2020-08-12T13:54:17-05:00 2019-09-30 BKD LLP 14241 DALLAS PARKWAY SUITE 1100 DALLAS TX 75254 990 2018-10-01 752705881 Cook Children's Health Care System % CORY RHOADES COOK 6828854000 801 Seventh Avenue Fort Worth TX 76104 CORY RHOADES SVP FINANCE 2020-08-17 true Kevin Ensminger P01310558 9727028262 167.68.126.162 76915820202255000013 2020-08-12 P 21E6481FF4EC5D606F81E380A49442717B3AD96E 80CEAFDD65D51D1B4C2E8E44F3E4B5709E882E31 2018 2020-09-23 17:36:50Z RICK W MERRILL 801 SEVENTH AVE FORT WORTH TX 76104 319882048 false X WWW.COOKCHILDRENS.ORG X 1996 TX KNOWING THAT EVERY CHILD'S LIFE IS SACRED IT IS OUR PROMISE TO IMPROVE THE HEALTH OF EVERY CHILD IN OUR REGION THROUGH THE PREVENTION AND TREATMENT OF ILLNESS, DISEASE AND INJURY. 22 15 796 25 0 0 1978834 2602327 184436150 213162135 5603663 11676557 2576106 3113703 194594753 230554722 96240 608450 0 0 53960711 59281044 0 0 0 168096847 167666181 222153798 227555675 -27559045 2999047 436259628 470709212 170284587 193616133 265975041 277093079 X 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. false false 191397539 608450 216275838 FROM PRIMARY CARE TO MORE THAN 100 SPECIALTIES AND SUBSPECIALTIES, COOK CHILDREN'S DOCTORS OFFER WORLD-CLASS, AWARD-WINNING CARE. COOK CHILDREN'S HEALTH CARE SYSTEM EMBRACES AN INSPIRING PROMISE - TO IMPROVE THE HEALTH OF EVERY CHILD IN OUR REGION THROUGH THE PREVENTION AND TREATMENT OF ILLNESS, DISEASE AND INJURY. BASED IN FORT WORTH, TEXAS, WE'RE PROUD OF OUR LONG AND RICH TRADITION OF SERVING THE COMMUNITY. OUR NOT-FOR-PROFIT ORGANIZATION ENCOMPASSES TWELVE COMPANIES - A MEDICAL CENTER, TWO SURGERY CENTERS, A PHYSICIAN NETWORK, HOME HEALTH SERVICES AND A HEALTH PLAN. IT ALSO INCLUDES CHILD STUDY CENTER AT COOK CHILDREN'S, COOK CHILDREN'S HEALTH SERVICES INC., ROSEDALE OFFICE BUILDING, AN ACO, AN INDEMNITY COMPANY, AND COOK CHILDREN'S HEALTH FOUNDATION. WITH MORE THAN 60 PRIMARY, SPECIALTY AND URGENT CARE LOCATIONS THROUGHOUT TEXAS, FAMILIES CAN ACCESS OUR TOP-RANKED SPECIALTY PROGRAMS AND NETWORK OF SERVICES TO MEET THEIR UNIQUE NEEDS. FOR MORE THAN 100 YEARS WE'VE WORKED TO COMBINE THE ART OF CARING WITH LEADING TECHNOLOGY AND EXTRAORDINARY COLLABORATION TO PROVIDE EXCEPTIONAL CARE FOR EVERY CHILD. THIS HAS EARNED COOK CHILDREN'S A STRONG, FAR-REACHING REPUTATION WITH PATIENTS TRAVELING FROM AROUND THE COUNTRY AND THE GLOBE TO RECEIVE LIFE-SAVING PEDIATRIC CARE. COOK CHILDREN'S IS HONORED TO CONTINUALLY RECEIVE RECOGNITION FOR OUR OUTSTANDING EFFORTS AND OUTCOMES IN PEDIATRIC HEALTH CARE. 191397539 true true false true false false false false false false true false false false false false false true false false true false false