2014-08-07T11:31:25-05:00 2013-09-30 PricewaterhouseCoopers LLP 2001 MARKET ST SUITE 1700 PHILADELPHIA PA 19103 990 2012-10-01 650244276 COLLIER HEALTH CARE INC % MICHAEL E STEPHENS CFO COLL 2396246338 PO BOX 413029 Suite NAPLES FL 341013029 MICHAEL STEPHENS 2396246338 2014-08-05 true 2673303000 2012 2015-11-30 17:44:51Z MICHAEL E STEPHENS PO BOX 413029 NAPLES FL 341013029 1384276 false X www.nchmd.org X 1991 FL THROUGH THE PROVISION OF CHARITABLE HEALTHCARE, OUR MISSION IS TO HELP EVERYONE LIVE A LONGER, HAPPIER, AND HEALTHIER LIFE. 17 10 25 2 0 2968969 1319776 0 0 0 0 8405 12092 2977374 1331868 0 0 0 0 1141214 1027562 0 0 0 1665389 400232 2806603 1427794 170771 -95926 7858420 7230172 2332998 1998363 5525422 5231809 THROUGH THE PROVISION OF CHARITABLE HEALTHCARE, OUR MISSION IS TO HELP EVERYONE LIVE A LONGER, HAPPIER, AND HEALTHIER LIFE. false false 609232 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. 818562 CHILDREN'S MEDICAL SERVICES: PROVISION OF CARE COORDINATION FOR SPECIAL NEEDS CHILDREN WHO QUALIFY FOR MEDICAID OR KIDCARE. 1427794 true true false false false false false false false true true false false false false false true false false false false false false false false false false false true false false false false false false false false false false false false false true false false false true 107 0 true 25 true false false false false false false false false false false X 17 10 true false false false true true true true true false true true true true true true true true true true false FL X X MICHAEL E STEPHENS CFO 2396246338 350 7TH STREET NORTH NAPLES FL 341023029 X Mariann MacDonald 0.5 1.5 X X 0 0 0 Thomas J Gazdic 0.5 1.5 X X 0 0 0 William Allyn 0.5 1.5 X 0 0 0 Kenneth Bookman MD 0.5 41.5 X 0 543154 33094 Alberto M De La Rivaherrera MD 0.5 1.5 X 0 0 0 Terrance Flynn 0.5 1.5 X 0 0 0 Daniel Gill 0.5 1.5 X 0 0 0 Kay Gow 0.5 1.5 X X 0 0 0 Elizabeth FosterRN 0.5 41.5 X 0 75262 12289 Kim Ciccarelli Kantor 0.5 1.5 X 0 0 0 Hermes Koop MD 0.5 1.5 X 0 0 0 John Lewis MD 0.5 1.5 X X 0 0 0 Robert Moses 0.5 1.5 X 0 0 0 Wayne Mullican 0.5 1.5 X 0 0 0 Michelle Barrett 0.5 41.5 X 0 72755 26229 Scot C Schultz MD 0.5 1.5 X 0 0 0 Norman Thomson MD 0.5 1.5 X 0 0 0 Gregory Russo 0.5 1.5 X 0 0 0 Allen Weiss MD 1.0 44.0 X X 0 1333749 26068 Ken Plunkitt MD 0.5 1.5 X 0 0 0 Stephen Lange MD 0.5 1.5 X 0 0 0 Vincent P Mona 0.5 1.5 X 0 0 0 Craig Smith MD 0.5 1.5 X 0 0 0 Ralph Stayer 0.5 1.5 X 0 0 0 Kevin D Cooper 1.0 44.0 X 0 463096 33284 Phillip Dutcher 1.0 44.0 X 0 468149 10388 Aurora Estevez MD 1.0 44.0 X 0 493680 18677 Vicki D Orr- Term 0513 1.0 44.0 X 0 454402 33334 Elizabeth Martin 1.0 44.0 X 0 57567 14812 John Mcgirl 1.0 44.0 X 0 126861 5356 Helen Thompson 1.0 44.0 X 0 125585 2417 Michele Thoman 1.0 44.0 X 0 326473 33554 Michael Riley 1.0 44.0 X 0 234325 31934 James K Martin 1.0 44.0 X 0 277234 33175 Zachary Bostock 1.0 44.0 X 0 246115 25341 Gary Parsons MD 1.0 44.0 X 0 383268 18018 Michael Stephens- Start 0513 0.5 44.0 X 0 0 0 0 5681675 357970 0 false true false 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 3 1319776 1319776 0 0 0 0 64500 52408 12092 0 12092 12092 0 0 0 0 0 1331868 12092 X 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 844709 844709 0 30474 30474 0 0 89816 89816 0 0 62563 62563 0 0 4760 4760 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 147587 147587 0 0 0 0 0 0 36830 36830 0 0 0 0 0 0 0 0 0 0 117226 117226 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 74649 74649 0 0 14095 14095 0 0 MEDICAL SUPPLIES 5085 5085 1427794 1427794 0 0 X 384429 53 0 0 118342 199019 0 0 0 0 0 0 3396250 3182500 0 0 0 0 4679832 1234916 3557116 3444916 0 0 402283 403684 0 0 0 0 0 0 7858420 7230172 1309370 1123353 0 0 1023628 875010 0 0 0 0 0 0 0 0 0 0 0 0 2332998 1998363 X 5525422 5231809 0 0 0 0 5525422 5231809 7858420 7230172 X -95926 -197687 X false true X true true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 683663 683663 3916200 1210159 2706041 79969 24757 55212 3444916 CERTIFICATE OF DEPOSIT BOA 403684 F 403684 X X X X X false true false false false false false true false Kenneth Bookman MD 0 439668 0 86486 0 17000 0 10000 0 23094 0 576248 0 0 Kevin D Cooper 0 382343 0 63753 0 17000 0 9800 0 23484 0 496380 0 0 Phillip Dutcher 0 387396 0 63753 0 17000 0 9800 0 588 0 478537 0 0 Aurora Estevez MD 0 409138 0 67542 0 17000 0 9800 0 8877 0 512357 0 0 Vicki D Orr- Term 0513 0 373649 0 63753 0 17000 0 9800 0 23534 0 487736 0 0 Michele Thoman 0 266666 0 44207 0 15600 0 10000 0 23554 0 360027 0 0 Michael Riley 0 217566 0 16759 0 0 0 8808 0 23126 0 266259 0 0 James K Martin 0 257179 0 20055 0 0 0 9731 0 23444 0 310409 0 0 Zachary Bostock 0 232081 0 13572 0 462 0 2369 0 22972 0 271456 0 0 Allen Weiss MD 0 1206453 0 110296 0 17000 0 9800 0 16268 0 1359817 0 492651 Gary Parsons MD 0 314265 0 52060 0 16943 0 9164 0 8854 0 401286 0 0 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. 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 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 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 true true true false false false false false true true true true true true false true true true true