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NCHMD INC: Form 990, tax year 2016

View the entire original 990 at ProPublica ↗

Organization
NCHMD INC (EIN 33-1075317)
Tax period
2016-10-01 to 2017-09-30
Filed
2018-08-15
IRS object ID
201842279349301309
Schema version
2016v3.0
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

FieldValueIRS element (for citing)
Return2018-08-15T09:29:57-05:00ReturnTs
Tax Period End2017-09-30TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN420714325PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1RSM US LLPBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1ONE SOUTH WACKER STE 800AddressLine1Txt
CityCHICAGOCityNm
State AbbreviationILStateAbbreviationCd
ZIP60606ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2016-10-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN331075317EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1NCHMD INCBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlNCHMBusinessNameControlTxt
Phone2396246338PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1PO BOX 413029AddressLine1Txt
CityNAPLESCityNm
State AbbreviationFLStateAbbreviationCd
ZIP341013029ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonRICK WYLESPersonNm
Person TitleCHIEF FINANCIAL OFFICERPersonTitleTxt
Phone2396244005PhoneNum
Signature2018-08-14SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonWAYNE HARDERPreparerPersonNm
PTINP00294296PTIN
Phone3126343400PhoneNum
FieldValueIRS element (for citing)
Tax2016TaxYr
Build TS2022-09-23 18:48:47ZBuildTS

Form 990 IRS990

Doing Business As Name DoingBusinessAsName

FieldValueIRS element (for citing)
Business Name Line1NCH PHYSICIAN GROUPBusinessNameLine1Txt
FieldValueIRS element (for citing)
Principal OfficerRICK WYLESPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line1PO BOX 413029AddressLine1Txt
CityNAPLESCityNm
State AbbreviationFLStateAbbreviationCd
ZIP341013029ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$90,930,848GrossReceiptsAmt
Group Return For Affiliates0GroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressWWW.NCHMD.ORGWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation2003FormationYr
Legal Domicile StateFLLegalDomicileStateCd
Activity Or MissionHELPING EVERYONE LIVE A LONGER, HAPPIER, AND HEALTHIER LIFE.ActivityOrMissionDesc
Voting Members Governing Body11VotingMembersGoverningBodyCnt
Voting Members Independent2VotingMembersIndependentCnt
Total Employee697TotalEmployeeCnt
Total Volunteers3TotalVolunteersCnt
Total Gross UBI$30,766TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$0PYContributionsGrantsAmt
CY Contributions Grants$0CYContributionsGrantsAmt
PY Program Service Revenue$72,592,000PYProgramServiceRevenueAmt
CY Program Service Revenue$90,888,451CYProgramServiceRevenueAmt
PY Investment Income-$47,708PYInvestmentIncomeAmt
CY Investment Income$0CYInvestmentIncomeAmt
PY Other Revenue$213,666PYOtherRevenueAmt
CY Other Revenue$42,397CYOtherRevenueAmt
PY Total Revenue$72,757,958PYTotalRevenueAmt
CY Total Revenue$90,930,848CYTotalRevenueAmt
PY Grants And Similar Paid$0PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$70,539,980PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$85,586,452CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$24,140,471PYOtherExpensesAmt
CY Other Expenses$27,903,861CYOtherExpensesAmt
PY Total Expenses$94,680,451PYTotalExpensesAmt
CY Total Expenses$113,490,313CYTotalExpensesAmt
PY Revenues Less Expenses-$21,922,493PYRevenuesLessExpensesAmt
CY Revenues Less Expenses-$22,559,465CYRevenuesLessExpensesAmt
Total Assets BOY$20,703,752TotalAssetsBOYAmt
Total Assets EOY$36,813,623TotalAssetsEOYAmt
Total Liabilities BOY$15,258,363TotalLiabilitiesBOYAmt
Total Liabilities EOY$16,004,130TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$5,445,389NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$20,809,493NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part IIIYes (X)InfoInScheduleOPartIIIInd
MissionHELPING EVERYONE LIVE A LONGER, HAPPIER, AND HEALTHIER LIFE.MissionDesc
Significant New Program Srvc0SignificantNewProgramSrvcInd
Significant ChangeYes (1)SignificantChangeInd
Expense$17,927,178ExpenseAmt
Revenue$16,550,486RevenueAmt
DescFAMILY PRACTICE SERVICES WERE NCH PHYSICIAN GROUP'S LARGEST PROGRAM SERVICE ACCOMPLISHMENT IN 2017. 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 53 LICENSED INDEPENDENT PRACTITIONERS AND 82 FULL-TIME EQUIVALENT EMPLOYEES WHO PERFORMED 138,007 RELATIVE VALUE UNITS, PROVIDED $5,286. OF CHARITY CARE AND ALSO WROTE OFF $41,057. OF BAD DEBT.Desc

Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp

FieldValueIRS element (for citing)
Expense$15,907,628ExpenseAmt
Revenue$11,379,854RevenueAmt
DescCARDIOLOGY SERVICES WERE NCH PHYSICIAN GROUP'S SECOND LARGEST PROGRAM SERVICE ACCOMPLISHMENT IN 2017. NCHMD, INC., IN CONJUNCTION WITH THE NCH DOWNTOWN NAPLES HOSPITAL, IS HOME TO THE NCH HEART INSTITUTE, ONE OF THE MOST SUCCESSFUL CARDIAC PROGRAMS IN THE NATION. THE NCH HEART INSTITUTE IS RANKED #1 IN FLORIDA AGAIN FOR OVERALL CARDIC CARE AND IS RECOGNIZED FOR ITS CODE SAVE-A-HEART PROGRAM. OUR SERVICES INCLUDE INVASIVE AND NON-INVASIVE CARDIAC PROCEEDURES, CARDIAC REHABILITATION AND WELLNESS PROGRAMS.WITHIN THIS SERVICE LINE, NCHMD EMPLOYED 37 LICENSED INDEPENDENT PRACTITIONERS AND 36 FULL-TIME EQUIVALENT EMPLOYEES WHO PERFORMED 179,815 RELATIVE VALUE UNITS, PROVIDED $507,664. OF CHARITY CARE AND ALSO WROTE OFF $263,426 OF BAD DEBT.Desc

Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp

FieldValueIRS element (for citing)
Expense$15,889,122ExpenseAmt
Revenue$11,856,260RevenueAmt
DescSEE SCHEDULE OINTERNAL MEDICINE SERVICES WERE NCH PHYSICIAN GROUP'S THIRD LARGEST PROGRAM SERVICE ACCOMPLISHMENT IN 2017. 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 COMPASSSIONATE 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 69 LICENSED INDEPENDENT PRACTITIONS AND 29 FULL-TIME EQUIVALENT EMPLOYEES WHO PERFORMED 202,548 RELATIVE VALUE UNITS, PROVIDED $660,924 OF CHARITY CARE AND ALSO WROTE OFF $256,110 OF BAD DEBT.Desc

