2022-05-09T20:24:34-05:00 2021-06-30 990 2020-07-01 593425191 PEDIATRIC PHYSICIAN SERVICES INC PEDI 4439975771 3910 KESWICK RD S BLDG BALTIMORE MD 21211 SHERRON ROGERS CFO 4439975771 2022-05-09 SHERRON ROGERS XXX-XX-XXXX 3 AAL1 IAL1 2020 2022-09-23 18:48:47Z SHERRON ROGERS 501 SIXTH AVE S ST PETERSBURG FL 33701 104702808 0 X WWW.HOPKINSALLCHILDRENS.ORG X 1997 FL PROVIDE HEALTHCARE SERVICES BY PEDIATRIC SPECIALTY PHYSICIANS 5 0 426 0 0 0 2704318 11249405 102419837 93446559 12311 6844 0 0 105136466 104702808 0 0 0 0 75897957 74351006 0 0 0 29175961 29593801 105073918 103944807 62548 758001 6942011 9051384 7527624 8851693 -585613 199691 THE CORPORATION IS ORGANIZED FOR CHARITABLE, EDUCATIONAL AND SCIENTIFIC PURPOSES, AND TO PROVIDE HEALTHCARE SERVICES OF PEDIATRIC SPECIALTY PHYSICIANS AND OTHER PERSONNEL TO THE PATIENTS OF JOHNS HOPKINS ALL CHILDREN'S HOSPITAL AND AFFILIATED LOCATIONS. 0 0 103944807 93446559 PEDIATRIC PHYSICIAN SERVICES IS A MULTI-SPECIALTY PEDIATRIC PHYSICIAN CLINIC AFFILIATED WITH JOHNS HOPKINS ALL CHILDREN'S HOSPITAL. PEDIATRIC PHYSICIAN SERVICES PROVIDES PHYSICIAN AND OTHER HEALTHCARE SERVICES TO THE PATIENTS AT JOHNS HOPKINS ALL CHILDREN'S HOSPITAL, INC. IN ADDITION, THE PHYSICIANS AT PEDIATRIC PHYSICIAN SERVICES PROVIDE PATIENT, NURSING AND MEDICAL STUDENT EDUCATION AND PARTICIPATE IN CLINICAL RESEARCH STUDIES WITH JOHNS HOPKINS ALL CHILDREN'S HOSPITAL AND ALL CHILDREN'S RESEARCH INSTITUTE. 103944807 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 X 15 0 1 426 1 0 0 0 0 0 0 0 0 0 0 0 0 X 5 0 0 0 0 0 1 1 1 1 0 0 0 1 1 1 1 1 1 1 1 0 X THE CORPORATION 4439975771 3910 KESWICK RD S BLDG BALTIMORE MD 21211 TOM KMETZ TRUSTEE 1.00 59.00 X 0 935591 3649 JEFF ROONEY INTERIM VP/CFO/TRUSTEE 1.00 59.00 X X 0 652088 0 DIVYA JOSHI MD PRESIDENT/TRUSTEE 30.00 30.00 X X 0 571777 8142 STEPHEN KENNEDY MD TRUSTEE 1.00 0.00 X 0 301682 39673 SYLVIA POWELL TRUSTEE 1.00 59.00 X 0 277560 40399 ANGELA GREEN TRUSTEE 1.00 59.00 X 0 254232 36411 GERAD THERIAC INTERIM VP/CFO/TRUSTEE 1.00 59.00 X X 0 232666 12837 KEVIN CREWS SECRETARY 5.00 55.00 X 0 164227 11418 JOSEPH PERNO VICE CHAIR PEDIATRIC MEDICINE 40.00 0.00 X 0 502705 77247 WASSAM RAHMAN DEPT CHAIR EMERGENCY MEDICINE 40.00 0.00 X 426605 0 47513 JAMES QUINTESSENZA PHYSICIAN 40.00 0.00 X 1596286 0 26712 ERIC CEITHAML PHYSICIAN 40.00 0.00 X 1015746 0 20802 PAUL DANIELSON PHYSICIAN DIVISION CHIEF 40.00 0.00 X 935092 0 39389 LUIS RODRIGUEZ NEUROSURGEON 40.00 0.00 X 928842 0 35109 DREW RIDEOUT PHYSICIAN 40.00 0.00 X 814819 0 16302 KEVIN W SOWERS MSN RN FAA FORMER CEO/TRUSTEE 1.00 59.00 X 0 1672257 221428 ROBERTA ALESSI FORMER OFFICER/TRUSTEE 0.00 0.00 X 0 735362 514 JONATHAN ELLEN MD FORMER CEO/TRUSTEE 0.00 0.00 X 0 725000 0 DAVID CLENDENIN MD FORMER INTERIM PRESIDENT/TRUSTEE 40.00 10.00 X 368444 0 23112 CHRISTOPHER WHITBY FORMER OFFICER/TRUSTEE 0.00 0.00 X 0 220791 0 PAUL COLOMBANI MD FORMER OFFICER/TRUSTEE 0.00 0.00 X 0 109629 0 6085834 7355567 660657 273 1 1 0 LOCUMTENENS COM PO BOX 405547 ATLANTA GA 30384 LABOR SERVICES 877632 WEATHERBY MEDICAL STAFFING PO BOX 972633 DALLAS TX 75397 LABOR SERVICES 538191 COMPHEALTH INC PO BOX 972651 DALLAS TX 75397 LABOR SERVICES 402080 HAYES LOCUM 6700 N ANDREWS AVE FT LAUDERDALE FL 33309 LABOR SERVICES 267146 UNIVERSITY MEDICAL SERVICE ASSN 12901 BRUCE B DOWN BLVD TAMPA FL 33612 LABOR SERVICES 130697 5 1966660 9282242 503 11249405 PATIENT SERVICE REV. 621110 49713043 49713043 CONTRACT REIMBURSEMENT 621110 43733516 43733516 93446559 6844 6844 104702808 93446559 0 6844 377691 377691 65379900 65379900 8593415 8593415 67749 67749 22114 22114 5245 5245 5005738 5005738 26609 26609 172269 172269 73251 73251 1019968 1019968 775417 775417 172472 172472 65036 65036 6323964 6323964 HOSPITAL LEASE UTILIZAT 8773358 8773358 PURCHASED SERVICES- INT 6078912 6078912 DUES, LICENSES & FEES 589076 589076 MEDICAL SUPPLIES 422623 422623 103944807 103944807 0 0 342209 1598058 4835973 5031870 1208432 1013842 204492 194590 1559337 2226866 6942011 9051384 7169513 3316935 32863 358111 5501895 7527624 8851693 X -585613 199691 -585613 199691 6942011 9051384 X 758001 27303 X 0 1 X 1 0 X 131990 16879328 9601998 2704318 11249405 40567039 62844715 84742722 91707061 102419837 93446559 435160894 62976705 101622050 101309059 105124155 104695964 475727933 0 0 0 475727933 22788 44804 24058 12311 6844 110805 22788 44804 24058 12311 6844 110805 62999493 101666854 101333117 105136466 104702808 475838738 0.99980 0.99970 0.00020 0.00030 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 1 5245 0 0 5245 0 PART II-B, LINE 1: THE ORGANIZATION PAID CERTAIN DUES OR MEMBERSHIP FEES TO VARIOUS PROFESSIONAL ASSOCIATIONS, STATE HOSPITAL ASSOCIATIONS, AND OTHER PROFESSIONAL MEDICAL SOCIETIES WHO ALLOCATE A PORTION OF THOSE DUES TOWARDS LOBBYING EXPENSES. FOR FY21, THE ORGANIZATION HAS CONFIRMED THAT $5,245 OF SUCH DUES WERE ALLOCATED TOWARDS LOBBYING ACTIVITIES. 