SCHEDULE H
(Form 990)
Department of the Treasury
Internal Revenue Service
Hospitals
MediumBullet Complete if the organization answered "Yes" on Form 990, Part IV, question 20.
MediumBullet Attach to Form 990.
MediumBullet Go to www.irs.gov/form990 for instructions and the latest informtion.
OMB No. 1545-0047
2017
Open to Public Inspection
Name of the organization
Variety Children's Hospital
 
Employer identification number

59-0638499
Part I
Financial Assistance and Certain Other Community Benefits at Cost
Yes
No
1a
Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a . . . .
1a
Yes
 
b
If "Yes," was it a written policy? ......................
1b
Yes
 
2
If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.
3
Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.
a
Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?
If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:
3a
Yes
 
%
b
Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate
which of the following was the family income limit for eligibility for discounted care: . . . . . . . .
3b
 
No
%
c
If the organization used factors other than FPG in determining eligibility, describe in Part VI the criteria used for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.
4
Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? . . . . . . . . . . . . .

4

Yes

 
5a
Did the organization budget amounts for free or discounted care provided under its financial assistance policy during
the tax year? . . . . . . . . . . . . . . . . . . . . . . .

5a

Yes

 
b
If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? . . . . . .
5b
 
No
c
If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? . . . . . . . . . . . . .
5c
 
 
6a
Did the organization prepare a community benefit report during the tax year? . . . . . . . . .
6a
Yes
 
b
If "Yes," did the organization make it available to the public? . . . . . . . . . . . . .
6b
Yes
 
Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.
7
Financial Assistance and Certain Other Community Benefits at Cost
Financial Assistance and
Means-Tested
Government Programs
(a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community benefit expense (d) Direct offsetting revenue (e) Net community benefit expense (f) Percent of total expense
a Financial Assistance at cost
(from Worksheet 1) . . .
    264,021   264,021 0.05 %
b Medicaid (from Worksheet 3, column a) . . . . .     362,526,039 300,119,909 62,406,130 11.66 %
c Costs of other means-tested government programs (from Worksheet 3, column b) . .     4,195,393 3,331,844 863,549 0.16 %
d Total Financial Assistance and Means-Tested Government Programs . . . . . 0 0 366,985,453 303,451,753 63,533,700 11.87 %
Other Benefits
e Community health improvement services and community benefit operations (from Worksheet 4).     2,000,292 131,385 1,868,907 0.35 %
f Health professions education (from Worksheet 5) . . .     11,366,027 8,683,013 2,683,014 0.50 %
g Subsidized health services (from Worksheet 6) . . . .         0 0 %
h Research (from Worksheet 7) .     780,931 192,445 588,486 0.11 %
i Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .         0 0 %
j Total. Other Benefits . . 0 0 14,147,250 9,006,843 5,140,407 0.96 %
k Total. Add lines 7d and 7j . 0 0 381,132,703 312,458,596 68,674,107 12.83 %
For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2017
Schedule H (Form 990) 2017
Page
Part II
Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.
(a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community building expense (d) Direct offsetting
revenue
(e) Net community building expense (f) Percent of total expense
1 Physical improvements and housing         0 0 %
2 Economic development         0 0 %
3 Community support         0 0 %
4 Environmental improvements         0 0 %
5 Leadership development and
training for community members
        0 0 %
6 Coalition building         0 0 %
7 Community health improvement advocacy         0 0 %
8 Workforce development         0 0 %
9 Other         0 0 %
10 Total 0 0 0 0 0 0 %
Part III
Bad Debt, Medicare, & Collection Practices
Section A. Bad Debt Expense
Yes
No
1
Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................
1
Yes
 
2
Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......
2
13,337,683
3
Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......
3
0
4
Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.
Section B. Medicare
5
Enter total revenue received from Medicare (including DSH and IME).....
5
612,356
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
1,276,930
7
Subtract line 6 from line 5. This is the surplus (or shortfall)........
7
-664,574
8
Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:
Section C. Collection Practices
9a
Did the organization have a written debt collection policy during the tax year? ..........
9a
Yes
 
b
If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year
contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI .........................

