2022-08-05T10:35:45-05:00 2021-09-30 420714325 RSM US LLP 30 SOUTH WACKER DR SUITE 3300 CHICAGO IL 606063392 990 2020-10-01 331075317 NCHMD INC NCHM 2396246338 PO BOX 413029 NAPLES FL 341013029 RICK WYLES CHIEF FINANCIAL OFFICER 2396244005 2022-08-03 1 RICK WYLES 999009999 REBEKUH ELEY P01247672 3126343400 2022-08-01 3 AAL1 IAL1 2020 2022-09-23 18:48:47Z NCH PHYSICIAN GROUP PAUL HILTZ PO BOX 413029 NAPLES FL 341013029 128210319 0 X WWW.NCHMD.ORG X 2003 FL 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. 11 3 1058 3 0 0 0 3354173 113273393 124724841 -267 -471592 37500 125775 113310626 127733197 0 0 0 0 121859774 133594557 0 0 0 31038764 33160605 152898538 166755162 -39587912 -39021965 41550306 43477542 33787455 30380405 7762851 13097137 X HELPING EVERYONE LIVE A LONGER, HAPPIER, AND HEALTHIER LIFE. 0 0 23997290 21466317 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. 22773261 15752158 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. 22108206 17514113 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. 88786400 70028253 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 - 88786400 70028253 157665157 1 1 0 0 0 0 0 0 0 0 1 0 1 0 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1 1 0 0 1 88 0 1 1058 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 11 3 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 FL X X RICK WYLES CHIEF FINANCIAL OFFICER 2396244005 350 SEVENTH STREET NORTH NAPLES FL 34102 HOWARD KAPP MD PHYSICIAN 40.00 0.00 X 2066309 0 26046 JON DOUNCHIS MD PHYSICIAN 40.00 0.00 X 1770347 0 33201 DINESH SHARMA MD PHYSICIAN 40.00 0.00 X 1741970 0 36450 DAVID AXLINE MD PHYSICIAN 40.00 0.00 X 1116222 0 34503 LARRY LESLIE MD PHYSICIAN 40.00 0.00 X 1100753 0 36858 PAUL HILTZ PRESIDENT/CEO/TRUSTEE 1.00 44.00 X X 0 897053 33680 ALLEN S WEISSMD TERM 119 FORMER PRESIDENT/CEO/TRUSTEE 0.00 0.00 X 0 909806 17158 MAZEN ALBELDAWI MD PHYSICIAN/TRUSTEE 40.00 0.00 X 807557 0 36338 BRYAN MURPHEY MD PHYSICIAN/CHAIRMAN 40.00 0.00 X 771952 0 33608 MICHAEL S FLYNN MD PHYSICIAN/TRUSTEE 40.00 0.00 X 731802 0 33608 PHILLIP DUTCHER TERM 0721 CHIEF OPERATING OFFICER SYSTEM 1.00 44.00 X 0 707824 14142 MARC D COLTON MD TERM 821 PHYSICIAN/TRUSTEE 40.00 0.00 X 620275 0 36358 RICK WYLES CHIEF FINANCIAL OFFICER 1.00 44.00 X 0 516031 34675 KEVIN D COOPER TERM 119 FORMER CHIEF OF STAFF 0.00 0.00 X 0 522084 16889 DAVID LINZ MD START 1120 PHYSICIAN/TRUSTEE 40.00 0.00 X 501008 0 35608 SHARLA PATTERSON MD PHYSICIAN/TRUSTEE 40.00 0.00 X 475600 0 36430 FRANK ASTOR MD TERM 1119 FORMER TRUSTEE/CMO 0.00 0.00 X 0 487788 16236 JONATHAN KLING RN STRT 0721 CHIEF OPERATING OFFICER SYSTEM 1.00 44.00 X 0 446398 33658 ZACKARY BOSTOCK TERM 320 FORMER CHIEF ADMIN OFFICER 0.00 0.00 X 0 441291 29611 EMILY ESSERT MD PHYSICIAN/TRUSTEE 40.00 0.00 X 430610 0 33293 KRISTIN MASCOTTI MD TRUSTEE/CMO 1.00 44.00 X X 0 425744 9008 LINDA ROEBACK TERM 520 FORMER CHIEF COUNSEL 0.00 0.00 X 0 397178 22045 JIM MAHON SENIOR VICE PRESIDENT 1.00 44.00 X 0 399133 2931 RENEE M THIGPEN CHIEF HR OFFICER 1.00 44.00 X 0 356246 30108 MICHAEL RILEY TERM 1120 CHIEF STRATEGY OFFICER 1.00 44.00 X 0 339701 28889 PAMELA ZIPPERER-DAVIS TRM 0321 TRUSTEE/CHIEF ADMIN. OFFICER 1.00 44.00 X X 0 322328 12569 GARY TOMCIK TERM 420 FORMER CHIEF EXPERIENCE OFFICER 0.00 