COLLIER HEALTH CARE INC: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- COLLIER HEALTH CARE INC (EIN 65-0244276)
- Tax period
- 2012-10-01 to 2013-09-30
- Filed
- 2014-08-07
- IRS object ID
- 201412199349300526
- Schema version
- 2012v2.3
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2014-08-07T11:31:25-05:00 | Timestamp |
| Tax Period End Date | 2013-09-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PricewaterhouseCoopers LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2001 MARKET ST SUITE 1700 | AddressLine1 |
| City | PHILADELPHIA | City |
| State | PA | State |
| ZIP Code | 19103 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2012-10-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 650244276 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | COLLIER HEALTH CARE INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| In Care Of Name | % MICHAEL E STEPHENS CFO | InCareOfName |
| Name Control | COLL | NameControl |
| Phone | 2396246338 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 413029 | AddressLine1 |
| Address Line2 | Suite | AddressLine2 |
| City | NAPLES | City |
| State | FL | State |
| ZIP Code | 341013029 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | MICHAEL STEPHENS | Name |
| Title | CFO | Title |
| Phone | 2396246338 | Phone |
| Date Signed | 2014-08-05 | DateSigned |
| Authorize Third Party | true | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 2673303000 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2015-11-30 17:44:51Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | MICHAEL E STEPHENS | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 413029 | AddressLine1 |
| City | NAPLES | City |
| State | FL | State |
| ZIP Code | 341013029 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 1384276 | GrossReceipts |
| Group Return For Affiliates | false | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | www.nchmd.org | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1991 | YearFormation |
| State Legal Domicile | FL | StateLegalDomicile |
| Activity Or Mission Description | THROUGH THE PROVISION OF CHARITABLE HEALTHCARE, OUR MISSION IS TO HELP EVERYONE LIVE A LONGER, HAPPIER, AND HEALTHIER LIFE. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 17 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 10 | NbrIndependentVotingMembers |
| Total Nbr Employees | 25 | TotalNbrEmployees |
| Total Nbr Volunteers | 2 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Contributions Grants Prior Year | 2968969 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 1319776 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 0 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 0 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 0 | InvestmentIncomePriorYear |
| Investment Income Current Year | 0 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 8405 | OtherRevenuePriorYear |
| Other Revenue Current Year | 12092 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 2977374 | TotalRevenuePriorYear |
| Total Revenue Current Year | 1331868 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 1141214 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 1027562 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 1665389 | OtherExpensePriorYear |
| Other Expenses Current Year | 400232 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 2806603 | TotalExpensesPriorYear |
| Total Expenses Current Year | 1427794 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 170771 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -95926 | RevenuesLessExpensesCY |
| Total Assets BOY | 7858420 | TotalAssetsBOY |
| Total Assets EOY | 7230172 | TotalAssetsEOY |
| Total Liabilities BOY | 2332998 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 1998363 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 5525422 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 5231809 | NetAssetsOrFundBalancesEOY |
| Mission Description | THROUGH THE PROVISION OF CHARITABLE HEALTHCARE, OUR MISSION IS TO HELP EVERYONE LIVE A LONGER, HAPPIER, AND HEALTHIER LIFE. | MissionDescription |
| Significant New Program Services | false | SignificantNewProgramServices |
