Civic Intelligence

Cook Children'S Medical Center

EIN 75-2051646 • 501(c)3 • Fort Worth, TX

Profile

Knowing that every child's life is sacred, our promise is to improve the health of every child in our region through the prevention and treatment of illness, disease and injury.

801 Seventh AvenueFort Worth, TX 76104

www.cookchildrens.org

Siviq Scores

Precomputed percentiles relative to similar nonprofits. These scores are descriptive rather than judgmental.

Liabilities / Assets

54th percentile

0.33x

Higher debt load relative to assets than 54% of similar nonprofits.

501(c)3 • $1B+ nonprofits • Source year 2024

Liabilities / Revenue

32nd percentile

0.37x

Higher debt load relative to revenue than 32% of similar nonprofits.

501(c)3 • $1B+ nonprofits • Source year 2024

Net Margin

82nd percentile

25%

Higher net margin than 82% of similar nonprofits.

501(c)3 • $1B+ nonprofits • Source year 2024

Top Officer Pay

71st percentile

$3,305,517

Higher top officer pay than 71% of similar nonprofits.

Top officer pay equals 0.1% of source-year revenue.

501(c)3 • $1B+ nonprofits • Source year 2024

Asset Growth

92nd percentile

30%

Faster asset growth than 92% of similar nonprofits.

501(c)3 • $1B+ nonprofits • Annualized from 2023 to 2024

Revenue Growth

69th percentile

16%

Faster revenue growth than 69% of similar nonprofits.

501(c)3 • $1B+ nonprofits • Annualized from 2023 to 2024

Assets

Up

$2,486,656,392

Up $576,696,873 (+30%) from 2023

Liabilities

Up

$814,134,605

Up $19,249,420 (+2.4%) from 2023

Net Assets

Up

$1,672,521,787

Up $557,447,453 (+50%) from 2023

Revenue

Up

$2,221,876,718

Up $299,166,330 (+16%) from 2023

Expenses

Up

$1,663,759,026

Up $141,861,633 (+9.3%) from 2023

Net Income

Up

$558,117,692

Up $157,304,697 (+39%) from 2023

Trend Graphs

Balance Sheet Trend

Grouped bars show assets, liabilities, and net assets across loaded filings.

$3.0B$2.0B$1.0B$0Assets 2010: $761,990,272Liabilities 2010: $404,033,064Net Assets 2010: $357,957,2082010Assets 2011: $717,528,502Liabilities 2011: $414,633,348Net Assets 2011: $302,895,1542011Assets 2012: $842,018,414Liabilities 2012: $389,375,498Net Assets 2012: $452,642,9162012Assets 2013: $854,499,605Liabilities 2013: $383,129,428Net Assets 2013: $471,370,1772013Assets 2014: $1,217,738,885Liabilities 2014: $558,969,359Net Assets 2014: $658,769,5262014Assets 2015: $1,047,972,021Liabilities 2015: $527,141,093Net Assets 2015: $520,830,9282015Assets 2016: $1,118,765,172Liabilities 2016: $526,989,012Net Assets 2016: $591,776,1602016Assets 2017: $1,153,835,594Liabilities 2017: $509,289,156Net Assets 2017: $644,546,4382017Assets 2018: $1,200,788,157Liabilities 2018: $436,324,447Net Assets 2018: $764,463,7102018Assets 2019: $1,426,284,240Liabilities 2019: $450,333,040Net Assets 2019: $975,951,2002019Assets 2020: $1,804,052,601Liabilities 2020: $677,130,790Net Assets 2020: $1,126,921,8112020Assets 2021: $1,871,901,068Liabilities 2021: $624,234,763Net Assets 2021: $1,247,666,3052021Assets 2022: $1,720,011,003Liabilities 2022: $656,624,458Net Assets 2022: $1,063,386,5452022Assets 2023: $1,909,959,519Liabilities 2023: $794,885,185Net Assets 2023: $1,115,074,3342023Assets 2024: $2,486,656,392Liabilities 2024: $814,134,605Net Assets 2024: $1,672,521,7872024

Highlighted filing

2024

Assets$2,486,656,392
Liabilities$814,134,605
Net Assets$1,672,521,787

Operations Trend

Revenue, expenses, and net income by year, with the latest filing highlighted.

