2014-05-14T12:04:36-05:00 2013-09-30 742014723 LAUTERBACH BORSCHOW & COMPANY PC 4130 RIO BRAVO DRIVE EL PASO TX 79902 990 2012-10-01 263075429 EL PASO CHILDREN'S HOSPITAL CORPORATION ELPA 9152428602 4845 ALAMEDA EL PASO TX 79905 RAY DZIESINSKI 9152428602 2014-05-14 1 CINDY F LYONS CPA P00061457 9155446950 2014-05-14 2012 2015-11-30 17:44:51Z RAY DZIESINSKI 4845 ALAMEDA EL PASO TX 79905 90534948 0 X ELPASOCHILDRENSHOSPITAL.ORG X 2007 TX TO PROVIDE CARE FOR CHILDREN 11 11 650 117 0 0 2448077 981929 44766803 89548157 3230 4862 0 0 47218110 90534948 0 0 0 0 21008102 34346727 0 0 0 49342624 69476740 70350726 103823467 -23132616 -13288519 32057358 28660434 55000672 64892267 -22943314 -36231833 X TO PROVIDE COMPASSIONATE, COORDINATED, FAMILY-CENTERED CARE FOR CHILDREN WITH A DEDICATED COMMITMENT TO EXCELLENT PATIENT OUTCOMES, INCLUSIVE LEADERSHIP AND INNOVATIVE PEDIATRIC RESEARCH AND EDUCATION 0 0 88424308 89548157 EL PASO CHILDREN'S HOSPITAL IS THE ONLY SEPARATELY LICENSED, NON-TAXING, INDEPENDENT, 501(C)(3) NOT-FOR-PROFIT CHILDRENS' HOSPITAL IN THE EL PASO, TEXAS REGION AND THE ONLY DEDICATED PEDIATRIC HOSPITAL WITHIN A 200-MILE RADIUS. THE HOSPITAL PROVIDES PEDIATRIC INPATIENT, OUTPATIENT AND EMERGENCY CARE SERVICES TO CHILDREN FROM BIRTH THROUGH ADOLESCENCE. IT RECEIVED THE JOINT COMMISSION ACCREDITATION ON MARCH 9, 2012, ITS MEDICAID PROVIDER NUMBER IN JUNE, 2012, AND OPENED FEBRUARY 14, 2012. THROUGH THE HOSPITAL'S AFFILIATION WITH TEXAS TECH UNIVERSITY HEALTH SCIENCE CENTER, THE HOSPITAL CONDUCTS PEDIATRIC RESEARCH AND EDUCATION, AND SERVES AS A TEACHING HOSPITAL FOR THE TEXAS TECH RESIDENCY PROGRAM.THE HOSPITAL HAS FOUR FULL-TIME TEXAS MEDICAID HEALTHCARE PARTNERSHIP (TMHP) PERSONNEL LOCATED IN THE BUILDING TO ENSURE THAT EVERY ELIGIBLE PATIENT IS ENROLLED. CHIP-TEXAS IS SPECIFICALLY LEGISLATED TO PROVIDE MEDICAID-LIKE COVERAGE TO CHILDREN EVEN IF THEIR PARENTS DO NOT QUALIFY. AS A RESULT, THE FEDERALLY DEFINED AND REPORTED 1.8% OF TOTAL EXPENSE ON SCHEDULE H ON FORM 990 FOR TEXAS-BASED PEDIATRIC HOSPITALS IS GENERALLY LOW. THIS INDICATES THAT THE LARGE MARJORITY OF CHILDREN CAN BE ENROLLED IN SOME TYPE OF GOVERNMENT PROGRAM. AS A RESULT, ONLY A VERY FEW CASES REMAIN IN THE TRADITIONAL CATEGORY OF "CHARITY". THOSE PATIENTS REMAINING IN A "CHARITY" CLASSIFICATION ARE PROVIDED FREE OR REDUCED CHARGES PER WRITTEN EL PASO CHILDREN'S HOSPITAL POLICY. MORE CHARITY CARE INFORMATION IS AVAILABLE ON PAGE 18 OF THE ORGANIZATION'S AUDITED FINANCIAL STATEMENTS, ATTACHED. 