| Significant Change | false | SignificantChange |
| Expense | 609232 | Expense |
| Description | TITLE 21 GRANT: CONTRACT TO PROVIDE HEALTH CARE SERVICES TO CHILDREN WITH SPECIAL NEEDS WHO RESIDE IN COLLIER COUNTY AND HAVE FAMILY INCOME THAT IS 200% OR MORE BELOW THE POVERTY LINE. | Description |
Activity2 Activity2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 818562 | Expense |
| Description | CHILDREN'S MEDICAL SERVICES: PROVISION OF CARE COORDINATION FOR SPECIAL NEEDS CHILDREN WHO QUALIFY FOR MEDICAID OR KIDCARE. | Description |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expense | 1427794 | TotalProgramServiceExpense |
| Described In501 C3 | true | DescribedIn501C3 |
| Schedule B Required | true | ScheduleBRequired |
| Political Activities | false | PoliticalActivities |
| Lobbying Activities | false | LobbyingActivities |
| Donor Advised Funds | false | DonorAdvisedFunds |
| Conservation Easements | false | ConservationEasements |
| Collections Of Art | false | CollectionsOfArt |
| Credit Counseling | false | CreditCounseling |
| Term Or Permanent Endowments | false | TermOrPermanentEndowments |
| Report Land Bldg Equip | true | ReportLandBldgEquip |
| Report Invest Oth Securities | true | ReportInvestOthSecurities |
| Report Prog Rel Invest | false | ReportProgRelInvest |
| Report Other Assets | false | ReportOtherAssets |
| Report Other Liabilities | false | ReportOtherLiabilities |
| Report Fin48 Footnote | false | ReportFin48Footnote |
| Independent Audit Financial Stmt | false | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | true | ConsolidatedAuditFinancialStmt |
| School | false | School |
| Foreign Office | false | ForeignOffice |
| Foreign Activities | false | ForeignActivities |
| More Than5000 K To Organizations | false | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividuals |
| Professional Fundraising | false | ProfessionalFundraising |
| Fundraising Activities | false | FundraisingActivities |
| Gaming | false | Gaming |
| Hospital | false | Hospital |
| Grants To Organizations | false | GrantsToOrganizations |
| Grants To Individuals | false | GrantsToIndividuals |
| Schedule J Required | true | ScheduleJRequired |
| Tax Exempt Bonds | false | TaxExemptBonds |
| Excess Benefit Transaction | false | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | false | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | false | LoanToOfficerOrDQP |
| Grant To Related Person | false | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | false | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | false | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | false | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | false | DeductibleNonCashContributions |
| Deductible Contributions Of Art | false | DeductibleContributionsOfArt |
| Terminated | false | Terminated |
| Partial Liquidation | false | PartialLiquidation |
| Disregarded Entity | false | DisregardedEntity |
| Related Entity | true | RelatedEntity |
| Related Org Controlled Entity | false | RelatedOrgControlledEntity |
| Transfers To Exempt Non Chrtbl Org | false | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | false | ActivitiesConductedPartnership |
| Schedule O Required | true | ScheduleORequired |
| Number Forms Transmitted With1096 | 107 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | true | ComplianceWithBackupWitholding |
| Number Of Employees | 25 | NumberOfEmployees |
| Employment Tax Returns Filed | true | EmploymentTaxReturnsFiled |
| Unrelated Business Income | false | UnrelatedBusinessIncome |
| Foreign Financial Account | false | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTrans |
| Taxable Party Notification | false | TaxablePartyNotification |
| Non Deductible Contributions | false | NonDeductibleContributions |
| Quid Pro Quo Contributions | false | QuidProQuoContributions |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | false | FundsToPayPremiums |
| Premiums Paid | false | PremiumsPaid |
| Indoor Tanning Services | false | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 17 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 10 | NumberIndependentVotingMembers |