9b

Yes

 
Part IV
Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)
(a) Name of entity (b) Description of primary
activity of entity
(c) Organization's
profit % or stock
ownership %
(d) Officers, directors,
trustees, or key
employees' profit %
or stock ownership %
(e) Physicians'
profit % or stock
ownership %
1MIAMI CHILDREN'S HOSPITAL AMBULATORY SURGERY CENTER LLC
 
SURGERY CENTER 53 % 0 % 47 %
2
3
4
5
6
7
8
9
10
11
12
13
Schedule H (Form 990) 2017
Schedule H (Form 990) 2017
Page
Part VFacility Information
Section A. Hospital Facilities
(list in order of size from largest to smallest—see instructions)How many hospital facilities did the organization operate during the tax year?1Name, address, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility)
Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital ResearchGrp Facility ER-24Hours ER-Other Other (describe) Facility reporting group
1 NICKLAUS Children's Hospital
3100 SW 62nd Avenue
Miami,FL33155
WWW.NICKLAUSCHILDRENS.ORG
4067
X   X X   X X      
Schedule H (Form 990) 2017
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Schedule H (Form 990) 2017
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Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)
NICKLAUS Children's Hospital
Name of hospital facility or letter of facility reporting group  
Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A):
1
Yes No
Community Health Needs Assessment
1 Was the hospital facility first licensed, registered, or similarly recognized by a state as a hospital facility in the current tax year or the immediately preceding tax year?........................ 1   No
2 Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C............... 2   No
3 During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 12...................... 3 Yes  
If "Yes," indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
4 Indicate the tax year the hospital facility last conducted a CHNA: 20 15
5 In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted ................. 5 Yes  
6 a Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C.................................. 6a   No
b Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................ 6b   No
7 Did the hospital facility make its CHNA report widely available to the public?.............. 7 Yes  
If "Yes," indicate how the CHNA report was made widely available (check all that apply):
a
b
c
d
8 Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. ..............
8 Yes  
9 Indicate the tax year the hospital facility last adopted an implementation strategy: 20 15
10 Is the hospital facility's most recently adopted implementation strategy posted on a website?......... 10 Yes  
a If "Yes" (list url): https://www.nicklauschildrens.org/news-and-events/publications/community-health-needs-assessment
b If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ...... 10b    
11 Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.
12a Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)?............................... 12a   No
b If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........ 12b    
c If "Yes" on line 12b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $  

Schedule H (Form 990) 2017
Page 5
Schedule H (Form 990) 2017
Page 5
Part VFacility Information (continued)

Financial Assistance Policy (FAP)
NICKLAUS Children's Hospital
Name of hospital facility or letter of facility reporting group  
Yes No
Did the hospital facility have in place during the tax year a written financial assistance policy that:
13 Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care? 13 Yes  
If “Yes,” indicate the eligibility criteria explained in the FAP:
a
b
c
d
e
f
g
h
14 Explained the basis for calculating amounts charged to patients?................. 14 Yes  
15 Explained the method for applying for financial assistance?................... 15 Yes  
If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):
a
b
c
d
e
16 Was widely publicized within the community served by the hospital facility?........ 16 Yes  
If "Yes," indicate how the hospital facility publicized the policy (check all that apply):
a
See Part VI
b
See Part VI
c
d
e
f
g
h
i
j
Schedule H (Form 990) 2017
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Schedule H (Form 990) 2017
Page 6
Part VFacility Information (continued)

