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Pediatric Specialty Group Inc: Form 990, tax year 2018

View the entire original 990 at ProPublica ↗

Organization
Pediatric Specialty Group Inc (EIN 46-3756071)
Tax period
2018-01-01 to 2018-12-31
Filed
2019-11-11
IRS object ID
201903159349303305
Schema version
2018v3.1
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

FieldValueIRS element (for citing)
Return2019-11-11T13:32:31-06:00ReturnTs
Tax Period End2018-12-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN350921680PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1CROWE LLPBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1401 East Las Olas Blvd Suite 1100AddressLine1Txt
CityFort LauderdaleCityNm
State AbbreviationFLStateAbbreviationCd
ZIP333014230ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2018-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN463756071EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1Pediatric Specialty Group IncBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlPEDIBusinessNameControlTxt
Phone3056666511PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line13100 SW 62ND AVENUEAddressLine1Txt
CityMIAMICityNm
State AbbreviationFLStateAbbreviationCd
ZIP33155ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonMatthew A LovePersonNm
Person TitlePresident and CEOPersonTitleTxt
Signature2019-11-11SignatureDt
Discuss With Paid PreparerYes (true)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonBrittney KocajPreparerPersonNm
PTINP01320603PTIN
Phone9542028600PhoneNum
FieldValueIRS element (for citing)
Tax2018TaxYr
Build TS2020-03-31 21:24:44ZBuildTS

Form 990 IRS990

Doing Business As Name DoingBusinessAsName

FieldValueIRS element (for citing)
Business Name Line1Pediatric Specialists of AmericaBusinessNameLine1Txt

