STRATEGY STUDIO / PUBLIC DATA EXPLORER

COOK CHILDRENS PHYSICIAN NETWORK: Form 990, tax year 2013

View the entire original 990 at ProPublica ↗

Organization
COOK CHILDRENS PHYSICIAN NETWORK (EIN 75-2485366)
Tax period
2013-10-01 to 2014-09-30
Filed
2015-08-13
IRS object ID
201502259349304000
Schema version
2013v4.0
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Return2015-08-13T19:03:15-05:00ReturnTs
Tax Period End2014-09-30TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1BKD LLPBusinessNameLine1

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line12800 Post Oak Blvd Ste 3200AddressLine1
CityHOUSTONCity
StateTXState
ZIP Code77056ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2013-10-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN752485366EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1COOK CHILDREN'S PHYSICIAN NETWORKBusinessNameLine1
FieldValueIRS element (for citing)
In Care Of% CORY RHOADESInCareOfNm
Business Name ControlCOOKBusinessNameControlTxt
Phone6828854480PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1801 SEVENTH AVENUEAddressLine1
Address Line2SuiteAddressLine2
CityFORT WORTHCity
StateTXState
ZIP Code76104ZIPCode

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonCORY RHOADESPersonNm
Person TitleVP & CHIEF ACCOUNTING OFFICERPersonTitleTxt
Phone6828854000PhoneNum
Signature2015-08-15SignatureDt
Discuss With Paid PreparerYes (true)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonM P GerichPreparerPersonNm
PTINP00226776PTIN
Phone6828854000PhoneNum
FieldValueIRS element (for citing)
Tax2013TaxYr
Build TS2016-02-25 16:41:14ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerW BRITT NELSON MDPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line1801 SEVENTH AVEAddressLine1
CityFORT WORTHCity
StateTXState
ZIP Code76104ZIPCode
FieldValueIRS element (for citing)
Gross Receipts$230,437,174GrossReceiptsAmt
Group Return For AffiliatesfalseGroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressWWW.COOKCHILDRENS.ORGWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1992FormationYr
Legal Domicile StateTXLegalDomicileStateCd
Activity Or MissionKNOWING THAT EVERY CHILD'S LIFE IS SACRED, IT IS THE PROMISE OF COOK OUR PROMISE IS TO IMPROVE THE HEALTH OF EVERY CHILD IN OUR REGION THROUGH THE PREVENTION AND TREATMENT OF ILLNESS, DISEASE AND INJURY.ActivityOrMissionDesc
Voting Members Governing Body13VotingMembersGoverningBodyCnt
Voting Members Independent0VotingMembersIndependentCnt
Total Employee1060TotalEmployeeCnt
Total Volunteers4TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$46,740,845PYContributionsGrantsAmt
CY Contributions Grants$52,353,709CYContributionsGrantsAmt
PY Program Service Revenue$170,206,589PYProgramServiceRevenueAmt
CY Program Service Revenue$178,040,964CYProgramServiceRevenueAmt
PY Investment Income$4,000PYInvestmentIncomeAmt
CY Investment Income-$30,871CYInvestmentIncomeAmt
PY Other Revenue$6,075PYOtherRevenueAmt
CY Other Revenue$42,501CYOtherRevenueAmt
PY Total Revenue$216,957,509PYTotalRevenueAmt
CY Total Revenue$230,406,303CYTotalRevenueAmt
PY Grants And Similar Paid$1,000PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$171,292,004PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$184,529,652CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$42,363,251PYOtherExpensesAmt
CY Other Expenses$46,250,628CYOtherExpensesAmt
PY Total Expenses$213,656,255PYTotalExpensesAmt
CY Total Expenses$230,780,280CYTotalExpensesAmt
PY Revenues Less Expenses$3,301,254PYRevenuesLessExpensesAmt
CY Revenues Less Expenses-$373,977CYRevenuesLessExpensesAmt
Total Assets BOY$40,276,365TotalAssetsBOYAmt
Total Assets EOY$40,529,114TotalAssetsEOYAmt
Total Liabilities BOY$24,406,742TotalLiabilitiesBOYAmt
Total Liabilities EOY$32,033,467TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$15,869,623NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$8,495,647NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part IIIYes (X)InfoInScheduleOPartIIIInd
MissionKNOWING 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.MissionDesc
Significant New Program SrvcfalseSignificantNewProgramSrvcInd
Significant ChangefalseSignificantChangeInd
Expense$207,178,039ExpenseAmt
Revenue$178,083,465RevenueAmt
DescCOOK CHILDREN'S PHYSICIAN NETWORK (CCPN) IS THE LARGEST PEDIATRIC MULTI-SPECIALTY PHYSICIAN GROUP IN NORTH TEXAS. THE NETWORK INCLUDES MORE THAN 340 PHYSICIANS AND 184 MID-LEVEL PROVIDERS IN ADDITION TO THOUSANDS OF OTHER CARING EMPLOYEES. DURING 2014, CCPN'S PROVIDER COUNT GREW BY 40 PROVIDERS: INCLUDING 18 NET NEW PHYSICIANS AND 22 NET NEW MIDLEVEL PROVIDERS. CCPN PROVIDES MEDICAL CARE IN MORE THAN 60 LOCATIONS AT MORE THAN 30 PRIMARY CARE AND SUBSPECIALTY PRACTICES. ADDITIONALLY, WE OFFER ACCESS TO NINE SPECIALTIES VIA TELEMEDICINE: ENDOCRINOLOGY, GASTROENTEROLOGY, GENETICS, HEMATOLOGY AND ONCOLOGY, INFECTIOUS DISEASE, NEPHROLOGY, NEUROLOGY, NEUROPSYCHOLOGY, AND PSYCHIATRY. THESE SPECIALISTS HOSTED 1,423 VISITS VIA TELEMEDICINE IN 2014 OFFERING IMMEDIATE CARE AND PATIENT MONITORING - SAVING MANY HOURS OF TRAVEL FOR PATIENT FAMILIES. THE NETWORK'S PHYSICIANS AND SPECIALISTS HAVE OFFICES IN TARRANT, DENTON AND HOOD COUNTIES AND PROVIDE A PRIMARY CARE HOME IN ECONOMICALLY DISADVANTAGED NEIGHBORHOODS AND AREAS WHERE ACCESS TO PEDIATRIC HEALTH CARE IS DIFFICULT TO COME BY. THE PHYSICIAN NETWORK HAS ALSO INCREASED ACCESS TO PEDIATRIC SPECIALTY CARE THROUGH OUTREACH CLINICS IN MANY COMMUNITIES IN NORTH, WEST AND CENTRAL TEXAS. EACH MONTH, PHYSICIANS TRAVEL TO PROVIDE SERVICES IN SEVERAL AREAS THAT ARE NOT LARGE ENOUGH TO SUPPORT FULL-TIME SPECIALTY CARE. COOK CHILDREN'S OFFERS SIX NEIGHBORHOOD CLINICS (FIVE IN FORT WORTH AND ONE IN ARLINGTON). THE NEIGHBORHOOD CLINICS OFFER WELL-CHILD VISITS, DENTAL CARE, VACCINES AND TREAT ILLNESSES. STAFF SPEAKS BOTH ENGLISH AND SPANISH, ACCEPTING MOST CHIP, MEDICAID AND COMMERCIAL INSURANCE PLANS. THE CLINICAL STAFF IS LED BY 18 TOTAL PHYSICIANS AND FIVE NURSE PRACTITIONERS. PATIENTS CONTINUE TO BENEFIT FROM THE CCPN ON-LINE PATIENT PORTAL, CALLED MYCOOKCHILDRENS, WHICH PROVIDES FAMILIES ON-DEMAND ACCESS TO PRIOR VISIT SUMMARIES, MEDICATION LISTS, VACCINE RECORDS, LAB RESULTS AND APPOINTMENT REQUESTS.Desc