Billing and Collections
NICKLAUS Children's Hospital
Name of hospital facility or letter of facility reporting group  
Yes No
17 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained all of the actions the hospital facility or other authorized party may take upon nonpayment?.................................. 17 Yes  
18 Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:
a
b
c
d
e
f
19 Did the hospital facility or other authorized party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?............ 19   No
If "Yes," check all actions in which the hospital facility or a third party engaged:
a
b
c
d
e
20 Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 19. (check all that apply):
a
b
c
d
e
f
Policy Relating to Emergency Medical Care
21 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.................. 21 Yes  
If "No," indicate why:
a
b
c
d
Schedule H (Form 990) 2017
Page 7
Schedule H (Form 990) 2017
Page 7
Part VFacility Information (continued)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)
NICKLAUS Children's Hospital
Name of hospital facility or letter of facility reporting group  
Yes No
22 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a
b
c
d
23 During the tax year, did the hospital facility charge any FAP-eligible individual to whom the hospital facility provided emergency or other medically necessary services more than the amounts generally billed to individuals who had insurance covering such care? ............................... 23   No
If "Yes," explain in Section C.
24 During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ........................... 24   No
If "Yes," explain in Section C.
Schedule H (Form 990) 2017
Page 8
Schedule H (Form 990) 2017
Page 8
Part V
Facility Information (continued)
Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16j, 18e, 19e, 20e, 21c, 21d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference Explanation
Schedule H, Part V, Section B, Line 5 Facility , 1 Facility , 1 - NIcklaus Children's Hospital. Focus Group: External and Internal This assessment was conducted by Professional Research Consultants, Inc. (PRC) on behalf of Nicklaus Children's Hospital (renamed in March 2015, and the flagship for Nicklaus Children's Health System). PRC is a nationally-recognized healthcare consulting firm with extensive experience conducting Community Health Needs Assessments in hundreds of communities across the United States since 1994. This assessment incorporates data from both quantitative and qualitative sources. Quantitative data input includes primary research (the 2015 PRC Child & Adolescent Health Survey) and secondary research (vital statistics and other existing health-related data); these quantitative components allow for comparison to benchmark data at the state and national levels. Qualitative data input includes primary research gathered through an Online Key Informant Survey. A precise and carefully executed methodology is critical in asserting the validity of the results gathered in the PRC Child & Adolescent Survey. Thus, to ensure the best representation of the population surveyed, a telephone interview methodology - one that incorporates both landline and cell phone interviews - was employed. The primary advantages of telephone interviewing are timeliness, efficiency and random-selection capabilities. In addition, these telephone interviews were supplemented with surveys among families in the total service area requested to participate in the study via a questionnaire completed online. The sample design used for this effort consisted of a stratified random sample of 1,057 parents of children under 18 in the Nicklaus Children's Hospital Service Area. By geography, a total of 412 surveys were conducted in Miami-Dade County, 349 in Broward County and 296 in Palm Beach County. Once the interviews were completed, these were weighted in proportion to the actual child population distribution so as to appropriately represent the Nicklaus Children's Hospital Service Area as a whole. All administration of the surveys, data collection and data analysis was conducted by Professional Research Consultants, Inc. (PRC). To solicit input from key informants, those individuals who have a broad interest in the health of the community, an Online Key Informant Survey was also implemented as part of this process. A list of recommended participants was provided by the sponsors of this study; this list included names and contact information for physicians, public health representatives, other health professionals, social service providers, and a variety of other community leaders. Potential participants were chosen because of their ability