NCHMD INC: Form 990, tax year 2020
View the entire original 990 at ProPublica ↗
- Organization
- NCHMD INC (EIN 33-1075317)
- Tax period
- 2020-10-01 to 2021-09-30
- Filed
- 2022-08-05
- IRS object ID
- 202222179349300622
- Schema version
- 2020v4.2
- 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) |
|---|---|---|
| Return | 2022-08-05T10:35:45-05:00 | ReturnTs |
| Tax Period End | 2021-09-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 420714325 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RSM US LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 30 SOUTH WACKER DR SUITE 3300 | AddressLine1Txt |
| City | CHICAGO | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 606063392 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2020-10-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 331075317 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NCHMD INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | NCHM | BusinessNameControlTxt |
| Phone | 2396246338 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 413029 | AddressLine1Txt |
| City | NAPLES | CityNm |
| State Abbreviation | FL | StateAbbreviationCd |
| ZIP | 341013029 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | RICK WYLES | PersonNm |
| Person Title | CHIEF FINANCIAL OFFICER | PersonTitleTxt |
| Phone | 2396244005 | PhoneNum |
| Signature | 2022-08-03 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | RICK | PersonFirstNm |
| Person Last | WYLES | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | REBEKUH ELEY | PreparerPersonNm |
| PTIN | P01247672 | PTIN |
| Phone | 3126343400 | PhoneNum |
| Preparation | 2022-08-01 | PreparationDt |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 3 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2020 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NCH PHYSICIAN GROUP | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | PAUL HILTZ | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 413029 | AddressLine1Txt |
| City | NAPLES | CityNm |
| State Abbreviation | FL | StateAbbreviationCd |
| ZIP | 341013029 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $128,210,319 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.NCHMD.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2003 | FormationYr |
| Legal Domicile State | FL | LegalDomicileStateCd |
| Activity Or Mission | HELPING EVERYONE LIVE A LONGER, HAPPIER, AND HEALTHIER LIFE.OUR VISION IS TO BE A WORLD-CLASS LEADER OF EXCELLENCE INHEALTHCARE AND TO PROVIDE EXCELLENCE IN EVERY PATIENT EXPERIENCE. | ActivityOrMissionDesc |
| Voting Members Governing Body | 11 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 3 | VotingMembersIndependentCnt |
| Total Employee | 1058 | TotalEmployeeCnt |
| Total Volunteers | 3 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $0 | PYContributionsGrantsAmt |
| CY Contributions Grants | $3,354,173 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $113,273,393 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $124,724,841 | CYProgramServiceRevenueAmt |
| PY Investment Income | -$267 | PYInvestmentIncomeAmt |
| CY Investment Income | -$471,592 | CYInvestmentIncomeAmt |
| PY Other Revenue | $37,500 | PYOtherRevenueAmt |
| CY Other Revenue | $125,775 | CYOtherRevenueAmt |
| PY Total Revenue | $113,310,626 | PYTotalRevenueAmt |
| CY Total Revenue | $127,733,197 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $121,859,774 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $133,594,557 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $31,038,764 | PYOtherExpensesAmt |
| CY Other Expenses | $33,160,605 | CYOtherExpensesAmt |
| PY Total Expenses | $152,898,538 | PYTotalExpensesAmt |
| CY Total Expenses | $166,755,162 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$39,587,912 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$39,021,965 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $41,550,306 | TotalAssetsBOYAmt |
| Total Assets EOY | $43,477,542 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $33,787,455 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $30,380,405 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $7,762,851 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $13,097,137 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | HELPING EVERYONE LIVE A LONGER, HAPPIER, AND HEALTHIER LIFE. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $23,997,290 | ExpenseAmt |
| Revenue | $21,466,317 | RevenueAmt |
