2012-11-14T14:45:33-06:00 2011-12-31 861065772 DELOITTE TAX LLP 201 E KENNEDY BLVD STE 1200 TAMPA FL 33602 990 2011-01-01 592602318 MCH RESEARCH INSTITUTE INC MIAM 3056666511 3100 SW 62ND AVENUE MIAMI FL 33155 TIMOTHY BIRKENSTOCK 3056666511 2012-11-13 0 P00648526 8132738355 2011 2016-02-24 21:20:13Z TIMOTHY BIRKENSTOCK 3100 SW 62ND AVENUE MIAMI FL 331553009 2826615 0 X WWW.MCH.COM X 1984 FL IMPROVE CHILD HEALTH BY PROVIDING ACCESS TO NEW INNOVATIONS FOR THEDIAGNOSIS, TREATMENT AND CURE OF PEDIATRIC DISEASES PROMOTING RESEARCHTO ADVANCE SCIENCE AND GENERATE KNOWLEDGE IN CHILD HEALTH AND MEDICINE 19 14 37 1 704401 -444003 2577360 1809635 1954642 978821 -28711 0 38145 38159 4541436 2826615 0 0 0 0 2652897 2458165 0 0 0 1852667 2026359 4505564 4484524 35872 -1657909 889311 427860 6573690 7292363 -5684379 -6864503 X MIAMI CHILDREN'S HOSPITAL RESEARCH INSTITUTE STUDIES THE ROLE OF NUTRITION IN THE CAUSE, CURE, AND PREVENTION OF CHILDHOOD DISEASES. IN ADDITION TO NUTRITION, RESEARCH CENTERS OF EXCELLENCE ARE ORGANIZED TO FOCUS ON PEDIATRIC CRITICAL CARE, PRIMARY CARE, CELLULAR AND MOLECULAR PATHOBIOLOGY, MOLECULAR GENETICS, AND NEUROSCIENCE. THE COMMON THREAD RUNNING THROUGH ALL THESE RESEARCH AREAS OF EXCELLENCE IS CHRONIC DISEASE, WELLNESS, AND ACUTE CARE. ALL THESE RESEARCH AREAS ARE SUPPORTED BY A CORE LABORATORY. 0 0 4045537 978821 COSTS INCURRED FOR FACILITIES TO CONDUCT SCIENTIFIC RESEARCH BY MEANS OF EXPERIMENTS TO PROMOTE HUMAN KNOWLEDGE IN THE FIELD OF MEDICAL SCIENCE. SEE STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS. 4045537 1 1 0 0 0 0 0 0 0 0 1 0 0 0 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 0 1 X 0 0 37 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 X 19 14 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X FISCAL SERVICES - CONTROLLER 3056666511 3100 SW 62ND AVENUE MIAMI FL 331553009 X JEFRY BIEHLER MD 0.50 X 0 370661 31448 THOMAS M CORNISH 0.50 X 0 0 0 JARET DAVIS ESQUIRE 0.50 X 0 0 0 MARIA FRANCO MD 0.50 X 0 0 0 MICHAEL FUX 0.50 X 0 0 0 LUIS GONZALEZ-MENDOZA MD 0.50 X 0 286521 18508 GHISLAIN GOURAIGE JR 0.50 X 0 0 0 DEISE GRANADO-VILLAR MD 0.50 X 0 334372 74571 GARY GREGORY 0.50 X 0 0 0 JUAN C MAS 0.50 X 0 0 0 JAY MASSIRMAN 0.50 X 0 0 0 STEVEN MCKEAN 0.50 X 0 0 0 MARIO MURGADO 0.50 X 0 0 0 PHILIP NEWCOMM MD 0.50 X 0 0 0 CARMEN PEREZ 0.50 X 0 0 0 GENE PRESCOTT 0.50 X 0 0 0 ALEX SOTO 0.50 X 0 0 0 KEITH WARD 0.50 X 0 0 0 NARENDRA KINI MD 0.50 X X 0 737885 154351 PEDRO ALFARO 0.50 X 0 399326 83599 BYRON BERNAL 40.00 X 148747 0 26597 RAUL HERRERA 40.00 X 161039 0 21616 DORA A HALAC 40.00 X 103762 0 17666 