Total Program Service Expenses$207,178,039TotalProgramServiceExpensesAmt
Described In Section501c3Yes (true)DescribedInSection501c3Ind
Schedule B RequiredYes (true)ScheduleBRequiredInd
Political Campaign ActyfalsePoliticalCampaignActyInd
Lobbying ActivitiesfalseLobbyingActivitiesInd
Subject To Proxy TaxfalseSubjectToProxyTaxInd
Donor Advised FundfalseDonorAdvisedFundInd
Conservation EasementsfalseConservationEasementsInd
Collections Of ArtfalseCollectionsOfArtInd
Credit CounselingfalseCreditCounselingInd
Temp Or Permanent EndowmentsfalseTempOrPermanentEndowmentsInd
Report Land Building EquipmentYes (true)ReportLandBuildingEquipmentInd
Report Investments Other SecfalseReportInvestmentsOtherSecInd
Report Program Related InvstfalseReportProgramRelatedInvstInd
Report Other AssetsYes (true)ReportOtherAssetsInd
Report Other LiabilitiesYes (true)ReportOtherLiabilitiesInd
Include FIN48 FootnotefalseIncludeFIN48FootnoteInd
Independent Audit Fincl StmtfalseIndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (true)ConsolidatedAuditFinclStmtInd
School OperatingfalseSchoolOperatingInd
Foreign OfficefalseForeignOfficeInd
Foreign ActivitiesfalseForeignActivitiesInd
More Than5000 K To OrgfalseMoreThan5000KToOrgInd
More Than5000 K To IndividualsfalseMoreThan5000KToIndividualsInd
Professional FundraisingfalseProfessionalFundraisingInd
Fundraising ActivitiesfalseFundraisingActivitiesInd
Gaming ActivitiesfalseGamingActivitiesInd
Operate HospitalfalseOperateHospitalInd
Grants To OrganizationsfalseGrantsToOrganizationsInd
Grants To IndividualsfalseGrantsToIndividualsInd
Schedule J RequiredYes (true)ScheduleJRequiredInd
Tax Exempt BondsfalseTaxExemptBondsInd
Engaged In Excess Benefit TransfalseEngagedInExcessBenefitTransInd
PY Excess Benefit TransfalsePYExcessBenefitTransInd
Loan OutstandingfalseLoanOutstandingInd
Grant To Related PersonfalseGrantToRelatedPersonInd
Business Rln With Org MemfalseBusinessRlnWithOrgMemInd
Business Rln With Fam MemYes (true)BusinessRlnWithFamMemInd
Business Rln With Officer EntfalseBusinessRlnWithOfficerEntInd
Deductible Non Cash ContrifalseDeductibleNonCashContriInd
Deductible Art ContributionfalseDeductibleArtContributionInd
Terminate OperationsfalseTerminateOperationsInd
Partial LiquidationfalsePartialLiquidationInd
Disregarded EntityfalseDisregardedEntityInd
Related EntityYes (true)RelatedEntityInd
Related Organization Ctrl EntfalseRelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd OrgfalseTrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted PrtshpfalseActivitiesConductedPrtshpInd
Schedule O RequiredYes (true)ScheduleORequiredInd
IRP Document73IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (true)BackupWthldComplianceInd
Employee1060EmployeeCnt
Employment Tax Returns FiledYes (true)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over LimitfalseUnrelatedBusIncmOverLimitInd
Foreign Financial AccountfalseForeignFinancialAccountInd
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTransInd
Taxable Party NotificationfalseTaxablePartyNotificationInd
Nondeductible ContributionsfalseNondeductibleContributionsInd
Quid Pro Quo ContributionsfalseQuidProQuoContributionsInd
Form8282 Property Disposed OffalseForm8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft CntrctfalseRcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft CntrctfalsePayPremiumsPrsnlBnftCntrctInd
Indoor Tanning ServicesfalseIndoorTanningServicesInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members13GoverningBodyVotingMembersCnt
Independent Voting Member0IndependentVotingMemberCnt
Family Or Business RlnfalseFamilyOrBusinessRlnInd
Delegation Of Mgmt DutiesfalseDelegationOfMgmtDutiesInd
Change To Org DocumentsfalseChangeToOrgDocumentsInd
Material Diversion Or MisusefalseMaterialDiversionOrMisuseInd
Members Or StockholdersYes (true)MembersOrStockholdersInd
Election Of Board MembersYes (true)ElectionOfBoardMembersInd
Decisions Subject To ApprovaYes (true)DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (true)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (true)MinutesOfCommitteesInd
Officer Mailing AddressfalseOfficerMailingAddressInd
Local ChaptersfalseLocalChaptersInd
Form990 Provided To Gvrn BodyYes (true)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (true)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (true)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (true)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (true)WhistleblowerPolicyInd
Document Retention PolicyYes (true)DocumentRetentionPolicyInd
Compensation Process CEOYes (true)CompensationProcessCEOInd
Compensation Process OtherYes (true)CompensationProcessOtherInd
Investment In Joint VenturefalseInvestmentInJointVentureInd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