false false false false true true true false false false false false false false false false false false false false true true true false false true 222 0 796 true false true CJ false false false false false false false false false false X 22 15 false false false false true true true true true false false true true true true true true true true false X CORY RHOADES 6828854480 801 SEVENTH AVENUE FORT WORTH TX 76104 X Brian D Barnard Trustee 1.0 3.0 X 0 0 0 G Thomas Boswell Trustee 1.0 2.0 X 0 0 0 John P Boswell Trustee 1.0 3.0 X 0 0 0 Matthew Carroll MD Trustee 1.0 40.0 X 0 302645 20940 Samson Cantu MD Trustee 1.0 42.0 X 0 486992 49421 Jerry R Conatser Trustee-Chairman 2.0 6.0 X X 0 0 0 Jeffrey H Conner Trustee-Secretary/Treasurer 2.0 2.0 X X 0 0 0 Brian C Crumley Trustee 1.0 2.0 X 0 0 0 James R Dunaway Jr Trustee 1.0 1.0 X 0 0 0 Mathew Dzurik MD Trustee-Vice Chairman 2.0 42.0 X X 0 469651 34864 Jose Iglesias MD Trustee 1.0 42.0 X 0 1010328 38048 G Malcolm Louden Trustee 1.0 1.0 X 0 0 0 Saleem Malik MD Trustee 1.0 40.0 X 0 483115 46826 Jonathan Nedrelow MD Trustee 1.0 0.0 X 0 0 0 Brian C Newby Trustee 1.0 0.0 X 0 0 0 Lindsay Newton MD Trustee 1.0 42.0 X 0 252941 29851 Bonnie Petsche Trustee 1.0 4.0 X 0 0 0 Peter L Philpott Trustee 1.0 4.0 X 0 0 0 Alice W Philips MD Trustee 1.0 42.0 X 0 444213 41724 Billie R Pugh Jr MD Trustee 1.0 2.0 X 0 0 0 Andrew J Rosell Trustee 1.0 2.0 X 0 0 0 Jason V Terk MD Trustee 1.0 40.0 X 0 329975 37185 JAMES WEBB TRUSTEE 1.0 3.0 X 0 0 0 R RUSSELL MORTON TRUSTEE 1.0 3.0 X 0 0 0 W M MACK LAWHON TRUSTEE 1.0 3.0 X 0 0 0 GAVIN FINE MD TRUSTEE 1.0 3.0 X 0 576352 41799 MICHAEL R DIKE TRUSTEE 1.0 3.0 X 0 0 0 RICHARD W DYESS TRUSTEE 1.0 3.0 X 0 0 0 James C Cunningham Exec VP, Chief Medical Officer 40.0 0.0 X 920215 0 36147 Stephen W Kimmel CFO 10.0 30.0 X 220231 660692 94312 Cara Martz Secretary 35.0 5.0 X 141294 0 22922 Rick W Merrill President & CEO 12.0 28.0 X 532043 1241435 234191 Cory R Rhoades SR V PRESIDENT-FINANCE 40.0 0.0 X 429515 0 80363 Spencer D Seals VP Real Estate & Construction 40.0 0.0 X 172845 0 37774 James D Marshall CRO 40.0 0.0 X 695016 0 45674 ANTHONY BAGWELL SVP, CIIO 40.0 0.0 X 0 0 0 JOHN MCNEY SR V PRESIDENT-GEN COUNSEL 40.0 0.0 X 604654 0 37758 JOANN M SANDERS MD CHIEF QUALITY OFFICER 40.0 0.0 X 580621 0 84584 ERIC H HUBLI MD CHIEF SYS EFFECTIVENESS OFFCR 40.0 0.0 X 561676 0 38422 THERESA ZAK MEADOWS SR V PRESIDENT-CIO 40.0 0.0 X 560796 0 41593 ROBERT K FEATHER SR. VP PUBLIC POLICY 40.0 0.0 X 503162 0 47409 SCOTT LEDDY CHIEF MEDICAL INFO OFFICER 40.0 0.0 X 398795 0 39393 JOSE GONZALEZ MD VP COMMUNITY HEALTH 40.0 0.0 X 377455 0 39364 JOSEPH GALLAGHER SVP, CHIEF LEGAL