2018-10-24T12:37:16-05:00 2017-12-31 ERNST & YOUNG US LLP TWO NORTH CENTRAL AVENUE STE 2300 PHOENIX AZ 85004 990 2017-01-01 742838488 Driscoll Children's Health Plan % RICK VILLARREAL DRIS 3616946432 615 N Upper Broadway St Suite 1621 CORPUS CHRISTI TX 78401 Mary D Peterson CEO 3616946432 2018-10-22 true STEVEN T RUTTI P00775456 6023223000 72.217.96.156 75306120182975000001 2018-10-24 P E94FFBFEF556666C2017410EF3F1708D338ADEDF F48376F03B285C4FC97216DA7232BDE577FE7092 2017 2018-06-14 16:35:46Z Dr Mary Dahlen Peterson SAME AS C ABOVE CORPUS CHRISTI TX 78401 665211972 false X www.DCHPKIDS.COM X 1997 TX Committed to providing efficient, cost-effective, quality care through a dedicated and compassionate health care team & respectful collaboration with its provider network. 6 3 431 1 0 0 0 8194 523498054 663466548 629976 1737230 0 0 524128030 665211972 0 0 0 0 21000933 29896820 0 0 0 496717074 609687378 517718007 639584198 6410023 25627774 119306399 144629643 65402166 65284858 53904233 79344785 X DRISCOLL CHILDREN'S HEALTH PLAN IS COMMITTED TO PROVIDING EFFICIENT, COST-EFFECTIVE, QUALITY CARE THROUGH A DEDICATED AND COMPASSIONATE HEALTHCARE TEAM AND RESPECTFUL COLLABORATION WITH ITS PROVIDER NETWORK. false false 583466496 0 663466548 SEE SCHEDULE O. 583466496 true false false true false false false false false false true false false false true true true 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 0 0 431 true false false false false false false false false false false X 6 3 false false false false true true true true true false false true true true true true true false false false X RICK VILLARREAL 3616946781 615 N UPPER BROADWAY ST STE 1621 CORPUS CHRISTI TX 78401 MIKE CARRELL CHAIRMAN OF THE BOARD 1.0 2.0 X X 0 10000 0 MARY DAHLEN PETERSON PRESIDENT 39.0 1.0 X X 0 435456 142873 ERIC HAMON SECRETARY/TREASURER 1.0 39.0 X X 0 595091 249729 S LOYD NEAL JR DIRECTOR 1.0 2.0 X 0 10000 0 SAM L SUSSER DIRECTOR 1.0 2.0 X 0 0 0 STEVE WOERNER DIRECTOR 1.0 39.0 X 0 590832 740592 ERNEST DALE BUCK Chief Medical Director 40.0 0.0 X 0 367467 30630 JOSEPH CECIL Vice President, STAR Kids 40.0 0.0 X 0 231854 20017 MICHAEL PIERCE LANCE VICE PRESIDENT 40.0 0.0 X 0 287388 35647 RICK VILLARREAL VICE PRESIDENT 40.0 0.0 X 0 277417 39119 WILLIAM BRENDEL MEDICAL DIRECTOR 40.0 0.0 X 0 324892 43403 FREDRICK McCURDY Medical Director 40.0 0.0 X 0 295508 43791 KARL SERRAO Associate Medical Director 40.0 0.0 X 0 265373 25558 TERRY JOHNSON SENIOR DIR SERVICE COORDINATOR 40.0 0.0 X 0 197011 21841 HEATHER PIGOTT SENIOR DIRECTOR OF HEALTH SVCS 40.0 0.0 X 0 180812 19706 0 4069101 1412906 0 false true false EvolentValence Health 540 West Madison Suite 1500 Chicago IL 60661 Claim Administration 13128564 Navitus Health 2601 W Beltline Hwy 600 Madison WI 53713 Pharmacy Benefit mgr 3020799 Epic Systems Corporation 1979 Milky Way Verona WI 53593 IT SERVICES 738599 Health Management Systems 5615 High Point Drive 900 New York NY 100877151 BENEFIT SERVICES 591509 VITAL DATA TECHNOLOGY LLC 130 Newport Center Dr Suite 240 NEWPORT BEACH CA 92660 IT SERVICES 239100 22 0 8194 0 8194 PREMIUM REVENUE 524292 661370024 661370024 0 0 NET REINSURANCE 524292 2049347 