Attach to Form 990 or Form 990-EZ.
Go to
www.irs.gov/Form990 for instructions and the latest information.
| (i) Name of supported organization | (ii) EIN | (iii) Type of organization (described on lines 1- 10 above (see instructions)) | (iv) Is the organization listed in your governing document? | (v) Amount of monetary support (see instructions) | (vi) Amount of other support (see instructions) | |
|---|---|---|---|---|---|---|
| Yes | No | |||||
|
Total |
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Calendar year (or fiscal year beginning in) ![]() |
(a) 2016 | (b) 2017 | (c) 2018 | (d) 2019 | (e) 2020 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") .. | ||||||
| 2 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.... | ||||||
| 3 | The value of services or facilities furnished by a governmental unit to the organization without charge.. | ||||||
| 4 | Total. Add lines 1 through 3 | ||||||
| 5 | The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f).. | ||||||
| 6 | Public support. Subtract line 5 from line 4. | ||||||
Calendar year
(or fiscal year beginning in) ![]() |
(a) 2016 | (b) 2017 | (c) 2018 | (d) 2019 | (e) 2020 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | ||||||
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources... | ||||||
| 9 | Net income from unrelated business activities, whether or not the business is regularly carried on.. | ||||||
| 10 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.).. | ||||||
| 11 | Total support. Add lines 7 through 10 | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2016 | (b) 2017 | (c) 2018 | (d) 2019 | (e) 2020 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") . | ||||||
| 2 | Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose | ||||||
| 3 | Gross receipts from activities that are not an unrelated trade or business under section 513 ..... | ||||||
| 4 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf... | ||||||
| 5 | The value of services or facilities furnished by a governmental unit to the organization without charge | ||||||
| 6 | Total. Add lines 1 through 5 | ||||||
| 7a | Amounts included on lines 1, 2, and 3 received from disqualified persons | ||||||
| b | Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year. | ||||||
| c | Add lines 7a and 7b.. | ||||||
| 8 | Public support. (Subtract line 7c from line 6.) | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2016 | (b) 2017 | (c) 2018 | (d) 2019 | (e) 2020 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | ||||||
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | ||||||
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | ||||||
| c | Add lines 10a and 10b. | ||||||
| 11 | Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on. | ||||||
| 12 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) .. | ||||||
| 13 | Total support. (Add lines 9, 10c, 11, and 12.).. | ||||||
| Section A - Adjusted Net Income | (A) Prior Year |
(B) Current Year (optional) |
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| 1 | Net short-term capital gain | 1 | ||||
| 2 | Recoveries of prior-year distributions | 2 | ||||
| 3 | Other gross income (see instructions) | 3 | ||||
| 4 | Add lines 1 through 3 | 4 | ||||
| 5 | Depreciation and depletion | 5 | ||||
| 6 | Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) | 6 | ||||
| 7 | Other expenses (see instructions) | 7 | ||||
| 8 | Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) | 8 | ||||
| Section B - Minimum Asset Amount | (A) Prior Year |
(B) Current Year (optional) |
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| 1 | Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year): | 1 | ||||
| a | Average monthly value of securities | 1a | ||||
| b | Average monthly cash balances | 1b | ||||
| c | Fair market value of other non-exempt-use assets | 1c | ||||
| d | Total (add lines 1a, 1b, and 1c) | 1d | ||||
| e |
Discount claimed for blockage or other factors (explain in detail in Part VI): |
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| 2 | Acquisition indebtedness applicable to non-exempt use assets | 2 | ||||
| 3 | Subtract line 2 from line 1d | 3 | ||||
| 4 | Cash deemed held for exempt use. Enter 0.015 of line 3 (for greater amount, see instructions). | 4 | ||||
| 5 | Net value of non-exempt-use assets (subtract line 4 from line 3) | 5 | ||||
| 6 | Multiply line 5 by 0.035 | 6 | ||||