| Family Or Business Relationship | true | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | false | DelegationOfManagementDuties |
| Changes To Organizing Docs | false | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuse |
| Members Or Stockholders | true | MembersOrStockholders |
| Election Of Board Members | true | ElectionOfBoardMembers |
| Decisions Subject To Approval | true | DecisionsSubjectToApproval |
| Minutes Of Governing Body | true | MinutesOfGoverningBody |
| Minutes Of Committees | true | MinutesOfCommittees |
| Officer Mailing Address | false | OfficerMailingAddress |
| Local Chapters | true | LocalChapters |
| Policies Reference Chapters | true | PoliciesReferenceChapters |
| Form990 Provided To Governing Body | true | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | true | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | true | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | true | RegularMonitoringEnforcement |
| Whistleblower Policy | true | WhistleblowerPolicy |
| Document Retention Policy | true | DocumentRetentionPolicy |
| Compensation Process CEO | true | CompensationProcessCEO |
| Compensation Process Other | true | CompensationProcessOther |
| Investment In Joint Venture | false | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | FL | StatesWhereCopyOfReturnIsFiled |
| Own Website | X | OwnWebsite |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | MICHAEL E STEPHENS CFO | NamePerson |
| Telephone Number | 2396246338 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 350 7TH STREET NORTH | AddressLine1 |
| City | NAPLES | City |
| State | FL | State |
| ZIP Code | 341023029 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | X | InfoInScheduleOPartVII |
Form990 Part VII Section A Form990PartVIISectionA (37 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Average Hours Per Week RelatedAverageHoursPerWeekRelated | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation |
|---|---|---|---|---|---|---|---|
| Mariann MacDonald | |||||||
| Chairwoman | 0.5 | 1.5 | X | X | 0 | 0 | 0 |
| Thomas J Gazdic | |||||||
| 1st Vice Chairman/Treasurer | 0.5 | 1.5 | X | X | 0 | 0 | 0 |
| William Allyn | |||||||
| Trustee | 0.5 | 1.5 | X | 0 | 0 | 0 | |
| Kenneth Bookman MD | |||||||
| Trustee | 0.5 | 41.5 | X | 0 | 543154 | 33094 | |
| Alberto M De La Rivaherrera MD | |||||||
| Trustee | 0.5 | 1.5 | X | 0 | 0 | 0 | |
| Terrance Flynn | |||||||
| Trustee | 0.5 | 1.5 | X | 0 | 0 | 0 | |
| Daniel Gill | |||||||
| Trustee | 0.5 | 1.5 | X | 0 | 0 | 0 | |
| Kay Gow | |||||||
| 2nd Vice Chairwoman | 0.5 | 1.5 | X | X | 0 | 0 | 0 |
| Elizabeth FosterRN | |||||||
| Trustee | 0.5 | 41.5 | X | 0 | 75262 | 12289 | |
| Kim Ciccarelli Kantor | |||||||
| Trustee | 0.5 | 1.5 | X | 0 | 0 | 0 | |
| Hermes Koop MD | |||||||
| Trustee | 0.5 | 1.5 | X | 0 | 0 | 0 | |
| John Lewis MD | |||||||
| Secretary | 0.5 | 1.5 | X | X | 0 | 0 | 0 |
| Robert Moses | |||||||
| Trustee | 0.5 | 1.5 | X | 0 | 0 | 0 | |
| Wayne Mullican | |||||||
| Trustee | 0.5 | 1.5 | X | 0 | 0 | 0 | |
| Michelle Barrett | |||||||
| Trustee | 0.5 | 41.5 | X | 0 | 72755 | 26229 | |
| Scot C Schultz MD | |||||||
| Trustee | 0.5 | 1.5 | X | 0 | 0 | 0 | |
| Norman Thomson MD | |||||||
| Trustee | 0.5 | 1.5 | X | 0 | 0 | 0 | |
| Gregory Russo | |||||||
| Trustee | 0.5 | 1.5 | X | 0 | 0 | 0 | |
| Allen Weiss MD | |||||||
| President/CEO/Trustee | 1.0 | 44.0 | X | X | 0 | 1333749 | 26068 |
| Ken Plunkitt MD | |||||||
| Trustee | 0.5 | 1.5 | X | 0 | 0 | 0 | |
| Stephen Lange MD | |||||||
| TRUSTEE | 0.5 | 1.5 | X | 0 | 0 | 0 | |
| Vincent P Mona | |||||||
| Trustee | 0.5 | 1.5 | X | 0 | 0 | 0 | |
| Craig Smith MD | |||||||
| Trustee | 0.5 | 1.5 | X | 0 | 0 | 0 | |
| Ralph Stayer | |||||||
| Trustee | 0.5 | 1.5 | X | 0 | 0 | 0 | |
| Kevin D Cooper | |||||||
| General Counsel/Chief of Staff | 1.0 | 44.0 | X | 0 | 463096 | 33284 | |
| Phillip Dutcher | |||||||
| COO, NCH Healthcare System | 1.0 | 44.0 | X | 0 | 468149 | 10388 | |
| Aurora Estevez MD | |||||||
| Chief Medical Officer | 1.0 | 44.0 | X | 0 | 493680 | 18677 | |
| Vicki D Orr- Term 0513 | |||||||