OFFICER 40.0 0.0 X 336158 0 38146 GREGORY K JIMERSON VP-PAYOR RELATIONS 40.0 0.0 X 317814 0 48817 JAMES STALDER VICE PRESIDENT-INFO SYSTEMS 40.0 0.0 X 315269 0 43595 KENT SMITH VICE PRESIDENT-COMPLIANCE 40.0 0.0 X 309257 0 26147 NATALIE WILKINS CHIEF OF STAFF 40.0 0.0 X 284868 0 23311 CHRISTIAN PEDIGO VP SYS PLANNING & HEALTH ANALY 40.0 0.0 X 264845 0 50446 DAVID LANCASTER VP-INTERNAL AUDIT 40.0 0.0 X 259873 0 38060 LORRAINEA WILLIAMS PAT/MEDICATION SAFETY OFFICER 40.0 0.0 X 243261 0 43515 AARON WISHON VP-CHIEF INFO SECURITY OFFICER 40.0 0.0 X 241811 0 29294 TINA HASKINS AVP, EPIC ENTERPRISE APPS 40.0 0.0 X 221447 0 17197 Keith M Holtz CAO 40.0 0.0 X 677368 0 87097 MAYNARD DYSON MEDICAL DIRECTOR 40.0 0.0 X 328782 0 47995 KAREN WARDELL ASSOCIATE GENERAL COUNSEL 40.0 0.0 X 316335 0 34493 BETH SCHMIDT AVP-HUMAN RESOURCES 40.0 0.0 X 252963 0 26898 AMIT PATEL ASSISTANT CHIEF MED INFO OFFCR 40.0 0.0 X 233086 0 21315 11301455 6258339 1796890 223 false true false EPIC SYSTEMS CORPORATION PO BOX 88314 MILWAUKEE WI 53288 SOFTWARE SERVICES 12960373 DIVURGENT LLC 4445 CORPORATION LANE VIRGINIA BEACH VA 23462 CONSULTING 8093903 FPI BUILDERS LLC 2116 WENNECA AVE FORT WORTH TX 76102 CONSTRUCTION SVCS 2444813 TECHNOLOGENT 15821 VENTURA BLVD STE 100 ENCINO CA 91436 SOFTWARE SERVICES 1677466 GUIDEHOUSE INC 150 N RIVERSIDE PLZ SUITE 2100 CHICAGO IL 60606 CONSULTING 1120907 34 1217299 1385028 2602327 Shared Services 900099 189221138 189221138 Human Resources 900099 9271552 9271552 Rent 900099 7278965 7278965 COMMUNITY HEALTH OUTREACH 900099 5057720 5057720 REAL ESTATE MANAGEMENT 900099 485258 485258 1847502 1847502 213162135 12454262 12454262 0 0 0 0 0 88496741 52880 89275462 51864 -778721 1016 -777705 -777705 0 0 0 0 0 0 0 0 0 Rebate 900099 3011338 3011338 Other Revenue 900099 67757 67757 CONCIERGE 900099 34608 34608 3113703 230554722 216275838 11676557 558450 558450 50000 50000 0 0 10331825 2105497 8226328 0 35146187 27071140 8075047 960779 344450 616329 10017772 7773494 2244278 2824481 2048678 775803 0 1730562 56276 1674286 417848 417848 166600 166600 0 168421 168421 16269631 9416451 6853180 4152431 969384 3183047 1622602 1577065 45537 105301980 105301980 0 2481661 2481661 1237694 912887 324807 0 348727 290805 57922 0 0 10440128 10440128 2457027 2457027 Physician Remuneration 12674171 9903117 2771054 Minor Equipment 3498584 3498584 Recruitment 1134057 1134057 Dues & Subscriptions 1304112 561648 742464 2259945 2026912 233033 227555675 191397539 36158136 0 9950 10350 17082912 19128390 595483 836928 3558341 3876582 0 0 0 0 0 0 6087 8016 3407583 5052304 297094139 98036044 186303384 199058095 218735152 231553055 0 0 0 0 0 0 6560736 