| 7 | Recoveries of prior-year distributions | 7 | ||||
| 8 | Minimum Asset Amount (add line 7 to line 6) | 8 | ||||
| Section C - Distributable Amount | Current Year | |||||
| 1 | Adjusted net income for prior year (from Section A, line 8, Column A) | 1 | ||||
| 2 | Enter 85% of line 1 | 2 | ||||
| 3 | Minimum asset amount for prior year (from Section B, line 8, Column A) | 3 | ||||
| 4 | Enter greater of line 2 or line 3 | 4 | ||||
| 5 | Income tax imposed in prior year | 5 | ||||
| 6 | Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions) | 6 | ||||
| Section D - Distributions | Current Year | |
|---|---|---|
| 1 Amounts paid to supported organizations to accomplish exempt purposes | 1 | |
|
2
Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity |
2 | |
| 3 Administrative expenses paid to accomplish exempt purposes of supported organizations | 3 | |
| 4 Amounts paid to acquire exempt-use assets | 4 | |
| 5 Qualified set-aside amounts (prior IRS approval required - provide details in Part VI) | 5 | |
| 6 Other distributions (describe in Part VI). See instructions | 6 | |
| 7Total annual distributions. Add lines 1 through 6. | 7 | |
|
8
Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions |
8 | |
| 9 Distributable amount for 2020 from Section C, line 6 | 9 | |
| 10 Line 8 amount divided by Line 9 amount | 10 | |
| Section E - Distribution Allocations (see instructions) |
(i) Excess Distributions |
(ii) Underdistributions Pre-2020 |
(iii) Distributable Amount for 2020 |
|
|---|---|---|---|---|
| 1 Distributable amount for 2020 from Section C, line 6 | ||||
|
2
Underdistributions, if any, for years prior to 2019 (reasonable cause required-- explain in Part VI). See instructions. |
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| 3 Excess distributions carryover, if any, to 2020: | ||||
| a From 2015....... | ||||
| b From 2016....... | ||||
| c From 2017....... | ||||
| d From 2018....... | ||||
| e From 2019....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2020 distributable amount | ||||
|
i
Carryover from 2015 not applied (see instructions) |
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| j Remainder. Subtract lines 3g, 3h, and 3i from line 3f. | ||||
| 4Distributions for 2020 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2020 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from line 4. | ||||
|
5
Remaining underdistributions for years prior to 2020, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions. |
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|
6
Remaining underdistributions for 2020. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions. |
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|
7 Excess distributions carryover to 2021. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a Excess from 2016..... | ||||
| b Excess from 2017..... | ||||
| c Excess from 2018..... | ||||
| d Excess from 2019..... | ||||
| e Excess from 2020..... | ||||
| Facts And Circumstances Test |
|---|
| Return Reference | Explanation |
|---|
| Software ID: | 20011424 |
| Software Version: | 2020v4.0 |
Attach to Form 990 or 990-EZ.
Go to www.irs.gov/Form990 for the latest information.
| Return Reference | Explanation |
|---|---|
| Form 990, Part III, Line 4a CONTINUED PROGRAM DESCRIPTION | (CONTINUED FROM PART III) IN IN 2020, 4,359 PATIENTS WERE TRANSFERRED FROM HOSPITALS THROUGHOUT FLORIDA, CENTRAL AND SOUTH AMERICA AND THE CARIBBEAN. WHEN CHILDREN NEED THE SERVICES OF A SPECIALIST, IT IS IMPORTANT THAT SUCH SERVICES BE PROVIDED BY A PRACTITIONER WITH SPECIFIC TRAINING AND EXPERTISE IN PEDIATRIC CARE. THE CARE OF CHILDREN WITH CERTAIN COMPLEX CHRONIC CONDITIONS, SUCH AS JUVENILE DIABETES, CANCER, OR CYSTIC FIBROSIS IS BEST MANAGED BY A PEDIATRIC SPECIALIST IN ORDER TO ELIMINATE REFERRAL DELAYS AND EXPEDITE POSITIVE TREATMENT. CHILDREN ARE MORE VULNERABLE TO COMPLICATIONS DUE TO DELAYS THAN ADULTS. THEY DEVELOP SERIOUS COMPLICATIONS MORE RAPIDLY THAN ADULTS BECAUSE THEY HAVE LESS PHYSIOLOGICAL RESERVES AND LESS DEVELOPED ORGAN SYSTEMS. IN 2020 THE HOSPITAL HAD APPROXIMATELY 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, 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.THIS CRITICAL MASS OF PHYSICIANS SIGNIFICANTLY CONTRIBUTES TO THE QUALITY AND RANGE OF PEDIATRIC SERVICES AVAILABLE AT THE HOSPITAL. 