2021-11-15T14:02:51-06:00 2020-12-31 350921680 CROWE LLP 401 East Las Olas Blvd Suite 1100 Fort Lauderdale FL 333014230 990 2020-01-01 463756071 Pediatric Specialty Group Inc PEDI 3056666511 3100 SW 62ND AVENUE MIAMI FL 33155 Dawn Javersack SVP and CFO 2021-11-15 true Dawn Javersack 999009999 Brittney Kocaj P01320603 9542028600 2020 2022-09-23 18:48:47Z X Nicklaus Childrens Pediatric Specialists Matthew A Love 3100 SW 62ND AVENUE MIAMI FL 33155 58299031 false X https://www.nicklauschildrens.org/about-us/pediatric-specialists X 2012 FL Pediatric Specialty Group, Inc. (d/b/a Nicklaus Children's Pediatric Specialists ("NCPS")) IS A PHYSICIAN-DIRECTED, MULTI-SPECIALTY PEDIATRIC GROUP WITH A REGIONAL, NATIONAL, AND INTERNATIONAL PRESENCE IN PROVIDING PEDIATRIC-CENTRIC CARE THROUGH A COLLABORATIVE TEAM APPROACH, EXCELLENCE IN CLINICAL CARE, EDUCATION, AND RESEARCH. X 20 5 533 5 0 0 1050346 1658824 71457446 56633609 0 25365 6598 72533157 58299031 0 0 74863270 63702540 0 0 31402970 27193752 106266240 90896292 -33733083 -32597261 10821169 0 10821169 0 0 0 Pediatric Specialty Group, Inc. (d/b/a Nicklaus Children's Pediatric Specialists ("NCPS")) IS A PHYSICIAN-DIRECTED, MULTI-SPECIALTY PEDIATRIC GROUP WITH A REGIONAL, NATIONAL, AND INTERNATIONAL PRESENCE IN PROVIDING PEDIATRIC-CENTRIC CARE THROUGH A COLLABORATIVE TEAM APPROACH, EXCELLENCE IN CLINICAL CARE, EDUCATION, AND RESEARCH. (Continued on Schedule O) false false 72724089 56640207 IN 2020, NICKLAUS CHILDREN'S PEDIATRIC SPECIALISTS EMPLOYED 251 PROVIDERS TO SUPPORT THE ONGOING FUNCTIONS OF NICKLAUS CHILDREN'S HEALTH SYSTEM AND NICKLAUS CHILDREN'S HOSPITAL IN THE FOLLOWING SUB-SPECIALTIES: ADOLESCENT MEDICINE, ALLERGY/IMMUNOLOGY, CARDIOLOGY, CARDIOVASCULAR SURGERY, CLINICAL GENETICS AND METABOLISM, CRITICAL CARE MEDICINE, EMERGENCY MEDICINE, ENDOCRINOLOGY, GASTROENTEROLOGY, GENERAL PEDIATRICS, INFECTIOUS DISEASES, MATERNAL FETAL, NEPHROLOGY, NEUROPSYCHOLOGY, NEUROSURGERY, NUTRITION, OPHTHALMOLOGY, ORTHOPEDICS, OTOLARYNGOLOGY, PLASTIC AND RECONSTRUCTIVE SURGERY, PSYCHIATRY,PHYSIATRY AND PSYCHOLOGY, RADIOLOGY/SEDATION AND RHEUMATOLOGY. (CONTINUED ON SCHEDULE O) 72724089 true true false false false false false false false false false false false false true false true false false false false false false false false false false false true false false false false false false false false false false true false false true false false false true 34 0 true 533 true false false false false false false false false false false false false X 20 5 true false true false true true true true true false false true true true true true true false false false X Laurie Levine 3056666511 5301 Blue Lagoon Drive MIAMI FL 33126 Alex Soto Chairman & Director 0.1 1.5 X X 0 0 0 Chad A Perlyn Director & Interim President & Sec (as of Aug 2020) 40.0 0 X X 1023763 0 53107 Craig J Spurdle Director & Vice Chair 40.0 0 X X 1021470 0 8813 Ramesh C Sachdeva Director, President & Sec untilAug 2020 0.1 40.0 X X 0 585014 91426 Alisa Muniz Crim Director 40.0 0 X 408590 0 14412 Anthony F Rossi Director - Partial Yr. 40.0 0 X 471060 0 21284 Barbara Pena MD Director/Attending Physician 40.0 0 X 237944 0 25157 David Drossner MD Director/Attending Physician 