11185492 436259628 470709212 169920068 192788298 0 0 364519 827835 0 0 0 0 0 0 0 0 0 0 0 0 170284587 193616133 X 265975041 277093079 0 0 0 0 265975041 277093079 436259628 470709212 X 2999047 7939033 179958 X false true X true true true X X 1 CC MEDICAL CENTER 752051646 3 true 191397539 0 1 191397539 true false false false false false false false false false false false false false false true true false X true true SCHEDULE A, PART IV, SECTION E, LINE 3A POWER TO REGULARLY APPOINT: THE ORGANIZATION IS THE SOLE MEMBER OF THE SUPPORTED ORGANIZATION, COOK CHILDREN'S MEDICAL CENTER, AND AS SUCH HAS THE POWER TO DETERMINE THE NUMBER OF MEMBERS OF THE BOARD OF TRUSTEES AND TO ELECT THE MEMBERS OF THE BOARD OF TRUSTEES OF THE SUPPORTED ORGANIZATION. SCHEDULE A, PART IV, SECTION E, LINE 3B SUBSTANTIAL DEGREE OF DIRECTION OVER POLICIES, PROGRAMS, AND ACTIVITIES: THE ORGANIZATION IS THE SOLE MEMBER OF THE SUPPORTED ORGANIZATION, COOK CHILDREN'S MEDICAL CENTER, AND AS SUCH 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. THE ORGANIZATION IS ALSO RESPONSIBLE FOR IMPLEMENTATION AND ENFORCEMENT OF VARIOUS POLICIES AND PROCEDURES OF THE SUPPORTED ORGANIZATION INCLUDING THE CONFLICT OF INTEREST POLICY AND COMPENSATION ARRANGEMENTS. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 166600 166600 227389075 227555675 1000000 250000 false 1000000 1000000 1000000 1000000 4000000 6000000 150577 177550 178153 166600 672880 250000 250000 250000 250000 1000000 1500000 72310152 72310152 89586165 20105603 69480562 907109 840972 66137 111363915 75935610 35428305 22926798 1153859 21772939 199058095 240498975 7939034 2174656 10113690 230385285 168421 1016 169437 230554722 229560894 2173640 2173640 227387254 168421 168421 227555675 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 RECOREDED OR DISCLOSED IN THE FINANCIAL STATEMENTS. SCHEDULE D, PART XI, LINE 2D RECONCILIATION OF REVENUES PER AUDITED FINANCIALS TO TAX RETURN: MANAGEMENT FEE REDUCTION $ 2,174,656 SCHEDULE D, PART XI, LINE 4B RECONCILIATION OF REVENUES PER AUDITED FINANCIALS TO TAX RETURN: GAIN ON DISPOSITION OF ASSETS $ 1,016 SCHEDULE D, PART XII, LINE 2D RECONCILIATION OF EXPENSES PER AUDITED FINANCIALS TO TAX RETURN: MANAGEMENT FEE REDUCTION $ 2,174,656 GAIN ON DISPOSITION OF ASSET $ (1,016) ------------- TOTAL $ 2,173,640 Central America and the Caribbean Investments 7758762 7758762 7758762 true false true false false false true TMA FOUNDATION 401 W 15TH STREET AUSTIN TX 78701 752022128 501(C)(3) 10000 ASSISTANCE UNITED WAY OF TARRANT COUNTY 1500 N MAIN ST FORT WORTH TX 76164 752541065 501(C)(3) 20000 GENERAL SUPPORT TEXAS CHRISTIAN UNIV UNTHCS SCHOOL OF MEDICINE