2016-03-04T13:25:34-06:00 2015-04-30 BKD LLP 2800 Post Oak Blvd Ste 3200 HOUSTON TX 77056 990 2014-05-01 742577746 DRISCOLL CHILDREN'S HOSPITAL % GREGORY WARD DRIS 3616946126 3533 SOUTH ALAMEDA CORPUS CHRISTI TX 78411 ERIC HAMON EXECUTIVE VICE PRESIDENT & CFO 3616945000 2016-03-15 true M P Gerich P00226776 7134994600 2014 2016-08-17 19:52:53Z ERIC HAMON 3533 SOUTH ALAMEDA CORPUS CHRISTI TX 78411 348971047 false X DRISCOLLCHILDRENS.ORG X 1953 TX REMEMBERING ALWAYS OUR COMMITMENT TO RELIEVE SUFFERING AND MEET THE NEEDS OF CHILDREN; IT IS OUR MISSION TO OFFER HOPE & HEALING IN AN ENVIRONMENT OF TRUST, COMPASSION, & CARE. 14 12 1862 459 0 0 23850204 15349226 269092443 268488481 4854159 9954947 25711138 40150198 323507944 333942852 32881921 24368594 0 0 109310677 120776062 0 0 1338470 98897996 109250669 241090594 254395325 82417350 79547527 542305750 663371301 95799441 126726017 446506309 536645284 REMEMBERING ALWAYS OUR COMMITMENT TO RELIEVE SUFFERING AND MEET THE NEEDS OF CHILDREN; IT IS THE HOSPITAL'S MISSION TO OFFER HOPE AND HEALING IN AN ENVIRONMENT OF TRUST, COMPASSION, AND CARE. false false 246879255 24368594 268488481 PROVISION OF HIGH QUALITY HOSPITAL, MEDICAL, AND NURSING SERVICES TO CHILDREN IN THE SURROUNDING SOUTH TEXAS REGION WITHOUT REGARD TO THE ABILITY TO PAY. CARE IS PERFORMED ON BOTH AN INPATIENT AND AN OUTPATIENT BASIS. 246879255 true true false true false false false false false true true true false false true false false true false false true false false false false false true true true false true false false false false false false false false false false false false false true true true true false true 298 0 true 1862 true false true CJ false false false false false false false false X 14 12 false false false false true false true true true false false true true true true true true true true false X GREGORY WARD 3616946126 3533 SOUTH ALAMEDA CORPUS CHRISTI TX 78411 C IVAN WILSON DIRECTOR 1.0 4.0 X 0 10000 0 MURRAY BASS JR DIRECTOR 1.0 0.0 X 0 0 0 PAUL CHAPA DIRECTOR 1.0 0.0 X 0 0 0 MARY CLARK DIRECTOR 1.0 1.0 X 0 0 0 JIM DEVLIN DIRECTOR 1.0 0.0 X 0 0 0 LEON SMITH-HARRISON MD DIRECTOR 1.0 39.0 X 0 483206 40474 LENORA KEAS DIRECTOR 1.0 0.0 X 0 0 0 REBA CARDENAS MCNAIR DIRECTOR 1.0 0.0 X 0 0 0 S LOYD NEAL JR DIRECTOR 1.0 3.0 X 0 10000 0 BILL STERETT DIRECTOR 1.0 0.0 X 0 0 0 THOMAS MORRIS MD DIRECTOR 1.0 0.0 X 0 0 0 SAM L SUSSER VICE CHAIRMAN 1.0 4.0 X X 0 0 0 MIKE CARRELL DIRECTOR 1.0 0.0 X 0 0 0 WES HOSKINS DIRECTOR 1.0 1.0 X 0 0 0 STEVE WOERNER CEO & VICE CHAIRMAN 39.0 4.0 X X 544360 0 434821 WILLIAM LARSEN VICE PRES HUMAN RESOURCES 40.0 1.0 X 312511 0 77715 DONNA M QUINN VICE PRES OPERATIONS/QUALITY 40.0 1.0 X 278641 0 64004 KAREN C LONG VICE