FieldValueIRS element (for citing)
PersonCORY RHOADESPersonNm
Phone6828854000PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1801 SEVENTH AVENUEAddressLine1
CityFORT WORTHCity
StateTXState
ZIP Code76104ZIPCode
FieldValueIRS element (for citing)
Info In Schedule O Part VIIYes (X)InfoInScheduleOPartVIIInd

Form990 Part VII Section A Form990PartVIISectionAGrp (24 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtOfficerOfficerIndHighest Compensated EmployeeHighestCompensatedEmployeeInd
JAMES P MILLER MD
TRUSTEE41.0Yes (X)$855,713$0$33,864
DEBORAH SCHUTTE MD
TRUSTEE-VICE CHAIR SPLTY CARE42.0Yes (X)$533,351$13,3891.0Yes (X)
JASON V TERK MD
TRUSTEE41.0Yes (X)$374,593$31,3641.0
KEVIN D WYLIE DO
TRUSTEE41.0Yes (X)$290,005$38,6692.0
BARRY BZOSTEK MD
TRUSTEE41.0Yes (X)$266,316$7,6640.0
MARK MAZADE MD
TRUSTEE41.0Yes (X)$282,718$26,2370.0
AUDREY ROGERS MD
TRUSTEE41.0Yes (X)$199,835$24,8770.0
SANDRA ARCA MD
TRUSTEE-VICE CHAIRMN, PRIM CAR42.0Yes (X)$267,075$37,4261.0Yes (X)
LINDA M THOMPSON MD
TRUSTEE-CHAIRMAN42.0Yes (X)$346,699$16,5722.0Yes (X)
TODD WOLF MD
TRUSTEE-SECRETARY42.0Yes (X)$393,997$35,5521.0Yes (X)
VANESSA CHARETTE MD
TRUSTEE-TREASURER42.0Yes (X)$261,906$18,7941.0Yes (X)
BRYAN STEINMANN MD
TRUSTEE41.0Yes (X)$234,817$29,0190.0
DEBORAH VERT DO
TRUSTEE41.0Yes (X)$342,627$25,1980.0
KENNETH HEYM MD
TRUSTEE41.0Yes (X)$301,339$32,5280.0
SANDRA PEAK MD
TRUSTEE41.0Yes (X)$300,812$25,8410.0
WILFRED L RAINE MD
TRUSTEE41.0Yes (X)$389,782$27,5440.0
JANELL MASON-BRISCOE
ASST VP, PRIM CARE & SPLTY SVC40.0$237,102$12,4420.0Yes (X)
W BRITT NELSON MD
PRESIDENT40.0$637,533$35,4170.0Yes (X)
ROBERT GOODWILL
VP, OPNS PRIM CARE & SPLTY SVC40.0$339,488$21,0260.0Yes (X)
VINCENT TAM MD
PHYSICIAN40.0$1,701,132$14,6640.0Yes (X)
JOSE L IGLESIAS MD
PHYSICIAN40.0$844,742$21,9120.0Yes (X)
MARK PALMER MD
PHYSICIAN40.0$981,165$19,9470.0Yes (X)
PATRICK THOMAS MD
PHYSICIAN40.0$783,006$31,8140.0Yes (X)
JOHN UFFMAN MD
MEDICAL DIRECTOR40.0$785,204$26,6350.0Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$11,950,957TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$0TotReportableCompRltdOrgAmt
Total Other Compensation$608,395TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K431IndivRcvdGreaterThan100KCnt
Former Ofcr Employees ListedfalseFormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (true)TotalCompGreaterThan150KInd
Compensation From Other SrcsfalseCompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