Principal Ofcr Business Name PrincipalOfcrBusinessName

FieldValueIRS element (for citing)
Business Name Line1Matthew A LoveBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line13100 SW 62ND AVENUEAddressLine1Txt
CityMIAMICityNm
State AbbreviationFLStateAbbreviationCd
ZIP33155ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$72,440,780GrossReceiptsAmt
Group Return For AffiliatesfalseGroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website Addresshttps://www.nicklauschildrens.org/medical-professionals/pediatric-specialists-of-americaWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation2012FormationYr
Legal Domicile StateFLLegalDomicileStateCd
Activity Or MissionWe are an outstanding group of physicians bringing lifelong health and hope to children and families through innovative compassionate care.ActivityOrMissionDesc
Voting Members Governing Body12VotingMembersGoverningBodyCnt
Voting Members Independent1VotingMembersIndependentCnt
Total Employee327TotalEmployeeCnt
Total Volunteers1TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$44,063PYContributionsGrantsAmt
CY Contributions Grants$52,147CYContributionsGrantsAmt
PY Program Service Revenue$66,279,940PYProgramServiceRevenueAmt
CY Program Service Revenue$72,360,227CYProgramServiceRevenueAmt
CY Investment Income$0CYInvestmentIncomeAmt
PY Other Revenue$32,815PYOtherRevenueAmt
CY Other Revenue-$20,980CYOtherRevenueAmt
PY Total Revenue$66,356,818PYTotalRevenueAmt
CY Total Revenue$72,391,394CYTotalRevenueAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$70,634,183PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$73,316,626CYSalariesCompEmpBnftPaidAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$34,351,696PYOtherExpensesAmt
CY Other Expenses$30,415,785CYOtherExpensesAmt
PY Total Expenses$104,985,879PYTotalExpensesAmt
CY Total Expenses$103,732,411CYTotalExpensesAmt
PY Revenues Less Expenses-$38,629,061PYRevenuesLessExpensesAmt
CY Revenues Less Expenses-$31,341,017CYRevenuesLessExpensesAmt
Total Assets BOY$10,099,049TotalAssetsBOYAmt
Total Assets EOY$9,831,649TotalAssetsEOYAmt
Total Liabilities BOY$4,652,220TotalLiabilitiesBOYAmt
Total Liabilities EOY$9,831,649TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$5,446,829NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$0NetAssetsOrFundBalancesEOYAmt
MissionPEDIATRIC SPECIALISTS OF AMERICA ("PSA") 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)MissionDesc
Significant New Program SrvcfalseSignificantNewProgramSrvcInd
Significant ChangefalseSignificantChangeInd
Expense$82,985,928ExpenseAmt
Revenue$72,370,633RevenueAmt
DescIN 2018, PEDIATRIC SPECIALISTS OF AMERICA EMPLOYED 262 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, DENTISTRY, EMERGENCY MEDICINE, ENDOCRINOLOGY, GASTROENTEROLOGY, GENERAL PEDIATRICS, INFECTIOUS DISEASES, MATERNAL FETAL, NEPHROLOGY, NEUROPSYCHOLOGY, NEUROSURGERY, NUTRITION, OPHTHALMOLOGY, ORTHOPEDICS, OTOLARYNGOLOGY, PLASTIC AND RECONSTRUCTIVE SURGERY, PSYCHIATRY AND PSYCHOLOGY, RADIOLOGY/SEDATION AND RHEUMATOLOGY. (CONTINUED ON SCHEDULE O)Desc
Total Program Service Expenses$82,985,928TotalProgramServiceExpensesAmt
Described In Section501c3Yes (true)DescribedInSection501c3Ind
Schedule B RequiredYes (true)ScheduleBRequiredInd
Political Campaign ActyfalsePoliticalCampaignActyInd
Lobbying ActivitiesfalseLobbyingActivitiesInd
Donor Advised FundfalseDonorAdvisedFundInd
Conservation EasementsfalseConservationEasementsInd
Collections Of ArtfalseCollectionsOfArtInd
Credit CounselingfalseCreditCounselingInd
Temp Or Permanent EndowmentsfalseTempOrPermanentEndowmentsInd
Report Land Building EquipmentfalseReportLandBuildingEquipmentInd
Report Investments Other SecfalseReportInvestmentsOtherSecInd
Report Program Related InvstfalseReportProgramRelatedInvstInd
Report Other AssetsYes (true)ReportOtherAssetsInd
Report Other LiabilitiesYes (true)ReportOtherLiabilitiesInd
Include FIN48 FootnoteYes (true)IncludeFIN48FootnoteInd
Independent Audit Fincl StmtfalseIndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (true)ConsolidatedAuditFinclStmtInd
School OperatingfalseSchoolOperatingInd
Foreign OfficefalseForeignOfficeInd
Foreign ActivitiesfalseForeignActivitiesInd
More Than5000 K To OrgfalseMoreThan5000KToOrgInd
More Than5000 K To IndividualsfalseMoreThan5000KToIndividualsInd
Professional FundraisingfalseProfessionalFundraisingInd
Fundraising ActivitiesfalseFundraisingActivitiesInd
Gaming ActivitiesfalseGamingActivitiesInd
Operate HospitalfalseOperateHospitalInd
Grants To OrganizationsfalseGrantsToOrganizationsInd
Grants To IndividualsfalseGrantsToIndividualsInd
Schedule J RequiredYes (true)ScheduleJRequiredInd
Tax Exempt BondsfalseTaxExemptBondsInd
Engaged In Excess Benefit TransfalseEngagedInExcessBenefitTransInd
PY Excess Benefit TransfalsePYExcessBenefitTransInd
Loan OutstandingfalseLoanOutstandingInd
Grant To Related PersonfalseGrantToRelatedPersonInd
Business Rln With Org MemfalseBusinessRlnWithOrgMemInd
Business Rln With Fam MemfalseBusinessRlnWithFamMemInd
Business Rln With Officer EntfalseBusinessRlnWithOfficerEntInd
Deductible Non Cash ContrifalseDeductibleNonCashContriInd
Deductible Art ContributionfalseDeductibleArtContributionInd
Terminate OperationsfalseTerminateOperationsInd
Partial LiquidationfalsePartialLiquidationInd
Disregarded EntityfalseDisregardedEntityInd
Related EntityYes (true)RelatedEntityInd
Related Organization Ctrl EntfalseRelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd OrgfalseTrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted PrtshpfalseActivitiesConductedPrtshpInd
Schedule O RequiredYes (true)ScheduleORequiredInd