40.0 0 X 527986 0 26299 DR Sara Rivero-Conil Director/Mgr Clinical Psych 40.0 0 X 154592 0 14250 Jaret Davis Director 0.1 1.5 X 0 0 0 Marcelo Laufer MD Director 0.1 0 X 0 0 0 Maria Ramon-Coton MD Director/Chief Urgent Care 40.0 0 X 278396 0 20143 Mario Murgado Director 0.1 1.5 X 0 0 0 Matthew Love Director- NCHS Pres/CEO 0.1 40.5 X 0 906180 204098 Miladys Palau-Collazo MD Attending Physician & Partial Year Director 40.0 0 X 113104 0 17122 Nicole Christin MD Director/Attending Physician 40.0 0 X 267723 0 9297 Ricky Patel ESQ Director 0.1 0.6 X 0 0 0 Sandeep Dave Director 40.0 0 X 796765 0 11094 Stephen George Director 40.0 0 X 984360 0 20072 Toba N Niazi Director 40.0 0 X 1039000 0 9616 Dawn E Javersack SVP/CFO Health System 0.1 40.4 X 0 423463 65573 Jodi Laurence SVP and General Counsel 0.1 40.4 X 0 382573 80301 Marcos A Mestre Senior Medical Director 1.0 40.0 X 0 305901 27668 Maria Jayoussi NCPS CFO 40.0 0 X 143631 0 12439 Brian Ho Physician 40.0 0 X 714766 0 5975 John Ragheb Chief Neurosurgery 40.0 0 X 1035048 0 29283 Redmond P Burke Chief Cardiovascular Surg 40.0 0 X 1955063 0 19693 Shelly Wang Attending Physician 40.0 0 X 636508 0 18126 Thomas J Errico Orthopedic Attending Physician 40.0 0 X 858617 0 13834 Narendra M Kini CEO/Director (Former) 0.0 0.0 X 0 1178819 0 12668388 3781950 819081 224 true true false ALLSCRIPTS HEALTHCARE LLC 24630 NETWORK PLACE CHICAGO IL 606731246 Maintenance Service /IT 1081685 SULLIVAN COTTER AND ASSOCIATES 62272 COLLECTIONS CENTER DRIVE CHICAGO IL 606930622 Consulting - Compensation programs 243752 PRICEWATERHOUSE COOPERS LLP 3109 W DR MARTIN L K JR BLV TAMPA FL 33607 PROFESSIONAL SERVICES 108000 3 201869 1456955 1658824 PATIENT SERVICE REVENUE 561110 55994788 55994788 M.U INCENTIVE PAYMENTS 900099 638821 638821 0 0 0 0 56633609 0 0 0 0 0 0 MISCELLANEOUS 900099 6598 6598 0 0 0 0 6598 58299031 56640207 0 0 X 5548216 4438573 1109643 0 50714140 40571312 10142828 418700 325562 93138 4054134 3242719 811415 2967350 2383866 583484 18546604 14837283 3709321 0 23613 18890 4723 441002 352802 88200 8574 6859 1715 3189447 2551558 637889 177001 141601 35400 3617828 2894262 723566 Medical Supplies 775190 620152 155038 Dues & Subscriptions 349894 279915 69979 Course Expenses 53229 42583 10646 Recruitment Expenses 12389 9911 2478 -1019 6241 -7260 0 90896292 72724089 18172203 0 1130 0 8437763 0 0 0 0 0 0 0 3769 0 0 0 2378507 0 10821169 0 6907194 0 0 0 3913975 0 10821169 0 X 0 0 10821169 0 X -32597261 0 32597261 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED Intercompany payables Current portion of liability for self-insurance Operating Lease Liabilities 0 X Schedule D, Part X, Line 2 FIN 48 (ASC 740) footnote PEDIATRIC SPECIALISTS OF AMERICA'S (PSA) 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." true true false false false false false false false Narendra M Kini CEO/Director (Former) 0 0 0 0 0 1178819 0 0 0 0 0 1178819 0 0 Chad A Perlyn Director & Interim President & Sec (as of Aug 2020) 1022161 0 0 0 1602 0 29769 0 23338 0 1076871 0 0 0 Ramesh C Sachdeva Director, President & Sec untilAug 2020 0 578585 0 0 0 6429 0 78248 0 13178 0 676440 0 0 Craig J Spurdle Director & Vice Chair 1001280 0 0 0 20190 0 8550 0 263 