TCU BOX 297085 FORT WORTH TX 76129 752220859 501(C)(3) 500000 GENERAL SUPPORT 3 SCHOLARSHIPS FOR INDIVIDUALS 11 50000 SCHEDULE I, PART I, LINE 2 PROCEDURE FOR MONITORING THE USE OF GRANT FUNDS IN THE UNITED STATES: THE ORGANIZATION USES PUBLIC AND PRIVATE DATA TO MONITOR THE USE OF FUNDS, AS NEEDED. IN ORDER TO BE ELIGIBLE FOR THE PRESIDENT'S SCHOLARSHIP AWARD THE APPLICANTS MUST MEET THE FOLLOWING REQUIREMENTS: 1) BE A CHILD OF A FULL TIME EMPLOYEE WITH ONE YEAR FULL TIME EXPERIENCE, 2) BE A FULL TIME STUDENT IN A BACCALAUREATE PROGRAM AND 3) PURSUING A DEGREE APPLICABLE TO THE HEALTHCARE WORKFORCE. THE SCHOLARSHIP RECIPIENTS ARE SELECTED BY THE SCHOLARSHIP COMMITTEE. THE SELECTION IS BASED ON ESSAYS SUBMITTED BY THE APPLICANTS, AS WELL AS GRADES. THE MINIMUM AWARD IS $5,000 FOR FIRST TIME RECIPIENTS AND $2,500 FOR REPEAT RECIPIENTS. SCHOLARSHIP PAYMENTS ARE ISSUED DIRECTLY TO THE UNIVERSITIES. X X false true X X X X X false true false false false false false false false James C Cunningham Exec VP, Chief Medical Officer 553599 0 224310 0 142306 0 20625 0 15522 0 956362 0 0 0 Stephen W Kimmel CFO 109766 329301 73012 219033 37453 112358 20301 60902 3278 9831 243810 731425 63144 0 Cara Martz Secretary 95694 0 24526 0 21074 0 7553 0 15369 0 164216 0 0 0 Rick W Merrill President & CEO 303290 707677 147071 343166 81682 190592 63956 149231 6301 14703 602300 1405369 0 0 Cory R Rhoades SR V PRESIDENT-FINANCE 219353 0 134085 0 76077 0 53370 0 26993 0 509878 0 13437 0 Spencer D Seals VP Real Estate & Construction 126845 0 26187 0 19813 0 11173 0 26601 0 210619 0 0 0 Keith M Holtz CAO 341274 0 225618 0 110476 0 60079 0 27018 0 764465 0 45133 0 James D Marshall CRO 530695 0 115706 0 48615 0 20625 0 25049 0 740690 0 0 0 Matthew Carroll MD Trustee 0 255473 0 25688 0 21484 0 9410 0 11530 0 323585 0 0 Samson Cantu MD Trustee 0 481582 0 500 0 4910 0 17188 0 32233 0 536413 0 0 Mathew Dzurik MD Trustee-Vice Chairman 0 394440 0 36803 0 38408 0 20625 0 14239 0 504515 0 0 Jose Iglesias MD Trustee 0 904412 0 43944 0 61972 0 17188 0 20860 0 1048376 0 0 Saleem Malik MD Trustee 0 441638 0 500 0 40977 0 19984 0 26842 0 529941 0 0 Lindsay Newton MD Trustee 0 168898 0 46725 0 37318 0 9674 0 20177 0 282792 0 0 Alice W Philips MD Trustee 0 396576 0 10159 0 37478 0 20625 0 21099 0 485937 0 0 Jason V Terk MD Trustee 0 299659 0 500 0 29816 0 18500 0 18685 0 367160 0 0 GAVIN FINE MD TRUSTEE 0 540380 0 500 0 35472 0 20625 0 21174 0 618151 0 0 JOHN MCNEY SR V PRESIDENT-GEN COUNSEL 337458 0 144770 0 122426 0 20625 0 17133 0 642412 0 0 0 JOANN M SANDERS MD CHIEF QUALITY OFFICER 302694 0 180073 0 97854 0 66666 0 17918 0 665205 0 38471 0 ERIC H