2013-11-13T09:05:11-06:00 2012-12-31 366055558 Grant Thornton LLP 1717 Main Street Suite 1500 Dallas TX 75201 990 2012-01-01 752062015 Children's Medical Center Foundation CHIL 2144567000 1935 Medical District Drive Dallas TX 75235 Jerry Lee 2144567000 2013-11-13 1 Kimberly Temple CPA P00669176 2145612300 2012 2016-02-24 21:20:13Z Kern Wildenthal MD PhD 1935 Medical District Dr Dallas TX 75235 58072287 0 X www.childrens.com X 1985 TX To provide financial support for CMCD to enable the hospital to accomplish its mission. 18 13 0 4740 0 0 25338047 45414532 0 0 12403566 10820117 -1026612 -1294660 36715001 54939989 14489080 25465802 0 0 4914416 5475216 0 0 5354545 4207855 4431135 23611351 35372153 13103650 19567836 284583295 310512678 17514187 12884491 267069108 297628187 To provide financial support for CMCD to enable the hospital to accomplish its mission to make life better for children. To accomplish this, the foundation is committed to supporting the guiding principles of CMCD. 0 0 25465802 25465802 Children's Medical Center Foundation is an organization devoted to raising money in support of Children's Medical Center of Dallas, a 501(c)(3) organization. To accomplish this purpose, the foundation, like the hospital, is committed to supporting the guiding principles: quality care, research and innovation, education and advocacy, excellence and accountability. 25465802 1 1 0 0 0 0 0 0 0 1 1 0 0 0 1 0 1 1 0 0 0 0 0 0 1 0 0 1 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 0 0 X 18 13 1 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X Stephanie K Smith 2144567000 1935 Medical District Drive Dallas TX 75235 X Steven M Gruber 1.00 0.00 X X 0 0 0 Christopher J Durovich 1.00 60.00 X X 0 1975308 85059 Samuel J Beard 1.00 0.00 X 0 0 0 James B Goodson 1.00 0.00 X 0 0 0 H Leslie Moore MD 1.00 0.00 X 0 0 0 Ann Goddard Corrigan 1.00 0.00 X 0 0 0 H Grady Jordan Sr 1.00 0.00 X 0 0 0 Ann Duckett Reed 1.00 0.00 X 0 0 0 John L Adams 1.00 0.00 X 0 0 0 Ashley Arnold 1.00 0.00 X 0 0 0 Marilyn Augur 1.00 0.00 X 0 0 0 Martha Lou Beaird 1.00 0.00 X 0 0 0 Jill Bee 1.00 0.00 X 0 0 0 David Beuerlein 1.00 0.00 X 0 0 0 Sheila Beuerlein 1.00 0.00 X 0 0 0 Cordelia Boone 1.00 0.00 X 0 0 0 Bill Carter 1.00 0.00 X 0 0 0 Dan Chapman 1.00 0.00 X 0 0 0 Bryan H Corrigan 1.00 0.00 X 0 0 0 Marie Crowe 1.00 0.00 X 0 0 0 R Brooks Cullum Jr 1.00 0.00 X 0 0 0 Scott Dabney 1.00 0.00 X 0 0 0 Ann Delatour 1.00 0.00 X 0 0 0 Kent Eastman 1.00 0.00 X 0 0 0 Sandra Estess 1.00 0.00 X 0 0 0 Susan Farris 1.00 0.00 X 0 0 0 Steve Folsom 1.00 0.00 X 0 0 0 Kelli Ford 1.00 0.00 X 0 0 0 Linda Gibbons 1.00 0.00 X 0 0 0 Leslie Greco 1.00 0.00 X 0 0 0 Randi Halsell 1.00 0.00 X 0 0 0 Juli Harrison 1.00 0.00 X 0 0 0 Hunter Henry 1.00 0.00 X 0 0 0 Blake Holmes 1.00 0.00 X 0 0 0 Joyce Houlihan 1.00 0.00 X 0 0 0 Ward Hunt 1.00 0.00 X 0 0 0 Gene Jones 1.00 0.00 X 0 0 0 Caren Kline 1.00 0.00 X 0 0 0 Charles Koetting 1.00 0.00 X 0 0 0 Amy Korenvaes 1.00 0.00 X 0 0 0 Harlan Korenvaes 1.00 0.00 X 0 0 0 Tracey Kozmetsky 1.00 0.00 X 0 0 0 C S Lee 1.00 0.00 X 0 0 0 Anne Logan 1.00 0.00 X 0 0 0 Karen A Matthews 1.00 0.00 X 0 0 0 Lynn McBee 1.00 0.00 X 0 0 0 Albert McClendon 1.00 0.00 X 0 0 0 Jill McClung 1.00 0.00 X 0 0 0 P Mike McCullough 1.00 0.00 X 0 0 0 Gail McDonald 1.00 0.00 X 0 0 0 Melanie Medanich 1.00 0.00 X 0 0 0 Thomas A Montgomery 1.00 0.00 X 0 0 0 Vikki Moody 1.00 0.00 X 0 0 0 Robert Morgan DDS 1.00 0.00 X 0 0 0 Randall Muck 1.00 0.00 X 0 0 0 Burk Murchison 1.00 0.00 X 0 0 0 Jan Myers 1.00 0.00 X 0 0 0 Connie O'Neill 1.00 0.00 X 0 0 0 Teresa Parravano 1.00 0.00 X 0 0 0 Chris Patrick 1.00 0.00 X 0 0 0 Pamela Dealey Petty 1.00 0.00 X 0 0 0 John T Pickens 1.00 0.00 X 0 0 0 Jacob Pollack 1.00 0.00 X 0 0 0 Claude Prestidge MD 1.00 0.00 X 0 0 0 Deborah R Price Au D 1.00 