0.00 X 0 282293 27943 GINA TEEGARDEN RN ST 0721 INTERIM CHIEF NURSING OFFICER 1.00 44.00 X 0 197163 14989 KEVIN BEEBE TRUSTEE 0.50 1.50 X 0 0 0 SCOTT LUTGERT TRUSTEE 0.50 1.50 X 0 0 0 MICHAEL WYNN TRUSTEE 0.50 1.50 X 0 0 0 12134405 7648061 756832 215 1 1 0 NEUROINTERVENTIONAL ASSOCIATES PA 335 31ST STREET SOUTH ST PETERSBURG FL 33712 PHYSICIAN STAFFING SERVICES 1599996 SURETY CONSTRUCTION 6640 WILLOW PARK DRIVE SUITE B NAPLES FL 34109 COMMERCIAL CONSTRUCTION 1305677 CERNER CORPORATION PO BOX 959156 ST LOUIS MO 631959156 IT SOFTWARE & CONSULTING SERVICES 1091571 LOCUM-TENENS COM LLC PO BOX 405547 ATLANTA GA 303845547 PHYSICIAN STAFFING SERVICES 1006412 NFV HEALTHCARE GROUP PO BOX 1118 FORT MYERS FL 33902 PHYSICIAN STAFFING SERVICES 710866 23 X 3354173 3354173 OFFICES OF PHYSICIANS 621110 124724841 124724841 124724841 95305 5530 89775 89775 89775 471592 -471592 -471592 -471592 MEDICAL DIRECTORSHIP 900099 36000 36000 36000 127733197 124760841 0 -381817 5496231 4902972 593259 588609 333618 254991 115599353 110943012 4656341 2601054 2483486 117568 3848687 3676094 172593 5460623 5213803 246820 4500507 3333810 1166697 46351 46351 3314567 2170164 1144403 1852702 1768960 83742 5613318 5093660 519658 47016 46028 988 3813068 3725694 87374 1747904 1713425 34479 MEDICAL SUPPLIES 12214489 12211680 2809 BAD DEBT 8283 8283 2400 2400 166755162 157665157 9090005 0 0 8392908 9808361 1454254 1533399 426960 2460255 38647022 18730538 27221399 19916484 7818678 4054785 1940365 41550306 43477542 17365492 21596564 5279114 1931977 11142849 6851864 33787455 30380405 X 7762851 13097137 7762851 13097137 41550306 43477542 X -39021965 44356251 X 0 1 X 1 0 X 3354173 3354173 90888451 110657971 112927917 113273393 124724841 552472573 90888451 110657971 112927917 113273393 128079014 555826746 0 0 0 555826746 5990 89775 95765 5990 89775 95765 11631 39452 42000 37500 36000 166583 90900082 110697423 112975907 113310893 128204789 556089094 0.99950 0.99970 0.00020 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: 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. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 2559424 2559424 13197550 3320317 9877233 7927668 5240347 2687321 14458246 10169874 4288372 504134 504134 19916484 INVESTMENT IN PROSCAN 7818678 C 7818678 MEDICARE ADVANCED PAYMENT 6851864 6851864 X PART X, LINE 2: 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. X X X X 1 1 0 0 0 0 0 1 0 HOWARD KAPP MD PHYSICIAN 1941684 0 103937 0 20688 0 11400 0 14646 0 2092355 0 0 0 JON DOUNCHIS MD PHYSICIAN 1601587 0 148846 0 19914 0 11400 0 21801 0 1803548 0 0 0 DINESH SHARMA MD PHYSICIAN 1375735 0 346573 0 19662 0 11400 0 25050 0 1778420 0 0 0 DAVID AXLINE MD PHYSICIAN 952531 0 143417 0 20274 0 11400 0 23103 0 1150725 0 0 0 LARRY LESLIE MD PHYSICIAN 931157 0 149682 0 19914 0 11400 0 25458 0 1137611 0 0 0 PAUL HILTZ PRESIDENT/CEO/TRUSTEE 0 855115 0 21250 0 20688 0 11400 0 22280 0 930733 0 0 ALLEN S WEISSMD TERM 119 FORMER PRESIDENT/CEO/TRUSTEE 0 0 0 0 0 909806 0 0 0 17158 0 926964 0 0 MAZEN ALBELDAWI MD PHYSICIAN/TRUSTEE 787365 0 512 0 19680 0 11400 0 24938 0 843895 0 0 0 BRYAN MURPHEY MD PHYSICIAN/CHAIRMAN 676051 0 75987 0 19914 0 11400 0 22208 0 805560 0 0 0 MICHAEL S FLYNN MD PHYSICIAN/TRUSTEE 630504 0 80610 0 20688 0 11400 0 22208 0 