IRP Document40IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (true)BackupWthldComplianceInd
Employee327EmployeeCnt
Employment Tax Returns FiledYes (true)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over LimitYes (true)UnrelatedBusIncmOverLimitInd
Form990 T FiledYes (true)Form990TFiledInd
Foreign Financial AccountfalseForeignFinancialAccountInd
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTransInd
Taxable Party NotificationfalseTaxablePartyNotificationInd
Nondeductible ContributionsfalseNondeductibleContributionsInd
Quid Pro Quo ContributionsfalseQuidProQuoContributionsInd
Form8282 Property Disposed OfYes (true)Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft CntrctfalseRcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft CntrctfalsePayPremiumsPrsnlBnftCntrctInd
Indoor Tanning ServicesfalseIndoorTanningServicesInd
Subj To Tax Rmnrtn Ex Prcht PymtfalseSubjToTaxRmnrtnExPrchtPymtInd
Subject To Excs Tax Net Invst IncfalseSubjectToExcsTaxNetInvstIncInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members12GoverningBodyVotingMembersCnt
Independent Voting Member1IndependentVotingMemberCnt
Family Or Business RlnYes (true)FamilyOrBusinessRlnInd
Delegation Of Mgmt DutiesfalseDelegationOfMgmtDutiesInd
Change To Org DocumentsfalseChangeToOrgDocumentsInd
Material Diversion Or MisusefalseMaterialDiversionOrMisuseInd
Members Or StockholdersYes (true)MembersOrStockholdersInd
Election Of Board MembersYes (true)ElectionOfBoardMembersInd
Decisions Subject To ApprovaYes (true)DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (true)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (true)MinutesOfCommitteesInd
Officer Mailing AddressfalseOfficerMailingAddressInd
Local ChaptersfalseLocalChaptersInd
Form990 Provided To Gvrn BodyYes (true)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (true)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (true)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (true)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (true)WhistleblowerPolicyInd
Document Retention PolicyYes (true)DocumentRetentionPolicyInd
Compensation Process CEOfalseCompensationProcessCEOInd
Compensation Process OtherfalseCompensationProcessOtherInd
Investment In Joint VenturefalseInvestmentInJointVentureInd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1Ramon CotoBusinessNameLine1Txt
FieldValueIRS element (for citing)
Phone3056666511PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line15301 Blue Lagoon DriveAddressLine1Txt
CityMIAMICityNm
State AbbreviationFLStateAbbreviationCd
ZIP33126ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (22 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtHighest Compensated EmployeeHighestCompensatedEmployeeInd
Leonard G Feld MD
President/DIRECTOR - Partial Year40.00.0Yes (X)Yes (X)$0$721,131$34,395
Alex Soto
Chairman0.11.4Yes (X)Yes (X)$0$0$0
Marcos A Mestre MD
Vice Chairman40.00Yes (X)Yes (X)$267,830$0$31,476
Narendra M Kini MD
CEO & Director0.140.4Yes (X)Yes (X)$0$2,186,311$263,462
Michael S Davis
Interim President/Director0.140.0Yes (X)Yes (X)$0$388,437$66,802
Andrij Susla
SECRETARY/Deputy General Counsel - Partial Year40.00Yes (X)Yes (X)$0$224,969$12,003
Saima Aftab MD
Director40.00Yes (X)$411,388$0$30,537
Michael L Harrington
Director0.140.3Yes (X)$0$491,345$87,200
George Lesmes PhD
DIRECTOR - Partial Year40.00Yes (X)$0$15,590$1,826
Alisa Muniz Crim MD
Director40.00Yes (X)$355,156$0$17,496
Chad Perlyn MD
Director40.00Yes (X)$693,146$0$31,873
Jose Rosa-Olivares MD
Director40.00Yes (X)$383,008$0$23,934
Anthony Rossi MD
Director40.00Yes (X)$507,023$0$26,615
Dave Sandeep MD
Director40.00Yes (X)$786,458$0$19,561
Craig Spurdle MD
Director40.00Yes (X)$660,707$0$8,595
Timothy L Birkenstock
Treasurer & CFO0.140.4Yes (X)$0$979,128$82,617
Matthew Love
SVP & CFO (partial year)0.140.4Yes (X)$0$93,638$3,818
Redmond P Burke MD
Chief Cardiovascular Surgeon40.00$1,640,970$0$26,615Yes (X)
Kristine Guleserian
Cardiovascular Surgeon40.00$1,186,236$0$14,075Yes (X)
John Ragheb MD
Chief Neurosurgery40.00$934,000$0$31,572Yes (X)
Harry Shufflebarger MD
Orthopedic Attending Physician40.00$1,022,411$0$26,990Yes (X)
Michael A Tidwell MD
Chief Orthopedics40.00$765,314$0$23,563Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$9,613,649TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$5,100,549TotReportableCompRltdOrgAmt
Total Other Compensation$865,027TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K240IndivRcvdGreaterThan100KCnt
Former Ofcr Employees ListedfalseFormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (true)TotalCompGreaterThan150KInd
Compensation From Other SrcsfalseCompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmt
CERNER CORPORATION
PO BOX 412732KANSAS CITYMO641412732Software License$4,378,350
TACTICAL MANAGEMENT INC
2699 Lee RoadWinter ParkFL32789Coding Services$377,584
SULLIVAN COTTER AND ASSOCIATES
62272 COLLECTIONS CENTER DRIVECHICAGOIL606930622Consulting - Compensation programs$360,183
MEDICAL MANAGEMENT ASSOCIATES
3330 Cumberland BlvdAtlantaGA30339Health Care Connsultants$161,329
DENTOFACIAL ORTHOPEDICS
4521 NW 94TH COURTDoralFL33178Medical Supplies$109,313
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K5CntrctRcvdGreaterThan100KCnt
Related Organizations$50,784RelatedOrganizationsAmt
Government Grants$1,363GovernmentGrantsAmt
Total Contributions$52,147TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (3 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
PATIENT SERVICE REVENUE561110$72,205,795$72,205,795
M.U INCENTIVE PAYMENTS900099$49,850$49,850
TELEHEALTH SERVICES900099$104,582$104,582