PRESIDENT & CPCO 40.0 0.0 X 256686 0 50959 GREGORY A WARD VICE PRESIDENT ADMINISTRATION 40.0 1.0 X 269202 0 47096 DALE V OBERMUELLER VICE PRESIDENT CPSST 40.0 4.0 X 330243 0 64648 D ERIC HAMON EXECUTIVE VICE PRESIDENT & CFO 29.0 16.0 X 334938 22000 316130 MARTHA A AVERY VICE PRESIDENT OF DEVELOPMENT 1.0 40.0 X 258944 0 67589 JENNIFER R HENDERSON GENERAL COUNSEL 40.0 1.0 X 269034 0 24234 SHEREE G FEDDER NEONATAL NURSE PRACTITIONER 40.0 0.0 X 219167 0 35256 LORRAINE A ANTONI NEONATAL NURSE PRACTITIONER 40.0 0.0 X 206249 0 23839 MIGUEL PEREZ III SYSTEM DIRECTOR IS CIO 40.0 0.0 X 195379 0 33217 DOUGLAS A WSZOLEK CLINICAL PHARMACIST 40.0 0.0 X 194475 0 33395 3669829 525206 1313377 97 true true false UNIVERSITY OF TEXAS MEDICAL BRANCH 201 UNIVERSITY BLVD JOHN SEALY BLD GALVESTON TX 775550591 PHYSICIANS/TEACH/LAB 6853349 FULTON CONSTRUCTION CORP COASTCON 1102 SECOND ST CORPUS CHRISTI TX 78404 CONSTRUCTION 5075596 SODEXO SERVICES OF TEXAS LP 3033 FIFTH AVE STE 335 SAN DIEGO CA 92103 MANAGEMENT 2831996 SIGMA TECHNOLOGY SOLUTIONS INC 607 E SONTERRA BLVD STE 250 SAN ANTONIO TX 78258 TECHNOLOGY 2256350 GE HEALTHCARE 3200 N GRANDVIEW BLVD WAUKESHA WI 531881693 MEDICAL EQUIP MAINT 2047049 74 13138039 2020566 190621 15349226 Net Patient Service Revenue 621110 268488481 268488481 268488481 8970043 8970043 0 0 610306 610306 0 610306 610306 16012879 220 15028195 984684 220 984904 984904 0 0 0 Cafeteria and Vending Sales 722320 820693 820693 Medical Education 621110 1602490 1602490 DELIVERY SYSTEM REFORM INCENTIVE PMT 624410 32211204 32211204 4905505 4905505 39539892 333942852 268488481 50105145 24368594 24368594 0 0 0 3716065 3708487 7578 0 88537717 83986725 3920947 630045 5509924 5192459 278812 38653 16543912 15747362 710784 85766 6468444 6151388 278603 38453 1509063 1509063 136456 136456 0 0 0 0 34199922 33960415 204786 34721 1780927 1398762 14752 367414 5526244 5350724 76898 98622 6598735 6598735 0 4518372 4518372 53637 23707 21471 8459 0 0 205339 205339 0 8808831 8804706 4125 5503243 5120192 383051 Bad Debt Expense 7927882 7927882 Medical Supplies 24411073 24410953 32 88 Equipment Rental/Maintenance 5712005 5673534 13936 24535 ADMINISTRATIVE 1968590 1966742 1848 390350 118658 271681 11 254395325 246879255 6177601 1338470 13617115 13570205 150227856 33909682 297658 1118690 32151696 31553868 0 0 0 0 15520005 10791623 1194850 1562981 2620307 2241740 276982876 183723726 86625629 93259150 0 0 223426207 454001641 0 0 0 0 16624427 21361721 542305750 663371301 39992527 33697053 0 0 211628 211628 19000000 19000000 0 0 0 0 0 0 0 0 36595286 73817336 95799441 126726017 X 437439056 521901892 1365253 3125392 7702000 11618000 446506309 536645284 542305750 663371301 X 79547527 13015546 2346470 -4770568 X false true X true true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false true 262691 false false false 262691 false false SCHEDULE C, PART II-B, LINE 1F GRANTS TO OTHER ORGANIZATIONS FOR LOBBYING PURPOSES MEETING WITH AND CALLING GOVERNMENT OFFICIALS OR LEGISLATORS AND SENDING LETTERS OR PUBLICATIONS TO GOVERNMENT OFFICIALS AND LEGISLATORS. 