$3.0B$2.0B$1.0B$0Expenses 2010: $484,345,5232010Expenses 2011: $524,854,2952011Revenue 2012: $827,619,372Expenses 2012: $607,012,759Net Income 2012: $220,606,6132012Expenses 2013: $667,703,4542013Revenue 2014: $856,309,576Expenses 2014: $675,739,824Net Income 2014: $180,569,7522014Revenue 2015: $853,853,150Expenses 2015: $688,350,982Net Income 2015: $165,502,1682015Revenue 2016: $957,111,477Expenses 2016: $759,991,385Net Income 2016: $197,120,0922016Revenue 2017: $1,019,058,898Expenses 2017: $859,199,784Net Income 2017: $159,859,1142017Revenue 2018: $1,090,922,156Expenses 2018: $913,301,081Net Income 2018: $177,621,0752018Revenue 2019: $1,193,947,458Expenses 2019: $981,175,755Net Income 2019: $212,771,7032019Revenue 2020: $1,312,743,878Expenses 2020: $1,075,441,684Net Income 2020: $237,302,1942020Revenue 2021: $1,513,660,147Expenses 2021: $1,155,105,021Net Income 2021: $358,555,1262021Revenue 2022: $1,772,072,835Expenses 2022: $1,350,787,048Net Income 2022: $421,285,7872022Revenue 2023: $1,922,710,388Expenses 2023: $1,521,897,393Net Income 2023: $400,812,9952023Revenue 2024: $2,221,876,718Expenses 2024: $1,663,759,026Net Income 2024: $558,117,6922024

Highlighted filing

2024

Revenue$2,221,876,718
Expenses$1,663,759,026
Net Income$558,117,692

Filings

Balance SheetOperations
YearAssetsLiabilitiesNet AssetsRevenueExpensesNet Income
2024Detailed filing. Detailed filing data is available for this year.$2,487$814$1,673$2,222$1,664$558
2023Detailed filing. Detailed filing data is available for this year.$1,910$795$1,115$1,923$1,522$401
2022Detailed filing. Detailed filing data is available for this year.$1,720$657$1,063$1,772$1,351$421
2021Detailed filing. Detailed filing data is available for this year.$1,872$624$1,248$1,514$1,155$359
2020Detailed filing. Detailed filing data is available for this year.$1,804$677$1,127$1,313$1,075$237
2019Detailed filing. Detailed filing data is available for this year.$1,426$450$976$1,194$981$213
2018Detailed filing. Detailed filing data is available for this year.$1,201$436$764$1,091$913$178
2017Detailed filing. Detailed filing data is available for this year.$1,154$509$645$1,019$859$160
2016Detailed filing. Detailed filing data is available for this year.$1,119$527$592$957$760$197
2015Detailed filing. Detailed filing data is available for this year.$1,048$527$521$854$688$166
2014Detailed filing. Detailed filing data is available for this year.$1,218$559$659$856$676$181
2013Facts available. Structured filing facts are available, but richer extracted sections are limited.$854$383$471$668
2012Summary only. Only limited summary data is available for this year.$842$389$453$828$607$221
2011Facts available. Structured filing facts are available, but richer extracted sections are limited.$718$415$303$525
2010Facts available. Structured filing facts are available, but richer extracted sections are limited.$762$404$358$484
Latest Filing Detail
Jump To
Filing Snapshot
Filing Period
Oct 1, 2023 to Sep 30, 2024
Signed
Aug 13, 2025
Return Version
2023v6.0
Gross Receipts
$2,223,282,313
Mission and Program Overview

Mission

Knowing that every child's life is sacred, our promise is to improve the health of every child in our region through the prevention and treatment of illness, disease and injury.