0.00 X 0 0 0 Debbie Raynor 1.00 0.00 X 0 0 0 Richard L Rogers 1.00 0.00 X 0 0 0 Steve Rudner 1.00 0.00 X 0 0 0 Mardie Schoellkopf 1.00 0.00 X 0 0 0 Betty M Schultz 1.00 0.00 X 0 0 0 John Field Scovell 1.00 0.00 X 0 0 0 Debbie Scripps 1.00 0.00 X 0 0 0 Ric Scripps 1.00 0.00 X 0 0 0 John R Sears Jr 1.00 0.00 X 0 0 0 Mary Louise Sinclair 1.00 0.00 X 0 0 0 Frank O Sloan 1.00 0.00 X 0 0 0 Sandra Snyder 1.00 0.00 X 0 0 0 Sally Seay Stout 1.00 0.00 X 0 0 0 Barbara Stuart 1.00 0.00 X 0 0 0 Stephen Suellentrop 1.00 0.00 X 0 0 0 Smokey Swenson 1.00 0.00 X 0 0 0 Debra Brennan Tagg 1.00 0.00 X 0 0 0 Michael Tanner 1.00 0.00 X 0 0 0 Richard Terrell 1.00 0.00 X 0 0 0 John P Thompson Jr 1.00 0.00 X 0 0 0 Gifford Touchstone 1.00 0.00 X 0 0 0 Jimmy Westcott 1.00 0.00 X 0 0 0 Joel T Williams III 1.00 0.00 X 0 0 0 Darrell W Wootton 1.00 0.00 X 0 0 0 Sharon Worrell 1.00 0.00 X 0 0 0 Terry N Worrell 1.00 0.00 X 0 0 0 Mark Zacheis 1.00 0.00 X 0 0 0 Michael Frick 1.00 55.00 X X 0 160175 0 John P Kline 1.00 55.00 X X 0 698016 15009 Ray R Dziesinski 1.00 55.00 X X 0 722122 20019 Michele Whitsett 1.00 50.00 X 0 210425 12073 Stephanie K Smith 1.00 40.00 X 0 102713 744 Katherine Friend 40.00 0.00 X 0 220391 1357 Douglass Reed 40.00 0.00 X 0 197193 14020 Carol Mann-Bieler 40.00 0.00 X 0 194054 1623 William Braem 40.00 0.00 X 0 175477 2590 Lori Waggoner 40.00 0.00 X 0 173188 1138 0 4829062 153632 0 0 1 0 0 X 45875 1144902 44223755 32570 45414532 -790069 -790069 13086953 717184 759583 12369769 -759583 11610186 11610186 267085 1144902 1655531 -1388446 -1388446 Other Revenue 900099 93786 93786 93786 54939989 0 0 9525457 25461302 25461302 4500 4500 4228718 1734363 2494355 280170 114909 165261 714902 293209 421693 251426 103120 148306 521246 521246 88200 88200 630233 210846 419387 1511216 314544 1196672 558389 558063 326 13751 13438 313 381716 381716 71733 18996 52737 23124 23124 External Charitable Sup 317045 29875 287170 Special Events 122524 122524 Dues and Subscriptions 90027 81304 8723 Recruitment 42226 42226 59705 22627 37078 35372153 25465802 4551806 5354545 22417599 27328680 14800907 22182270 12161 13811872 0 188095 216231 19782675 232293 18911464 19550382 208362065 234019488 6091293 7203466 284583295 310512678 25895 141783 4636461 11290442 9868840 0 2982991 1452266 17514187 12884491 X 134757602 148350211 82212618 76097508 50098888 73180468 267069108 297628187 284583295 310512678 19567836 10991243 0 X 0 1 X 1 0 X 21344153 14371441 22099020 25338047 45414532 128567193 21344153 14371441 22099020 25338047 45414532 128567193 128567193 5517933 2345340 7174978 12403566 10221740 37663557 152057 18012 162350 16037 93786 442242 166672992 1995521 0.77140 0.75720 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 50098887 17127644 6458705 504768 73180468 48347994 1877733 575900 702740 50098887 41912397 812733 5622864 48347994 39929360 1180734 802303 41912397 38556230 2095272 -722142 39929360 1.00000 0 0 19537812 19537812 244863 232293 12570 19550382 Annuities and Trust Payable 1450678 Other LT Liabilities 1588 1452266 65931232 10991243 10991243 54939989 0 54939989 35372153 0 35372153 0 35372153 Description of Intended Use of Endowment Funds: Part V, Line 4: The Foundation's endowment fund earnings, depending on the donor's designation, are used for patient care, education, and research. If an endowment is designated as unrestricted, management may determine how the earnings are used. Part X, Line 2: The Children's Medical Center Foundation audited financial statements for the year ending December 31, 2012 do not contain a FIN 48 footnote. Red Balloon Run 774733 764533 10200 42057 490 6401 380182 Parade 478481 243090 235391 556 4425 1178032 1 158773 137279 21494 60 43328 1411987 1144902 267085 42057 1106 10826 1601542 1655531 -1388446 1 Children's