2016-08-11T14:05:40-05:00 2015-09-30 420714325 RSM US LLP ONE SOUTH WACKER STE 800 CHICAGO IL 60606 990 2014-10-01 331075317 NCHMD INC NCHM 2396246338 PO BOX 413029 NAPLES FL 341013029 RICK WYLES CHIEF FINANCIAL OFFICER 2396244005 2016-08-05 1 WAYNE HARDER P00294296 3126343400 2014 2016-12-15 16:53:06Z NCH PHYSICIAN GROUP RICK WYLES PO BOX 413029 NAPLES FL 341013029 71167816 0 X WWW.NCHMD.ORG X 2003 FL THROUGH THE PROVISION OF CHARITABLE HEALTHCARE, OUR MISSION IS HELPING EVERYONE LIVE A LONGER, HAPPIER, AND HEALTHIER LIFE. 11 2 567 6 240079 0 0 0 68075529 70021282 -262 9702 1088652 1136832 69163919 71167816 0 0 0 0 58912616 62976919 0 0 0 22204966 25212049 81117582 88188968 -11953663 -17021152 18449997 17256560 13190615 14360571 5259382 2895989 X THROUGH THE PROVISION OF CHARITABLE HEALTHCARE, OUR MISSION IS HELPING EVERYONE LIVE A LONGER, HAPPIER, AND HEALTHIER LIFE. 0 0 13782178 10413760 CARDIOLOGY SERVICES WERE NCH PHYSICIAN GROUP'S LARGEST PROGRAM SERVICE ACCOMPLISHMENT IN 2015. NCHMD, INC., IN CONJUNCTION WITH THE NCH DOWNTOWN NAPLES HOSPITAL, IS HOME TO ONE OF THE MOST SUCCESSFUL CARDIAC PROGRAMS IN THE NATION. WE HAVE BEEN RANKED AMONG THE TOP 5% IN THE NATION FOR OVERALL CARDIAC SERVICES AND CARDIOLOGY SERVICES FOR 10 CONSECUTIVE YEARS (2013). OUR SERVICES INCLUDE INVASIVE AND NON-INVASIVE CARDIAC PROCEDURES, CARDIAC REHABILITATION AND WELLNESS PROGRAMS.WITHIN THIS SERVICE LINE, NCHMD EMPLOYED 27 LICENSED INDEPENDENT PRACTITIONERS AND 32 FULL-TIME EQUIVALENT EMPLOYEES WHO SERVICED 43,411 ARRIVED APPOINTMENTS, PROVIDED $290,768 OF CHARITY CARE AND ALSO WROTE OFF $401,646 OF BAD DEBT. 13411523 10744953 FAMILY PRACTICE SERVICES WERE NCH PHYSICIAN GROUP'S SECOND LARGEST PROGRAM SERVICE ACCOMPLISHMENT IN 2015. THIS PROGRAM SERVICE OFFERS CARE TO THE WHOLE FAMILY, BY TREATING NOT ONLY ILLNESSES, BUT BY HELPING YOU FIND WAYS TO IMPROVE YOUR HEALTH AND PREVENT DISEASE. OUR FAMILY MEDICINE OFFICES PROVIDE COMPLETE CARE TO INFANTS, CHILDREN, ADOLESCENTS, ADULTS AND THE ELDERLY.WITHIN THIS SERVICE LINE, NCHMD EMPLOYED 34 LICENSED INDEPENDENT PRACTITIONERS AND 63 FULL-TIME EQUIVALENT EMPLOYEES WHO SERVICED 84,955 ARRIVED APPOINTMENTS, PROVIDED $2,054. OF CHARITY CARE AND ALSO WROTE OFF $102,065 OF BAD DEBT. 10222834 8395125 SEE SCHEDULE OINTERNAL MEDICINE SERVICES WERE NCH PHYSICIAN GROUP'S THIRD LARGEST PROGRAM SERVICE ACCOMPLISHMENT IN 2015. THE NCH PHYSICIAN GROUP'S INTERNAL MEDICINE