to identify primary concerns among the families and children/adolescents with whom they work, as well as of the community overall. Key informants were contacted by email, introducing the purpose of the survey and providing a link to take the survey online; reminder emails were sent as needed to increase participation. In all, 144 community stakeholders took part in the Online Key Informant Survey. Final participation included representatives of the organizations outlined below. Alvis, PA Banyan Health Systems Baptist Children's Hospital Borinquen Medical Centers Catholic Hospice Citrus Health Network City of Hialeah Fire Department City of Miami Fire Rescue Collier County Public Schools Department of Pathology and Clinical Lab, Nicklaus Children's Hospital El Sol Jupiter Neighborhood Resource Center Florida Blue Florida International University Florida International University- School of Social Work Florida Poison Information Center - Miami Golisano Children's Hospital of Southwest Florida Group Pediatric Office Handal-Saca Pediatrics Jehovah's Witnesses Jessie Trice Community Health Center Jorge Mas Canosa Middle School Kids Quality Therapy Live Like Bella Childhood Cancer Foundation March of Dimes Miami Beach Community Health Center (MBCHC) Miami Children's Health System Miami Dade Miami Dade College Miami-Dade Fire Rescue Monroe County School District Neuro Network Partners (NNP) Nicklaus Children's Hospital Nicklaus Children's Dan Marino Outpatient Center Nicklaus Children's Doral Outpatient Center Nora Daniel Nova Southeastern University Palm Beach State College Center for Early Learning Pediatric Associates Pediatric Office Pediatric Infectious Diseases LLC Physicians to Children Prime Care Medical Center Rub Pediatrics South Florida Hispanic Chamber of Commerce South Florida Pediatric Partners (SFPP) The Children's Trust of Miami-Dade County The Dan Marino Foundation The School District of Palm Beach County Through this process, input was gathered from several individuals whose organizations work with low-income, minority populations (including adopted children, African-Americans, Albanians, American Indians, Asians, biologically and socially at-risk infants and children, Caribbean people, Central Americans, children with autism, children with chronic medical problems, children with special needs, Cubans, the disabled, Dominicans, Europeans, foster children, grandparents raising grandchildren, Haitians, Hispanics, the homeless, immigrants, inner-city youth, international, children with lack of parental involvement, LGBT community, those with low education, low income residents, Medicare/Medicaid beneficiaries, the mentally ill, people of Middle Eastern decent, non-English speaking persons, Non-Whites, school-aged children, single parents, South Americans, the undocumented, the unemployed, the uninsured/underinsured, victims of human trafficking, people from the Virgin Islands), or other medically underserved populations (including African-Americans, children with autism, children with chronic medical problems, children with special needs, children with substance abuse issues, the disabled, family and individual counseling centers, foster children, Haitians, Hispanics, the homeless, immigrants, persons that lack dental care, persons that lack transportation, LGBT community, low income residents, Medicare/Medicaid beneficiaries, the mentally ill, the undocumented, the uninsured/underinsured). In the online survey, key informants were asked to rate the degree to which various children's health issues are a problem in their own community. Follow-up questions asked them to describe why they identify problem areas as such, and how these might be better addressed. Results of their ratings, as well as their verbatim comments, are included throughout this report as they relate to the various other data presented.
Schedule H, Part V, Section B, Line 11 Facility , 1 Facility , 1 - NICKLAUS CHILDREN'S HOSPITAL. NUTRITION, PHYSICAL ACTIVITY AND WEIGHT - NCH EXPANDED OUTPATIENT NUTRITION THROUGHOUT OUR AMBULATORY NETWORK AND MIGRATED FROM AN OUT-OF-POCKET MODEL TO BE A COVERED SERVICE BY MOST INSURANCE PLANS. NCH SUPPORTS THE EDUCATION AND TRAINING OF SCHOOL NURSES PROVIDING NUTRITION SERVICES VIA THE VIRTUAL SCHOOL NURSE PILOT (FULL EXPLANATION IN 'ACCESS TO HEALTHCARE SERVICES'). NCH ENHANCED OUR SPORTS HEALTH PROGRAM WITH SERVICES COVERING THE FULL SPECTRUM OF SCREENING, INJURY PREVENTION, TREATMENT, RECOVERY AND WELLNESS. GiveMe5- A MULTIDISCIPLINARY, TRAINING, EDUCATIONAL AND MARKETING TOOL TO ENCOURAGE THE CONSUMPTION OF FRUITS AND VEGETABLES AMONG CHILDREN OF ALL ETHNICITIES IN SOUTH FLORIDA - DEVELOPED