Balance Sheet Detail
LineBeginningEndChange
Assets
Savings and Temporary Cash Investments$766,934,702$1,216,988,006▲ $450,053,304
Land, Buildings, and Equipment, Net$683,558,771$677,505,071▼ $6,053,700
Accounts Receivable$271,351,844$320,616,591▲ $49,264,747
Inventories for Sale or Use$15,571,471$20,825,319▲ $5,253,848
Investments Other Securities$10,284,947$9,500,076▼ $784,871
Other Notes and Loans Receivable, Net$7,302,817$4,806,246▼ $2,496,571
Intangible Assets$5,269,992$4,517,494▼ $752,498
Prepaid Expenses and Deferred Charges$408,900$574,843▲ $165,943
Cash and Non-Interest-Bearing Accounts$17,176$16,486▼ $690
Receivable From Disqualified Prsn$0$0→ $0
Receivables From Officers Etc$0$0→ $0
Investments Program Related$0--
Loans From Officers Directors$0$0→ $0
Total Assets$1,909,959,519$2,486,656,392▲ $576,696,873
Other Assets Total$149,258,899$231,306,260▲ $82,047,361
Liabilities
Tax Exempt Bond Liabilities$469,477,399$457,651,530▼ $11,825,869
Other Liabilities$212,320,923$225,455,361▲ $13,134,438
Accounts Payable and Accrued Expenses$112,948,758$130,863,370▲ $17,914,612
Deferred Revenue$138,105$164,344▲ $26,239
Total Liabilities$794,885,185$814,134,605▲ $19,249,420
Net Assets / Fund Balance
Net Assets Without Donor Restrictions$1,115,074,334$1,672,521,787▲ $557,447,453
Total Net Assets Fund Balance$1,115,074,334$1,672,521,787▲ $557,447,453
Total Liabilities and Net Assets / Fund Balance$1,909,959,519$2,486,656,392▲ $576,696,873

Asset Categories

AssetBook ValueDepreciationBasis
Buildings$548,828,460$515,724,871$1,064,553,331
Equipment$52,982,337$234,407,941$287,390,278
Other Land Buildings$59,337,291$9,868,730$69,206,021
Land$16,179,074-$16,179,074
Leasehold Improvements$177,909$4,532,313$4,710,222
Other Assets Org$16,606,646--

Endowment Activity

PeriodBeginningContrib.Gain/LossOther UsesEnd
2023$150,274,073$573,248▲ $17,653,678$961,797$167,539,202
2022$147,891,893$556,006▲ $3,075,768$1,249,594$150,274,073
2021$144,754,164$769,694▲ $4,015,935$1,647,900$147,891,893
2020$111,066,541$503,149▲ $35,817,291$2,632,817$144,754,164
2019$116,417,669$1,190,088▲ $4,361,068$10,902,284$111,066,541
Compensation and Service Providers

Employees

NameTitleFull / Part TimeBaseOtherTotal
Stanley E DavisSr. VP, Chief Operating OfficerFT$577,823$496,711$1,074,534
Nancy C CycholPresident/Chief Hospital ServicesFT$458,980$392,007$850,987
Rick W MerrillCEOPT$366,013$460,366$826,379
Cheryl PetersenVP Nursing, CNOFT$339,737$271,073$610,810
Jack SosebeeVice presidentFT$348,978$260,005$608,983
Elia Valencia-StokesVP FinanceFT$318,662$204,302$522,964
Stephen W KimmelEvp, Sys FinancePT$260,695$240,807$501,502
Natalie WilkinsVP, OperationsFT$311,580$171,811$483,391
Orlando ChapaAVP, NursingFT$249,944$179,042$428,986
Deborah BoudreauxAVP NursingFT$244,019$178,133$422,152
Nicholas MarkhamAVP Facilities/Campus SvcsFT$211,760$123,867$335,627
Ozioma OlowuChief Pharmacy OfficerFT$215,625$111,979$327,604
Tammy ThomlisonAVP RevenueFT$237,035$73,470$310,505
Tommie MossPharmacistFT$218,385$60,984$279,369
Eric NimelyRespiratory TherapistFT$231,458$46,705$278,163
Jessica SibrPharmacistFT$237,813$40,036$277,849
Tammy ElizondoProgram CoordinatorFT$231,122$31,666$262,788
Aldrena HeadAssistant VPFT$164,254$90,285$254,539
Toni SmithNight/Weekend AdministratorFT$193,057$57,685$250,742

