2020-11-16T08:32:27-06:00 2019-12-31 350921680 CROWE LLP 750 N St Paul Suite 850 Dallas TX 75201 990 2019-01-01 752854505 Physicians for Children PHYS 2144567000 1935 Medical District Drive Dallas TX 75235 Robert Fries Senior Vice President, Finance 2020-11-16 true Rachel Spurlock P00520729 2147775200 2019 2021-01-29 14:40:06Z Children's Health Pediatric Group Ray Tsai MD 1935 Medical District Drive Dallas TX 75235 4899115 false X N/A X 1999 TX TO DELIVER PRIMARY CARE TO CHILDREN IN UNDERSERVED AREAS OF NORTH CENTRAL TEXAS. 4 0 138 0 0 0 1574704 1582281 11985181 3316834 0 0 14458 0 13574343 4899115 0 0 0 23964670 11512435 0 0 0 16758795 12636261 40723465 24148696 -27149122 -19249581 3504989 3175660 100642027 119562279 -97137038 -116386619 To deliver primary care to children in critically under served areas of the North Central Texas community in a private physician office setting. false false 16877564 0 3316834 Physicians for Children dba Children's Health Pediatric Group (CHPG) provides a medical home for children when they are both sick and well. CHPG cares for all aspects of children and their health care needs, from well child exams and treatment of common illnesses like cold and flu, to treatment of chronic conditions such as asthma. Our main objective is to improve the lives of children in our community by providing them with a high-quality, affordable patient centered medical home. 16877564 true true false false false false false false false true false false false true true false true false false false false false false false false false false false true false false false false false false false false false false false false false true false false false true 53 0 true 138 true false false false false false false false false false false false false X 4 0 false false false false true true true true true false false false true true true true true false false false X Amy Yeager 2144567000 1935 MEDICAL DISTRICT DRIVE DALLAS TX 75235 Ray Tsai MD President (CHST SVP Ops) 1.0 54.0 X X 0 812977 161690 John D Polousky MD Director 1.0 39.0 X 0 848682 19152 Michael Day MD Former Director 1.0 39.0 X 0 531725 23163 Michael Tate MD Director 1.0 39.0 X 0 371133 29945 Lisa M Frenkel Secretary 1.0 5.0 X 0 318389 6579 Tammie L Sibley Treasurer (CHST SVP Finance) (Until 11/6/19) 1.0 49.0 X 0 1152385 67689 Amrita Nagra Physician MyChildrens 40.0 0 X 193697 0 10032 Dawn Johnson Medical Director 40.0 0 X 289469 0 13594 Jarvis Archibald Sr Dir Network Development Srvcs 40.0 0 X 158111 0 10527 Ranjana Chandramouli Physician MyChildrens 40.0 0 X 161039 0 14094 Tamara Perry Sr Dir Telehealth Ops 40.0 0 X 149929 0 20828 Stephanie K Smith Former Corporate Secretary 0.0 40.0 X 0 154475 4593 952245 4189766 381886 24 true true false CHARTIS GROUP 203 N LASALLE ST STE 2100 CHICAGO IL 60601 PROFESSIONAL SERVICES 734685 UTSW HI 108 5323 Harry Hines Blvd Dallas TX 753908886 Phys & Medical Services 343097 MERCK SHARP AND DOHME CORP ONE MERCK DR Whitehouse Station NJ 08889 Medical Supplies/Services 111449 GLAXOSMITHKLINE PHARMACEUTICAL PO BOX 740415 ATLANTA GA 30374 MEDICAL SUPPLIES/SERVICES 110804 HENRY SCHEIN INC DEPT CH 10241 PALATINE IL 600550241 Medical Supplies/Services 101529 5 1582281 1582281 NET PATIENT REVENUE 621110 3316834 3316834 0 0 0 0 3316834 0 0 0 0 0 0 0 0 0 4899115 3316834 0 0 9073244 8584288 488956 405138 365653 39485 1186673 1109737 76936 847380 566990 280390 1603618 1601925 1693 0 466025 466025 81955 69450 12505 1656566 1656241 325 617363 503884 113479 142066 136183 5883 56610 54517 2093 1196409 1184046 12363 43543 33000 10543 Shared Services 6224153 6224153 Medical Surgical