Form990
Click to see attachment
Department of the Treasury
Internal Revenue Service
Return of Organization Exempt From Income Tax
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except black lung benefit trust or private foundation)

MediumBullet The organization may have to use a copy of this return to satisfy state reporting requirements.
OMB No. 1545-0047
2010
Open to Public Inspection
A For the calendar year, or tax year beginning 10-01-2010 and ending 09-30-2011
BCheck if applicable:
CName of organization
Cook Children's Medical Center
 
Doing Business As
 
 
Number and street (or P.O. box if mail is not delivered to street address)
801 Seventh Avenue
 
Room/suite
City or town, state or country, and ZIP + 4
Fort Worth, TX76104
D Employer identification number

75-2051646
E Telephone number

G Gross receipts $ 657,673,218
F Name and address of principal officer:
NANCY CYCHOL
801 SEVENTH AVENUE
FORT WORTH,TX76104
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
WWW.COOKCHILDRENS.ORG
H(a)
Is this a group return for
affiliates?
H(b)
Are all affiliates included?
If "No," attach a list. (see instructions)
H(c)
Group exemption number MediumBullet  
K Form of organization:
 
L Year of formation: 1985
M State of legal domicile: TX
Part I
Summary
Activities & Governance 1 Briefly describe the organization’s mission or most significant activities: KNOWING THAT EVERY CHILD'S LIFE IS SACRED, IT IS THE PROMISE OF COOK CHILDREN'S TO IMPROVE THE HEALTH OF EVERY CHILD IN OUR REGION THROUGH THE PREVENTION AND TREATMENT OF ILLNESS, DISEASE AND INJURY.
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a) .... 3 18
4 Number of independent voting members of the governing body (Part VI, line 1b) .... 4 14
5 Total number of individuals employed in calendar year 2010 (Part V, line 2a) ... 5 3,551
6 Total number of volunteers (estimate if necessary) .... 6 1,192
7a Total unrelated business revenue from Part VIII, column (C), line 12 .. 7a 37,046
b Net unrelated business taxable income from Form 990-T, line 34 .. 7b  
Revenues; Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 5,735,863 5,788,048
9 Program service revenue (Part VIII, line 2g) ......... 561,457,980 646,232,800
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 1,962,612 79,302
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 7,023,290 3,885,405
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)................... 576,179,745 655,985,555
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 36,628,234 42,862,351
14 Benefits paid to or for members (Part IX, column (A), line 4) .... 0 0
15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10) 215,700,718 236,534,786
16a Professional fundraising fees (Part IX, column (A), line 11e).... 0 0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet0    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24f).... 232,016,571 245,457,158
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 484,345,523 524,854,295
19 Revenue less expenses. Subtract line 18 from line 12...... 91,834,222 131,131,260
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............ 761,990,272 717,528,502
21 Total liabilities (Part X, line 26)............ 404,033,064 414,633,348
22 Net assets or fund balances. Subtract line 21 from line 20 ..... 357,957,208 302,895,154
Part II
Signature Block
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.
Sign Here
JumboBullet
Signature of officer Date
JumboBullet
Type or print name and title.
Paid Preparer's Use Only Preparer's
signatureBig Right Arrow 		Date
right pointing bullet image Preparer’s taxpayer identification number
(see instructions)
Firm’s name (or yours
if self-employed),
address, and ZIP + 4Big Right Arrow




 		EIN right pointing bullet image
Phone no. right pointing bullet image
May the IRS discuss this return with the preparer shown above? (see instructions) .........
For Privacy Act and Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y
Form 990 (2010)
Form 990 (2010)
Page 2
Part III
Statement of Program Service Accomplishments
Check if Schedule O contains a response to any question in this Part III . . . . . . . . . .
1
Briefly describe the organization’s mission: KNOWING THAT EVERY CHILD'S LIFE IS SACRED, IT IS THE PROMISE OF COOK CHILDREN'S TO IMPROVE THE HEALTH OF EVERY CHILD IN OUR REGION THROUGH THE PREVENTION AND TREATMENT OF ILLNESS, DISEASE AND INJURY.
2
Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? ....................
If “Yes,” describe these new services on Schedule O.
3
Did the organization cease conducting, or make significant changes in how it conducts, any program services? ..........................
If “Yes,” describe these changes on Schedule O.
4
Describe the exempt purpose achievements for each of the organization’s three largest program services by expenses.
Section 501(c)(3) and 501(c)(4) organizations and section 4947(a)(1) trusts are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.
4a (Code:   ) (Expenses $ 397,030,619 including grants of $ 42,862,351 ) (Revenue $ 648,847,942 )
Cook CHILDREN'S MEDICAL CENTER IS RANKED IN THE TOP 6 PERCENT OF THE NATION'S hospitals for its nursing excellence and has a distinguished international reputation for providing extraordinary care and achieving positive outcomes in its neurology, neurosurgery, cardiology, cardiothoracic surgery, hematology and oncology, neonatology, and pulmonology programs. The medical center accounted for 81% of Tarrant County's pediatric admissions in 2008. CONTINUED ON SCHEDULE O
4b (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4c (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4d Other program services. (Describe in Schedule O.)
(Expenses $   including grants of $   ) (Revenue $   )
4e Total program service expensesMediumBullet$ 397,030,619
Form 990 (2010)
Form 990 (2010)
Page 3
Part IV
Checklist of Required Schedules
Yes
No
1
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If “Yes,” complete Schedule AClick to see attachment.....................
1
Yes
 
2
Is the organization required to complete Schedule B, Schedule of Contributors? Click to see attachment........
2
Yes
 
3
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If “Yes,” complete Schedule C, Part I..........
3
 
No
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities? If “Yes,” complete Schedule C,
Part II.........................
4
 
No
5
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19? If “Yes,” complete Schedule C, Part III........................
5
 
 
6
Did the organization maintain any donor advised funds or any similar funds or accounts where donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If “Yes,” complete
Schedule D, Part IClick to see attachment.......................
6
 
No
7
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas or historic structures? If “Yes,” complete Schedule D, Part IIClick to see attachment...
7
 
No
8
Did the organization maintain collections of works of art, historical treasures, or other similar assets? If “Yes,” complete Schedule D, Part III Click to see attachment....................
8
 
No
9
Did the organization report an amount in Part X, line 21; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If “Yes,”
complete Schedule D, Part IVClick to see attachment...................
9
 
No
10
Did the organization, directly or through a related organization, hold assets in term, permanent,or quasi-endowments? If “Yes,” complete Schedule D, Part VClick to see attachment
10
Yes
 
11
If the organization’s answer to any of the following questions is ‘Yes,’ then complete Schedule D, Parts VI, VII, VIII, IX, or X as applicable:
a
Did the organization report an amount for land, buildings, and equipment in Part X, line10? If “Yes,” complete Schedule D, Part VI.Click to see attachment
11a
Yes
 
b
Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VII.Click to see attachment
11b
 
No
c
Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VIII.Click to see attachment
11c
 
No
d
Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part IX.Click to see attachment
11d
 
No
e
Did the organization report an amount for other liabilities in Part X, line 25? If “Yes,” complete Schedule D, Part X.Click to see attachment
11e
Yes
 
f
Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If “Yes,” complete Schedule D, Part X.Click to see attachment
11f
Yes
 
12a
Did the organization obtain separate, independent audited financial statements for the tax year? If “Yes,” complete Schedule D, Parts XI, XII, and XIII Click to see attachment
12a
 
No
b
Was the organization included in consolidated, independent audited financial statements for the tax year? If “Yes,” and if the organization answered ‘No’ to line 12a, then completing Schedule D, Parts XI, XII, and XIII is optional Click to see attachment
12b
Yes
 
13
Is the organization a school described in section 170(b)(1)(A)(ii)? If “Yes,” complete Schedule E
13
 
No
14a
Did the organization maintain an office, employees, or agents outside of the United States?....
14a
 
No
b
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, and program service activities outside the United States? If “Yes,” complete Schedule F, Part I.........
14b
 
No
15
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or assistance to any organization or entity located outside the U.S.? If “Yes,” complete Schedule F, Part II..
15
 
No
16
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or assistance to individuals located outside the U.S.? If “Yes,” complete Schedule F, Part III..
16
 
No
17
Did the organization report a total of more than $15,000, of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11e? If “Yes,” complete Schedule G, Part I
17
 
No
18
Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If “Yes,” complete Schedule G, Part II..........
18
 
No
19
Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If “Yes,” complete Schedule G, Part III...................
19
 
No
Form 990 (2010)
Form 990 (2010)
Page 4
Part IV
Checklist of Required Schedules (continued)
20a
Did the organization operate one or more hospitals? If “Yes,” complete Schedule H..... Click to see attachment
20a
Yes
 
b
Did the organization attach its audited financial statement to this return? Note: All Form 990 filers that operate one or more hospitals must attach audited financial statements. ..... Click to see attachment
20b
Yes
 
21
Did the organization report more than $5,000 of grants and other assistance to governments and organizations in the United States on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II.. Click to see attachment
21
Yes
 
22
Did the organization report more than $5,000 of grants and other assistance to individuals in the United States on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III..... Click to see attachment
22
Yes
 
23
Did the organization answer “Yes” to Part VII, Section A, questions 3, 4, or 5, about compensation of the organization’s current and former officers, directors, trustees, key employees, and highest compensated employees? If “Yes,” complete Schedule J................ Click to see attachment
23
Yes
 
24a
Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If “Yes,” answer questions 24b–24d and complete Schedule K. If “No,” go to line 25................ Click to see attachment
24a
Yes
 
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
No
c
Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds?......................
24c
 
No
d
Did the organization act as an “on behalf of” issuer for bonds outstanding at any time during the year?...
24d
 
No
25a
Section 501(c)(3) and 501(c)(4) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If “Yes,” complete Schedule L, Part I......
25a
 
No
b
Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If “Yes,” complete Schedule L, Part I................
25b
 
No
26
Was a loan to or by a current or former officer, director, trustee, key employee, highly compensated employee, or disqualified person outstanding as of the end of the organization’s tax year? If “Yes,” complete Schedule L,
Part II...........................
26
 
No
27
Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial contributor, or a grant selection committee member, or to a person related to such an individual? If “Yes,” complete Schedule L, Part III...............
27
 
No
28
Was the organization a party to a business transaction with one of the following parties? (see Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):
a
A current or former officer, director, trustee, or key employee? If “Yes,” complete Schedule L, Part IV .........................
28a
 
No
b
A family member of a current or former officer, director, trustee, or key employee? If “Yes,”
complete Schedule L, Part IV...................
28b
 
No
c
An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof) was an officer, director, trustee, or owner? If “Yes,” complete Schedule L, Part IV..
28c
 
No
29
Did the organization receive more than $25,000 in non-cash contributions? If “Yes,” complete Schedule M
29
 
No
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If “Yes,” complete Schedule M............
30
 
No
31
Did the organization liquidate, terminate, or dissolve and cease operations? If “Yes,” complete Schedule N,
Part I...........................
31
 
No
32
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If “Yes,” complete Schedule N, Part II.......................
32
 
No
33
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If “Yes,” complete Schedule R, Part I........ Click to see attachment
33
 
No
34
Was the organization related to any tax-exempt or taxable entity? If “Yes,” complete Schedule R, Parts II, III, IV, and V, line 1..................... Click to see attachment
34
Yes
 
35
Is any related organization a controlled entity within the meaning of section 512(b)(13)? .....
35
 
No
a
Did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If “Yes,” complete Schedule R, Part V, line 2... Click to see attachment
36
Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If “Yes,” complete Schedule R, Part V, line 2........... Click to see attachment
36
 
No
37
Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If “Yes,” complete Schedule R, Part VIClick to see attachment
37
 
No
38
Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11 and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Form 990 (2010)
Form 990 (2010)
Page 5
Part V
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response to any question in this Part V . . . . . . . . . .
Yes
No
1a
Enter the number reported in Box 3 of Form 1096. Enter -0- if not applicable. .......
1a
172
b
Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable.
1b
0
c
Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................
1c
Yes
 
2a
Enter the number of employees reported on Form W-3, Transmittal of Wage and Tax Statements filed for the calendar year ending with or within the year covered by this return .....................
2a
3,551
b
If at least one is reported on line 2a, did the organization file all required federal employment tax returns?

Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file. (see instructions)
2b
Yes
 
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?.............................
3a
Yes
 
b
If “Yes,” has it filed a Form 990-T for this year? If “No,” provide an explanation in Schedule O.....
3b
Yes
 
4a
At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account or securities account)?.......................
4a
 
No
b
If "Yes," enter the name of the foreign country: MediumBullet
See instructions for filing requirements for Form TD F 90-22.1, Report of Foreign Bank and Financial Accounts.
5a
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year?..
5a
 
No
b
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
5b
 
No
c
If “Yes” to line 5a or 5b, did the organization file Form 8886-T? ........
5c
 
 
6a
Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible?..........
6a
 
No
b
If “Yes,” did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible?........................
6b
 
 
7
Organizations that may receive deductible contributions under section 170(c).
a
Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor?....................
7a
 
No
b
If “Yes,” did the organization notify the donor of the value of the goods or services provided?.....
7b
 
 
c
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282?...........................
7c
 
No
d
If “Yes,” indicate the number of Forms 8282 filed during the year ....
7d
 
e
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?..........................
7e
 
No
f
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract?..
7f
 
No
g
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required?...................
7g
 
 
h
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C?...............
7h
 
 
8
Sponsoring organizations maintaining donor advised funds and section 509(a)(3) supporting organizations. Did the supporting organization, or a donor advised fund maintained by a sponsoring organization, have excess business holdings at any time during the year?................
8
 
 
9
Sponsoring organizations maintaining donor advised funds.
a
Did the organization make any taxable distributions under section 4966?.........
9a
 
 
b
Did the organization make a distribution to a donor, donor advisor, or related person?......
9b
 
 
10
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on Part VIII, line 12 ...
10a
 
b
Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
10b
 
11
Section 501(c)(12) organizations. Enter:
a
Gross income from members or shareholders .........
11a
 
b
Gross income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them.) ........
11b
 
12a
Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?
12a
 
 
b
If “Yes,” enter the amount of tax-exempt interest received or accrued during the year.
12b
 
13
Section 501(c)(29) qualified nonprofit health insurance issuers.
a
Is the organization licensed to issue qualified health plans in more than one state?
Note. All 501(c)(29) organizations must list in Schedule O each state in which they are licensed to issue qualified health plans, the amount of reserves required by each state, and the amount of reserves the organization allocated to each state.
13a
 
 
b
Enter the aggregate amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans.
13b
 
c
Enter the aggregate amount of reserves on hand.
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
 
b
If "Yes," has it filed a Form 720 to report these payments? If “No,” provide an explanation in Schedule O..
14b
 
 
Form 990 (2010)
Form 990 (2010)
Page 6
Part VI
Governance, Management, and Disclosure For each “Yes” response to lines 2 through 7b below, and for a “No” response to lines 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.
Check if Schedule O contains a response to any question in this Part VI . . . . . . . . . .
Section A. Governing Body and Management
Yes
No
1a
Enter the number of voting members of the governing body at the end of the tax year ..............
1a
18
b
Enter the number of voting members included in line 1a, above, who are independent .................
1b
14
2
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................
2
 
No
3
Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? ..
3
Yes
 
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed?
4
 
No
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
 
No
6
Does the organization have members or stockholders? ................
6
Yes
 
7a
Does the organization have members, stockholders, or other persons who may elect one or more members of the governing body? .........................
7a
Yes
 
b
Are any decisions of the governing body subject to approval by members, stockholders, or other persons? ..
7b
Yes
 
8
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a
The governing body? .........................
8a
Yes
 
b
Each committee with authority to act on behalf of the governing body? ............
8b
Yes
 
9
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If “Yes,” provide the names and addresses in Schedule O .....
9
 
No
Section B. Policies (This Section B requests information about policies not required by the Internal
Revenue Code.)
Yes
No
10a
Does the organization have local chapters, branches, or affiliates? ............
10a
 
No
b
If “Yes,” does the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with those of the organization? ....
10b
 
 
11a
Has the organization provided a copy of this Form 990 to all members of its governing body before filing the form?
11a
Yes
 
b
Describe in Schedule O the process, if any, used by the organization to review the Form 990. .....
12a
Does the organization have a written conflict of interest policy? If “No,” go to line 13.......
12a
Yes
 
b
Are officers, directors or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ...........................
12b
Yes
 
c
Does the organization regularly and consistently monitor and enforce compliance with the policy? If “Yes,” describe in Schedule O how this is done ....................
12c
Yes
 
13
Does the organization have a written whistleblower policy? ...............
13
Yes
 
14
Does the organization have a written document retention and destruction policy? .........
14
Yes
 
15
Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
a
The organization’s CEO, Executive Director, or top management official ...........
15a
Yes
 
b
Other officers or key employees of the organization ................
15b
Yes
 
If "Yes" to line a or b, describe the process in Schedule O. (See instructions.)
16a
Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? ......................
16a
Yes
 
b
If “Yes,” has the organization adopted a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and taken steps to safeguard the organization’s exempt status with respect to such arrangements? ............
16b
Yes
 
Section C. Disclosure
17
List the States with which a copy of this Form 990 is required to be filedMediumBullet
18
Section 6104 requires an organization to make its Form 1023 (or 1024 if applicable), 990, and 990-T (501(c)(3)s only) available for public inspection. Indicate how you make these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how), the organization makes its governing documents, conflict of interest policy, and financial statements available to the public.
20
State the name, physical address, and telephone number of the person who possesses the books and records of the organization: MediumBullet
CORY RHOADES
801 SEVENTH AVENUE
FORT WORTH,TX76104
(682) 885-4480
Form 990 (2010)
Form 990 (2010)
Page 7
Part VII
Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
Check if Schedule O contains a response to any question in this Part VII . . . . . . . . . .
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization’s tax year.
RoundBullet List all of the organization’s current officers, directors, trustees (whether individuals or organizations), regardless of amount
of compensation, and current key employees. Enter -0- in columns (D), (E), and (F) if no compensation was paid.

RoundBullet List all of the organization’s current key employees, if any. See instructions for definition of "key employee."
RoundBullet List the organization’s five current highest compensated employees (other than an officer, director, trustee or key employee)
who received reportable compensation (Box 5 of Form W-2 and/or Box 7 of Form 1099-MISC) of more than $100,000 from the
organization and any related organizations.

RoundBullet List all of the organization’s former officers, key employees, or highest compensated employees who received more than $100,000
of reportable compensation from the organization and any related organizations.

RoundBullet List all of the organization’s former directors or trustees that received, in the capacity as a former director or trustee of the
organization, more than $10,000 of reportable compensation from the organization and any related organizations.

List persons in the following order: individual trustees or directors; institutional trustees; officers; key employees; highest
compensated employees; and former such persons.
Check this box if neither the organization nor any related organizations compensated any current or former officer, director, or trustee.
(A)
Name and Title 		(B)
Average hours per week (describe hours for related organizations in Schedule O) 		(C)
Position (check all that apply) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(1) CORLISS BALDWIN
TRUSTEE
 1.0 X           0 0 0
(2) JAMES F HERD SR MD
TRUSTEE
 1.0 X           0 0 0
(3) MARSHA HILCHER
TRUSTEE-VICE CHAIRMAN
 2.0 X   X       0 0 0
(4) CHRISTOPHER M HUCKABEE
TRUSTEE
 1.0 X           0 0 0
(5) WM MACK LAWHON
TRUSTEE
 1.0 X           0 0 0
(6) PATTI MCCONNELL
TRUSTEE
 1.0 X           0 0 0
(7) ROGER NOBER
TRUSTEE
 1.0 X           0 0 0
(8) BONNIE PETSCHE
TRUSTEE
 1.0 X           0 0 0
(9) PETER L PHILPOT
TRUSTEE-CHAIRMAN
 2.0 X   X       0 0 0
(10) G DOUGLAS TATUM MD
TRUSTEE
 1.0 X           0 0 0
(11) ANDREW S WAYNE
TRUSTEE-SECRETARY/TREASURER
 2.0 X   X       0 0 0
(12) JOHN P BOSWELL
TRUSTEE
 1.0 X           0 0 0
(13) JAMES R DUNAWAY JR
TRUSTEE
 1.0 X           0 0 0
(14) GRETCHEN EAMES MD
TRUSTEE
 1.0 X           0 296,710 12,156
(15) SHARON S MAYES
TRUSTEE
 1.0 X           0 0 0
(16) JOHN M RICHARDSON MD
TRUSTEE
 1.0 X           0 0 0
(17) JOANN M SANDERS MD
TRUSTEE
 1.0 X           0 346,541 30,701
Form 990 (2010)
Form 990 (2010)
Page 8
Part VII
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)
(A)
Name and Title 		(B)
Average hours per week (describe hours for related organizations in Schedule O) 		(C)
Position (check all that apply) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(18) DONALD K MURPHEY MD
TRUSTEE
 1.0 X           0 297,404 32,461
(19) ANGEL W HERNANDEZ-MULERO MD
TRUSTEE
 1.0 X           0 512,850 35,949
(20) WILLIAM H CRAIG
VP, CLINICAL SUPPORT
 40.0     X       107,988 0 2,853
(21) NANCY C CYCHOL
PRESIDENT
 40.0     X       615,305 0 26,678
(22) STANLEY E DAVIS
VP, SUPPORT SERVICES
 40.0     X       215,130 0 26,385
(23) RICHARD P GOODE
CHIEF FINANCIAL OFFICER
 20.0     X       272,138 283,246 30,985
(24) CARA MARTZ
SECRETARY
 1.0     X       0 95,216 7,326
(25) RICK W MERRILL
CHIEF EXECUTIVE OFFICER
 11.0     X       344,839 886,728 156,115
(26) GEORGE B MONTAGUE
VP, REAL ESTATE
 2.0     X       0 278,703 26,894
(27) PAULA J WEBB
VP, NURSING
 40.0     X       264,613 0 20,452
(28) TERESA J CLARK
AVP-NURSING
 40.0     X       182,567 0 14,427
(29) JANELL P MASON-BRISCOE
VP-SPECIALTY SERVICES
 38.0     X       167,751 0 11,196
(30) ERIC PRESSON
VP-CLINICAL/FAMILY SUPPORT SVC
 40.0     X       40,278 0 3,072
(31) KEVIN L DAHLE
PHARMACIST
 40.0         X   183,209 0 24,727
(32) EDWIN VIRGIL EASON
PHARMACY SYSTEMS SPECIALIST
 40.0         X   170,692 0 24,920
(33) MIKE SMITH
PHARMACIST
 40.0         X   183,627 0 19,606
(34) DONALD K FAISON
DIRECTOR-NURSING ADMIN
 40.0         X   168,776 0 20,302
(35) MARY L HICKS
PHARMACIST
 40.0         X   167,916 0 17,075
1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)............MediumBullet 3,084,829 2,997,398 544,280
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 in reportable compensation from the organizationMediumBullet186
Yes
No
3
Did the organization list any former officer, director or trustee, key employee, or highest compensated employee on line 1a? If “Yes,” complete Schedule J for such individual .............
3
 
No
4
For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If “Yes,” complete Schedule J for such individual...........................
4
Yes
 
5
Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If “Yes,” complete Schedule J for such person .....
5
 