| CFO/Assistant Treasurer | 1.0 | 44.0 | X | 0 | 454402 | 33334 | |
| Elizabeth Martin | |||||||
| Assistant Secretary | 1.0 | 44.0 | X | 0 | 57567 | 14812 | |
| John Mcgirl | |||||||
| Chief Human Resources Officer | 1.0 | 44.0 | X | 0 | 126861 | 5356 | |
| Helen Thompson | |||||||
| Chief Information Officer | 1.0 | 44.0 | X | 0 | 125585 | 2417 | |
| Michele Thoman | |||||||
| Chief Nursing Officer | 1.0 | 44.0 | X | 0 | 326473 | 33554 | |
| Michael Riley | |||||||
| Chief Strategy Officer | 1.0 | 44.0 | X | 0 | 234325 | 31934 | |
| James K Martin | |||||||
| Chief Development Officer | 1.0 | 44.0 | X | 0 | 277234 | 33175 | |
| Zachary Bostock | |||||||
| CHIEF ADMINISTRATIVE OFFICER | 1.0 | 44.0 | X | 0 | 246115 | 25341 | |
| Gary Parsons MD | |||||||
| Chief Medical Officer | 1.0 | 44.0 | X | 0 | 383268 | 18018 | |
| Michael Stephens- Start 0513 | |||||||
| CFO/Assistant Treasurer | 0.5 | 44.0 | X | 0 | 0 | 0 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 0 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 5681675 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 357970 | TotalOtherCompensation |
| Number Individuals GT100 K | 0 | NumberIndividualsGT100K |
| Formers Listed | false | FormersListed |
| Total Comp GT150 K | true | TotalCompGT150K |
| Compensation From Other Sources | false | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (3 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| LEE MEMORIAL HOSPITAL | |||||
| 636 DEL PRADO BLVD | CAPE CORAL | FL | 33660 | HEALTHCARE SERVICES | 228691 |
| COLLIER HEALTH SERVICES INC | |||||
| PO BOX 12229 | NAPLES | FL | 34101 | HEALTHCARE SERVICES | 158347 |
| NAPLES COMMUNITY HOSPITAL | |||||
| PO BOX 413029 | NAPLES | FL | 34101 | HEALTHCARE SERVICES | 143959 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 3 | NumberOfContractorsGT100K |
| Government Grants | 1319776 | GovernmentGrants |
| Total Contributions | 1319776 | TotalContributions |
| Total Program Service Revenue | 0 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Income From Invest Bond Proceeds IncomeFromInvestBondProceeds
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Royalties Revenue RoyaltiesRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 64500 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 52408 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 12092 | Real |
| Personal | 0 | Personal |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 12092 | TotalRevenueColumn |
| Exclusion | $12,092 | ExclusionAmount |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Income From Gaming NetIncomeFromGaming
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Income Or Loss NetIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 0 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 1331868 | TotalRevenueColumn |
| Exclusion | $12,092 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | X | InfoInScheduleOPartIX |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
| Program Services | 0 | ProgramServices |
Grants To Domestic Individuals GrantsToDomesticIndividuals
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
| Program Services | 0 | ProgramServices |
Foreign Grants ForeignGrants
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
| Program Services | 0 | ProgramServices |
Benefits To Members BenefitsToMembers
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
| Program Services | 0 | ProgramServices |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
| Program Services | 0 | ProgramServices |
| Management And General | 0 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Comp Disqual Persons CompDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
| Program Services | 0 | ProgramServices |
| Management And General | 0 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 844709 | Total |
| Program Services | 844709 | ProgramServices |
| Fundraising | 0 | Fundraising |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 30474 | Total |
| Program Services | 30474 | ProgramServices |
| Management And General | 0 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 89816 | Total |
| Program Services | 89816 | ProgramServices |