867839 673249 194590 340593 340593 0 194590 OTHER ASSETS 1099272 DUE FR AFFILIATES 1066399 OPERATING LEASE ROU ASSETS 61195 2226866 DUE TO AFFILIATES 5440557 OPERATING LEASE ROU LIABILITIES 61338 5501895 X PART X, LINE 2: FASB GUIDANCE ON ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES CLARIFIES THE ACCOUNTING FOR UNCERTAINTY OF INCOME TAX POSITIONS. THIS GUIDANCE DEFINES THE THRESHOLD FOR RECOGNIZING TAX RETURN POSITIONS IN THE FINANCIAL STATEMENTS AS "MORE LIKELY THAN NOT" THAT THE POSITION IS SUSTAINABLE, BASED ON ITS TECHNICAL MERITS. THE GUIDANCE ALSO PROVIDES GUIDANCE ON THE MEASUREMENT, CLASSIFICATION AND DISCLOSURE OF TAX RETURN POSITIONS IN THE FINANCIAL STATEMENTS. THERE WAS NO IMPACT ON PEDIATRIC PHYSICIAN SERVICES' FINANCIAL STATEMENTS DURING THE YEARS ENDED JUNE 30, 2021 AND 2020. 1 X X X X X 1 1 0 0 0 0 0 1 0 KEVIN W SOWERS MSN RN FAA FORMER CEO/TRUSTEE 0 1159544 0 501563 0 11150 0 208657 0 12771 0 1893685 0 0 JAMES QUINTESSENZA PHYSICIAN 1455062 0 120500 0 20724 0 8308 0 18404 0 1622998 0 0 0 ERIC CEITHAML PHYSICIAN 998804 0 15720 0 1222 0 8550 0 12252 0 1036548 0 0 0 PAUL DANIELSON PHYSICIAN DIVISION CHIEF 932680 0 0 0 2412 0 8550 0 30839 0 974481 0 0 0 LUIS RODRIGUEZ NEUROSURGEON 907450 0 0 0 21392 0 8550 0 26559 0 963951 0 0 0 TOM KMETZ TRUSTEE 0 777438 0 0 0 158153 0 0 0 3649 0 939240 0 0 DREW RIDEOUT PHYSICIAN 793339 0 0 0 21480 0 0 0 16302 0 831121 0 0 0 ROBERTA ALESSI FORMER OFFICER/TRUSTEE 0 11141 0 0 0 724221 0 0 0 514 0 735876 0 241425 JONATHAN ELLEN MD FORMER CEO/TRUSTEE 0 0 0 0 0 725000 0 0 0 0 0 725000 0 0 JEFF ROONEY INTERIM VP/CFO/TRUSTEE 0 0 0 0 0 652088 0 0 0 0 0 652088 0 0 JOSEPH PERNO VICE CHAIR PEDIATRIC MEDICINE 0 429944 0 55315 0 17446 0 46381 0 30866 0 579952 0 0 DIVYA JOSHI MD PRESIDENT/TRUSTEE 0 421515 0 100000 0 50262 0 0 0 8142 0 579919 0 0 WASSAM RAHMAN DEPT CHAIR EMERGENCY MEDICINE 423383 0 0 0 3222 0 8005 0 39508 0 474118 0 0 0 DAVID CLENDENIN MD FORMER INTERIM PRESIDENT/TRUSTEE 367447 0 0 0 997 0 7805 0 15307 0 391556 0 0 0 STEPHEN KENNEDY MD TRUSTEE 0 300955 0 0 0 727 0 4918 0 34755 0 341355 0 0 SYLVIA POWELL TRUSTEE 0 223116 0 37600 0 16844 0 14834 0 25565 0 317959 0 0 ANGELA GREEN TRUSTEE 0 218995 0 28884 0 6353 0 7570 0 28841 0 290643 0 0 GERAD THERIAC INTERIM VP/CFO/TRUSTEE 0 198617 0 25000 0 9049 0 3128 0 9709 0 245503 0 0 CHRISTOPHER WHITBY FORMER OFFICER/TRUSTEE 0 0 0 0 0 220791 0 0 0 0 0 220791 0 