2019-08-12T21:38:37-05:00 2018-09-30 BKD LLP 2700 Post Oak Blvd Ste 1500 HOUSTON TX 77056 990 2017-10-01 752705881 Cook Children's Health Care System % CORY RHOADES COOK 6828854000 801 Seventh Avenue Fort Worth TX 76104 CORY RHOADES SENIOR V.P. 2019-08-15 true Amanda Maya P01067777 7134994600 167.68.126.162 76915820192245000016 2019-08-12 P 3C05F97901279AF0647DFC7D8771036E0E35E774 40A118951004ACB7D6FC4F8785F06E4FCB5438C7 2017 2019-02-21 02:37:17Z RICK W MERRILL 801 SEVENTH AVE FORT WORTH TX 76104 362777001 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 14 765 25 0 106267 2472065 1978834 166641182 184436150 4113563 5603663 4594607 2576106 177821417 194594753 158200 96240 0 0 42950507 53960711 0 0 0 126440507 168096847 169549214 222153798 8272203 -27559045 346897985 436259628 53286182 170284587 293611803 265975041 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 193494411 96240 187012256 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. 193494411 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 false true true false false false false false false false false false false false false false true true true false false true X 186 0 true 765 true true true true CJ false false false false false false false false X 22 14 true 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 PETER L PHILPOTT TRUSTEE 1.0 4.0 X 0 0 0 MATTHEW DZURIK MD TRUSTEE-VICE CHAIR 2.0 42.0 X X 0 479538 34006 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 253994 19576 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 JULIA DAVIDSON TRUSTEE THRU 5/31/18 1.0 1.0 X 0 0 0 JAMES R DUNAWAY JR TRUSTEE 1.0 1.0 X 0 0 0 W M MACK LAWHON TRUSTEE THRU 5/31/18 1.0 1.0 X 0 0 0 G MALCOLM LOUDEN TRUSTEE 1.0 1.0 X 0 0 0 BRIAN C NEWBY TRUSTEE THRU 5/31/18 1.0 0.0 X 0 0 0 BONNIE PETSCHE TRUSTEE 1.0 4.0 X 0 0 0 RAY RHODES MD TRUSTEE THRU 5/31/18 1.0 42.0 X 0 408690 39595 JASON V TERK MD TRUSTEE 1.0 40.0 X 0 368204 38041 SAM CANTU MD TRUSTEE 1.0 42.0 X 0 408384 51314 BRIAN CRUMLEY TRUSTEE 1.0 2.0 X 0 0 0 JOSE IGLESIAS MD TRUSTEE 1.0 42.0 X 0 1037962 42407 SALEEM MALIK MD TRUSTEE 1.0 40.0 X 0 539536 49197 MARC MAZADE MD TRUSTEE THRU 5/31/18 1.0 42.0 X 0 359881 49689 JONATHAN NEDRELOW MD TRUSTEE 1.0 0.0 X 0 0 0 LINDSAY NEWTON MD TRUSTEE 1.0 42.0 X 0 165848 32941 ALICE PHILLIPS MD TRUSTEE 1.0 42.0 X 0 339515 45056 BILLIE R PUGH JR MD TRUSTEE 1.0 2.0 X 0 0 0 ANDREW ROSELL TRUSTEE 1.0 2.0 X 0 0 0 RICK W MERRILL PRESIDENT AND CEO 12.0 28.0 X 726359 1694844 216152 JOANN M SANDERS MD CHIEF QUALITY OFFICER 40.0 0.0 X 518890 0 38812 JAMES C CUNNINGHAM MD EXEC VP, CHIEF MEDICAL OFFICER 40.0 0.0 X 875122 0 38944 KEITH HOLTZ CHIEF ADMINISTRATIVE OFFICER 40.0 0.0 X 665485 0 33675 ERIC H HUBLI MD CHIEF SYS EFFECTIVENESS OFFCR 40.0 0.0 X 553370 0 41297 GREGORY K JIMERSON VP-PAYOR RELATIONS 40.0 0.0 X 310264 0 44767 STEPHEN W KIMMEL CFO 10.0 30.0 X 211885 635653 104515 DAVID F LANCASTER VP-INTERNAL AUDIT 40.0 0.0 X 250895 0 36588 