2023-11-09T14:44:02-07:00 2022-12-31 135565207 KPMG LLP 500 W 5th Street Ste 800 Winston Salem NC 27101 990 2022-01-01 453584225 PEDIATRIC MEDICAL SERVICES OF FLORIDA INC PEDI 9046974100 10140 Centurion Parkway North Jacksonville FL 32256 William Higginbotham II Assistant Treasurer 9046974100 2023-11-13 1 1 Timothy Kearns P02061479 3364337102 2023-11-09 1 11 1 AAL2 2022 2023-04-26 12:10:37Z Martha McGill 10140 Centurion Parkway North Jacksonville FL 32256 30322523 0 X WWW.NEMOURS.ORG X 2011 FL Pediatric Medical Services of Florida Inc (PMSI) mission is to provide services to restore and improve the health of children, with one high standard of quality, regardless of the recipient's financial status. 5 0 252 6 0 0 28071 1322132 26628566 28525978 0 -62033 60289 474413 26716926 30260490 1300 0 0 0 18492834 21282712 0 0 0 14221624 14925576 32715758 36208288 -5998832 -5947798 8372722 8628054 57000976 63204106 -48628254 -54576052 To engage in activities relating to the purposes described in Part I; and to invest in, receive, hold, use and dispose of all property, real or personal, as may be necessary or desirable to carry into effect the aforementioned purposes. Specifically, PMSI is organized and shall at all times be operated exclusively to support and further the mission of its sole member, (The Nemours Foundation, EIN 59-0634433, ("Nemours"), an IRC section 501(c)(3) charitable IRC section 170(b)(1)(A)(iii) health care organization), through the provision of health care to the community. 0 0 34363377 29000391 PMSI was organized as a charitable organization to operate, support, and further the mission of its sole member, The Nemours Foundation. PMSI's mission, similar to that of Nemours, is to provide services to restore and improve the health of children, with one high standard of quality, regardless of the recipient's financial status. PMSI has received recognition as an IRC section 501(c)(3) charitable organization as an IRC section 509(a)(2) public charity. Nemours, PMSI's sole member, has constructed a pediatric hospital in Orlando, the Nemours Children's Hospital, Florida ("NCH-FL"), which is operated as a division of Nemours. Nemours established PMSI in concert with NCH-FL to provide a flexible and responsive organization that facilitates the clinical practices Nemours wishes to foster, in order to promote the welfare of the community through the advancement of pediatric health care. In support of Nemours and NCH-FL, PMSI may engage in activities including, but not limited to patient care, strategic planning, budgeting, reporting, coding, charge entry, billing, collection, practice development, human resources, information technology, and clinical practice redesign activities. 0 0 0 34363377 1 1 0 0 0 0 0 0 0 0 1 0 0 1 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 1 1 0 0 0 1 X 28 0 1 252 1 0 0 0 0 0 0 0 0 0 0 0 0 X 5 0 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 FL X William W Higginbotham II 9046974100 10140 Centurion Parkway North Jacksonville FL 32256 Robert D Bridges PMSI Director and Treasurer 5 42 X X 0 1304834 209863 Rodney A McKendree PMSI Director 1 42 X 0 1167653 179616 Michael J Erhard MD PMSI Director 1 40 X 0 935736 172900 Martha G McGill PMSI President and Board Chair 1 40 X X 0 752177 130089 William W Higginbotham II PMSI Assistant Treasurer 1 47 X 0 467255 99054 Mary B Mehta MD Director 0 40 X 0 490762 55282 Carrie Grant PMSI Director 1 40 X 0 394633 87799 Ray J Hejmanowski CHA Council Member 20 20 X 0 406237 57127 Thomas A Lacy MD Physician 40 0 X 368791 0 38778 John Clore MD Physician 40 0 X 350661 0 41754 Chad E McRae MD Physician 40 0 X 347948 0 41611 Nam Phuong Nguyen MD Physician 40 0 X 336473 0 36764 Janette Magarino-Liriano MD Physician 40 0 X 340653 0 32290 Karen Westberry MD Physician 40 0 X 328431 0 21331 Kelli E Mahan CHA Council Member 40 0 X 0 247085 40252 Caroline E Bissett PMSI Secretary 1 40 X 0 238430 37553 2072957 6404802 1282063 46 1 1 0 0 0 0 0 