765410 0 0 0 PHILLIP DUTCHER TERM 0721 CHIEF OPERATING OFFICER SYSTEM 0 607258 0 77358 0 23208 0 11400 0 2742 0 721966 0 0 MARC D COLTON MD TERM 821 PHYSICIAN/TRUSTEE 600001 0 0 0 20274 0 11400 0 24958 0 656633 0 0 0 RICK WYLES CHIEF FINANCIAL OFFICER 0 452476 0 42867 0 20688 0 11400 0 23275 0 550706 0 0 KEVIN D COOPER TERM 119 FORMER CHIEF OF STAFF 0 0 0 0 0 522084 0 0 0 16889 0 538973 0 0 DAVID LINZ MD START 1120 PHYSICIAN/TRUSTEE 430307 0 51039 0 19662 0 11400 0 24208 0 536616 0 0 0 SHARLA PATTERSON MD PHYSICIAN/TRUSTEE 431585 0 24335 0 19680 0 11400 0 25030 0 512030 0 0 0 FRANK ASTOR MD TERM 1119 FORMER TRUSTEE/CMO 0 0 0 0 0 487788 0 0 0 16236 0 504024 0 0 JONATHAN KLING RN STRT 0721 CHIEF OPERATING OFFICER SYSTEM 0 384005 0 42623 0 19770 0 11400 0 22258 0 480056 0 0 ZACKARY BOSTOCK TERM 320 FORMER CHIEF ADMIN OFFICER 0 98702 0 41802 0 300787 0 5559 0 24052 0 470902 0 0 EMILY ESSERT MD PHYSICIAN/TRUSTEE 353735 0 57213 0 19662 0 11400 0 21893 0 463903 0 0 0 KRISTIN MASCOTTI MD TRUSTEE/CMO 0 316117 0 90000 0 19627 0 0 0 9008 0 434752 0 0 LINDA ROEBACK TERM 520 FORMER CHIEF COUNSEL 0 119967 0 29754 0 247457 0 6514 0 15531 0 419223 0 0 JIM MAHON SENIOR VICE PRESIDENT 0 374692 0 3095 0 21346 0 2338 0 593 0 402064 0 0 RENEE M THIGPEN CHIEF HR OFFICER 0 305567 0 29991 0 20688 0 11400 0 18708 0 386354 0 0 MICHAEL RILEY TERM 1120 CHIEF STRATEGY OFFICER 0 264261 0 29630 0 45810 0 11400 0 17489 0 368590 0 0 PAMELA ZIPPERER-DAVIS TRM 0321 TRUSTEE/CHIEF ADMIN. OFFICER 0 252554 0 50000 0 19774 0 0 0 12569 0 334897 0 0 GARY TOMCIK TERM 420 FORMER CHIEF EXPERIENCE OFFICER 0 82909 0 26378 0 173006 0 4422 0 23521 0 310236 0 0 GINA TEEGARDEN RN ST 0721 INTERIM CHIEF NURSING OFFICER 0 190216 0 6533 0 414 0 6010 0 8979 0 212152 0 0 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. RASAI ERNST MD FMLY MEMBER/TRUSTEE 208826 EMPLOYED PHYSICIAN 0 ALYSSA J CENZI FMLY MEMBER/OFFICER 73903 EMPLOYEE 0 VLADIMIRA KLING FMLY MEMBER/OFFICER 23330 EMPLOYEE 0 TIFFANY WYNN FMLY MEMBER/TRUSTEE 18826 EMPLOYEE 0 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. 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. 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 NCH SYSTEM 1 MARCO ISLAND HOSPITAL INC 40 HEATHWOOD DRIVE MARCO ISLAND FL 34145 592315435 SUPPORT ORG. FL 501(C) (3) LINE 3 NCH SYSTEM 1 COMMUNITY HOME SERVICES INC PO BOX 413029 NAPLES FL 34101 592440516 SUPPORT ORG. FL 501(C) (3) LINE 12B, II NCH SYSTEM 1 COLLIER HEALTH CARE INC PO BOX 413029 NAPLES FL 34101 650244276 HOLDING CO FL 501(C) (3) LINE 3 NCH SYSTEM 1 PROSCAN NCH IMAGING LLC 350 7TH STREET NORTH NAPLES FL 34102 861212843 RADIOLOGY SERVICES DE NCHMD INC RELATED 0 1 0.51000 HEALTH RESOURCES CORPORATION 350 7TH STREET NORTH NAPLES FL 34102 592568003 HOLDING COMPANY FL NCH SYSTEM C 1 AMBULATORY SURGICAL CARE CENTER INC 350 7TH STREET NORTH NAPLES FL 34102 592568029 OUTPAT. SURGERY FL HRC C 1 COMMUNITY HOME CARE INC 350 7TH STREET NORTH NAPLES FL 34102 592372966 HOME HEALTH FL HRC C 1 COMMUNITY IMAGING INC 350 7TH STREET NORTH NAPLES FL 34102 592446336 RADIOLOGY LAB FL HRC C 1 1 1 1 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1 1 NAPLES COMMUNITY HOSPITAL INC Q 44041092 FMV NAPLES COMMUNITY HOSPITAL INC K 1385522 FMV NCH HEALTHCARE SYSTEM INC Q 987102 FMV