2049347 0 0 OTHER PROGRAM SERVICE REVENUE 900099 47177 47177 0 0 663466548 1737230 1737230 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 665211972 663466548 0 1737230 0 0 0 0 0 0 0 0 2236163 1565314 670849 0 0 0 0 0 21849481 8104895 13744586 0 1011858 280437 731421 0 3183789 1271829 1911960 0 1615529 678522 937007 0 20475250 2311754 18163496 0 0 0 0 0 69162 0 69162 0 118743 0 118743 0 0 0 8500 0 8500 0 3401861 0 3401861 0 161392 0 161392 0 2119478 0 2119478 0 3156952 0 3156952 0 0 0 0 0 1236956 0 1236956 0 571079 0 571079 0 0 0 0 0 57836 0 57836 0 0 0 0 0 0 0 0 0 233720 0 233720 0 146038 0 146038 0 MEDICAL EXPENSES 558577144 558577144 PREMIUM TAXES 11605001 10676601 928400 MEMBER VALUE ADD EXPENSE 4361823 4361823 ALLOCATED COSTS 2507000 2507000 879443 879443 639584198 583466496 56117702 0 0 70704942 29478851 15609860 17683144 0 0 6934657 5518417 0 0 0 0 0 0 0 0 88846 50000 3393296 902882 265190 2490414 24437904 88143817 0 0 0 0 0 0 1265000 1265000 119306399 144629643 60401877 62226163 0 0 0 0 0 0 0 0 0 0 0 0 0 0 5000289 3058695 65402166 65284858 X 0 0 0 0 53904233 79344785 53904233 79344785 119306399 144629643 25627774 -187222 X false true X false true true X 35154 0 0 0 8194 43348 317186494 385360095 436170194 523498054 663466548 2325681385 0 0 0 317221648 385360095 436170194 523498054 663474742 2325724733 0 0 0 2325724733 387321 343424 327076 562737 1722784 3343342 0 387321 343424 327076 562737 1722784 3343342 0 0 317608969 385703519 436497270 524060791 665197526 2329068075 0.99857 0.99900 0.00144 0.00110 X false false false 0 false 0 false 0 false 0 false 0 false 0 true 122408 122408 false SCHEDULE C, PART II-B, LINE 11I OTHER ACTIVITIES: PAYMENTS MADE TO VARIOUS ORGANIZATIONS FOR THE PURPOSE OF MEETING WITH AND CALLING GOVERNMENT OFFICIALS OR LEGISLATORS AND SENDING LETTERS OR PUBLICATIONS TO GOVERNMENT OFFICIALS AND LEGISLATORS REGARDING ISSUES THAT HAVE AN IMPACT ON THE EXEMPT PURPOSE OF THE HOSPITAL. DCHP pays membership dues to certain medical associations. A portion of these dues, $21,665, is attributable to lobbying expenses for healthcare issues and included in the amount reported on line 1I. 2119077 174925 1944152 986517 727957 258560 287702 287702 2490414 0 DUE TO AFFILIATES 3012510 DUE TO DVPG 46185 3058695 X 662042240 0 0 662042240 3169732 3169732 665211972 636420512 0 0 636420512 3163686 3163686 639584198 SCHEDULE D, PART X, LINE 2 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 D, PART XI, LINE 4B ADJUSTMENT FROM STATUTORY STATEMENT $3,169,732 SCHEDULE D, PART XII, LINE 4B ADJUSTMENT FROM STATUTORY STATEMENT $3,163,686 X X X X false true false false false false false true false MARY DAHLEN PETERSON PRESIDENT 0 302473 0 114983 0 18000 0 121001 0 21872 0 578329 0 0 ERIC HAMON SECRETARY/TREASURER 0 368796 0 178604 0 47691 0 221473 0 28256 0 844820 0 0 WILLIAM BRENDEL MEDICAL DIRECTOR 0 275846 0 48941 0 105 0 23625 0 19778 0 368295 0 0 ERNEST DALE BUCK Chief Medical Director 0 288563 0 54833 0 24071 0 14092 0 16538 0 398097 0 0 STEVE WOERNER DIRECTOR 0 224518 0 316963 0 49351 0 716373 0 24219 0 1331424 0 0 JOSEPH CECIL Vice President, STAR Kids 0 209009 0 22609 0 236 0 2923 0 17094 0 251871 0 