2020 STATISTICAL DATA INCLUDES TOTAL INPATIENT DAYS: 56,720 TOTAL INPATIENT ADMISSIONS: 8,170 INPATIENT AVERAGE DAILY CENSUS: 154.97 TOTAL OUTPATIENT VISITS (MAIN CAMPUS): 151,059 TOTAL OUTPATIENT VISITS (AMBULATORY CENTERS): 191,357 TOTAL AMBULATORY URGENT CARE VISITS: 92,548 TOTAL SURGICAL CASES: 8,498 AVERAGE LENGTH OF STAY: 7.04 DAYS THE HOSPITAL IS INTERNATIONALLY RECOGNIZED FOR CARE EXCELLENCE. NICKLAUS CHILDREN'S HOSPITAL PROGRAMS WERE RANKED AMONG THE NATION'S BEST IN FIVEPEDIATRIC SUB-SPECIALTY PROGRAMS SURVEYED BY U.S. NEWS AND WORLD REPORT IN ITS 2020-21 LISTING OF "AMERICA'S BEST CHILDREN'S HOSPITALS." THE HOSPITAL HAD MORE RANKED PEDIATRIC PROGRAMS THAN ANY OTHER HOSPITAL IN FLORIDA ensuring the hospital continued status as the region's pediatric specialty care leader. In 2020 Seven Nicklaus Children's Hospital specialty programs are again identified among the best in the nation, according to U.S. News & World Report's 2020-21 "Best Children's Hospitals" rankings, posted online today. Nicklaus Children's has more ranked pediatric programs than any other hospital in Florida. Nicklaus Children's 2020-21 rankings are as follows: Cardiology & Heart Surgery, Diabetes & endocrinology Neonatology, Neurology & Neurosurgery Orthopedics and Pulmonology. Nicklaus Children's Hospital completed the ISO 9001 Quality Management System certification by DNV GL. Nicklaus Children's is the second freestanding children's hospital in the nation to obtain this certification. Since the hospital's initial DNV GL accreditation in 2016, Nicklaus Children's and its network of outpatient centers have participated in annual accreditation site visit evaluations to ensure steady progression toward ISO 9001 certification. ISO 9001 sets forth criteria for quality management that include a strong customer focus, engagement of top management, a process approach and continual improvement. The ultimate impact of ISO within hospitals is the reduction or elimination of variation, so that critical work processes are done consistently and the "best ideas" aren't by one person or department, but are ingrained in the organization itself. COMMUNITY TRAINING OUTREACH PROGRAMS: IN ADDITION, THE HOSPITAL SUPPORTS A NUMBER OF PROGRAMS THAT ENHANCE THE SKILLS AND WORK READINESS OF YOUNG PEOPLE AS WELL AS PROMOTE HEALTH AWARENESS. PROJECT VICTORY: THIS PROJECT IS A COOPERATIVE EFFORT BETWEEN NICKLAUS CHILDREN'S COMMUNITY AND VOLUNTEER RESOURCE PROGRAM AND THE COMMUNITY. TEENS WITH DISABILITIES ARE GIVEN THE OPPORTUNITY TO GAIN LIFE SKILLS THROUGH THE WORLD OF WORK. TWENTY STUDENTS ARE PROVIDED THREE HOURS OF WORK SERVICE PER DAY AT THE HOSPITAL DURING THE COURSE OF THE SCHOOL YEAR. THE STUDENTS GAIN VOCATIONAL EXPERIENCE WORKING IN THE HOSPITAL'S DIETARY DEPARTMENT, MAIL ROOM, VISITOR INFORMATION SERVICE AND OTHER DEPARTMENTS. HONORS AND EXECUTIVE INTERNSHIP PROGRAM, MIAMI DADE COUNTY PUBLIC SCHOOLS EACH YEAR, MEDICAL STUDENTS AND SCHOLARS FROM ALL PARTS OF THE UNITED STATES AND AROUND THE WORLD APPLY FOR ACCEPTANCE TO THE HOSPITAL'S PEDIATRIC RESIDENCY TRAINING PROGRAM, WHICH HAS BEEN IN OPERATION FOR OVER 50 YEARS. THE PEDIATRIC RESIDENCY PROGRAM IS AFFILIATED WITH THE FLORIDA INTERNATIONAL UNIVERSITY (FIU) HEBERT WERTHEIM COLLEGE OF MEDICINE. THE PROGRAM'S ACADEMIC ACCOMPLISHMENTS INCLUDE EXCELLENT BOARD EXAM PASS RATES, FELLOWSHIP MATCHES AT TOP SUB-SPECIALTY PROGRAMS ACROSS THE NATION, AND RESEARCH PRESENTATIONS AT WELL-ESTABLISHED REGIONAL/NATIONAL PEDIATRIC AND PEDIATRIC SUB-SPECIALTY MEETINGS AND CONFERENCES. |
| Form 990, Part III, Line 4a CONTINUED PROGRAM DESCRIPTION | KIDS AND THE POWER OF WORK (KAPOW): THIS PROGRAM IS A NATIONAL VOLUNTEER PROGRAM. THE HEALTH SYSTEM PARTICIPATES WITH MIAMI-DADE COUNTY PUBLIC SCHOOLS. HEALTH SYSTEM STAFF MEMBERS VOLUNTEER TO VISIT STUDENTS AT ONE OF TWO AREA PUBLIC ELEMENTARY SCHOOLS. THEY PRESENT AND PREPARE LESSONS FOR SECOND GRADE STUDENTS TO HELP CREATE A FOUNDATION FOR YOUNG STUDENTS, INTRODUCING THEM TO WORK AND RELATED CONCEPTS. EMPLOYEES DONATE ABOUT 200 HOURS OF TIME TO THE PROGRAM. |