Board Members and Trustees

NameTitle
John P BoswellTrustee - Chairman
Andrew S WayneTrustee - Vice Chairman
Anne M CarvalhoTrustee - Vice Chairman END 5/31/24
Bonnie PetscheTrustee
Edwin S RyanTrustee
Judge Jeffrey L CuretonTrustee
Laura MillerTrustee
Leah M KingTrustee
Michael A LaGattaTrustee
Peggy L CassidyTrustee
Thomas Breckinridge RayTrustee
Wally JonesTrustee
Ryan B DickersonTrustee - Sec/Treasurer
Frank A AndersonTrustee END 5/31/24
Robert J BattonTrustee END 5/31/24
Na'im R MosesTrustee START 6/1/24
Jonathan Nedrelow MDAssociate Chief Medical Officer
Cory R RhoadesChief Financial Officer
James C Cunningham MDEvp, CMO
Matthew Carroll MDFORMER VP, Assoc Chief Quality Officer
Mary Cara MartzSecretary
Theresa Z MeadowsSr. VP, Chief Information Officer
Joseph M GallagherSr. VP, Chief Legal Officer
Spencer D SealsVP Construction & Real Estate
Kevin GreeneVP, Prosper Medical Center

Highest Paid Contractors

ContractorServicesLocationCompensation
Linbeck Group LLCConstruction1263 W ROSEDALE STE 202, Ste 401, Fort Worth, TX 76104$36,383,777
Fisk Electric CoConstruction1617 W CROSBY RD 120, Carrollton, TX 75006$4,151,259
Bottom Line Systems LLCProfessional Services541 BUTTERMILK PIKE, Crescent Springs, KY 41017$2,642,074
Dynamic Systems INCConstruction2315 EAST LOOP 820 NORTH, Fort Worth, TX 76118$2,180,046
Hks INCProfessional ServicesPO BOX 731121, Dallas, TX 75373$1,485,246
Revenue and Support

Revenue Composition

Contributions and Grants
$22,942,471
Program Service Revenue
$2,195,940,423
Investment Income
$2,770,914
Other Revenue
$222,910
Change in Net Assets
$558,117,692

Audited Revenue Reconciliation

Revenue per Audited Statements
$2,209,094,434
Revenue Not Reported on Financial Statements
$12,782,284
Revenue Not Reported on Form 990
$-3,167,527
Other Revenue Adjustments
$12,782,284
Total Revenue per Audited Statements
$2,205,926,907
Total Revenue per Form 990
$2,221,876,718
Expenses and Functional Allocation

Major Expense Lines

Line ItemAmount
Other Expenses$988,635,221
Salaries, Compensation, and Employee Benefits$574,668,377
Grants and Similar Amounts Paid$100,455,428
Professional Fundraising Fees$0
Total Fundraising Expense$0

