	Procs Nonqualified Bond RemdtdProcsNonqualifiedBondRemdtdInd
A	false	Yes (true)	false	false	0.00210	0.00210	Yes (true)	false	false	Yes (true)
B	false	false	false	false	0.00080	0.00080	Yes (true)	false	false	Yes (true)
C	false	false	false	false	0.00000	0.00000	Yes (true)	false	false	Yes (true)
D	false	false	false	false	0			false	false	Yes (true)

Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp (4 entries)

Bond ReferenceBondReferenceCd	Form8038 T FiledForm8038TFiledInd	Rebate Not Due YetRebateNotDueYetInd	Exception To RebateExceptionToRebateInd	No Rebate DueNoRebateDueInd	Variable Rate IssueVariableRateIssueInd	Hedge Identified In Bks And RecHedgeIdentifiedInBksAndRecInd	Term Of HedgeTermOfHedgePct	Superintegrated HedgeSuperintegratedHedgeInd	Hedge TerminatedHedgeTerminatedInd	Gross Proceeds Invested In GICGrossProceedsInvestedInGICInd	Business Name Line1GICProviderName/BusinessNameLine1Txt	Written Proc To Monitor ReqsWrittenProcToMonitorReqsInd
bank of america
A	false	false	false	Yes (true)	Yes (true)	Yes (true)	0.213	false	false	false	0	Yes (true)
0
B	false	false	false	Yes (true)	false	false				false	0	Yes (true)
0
C	false	false	false	Yes (true)	false	false				false	0	Yes (true)
0
D	false	Yes (true)	false	false	false	false				false	0	Yes (true)

Procedures Corrective Action ProceduresCorrectiveActionGrp (4 entries)

Bond ReferenceBondReferenceCd	Procedures Corrective ActionProceduresCorrectiveActionInd
A	Yes (true)
B	Yes (true)
C	Yes (true)
D	Yes (true)

Supplemental Information Detail SupplementalInformationDetail (5 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
Part IV, Column A, Line 2C	No Rebate Due The final rebate computation was performed as of 2/4/2014
Part IV, Column B, Line 2C	No rebate due The final rebate computation was performed as of 2/4/2014.
Part IV, Column C, Line 2C	No rebate due the final rebate computation was performed as of 03/22/2017.
Part III, line 7, Columns A, B, & C	FOR THE PURPOSES OF CALCULATING THE PRIVATE SECURITY OR PAYMENT TEST, COOK CHILDREN'S MEDICAL CENTER (CCMC) HAS INCLUDED GROSS RECEIPTS FROM CERTAIN ACTIVITIES THAT CCMC HAS CONCLUDED GENERATE PRIVATE PAYMENTS. CALCULATED IN THAT MANNER, CCMC HAS CONCLUDED THAT THE PRIVATE PAYMENT TEST HAS BEEN MET WITH RESPECT TO THE BOND ISSUES DESCRIBED IN COLUMNS C & D. HOWEVER, THE AMOUNT OF PRIVATE BUSINESS USE WITH RESPECT TO THE BOND ISSUES DESCRIBED IN COLUMNS C & D IS LESS THAN 5%, IN EACH CASE, SO THAT EACH OF THOSE BOND ISSUES FAILS THE PRIVATE BUSINESS USE TEST AND CONTINUES TO MEET THE REQUIREMENTS IMPOSED ON "QUALIFIED 501(C)(3) BONDS."
Part II, Column A & C, Line 3	Total Proceeds include investment earnings.

Schedule L IRS990ScheduleL

Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp

Name Of Interested NameOfInterested

Field	Value	IRS element (for citing)
Person	KATHARINE CARVALHO	PersonNm

Field	Value	IRS element (for citing)
Relationship Description	DAUGHTER OF BOARD MEMBER	RelationshipDescriptionTxt
Transaction	$83,258	TransactionAmt
Transaction	COMPENSATION	TransactionDesc
Sharing Of Revenues	false	SharingOfRevenuesInd