| Desc | FAMILY PRACTICE IS THE LARGEST SERVICE LINE ACCOMPLISHMENT FOR NCH PHYSICIANS GROUP FOR 2021. 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 32 LICENSED INDEPENDENT PRACTITIONERS AND 103 FULL-TIME EQUIVALENT EMPLOYEES WHO PERFORMED 156,990 RELATIVE VALUE UNITS AND PROVIDED $13,486 OF CHARITY CARE. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $22,773,261 | ExpenseAmt |
| Revenue | $15,752,158 | RevenueAmt |
| Desc | CARDIOLOGY IS THE SECOND LARGEST SERVICE LINE OF THE NCH PHYSICIANS GROUP FOR 2021. THIS PROGRAM OFFERS SPECIALIZED SERVICES THAT FOCUS ON THE STUDY AND TREATMENT OF DISORDERS OF THE CARDIOVASCULAR SYSTEM, WHICH INCLUDE THE HEART, ARTERIES, AND VIENS. THESE PHYSICIANS USE A VARIETY OF TREATMENTS INCLUDING SURGERY, MEDICATION, LIFESTYLE CHANGES, WEIGHT LOSS RECOMMENDATIONS, DIET MANAGEMENT, THERAPIES, AND OTHER METHODS TO HELP OUR PATIENTS LIVE A HAPPIER, HEALTHIER LIFE. WITHIN THIS SERVICE LINE, NCHMD EMPLOYED 27 LICENSED INDEPENDENT PRACTITIONERS AND 52 FULL-TIME EQUIVALENT EMPLOYEES WHO PERFORMED 237,403 RELATIVE VALUE UNITS AND PROVIDED $413,945 OF CHARITY CARE. | Desc |
Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $22,108,206 | ExpenseAmt |
| Revenue | $17,514,113 | RevenueAmt |
| Desc | INTERNAL MEDICINE SERVICES WERE NCH PHYSICIAN GROUP'S THIRD LARGEST PROGRAM SERVICE IN 2021. 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 AND LABORATORY TO HELP SOLVE DIAGNOSTIC PROBLEMS.WITHIN THIS SERVICE LINE, NCHMD EMPLOYED 49 LICENSED INDEPENDENT PRACTITIONERS AND 37 FULL-TIME EQUIVALENT EMPLOYEES WHO PERFORMED 285,584 RELATIVE VALUE UNITS, PROVIDED $1,671,694 OF CHARITY CARE. | Desc |
Prog Srvc Accom Acty Other ProgSrvcAccomActyOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $88,786,400 | ExpenseAmt |
| Revenue | $70,028,253 | RevenueAmt |
| Desc | IN PROVIDING THE OTHER SERVICE PROGRAM SERVICE LINES, NCHMD EMPLOYED 184 LICENSED INDEPENDENT PRACTICIONERS AND 304 FTES WHO PERFORMED 771,428 RELATIVE VALUE UNITS AND PROVIDED $2,416,226 OF CHARITY CARE.SERVICE LINE EXPENSE REVENUE LAB AND RADIOLOGY 21,038,252 19,683,496INFECTIOUS DISEASE 11,223,111 10,581,465 ORTHOPEDICS 12,203,134 9,410,148 PULMONARY 11,939,143 7,084,234GASTROENTEROLOGY 6,219,838 4,415,143 GENERAL SURGERY 5,526,300 3,898,171 URGENT CARE 3,523,563 3,391,131 ENDOCRINOLOGY 2,712,809 1,896,128 PAIN MANAGEMENT 2,888,749 1,748,797 PSYCHIATRY 2,307,772 1,114,710 PEDIATRICS 1,597,723 1,510,855UROLOGY 2,272,031 1,462,771 GME 1,299,173 1,094,316 NEUROSURGERY 1,739,483 1,027,839 POST ACUTE 802,049 615,470 WOUND HEALING 389,617 492,995 RHEUMATOLOGY 575,983 396,776 PRO TIME 273,281 203,797 GERIATRICS 254,034 11CHRONIC CARE 355 - | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Prog Srvc Expense | $88,786,400 | TotalOtherProgSrvcExpenseAmt |
| Total Other Prog Srvc Revenue | $70,028,253 | TotalOtherProgSrvcRevenueAmt |
| Total Program Service Expenses | $157,665,157 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | 0 | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | Yes (1) | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | Yes (1) | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | Yes (1) | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 88 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 1058 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | Yes (1) | UnrelatedBusIncmOverLimitInd |
| Form990 T Filed | Yes (1) | Form990TFiledInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 11 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 3 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | Yes (1) | InvestmentInJointVentureInd |
| Written Policy Or Procedure | Yes (1) | WrittenPolicyOrProcedureInd |
| States Where Copy Of Return Is Fld | FL | StatesWhereCopyOfReturnIsFldCd |
| Own Website | Yes (X) | OwnWebsiteInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RICK WYLES CHIEF FINANCIAL OFFICER | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 2396244005 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 350 SEVENTH STREET NORTH | AddressLine1Txt |
| City | NAPLES | CityNm |
| State Abbreviation | FL | StateAbbreviationCd |
| ZIP | 34102 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (31 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd |
|---|---|---|---|---|---|---|---|---|---|
| HOWARD KAPP MD | |||||||||
| PHYSICIAN | 40.00 | 0.00 | Yes (X) | $2,066,309 | $0 | $26,046 | |||
| JON DOUNCHIS MD | |||||||||
| PHYSICIAN | 40.00 | 0.00 | Yes (X) | $1,770,347 | $0 | $33,201 | |||
| DINESH SHARMA MD | |||||||||
| PHYSICIAN | 40.00 | 0.00 | Yes (X) | $1,741,970 | $0 | $36,450 | |||
| DAVID AXLINE MD | |||||||||
| PHYSICIAN | 40.00 | 0.00 | Yes (X) | $1,116,222 | $0 | $34,503 | |||
| LARRY LESLIE MD | |||||||||
| PHYSICIAN | 40.00 | 0.00 | Yes (X) | $1,100,753 | $0 | $36,858 | |||
| PAUL HILTZ | |||||||||