Address Line1ContractorAddress/USAddress/AddressLine1CityContractorAddress/USAddress/CityStateContractorAddress/USAddress/StateZIP CodeContractorAddress/USAddress/ZIPCodeServicesServicesDescCompensationCompensationAmt
JESSE A CLAUDIA L ROCHA
1413 HEIDI COURTFORT WORTHTX76108JANITORIAL$205,579
ELDAD EREZ MD
6707 CANYON CRESTFORT WORTHTX76132COVERAGE$148,000
ATHENAHEALTH
311 ARSENAL STWATERTOWNMA02472CLAIMS PROCESSING$10,182,315
TARRANT CONSTRUCTION SERVICES
2225 W PETERSMITH STFORT WORTHTX76102CONSTRUCTION$482,868
CREDIT SYSTEMS INTERNATIONAL
PO BOX 1088ARLINGTONTX76004COLLECTIONS$191,431
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K6CntrctRcvdGreaterThan100KCnt
Related Organizations$52,163,511RelatedOrganizationsAmt
Government Grants$176,890GovernmentGrantsAmt
All Other Contributions$13,308AllOtherContributionsAmt
Total Contributions$52,353,709TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (5 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
NET PATIENT FEES621110$166,309,126$166,309,126
CONTRACTED FEES621110$3,327,095$3,327,095
MANAGEMENT FEES900099$7,091,316$7,091,316
OTHER INCOME621110$1,270,161$1,270,161
RESEARCH900099$43,266$43,266
FieldValueIRS element (for citing)
Total Program Service Revenue$178,040,964TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Royalties Revenue RoyaltiesRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Rental Income Or Loss RentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Real$0RealAmt
Personal$0PersonalAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

FieldValueIRS element (for citing)
Other$30,871OtherAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Other-$30,871OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column-$30,871TotalRevenueColumnAmt
Exclusion-$30,871ExclusionAmt

Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Net Income From Gaming NetIncomeFromGamingGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Net Income Or Loss NetIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Other Revenue Misc OtherRevenueMiscGrp

FieldValueIRS element (for citing)
DescOTHER INCOMEDesc
Business900099BusinessCd
Total Revenue Column$42,501TotalRevenueColumnAmt
Related Or Exempt Func Income$42,501RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Other Revenue Total$42,501OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$230,406,303TotalRevenueColumnAmt
Related Or Exempt Func Income$178,083,465RelatedOrExemptFuncIncomeAmt
Exclusion-$30,871ExclusionAmt

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Grants To Domestic Individuals GrantsToDomesticIndividualsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Foreign Grants ForeignGrantsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Benefits To Members BenefitsToMembersGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$7,582,548TotalAmt
Program Services$6,167,442ProgramServicesAmt
Management And General$1,415,106ManagementAndGeneralAmt

Comp Disqual Persons CompDisqualPersonsGrp

FieldValueIRS element (for citing)
Total$130,910TotalAmt
Program Services$130,910ProgramServicesAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$153,916,075TotalAmt
Program Services$149,949,697ProgramServicesAmt
Management And General$3,966,378ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$22,900,119TotalAmt
Program Services$21,420,413ProgramServicesAmt
Management And General$1,479,706ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Services Management FeesForServicesManagementGrp

FieldValueIRS element (for citing)
Total$3,905,201TotalAmt
Management And General$3,905,201ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Services Lobbying FeesForServicesLobbyingGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$1,396,562TotalAmt
Program Services$681,554ProgramServicesAmt
Management And General$715,008ManagementAndGeneralAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$87,451TotalAmt
Program Services$36,345ProgramServicesAmt
Management And General$51,106ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$476,028TotalAmt
Program Services$538,670ProgramServicesAmt
Management And General-$62,642ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Royalties RoyaltiesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$5,642,121TotalAmt
Program Services$5,510,088ProgramServicesAmt
Management And General$132,033ManagementAndGeneralAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$226,900TotalAmt
Program Services$207,075ProgramServicesAmt
Management And General$19,825ManagementAndGeneralAmt

Pymt Travel Entrtnmnt Pub Ofcl PymtTravelEntrtnmntPubOfclGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$8,258TotalAmt
Program Services$4,515ProgramServicesAmt
Management And General$3,743ManagementAndGeneralAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$2,918TotalAmt
Program Services$2,918ProgramServicesAmt