Functional Expense Allocation

Line ItemProgramManagementFundraisingTotal
Other Salaries and Wages$391,746,300$17,327,630-$409,073,930
Fees for Services Management-$295,469,547-$295,469,547
Other Employee Benefits$102,318,437$4,974,645-$107,293,082
Grants to Domestic Orgs$99,753,309--$99,753,309
Depreciation Depletion$44,636,992$13,865,650-$58,502,642
Fees for Services Other$41,832,386$8,637,276$0$50,469,662
All Other Expenses$32,484,186$1,331,969$0$33,816,155
Payroll Taxes$29,101,552$1,401,223-$30,502,775
Pension Plan Contributions$18,920,652$1,131,733-$20,052,385
Other Expenses$7,567,469$9,320,884-$16,888,353
Office Expenses$13,418,600$736,078-$14,154,678
Occupancy$7,647,746$2,635,643-$10,283,389
Current Officers, Directors, Trustees, and Key Employees$1,724,752$5,930,421-$7,655,173
Insurance$3,716,595--$3,716,595
Payments to Affiliates$1,799,502--$1,799,502
Travel$887,917$67,851-$955,768
Conferences and Meetings$852,009$27,049-$879,058
Grants to Domestic Individuals$702,119--$702,119
Interest$175,513$7,226-$182,739
Fees for Services Legal-$117,855-$117,855
Comp Disqual Persons$91,032--$91,032
Advertising$87,692$854-$88,546
Fees for Services Accounting-$54,075-$54,075
Total Functional Expenses$1,300,721,417$363,037,609$0$1,663,759,026

Audited Expense Reconciliation

Line ItemAmount
Total Expenses per Form 990$1,663,759,026
Total Expenses per Audited Statements$1,662,187,315
Expenses per Audited Statements$1,661,261,738
Expenses Not Reported on Financial Statements$2,497,288
Other Expense Adjustments$2,497,288
Expenses Not Reported on Form 990$925,577
International Activity

Grant and Assistance Recipients

RecipientLocationCategoryPurposeAmount
Cook Children's Physician NetworkFORT Worth, TX501(c)(3)Subsidize Operations$99,658,309
Junior League of Fort WorthFort Worth, TX501(c)(3)Sponsorship$35,000
March of DimesAtlanta, GA501(c)(3)Sponsorship$17,500
Ronald McDonald HouseFort Worth, TX501(c)(3)Sponsorship$10,000
Juvenile Diabetes Research FoundationDallas, TX501(c)(3)Sponsorship$7,500
Fundraising, Events, and Gaming
Fundraising activities
No
Gaming activities
No
Professional fundraiser used
No

Fundraising and Gaming Totals

Line ItemAmount
Professional Fundraising Fees$0
Political and Lobbying Activity
Political campaign activity
No
Lobbying activity
Yes
Insider Transactions and Loans

Interested-Person Transactions

Interested PartyRelationshipDescriptionShared RevenueAmount
-Daughter of Board MemberCompensationNo$91,032

Loans and Receivables

Line ItemBeginningEndChange
Loans from Officers, Directors, Trustees, and Key Employees$0$0→ $0
Receivables from Disqualified Persons$0$0→ $0
Receivables from Officers, Directors, Trustees, and Key Employees$0$0→ $0
Debt and Bond Financing

Other Reported Liabilities

LiabilityAmount
Intercompany Payables$171,862,122
Estimated Due to Third Parties$46,481,809
Right of Use Liability$7,111,430

Bond Issues

BondIssuerIssuedIssue PricePurpose
CTarrant County Cultural Education Facilities2020-02-25$241,629,204Refunding and construction and equipment
ATarrant County Cultural Education Facilities2010-02-24$231,948,097Development, const, equipment
BTarrant County Cultural Education Facilities2014-02-02$176,767,688Construction & equipment costs
DTarrant County Cultural Education Facilities2023-09-05$163,310,000Refunding 2013 & 2014 Bonds

Bond Proceeds

BondTotal ProceedsSpentRetiredIssuance Costs
C$242,464,102-$17,685,000$2,221,088
A$231,948,097$2,059,954$199,770,000$2,686,446
B$176,767,688-$28,820,000$1,755,350
D$165,369,955-$2,225,000$710,063

Bond Financing Compliance

No rebate due
Yes
Rebate not yet due
No
Form 8038-T filed
No
Gross proceeds invested
No
Gross proceeds invested in GIC
No
Exception to rebate
No
Corrective action procedures
Yes
Governance and Compliance