Prog Srvc Accom Acty Other ProgSrvcAccomActyOtherGrp

FieldValueIRS element (for citing)
Expense$57,581,534ExpenseAmt
Revenue$51,104,378RevenueAmt
DescIN PROVIDING THE OTHER PROGRAM SERVICE LINES, NCHMD EMPLOYED 86 LICENSED INDEPENDENT PRACTITIONERS AND 260 FTES WHO PERFORMED 467,468 RELATIVE VALUE UNITS, PROVIDED $1,518,459 OF CHARITY CARE AND ALSO WROTE OFF $1,217,306 OF BAD DEBT.NCH PHYSICIAN GROUP'S OTHER PROGRAM SERVICE LINES ARE: EXPENSE REVENUELAB AND RADIOLOGY $14,589,319 $16,679,838PULMONARY 9,264,872 6,262,516 INFECTIOUS DISEASE 8,286,146 8,696,373ORTHOPEDICS 7,844,357 5,817,898GASTROENTEROLOGY 4,225,510 3,308,582 GENERAL SURGERY 3,036,737 2,596,482PAIN MANAGEMENT 2,930,232 1,785,941URGENT CARE 1,606,648 1,898,359PSYCHIATRY 1,563,614 922,896PEDIATRICS 1,496,613 1,202,799ENDOCRINOLOGY 971,483 577,483GERIATRICS 618,712 327,277RHEUMATOLOGY 559,767 394,404PRO TIME 366,621 305,257GME 144,654 229,389 WOUND HEALING 48,527 98,884CHRONIC CARE 27,722 0Desc
FieldValueIRS element (for citing)
Total Other Prog Srvc Expense$57,581,534TotalOtherProgSrvcExpenseAmt
Total Other Prog Srvc Revenue$51,104,378TotalOtherProgSrvcRevenueAmt
Total Program Service Expenses$107,305,462TotalProgramServiceExpensesAmt
Described In Section501c3Yes (1)DescribedInSection501c3Ind
Schedule B Required0ScheduleBRequiredInd
Political Campaign Acty0PoliticalCampaignActyInd
Lobbying Activities0LobbyingActivitiesInd
Subject To Proxy Tax0SubjectToProxyTaxInd
Donor Advised Fund0DonorAdvisedFundInd
Conservation Easements0ConservationEasementsInd
Collections Of Art0CollectionsOfArtInd
Credit Counseling0CreditCounselingInd
Temp Or Permanent Endowments0TempOrPermanentEndowmentsInd
Report Land Building EquipmentYes (1)ReportLandBuildingEquipmentInd
Report Investments Other Sec0ReportInvestmentsOtherSecInd
Report Program Related Invst0ReportProgramRelatedInvstInd
Report Other Assets0ReportOtherAssetsInd
Report Other Liabilities0ReportOtherLiabilitiesInd
Include FIN48 FootnoteYes (1)IncludeFIN48FootnoteInd
Independent Audit Fincl Stmt0IndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (1)ConsolidatedAuditFinclStmtInd
School Operating0SchoolOperatingInd
Foreign Office0ForeignOfficeInd
Foreign Activities0ForeignActivitiesInd
More Than5000 K To Org0MoreThan5000KToOrgInd
More Than5000 K To Individuals0MoreThan5000KToIndividualsInd
Professional Fundraising0ProfessionalFundraisingInd
Fundraising Activities0FundraisingActivitiesInd
Gaming Activities0GamingActivitiesInd
Operate Hospital0OperateHospitalInd
Grants To Organizations0GrantsToOrganizationsInd
Grants To Individuals0GrantsToIndividualsInd
Schedule J RequiredYes (1)ScheduleJRequiredInd
Tax Exempt Bonds0TaxExemptBondsInd
Engaged In Excess Benefit Trans0EngagedInExcessBenefitTransInd
PY Excess Benefit Trans0PYExcessBenefitTransInd
Loan Outstanding0LoanOutstandingInd
Grant To Related Person0GrantToRelatedPersonInd
Business Rln With Org Mem0BusinessRlnWithOrgMemInd
Business Rln With Fam MemYes (1)BusinessRlnWithFamMemInd
Business Rln With Officer EntYes (1)BusinessRlnWithOfficerEntInd
Deductible Non Cash Contri0DeductibleNonCashContriInd
Deductible Art Contribution0DeductibleArtContributionInd
Terminate Operations0TerminateOperationsInd
Partial Liquidation0PartialLiquidationInd
Disregarded Entity0DisregardedEntityInd
Related EntityYes (1)RelatedEntityInd
Related Organization Ctrl Ent0RelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org0TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp0ActivitiesConductedPrtshpInd
Schedule O RequiredYes (1)ScheduleORequiredInd
IRP Document72IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (1)BackupWthldComplianceInd
Employee697EmployeeCnt
Employment Tax Returns FiledYes (1)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over LimitYes (1)UnrelatedBusIncmOverLimitInd
Form990 T FiledYes (1)Form990TFiledInd
Foreign Financial Account0ForeignFinancialAccountInd
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTransInd
Taxable Party Notification0TaxablePartyNotificationInd
Nondeductible Contributions0NondeductibleContributionsInd
Quid Pro Quo Contributions0QuidProQuoContributionsInd
Form8282 Property Disposed Of0Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct0RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct0PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services0IndoorTanningServicesInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members11GoverningBodyVotingMembersCnt
Independent Voting Member2IndependentVotingMemberCnt
Family Or Business Rln0FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties0DelegationOfMgmtDutiesInd