0 588661 733471 0 1322132 Gross patient revenue 621110 64340399 64340399 0 0 Patient deductions 621110 -34699249 -34699249 0 0 Provision for bad debts 621110 -1285969 -1285969 0 0 Net research grants 900099 120000 120000 0 0 Rental Income from related org 900099 50797 50797 0 0 0 0 0 0 28525978 0 0 0 0 0 62033 0 -62033 -62033 0 0 -62033 0 Specialized Services 900099 357173 357173 0 0 117240 117240 0 0 474413 30260490 29000391 0 -62033 0 0 0 0 0 0 0 0 463363 0 463363 0 0 0 0 0 16916345 15790524 1125821 0 801105 749211 51894 0 2065508 1931709 133799 0 1036391 969256 67135 0 3732423 3732423 0 0 5465 5465 0 0 0 0 0 0 69 69 0 0 0 0 0 0 0 0 85416 85416 0 0 900 900 0 0 6821685 6821663 22 0 121277 121277 0 0 0 0 0 0 2629192 2629055 137 0 121499 121499 0 0 0 0 0 0 36817 34591 2226 0 0 0 0 0 0 0 0 0 730251 729737 514 0 519982 519982 0 0 120600 120600 0 0 36208288 34363377 1844911 0 860094 960980 0 0 0 0 1049202 1631153 0 0 0 0 0 0 0 0 159 0 5972990 4178514 2300400 1794476 0 0 0 0 0 0 139353 123371 4023514 4118074 8372722 8628054 2579622 2599739 0 0 232023 67278 0 0 0 0 0 0 0 0 0 0 54189331 60537089 57000976 63204106 X -48651254 -55203121 23000 627069 -48628254 -54576052 8372722 8628054 X -5947798 0 0 0 0 0 X X 0 1 X 1 0 X 0 0 705240 28071 1322132 2055443 19472308 23209001 21023236 26688855 28883151 119276551 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 19472308 23209001 21728476 26716926 30205283 121331994 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 121331994 3817 3621 -1386 0 0 6052 0 0 0 0 0 0 3817 3621 -1386 0 0 6052 0 0 0 0 0 0 0 0 0 0 117240 117240 19476125 23212622 21727090 26716926 30322523 121455286 0.99898 0.9998 0.00005 0.0002 X Schedule A, Part III, Line 12 PMSI received additional incentive revenue. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 5473193 3811358 1661835 0 493333 367156 126177 0 6464 0 6464 1794476 Operating Leases Asset 3929370 Prepaid Long-Term Leases 154206 Other Assets - Deposits 34498 4118074 Intercompany-Corporate Office 56607719 Operating Lease Liability 3929370 60537089 X Schedule D, Part X, Line 1 PMSI has liabilities due to The Nemours Foundation in the amounts of $56.6 million for intercompany corporate office and $3.9 million for operating leases. These amounts are in support of the charitable purpose of The Nemours Foundation and PMSI in the furtherance of pediatric healthcare. Schedule D, Part X, Line 2 Per the Nemours consolidated audited financial statements footnote 2(q), Nemours, Nemours New Jersey Physician Practice PC (NJPP), PMSI, Delaware Children's Health Network (DCHN), and Cruden Bay Retention Group (CBRRG) are exempt from federal income taxes on related income under Section 501(a) of the Internal Revenue Code as organizations described in Section 501(c)(3), and are also exempt from state income taxes. Dornoch is exempted through 2042 from all local income, profit or capital gains taxes under the Cayman Islands Tax Concessions Law. Management believes that the unrelated business income generated by Nemours is not material to the combined financial statements. X 1 1 X X X X 0 1 0 0 0 0 0 1 0 Robert D Bridges PMSI Director and Treasurer 0 761337 0 241520 0 301977 0 155161 0 54702 0 1514697 0 298413 Rodney A McKendree PMSI Director 0 775922 0 198572 0 193159 0 128069 0 51547 0 1347269 0 190837 Michael J Erhard MD PMSI Director 0 676780 0 176786 0 82170 0 111479 0 61421 0 1108636 0 53420 Martha G McGill PMSI President and Board Chair 0 561743 0 121550 0 68884 0 91886 0 38203 0 882266 0 48847 William W Higginbotham II PMSI Assistant Treasurer 0 349255 0 74191 0 43809 0 43235 0 55819 0 566309 0 35279 Mary B Mehta MD Director 0 427655 0 60160 0 2948 0 0 0 55282 0 546045 0 0 Carrie Grant PMSI Director 0 312986 0 80894 0 753 0 50144 0 37655 0 482432 0 0 Ray J Hejmanowski CHA Council Member 0 318616 0 73688 0 13933 0 0 0 57127 0 463364 0 0 Thomas A Lacy MD Physician 330882 0 33550 0 4359 0 0 0 38778 0 407569 0 0 0 John Clore MD Physician 350391 0 0 