0 1030283 0 0 0 Nicole Christin MD Director/Attending Physician 267453 0 0 0 270 0 2373 0 6924 0 277020 0 0 0 David Drossner MD Director/Attending Physician 527686 0 0 0 300 0 3305 0 22994 0 554285 0 0 0 Stephen George Director 964591 0 0 0 19770 0 7277 0 12795 0 1004433 0 0 0 Matthew Love Director- NCHS Pres/CEO 0 880893 0 0 0 25287 0 179228 0 24870 0 1110278 0 0 Alisa Muniz Crim Director 408140 0 0 0 450 0 3745 0 10667 0 423003 0 0 0 Toba N Niazi Director 1038700 0 0 0 300 0 7043 0 2573 0 1048616 0 0 0 Barbara Pena MD Director/Attending Physician 237254 0 0 0 690 0 2163 0 22994 0 263101 0 0 0 Maria Ramon-Coton MD Director/Chief Urgent Care 276416 0 0 0 1980 0 2585 0 17558 0 298539 0 0 0 DR Sara Rivero-Conil Director/Mgr Clinical Psych 154317 0 0 0 275 0 1105 0 13145 0 168842 0 0 0 Anthony F Rossi Director - Partial Yr. 469080 0 0 0 1980 0 4398 0 16886 0 492344 0 0 0 Sandeep Dave Director 776815 0 0 0 19950 0 4273 0 6821 0 807859 0 0 0 Dawn E Javersack SVP/CFO Health System 0 418147 0 0 0 5316 0 55389 0 10185 0 489036 0 0 Maria Jayoussi NCPS CFO 136898 0 0 0 6733 0 8000 0 4439 0 156069 0 0 0 Jodi Laurence SVP and General Counsel 0 376723 0 0 0 5850 0 62471 0 17830 0 462873 0 0 Marcos A Mestre Senior Medical Director 0 305268 0 0 0 632 0 4677 0 22991 0 333569 0 0 Redmond P Burke Chief Cardiovascular Surg 1953083 0 0 0 1980 0 2808 0 16886 0 1974756 0 0 0 Thomas J Errico Orthopedic Attending Physician 856316 0 0 0 2301 0 8538 0 5295 0 872451 0 0 0 Brian Ho Physician 714496 0 0 0 270 0 0 0 5975 0 720740 0 0 0 John Ragheb Chief Neurosurgery 1013568 0 0 0 21480 0 6958 0 22325 0 1064330 0 0 0 Shelly Wang Attending Physician 636268 0 0 0 240 0 5331 0 12795 0 654635 0 0 0 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 or Compensation Committee. Schedule J, Part I, Line 4a Severance or change-of-control payment THE FOLLOWING INDIVIDUALS RECEIVED SEVERANCE PAYMENTS DURING THE YEAR - 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 - MARIA JAYOUSSI 8,000.10 CHAD A PERLYN 25,000.00 MARCOS A MESTRE 4,000.00 MATTHEW LOVE 174,520.32 DAWN E JAVERSACK 55,388.58 RAMESH C. SACHDEVA 73,503.04 JODI LAURENCE 59,585.76 Cash 2020-12-31 1020 BV 453481327 NICKLAUS CHILDREN'S HEALTH SYSTEM 3100 SW 62ND AVENUE Miami FL 33155 501(C)(3) Accounts and Others Receivables 2020-12-31 7416744 BV 453481327 NICKLAUS CHILDREN'S HEALTH SYSTEM 3100 SW 62ND AVENUE MIAMI FL 33155 501(C)(3) Other Assets 2020-12-31 1801800 BV 453481327 NICKLAUS CHILDREN'S HEALTH SYSTEM 3100 SW 62ND AVENUE MIAMI FL 33155 501(C)(3) true true false false true true true false false Schedule N, Part I, Line 1, Column (f) NAME & ADDRESS OF RECEIPENT - ITEMS 1 - 4 NICKLAUS CHILDREN'S PEDIATRIC SPECIALISTS, LLC- BECAME A DISREGARDED ENTITY OF NICKLAUS CHILDREN'S HEALTH SYSTEM, INC. SEE FORM 990, PART IV, LINE 4 AND ATTACHED FLORIDA NOTICE OF CONVERSION TO LIMITED LIABILITY COMPANY CERTIFICATE Schedule N, Part I, Line 5 Liabilities THE FILING ORGANIZATION BECAME A DISREGARDED ENTITY OF NICKLAUS CHILDREN'S HEALTH SYSTEM, INC. AS A RESULT, THE QUESTION REGARDING THE LIQUIDATION OF LIABILITIES IS NOT APPLICABLE. Schedule N, Part I, Line 2a Interested person is a director or trustee of successor org. ALL BOARD