No
Section B. Independent Contractors
1
Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization.
(A)
Name and business address 		(B)
Description of services 		(C)
Compensation
LINBECK GROUP LLC
201 MAIN ST STE 1801
FORT WORTH,TX76102 		CONST. CONTRACTOR 89,954,150
FKP ARCHITECTS INC
8 GREENWAY PLAZE 300
HOUSTON,TX77046 		CONST. ARCHITECTS 4,580,969
PRO ACTION FIRE ALARM INC
1933 SILVER CREEK ROAD
AZLE,TX76020 		PROFESSIONAL SERVICE 1,401,370
SIEMENS MEDICAL SOLUTIONS
PO BOX 120001 DEPT 0733
DALLAS,TX75312 		CONTR SERVICES/R&M 1,319,128
NATIONAL MARROW DONOR PROGRAM
NW 8428 PO BOX 1450
MINNEAPOLIS,MN55485 		REFERAL LAB 1,112,709
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 in compensation from the organization MediumBullet64
Form 990 (2010)
Form 990 (2010)
Page 9
Part VIII
Statement of Revenue
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512, 513, or 514
Contributions, gifts, grants and other similar amounts 1a Federated campaigns..1a  
b Membership dues....1b  
c Fundraising events....1c  
d Related organizations...1d 4,598,757
e Government grants (contributions)1e 288,649
f All other contributions, gifts, grants, and
similar amounts not included above1f 		900,642
g Noncash contributions included in lines 1a-1f:$  
h Total. Add lines 1a-1f.......MediumBullet 5,788,048
Program Service Revenue Business Code
2a PATIENT SERVICES 621,110 603,633,096 603,633,096    
b OTHER OPERATING REVENUE 621,110 28,623,729 28,623,729    
c JOINT VENTURE REVENUE 621,110 13,938,929 13,938,929    
d LAB REFERRALS 621,500 37,046   37,046  
e
f All other program service revenue .        
g Total. Add lines 2a–2f........MediumBullet 646,232,800
Other Revenue 3 Investment income (including dividends, interest
and other similar amounts).....MediumBullet 0      
4 Income from investment of tax-exempt bond proceeds..MediumBullet 0      
5 Royalties............MediumBullet 0      
(i) Real (ii) Personal
6a Gross Rents 2,931,782  
b Less: rental expenses 1,661,519  
c Rental income or (loss) 1,270,263  
d Net rental income or (loss).......MediumBullet 1,270,263     1,270,263
(i) Securities (ii) Other
7a Gross amount from sales of assets other than inventory   105,446
b Less: cost or other basis and sales expenses   26,144
c Gain or (loss)   79,302
d Net gain or (loss)..........MediumBullet 79,302     79,302
8a Gross income from fundraising events (not including
$  
of contributions reported on line 1c). See Part IV, line 18 ...
a  
b Less: direct expenses ...b  
c Net income or (loss) from fundraising events..MediumBullet 0    
9a Gross income from gaming activities.
See Part IV, line 19 ...
a  
b Less: direct expenses ...b  
c Net income or (loss) from gaming activities...MediumBullet 0      
10a Gross sales of inventory, less
returns and allowances .
a  
b Less: cost of goods sold ..b  
c Net income or (loss) from sales of inventory..MediumBullet 0      
Miscellaneous Revenue Business Code
11a CCIC RETRO PREMIUM 900,099 2,615,142 2,615,142    
b            
c            
d All other revenue ....        
e Total. Add lines 11a–11d ......MediumBullet 2,615,142
12 Total revenue. See Instructions....MediumBullet 655,985,555 648,810,896 37,046 1,349,565
Form 990 (2010)
Form 990 (2010)
Page 10
Part IX
Statement of Functional Expenses
Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A) but are not required to complete columns (B), (C), and (D).
Do not include amounts reported on lines 6b,
7b, 8b, 9b, and 10b of Part VIII. 		(A)
Total expenses 		(B)
Program service expenses 		(C)
Management and general expenses 		(D)
Fundraising expenses
1 Grants and other assistance to governments and organizations in the U.S. See Part IV, line 21 42,788,659 42,788,659
2 Grants and other assistance to individuals in the U.S. See Part IV, line 22 73,692 73,692
3 Grants and other assistance to governments, organizations, and individuals outside the U.S. See Part IV, lines 15 and 16 0  
4 Benefits paid to or for members 0  
5 Compensation of current officers, directors, trustees, and key employees .... 2,669,058   2,669,058  
6 Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .... 0      
7 Other salaries and wages 184,501,255 165,408,266 19,092,989  
8 Pension plan contributions (include section 401(k) and section 403(b) employer contributions) .... 0      
9 Other employee benefits ....... 49,364,473 44,332,100 5,032,373  
10 Payroll taxes ........... 0      
11 Fees for services (non-employees):        
a Management ...... 75,316,675 2,569,627 72,747,048  
b Legal ......... 121,411   121,411  
c Accounting ........... 0      
d Lobbying ........... 0      
e Professional fundraising. See Part IV, line 17.. 0  
f Investment management fees ...... 0      
g Other .......... 19,200,833 13,214,172 5,986,661  
12 Advertising and promotion .... 59,845 49,046 10,799  
13 Office expenses ....... 61,724,044 60,096,652 1,627,392  
14 Information technology ...... 0      
15 Royalties .. 0      
16 Occupancy ........... 4,798,107 3,752,268 1,045,839  
17 Travel ............ 1,015,337 821,503 193,834  
18 Payments of travel or entertainment expenses for any federal, state, or local public officials ...... 0      
19 Conferences, conventions, and meetings .... 463,914 343,335 120,579  
20 Interest ........... 6,244,610 6,244,610    
21 Payments to affiliates ....... 0      
22 Depreciation, depletion, and amortization ..... 23,556,593 16,866,520 6,690,073  
23 Insurance .............. 2,746,500 2,746,500    
24 Other expenses. Itemize expenses not covered above. (Expenses grouped together and labeled miscellaneous may not exceed 5% of total expenses shown on line 25 below.)
a PHYSICIAN REMUNERATION 8,950,056 7,765,974 1,184,082 0
b BAD DEBT EXPENSE 17,920,430 17,920,430 0 0
c MINOR EQUIPMENT 8,645,179 2,456,767 6,188,412 0
d REPAIRS & MAINTENANCE 3,693,603 1,906,618 1,786,985 0
e FOOD/LINENS 3,522,735 3,236,964 285,771 0
f All other expenses 7,477,286 4,436,916 3,040,370 0
25 Total functional expenses. Add lines 1 through 24f 524,854,295 397,030,619 127,823,676 0
26 Joint costs. Check here MediumBullet if following
SOP 98-2 (ASC 958-720). Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation 		       
Form 990 (2010)
Form 990 (2010)
Page 11
Part X Balance Sheet
(A)
Beginning of year 		(B)
End of year
Assets 1 Cash—non-interest-bearing .......... 8,887 1 10,832
2 Savings and temporary cash investments ....... 112,756,159 2 170,399,587
3 Pledges and grants receivable, net .........   3  
4 Accounts receivable, net ......... 52,427,080 4 59,005,895
5 Receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
Schedule L ..........   5  
6 Receivables from other disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B). Complete Part II of
Schedule L ..........   6  
7 Notes and loans receivable, net .............   7  
8 Inventories for sale or use .............. 4,840,500 8 4,666,661
9 Prepaid expenses and deferred charges ............ 980,061 9 980,061
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 594,316,890
b Less: accumulated depreciation. ..... 10b 186,169,847 290,360,263 10c 408,147,043
11 Investments—publicly traded securities .......... 277,460,608 11 48,874,181
12 Investments—other securities. See Part IV, line 11 ......   12  
13 Investments—program-related. See Part IV, line 11 ..   13  
14 Intangible assets ......... 7,424,990 14 7,424,990
15 Other assets. See Part IV, line 11 ........... 15,731,724 15 18,019,252
16 Total assets. Add lines 1 through 15 (must equal line 34)... 761,990,272 16 717,528,502
Liabilities 17 Accounts payable and accrued expenses . 60,258,395 17 81,960,202
18 Grants payable ..........   18  
19 Deferred revenue ..........   19 590
20 Tax-exempt bond liabilities .......... 310,673,876 20 307,668,911
21 Escrow or custodial account liability. Complete Part IV of Schedule D..   21  
22 Payables to current and former officers, directors, trustees, key
employees, highest compensated employees, and disqualified
persons. Complete Part II of Schedule L..........   22  
23 Secured mortgages and notes payable to unrelated third parties ..   23  
24 Unsecured notes and loans payable to unrelated third parties ....   24  
25 Other liabilities. Complete Part X of Schedule D..... 33,100,793 25 25,003,645
26 Total liabilities. Add lines 17 through 25..... 404,033,064 26 414,633,348
Net Assets or Fund Balance Organizations that follow SFAS 117, check here MediumBullet and complete lines 27 through 29, and lines 33 and 34.
27 Unrestricted net assets ..... 357,957,208 27 302,895,154
28 Temporarily restricted net assets .....   28  
29 Permanently restricted net assets .....   29  
Organizations that do not follow SFAS 117, check here MediumBullet and complete lines 30 through 34.
30 Capital stock or trust principal, or current funds .....   30  
31 Paid-in or capital surplus, or land, building or equipment fund .....   31  
32 Retained earnings, endowment, accumulated income, or other funds   32  
33 Total net assets or fund balances ..... 357,957,208 33 302,895,154
34 Total liabilities and net assets/fund balances ..... 761,990,272 34 717,528,502
Form 990 (2010)
Form 990 (2010)
Page 12
Part XI
Reconcilliation of Net Assets
Check if Schedule O contains a response to any question in this Part XI . . . . . . . . . .
1
Total revenue (must equal Part VIII, column (A), line 12) . . .
1
655,985,555
2
Total expenses (must equal Part IX, column (A), line 25) . . . . .
2
524,854,295
3
Revenue less expenses. Subtract line 2 from line 1 . . . .
3
131,131,260
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) . .
4
357,957,208
5
Other changes in net assets or fund balances (explain in Schedule O) . . . .
5
-186,193,314
6
Net assets or fund balances at end of year. Combine lines 3, 4, and 5 (must equal Part X, line 33, column (B)) . . . . . .
6
302,895,154
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response to any question in this Part XII . . . . . . . . . .
Yes
No
1
Accounting method used to prepare the Form 990:  
If the organization changed its method of accounting from a prior year or checked "Other," explain in
Schedule O.
2a
Were the organization’s financial statements compiled or reviewed by an independent accountant?..
2a
 
No
b
Were the organization’s financial statements audited by an independent accountant?........
2b
Yes
 
c
If “Yes,” to 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant?
If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O............................
2c
Yes
 
d
If “Yes” to line 2a or 2b, check a box below to indicate whether the financial statements for the year were issued on a separate basis, consolidated basis, or both:
3a
As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A-133? ................
3a
 
No
b
If “Yes,” did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits. ..
3b
 
 
Form 990 (2010)
Additional Data


Software ID:  
Software Version:  
Form 990, Special Condition Description:
Special Condition Description
SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service
Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.
right arrow Attach to Form 990 or Form 990-EZ. right arrow See separate instructions.
OMB No. 1545-0047
2010
Open to Public
Inspection
Name of the organization
Cook Children's Medical Center
 
Employer identification number

75-2051646
Part I
Reason for Public Charity Status (All organizations must complete this part.) See instructions
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
11
e
f
g
(i) a person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
and (iii) below, the governing body of the the supported organization? ................
11g(i)
 
 
(ii) a family member of a person described in (i) above? ......................
11g(ii)
 
 
(iii) a 35% controlled entity of a person described in (i) or (ii) above? ................
11g(iii)
 
 
h
(i)
Name of supported organization 		(ii)
EIN 		(iii)
Type of organization (described on lines 1- 9 above or IRC section (see instructions)) 		(iv)
Is the organization in col. (i) listed in your governing document? 		(v)
Did you notify the organization in col. (i) of your support? 		(vi)
Is the organization in col. (i) organized in the U.S.? 		(vii)
Amount of support?
Yes No Yes No Yes No
Total                  

For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 2
Part II
Support Schedule for Organizations Described in IRC 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year(or fiscal year beginning in) (a) 2006 (b) 2007 (c) 2008 (d) 2009 (e) 2010 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....            
2 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......            
3 The value of services or facilities furnished by a governmental unit to the organization without charge..            
4 Total. Add lines 1 through 3..            
5 The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..            
6 Public Support. Subtract line 5 from line 4.            
Section B. Total Support
Calendar year(or fiscal year beginning in) (a) 2006 (b) 2007 (c) 2008 (d) 2009 (e) 2010 (f) Total
7 Amounts from line 4..            
8 Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..            
9 Net income from unrelated business activities, whether or not the business is regularly carried on..            
10 Other income. (Explain in Part IV.) Do not include gain or loss from the sale of capital assets..            
11 Total support (Add lines 7 through 10).            
12
12
 
13
Section C. Computation of Public Support Percentage
14
14
 
15
15
 
16a
b
17a
b
18
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 3
Part III
Support Schedule for Organizations Described in IRC 509(a)(2)
(Complete only if you checked the box on line 9 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)
Section A. Public Support
Calendar year(or fiscal year beginning in) (a) 2006 (b) 2007 (c) 2008 (d) 2009 (e) 2010 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .            
2 Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......            
3 Gross receipts from activities that are not an unrelated trade or business under section 513..            
4 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...            
5 The value of services or facilities furnished by a governmental unit to the organization without charge..            
6 Total. Add lines 1 through 5.            
7a Amounts included on lines 1, 2, and 3 received from disqualified persons...            
b Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.            
c Add lines 7a and 7b..            
8 Public Support (Subtract line 7c from line 6.)            
Section B. Total Support
Calendar year (or fiscal year beginning in) (a) 2006 (b) 2007 (c) 2008 (d) 2009 (e) 2010 (f) Total
9 Amounts from line 6...            
10a Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..            
b Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.            
c Add lines 10a and 10b.            
11 Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.            
12 Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)            
13 Total support (Add lines 9, 10c, 11 and 12.).            
14
Section C. Computation of Public Support Percentage
15
15
 
16
16
 
Section D. Computation of Investment Income Percentage
17
17
 
18
18
 
19a
b
20
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 4
Part IV
Supplemental Information. Supplemental Information. Complete this part to provide the explanation required by Part II, line 10; Part II, line 17a or 17b; or Part III, line 12. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
 
Explanation
 
 
 
 
Schedule A (Form 990 or 990-EZ) 2010

Additional Data


Software ID:  
Software Version:  
Schedule B
(Form 990, 990-EZ,
or 990-PF)
Department of the Treasury
Internal Revenue Service
Schedule of Contributors
Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
OMB No. 1545-0047
2010
Name of organization
Cook Children's Medical Center
 
Employer identification number

75-2051646
Organization type (check one):
Filers of:
Section:
Form 990 or 990-EZ





Form 990-PF




Check if your organization is covered by the General Rule or a Special Rule.  
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.
General Rule—
Special Rules
......................... Arrow Bullet   $    
Caution. An Organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2 of its Form 990, or check the box in the heading of its
Form 990-EZ, or on line 2 of its Form 990-PF, to certify that it does not meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).
For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.
Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2010)

Schedule B (Form 990, 990-EZ, or 990-PF) (2010)
Page 1 of 1 of Part I
Name of organization
Cook Children's Medical Center
  		Employer identification number

75-2051646
Part I
Contributors (see Instructions)
     
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Aggregate contributions		 (d)
Type of contribution
RESTRICTED
RESTRICTED
 

     
RESTRICTED
RESTRICTED  
RESTRICTED, RESTRICTED   RESTRICTED

$RESTRICTED




(Complete Part II if there is
a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Aggregate contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is
a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Aggregate contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is
a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Aggregate contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is
a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Aggregate contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is
a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Aggregate contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is
a noncash contribution.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2010)

Schedule B (Form 990, 990-EZ, or 990-PF) (2010)
Page 1 of 1 of Part II
Name of organization
Cook Children's Medical Center
  		Employer identification number

75-2051646
Part II
Noncash Property (see Instructions)
     
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
Schedule B (Form 990, 990-EZ, or 990-PF) (2010)

Schedule B (Form 990, 990-EZ, or 990-PF) (2010)
Page 1 of 1 of Part III
Name of organization
Cook Children's Medical Center
  		Employer identification number

75-2051646
Part III
Exclusively religious, charitable, etc., individual contributions to section 501(c)(7), (8), or (10) organizations
aggregating more than $1,000 for the year. (Complete columns (a) through (e) and the following line entry.)
For organizations completing Part III, enter the total of exclusively religious, charitable, etc.,
contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet $  
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
Schedule B (Form 990, 990-EZ, or 990-PF) (2010)

Additional Data


Software ID:  
Software Version:  
SCHEDULE D
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Financial Statements
SchDMd Bullet Complete if the organization answered "Yes," to Form 990,
Part IV, line 6, 7, 8, 9, 10, 11, or 12.
SchDMd Bullet Attach to Form 990. SchDMd Bullet See separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
Cook Children's Medical Center
 