| Form 990, Part VI, Line 15a Process for determininig compensation for the organization's CEO | 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, 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 15b Process for determining compensation for other officers or key employees | NCH RELIED ON THE METHODS OF ESTABLISHING COMPENSATION USED BY Nicklaus CHILDREN'S HEALTH SYSTEM, INC. 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 | Matthew Love, Mario Murgado, 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 | The Executive Committee of the Board of Directors is composed of three (3) Directors elected by the Board of Directors, one of whom must be the Chair of the Board. No non-Director members shall serve on the Executive Committee. A majority of the members of the Executive Committee present and voting shall constitute a quorum for the transaction of business. The Executive Committee shall have and exercise the authority of 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 at any regular or special meeting of the Board of Directors. |
| 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 Hospital shall be established by resolution of the Board of Directors of the sole member; provided that there shall be no fewer than 7 and no more than 20 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 hospital, or materially change the location, size or scope of services, programs, operations or educational or medical school affiliations of the hospital or related agreements; b) Create any entity in which the hospital is the sole member or sole shareholder, or any entity in which the hospital 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 NICKLAUS CHILDREN'S HOSPITAL'S PROCESS FOR PROVIDING ITS 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 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 THE HOSPITAL IS A CHARITABLE ORGANIZATION AND THAT IN ORDER TO MAINTAIN ITS FEDERAL EXEMPTION IT MUST ENGAGE PRIMARILY IN ACTIVITIES WHICH ACCOMPLISH ONE OR MORE OF IT'S TAX-EXEMPT PURPOSES. A PROCESS IS IN PLACE FOR MANAGING SITUATIONS IN WHICH IT IS DISCOVERED THAT AN INDIVIDUAL WHO IS COVERED BY THE HOSPITAL'S CONFLICT OF INTEREST POLICY FAILED TO PROPERLY DISCLOSE A POTENTIAL CONFLICT OF INTEREST. |
| Form 990, Part VI, Line 19 Required documents available to the public | Financial statements, governing documents, and conflict of interest policies are not required disclosures pursuant to Internal Revenue Code (IRC) Section 6104. These documents are not available to the public at this time. |
| Form 990, Part VIII, Line 11d Other Miscellaneous Revenue | Cafeteria Vending - Total Revenue: 2289932, Related or Exempt Function Revenue: , Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: 2289932; OTHER REVENUE - Total Revenue: 236273, Related or Exempt Function Revenue: , Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: 236273; LAB REVENUES - Total Revenue: 117717, Related or Exempt Function Revenue: , Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: 117717; |
| Form 990, Part IX, Line 11g Other Fees | FEES PHYSICIANS - Total Expense: 6663106, Program Service Expense: 5221499, Management and General Expenses: 1441607, Fundraising Expenses: ; PURCHASED SERVICES - Total Expense: 8779141, Program Service Expense: 7023313, Management and General Expenses: 1755828, Fundraising Expenses: ; STORAGE FEES - Total Expense: 526588, Program Service Expense: 421270, Management and General Expenses: 105318, Fundraising Expenses: ; LABORATORY FEES - Total Expense: 4331062, Program Service Expense: 3464850, Management and General Expenses: 866212, Fundraising Expenses: ; CONSULTANTS - Total Expense: 1143972, Program Service Expense: 915178, Management and General Expenses: 228794, Fundraising Expenses: ; TRANSCRIPTION SERVICES - Total Expense: 28577, Program Service Expense: 22862, Management and General Expenses: 5715, Fundraising Expenses: ; COLLECTION SERVICES - Total Expense: 245029, Program Service Expense: 196023, Management and General Expenses: 49006, Fundraising Expenses: ; MANAGEMENT FEE EXPENSE - Total Expense: XXX-XX-XXXX, Program Service Expense: 93335330, Management and General Expenses: 23333833, Fundraising Expenses: ; CASUAL LABOR - Total Expense: 1985756, Program Service Expense: 1588605, Management and General Expenses: 397151, Fundraising Expenses: ; |
| Form 990, Part XI, Line 9 Other changes in net assets or fund balances | Net payments on swap agreements - -4604907; Gain from subsidiaries - 5836362; Loss on net change in fair value of swap agreements - -9510281; Change in value of charitable remainder trusts held by others - 108186; Change in beneficial interest in NCHF - 7049477; Transfer to Affiliate - -21409495; Distribution to noncontrolling interest - -209060; |
| Software ID: | 20011424 |
| Software Version: | 2020v4.0 |