Supplies 433753 433753 Dietary and Food Costs 41563 40408 1155 Special Events 35921 34748 1173 36716 36716 0 0 24148696 16877564 7271132 0 227652 104248 0 0 0 0 833333 750000 4569138 2247726 2444004 2321412 0 0 0 0 3504989 3175660 1514535 1521310 0 0 99127492 118040969 100642027 119562279 -97137038 -116386619 -97137038 -116386619 3504989 3175660 -19249581 0 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1626939 758522 868417 1253757 467300 786457 1688442 1021904 666538 2321412 LT ADVANCES-Affiliates 118040969 118040969 X Schedule D, Part X, Line 2 FIN 48 (ASC 740) footnote Physicians for Children's financial information is included in the consolidated audited financial statements of Children's Health System of Texas, a related organization. Children's Health System of Texas's FIN 48 (ASC 740) footnote for the year ended December 31, 2019, reads as follows: "The authoritative guidance in ASC 740 Income Taxes, creates a single model to address uncertainty in tax positions and clarifies the accounting for income taxes by prescribing the minimum recognition threshold a tax position is required to meet before being recognized in the financial statements. Management annually reviews its tax positions and has determined that there are no material uncertain tax positions that require recognition in the accompanying consolidated balance sheets. The statute of limitations remains open for tax years 2016 through 2019 in Children's Health main taxing jurisdictions." true true false false false false false false false Ray Tsai MD President (CHST SVP Ops) 0 393135 0 295959 0 123883 0 142652 0 19038 0 974667 0 0 Michael Day MD Former Director 0 428767 0 98575 0 4383 0 14680 0 8483 0 554888 0 0 John D Polousky MD Director 0 842048 0 0 0 6634 0 11200 0 7952 0 867834 0 0 Michael Tate MD Director 0 327999 0 39744 0 3390 0 16800 0 13145 0 401078 0 0 Stephanie K Smith Former Corporate Secretary 0 132475 0 20759 0 1241 0 0 0 4593 0 159068 0 0 Lisa M Frenkel Secretary 0 257119 0 51226 0 10044 0 0 0 6579 0 324968 0 0 Tammie L Sibley Treasurer (CHST SVP Finance) (Until 11/6/19) 0 272798 0 257450 0 622137 0 54936 0 12753 0 1220074 0 0 Jarvis Archibald Sr Dir Network Development Srvcs 145273 0 10000 0 2838 0 6377 0 4150 0 168638 0 0 0 Ranjana Chandramouli Physician MyChildrens 156440 0 2512 0 2087 0 6656 0 7438 0 175133 0 0 0 Dawn Johnson Medical Director 213655 0 71278 0 4536 0 7547 0 6047 0 303063 0 0 0 Amrita Nagra Physician MyChildrens 168020 0 23668 0 2009 0 7758 0 2274 0 203729 0 0 0 Tamara Perry Sr Dir Telehealth Ops 124504 0 22537 0 2888 0 8304 0 12524 0 170757 0 0 0 Schedule J, Part I, Line 3 Arrangement used to establish the top management official's compensation CHILDREN'S HEALTH SYSTEM OF TEXAS IS THE SOLE MEMBER FOR PHYSICIANS FOR CHILDREN (PFC). PFC'S TOP MANAGEMENT OFFICIAL IS COMPENSATED BY PFC. COMPENSATION FOR THE TOP MANAGEMENT OFFICIAL IS ESTABLISHED BY CHST. The CHST process for determining executive compensation is as follows: The Human Resources Committee (Committee) of the CHST Board is responsible for setting the compensation for executives. The Committee is comprised of independent, non-employee directors. A written compensation philosophy has been developed by the Human Resources Committee for timeliness and appropriateness and defines the desired peer groups for compensation surveys. The HR Committee engages the services of an independent compensation consultant for executive compensation. COMPENSATION PROGRAM COMPONENTS: The elements of total compensation provided to CHST executives include: - Cash compensation (i.e., base salary, short-term and long-term incentive