Governance Checklist

Compiled or reviewed by an accountant
No
Annual disclosure for covered persons
Yes
Audit committee
Yes
Backup withholding compliance
Yes
Business relationship with 35% controlled entity
No
Business relationship with family members
Yes
Business relationship with organization members
No
Material changes to governing documents
No
Compensation from other sources disclosed
No
CEO compensation reviewed
Yes
Other officer compensation reviewed
Yes
Conflict-of-interest policy
Yes
Audited financial statements prepared
Yes
Key decisions subject to board approval
Yes
Management duties delegated
Yes

Governance Explanations

Form 990, Part VI, Line 2 Family/business relationships amongst interested persons

VARIOUS TRUSTEES & OFFICERS EMPLOYED OR SERVING BOARDS WITHIN THE SYSTEM - Business relationship

Form 990, Part VI, Line 3 Delegation of management duties

A management company manages the day to day operations of the joint ventures.

Form 990, Part VI, Line 6 Classes of members or stockholders

Cook children's health care system, a texas non-profit corporation, is the sole member of the organization.

Form 990, Part VI, Line 7A Members or stockholders electing members of governing body

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.

Form 990, Part VI, Line 7B Decisions requiring approval by members or stockholders

As the sole member of the organization, cook children's health care system has the exclusive power and reserved power to do any of the following: a. Amend, alter or repeal the bylaws; b. Amend the certificate of formation of the organization; c. Determine the number of members of the board of trustees and to elect the members of the board of trustees; d. Approve any merger, acquisition, liquidation, winding up, termination or consolidation of the organization; e. Approve the sale, gift or other disposition of all or substantially all of the property of the organization; and, f. Approve the creation of, or investment in, any subsidiary entity.

Form 990, Part VI, Line 11B Review of form 990 by governing body

The organization engages an outside independent accounting firm to assist in the preparation of the form 990 and related filings. All information provided to the outside accounting firm is gathered by key company employees and executives. Once the form 990 is prepared, it is reviewed by company finance, legal and compliance staff and then provided to the board of trustees for review and comment. In addition, it is provided to the cook children's health care system audit committee for review and comment. Subsequent to the board and audit committee review, the form 990 is filed with the internal revenue service and made available to the public for review.

Form 990, Part VI, Line 12C Conflict of interest policy

Every year the legal department of the cook children's health care system (system) sends out a form 990 questionnaire/conflict of interest disclosure statement to officers, directors, trustees and key employees of all system companies, as well as certain other employees, including physicians, who are determined to be employed in positions that might be subject to the system's conflict of interest policy. The responses are reviewed by the legal, finance, and compliance departments. Follow up and/or corrective action is taken as needed with respect to responses that indicate the existence of actual or potential conflicts of interest. A summary of the responses to the questionnaires and follow-up information are provided to the system audit committee for review and follow-up. Further, the audit committee of cook children's health care system is responsible for monitoring the implementation and enforcement of the conflict of interest policy that is applicable to all affiliated companies of the cook children's health care system. The audit committee is also responsible for oversight of the compliance department of cook children's health care system. The compliance department maintains a hotline to receive reports of inappropriate activities including activities that might constitute a conflict of interest. Internal audit and compliance also conduct random audits of corporate activities such as expense reimbursements and accounts payable to determine if any inappropriate payments are being made to individuals, some of which could be evidence of a conflict of interest. Any corrective action related to conflicts of interest would be reported to the audit committee for review, approval, and modification, as necessary, with further reporting to the system board of trustees as appropriate.

Form 990, Part VI, Line 15A Process to establish compensation of top management official

Cook children's health care system has established a compensation committee with oversight of the ceo. The compensation committee approves compensation arrangement in advance, which includes a review and approval by independent committee members, using comparable market data relating to compensation, which is provided by sullivan cotter and associates, inc. , which is an independent, nationally recognized compensation consultant. The compensation committee documents the basis for its determinations following contemporaneous substantiation of the compensation committee's deliberations and decisions. The compensation committee requires the compensation consultant to update market data periodically, usually every two years, with interim reviews being conducted as needed.

