2017-11-13T11:02:43-06:00 2016-12-31 990 2016-01-01 810584868 Dallas Physician Medical Services for Children Inc DALL 2144567000 1935 MEDICAL DISTRICT DRIVE DALLAS TX 75235 JERRY LEE Treasurer 2017-11-09 2016 2017-02-10 21:41:12Z W Robert Morrow MD 1935 MEDICAL DISTRICT DRIVE DALLAS TX 75235 10150397 false X N/A X 2002 TX PROVIDE SERVICES TO PATIENTS AT SEVERAL HOSPITALS, INCLUDING CHILDREN'S MEDICAL CENTER DALLAS. 4 1 55 1 0 0 0 4490587 10150397 0 0 4490587 10150397 0 0 3498196 8629602 0 0 1725451 4420579 5223647 13050181 -733060 -2899784 1427115 1406270 5324975 8203914 -3897860 -6797644 PROVIDE DENTAL, GENERAL PEDIATRIC, AND PEDIATRIC SUB-SPECIALTY SERVICES, INCLUDING, BUT NOT LIMITED TO EMERGENCY DEPARTMENT COVERAGE, INPATIENT COVERAGE, ORTHOPEDIC SURGERY, AND CRANIOFACIAL ORTHODONTICS. false false 10772295 10150397 PROVIDE PHYSICIAN SERVICES TO PATIENTS AT CHILDREN'S MEDICAL CENTER DALLAS. THESE SERVICES ARE PROVIDED WITHOUT REGARD TO THE PATIENTS' ABILITY TO PAY. 10772295 true false 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 47 0 true 55 true false false false false false false false false false false X 4 1 false false false false true true true true true false false false true true true true true false false false X Jeffrey Vawrinek 2144567000 1935 MEDICAL DISTRICT DRIVE DALLAS TX 75235 William Morrow MD President DPMSC, Pres Phys Orgs Acdmc Rel CCO CHST 1.0 54.0 X X 0 822400 18621 Maeve Sheehan MD Chair 1.0 0 X 0 0 0 John Polousky MD Medical Director 50.0 0 X 830946 0 6488 Michael Tate MD Medical Director 50.0 0 X 271607 0 9046 Jerry Lee Treasurer DPMSC, VP Acctg/Treas CHST 1.0 49.0 X 0 395942 32898 Lisa Frenkel Secretary DPMSC, Asst Gen Counsel CHST 1.0 49.0 X 0 217708 12255 Dustin Loveland MD Physician 40.0 0 X 589554 0 7752 Christopher Redman MD Physician 40.0 0 X 529546 0 6014 Kathryn Bauer MD Physician 40.0 0 X 528245 0 2315 Yongjong Park MD Dentist Orthodontist 40.0 0 X 332697 0 11600 David Brown MD Physician 40.0 0 X 274438 0 6691 Patricia Winning Former Pres DPMSC, SVP Business Development CHST 0.0 50.0 X 0 767498 115175 Stephanie Smith Former Secretary DPMSC, Sr Legal Counsel CHST 0.0 50.0 X 0 135085 11262 3357032 2338633 240116 0 true true false COMPHEALTH PO Box 972651 Dallas TX 75397 Physician Services 619520 GREATER DALLAS ORTHOPEDICS 12230 COIT RD STE 100 DALLAS TX 75251 PHYSICIAN Services 415227 SHIMADZU MEDICAL SYSTEMS 10625 NEWKIRK 500 Dallas TX 75220 Medical Services 158000 ALINA OLTEANU 3001 AURORA DR Plano TX 75093 Physician Services 114855 PEDIATRIC SEARCH PARTNERS 6505 W PARK BLVD STE 306 Plano TX 75093 Recruitment Services 110000 5 0 PROFESSIONAL SVC REV 621110 10150397 10150397 0 0 0 0 10150397 0 0 0 0 0 0 0 0 0 10150397 10150397 0 0 X 1102553 1102553 5750932 5386073 364859 311918 292129 19789 994912 931791 63121 469287 439514 29773 1755986 1755986 0 0 99026 75238 23788 5298 3484 1814 669398 633589 35809 34521 34245 276 46402 45259 1143 10345 10345 38031 37995 36 Shared Services 1736795 1736795 Medical Surgical Supplies 18714 18714 Dietary and Food