compensation, and/or other cash compensation), determined in consideration of competitive market practices, organizational and individual performance, recruitment and retention considerations, and other relevant factors. - Standard benefits, assisting in each executive's medical, dental, disability, life insurance, time off, and retirement needs, reflective of the employment status (i.e., full or part time) of the executive. - Supplemental benefits, including supplemental insurance, retirement benefits, and/or other supplemental benefits determined by the Committee to be appropriate and reasonable in relation to marketplace practices. Compensation and benefits decisions are made in consideration of each executive's position, responsibilities, skills, effort, and performance, in relation to documented practices within the appropriate comparator group(s). PEER GROUP: The Committee has defined its primary peer group for executives as not-for-profit health care organizations similar in size, structure, and complexity. This group will include leading pediatric health systems as well as integrated health systems and academic medical centers. - Data will be compiled in a manner consistent with the IRS Intermediate Sanctions rules of federal tax law, to reflect what is "ordinarily paid to like executives by like enterprises under like circumstances." - In certain circumstances, market data from additional comparator groups (e.g., research institutions, insurance industry, and general industry companies) may also be referenced. - The specific nature of the role at CHST will be considered when adding comparator groups outside of the primary peer group, and the Committee will discuss and agree on the appropriateness of adding comparator groups whenever the specific nature of the CHST role requires additional comparator groups to be used. Schedule J, Part I, Line 4a Severance or change-of-control payment Tammie Sibley - $472,500. Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan Savings Restoration Plan: Ray Tsai participated in the Savings Restoration Plan; however, no payments were received in 2019. Executive Defined Contribution Retirement Plan (EDCRP): Employees who received taxable income from the EDCRP include: Ray Tsai - $72,007 and Tammie Sibley - $119,039. Employees who participated in and have contributions to the EDCRP include: Ray Tsai - $123,652 and Tammie Sibley - $44,538. Form 990, Part VI, Line 15a PROCESS TO ESTABLISH COMPENSATION OF TOP MANAGEMENT OFFICIAL CHILDREN'S HEALTH SYSTEM OF TEXAS IS THE SOLE MEMBER FOR PHYSICIANS FOR CHILDREN (PFC). PFC'S TOP MANAGEMENT OFFICIAL IS EMPLOYED AND COMPENSATED BY PFC. Compensation setting takes place at the related entity Children's Health System of Texas (CHST). Form 990, Part VI, Line 8b Committees Children's Health System of Texas has established seven standing Committees of the Board, which have the authority to act for and on behalf of CHST, Children's Health Clinical Operations, Children's Medical Center Foundation, and their affiliates, operating divisions and division facilities to fulfill the responsibilities designated in the respective Committee charters. Written minutes are prepared and maintained for all formal meetings of each Committee. Actions by Written Consent are also prepared and maintained as they occur. Form 990, Part VI, Line 15b PROCESS TO ESTABLISH COMPENSATION OF OFFICERS AND OTHER KEY EMPLOYEES Line 15b is answered no in accordance with the IRS Form 990 instructions because salary is paid and determined by a related party, Children's Health System of Texas (CHST). CHST is the sole member and officers are employed and paid by CHST. Form 990, Part VI, Line 6 Classes of members or stockholders Children's Health System of Texas (CHST) is the sole member. Form 990, Part VI, Line 7a Members or stockholders electing members of governing body Directors are appointed by the member and approved by the current Physicians for Children Board of Directors. Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders Member reserve powers are specified in the organization's bylaws and represent those actions by the organization which require member approval. These powers generally encompass changes in the mission of the organization, addition of new members, certain dispositions of assets, amendments to the organization's Certificate of Formation and Bylaws, and appointment of directors. Form 990, Part VI, Line 11b Review of form 990 by governing body Physicians for Children has delegated its oversight and review of the Form 990 to the Board of Directors of Children's Health System of Texas (CHST), its Sole Member. A draft of the Form 990 is presented to the CHST Audit Committee for review prior to filing. A copy of the Final Form 990 is made available to the CHST directors through our Board portal before it is filed. Form 990, Part VI, Line 12c Conflict of interest policy Officers, directors, and key employees receive annually a copy of the Children's Health Statement of Interest form to complete. Disclosures made are reviewed by the CHST Legal Department and the Chief Compliance Officer, who are authorized under the Children's Health Conflict of Interest Policy to make determinations under the Policy regarding persons who are medical staff members or employees of Children's Health and its affiliates. Disclosures made by senior officers (as defined in the Policy) are reviewed by the Compliance Officer, the Chief Legal Officer, and CHST's President and Chief Executive Officer to determine if a conflict exists. Disclosures made by directors of CHST and its affiliates, as well as by the President and Chief Executive Officer of CHST, are discussed as necessary with the appropriate delegated Board Committee and, if required pursuant to the Policy, by the appropriate Board of Directors at meetings to determine if further action is needed. A Statement of Interest must be completed annually and Board members are requested to report changes if they occur. A Committee or Board member with a potential conflict is prohibited from participating in deliberations regarding the transaction in question and will recuse themselves from voting. Form 990, Part VI, Line 19 Required documents available to the public IRC section 6104 does not require disclosure of the financial statements, conflict of interest policy and governing documents. The Certificate of Formation, Consolidated Financial Statements, and the conflict of interest policy are made available upon request. Children's Health Clinical Operations 1935 MEDICAL DISTRICT DRIVE DALLAS TX 75235 750800628 Hospital TX 501(c)(3) 3 CHILDREN'S HEALTH SYSTEM OF TEXAS false CHILDREN'S MEDICAL CENTER FOUNDATION 1935 MEDICAL DISTRICT DRIVE DALLAS TX 75235 752062015 FOUNDATION TX 501(c)(3) 7 CHILDREN'S HEALTH SYSTEM OF TEXAS false DALLAS PHYS MED SVCS FOR CHILDREN INC 1935 MEDICAL DISTRICT DRIVE DALLAS TX 75235 810584868 PHYSICIANS TX 501(c)(3) 3 CHILDREN'S HEALTH SYSTEM OF TEXAS false COMPLEX CARE MED SVC CORP 1935 MEDICAL DISTRICT DRIVE DALLAS TX 75235 461893597 MEDICAL SERVICES TX 501(c)(3) 3 CHILDREN'S HEALTH SYSTEM OF TEXAS false CHILDREN'S MEDICAL CENTER HEALTH PLAN 1935 MEDICAL DISTRICT DRIVE DALLAS TX 75235 462737696 HMO TX 501(c)(3) 10 