PHYSICIANS FOCUS ON ADULT MEDICINE BY EMPHASIZING PREVENTION AND TREATMENT OF ADULT DISEASES WITH STATE OF THE ART TECHNOLOGY IN A COMPASSIONATE ENVIRONMENT. THESE PHYSICIANS WORK CLOSELY WITH ALL OUR SPECIALISTS AS WELL AS OUR ANCILLARY TESTING DEPARTMENTS SUCH AS RADIOLOGY, LABORATORY AND PHYSICAL THERAPY TO HELP SOLVE DIAGNOSTIC PROBLEMS. WITHIN THIS SERVICE LINE, NCHMD EMPLOYED 30 LICENSED INDEPENDENT PRACTITIONERS AND 37 FULL-TIME EQUIVALENT EMPLOYEES WHO SERVICED 39,715 ARRIVED APPOINTMENTS, PROVIDED $63,187 OF CHARITY CARE AND ALSO WROTE OFF $88,863 OF BAD DEBT. 45425590 41358152 IN PROVIDING THE OTHER PROGRAM SERVICE LINES, NCHMD EMPLOYED 80 LICENSED INDEPENDENT PRACTITIONERS AND 136 FTES WHO SERVICED 175,194 ARRIVED APPOINTMENTS, PROVIDED $932,196 OF CHARITY CARE AND ALSO WROTE OFF $1,465,582 OF BAD DEBT.NCH PHYSICIAN GROUP'S OTHER PROGRAM SERVICE LINES ARE: EXPENSE REVENUEINFECTIOUS DISEASE $8,331,947 $7,724,611LAB & RADIOLOGY 7,313,092 8,033,806PULMONARY 6,789,322 5,868,005ORTHOPEDICS 6,160,340 4,897,791GENERAL SURGERY 2.579.430 2,576,507PEDIATRICS 2,495,356 2,334,518GASTROENTEROLOGY 2,310,169 1,923,977PAIN MANAGEMENT 2,154,026 2.070.834GERIATRICS 1,994,167 1,514,958URGENT CARE 1,829,888 1,915,463PSYCHIATRY 1,670,059 991,368 RHEUMATOLOGY 669,658 622,270PHYSICAL THERAPY 563,231 425,543PRO TIME 436,357 381,034WOUND HEALING 128,548 77,467 45425590 41358152 82842125 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 1 81 0 1 567 1 1 1 0 0 0 0 0 0 0 0 0 X 11 2 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 FL X X RICK WYLES CHIEF FINANCIAL OFFICER 2396244005 350 SEVENTH STREET NORTH NAPLES FL 34102 MARIANN MACDONALD TRUSTEE 0.50 1.50 X 0 0 0 THOMAS J GAZDIC TRUSTEE 0.50 1.50 X 0 0 0 DAVID R AXLINE MD PHYSICIAN/TRUSTEE 40.00 X 986820 0 32867 JON S DOUNCHIS MD PHYSICIAN/TRUSTEE 40.00 X 1495097 0 31788 KAREN HENRICHSEN DO PHYSICIAN/TRUSTEE CHAIR 40.00 X X 323624 0 20476 ROBERT HANSON MD PHYSICIAN/TRUSTEE 40.00 X 413862 0 27343 GARY SWAIN MD PHYSICIAN/TRUSTEE VICE CHAIR 40.00 X 304163 0 0 DAVID LAMON MD PHYSICIAN/TRUSTEE 40.00 X 532184 0 29144 DAMIAN M MCGOVERN MD PHYSICIAN/TRUSTEE 40.00 X 563415 0 31788 KEVIN D COOPER SEC/TREAS/GNRL COUNSEL/CHF OF STAFF 1.00 44.00 X X 0 460368 32115 MICHELE THOMAN RN CHIEF NURSING OFFICER 1.00 44.00 X X 0 346330 28585 ALLEN S WEISS MD PRESIDENT/CEO 1.00 44.00 X 0 792105 25971 PHILLIP DUTCHER COO, NCH HEALTHCARE SYSTEM 1.00 44.00 X 