6611029 640681 390130 7641840 5840401 385661 384967 6611029 3867634 1344707 628060 5840401 3730935 242161 -105462 3867634 3272065 67189 391681 3730935 0.51420 0.48580 false true true 10141347 10141347 119682193 73809626 45872567 1855396 1671910 183486 127210392 108242190 18968202 18093548 0 18093548 93259150 Vanguard 454001641 C 454001641 0 Self Insurance Claims Payable 5602477 Due to Third Party Payor 68214809 Other Liabilities 50 73817336 337719376 13015546 1008000 -7102570 6920976 330798400 3144452 3144452 333942852 238675384 -1338470 -6453589 -7792059 246467443 7927882 7927882 254395325 SCHEDULE D, PART XI, LINE 2D RECONCILIATION OF AUDITED FINANCIAL STATEMENTS TO FORM 990 NET ASSETS RELEASED FROM RESTRICTION $ 825,312 PROVISION FOR BAD DEBT $ (7,927,882) ------------- $ (7,102,570) SCHEDULE D, PART XI, LINE 4B RECONCILIATION OF AUDITED FINANCIAL STATEMENTS TO FORM 990 CONTRIBUTIONS RECORDED TO NET ASSETS $ 3,124,352 OTHER ADJUSTMENTS $ 20,100 ----------- $ 3,144,452 SCHEDULE D, PART XII, LINE 4B RECONCILIATION OF AUDITED FINANCIAL STATEMENTS TO FORM 990 PROVISION FOR BAD DEBT $ 7,927,882 SCHEDULE D, PART X, LINE 2 UNCERTAIN TAX POSITIONS UNDER FIN 48 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 XII, LINE 2D RECONCILIATION OF AUDITED FINANCIAL STATEMENTS TO FORM 990 INTERCOMPANY SUPPORT $ (6,453,589) SCHEDULE D, PART V, LINE 4 INTENDED USES OF ENDOWMENT FUNDS DRISCOLL CHILDREN'S HOSPITAL INDIRECTLY HOLDS ENDOWMENT FUNDS THROUGH THE DRISCOLL CHILDREN'S HOSPITAL DEVELOPMENT FOUNDATION. THE INTENDED USE OF THESE FUNDS IS TO FURTHER THE DEVELOPMENT FOUNDATION'S MISSION OF PROVIDING SERVICES TO CHILDREN AT DRISCOLL CHILDREN'S HOSPITAL. false CENTRAL AMERICA AND THE CARIBBEAN PROGRAM SERVICES INVESTMENT true false true false false false true true true X true X true true false true true 4219526 4219526 0.01770 162988588 155079714 7908873 0.03310 340325 108374 231951 0.00100 167548439 155188088 12360350 0.05180 1569075 1569075 0.00660 4797357 1602490 3194867 0.01340 35846773 35846773 0.15020 42213205 1602490 40610715 0.17020 209761644 156790578 52971065 0.22200 true 4786616 4786616 1267307 1093044 174263 X true true 1 1 DRISCOLL CHILDREN'S HOSPITAL 3533 SOUTH ALAMEDA STREET CORPUS CHRISTI TX 78411 driscollchildrens.org 000488 X X X X X DRISCOLL CHILDREN'S HOSPITAL 1 false false true X X X X X X X X 13 true true false true X HTTP://WWW.DRISCOLLCHILDRENS.ORG/ X WWW.COASTALBENDHEALTHFINDER.COM X X true 14 false true false true X 200. 