| PRESIDENT/CEO/TRUSTEE | 1.00 | 44.00 | $0 | $897,053 | $33,680 | Yes (X) | Yes (X) | ||
| ALLEN S WEISSMD TERM 119 | |||||||||
| FORMER PRESIDENT/CEO/TRUSTEE | 0.00 | 0.00 | $0 | $909,806 | $17,158 | Yes (X) | |||
| MAZEN ALBELDAWI MD | |||||||||
| PHYSICIAN/TRUSTEE | 40.00 | 0.00 | $807,557 | $0 | $36,338 | Yes (X) | |||
| BRYAN MURPHEY MD | |||||||||
| PHYSICIAN/CHAIRMAN | 40.00 | 0.00 | $771,952 | $0 | $33,608 | Yes (X) | |||
| MICHAEL S FLYNN MD | |||||||||
| PHYSICIAN/TRUSTEE | 40.00 | 0.00 | $731,802 | $0 | $33,608 | Yes (X) | |||
| PHILLIP DUTCHER TERM 0721 | |||||||||
| CHIEF OPERATING OFFICER SYSTEM | 1.00 | 44.00 | $0 | $707,824 | $14,142 | Yes (X) | |||
| MARC D COLTON MD TERM 821 | |||||||||
| PHYSICIAN/TRUSTEE | 40.00 | 0.00 | $620,275 | $0 | $36,358 | Yes (X) | |||
| RICK WYLES | |||||||||
| CHIEF FINANCIAL OFFICER | 1.00 | 44.00 | $0 | $516,031 | $34,675 | Yes (X) | |||
| KEVIN D COOPER TERM 119 | |||||||||
| FORMER CHIEF OF STAFF | 0.00 | 0.00 | $0 | $522,084 | $16,889 | Yes (X) | |||
| DAVID LINZ MD START 1120 | |||||||||
| PHYSICIAN/TRUSTEE | 40.00 | 0.00 | $501,008 | $0 | $35,608 | Yes (X) | |||
| SHARLA PATTERSON MD | |||||||||
| PHYSICIAN/TRUSTEE | 40.00 | 0.00 | $475,600 | $0 | $36,430 | Yes (X) | |||
| FRANK ASTOR MD TERM 1119 | |||||||||
| FORMER TRUSTEE/CMO | 0.00 | 0.00 | $0 | $487,788 | $16,236 | Yes (X) | |||
| JONATHAN KLING RN STRT 0721 | |||||||||
| CHIEF OPERATING OFFICER SYSTEM | 1.00 | 44.00 | $0 | $446,398 | $33,658 | Yes (X) | |||
| ZACKARY BOSTOCK TERM 320 | |||||||||
| FORMER CHIEF ADMIN OFFICER | 0.00 | 0.00 | $0 | $441,291 | $29,611 | Yes (X) | |||
| EMILY ESSERT MD | |||||||||
| PHYSICIAN/TRUSTEE | 40.00 | 0.00 | $430,610 | $0 | $33,293 | Yes (X) | |||
| KRISTIN MASCOTTI MD | |||||||||
| TRUSTEE/CMO | 1.00 | 44.00 | $0 | $425,744 | $9,008 | Yes (X) | Yes (X) | ||
| LINDA ROEBACK TERM 520 | |||||||||
| FORMER CHIEF COUNSEL | 0.00 | 0.00 | $0 | $397,178 | $22,045 | Yes (X) | |||
| JIM MAHON | |||||||||
| SENIOR VICE PRESIDENT | 1.00 | 44.00 | $0 | $399,133 | $2,931 | Yes (X) | |||
| RENEE M THIGPEN | |||||||||
| CHIEF HR OFFICER | 1.00 | 44.00 | $0 | $356,246 | $30,108 | Yes (X) | |||
| MICHAEL RILEY TERM 1120 | |||||||||
| CHIEF STRATEGY OFFICER | 1.00 | 44.00 | $0 | $339,701 | $28,889 | Yes (X) | |||
| PAMELA ZIPPERER-DAVIS TRM 0321 | |||||||||
| TRUSTEE/CHIEF ADMIN. OFFICER | 1.00 | 44.00 | $0 | $322,328 | $12,569 | Yes (X) | Yes (X) | ||
| GARY TOMCIK TERM 420 | |||||||||
| FORMER CHIEF EXPERIENCE OFFICER | 0.00 | 0.00 | $0 | $282,293 | $27,943 | Yes (X) | |||
| GINA TEEGARDEN RN ST 0721 | |||||||||
| INTERIM CHIEF NURSING OFFICER | 1.00 | 44.00 | $0 | $197,163 | $14,989 | Yes (X) | |||
| KEVIN BEEBE | |||||||||
| TRUSTEE | 0.50 | 1.50 | $0 | $0 | $0 | Yes (X) | |||
| SCOTT LUTGERT | |||||||||
| TRUSTEE | 0.50 | 1.50 | $0 | $0 | $0 | Yes (X) | |||
| MICHAEL WYNN | |||||||||
| TRUSTEE | 0.50 | 1.50 | $0 | $0 | $0 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $12,134,405 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $7,648,061 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $756,832 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 215 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | Yes (1) | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| NEUROINTERVENTIONAL ASSOCIATES PA | |||||
| 335 31ST STREET SOUTH | ST PETERSBURG | FL | 33712 | PHYSICIAN STAFFING SERVICES | $1,599,996 |
| SURETY CONSTRUCTION | |||||
| 6640 WILLOW PARK DRIVE SUITE B | NAPLES | FL | 34109 | COMMERCIAL CONSTRUCTION | $1,305,677 |
| CERNER CORPORATION | |||||
| PO BOX 959156 | ST LOUIS | MO | 631959156 | IT SOFTWARE & CONSULTING SERVICES | $1,091,571 |
| LOCUM-TENENS COM LLC | |||||
| PO BOX 405547 | ATLANTA | GA | 303845547 | PHYSICIAN STAFFING SERVICES | $1,006,412 |
| NFV HEALTHCARE GROUP | |||||
| PO BOX 1118 | FORT MYERS | FL | 33902 | PHYSICIAN STAFFING SERVICES | $710,866 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 23 | CntrctRcvdGreaterThan100KCnt |
| Info In Schedule O Part VIII | Yes (X) | InfoInScheduleOPartVIIIInd |
| Government Grants | $3,354,173 | GovernmentGrantsAmt |
| Total Contributions | $3,354,173 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | OFFICES OF PHYSICIANS | Desc |
| Business | 621110 | BusinessCd |
| Total Revenue Column | $124,724,841 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $124,724,841 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $124,724,841 | TotalProgramServiceRevenueAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $95,305 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $5,530 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $89,775 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $89,775 | TotalRevenueColumnAmt |