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (9 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
FORM 990, PART VI, SECTION A, LINE 3	DELEGATION OF MANAGEMENT AUTHORITY: A MANAGEMENT COMPANY MANAGES THE DAY TO DAY OPERATIONS OF BOTH OF OUR JOINT VENTURES.
FORM 990, PART VI, SECTION A, LINE 6	SOLE MEMBER: COOK CHILDREN'S HEALTH CARE SYSTEM, A TEXAS NON-PROFIT CORPORATION, IS THE SOLE MEMBER OF THE ORGANIZATION.
FORM 990, PART VI, SECTION A, LINE 7A	MEMBER ELECTION ABILITIES: 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.
FORM 990, PART VI, SECTION A, LINE 7B	MEMBER DECISION ABILITIES: AS THE SOLE MEMBER OF THE ORGANIZATION, COOK CHILDREN'S HEALTH CARE SYSTEM HAS THE EXCLUSIVE POWER AND RESERVED POWER TO DO ANY OF THE FOLLOWING: A. AMEND, ALTER OR REPEAL THE BYLAWS; B. AMEND THE CERTIFICATE OF FORMATION OF THE ORGANIZATION; C. DETERMINE THE NUMBER OF MEMBERS OF THE BOARD OF TRUSTEES AND TO ELECT THE MEMBERS OF THE BOARD OF TRUSTEES; D. APPROVE ANY MERGER, ACQUISITION, LIQUIDATION, WINDING UP, TERMINATION OR CONSOLIDATION OF THE ORGANIZATION; E. APPROVE THE SALE, GIFT OR OTHER DISPOSITION OF ALL OR SUBSTANTIALLY ALL OF THE PROPERTY OF THE ORGANIZATION; AND, F. APPROVE THE CREATION OF, OR INVESTMENT IN, ANY SUBSIDIARY ENTITY.
FORM 990, PART VI, SECTION B, LINE 11B	REVIEW PROCESS FOR FORM 990: THE ORGANIZATION ENGAGES AN OUTSIDE INDEPENDENT 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 FORM 990 IS PREPARED, IT IS REVIEWED BY COMPANY FINANCE, LEGAL AND COMPLIANCE STAFF AND THEN PROVIDED TO THE BOARD OF TRUSTEES FOR REVIEW AND COMMENT. IN ADDITION, IT IS PRESENTED TO THE COOK CHILDREN'S HEALTH CARE SYSTEM AUDIT COMMITTEE FOR REVIEW AND COMMENT. SUBSEQUENT TO AUDIT COMMITTEE REVIEW, THE FORM 990 IS FILED WITH THE INTERNAL REVENUE SERVICE AND MADE AVAILABLE TO THE PUBLIC FOR REVIEW.
FORM 990, PART VI, SECTION B, LINE 12C	WRITTEN CONFLICT OF INTEREST POLICY: EVERY YEAR THE LEGAL DEPARTMENT OF THE COOK CHILDREN'S HEALTH CARE SYSTEM (SYSTEM) SENDS OUT A FORM 990 QUESTIONNAIRE/CONFLICT OF INTEREST DISCLOSURE STATEMENT TO OFFICERS, DIRECTORS, TRUSTEES AND KEY EMPLOYEES OF ALL SYSTEM COMPANIES, AS WELL AS CERTAIN OTHER EMPLOYEES, INCLUDING PHYSICIANS, WHO ARE DETERMINED TO BE EMPLOYED IN POSITIONS THAT MIGHT BE SUBJECT TO THE SYSTEM'S CONFLICT OF INTEREST POLICY. 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. A SUMMARY OF THE RESPONSES TO THE QUESTIONNAIRES AND FOLLOW-UP INFORMATION ARE PROVIDED TO THE SYSTEM 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 THAT IS APPLICABLE TO ALL AFFILIATED COMPANIES 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 HOTLINE 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, WITH FURTHER REPORTING TO THE SYSTEM BOARD OF TRUSTEES AS APPROPRIATE.
FORM 990, PART VI, SECTION B, LINE 15A & 15B	REVIEW AND APPROVAL OF COMPENSATION: COOK CHILDREN'S HEALTH CARE SYSTEM HAS ESTABLISHED A COMPENSATION COMMITTEE WITH OVERSIGHT OF EXECUTIVE AND PHYSICIAN COMPENSATION, WHICH INCLUDES THE ORGANIZATION'S CEO AND OTHER OFFICERS AND KEY EMPLOYEES OF THE ORGANIZATION. THE COMPENSATION COMMITTEE APPROVES COMPENSATION ARRANGEMENTS IN ADVANCE, WHICH INCLUDES A REVIEW AND APPROVAL BY INDEPENDENT COMMITTEE MEMBERS, USING COMPARABLE MARKET DATA RELATING TO COMPENSATION, WHICH IS PROVIDED BY SULLIVAN COTTER AND ASSOCIATES, INC. FOR EXECUTIVE COMPENSATION, AND BY ECG MANAGEMENT CONSULTANTS AND SULLIVAN COTTER AND ASSOCIATES FOR PHYSICIAN COMPENSATION, BOTH OF WHICH ARE INDEPENDENT, NATIONALLY RECOGNIZED COMPENSATION CONSULTANTS. THE COMPENSATION COMMITTEE DOCUMENTS THE BASIS FOR ITS DETERMINATIONS FOLLOWING CONTEMPORANEOUS SUBSTANTIATION OF THE COMPENSATION COMMITTEE'S DELIBERATIONS AND DECISIONS. THE COMPENSATION COMMITTEE REQUIRES THE COMPENSATION CONSULTANT TO UPDATE MARKET DATA PERIODICALLY, USUALLY EVERY TWO YEARS, WITH INTERIM REVIEWS BEING CONDUCTED AS NEEDED. WITH REGARD TO PHYSICIAN COMPENSATION, THE COMPENSATION COMMITTEE ALSO RETAINS THE LAW FIRM OF MCDERMOTT, WILL AND EMERY OF CHICAGO, ILLINOIS, TO ISSUE A REASONABLENESS OPINION COVERING THE PHYSICIAN COMPENSATION PLAN FOR COOK CHILDREN'S PHYSICIAN NETWORK.
FORM 990, PART VI, SECTION C, LINE 19	PROCESS OF MAKING GOVERNING DOCUMENTS AVAILABLE TO THE PUBLIC: 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 AND BOARD MEMBERS 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.
Form 990, Part XI, Line 9	OTHER CHANGES IN NET ASSETS OR FUND BALANCES: Fund Balance Transfers Between Affiliates: (85,000,000) Change in FV of SWAP: (1,148,663) Other Reconciling Items: (182,920) ------------- (86,331,583)