Payments To Affiliates PaymentsToAffiliatesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$693,171TotalAmt
Program Services$604,128ProgramServicesAmt
Management And General$89,043ManagementAndGeneralAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$1,535,729TotalAmt
Program Services$1,534,683ProgramServicesAmt
Management And General$1,046ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
MEDICAL SUPPLIES$13,421,115$13,419,754$1,361
COLLECTION EXPENSE$11,063,216$131,230$10,931,986
BAD DEBT EXPENSE$5,498,675$5,498,675$0
MINOR EQUIPMENT EXPENSE$1,265,310$543,042$722,268

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$1,027,973TotalAmt
Program Services$796,900ProgramServicesAmt
Management And General$231,073ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$230,780,280TotalAmt
Program Services$207,178,039ProgramServicesAmt
Management And General$23,602,241ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$8,431BOYAmt
EOY$8,832EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$23,543,093BOYAmt
EOY$11,046,459EOYAmt

Pledges And Grants Receivable PledgesAndGrantsReceivableGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$11,898,732BOYAmt
EOY$9,051,258EOYAmt

Receivables From Officers Etc ReceivablesFromOfficersEtcGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$1,137,648BOYAmt
EOY$1,089,879EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$1,001,698BOYAmt
EOY$1,022,371EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$14,173,199LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$5,191,906LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$2,594,298BOYAmt
EOY$8,981,293EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Investments Program Related InvestmentsProgramRelatedGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Intangible Assets IntangibleAssetsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$92,465BOYAmt
EOY$9,329,022EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$40,276,365BOYAmt
EOY$40,529,114EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$3,831,154BOYAmt
EOY$9,194,021EOYAmt

Grants Payable GrantsPayableGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Deferred Revenue DeferredRevenueGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Escrow Account Liability EscrowAccountLiabilityGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Loans From Officers Directors LoansFromOfficersDirectorsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$20,575,588BOYAmt
EOY$22,839,446EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$24,406,742BOYAmt
EOY$32,033,467EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY$15,869,623BOYAmt
EOY$8,495,647EOYAmt

Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$15,869,623BOYAmt
EOY$8,495,647EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$40,276,365BOYAmt
EOY$40,529,114EOYAmt
FieldValueIRS element (for citing)
Info In Schedule O Part XIYes (X)InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss-$373,977ReconcilationRevenueExpnssAmt
Other Changes In Net Assets-$6,999,999OtherChangesInNetAssetsAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or ReviewfalseAccountantCompileOrReviewInd
FS AuditedYes (true)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Consolidated Basis Fincl StmtYes (X)ConsolidatedBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (true)AuditCommitteeInd
Federal Grant Audit RequiredfalseFederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
HospitalYes (X)HospitalInd
Contribution ControllerfalseContributionControllerInd
Contribution FamilyfalseContributionFamilyInd
Contribution35 ControlledfalseContribution35ControlledInd

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Total ContributionsRESTRICTEDTotalContributionsAmt

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Art Public Exhibition AmountsArtPublicExhibitionAmountsGrp
Held Works ArtHeldWorksArtGrp
CY Minus3 Yr Endwmt FundCYMinus3YrEndwmtFundGrp
CY Minus4 Yr Endwmt FundCYMinus4YrEndwmtFundGrp
LandLandGrp

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$6,543,967OtherCostOrOtherBasisAmt
Depreciation$1,019,119DepreciationAmt
Book Value$5,524,848BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$4,042,642OtherCostOrOtherBasisAmt
Depreciation$2,154,030DepreciationAmt
Book Value$1,888,612BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$3,487,639OtherCostOrOtherBasisAmt
Depreciation$1,990,499DepreciationAmt
Book Value$1,497,140BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$98,951OtherCostOrOtherBasisAmt
Depreciation$28,258DepreciationAmt
Book Value$70,693BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$8,981,293TotalBookValueLandBuildingsAmt

Other Assets Org OtherAssetsOrgGrp (2 entries)

DescDescBook ValueBookValueAmt
OTHER ASSETS$379,158
A/R OTHER MISC - ACA RCV$8,949,864
FieldValueIRS element (for citing)
Total Book Value Other Assets$9,329,022TotalBookValueOtherAssetsAmt
Federal Income Tax Liability$0FederalIncomeTaxLiabilityAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (7 entries)