HUBLI MD CHIEF SYS EFFECTIVENESS OFFCR 487186 0 15000 0 59490 0 17187 0 21235 0 600098 0 0 0 THERESA ZAK MEADOWS SR V PRESIDENT-CIO 331072 0 135909 0 93815 0 17187 0 24406 0 602389 0 0 0 ROBERT K FEATHER SR. VP PUBLIC POLICY 260082 0 128785 0 114295 0 20625 0 26784 0 550571 0 0 0 SCOTT LEDDY CHIEF MEDICAL INFO OFFICER 285563 0 88028 0 25204 0 11000 0 28393 0 438188 0 0 0 JOSE GONZALEZ MD VP COMMUNITY HEALTH 253252 0 83528 0 40675 0 17187 0 22177 0 416819 0 0 0 JOSEPH GALLAGHER SVP, CHIEF LEGAL OFFICER 223683 0 74012 0 38463 0 20625 0 17521 0 374304 0 0 0 MAYNARD DYSON MEDICAL DIRECTOR 220430 0 70139 0 38213 0 19952 0 28043 0 376777 0 0 0 GREGORY K JIMERSON VP-PAYOR RELATIONS 218196 0 72673 0 26945 0 18037 0 30780 0 366631 0 0 0 KAREN WARDELL ASSOCIATE GENERAL COUNSEL 209884 0 71768 0 34683 0 14651 0 19842 0 350828 0 0 0 JAMES STALDER VICE PRESIDENT-INFO SYSTEMS 212014 0 70117 0 33138 0 13273 0 30322 0 358864 0 0 0 KENT SMITH VICE PRESIDENT-COMPLIANCE 187789 0 67466 0 54002 0 13334 0 12813 0 335404 0 0 0 NATALIE WILKINS CHIEF OF STAFF 200192 0 63947 0 20729 0 11000 0 12311 0 308179 0 0 0 CHRISTIAN PEDIGO VP SYS PLANNING & HEALTH ANALY 177818 0 61582 0 25445 0 20379 0 30067 0 315291 0 0 0 DAVID LANCASTER VP-INTERNAL AUDIT 169163 0 58987 0 31723 0 19576 0 18484 0 297933 0 0 0 BETH SCHMIDT AVP-HUMAN RESOURCES 157064 0 42645 0 53254 0 15480 0 11418 0 279861 0 0 0 LORRAINEA WILLIAMS PAT/MEDICATION SAFETY OFFICER 169912 0 42007 0 31342 0 12963 0 30552 0 286776 0 0 0 AARON WISHON VP-CHIEF INFO SECURITY OFFICER 177654 0 43261 0 20896 0 9151 0 20143 0 271105 0 0 0 AMIT PATEL ASSISTANT CHIEF MED INFO OFFCR 194647 0 25697 0 12742 0 9242 0 12073 0 254401 0 0 0 TINA HASKINS AVP, EPIC ENTERPRISE APPS 120772 48144 52531 8087 9110 238644 0 SCHEDULE J, PART I, LINES 1A GENERAL GROSS UP PAYMENTS: MATHEW DZURIK, M.D. $110 GROSS UP JOSE IGLESIAS, M.D. $110 GROSS UP GAVIN FINE, M.D. $110 GROSS UP SALEEM MALIK, M.D. $110 GROSS UP LINDSEY NEWTON, M.D. $110 GROSS UP ALICE W. PHILLIPS M.D. $110 GROSS UP JASON TERK M.D. $110 GROSS UP MATTHEW CARROLL M.D. $110 GROSS UP SCHEDULE J, PART I, LINES 1A & 1B 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 EXTREMELY UNUSUAL 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. CY 2018 CME GROSS UP AMOUNTS MATTHEW DZURIK, M.D. $ 6,500 GAVIN FINE, M.D. 6,500 JOSE IGLESIAS, M.D. 14,500 SALEEM MALIK, M.D. 9,750 LINDSAY NEWTON, M.D. 4,875 ALICE PHILLIPS, M.D. 6,500 JASON TERK, M.D. 6,500 SAMSON CANTU, M.D. 3,900 MATTHEW CARROLL, M.D. 750 CME GROSS UP PAYMENTS: IN ADDITION TO THE GIFT CARD INCENTIVE BONUSES DESCRIBED ABOVE, THERE IS NO WRITTEN POLICY REGARDING PAYMENT OR REIMBURSEMENT OF TAX