0 466178 10571 MICHAEL STEPHENS TERM 0715 CFO/ASSISTANT TREASURER 1.00 44.00 X 0 387885 22864 CHARLES DARDOINMDTERM 0115 CHIEF MEDICAL OFFICER 1.00 44.00 X 0 418488 8140 FRANK ASTOR MD START 0315 CHIEF MEDICAL OFFICER 1.00 44.00 X 0 0 0 MICHAEL RILEY CHIEF STRATEGY OFFICER 1.00 44.00 X 0 247326 27078 SARAH RICHARDSON CHIEF INFORMATION OFFICER 1.00 44.00 X 0 35961 80 RENEE M THIGPEN CHIEF HR OFFICER 1.00 44.00 X 0 169999 24213 ELIZABETH MARTIN ASSISTANT SECRETARY 1.00 44.00 X 0 59511 14442 JAMES K MARTIN CHIEF DEVELOPMENT OFFICER 1.00 44.00 X 0 296444 26905 ZACHARY BOSTOCK CHIEF ADMINISTRATIVE OFFICER 40.00 5.00 X 301623 0 27567 HOWARD KAPP MD PHYSICIAN 40.00 0.00 X 2017688 0 30380 DENNIS STAPLETON MD PHYSICIAN 40.00 0.00 X 1438774 0 29484 JAN BARRIOS MD PHYSICIAN 40.00 0.00 X 915347 0 31788 ROBERT D PASCOTTO JR MD PHYSICIAN 40.00 0.00 X 897809 0 31150 GARY BERGEN MD PHYSICIAN 40.00 0.00 X 705071 0 26561 DAVID LINDNER DO PHYSICIAN/FORMER TRUSTEE 0.00 0.00 X 437790 0 27925 MARYANN LOMONACO MD PHYSICIAN/FORMER TRUSTEE 0.00 0.00 X 260193 0 25964 DOREEN CASSARINO ARNP NURSE PRACTITIONER/FORMER TRUSTEE 0.00 0.00 X 35032 0 4471 GARY PARSONSMD TERM 1213 FORMER CHIEF MEDICAL OFFICER 0.00 0.00 X 212710 0 7256 JOHN MCGIRL TERM 0814 FORMER CHIEF HR OFFICER 0.00 0.00 X 0 201904 22516 VICKI D ORR TERM 0513 FORMER CHIEF FINANCIAL OFFICER 0.00 0.00 X 0 412833 21413 11841202 4295332 680845 90 1 1 0 F & S RADIOLOGY PO BOX 674360 DETROIT MI 482674360 RADIOLOGY SERVICES 1230280 CERNER CORPORATION PO BOX 959156 ST LOUIS MO 631959156 IT CONSULTING SERVICES & SUPPORT 811232 GE HEALTHCARE PO BOX 96483 CHICAGO IL 60693 MAINTANENCE SERVICES 437872 GE HEALTHCARE IITS 15724 COLLECTIONS CENTER DRIVE CHICAGO IL 60693 PATIENT BILLING MAINTENANCE 333915 NEXTGEN HEALTHCARE INC PO BOX 809390 CHICAGO IL 606809390 IT SOFTWARE SUPPORT 164957 10 OFFICES OF PHYSICIANS 621110 70021282 70021282 70021282 9702 0 9702 9702 9702 PHYSICIAN ON-CALL REV 900099 889634 889634 SUBLEASE SPACE/PERS 561000 240079 240079 EMPLOYEE SALES 900099 6045 6045 1074 1074 1136832 71167816 70911990 240079 15747 X 5033483 4756906 276577 22910 9542 13368 53493204 50755530 2737674 967224 917219 50005 771149 731518 39631 2688949 2549930 139019 3017584 2425315 592269 232399 232399 2082481 1292364 790117 1184108 1122890 61218 4385324 3808673 576651 118017 116891 1126 2799390 2758361 41029 1872622 1845402 27220 MEDICAL SUPPLIES 7454182 7453243 939 BAD