BY NCH AND BEING ROLLED OUT IN CONJUNCTION WITH ADDITIONAL PARTNER ORGANIZATIONS. MENTAL HEALTH - NCH IS COLLABORATING WITH LOCAL UNIVERSITIES AND COMMUNITY PARTNER TO OFFER A MORE COORDINATED AND ROBUST DELIVERY MODEL FOR PSYCHOLOGICAL SCREENING AND CONSULTATION. ACCESS TO HEALTHCARE SERVICES - MCHS FORMALIZED ITS MULTI-SPECIALTY GROUP PRACTICE, PEDIATRIC SPECIALISTS OF AMERICA (PSA), IN JANUARY 2015. THE PSA WAS ESTABLISHED TO FACILITATE OPERATIONAL EFFICIENCY AND GROWTH OF OUR PEDIATRIC SUB-SPECIALIST SERVICES. SINCE ITS FOUNDING THE PSA HAS RECRUITED PHYSICIANS IN: URGENT CARE, EMERGENCY MEDICINE, DENTAL, CARDIOLOGY, GASTROENTEROLOGY, AND HOSPITALIST MEDICINE; AS WELL AS ADDED TWO NEW SPECIALTIES TO THE MEMBERSHIP, INFECTIOUS DISEASE AND NEPHROLOGY. A PROCESS IS UNDERWAY TO EXTEND CENTRAL SCHEDULING SYSTEM-WIDE TO STREAMLINE AND COORDINATE ACCESS TO OUR PEDIATRIC SUB-SPECIALISTS. NCH'S SCHOOL HEALTH PROGRAM IN PARTNERSHIP WITH THE CHILDREN'S TRUST, MIAMI-DADE COUNTY DEPARTMENT OF HEALTH, AND MIAMI-DADE COUNTY PUBLIC SCHOOLS SERVES CHILDREN ENROLLED IN THE PUBLIC SCHOOL SYSTEM. THE PROGRAM STAFFS SCHOOL HEALTH OFFICES WITH A MULTIDISCIPLINARY TEAM OF REGISTERED NURSES, LICENSED PRACTICAL NURSES, AND SOCIAL WORKERS WHO WORK COLLABORATIVELY TO IDENTIFY, PREVENT, OR REMEDY STUDENT'S PHYSICAL AND BEHAVIORAL HEALTH NEEDS AND PROVIDE A LINKAGE TO APPROPRIATE COMMUNITY CARE. THE PROGRAM GOAL IS TO PROMOTE A HEALTHY SCHOOL ENVIRONMENT THAT IS CONDUCIVE TO STUDENT WELL BEING, FOSTERS POSITIVE BEHAVIOR, AND SUPPORTS HIGHER ACADEMIC ACHIEVEMENT. NICKLAUS CHILDREN'S HOSPITAL OPERATES 12 SITES IN SOUTHERN MIAMI DADE. CARE COORDINATORS HAVE BEEN AND CONTINUE TO BE INTEGRATED IN THE DELIVER MODEL FOR SPECIFIC SUB-SPECIALTY CLINICS AND SERVICES. DIABETES - NCH ENDOCRINOLOGY NOW OFFERS A CERTIFIED DIABETES EDUCATOR AND DIETICIAN ON PREMISES AND AVAILABLE AT ALL TIMES - IT IS THE ONLY CHILDREN'S PROGRAM IN MIAMI-DADE COUNTY TO OFFER THIS SERVICE. ADDITIONALLY, WE'VE HIRED A CERTIFIED DIABETES EDUCATOR IN PALM BEACH, AND ARE NOW THROUGH THE HEART PROGRAM OFFERING OBESITY CLINICS IN MARTIN COUNTY. INJURY AND VIOLENCE - AS PART OF NCH'S SCHOOL PROGRAM, WE ARE COLLABORATING WITH LOCAL SCHOOL DISTRICTS TO ASCERTAIN THEIR NEEDS AND IDENTIFY AREAS WHERE WE CAN SUPPORT IN ADDRESSING ISSUES OF INJURY AND VIOLENCE. ASTHMA'S & OTHER RESPIRATORY CONDITIONS - NCH LAUNCHED A PILOT WITH THE DEPARTMENT OF HEALTH (DOH) TARGETING CHILDREN WITH ASTHMA WHO ARE FREQUENT UTILIZERS OF HEALTHCARE SERVICES. THE STUDY AIMS TO DEMONSTRATE IMPROVEMENT IN REDUCED MISSED SCHOOL DAYS AND REDUCED TOTAL COSTS OF CARE. NCH IS EXPLORING OUTREACH AND EDUCATION TO PROMOTE COMPLIANCE WITH ASTHMA TREATMENT PLANS, AS WELL AS PREVENTATIVE MEASURES TO ADDRESS ENVIRONMENTAL TRIGGERS OF ASTHMA. ORAL HEALTH - NCH ACQUIRED A STATE OF THE ART DENTISTRY VAN WHICH WILL BE PROVIDING CARE TO UNDERSERVED COMMUNITIES. ONSITE DENTISTS WILL BE ABLE TO ACCESS ORAL SURGEONS AND COLLABORATE WITH OTHER SPECIALISTS VIA TELEHEALTH. POTENTIALLY DISABLING CONDITIONS - NCH'S ON CAMPUS PRIMARY CARE CENTER IS BUILDING THE INFRASTRUCTURE AND WORKING THROUGH THE PROCESS OF APPLYING FOR NCQA DESIGNATION AS A PATIENT CENTERED MEDICAL HOME - WITH UNIQUE COMPETENCIES IN MANAGING CARE FOR FAMILIES WITH A HIGHER DEGREE OF COMPLEXITY. PHYSICAL THERAPY, OCCUPATIONAL THERAPY, AND SPEECH THERAPY CONTINUE TO BE STAPLES OF OUR AMBULATORY NETWORK, AND WITH THE FURTHER GROWTH OF OUR OUTPATIENT PRESENCE, THE HEALTH SYSTEM IS EXTENDING THOSE SERVICES TO NEW MARKETS AND WORKING TO SUPPORT PATIENTS WITH ACTIVITY LIMITATIONS. NCH IS PREPARING FOR THE LAUNCH OF OUR LABOR AND DELIVERY UNITY FOR HIGH RISK NEWBORNS REQUIRING IMMEDIATE INTERVENTION. THE UNIT WILL PROVIDE THE HIGHEST QUALITY CARE, AVOID THE NEED FOR SEPARATION OF MOTHER AND NEWBORN, AND GIVE FAMILIES ACCESS TO THE FULL TEAM OF SUB-SPECIALISTS TO ENSURE SAFE DELIVERY AND TREATMENT FOR THE BABY. NCH IS IN ONGOING DISCUSSION WITH GOVERNMENT, PRIVATE, AND COMMUNITY AGENCIES TO FURTHER SUPPORT PATIENTS WITH COMPLEX, CHRONIC, POTENTIALLY DISABLING CONDITIONS.
Schedule H, Part V, Section B, Line 20 Facility , 1 Facility , 1 - NICKLAUS CHILDREN'S HOSPITAL. Notified individuals of the financial assistance policy on admission Notified individuals of the financial assistance policy in communications with the individuals regarding the individuals' bills Documented its determination of whether individuals were eligible for financial assistance under the hospital facility's financial assistance policy
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
Schedule H (Form 990) 2017
Page 9
Schedule H (Form 990) 2017
Page 9
Part VFacility Information (continued)

