Variety Children's Hospital Professional Liability Trust: Form 990, tax year 2020
View the entire original 990 at ProPublica ↗
- Organization
- Variety Children's Hospital Professional Liability Trust (EIN 59-2551434)
- Tax period
- 2020-01-01 to 2020-12-31
- Filed
- 2022-11-09
- IRS object ID
- 202233139349304133
- Schema version
- 2020v4.0
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2022-11-09T15:31:06-06:00 | ReturnTs |
| Tax Period End | 2020-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 350921680 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CROWE LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 401 East Las Olas Blvd Suite 1100 | AddressLine1Txt |
| City | Fort Lauderdale | CityNm |
| State Abbreviation | FL | StateAbbreviationCd |
| ZIP | 333014230 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2020-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 592551434 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Variety Children's Hospital Professional Liability Trust | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | VARI | BusinessNameControlTxt |
| Phone | 3056666511 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3100 SW 62nd Avenue | AddressLine1Txt |
| City | Miami | CityNm |
| State Abbreviation | FL | StateAbbreviationCd |
| ZIP | 331553009 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Dawn Javersack | PersonNm |
| Person Title | SVP and CFO | PersonTitleTxt |
| Signature | 2022-11-09 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | Dawn | PersonFirstNm |
| Person Last | Javersack | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Brittney Kocaj | PreparerPersonNm |
| PTIN | P01320603 | PTIN |
| Phone | 9542028600 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2020 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Final Return | Yes (X) | FinalReturnInd |
| Amended Return | Yes (X) | AmendedReturnInd |
Principal Ofcr Business Name PrincipalOfcrBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Matthew A Love | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3100 SW 62nd Avenue | AddressLine1Txt |
| City | Miami | CityNm |
| State Abbreviation | FL | StateAbbreviationCd |
| ZIP | 331553009 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $11,587 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.nicklauschildrens.org | WebsiteAddressTxt |
| Type Of Organization Trust | Yes (X) | TypeOfOrganizationTrustInd |
| Formation | 1984 | FormationYr |
| Legal Domicile State | FL | LegalDomicileStateCd |
| Activity Or Mission | TO ENABLE NICKLAUS CHILDREN'S HOSPITAL ("NCH") TO FUND AND PAY THE COST OF PROFESSIONAL LIABILITY CLAIMS AGAINST THE HOSPITAL | ActivityOrMissionDesc |
| Contract Termination | Yes (X) | ContractTerminationInd |
| Voting Members Governing Body | 17 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 13 | VotingMembersIndependentCnt |
| Total Employee | 0 | TotalEmployeeCnt |
| Total Volunteers | 13 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| CY Contributions Grants | $0 | CYContributionsGrantsAmt |
| CY Program Service Revenue | $0 | CYProgramServiceRevenueAmt |
| PY Investment Income | $11,381 | PYInvestmentIncomeAmt |
| CY Investment Income | $11,493 | CYInvestmentIncomeAmt |
| CY Other Revenue | $0 | CYOtherRevenueAmt |
| PY Total Revenue | $11,381 | PYTotalRevenueAmt |
| CY Total Revenue | $11,493 | CYTotalRevenueAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| CY Salaries Comp Emp Bnft Paid | $0 | CYSalariesCompEmpBnftPaidAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $250 | PYOtherExpensesAmt |
| CY Other Expenses | $274 | CYOtherExpensesAmt |
| PY Total Expenses | $250 | PYTotalExpensesAmt |
| CY Total Expenses | $274 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $11,131 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $11,219 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $693,654 | TotalAssetsBOYAmt |
| Total Assets EOY | $0 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $0 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $0 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $693,654 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $0 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | THE PROFESSIONAL LIABILITY TRUST WAS SET UP TO ENABLE NICKLAUS CHILDREN'S HOSPITAL TO FUND AND PAY THE COST OF PROFESSIONAL LIABILITY CLAIMS AGAINST THE HOSPITAL. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | Yes (true) | SignificantChangeInd |