Total Oth Program Service Rev TotalOthProgramServiceRevGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt
Related Or Exempt Func Income$0RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$0ExclusionAmt
FieldValueIRS element (for citing)
Total Program Service Revenue$72,360,227TotalProgramServiceRevenueAmt

Gross Rents GrossRentsGrp

FieldValueIRS element (for citing)
Real$18,000RealAmt

Less Rental Expenses LessRentalExpensesGrp

FieldValueIRS element (for citing)
Real$49,386RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Real-$31,386RealAmt
Personal$0PersonalAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column-$31,386TotalRevenueColumnAmt
Exclusion-$31,386ExclusionAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Securities$0SecuritiesAmt
Other$0OtherAmt

Other Revenue Misc OtherRevenueMiscGrp

FieldValueIRS element (for citing)
DescMiscellaneous RevenueDesc
Business900099BusinessCd
Total Revenue Column$10,406TotalRevenueColumnAmt
Related Or Exempt Func Income$10,406RelatedOrExemptFuncIncomeAmt

Miscellaneous Revenue MiscellaneousRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt
Related Or Exempt Func Income$0RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$0ExclusionAmt
FieldValueIRS element (for citing)
Other Revenue Total$10,406OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$72,391,394TotalRevenueColumnAmt
Related Or Exempt Func Income$72,370,633RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion-$31,386ExclusionAmt
FieldValueIRS element (for citing)
Info In Schedule O Part IXYes (X)InfoInScheduleOPartIXInd