Section D. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility
(list in order of size, from largest to smallest)
How many non-hospital health care facilities did the organization operate during the tax year?10
Name and address Type of Facility (describe)
1 Nicklaus Children's Doral Outpatient Center
3601 NW 107th Avenue
Doral,FL33178
Outpatient / Urgent Center
2 Nicklaus Children's Dan Marino Outpatient Center
2900 S Commerce Parkway
Weston,FL33331
Outpatient Center
3 Nicklaus Children's Palm Beach Gardens Outpatient Center
11310 Legacy Avenue Legacy Place
Palm Beach Gardens,FL33410
Outpatient / Urgent Care Center
4 Nicklaus Children's Miramar Outpatient Center
12246 Miramar Parkway Miramar Squar
e
Miramar,FL33025
Outpatient / Urgent Care Center
5 Nicklaus Children's Miami Lakes Outpatient Center
15025 NW 77th Avenue
Miami Lakes,FL33014
Outpatient / Urgent Care Center
6 Nicklaus Children's Midtown Outpatient Center
3915 Biscayne Boulevard
Miami,FL33137
Outpatient / Urgent Care Center
7 Nicklaus Children's West Kendall Outpatient Center
13400 SW 120th Street Suite 100
Miami,FL33186
Outpatient / Urgent Care Center
8 Nicklaus Children's Palmetto Bay Outpatient Center
17615 SW 97th Avenue
Palmetto Bay,FL33157
Outpatient / Urgent Care Center
9 Nicklaus Children's West Bird Outpatient Center
11449 SW 40 St
Miami,FL33165
Outpatient / Urgent Care Center
10 Nicklaus Children's Pinecrest Outpatient Center
11521 Suth Dixie Highway 1st Floor
Pinecrest,FL33156
Outpatient/Urgent Care Center
Schedule H (Form 990) 2017
Page 10
Schedule H (Form 990) 2017
Page 10
Part VI
Supplemental Information
Provide the following information.
1 Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2 Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs reported in Part V, Section B.
3 Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4 Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5 Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6 Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7 State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.
Form and Line Reference Explanation
Schedule H, Part V, Section B, Line 16a FAP AVAILABLE WEBSITE https://www.nicklauschildrens.org/patients-and-families/patient-financial-services/financial-assistance-program
Schedule H, Part V, Section B, Line 16b FAP APPLICATION FORM WEBSITE https://www.nicklauschildrens.org/patients-and-families/patient-financial-services/financial-assistance-program
Schedule H, Part V, Section B, Line 16c PLAIN LANGUAGE FAP SUMMARY WEBSITE https://www.nicklauschildrens.org/patients-and-families/patient-financial-services/financial-assistance-program
Schedule H, Part I, Line 7 Bad Debt Expense excluded from financial assistance calculation 39230318
Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance THE ORGANIZATION USES THE COST TO CHARGE RATIO IN IRS WORKSHEET 2 TO DETERMINE THE COST OF COMMUNITY BENEFITS AND FINANCIAL ASSISTANCE.
Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount Bad debt expense is reported at cost using the cost to charge ratio.
Schedule H, Part III, Line 3 Bad Debt Expense Methodology THE HOSPITAL IS UNABLE TO ESTIMATE ACCURATELY THE AMOUNT OF BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE FOR FREE SERVICES UNDER THE FINANCIAL ASSISTANCE POLICY. ALTHOUGH A PORTION OF BAD DEBT EXPENSES MAY RELATE TO PATIENTS WHO WOULD QUALIFY FOR CHARITY CARE, A REPORTABLE FIGURE CANNOT BE REASONABLY ESTIMATED.
Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote The System's estimation of the allowance for bad debts is based primarily upon the type and age of the patient accounts receivable and the effectiveness of the System s collection efforts. As a policy, the System reserves for all balances over 180 days old. Certain third-party payors with increased volume are slow payors or are in negotiations to resolve outstanding balances, increasing reserves recorded in 2017. In addition, the System has forgiven balances due from patients which, while they do form as a basis to assist families with their financial obligations, do not qualify as charity care and must be recognized as bad debt.
Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs VARIETY CHILDREN'S HOSPITAL ("VCH") ACCEPTS ALL MEDICARE PATIENTS WITH THE KNOWLEDGE THAT THERE MAY BE SHORTFALLS AND OPERATES TO PROMOTE THE HEALTH OF THE COMMUNITY. VCH BELIEVES THAT THE MEDICARE SHORTFALL SHOULD BE TREATED AS A COMMUNITY BENEFIT BECAUSE MEDICARE DOES NOT FULLY COMPENSATE HOSPITALS FOR THE COST OF PROVIDING HOSPITAL CARE TO MEDICARE BENEFICIARIES. VCH EXPERIENCED LOSSES ($664,574 FOR 2017) DUE TO UNDERPAYMENT FOR THE TREATMENT OF MEDICARE PATIENTS. UNREIMBURSED MEDICARE COSTS REPRESENT A SIGNIFICANT VALUE THAT NONPROFIT HOSPITALS PROVIDE TO THE COMMUNITY AS THE HOSPITAL RELIEVES THE FEDERAL GOVERNMENT OF A FINANCIAL BURDEN WHEN IT PROVIDES ESSENTIAL HEALTHCARE SERVICES TO MEDICARE COVERED PATIENTS. THE MEDICARE COST REPORT AND THE ORGANIZATION'S COST ACCOUNTING SYSTEM ARE USED TO DETERMINE THE MEDICARE ALLOWABLE COSTS.
Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance Hospital patient accounts may be subject to the following collection actions to be conducted by the Hospital or an authorized party thereof: 1. Following the initial bill, monthly statements and collection letters are mailed and phone calls are completed in an effort to collect all outstanding balances due. 2. The patient responsible portion of an outstanding balance may be transferred to a bad debt collection agency. 3. Payment plan arrangements may be made for patients who indicate they may have difficulty paying their balance in a single installment.
Schedule H, Part V, Section B, Line 16a FAP website - NICKLAUS Children's Hospital: Line 16a URL: See Part VI;
Schedule H, Part V, Section B, Line 16b FAP Application website - NICKLAUS Children's Hospital: Line 16b URL: See Part VI;
Schedule H, Part V, Section B, Line 16c FAP plain language summary website - NICKLAUS Children's Hospital: Line 16c URL: See Part VI;
Schedule H, Part VI, Line 2 Needs assessment Under direction of the Board of Directors, management strives to provide hope through advanced care for our children and families. The vision is to be where the children are. The hospital uses a quarterly operating calendar to develop programs and communicate goals, accomplishments and gaps in plans. Nicklaus Children's Hospital participates in many community organizations that collectively strive to improve the health status of children. NCH has representation on The Children's Trust, the Miami Dade County Public Schools Wellness Committee, the Greater Miami Chamber of Commerce's Health and Bio-Science Committee and the Health Council of South Florida. Through our involvement with the Health Council, we consistently analyze data to identify unmet needs and serve in an advisory capacity assisting the Council to address health disparities. Additionally, our Preventive Medicine Program deploys a medical and dental van into underserved areas of the community. NCH has a robust mechanism to analyze health data.
Schedule H, Part VI, Line 3 Patient education of eligibility for assistance Nicklaus Children's Hospital has a financial assistance program to assist patients that are uninsured or underinsured and to be given the opportunity to apply for various programs. With the patient/family general consent form, financial agreement for professional services form, and a coordination of benefits form, patients/families are provided referral to an eligibility assistance counselor who will explain various programs offered. The patients are provided pamphlets of the financial assistance policy summary and signage is posted at each location indicating that financial counseling is available and that they may be eligible for financial assistance.
Schedule H, Part VI, Line 4 Community information Nicklaus Children's Hospital - the flagship of Nicklaus Children's Health System - primarily serves the pediatric population of Miami-Dade County. Approximately 587,000 people under the age of 18 reside within the county. In 2017, 65 percent of the health system's patient population was funded by Medicaid. Miami-Dade is comprised of a diverse mixture of residents and visitors, making it one of the most international communities in the nation. According to the 2010 census, the county led the nation in foreign-born residents, at 52 percent, with 66 percent of the population comprised of individuals of Latin or Hispanic descent and 71 percent reporting