SCOTT LEDDY CHIEF MEDICAL INFO OFFICER 40.0 0.0 X 384147 0 37069 JAMES D MARSHALL MD CHIEF RESEARCH OFFICER 40.0 1.0 X 600034 0 44782 CARA MARTZ SECRETARY 35.0 5.0 X 140312 0 22833 JOHN W MCNEY SR V PRESIDENT-GEN COUNSEL 40.0 0.0 X 581115 0 40446 THERESA ZAK MEADOWS SR V PRESIDENT-CIO 40.0 0.0 X 549278 0 45150 CORY RHOADES SR V PRESIDENT-FINANCE 40.0 0.0 X 399156 0 45547 JAMES R STALDER V PRES-INFO SYSTEMS 40.0 0.0 X 366625 0 41193 LARRY L TUBB SR VP-PLANNING THRU 2/16/18 40.0 0.0 X 408934 0 37148 LORRAINEA WILLIAMS PAT/MEDICATION SAFETY OFFCR 40.0 0.0 X 237343 0 40214 KENT SMITH VP-COMPLIANCE 40.0 0.0 X 287014 0 20787 ROBERT K FEATHER SR. VP PUBLIC POLICY 40.0 0.0 X 488169 0 47295 JOSE GONZALEZ MD VP CHILDRENS HEALTH 40.0 0.0 X 369794 0 32890 CHRISTIAN PEDIGO VP SYS PLANNING & HEALTH ANALY 40.0 0.0 X 208593 0 44366 SPENCER SEALS VP REAL ESTATE & CONSTRUCTION 40.0 0.0 X 126854 0 33683 NATALIE WILKINS CHIEF OF STAFF 40.0 0.0 X 278836 0 20874 JOSEPH GALLAHGER DEPUTY GENERAL COUNSEL 40.0 0.0 X 327848 0 36922 BETH SCHMIDT AVP-HUMAN RESOURCES 40.0 0.0 X 242824 0 25973 KAREN WARDELL ASSOCIATE GENERAL COUNSEL 40.0 0.0 X 308163 0 32302 MAYNARD DYSON MEDICAL DIRECTOR 40.0 0.0 X 328324 0 45640 TINA HASKINS AVP, EPIC ENTERPRISE APPS 40.0 0.0 X 232799 0 10058 GEORGE B MONTAGUE V PRESIDENT-REAL ESTATE 38.0 2.0 X 250714 0 25648 11229146 6692049 1687392 199 true true false EPIC SYSTEMS CORPORATION PO BOX 88314 MILWAUKEE WI 53288 SOFTWARE SERVICES 8066913 MUCKLEROY FALLS 5801 EDWARDS RANCH RD 100 FORT WORTH TX 76104 CONSTRUCTION 3001450 FPI BUILDERS LLC 2116 WENNECA AVE FORT WORTH TX 76102 CONSTRUCTION 1957374 TECHNOLOGENT 15821 VENTURA BLVD STE 100 ENCINO CA 91436 HRDWARE/SOFTWARE SVC 1507369 HYLAND SOFTWARE INC PO BOX 846261 DALLAS TX 75284 SOFTWARE SERVICES 1294214 41 807159 1171675 0 1978834 SHARED SERVICES 900099 162780805 162780805 HUMAN RESOURCES 900099 8937721 8937721 RENT 900099 6145605 6145605 COMMUNITY HEALTH OUTREACH 900099 4760046 4760046 REAL ESTATE MANAGEMENT 900099 429470 429470 1382503 1382503 184436150 6975545 6975545 0 0 0 0 0 166795571 14795 168160881 21367 -1365310 -6572 -1371882 -1371882 0 0 0 0 0 0 0 0 0 REBATE 900099 2461344 2461344 CONCIERGE 900099 109242 109242 OTHER REVENUE 900099 5520 5520 2576106 194594753 187012256 5603663 48740 48740 47500 47500 0 0 9748412 2446419 7301993 0 31445627 24208450 7237177 0 12766672 9659059 3107613 0 0 1751444 216544 1534900 389021 389021 178153 178153 0 215681 215681 12256972 9689371 2567601 3447898 797608 2650290 987758 783023 204735 104737485 104737485 0 2878934 2878934 1060456 864700 195756 0 229926 187210 42716 0 0 10580043 10580043 3685427 3685427 PHYSICIAN REMUNERATION 11143841 8714925 2428916 MINOR EQUIPMENT 9024745 9023854 891 RECRUITMENT 1584832 1584832 DUES & SUBSCRIPTIONS 1406166 489047 917119 2538065 2068385 469680 222153798 193494411 28659387 0 9950 9950 5392329 17082912 557593 595483 2671604 3558341 0 0 0 0 0 0 9236 6087 