Employer identification number

75-2051646
Part I
Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" to Form 990, Part IV, line 6.
(a) Donor advised funds (b) Funds and other accounts
1 Total number at end of year .......    
2 Aggregate contributions to (during year) ...    
3 Aggregate grants from (during year) ...    
4 Aggregate value at end of year .......    
5
Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ............
6
Did the organization inform all grantees, donors, and donor advisors in writing that grant funds may be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit. ...................................
Part II
Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.
1
Purpose(s) of conservation easements held by the organization (check all that apply).
2
Complete lines 2a–2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.
Held at the End of the Year
a Total number of conservation easements ....................... 2a  
b Total acreage restricted by conservation easements .................. 2b  
c Number of conservation easements on a certified historic structure included in (a) ..... 2c  
d Number of conservation easements included in (c) acquired after 8/17/06 ........ 2d  
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the taxable year SchDMd Bullet  
4
Number of states where property subject to conservation easement is located SchDMd Bullet  
5
Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................
6
Staff and volunteer hours devoted to monitoring, inspecting and enforcing conservation easements during the year SchDMd Bullet  
7
Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year SchDMd Bullet $  
8
Does each conservation easement reported on line 2(d) above satisfy the requirements of section
170(h)(4)(B)(i) and 170(h)(4)(B)(ii)? ....................................
9
In Part XIV, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" to Form 990, Part IV, line 8.
1a
If the organization elected, as permitted under SFAS 116, not to report in its revenue statement and balance sheet works of
art, historical treasures, or other similar assets held for public exhibition, education or research in furtherance of public service,
provide, in Part XIV, the text of the footnote to its financial statements that describes these items.
b
If the organization elected, as permitted under SFAS 116, to report in its revenue statement and balance sheet works of art,
historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service,
provide the following amounts relating to these items:
(i)
Revenues included in Form 990, Part VIII, line 1 ........................SchDMd Bullet $  
(ii)
Assets included in Form 990, Part X ..............................SchDMd Bullet $  
2
If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 relating to these items:
a
Revenues included in Form 990, Part VIII, line 1 ..........................SchDMd Bullet $  
b
Assets included in Form 990, Part X ...............................SchDMd Bullet $  
For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990
Cat. No. 52283D
Schedule D (Form 990) 2010

Schedule D (Form 990) 2010
Page 2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3
Using the organization’s accession and other records, check any of the following that are a significant use of its collection
items (check all that apply):
a
d
b
e
 
c
4
Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIV.
5
During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?........
Part IV
Escrow and Custodial Arrangements. Complete if the organization answered "Yes" to Form 990,
Part IV, line 9, or reported an amount on Form 990, Part X, line 21.
1a
Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................
b
If "Yes," explain the arrangement in Part XIV and complete the following table:
Amount
c Beginning balance ................................. 1c  
d Additions during the year .............................. 1d  
e Distributions during the year ............................. 1e  
f Ending balance ................................... 1f  
2a
Did the organization include an amount on Form 990, Part X, line 21? .....................
b
If “Yes,” explain the arrangement in Part XIV.
Part V
Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.
(a)Current Year (b)Prior Year (c)Two Years Back (d)Three Years Back (e)Four Years Back
1a Beginning of year balance .... 80,357,260 70,947,601 65,867,824
b Contributions ........ 18,935 3,803,664 7,205,558
c Investment earnings or losses ... 2,595,270 5,976,642 -1,698,302
d Grants or scholarships .....      
e Other expenditures for facilities
and programs ........ 		433,103 370,647 427,479
f Administrative expenses ....      
g End of year balance ...... 82,538,362 80,357,260 70,947,601
2
Provide the estimated percentage of the year end balance held as:
a
Board designated or quasi-endowment: SchDMd Bullet54.000 %
b
Permanent endowment: SchDMd Bullet46.000 %
c
Term endowment: SchDMd Bullet  
3a
Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes
No
(i) unrelated organizations ........................
3a(i)
 
No
(ii) related organizations ........................
3a(ii)
Yes
 
b
If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........
3b
Yes
 
4
Describe in Part XIV the intended uses of the organization's endowment funds.
Part VI
Investments—Land, Buildings, and Equipment. See Form 990, Part X, line 10.
Description of investment (a) Cost or other basis (investment) (b)Cost or other basis (other) (c) Accumulated depreciation (d) Book value
1a Land .................   11,234,574 11,234,574
b Buildings ................   245,824,436 103,200,356 142,624,080
c Leasehold improvements ............   4,497,023 1,924,177 2,572,846
d Equipment ................   111,700,345 76,768,252 34,932,093
e Other .................   221,060,512 4,277,062 216,783,450
Total. Add lines 1a-1e. (Column (d) should equal Form 990, Part X, column (B), line 10(c).)........SchDMdBullet 408,147,043
Schedule D (Form 990) 2010

Schedule D (Form 990) 2010
Page 3
Part VII
Investments—Other Securities. See Form 990, Part X, line 12.
(a) Description of security or category
(including name of security)		 (b)Book value (c) Method of valuation:
Cost or end-of-year market value
(1)Financial derivatives    
(2)Closely-held equity interests    
Other








Total. (Column (b) should equal Form 990, Part X, col.(B) line 12.)Small Bullet  
Part VIII
Investments—Program Related. See Form 990, Part X, line 13.
(a) Description of investment type (b) Book value (c) Method of valuation:
Cost or end-of-year market value








Total. (Column (b) should equal Form 990, Part X, col.(B) line 13.)Small Bullet  
Part IX
Other Assets. See Form 990, Part X, line 15.
(a) Description (b) Book value








Total. (Column (b) should equal Form 990, Part X, col.(B) line 15.)...........Small Bullet  
Part X
Other Liabilities. See Form 990, Part X, line 25.
1.(a) Description of Liability (b) Amount
Federal Income Taxes 0
EST. PAYABLE (THIRD PARTY) 22,986,369
DUE TO AFFILIATES 2,017,276







Total. (Column (b) should equal Form 990, Part X, col.(B) line 25.)Small Bullet 25,003,645
2. Fin 48 (ASC 740) Footnote. In Part XIV, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC740).
Schedule D (Form 990) 2010

Schedule D (Form 990) 2010
Page 4
Part XI Reconciliation of Change in Net Assets from Form 990 to Financial Statements
1 Total revenue (Form 990, Part VIII, column (A), line 12) .................... 1 655,985,555
2 Total expenses (Form 990, Part IX, column (A), line 25) ..................... 2 524,854,295
3 Excess or (deficit) for the year. Subtract line 2 from line 1 ............. 3 131,131,260
4 Net unrealized gains (losses) on investments .......................... 4  
5 Donated services and use of facilities ............................. 5  
6 Investment expenses ................................... 6  
7 Prior period adjustments .................................. 7  
8 Other (Describe in Part XIV) ................................. 8 10,345,206
9 Total adjustments (net). Add lines 4 - 8 ............................. 9 10,345,206
10 Excess or (deficit) for the year per financial statements. Combine lines 3 and 9 ......... 10 141,476,466
Part XII Reconciliation of Revenue per Audited Financial Statements With Revenue per Return
1 Total revenue, gains, and other support per audited financial statements ....... 1 697,196,432
2 Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a Net unrealized gains on investments .......... 2a  
b Donated services and use of facilities ......... 2b  
c Recoveries of prior year grants ........... 2c  
d Other (Describe in Part XIV): ............ 2d 41,363,949
e Add lines 2a through 2d ..................... 2e 41,363,949
3 Subtract line 2e from line 1..................... 3 655,832,483
4 Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b . 4a  
b Other (Describe in Part XIV): ........... 4b 153,072
c Add lines 4a and 4b....................... 4c 153,072
5 Total Revenue. Add lines 3 and 4c. (This should equal Form 990, Part I, line 12.) ...... 5 655,985,555
Part XIII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return
1 Total expenses and losses per audited financial statements ............. 1 555,719,966
2 Amounts included on line 1 but not on Form 990, Part IX, line 25:
a Donated services and use of facilities .......... 2a  
b Prior year adjustments .............. 2b  
c Other losses ................ 2c  
d Other (Describe in Part XIV): ............ 2d 30,865,671
e Add lines 2a through 2d...................... 2e 30,865,671
3 Subtract line 2e from line 1..................... 3 524,854,295
4 Amounts included on Form 990, Part IX, line 25, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b .. 4a  
b Other (Describe in Part XIV): ............ 4b  
c Add lines 4a and 4b....................... 4c  
5 Total expenses. Add lines 3 and 4c. (This should equal Form 990, Part I, line 18.) ...... 5 524,854,295
Part XIV
Supplemental Information
Complete this part to provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b;
Part V, line 4; Part X; Part XI, line 8; Part XII, lines 2d and 4b; and Part XIII, lines 2d and 4b. Also complete this part to provide any additional information.
Identifier Return Reference Explanation
SCHEDULE D, PART XI, LINE 8 OTHER CHANGE INTEREST RATE SWAP ADJUSTMENT ($1,793,056) CONTR. FROM HF RECORDED TO NET ASSETS ($ 138,843) CONTR. FROM HS RECORDED TO NET ASSETS ($ 14,229) MINORITY INTEREST $12,291,334 ----------- TOTAL $10,345,206
SCHEDULE D, PART XII, LINE 2D OTHER CHANGE JOINT VENTURE ACCOUNTS NOT INCLUDED ON 990 $41,606,076 INTEREST RATE SWAP ADJUSTMENT ($ 1,793,056) NE GAIN ON SALE OF ASSET (IN AUDIT EXP) ($ 31,290) GAIN ON SALE/DISPOSAL OF ASSET (IN AUDIT EXP) ($ 79,300) Rental Expense $ 1,661,519 ------------- TOTAL OTHER CHANGE $ 41,363,949
SCHEDULE D, PART XII, LINE 4B OTHER CHANGE CONTRIBUTION FROM HS RECORDED TO NET ASSETS $ 138,843 CONTRIBUTION FROM HF RECORDED TO NET ASSETS $ 14,229 ------------- TOTAL OTHER CHANGE $ 153,072
SCHEDULE D, PART XIII, LINE 2D OTHER CHANGE JOINT VENTURE ACCOUNTS NOT INCLUDED ON 990 $41,606,076 MINORITY INTEREST ($12,291,334) NE GAIN ON SALE OF ASSET (IN AUDIT EXP) ($ 31,290) RENTAL EXPENSE $ 1,661,519 GAIN ON SALE/DISPOSAL OF ASSET (IN AUDIT EXP)($ 79,300) ------------- TOTAL OTHER CHANGE $30,865,671
UNCERTAIN TAX POSITIONS SCHEDULE D, PART X, LINE 2 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.
INTENDED USE OF ENDOWMENT FUNDS SCHEDULE D, PART V, QUESTION 4 COOK CHILDREN'S HAS ADOPTED INVESTMENT AND SPENDING POLICIES FOR ENDOWMENT ASSETS THAT ATTEMPT TO PROVIDE A PREDICTABLE STREAM OF FUNDING TO PROGRAMS AND OTHER ITEMS SUPPORTED BY ITS ENDOWMENT WHILE SEEKING TO MAINTAIN THE PURCHASING POWER OF THE ENDOWMENT. UNDER COOK CHILDREN'S POLICIES, ENDOWMENT ASSETS ARE INVESTED IN A MANNER THAT IS INTENDED TO PRODUCE AN AMOUNT THAT IS EQUAL TO A RETURN HURDLE DEFINED AS THE SPENDING RATE, INFLATION RATE AND THE MANAGEMENT COST OF THE ENDOWMENT ON AN ANNUAL BASIS WHILE ASSUMING A PRUDENT LEVEL OF INVESTMENT RISK. ACTUAL RETURNS IN ANY GIVEN YEAR MAY VARY FROM THIS AMOUNT. TO SATISFY ITS LONG-TERM RATE OF RETURN OBJECTIVES, COOK CHILDREN'S RELIES ON A TOTAL RETURN STRATEGY IN WHICH INVESTMENT RETURNS ARE ACHIEVED THROUGH BOTH CURRENT YIELD (INVESTMENT INCOME SUCH AS DIVIDENDS AND INTEREST) AND CAPITAL APPRECIATION (BOTH REALIZED AND UNREALIZED. COOK CHILDREN'S TARGETS A DIVERSIFIED ASSET ALLOCATION THAT PLACED A GREATER EMPHASIS ON EQUITY-BASED INVESTMENTS TO ACHIEVE ITS LONG-TERM RETURN OBJECTIVES WITHIN PRUDENT RISK CONSTRAINTS. COOK CHILDREN'S HAS A POLICY (THE SPENDING POLICY) OF APPROPRIATING FOR EXPENDITURE EACH YEAR 5% OF THE FOUNDATION'S INVESTMENTS AVERAGE FAIR VALUE OVER THE PRIOR 5 YEARS ENDED JUNE 30 PRECEDING THE YEAR IN WHICH EXPENDITURE IS PLANNED. IN ESTABLISHING THIS POLICY, COOK CHILDREN'S CONSIDERED THE LONG-TERM EXPECTED RETURN ON ITS ENDOWMENT. ACCORDINGLY, OVER THE LONG TERM, COOK CHILDREN'S EXPECTS THE CURRENT SPENDING POLICY TO ALLOW ITS ENDOWMENT TO GROW AT THE RETURN HURDLE. THIS IS CONSISTENT WITH COOK CHILDREN'S OBJECTIVE TO MAINTAIN THE PURCHASING POWER OF ENDOWMENT ASSETS HELD IN PERPETUITY OR FOR A SPECIFIED TERM, AS WELL AS TO PROVIDE ADDITIONAL REAL GROWTH THROUGH NEW GIFTS AND INVESTMENT RETURN.
Schedule D (Form 990) 2010