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$4,254,804TotalAmt
Program Services$3,403,843ProgramServicesAmt
Management And General$850,961ManagementAndGeneralAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$59,911,608TotalAmt
Program Services$47,929,287ProgramServicesAmt
Management And General$11,982,321ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$2,686,777TotalAmt
Program Services$2,149,422ProgramServicesAmt
Management And General$537,355ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$3,352,448TotalAmt
Program Services$2,681,958ProgramServicesAmt
Management And General$670,490ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$3,110,989TotalAmt
Program Services$2,488,791ProgramServicesAmt
Management And General$622,198ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$23,878,423TotalAmt
Program Services$19,102,738ProgramServicesAmt
Management And General$4,775,685ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$530,670TotalAmt
Program Services$424,536ProgramServicesAmt
Management And General$106,134ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$7,093TotalAmt
Program Services$5,674ProgramServicesAmt
Management And General$1,419ManagementAndGeneralAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$400,456TotalAmt
Program Services$320,365ProgramServicesAmt
Management And General$80,091ManagementAndGeneralAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$441,893TotalAmt
Program Services$353,514ProgramServicesAmt
Management And General$88,379ManagementAndGeneralAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$91,960TotalAmt
Program Services$73,568ProgramServicesAmt
Management And General$18,392ManagementAndGeneralAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$3,483,190TotalAmt
Program Services$2,786,552ProgramServicesAmt
Management And General$696,638ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
Medical Supplies$884,792$707,834$176,958
Recruitment Expenses$37,930$30,344$7,586
Dues & Subscriptions$431,936$345,549$86,387
Course Expenses$139,943$111,954$27,989

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$87,499TotalAmt
Program Services$69,999ProgramServicesAmt
Management And General$17,500ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$103,732,411TotalAmt
Program Services$82,985,928ProgramServicesAmt
Management And General$20,746,483ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$1,130BOYAmt
EOY$1,130EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$9,341,277BOYAmt
EOY$9,188,162EOYAmt

Receivables From Officers Etc ReceivablesFromOfficersEtcGrp

FieldValueIRS element (for citing)
EOY$0EOYAmt

Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp

FieldValueIRS element (for citing)
EOY$0EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$3,744BOYAmt
EOY$0EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$0LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$0LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
EOY$0EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt

Investments Program Related InvestmentsProgramRelatedGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$752,898BOYAmt
EOY$642,357EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$10,099,049BOYAmt
EOY$9,831,649EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$4,652,220BOYAmt
EOY$5,705,331EOYAmt

Loans From Officers Directors LoansFromOfficersDirectorsGrp

FieldValueIRS element (for citing)
EOY$0EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$4,126,318EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$4,652,220BOYAmt
EOY$9,831,649EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY$5,446,829BOYAmt
EOY$0EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$5,446,829BOYAmt
EOY$0EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$10,099,049BOYAmt
EOY$9,831,649EOYAmt
FieldValueIRS element (for citing)
Info In Schedule O Part XIYes (X)InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss-$31,341,017ReconcilationRevenueExpnssAmt
Other Changes In Net Assets$25,894,188OtherChangesInNetAssetsAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or ReviewfalseAccountantCompileOrReviewInd
FS AuditedYes (true)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Consolidated Basis Fincl StmtYes (X)ConsolidatedBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (true)AuditCommitteeInd
Federal Grant Audit RequiredfalseFederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
HospitalYes (X)HospitalInd

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Total ContributionsRESTRICTEDTotalContributionsAmt

Schedule D IRS990ScheduleD

Other Assets Org OtherAssetsOrgGrp (2 entries)

DescDescBook ValueBookValueAmt
Physicians Startup Payments$637,695
Intercompany receivables$4,662
FieldValueIRS element (for citing)
Total Book Value Other Assets$642,357TotalBookValueOtherAssetsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)

DescDescAmtAmt
Intercompany payables$3,282,056
Current portion of liability for self-insurance$844,262
FieldValueIRS element (for citing)
Total Liability$4,126,318TotalLiabilityAmt
Footnote TextYes (X)FootnoteTextInd

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceSchedule D, Part X, Line 2 FIN 48 (ASC 740) footnoteFormAndLineReferenceDesc
ExplanationPEDIATRIC 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' FIN 48 (ASC 740) FOOTNOTE FOR THE YEAR ENDED DECEMBER 31, 2018, 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, PSA, NCHF 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, 2018 AND 2017. 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, 2018 AND 2017. 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