| Exclusion | $89,775 | ExclusionAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $471,592 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -$471,592 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$471,592 | TotalRevenueColumnAmt |
| Exclusion | -$471,592 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | MEDICAL DIRECTORSHIP | Desc |
| Business | 900099 | BusinessCd |
| Total Revenue Column | $36,000 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $36,000 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $36,000 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $127,733,197 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $124,760,841 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | -$381,817 | ExclusionAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,496,231 | TotalAmt |
| Program Services | $4,902,972 | ProgramServicesAmt |
| Management And General | $593,259 | ManagementAndGeneralAmt |
Comp Disqual Persons CompDisqualPersonsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $588,609 | TotalAmt |
| Program Services | $333,618 | ProgramServicesAmt |
| Management And General | $254,991 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $115,599,353 | TotalAmt |
| Program Services | $110,943,012 | ProgramServicesAmt |
| Management And General | $4,656,341 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,601,054 | TotalAmt |
| Program Services | $2,483,486 | ProgramServicesAmt |
| Management And General | $117,568 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,848,687 | TotalAmt |
| Program Services | $3,676,094 | ProgramServicesAmt |
| Management And General | $172,593 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,460,623 | TotalAmt |
| Program Services | $5,213,803 | ProgramServicesAmt |
| Management And General | $246,820 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,500,507 | TotalAmt |
| Program Services | $3,333,810 | ProgramServicesAmt |
| Management And General | $1,166,697 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $46,351 | TotalAmt |
| Program Services | $46,351 | ProgramServicesAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,314,567 | TotalAmt |
| Program Services | $2,170,164 | ProgramServicesAmt |
| Management And General | $1,144,403 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,852,702 | TotalAmt |
| Program Services | $1,768,960 | ProgramServicesAmt |
| Management And General | $83,742 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,613,318 | TotalAmt |
| Program Services | $5,093,660 | ProgramServicesAmt |
| Management And General | $519,658 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $47,016 | TotalAmt |
| Program Services | $46,028 | ProgramServicesAmt |
| Management And General | $988 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,813,068 | TotalAmt |
| Program Services | $3,725,694 | ProgramServicesAmt |
| Management And General | $87,374 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,747,904 | TotalAmt |
| Program Services | $1,713,425 | ProgramServicesAmt |
| Management And General | $34,479 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (2 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL SUPPLIES | $12,214,489 | $12,211,680 | $2,809 |
| BAD DEBT | $8,283 | $8,283 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,400 | TotalAmt |
| Program Services | $2,400 | ProgramServicesAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $166,755,162 | TotalAmt |
| Program Services | $157,665,157 | ProgramServicesAmt |
| Management And General | $9,090,005 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,392,908 | BOYAmt |
| EOY | $9,808,361 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,454,254 | BOYAmt |
| EOY | $1,533,399 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $426,960 | BOYAmt |
| EOY | $2,460,255 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $38,647,022 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $18,730,538 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $27,221,399 | BOYAmt |
| EOY | $19,916,484 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $7,818,678 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,054,785 | BOYAmt |
| EOY | $1,940,365 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $41,550,306 | BOYAmt |
| EOY | $43,477,542 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $17,365,492 | BOYAmt |
| EOY | $21,596,564 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,279,114 | BOYAmt |
| EOY | $1,931,977 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,142,849 | BOYAmt |
| EOY | $6,851,864 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $33,787,455 | BOYAmt |