| Desc | THE PROFESSIONAL LIABILITY TRUST WAS SET UP TO ENABLE NICKLAUS CHILDREN'S HOSPITAL TO FUND AND PAY THE COST OF PROFESSIONAL LIABILITY CLAIMS AGAINST THE HOSPITAL. THE FUND IS BASED ON ACTUARIAL ESTIMATES OF EXPECTED PROFESSIONAL LIABILITY CLAIMS. | Desc |
| Total Program Service Expenses | $0 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | false | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | false | LobbyingActivitiesInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | false | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | false | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | false | ReportOtherAssetsInd |
| Report Other Liabilities | false | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (true) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | false | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (true) | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | false | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | false | OperateHospitalInd |
| Grants To Organizations | false | GrantsToOrganizationsInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Schedule J Required | Yes (true) | ScheduleJRequiredInd |
| Tax Exempt Bonds | false | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | false | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | false | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | false | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | false | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | Yes (true) | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | false | DisregardedEntityInd |
| Related Entity | Yes (true) | RelatedEntityInd |
| Related Organization Ctrl Ent | false | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 0 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 0 | EmployeeCnt |
| Unrelated Bus Incm Over Limit | false | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | false | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | false | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | false | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 17 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 13 | IndependentVotingMemberCnt |
| Family Or Business Rln | Yes (true) | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | false | DelegationOfMgmtDutiesInd |
| Change To Org Documents | Yes (true) | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (true) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (true) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (true) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (true) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (true) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (true) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (true) | DocumentRetentionPolicyInd |
| Compensation Process CEO | false | CompensationProcessCEOInd |
| Compensation Process Other | false | CompensationProcessOtherInd |
| Investment In Joint Venture | false | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Laurie Levine | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 3056666511 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 5301 Blue Lagoon Drive | AddressLine1Txt |
| City | Miami | CityNm |
| State Abbreviation | FL | StateAbbreviationCd |
| ZIP | 33126 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (24 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Institutional TrusteeInstitutionalTrusteeInd | Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd |
|---|---|---|---|---|---|---|---|---|---|
| Jaret Davis | |||||||||
| Chairman/Director | 0.1 | 1.5 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| Jefry Biehler | |||||||||
| Secretary/Director | 0.1 | 40.2 | Yes (X) | Yes (X) | $0 | $389,033 | $20,250 | ||
| Jose Perdomo | |||||||||
| Director, Interim President & COO NCH (Partial Year) | 0.1 | 40.3 | Yes (X) | Yes (X) | $0 | $538,755 | $10,282 | ||