Additional Data


Software ID:  
Software Version:  




SCHEDULE H
(Form 990)
Department of the Treasury
Internal Revenue Service
Hospitals
MediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, question 20.
MediumBullet Attach to Form 990. MediumBullet See separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
Cook Children's Medical Center
 
Employer identification number

75-2051646
Part I
Charity Care and Certain Other Community Benefits at Cost
Yes
No
1a
Does the organization have a charity care policy? If "No," skip to question 6a...........
1a
Yes
 
b
If "Yes," is it a written policy? .......................
1b
Yes
 
2
If the organization has multiple hospitals, indicate which of the following best describes application of the charity care policy to the various hospitals.
3
Answer the following based on the charity care eligibility criteria that applies to the largest number of the organization's patients.
a
Does the organization use Federal Poverty Guidelines (FPG) to determine eligibility for providing free care to low
income individuals? If "Yes," indicate which of the following is the FPG family income limit for eligibility for free care:
3a
Yes
 
b
Does the organization use FPG to determine eligibility for providing discounted care to low income individuals? If
"Yes," indicate which of the following is the family income limit for eligibility for discounted care: .....
3b
Yes
 
c
If the organization does not use FPG to determine eligibility, describe in Part VI the income based criteria for determining eligibility for free or discounted care. Include in the description whether the organization uses an asset test or other threshold, regardless of income, to determine eligibility for free or discounted care.
4
Does the organization's policy provide free or discounted care to the "medically indigent"? ......
4
Yes
 
5a
Does the organization budget amounts for free or discounted care provided under its charity care policy? ...
5a
 
No
b
If "Yes," did the organization's charity care expenses exceed the budgeted amount?.........
5b
 
 
c
If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discounted
care to a patient who was eligibile for free or discounted care?...............
5c
 
 
6a
Does the organization prepare an annual community benefit report?.............
6a
Yes
 
6b
If "Yes," does the organization make it available to the public? ..............
6b
Yes
 
Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.
7
Charity Care and Certain Other Community Benefits at Cost
Charity Care and
Means-Tested Government Programs		 (a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community benefit expense (d) Direct offsetting revenue (e) Net community benefit expense (f) Percent of total expense
a Charity care at cost (from
Worksheets 1 and 2) .. 		    2,414,460 0 2,414,460 0.450 %
b Unreimbursed Medicaid (from
Worksheet 3, column a) . 		    274,987,634 255,531,254 19,456,380 3.630 %
c Unreimbursed costs—other means-tested government programs (from Worksheet 3, column b) ....            
dTotal Charity Care and
Means-Tested Government Programs ..... 		    277,402,094 255,531,254 21,870,840 4.080 %
Other Benefits
e Community health improvement
services and community
benefit operations (from
(Worksheet 4) .... 		    2,905,016 6,222 2,898,794 0.540 %
f Health professions education
(from Worksheet 5) .. 		    295,312 115,147 180,165 0.030 %
g Subsidized health services
(from Worksheet 6) .. 		           
h Research (from Worksheet 7)     823,934 0 823,934 0.150 %
i Cash and in-kind contributions
to community groups
(from Worksheet 8) .. 		    43,069,548 0 43,069,548 8.040 %
jTotal Other Benefits ...     47,093,810 121,369 46,972,441 8.760 %
kTotal. Add lines 7d and 7j. ..     324,495,904 255,652,623 68,843,281 12.840 %
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 2
Part II
Community Building Activities Complete this table if the organization conducted any community building activities.
(a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community building expense (d) Direct offsetting
revenue 		(e) Net community building expense (f) Percent of total expense
1 Physical improvements and housing     20,000 0 20,000 0 %
2 Economic development            
3 Community support     8,071 0 8,071 0 %
4 Environmental improvements            
5 Leadership development and training for community members            
6 Coalition building     47,402 0 47,402 0.010 %
7 Community health improvement advocacy     129,480 0 129,480 0.020 %
8 Workforce development     1,114 0 1,114 0 %
9 Other            
10 Total     206,067 0 206,067 0.030 %
Part III
Bad Debt, Medicare, & Collection Practices
Section A. Bad Debt Expense
Yes
No
1
Does the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................
1
Yes
 
2
Enter the amount of the organization's bad debt expense (at cost).....
2
8,277,880
3
Enter the estimated amount of the organization's bad debt expense (at cost) attributable to patients eligible under the organization's charity care policy ..
3
0
4
Provide in Part VI the text of the footnote to the organization's financial statements that describes bad debt expense. In addition, describe the costing methodology used in determining the amounts reported on lines 2 and 3, and rationale for including a portion of bad debt amounts as community benefit.
Section B. Medicare
5
Enter total revenue received from Medicare (including DSH and IME).....
5
2,346,591
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
4,243,327
7
Subtract line 6 from line 5. This is the surplus or (shortfall)........
7
-1,896,736
8
Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.
Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.
Check the box that describes the method used:
Section C. Collection Practices
9a
Does the organization have a written debt collection policy? ...............
9a
Yes
 
b
If "Yes," does the organization's collection policy contain provisions on the collection practices to be followed for patients who are known to qualify for charity care or financial assistance? Describe in Part VI......
9b
Yes
 
Part IV
Management Companies and Joint Ventures
(a) Name of entity (b) Description of primary
activity of entity 		(c) Organization's
profit % or stock
ownership % 		(d) Officers, directors,
trustees, or key
employees' profit %
or stock ownership% 		(e) Physicians'
profit % or stock
ownership %
1CC NORTHEAST HOSP
  		FREESTANDING SURGICAL HOSP 55.140 % 0 % 32.960 %
2
3
4
5
6
7
8
9
10
11
12
13
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 3
Part VFacility Information
Section A. Hospital Facilities
(list in order of size, measured by total revenue per facility, from largest to smallest)
How many hospital facilities did the organization operate during the tax year?2
Name and address 		Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital Research Facility ER-24Hours ER-Other Other (Describe)
1 COOK CHILDREN'S MEDICAL CENTER
801 SEVENTH AVENUE
FORT WORTH,TX76104 		    X            
2 COOK CHILDREN'S NORTHEAST HOSPITAL
6316 Precinct Line Rd
Hurst,TX76054 		    X            
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 4
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
Name of Hospital Facility:COOK CHILDREN'S MEDICAL CENTER
Line Number of Hospital Facility (from Schedule H, Part V, Section A):1

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2010)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet those needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess all of the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Development of a community benefit plan for the facility
d Participation in community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the CHNA
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed together with the reasons why it has not addressed such needs. 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explains eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8    
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care to low incomeindividuals?.. 9    
If “Yes,” indicate the FPG family income limit for eligibility for free care:   %
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 5
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care to low income individuals?......... 10    
If “Yes,” indicate the FPG family income limit for eligibility for discounted care:   %
11 Explained the basis for calculating amounts charged to patients?................. 11    
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12    
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13    
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted at all times on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy that explained actions the hospital facility may take upon non-payment?........ 14    
15 Check all of the following collection actions against a patient that were permitted under the hospital facility's policies at any time during the tax year:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments or arrests
e Other (describe in Part VI)
16 Did the hospital facility engage in or authorize a third party to engage in any of the following collection actions during the tax year?................................... 16    
If “Yes,” check all collection actions in which the hospital facility or a third party engaged (check all that apply):
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other (describe in Part VI)
17 Indicate which actions the hospital facility took before initiating any of the collection actions checked in question 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether a patient who applied for financial assistance under the financial assistance policy qualified for financial assistance
e Other (describe in Part VI)
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 6
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18    
If “No,” indicate the reasons why (check all that apply):
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility did not have a policy relating to emergency medical care
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Charges for Medical Care
19 Indicate how the hospital facility determined the amounts generally billed to individuals who had insurance covering emergency or other medically necessary care (check all that apply):
a The hospital facility used the lowest negotiated commercial insurance rate for those services at the hospital facility
b The hospital facility used the average of the three lowest negotiated commercial insurance rates for those services at the hospital facility
c The hospital facility used the Medicare rate for those services
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20    
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its patients an amount equal to the gross charge for services provided to that patient?................................... 21    
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 4
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
Name of Hospital Facility:COOK CHILDREN'S NORTHEAST HOSPITAL
Line Number of Hospital Facility (from Schedule H, Part V, Section A):2

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2010)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet those needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess all of the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Development of a community benefit plan for the facility
d Participation in community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the CHNA
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed together with the reasons why it has not addressed such needs. 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explains eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8    
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care to low incomeindividuals?.. 9    
If “Yes,” indicate the FPG family income limit for eligibility for free care:   %
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 5
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care to low income individuals?......... 10    
If “Yes,” indicate the FPG family income limit for eligibility for discounted care:   %
11 Explained the basis for calculating amounts charged to patients?................. 11    
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12    
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13    
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted at all times on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy that explained actions the hospital facility may take upon non-payment?........ 14    
15 Check all of the following collection actions against a patient that were permitted under the hospital facility's policies at any time during the tax year:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments or arrests
e Other (describe in Part VI)
16 Did the hospital facility engage in or authorize a third party to engage in any of the following collection actions during the tax year?................................... 16    
If “Yes,” check all collection actions in which the hospital facility or a third party engaged (check all that apply):
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other (describe in Part VI)
17 Indicate which actions the hospital facility took before initiating any of the collection actions checked in question 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether a patient who applied for financial assistance under the financial assistance policy qualified for financial assistance
e Other (describe in Part VI)
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 6
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18    
If “No,” indicate the reasons why (check all that apply):
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility did not have a policy relating to emergency medical care
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Charges for Medical Care
19 Indicate how the hospital facility determined the amounts generally billed to individuals who had insurance covering emergency or other medically necessary care (check all that apply):
a The hospital facility used the lowest negotiated commercial insurance rate for those services at the hospital facility
b The hospital facility used the average of the three lowest negotiated commercial insurance rates for those services at the hospital facility
c The hospital facility used the Medicare rate for those services
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20    
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its patients an amount equal to the gross charge for services provided to that patient?................................... 21    
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 7
Part VFacility Information (continued)