88424308 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 77 0 1 650 1 0 0 0 0 0 0 0 0 0 0 X 11 11 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X X X X CHRISTOPHER BARELA 9152428602 4845 ALAMEDA EL PASO TX 79905 LAWRENCE G DUNCAN 60.00 X X 387754 0 25999 SAM LEGATE 1.00 X 0 0 0 JOHN GUGGEDAHL MD 1.00 X 0 0 0 SADHANA CHHEDA MD 1.00 X 0 0 0 CLARENCE ANSLEY 1.00 X 0 0 0 THOMAS A SPIECZNY 1.00 X 0 0 0 MARY LOU CAMARENA 1.00 X 0 0 0 ROSEMARY CASTILLO 1.00 X 0 0 0 KRISTEN COX 1.00 X 0 0 0 HECTOR ALMEIDA 1.00 X 0 0 0 CHRIS KLEBERG 1.00 X 0 0 0 JILL VOGEL 40.00 X 102858 0 12013 DEBBIE CHASCO 40.00 X 104167 0 11583 KRISTA RATLIFF 40.00 X 91775 0 5121 ELISA GARCIA 40.00 X 96921 0 1570 CHRISTOPHER BARELA 40.00 X 78156 0 7655 ANA MARIA HERNANDEZ 40.00 X 69949 0 15203 JANE SANCHEZ 40.00 X 62225 0 7788 PAUL OCON 40.00 X 181510 0 14871 DAVID MIER 40.00 X 170244 0 13321 ELIAS ARMENDARIZ 40.00 X 141016 0 11079 ANDREW TEN EICK 40.00 X 132007 0 10189 1618582 0 136392 7 0 1 0 TEXAS TECH UNIVERSITY HEALTH SCIENCE CEN 4800 ALBERTA EL PASO TX 79905 PHYSICIAN SERVICES 6628857 WESTERN RESERVE LIFE INSURANCE COMPANY C 190 US ROUTE ONE PMB 365 FALMOUTH ME 04105 INSURANCE 1166417 QUESTCARE MEDICAL SERVICES PA 12221 MERIT DR STE 1610 DALLAS TX TX 75251 CONTRACT LABOR - ED PHYSICIANS 977675 QUEST DIAGNOSTICS NICHOLS INSTITUTE 12436 COLLECTION CENTER DR CHICAGO IL 60693 LABORATORY SERVICES 743899 BLOOD SYSTEMS INC PO BOX 53022 PHOENIX AZ 85072 BLOOD SERVICES 627786 12 235683 746246 981929 PATIENT CARE 621500 89548157 89548157 89548157 4862 4862 90534948 89548157 0 4862 X 28311233 24244200 4067033 1281636 1049328 232308 2681827 2681827 2072031 1774375 297656 112441 112441 12072265 12072265 97927 97927 1663 1663 15137162 11632620 3504542 35974 35974 2119243 2119243 607403 607403 389662 389662 PURCHASED SERVICES 21437808 19792137 1645671 MEDICAL/SURGICAL SUPPLI 8974600 8974600 BAD DEBTS 4734345 4734345 UTILITIES 987244 987244 2769003 1468611 1300392 103823467 88424308 15399159 0 3235320 1895353 65965 38520 23325120 21179168 1721795 1650880 128261 202518 4482119 788124 3580897 3693995 32057358 28660434 55000672 64044147 848120 55000672 64892267 X 0 0 0 0 -22943314 -36231833 -22943314 -36231833 32057358 28660434 -13288519 0 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 466072 51786 414286 4016047 736338 3279709 3693995 X DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: FIN 48 DISCLOSURE REFLECTED IN ENTITY'S CONSOLIDATED FINANCIAL STATEMENTS: THE HOSPITAL RECOGNIZES THE TAX BENEFIT FROM UNCERTAIN TAX POSITIONS ONLY IF IT IS MORE LIKELY THAN NOT THAT THE TAX POSITIONS WILL BE SUSTAINED ON EXAMINATION BY THE TAX AUTHORITIES, BASED ON THE TECHNICAL MERITS OF THE POSITION. THE TAX BENEFIT IS