Change To Org Documents0ChangeToOrgDocumentsInd
Material Diversion Or Misuse0MaterialDiversionOrMisuseInd
Members Or StockholdersYes (1)MembersOrStockholdersInd
Election Of Board MembersYes (1)ElectionOfBoardMembersInd
Decisions Subject To ApprovaYes (1)DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (1)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (1)MinutesOfCommitteesInd
Officer Mailing Address0OfficerMailingAddressInd
Local Chapters0LocalChaptersInd
Form990 Provided To Gvrn BodyYes (1)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (1)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (1)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (1)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (1)WhistleblowerPolicyInd
Document Retention PolicyYes (1)DocumentRetentionPolicyInd
Compensation Process CEOYes (1)CompensationProcessCEOInd
Compensation Process OtherYes (1)CompensationProcessOtherInd
Investment In Joint Venture0InvestmentInJointVentureInd
States Where Copy Of Return Is FldFLStatesWhereCopyOfReturnIsFldCd
Own WebsiteYes (X)OwnWebsiteInd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1RICK WYLES CHIEF FINANCIAL OFFICERBusinessNameLine1Txt
FieldValueIRS element (for citing)
Phone2396244005PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1350 SEVENTH STREET NORTHAddressLine1Txt
CityNAPLESCityNm
State AbbreviationFLStateAbbreviationCd
ZIP34102ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (28 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtOfficerOfficerIndHighest Compensated EmployeeHighestCompensatedEmployeeIndFormer Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd
THOMAS J GAZDIC
TRUSTEE0.501.50Yes (X)$0$0$0
JOHN LEWIS MD
TRUSTEE0.501.50Yes (X)$0$0$0
BRYAN MURPHEY MD
PHYSICIAN/CHAIRMAN40.00Yes (X)$459,878$0$25,634Yes (X)
DAMIAN MCGOVERN MD
PHYSICIAN/SECRETARY/TREASURER40.00Yes (X)$914,871$0$26,263Yes (X)
GARY SWAIN MD
PHYSICIAN/VICE CHAIRMAN40.00Yes (X)$269,042$0$8,623Yes (X)
MAZEN ALBELDAWI MD
PHYSICIAN/TRUSTEE40.00Yes (X)$1,120,596$0$41,417
MICHAEL FLYNN MD
PHYSICIAN/TRUSTEE40.00Yes (X)$635,595$0$28,520
DAVID LAMON MD
PHYSICIAN/TRUSTEE40.00Yes (X)$480,218$0$30,044
KAREN M HENRICHSENDO
PHYSICIAN/TRUSTEE TERM 05/1740.00Yes (X)$268,652$0$22,941
ALLEN S WEISS MD
TRUSTEE/PRESIDENT/CEO1.0044.00Yes (X)$0$912,173$21,876Yes (X)
FRANK ASTOR MD
TRUSTEE/CHIEF MEDICAL OFFICER1.0044.00Yes (X)$0$467,349$22,425Yes (X)
KEVIN D COOPER
CHIEF OF STAFF1.0044.00$0$529,363$29,317Yes (X)
MICHELE THOMANRN TERM 1116
CHIEF NURSING OFFICER1.0044.00$0$362,284$27,130Yes (X)
PHILLIP DUTCHER
COO, NCH HEALTHCARE SYSTEM1.0044.00$0$537,567$3,524Yes (X)
RICK WYLES
CHIEF FINANCIAL OFFICER1.0044.00$0$338,594$27,896Yes (X)
MICHAEL RILEY
CHIEF STRATEGY OFFICER1.0044.00$0$303,612$33,976Yes (X)
RENEE M THIGPEN
CHIEF HR OFFICER1.0044.00$0$276,470$27,426Yes (X)
ELIZABETH MARTIN
ASSISTANT SECRETARY1.0044.00$0$66,039$20,675Yes (X)
JAMES K MARTIN TERM 517
CHIEF DEVELOPMENT OFFICER1.0044.00$0$340,526$32,471Yes (X)
GARY TOMCIK
CHIEF EXPERIENCE OFFICER1.0044.00$0$192,512$28,013Yes (X)
ZACHARY BOSTOCK
CHIEF ADMINISTRATIVE OFFICER1.0044.00$0$398,248$30,149Yes (X)
JONATHAN KLINGRN START 1116
CHIEF NURSING OFFICER1.0044.00$0$173,316$30,102Yes (X)
HOWARD KAPP MD
PHYSICIAN40.000.00$1,983,802$0$16,251Yes (X)
JON DOUNCHIS MD
PHYSICIAN40.000.00$1,320,136$0$25,707Yes (X)
CARLO D SANTOS-OCAMPO MD
PHYSICIAN40.000.00$1,050,339$0$29,834Yes (X)
DAVID R AXLINE MD
PHYSICIAN40.000.00$1,007,257$0$26,550Yes (X)
ADAM J FRANK MD
PHYSICIAN40.000.00$823,430$0$19,541Yes (X)
SARAH RICHARDSON TERM 216
FORMER CHIEF INFORMATION OFFICER0.000.00$0$178,044$2,271Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$10,333,816TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$5,076,097TotReportableCompRltdOrgAmt
Total Other Compensation$638,576TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K128IndivRcvdGreaterThan100KCnt
Former Ofcr Employees ListedYes (1)FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (1)TotalCompGreaterThan150KInd
Compensation From Other Srcs0CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmt
LOCUMTENENS COM LLC
PO BOX 405547ATLANTAGA303845547PHYSICIAN STAFFING SERVICES$1,554,066
SHERIDAN RADIOLOGY MGMT
PO BOX 452796SUNRISEFL333232197RADIOLOGY SERVICES$1,282,945
CERNER CORPORATION
PO BOX 959156ST LOUISMO631959156IT CONSULTING AND SUPPORT SERVICES$951,932
BCBE CONSTRUCTION LLC
3570 ENTERPRISE AVE SUITE 200NAPLESFL34104CONSTRUCTION SERVICES$436,490
GE HEALTHCARE IITS
15724 COLLECTIONS CENTER DRCHICAGOIL60693IT CONSULTING AND SUPPORT SERVICES$332,119
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K9CntrctRcvdGreaterThan100KCnt