413548 2128765 428356 3 0 1 0 WESTERN INSTITUTIONAL REVIEW PO BOX 12029 OLYMPIA WA 985082029 RESEARCH PROTOCOL REVIEW 394940 UNIVERSITY OF MIAMI 1507 LEVANTE AVENUE CORAL GABLES FL 33124 MEDICAL RESEARCH/STUDIES 160694 FILE ENTERPRISES INC 8021 LAKE DRIVE SUITE 201 DORAL FL 33166 MARKETING SERVICES 103560 3 1754648 54987 1809635 CLINICAL TRIAL REVENUE 900099 704401 704401 GRANT REVENUE 900099 274420 274420 978821 38159 0 38159 38159 38159 2826615 274420 704401 38159 413548 413548 1596299 1596299 448318 448318 50879 25440 25439 1247544 1247544 2252 2252 43260 43260 63671 63671 468776 468776 41879 41879 SUPPLIES 48918 48918 DUES & SUBSCRIPTIONS 27747 27747 EQUIPMENT RENTAL & MAIN 10268 10268 TELEPHONE EXPENSE 244 244 20921 20921 4484524 4045537 438987 0 3928101 3500241 889311 427860 889311 427860 6573690 7292363 6573690 7292363 X -6672205 -8064379 987826 1199876 -5684379 -6864503 889311 427860 X -1657909 477785 X 0 1 1 X 1 1 X X 0 0 0 SEE PART IV 590638499 3 0 1 4484524 1 4484524 SCHEDULE A, PART IV, SUPPLEMENTAL INFORMATION: PART I, LINE 11(H), COLUMN (I) NAME OF SUPPORTED ORGANIZATION: VARIETY CHILDREN'S HOSPITAL D/B/A MIAMI CHILDREN'S HOSPITAL RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 3928101 3500241 427860 427860 DUE TO AFFILIATES 7292363 7292363 PART X, LINE 2: THE HOSPITAL BELIEVES THERE IS NO UNCERTAIN TAX LIABILITY WHICH SHOULD BE RECORDED AS OF DECEMBER 31, 2011. 0 1 0 0 0 0 0 0 0 JEFRY BIEHLER MD 0 354315 0 16346 0 0 0 0 0 31448 0 402109 0 0 LUIS GONZALEZ-MENDOZA MD 0 286521 0 0 0 0 0 0 0 18508 0 305029 0 0 DEISE GRANADO-VILLAR MD 0 281891 0 52481 0 0 0 45624 0 28947 0 408943 0 0 NARENDRA KINI MD 0 576999 0 160886 0 0 0 123724 0 30627 0 892236 0 0 PEDRO ALFARO 0 328411 0 70915 0 0 0 50386 0 33213 0 482925 0 0 BYRON BERNAL 147187 0 1560 0 0 0 0 0 26597 0 175344 0 0 0 RAUL HERRERA 149494 0 11545 0 0 0 0 0 21616 0 182655 0 0 0 PART I, LINE 3 PART I, LINE 3: THE ORGANIZATION RELIED ON THE METHODS OF ESTABLISHING COMPENSATION FOR THE ORGANIZATION'S CEO/EXECUTIVE DIRECTOR EMPLOYED BY VARIETY CHILDREN'S HOSPITAL D/B/A MIAMI CHILDREN'S HOSPITAL (EIN: 59-0638499). MIAMI CHILDREN'S HOSPITAL USES THE FOLLOWING METHODS TO ESTABLISH SUCH COMPENSATION: - COMPENSATION COMMITTEE - INDEPENDENT COMPENSATION CONSULTANT - WRITTEN EMPLOYMENT CONTRACT - COMPENSATION SURVEY OR STUDY - APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE SUPPLEMENTAL INFORMATION PART III PART I, LINE 4(B) THE EXECUTIVES PARTICIPATE IN A SUPPLEMENTAL 457(F) DEFINED CONTRIBUTION RETIREMENT ACCOUNT. THE VALUES ARE REPORTED IN SCHEDULE J, PART II, COLUMN C PROGRAM