0 MICHAEL PIERCE LANCE VICE PRESIDENT 0 217153 0 68747 0 1488 0 17545 0 18102 0 323035 0 0 RICK VILLARREAL VICE PRESIDENT 0 201548 0 64009 0 11860 0 19117 0 20002 0 316536 0 0 FREDRICK McCURDY Medical Director 0 225814 0 46762 0 22932 0 23625 0 20166 0 339299 0 0 KARL SERRAO Associate Medical Director 0 234958 0 29524 0 891 0 3190 0 22368 0 290931 0 0 TERRY JOHNSON SENIOR DIR SERVICE COORDINATOR 0 151830 0 12027 0 33154 0 11683 0 10158 0 218852 0 0 HEATHER PIGOTT SENIOR DIRECTOR OF HEALTH SVCS 0 153541 0 27221 0 50 0 9675 0 10031 0 200518 0 0 SCHEDULE J, PART I, LINES 1-3 THE FILING ORGANIZATION, DRISCOLL CHILDREN'S HEALTH PLAN, DOES NOT COMPENSATE OR PROVIDE BENEFITS. ALL COMPENSATION AND BENEFITS ARE DETERMINED AND PAID BY DRISCOLL CHILDREN'S HOSPITAL, A RELATED TAX EXEMPT ORGANIZATION. SCHEDULE J, PART I, LINE 4B PARTICIPANTS IN/PAYMENT FROM A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN The Nonqualified 457(f) plan covered the executive leadership team which totaled 12 employees during 2017. Vesting occurs when employees meet a preselected date they choose at the time of enrollment. There were no payouts made in 2017. THE FOLLOWING INDIVIDUALS PARTICIPATED IN The PROGRAM: 457(F) CONTRIBUTION MARY DAHLEN PETERSON $57,241 STEVE WOERNER $572,907 ERIC HAMON $143,171 SCHEDULE J, PART I, LINE 7 nonfixed payments Certain executives and management team members are eligible for Discretionary incentive bonuses determined through a review of system and individual accomplished goals. All bonuses require Board approval. FORM 990, PART III, LINE 4A DRISCOLL CHILDREN'S HEALTH PLAN IS THE CONTRACTOR FOR THE CHILDREN'S HEALTH INSURANCE PROGRAM (CHIP). THIS SERVICE AREA INCLUDES 14 COUNTIES COMPRISED OF ARANSAS, BEE, BROOKS, CALHOUN, GOLIAD, JIM WELLS, KARNES, KENEDY, KLEBERG, LIVE OAK, NUECES, REFUGIO, SAN PATRICIO, AND VICTORIA. THE PLAN ALSO PROVIDES HEALTH BENEFITS FOR CHILDREN ENROLLED IN THE STATE OF TEXAS ACCESS REFORM (STAR) PROGRAM FOR 24 COUNTIES. THE PLAN IS A HEALTH MAINTENANCE ORGANIZATION (HMO) COMMITTED TO PROVIDING ITS MEMBERS A NETWORK OF HEALTH SERVICE PROVIDERS. ITS AFFILIATION WITH DRISCOLL CHILDREN'S HOSPITAL (DCH), THE SOLE CORPORATE MEMBER, LENDS TO THE PLAN'S SUCCESS BY OFFERING ITS MEMBERS DCH'S EXTENSIVE NETWORK INCLUDING PHYSICIANS, HOSPITAL, AND SERVICES IN ITS TOTAL EXPANDED SERVICE AREA, THUS OFFERING CHIP AND STAR MEMBERS WHO LIVE IN THE ADJACENT COUNTIES A FULL CONTINUUM OF QUALITY SERVICES TAILORED TO MEET THE NEEDS OF THE CHIP AND STAR POPULATION. IN ADDITION TO STAR AND CHIP LINES OF BUSINESS, DRISCOLL HEALTH PLAN ENTERED INTO STAR KIDS ON NOVEMBER 1, 2016. STAR KIDS IS A NEW LINE OF BUSINESS PRIMARILY RELATED TO CHILDREN WITH DISABILITIES AND IT RESIDES WITHIN THE SAME COUNTIES AND SERVICE AREAS AS DESCRIBED ABOVE WITH STAR AND CHIP. THE PLAN'S ENROLLMENT WAS 174,613 AND 169,262 AT DECEMBER 31, 2017 AND 2016, RESPECTIVELY. FORM 990, PART VI, SECTION A, LINE 6 CLASSES OF MEMBERS OR STOCKHOLDERS DRISCOLL CHILDREN'S HOSPITAL IS THE SOLE MEMBER OF DRISCOLL CHILDREN'S HEALTH PLAN. FORM 990, PART VI, SECTION A, LINE 7A ELECTION OF GOVERNING BODY THE MEMBER SHALL ELECT AND APPOINT A CANDIDATE