Form 990, Part VI, Line 15B Process to establish compensation of other employees

Cook children's health care system has established a compensation committee with oversight of the compensation of the other officers and key employees of the organization. The compensation committee approves compensation arrangements in advance, which includes a review and approval by independent committee members, using comparable market data relating to compensation, which is provided by sullivan cotter and associates, inc. For executive compensation and physician compensation, which is an independent, nationally recognized compensation consultant. The compensation committee documents the basis for its determinations following contemporaneous substantiation of the compensation committee's deliberations and decisions. The compensation committee requires the compensation consultant to update market data periodically, usually every two years, with interim reviews being conducted as needed. With regard to physician compensation, the compensation committee also retains the law firm of mcdermott, will & emery of chicago, illinois, to issue a reasonableness opinion covering the physician compensation plan for cook children's physician network.

Form 990, Part VI, Line 19 Required documents available to the public

The organization does not make its governing documents or conflict of interest policy available to the public, except to the extent they are on file with the texas secretary of state. The conflict-of-interest policy is posted on the organization's internal website and available to all employees and board members of cook children's health care system entities. Consolidated financial statements are reported electronically for all cook children's health care system entities via the electronic municipal market access ("emma") web site.

Filing and Contact Details

Filer

Filer Name
Cook Children's Medical Center
EIN
75-2051646
Phone
6828854000
Address
801 Seventh Avenue, Fort Worth, TX 76104

Signing Officer

Name
Nancy Cychol
Title
Nancy Cychol
Signed
2025-08-13
Discuss with paid preparer
Yes

Organization Details

Formed
1985
Legal Domicile
TX
Voting Board Members
13
Independent Board Members
13
Employees
6,009
Volunteers
723

Preparer

Firm
Forvis Mazars LLP
Address
1201 Walnut Street Suite 1700, Kansas City, MO 64106-2246
Preparer
Michael Engle
Phone
8162216300
Supplemental Narrative

Additional Explanations

Form 990, Part XI, Line 9 Other changes in net assets or fund balances

Change in fair value of swap - -670239;

Financial Statement Notes

Schedule D, Part X, Line 2 ASC 740 Footnote

Management has evaluated their income tax positions under the guidance included in asc 740. Based on their review, management has not identified any material uncertain tax positions to be recorded or disclosed in the financial statements.

Schedule D, Part V, Line 4 Intended uses of endowment funds

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 PLUS INFLATION OVER A ROLLING SEVEN-YEAR PERIOD, AS WELL AS SHOW FAVORABLE PERFORMANCE CHARACTERISTICS RELATIVE TO OTHER MARKET INDICES WEIGHTED FOR ASSET ALLOCATIONS AS WELL AS SIMILARLY MANAGED FUNDS. 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 PLACES A GREATER EMPHASIS ON PUBLIC AND PRIVATE EQUITY-BASED INVESTMENTS TO ACHIEVE ITS LONG-TERM RETURN OBJECTIVES WITHIN PRUDENT RISK CONSTRAINTS. COOK CHILDREN'S HAS A POLICY (THE SPENDING POLICY) IN WHERE W.I. COOK FOUNDATION, INC. MAY MAKE AVAILABLE EACH YEAR OF UP TO 5% Of THE FOUNDATION'S INVESTMENTS AVERAGE FAIR VALUE OVER THE PRIOR 5 YEARS ENDED JUNE 30 PRECEDING THE YEAR IN WHICH THE EXPENDITURE IS PLANNED AND/OR ACCORDING TO THE DONOR REQUIREMENTS AS SET FORTH IN EACH ENDOWMENT DOCUMENT. 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. THE INTENDED USE OF THE HIGHEST AMOUNTS OF ENDOWMENTS IS CHARITY CARE, OPERATIONAL NEEDS OF THE CHILD LIFE DEPARTMENT, OPERATIONS OF THE HOSPITAL, TO SUPPORT THE FACILITY DOG PROGRAM, SUPPORT THE OPERATIONAL NEEDS OF THE PASTORAL CARE DEPARTMENT AND NURSING RESEARCH.