Program Service Revenue ProgramServiceRevenueGrp

FieldValueIRS element (for citing)
DescOFFICES OF PHYSICIANSDesc
Business621110BusinessCd
Total Revenue Column$90,888,451TotalRevenueColumnAmt
Related Or Exempt Func Income$90,888,451RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Total Program Service Revenue$90,888,451TotalProgramServiceRevenueAmt

Other Revenue Misc OtherRevenueMiscGrp (3 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtUnrelated Business RevenueUnrelatedBusinessRevenueAmtExclusionExclusionAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
SUBLEASE SPACE/PERS561000$30,766$30,766
EMPLOYEE SALES900099$9,104$9,104
MISC RECEIPTS900099$2,527$2,527
FieldValueIRS element (for citing)
Other Revenue Total$42,397OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$90,930,848TotalRevenueColumnAmt
Related Or Exempt Func Income$90,890,978RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$30,766UnrelatedBusinessRevenueAmt
Exclusion$9,104ExclusionAmt
FieldValueIRS element (for citing)
Info In Schedule O Part IXYes (X)InfoInScheduleOPartIXInd

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$4,555,335TotalAmt
Program Services$4,159,800ProgramServicesAmt
Management And General$395,535ManagementAndGeneralAmt

Comp Disqual Persons CompDisqualPersonsGrp

FieldValueIRS element (for citing)
Total$344,674TotalAmt
Program Services$344,674ProgramServicesAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$73,629,962TotalAmt
Program Services$70,358,324ProgramServicesAmt
Management And General$3,271,638ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$1,683,881TotalAmt
Program Services$1,605,244ProgramServicesAmt
Management And General$78,637ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$1,597,449TotalAmt
Program Services$1,523,005ProgramServicesAmt
Management And General$74,444ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$3,775,151TotalAmt
Program Services$3,598,851ProgramServicesAmt
Management And General$176,300ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$4,776,159TotalAmt
Program Services$4,260,547ProgramServicesAmt
Management And General$515,612ManagementAndGeneralAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$215,520TotalAmt
Program Services$215,520ProgramServicesAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$2,824,130TotalAmt
Program Services$1,957,027ProgramServicesAmt
Management And General$867,103ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$1,466,077TotalAmt
Program Services$1,397,611ProgramServicesAmt
Management And General$68,466ManagementAndGeneralAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$4,343,324TotalAmt
Program Services$3,699,195ProgramServicesAmt
Management And General$644,129ManagementAndGeneralAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$111,474TotalAmt
Program Services$110,516ProgramServicesAmt
Management And General$958ManagementAndGeneralAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$3,039,736TotalAmt
Program Services$2,988,271ProgramServicesAmt
Management And General$51,465ManagementAndGeneralAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$747,123TotalAmt
Program Services$706,714ProgramServicesAmt
Management And General$40,409ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (2 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
MEDICAL SUPPLIES$8,600,194$8,600,039$155
BAD DEBT$1,777,899$1,777,899