| Joseph Nader | |||||||||
| Vice Chairman/Director | 0.1 | 0.4 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| Matthew Love | |||||||||
| Director, PRESIDENT & CEO | 0.1 | 40.5 | Yes (X) | Yes (X) | $0 | $906,180 | $204,098 | ||
| Perry Ann Reed | |||||||||
| Director/President NCH | 0.1 | 40.3 | Yes (X) | Yes (X) | $0 | $446,811 | $71,411 | ||
| Alex Soto | |||||||||
| Director | 0.1 | 1.5 | Yes (X) | $0 | $0 | $0 | |||
| Amy Charley | |||||||||
| Director | 0.1 | 0.3 | Yes (X) | $0 | $0 | $0 | |||
| Balagangadhar Totapally | |||||||||
| Director | 0.1 | 0.3 | Yes (X) | $0 | $0 | $0 | |||
| Drew Kern | |||||||||
| Director | 0.1 | 0.4 | Yes (X) | $0 | $0 | $0 | |||
| Fred Moreno | |||||||||
| Director | 0.1 | 0.3 | Yes (X) | $0 | $0 | $0 | |||
| John Lie-Nielsen | |||||||||
| Director | 0.1 | 0.3 | Yes (X) | $0 | $0 | $0 | |||
| Jorge Gonzalez | |||||||||
| Director | 0.1 | 0.4 | Yes (X) | $0 | $0 | $0 | |||
| Marcos A Mestre | |||||||||
| Director | 0.1 | 40.0 | Yes (X) | $0 | $305,901 | $27,668 | |||
| Maria Franco MD | |||||||||
| Director | 0.1 | 0.3 | Yes (X) | $0 | $0 | $0 | |||
| Mario Murgado | |||||||||
| Director | 0.1 | 1.5 | Yes (X) | $0 | $0 | $0 | |||
| Ricky Patel ESQ | |||||||||
| Director | 0.1 | 0.6 | Yes (X) | $0 | $0 | $0 | |||
| Steven Melnick MD | |||||||||
| Director | 0.1 | 0.3 | Yes (X) | $0 | $0 | $0 | |||
| Regions Bank | |||||||||
| Institutional Trustee | 0 | $0 | $0 | $0 | Yes (X) | ||||
| Arianna Urquia | |||||||||
| VP/CFO Hospital | 0.1 | 40.2 | Yes (X) | $0 | $286,156 | $23,729 | |||
| Dawn E Javersack | |||||||||
| SVP/CFO Health System | 0.1 | 40.4 | Yes (X) | $0 | $423,463 | $65,573 | |||
| Jodi Laurence | |||||||||
| SVP and General Counsel | 0.1 | 40.4 | Yes (X) | $0 | $382,573 | $80,301 | |||
| Michael L Harrington | |||||||||
| President (Former) | 0.0 | 0.0 | $0 | $258,221 | $0 | Yes (X) | |||
| Narendra M Kini | |||||||||
| CEO (Former) | 0.0 | 0.0 | $0 | $1,178,819 | $0 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $0 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $5,115,912 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $503,312 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 0 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | Yes (true) | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
| Cntrct Rcvd Greater Than100 K | 0 | CntrctRcvdGreaterThan100KCnt |
| Total Contributions | $0 | TotalContributionsAmt |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $0 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $0 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $0 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $11,473 | TotalRevenueColumnAmt |
| Exclusion | $11,473 | ExclusionAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
| Personal | $0 | PersonalAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $114 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $94 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $20 | SecuritiesAmt |
| Other | $0 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $20 | TotalRevenueColumnAmt |
| Exclusion | $20 | ExclusionAmt |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $0 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $0 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $0 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $11,493 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $0 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $11,493 | ExclusionAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $274 | TotalAmt |
| Management And General | $274 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
| Program Services | $0 | ProgramServicesAmt |
| Management And General | $0 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
| Program Services | $0 | ProgramServicesAmt |
| Management And General | $0 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $274 | TotalAmt |
| Program Services | $0 | ProgramServicesAmt |
| Management And General | $274 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $210 | BOYAmt |
Receivables From Officers Etc ReceivablesFromOfficersEtcGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $0 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $0 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $693,444 | BOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $693,654 | BOYAmt |