| EOY | $30,380,405 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,762,851 | BOYAmt |
| EOY | $13,097,137 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,762,851 | BOYAmt |
| EOY | $13,097,137 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $41,550,306 | BOYAmt |
| EOY | $43,477,542 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$39,021,965 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $44,356,251 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Publicly Supported Org509a2 | Yes (X) | PubliclySupportedOrg509a2Ind |
Gifts Grants Contris Rcvd509 GiftsGrantsContrisRcvd509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year | $3,354,173 | CurrentTaxYearAmt |
| Total | $3,354,173 | TotalAmt |
Gross Receipts Admissions GrossReceiptsAdmissionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $90,888,451 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $110,657,971 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $112,927,917 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $113,273,393 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $124,724,841 | CurrentTaxYearAmt |
| Total | $552,472,573 | TotalAmt |
Total509 Total509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $90,888,451 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $110,657,971 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $112,927,917 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $113,273,393 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $128,079,014 | CurrentTaxYearAmt |
| Total | $555,826,746 | TotalAmt |
Amounts Rcvd Dsqlfy Person AmountsRcvdDsqlfyPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Substantial Contributors Amt SubstantialContributorsAmtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Subst And Dsqlfy Prsns Tot SubstAndDsqlfyPrsnsTotGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total509 | $555,826,746 | PublicSupportTotal509Amt |
Gross Investment Income509 GrossInvestmentIncome509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus2 Years | $5,990 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year | $89,775 | CurrentTaxYearAmt |
| Total | $95,765 | TotalAmt |
Investment Income And UBTI InvestmentIncomeAndUBTIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus2 Years | $5,990 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year | $89,775 | CurrentTaxYearAmt |
| Total | $95,765 | TotalAmt |
Other Income509 OtherIncome509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $11,631 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $39,452 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $42,000 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $37,500 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $36,000 | CurrentTaxYearAmt |
| Total | $166,583 | TotalAmt |
Total Support Calendar Year TotalSupportCalendarYearGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $90,900,082 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $110,697,423 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $112,975,907 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $113,310,893 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $128,204,789 | CurrentTaxYearAmt |
| Total | $556,089,094 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support CY509 | 0.99950 | PublicSupportCY509Pct |
| Public Support PY509 | 0.99970 | PublicSupportPY509Pct |
| Investment Income CY | 0.00020 | InvestmentIncomeCYPct |
| Thirty Thr Pct Suprt Tests CY509 | Yes (X) | ThirtyThrPctSuprtTestsCY509Ind |
Form990 Schedule A Part VI Form990ScheduleAPartVIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: | FormAndLineReferenceDesc |
| Explanation | MISC ACCOUNTS REC RECEIPTS - 2016 AMOUNT: $ 2,527. 2017 AMOUNT: $ 12,851. EMPLOYEE SALES - 2016 AMOUNT: $ 9,104. 2017 AMOUNT: $ 26,601. MEDICAL DIRECTORSHIP - 2018 AMOUNT: $ 42,000. 2019 AMOUNT: $ 37,500. 2020 AMOUNT: $ 36,000. | ExplanationTxt |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| 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) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,559,424 | OtherCostOrOtherBasisAmt |
| Book Value | $2,559,424 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $13,197,550 | OtherCostOrOtherBasisAmt |
| Depreciation | $3,320,317 | DepreciationAmt |
| Book Value | $9,877,233 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $7,927,668 | OtherCostOrOtherBasisAmt |
| Depreciation | $5,240,347 | DepreciationAmt |
| Book Value | $2,687,321 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $14,458,246 | OtherCostOrOtherBasisAmt |
| Depreciation | $10,169,874 | DepreciationAmt |