DescDescAmtAmt
ACCRUED PAYROLL$1,331,282
ACCRUED PHYSICIAN RECONS$9,509,219
DUE TO AFFILIATES$4,514,570
ACCRUED PTO LIABILITY$2,685,211
ACCRUED EXECUTIVE BONUS$557,880
ACCRUED EIB LIABILITY$4,207,285
CAPITAL LEASE OBLIGATION$33,999
FieldValueIRS element (for citing)
Total Liability$22,839,446TotalLiabilityAmt
Footnote TextYes (X)FootnoteTextInd
Total Rev Etc Audited Fincl Stmt$224,591,999TotalRevEtcAuditedFinclStmtAmt
Other Revenue-$5,498,675OtherRevenueAmt
Revenue Not Reported-$5,498,675RevenueNotReportedAmt
Revenue Subtotal$230,090,674RevenueSubtotalAmt
Other Revenues Not Included$315,629OtherRevenuesNotIncludedAmt
Revenue Not Reported Fincl Stmt$315,629RevenueNotReportedFinclStmtAmt
Total Revenue Per Form990$230,406,303TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt$225,312,476TotExpnsEtcAuditedFinclStmtAmt
Other Expenses Included$30,871OtherExpensesIncludedAmt
Expenses Not Reported$30,871ExpensesNotReportedAmt
Expenses Subtotal$225,281,605ExpensesSubtotalAmt
Other Expenses Not Included$5,498,675OtherExpensesNotIncludedAmt
Expenses Not Rpt Fincl Stmt$5,498,675ExpensesNotRptFinclStmtAmt
Total Expenses Per Form990$230,780,280TotalExpensesPerForm990Amt

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART XI, LINES 2D & 4BRECONCILIATION OF REVENUE FINANCIAL STATEMENTS TO FORM 990 BAD DEBT TOTAL: ($ 5,498,675) LOSS ON DISPOSAL OF ASSETS: ($ 30,871) CONTRIBUTIONS FROM CCHF RECORDED TO NET ASSETS: 346,500 -------------- TOTAL $ 315,629
PART XII, LINES 2D & 4BRECONCILIATION OF EXPENSES FINANCIAL STATEMENTS TO FORM 990 LOSS ON DISPOSAL OF ASSETS: $ 30,871 BAD DEBT TOTAL: $ 5,498,675

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Idemnification Gross Up PmtsYes (X)IdemnificationGrossUpPmtsInd
Written Policy Ref T And E ExpnssfalseWrittenPolicyRefTAndEExpnssInd
Substantiation RequiredYes (true)SubstantiationRequiredInd
Severance PaymentfalseSeverancePaymentInd
Supplemental Nonqual Rtr PlanYes (true)SupplementalNonqualRtrPlanInd
Equity Based Comp ArrngmfalseEquityBasedCompArrngmInd
Comp Based On Revenue Of Flng OrgfalseCompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related OrgsfalseCompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng OrgfalseCompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd OrgsfalseCompBsdNetEarnsRltdOrgsInd
Any Non Fixed PaymentsfalseAnyNonFixedPaymentsInd
Initial Contract ExceptionfalseInitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (24 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Filing OrganizationBonusFilingOrganizationAmountBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Filing OrgOtherCompensationFilingOrgAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtComp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmtComp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
JAMES P MILLER MD
TRUSTEE$814,152$0$0$0$41,561$0$0$0$0$0$855,713$0$0$0
DEBORAH SCHUTTE MD
TRUSTEE-VICE CHAIR SPLTY CARE$513,832$10,000$9,519$13,389$546,740
JASON V TERK MD
TRUSTEE$361,691$4,167$8,735$19,125$12,239$405,957
KEVIN D WYLIE DO
TRUSTEE$234,811$49,689$5,505$19,125$19,544$328,674
JANELL MASON-BRISCOE
ASST VP, PRIM CARE & SPLTY SVC$177,679$57,948$1,475$7,496$4,946$249,544
VINCENT TAM MD
PHYSICIAN$1,558,080$125,000$18,052$14,664$1,715,796
BARRY BZOSTEK MD
TRUSTEE$240,755$15,000$10,561$0$7,664$273,980
MARK MAZADE MD
TRUSTEE$271,075$11,643$12,928$13,309$308,955
AUDREY ROGERS MD
TRUSTEE$190,138$9,697$14,787$10,090$224,712
SANDRA ARCA MD
TRUSTEE-VICE CHAIRMN, PRIM CAR$258,731$8,344$14,097$23,329$304,501
LINDA M THOMPSON MD
TRUSTEE-CHAIRMAN$325,667$10,750$10,282$15,938$634$363,271
TODD WOLF MD
TRUSTEE-SECRETARY$266,683$120,049$7,265$15,938$19,614$429,549
W BRITT NELSON MD
PRESIDENT$366,527$165,227$105,779$19,125$16,292$672,950
JOSE L IGLESIAS MD
PHYSICIAN$805,473$39,269$10,200$11,712$866,654
VANESSA CHARETTE MD
TRUSTEE-TREASURER$187,865$68,280$5,761$14,663$4,131$280,700
BRYAN STEINMANN MD
TRUSTEE$225,813$9,004$17,357$11,662$263,836
DEBORAH VERT DO
TRUSTEE$336,674$5,953$18,780$6,418$367,825
ROBERT GOODWILL
VP, OPNS PRIM CARE & SPLTY SVC$265,673$71,437$2,378$9,080$11,946$360,514
KENNETH HEYM MD
TRUSTEE$285,647$5,500$10,192$15,938$16,590$333,867
SANDRA PEAK MD
TRUSTEE$295,026$5,786$15,938$9,903$326,653
WILFRED L RAINE MD
TRUSTEE$374,682$15,100$19,125$8,419$417,326
MARK PALMER MD
PHYSICIAN$943,288$30,000$7,877$12,750$7,197$1,001,112
PATRICK THOMAS MD
PHYSICIAN$763,491$19,515$10,200$21,614$814,820
JOHN UFFMAN MD
MEDICAL DIRECTOR$749,072$36,132$10,200$16,435$811,839