| EOY | $0 | EOYAmt |
Loans From Officers Directors LoansFromOfficersDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $693,654 | BOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $693,654 | BOYAmt |
| EOY | $0 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $693,654 | BOYAmt |
| EOY | $0 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $11,219 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $132,914 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | -$837,787 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | Yes (true) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (true) | AuditCommitteeInd |
| Federal Grant Audit Required | false | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supporting Organization509a3 | Yes (X) | SupportingOrganization509a3Ind |
| Supporting Org Type2 | Yes (X) | SupportingOrgType2Ind |
| Supported Organizations | 1 | SupportedOrganizationsCnt |
Supported Org Information SupportedOrgInformationGrp
Supported Organization Name SupportedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | VARIETY CHILDREN'S HOSPITAL DBA NICKLAUS CHILDREN'S HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 590638499 | EIN |
| Organization Type | 3 | OrganizationTypeCd |
| Governing Document Listed | Yes (true) | GoverningDocumentListedInd |
| Support | $0 | SupportAmt |
| Other Support | $274 | OtherSupportAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supported Organizations Total | 1 | SupportedOrganizationsTotalCnt |
| Support Sum | $0 | SupportSumAmt |
| Other Support Sum | $274 | OtherSupportSumAmt |
Form990 Sch A Supporting Org Form990SchASupportingOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Listed By Name Governing Doc | Yes (true) | ListedByNameGoverningDocInd |
| Suprt Org No IRS Determination | false | SuprtOrgNoIRSDeterminationInd |
| Supported Org Section C456 | false | SupportedOrgSectionC456Ind |
| Supported Org Not Organized US | false | SupportedOrgNotOrganizedUSInd |
| Organization Change Suprt Org | false | OrganizationChangeSuprtOrgInd |
| Support Non Supported Org | false | SupportNonSupportedOrgInd |
| Payment Substantial Contribtr | false | PaymentSubstantialContribtrInd |
| Loan Disqualified Person | false | LoanDisqualifiedPersonInd |
| Controlled Disqualified Prsn | false | ControlledDisqualifiedPrsnInd |
| Disqualified Prsn Controll Int | false | DisqualifiedPrsnControllIntInd |
| Disqualified Prsn Ownr Int | false | DisqualifiedPrsnOwnrIntInd |
| Excess Business Holdings Rules | false | ExcessBusinessHoldingsRulesInd |
| Contribution Controller | false | ContributionControllerInd |
| Contribution Family | false | ContributionFamilyInd |
| Contribution35 Controlled | false | Contribution35ControlledInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Majority Dir Trst Supported Org | Yes (true) | MajorityDirTrstSupportedOrgInd |
Schedule D IRS990ScheduleD
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Intercompany | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $0 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Schedule D, Part X, Line 2 FIN 48 (ASC 740) footnote | FormAndLineReferenceDesc |
| Explanation | VARIETY CHILDREN'S HOSPITAL PROFESSIONAL LIABILITY TRUST'S FINANCIAL INFORMATION IS INCLUDED IN THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS OF NICKLAUS CHILDREN'S HEALTH SYSTEM (NCHS), A RELATED ORGANIZATION. NCHS' ASC 740 FOOTNOTE FOR THE YEAR ENDED DECEMBER 31, 2020, READS AS FOLLOWS: "THE SYSTEM AND CERTAIN OF ITS AFFILIATED ORGANIZATIONS QUALIFY AS TAX-EXEMPT, NONPROFIT ORGANIZATIONS UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (THE CODE). THE HOSPITAL, NCPS, THE FOUNDATION, AND THE RESEARCH INSTITUTE ARE EXEMPT FROM FEDERAL INCOME TAX ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE AS DESCRIBED IN SECTION 501(C)(3). THESE TAX-EXEMPT ENTITIES HAD NO TAX PROVISION FOR THE YEARS ENDED DECEMBER 31, 2020 AND 2019. THE CAPTIVE INSURANCE COMPANY IS NOT SUBJECT TO INCOME TAXES, AS NO INCOME TAXES ARE LEVIED IN THE CAYMAN ISLANDS. THE SYSTEM BELIEVES THERE IS