2012-08-09T07:47:56-05:00 2011-09-30 PricewaterhouseCoopers LLP 2001 MARKET ST SUITE 1700 PHILADELPHIA PA 19103 990 2010-10-01 650244276 COLLIER HEALTH CARE INC COLL PO BOX 413029 NAPLES FL 341013029 VICKI ORR 2012-08-03 2673303000 2010 2016-02-24 21:20:13Z VICKI D ORR PO BOX 413029 NAPLES FL 341013029 2672479 false X www.nchmd.org X 1991 FL THROUGH THE PROVISION OF CHARITABLE HEALTHCARE, OUR MISSION IS TO PROMOTE, MAINTAIN, AND RESTORE HEALTH FOR THOSE WE SERVE. 22 13 27 4 0 0 2419944 2607979 0 0 0 0 8328 10095 2428272 2618074 0 0 0 0 1299495 1262799 0 0 0 1216365 1332730 2515860 2595529 -87588 22545 8642404 8134250 2588681 2560406 6053723 5573844 THROUGH THE PROVISION OF CHARITABLE HEALTHCARE, OUR MISSION IS TO PROMOTE, MAINTAIN, AND RESTORE HEALTH FOR THOSE WE SERVE. false false 1596139 0 0 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. 978731 0 0 CHILDREN'S MEDICAL SERVICES: PROVISION OF CARE COORDINATION FOR SPECIAL NEEDS CHILDREN WHO QUALIFY FOR MEDICAID OR KIDCARE. 20659 0 0 MEDICAL SERVICES: PROVISION OF NURSING SERVICES. 2595529 true true false false false false false false false true false 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 false true 98 0 true 27 true false false false false false false false false false false X 22 13 true false false false true true true true true false true true true true true true true true true true false FL X X VICKI ORR CFOASST TREASURER 2395137630 350 7TH STREET NORTH NAPLES FL 341023029 X Joseph I Perkovich 0.5 X X 0 0 0 Mariann MacDonald 0.5 X X 0 0 0 Ambassador Francis Rooney 0.5 X X 0 0 0 Thomas J Gazdic 0.5 X X 0 0 0 William Allyn 0.5 X 0 0 0 Jay H Baker 0.5 X 0 0 0 Kenneth Bookman MD 0.5 X 0 144916 8879 Susan L Dalton 0.5 X 0 0 0 Paul Dernbach MD 0.5 X 0 85500 0 Alberto M de la Rivaherrera MD 0.5 X 0 0 0 Michael Feuer 0.5 X 0 0 0 Terrance Flynn 0.5 X 0 0 0 Daniel Gill 0.5 X 0 0 0 Kay Gow 0.5 X 0 0 0 Joann Jenner 0.5 X 0 77422 18575 Amy Jewell RN 0.5 X 0 30423 6972 Kim Ciccarelli Kantor 0.5 X 0 0 0 Hermes Koop MD 0.5 X 0 5250 0 John Lewis MD 0.5 X 0 0 0 Frank Linsalata 0.5 X 0 0 0 Admiral Paul D Miller 0.5 X 0 0 0 Robert Moses 0.5 X 0 0 0 Wayne Mullican 0.5 X 0 0 0 Karli Sander 0.5 X 0 48284 1912 Scot C Schultz MD 0.5 X 0 0 0 Norman Thomson MD 0.5 X 0 0 0 Carl E Westman 0.5 X 0 0 0 Gregory Wilkerson RN 0.5 X 0 64057 10986 Allen Weiss MD 1.0 X X 0 643511 55504 Kevin D Cooper 1.0 X 0 374799 18113 Phillip Dutcher 1.0 X 0 376608 10431 Aurora Estevez MD 1.0 X 0 394146 18216 Vicki D Orr 1.0 X 0 369494 31028 Elizabeth Martin 1.0 X 0 59103 14080 BRIAN SETTLE TERM 9302011 1.0 X 0 254326 23972 SUSAN WOLFF TERM 9302011 1.0 X 0 261411 17919 Michele Thoman 1.0 X 0 242658 22465 Michael Riley 1.0 X 0 189961 29055 James K Martin 1.0 X 0 298520 13603 WILLIAM EDWARDS TERM 642011 1.0 X 0 107111 6012 Zach Bostock Start 091911 1.0 X 0 0 0 Gary Parsons MD 1.0 X 0 153351 3326 0 4180851 311048 1 false true false LEE MEMORIAL HOSPITAL 636 DEL PRADO BLVD CAPE CORAL FL 33660 HEALTHCARE SERVICES 108328 NAPLES COMMUNITY HOSPITAL PO BOX 413029 NAPLES FL 34101 HEALTHCARE SERVICES 131839 2 2607979 2607979 0 0 0 0 64500 54405 10095 10095 10095 0 0 0 0 0 2618074 10095 0 0 0 0 0 0 1047120 1047120 0 0 36045 36045 0 0 102521 102521 0 0 77113 77113 0 0 49150 49150 0 0 0 0 0 0 0 987387 987387 0 0 0 83060 83060 0 0 0 0 122060 122060 0 0 345 345 0 0 0 0 0 0 67809 67809 0 0 22619 22619 0 0 OTHER MISCELLANEOUS 300 300 0 0 2595529 2595529 0 0 420094 154696 64726 172538 4037500 3752500 4665401 1011685 3719871 3653716 400213 400800 8642404 8134250 1242680 1377548 1346001 1182858 2588681 2560406 X 6053723 5573844 6053723 5573844 8642404 8134250 X 22545 -502424 X false true true X true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 683663 683663 3916199 1004308 2911891 65539 7377 58162 3653716 X true true X X X X X true true false false false false false true false Kenneth Bookman MD 0 100723 0 40068 0 4125 0 4059 0 4820 0 153795 0 0 Kevin D Cooper 0 343159 0 15140 0 16500 0 9800 0 8313 0 392912 