a language other than English spoken in the home. Classifying the hospital's inpatient population using Experian's MOSAIC segmentation tool, 35 percent of the customer base fits into the Group I: Family Union profile: predominantly Hispanic families living in middle-class comfort within the tri-county area. The hospital also serves children from all over the United States and throughout Florida (patients from every county in the state have been served by the hospital). In 2017, the hospital served international patients from 68 countries. The health system, through its network of 10 outpatient centers, also provides services within Broward, Palm Beach, Lee and Martin counties. The ambulatory centers offer subspecialty physician consultations, urgent care, imaging and outpatient rehabilitation services. According to the latest drive-time trade area analysis conducted in 2013, average drive time to the main hospital was 35 minutes, with a maximum drive-time of two hours for subspecialty care.
Schedule H, Part VI, Line 5 Promotion of community health A majority of the Board of Directors is comprised of persons who live in Miami-Dade County, who are neither employees nor independent contractors of the Hospital, nor family members thereof. The organization extends medical staff privileges to all qualified physicians in the community and applies surplus funds to improvements in patient care, medical education and research. In addition, NICKLAUS Children's Hospital has an active community education program, various camp programs including asthma, diabetes, cancer center, psychiatric programs, early intervention program, preventative medicine program, dental mobile program, after hours program, healthy connections program, medical education residency program, pediatric post graduate program, fellowship programs, pediatric care call program, multiple ambulatory care centers all designed to promote health in the community.
Schedule H, Part VI, Line 6 Affiliated health care system Nicklaus Children's Hospital - the flagship of Nicklaus Children's Health System - primarily serves the pediatric population of Miami-Dade County and is a leading provider of healthcare services for medically needy children. In addition, the hospital is proud to be the largest provider of pediatric medical education in the southeastern United States. NICKLAUS Children's Hospital provides primary care and a medical home to the Medicaid population through its Pediatric Care Center located on the hospital's main campus. The hospital also provides dental services through its Pediatric Dental Residency program. NICKLAUS Children's Hospital also houses Early Steps Southernmost Coast, an early intervention program for children at risk of developmental delays. The program evaluates over 2,000 children annually. NICKLAUS Children's offers primary care services to needy children through the Health Connect in Our Schools program. The hospital provides nursing staff for school-based clinics situated in high-risk communities to ensure that children have access to care. NICKLAUS Children's Hospital's Brain Institute is the first and largest pediatric neuroscience collaboration in the nation. The program is recognized for excellence in treatment of children with brain tumors, intractable epilepsy and other brain anomalies, and offers the latest minimally invasive methods, including Visualase, an image-guided laser technique for epilepsy surgery in children. The Heart Program at NICKLAUS Children's Hospital provides care for more children with congenital heart disorders than any other hospital in Florida. It is consistently ranked among the best programs in the nation for cardiology and heart surgery. NICKLAUS Children's Hospital's Cancer Center is the largest provider of pediatric cancer services in the region. The center participates in research protocols, offering the latest interventions for children receiving treatment for all forms of cancer and blood disorders. NICKLAUS Children's LifeFlight Critical Care Transport team provides transport of critically ill children from referring hospitals to NICKLAUS Children's Hospital critical care units.
Schedule H (Form 990) 2017
Additional Data


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