| Book Value | $4,288,372 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $504,134 | OtherCostOrOtherBasisAmt |
| Book Value | $504,134 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $19,916,484 | TotalBookValueLandBuildingsAmt |
Invst Program Related Org InvstProgramRelatedOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | INVESTMENT IN PROSCAN | Desc |
| Book Value | $7,818,678 | BookValueAmt |
| Method Valuation | C | MethodValuationCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Program Rltd | $7,818,678 | TotalBookValueProgramRltdAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | MEDICARE ADVANCED PAYMENT | Desc |
| Amt | $6,851,864 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $6,851,864 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART X, LINE 2: | FormAndLineReferenceDesc |
| Explanation | THE SYSTEM AND ALL OF ITS NOT-FOR-PROFIT SUBSIDIARIES ARE EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME UNDER SECTION 501(A) OF THE INTERNAL REVENUE CODE (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 GENERALLY NO LONGER SUBJECT TO TAX EXAMINATIONS IN THE MAJOR U.S. TAXING JURISDICTIONS IN WHICH THEY OPERATE FOR TAX YEARS PRIOR TO 2017. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Independent Consultant | Yes (X) | IndependentConsultantInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | Yes (1) | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (1) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | Yes (1) | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (28 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| HOWARD KAPP MD | ||||||||||||||
| PHYSICIAN | $1,941,684 | $0 | $103,937 | $0 | $20,688 | $0 | $11,400 | $0 | $14,646 | $0 | $2,092,355 | $0 | $0 | $0 |
| JON DOUNCHIS MD | ||||||||||||||
| PHYSICIAN | $1,601,587 | $0 | $148,846 | $0 | $19,914 | $0 | $11,400 | $0 | $21,801 | $0 | $1,803,548 | $0 | $0 | $0 |
| DINESH SHARMA MD | ||||||||||||||
| PHYSICIAN | $1,375,735 | $0 | $346,573 | $0 | $19,662 | $0 | $11,400 | $0 | $25,050 | $0 | $1,778,420 | $0 | $0 | $0 |
| DAVID AXLINE MD | ||||||||||||||
| PHYSICIAN | $952,531 | $0 | $143,417 | $0 | $20,274 | $0 | $11,400 | $0 | $23,103 | $0 | $1,150,725 | $0 | $0 | $0 |
| LARRY LESLIE MD | ||||||||||||||
| PHYSICIAN | $931,157 | $0 | $149,682 | $0 | $19,914 | $0 | $11,400 | $0 | $25,458 | $0 | $1,137,611 | $0 | $0 | $0 |
| PAUL HILTZ | ||||||||||||||
| PRESIDENT/CEO/TRUSTEE | $0 | $855,115 | $0 | $21,250 | $0 | $20,688 | $0 | $11,400 | $0 | $22,280 | $0 | $930,733 | $0 | $0 |
| ALLEN S WEISSMD TERM 119 | ||||||||||||||
| FORMER PRESIDENT/CEO/TRUSTEE | $0 | $0 | $0 | $0 | $0 | $909,806 | $0 | $0 | $0 | $17,158 | $0 | $926,964 | $0 | $0 |
| MAZEN ALBELDAWI MD | ||||||||||||||
| PHYSICIAN/TRUSTEE | $787,365 | $0 | $512 | $0 | $19,680 | $0 | $11,400 | $0 | $24,938 | $0 | $843,895 | $0 | $0 | $0 |
| BRYAN MURPHEY MD | ||||||||||||||
| PHYSICIAN/CHAIRMAN | $676,051 | $0 | $75,987 | $0 | $19,914 | $0 | $11,400 | $0 | $22,208 | $0 | $805,560 | $0 | $0 | $0 |
| MICHAEL S FLYNN MD | ||||||||||||||
| PHYSICIAN/TRUSTEE | $630,504 | $0 | $80,610 | $0 | $20,688 | $0 | $11,400 | $0 | $22,208 | $0 | $765,410 | $0 | $0 | $0 |
| PHILLIP DUTCHER TERM 0721 | ||||||||||||||
| CHIEF OPERATING OFFICER SYSTEM | $0 | $607,258 | $0 | $77,358 | $0 | $23,208 | $0 | $11,400 | $0 | $2,742 | $0 | $721,966 | $0 | $0 |
| MARC D COLTON MD TERM 821 | ||||||||||||||
| PHYSICIAN/TRUSTEE | $600,001 | $0 | $0 | $0 | $20,274 | $0 | $11,400 | $0 | $24,958 | $0 | $656,633 | $0 | $0 | $0 |
| RICK WYLES | ||||||||||||||
| CHIEF FINANCIAL OFFICER | $0 | $452,476 | $0 | $42,867 | $0 | $20,688 | $0 | $11,400 | $0 | $23,275 | $0 | $550,706 | $0 | $0 |
| KEVIN D COOPER TERM 119 | ||||||||||||||
| FORMER CHIEF OF STAFF | $0 | $0 | $0 | $0 | $0 | $522,084 | $0 | $0 | $0 | $16,889 | $0 | $538,973 | $0 | $0 |
| DAVID LINZ MD START 1120 | ||||||||||||||
| PHYSICIAN/TRUSTEE | $430,307 | $0 | $51,039 | $0 | $19,662 | $0 | $11,400 | $0 | $24,208 | $0 | $536,616 | $0 | $0 | $0 |
| SHARLA PATTERSON MD | ||||||||||||||
| PHYSICIAN/TRUSTEE | $431,585 | $0 | $24,335 | $0 | $19,680 | $0 | $11,400 | $0 | $25,030 | $0 | $512,030 | $0 | $0 | $0 |
| FRANK ASTOR MD TERM 1119 | ||||||||||||||
| FORMER TRUSTEE/CMO | $0 | $0 | $0 | $0 | $0 | $487,788 | $0 | $0 | $0 | $16,236 | $0 | $504,024 | $0 | $0 |
| JONATHAN KLING RN STRT 0721 | ||||||||||||||
| CHIEF OPERATING OFFICER SYSTEM | $0 | $384,005 | $0 | $42,623 | $0 | $19,770 | $0 | $11,400 | $0 | $22,258 | $0 | $480,056 | $0 | $0 |
| ZACKARY BOSTOCK TERM 320 | ||||||||||||||
| FORMER CHIEF ADMIN OFFICER | $0 | $98,702 | $0 | $41,802 | $0 | $300,787 | $0 | $5,559 | $0 | $24,052 | $0 | $470,902 | $0 | $0 |
| EMILY ESSERT MD | ||||||||||||||