Supplemental Information Detail SupplementalInformationDetail (3 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART I, QUESTION 4BPARTICIPATION IN A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN: PARTICIPANTS IN SERP REPORTED IN W-2 DEFERRED COMPENSATION -------------------- --------------- --------------------- JAMES P. MILLER, MD 17,500 NONE W. BRITT NELSON, MD 72,359 NONE JOSE L. IGLESIAS, MD 17,500 NONE JOHN UFFMAN, MD 17,500 NONE
PART I, QUESTION 3METHODS USED BY CCHCS TO ESTABLISH COMPENSATION OF THE CEO/EXEC DIRECTOR: COMPENSATION COMMITTEE INDEPENDENT COMPENSATION CONSULTANT WRITTEN EMPLOYMENT CONTRACT COMPENSATION SURVEY OR STUDY APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE
PART I, QUESTION 1BGROSS-UP DISCLOSURE: 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-UPS IN TAX PAYMENTS EXCEPT IN UNUSUAL CIRCUMSTANCES AND ONLY THEN IF APPROVED BY SENIOR MANAGEMENT. IN THIS CASE, A $750.00 INCENTIVE AWARD WAS GIVEN TO AN EMPLOYEE FOR SUBMITTING AN ACCEPTED COST REDUCTION IDEA AS PART OF A COMPANY-WIDE COST REDUCTION PROGRAM. THE SENIOR VICE PRESIDENT OF HUMAN RESOURCES APPROVED THE GROSS-UP OF $363.59 SO THE EMPLOYEE WOULD RECEIVE THE FULL STATED BENEFIT OF THE INCENTIVE AWARD.

Schedule L IRS990ScheduleL

Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp

Name Of Interested NameOfInterested

FieldValueIRS element (for citing)
PersonTOM ROGERS JR MDPersonNm
FieldValueIRS element (for citing)
Relationship DescriptionA. ROGERS FATHER-IN-LAWRelationshipDescriptionTxt
Transaction$130,910TransactionAmt
TransactionCOMPENSATIONTransactionDesc
Sharing Of RevenuesfalseSharingOfRevenuesInd

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (8 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART VI, QUESTION 7AMEMBER ELECTION ABILITIES: AS THE SOLE MEMBER OF THE ORGANIZATION, COOK CHILDREN'S HEALTH CARE SYSTEM HAS THE ABSOLUTE RIGHT TO APPOINT OR APPROVE MEMBERSHIP ON THE BOARD OF DIRECTORS OF THE ORGANIZATION.
FORM 990, PART VI, QUESTION 7BMEMBER DECISION ABILITIES: AS THE SOLE MEMBER OF THE ORGANIZATION, COOK CHILDREN'S HEALTH CARE SYSTEM HAS THE EXCLUSIVE AND RESERVED POWER TO DO ANY OF THE FOLLOWING: A. APPROVE THE ANNUAL OPERATING AND CAPITAL BUDGETS OF THE ORGANIZATION; B. APPROVE DEVIATIONS IN EXCESS OF $249,999 FROM ANNUAL OPERATING AND CAPITAL BUDGETS OF THE ORGANIZATION; C. APPROVE THE PURCHASE OR ACQUISITION OF ANY PROPERTY, REAL, PERSONAL, OR MIXED, BY THE ORGANIZATION EXCEEDING $249,999; D. APPROVE THE SALE, GIFT OR OTHER DISPOSITION OF ANY PROPERTY, REAL, PERSONAL, OR MIXED, OF THE ORGANIZATION EXCEEDING $249,999; E. APPROVE THE MORTGAGE OR OTHER ENCUMBRANCE OF ANY PROPERTY, REAL, PERSONAL, OR MIXED, OF THE ORGANIZATION IN EXCESS OF $249,999; F. APPROVE THE ACQUISITION, LIQUIDATION, MERGER, WINDING UP, TERMINATION, OR CONSOLIDATION OF THE ORGANIZATION; G. APPROVE THE CREATION OF, OR INVESTMENT IN, ANY SUBSIDIARY ENTITY OF THE ORGANIZATION; H. APPROVE THE ADOPTION, AMENDMENT OR REPEAL OF THE CERTIFICATE OF FORMATION OF THE ORGANIZATION AND/OR PARAGRAPHS 1.2, 2.1, 2.2, 2.3, 2.4, 2. 5, 2.6, 2.7, 2.8, 2.9, 3.1(B), 3.1(E), 5.3(C), 7.1(A), 7.1(D), 7.1(E), 7. 1(F) AND 8.1 OF THE ORGANIZATION'S BYLAWS; I. APPROVE THE SIGNING OF CONTRACTS IN WHICH THE ORGANIZATION IS AT FINANCIAL RISK EXCEEDING $249,999, INCLUDING BUT NOT LIMITED TO MANAGEMENT AGREEMENTS, EMPLOYMENT CONTRACTS (INCLUDING COMPENSATION, BENEFITS AND INCENTIVES), PHYSICIAN PRACTICE ACQUISITION CONTRACTS, AND MANAGED CARE CONTRACTS, INCLUDING FEE-FOR-SERVICE, DISCOUNTED FEE-FOR-SERVICE, RISK POOL, CAPITATED, AND OTHER "AT-RISK" SERVICE AGREEMENTS; J. APPROVE THE SETTLEMENT OF CLAIMS AND LITIGATION OF THE ORGANIZATION; AND K. APPROVE THE APPOINTMENT OR ELECTION OF DIRECTORS IN ACCORDANCE WITH SECTION 3.2 OF THE ORGANIZATION'S BYLAWS.
FORM 990, PART VI, QUESTION 11BPROCESS FOR REVIEW OF THE 990: THE ORGANIZATION ENGAGES AN OUTSIDE 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, QUESTION 12CWRITTEN 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 VI, QUESTION 15A & 15BREVIEW AND APPROVAL OF COMPENSATION: COOK CHILDREN'S 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., AN INDEPENDENT, NATIONALLY RECOGNIZED COMPENSATION CONSULTANT. THE COMPENSATION COMMITTEE DOCUMENTS THE BASIS FOR ITS DETERMINATIONS FOLLOWING CONTEMPORANEOUS SUBSTANTIATION OF THE COMPENSATION COMMITTEE'S DELIBERATIONS AND DECISIONS. THE COMPENSATION COMMITTEE REQUIRES THE COMPENSATION CONSULTANT TO UPDATE MARKET DATA PERIODICALLY, USUALLY EVERY TWO YEARS, WITH 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, QUESTION 19MAKING GOVERNING DOCUMENTS 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, QUESTION 6SOLE MEMBER: COOK CHILDREN'S HEALTH CARE SYSTEM, A TEXAS NON-PROFIT CORPORATION, IS THE SOLE MEMBER OF THE ORGANIZATION.
FORM 990, PART XI, LINE 9OTHER CHANGES IN NET ASSETS OR FUND BALANCES: TRANSFERS BETWEEN AFFILIATES (6,999,999)