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (9 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	EINEIN	Primary ActivitiesPrimaryActivitiesTxt	Legal Domicile StateLegalDomicileStateCd	Exempt Code SectionExemptCodeSectionTxt	Public Charity StatusPublicCharityStatusTxt	Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt	Controlled OrganizationControlledOrganizationInd
COOK CHILDREN'S PHYSICIAN NETWORK
801 SEVENTH AVE	FORT WORTH	TX	76104	752485366	PHYSICIAN SVC	TX	501(C)(3)	3	CCHCS	Yes (true)
WI COOK FOUNDATION
801 SEVENTH AVE	FORT WORTH	TX	76104	752056149	FUNDRAISING	TX	501(C)(3)	7	NA	false
COOK CHILDREN'S HOME HEALTH
801 SEVENTH AVE	FT WORTH	TX	76104	752896983	HEALTHCARE	TX	501(C)(3)	10	CCHCS	Yes (true)
COOK CHILDREN'S HEALTH CARE SYSTEM
801 SEVENTH AVE	FORT WORTH	TX	76104	752705881	HLTH CARE SUP	TX	501(C)(3)	12C	CCHF	false
COOK CHILDREN'S HEALTH PLAN
801 SEVENTH AVE	FORT WORTH	TX	76104	760585240	INSURANCE	TX	501(C)(3)	10	CCHCS	Yes (true)
ROSEDALE OFFICE BUILDING INC
1500 W ROSEDALE	FORT WORTH	TX	76104	460866421	TITLE HOLDING	TX	501(C)(2)	N/A	CCHF	false
CHILD STUDY CENTER
1300 W LANCASTER	FORT WORTH	TX	76102	751099536	HLTHCARE SRVC	TX	501(C)(3)	7	CCMC	Yes (true)
COOK CHILDREN'S HEALTH ENTERPRISES
801 SEVENTH AVE	FORT WORTH	TX	76104	842625990	SUPPORT	TX	501(C)(3)	12B	CCHF	false
Cook Childrens Medical Center Prosper
801 Seventh Ave	Fort Worth	TX	76104	852354189	Healthcare SV	TX	501(C)(3)	3	CCHCS	Yes (true)

Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (3 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	EINEIN	Primary ActivitiesPrimaryActivitiesTxt	Legal Domicile StateLegalDomicileStateCd	Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt	Predominant Income TypePredominantIncomeTypeTxt	Share Of Total IncomeShareOfTotalIncomeAmt	Share Of EOY AssetsShareOfEOYAssetsAmt	Disproportionate AllocationsDisproportionateAllocationsInd	UBI Code VUBICodeVAmt	General Or Managing PartnerGeneralOrManagingPartnerInd	OwnershipOwnershipPct
COOK CHILDREN'S sURGERY cENTER
11221 ROE AVE SUITE 320	LEAWOOD	KS	66211	205227064	asc	TX	NA	RELATED	$3,726,357	$2,871,020	false	$0	false	0.60000
CENTER FOR PEDIATRIC SURGERY
11221 ROE AVE SUITE 320	LEAWOOD	KS	66211	470871715	ASC	TX	NA	RELATED	$7,610,856	$13,328,144	false	$0	false	0.53477
CPS PEDIATRICS LLC
11221 ROE AVE SUITE 320	LEAWOOD	KS	66211	470871718	ASC	TX	NA	RELATED	$36,449	$100,148	false	$0	false	0.53733

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp

Related Organization Name RelatedOrganizationName

Field	Value	IRS element (for citing)
Business Name Line1	COOK CHILDREN'S HEALTH SERVICES INC	BusinessNameLine1Txt

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	801 7TH AVENUE	AddressLine1Txt
City	FORT WORTH	CityNm
State Abbreviation	TX	StateAbbreviationCd
ZIP	76104	ZIPCd

Field	Value	IRS element (for citing)
EIN	454024843	EIN
Primary Activities	HEALTHCARE	PrimaryActivitiesTxt
Legal Domicile State	TX	LegalDomicileStateCd

Direct Controlling Entity Name DirectControllingEntityName

Field	Value	IRS element (for citing)
Business Name Line1	CCHCS	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Entity Type	C CORPORATION	EntityTypeTxt
Controlled Organization	Yes (true)	ControlledOrganizationInd

Field	Value	IRS element (for citing)
Receipt Of Int Annts Rnts Rylts	Yes (true)	ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth Org	Yes (true)	GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth Org	Yes (true)	GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other Org	false	LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth Org	Yes (true)	LoansOrGuaranteesFromOthOrgInd
Div Related Organization	Yes (true)	DivRelatedOrganizationInd
Asset Sale To Other Org	false	AssetSaleToOtherOrgInd
Asset Purchase From Other Org	false	AssetPurchaseFromOtherOrgInd
Asset Exchange	Yes (true)	AssetExchangeInd
Rental Of Facilities To Oth Org	Yes (true)	RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth Org	Yes (true)	RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth Org	false	PerformOfServicesForOthOrgInd
Perform Of Services By Other Org	Yes (true)	PerformOfServicesByOtherOrgInd
Sharing Of Facilities	false	SharingOfFacilitiesInd
Paid Employees Sharing	Yes (true)	PaidEmployeesSharingInd
Reimbursement Paid To Other Org	Yes (true)	ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other Org	Yes (true)	ReimbursementPaidByOtherOrgInd
Transfer To Other Org	Yes (true)	TransferToOtherOrgInd
Transfer From Other Org	Yes (true)	TransferFromOtherOrgInd

Transactions Related Org TransactionsRelatedOrgGrp (12 entries)

Transaction TypeTransactionTypeTxt	InvolvedInvolvedAmt	Method Of Amount DeterminationMethodOfAmountDeterminationTxt
Cook Children's Physician Network
A	$1,702,303	FMV
Cook Children's Physician Network
R	$539,689	FMV
COOK CHILDREN'S PHYSICIAN NETWORK
O	$32,774,515	FMV
COOK CHILDREN'S PHYSICIAN NETWORK
B	$75,625,445	FMV
COOK CHILDREN'S PHYSICIAN NETWORK
Q	$375,466	FMV
COOK CHILDREN'S PHYSICIAN NETWORK
Q	$334,809	FMV
COOK CHILDREN'S HOME HEALTH
R	$2,709,368	FMV
COOK CHILDREN'S HOME HEALTH
P	$221,785	FMV
Cook Children's Health Plan
S	$146,199,127	FMV
Cook Children's Health Plan
Q	$71,134	FMV
Child Study Center
O	$135,743	FMV
Cook Children's Surgery Center (NE)
J	$1,359,436	fmv