FieldValueIRS element (for citing)
Idemnification Gross Up PmtsYes (X)IdemnificationGrossUpPmtsInd
Written Policy Ref T And E ExpnssYes (true)WrittenPolicyRefTAndEExpnssInd
Substantiation RequiredYes (true)SubstantiationRequiredInd
Severance PaymentYes (true)SeverancePaymentInd
Supplemental Nonqual Rtr PlanYes (true)SupplementalNonqualRtrPlanInd
Equity Based Comp ArrngmfalseEquityBasedCompArrngmInd
Comp Based On Revenue Of Flng OrgfalseCompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related OrgsfalseCompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng OrgfalseCompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd OrgsfalseCompBsdNetEarnsRltdOrgsInd
Any Non Fixed PaymentsfalseAnyNonFixedPaymentsInd
Initial Contract ExceptionfalseInitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (19 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Filing OrganizationBonusFilingOrganizationAmountBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Filing OrgOtherCompensationFilingOrgAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtComp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmtComp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
Leonard G Feld MD
President/DIRECTOR - Partial Year$0$206,526$0$82,369$0$432,235$0$29,021$0$5,374$0$755,526$0$0
Marcos A Mestre MD
Vice Chairman$267,018$0$354$0$458$0$7,630$0$23,846$0$299,306$0$0$0
Narendra M Kini MD
CEO & Director$0$2,029,253$0$126,713$0$30,345$0$236,948$0$26,514$0$2,449,774$0$0
Michael S Davis
Interim President/Director$0$370,647$0$16,779$0$1,011$0$52,537$0$14,265$0$455,240$0$0
Andrij Susla
SECRETARY/Deputy General Counsel - Partial Year$0$88,068$0$8,134$0$128,766$0$2,734$0$9,269$0$236,972$0$0
Saima Aftab MD
Director$410,836$0$244$0$308$0$7,892$0$22,645$0$441,925$0$0$0
Michael L Harrington
Director$0$423,810$0$38,778$0$28,757$0$78,502$0$8,699$0$578,545$0$0
Alisa Muniz Crim MD
Director$354,904$0$244$0$8$0$8,250$0$9,246$0$372,652$0$0$0
Chad Perlyn MD
Director$692,334$0$354$0$458$0$8,250$0$23,623$0$725,019$0$0$0
Jose Rosa-Olivares MD
Director$291,355$0$90,955$0$698$0$312$0$23,623$0$406,943$0$0$0
Anthony Rossi MD
Director$503,563$0$1,472$0$1,988$0$8,250$0$18,365$0$533,638$0$0$0
Dave Sandeep MD
Director$768,214$0$244$0$18,000$0$8,250$0$11,311$0$806,019$0$0$0
Craig Spurdle MD
Director$641,956$0$529$0$18,222$0$8,250$0$345$0$669,303$0$0$0
Timothy L Birkenstock
Treasurer & CFO$0$737,250$0$126,658$0$115,220$0$62,891$0$19,726$0$1,061,745$0$76,356
Redmond P Burke MD
Chief Cardiovascular Surgeon$1,637,510$0$1,472$0$1,988$0$8,250$0$18,365$0$1,667,585$0$0$0
Kristine Guleserian
Cardiovascular Surgeon$1,166,509$0$529$0$19,198$0$8,250$0$5,825$0$1,200,311$0$0$0
John Ragheb MD
Chief Neurosurgery$784,873$0$129,337$0$19,790$0$8,250$0$23,322$0$965,572$0$0$0
Harry Shufflebarger MD
Orthopedic Attending Physician$1,018,099$0$1,832$0$2,480$0$8,250$0$18,740$0$1,049,402$0$0$0
Michael A Tidwell MD
Chief Orthopedics$747,891$0$1,707$0$15,716$0$8,250$0$15,313$0$788,877$0$0$0

Supplemental Information Detail SupplementalInformationDetail (4 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Schedule J, Part I, Line 3 METHODS USED BY RELATED ORGANIZATION TO ESTABLISH CEO'S COMPENSATIONThe 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 1a Tax indemnification and gross-up paymentsAll of the compensated individuals listed on Part VII received tax gross-up payments during the year. The gross-up payment was treated as taxable compensation to them.
Schedule J, Part I, Line 4a Severance or change-of-control paymentLEONARD G. FELD -$420,933 ANDRIJ B SUSLA - $128,593
Schedule J, Part I, Line 4b Supplemental nonqualified retirement planTHE FOLLOWING CONTRIBUTIONS WERE MADE TO A SECTION 457(F) PLAN DURING THE YEAR - NARENDRA KINI- $228,698 TIMOTHY BIRKENSTOCK - $54.641 LEONARD FELD - $23.818 MICHAEL DAVIS - $44,287 MICHAEL HARRINGTON - $70,252 THE FOLLOWING DISTRIBUTIONS WERE MADE FROM A SECTION 457(F) PLAN DURING THE YEAR - TIMOTHY BIRKENSTOCK - $76,356