0 KEVIN CREWS SECRETARY 0 147254 0 16831 0 142 0 5073 0 6345 0 175645 0 0 PAUL COLOMBANI MD FORMER OFFICER/TRUSTEE 0 0 0 0 0 109629 0 0 0 0 0 109629 0 0 PART I, LINES 4A-B PART I, LINE 4A: SEVERANCE PAYMENTS: JONATHAN ELLEN, M.D. $725,000 ROBERTA ALESSI $406,682.88 CHRISTOPHER WHITBY $197,723.04 PART I, LINE 4B: A SELECT GROUP OF SENIOR LEADERS OF THE JOHNS HOPKINS HEALTH SYSTEM CORPORATION (JHHSC) PARTICIPATE IN SUPPLEMENTAL RETIREMENT/DEFERRED COMPENSATION PROGRAMS, INCLUDING SOME LEGACY ARRANGEMENTS THAT ARE NO LONGER AVAILABLE TO NEW HIRES. PRE-2011 PARTICIPANTS RECEIVE CASH PAYMENTS EACH YEAR DETERMINED WITH REFERENCE TO THEIR SERVICE WITH JHHSC AND THEIR FINAL AVERAGE COMPENSATION. AS OF JANUARY 2019, FUTURE CASH PAYMENTS ARE MADE ACCORDING TO A FIXED SCHEDULE FOR THESE PARTICIPANTS. POST-2011 PARTICIPANTS ACCRUE BENEFITS UNDER A DEFINED CONTRIBUTION FORMULA WHERE CONTRIBUTIONS ARE TIERED BY POSITION LEVEL. CONTRIBUTIONS MADE IN 2018 AND PRIOR YEARS GENERALLY VEST AFTER THE LATER OF FIVE YEARS OF SERVICE WITH JHHSC OR THREE YEARS OF PLAN PARTICIPATION; CONTRIBUTIONS MADE IN 2019 AND FUTURE YEARS VEST THREE YEARS AFTER EACH CONTRIBUTION IS MADE, WITH FULL VESTING ON THE LATER OF AGE 65 OR THREE YEARS OF PLAN PARTICIPATION. ALL CONTRIBUTIONS VEST ON DEATH, DISABILITY OR INVOLUNTARY TERMINATION WITHOUT CAUSE. IF A PARTICIPANT VOLUNTARILY TERMINATES EMPLOYMENT OR IS TERMINATED BY THE EMPLOYER FOR CAUSE PRIOR TO THE APPLICABLE VESTING DATE, THE PARTICIPANT'S ENTIRE NON-VESTED BENEFIT IS FORFEITED ALL OF THESE ARRANGEMENTS WERE APPROVED, IN ADVANCE, BY AN INDEPENDENT COMPENSATION COMMITTEE, WHICH BASED ITS DECISION ON DATA PROVIDED BY AN INDEPENDENT COMPENSATION CONSULTANT. PARTICIPANTS' INTERESTS UNDER THESE ARRANGEMENTS ARE NOT GUARANTEED OR SECURED AT ANY WAY AND AT ALL TIMES ARE SUBJECT TO CLAIMS OF EMPLOYER'S BANKRUPTCY/INSOLVENCY CREDITORS. THE FOLLOWING INDIVIDUALS LISTED ON FORM 990, PART VII, SECTION A, LINE 1A RECEIVED PAYMENT FROM ONE OR MORE SUPPLEMENTAL RETIREMENT/DEFERRED COMPENSATION PROGRAMS, WITH PAYMENTS REPORTED IN SCHEDULE J, PART II, COLUMN (B)(III); THE TOTAL OF AMOUNTS PAYABLE DURING 2020 BUT REPORTED AS DEFERRED COMPENSATION IN COLUMN (C) IN PREVIOUS YEARS IS REPORTED IN SCHEDULE J, PART II, COLUMN (F). THE AMOUNTS BELOW MAY REFLECT ANNUAL CASH PAYMENTS OR MULTIPLE YEARS OF ACCRUALS THAT VESTED IN 2020. ROBERTA ALESSI $317,053.53 PART I, LINE 7 ANNUAL INCENTIVE