NO UNCERTAIN TAX LIABILITY WHICH SHOULD BE RECORDED AS OF DECEMBER 31, 2020 AND 2019. THE HEALTH PLAN IS A LIMITED LIABILITY COMPANY WHICH IS TAXED AS A PARTNERSHIP AND THEREFORE IS GENERALLY NOT A TAXPAYING ENTITY FOR FEDERAL OR STATE INCOME TAX PURPOSES. IN LIEU OF CORPORATE INCOME TAXES, THE MEMBERS ARE TAXED ON THE HEALTH PLAN'S TAXABLE INCOME. THEREFORE, NO PROVISION OR LIABILITY FOR INCOME TAXES HAS BEEN INCLUDED IN THESE FINANCIAL STATEMENTS." | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | Yes (true) | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (true) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | false | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | false | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | false | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | false | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | false | CompBsdNetEarnsRltdOrgsInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (10 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Jefry Biehler | ||||||||||||||
| Secretary/Director | $0 | $387,053 | $0 | $0 | $0 | $1,980 | $0 | $3,831 | $0 | $16,419 | $0 | $409,283 | $0 | $0 |
| Matthew Love | ||||||||||||||
| Director, PRESIDENT & CEO | $0 | $880,893 | $0 | $0 | $0 | $25,287 | $0 | $179,228 | $0 | $24,870 | $0 | $1,110,278 | $0 | $0 |
| Jose Perdomo | ||||||||||||||
| Director, Interim President & COO NCH (Partial Year) | $0 | $433,269 | $0 | $0 | $0 | $105,486 | $0 | $2,694 | $0 | $7,588 | $0 | $549,037 | $0 | $0 |
| Perry Ann Reed | ||||||||||||||
| Director/President NCH | $0 | $424,425 | $0 | $0 | $0 | $22,386 | $0 | $56,640 | $0 | $14,771 | $0 | $518,222 | $0 | $0 |
| Marcos A Mestre | ||||||||||||||
| Director | $0 | $305,268 | $0 | $0 | $0 | $632 | $0 | $4,677 | $0 | $22,991 | $0 | $333,569 | $0 | $0 |
| Michael L Harrington | ||||||||||||||
| President (Former) | $0 | $0 | $0 | $0 | $0 | $258,221 | $0 | $0 | $0 | $0 | $0 | $258,221 | $0 | $0 |
| Narendra M Kini | ||||||||||||||
| CEO (Former) | $0 | $0 | $0 | $0 | $0 | $1,178,819 | $0 | $0 | $0 | $0 | $0 | $1,178,819 | $0 | $0 |
| Dawn E Javersack | ||||||||||||||
| SVP/CFO Health System | $0 | $418,147 | $0 | $0 | $0 | $5,316 | $0 | $55,389 | $0 | $10,185 | $0 | $489,036 | $0 | $0 |
| Jodi Laurence | ||||||||||||||
| SVP and General Counsel | $0 | $376,723 | $0 | $0 | $0 | $5,850 | $0 | $62,471 | $0 | $17,830 | $0 | $462,873 | $0 | $0 |
| Arianna Urquia | ||||||||||||||
| VP/CFO Hospital | $0 | $285,292 | $0 | $0 | $0 | $864 | $0 | $22,862 | $0 | $867 | $0 | $309,885 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Schedule J, Part I, Line 3 METHODS USED BY RELATED ORGANIZATION TO ESTABLISH CEO'S COMPENSATION | The organization relied on the methods of establishing compensation for the organization's CEO employed by NICKLAUS CHILDREN'S HEALTH SYSTEM. (EIN: 45-3481327). NICKLAUS CHILDREN'S HEALTH SYSTEM uses the following methods to establish such compensation: - Compensation Committee - Independent Compensation Consultant - Compensation survey or study - Approval by the Board of Compensation Committee |
| Schedule J, Part I, Line 4a Severance or change-of-control payment | THE FOLLOWING INDIVIDUALS RECEIVED SEVERANCE PAYMENTS DURING THE YEAR - MICHAEL L HARRINGTON - $ 258,220.60 NARENDRA M KINI - $1,178,819.20 |
| Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan | THE FOLLOWING CONTRIBUTIONS WERE MADE TO A SECTION 457(F) PLAN DURING THE YEAR - PERRY ANN REED 56,639.96 MATTHEW LOVE 174,520.32 DAWN E JAVERSACK 55,388.58 JODI LAURENCE 59,585.76 ARIANNA URQUIA 22,861.97 MARCOS A MESTRE 4,000.00 THE FOLLOWING DISTRIBUTIONS WERE MADE FROM A SECTION 457(F) PLAN DURING THE YEAR - JOSE PERDOMO - 100,893.72 |
Schedule N IRS990ScheduleN
Liquidation Of Assets Table LiquidationOfAssetsTableGrp
Liquidation Of Assets Detail LiquidationOfAssetsDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Assets Distri Or Expnss Paid | Cash and Securities | AssetsDistriOrExpnssPaidDesc |
| Distribution | 2020-12-15 | DistributionDt |
| Fair Market Value Of Asset | $837,787 | FairMarketValueOfAssetAmt |
| Method Of FMV Determination | FMV | MethodOfFMVDeterminationTxt |
| EIN | 453481327 | EIN |