2597416 3407583 262543357 76239973 110805522 186303384 219354079 218735152 0 0 0 0 0 0 5500256 6560736 346897985 436259628 52606436 169920068 0 0 679746 364519 0 0 0 0 0 0 0 0 0 0 0 0 53286182 170284587 X 293611803 265975041 0 0 0 0 293611803 265975041 346897985 436259628 X -27559045 -3594321 3516604 X false true X true false X X 1 CC MEDICAL CENTER 752051646 3 true 193494411 0 1 193494411 true false false false false false false false false false false false false false false true true false X true true PART IV, SECTION E, LINE 3A 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. PART IV, SECTION E, LINE 3B 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. 178153 178153 221978496 222156649 1000000 250000 false 1000000 1000000 1000000 1000000 4000000 6000000 169449 150577 177550 178153 675729 250000 250000 250000 250000 1000000 1500000 66658053 66658053 82468577 15436709 67031868 907109 809975 97134 109101995 59150074 49951921 3407623 843215 2564408 186303384 192854681 -3594320 2063357 -1530963 194385644 215681 -6572 209109 194594753 224008046 2069929 2069929 221938117 215681 215681 222153798 SCHEDULE D, PART XI, LINE 2D OTHER CHANGE: MANAGEMENT FEE REDUCTION $ 2,063,357 SCHEDULE D, PART XII, LINE 2D OTHER CHANGE: MANAGEMENT FEE REDUCTION $ 2,063,357 LOSS ON ASSET DISPOSITION $ 6,572 ----------- TOTAL OTHER CHANGES: $ 2,069,929 SCHEDULE D, PART XI, LINE 4B OTHER CHANGES: LOSS ON ASSET DISPOSITION $ (6,572) Central America and the Caribbean Investments 7117073 7117073 7117073 true false true false false false true SCHOLARSHIPS FOR INDIVIDUALS 10 47500 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 & 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 true true false false false false false false false RICK W MERRILL PRESIDENT AND CEO 318789 743842 143872 335704 263698 615298 57519 134211 7327 17095 791205 1846150 243000 567000 MATTHEW DZURIK MD TRUSTEE-VICE CHAIR 0 470553 0 0 0 8985 0 16875 0 17131 0 513544 0 0 JOANN M SANDERS MD CHIEF QUALITY OFFICER 356388 0 107424 0 55078 0 20250 0 18562 0 557702 0 18000 0 JAMES C CUNNINGHAM MD EXEC VP, CHIEF MEDICAL OFFICER 615344 0 211166 0 48612 0 20250 0 18694 0 914066 0 0 0 MATTHEW CARROLL MD TRUSTEE 0 210217 0 21656 0 22121 0 9326 0 10250 0 273570 0 0 RAY RHODES MD TRUSTEE THRU 5/31/18 0 385979 0 3000 0 19711 0 20250 0 19345 0 448285 0 0 JASON V TERK MD TRUSTEE 0 358400 0 0 0 9804 0 18000 0 20041 0 406245 0 0 KEITH HOLTZ CHIEF ADMINISTRATIVE OFFICER 382067 0 227582 0 55836 0 4800 0 28875 0 699160 0 18000 0 ERIC H HUBLI MD CHIEF SYS EFFECTIVENESS OFFCR 510114 0 17104 0 26152 0 16875 0 24422 0 594667 0 18000 0 GREGORY K JIMERSON VP-PAYOR RELATIONS 229037 0 74337 0 6890 0 16257 0 28510 0 355031 0 0 0 STEPHEN W KIMMEL CFO 130076 390228 70258 210773 11551 34652 19909 59728 6220 18658 238014 714039 0 0 DAVID F LANCASTER VP-INTERNAL AUDIT 185076 0 60337 0 5482 0 18996 0 17592 0 287483 0 0 0 SCOTT LEDDY CHIEF MEDICAL INFO OFFICER 285203 