PLAN: EXECUTIVES PARTICIPATE IN AN ANNUAL INCENTIVE PLAN THAT REWARDS PARTICIPANTS FOR THE ACHIEVEMENT OF ORGANIZATION OBJECTIVES APPROVED BY THE JOHNS HOPKINS MEDICINE COMPENSATION COMMITTEE EACH YEAR, INCLUDING FINANCIAL AND NON-FINANCIAL MEASURES. A PORTION OF THE OVERALL AWARD IS DETERMINED BASED ON INDIVIDUAL PERFORMANCE. FORM 990, PART I, LINE 8 PURSUANT TO THE CORONAVIRUS AID, RELIEF, AND ECONOMIC SECURITY (CARES) ACT, PEDIATRIC PHYSICIANS SERVICES, INC. RECOGNIZED $9,282,242 OF FUNDING FROM THE PROVIDER RELIEF FUND ADMINISTERED BY THE HEALTH RESOURCES AND SERVICES ADMINISTRATION, AN AGENCY OF THE U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES DURING FY21. THIS AMOUNT HAS BEEN RECOGNIZED AS GRANT REVENUE ON PART I, LINE 8 OF THE ORGANIZATION'S FORM 990. FORM 990, PART V, QUESTION 2A ALL COMPENSATION OF PEDIATRIC PHYSICIAN SERVICES EMPLOYEES IS PAID THROUGH ALL CHILDREN'S HEALTH SYSTEM, INC. USING ITS FEDERAL TAX ID NUMBER. THIS IS KNOWN AS A COMMON PAYMASTER AGREEMENT. EMPLOYEES OF ALL CHILDREN'S HEALTH SYSTEM AND ITS OTHER SUBSIDIARIES ARE ALSO PAID THROUGH THE SAME AGREEMENT. FORM 990, PART VI, SECTION A, LINE 6 ALL CHILDREN'S HEALTH SYSTEM, INC. IS THE SOLE CORPORATE MEMBER OF PEDIATRIC PHYSICIAN SERVICES, INC. FORM 990, PART VI, SECTION A, LINE 7A ALL CHILDREN'S HEALTH SYSTEM, INC, A IRC 501(C)(3) TAX EXEMPT SOLE MEMBER OF PEDIATRIC PHYSICIAN SERVICES, ELECTS THE BOARD OF TRUSTEES. THIS IS SUBJECT TO THE APPROVAL OF THE JOHNS HOPKINS HEALTH SYSTEM CORPORATION, A IRC 501(C)(3) TAX EXEMPT SOLE MEMBER OF ALL CHILDREN'S HEALTH SYSTEM, INC. FORM 990, PART VI, SECTION A, LINE 7B THE GOVERNING BODY OF PEDIATRIC PHYSICIAN SERVICES, INC. IS EMPOWERED BY ITS BYLAWS TO MAKE CERTAIN DECISIONS; ALL OTHER DECISIONS ARE SUBJECT TO APPROVAL OF THE SOLE MEMBER ALL CHILDREN'S HEALTH SYSTEM, INC. FORM 990, PART VI, SECTION A, LINE 8B PEDIATRIC PHYSICIAN SERVICES, INC. CURRENTLY ONLY HAS A GOVERNING BODY WITH NO ADDITIONAL COMMITTEES, BUT RELIES ON THE COMMITTEES OF JOHNS HOPKINS HEALTH SYSTEM. THE COMMITTEES OF JOHNS HOPKINS HEALTH SYSTEM HAVE DOCUMENTED ITS MEETINGS AND ACTIONS. FORM 990, PART VI, SECTION B, LINE 11B A COPY OF THE FORM 990 WAS PROVIDED TO THE ORGANIZATION'S GOVERNING BODY BEFORE IT WAS FILED. FORM 990, PART VI, SECTION B, LINE 12C THE FILING ENTITY AS PART OF ALL CHILDREN'S HEALTH SYSTEM, HAS AN ANNUAL CONFLICT OF INTEREST DISCLOSURE PROCESS THAT HAS BEEN FORMALLY