| PHYSICIAN/TRUSTEE | $353,735 | $0 | $57,213 | $0 | $19,662 | $0 | $11,400 | $0 | $21,893 | $0 | $463,903 | $0 | $0 | $0 |
| KRISTIN MASCOTTI MD | ||||||||||||||
| TRUSTEE/CMO | $0 | $316,117 | $0 | $90,000 | $0 | $19,627 | $0 | $0 | $0 | $9,008 | $0 | $434,752 | $0 | $0 |
| LINDA ROEBACK TERM 520 | ||||||||||||||
| FORMER CHIEF COUNSEL | $0 | $119,967 | $0 | $29,754 | $0 | $247,457 | $0 | $6,514 | $0 | $15,531 | $0 | $419,223 | $0 | $0 |
| JIM MAHON | ||||||||||||||
| SENIOR VICE PRESIDENT | $0 | $374,692 | $0 | $3,095 | $0 | $21,346 | $0 | $2,338 | $0 | $593 | $0 | $402,064 | $0 | $0 |
| RENEE M THIGPEN | ||||||||||||||
| CHIEF HR OFFICER | $0 | $305,567 | $0 | $29,991 | $0 | $20,688 | $0 | $11,400 | $0 | $18,708 | $0 | $386,354 | $0 | $0 |
| MICHAEL RILEY TERM 1120 | ||||||||||||||
| CHIEF STRATEGY OFFICER | $0 | $264,261 | $0 | $29,630 | $0 | $45,810 | $0 | $11,400 | $0 | $17,489 | $0 | $368,590 | $0 | $0 |
| PAMELA ZIPPERER-DAVIS TRM 0321 | ||||||||||||||
| TRUSTEE/CHIEF ADMIN. OFFICER | $0 | $252,554 | $0 | $50,000 | $0 | $19,774 | $0 | $0 | $0 | $12,569 | $0 | $334,897 | $0 | $0 |
| GARY TOMCIK TERM 420 | ||||||||||||||
| FORMER CHIEF EXPERIENCE OFFICER | $0 | $82,909 | $0 | $26,378 | $0 | $173,006 | $0 | $4,422 | $0 | $23,521 | $0 | $310,236 | $0 | $0 |
| GINA TEEGARDEN RN ST 0721 | ||||||||||||||
| INTERIM CHIEF NURSING OFFICER | $0 | $190,216 | $0 | $6,533 | $0 | $414 | $0 | $6,010 | $0 | $8,979 | $0 | $212,152 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINES 4A-B | PART I, LINE 4A: PRESIDENT AND CEO RESIGNED 01/2019 AND RECEIVED A SEVERANCE PAYMENT OF $909,806 FOR CALENDAR YEAR 2020. CHIEF OF STAFF RESIGNED 01/2019 AND RECEIVED A SEVERANCE PAYMENT OF $522,084 FOR CALENDAR YEAR 2020. CHIEF MEDICAL OFFICER/TRUSTEE RESIGNED 11/2019 AND RECEIVED A SEVERANCE PAYMENT OF $487,788 FOR CALENDAR YEAR 2020. CHIEF ADMINISTRATIVE OFFICER RESIGNED 03/2020 AND RECEIVED A SEVERANCE PAYMENT OF $296,107 FOR CALENDAR YEAR 2020. VP & GENERAL COUSEL RESIGNED 5/2020 AND RECEIVED A SERVERANCE PAYMENT OF $239,933 FOR CALENDAR YEAR 2020. CHIEF EXPERIENCE OFFICER RESIGNED 4/2020 AND RECEIVED A SEVERANCE PAYMENT OF $165,818 FOR CALENDAR YEAR 2020. PART I, LINE 4B: THE FOLLOWING EXECUTIVES PARTICIPATED IN A 457 (F) SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN. NO DISTRIBUTIONS WERE PAID IN CALENDAR YEAR 2020. PAUL HILTZ, PRESIDENT AND CEO PHILLIP DUTCHER, CHIEF OPERATING OFFICER RICK WYLES, CHIEF FINANCIAL OFFICER JONATHAN KLING, CHIEF OPERATIONS OFFICER KRISTIN MASCOTTI, M.D., CHIEF MEDICAL OFFICER JIM MAHON, SENIOR VICE PRESIDENT RENEE THIGPEN, CHIEF HUMAN RESOURCES OFFICER PAMELA ZIPPERER-DAVIS, CHIEF ADMINISTRATIVE OFFICER |
| PART I, LINE 7 | PROVISIONS OF NON-FIXED PAYMENTS THIS ORGANIZATION IS AN AFFILIATE OF NCH HEALTHCARE SYSTEM, INC. ("THE SYSTEM"). THE SYSTEM MAY PROVIDE DISCRETIONARY BONUS AND/OR INCENTIVE COMPENSATION PAYMENTS TO ELIGIBLE EMPLOYEES. COMPENSATION PAYMENTS FOR ALL EMPLOYEES EXCLUDING THE CEO AND SENIOR LEADERSHIP TEAM IS DETERMINED BY THE SYSTEM BOARD OF TRUSTEES HUMAN RESOURCES COMMITTEE AND/OR CEO. COMPENSATION PAYMENTS MADE TO ANY DISQUALIFIED PERSON IS APPROVED BY THE SYSTEM THROUGH THE PROCESS DESCRIBED IN FORM 990, PART VI, SECTION B, LINE 15. |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (4 entries)
| Relationship DescriptionRelationshipDescriptionTxt | TransactionTransactionAmt | TransactionTransactionDesc | Sharing Of RevenuesSharingOfRevenuesInd |
|---|---|---|---|
| RASAI ERNST MD | |||
| FMLY MEMBER/TRUSTEE | $208,826 | EMPLOYED PHYSICIAN | 0 |
| ALYSSA J CENZI | |||
| FMLY MEMBER/OFFICER | $73,903 | EMPLOYEE | 0 |
| VLADIMIRA KLING | |||
| FMLY MEMBER/OFFICER | $23,330 | EMPLOYEE | 0 |
| TIFFANY WYNN | |||
| FMLY MEMBER/TRUSTEE | $18,826 | EMPLOYEE | 0 |
Supplemental Information Detail SupplementalInformationDetail (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, SCHEDULE L, PART IV | MAZEN ALBELDAWI M.D., BOARD TRUSTEE IS THE SPOUSE OF RASAI ERNST, M.D. AN EMPLOYED PHYSICIAN OF NCHMD. |
| FORM 990, SCHEDULE L, PART IV | ALYSSA J. CENZI IS THE DAUGHTER OF RENEE THIGPEN, CHIEF HUMAN RESOURCES OFFICER. |
| FORM 990, SCHEDULE L, PART IV | VLADIMIRA KLING, ARNP. IS THE SPOUSE OF JONATHAN KLING, CHIEF NURSING OFFICER. |