Costs 6063 5380 683 0 0 0 0 13050181 10772295 2277886 0 1075496 350856 1258039 0 0 0 763 576 172995 25340 0 147655 0 0 0 0 1427115 1406270 413161 611165 4911814 7592749 5324975 8203914 -3897860 -6797644 -3897860 -6797644 1427115 1406270 -2899784 0 X false true X true false X 172995 25340 147655 147655 LT ADVANCES-Affiliates 7592749 7592749 Schedule D, Part X, Line 2 THE DALLAS PHYSICIAN MEDICAL SERVICES FOR CHILDREN, INC.'S CONSOLIDATED FINANCIAL STATEMENTS FOR THE YEAR ENDING DECEMBER 31, 2016 DO NOT CONTAIN A FIN 48 FOOTNOTE. false true false false false false false true false William Morrow MD President DPMSC, Pres Phys Orgs Acdmc Rel CCO CHST 0 534242 0 283208 0 4950 0 10600 0 8021 0 841021 0 0 John Polousky MD Medical Director 693512 0 133333 0 4101 0 0 0 6488 0 837434 0 0 0 Michael Tate MD Medical Director 254781 0 16000 0 826 0 0 0 9046 0 280653 0 0 0 Patricia Winning Former Pres DPMSC, SVP Business Development CHST 0 400707 0 306674 0 60117 0 99056 0 16119 0 882673 0 80495 Stephanie Smith Former Secretary DPMSC, Sr Legal Counsel CHST 0 123291 0 10547 0 1247 0 6812 0 4450 0 146347 0 0 Jerry Lee Treasurer DPMSC, VP Acctg/Treas CHST 0 270923 0 87472 0 37547 0 14597 0 18301 0 428840 0 0 Lisa Frenkel Secretary DPMSC, Asst Gen Counsel CHST 0 213182 0 0 0 4526 0 6590 0 5665 0 229963 0 0 Dustin Loveland MD Physician 467248 0 120080 0 2226 0 0 0 7752 0 597306 0 0 0 Christopher Redman MD Physician 468986 0 58333 0 2226 0 0 0 6014 0 535559 0 0 0 Kathryn Bauer MD Physician 472685 0 53333 0 2226 0 0 0 2315 0 530559 0 0 0 Yongjong Park MD Dentist Orthodontist 329400 0 0 0 3297 0 0 0 11600 0 344297 0 0 0 David Brown MD Physician 272829 0 0 0 1609 0 0 0 6691 0 281128 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 DALLAS PHYSICIAN MEDICAL SERVICES FOR CHILDREN (DPMSC). THEREFORE, DPMSC'S TOP MANAGEMENT OFFICIAL, OTHER OFFICERS, AND KEY EMPLOYEES ARE EMPLOYED AND COMPENSATED BY CHILDREN'S HEALTH SYSTEM OF TEXAS (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. Dr. William Morrow 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 DALLAS PHYSICIAN MEDICAL SERVICES FOR CHILDREN (DPMSC). THEREFORE, DPMSC'S TOP MANAGEMENT OFFICIAL, OTHER OFFICERS, AND KEY EMPLOYEES ARE EMPLOYED AND COMPENSATED BY CHILDREN'S HEALTH SYSTEM OF TEXAS (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 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 DPMSC 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 to be effective. 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 Dallas Physician Medical Services 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 conflict of interest policy is made available to the public upon request. Form 990, Part IX, Line 11g Other Fees Consulting & Professional fees - Total Expense: 1755986, Program Service Expense: 1755986, Management and General Expenses: , Fundraising Expenses: ; 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 Physicians for Children 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 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