0 90045 0 8899 0 10800 0 26269 0 421216 0 0 0 JAMES D MARSHALL MD CHIEF RESEARCH OFFICER 498249 0 93764 0 8021 0 20250 0 24532 0 644816 0 0 0 CARA MARTZ SECRETARY 100505 0 34068 0 5739 0 7222 0 15611 0 163145 0 0 0 JOHN W MCNEY SR V PRESIDENT-GEN COUNSEL 389084 0 148086 0 43945 0 20250 0 20196 0 621561 0 18000 0 THERESA ZAK MEADOWS SR V PRESIDENT-CIO 366158 0 139024 0 44096 0 16875 0 28275 0 594428 0 18000 0 GEORGE B MONTAGUE V PRESIDENT-REAL ESTATE 164310 0 0 0 86404 0 14065 0 11583 0 276362 0 0 0 CORY RHOADES SR V PRESIDENT-FINANCE 256800 0 113179 0 29177 0 16875 0 28672 0 444703 0 18000 0 JAMES R STALDER V PRES-INFO SYSTEMS 222854 0 141185 0 2586 0 12746 0 28447 0 407818 0 0 0 LARRY L TUBB SR VP-PLANNING THRU 2/16/18 269101 0 102874 0 36959 0 20250 0 16898 0 446082 0 18000 0 LORRAINEA WILLIAMS PAT/MEDICATION SAFETY OFFCR 184313 0 42969 0 10061 0 12358 0 27856 0 277557 0 0 0 JOSEPH GALLAHGER DEPUTY GENERAL COUNSEL 239356 0 75703 0 12789 0 20250 0 16672 0 364770 0 0 0 BETH SCHMIDT AVP-HUMAN RESOURCES 174201 0 42249 0 26374 0 15098 0 10875 0 268797 0 18000 0 KENT SMITH VP-COMPLIANCE 192373 0 65723 0 28918 0 10800 0 9987 0 307801 0 17349 0 KAREN WARDELL ASSOCIATE GENERAL COUNSEL 208375 0 73409 0 26379 0 14285 0 18017 0 340465 0 18000 0 SAM CANTU MD TRUSTEE 0 401606 0 0 0 6778 0 16875 0 34439 0 459698 0 0 JOSE IGLESIAS MD TRUSTEE 0 1001319 0 0 0 36643 0 16875 0 25532 0 1080369 0 18000 SALEEM MALIK MD TRUSTEE 0 523415 0 0 0 16121 0 19758 0 29439 0 588733 0 0 MARC MAZADE MD TRUSTEE THRU 5/31/18 0 346851 0 0 0 13030 0 20250 0 29439 0 409570 0 0 LINDSAY NEWTON MD TRUSTEE 0 112053 0 39459 0 14336 0 10636 0 22305 0 198789 0 8509 ALICE PHILLIPS MD TRUSTEE 0 328872 0 0 0 10643 0 20250 0 24806 0 384571 0 0 ROBERT K FEATHER SR. VP PUBLIC POLICY 317980 0 121504 0 48685 0 20250 0 27045 0 535464 0 0 0 JOSE GONZALEZ MD VP CHILDRENS HEALTH 270117 0 85438 0 14239 0 13500 0 19390 0 402684 0 0 0 CHRISTIAN PEDIGO VP SYS PLANNING & HEALTH ANALY 167795 0 38371 0 2427 0 16255 0 28111 0 252959 0 0 0 SPENCER SEALS VP REAL ESTATE & CONSTRUCTION 107229 0 14360 0 5265 0 8388 0 25295 0 160537 0 0 0 NATALIE WILKINS CHIEF OF STAFF 211510 0 65407 0 1919 0 10800 0 10074 0 299710 0 0 0 MAYNARD DYSON MEDICAL DIRECTOR 248111 0 68983 0 11230 0 19497 0 26143 0 373964 0 0 0 TINA HASKINS AVP, EPIC ENTERPRISE APPS 166489 0 59902 0 6408 0 0 0 10058 0 242857 0 0 0 SCHEDULE J, PART I, LINE 1A JAMES C CUNNINGHAM $25 GROSS-UP ROBERT K. FEATHER $934 GROSS-UP JOHN W. MCNEY $25 GROSS-UP KEITH HOLTZ $25 GROSS-UP DAVID F. LANCASTER $25 GROSS-UP JAMES R. STALDER $25 GROSS-UP JOSE GONZALEZ $180 GROSS-UP SCHEDULE J, PART I, LINE 1A & 1B General Gross Up Payments 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 2017 CME GROSS UP AMOUNTS MATTHEW CAROLL, MD $ 3,000.00 JAMES C. CUNNINGHAM, MD $ 3,250.00 MATTHEW DZURIK, MD $ 6,500.00 GRETCHEN EAMES, MD $ 9,750.00 ERIC H. HUBLI, MD $ 3,250.00 JAMES D. MARSHALL, MD $ 4,550.00 JOANN