| Management And General | 0 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 62563 | Total |
| Program Services | 62563 | ProgramServices |
| Management And General | 0 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4760 | Total |
| Program Services | 4760 | ProgramServices |
| Management And General | 0 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
| Program Services | 0 | ProgramServices |
| Management And General | 0 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
| Program Services | 0 | ProgramServices |
| Management And General | 0 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Fees For Services Lobbying FeesForServicesLobbying
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
| Program Services | 0 | ProgramServices |
| Management And General | 0 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
| Fundraising | 0 | Fundraising |
Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
| Program Services | 0 | ProgramServices |
| Management And General | 0 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 147587 | Total |
| Program Services | 147587 | ProgramServices |
| Management And General | 0 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
| Program Services | 0 | ProgramServices |
| Management And General | 0 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 36830 | Total |
| Program Services | 36830 | ProgramServices |
| Management And General | 0 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
| Program Services | 0 | ProgramServices |
| Management And General | 0 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Royalties Royalties
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
| Program Services | 0 | ProgramServices |
| Management And General | 0 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 117226 | Total |
| Program Services | 117226 | ProgramServices |
| Management And General | 0 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
| Program Services | 0 | ProgramServices |
| Management And General | 0 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
| Program Services | 0 | ProgramServices |
| Management And General | 0 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
| Program Services | 0 | ProgramServices |
| Management And General | 0 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
| Program Services | 0 | ProgramServices |
| Management And General | 0 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Payments To Affiliates PaymentsToAffiliates
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
| Program Services | 0 | ProgramServices |
| Management And General | 0 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 74649 | Total |
| Program Services | 74649 | ProgramServices |
| Management And General | 0 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 14095 | Total |
| Program Services | 14095 | ProgramServices |
| Management And General | 0 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Other Expenses OtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | MEDICAL SUPPLIES | Description |
| Total | 5085 | Total |
| Program Services | 5085 | ProgramServices |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1427794 | Total |
| Program Services | 1427794 | ProgramServices |
| Management And General | 0 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part X | X | InfoInScheduleOPartX |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 384429 | BOY |
| EOY | 53 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 118342 | BOY |
| EOY | 199019 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Receivables From Officers Etc ReceivablesFromOfficersEtc
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Receivables From Disqual Persons ReceivablesFromDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3396250 | BOY |
| EOY | 3182500 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 4679832 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 1234916 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3557116 | BOY |
| EOY | 3444916 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 402283 | BOY |
| EOY | 403684 | EOY |
Investments Program Related InvestmentsProgramRelated