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (14 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Form 990, Part III, Line 1 ORGANIZATION'S MISSIONTHE 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.
Form 990, Part III, Line 4a PROGRAM SERVICE DESCRIPTIONOVERALL, THE 2018 PROGRAM ACCOMPLISHMENTS OF PSA PHYSICIANS INCLUDE BEING INTERNATIONALLY RECOGNIZED FOR CARE EXCELLENCE BY BEING RANKED AMONG THE NATION'S BEST IN 3 OF THE ABOVE LISTED SPECIALTIES SURVEYED BY U.S. NEWS AND WORLD REPORT IN ITS 2018-2019 LISTING OF "AMERICA'S BEST CHILDREN'S HOSPITALS." (RESULTS WERE RELEASED IN 2018.) NICKLAUS CHILDREN'S HOSPITAL HAD MORE RANKED PEDIATRIC PROGRAMS THAN ANY OTHER HOSPITAL IN SOUTH FLORIDA. CATEGORIES IN WHICH THE PSA SPECIALTIES WERE RANKED IN 2018 INCLUDE CARDIOLOGY AND HEART SURGERY, NEUROLOGY & NEUROSURGERY, AND ORTHOPEDICS. COLLECTIVELY THE PSA SPECIALISTS GENERATED MORE THAN 583,606 ENCOUNTERS IN 2018 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 DIRECTORTHE 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 AND USED IN ESTABLISHING EXECUTIVE SALARY AND BENEFITS PROGRAMS. THIS PROCESS IS COMPLETED IN THE FIRST QUARTER EACH YEAR. 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.
Form 990, Part VI, Line 15b Determining compensation for other officers or key employeesTHE 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 AND USED IN ESTABLISHING EXECUTIVE SALARY AND BENEFITS PROGRAMS. PEDIATRIC SPECIALISTS OF AMERICA RELIED ON THE METHODS OF ESTABLISHING COMPENSATION USED BY NICKLAUS CHILDREN'S HEALTH SYSTEM.
Form 990, Part VI, Line 1a Delegate broad authority to a committeeThere 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 2 Family/business relationships amongst interested personsNARENDRA KINI, MATTHEW A. LOVE, AND TIMOTHY BIRKENSTOCK - Business relationship
Form 990, Part VI, Line 6 Classes of members or stockholdersTHE 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 bodyTHE 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 stockholdersThe 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 bodyTHE 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 COMMENT. 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.
Form 990, Part VI, Line 12c Conflict of interest policyALL PEDIATRIC SPECIALISTS OF AMERICA ("PSA") 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 PSA 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 PSA'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 publicFINANCIAL 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 FeesSupport Fees - Total Expense: 14310366, Program Service Expense: 11448293, Management and General Expenses: 2862073, Fundraising Expenses: ; Management Fees - Total Expense: 974408, Program Service Expense: 779526, Management and General Expenses: 194882, Fundraising Expenses: ; Miscellaneous - Total Expense: 33750, Program Service Expense: 27000, Management and General Expenses: 6750, Fundraising Expenses: ; Coding Services - Total Expense: 3875924, Program Service Expense: 3100739, Management and General Expenses: 775185, Fundraising Expenses: ; Purchased Services - Total Expense: 4260902, Program Service Expense: 3408722, Management and General Expenses: 852180, Fundraising Expenses: ; Medical fees - Total Expense: 381295, Program Service Expense: 305036, Management and General Expenses: 76259, Fundraising Expenses: ; Casual Labor - Total Expense: 41778, Program Service Expense: 33422, Management and General Expenses: 8356, Fundraising Expenses: ;
Form 990, Part XI, Line 9 Other changes in net assets or fund balancesEquity Transfer with affiliate - 25894188;