SERVICE ACCOMPLISHMENTS FORM 990, PART III, LINE 4A MIAMI CHILDREN'S RESEARCH INSTITUTE IS ONE OF THE LARGEST PROVIDERS OF PEDIATRIC MEDICAL RESEARCH IN THE SOUTHEASTERN UNITED STATES. IT CURRENTLY PARTICIPATES IN APPROXIMATELY 214 RESEARCH PROTOCOLS INVOLVING NEW MEDICATIONS AND INTERVENTIONS FOR CHILDREN WITH COMPLEX MEDICAL NEEDS. THE MCH RESEARCH INSTITUTE WILL UNDERGO RE-ACCREDITATION IN 2012 BY THE ASSOCIATION OF HUMAN RESEARCH PROTECTION PROGRAMS (AHRPP). HAVING BECOME THE FIRST PEDIATRIC RESEARCH PROGRAM IN THE STATE OF FLORIDA AND ONE OF THE FEW CHILDREN'S HOSPITALS IN THE NATION TO EARN THIS DISTINCTION IN 2009. AHRPP ACCREDITATION AFFIRMS THE HOSPITAL'S COMMITMENT TO MAINTAINING THE MOST STRINGENT STANDARDS IN PROTECTING THE HEALTH OF RESEARCH PARTICIPANTS AND EDUCATING PARTICIPANTS AND THEIR FAMILIES REGARDING RISKS AND POTENTIAL BENEFITS OF TAKING PART IN RESEARCH ACTIVITIES. THE MISSION OF THE MIAMI CHILDREN'S HOSPITAL RESEARCH INSTITUTE IS TO PROMOTE RESEARCH FOR THE ADVANCEMENT OF SCIENCE AND TO GENERATE KNOWLEDGE IN CHILD HEALTH AND PEDIATRIC MEDICINE. THE MCH RESEARCH INSTITUTE PARTICIPATES IN BOTH CLINICAL RESEARCH, WHICH TESTS NEW DIAGNOSTIC PROCEDURES, PHARMACEUTICALS, MEDICAL DEVICES AND INTERVENTIONAL PROCEDURES; AND TRANSLATIONAL RESEARCH, WHICH FOCUSES ON TRANSLATING LABORATORY DISCOVERIES TO THE PATIENT-CARE ENVIRONMENT. HOSPITAL DEPARTMENTS THAT ARE PARTICULARLY ACTIVE IN FOSTERING RESEARCH INCLUDE ADOLESCENT MEDICINE, RADIOLOGY, CARDIOLOGY, ENDOCRINOLOGY, GASTROENTEROLOGY, GENETICS, HEMATOLOGY-ONCOLOGY, NEUROSCIENCES, NEPHROLOGY, ORTHOPAEDICS, PSYCHIATRY, PULMONOLOGY AND UROLOGY. AS PART OF ITS WORK IN THE FIELD OF HEMATOLOGY-ONCOLOGY RESEARCH, MIAMI CHILDREN'S HOSPITAL MAINTAINS FULL MEMBERSHIP IN CHILDREN'S ONCOLOGY GROUP, A FEDERALLY FUNDED CONSORTIUM OF PEDIATRIC HOSPITALS AND PEDIATRIC DEPARTMENTS CONDUCTING A LARGE ARRAY OF CLINICAL RESEARCH STUDIES OFFERING LATEST ADVANCEMENTS FOR TREATMENT OF CHILDHOOD CANCERS. FUTURE PLANS FOR THE MCH RESEARCH INSTITUTE INCLUDE ESTABLISHING A MOLECULAR RESEARCH CENTER, A UNIQUE PROGRAM THAT COMBINES CLINICAL AND MOLECULAR MEDICINE TO DELIVER CARE DESIGNED EXPRESSLY FOR THE NEEDS OF THE INDIVIDUAL CHILD. 