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Intangible Assets IntangibleAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7858420 | BOY |
| EOY | 7230172 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1309370 | BOY |
| EOY | 1123353 | EOY |
Grants Payable GrantsPayable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Deferred Revenue DeferredRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1023628 | BOY |
| EOY | 875010 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Escrow Account Liability EscrowAccountLiability
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Loans From Officers Directors LoansFromOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2332998 | BOY |
| EOY | 1998363 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5525422 | BOY |
| EOY | 5231809 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5525422 | BOY |
| EOY | 5231809 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7858420 | BOY |
| EOY | 7230172 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | -95926 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | -197687 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | false | AccountantCompileOrReview |
| FS Audited | true | FSAudited |
FS Audited Basis FSAuditedBasis
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | true | AuditCommittee |
| Federal Grant Audit Required | true | FederalGrantAuditRequired |
| Federal Grant Audit Performed | true | FederalGrantAuditPerformed |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Art Public Exhibition Amts | ArtPublicExhibitionAmts | |
| Held Works Of Art Amts | HeldWorksOfArtAmts | |
| Current Year Minus3 Years | CurrentYearMinus3Years | |
| Current Year Minus4 Years | CurrentYearMinus4Years |
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 683663 | OtherCostOrOtherBasis |
| Book Value | 683663 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 3916200 | OtherCostOrOtherBasis |
| Depreciation | 1210159 | Depreciation |
| Book Value | 2706041 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Leasehold Improvements | LeaseholdImprovements |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 79969 | OtherCostOrOtherBasis |
| Depreciation | 24757 | Depreciation |
| Book Value | 55212 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Land Buildings | OtherLandBuildings | |
| Total Of Book Value Land Buildings | 3444916 | TotalOfBookValueLandBuildings |
| Financial Derivatives | FinancialDerivatives | |
| Closely Held Equity Interests | CloselyHeldEquityInterests |
Other Securities OtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | CERTIFICATE OF DEPOSIT BOA | Description |
| Book Value | 403684 | BookValue |
| Method Of Valuation | F | MethodOfValuation |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Securities | 403684 | TotalOfBookValueSecurities |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | X | CompensationCommittee |
| Independent Consultant | X | IndependentConsultant |
| Written Employment Contract | X | WrittenEmploymentContract |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | false | SeverancePayment |
| Supplemental Nonqual Retire Plan | true | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | false | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | false | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | false | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | false | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | false | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | true | AnyNonFixedPayments |
| Initial Contract Exception | false | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (11 entries)
| TitleTitle | Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Kenneth Bookman MD | ||||||||||||||
| Trustee | 0 | 439668 | 0 | 86486 | 0 | 17000 | 0 | 10000 | 0 | 23094 | 0 | 576248 | 0 | 0 |
| Kevin D Cooper | ||||||||||||||
| General Counsel/Chief of Staff | 0 | 382343 | 0 | 63753 | 0 | 17000 | 0 | 9800 | 0 | 23484 | 0 | 496380 | 0 | 0 |
| Phillip Dutcher | ||||||||||||||
| COO, NCH Healthcare System | 0 | 387396 | 0 | 63753 | 0 | 17000 | 0 | 9800 | 0 | 588 | 0 | 478537 | 0 | 0 |