0 270 0 0 0 41754 0 392415 0 0 0 Chad E McRae MD Physician 347090 0 0 0 858 0 0 0 41611 0 389559 0 0 0 Nam Phuong Nguyen MD Physician 336120 0 0 0 353 0 0 0 36764 0 373237 0 0 0 Janette Magarino-Liriano MD Physician 340145 0 0 0 508 0 0 0 32290 0 372943 0 0 0 Karen Westberry MD Physician 326892 0 0 0 1539 0 0 0 21331 0 349762 0 0 0 Kelli E Mahan CHA Council Member 0 215277 0 31342 0 466 0 0 0 40252 0 287337 0 0 Caroline E Bissett PMSI Secretary 0 226737 0 11470 0 223 0 0 0 37553 0 275983 0 0 Schedule J, Part I, Line 1a Nemours has established and PMSI has adopted a policy for the reimbursement of travel and related expenses incurred by its employees. All transportation and travel arrangements shall be the most economical under the circumstances. Excursion or coach fares shall be ordered whenever available. Approval shall be required for any other class of travel. Each department has the right to limit travel expenditures based on budgetary restrictions and may limit coverage to certain categories of travel expense. First class travel may occur in situations for Nemours employees wherein other fares are not available or travel is for a long period of time or overseas. Board members also have the option of traveling first class under certain conditions in accordance with Nemours policy. Schedule J, Part I, Line 4 The Nemours Foundation maintained a Supplemental Executive Retirement Plan ("SERP") for a select group of management or highly compensated employees as determined by the Board of Directors. The SERP was adopted in order to provide certain key employees with non-qualified deferred compensation benefits subject to IRC section 457(f) in recognition of the services they provide. The Nemours Foundation makes discretionary contributions to the plan and may amend or terminate the plan at any time. Participants receiving distributions in 2022 include: Robert Bridges (298,413), Rodney A McKendree (190,837), Michael Erhard MD (53,420), Martha McGill (48,847) and William W Higginbotham II (35,279). Schedule J, Part I, Line 7 Certain employees of Nemours and PMSI are eligible for incentive compensation. This compensation is based on qualitative and quantitative organizational goals and the achievement of such goals by its divisions and individuals. Form 990, Part V, Line 2a PMSI payroll and withholding is prepared by Nemours Foundation (EIN: 59-0634433). Nemours Foundation also files information and withholding forms on behalf of PMSI. Form 990, Part VI, Section A, Line 2 Mr. Bridges, Ms. Bissett, Ms. McGill, Mr. Higginbotham, Dr. Erhard, Mr. McKendree, Mr. Hejmanowski, Ms. Grant and Ms. Mahan have a shared business relationship. All are employees of The Nemours Foundation (Nemours). Form 990, Part VI, Section A, Line 6 The sole member of PMSI is The Nemours Foundation (Nemours), which is recognized as an IRC section 501(c)(3) charity as a hospital under IRC section170(b)(1)(A)(iii). The PMSI board of directors has full governance over the activities of PMSI. However, Nemours has the power to elect the PMSI Board of Directors based on a slate of candidates proposed by the Nominating and Governance Committee of PMSI. Additionally, Nemours reserves the specific rights as sole member such as establishment of the organization's purpose; approval of any amendment to or repeal of the Articles of Incorporation or Bylaws; approval of annual operating and capital budgets; approval of capital expenditures over a specified threshold; approval or execution of any debt instrument, note, pledge, mortgage, encumbrance, execution of any contract involving the preceding; and other selected powers. Form 990, Part VI, Section A, Line 7a See explanation under Form 990, Part VI, Section A, Line 6. Form 990, Part VI, Section A, Line 7b See explanation under Form 990, Part VI, Section A, Line 6. Form 990, Part VI, Section B, Line 11b Management reviewed a draft of the Form 990 prior to filing. Upon finalization of the return, management