MEMBERS OF PEDIATRIC SPECIALTY GROUP REMAINED AS REPORTED AFTER CONVERSION TO A DISREGARDED LLC. Schedule N, Part I, Line 2b Interested person is an employee or ind. contractor of successor org. ALL OFFICERS OF THE PEDIATRIC SPECIALTY GROUP REMAINED AS REPORTED AFTER CONVERSION TO A DISREGARDED LLC. Form 990, Part III, Line 1 ORGANIZATION'S MISSION THE CORPORATION IS ORGANIZED EXCLUSIVELY FOR CHARITABLE, EDUCATIONAL, AND SCIENTIFIC PURPOSES WITH THE MISSION OF ENHANCING WELLNESS IN PEDIATRIC PATIENTS THROUGH THE OPTIMAL DELIVERY OF PEDIATRIC MULTI-SPECIALTY CARE REGARDLESS OF THE ABILITY TO PAY, COVERING THE UNDERSERVED AND UNINSURED. Form 990, Part III, Line 4a PROGRAM SERVICE DESCRIPTION OVERALL, THE 2020 PROGRAM ACCOMPLISHMENTS OF NCPS PHYSICIANS INCLUDE BEING INTERNATIONALLY RECOGNIZED FOR CARE EXCELLENCE BY BEING RANKED ATHE NATION'S BEST IN 5 OF THE ABOVE LISTED SPECIALTIES SURVEYED BY U.S. NEWS AND WORLD REPORT IN ITS 2020-20201 LISTING OF " BEST CHILDREN'S HOSPITALS." (RESULTS WERE RELEASED IN 2020.) NICKLAUS CHILDREN'S HOSPITAL HAD MORE RANKED PEDIATRIC PROGRAMS THAN ANY OTHER HOSPITAL IN SOUTH FLORIDA. CATEGORIES IN WHICH THE NCPS SPECIALTIES WERE RANKED IN 2020 INCLUDE CARDIOLOGY AND HEART SURGERY, DIABETES AND ENDOCRINOLOGY, NEONATOLOGY. NEUROLOGY & NEUROSURGERY, ORTHOPEDICS,AND PULMONOLOGY. COLLECTIVELY THE NCPS SPECIALISTS GENERATED MORE THAN 443,914 ENCOUNTERS IN 2020 SERVING PREDOMINATELY POOR AND UNDERSERVED COMMUNITIES IN ORDER TO IMPROVE POPULATION HEALTH AND WELL-BEING FOR THE CHILDREN THAT WE SERVE. EXPANSION OF SERVICE AREAS INCLUDED MIAMI DADE COUNTY, BROWARD COUNTY, PALM BEACH COUNTY AND COLLIER COUNTY. Form 990, Part VI, Line 15a DETERMINING COMPENSATION FOR CEO AND EXECUTIVE DIRECTOR THE CEO IS PAID BY NICKLAUS CHILDREN'S HEALTH SYSTEM, INC. A RELATED ORGANIZATION, THEREFORE THIS HAS BEEN ANSWERED NO IN ACCORDANCE WITH THE INSTRUCTIONS. THE ORGANIZATION AND COMPENSATION COMMITTEE OF NICKLAUS CHILDREN'S HEALTH SYSTEM'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 15b Determining compensation for other officers or key employees Nicklaus Children's Pediatric Specialists RELIED ON THE METHODS OF ESTABLISHING COMPENSATION USED BY NICKLAUS CHILDREN'S HEALTH SYSTEM. THE ORGANIZATION AND COMPENSATION COMMITTEE OF NICKALUS 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 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 1a Delegate broad authority to a committee There shall be an Executive Committee of the Board of Directors composed of three (3) Directors elected by the Board of Directors, one of whom must be the Chair of the Board and one of whom must be a physician employed by the Corporation. No non-Director members shall serve on the Executive Committee. A majority of the members of the Executive Committee shall constitute a quorum for the transaction of business and for taking any action. The Executive Committee shall have and exercise the authority designated to it by the Board of Directors in the management of the Corporation. The Executive Committee shall report to the Board of Directors any action taken by the Executive Committee at the next meeting of the Board of Directors. Members of the Executive Committee