MEASURED BASED ON THE LARGEST BENEFIT THAT HAS A GREATER THAN 50% LIKELIHOOD OF BEING REALIZED UPON ULTIMATE SETTLEMENT. THE HOSPITAL HAD NO UNRECOGNIZED TAX BENEFITS AT SEPTEMBER 30, 2013 AND 2012. THE HOSPITAL FILES EXEMPT ORGANIZATION RETURNS AND APPLICABLE UNRELATED BUSINESS INCOME TAX RETURNS IN THE U.S. FEDERAL JURISDICTION AND TEXAS DEPARTMENT OF REVENUE. THE HOSPITAL IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS BY TAXING AUTHORITIES FOR YEARS BEFORE FISCAL YEAR 2008 FOR ITS FEDERAL AND STATE FILINGS. 1 1 1 X 1 X 1 1 1 0 0 1357000 1357000 0.01370 20881615 20455097 426518 0.00430 22238615 20455097 1783518 0.01800 22238615 20455097 1783518 0.01800 1 4734345 2811013 119998 119998 1 1 1 1 EL PASO CHILDREN'S HOSPITAL

4845 ALAMEDA AVE EL PASO TX 79905

X X EL PASO CHILDREN'S HOSPITAL 1 0 1 1 200.000000000000 1 200.000000000000 1 X X X X 1 1 X X X 1 0 1 X 0 0 PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 4734345. PART III, LINE 4: THE HOSPITALS ALLOWANCE FOR DOUBTFUL ACCOUNTS FOR SELF-PAY PATIENTS WAS 93% AND 99% OF SELF-PAY ACCOUNTS RECEIVABLE AT SEPTEMBER 30, 2013 AND 2012, RESPECTIVELY. DURING THE YEARS ENDED SEPTEMBER 30, 2013 AND 2012, THE HOSPITAL WROTE OFF $4,054,000 AND $960,000 SELF-PAY RECEIVABLES, AND DID NOT CHANGE ITS CHARITY CARE OR UNINSURED DISCOUNT POLICIES. THE HOSPITAL DOES NOT MAINTAIN A MATERIAL ALLOWANCE FOR DOUBTFUL ACCOUNTS FROM THIRD-PARTY PAYORS, NOR DID IT HAVE SIGNIFICANT WRITEOFFS FROM THIRD-PARTY PAYORS. PART III, LINE 9B: THE HOSPITAL OUTSOURCES BILLING AND COLLECTION FUNCTIONS TO A THIRD-PARTY SERVICE PROVIDER. IT DOES NOT PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE. X X 0 0 0 0 0 0 0 0 0 LAWRENCE G DUNCAN 312280 0 58365 0 17109 0 20500 0 5499 0 413753 0 0 0 PAUL OCON 154860 0 15182 0 11468 0 11811 0 3060 0 196381 0 0 0 DAVID MIER 150547 0 8404 0 11293 0 8357 0 4964 0 183565 0 0 0 ELIAS ARMENDARIZ 120665 0 9946 0 10405 0 8154 0 2925 0 152095 0 0 0 FORM 990, PART VI, SECTION B, LINE 11 EL PASO CHILDREN'S HOSPITAL ENGAGES AN INDEPENDENT ACCOUNTING FIRM EXPERIENCED IN THE PREPARATION OF THE FORM 990 TO PREPARE ITS FORM 990. THE ORGANIZATION'S FINANCE AND LEGAL DEPARTMENTS REVIEW THE 990. THE FINAL 990 WITH ALL REQUIRED SCHEDULES IS PROVIDED TO ALL VOTING MEMBERS OF THE BOARD OF DIRECTORS, THE CHIEF EXECUTIVE OFFICER, THE CHIEF FINANCIAL OFFICER, THE CONTROLLER, AND THE ACCOUNTING MANAGER FOR REVIEW, CHANGES, AND APPROVAL PRIOR TO FILING FORM 990. FORM 990, PART VI, SECTION B, LINE 12C EPCH LEADERS AND MEMBERS OF THE MEDICAL STAFF SIGN A CONFLICT OF INTEREST CERTIFICATION AND ACKNOWLEDGEMENT OF CONFLICT OF INTEREST