DEBT 2058157 2058157 0 7785 7785 88188968 82842125 5346843 0 4271598 4128318 828721 820004 512761 569713 22130090 12376742 9629228 9753348 3087969 1923865 119720 61312 18449997 17256560 12350895 13257529 588500 995377 251220 107665 13190615 14360571 X 5259382 2895989 5259382 2895989 18449997 17256560 X -17021152 14657759 X 0 1 X 1 0 X 59422838 58705784 59487869 68075529 70021282 315713302 59422838 58705784 59487869 68075529 70021282 315713302 0 0 0 315713302 -28315 -43979 -4596 -262 9702 -67450 -28315 -43979 -4596 -262 9702 -67450 798247 939411 911014 1088652 896753 4634077 60192770 59601216 60394287 69163919 70927737 320279929 0.98570 0.98550 0.00000 0.00000 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: PHYSICIAN ON CALL REVENUE - 2010 AMOUNT: $ 572,899. 2011 AMOUNT: $ 910,408. 2012 AMOUNT: $ 802,140. 2013 AMOUNT: $ 1,085,355. 2014 AMOUNT: $ 889,634. MISC ACCOUNTS REC RECEIPTS - 2010 AMOUNT: $ 212,499. 2011 AMOUNT: $ 10,860. 2012 AMOUNT: $ 5,478. 2013 AMOUNT: $ 452. 2014 AMOUNT: $ 1,074. EMPLOYEE SALES - 2010 AMOUNT: $ 3,320. 2011 AMOUNT: $ 3,070. 2012 AMOUNT: $ 2,943. 2013 AMOUNT: $ 2,845. 2014 AMOUNT: $ 6,045. MISC VENDOR RECEIPTS - 2010 AMOUNT: $ 9,529. 2011 AMOUNT: $ 15,073. PHYSICIAN CONTRACT BUYOUT - 2012 AMOUNT: $ 100,453. 5139363 690523 4448840 3133523 3028942 104581 13185701 8657277 4528424 671503 671503 9753348 LONG-TERM LEASE LIABILITY 107665 107665 X PART X, LINE 2: THE SYSTEM AND ALL OF ITS NOT-FOR-PROFIT SUBSIDIARIES ARE EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(A) OF THE INTERNAL REVENUE CODE (THE CODE) AS ORGANIZATIONS DESCRIBED IN SECTION 501(C)(3) OF THE CODE, AND ARE EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. THE SYSTEM AND ALL OF ITS NOT-FOR-PROFIT SUBSIDIARIES DO NOT HAVE SIGNIFICANT UNRELATED BUSINESS INCOME; HOWEVER, SUCH STATUS IS SUBJECT TO FINAL DETERMINATION UPON EXAMINATION OF THE RELATED INCOME TAX RETURNS BY THE APPROPRIATE TAXING AUTHORITIES. THE SYSTEM IS NO LONGER SUBJECT TO TAX EXAMINATIONS IN THE MAJOR U.S. TAXING JURISDICTIONS IN WHICH THEY OPERATE FOR TAX YEARS PRIOR TO 2011. X X X X 1 0 0 0 0 0 0 1 0 DAVID R AXLINE MD PHYSICIAN/TRUSTEE 549201 0 420119 0 17500 0 10400 0 22467 0 1019687 0 0 0 JON S DOUNCHIS MD PHYSICIAN/TRUSTEE 1127751 0 349846 0 17500 0 10400 0 21388 0 1526885 0 0 0 KAREN HENRICHSEN DO PHYSICIAN/TRUSTEE CHAIR 238383 0 67741 0 17500 0 6075 0 14401 0 344100 0 0 0 ROBERT HANSON MD PHYSICIAN/TRUSTEE 