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (6 entries)

Address Line1USAddress/AddressLine1CityUSAddress/CityStateUSAddress/StateZIP CodeUSAddress/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtPublic Charity StatusPublicCharityStatusTxtBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Controlled OrganizationControlledOrganizationInd
COOK CHILDREN'S MEDICAL CENTER
801 SEVENTH AVEFORT WORTHTX76104752051646HOSPITALTX501(C)(3)3CCHCSfalse
WI COOK FOUNDATION
801 SEVENTH AVENUEFORT WORTHTX76104752051649FUNDRAISINGTX501(C)(3)11DNAfalse
COOK CHILDREN'S HOME HEALTH
801 SEVENTH AVENUEFORT WORTHTX76104752896983HEALTHCARETX501(C)(3)9CCHCSfalse
COOK CHILDREN'S HEALTH CARE SYSTEM
801 SEVENTH AVEFORT WORTHTX76104752705881HLTH CARE SUPTX501(C)(3)11CCCHFfalse
COOK CHILDREN'S HEALTH PLAN
801 SEVENTH AVEFORT WORTHTX76104760585240INSURANCETX501(C)(3)9CCHCSfalse
ROSEDALE OFFICE BUILDING INC
1500 W ROSEDALEFORT WORTHTX76104460866421TITLE HOLDINGTX501(C)(2)N/ACCHFfalse

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp

Related Organization Name RelatedOrganizationName

FieldValueIRS element (for citing)
Business Name Line1COOK CHILDREN'S HEALTH SERVICESBusinessNameLine1

US Address USAddress

FieldValueIRS element (for citing)
Address Line1801 7TH AVENUEAddressLine1
CityFORT WORTHCity
StateTXState
ZIP Code76104ZIPCode
FieldValueIRS element (for citing)
EIN454024843EIN
Primary ActivitiesHEALTHCAREPrimaryActivitiesTxt
Legal Domicile StateTXLegalDomicileStateCd

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1CCHCSBusinessNameLine1
FieldValueIRS element (for citing)
Entity TypeC CORPORATIONEntityTypeTxt
Controlled OrganizationfalseControlledOrganizationInd
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts RyltsfalseReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth OrgfalseGiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth OrgYes (true)GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth OrgfalseLoansOrGuaranteesFromOthOrgInd
Div Related OrganizationfalseDivRelatedOrganizationInd
Asset Sale To Other OrgfalseAssetSaleToOtherOrgInd
Asset Purchase From Other OrgfalseAssetPurchaseFromOtherOrgInd
Asset ExchangeYes (true)AssetExchangeInd
Rental Of Facilities To Oth OrgYes (true)RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth OrgYes (true)RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth OrgfalsePerformOfServicesForOthOrgInd
Perform Of Services By Other OrgfalsePerformOfServicesByOtherOrgInd
Sharing Of FacilitiesfalseSharingOfFacilitiesInd
Paid Employees SharingfalsePaidEmployeesSharingInd
Reimbursement Paid To Other OrgYes (true)ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other OrgYes (true)ReimbursementPaidByOtherOrgInd
Transfer To Other OrgYes (true)TransferToOtherOrgInd
Transfer From Other OrgYes (true)TransferFromOtherOrgInd