0 0 Phillip Dutcher 0 361468 0 15140 0 0 0 9800 0 631 0 387039 0 0 Aurora Estevez MD 0 360652 0 16994 0 16500 0 9800 0 8416 0 412362 0 0 Vicki D Orr 0 337854 0 15140 0 16500 0 9800 0 21228 0 400522 0 0 BRIAN SETTLE TERM 9302011 0 226108 0 11718 0 16500 0 9800 0 14172 0 278298 0 0 SUSAN WOLFF TERM 9302011 0 232727 0 12184 0 16500 0 9800 0 8119 0 279330 0 0 Michele Thoman 0 232585 0 10073 0 0 0 6743 0 15722 0 265123 0 0 Michael Riley 0 189893 0 68 0 0 0 7753 0 21302 0 219016 0 0 James K Martin 0 208452 0 90068 0 0 0 1177 0 12426 0 312123 0 0 Allen Weiss MD 0 598143 0 28868 0 16500 0 40671 0 14833 0 699015 0 0 Gary Parsons MD 0 69158 0 80068 0 4125 0 1467 0 1859 0 156677 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. THE TRUST IS OWNED BY NCH AND IS SUBJECT TO THE RISK OF CREDITORS OF NCH. CONSEQUENTLY, DEPOSITS MADE TO THE TRUSTS REMAIN AS ASSETS OF NCH UNTIL THE PARTICIPANT VESTS IN ACCORDANCE WITH THE PLAN. THE SERP HAS BEEN DISCONTINUED WITH THE EXCEPTION OF DR. ALLEN WEISS, PRESIDENT & CEO, WHO IS NO LONGER RECEIVING CONTRIBUTIONS TO THE PLAN, BUT WHOSE PLAN CONTINUES TO REALIZE INVESTMENT INCOME/LOSSES ON PREVIOUS CONTRIBUTIONS WHICH HAVE BEEN REPORTED ON PRIOR YEAR FORMS 990. THE ACCOUNT OF ALLEN S. WEISS, MD REALIZED AN INVESTMENT INCOME OF $30,871 FOR THE CALENDAR YEAR 2010 ON SERP. THIS INVESTMENT INCOME IS INCLUDED IN SCHEDULE J, PART II, COLUMN C. PROVISION OF HOUSING ALLOWANCE FORM 990, SCHEDULE J, PART I, LINE 1A HOUSING WAS PROVIDED FOR OUR CHIEF DEVELOPMENT OFFICER, JAMES MARTIN. THE VALUE OF SUCH HOUSING ($4,500) WAS INCLUDED AS A COMPONENT OF HIS REPORTABLE COMPENSATION LISTED ON FORM 990, PART VII. DETAIL OF SEVERANCE PAYMENTS FORM 990, SCHEDULE J, PART I, LINE 4A WILLIAM EDWARDS, CHIEF ADMINISTRATIVE OFFICER, NCHMD, INC., RESIGNED 6/4/11 AND RECEIVED A SEVERANCE PAYMENT OF $146,505 FOR CALENDAR YEAR 2011. PROVISIONS OF NON-FIXED PAYMENTS FORM 990, SCHEDULE J, LINE 7 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. SUPPLEMENTAL INFORMATION 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 EMERGENCY PHYSICIANS OF NAPLES. GOVERNING BODY AND MANAGEMENT FORM 990, PART VI, SECTION A, LINE 6,7A,B 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 11A 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 2010 FORM 990 FOR THE FISCAL YEAR ENDING SEPTEMBER 30, 2011 WAS REVIEWED AND APPROVED BY THE CHAIRMAN OF THE NCH AUDIT AND FINANCE COMMITTEES, RESPECTIVELY, 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 COLLIER HEALTH CARE INC. ARE AVAILABLE TO THE PUBLIC UPON REQUEST. FINANCIAL STATEMENTS ARE ALSO AVAILABLE VIA OUR WEBSITE: WWW.NCHMD.ORG. 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. DETAIL OF OTHER CHANGES IN NET ASSETS FORM 990, PART XI, LINE 5 TRANSFERS TO RELATED ORGANIZATIONS $ (665,567) DEFERRED CAPITAL LEASE REVENUE 163,143 --------- TOTAL OTHER CHANGES IN NET ASSETS $ (502,424) HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Joseph I. Perkovich TITLE:Chairman HOURS:2 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Mariann MacDonald TITLE:1st Vice Chairman HOURS:2 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Ambassador Francis Rooney TITLE:2nd Vice Chairman HOURS:2 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Thomas J. Gazdic TITLE:Secretary/Treasurer HOURS:2 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:William Allyn TITLE:Trustee HOURS:2 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Jay H. Baker TITLE:Trustee HOURS:2 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Kenneth Bookman, M.D. TITLE:Trustee HOURS:2 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Susan L. Dalton TITLE:Trustee HOURS:2 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Paul Dernbach, M.D. TITLE:Trustee HOURS:2 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Alberto M de la Rivaherrera, M.D. TITLE:Trustee HOURS:2 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Michael Feuer TITLE:Trustee HOURS:2 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Terrance