may be removed by the Board at any regular or special meeting of the Board of Directors. Form 990, Part VI, Line 4 Significant changes to organizational documents NICKLAUS CHILDREN'S PEDIATRIC SPECIALISTS WAS CONVERTED TO A DISREGARDED ENTITY OF MIAMI CHILDREN'S HEALTH SYSTEM AS OF 12/31/2020. SEE ATTACHED ARTICLES OF CONVERSION AND ARTICLES OF ORGANIZATION. Form 990, Part VI, Line 6 Classes of members or stockholders THE ORGANIZATION'S SOLE MEMBER IS NICKLAUS CHILDREN'S HEALTH SYSTEM, INC. THE SOLE MEMBER HAS THE AUTHORITY TO ELECT MEMBERS TO THE BOARD OF DIRECTORS AND APPROVE DECISIONS OF THE BOARD. Form 990, Part VI, Line 7a Members or stockholders electing members of governing body THE ELECTED MEMBERS OF THE BOARD SHALL BE ELECTED BY NICKLAUS CHILDREN'S HEALTH SYSTEM (THE SOLE MEMBER), AFTER TAKING INTO CONSIDERATION ANY RECOMMENDATIONS OF THE BOARD. THE NUMBER OF DIRECTORS OF THE CORPORATION SHALL BE ESTABLISHED BY RESOLUTION OF THE BOARD OF DIRECTORS OF THE SOLE MEMBER; PROVIDED THAT THERE SHALL BE NO FEWER THAN 6 AND NO MORE THAN 15 DIRECTORS. ANY DIRECTOR MAY BE REMOVED FROM OFFICE BY ACTION OF THE SOLE MEMBER OR THE ELECTED MEMBERS OF THE BOARD SO PERMITTED TO VOTE, FOR ANY CAUSE OR REASON DEEMED SUFFICIENT BY THE MEMBER OR THE ELECTED MEMBERS OF THE BOARD SO PERMITTED TO VOTE. Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders The Board shall not take any action with respect to the following without the approval of Nicklaus Children's Health System (the sole Member): a) Modify the mission, purpose or scope of the CORPORATION, or materially change the location, size or scope of services, programs, operations or educational or medical school affiliations of the CORPORATION or related agreements; b) Create any entity in which the CORPORATION is the sole member or sole shareholder, or any entity in which the CORPORATION has a direct or indirect oversight role, which may include not-for-profit, for profit, limited liability companies, or any other legal entity; c) Sell, lease, purchase, create, dissolve, convey, mortgage, grant a security interest or otherwise dispose of any affiliated, controlled, or joint venture entity, any real or personal property or other assets (or any interest in any of the foregoing), or incur debt for money borrowed or guarantee the debt of another, not in the ordinary course of business; d) Approve annual operating or capital budgets, strategic and long-range plans, major fund-raising programs, physician compensation or other agreements, managed care contracts or other financial commitments or material deviations from such budgets, plans, agreements or commitments; and e) Approve financial, accounting, human resource, employee benefit, compliance policies or procedures, medical staff bylaws (including amendments) or other policies and procedures, or the appointment or engagement of auditors, legal counsel and consultants, which are in any way contrary to the policies and procedures adopted from time to time by the Member. 