400. X X X X X true true X X X true X SEE DISCLOSURE IN SECTION C X X X X X true X false X X X X true X false false SCHEDULE H, PART V, SECTION B, LINE 5 INPUT FROM PERSONS FOR CHNA INTERVIEW OF FOCUS GROUPS, INPUT FROM COMMUNITY GROUPS SUCH AS UNITED WAY AND SCHOOL DISTRICTS, SOCIAL SERVICE AND DEMOGRAPHIC DATA FROM THE PATIENT DATABASES OF EACH PARTICIPATING HOSPITAL; STATISTICS FROM GOVERNMENT DATABASES OBTAINED FOR THE ASSESSMENT BY TEXAS A&M UNIVERSITY AT CORPUS CHRISTI. SCHEDULE H, PART V, SECTION B, LINE 6A CHNA CONDUCTED WITH OTHER HOSPITAL FACILITIES CHRISTUS SPOHN HEALTH SYSTEM; CORPUS CHRISTI MEDICAL CENTER SCHEDULE H, PART V, SECTION B, LINE 7D DRISCOLL CHILDREN'S HOSPITAL WAS ESTABLISHED BY THE WILL OF CLARA DRISCOLL TO PROVIDE HOSPITAL CARE TO CHILDREN WHOSE FAMILIES CANNOT AFFORD TO PAY. THE MISSION AND OPERATIONS OF THE HOSPITAL COMPLY TO THIS DAY WITH THE INTENT OF THE WILL. THE HOSPITAL'S MEDICAL STAFF INCLUDES EMPLOYED PHYSICIANS AS WELL AS PHYSICIANS IN PRIVATE PRACTICE. EXAMPLES OF THE HOSPITAL GIVING INFORMATION TO THE PUBLIC REGARDING COMMUNITY HEALTH ISSUES WERE TELEVISION AND RADIO NEWS STORIES ABOUT H1N1 FLU AND MRSA. THE PUBLIC WAS INFORMED ABOUT SYMPTOMS AND WHAT TO DO IF SOMEONE HAD THESE SYMPTOMS. SCHEDULE H, PART V, SECTION B, LINE 16I OTHER MEASURES USED TO PUBLICIZE THE POLICY WITHIN THE COMMUNITY THE WEBSITE PROVIDES PHONE NUMBERS FOR INQUIRIES ABOUT CHARITY AND DISCOUNTS. SCHEDULE H, PART V, SECTION B, LINE 22D CHARGES TO INDIVIDUALS ELIGIBLE FOR ASSISTANCE UNDER THE FAP ALL PATIENTS ARE CHARGED AT GROSS. BASED ON PATIENT'S QUALIFICATION FOR CHARITY ALL OR A PORTION WILL BE ADJUSTED. SCHEDULE H, PART V, SECTION B, LINE 11 NEEDS NOT ADDRESSED IN CHNA THE NEEDS DESCRIBED AND DEFINED IN THE ASSESSMENT ARE TOO PERVASIVE FOR ANY SINGLE HOSPITAL TO ADDRESS ON ITS OWN DUE TO LIMITED RESOURCES. THESE NEEDS INCLUDE BARRIERS TO HEALTHCARE ACCESS; CULTURAL INFLUENCES ON DIABETES AND OBESITY; POVERTY AND POOR EDUCATION AMONG OTHERS. LIMITED RESOURCES PREVENTED A COMPREHENSIVE PLAN FROM BEING DEVELOPED. EXPANDING THE ASSESSMENT STAKEHOLDERS (SUCH AS INCLUDING COUNTY HEALTH OFFICERS) WILL PROVIDE A BETTER OPPORTUNITY FOR A COMPREHENSIVE PLAN TO ADDRESS THIS AREA'S HEALTH NEEDS. SCHEDULE H, PART V, SECTION B, LINE 13B PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE EACH PATIENT'S FAMILY IS PROVIDED WITH WRITTEN MATERIAL AS WELL AS PERSONAL INSTRUCTION AS TO ASSISTANCE THAT IS AVAILABLE TO THEM. STATE EMPLOYEES ARE ON SITE TO EXPEDITE THE MEDICAID ENROLLMENT PROCESS. OTHER THIRD PARTIES ARE ENGAGED TO ASSIST