2017-11-13T11:04:28-06:00 2016-12-31 990 2016-01-01 752854505 Physicians for Children PHYS 2144567000 1935 MEDICAL DISTRICT DRIVE DALLAS TX 75235 JERRY LEE TREASURER 2017-11-09 2016 2017-02-10 21:41:12Z CHILDREN'S HEALTH PEDIATRIC GROUP Leann Kridelbaugh MD 1935 MEDICAL DISTRICT DRIVE DALLAS TX 75235 42419383 false X N/A X 1999 TX TO DELIVER PRIMARY CARE TO CHILDREN IN UNDERSERVED AREAS OF NORTH CENTRAL TEXAS. 6 5 429 5 0 0 1775081 2612402 38794075 39806981 -1219702 0 40569156 41199681 0 0 25587531 28639558 0 0 26215189 32529739 51802720 61169297 -11233564 -19969616 27960147 33689077 63433327 89131872 -35473180 -55442795 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 40541797 39806981 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. 40541797 true true false false false false false false false false true false false false true false 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 164 0 true 429 true false false false false false false false false false false X 6 5 true false false false true true true true true false false false true true true true true false false false X Stephanie K Smith 2144567000 1935 MEDICAL DISTRICT DRIVE DALLAS TX 75235 Michael Brown MD Director, Physician 1.0 20.0 X 0 36000 0 Debra Burns MD Director 1.0 0 X 0 0 0 Richard Daniel MD Director 1.0 0 X 0 0 0 Ernie Fernandez MD Director 1.0 0 X 0 0 0 Larry Gray MD Director 1.0 0 X 0 0 0 Frank Lieu MD Director 1.0 0 X 0 0 0 Jerry Lee Treasurer PFC, VP Acctg/Treas CHST 1.0 49.0 X 0 395942 32898 Lisa Frenkel Secretary PFC, Asst Gen Counsel CHST 1.0 49.0 X 0 217708 12255 Leann Kridelbaugh MD President PFC 50.0 0 X 270823 0 4245 Achala Ellepola MD Physician 40.0 0 X 212473 0 1144 Mansi Lalwani MD Physician 40.0 0 X 206258 0 0 Rekha Sivadasan MD Associate Medical Director 40.0 0 X 205649 0 5834 Stormee Williams MD Medical Director 40.0 0 X 202312 0 6754 Agboola FatiregunMD Physician 40.0 0 X 200325 0 10908 Ray Tsai MD Former President, SVP Medical Dir Network Dev CHST 0.0 55.0 X 326560 274777 13404 Stephanie Smith Former Secretary PFC, Sr Legal Counsel CHST 0.0 50.0 X 0 135085 11262 1624398 1059512 98705 61 true true false HENRY SCHEIN INC DEPT CH 10241 PALATINE IL 600550241 Medical Supplies/Services 951669 SANOFI PASTEUR INC 12458 Collections Center Dr Chicago IL 60693 Medical Supplies/Services 590530 MERCK SHARP AND DOHME CORP ONE MERCK DR Whitehouse Station NJ 08889 Medical Supplies/Services 257972 NIGHT LINE JANITORIAL SERVICES 16970 Dallas Parkway Suite 100 Dallas TX 75248 Facility Services 207675 CTG HEALTHCARE SOLUTIONS PO Box 711778 Cincinnati OH 45271 Professional Services 151440 21 2612402 2612402 PROFESSIONAL SVC REV 621110 39806981 39806981 0 0 0 0 39806981 0 0 1219702 0 -1219702 -1219702 -1219702 0 0 0 0 0 41199681 39806981 0 -1219702 270823 270823 22818971 17777225 5041746 947699 738309 209390 3057936 2382300 675636 1544129 1202961 341168 16784 16784 4739 4739 1734125 1435268 298857 0 5120 665 4455 390615 312679 77936 2051779 1977137 74642 57235 39885 17350 271051 207770 63281 1423642 1423642 307664 264743 42921 Shared Services 13652710 13652710 Community Relations 10181741 10181741 Medical Surgical Supplies 2167814 2167814 Dietary and Food Costs 52740 44277 8463 211980 114558 97422 0 61169297 40541797 20627500 0 673182 20107107 28221917 0 0 0 115865 170327 12937644 7640811 7063993 5296833 0 0 0 0 27960147 33689077 3150095 3430488 60283232 85701384 63433327 89131872 -35473180 -55442795 -35473180 -55442795 27960147 33689077 X -19969616 1 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1626939 136456 1490483 10158038 6704637 3453401 1152667 799718 352949 5296833 LT ADVANCES-Affiliates 85336219 LT DEFERRED RENT 365165 85701384 Schedule D, Part XI, Line 2 The organization's consolidated financial statements for the year ending December 31, 2016 did not require a FIN 48 footnote. false true false false false false false true false Ray Tsai MD Former President, SVP Medical Dir Network Dev CHST 121559 253706 189941 19425 15060 1646 0 0 4635 8769 331195 283546 0 0 Stephanie Smith Former Secretary PFC, Sr Legal Counsel CHST 0 123291 0 10547 0 1247 0 6812 0 4450 0 146347 0 0 Jerry Lee Treasurer PFC, VP Acctg/Treas CHST 0 270923 0 87472 0 37547 0 14597 0 18301 0 428840 0 0 Lisa Frenkel Secretary PFC, Asst Gen Counsel CHST 0 213182 0 0 0 4526 0 6590 0 5665 0 229963 0 0 Leann Kridelbaugh MD President PFC 224034 0 45375 0 1414 0 0 0 4245 0 275068 0 0 0 Achala Ellepola MD Physician 169983 0 40166 0 2324 0 0 0 1144 0 213616 0 0 0 Mansi Lalwani MD Physician 165536 0 40614 0 109 0 0 0 0 0 206258 0 0 0 Rekha Sivadasan MD Associate Medical Director 175848 0 26994 0 2807 0 0 0 5834 0 211483 0 0 0 Stormee Williams MD Medical Director 183246 0 17638 0 1428 0 0 0 6754 0 209066 0 0 0 Agboola FatiregunMD Physician 159720 0 37628 0 2977 0 0 0 10908 0 211233 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. OTHER OFFICERS AND KEY EMPLOYEES ARE EMPLOYED AND COMPENSATED BY CHILDREN'S HEALTH SYSTEM OF TEXAS (CHST). COMPENSATION FOR ALL PFC'S OFFICERS 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. 