386490 0 9872 0 17500 0 5955 0 21388 0 441205 0 0 0 GARY SWAIN MD PHYSICIAN/TRUSTEE VICE CHAIR 288413 0 0 0 15750 0 0 0 0 0 304163 0 0 0 DAVID LAMON MD PHYSICIAN/TRUSTEE 494125 0 20559 0 17500 0 7756 0 21388 0 561328 0 0 0 DAMIAN M MCGOVERN MD PHYSICIAN/TRUSTEE 457916 0 87999 0 17500 0 10400 0 21388 0 595203 0 0 0 KEVIN D COOPER SEC/TREAS/GNRL COUNSEL/CHF OF STAFF 0 392917 0 49951 0 17500 0 9687 0 22428 0 492483 0 0 MICHELE THOMAN RN CHIEF NURSING OFFICER 0 294211 0 34619 0 17500 0 5399 0 23186 0 374915 0 0 ALLEN S WEISS MD PRESIDENT/CEO 0 688145 0 86460 0 17500 0 10400 0 15571 0 818076 0 0 PHILLIP DUTCHER COO, NCH HEALTHCARE SYSTEM 0 398727 0 49951 0 17500 0 9531 0 1040 0 476749 0 0 MICHAEL STEPHENS TERM 0715 CFO/ASSISTANT TREASURER 0 354800 0 15585 0 17500 0 436 0 22428 0 410749 0 0 CHARLES DARDOINMDTERM 0115 CHIEF MEDICAL OFFICER 0 237245 0 0 0 181243 0 0 0 8140 0 426628 0 0 MICHAEL RILEY CHIEF STRATEGY OFFICER 0 203647 0 26179 0 17500 0 3923 0 23155 0 274404 0 0 RENEE M THIGPEN CHIEF HR OFFICER 0 166509 0 3490 0 0 0 3104 0 21109 0 194212 0 0 JAMES K MARTIN CHIEF DEVELOPMENT OFFICER 0 247593 0 31351 0 17500 0 4650 0 22255 0 323349 0 0 ZACHARY BOSTOCK CHIEF ADMINISTRATIVE OFFICER 251963 0 32160 0 17500 0 6352 0 21215 0 329190 0 0 0 HOWARD KAPP MD PHYSICIAN 1562547 0 437641 0 17500 0 10400 0 19980 0 2048068 0 0 0 DENNIS STAPLETON MD PHYSICIAN 955135 0 466139 0 17500 0 10400 0 19084 0 1468258 0 0 0 JAN BARRIOS MD PHYSICIAN 513805 0 384042 0 17500 0 10400 0 21388 0 947135 0 0 0 ROBERT D PASCOTTO JR MD PHYSICIAN 729911 0 150398 0 17500 0 9762 0 21388 0 928959 0 0 0 GARY BERGEN MD PHYSICIAN 510796 0 176775 0 17500 0 5157 0 21404 0 731632 0 0 0 DAVID LINDNER DO PHYSICIAN/FORMER TRUSTEE 398828 0 21462 0 17500 0 6537 0 21388 0 465715 0 0 0 MARYANN LOMONACO MD PHYSICIAN/FORMER TRUSTEE 186250 0 56443 0 17500 0 4576 0 21388 0 286157 0 0 0 DOREEN CASSARINO ARNP NURSE PRACTITIONER/FORMER TRUSTEE 34038 0 994 0 0 0 0 0 4471 0 39503 0 0 0 GARY PARSONSMD TERM 1213 FORMER CHIEF MEDICAL OFFICER 12763 0 40778 0 159169 0 2196 0 5060 0 219966 0 0 0 JOHN MCGIRL TERM 0814 FORMER CHIEF HR OFFICER 0 160172 0 28944 0 12788 0 5749 0 16767 0 224420 0 0 VICKI D ORR TERM 0513 FORMER CHIEF FINANCIAL OFFICER 0 -8121 0 32660 0 388294 0 0 0 21413 0 434246 0 0 PART I, LINE 4A DETAIL OF SEVERANCE PAYMENTS: CHARLES D. ARDOIN, M.D., CHIEF MEDICAL OFFICER RESIGNED 01/13/15, AND RECEIVED A SEVERANCE PAYMENT OF $171,147 