| Person | MIAMI CHILDREN'S HEALTH SYSTEM | PersonNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3100 SW 62ND AVENUE | AddressLine1Txt |
| City | Miami | CityNm |
| State Abbreviation | FL | StateAbbreviationCd |
| ZIP | 33155 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IRC Section | 501(C)(3) | IRCSectionTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Director Of Successor | Yes (true) | DirectorOfSuccessorInd |
| Employee Of Successor | Yes (true) | EmployeeOfSuccessorInd |
| Owner Of Successor | false | OwnerOfSuccessorInd |
| Receive Compensation | false | ReceiveCompensationInd |
| Assets Distributed | Yes (true) | AssetsDistributedInd |
| Required To Notify AG | false | RequiredToNotifyAGInd |
| Liabilities Paid | Yes (true) | LiabilitiesPaidInd |
| Bonds Outstanding | false | BondsOutstandingInd |
Disposition Of Assets Detail DispositionOfAssetsDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Assets Distri Or Expnss Paid | Transfer to Affiliate | AssetsDistriOrExpnssPaidDesc |
| Distribution | 2017-12-31 | DistributionDt |
| Fair Market Value Of Asset | $4,004,249 | FairMarketValueOfAssetAmt |
| Method Of FMV Determination | FMV | MethodOfFMVDeterminationTxt |
| EIN | 590638499 | EIN |
| Person | VARIETY CHILDREN'S HOSPITAL | PersonNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3100 SW 62ND AVENUE | AddressLine1Txt |
| City | MIAMI | CityNm |
| State Abbreviation | FL | StateAbbreviationCd |
| ZIP | 331553009 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IRC Section | 501(c)(3) | IRCSectionTxt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Schedule N, Part I Lines 2a and 2b | FormAndLineReferenceDesc |
| Explanation | Miami Children's Health System has officers, directors, and employees who were also officers, directors, and employees of VARIETY CHILDREN'S HOSPITAL PROFESSIONAL LIABILITY TRUST. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (12 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part III, Line 3 Significant changes in program services | Effective December 15, 2020, the board voted to terminate and dissolve the Variety Children's Hospital Professional Liability Trust. |
| Form 990, Part VI, Line 15 DETERMINING COMPENSATION | VARIETY CHILDREN'S HOSPITAL PROFESSIONAL LIABILITY TRUST RELIED ON THE METHODS OF ESTABLISHING COMPENSATION USED BY NICKLAUS CHILDREN'S HEALTH SYSTEM, INC. NO COMPENSATION WAS PAID BY THIS ENTITY DURING THE YEAR, THEREFORE THIS QUESTION HAS BEEN ANSWERED NO IN ACCORDANCE WITH THE INSTRUCTIONS. THE ORGANIZATION AND COMPENSATION COMMITTEE OF NICKLAUS CHILDREN'S HEALTH SYSTEM, INC.'S BOARD OF DIRECTORS CONTRACTS WITH AN EXTERNAL CONSULTANT TO OBTAIN MARKET SURVEYS FOR THE CEO AND OTHER EXECUTIVES. THE CONSULTANT ASSISTS THE ORGANIZATION AND COMPENSATION COMMITTEE IN ESTABLISHING A COMPENSATION PROGRAM FOR THE CEO AND OTHER EXECUTIVES. SURVEY RESULTS AND COMPENSATION BEST PRACTICES ARE SHARED WITH THE ORGANIZATION AND COMPENSATION COMMITTEE OF THE BOARD. PERSONS WITH A CONFLICT OF INTEREST WITH RESPECT TO THE COMPENSATION ARRANGEMENT AT ISSUE ARE NOT INVOLVED IN ESTABLISHING EXECUTIVE SALARY AND BENEFITS PROGRAMS. DELIBERATIONS AND DECISIONS REGARDING THE COMPENSATION AGREEMENT ARE CONTEMPORANEOUS DOCUMENTED. THIS PROCESS IS COMPLETED IN THE FIRST QUARTER EACH YEAR. |
| Form 990, Part VI, Line 2 FAMILY/BUSINESS RELATIONSHIPS AMONGST INTERESTED PERSONS. | MARIO MURGADO, MATTHEW A. LOVE, Jodi Laurence and Dawn Javersack have a business relationship due to serving on the board of directors of Children's Health Ventures. |
| Form 990, Part VI, Line 4 Significant changes to organizational documents | Effective December 15, 2020, the board voted to terminate and dissolve the Variety Children's Hospital Professional Liability Trust. All assets were transferred to affiliated 501(c)(3) organizations. See attached board resolution of termination and dissolution. |
| Form 990, Part VI, Line 6 Classes of members or stockholders | Variety Children's Hospital d/b/a Nicklaus Children's Hospital, a Florida corporation, is the sole Member. |
| Form 990, Part VI, Line 7a Members or stockholders electing members of governing body | Variety Children's Hospital may remove the Trustee at any time and appoint a successor trustee. |
| Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders | Variety Children's Hospital (the sole member) has the right to amend the trust agreement in order to ensure that it conforms to the current laws and regulations governing this agreement as well as such amendments as the sole member deems necessary. The sole member may, in its sole discretion, at any time direct the Trustee to merge this Trust with other self-insurance trusts of other qualified hospitals or employers upon receipt of an opinion from an independent Counsel. |
| Form 990, Part VI, Line 11b Review of form 990 by governing body | THE FOLLOWING DESCRIBES THE PROCESS FOR PROVIDING THE BOARD OF DIRECTORS WITH A COPY OF THE FORM 990 AND REVIEWING IT: 1. THE DRAFT TAX FORM 990 WILL BE EMAILED TO THE AUDIT AND COMPLIANCE COMMITTEE CHAIR FOR REVIEW AND COMMENTS PRIOR TO FILING. 2. THE PAID TAX PREPARER WILL PRESENT A SUMMARY OF THE INFORMATION TO THE FINANCE COMMITTEE OF THE BOARD. 3. QUESTIONS WILL BE ANSWERED AND IF NECESSARY, TAX FORMS WILL BE ADJUSTED. THE CHAIR WILL APPROVE THE FORM 990. 4. THE FINAL FORM 990 WILL BE POSTED ON THE BOARD WEB PORTAL PRIOR TO FILING. |
| Form 990, Part VI, Line 12c Conflict of interest policy | ALL NICKLAUS CHILDREN'S HOSPITAL EMPLOYEES ARE INFORMED UPON HIRE, AND ON AN ANNUAL BASIS THEREAFTER, THAT THEY HAVE AN AFFIRMATIVE DUTY TO DISCLOSE ANY ACTUAL, POTENTIAL OR PERCEIVED CONFLICTS OF INTEREST. THEY ARE REQUIRED TO COMPLETE A CONFLICT OF INTEREST DISCLOSURE FORM UPON HIRE, ANNUALLY AND WHENEVER A CHANGE IN CIRCUMSTANCES WARRANTS. CONFLICT OF INTEREST DISCLOSURE FORMS ARE FORWARDED TO THE COMPLIANCE DEPARTMENT BY THE TALENT MANAGEMENT AND EFFECTIVENESS DEPARTMENT. THESE FORMS ARE INITIALLY REVIEWED BY COMPLIANCE DEPARTMENT STAFF. WHEN DEEMED NECESSARY, THE COMPLIANCE DEPARTMENT COLLABORATES WITH THE LEGAL DEPARTMENT. CONFLICTS OF INTEREST THAT NECESSITATE BOARD AWARENESS AND ACTION ARE PRESENTED TO THE AUDIT AND COMPLIANCE COMMITTEE OF THE BOARD FOR RESOLUTION AND IMPOSITION OF SANCTIONS, IF WARRANTED. ANY POTENTIALLY CONFLICTED BOARD MEMBERS ARE RECUSED FROM BOARD DELIBERATIONS AND VOTING ON ITEMS IN WHICH THEY HAVE A POTENTIAL CONFLICT. IN ADDITION, ON AN ANNUAL BASIS, BOARD MEMBERS, PRINCIPAL OFFICERS AND BOARD-DELEGATED COMMITTEE MEMBERS SIGN A STATEMENT WHICH AFFIRMS THAT EACH INDIVIDUAL: (A) HAS RECEIVED A COPY OF THE CONFLICT OF INTEREST POLICY; (B) HAS READ AND UNDERSTANDS THE POLICY (C) HAS AGREED TO COMPLY WITH THE POLICY, AND (D) UNDERSTANDS THAT THE HOSPITAL IS A CHARITABLE ORGANIZATION AND THAT IN ORDER TO MAINTAIN ITS FEDERAL EXEMPTION IT MUST ENGAGE PRIMARILY IN ACTIVITIES WHICH ACCOMPLISH ONE OR MORE OF IT'S TAX-EXEMPT PURPOSES. A PROCESS IS IN PLACE FOR MANAGING SITUATIONS IN WHICH IT IS DISCOVERED THAT AN INDIVIDUAL WHO IS COVERED BY THE HOSPITAL'S CONFLICT OF INTEREST POLICY FAILED TO PROPERLY DISCLOSE A POTENTIAL CONFLICT OF INTEREST. |
| Form 990, Part VI, Line 19 Required documents available to the public | Financial statements, governing documents, and conflict of interest policies are not required disclosures pursuant to Internal Revenue Code (IRC) Section 6104. These documents are not available to the public at this time. |
| Form 990, Part XI, Line 9 Other changes in net assets or fund balances | Transfer to Affiliate - -837787; |
| Form 990, Page 1 Header Box B Amended Return | The Form 990 for tax year ending 12/31/2020 has been amended to file a final return in accordance with the attached board resolution to terminate and dissolve the Variety Children's Hospital Professional Liability Trust. As a result of this amendment, the following part of and schedules to Form 990 have been changed: Form 990, Page 1, Header Box B, Amended and Final Return Form 990, Part III, Line 3 Form 990, Part IV, Line 31 Form 990, Part VI, Line 4 Form 990, Part X Form 990, Part XI, Line 9 Schedule N Schedule O narratives associated with the aforementioned schedules These amendments were a result of the termination and dissolution of the trust. These amendments were necessary to file a final return in accordance with the instructions to Form 990. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (6 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd | Business Name Line2DisregardedEntityName/BusinessNameLine2Txt |