Section C. Other Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility
(list in order of size, measured by total revenue per facility, from largest to smallest)
How many non-hospital facilities did the organization operate during the tax year?1
Name and address Type of Facility (Describe)
1 CENTER FOR PEDIATRIC SURGERY
7000 W PLANO PARKWAY SUITE 100
PLANO,TX75093 		AMBULATORY SURGERY CENTER
2
3
4
5
6
7
8
9
10
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 8
Part VI
Supplemental Information
Complete this part to provide the following information.
1 Required descriptions. Provide the description required for Part I, lines 3c, 6a, and 7; Part II; Part III, lines 4, 8, and 9b; and Part V, Section B, lines 1j, 2, 4c, 6i, 7, 11i, 13i, 17l, 18l, 19e, 21d, 25, and 26.
2 Community health needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any community health needs assessments reported in Part V, Section B.
3 Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4 Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5 Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6 Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7 State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.
Identifier ReturnReference Explanation
PART I, LINE 3C   COOK CHILDREN'S USES FPG TO DETERMINE ELIGIBILITY FOR FREE AND DISCOUNTED CARE.
PART I, LINE 6A   THE ANNUAL REPORT AND COMMUNITY BENEFITS ARE LOCATED ON THE COOK CHILDREN'S WEB SITE (WWW.COOKCHILDRENS.ORG). A HARD COPY OF THE REPORT IS ALSO AVAILABLE IN THE PUBLICATION "KEEPING OUR PROMISE".
PART I, LINE 7G   NOT APPLICABLE
PART I, LINE 7, COLUMN F   BAD DEBT EXPENSE OF $17,920,430 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.
PART I, LINE 7   COSTS FOR LINE 7 WERE CALCULATED USING AN OVERALL COST TO CHARGE RATIO CALCULATED BY THE HOSPITAL'S COST ACCOUNTING SYSTEM.
PART III, LINE 4   We record self pay accounts at the full expected amount. Each account goes through the collection process as necessary. An allowance is established based on historical experience. Bad debt expense at cost was calculated using an overall cost to charge ratio calculated by the hospital's cost accounting system. We are unable to calculate an accurate estimate for this category. Footnote disclosure regarding the treatment of bad debts is as follows: Cook Children's reports patient accounts receivable for services rendered at net realizable amounts from government payors, managed care plans, patients and others. Amounts due from patients include both amounts due from fully uninsured patients and co-payments and deductibles for which insured patients are responsible. As a service to the patient, Cook Children's bills third-party payors directly and bills the patient when the patient's liability is determined. Patient accounts receivable are due in full when billed. Cook Children's provides an allowance for doubtful accounts based upon a review of outstanding receivables, historical collection information and existing economic conditions. Accounts are considered delinquent and subsequently written off as bad debts based on individual credit evaluation and specific circumstances of the account. Bad debt, in whole or in part, should be included in community benefit given the tangible and measurable benefit of the underlying services provided to, primarily, underserved members of our community. For instance, we have a significant non-insured, undocumented worker population that may not participate in the charity or medical indigent discount qualification process due to concerns about their immigration status. We provide critical inpatient, emergency room, and outpatient services to this demographic for little or no reimbursement and without regard for their ability to pay, but receive no community benefit consideration. At minimum, hospitals should have the opportunity to delineate how much bad debt stems from non-insured patients and then be given community benefit consideration for the cost burden associated with providing these needed services knowing that we have already done all we can with regard to screening patients for charity and medical indigent discounts and written the patients' balances off as such.
PART III, LINE 8   The Medicare shortfall should be considered community benefit since it is representative of the non-covered cost of patient care that hospitals are using to justify the need for their tax exempt status. Presenting the Medicare shortfall in the community benefit section allows regulators and the public to see the unfunded costs of services that hospitals provide to community members. This presentation would help the community better understand that in the absence of a tax exempt status (which in effect is granted to them by the public), the hospitals would have to look to the community to fund the shortfall or risk losing valued hospital services. The ratio of cost to charges used in the calculation of costs for Medicare was taken from the Medicare Cost Report.
PART III, LINE 9B   The hospital does not pursue collection of amounts determined to qualify as charity care.
NEEDS ASSESSMENT   In 2009 Cook Children's completed the first community-wide children's health assessment and planning survey. This random household survey of families with a child aged 0 - 14 years generated 7,439 responses to 200 questions about their child's health. The CCHAPS effort is the first known project of its kind in this state to focus solely on the overall health status of children. Cook Children's is committed to the health and well-being of our children, which can only be achieved through actions based on solid information. While a great amount of medical information exists about children, there are large gaps in understanding and measurement of children's health. CCHAPS fills that void and helps us honor our commitment. The data gathered through CCHAPS allows our community to: -Evaluate children's health needs within the region by reviewing measures of health status, as well as factors that influence health status. -Identify children's health priorities within our community. -Promote and support community collaborations that identify and implement solutions to specifically targeted children's health priorities. -Create and monitor community benchmarks to measure progress. Access to the children's health data provides a valuable community tool to support planning and fundraising efforts on behalf of children. Health status data can be used by community planning organizations to develop initiatives for action on children's issues, by foundations for determining funding priorities where children are affected and by faith-based organizations to focus outreach ministry efforts. The data is instrumental in helping to identify any disparities in children's healthcare. Cook Children's has identified a group of "top-line" children's health issues in its six-county service region which will be the focus of Cook Children's initial efforts to act on the data: abuse/neglect, accidental injury, access to healthcare, asthma, dental health, mental health and obesity. Asthma and obesity proved to be especially prevalent in the survey findings. As stewards of the data, which was gathered for the benefit of the community, Cook Children's wants to be sure the data is not only widely available, but also that additional resources accompany it for those individuals and organizations that want to put the information to use. Cook Children's will continue its in-depth analysis of the CCHAPS data to better understand and communicate children's health issues and potential solutions in our area. Cook Children's will focus its efforts over the next 10 years to realize our promise ... "to improve the health of every child in our region through the prevention and treatment of illness, disease and injury." CCHAPS offers the potential of regional collaboration on children's health issues. Cook Children's recognizes this and calls on the community to participate in a joint effort. The plan is to partner with the community and the various organizations that embrace children's health. Cook Children's wants to play the role in those efforts that is most appropriate for helping improve children's health - be that leader, partner, collaborator, follower or supporter. The hope is to join with many allies and partners in the quest to be one of the healthiest areas to raise a child in the coming decade. The goal of improving children's health can only become a reality if communities, collaborations and coalitions work together to use CCHAPS to set and achieve realistic, quantitative goals to improve children's health in areas of specific concerns or interest to that group. Cook Children's will continue to offer support as needed in efforts to research data, foster sharing information and build a solid enduring foundation that continues the work of improving the lives of children. A public Web site launched on January 15, 2010 that allows anyone direct access to the data from the Community-wide Children's Health Assessment and Planning Survey. www.cchaps.org deliberately places the data into the hands of each community where it can be best understood and used for planning actions. Cook Children's Health Care System employed three additional community outreach workers specifically assigned to counties to foster the use of the data and coordinate child health summits in each county. During 2010, the CCHAPS team presented data and information in each of the five-outlying counties to diverse members from each community. Each, daylong summit, co-hosted by one or more local community sponsors, foreshadowed individual strategic planning efforts at the local community level to improve the health of children in each community planned during 2011. The CCHAPS data continues to be a source of new information. In 2010, the team calculated the age and gender specific BMI percentiles and reported this new information in a "CCHAPS Special Report on Childhood Obesity" available on the Web site. To give strategic focus to community-planning efforts, a novel Ecosystem Model for Children's Health provides a way TO identify the relevant factors and interaction affecting each child health issue. A "think-tank" provided participants from a wide-range of backgrounds the opportunity to understand the complex systems and interactions involved in childhood asthma.
PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE   English and Spanish versions of a one-page document explaining the charity care offered at Cook Children's are posted in each of the patient registration areas, the Emergency Room, night clinic, and Medical Office Building. This document includes information on the following: 1)how one might qualify for financial assistance 2)explains qualification is determined by family size and income, and 3)guides families to contact the Patient Accounting department to apply for financial assistance. In all areas of Patient Registration, registration clerks offer a Medicaid application to all self pay registrations. Patient Registration staff will assist the family with the application for Medicaid, and then Charity if Medicaid is denied. Patient Representatives and Case Management personnel also direct families to the Patient Registration staff when they need financial assistance.
COMMUNITY INFORMATION   The Medical Center provides primary, secondary, tertiary, and quaternary levels of pediatric care in Tarrant and contiguous counties and appropriate specialty care regionally throughout Texas. The Medical Center defines its 132-county service area into the major markets listed below: Six-County Area: The Six-County Area consists of Denton, Hood, Johnson, Parker, Tarrant, and Wise Counties. In 2010, the population of the Six-County Area was reported to be 2,820,112, approximately 23% of which are ages 0 to 14. Within the six counties, Tarrant County serves as Cook Children's Primary Service Area (PSA) generating approximately 75% of the Medical Center's inpatients each year. Referral Market: The Outlying Referral Markets stretch northwest from the panhandle, southward through Midland/Odessa into central Texas and the Killeen-Temple area, east to Tyler and due north to the Oklahoma/Texas border (126-COUNTIES TO THE SOUTH AND WEST OF THE DFW METROPLEX). For fiscal year 2010, 2,517 inpatient discharges originateD from this area. Regional outpatient pediatric specialty clinics are staffed in several locations in this area with multi-specialty clinics located in Abilene, Brownwood, Midland/Odessa, San Angelo and Waco. Other Markets: As a result of aggressive and targeted marketing, new volume comes from Other Markets outside the Referral Markets (OUTSIDE OF THE TRADITIONAL 132-COUNTIES AND INCLUDES OUT OF STATE PATIENTS). Some larger markets with tertiary, commercial referral potential (Houston, San Antonio, etc.) are marketed for referral volume, particularly quaternary care. Patient volume from these areas is significantly smaller than from the Six-County Area and Referral Markets due to the presence of other children's hospitals. The hospitals that serve the pediatric population and compete with the Medical Center for market share differ for each of the markets.
PROMOTION OF COMMUNITY HEALTH:   Cook Children's maintains an open medical staff and the governing bodies of the various companies are made up (unless constrained by the Texas Medical Practice Act) of voluntary community members along with physicians. The organization cares for all children regardless of their ability to pay and proactively seeks to enroll all eligible children into appropriate programs to improve access to care.
AFFILIATED HEALTH CARE SYSTEM ROLES   Cook Children's also operates five Neighborhood Clinics providing primary care to underserved populations around the city's perimeter and inner city to help assure care is provided in the most appropriate setting. Both preventive and therapeutic dental health care are provided to underserved populations. Mental and behavioral health is provided in both inpatient and outpatients settings subsidized by Cook Children's. Cook Children's Health Plan is a contracted intermediary for Medicaid Managed Care and sCHIP, providing an open provider panel for all eligible children in the six-county primary service area. Cook Children's offers pediatric specific home care to assure care is provided in the most appropriate and lowest cost setting.
ALL STATES WHICH ORGANIZATION FILES A COMMUNITY BENEFIT REPORT   TX
COMMUNITY BUILDING ACTIVITIES PART II PHYSICAL IMPROVEMENTS AND HOUSING: COOK CHILDREN'S IS LOCATED IN THE NEAR SOUTH SIDE OF FORT WORTH WHICH INCLUDES THE MEDICAL DISTRICT AS WELL AS A DIVERSE MIX OF RESIDENTIAL NEIGHBORHOODS. TO ADDRESS NEIGHBORHOOD IMPROVEMENT NEEDS, COOK CHILDREN'S IS A MEMBER OF FORT WORTH SOUTH, INC., A NONPROFIT ORGANIZATION THAT PARTNERS WITH THE CITY OF FORT WORTH AND OTHER COMMUNITY ORGANIZATIONS TO ADVANCE EDUCATIONAL INITIATIVES, PUBLIC POLICIES, AND COMMUNITY PROGRAMS THAT FOSTER A REVITALIZED AND SAFE CENTRAL CITY. STRATEGIC PLANNING HAS RESULTED IN IMPROVED SECURITY, CODE ENFORCEMENT, AND TRANSPORTATION FOR RESIDENTS AND EMPLOYEES WHO WORK IN THIS AREA. COMMUNITY SUPPORT: MORE THAN 24 COOK CHILDREN'S EMPLOYEES PARTICIPATE AT A NEARBY ELEMENTARY SCHOOL AS MENTORS THROUGH THE JUNIOR ACHIEVEMENT PROGRAM. THESE EMPLOYEES SPENT 120 HOURS DURING WORK TIME TEACHING CLASSES TO HELP INSPIRE THE STUDENTS TO "DREAM BIG AND REACH THEIR POTENTIAL. THE EXPERIENTIAL PROGRAM DEVELOPS AND STRENGTHENS THE YOUTHS' ASSETS AS THE STUDENTS LEARN KEY CONCEPTS RELATED TO WORK READINESS, ENTREPRENEURSHIP, AND FINANCIAL LITERACY. COALITION BUILDING: COOK CHILDREN'S IS A CO-FOUNDING MEMBER OF THE INFANT MORTALITY NETWORK ORGANIZED TO ADDRESS THE HIGH RATES OF INFANT MORTALITY IN THE COUNTY. THE CURRENT CO-CHAIR OF THE NETWORK IS A NURSING DIRECTOR AT COOK CHILDREN'S. THE NETWORK HAS RAISED COMMUNITY AWARENESS OF THE PROBLEM AND WORKED WITH LEGISLATORS TO CREATE PUBLIC POLICY TO HELP ADDRESS THE PROBLEM. COOK CHILDREN'S IS ALSO AN ACTIVE MEMBER OF THE HEALTHY TARRANT COUNTY COLLABORATION - A HEALTH PROMOTION NETWORK OF NON-PROFIT HOSPITALS, PUBLIC HEALTH AND LOCAL UNIVERSITIES. THE COLLABORATION EFFORTS INCLUDE HEALTH EDUCATION AT A SUMMER CAMP FOR UNDERSERVED CHILDREN. THE CURRENT VICE-CHAIR OF THE INTELLECTUAL AND DEVELOPMENTAL DISABILITIES NEEDS COUNCIL OF TARRANT COUNTY IS A DIRECTOR OF PSYCHIATRIC SERVICES AT COOK CHILDREN'S. COMMUNITY HEALTH IMPROVEMENT ADVOCACY: ADVOCACY EFFORTS BY COOK CHILDREN'S ARE ENHANCED THROUGH MEMBERSHIP IN VARIOUS LOCAL, STATE, AND NATIONAL ORGANIZATIONS. ASSESSMENT OF COMMUNITY NEEDS, ACCESS TO HEALTH CARE AND INSURANCE FOR UNDERSERVED POPULATIONS AND ADVOCACY ON SPECIFIC HEALTH ISSUES SUCH AS CHILD ABUSE AND NEGLECT AND PREVENTABLE INJURIES ARE AMONG THE ISSUES ADDRESSED. WORKFORCE DEVELOPMENT: COOK CHILDREN'S HAS REPRESENTATION ON ADVISORY BOARDS AT LOCAL UNIVERSITIES AND COLLEGES TO PROVIDE GUIDANCE IN SPECIFIC AREAS OF STUDY.
FACILITY INFORMATION SCHEDULE H, PART V, SECTION B THE ORGANIZATION HAS ELECTED NOT TO COMPLETE THE OPTIONAL SCHEDULE H, PART V, SECTION B FOR THE 2010 TAX YEAR FORM 990.
Schedule H (Form 990) 2010
Additional Data


Software ID:  
Software Version:  
Schedule I
(Form 990)
Department of the Treasury
Internal Revenue Service
Grants and Other Assistance to Organizations,
Governments and Individuals in the United States
Complete if the organization answered "Yes," to Form 990, Part IV, line 21 or 22.
lBullet Attach to Form 990
OMB No. 1545-0047
2010
Open to Public
Inspection
Name of the organization
Cook Children's Medical Center
 
Employer identification number
75-2051646
Part I
General Information on Grants and Assistance
1
Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ....................................
2
Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.
Part II
Grants and Other Assistance to Governments and Organizations in the United States. Complete if the organization answered "Yes" to
Form 990, Part IV, line 21 for any recipient that received more than $5,000. Check this box if no one recipient received more than $5,000. Use
Part IV and Schedule I-1 (Form 990) if additional space is needed ......................... lBullet
(a) Name and address of organization
or government		 (b) EIN (c) IRC Code section
if applicable		 (d) Amount of cash grant (e) Amount of non-cash
assistance		 (f) Method of valuation
(book, FMV, appraisal,
other)		 (g) Description of
non-cash assistance		 (h) Purpose of grant
or assistance
(1) COOK CHILDREN'S PHYSICIAN NETWORK801 SEVENTH AVENUE
FORT WORTH,TX76104 		75-2485366 501(C)(3) 42,661,100       subsidize operations
(2) AMERICAN HEART ASSOCIATION2630 W FREEWAY 250
FORT WORTH,TX76104 		13-5613797 501(C)(3) 70,000       SPONSOR
(3) CAREITY FOUNDATIONPO BOX 126038
FORT WORTH,TX76126 		06-1704800 501(C)(3) 15,000       SPONSOR
(4) ARTS COUNCIL OF NE- ARTS LEAGUE2819 R D HURT PKY
BEDFORD,TX76126 		75-1586473 501(C)(3) 7,000       SPONSOR
