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 4b Supplemental nonqualified retirement plan Non-Qualified Retirement Plan: * Children's Health Savings Restoration Plan - There were no employees that received taxable income from the Savings Restoration Plan. Ray Tsai, MD and Jerry Lee participated in the Savings Restoration Plan. Schedule J, Part I, Line 7 Non-fixed payments Non-Fixed Payments - The Human Resources Committee of the Board of Directors retains the authority to adjust annual payout percentages solely at their discretion. There were no non-fixed payments in 2016. 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 COMPENSATED BY PFC. OTHER OFFICERS AND KEY EMPLOYEES ARE EMPLOYED AND COMPENSATED BY CHILDREN'S HEALTH SYSTEM OF TEXAS (CHST). COMPENSATION FOR ALL PFC'S OFFICERS 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. 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. Form 990, Part VI, Line 2 Family/business relationships amongst interested persons Dr. Ernie Fernandez and Dr. Debra Burns - Business relationship 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 sole member and approved by the current PFC 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 received a copy of the Statement of Interest form to execute. Disclosures made are reviewed by the CHST Executive Vice President, Chief Legal Officer and General Counsel and the Chief Compliance Officer and discussed as necessary at the appropriate Board meeting to determine if further action is needed. Form 990, Part VI, Line 19 Required documents available to the public Certificate of Formation and Consolidated Financial Statements are publicly available. The conflicts of interest policy is made available upon request. Form 990, Part XI, Line 9 Other changes in net assets or fund balances Rounding - 1; Children's Medical Center of Dallas 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 Anesthesiologists for Children 1935 MEDICAL DISTRICT DRIVE DALLAS TX 75235 752917570 PHYSICIANS TX 501(c)(3) 10 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 433462044 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 CHILDREN'S MEDICAL CENTER SERVICES 1935 MEDICAL DISTRICT DRIVE DALLAS TX 75235 461934007 MEDICAL SERVICES TX 501(c)(3) 10 CHILDREN'S HEALTH SYSTEM OF TEXAS false CHILDREN'S POPULATION HEALTH 1935 MEDICAL DISTRICT DRIVE DALLAS TX 75235 463104601 POPULATION HEALTH TX 501(c)(3) Type I 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 N/A false OCH Holdings 1935 MEDICAL DISTRICT DRIVE DALLAS TX 75235 474837308 Hospital TX 501(c)(3) 3 CHILDREN'S HEALTH SYSTEM OF TEXAS false SPECIALISTS FOR CHILDREN 1935 MEDICAL DISTRICT DRIVE DALLAS TX 75235 463110125 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 COMMUNITY PROVIDERS FOR CHILDREN 1935 MEDICAL DISTRICT DRIVE DALLAS TX 75235 463675742 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 N/A false WOMEN'S AUXILIARY OF CMCD 12720 HILLCREST RD DALLAS TX 75230 752485538 WOMEN'S AUXILIARY TX 501(c)(3) 10 N/A false THE HEALTH AND WELLNESS ALLIANCE FOR CHILDREN 1935 MEDICAL DISTRICT DRIVE DALLAS TX 75235 463080586 PHYSICIANS TX 501(c)(3) Type I CHILDREN'S HEALTH SYSTEM OF TEXAS false Children's BMG dba One Care Domain 1935 Medical District Drive Dallas TX 75235 475057374 Physician TX 501(c)(3) 3 CHILDREN'S HEALTH SYSTEM OF TEXAS false Wellness Innovations Physician Partners 1935 Medical District Drive Dallas TX 75235 811734937 Physician TX 501(c)(3) 3 Wellness Innovations LLC false CHST Physician Group 1 1935 Medical District Drive Dallas TX 75235 813582843 Physician TX 501(c)(3) 10 CHILDREN'S HEALTH SYSTEM OF TEXAS 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 Wellness Innovations LLC 1935 Medical District Drive Dallas TX 75235 475246461 Physicians TX CHST Investment Holdings LLC Unrelated false false 0 CHILDREN'S INSURANCE COMPANY 76 ST PAUL STREET SUITE 500 BURLINGTON VT 05401 030328102 INSURANCE COMPANY VT CHILDREN'S HEALTH SYSTEM OF TEXAS C Corporation 0 false ALTERNATIVE CARE SYSTEMS 1935 MEDICAL DISTRICT DRIVE DALLAS TX 75235 752244475 OTHER MEDICAL SERVICES TX CHILDREN'S HEALTH SYSTEM OF TEXAS C Corporation 0 false NTPSS INC 1935 MEDICAL DISTRICT DRIVE DALLAS TX 75235 471036641 PHYSICIAN SOLUTIONS TX Pediatric Partners C Corporation 0 false Texas Bluebonnet Insurance Company 1935 Medical District Drive Dallas TX 75235 475032893 Insurance Company TX Children's Health System of Texas C Corporation 0 false TEXAS TRINITY RIVER ASSURANCE COMPANY LTD 878 West Bay Road PO Box 1159 Grand Cayman CJ KY11202 981318151 Self-insurance CJ Children's Health System of Texas C Corporation 0 false false false true false true false false false false 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