Medical Center of Dallas 1935 Medical District Drive Dallas TX 75235 750800628 501(c)(3) 21467207 Program operations & Capital support Children's Medical Center Research Inst at UTSWMC 1935 Medical District Drive Dallas TX 75235 453462044 501(c)(3) 1929770 Program operations & Capital support Physicians for Children 1935 Medical District Drive Dallas TX 75235 752854505 501(c)(3) 1839681 Program operations & Capital support UT Southwestern Medical Center 5323 Harry Hines Blvd Dallas TX 75390 752556007 501(c)(3) 213844 Research salary support and Lectureship Anesthesiologists for Children 1935 Medical District Drive Dallas TX 75235 752917570 501(c)(3) 10800 Program operations & Capital support 5 Procedure for Monitoring Grants in the U.S.: Part I, Line 2: Schedule I, Part I, Line 2: Transfer of funds by the Foundation to Children's Medical Center and its affiliates as well as to UTSW are to reimburse them for expenditures that are to be covered by Foundation donated funds. 0 1 0 0 0 0 0 1 0 Christopher J Durovich 0 893847 0 934334 0 147127 0 60405 0 24653 0 2060366 0 514968 Michael Frick 0 105897 0 20000 0 34278 0 0 0 0 0 160175 0 0 John P Kline 0 256157 0 237295 0 204564 0 1666 0 13343 0 713025 0 64257 Ray R Dziesinski 0 383861 0 287925 0 50336 0 13379 0 6639 0 742140 0 173018 Michele Whitsett 0 186135 0 20580 0 3710 0 0 0 12073 0 222498 0 0 Katherine Friend 0 187096 0 20950 0 12345 0 0 0 1357 0 221748 0 0 Douglass Reed 0 188750 0 6760 0 1683 0 0 0 14020 0 211213 0 0 Carol Mann-Bieler 0 152317 0 36305 0 5432 0 0 0 1623 0 195677 0 0 William Braem 0 156526 0 17636 0 1315 0 0 0 2590 0 178067 0 0 Lori Waggoner 0 153084 0 16343 0 3761 0 0 0 1138 0 174326 0 0 Part I, Line 4b * Retirement Income Restoration Plan - Christopher J Durovich participated in the Retirement Income Restoration Plan. * Savings Restoration Plan - John P Kline received $44,386 as taxable income from the Savings Restoration Plan, as a result of a Qualifying Termination under the severance plan. Additional employees who participate in the Savings Restoration Plan are Christopher J Durovich and Ray R Dziesinski. Part I, Line 7 Non-Fixed Payments - The Human Resources Committee of the Board of Directors retains the authority to adjust annual payout percentages solely at their discretion. X 2 32570 Expert Appraisal 2 0 1 0 Form 990, Part VI, Section A, line 1 Executive Committee, whose charter and membership shall be reviewed and approved annually by the Board of Directors of CHST, and shall be comprised of 10-15 members, the majority of whom must be Directors of the Corporation. The Chairman of the Executive Committee shall be the Chairman of the Board of the Corporation. The Executive Committee shall have the power to perform any and all acts relating to the affairs of the Corporation and to exercise any and all powers of the Board in the management and direction of the business and conduct of the Corporation, subject to any limitations provided by applicable law, the articles of incorporation of the Corporation or these bylaws. It may meet or conduct its business in any fashion or by any means applicable to the meetings of the Board or Directors and shall keep a record of its proceedings and report the same to the Board at each succeeding meeting of the Board. Form 990, Part VI, Section A, line 2 David Beuerlein and Sheila Beuerlein - Family Relationship Harlan Korenvaes and Amy Korenvaes - Family Relationship Ric Scripps and Debbie Scripps - Family Relationship Sharon Worrell and Terry Worrell - Family Relationship Form 990, Part VI, Section A, line 3 All management duties are performed by employees of the organization's affiliate, Children's Medical Center of Dallas ("Children's"). A contract between the organization and Children's covers all