Flynn TITLE:Trustee HOURS:2 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Daniel Gill TITLE:Trustee HOURS:2 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Kay Gow TITLE:Trustee HOURS:2 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Joann Jenner TITLE:Trustee HOURS:2 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Amy Jewell, R.N. TITLE:Trustee HOURS:2 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Kim Ciccarelli Kantor TITLE:Trustee HOURS:2 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Hermes Koop, M.D. TITLE:Trustee HOURS:2 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:John Lewis, M.D. TITLE:Trustee HOURS:2 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Frank Linsalata TITLE:Trustee HOURS:2 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Admiral Paul D. Miller TITLE:Trustee HOURS:2 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Robert Moses TITLE:Trustee HOURS:2 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Wayne Mullican TITLE:Trustee HOURS:2 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Karli Sander TITLE:Trustee HOURS:2 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Scot C. Schultz, M.D. TITLE:Trustee HOURS:2 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Norman Thomson, M.D. TITLE:Trustee HOURS:2 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Carl E. Westman TITLE:Trustee HOURS:2 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Gregory Wilkerson, R.N. TITLE:Trustee HOURS:2 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Allen Weiss, M.D. TITLE:President & CEO HOURS:44 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Kevin D. Cooper TITLE:General Counsel/Chief of Staff HOURS:44 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Phillip Dutcher TITLE:COO, NCH Healthcare System HOURS:44 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Aurora Estevez, M.D. TITLE:Chief Medical Officer HOURS:44 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Vicki D. Orr TITLE:CFO/Assistant Treasurer HOURS:44 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Elizabeth Martin TITLE:Assistant Secretary HOURS:44 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:BRIAN SETTLE (TERM 9/30/2011) TITLE:Chief Human Resources Officer HOURS:44 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:SUSAN WOLFF (TERM 9/30/2011) TITLE:Chief Information Officer HOURS:44 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Michele Thoman TITLE:CNO HOURS:44 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Michael Riley TITLE:Chief Strategy Officer HOURS:44 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:James K. Martin TITLE:Chief Development Officer HOURS:44 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:WILLIAM EDWARDS (TERM 6/4/2011) TITLE:CHIEF ADMINISTRATIVE OFFICER HOURS:44 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Zach Bostock (Start 09/19/11) TITLE:CHIEF ADMINISTRATIVE OFFICER HOURS:44 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Gary Parsons, M.D. TITLE:Chief Medical Officer HOURS:44 NCH HEALTHCARE SYSTEM INC PO BOX 413029 NAPLES FL 34101 592314655 HOLDING CO FL 501(C)(3) 11, B NA NAPLES COMMUNITY HOSPITAL INC PO BOX 413029 NAPLES FL 34101 590694358 HEALTHCARE FL 501(C)(3) 3 NCH SYSTEM NCHMD INC PO BOX 413029 NAPLES FL 34101 331075317 HEALTHCARE FL 501(C)(3) 9 NCH SYSTEM COMMUNITY HOME SERVICES INC PO BOX 413029 NAPLES FL 34101 592440516 SUPPORT ORG FL 501(C)(3) 11, B NCH SYSTEM MARCO ISLAND HOSPITAL INC 40 HEATHWOOD DRIVE MARCO ISLAND FL 34145 592315435 HEALTHCARE FL 501(C)(3) 3 NCH SYSTEM COUNSELING & EMPLOYEE ASSISTANCE PROGRAM 350 7TH STREET NORTH NAPLES FL 34102 650374989 EMPLOYEE ASSIST FL NCH SYSTEM C CORP HEALTH RESOURCES CORPORATION 350 7TH STREET NORTH NAPLES FL 34102 592568003 HOLDING COMPANY FL NCH SYSTEM C CORP AMBULATORY SURGICAL CARE CENTER INC 350 7TH STREET NORTH NAPLES FL 34102 592568029 OUTPAT. 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