PATIENTS WITH ENROLLMENT. SCHEDULE H, PART V, SECTION B, LINE16A FAP WAS WIDELEY AVAIALBLE ON THE FOLLOWING WEBSITE: HTTP://WWW.DRISCOLLCHILDRENS.ORG/PATIENT-SERVICES/BILLING SCHEDULE H, PART III, SECTION A, LINE 2 PART III, QUESTIONS: PATIENT ACCOUNTS RECEIVABLE: THE HOSPITAL REPORTS PATIENT ACCOUNTS RECEIVABLE FOR SERVICES RENDERED AT NET REALIZABLE AMOUNTS FROM THIRD-PARTY PAYERS, PATIENTS, AND OTHER. THE HOSPITAL PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS BASED UPON A REVIEW OF OUTSTANDING RECEIVABLES, HISTORICAL COLLECTION INFORMATION AND EXISTING ECONOMIC CONDITIONS. AS A SERVICE TO THE PATIENT, THE HOSPITAL BILLS THIRD-PARTY PAYERS DIRECTLY AND BILLS THE PATIENT WHEN THE PATIENT'S LIABILITY IS DETERMINED. PATIENT ACCOUNTS RECEIVABLE ARE DUE IN FULL WHEN BILLED. ACCOUNTS ARE CONSIDERED DELINQUENT AND SUBSEQUENTLY WRITTEN OFF AS BAD DEBTS BASED ON INDIVIDUAL CREDIT EVALUATION AND SPECIFIC CIRCUMSTANCES OF THE ACCOUNT. THE COST METHODOLOGY USED WAS RATIO OF COST TO CHARGES. SCHEDULE H, PART III, SECTION A, LINE 3 PATIENT ACCOUNTS RECEIVABLE ARE DUE IN FULL WHEN BILLED. ACCOUNTS ARE CONSIDERED DELINQUENT AND SUBSEQUENTLY WRITTEN OFF AS BAD DEBTS BASED ON INDIVIDUAL CREDIT EVALUATION AND SPECIFIC CIRCUMSTANCES OF THE ACCOUNT. THE COST METHODOLOGY USED WAS RATIO OF COST TO CHARGES. THE HOSPITAL SERVES A LARGE AREA THAT INCLUDES SOME OF THE LOWEST INCOME PER CAPITA COUNTIES IN THE UNITED STATES. A RELATIVELY SMALL NUMBER OF PATIENTS DO NOT QUALIFY FOR GOVERNMENT PROGRAMS AS WELL AS BEING UNINSURED OR UNDERINSURED. IF THE PATIENTS DO NOT QUALIFY FOR CHARITY UNDER HOSPITAL POLICY CRITERIA THEN THE ACCOUNT IS WRITTEN OFF AS A BAD DEBT. SCHEDULE H, PART III, SECTION A, LINE 4 THE PATIENT ACCOUNTS RECEIVABLE FOOTNOTE OF THE FINANCIAL STATEMENTS PAGES 8 & 9 DESCRIBES THE ORGANIZATION'S BAD DEBT EXPENSE. SCHEDULE H, PART III, SECTION B, LINE 8 MEDICARE IS COST SETTLED FOR THIS HOSPITAL AND THE COST SHOWN WERE CALCULATED ON THE MEDICARE COST REPORT. SCHEDULE H, PART III, SECTION C, LINE 9B AT ANY TIME, A PATIENT MAY REQUEST FINANCIAL ASSISTANCE WHICH INCLUDES UP TO 100% OF THE ACCOUNT BALANCE. SCHEDULE H, PART VI, LINE 2 INPUT FROM PERSONS FOR CHNA, INTERVIEW OF FOCUS GROUPS, INPUT FROM COMMUNITY GROUPS SUCH AS UNITED WAY AND SCHOOL DISTRICTS, SOCIAL SERVICE AND DEMOGRAPHIC DATA FROM THE PATIENT DATABASES OF EACH PARTICIPATING HOSPITAL; STATISTICS FROM GOVERNMENT DATABASES OBTAINED FOR THE ASSESSMENT BY TEXAS A&M UNIVERSITY AT CORPUS CHRISTI SCHEDULE H, PART VI, LINE 3 EACH PATIENT'S FAMILY IS PROVIDED WITH WRITTEN MATERIAL AS WELL AS PERSONAL INSTRUCTION AS TO ASSISTANCE THAT IS AVAILABLE TO THEM. STATE EMPLOYEES ARE ON SITE TO EXPEDITE THE MEDICAID