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 Pediatric Specialists ("NCPS") EMPLOYEES ARE INFORMED UPON HIRE, AND ON AN ANNUAL BASIS THEREAFTER, THAT THEY HAVE AN AFFIRMATIVE DUTY TO DISCLOSE ANY ACTUAL, POTENTIAL OR PERCEIVED CONFLICT 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 NCPS 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 NCPS'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 IX, Line 11g Other Fees LABORATORY SERVICES - Total Expense: -4980, Program Service Expense: -3984, Management and General Expenses: -996, Fundraising Expenses: ; FREIGHT - Total Expense: 250, Program Service Expense: 200, Management and General Expenses: 50, Fundraising Expenses: ; INSPECTIONS - Total Expense: 256, Program Service Expense: 205, Management and General Expenses: 51, Fundraising Expenses: ; FREIGHT - DOMESTIC - Total Expense: 503, Program Service Expense: 402, Management and General Expenses: 101, Fundraising Expenses: ; MISCELLANEOUS EXPENSES - Total Expense: 502, Program Service Expense: 402, Management and General Expenses: 100, Fundraising Expenses: ; STORAGE FEES - Total Expense: 2306, Program Service Expense: 1845, Management and General Expenses: 461, Fundraising Expenses: ; LICENSES AND OTHER TAXES - Total Expense: 5748, Program Service Expense: 4598, Management and General Expenses: 1150, Fundraising Expenses: ; COLLECTION SERVICES - Total Expense: 41395, Program Service Expense: 33116, Management and General Expenses: 8279, Fundraising Expenses: ; CONSULTANTS - Total Expense: 242547, Program Service Expense: 194038, Management and General Expenses: 48509, Fundraising Expenses: ; MEDICAL FEES - Total Expense: 502920, Program Service Expense: 402336, Management and General Expenses: 100584, Fundraising Expenses: ; MANAGEMENT FEE EXPENSE - Total Expense: 1005903, Program Service Expense: 804722, Management and General Expenses: 201181, Fundraising Expenses: ; CODING SERVICES - Total Expense: 2910619, Program Service Expense: 2328495, Management and General Expenses: 582124, Fundraising Expenses: ; PURCHASED SERVICES - Total Expense: 3324891, Program Service Expense: 2659913, Management and General Expenses: 664978, Fundraising Expenses: ; SUPPORT FEE EXPENSE - Total Expense: 10513744, Program Service Expense: 8410995, Management and General Expenses: 2102749, Fundraising Expenses: ; Form 990, Part XI, Line 9 Other changes in net assets or fund balances Equity Transfer with affiliated entity - conversion to disregarded LLC - 32597261; FORM 990, PART V, LINES 1A AND 2A FORMS W-2 AND 1099 FILED MIAMI CHILDREN'S HEALTH SYSTEM, INC. (EIN 45-3481327) FILES IN ITS NAME ALL FORMS W-2 AND 1099 FOR THE FILING ORGANIZATION, PEDIATRIC SPECIALTY GROUP, INC. 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 VARIETY CHILDREN'S HOSPITAL PROFESSIONAL LIABILITY TRUST 3100 SW 62ND AVENUE MIAMI FL 33155 592551434 LIAB. 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 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 ITAL FOUNDATION INC) 3100 SW 62ND AVENUE MIAMI FL 33155 461784918 FOUNDATION FL 501(c)(3) 7 MCHS false 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 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 3100 SW 62ND AVENUE MIAMI FL 331553009 454541147 MERCHANT WHOLESALE FL NA C Corporation false false false true false false false false false false false false false true true true true false false true