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$2,225TotalAmt
Program Services$2,225ProgramServicesAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$113,490,313TotalAmt
Program Services$107,305,462ProgramServicesAmt
Management And General$6,184,851ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$5,085,992BOYAmt
EOY$8,229,485EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$736,167BOYAmt
EOY$785,734EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$745,990BOYAmt
EOY$527,519EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$39,752,920LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$16,734,820LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$12,211,738BOYAmt
EOY$23,018,100EOYAmt

Intangible Assets IntangibleAssetsGrp

FieldValueIRS element (for citing)
BOY$1,923,865BOYAmt
EOY$4,252,785EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$20,703,752BOYAmt
EOY$36,813,623EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$14,059,767BOYAmt
EOY$14,653,108EOYAmt

Deferred Revenue DeferredRevenueGrp

FieldValueIRS element (for citing)
BOY$1,198,596BOYAmt
EOY$1,351,022EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$15,258,363BOYAmt
EOY$16,004,130EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY$5,445,389BOYAmt
EOY$20,809,493EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$5,445,389BOYAmt
EOY$20,809,493EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$20,703,752BOYAmt
EOY$36,813,623EOYAmt
FieldValueIRS element (for citing)
Info In Schedule O Part XIYes (X)InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss-$22,559,465ReconcilationRevenueExpnssAmt
Other Changes In Net Assets$37,923,569OtherChangesInNetAssetsAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or Review0AccountantCompileOrReviewInd
FS AuditedYes (1)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Consolidated Basis Fincl StmtYes (X)ConsolidatedBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (1)AuditCommitteeInd
Federal Grant Audit Required0FederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org509a2Yes (X)PubliclySupportedOrg509a2Ind

Gross Receipts Admissions GrossReceiptsAdmissionsGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$59,487,869CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$68,075,529CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$70,021,282CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$72,592,000CurrentTaxYearMinus1YearAmt
Current Tax Year$90,888,451CurrentTaxYearAmt
Total$361,065,131TotalAmt

Total509 Total509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$59,487,869CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$68,075,529CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$70,021,282CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$72,592,000CurrentTaxYearMinus1YearAmt
Current Tax Year$90,888,451CurrentTaxYearAmt
Total$361,065,131TotalAmt

Amounts Rcvd Dsqlfy Person AmountsRcvdDsqlfyPersonGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Substantial Contributors Amt SubstantialContributorsAmtGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Subst And Dsqlfy Prsns Tot SubstAndDsqlfyPrsnsTotGrp

FieldValueIRS element (for citing)
Total$0TotalAmt
FieldValueIRS element (for citing)
Public Support Total509$361,065,131PublicSupportTotal509Amt

Gross Investment Income509 GrossInvestmentIncome509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years-$4,596CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years-$262CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$9,702CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year-$47,708CurrentTaxYearMinus1YearAmt
Current Tax Year$0CurrentTaxYearAmt
Total-$42,864TotalAmt

Investment Income And UBTI InvestmentIncomeAndUBTIGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years-$4,596CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years-$262CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$9,702CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year-$47,708CurrentTaxYearMinus1YearAmt
Current Tax Year$0CurrentTaxYearAmt
Total-$42,864TotalAmt

Other Income509 OtherIncome509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$911,014CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$1,088,652CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$896,753CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$11,815CurrentTaxYearMinus1YearAmt
Current Tax Year$11,631CurrentTaxYearAmt
Total$2,919,865TotalAmt

Total Support Calendar Year TotalSupportCalendarYearGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$60,394,287CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$69,163,919CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$70,927,737CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$72,556,107CurrentTaxYearMinus1YearAmt
Current Tax Year$90,900,082CurrentTaxYearAmt
Total$363,942,132TotalAmt
FieldValueIRS element (for citing)
Public Support CY5090.99210PublicSupportCY509Pct
Public Support PY5090.98870PublicSupportPY509Pct
Investment Income CY0.00000InvestmentIncomeCYPct
Investment Income PY0.00000InvestmentIncomePYPct
Thirty Thr Pct Suprt Tests CY509Yes (X)ThirtyThrPctSuprtTestsCY509Ind