CHILDREN'S HEALTH SYSTEM OF TEXAS false CHILDREN'S MED CTR RESEARCH INST AT UTSWMC 1935 MEDICAL DISTRICT DRIVE DALLAS TX 75235 453462044 RESEARCH INSTITUTE TX 501(c)(3) Type I CHILDREN'S HEALTH SYSTEM OF TEXAS false PEDIATRIC PARTNERS 1935 MEDICAL DISTRICT DRIVE DALLAS TX 75235 461917702 CLINICALLY INTEGRATED NETWORK TX 501(c)(3) Type I CHILDREN'S HEALTH SYSTEM OF TEXAS false ANESTHESIOLOGISTS FOR CHILDREN 1935 MEDICAL DISTRICT DRIVE DALLAS TX 75235 752917570 PHYSICIANS TX 501(c)(3) 10 CHILDREN'S HEALTH SYSTEM OF TEXAS false PHYSICIANS QUALITY ALLIANCE OF NORTH TEXAS 1935 MEDICAL DISTRICT DRIVE DALLAS TX 75235 464049491 PHYSICIANS TX 501(c)(3) Type I CHILDREN'S HEALTH SYSTEM OF TEXAS false SOUTHWESTERN MEDICAL DISTRICT 1935 MEDICAL DISTRICT DRIVE DALLAS TX 75235 204101612 MEDICAL DISTRICT TX 501(c)(3) Type I NA false WOMEN'S AUXILIARY TO THE CHILDREN'S MEDICAL CENTER 2777 N STEMMONS FWY 700 DALLAS TX 75207 752485538 WOMEN'S AUXILIARY TX 501(c)(3) 10 CHILDREN'S MEDICAL CENTER FOUNDATION false OCH Holdings 1935 Medical District Drive Dallas TX 75235 474837308 Hospital TX 501(c)(3) 3 Children's Health Clinical Operations false CHST Physician Group 2 1935 Medical District Drive Dallas TX 75235 813679995 Physician TX 501(c)(3) 10 CHILDREN'S HEALTH SYSTEM OF TEXAS false CHST Physician Group 3 1935 Medical District Drive Dallas TX 75235 813691209 Physician TX 501(c)(3) 10 CHILDREN'S HEALTH SYSTEM OF TEXAS false CHST Physician Group 4 1935 Medical District Drive Dallas TX 75235 814577909 Physician TX 501(c)(3) 10 CHILDREN'S HEALTH SYSTEM OF TEXAS false CHST Physician Group 5 1935 Medical District Drive Dallas TX 75235 814848085 Physician TX 501(c)(3) 10 CHILDREN'S HEALTH SYSTEM OF TEXAS false CHST Physician Group 6 1935 Medical District Drive Dallas TX 75235 814865847 Physician TX 501(c)(3) 10 CHILDREN'S HEALTH SYSTEM OF TEXAS false CHILDREN'S HEALTH SYSTEM OF TEXAS 1935 MEDICAL DISTRICT DRIVE DALLAS TX 75235 752062019 MANAGEMENT COMPANY TX 501(c)(3) Type II NA false Bradford Memorial Hospital for Babies 1935 MEDICAL DISTRICT DRIVE DALLAS TX 75235 756067819 Hospital TX 501(c)(3) 3 CHILDREN'S HEALTH SYSTEM OF TEXAS false The Children's Hospital of Texas 1935 MEDICAL DISTRICT DRIVE DALLAS TX 75235 756081004 Hospital TX 501(c)(3) 3 CHILDREN'S HEALTH SYSTEM OF TEXAS false Richmond Freeman Memorial Clinic 1935 MEDICAL DISTRICT DRIVE DALLAS TX 75235 237079698 Hospital TX 501(c)(3) 3 CHILDREN'S HEALTH SYSTEM OF TEXAS false Legacy Trail Surgery Center LLC dba Live Oak Surgery Center 7211 Preston Rd Ste 2100 Plano TX 750240258 822278618 Surgery Center TX NA N/A ALTERNATIVE CARE SYSTEMS 1935 MEDICAL DISTRICT DRIVE DALLAS TX 75235 752244475 OTHER MEDICAL SERVICES TX NA C Corporation false NTPSS INC 1935 MEDICAL DISTRICT DRIVE DALLAS TX 75235 471036641 PHYSICIAN SOLUTIONS TX NA C Corporation false Texas Bluebonnet Insurance Company 1935 Medical District Drive Dallas TX 75235 475032893 Insurance Company TX NA C Corporation false Texas Trinity River Assurance Company 981318151 Self-insurance CJ NA C Corporation false Children's Health 1935 Medical District Drive Dallas TX 75235 833809987 Other Medical Services TX NA C Corporation false CHST Physician Group 1 1935 Medical District Drive Dallas TX 75235 813582843 Physician TX NA C Corporation false CHFH Inc 1935 Medical District Drive Dallas TX 75235 831336111 Other Medical Services TX NA C Corporation false Children's Health Care Network 1935 Medical District Drive Dallas TX 75235 834560427 Other Medical Services TX NA C Corporation false false false true false true false false false false false false true true true true false false false true