POLICY (ATTACHMENT 1) ANNUALLY, CERTIFYING THAT THEY RECEIVED, READ, AND UNDERSTOOD THIS CONFLICT OF INTEREST POLICY AND AGREE TO COMPLY WITH IT. EPCH LEADERS OBTAIN THE CERTIFICATION FORM FROM THE COMPLIANCE OFFICE. ANNUALLY, THE COMPLIANCE OFFICER PROVIDES NOTIFICATION TO EPCH LEADERS TO COMPLETE THE FORM. IT IS THE EPCH LEADERS RESPONSIBILITY TO RETURN THE SIGNED FORM TO THE COMPLIANCE OFFICE NO LATER THAN THE SEVENTH (7TH) BUSINESS DAY UPON NOTIFICATION FROM THE COMPLIANCE OFFICER AS STATED ABOVE. FAILURE TO RETURN THE FORM TO THE COMPLIANCE OFFICE SHALL CAUSE THE EPCH LEADER TO BE IN VIOLATION OF THIS POLICY. MEMBERS OF THE MEDICAL STAFF OBTAIN THE CERTIFICATION FORM FROM MEDICAL STAFF SERVICES AT THE TIME OF INITIAL CREDENTIALING AND RECREDENTIALING. IT IS THE MEDICAL STAFF MEMBERS RESPONSIBILITY TO RETURN THE SIGNED FORM TO MEDICAL STAFF SERVICES IN A TIMELY MANNER. MEDICAL STAFF MEMBERS WILL NOT BE (RE)CREDENTIALED IN THE ABSENCE OF A SIGNED CONFLICT OF INTEREST CERTIFICATION AND ACKNOWLEDGEMENT OF CONFLICT OF INTEREST POLICY. EACH TIME A PROCUREMENT PROCESS IS INITIATED AND A COMMITTEE IS INVOLVED IN MAKING A DECISION OR RECOMMENDATION ON A BUSINESS RELATIONSHIP, A CONFLICT OF INTEREST CERTIFICATION STATEMENT MUST BE COMPLETED BY THOSE COMMITTEE MEMBERS WHO HAVE NOT PREVIOUSLY COMPLETED THE ANNUAL CERTIFICATION. THE COMPLIANCE OFFICE MAINTAINS THE FILE OF THE ANNUAL CERTIFICATION FORMS. IN CONNECTION WITH ANY ACTUAL OR POSSIBLE CONFLICTS OF INTEREST, AN INTERESTED PERSON MUST DISCLOSE THE EXISTENCE OF, AND ALL MATERIAL FACTS CONCERNING HIS OR HER FINANCIAL/PERSONAL INTEREST TO THE COMPLIANCE OFFICER WITHIN SEVEN (7) BUSINESS DAYS OF IDENTIFYING THE ACTUAL OR POTENTIAL CONFLICT. SUCH DISCLOSURE WILL BE MADE IN WRITING BY SUBMITTING A HOSPITAL CONFLICT OF INTEREST CERTIFICATION AND ACKNOWLEDGEMENT OF CONFLICT OF INTEREST POLICY FORM. OUTSIDE INTERESTS SHALL BE DISCLOSED AS A POTENTIAL CONFLICT OF INTEREST WHEN EPCH LEADERS RECEIVE MONIES FOR DUTIES PERFORMED AT ENTITIES WITH THE SAME OR SIMILAR SERVICE OFFERED AND IN A GEOGRAPHIC LOCATION SERVING THE SAME COMMUNITY. THE COMPLIANCE OFFICER REVIEWS WITH THE CEO AND GENERAL COUNSEL ANY CONFLICT OF INTEREST CERTIFICATION FORMS THAT IDENTIFY POTENTIAL CONFLICTS. THE COMPLIANCE OFFICER MAY ASK THE INTERESTED PERSON TO DISCUSS THE PROPOSED TRANSACTION IN ORDER TO OBTAIN FURTHER DETAILS. THE COMPLIANCE OFFICER MAY, IF APPROPRIATE, APPOINT A DISINTERESTED PERSON OR COMMITTEE TO INVESTIGATE ALTERNATIVES TO ANY PROPOSED TRANSACTION OR ARRANGEMENT AND DETERMINES WHETHER THE HOSPITAL CAN OBTAIN A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT WITH REASONABLE EFFORTS FROM A PERSON OR ENTITY THAT WOULD NOT GIVE RISE TO A CONFLICT OF INTEREST. THE COMPLIANCE OFFICER PROVIDES QUARTERLY REPORTS TO THE BOARD OF DIRECTORS DETAILING CONFLICTS OF INTEREST AND HOW THEY WERE ADDRESSED. WITH RESPECT TO RESEARCH CONFLICTS OF INTEREST, EPCH REQUIRES THAT A RESEARCH INVESTIGATOR DISCLOSE TO EPCH OUTSIDE FINANCIAL INTERESTS ABOVE SPECIFIED THRESHOLDS WHEN RESEARCH WOULD LIKELY BE AFFECTED BY THOSE INTERESTS. EPCH THEN REVIEWS THE DISCLOSURES, DETERMINES WHETHER THERE IS A CONFLICT AND, IF SO, MANAGES, REDUCES, OR ELIMINATES IT, BEFORE ALLOWING PARTICIPATION IN THE PROPOSED RESEARCH PROJECT. UPON DISCOVERY OF A POTENTIAL CONFLICT OF INTEREST THAT HAS NOT BEEN DISCLOSED, THE EPCH LEADER/MEDICAL STAFF MEMBER IS NOTIFIED BY THE COMPLIANCE OFFICER AND AFFORDED THE OPPORTUNITY TO EXPLAIN THE ALLEGED FAILURE TO DISCLOSE. IF, AFTER REVIEWING THE RESPONSE AND MAKING SUCH FURTHER INVESTIGATION AS APPROPRIATE, THE COMPLIANCE OFFICER SHALL INFORM THE CEO OF THE DETERMINATION WHETHER THE EPCH LEADER/MEDICAL STAFF MEMBER FAILED TO DISCLOSE AN ACTUAL OR POTENTIAL CONFLICT OF INTEREST. ANY VIOLATIONS OF THIS POLICY MAY BE GROUNDS FOR DISCIPLINARY ACTION INCLUDING TERMINATION OF EMPLOYMENT OR HOSPITAL CREDENTIALS, AND FOR CIVIL OR CRIMINAL PROSECUTION. FORM 990, PART VI, SECTION B, LINE 15 EL PASO CHILDREN'S HOSPITAL DETERMINES COMPENSATION FOR ITS CEO AND OTHER OFFICERS AND KEY EMPLOYEES BY CONSIDERING SALARY RANGES, SALARY SURVEYS, AND MARKET ANALYSES FOR EACH POSITION. SPECIFICALLY, THE BOARD OF DIRECTORS' COMPENSATION COMMITTEE REVIEWS AND RECOMMENDS SALARIES FOR THE CEO, OTHER OFFICERS, AND KEY EMPLOYEES. THE BOARD OF DIRECTORS APPROVES SALARIES FOR THE CEO AND OTHER OFFICERS. THE CEO APPROVES SALARIES FOR KEY EMPLOYEES (DIRECTOR LEVEL AND BELOW). FORM 990, PART VI, SECTION C, LINE 19 PART VI, SECTION C, LINE 19: THE ORGANIZATION FURNISHES COPIES OF ITS GOVERNING DOCUMENTS, CONFLICTS OF INTEREST POLICY, FORM 990, AND/OR FINANCIAL STATEMENTS TO THE PUBLIC UPON REQUEST. ADDITIONALLY, FORMS 990 WILL BE PUBLISHED ON THE ORGANIZATION'S WEBSITE AND CAN BE FOUND ON ANOTHER'S WEBSITE, GUIDESTAR.COM. OTHER FEES FORM 990, PART IX, LINE 11G PROFESSONAL FEES: PROGRAM SERVICE EXPENSES 12,072,265. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 12,072,265. EL PASO CHILDREN'S PHYSICIAN GROUP 4845 ALAMEDA EL PASO TX 79905 455465061 PHYSICIAN SERVICE TX 501(C)(3) LINE 3 N/A 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 EL PASO CHILDREN'S PHYSICIAN GROUP S 560855 COST EL PASO CHILDREN'S PHYSICIAN GROUP M 2860428 COST