DOCUMENTED IN POLICY. THE PROCESS IS FACILITATED BY THE COMPLIANCE OFFICER WITH OVERSIGHT FROM THE ALL CHILDREN'S HEALTH SYSTEM (PARENT) BOARD'S COMPLIANCE COMMITTEE. DISCLOSURES ARE REQUESTED FROM KEY EMPLOYEES, KEY CONTRACTORS, BOARD MEMBERS AND OFFICERS, AND DESIGNATED MEDICAL STAFF. ALL DISCLOSURES ARE REVIEWED BY THE COMPLIANCE OFFICER. SELECTED DISCLOSURES ARE REVIEWED BY THE PRESIDENT/CHIEF EXECUTIVE OFFICER. A FORMAL REPORT IS MADE ANNUALLY TO THE COMPLIANCE COMMITTEE WHERE CONFLICT MANANGEMENT IS ADDRESSED FOR EMPLOYEES, CONTRACTORS, AND PHYSICIANS. BOARD MEMEBER DISCLOSURES ARE REVIEWED BY THE RESPECTIVE BOARD PRESIDENTS FOR CONFLICT MANAGEMENT. BOARD MEMBERS ARE REQUIRED TO DECLARE ANY POTENTIAL CONFLICTS PRIOR TO CONDUCTING BUSINESS AT EACH MEETING. IF A CONFLICT IS FOUND TO EXIST BY A BOARD MEMBER, THE BOARD MEMBER IS PROHIBITED FROM VOTING. FORM 990, PART VI, SECTION B, LINE 15 EVERY THREE YEARS AN INDEPENDENT STUDY IS CONDUCTED GATHERING INDUSTRY COMPENSATION AVERAGES FROM SELECT PEER INSTITUTIONS. EVERY YEAR THE JOHNS HOPKINS BOARD OF TRUSTEES COMPENSATION COMMITTEE REVIEWS COMPENSATION AMOUNTS FOR OFFICERS AND ALL EMPLOYEES AT THE DIRECTOR AND HIGHER LEVELS. FORM 990, PART VI, SECTION C, LINE 19 PEDIATRIC PHYSICIAN SERVICES, INC.'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. FORM 990, PART XI, LINE 9: RELEASED FROM TEMP RESTRICTION 27,303. JOHNS HOPKINS HEALTH SYSTEM CORPORATION 3910 KESWICK RD SOUTH BLDG 4TH FL S BALTIMORE MD 21211 521465301 SUPPORTING ORGANIZATION MD 501(C)(3) LINE 12C, III-FI JOHNS HOPKINS HEALTH SYSTEM CORP 0 THE JOHNS HOPKINS HOSPITAL 3910 KESWICK RD SOUTH BLDG 4TH FL S BALTIMORE MD 21211 520591656 HOSPITAL MD 501(C)(3) LINE 3 JOHNS HOPKINS HEALTH SYSTEM CORP 0 LUCY WEBB HAYES NATIONAL TRAINING SCHOOL FOR 5255 LOUGHBORO RD NW WASHINGTON DC 20016 530196602 HOSPITAL DC 501(C)(3) LINE 3 JOHNS HOPKINS HEALTH SYSTEM CORP 0 JOHNS HOPKINS COMMUNITY PHYSICIANS INC 3910 KESWICK RD SOUTH BLDG 4TH FL S BALTIMORE MD 21211 521467441 HEALTHCARE SERVICES MD 501(C)(3) LINE 12C, III-FI JOHNS HOPKINS HEALTH SYSTEM CORP 0 JOHNS HOPKINS MEDICAL SERVICES CORPORATION 3910 KESWICK RD SOUTH BLDG 4TH FL S BALTIMORE MD 21211 521232569 HEALTHCARE SERVICES MD 501(C)(3) LINE 12B, II JOHNS HOPKINS HEALTH SYSTEM CORP 0 JOHNS HOPKINS BAYVIEW MEDICAL CENTER INC 3910 KESWICK RD SOUTH BLDG 4TH FL S BALTIMORE MD 21211 521341890 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