ENROLLMENT PROCESS. OTHER THIRD PARTIES ARE ENGAGED TO ASSIST PATIENTS WITH ENROLLMENT. SCHEDULE H, PART VI, LINE 4 THE HOSPITAL SERVES THE CHILDREN OF A 31 COUNTY AREA THAT COVERS SOUTH TEXAS TO THE BORDER WITH MEXICO. MOST OF THE COUNTIES IN THIS AREA HAVE THE LOWEST INCOME PER CAPITA IN THE COUNTRY. APPROXIMATELY 70% OF THE HOSPITAL'S PATIENTS ARE ENROLLED IN A GOVERNMENT PROGRAM. SCHEDULE H, PART VI, LINE 5 THE HOSPITAL SUBSIDIZES PEDIATRIC SPECIALISTS IN ORDER TO PROVIDE THESE SERVICES TO ITS SERVICE AREA. A SUBSTANTIAL AMOUNT OF HOSPITAL RESOURCES ARE USED TO PROVIDE SERVICES TO THE COMMUNITY IN THE FORM OF HEALTH EDUCATION, PREVENTION AND AWARENESS, AND HOSPITAL/CLINIC SERVICES TO THOSE WHO CANNOT AFFORD TO PAY. SCHEDULE H, PART VI, LINE 6 THE HOSPITAL IS AFFILIATED WITH SEVERAL PHYSICIAN ORGANIZATIONS TO PROVIDE SUPPORT FOR PEDIATRICIANS AND PEDIATRIC SPECIALISTS TO SERVE AREAS OF SOUTH TEXAS THAT OTHERWISE WOULD NOT HAVE THESE SERVICES AVAILABLE. SCHEDULE H, PART VI, LINE 7 STATE FILING OF COMMUNITY BENEFIT REPORT TEXAS SCHEDULE H, PART I, LINE 7, COLUMN F BAD DEBT EXPENSE OF $7,927,882 WAS INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT WAS SUBTRACTED FROM TOTAL EXPENSE FOR THE CALCULATION OF "PERCENT OF TOTAL EXPENSE" IN THIS COLUMN. true CHILDREN'S PHYS SERVICES OF SOUTH TEXAS 3533 SOUTH ALAMEDA CORPUS CHRISTI TX 78401 742620408 501 (C) (3) 24368594 CHARITABLE 1 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. X true true X X X X X false true false false false false false false false LEON SMITH-HARRISON MD DIRECTOR 0 467135 0 0 0 16071 0 19250 0 21224 0 523680 0 0 STEVE WOERNER CEO & VICE CHAIRMAN 322353 0 200813 0 21194 0 414628 0 20193 0 979181 0 0 0 JENNIFER R HENDERSON GENERAL COUNSEL 216894 0 32223 0 19917 0 20725 0 3509 0 293268 0 0 0 SHEREE G FEDDER NEONATAL NURSE PRACTITIONER 201331 0 16100 0 1736 0 13448 0 21808 0 254423 0 0 0 LORRAINE A ANTONI NEONATAL NURSE PRACTITIONER 187929 0 16675 0 1645 0 4258 0 19581 0 230088 0 0 0 MIGUEL PEREZ III SYSTEM DIRECTOR IS CIO 171061 0 23355 0 963 0 13354 0 19863 0 228596 0 0 0 DOUGLAS A WSZOLEK CLINICAL PHARMACIST 192699 0 0 0 1776 0 15801 0 17594 0 227870 0 0 0 WILLIAM LARSEN VICE PRES HUMAN RESOURCES 238195 0 53888 0 20428 0 50119 0 27596 0 390226 0 0 0 DONNA M QUINN VICE PRES OPERATIONS/QUALITY 228779 0 49838 0 24 0 44996 0 19008 0 342645 0 0 0 KAREN C LONG VICE PRESIDENT & CPCO 211189 0 45473 0 24 0 41199 0 9760 0 307645 0 0 0 GREGORY A WARD VICE PRESIDENT ADMINISTRATION 220328 0 47813 0 1061 0 27018 0 20078 0 316298 0 0 0 DALE V OBERMUELLER VICE PRESIDENT CPSST 254423 0 58320 0 17500 0 45254 0 19394 0 394891 0 0 0 D ERIC HAMON EXECUTIVE VICE PRESIDENT & CFO 172439 22000 109593 0 52906 0 