|---|---|---|---|---|---|---|---|---|---|---|---|
| VARIETY CHILDREN'S HOSPITAL | |||||||||||
| 3100 SW 62ND AVENUE | MIAMI | FL | 33155 | 590638499 | HOSPITAL | FL | 501(c)(3) | 3 | MCHS | false | |
| MIAMI CHILDREN'S HOSPITAL WORKER'S COMPENSATION TRUST | |||||||||||
| 3100 SW 62ND AVENUE | MIAMI | FL | 33155 | 597021572 | WC CLAIMS | FL | 4947 (a)(1) | VCH | false | ||
| MIAMI CHILDREN'S HOSPITAL RESEARCH INSTITUTE INC | |||||||||||
| 3100 SW 62ND AVENUE | MIAMI | FL | 33155 | 592602318 | RESEARCH | FL | 501(c)(3) | 3 | VCH | false | |
| Pediatric Specialty Group Inc (dba NICKLAUS CHILDREN'S PEDIATRIC SPECIALIST | |||||||||||
| 3100 SW 62ND AVENUE | MIAMI | FL | 33155 | 463756071 | EMPLOYED PHYSICIANS | FL | 501(c)(3) | 3 | MCHS | false | S INC) |
| MIAMI CHILDREN'S HEALTH SYSTEM INC | |||||||||||
| 3100 SW 62ND AVENUE | MIAMI | FL | 33155 | 453481327 | HEALTHCARE | FL | 501(c)(3) | Type II | NA | false | |
| MIAMI CHILDREN'S HEALTH SYSTEM FOUNDATION INC (DBA NICKLAUS CHILDREN'S HOSP | |||||||||||
| 3100 SW 62ND AVENUE | MIAMI | FL | 33155 | 461784918 | FOUNDATION | FL | 501(c)(3) | 7 | MCHS | false | ITAL FOUNDATION INC) |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (3 entries)
| Address Line1USAddress/AddressLine1Txt | Address Line2USAddress/AddressLine2Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Predominant Income TypePredominantIncomeTypeTxt |
|---|---|---|---|---|---|---|---|---|---|
| MIAMI CHILDREN'S HOSPITAL AMBULATORY SURGERY CENTER LLC | |||||||||
| 800 SW 108TH AVENUE | SUITE 200 | MIAMI | FL | 33174 | 463406805 | AMBULATORY CENTER | FL | NA | N/A |
| MIAMI CHILDREN'S HEALTH PLAN LLC | |||||||||
| 3100 SW 62ND AVE | MIAMI | FL | 33155 | 823111550 | INSURANCE | FL | NA | N/A | |
| MIAMI HOSPITAL HOLDINGS LLC | |||||||||
| 11221 ROE AVE SUITE 320 | LEAWOOD | KS | 66211 | 464077635 | HOLDING COMPANY | FL | NA | N/A | |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (2 entries)
| Address Line1ForeignAddress/AddressLine1Txt | Address Line2ForeignAddress/AddressLine2Txt | CityForeignAddress/CityNm | Province Or StateForeignAddress/ProvinceOrStateNm | CountryForeignAddress/CountryCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile Foreign CountryLegalDomicileForeignCountryCd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Entity TypeEntityTypeTxt | Controlled OrganizationControlledOrganizationInd | Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | Legal Domicile StateLegalDomicileStateCd |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| MIAMI CHILDREN'S INSURANCE CO SPC LTD | |||||||||||||||
| 720 WEST BAY ROAD | PO BOX 69GT BUCKINGHAM SQUARE | GEORGETOWN | GRAND CAYMAN | CJ | 980442086 | INSURANCE | CJ | NA | C Corporation | false | |||||
| CHILDREN'S HEALTH VENTURES INC AND SUBSIDIARIES | |||||||||||||||
| 454541147 | MERCHANT WHOLESALE | NA | C Corporation | false | 3100 SW 62ND AVENUE | MIAMI | FL | 331553009 | FL | ||||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | false | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | false | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | false | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | false | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | false | DivRelatedOrganizationInd |
| Asset Sale To Other Org | false | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | false | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | false | AssetExchangeInd |
| Rental Of Facilities To Oth Org | false | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | false | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | false | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (true) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (true) | SharingOfFacilitiesInd |
| Paid Employees Sharing | false | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | false | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | false | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | false | TransferToOtherOrgInd |
| Transfer From Other Org | false | TransferFromOtherOrgInd |
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