2
Enter total number of section 501(c)(3) and government organizations ......................... Bullet Image
4
3
Enter total number of other organizations ................................ . Bullet Image
 
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2010

Schedule I (Form 990) 2010
Page 2
Part III
Grants and Other Assistance to Individuals in the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 22.
Use Schedule I-1 (Form 990) if additional space is needed.
(a)Type of grant or assistance (b)Number of
recipients		 (c)Amount of
cash grant		 (d)Amount of
non-cash assistance		 (e)Method of valuation (book,
FMV, appraisal, other)		 (f)Description of non-cash assistance
(1) MEDICATIONS 216 31,053      
(2) TRANSPORTATION 343 16,505      
(3) RENT/MORTGAGE 22 12,356      
(4) UTILITIES 14 5,386      
(5) OTHER 66 6,352      
(6) MEAL TICKETS 103 2,040      



Part IV
Supplemental Information. Complete this part to provide the information required in Part I, line 2, and any other additional information.
Identifier Return Reference Explanation
PROCEDURES FOR MONITORING THE USE OF THE GRANT FUNDS IN THE US SCHEDULE I PART I QUESTION 2 THE ORGANIZATION USES PUBLIC AND PRIVATE DATA TO MONITOR THE USE OF FUNDS, AS NEEDED.
Schedule I (Form 990) 2010


Additional Data


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Software Version:  


Schedule J
(Form 990)
Department of the Treasury
Internal Revenue Service
Compensation Information
For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet Complete if the organization answered "Yes" to Form 990,
Part IV, question 23.
SchJMediumBullet Attach to Form 990. SchJMediumBullet See separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
Cook Children's Medical Center
 
Employer identification number

75-2051646
Part I
Questions Regarding Compensation
Yes
No
1a
Check the appropiate box(es) if the organization provided any of the following to or for a person listed in Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.
b
If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement orprovision of all the expenses described above? If "No," complete Part III to explain....
1b
 
 
2
Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
officers, directors, trustees, and the CEO/Executive Director, regarding the items checked in line 1a? ....
2
 
 
3
Indicate which, if any, of the following the organization uses to establish the compensation of the
organization's CEO/Executive Director. Check all that apply.
4
During the year, did any person listed in Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:
a
Receive a severance payment or change-of-control payment? ...............
4a
Yes
 
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan? ........
4b
Yes
 
c
Participate in, or receive payment from, an equity-based compensation arrangement? ........
4c
 
No
If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.
Only 501(c)(3) and 501(c)(4) organizations only must complete lines 5-9.
5
For persons listed in form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:
a
The organization? ...........................
5a
 
No
b
Any related organization? .........................
5b
 
No
If "Yes," to line 5a or 5b, describe in Part III.
6
For persons listed in form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:
a
The organization? ...........................
6a
 
No
b
Any related organization? .........................
6b
 
No
If "Yes," to line 6a or 6b, describe in Part III.
7
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............
7
 
No
8
Were any amounts reported in Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regs. section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................
8
 
No
9
If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................
9
 
 
For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990
Cat. No. 50053T
Schedule J (Form 990) 2010

Schedule J (Form 990) 2010
Page 2
Part II
Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use Schedule J-1 if additional space needed.
For each individual whose compensation must be reported in Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.

Note. The sum of columns (B)(i)-(iii) must equal the applicable column (D) or column (E) amounts on Form 990, Part VII, line 1a.
(A) Name (B) Breakdown of W-2 and/or 1099-MISC compensation (C) Retirement and other deferred compensation (D) Nontaxable
benefits		 (E) Total of columns
(B)(i)-(D) 		(F) Compensation
reported in prior
Form 990 or
Form 990-EZ
(i) Base compensation (ii) Bonus & incentive compensation (iii) Other reportable compensation
(1) NANCY C CYCHOL (i)
(ii)		 359,887
0 		151,549
0 		103,869
0 		18,375
0 		8,303
0 		641,983
0 		0
0
(2) STANLEY E DAVIS (i)
(ii)		 165,450
0 		47,936
0 		1,744
0 		8,955
0 		17,430
0 		241,515
0 		0
0
(3) RICHARD P GOODE (i)
(ii)		 170,675
177,643 		54,258
56,473 		47,205
49,130 		6,464
6,729 		8,718
9,074 		287,320
299,049 		0
0
(4) RICK W MERRILL (i)
(ii)		 186,794
480,325 		106,301
273,346 		51,744
133,057 		39,704
102,096 		4,008
10,307 		388,551
999,131 		36,960
95,040
(5) GEORGE B MONTAGUE (i)
(ii)		 0
202,686 		0
57,069 		0
18,948 		0
15,313 		0
11,581 		0
305,597 		0
0
(6) PAULA J WEBB (i)
(ii)		 207,686
0 		53,802
0 		3,125
0 		12,513
0 		7,939
0 		285,065
0 		0
0
(7) TERESA J CLARK (i)
(ii)		 151,109
0 		21,291
0 		10,167
0 		8,451
0 		5,976
0 		196,994
0 		0
0
(8) KEVIN L DAHLE (i)
(ii)		 172,098
0 		0
0 		11,111
0 		10,681
0 		14,046
0 		207,936
0 		0
0
(9) EDWIN VIRGIL EASON (i)
(ii)		 150,345
0 		0
0 		20,347
0 		11,158
0 		13,762
0 		195,612
0 		0
0
(10) MIKE SMITH (i)
(ii)		 163,768
0 		0
0 		19,859
0 		12,408
0 		7,198
0 		203,233
0 		0
0
(11) GRETCHEN EAMES MD (i)
(ii)		 0
295,000 		0
0 		0
1,710 		0
12,156 		0
0 		0
308,866 		0
0
(12) JOANN M SANDERS MD (i)
(ii)		 0
283,921 		0
59,286 		0
3,334 		0
18,375 		0
12,326 		0
377,242 		0
0
(13) DONALD K MURPHEY MD (i)
(ii)		 0
275,504 		0
20,000 		0
1,900 		0
18,375 		0
14,086 		0
329,865 		0
0
(14) ANGEL W HERNANDEZ-MULERO MD (i)
(ii)		 0
495,632 		0
0 		0
17,218 		0
15,313 		0
20,636 		0
548,799 		0
0
(15) JANELL P MASON-BRISCOE (i)
(ii)		 166,210
0 		0
0 		1,541
0 		6,679
0 		4,517
0 		178,947
0 		0
0
(16) DONALD K FAISON (i)
(ii)		 133,898
0 		18,333
0 		16,545
0 		12,812
0 		7,490
0 		189,078
0 		0
0
(17) MARY L HICKS (i)
(ii)		 166,167
0 		0
0 		1,749
0 		12,136
0 		4,939
0 		184,991
0 		0
0
Schedule J (Form 990) 2010

Schedule J (Form 990) 2010
Page 3
Part III
Supplemental Information
Complete this part to provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 4c, 5a, 5b, 6a, 6b, 7, and 8. Also complete this part for any additional information.
Identifier Return Reference Explanation
PAYMENTS FROM A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN SCHEDULE J PART I QUESTION 4B RICK W. MERRILL PARTICIPATES, BUT RECEIVED 0 PAYMENT DURING CALENDAR YEAR 2010.
ALLOCATION OF CEO AND CFO SALARIES SCHEDULE J PART II COOK CHILDREN'S HEALTH CARE SYSTEM IS COMPRISED OF 9 COMPANIES, INCLUDING A MEDICAL CENTER, PHYSICIAN NETWORK, HEALTH PLAN, HOME HEALTH COMPANY, INDEMNITY COMPANY, HEALTH FOUNDATION, NORTHEAST HOSPITAL, PEDIATRIC SURGERY CENTER, AND HEALTH CARE SYSTEM COMPANY. THE CEO AND CFO ARE RESPONSIBLE FOR THE OVERSIGHT OF ALL AFOREMENTIONED COMPANIES. AS A RESULT, THEIR SALARIES ARE ALLOCATED PRO-RATA, BASED ON THE AMOUNT OF TIME THEY SPEND WITH EACH COMPANY.
SEVERANCE PAYMENTS RECEIVED FROM ORGANIZATION SCHEDULE J PART I QUESTION 4A WILLIAM H. CRAIG RECEIVED A SEVERANCE PAYMENT OF $94,640 DURING CALENDAR YEAR 2010.
Schedule J (Form 990) 2010

Additional Data


Software ID:  
Software Version:  
Schedule K
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Information on Tax Exempt Bonds
SchKMediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, line 24a. Provide descriptions,
explanations, and any additional information in Schedule O (Form 990).
SchKMediumBullet Attach to Form 990. SchKMediumBullet See separate instructions.
OMB No. 1545-0047
2010
Open to Public
Inspection
Name of the organization
Cook Children's Medical Center
 
Employer identification number
75-2051646
Part I
Bond Issues
(a) Issuer Name (b) Issuer EIN (c) CUSIP # (d) Date Issued (e) Issue Price (f) Description of Purpose (g) Defeased (h) On
Behalf of
Issuer 		(i) Pool
financing
Yes No Yes No Yes No
A TARRANT COUNTY HEALTH FACILITIES DEVELOPMENT CORP
  		75-1881060 875906MV8 06-27-2007 52,156,976 REFUNDING BONDS 2000 & 2005   X   X   X
B BELL COUNTY HEALTH FACILITIES DEVELOPMENT CORP
  		74-2218760 078027HW2 06-27-2007 17,523,594 REFUNDING BONDS ISSUED 7/19/2000   X   X   X
C TARRANT COUNTY HEALTH FACILITIES DEVELOPMENT CORP
  		75-1881060 875906NY1 02-04-2010 231,948,097 DEVELOPMENT, CONSTR, EQUIP COST   X   X   X
Part II
Proceeds
A B C D
1 Amount of bonds retired. . . . . 0 0 0  
2 Amount of bonds defeased . . . . 0 0 0  
3 Total proceeds of issue . . . . 52,156,976 17,523,594 232,664,094  
4 Gross proceeds in reserve funds . . 0 0 0  
5 Capitalized interest from proceeds. 0 0 0  
6 Proceeds in refunding escrow. . . . . 50,833,752 17,116,642 0  
7 Issuance costs from proceeds . . . 672,932 229,475 2,691,188  
8 Credit enhancement from proceeds. 650,292 177,477 0  
9 Working capital expenditures from proceeds . . 0 0 0  
10 Capital expenditures from proceeds . . 0 0 187,884,787  
11 Other spent proceeds . . 0 0 0  
12 Other unspent proceeds. . . 0 0 42,088,119  
13 Year of substantial completion . . . 2007 2007 2013
Yes No Yes No Yes No Yes No
14 Were the bonds issued as part of a current refunding issue? X     X X      
15 Were the bonds issued as part of an advance refunding issue?   X X     X    
16 Has the final allocation of proceeds been made? . . X   X     X    
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? . X   X   X      
Part III
Private Business Use
A B C D
Yes No Yes No Yes No Yes No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? . . .   X   X   X    
2 Are there any lease arrangements that may result in private business use of bond-financed property? . . . . .   X   X X      
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50193E
Schedule K (Form 990) 2010
Schedule K (Form 990) 2010
Page 2
Part III
Private Business Use (Continued)
A B C D
Yes No Yes No Yes No Yes No
3a Are there any management or service contracts that may result in private business use?   X   X   X    
b Are there any research agreements that may result in private business use of bond-financed property? . .   X   X   X    
c Does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts or research agreements relating to the financed property? . X     X X      
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government . . . . . . . . . . . . . SchKMediumBullet 0 % 0 % 0.260 %  
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government . SchKMediumBullet 0 % 0 % 0 %  
6 Total of lines 4 and 5 . . .. . . . . . 0 % 0 % 0.260 %  
7 Has the organization adopted management practices and procedures to ensure the post-issuance compliance of its tax-exempt bond liabilities? X   X   X      
Part IV
Arbitrage
A B C D
Yes No Yes No Yes No Yes No
1 Has a Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate, been filed with respect to the bond issue? . . .   X   X   X    
2 Is the bond issue a variable rate issue?   X   X X      
3a Has the organization or the governmental issuer entered into a hedge with respect to the bond issue?   X   X   X    
b Name of provider .  
  		 
  		 
  		 
 
c Term of hedge . .        
d Was the hedge superintegrated? .                
e Was a hedge terminated? .                
4a Were gross proceeds invested in a GIC? .   X   X   X    
b Name of provider .  
  		 