2011 RESEARCH HIGHLIGHTS (1) THE RESEARCH INSTITUTE HAS BEEN INVOLVED IN THE LONG-TERM EFFICACY STUDY OF NEUROPACE'S RNS (REPETITIVE NEURO-SIMULATOR) SYSTEM USED TO CONTROL SEIZURES NOT OTHERWISE TREATABLE BY MEDICATION IN EPILEPSY PATIENTS. THE DEVICE WAS DESIGNED TO CONTINUOUSLY MONITOR ELECTRICAL BRAIN ACTIVITY AND ADJUST THE ELECTRICAL CURRENT BASED ON PATIENT'S UNIQUE PARAMETERS. THE DEVICE RECORDS THE SEIZURE AND DISCHARGES THE APPROPRIATE AMOUNT OF ELECTRICAL CURRENT TO STOP THAT SPECIFIC SEIZURE. PATIENTS OR CARETAKERS ALSO HAVE THE ABILITY TO OVERRIDE THE DEVICE VIA A MAGNET IF THE SEIZURE CONTINUES. (2) THE RESEARCH INSTITUTE CONTINUES ITS COMMITMENT TO PATIENTS IN ACQUIRING REGULATORY APPROVAL FOR DEVICES THAT HAVE NOT BEEN YET APPROVED BY THE FDA OR THAT ARE NEEDED IN EMERGENCY USE ON HUMAN SUBJECTS FOR LIFE-THREATENING SITUATIONS, AND THAT CAN BE PROVIDED IN SPECIAL SITUATIONS THROUGH THE REGULATORY PROCESS TO PATIENTS IN NEED. MORE THAN FOUR PATIENTS RECEIVED THE CHEATHAM PLATINUM COVERED STENT FOR THE TREATMENT OF HEART SURGICAL REPAIR. OBTAINING REGULATORY APPROVAL FOR THESE TYPE OF DEVICES ENHANCES THE QUALITY OF LIFE FOR THESE SPECIFIC PATIENTS WITH UNIQUE MEDICAL CONDITIONS. (3) IN A HOSPITAL ENVIRONMENT, EXEMPT STUDIES ARE USUALLY THE INITIAL STEP IN ACQUIRING KNOWLEDGE TO IDENTIFY POSSIBLE TREATMENTS, MEDICINES, AND PROCESSES THAT ARE BENEFITING PEDIATRIC PATIENTS BY REVIEWING THEIR MEDICAL RECORDS. THE RESEARCH INSTITUTE APPROVED 24 SUCH STUDIES IN 2011 EXPANDING PEDIATRIC MEDICAL KNOWLEDGE THROUGH PUBLICATIONS AND PRESENTATION OF ABSTRACTS AT MEDICAL EVENTS. ONE OF THESE STUDIES "THE USE OF THREE-DIMENSIONAL ROTATIONAL ANGIOGRAPHY TO ASSESS THE PULMONARY CIRCULATION FOLLOWING CAVO-PULMONARY CONNECTION IN PATIENTS WITH SINGLE VENTRICLE" HAS BECOME A ROUTINE DIAGNOSTIC TOOL FOR SPECIFIC PATIENTS AT MIAMI CHILDREN'S HOSPITAL. FORM 990, PART VI, SECTION B, LINE 11 THE FOLLOWING DESCRIBES MIAMI CHILDREN'S HOSPITAL RESEARCH INSTITUTE'S PROCESS FOR PROVIDING IT'S BOARD OF DIRECTORS WITH A COPY OF THE FORM 990 AND REVIEWING IT: 1. THE DRAFT TAX FORM 990 WILL BE MAILED TO FINANCE COMMITTEE OF MCH BOARD OF DIRECTORS FOR REVIEW AND COMMENT PRIOR TO REGULARLY SCHEDULED MEETING. 2. THE DRAFT TAX FORM 990 WILL BE REVIEWED WITH THE FINANCE COMMITTEE. 3. QUESTIONS WILL BE ANSWERED AND IF NECESSARY, TAX FORMS WILL BE ADJUSTED. 4. THE FINAL FORM 990 WILL BE POSTED ON THE MCH BOARD OF DIRECTOR'S WEB PORTAL. FORM 990, PART VI, SECTION B, LINE 12C ALL MIAMI CHILDREN'S HOSPITAL RESEARCH INSTITUTE 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. 