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (6 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtPublic Charity StatusPublicCharityStatusTxtBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtControlled OrganizationControlledOrganizationInd
VARIETY CHILDREN'S HOSPITAL
3100 SW 62ND AVENUEMIAMIFL33155590638499HOSPITALFL501(c)(3)3MCHSfalse
MIAMI CHILDREN'S HOSPITAL WORKER'S COMPENSATION TRUST
3100 SW 62ND AVENUEMIAMIFL33155597021572WC CLAIMSFL4947 (a)(1)VCHfalse
VARIETY CHILDREN'S HOSPITAL PROFESSIONAL LIABILITY TRUST
3100 SW 62ND AVENUEMIAMIFL33155592551434LIAB. CLAIMSFL4947 (a)(1)VCHfalse
MIAMI CHILDREN'S HOSPITAL RESEARCH INSTITUTE INC
3100 SW 62ND AVENUEMIAMIFL33155592602318RESEARCHFL501(c)(3)3VCHfalse
MIAMI CHILDREN'S HEALTH SYSTEM INC
3100 SW 62ND AVENUEMIAMIFL33155453481327HEALTHCAREFL501(c)(3)Type IINAfalse
MIAMI CHILDREN'S HEALTH SYSTEM FOUNDATION INC
3100 SW 62ND AVENUEMIAMIFL33155461784918FOUNDATIONFL501(c)(3)7MCHSfalse

Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (3 entries)

Address Line1USAddress/AddressLine1TxtAddress Line2USAddress/AddressLine2TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtPredominant Income TypePredominantIncomeTypeTxt
MIAMI CHILDREN'S HOSPITAL AMBULATORY SURGERY CENTER LLC
800 SW 108TH AVENUESUITE 200MIAMIFL33174463406805AMBULATORY CENTERFLNAN/A
MIAMI HOSPITAL HOLDINGS LLC
11221 ROE AVE SUITE 320LEAWOODKS66211464077635HOLDING COMPANYFLNAN/A
MIAMI CHILDREN'S HEALTH PLAN LLC
3100 SW 62ND AVEMIAMIFL33155823111550INSURANCEFLNAN/A

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (2 entries)

Address Line1ForeignAddress/AddressLine1TxtAddress Line2ForeignAddress/AddressLine2TxtCityForeignAddress/CityNmProvince Or StateForeignAddress/ProvinceOrStateNmCountryForeignAddress/CountryCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile Foreign CountryLegalDomicileForeignCountryCdBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtEntity TypeEntityTypeTxtControlled OrganizationControlledOrganizationIndAddress Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdLegal Domicile StateLegalDomicileStateCd
MIAMI CHILDREN'S INSURANCE CO SPC LTD
720 WEST BAY ROADPO BOX 69GT BUCKINGHAM SQUAREGEORGETOWNGRAND CAYMANCJ980442086INSURANCECJNAC Corporationfalse
CHILDREN'S HEALTH VENTURES INC AND SUBSIDIARIES
454541147MERCHANT WHOLESALENAC Corporationfalse3100 SW 62ND AVENUEMIAMIFL331553009FL
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts RyltsfalseReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth OrgfalseGiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth OrgYes (true)GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth OrgfalseLoansOrGuaranteesFromOthOrgInd
Div Related OrganizationfalseDivRelatedOrganizationInd
Asset Sale To Other OrgfalseAssetSaleToOtherOrgInd
Asset Purchase From Other OrgfalseAssetPurchaseFromOtherOrgInd
Asset ExchangefalseAssetExchangeInd
Rental Of Facilities To Oth OrgfalseRentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth OrgfalseRentalOfFcltsFromOthOrgInd
Perform Of Services For Oth OrgfalsePerformOfServicesForOthOrgInd
Perform Of Services By Other OrgYes (true)PerformOfServicesByOtherOrgInd
Sharing Of FacilitiesYes (true)SharingOfFacilitiesInd
Paid Employees SharingYes (true)PaidEmployeesSharingInd
Reimbursement Paid To Other OrgYes (true)ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other OrgfalseReimbursementPaidByOtherOrgInd
Transfer To Other OrgfalseTransferToOtherOrgInd
Transfer From Other OrgYes (true)TransferFromOtherOrgInd