Schedule D, Part XI, Line 2(D) Other revenues in audited financial statements not in form 990

Interest rate swap agreement - -670239 ccic retro premium - -2497288

Schedule D, Part XI, Line 4(B) Other revenues in form 990 not in audited financial statements

Gain on disposal of asset - 373073 additional contributions from foundation - 13707861 direct rent expense - -1298650

Schedule D, Part XII, Line 2(D) Other expenses in audited financial statements not in form 990

Direct rent expense - 1298650 gain on disposal of asset - -373073

Schedule D, Part XII, Line 4(B) Other expenses in form 990 not in audited financial statements

Ccic retro premium - 2497288

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IRS990/Desc0Cook Children's Medical Center (CCMC) - Fort Worth is the cornerstone of Cook Children's Health Care System. This 462-bed facility is home to top medical minds, advanced technologies, family-centered treatments and leading-edge clinical research, all designed to fulfill the System's Promise to improve the health and well-being of every child in our care and our communities. It is one of only 10 freestanding children's hospitals in the world to achieve Magnet designation with three consecutive re-designations from the American Nursing Credentialing Center, most recently in 2021. Nationally recognized services such as the Level IV Neonatal Intensive Care Unit (NICU), the Jane and John Justin Institute for Mind Health, and the hematology and oncology center are leading the way in providing the highest level of care to families who travel from across Texas, the United States and internationally. From complicated surgeries and Level II trauma care to physical therapy and behavioral health services, CCMC - Fort Worth offers a variety of services and amenities to meet the unique needs of every patient and family. CCMC-- Fort Worth set a new census record in January 2024 with 101 babies in the NICU, a milestone that reflects the growth in demand for the hospital's services. Raising Awareness With the help of the Center for Community Health, led by Cook Children's, the System works to inform and educate the public on timely topics. In FY24, Cook Children's continued to build on a communications campaign for safe baby sleep. The effort began a year earlier when the Fort Worth medical center saw an alarming spike in sudden unexplained infant deaths (SUIDs). Through a series of articles on checkupnewsroom.org, Cook Children's raised awareness about the safest sleep environment for babies. Additional articles in FY24 highlighted the risks of weighted sleep sacks and blankets in the crib. Other messages for injury prevention in FY24 included the importance of car seats, reminders of summer pool safety, and awareness of bathtub safety. An article during Poison Prevention Week reported the growing number of young children treated in the Emergency Department (ED) for accidental marijuana ingestion. The Aim for Safety program at Cook Children's spreads awareness about proper storage of firearms, focusing on education to prevent accidental shootings in the home. In conjunction with leaders of the program, the city of Fort Worth and several other cities in North Texas declared August 2024 as Gun Safety Awareness Month. Surging cases of flu and respiratory illnesses strained the ED, pediatric offices and urgent care center several times in FY24. Cook Children's responded on social media and other outlets by asking for the community's help to limit the spread. Through articles, charts and videos, the communications team promoted tips to help families manage mild illness at home - and to recognize the more severe symptoms that warrant a trip to urgent care or the ED. Telehealth remains a critical resource for the hospital, especially during times of intense viral spread. Fiscal year 2024 virtual health visits totaled 82,365 across all of Cook Children's Health Care System, an increase of 42% from the previous year. Mental Well-Being The Raising Joy Podcast, an outgrowth of Cook Children's suicide prevention JOY Campaign, aired its 85th episode in June 2024. Topics in FY24 covered everything from coping with pet loss and holiday grief to prevention of teen drug and alcohol abuse. And during National Suicide Prevention Month in September 2024, Cook Children's targeted the stigma of taking prescription medication for anxiety, depression and other disorders. Experts from Cook Children's addressed the reasons that parents might hesitate to start their teens on psychiatric medication. The article included a graphic of mental health resources in English and Spanish. Collaborative Care CCMC - Fort Worth opened the Jane and John Justin Institute for Mind Hea
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