services provided. Form 990, Part VI, Section A, line 6 Children's Health Services of Texas ("CHST"), a Texas non profit corporation, is the sole member of the organization. Form 990, Part VI, Section A, line 7a CHST elects all members of the organization's Board of Directors. Form 990, Part VI, Section A, line 7b Decisions requiring approval by the member include: (a) Any change in the mission or purpose of the Corporation; (b) Any amendment to the Certificate of Formation or Bylaws of the Corporation; (c) Any addition of new members; (d) Approval of the annual budget for the Corporation; (e) Acquiring, selling, leasing, disposing of or mortgaging any real estate; (f) Selling, exchanging, or otherwise disposing of all or substantially all of the Corporation's assets; (g) Making expenditures of the Corporation's funds in excess of an amount which is established by CHST from time to time or which represent a significant departure from established policies or objectives of the Corporation; (h) Guaranteeing the debts of others; (i) Merging, consolidating, or entering into any joint business venture with any other person, corporation, or other legal entity; (j) Transferring any portion of the Corporation's assets to another person or legal entity other than pursuant to Section(f) above, or pursuant to the annual budget or policies of the Corporation governing the Corporation's support of Children's and its affiliates; (k) Appointment and removal of directors in accordance with Article 3 of these Bylaws; or (l) Taking any action where the Board of Directors has received notice that such prior approval is required. Form 990, Part VI, Section B, line 11 A draft of the Form 990 is presented to the organization's Audit Committee. The Chief Financial Officer provides a detailed review of the Form 990 and answers questions presented by the Committee members. Form 990, Part VI, Section B, line 12c The Board members receive a copy of the policy, along with a Disclosure of possible Conflict of Interests form to complete, with their annual Board appointment letter. All disclosures made are reviewed by the Chief Compliance Officer and Vice President of Legal Affairs and Governance prior to being presented and discussed at a meeting of the board of directors to determine if further action is required. Form 990, Part VI, Section B, line 15 The organization's CEO, President, other officers, and key employees are employed and compensated by Children's Medical Center of Dallas ("Children's"). The Children's process for determining compensation is as follows: 1. The Human Resources Committee of the Board is responsible for setting the compensation for executives, except the President and CEO which is set by the Board of Directors. The Committee is comprised of independent, non-employee directors with no conflict of interest regarding executive compensation. A written compensation philosophy has been developed by the Human Resources Committee for timeliness and appropriateness. The philosophy defined desired comparator groups for compensation surveys. The comparator groups are from domestic healthcare industry sectors only and do not include any non-healthcare organizations. 2. The compensation philosophy also defines target levels relative to the marketplace comparator groups for base pay, base pay plus incentive pay, and fringe benefits provided to Children's executives. A third-party consultant, Sullivan Cotter, is engaged by the Human Resources Committee and provides independent, expert consulting services in the area of executive compensation market surveying, pay and benefits program design, and administrative services. Salaries for Children's executives (except for the President and CEO) are set by comparing the salaries paid