2021-11-15T14:03:49-06:00 2020-12-31 350921680 CROWE LLP 401 East Las Olas Blvd Suite 1100 Fort Lauderdale FL 333014230 990 2020-01-01 592551434 Variety Children's Hospital Professional Liability Trust VARI 3056666511 3100 SW 62nd Avenue Miami FL 331553009 Dawn Javersack SVP and CFO 2021-11-15 true Dawn Javersack 999009999 Brittney Kocaj P01320603 9542028600 2020 2022-09-23 18:48:47Z Matthew A Love 3100 SW 62nd Avenue Miami FL 331553009 11587 false X www.nicklauschildrens.org X 1984 FL TO ENABLE NICKLAUS CHILDREN'S HOSPITAL ("NCH") TO FUND AND PAY THE COST OF PROFESSIONAL LIABILITY CLAIMS AGAINST THE HOSPITAL 17 13 0 13 0 0 0 0 11381 11493 0 11381 11493 0 0 0 0 0 250 274 250 274 11131 11219 693654 837787 0 0 693654 837787 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. false false 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. 0 true false 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 false false false true false false false true 0 0 0 false false false false false false false false false false false false X 17 13 true false false 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 Jaret Davis Chairman/Director 0.1 1.5 X X 0 0 0 Jefry Biehler Secretary/Director 0.1 40.2 X X 0 389033 20250 Jose Perdomo Director, Interim President & COO NCH (Partial Year) 0.1 40.3 X X 0 538755 10282 Joseph Nader Vice Chairman/Director 0.1 0.4 X X 0 0 0 Matthew Love Director, PRESIDENT & CEO 0.1 40.5 X X 0 906180 204098 Perry Ann Reed Director/President NCH 0.1 40.3 X X 0 446811 71411 Alex Soto Director 0.1 1.5 X 0 0 0 Amy Charley Director 0.1 0.3 X 0 0 0 Balagangadhar Totapally Director 0.1 0.3 X 0 0 0 Drew Kern Director 0.1 0.4 X 0 0 0 Fred Moreno Director 0.1 0.3 X 0 0 0 John Lie-Nielsen Director 0.1 0.3 X 0 0 0 Jorge Gonzalez Director 0.1 0.4 X 0 0 0 Marcos A Mestre Director 0.1 40.0 X 0 305901 27668 Maria Franco MD Director 0.1 0.3 X 0 0 0 Mario Murgado Director 0.1 1.5 X 0 0 0 Ricky Patel ESQ Director 0.1 0.6 X 0 0 0 Steven Melnick MD Director 0.1 0.3 X 0 0 0 Regions Bank Institutional Trustee 0 X 0 0 0 Arianna Urquia VP/CFO Hospital 0.1 40.2 X 0 286156 23729 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 Michael L Harrington President (Former) 0.0 0.0 X 0 258221 0 Narendra M Kini CEO (Former) 0.0 0.0 X 0 1178819 0 0 5115912 503312 0 true true false 0 0 0 0 0 0 0 11473 11473 0 0 114 94 20 0 20 20 0 0 0 0 0 11493 0 0 11493 274 274 0 0 0 0 0 0 0 0 274 0 274 0 210 50 0 0 0 0 0 0 0 0 693444 837737 0 0 0 0 693654 837787 0 0 0 0 0 0 X 693654 837787 693654 837787 693654 837787 11219 132914 0 X false true X true false X X 1 VARIETY CHILDREN'S HOSPITAL DBA NICKLAUS CHILDREN'S HOSPITAL 590638499 3 true 0 274 1 0 274 true false false false false false false false false false false false false false false true Intercompany 0 X Schedule D, Part X, Line 2 FIN 48 (ASC 740) footnote 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." true true false false false false false Jefry Biehler Secretary/Director 0 387053 0 0 0 1980 0 3831 0 16419 0 409283 0 0 Matthew Love Director, PRESIDENT & CEO 0 880893 0 0 0 25287 0 179228 0 24870 0 1110278 0 0 Jose Perdomo Director, Interim President & COO NCH (Partial Year) 0 433269 0 0 0 105486 0 2694 0 7588 0 549037 0 0 Perry Ann Reed Director/President NCH 0 424425 0 0 0 22386 0 56640 0 14771 0 518222 0 0 Marcos A Mestre Director 0 305268 0 0 0 632 0 4677 0 22991 0 333569 0 0 Michael L Harrington President (Former) 0 0 0 0 0 258221 0 0 0 0 0 258221 0 0 Narendra M Kini CEO (Former) 0 0 0 0 0 1178819 0 0 0 0 0 1178819 0 0 Dawn E Javersack SVP/CFO Health System 0 418147 0 0 0 5316 0 55389 0 10185 0 489036 0 0 Jodi Laurence SVP and General Counsel 0 376723 0 0 0 5850 0 62471 0 17830 0 462873 0 0 Arianna Urquia VP/CFO Hospital 0 285292 0 0 0 864 0 22862 0 867 0 309885 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 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 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 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. 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 S INC) 3100 SW 62ND AVENUE MIAMI FL 33155 463756071 EMPLOYED PHYSICIANS FL 501(c)(3) 3 MCHS 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 false false false false false false false false false false true true false false false false false