  		 
  		 
 
c Term of GIC . .        
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? .                
5 Were any gross proceeds invested beyond an available temporary period? .   X   X   X    
6 Did the bond issue qualify for an exception to rebate? . . .   X   X   X    
Schedule K (Form 990) 2010

Schedule K (Form 990) 2010
Page 3
Part V
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule K (see instructions).
Identifier Return Reference Explanation
Schedule K (Form 990) 2010

Additional Data


Software ID:  
Software Version:  

SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
MediumBullet Attach to Form 990 or 990-EZ.
OMB No. 1545-0047
2010
Open to Public
Inspection
Name of the organization
Cook Children's Medical Center
 
Employer identification number

75-2051646
Identifier Return Reference Explanation
SOLE MEMBER FORM 990 PART VI, QUESTION 6 COOK CHILDREN'S HEALTH CARE SYSTEM, A TEXAS NON-PROFIT CORPORATION, IS THE SOLE MEMBER OF THE ORGANIZATION.
MEMBER ELECTION ABILITIES FORM 990 PART VI, QUESTION 7A AS THE SOLE MEMBER OF THE ORGANIZATION COOK CHILDREN'S HEALTH CARE SYSTEM HAS THE POWER TO DETERMINE THE NUMBER OF MEMBERS OF THE BOARD OF TRUSTEES AND TO ELECT THE MEMBERS OF THE BOARD OF TRUSTEES.
MEMBER DECISION ABILITIES FORM 990 PART VI, QUESTION 7B As the sole member of the organization, Cook Children's Health Care System has the exclusive power to do any of the following: a. Amend, alter, or repeal the bylaws; b. Amend the certificate of formation of the corporation; c. Approve any merger, acquisition, liquidation, winding up, termination or consolidation of the corporation; d. Approve the persons who are to be elected by the corporation to fill any vacancies on the board of trustees; e. Approve the sale, gift, or other disposition of all or substantially all of the property of the corporation; f. Approve the creation of, or investment in, any subsidiary entity; and g. Approve the removal of a member of the board of trustees.
REVIEW PROCESS FOR FORM 990 FORM 990 PART VI, QUESTION 11 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 FORMS ARE PREPARED, THEY ARE REVIEWED BY COMPANY EXECUTIVES AND THEN PROVIDED TO THE BOARD OF TRUSTEES FOR REVIEW. IN ADDITION, THEY ARE PRESENTED TO THE BOARD AUDIT COMMITTEE FOR REVIEW. SUBSEQUENT TO AUDIT COMMITTEE REVIEW, THE FORMS ARE FILED WITH THE INTERNAL REVENUE SERVICE AND MADE AVAILABLE TO THE PUBLIC FOR REVIEW.
REVIEW AND APPROVAL OF COMPENSATION FORM 990 PART VI, QUESTION 15A & 15B Cook Children's Health Care System has established a compensation committee with oversight of executive and physician compensation. The committee approves compensation arrangements in advance, relying upon comparable market data relating to compensation, which is provided by Mercer & Associates (executive compensation) and Sullivan Cotter (physician compensation), both independent, nationally recognized compensation consultants. The committee documents the basis for its determinations, and requires the compensation consultants to update market data periodically, usually every two years, with interim reviews being conducted as needed. With regard to physician compensation, the 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.
PROCESS OF MAKING GOVERNING DOCUMENTS AVAILABLE TO THE PUBLIC FORM 990 PART VI, QUESTION 19 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 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.
EXEMPT PURPOSE ACHIEVEMENTS CONTINUED 990 PART III QUESTION 4A (CONT.) With the culmination of a historic building initiative that began in 2009, the medical center is now licensed for 429 beds, making it one of the largest children's hospitals in the country. The 530,000 square foot expansion includes a conversion to a private layout for the hospital's 106 Neonatal Intensive Care unit rooms, more rooms in the HEMATOLOGY and Oncology unit and the Transitional Care and Rehabilitation Care units, two new helipads, a food court, a patient library and classrooms, a parent business center, an indoor/outdoor playground, and 1,300 additional parking spaces. This expansion has positioned Cook Children's to continue to provide the outstanding quality of care that is the cornerstone of its market dominance, in response to the challenges of an ever-growing population. The medical center offers advanced technological equipment, leading surgical techniques, rehabilitation facilities, and ancillary services designed to meet the special needs of children. Additionally, the campus boasts a professional and highly skilled staff of nurses, technologists, therapists, and other clinicians, as well as more than 500 physicians and dentists who provide primary, secondary, tertiary, and quaternary levels of pediatric care. Child Life staff, chaplains, teachers, social services coordinators, and translators help patients and families cope with the stressors that accompany a child's hospitalization. The medical center is home to Cook Children's Emergency Department and Urgent Care Center and the only EMS-designated pediatric trauma center in Tarrant County, Texas. More than 100,000 patients present to the Emergency Department and Urgent Care Center for treatment each year. Cook Children's Medical Center is supported by one of the nation's largest and award winning pediatric transport programs, which brings more than 2,200 children to the medical center annually, primarily for critical care. Services include ambulance, helicopter, and fixed-wing airplane transportation. During Hurricane Ike, in 2006, Cook Children's transport team helped to evacuate intensive care patients from a pediatric hospital in Corpus Christi, Texas.
DELEGATION OF CONTROL OVER MANAGEMENT FORM 990 PART VI QUESTION 3 A MANAGEMENT COMPANY MANAGES THE DAY TO DAY OPERATIONS OF BOTH OF OUR JOINT VENTURES.
WRITTEN CONFLICT OF INTEREST POLICY FORM 990 PART VI, QUESTION 12C Every year the Legal Department sends out a Form 990 questionnaire/Conflict of Interest Disclosure Statement to officers, directors, trustees and key employees. 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 are provided to the 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 in force for all affiliated entities 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.
OTHER CHANGES IN NET ASSETS FORM 990, PART XI, LINE 5 TRANSFERS BETWEEN AFFILIATES ($184,662,972) AMORTIZATION OF BOND SWAP EFFECTIVENESS $ 262,714 INTEREST RATE SWAP ADJUSTMENT ($ 1,793,056) ---------------- TOTAL CHANGE IN NET ASSETS ($186,193,314)
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:JAMES F. HERD, SR., MD TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:MARSHA HILCHER TITLE:TRUSTEE-VICE CHAIRMAN HOURS:1
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:CHRISTOPHER M. HUCKABEE TITLE:TRUSTEE HOURS:1
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:BONNIE PETSCHE TITLE:TRUSTEE HOURS:1
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:PETER L. PHILPOT TITLE:TRUSTEE-CHAIRMAN HOURS:1
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:G. DOUGLAS TATUM, MD TITLE:TRUSTEE HOURS:1
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:JOHN P. BOSWELL TITLE:TRUSTEE HOURS:1
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:JAMES R. DUNAWAY, JR. TITLE:TRUSTEE HOURS:6
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:GRETCHEN EAMES, MD TITLE:TRUSTEE HOURS:41
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:JOHN M. RICHARDSON, MD TITLE:TRUSTEE HOURS:1
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:JOANN M. SANDERS, MD TITLE:TRUSTEE HOURS:40
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:DONALD K. MURPHEY, MD TITLE:TRUSTEE HOURS:43
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:ANGEL W. HERNANDEZ-MULERO, MD TITLE:TRUSTEE HOURS:43
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:RICHARD P. GOODE TITLE:CHIEF FINANCIAL OFFICER HOURS:20
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:CARA MARTZ TITLE:SECRETARY HOURS:39
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:RICK W. MERRILL TITLE:CHIEF EXECUTIVE OFFICER HOURS:29
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:GEORGE B. MONTAGUE TITLE:VP, REAL ESTATE HOURS:38
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:JANELL P. MASON-BRISCOE TITLE:VP-SPECIALTY SERVICES HOURS:2
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2010

Additional Data


Software ID:  
Software Version:  
SCHEDULE R
(Form 990)
Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
MediumBulletComplete if the organization answered "Yes" to Form 990, Part IV, line 33, 34, 35, 36, or 37.
MediumBulletAttach to Form 990. MediumBullet See separate instructions.

OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
Cook Children's Medical Center
 
Employer identification number

75-2051646
Part I
Identification of Disregarded Entities (Complete if the organization answered "Yes" on Form 990, Part IV, line 33.)
(a)
Name, address, and EIN of disregarded entity


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Total income
(e)
End-of-year assets


 		(f)
Direct controlling
entity

















Part II
Identification of Related Tax-Exempt Organizations (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.)
(a)
Name, address, and EIN of related organization


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Exempt Code section
(e)
Public charity status
(if section 501(c)(3))

 		(f)
Direct controlling
entity

 		(g)
Section 512(b)(13) controlled organization
Yes No
(1) COOK CHILDREN'S PHYSICIAN NETWORK

801 SEVENTH AVE

FORT WORTH,TX76104
75-2485366 		PHYSICIAN SVC TX 501(C)(3) 3 NA
 
 
 
(2) WI COOK FOUNDATION

801 SEVENTH AVE

FORT WORTH,TX76104
75-2056149 		FUNDRAISING TX 501(C)(3) 11D NA
 
 
 
(3) COOK CHILDREN'S HOME HEALTH

801 SEVENTH AVE

HOUSTON,TX76104
75-2896983 		HEALTHCARE TX 501(C)(3) 11C NA
 
 
 
(4) COOK CHILDREN'S HEALTH CARE SYSTEM

801 SEVENTH AVE

FORT WORTH,TX76104
75-2705881 		HLTH CARE SUP TX 501(C)(3) 11C NA
 
 
 
(5) COOK CHILDREN'S HEALTH PLAN

801 SEVENTH AVE

FORT WORTH,TX76104
76-0585240 		INSURANCE TX 501(C)(3) 11C NA
 
 
 




For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2010
Schedule R (Form 990) 2010
Page 2
Part III
Identification of Related Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.)
(a)
Name, address, and EIN of
related organization



 		(b)
Primary activity




 		(c)
Legal
domicile
(state or foreign
country)


 		(d)
Direct controlling
entity



 		(e)
Predominant income(related, unrelated, excluded from tax under sections 512-514)

(f)
Share of total income




 		(g)
Share of end-of-year
assets



 		(h)
Disproprtionate allocations?




 		(i)
Code V—UBI
amount in box 20 of
Schedule K-1
(Form 1065)
 		(j)
General or
managing
partner?



 		(k)
Percentage
ownership
Yes No Yes No
(1) COOK CHILDREN'S NORTHEAST HOSPITAL

801 SEVENTH AVE
FORT WORTH,TX76104
20-5227064 		HOSPITAL TX NA
  		RELATED 4,788,523 4,910,619   No 0 Yes   55.140 %
(2) CENTER FOR PEDIATRIC SURGERY

801 SEVENTH AVE
FORT WORTH,TX76104
47-0871715 		ASC TX NA
  		RELATED 5,774,289 12,683,295   No 0   No 50.770 %
(3) CPS PEDIATRICS LLC

11221 ROE AVE SUITE 320
LEAWOOD,KS66211
47-0871718 		ASC TX NA
  		RELATED 29,936 105,541   No 0 Yes   51.000 %








Part IV
Identification of Related Organizations Taxable as a Corporation or Trust (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.)
(a)
Name, address, and EIN of related organization



 		(b)
Primary activity



 		(c)
Legal domicile
(state or
foreign
country)
 		(d)
Direct controlling
entity


 		(e)
Type of entity
(C corp, S corp,
or trust)

 		(f)
Share of total income



 		(g)
Share of
end-of-year
assets

 		(h)
Percentage
ownership












Schedule R (Form 990) 2010
Schedule R (Form 990) 2010
Page 3
Part V
Transactions With Related Organizations (Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35, 35A, or 36.)
Note. Complete line 1 if any entity is listed in Parts II, III or IV.
Yes
No
1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?
a Receipt of (i) interest (ii) annuities (iii) royalties (iv) rent from a controlled entity . . . . . . . . . . . . . . . . . . . . . . .
1a
Yes
 
b Gift, grant, or capital contribution to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1b
 
No
c Gift, grant, or capital contribution from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1c
Yes
 
d Loans or loan guarantees to or for other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1d
 
No
e Loans or loan guarantees by other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1e
Yes
 
f Sale of assets to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1f
 
No
g Purchase of assets from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1g
 
No
h Exchange of assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1h
Yes
 
i Lease of facilities, equipment, or other assets to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1i
Yes
 
j Lease of facilities, equipment, or other assets from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .
1j
Yes
 
k Performance of services or membership or fundraising solicitations for other organization(s) . . . . . . . . . . . . . . . . . . . . . .
1k
 
No
l Performance of services or membership or fundraising solicitations by other organization(s) . . . . . . . . . . . . . . . . . . . . . .
1l
Yes
 
m Sharing of facilities, equipment, mailing lists, or other assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1m
 
No
n Sharing of paid employees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1n
Yes
 
o Reimbursement paid to other organization for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1o
Yes
 
p Reimbursement paid by other organization for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1p
Yes
 
q Other transfer of cash or property to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1q
Yes
 
r Other transfer of cash or property from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1r
Yes
 
2
If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.
(a)
Name of other organization 		(b)
Transaction
type(a-r) 		(c)
Amount involved 		(d)
Method of determining amount involved
(1) COOK CHILDREN'S NORTHEAST HOSPITAL LLC

 R 4,252,143  
(2) CENTER FOR PEDIATRIC SURGERY LTD

 R 6,883,962  
(3)
(4)
(5)
(6)
Schedule R (Form 990) 2010
Schedule R (Form 990) 2010
Page 4
Part VI
Unrelated Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 37.)
Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.
(a)
Name, address, and EIN of entity 		(b)
Primary activity 		(c)
Legal domicile
(state or foreign
country) 		(d)
Are all
partners
section
501(c)(3)
organizations? 		(e)
Share of
end-of-year
assets 		(f)
Disproprtionate allocations? 		(g)
Code V—UBI
amount in box
20 of Schedule K-1
(Form 1065) 		(h)
General or
managing
partner?
Yes No Yes No Yes No






























Schedule R (Form 990) 2010
Schedule R (Form 990) 2010
Page 5
Part VII
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule R (see instructions).
Identifier Return Reference Explanation
Additional Data


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