| Aurora Estevez MD | ||||||||||||||
| Chief Medical Officer | 0 | 409138 | 0 | 67542 | 0 | 17000 | 0 | 9800 | 0 | 8877 | 0 | 512357 | 0 | 0 |
| Vicki D Orr- Term 0513 | ||||||||||||||
| CFO/Assistant Treasurer | 0 | 373649 | 0 | 63753 | 0 | 17000 | 0 | 9800 | 0 | 23534 | 0 | 487736 | 0 | 0 |
| Michele Thoman | ||||||||||||||
| Chief Nursing Officer | 0 | 266666 | 0 | 44207 | 0 | 15600 | 0 | 10000 | 0 | 23554 | 0 | 360027 | 0 | 0 |
| Michael Riley | ||||||||||||||
| Chief Strategy Officer | 0 | 217566 | 0 | 16759 | 0 | 0 | 0 | 8808 | 0 | 23126 | 0 | 266259 | 0 | 0 |
| James K Martin | ||||||||||||||
| Chief Development Officer | 0 | 257179 | 0 | 20055 | 0 | 0 | 0 | 9731 | 0 | 23444 | 0 | 310409 | 0 | 0 |
| Zachary Bostock | ||||||||||||||
| CHIEF ADMINISTRATIVE OFFICER | 0 | 232081 | 0 | 13572 | 0 | 462 | 0 | 2369 | 0 | 22972 | 0 | 271456 | 0 | 0 |
| Allen Weiss MD | ||||||||||||||
| President/CEO/Trustee | 0 | 1206453 | 0 | 110296 | 0 | 17000 | 0 | 9800 | 0 | 16268 | 0 | 1359817 | 0 | 492651 |
| Gary Parsons MD | ||||||||||||||
| Chief Medical Officer | 0 | 314265 | 0 | 52060 | 0 | 16943 | 0 | 9164 | 0 | 8854 | 0 | 401286 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN PARTICIPATION | FORM 990, SCHEDULE J, LINE 4B | IN 1996, THE NCH HEALTHCARE SYSTEM, INC. BOARD OF TRUSTEES APPROVED A RECOMMENDATION OF THE EXECUTIVE COMPENSATION COMMITTEE THAT CERTAIN EXECUTIVES OF THE NCH HEALTHCARE SYSTEM WOULD BE PROVIDED WITH A SERP THAT WAS SUPPORTED THROUGH THE USE OF LIFE INSURANCE PROGRAMS. DUE TO CHANGES IN THE IRS TAX CODE, EFFECTIVE OCTOBER 1, 2003, THE FUNDING MECHANISM FOR ACTIVE EMPLOYEES WAS CHANGED FROM USING LIFE INSURANCE TO FUNDING RABBI TRUSTS. HOWEVER, THE PLAN DESIGN WAS NOT CHANGED. DURING FISCAL YEAR 2013, THE TRUST WAS OWNED BY NCH AND WAS SUBJECT TO THE RISK OF CREDITORS OF NCH. CONSEQUENTLY, DEPOSITS MADE TO THE TRUSTS REMAINED AS ASSETS OF NCH UNTIL THE PARTICIPANT VESTS IN ACCORDANCE WITH THE PLAN. THE SERP HAD BEEN DISCONTINUED WITH THE EXCEPTION OF DR. ALLEN WEISS, PRESIDENT & CEO, WHO NO LONGER RECEIVED CONTRIBUTIONS TO THE PLAN, BUT WHOSE PLAN CONTINUED TO REALIZE INVESTMENT INCOME/LOSSES ON PREVIOUS CONTRIBUTIONS WHICH HAVE BEEN REPORTED ON PRIOR YEAR FORMS 990. DURING CALENDAR YEAR 2012, THE ACCOUNT OF DR. ALLEN WEISS MET THE CRITERIA FOR THE SERP PROGRAM AND HE RECEIVED A FINAL DISTRIBUTION IN THE AMOUNT OF $537,124. THIS DISTRIBUTION IS INCLUDED IN SCHEDULE J, PART II, COLUMN B(i). AS OF THE FINAL DISTRIBUTION TO DR. ALLEN WEISS THE RABBI TRUST AND ASSOCIATED SERP PLAN WERE DISCONTINUED. |
| PROVISIONS OF NON-FIXED PAYMENTS | FORM 990, SCHEDULE J, LINE 7 | THIS ORGANIZATION IS AN AFFILIATE OF NAPLES COMMUNITY HOSPITAL, INC. ("NCH"). ALL COMPENSATION ARRANGEMENTS ARE DETERMINED BY 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. |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (9 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| DETAIL OF BUSINESS RELATIONSHIPS | FORM 990, PART VI, SECTION A, LINE 2 | ALBERTO M. DE LA RIVAHERRERA, M.D. AND JOHN LEWIS, M.D. ARE MINORITY PARTNERS OF SOUTHWEST FLORIDA EMERGENCY MANAGEMENT, INC. |
| GOVERNING BODY AND MANAGEMENT | FORM 990, PART VI, SECTION A, LINES 6, 7A & 7B | THE BOARD OF DIRECTORS OF NCH HEALTHCARE SYSTEM, INC., SOLE MEMBER OF THIS ORGANIZATION, ELECTS THIS ORGANIZATION'S DIRECTORS. |
| FORM 990 REVIEW PROCESS | FORM 990, PART VI, SECTION B, LINE 11 | INFORMATION RELATED TO COLLIER HEALTH CARE INC.'S ("CHI") FORM 990 FILING IS GATHERED BY FINANCE STAFF AND PROVIDED TO PRICEWATERHOUSECOOPERS LLP FOR REVIEW AND RETURN PREPARATION. THE 2012 FORM 990 FOR THE FISCAL YEAR ENDING SEPTEMBER 30, 2013 WAS REVIEWED AND APPROVED BY THE CHAIRMAN OF THE NCH FINANCE COMMITTEE, SENIOR LEADERSHIP TEAM, AND OUTSIDE COUNSEL FOR THE BOARD PRIOR TO FILING WITH THE IRS. |
| CONFLICT OF INTEREST POLICY | FORM 990, PART VI, SECTION B, LINE 12 | ANNUALLY, ALL CHI OFFICERS, DIRECTORS, TRUSTEES, AND KEY EMPLOYEES ARE REQUIRED TO DISCLOSE INTERESTS THAT COULD POTENTIALLY GIVE RISE TO CONFLICTS. |
| COMPENSATION PROCESS | FORM 990, PART VI, SECTION B, LINE 15 | 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 DETERMINATIONS BY DISINTERESTED PERSONS, USE OF APPROPRIATE COMPARABILITY DATA, AND CONTEMPORANEOUS DOCUMENTATION OF THE PROCESS). WRITTEN EMPLOYMENT CONTRACTS ARE ALSO UTILIZED. |