Form990 Schedule A Part VI Form990ScheduleAPartVIGrp

FieldValueIRS element (for citing)
Form And Line ReferenceSCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME:FormAndLineReferenceDesc
ExplanationPHYSICIAN ON CALL REVENUE - 2012 AMOUNT: $ 802,140. 2013 AMOUNT: $ 1,085,355. 2014 AMOUNT: $ 889,634. MISC ACCOUNTS REC RECEIPTS - 2012 AMOUNT: $ 5,478. 2013 AMOUNT: $ 452. 2014 AMOUNT: $ 1,074. 2015 AMOUNT: $ 282. 2016 AMOUNT: $ 6. EMPLOYEE SALES - 2012 AMOUNT: $ 2,943. 2013 AMOUNT: $ 2,845. 2014 AMOUNT: $ 6,045. 2015 AMOUNT: $ 8,233. 2016 AMOUNT: $ 9,104. MISC VENDOR RECEIPTS - 2016 AMOUNT: $ 2,521. PHYSICIAN CONTRACT BUYOUT - 2012 AMOUNT: $ 100,453. PATIENT STUDY REGISTRATION SERVICES - 2015 AMOUNT: $ 3,300. 2016 AMOUNT: $ 0.ExplanationTxt

Schedule D IRS990ScheduleD

Land LandGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$3,559,424OtherCostOrOtherBasisAmt
Book Value$3,559,424BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$7,021,260OtherCostOrOtherBasisAmt
Depreciation$1,291,976DepreciationAmt
Book Value$5,729,284BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$5,313,206OtherCostOrOtherBasisAmt
Depreciation$3,711,728DepreciationAmt
Book Value$1,601,478BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$22,716,487OtherCostOrOtherBasisAmt
Depreciation$11,731,116DepreciationAmt
Book Value$10,985,371BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$1,142,543OtherCostOrOtherBasisAmt
Book Value$1,142,543BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$23,018,100TotalBookValueLandBuildingsAmt
Footnote TextYes (X)FootnoteTextInd

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePART X, LINE 2:FormAndLineReferenceDesc
ExplanationTHE 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 2013.ExplanationTxt