M. SANDERS, MD $ 4,875.00 JASON V. TERK, MD $ 6,500.00 ALICE PHILLIPS, MD $ 6,500.00 SALEM MALIK, MD $ 9,750.00 MARC MAZADE, MD $ 9,100.00 LINDSEY NEWTON, MD $ 4,875.00 JOSE IGLESIAS, MD $14,499.96 SAMSON CANTU, MD $ 3,900.00 RAY RHODES, JR MD $ 5,000.00 CME GROSS UPS PAYMENTS IN ADDITION TO THE GIFT CARD AND 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 EXPENSES 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 TRAVEL TO PERFORM PHYSICIAN DUTIES FOR COOK CHILDREN'S PHYSICIAN NETWORK. 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 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 828,000 174,855 CCHS JAMES C. CUNNINGHAM, MD NONE NONE CCHS ROBERT K. FEATHER NONE NONE CCHS KEITH HOLTZ 18,000 53,393 CCHS ERIC H. HUBLI, MD 18,000 NONE CCHS STEPHEN KIMMEL 18,000 68,837 CCHS JOHN W. MCNEY 18,000 NONE CCHS THERESA ZAK MEADOWS 18,000 NONE CCHS JOANN SANDERS, MD 18,000 NONE CCHS LARRY L. TUBB 18,000 NONE CCHS KENT SMITH 17,349 NONE CCHS BETH SCHIMIDT 18,000 NONE CCHS KAREN WARDELL 18,000 NONE CCHS JOSE IGLESIAS, MD 18,000 NONE CCPN LINSAY NEWTON, MD 8,509 NONE CCPN CORY RHOADES 18,000 34,702 CCHS SCHEDULE J, PART I, LINE 4A SEVERANCE PAYMENT: GEORGE B MONTAGUE RECEIVED A SEVERANCE PAYMENT OF $62,192 IN CALENDAR YEAR 2017. 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; AND (6) 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 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 & 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 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. 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 HOT-LINE 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 XI, LINE 9 OTHER CHANGES IN NET ASSETS OF FUND BALANCES: TRANSFER FROM CCHF $3,516,604 FORM 990, PART VI, SECTION A, LINE 2 BONNIE PETSCHE HAS A FAMILY RELATIONSHIP WITH JULIA DAVIDSON. 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 SERVICES INC 801 7TH AVENUE FORT WORTH TX 76104 454024843 HEALTHCARE TX CCHCS C CORPORATION 758260 4371992 1.00000 true true true false false false false false false false false true false false false true true true false true COOK CHILDREN'S MEDICAL CENTER A 734454 FMV COOK CHILDREN'S MEDICAL CENTER B 728840 FMV COOK CHILDREN'S MEDICAL CENTER O 54489 FMV COOK CHILDREN'S MEDICAL CENTER P 232714 FMV COOK CHILDREN'S MEDICAL CENTER Q 207872886 FMV COOK CHILDREN'S PHYSICIAN NETWORK A 2509664 FMV COOK CHILDREN'S PHYSICIAN NETWORK B 522588 FMV COOK CHILDREN'S PHYSICIAN NETWORK O 12181991 FMV COOK CHILDREN'S PHYSICIAN NETWORK P 691439 FMV COOK CHILDREN'S PHYSICIAN NETWORK Q 24182215 FMV COOK CHILDREN'S HOME HEALTH A 807753 FMV COOK CHILDREN'S HOME HEALTH Q 4681782 FMV COOK CHILDREN'S HEALTH PLAN A 690324 FMV COOK CHILDREN'S HEALTH PLAN Q 10588753 FMV COOK CHILDREN'S HEALTH SERVICES Q 189553 FMV ROSEDALE OFFICE BUILDING K 1301081 FMV ROSEDALE OFFICE BUILDING O 72592 FMV ROSEDALE OFFICE BUILDING P 1958873 FMV CHILD STUDY CENTER Q 1019240 FMV