provided a final copy of the return, via e-mail, to the Board of Directors prior to filing with the IRS. Form 990, Part VI, Section B, Line 12c PMSI has established a conflict of interest policy which has been reviewed and approved by the Board of Directors. PMSI's policy is consistent with that of its sole member, The Nemours Foundation (Nemours). Nemours is committed to the belief that sound business practices start with an absolute commitment from each employee to act ethically in carrying out Nemours business, and to comply with the laws and regulations that impact its business, thus Nemours employees must avoid participating in activities that create or appear to create a conflict of interest. Nemours has specifically identified the following areas in its policy to be potential conflicts of interest: financial interest, outside employment, paid faculty arrangements, consultant or research contracts, acceptance of gifts, gratuities, business courtesies, travel, lodging and entertainment, misuse of resources or assets, personal gain using undue influence, direct dealings with vendors, use of confidential information, and an individual's support of political causes. Nemours policy requires certain individuals to disclose participation in activities or circumstances that may present a conflict of interest on an annual basis or if at any time such individual becomes aware of circumstances that may present a conflict of interest. These disclosures are reviewed by the Nemours' Finance, Audit, and Compliance Committee, as necessary. Form 990, Part VI, Section B, Line 15 PMSI's Board of Directors is committed to establishing compensation practices which are reasonable and do not violate the private inurement prohibition. The practices and processes are designed to avoid any claim for intermediate sanctions and to satisfy the requirements to obtain the rebuttable presumption. PMSI will annually review outside, independent data to establish the compensation of our officers and key employees. Form 990, Part VI, Section C, Line 19 PMSI's governing documents and conflict of interest policy are included in PMSI's Form 1023, which is available for public disclosure. Form 990, Part XI, Line 10 PMSI's purpose is to provide pediatric care to the community. As part of the Nemours Foundation pediatric health care system, PMSI follows Nemours' charity care policy. Accordingly, the cost to provide such care exceeds the revenues earned by PMSI. Nemours demonstrates its commitment to the community through funding PMSI's deficits. Form 990, Part XII, Line 2c Pediatric Medical Services of Florida, Inc. is consolidated in The Nemours Foundation (Nemours) audited financial statements. The Nemours Finance, Audit and Compliance Committee is responsible for the selection of the independent auditors and has oversight of the audit. Children's Health Alliance 9145 Narcoossee Road Orlando FL 32827 453584282 Health Care FL -5947798 8628054 Pediatric Medical Services of Florida Inc The Nemours Foundation 10140 Centurion Parkway North Jacksonville FL 32256 590634433 Health Care FL 501(c)(3) 170(b)(1)(A)(iii) N/A 0 Cruden Bay Risk Retention Group Inc 135 Allen Brook Road Suite 101 Williston VT 05495 270057453 Risk Retention VT 501(c)(3) 509(a)(3) - Type 1 The Nemours Foundation 0 Nemours New Jersey Physician Practice 1801 Rockland Road Wilmington DE 19803 463160718 Health Care NJ 501(c)(3) 509(a)(2) The Nemours Foundation 0 Alfred I duPont Charitable Trust 510 Alfred dupont Place Jacksonville FL 32202 590226560 Charitable Trust FL 501(c)(3) 509(a)(3) N/A 0 Dornoch Sutherland Assurance LTD PO Box 1085 Grand Cayman CJ KY1-1102 980404800 Captive Insurance CJ The Nemours Foundation C 0 0 0 0 0 0 0 0 0 0 1 1 0 0 1 1 1 0 1 1 The return is being filed on a timely basis. The organization filed extensions on a timely basis. Accordingly, the return was properly extended and is now being filed timely by its extended due date of November 15, 2023.