TO FILL ANY VACANCY OCCURRING ON THE BOARD OF DIRECTORS FORM 990, PART VI, SECTION A, LINE 7B DECISIONS OF GOVERNING BODY SUBJECT TO APPROVAL THE FOLLOWING MATTERS ARE RESERVED TO THE MEMBER AND SHALL REQUIRE THE AFFIRMATIVE ACTION OF THE MEMBER TO BE EFFECTIVE: (A) ANNUAL OPERATING & CAPITAL BUDGETS OF THE CORPORATION, (B) MERGER, ACQUISITION OR CONSOLIDATION OF THE CORPORATION, (C) BORROWING OR LENDING OF MONEY OR THE CREATION OF INDEBTEDNESS THROUGH THE GUARANTEE OF ANOTHER DEBT OR SIMILAR ACTION, AND (D) APPOINTMENT & REMOVAL OF DIRECTORS IN ACCORDANCE WITH THE BY-LAWS. FORM 990, PART VI, SECTION B, LINE 11B PROCESS TO REVIEW THE FORM 990 THE ORGANIZATION ENGAGES AN OUTSIDE ACCOUNTING FIRM TO PREPARE FORM 990. ONCE PREPARED, THE FORM IS REVIEWED BY THE ORGANIZATION'S INTERNAL ACCOUNTANTS AND DISTRIBUTED TO THE GOVERNING BODY PRIOR TO FILING. FORM 990, PART VI, LINE 12C PROCESS FOR MONITORING COMPLIANCE WITH CONFLICT OF INTEREST POLICYY ANNUALLY, ALL DIRECTORS, OFFICERS, AND KEY PERSONNEL FILL OUT A CONFLICT OF INTEREST FORM. THE COMPLIANCE OFFICER MAKES SURE ALL CONFLICT OF INTEREST FORMS ARE TURNED IN AND REVIEWED ANNUALLY. FORM 990, PART VI, SECTION B, LINES 15A AND 15B PROCESS FOR DETERMINING COMPENSATION THE FILING ORGANIZATION DOES NOT DETERMINE COMPENSATION FOR OFFICERS OR KEY EMPLOYEES. THE PROCESSES DESCRIBED BELOW ARE THAT OF DRISCOLL CHILDREN'S HOSPITAL, A RELATED TAX-EXEMPT ORGANIZATION. THE ORGANIZATION USES MGMA AND SULLIVAN COTTER PERCENTILES TO SET BASE COMPENSATION AND SKILL LEVELS. IF COMPENSATION LEVELS EXCEED CERTAIN PERCENTILES, A THIRD OUTSIDE CONSULTING FIRM IS USED TO VALUE THE MARKET VALUE FOR SERVICES RENDERED AND FOR GROUP COVERAGE AGREEMENTS. FOR CERTAIN COVERAGE AGREEMENTS, A FOURTH CONSULTING FIRM ASSISTS IN DETERMINING MARKET VALUE. COMPENSATION IS APPROVED BY THE ORGANIZATION'S GOVERNING BODY WITH THE DELIBERATION AND DECISION DOCUMENTED CONTEMPORANEOUSLY. THE COMPENSATION REVIEW PROCESS WAS LAST COMPLETED IN 2016. FORM 990, PART VI, LINE 19 GOVERNING DOCUMENTS AVAILABLE TO THE PUBLIC THE ORGANIZATION DOES NOT MAKE ITS GOVERNING DOCUMENTS, POLICIES, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. DRISCOLL CHILDREN'S HOSPITAL 3533 SOUTH ALAMEDA CORPUS CHRISTI TX 78411 742577746 HOSPITAL TX 501(C)(3) 3 NA false DRISCOLL PHYSICIANS GROUP 3533 SOUTH ALAMEDA CORPUS CHRISTI TX 78411 742988134 HEALTHCARE TX 501(C)(3) 3 DCH true DRISCOLL VALLEY PHYSICIANS GROUP 3533 SOUTH ALAMEDA CORPUS CHRISTI TX 78411 201234322 HEALTHCARE TX 501(C)(3) 3 DCH true DRISCOLL MATERNAL AND FETAL PHYS GROUP 3533 SOUTH ALAMEDA CORPUS CHRISTI TX 78411 201234461 HEALTHCARE TX 501(C)(3) 10 DCH true CHILDREN'S PHYS SERVICES OF SOUTH TEXAS 3533 SOUTH ALAMEDA CORPUS CHRISTI TX 78411 742620408 HEALTHCARE TX 501(C)(3) 3 DCH true DRISCOLL HEALTHCARE SERVICES 3533 SOUTH ALAMEDA CORPUS CHRISTI TX 78411 010962276 AVIATION TX 501(C)(3) 12A-I DCH true DCH DEVELOPMENT FOUNDATION 3533 SOUTH ALAMEDA CORPUS CHRISTI TX 78411 742358461 CHARITABLE TX 501(C)(3) 7 DCH true ALLEGRA INSURANCE COMPANY LTD PO BOX 105GT WEST BAY ROAD GRAND CAYMAN CJ KY1-1109 980704641 CAPTIVE INS. 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