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 IF 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, SECTION B, LINE 15 THE ORGANIZATION AND COMPENSATION COMMITTEE OF MIAM CHILDREN'S HOSPITAL RESEARCH INSTITUTE 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 AND USED IN ESTABLISHING EXECUTIVE SALRAY AND BENEFITS PROGRAMS. FORM 990, PART VI, SECTION C, LINE 19 FORM 990, PART VI, SECTION C, LINE 19: DOCUMENTS THAT ARE REQUIRED TO BE OPEN FOR PUBLIC INSPECTION ARE MADE AVAILABLE UPON REQUEST. AVERAGE HOURS PER WEEK PART VII, LINE 1A, COLUMN B THE OFFICERS LISTED ON PART VII, SECTION A, LINE 1(A), COLUMN B DEVOTED THEIR TIME TO THE ORGANIZATION AND RELATED ORGANIZATIONS AS FOLLOWS: WORKER'S PROFESSIONAL MCH VARIETY COMPENSATION LIABILITY FOUNDATION CHILDREN'S TRUST TRUST INC. HOSPITAL JEFRY BIEHLER, MD 0.1 0.1 0.0 39.3 THOMAS M. CORNISH 0.1 0.1 1.5 1.3 JARET DAVIS, ESQUIRE 0.1 0.1 0.0 1.3 MARIA FRANCO, MD 0.1 0.1 0.0 1.3 MICHAEL FUX 0.1 0.1 0.0 1.3 LUIS GONZALEZ-MENDOZA, MD 0.1 0.1 0.0 39.3 GHISLAIN GOURAIGE, JR. 0.1 0.1 0.0 1.3 DEISE GRANADO-VILLAR, MD 0.1 0.1 0.0 39.3 GARY GREGORY 0.1 0.1 0.5 1.3 JUAN C. MAS 0.1 0.1 0.5 1.3 JAY MASSIRMAN 0.1 0.1 0.0 1.3 STEVEN MCKEAN 0.1 0.1 0.0 1.3 MARIO MURGADO 0.1 0.1 1.5 1.3 PHILIP NEWCOMM, MD 0.1 0.1 0.0 1.3 CARMEN PEREZ 0.1 0.1 0.0 1.3 GENE PRESCOTT 0.1 0.1 0.0 1.3 ALEX SOTO 0.1 0.1 0.0 1.3 KEITH WARD 0.1 0.1 0.0 1.3 PEDRO ALFARO 0.1 0.1 0.0 39.3 NARENDRA KINI, MD 0.1 0.1 0.0 39.3 CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: GRANT REVENUE USED FOR PURCHASE OF PP&E 259,974. NET REALIZED GAIN ON TEMPORARILY RESTRICTED ASSETS 14,446. RECLASS TO RELATED ORGANIZATION 271,566. PRIOR PERIOD ADJUSTMENT -62,371. AMOUNTS REPORTED SEPARATELY -5,830. TOTAL TO FORM 990, PART XI, LINE 5: 477,785. EMPLOYEES REPORTED ON W-3 PART V, LINE 2A VARIETY CHILDREN'S HOSPITAL D/B/A MIAMI CHILDREN'S HOSPITAL ("MCH") IS THE APPOINTED PAY AGENT FOR ALL OF ITS AFFILIATES. AS SUCH ONLY MCH ISSUES FORM W-3. MCH WORKER'S COMPENSATION TRUST 3100 SW 62ND AVENUE MIAMI FL 33155 597021572 WC CLAIMS FL 4947(A)(1) N/A VCH 0 PROFESSIONAL LIABILITY TRUST 3100 SW 62ND AVENUE MIAMI FL 33155 592551434 LIAB. CLAIMS FL 4947(A)(1) N/A VCH 0 MIAMI CHILDREN'S HOSPITAL FOUNDATION INC 3100 SW 62ND AVENUE MIAMI FL 33155 591720704 FOUNDATION FL 501(C)(3) 7 VCH 0 VARIETY CHILDREN'S HOSPITAL 3100 SW 62ND AVENUE MIAMI FL 33155 590638499 HOSPITAL FL 501(C)(3) 3 MCHS 0 MIAMI CHILDREN'S HEALTH SYSTEM INC 3100 SW 62ND AVENUE MIAMI FL 33155 453481327 HEALTHCARE FL 501(C)(3) 11 TYPE II N/A 0 CANAVAN PARTNERS C/O COHEN PO BOX 812170 BOCA RATON FL 334812170 650974245 MED.INTERL. P FL N/A CHILDREN'S HEALTH SERVICES INC 3100 SW 62ND AVENUE MIAMI FL 331553009 650438667 PHYSICIAN SUP FL N/A C MIAMI CHILDREN'S INSURANCE CO SPC LTD 720 WEST BAY ROADPO BOX 69GT BUCKI GEORGETOWN CJ 980442086 INSURANCE CJ N/A C 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 MIAMI CHILDREN'S HOSPITAL FOUNDATION INC C 1754648 FMV