INDEMNIFICATION AND GROSS-UP PAYMENTS FOR CONTINUING MEDICAL EDUCATION ALLOWANCES PAID TO EMPLOYED PHYSICIANS OF COOK CHILDREN'S PHYSICIAN NETWORK. THESE TYPE OF EXPENSES ARE USUALLY HANDLED AS NON-TAXABLE ACCOUNTABLE PLAN BUSINESS EXPENES UNDER THE INTERNAL REVENUE CODE, BUT THE COMPANY HAS ELECTED TO TREAT THESE PAYMENTS AND THE GROSS-UP PAYMENTS AS TAXABLE INCOME TO THE AFFECTED INDIVIDUALS. THESE PAYMENTS ARE APPROVED IN ADVANCE BY SENIOR MANAGEMENT AND REVIEWED BY THE COMPANY'S COMPLIANCE AND LEGAL DEPARTMENTS. FURTHER, THESE EXPENSES ARE INCLUDED IN THE BENEFITS CALCULATION FOR SUCH PHYSICIANS WHICH ARE REVIEWED BY THE COMPANY'S COMPENSATION COMMITTEE TO VERIFY THAT SUCH PAYMENTS ARE PAID AT FAIR MARKET VALUE AND COMMERCIALLY REASONABLE. CHARTER TRAVEL PROVIDED TO DR. MATTHEW DZURIK FOR CLINICAL CARE AND OUTREACH IN HIS CAPACITY AS A PHYSICIAN FOR COOK CHILDREN'S PHYSICIAN NETWORK. SCHEDULE J, PART I, QUESTION 4B PARTICIPATION IN A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN PARTICIPANTS IN SERP IN W-2 DEF COMP PAID BY -------------------- -------- ---------- --------- RICK W. MERRILL $ 126,903 $ 196,000 CCHS STEPHEN W. KIMMEL 63,144 70,202 CCHS KEITH M. HOLTZ 45,133 54,044 CCHS JOANN M. SANDERS, MD 38,471 46,041 CCHS CORY R. RHOADES 13,437 36,182 CCHS JOHN MCNEY 46,013 NONE CCHS THERESA ZAK MEADOWS 43,801 NONE CCHS ROBERT K. FEATHER 38,252 NONE CCHS JAMES C. CUNNINGHAM 68,591 NONE CCHS 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 CHILD STUDY CENTER COOK CHILDREN'S PHYSICIAN NETWORK FORM 990, PART VI, SECTION A, LINE 6 SOLE MEMBER: W. I. COOK FOUNDATION, INC., D/B/A COOK CHILDREN'S HEALTH FOUNDATION, 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, W.I. COOK FOUNDATION, INC., 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, W.I. COOK FOUNDATION, INC., HAS THE EXCLUSIVE 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; F. APPROVE THE CREATION OF, OR INVESTMENT IN, ANY SUBSIDIARY ENTITY; G. APPROVE THE REMOVAL OF A MEMBER OF THE BOARD OF TRUSTEES OF THE ORGANIZATION; AND H. APPROVE THE PERSONS WHO ARE TO BE ELECTED BY THE ORGANIZATION TO FILL ANY VACANCIES ON THE BOARD OF TRUSTEES OR BOARD OF DIRECTORS, AS APPLICABLE, OF (1) COOK CHILDREN'S MEDICAL CENTER, (2) COOK CHILDREN'S PHYSICIAN NETWORK, (3) COOK CHILDREN'S HOME HEALTH, (4) COOK CHILDREN'S HEALTH PLAN, (5) COOK CHILDREN'S INDEMNITY COMPANY (6) COOK CHILDREN'S HEALTH ENTERPRISES; AND (7) ANY OTHER SUBSIDIARY CORPORATION AFFILIATED WITH OR CONTROLLED BY THE ORGANIZATION (INCLUDING ANY VACANCIES ARISING FROM THE EXPIRATION OF THE TERMS OF ANY OF THE TRUSTEES OR DIRECTORS). 