| DOCUMENTS AVAILABILITY TO PUBLIC | FORM 990, PART VI, SECTION C, LINE 19 | THE FORMS 1023 AND 990, GOVERNING DOCUMENTS, AUDITED FINANCIAL STATEMENTS, AND CONFLICT OF INTEREST POLICY OF CHI ARE AVAILABLE TO THE PUBLIC UPON REQUEST. FINANCIAL STATEMENTS ARE ALSO AVAILABLE VIA OUR WEBSITE: WWW.NCHMD.ORG. |
| DETAIL OF OTHER CHANGES IN NET ASSETS | FORM 990, PART XI, LINE 9 | TRANSFERS TO RELATED ORGANIZATIONS $ (346,305) DEFERRED CAPITAL LEASE REVENUE 148,618 --------- TOTAL OTHER CHANGES IN NET ASSETS $ (197,687) ========= |
| INAPPLICABILITY OF SCHEDULE H | FORM 990, SCHEDULE A, PART I, LINE 3 | ALTHOUGH COLLIER HEALTH CARE, INC. RECEIVES ITS PUBLIC CHARITY STATUS AS A HOSPITAL, IT IS NOT REQUIRED TO FILE SCHEDULE H OF THE FORM 990, AS THE ORGANIZATION IS NOT, AND IS NOT REQUIRED TO BE, LICENSED, REGISTERED OR SIMILARLY RECOGNIZED BY THE STATE OF FLORIDA AS A HOSPITAL. |
| OTHER FEES FOR SERVICES FOR NON-EMPLOYEES | FORM 990 PART IX LINE 11G | DESCRIPTION:TITLE 21 GRANT TOTAL FEES:147587 |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (5 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Controlled OrgControlledOrg |
|---|---|---|---|---|---|---|---|---|---|---|
| NCH HEALTHCARE SYSTEM INC | ||||||||||
| PO BOX 413029 | NAPLES | FL | 34101 | 592314655 | HOLDING CO | FL | 501(C)(3) | 11, B | NA | false |
| NAPLES COMMUNITY HOSPITAL INC | ||||||||||
| PO BOX 413029 | NAPLES | FL | 34101 | 590694358 | HEALTHCARE | FL | 501(C)(3) | 3 | NCH SYSTEM | false |
| NCHMD INC | ||||||||||
| PO BOX 413029 | NAPLES | FL | 34101 | 331075317 | HEALTHCARE | FL | 501(C)(3) | 9 | NCH SYSTEM | false |
| COMMUNITY HOME SERVICES INC | ||||||||||
| PO BOX 413029 | NAPLES | FL | 34101 | 592440516 | SUPPORT ORG | FL | 501(C)(3) | 11, B | NCH SYSTEM | false |
| MARCO ISLAND HOSPITAL INC | ||||||||||
| 40 HEATHWOOD DRIVE | MARCO ISLAND | FL | 34145 | 592315435 | HEALTHCARE | FL | 501(C)(3) | 3 | NCH SYSTEM | false |
Form990 Schedule R Part IV Form990ScheduleRPartIV (4 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivityPrimaryActivity | Legal Domicile StateLegalDomicileState | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Type Of EntityTypeOfEntity | Controlled OrgControlledOrg |
|---|---|---|---|---|---|---|---|---|---|
| HEALTH RESOURCES CORPORATION | |||||||||
| 350 7TH STREET NORTH | NAPLES | FL | 34102 | 592568003 | HOLDING COMPANY | FL | NCH SYSTEM | C CORP | false |
| AMBULATORY SURGICAL CARE CENTER INC | |||||||||
| 350 7TH STREET NORTH | NAPLES | FL | 34102 | 592568029 | OUTPAT. SURGERY | FL | HRC | C CORP | false |
| COMMUNITY HOME CARE INC | |||||||||
| 350 7TH STREET NORTH | NAPLES | FL | 34102 | 592372966 | HOME HEALTH | FL | HRC | C CORP | false |
| COMMUNITY IMAGING INC | |||||||||
| 350 7TH STREET NORTH | NAPLES | FL | 34102 | 592446336 | RADIOLOGY LAB | FL | HRC | C CORP | false |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | true | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | true | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | true | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | false | LoansOrGuaranteesFromOtherOrg |
| Dividends Related Organization | false | DividendsRelatedOrganization |
| Sale Of Assets To Other Org | false | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | false | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | true | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | true | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | true | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | true | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | true | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | true | SharingOfFacilities |
| Sharing Of Paid Employees | false | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | true | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | true | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | true | OtherTransferToOtherOrg |
| Other Transfer From Other Org | true | OtherTransferFromOtherOrg |
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