FOR CALENDAR YEAR 2014. GARY A. PARSONS, M.D., FORMER CHIEF MEDICAL OFFICER RESIGNED 12/30/13, AND RECEIVED A SEVERANCE PAYMENT OF $158,496. FOR CALENDAR YEAR 2014. VICKI D. ORR, FORMER CHIEF FINANCIAL OFFICER/ASST TREASURER RESIGNED 5/22/13, AND RECEIVED A SEVERANCE PAYMENT OF $388,294. FOR CALENDAR YEAR 2014. PART I, LINE 7 PROVISION OF NON-FIXED PAYMENTS THIS ORGANIZATION IS AN AFFILIATE OF NAPLES COMMUNITY HOSPITAL, INC. ("NCH"). ALL COMPENSATION ARRANGEMENTS ARE DETERMINED AND PAID THROUGH NCH. NCH MAY PROVIDE DISCRETIONARY BONUS AND/OR INCENTIVE COMPENSATION PAYMENTS TO ELIGIBLE EMPLOYEES. PAYMENTS MADE TO ANY DISQUALIFIED PERSON IS APPROVED BY THE NCH COMPENSATION COMMITTEE THROUGH THE PROCESS DESCRIBED IN FORM 990, PART VI, SECTION B, LINE 15. GMANCHOR EAGLEVIEW DEVELOPMENT LLC FORMER TRUSTEE/PARTNER 761792 NCHMD LEASES BUILDING 0 LDCH REAL ESTATE HOLDINGS LLC FORMER TRUSTEE/PARTNER 129936 NCHMD LEASES BUILDING 0 FORM 990, SCHEDULE L, PART IV MARYANN LOMONACO M.D., FORMER BOARD TRUSTEE, AND GARY PARSONS M.D., FORMER CHIEF MEDICAL OFFICER, HAVE A PARTNERSHIP INTEREST IN GM/ANCHOR EAGLEVIEW DEVELOPMENT, LLC THAT NCHMD LEASES OFFICE SPACE FROM.DAVID LINDNER D.O., FORMER BOARD TRUSTEE, HAS A PARTNERSHIP INTEREST IN LDCH REAL ESTATE HOLDINGS THAT NCHMD LEASES OFFICE SPACE FROM. FORM 990, PART III, LINE 4, PROGRAM SERVICES NCHMD, INC. ("NDH PHYSICIAN GROUP") PROVIDES OUTPATIENT HEALTHCARE SERVICES WITHOUT REGARD TO A PATIENT'S ABILITY TO PAY. DURING 2015, NCHMD, INC. PROVIDED $1,288,205 OF CHARITY CARE TO PATIENTS WHO WERE UNABLE TO PAY AND NOT COVERED BY ANY GOVERNMENTAL OR PRIVATE INSURANCE PROGRAM. ADDITIONALLY, NCHMD, INC. WROTE OFF $2,058,157 CLASSIFIED AS BAD DEBTS. THE SERVICES OFFERED WITHIN THE NCH PHYSICIAN GROUP ARE EXTENSIVE AND INCLUDE A VARIETY OF MEDICAL SPECIALTIES SUCH AS CARDIOLOGY, PULMONARY, FAMILY MEDICINE, PEDIATRICS, INTERNAL MEDICINE AND URGENT CARE. A TOTAL OF 439 FULL-TIME EQUIVALENT EMPLOYEES, WHICH INCLUDE 171 LICENSED INDEPENDENT PRACTITIONERS, COMPRISE THE OUTSTANDING MEDICAL TEAM WORKING TOGETHER TO PROVIDE THESE SERVICES TO 343,275 ARRIVED APPOINTMENTS IN 2015. FORM 990, PART VI, SECTION A, LINE 6 GOVERNING BODY AND MANAGEMENT NCH HEALTHCARE SYSTEM,INC. IS THE SOLE CORPORATE MEMBER OF THE ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7A GOVERNING BODY AND MANAGEMENT NCH HEALTHCARE SYSTEM, INC. SOLE MEMBER OF THIS ORGANIZATION, ELECTS THIS