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, LINES 15A & 15B REVIEW AND APPROVAL OF COMPENSATION: COOK CHILDRENS 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 FOR PHYSICIAN COMPENSATION, BOTH OF WHICH ARE INDEPENDENT, NATIONALLY RECOGNIZED COMPENSATION CONSULTANTS. THE COMPENSATION COMMITTEE DOCUMENTS THE BASIS FOR ITS DETERMINATIONS AND DECISIONS. THE COMPENSATION COMMITTEE REQUIRES THE COMPENSATION CONSULTANT TO UPDATE MARKET DATA PERIODICALLY, USUALLY EVERY TWO YEARS, THE 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 OF FUND BALANCES: TRANSFER FROM AFFILIATES $ 179,958 COOK CHILDREN'S HEALTH PLAN 801 SEVENTH AVE FORT WORTH TX 76104 760585240 INSURANCE TX 501(C)(3) 10 CCHCS true COOK CHILDREN'S PHYSICIAN NETWORK 801 SEVENTH AVE FORT WORTH TX 76104 752485366 PHYSICIAN SVC TX 501(C)(3) 3 CCHCS true WI COOK FOUNDATION 801 SEVENTH AVE FORT WORTH TX 76104 752051649 FUNDRAISING TX 501(C)(3) 7 NA false COOK CHILDREN'S MEDICAL CENTER 801 SEVENTH AVE FORT WORTH TX 76104 752051646 HOSPITAL TX 501(C)(3) 3 CCHCS true COOK CHILDREN'S HOME HEALTH 801 SEVENTH AVE FORT WORTH TX 76104 752896983 HEALTHCARE TX 501(C)(3) 10 CCHCS true ROSEDALE OFFICE BUILDING INC 1500 W ROSEDALE FORT WORTH TX 76104 460866421 TITLE HOLDING TX 501(C)(2) N/A CCHF true CHILD STUDY CENTER 1300 WEST LANCASTER AVE FORT WORTH TX 76102 751099536 HEALTHCARE TX 501(C)3 7 CCMC true COOK CHILDREN'S HEALTH ENTERPRISES 801 7TH AVE FORT WORTH TX 76104 842625990 SUPPORT TX 501(C)(3) 12B CCHF true COOK CHILDREN'S HEALTH SERVICES INC 801 7TH AVENUE FORT WORTH TX 76104 454024843 HEALTHCARE TX CCHCS C CORPORATION 1535748 5873017 1.00000 true true true false false false false false false false false true true false false true true true false true COOK CHILDREN'S MEDICAL CENTER A 538818 FMV COOK CHILDREN'S PHYSICIAN NETWORK A 2530199 FMV COOK CHILDREN'S HOME HEALTH A 883352 FMV COOK CHILDREN'S HEALTH PLAN A 1123956 FMV COOK CHILDREN'S MEDICAL CENTER B 755199 FMV COOK CHILDREN'S PHYSICIAN NETWORK B 384963 FMV ROSEDALE OFFICE BUILDING K 1327104 FMV COOK CHILDREN'S PHYSCIAN NETWORK L 60000 FMV COOK CHILDREN'S PHYSCIAN NETWORK N 161727 FMV COOK CHILDREN'S MEDICAL CENTER O 477323 FMV COOK CHILDREN'S PHYSCIAN NETWORK O 13184230 FMV ROSEDALE OFFICE BUILDING O 99683 FMV COOK CHILDREN'S MEDICAL CENTER P 410039 FMV COOK CHILDERN'S PHYSCIAN NETWORK P 351441 FMV ROSEDALE OFFICE BUILDING P 1801632 FMV COOK CHILDREN'S MEDICAL CENTER Q 226227569 FMV COOK CHILDREN'S PHYSCIAN NETWORK Q 33707479 FMV COOK CHILDREN'S HOME HEALTH Q 4910274 FMV COOK CHILDREN'S HEALTH PLAN Q 14175651 FMV COOK CHILDREN'S HEALTH SERVICES INC Q 162471 FMV CHILD STUDY CENTER Q 1683571 FMV COOK CHILDREN'S MEDICAL CENTER S 606191 FMV