288804 0 27326 0 651068 22000 0 0 MARTHA A AVERY VICE PRESIDENT OF DEVELOPMENT 205950 0 44480 0 8514 0 51522 0 16067 0 326533 0 0 0 SCHEDULE J, PART I, LINE 1A HEALTH OR SOCIAL CLUB DUES: DUES AND CHARGES ARE PAID FOR STEVE WOERNER. ANY REIMBURSEMENTS FOR PERSONAL EXPENDITURES WERE INCLUDED IN MR. WOERNER'S FORM W-2. SCHEDULE J, PART I, LINE 4C THE FOLLOWING INDIVIDUALS PARTICIPATED IN A 457(F) NONQUALIFIED RETIREMENT PLAN: NAME AMOUNT PAID BY STEVE WOERNER $ 327,264 DRISCOLL CHILDREN'S HOSPITAL D. ERIC HAMON $ 221,758 DRISCOLL CHILDREN'S HOSPITAL MARTHA AVERY $ 13,495 DRISCOLL CHILDREN'S HOSPITAL WILLIAM LARSEN NONE DRISCOLL CHILDREN'S HOSPITAL FORM 990, PART VI, SECTION A, LINE 6 CLASSES OF MEMBERS OR STOCKHOLDERS ROBERT DRISCOLL, JULIA DRISCOLL, AND ROBERT DRISCOLL JR. FOUNDATION IS THE SOLE MEMBER OF DRISCOLL CHILDREN'S HOSPITAL. FORM 990, PART VI, SECTION A, LINE 7B MEMBERS OR STOCKHOLDERS THE MEMBER HAS TO APPROVE THE BOARD MEMBERS ELECTIONS. FORM 990, PART VI, SECTION B, LINE 11B PROCESS TO REVIEW THE FORM 990 THE ORGANIZATION ENGAGES AN OUTSIDE ACCOUNTING FIRM TO PREPARE ITS FORM 990. ONCE THE FORM 990 IS PREPARED BY THE ACCOUNTING FIRM AND REVIEWED BY THE ORGANIZATION'S INTERNAL FINANCIAL TEAM. THE FINAL FORM IS PRESENTED TO THE GOVERNING BODY BY THE SENIOR VP/CFO PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C PROCESS FOR MONITORING COMPLIANCE WITH CONFLICT OF INTEREST POLICY THE ORGANIZATION HIRES AN EMPLOYEE TO LEAD COMPLIANCE EFFORTS AND REPORT COMPLIANCE ISSUES THAT MAY ARISE. IN ADDITION, THE BOARD COMMITTEE REVIEWS THOSE ISSUES AND REPORTS. FORM 990, PART VI, SECTION B, LINES 15A AND 15B PROCESS FOR DETERMINING COMPENSATION 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. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS AVAILABLE TO THE PUBLIC THE ORGANIZATION DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. FORM 990, PART V, SECTION C, LINES 1A & 2B NUMBER OF EMPLOYESS DRISCOLL CHILDREN'S HOSPITAL REPORTS PAYROLL AND CONTRACTOR REPORTING FOR ALL ENTITIES WITHIN THE DRISCOLL SYSTEM INCLUDING: DRISCOLL CHILDREN'S HEALTH PLAN 74-2838488 ROBERT AND JULIA DRISCOLL FOUNDATION 74-1170270 DRISCOLL HEALTHCARE SERVICES 01-0962276 CHILDRENS PHYSICIAN SERVICES OF SOUTH TX 74-2620408 DRISCOLL PHYSICIANS GROUP 74-2988134 DRISCOLL MATERNAL & FETAL PHYSICIANS GROUP 72-1234461 DRISCOLL VALLEY PHYSICIANS GROUP 20-1234322 DRISCOLL CHILDREN'S HOSPITAL DEVELOPMENT FDN 74-2358461 FORM 990, PART XI, LINE 9 OTHER CHANGES IN NET ASSETS ASSETS RELEASED FROM RESTRICTION $ (120,057) TRANSFER FROM AFFILIATES $ (15,000,000) CHANGE IN BENEFICIAL INTEREST IN TRUST $ 3,916,000 INTERCOMPANY SUPPORT $ 6,453,589 OTHER ADJUSTMENTS $ (20,100) -------------- $ (4,750,468) FORM 990 PART IX LINE 11G DESCRIPTION:FEES FOR SERVICE TOTAL FEES:34199922 DRISCOLL CHILDRENS HEALTH PLAN 615 N UPPER BROADWAY STE 1621 CORPUS CHRISTI TX 78401 742838488 MEDICAID HMO TX 501(C)(3) 9 DCH true ROBERT BELL PARRISH MEMORIAL TRUST 615 N UPPER BROADWAY STE 1635 CORPUS CHRISTI TX 78401 746416039 CHARITABLE TX 501(C)(3) 11A DRISCOLL FDN false ROBERT AND JULIA DRISCOLL FOUNDATION 615 N UPPER BROADWAY STE 1635 CORPUS CHRISTI TX 78401 741170270 CHARITABLE TX 501(C)(3) 11C NA false JACK & DORIS SMOTHERS MEDICAL FOUNDATION 615 N UPPER BROADWAY STE 1635 CORPUS CHRISTI TX 78401 742750622 CHARITABLE TX 501(C)(3) 11A DRISCOLL FDN false CHILDREN'S PHYS SERVICES OF SOUTH TEXAS 3533 SOUTH ALAMEDA CORPUS CHRISTI TX 78411 742620408 HEALTHCARE TX 501(C)(3) 3 DCH true DRISCOLL PHYSICIANS GROUP 3533 SOUTH ALAMEDA CORPUS CHRISTI TX 78411 742988134 HEALTHCARE TX 501(C)(3) 3 DCH true DRISCOLL MATERNAL AND FETAL PHYSICIANS G 3533 SOUTH ALAMEDA CORPUS CHRISTI TX 78411 201234461 HEALTHCARE TX 501(C)(3) 9 DCH true DRISCOLL VALLEY PHYSICIANS GROUP 3533 SOUTH ALAMEDA CORPUS CHRISTI TX 78411 201234322 HEALTHCARE TX 501(C)(3) 3 DCH true DRISCOLL CHILDREN'S HOSPITAL DEVELOPMENT 3533 SOUTH ALAMEDA CORPUS CHRISTI TX 78411 742358461 CHARITABLE TX 501(C)(3) 7 NA false AUXILIARY TO DRISCOLL CHILDREN'S HOSPITA 3533 SOUTH ALAMEDA CORPUS CHRISTI TX 78411 741260701 SUPPORT HOSP TX 501(C)(3) 11A NA false DRISCOLL HEALTHCARE SERVICES 3533 S ALAMEDA ST CORPUS CHRISTI TX 78411 010962276 AVIATION TX 501(C)(3) 11A DCH true ALLEGRA INSURANCE COMPANY LTD PO BOX 1085 5TH FLOOR QUEENSGATE HOUSE GRAND CAYMAN CJ 000000000 INSURANCE CJ DCH C CORPORATION 3916787 26390608 1.00000 true true true true false false false false false false true false true false false true true true true true CHILDREN'S PHYSICIAN SERVICES OF SOUTH TEXAS A 254624 ACTUAL DRISCOLL PHYSICIANS GROUP A 120965 ACTUAL DRISCOLL VALLEY PHYSICIANS GROUP A 193878 ACTUAL DRISCOLL MATERNAL & FETAL PHYSICIANS GROUP A 48300 ACTUAL CHILDREN'S PHYSICIAN SERVICES OF SOUTH TEXAS B 24368594 ACTUAL DRISCOLL DEVELOPMENT FOUNDATION C 2381039 ACTUAL DRISCOLL PHYSICIANS GROUP O -111933 ACTUAL DRISCOLL HEALTHCARE SERVICES P -5552742 ACTUAL CHILDREN'S PHYSICIAN SERVICES OF SOUTH TEXAS P -1123198 ACTUAL DRISCOLL MATERNAL & FETAL PHYSICIANS GROUP P 7222354 ACTUAL DRISCOLL PHYSICIANS GROUP P -2944568 ACTUAL DRISCOLL VALLEY PHYSICIANS GROUP P -793755 ACTUAL DRISCOLL DEVELOPMENT FOUNDATION Q 1712155 ACTUAL DRISCOLL CHILDREN'S HEALTH PLAN Q 48404245 ACTUAL AUXILIARY TO DRISCOLL CHILDREN'S HOSPITAL Q 58592 ACTUAL ALLEGRA INSURANCE COMPANY R 429015 ACTUAL DRISCOLL DEVELOPMENT FOUNDATION S -1712155 ACTUAL DRISCOLL CHILDREN'S HEALTH PLAN S -48400000 ACTUAL