ORGANIZATION'S DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7B GOVERNING BODY AND MANAGEMENT ALL OF THE GOVERNANCE DECISIONS FOR NCHMD, INC. ARE RESERVED TO THE GOVERNING BODY OF NCH HEALTHCARE SYSTEM, INC. FORM 990, PART VI, SECTION B, LINE 11 REVIEW PROCESS INFORMATION RELATED TO NCHMD, INC.'S ("NCHMD") FORM 990 FILING IS GATHERED BY FINANCE STAFF AND PROVIDED TO RSM US, LLP FOR REVIEW. AFTER THE REVIEW BY RSM US, LLP THE TAX RETURN IS REVIEWED BY THE NCH HEALTHCARE SYSTEM CHIEF OF STAFF AND CHIEF FINANCIAL OFFICER. THE TAX RETURN IS THEN REVIEWED BY THE CHAIRMAN OF THE NCH FINANCE COMMITTEE AND OUTSIDE COUNSEL FOR THE BOARD. PRIOR TO BOARD APPROVAL, THE 990 IS PROVIDED TO ALL OF THE BOARD OF TRUSTEES FOR THEIR REVIEW VIA THE BOARD PORTAL. AT THE CONCLUSION OF THIS REVIEW PROCESS THE FORM 990 IS APPROVED BY THE BOARD OF TRUSTEES (COMPENSATION COMMITTEE) PRIOR TO FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C CONFLICT OF INTEREST POLICY ANNUALLY, ALL NCH HEALTHCARE SYSTEM, INC. OFFICERS, DIRECTORS, TRUSTEES AND KEY EMPLOYEES ARE REQUIRED TO DISCLOSE INTERESTS THAT COULD POTENTIALLY GIVE RISE TO CONFLICTS. AFTER DISCLOSURE OF THE FINANCIAL INTEREST AND ALL MATERIAL FACTS, AND AFTER ANY DISCUSSION WITH THE INTERESTED PERSON, HE/SHE SHALL LEAVE THE BOARD OR COMMITTEE MEETING WHILE THE DETERMINATION OF A CONFLICT OF INTEREST IS DISCUSSED AND VOTED UPON. THE REMAINING BOARD OR COMMITTEE MEMBERS SHALL DECIDE IF A CONFLICT OF INTEREST EXISTS. MANAGEMENT SHALL DISCLOSE OTHER POTENTIAL CONFLICTS WITH THE COMPLIANCE OFFICER. AFTER EXERCISING DUE DILIGENCE, THE BOARD OR COMMITTEE SHALL DETERMINE WHETHER THE CORPORATION CAN OBTAIN A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT WITH REASONABLE EFFORTS FROM A PERSON OR ENTITY THAT WOULD NOT GIVE RISE TO A CONFLICT OF INTEREST. IF A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT IS NOT REASONABLY ATTAINED UNDER CIRCUMSTANCES THAT WOULD NOT GIVE RISE TO A CONFLICT OF INTEREST, THE BOARD OR COMMITTEE SHALL DETERMINE BY A MAJORITY VOTE OF THE DISINTERESTED TRUSTEES WHETHER THE TRANSACTION OR ARRANGEMENT IS IN THE CORPORATION'S BEST INTEREST AND FOR ITS OWN BENEFIT AND WHETHER THE TRANSACTION IS FAIR AND REASONABLE TO THE CORPORATION AND SHALL MAKE ITS DECISION AS TO WHETHER TO ENTER INTO THE TRANSACTION OR ARRANGEMENT IN CONFORMITY WITH SUCH DETERMINATION. THE COMPLIANCE OFFICER WILL DETERMINE IF A MANAGEMENT TEAM MEMBER OR EMPLOYEE SHOULD BE EXCUSED FROM A DISCUSSION OR PARTICIPATE IN A DECISION IN WHICH THERE MAY BE A CONFLICT OF INTEREST. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION PROCESS THIS ORGANIZATION IS AN AFFILIATE OF NAPLES COMMUNITY HOSPITAL, INC. ("NCH"). ALL COMPENSATION ARRANGEMENTS ARE DETERMINED BY AND PAID THROUGH NCH. COMPENSATION ARRANGEMENTS INVOLVING OUR CEO AND SENIOR LEADERSHIP TEAM ARE ESTABLISHED BY NCH PURSUANT TO A PROCESS THAT SATISFIES THE REBUTTABLE PRESUMPTION PROCEDURE AVAILABLE FOR SECTION 4958 EXCESS BENEFIT TRANSACTION TAX PURPOSES (WHICH REQUIRES A REVIEW OF COMPENSATION DETERMINATION BY DISINTERESTED PERSONS, USE OF APPROPRIATE COMPARABILITY DATA, AND CONTEMPORANEOUS DOCUMENTATION OF THE PROCESS). FORM 990, PART VI, SECTION C, LINE 19 DOCUMENTS AVAILABLE TO THE PUBLIC THE FORMS 1023 AND 990, GOVERNING DOCUMENTS, AUDITED FINANCIAL STATEMENTS, AND CONFLICT OF INTEREST POLICY OF NHSI ARE AVAILABLE TO THE PUBLIC UPON REQUEST. FINANCIAL STATEMENTS ARE ALSO AVAILABLE VIA OUR WEBSITE: WWW.NCHMD.ORG. DOCUMENTS AVAILABLE FOR REQUEST ARE AVAILABLE PURSUANT TO THE PERIOD OF DISCLOSURE PROVIDED IN SECTION 6104(D). FORM 990, PART IX, LINE 9, OTHER EMPLOYEE BENEFITS BENEFIT EXPENSES CONTAIN A NON-CASH PAYMENT TRANSFER FROM NAPLES COMMUNITY HOSPITAL OF $1,582,874 FORM 990, PART XI, LINE 9: TRANSFERS FROM AFFILIATES 14,657,759. NCH HEALTHCARE SYSTEM INC PO BOX 413029 NAPLES FL 34101 592314655 HOLDING CO FL 501(C) (3) LINE 11B, II N/A 0 NAPLES COMMUNITY HOSPITAL INC PO BOX 413029 NAPLES FL 34101 590694358 HEALTHCARE FL 501(C) (3) LINE 3 NCH SYSTEM 0 MARCO ISLAND HOSPITAL INC 40 HEATHWOOD DRIVE MARCO ISLAND FL 34145 592315435 HEALTHCARE FL 501(C) (3) LINE 3 NCH SYSTEM 0 COMMUNITY HOME SERVICES INC PO BOX 413029 NAPLES FL 34101 592440516 SUPPORT ORG. FL 501(C) (3) LINE 11B, II NCH SYSTEM 0 COLLIER HEALTH CARE INC PO BOX 413029 NAPLES FL 34101 650244276 HEALTHCARE FL 501(C) (3) LINE 3 NCH SYSTEM 0 HEALTH RESOURCES CORPORATION 350 7TH STREET NORTH NAPLES FL 34102 592568003 HOLDING COMPANY FL NCH SYSTEM C 0 AMBULATORY SURGICAL CARE CENTER INC 350 7TH STREET NORTH NAPLES FL 34102 592568029 OUTPAT. SURGERY FL HRC C 0 COMMUNITY HOME CARE INC 350 7TH STREET NORTH NAPLES FL 34102 592372966 HOME HEALTH FL HRC C 0 COMMUNITY IMAGING INC 350 7TH STREET NORTH NAPLES FL 34102 592446336 RADIOLOGY LAB FL HRC C 0 1 1 1 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1 1