for comparable positions in integrated systems academic medical centers and children's hospitals in similar size and scope of services to Children's. 3. The salary for the President and CEO is set in reference to salaries paid for Presidents and CEOs of children's hospitals in similar size and scope of services to Children's. The data is compiled by Sullivan Cotter and they develop and update annually salary ranges unique to each executive position. The Human Resources Committee approves base pay for each executive )except the President and CEO, whose base pay is approved by the Board of Directors) aimed in the aggregate at approximately the middle of executive pay ranges. 4. For other officers and key employees, Children's uses a combination of job evaluation and survey data to determine the market pay range. Form 990, Part VI, Section C, line 19 Governing documents, the conflict of interest policy, and financial statements are made available upon request. Form 990, Part VII, Section A - Average Hours per Week Average hours per week have been identified as 60 hours/week for the CEO as there are numerous offsite community events which involve weekend, breakfast, and evening meetings. Average hours per week for Senior Vice Presidents have been identified as 55 hours per week as they are involved with limited offsite community events. Average hours per week for all Vice Presidents have been identified as 50 hours per week as they have some involvement with offsite community events. Form 990, Part VIII, Line 3 - Investment income A reversal of $1.3 million of accrued interest income as a result of a default on a prior year sale of land, combined with dividend and interest income earned for the current year, resulted in the negative investment income reported on Part VIII, Line 3. Children's Medical Center of Dallas 1935 Medical District Drive Dallas TX 75235 750800628 Hospital TX 501(c)(3) Line 3 Children's Hlth Svc of TX 0 Anesthesiologists For Children 1935 Medical District Drive Dallas TX 75235 752917570 Physicians TX 501(c)(3) Line 9 Children's Medical Center of Dallas 0 Dallas Phys Medical Svs for Children Inc 1935 Medical District Drive Dallas TX 75235 810584868 Physicians TX 501(c)(3) Line 9 Children's Medical Center of Dallas 0 Children's Health Svc of Texas 1935 Medical District Drive Dallas TX 75235 752062019 Management Company TX 501(c)(3) Line 11a, I N/A 0 Physicians For Children 1935 Medical District Drive Dallas TX 75235 752854505 Physicians TX 501(c)(3) Line 9 Children's Medical Center of Dallas 0 Children's Med Ctr Research Inst at UTSWMC 1935 Medical District Drive Dallas TX 75235 433462044 Research Institute TX Pending Pending Children's Hlth Svc of TX 0 Complex Care Medical Services 1935 Medical District Drive Dallas TX 75235 461893597 Medical Services TX Pending Pending Children's Medical Center of Dallas 0 Pediatric Partners For Children 1935 Medical District Drive Dallas TX 75235 461917702 Clinically Integrated Network TX Pending Pending Children's Medical Center of Dallas 0 Children's Medical Center Services 1935 Medical District Drive Dallas TX 75235 461934007 Medical Services TX Pending Pending Children's Medical Center of Dallas 0 Southwestern Medical District 1935 Medical District Drive Dallas TX 75235 204101612 Medical District TX 501(c)(3) Line 11a, I N/A 0 Women's Auxiliary of CMCD 1935 Medical District Drive Dallas TX 75235 752485538 Women's Auxiliary TX 501(c)(3) Line 9 N/A 0 Children's Insurance Company 76 St Paul Street Suite 500 Burlington VT 05401 030328102 Insurance Company VT Children's Hlth Svc of TX C 0 Alternative Care Systems 1935 Medical District Drive Dallas TX 75235 752244475 Other Medical Services TX Children's Med Ctr of Dallas C 0 0 1 0 0 0 0 0 0 0 0 0 1 0 1 1 1 0 0 0