| FORM 990, SCHEDULE L, PART IV | TIFFANY WYNN IS A RADIOLOGY SONOGRAPHER AND IS THE SISTER OF MICHAEL WYNN, BOARD TRUSTEE. |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (9 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 11B | 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 FORM 990 IS REVIEWED BY THE NCH HEALTHCARE SYSTEM CHIEF FINANCIAL OFFICER. THE FORM 990 IS THEN REVIEWED BY OUTSIDE COUNSEL FOR THE BOARD. PRIOR TO BOARD APPROVAL, THE FORM 990 IS PROVIDED TO ALL OF THE FINANCE COMMITTEE 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 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 GREATER THAN TWO-THIRDS 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 THE NCH HEALTHCARE SYSTEM, INC. ("THE SYSTEM"). COMPENSATION ARRANGEMENTS INVOLVING OUR CEO AND SENIOR LEADERSHIP TEAM ARE ESTABLISHED BY THE SYSTEM BOARD OF TRUSTEES COMPENSATION COMMITTEE 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: HTTP://WWW.NCHMD.ORG/ABOUT-US/ANNUAL-REPORTS. DOCUMENTS AVAILABLE FOR REQUEST ARE AVAILABLE PURSUANT TO THE PERIOD OF DISCLOSURE PROVIDED IN SECTION 6104(D). |
| FORM 990, PART VIII, LINE 1E | PHSSEF FUNDS OF THE PUBLIC HEALTH AND SOCIAL SERVICES EMERGENCY FUND (THE PHSSEF) PAYMENTS, $3,354,173 QUALIFIED AS REIMBUSEMENT FOR LOST OPERATING MARGIN AND INCREMENTAL EXPENSES AND WAS RECOGNIZED AS OTHER REVENUE IN THE CONSOLIDATED STATEMENTS OF OPERATIONS. |
| FORM 990, PART XI, LINE 9: | TRANSFERS FROM AFFILIATES 46,404,671. GOODWILL IMPAIRMENT -2,048,420. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (5 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Direct Controlling NADirectControllingNACd | Controlled OrganizationControlledOrganizationInd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt |
|---|---|---|---|---|---|---|---|---|---|---|---|
| NCH HEALTHCARE SYSTEM INC | |||||||||||
| PO BOX 413029 | NAPLES | FL | 34101 | 592314655 | HOLDING CO | FL | 501(C) (3) | LINE 12B, II | N/A | 0 | |
| NAPLES COMMUNITY HOSPITALINC | |||||||||||
| PO BOX 413029 | NAPLES | FL | 34101 | 590694358 | HOLDING CO | FL | 501(C) (3) | LINE 3 | Yes (1) | NCH SYSTEM | |
| MARCO ISLAND HOSPITAL INC | |||||||||||
| 40 HEATHWOOD DRIVE | MARCO ISLAND | FL | 34145 | 592315435 | SUPPORT ORG. | FL | 501(C) (3) | LINE 3 | Yes (1) | NCH SYSTEM | |
| COMMUNITY HOME SERVICES INC | |||||||||||
| PO BOX 413029 | NAPLES | FL | 34101 | 592440516 | SUPPORT ORG. | FL | 501(C) (3) | LINE 12B, II | Yes (1) | NCH SYSTEM | |
| COLLIER HEALTH CARE INC | |||||||||||
| PO BOX 413029 | NAPLES | FL | 34101 | 650244276 | HOLDING CO | FL | 501(C) (3) | LINE 3 | Yes (1) | NCH SYSTEM | |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PROSCAN NCH IMAGING LLC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 350 7TH STREET NORTH | AddressLine1Txt |
| City | NAPLES | CityNm |
| State Abbreviation | FL | StateAbbreviationCd |
| ZIP | 34102 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 861212843 | EIN |
| Primary Activities | RADIOLOGY SERVICES | PrimaryActivitiesTxt |
| Legal Domicile State | DE | LegalDomicileStateCd |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NCHMD INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Predominant Income Type | RELATED | PredominantIncomeTypeTxt |
| Disproportionate Allocations | 0 | DisproportionateAllocationsInd |
| General Or Managing Partner | Yes (1) | GeneralOrManagingPartnerInd |
| Ownership | 0.51000 | OwnershipPct |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (4 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Entity TypeEntityTypeTxt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|
| HEALTH RESOURCES CORPORATION | |||||||||
| 350 7TH STREET NORTH | NAPLES | FL | 34102 | 592568003 | HOLDING COMPANY | FL | NCH SYSTEM | C | Yes (1) |
| AMBULATORY SURGICAL CARE CENTER INC | |||||||||
| 350 7TH STREET NORTH | NAPLES | FL | 34102 | 592568029 | OUTPAT. SURGERY | FL | HRC | C | Yes (1) |
| COMMUNITY HOME CARE INC | |||||||||
| 350 7TH STREET NORTH | NAPLES | FL | 34102 | 592372966 | HOME HEALTH | FL | HRC | C | Yes (1) |
| COMMUNITY IMAGING INC | |||||||||
| 350 7TH STREET NORTH | NAPLES | FL | 34102 | 592446336 | RADIOLOGY LAB | FL | HRC | C | Yes (1) |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | Yes (1) | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | Yes (1) | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (1) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | Yes (1) | AssetExchangeInd |
| Rental Of Facilities To Oth Org | Yes (1) | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | Yes (1) | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | Yes (1) | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (1) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | Yes (1) | TransferToOtherOrgInd |
| Transfer From Other Org | Yes (1) | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (3 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| NAPLES COMMUNITY HOSPITAL INC | ||
| Q | $44,041,092 | FMV |
| NAPLES COMMUNITY HOSPITAL INC | ||
| K | $1,385,522 | FMV |
| NCH HEALTHCARE SYSTEM INC | ||
| Q | $987,102 | FMV |