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation CommitteeYes (X)CompensationCommitteeInd
Independent ConsultantYes (X)IndependentConsultantInd
Compensation SurveyYes (X)CompensationSurveyInd
Board Or Committee ApprovalYes (X)BoardOrCommitteeApprovalInd
Severance PaymentYes (1)SeverancePaymentInd
Supplemental Nonqual Rtr Plan0SupplementalNonqualRtrPlanInd
Equity Based Comp Arrngm0EquityBasedCompArrngmInd
Comp Based On Revenue Of Flng Org0CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related Orgs0CompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng Org0CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd Orgs0CompBsdNetEarnsRltdOrgsInd
Any Non Fixed PaymentsYes (1)AnyNonFixedPaymentsInd
Initial Contract Exception0InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (25 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Filing OrganizationBonusFilingOrganizationAmountBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Filing OrgOtherCompensationFilingOrgAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtComp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmtComp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
BRYAN MURPHEY MD
PHYSICIAN/CHAIRMAN$440,171$0$1,437$0$18,270$0$0$0$25,634$0$485,512$0$0$0
DAMIAN MCGOVERN MD
PHYSICIAN/SECRETARY/TREASURER$657,435$0$239,166$0$18,270$0$0$0$26,263$0$941,134$0$0$0
GARY SWAIN MD
PHYSICIAN/VICE CHAIRMAN$250,321$0$1,333$0$17,388$0$4,677$0$3,946$0$277,665$0$0$0
MAZEN ALBELDAWI MD
PHYSICIAN/TRUSTEE$832,725$0$269,871$0$18,000$0$10,600$0$30,817$0$1,162,013$0$0$0
MICHAEL FLYNN MD
PHYSICIAN/TRUSTEE$497,478$0$121,099$0$17,018$0$2,703$0$25,817$0$664,115$0$0$0
DAVID LAMON MD
PHYSICIAN/TRUSTEE$460,491$0$1,457$0$18,270$0$1,727$0$28,317$0$510,262$0$0$0
KAREN M HENRICHSENDO
PHYSICIAN/TRUSTEE TERM 05/17$249,558$0$2,610$0$16,484$0$4,805$0$18,136$0$291,593$0$0$0
ALLEN S WEISS MD
TRUSTEE/PRESIDENT/CEO$0$756,585$0$136,709$0$18,879$0$0$0$21,876$0$934,049$0$0
FRANK ASTOR MD
TRUSTEE/CHIEF MEDICAL OFFICER$0$405,570$0$42,591$0$19,188$0$0$0$22,425$0$489,774$0$0
KEVIN D COOPER
CHIEF OF STAFF$0$431,967$0$78,982$0$18,414$0$0$0$29,317$0$558,680$0$0
MICHELE THOMANRN TERM 1116
CHIEF NURSING OFFICER$0$286,878$0$59,244$0$16,162$0$2,351$0$24,779$0$389,414$0$0
PHILLIP DUTCHER
COO, NCH HEALTHCARE SYSTEM$0$438,299$0$78,982$0$20,286$0$0$0$3,524$0$541,091$0$0
RICK WYLES
CHIEF FINANCIAL OFFICER$0$319,880$0$0$0$18,714$0$0$0$27,896$0$366,490$0$0
MICHAEL RILEY
CHIEF STRATEGY OFFICER$0$240,129$0$44,295$0$19,188$0$4,471$0$29,505$0$337,588$0$0
RENEE M THIGPEN
CHIEF HR OFFICER$0$219,797$0$37,899$0$18,774$0$5,745$0$21,681$0$303,896$0$0
JAMES K MARTIN TERM 517
CHIEF DEVELOPMENT OFFICER$0$271,766$0$49,572$0$19,188$0$5,383$0$27,088$0$372,997$0$0
GARY TOMCIK
CHIEF EXPERIENCE OFFICER$0$173,857$0$0$0$18,655$0$0$0$28,013$0$220,525$0$0
ZACHARY BOSTOCK
CHIEF ADMINISTRATIVE OFFICER$0$324,700$0$55,368$0$18,180$0$3,059$0$27,090$0$428,397$0$0
JONATHAN KLINGRN START 1116
CHIEF NURSING OFFICER$0$162,816$0$10,230$0$270$0$4,366$0$25,736$0$203,418$0$0
HOWARD KAPP MD
PHYSICIAN$1,917,447$0$47,167$0$19,188$0$0$0$16,251$0$2,000,053$0$0$0
JON DOUNCHIS MD
PHYSICIAN$1,263,787$0$38,079$0$18,270$0$0$0$25,707$0$1,345,843$0$0$0
CARLO D SANTOS-OCAMPO MD
PHYSICIAN$799,806$0$231,759$0$18,774$0$0$0$29,834$0$1,080,173$0$0$0
DAVID R AXLINE MD
PHYSICIAN$879,185$0$109,658$0$18,414$0$0$0$26,550$0$1,033,807$0$0$0
ADAM J FRANK MD
PHYSICIAN$609,834$0$195,326$0$18,270$0$0$0$19,541$0$842,971$0$0$0
SARAH RICHARDSON TERM 216
FORMER CHIEF INFORMATION OFFICER$0$23,068$0$37,533$0$117,443$0$1,467$0$804$0$180,315$0$0

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART I, LINE 4ADETAIL OF SEVERANCE PAYMENTS: SARAH RICHARDSON, FORMER CHIEF INFORMATION OFFICER RESIGNED 2/2/16, AND RECEIVED A SEVERANCE PAYMENT OF $115,877 FOR CALENDAR YEAR 2016.
PART I, LINE 7PROVISIONS 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 (2 entries)

Relationship DescriptionRelationshipDescriptionTxtTransactionTransactionAmtTransactionTransactionDescSharing Of RevenuesSharingOfRevenuesInd
RASAI ERNST MD
FMLY MEMBER/TRUSTEE$333,597EMPLOYED PHYSICIAN0
ALYSSA J SCHLOTMANN
FMLY MEMBER/OFFICER$11,077EMPLOYEE0

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, SCHEDULE L, PART IVMAZEN ALBELDAWI M.D., BOARD TRUSTEE IS THE SPOUSE OF RASAI ERNST, M.D. AN EMPLOYED PHYSICIAN OF NCHMD.
FORM 990, SCHEDULE L, PART IVALYSSA J. SCHLOTMANN IS THE DAUGHTER OF RENEE THIGPEN, CHIEF HUMAN RESOURCES OFFICER.

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (11 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART III, LINE 3RHUEMATOLOGY AND CHRONIC CARE SERVICE LINES WERE DISCONTINUED DURING 2017
FORM 990, PART III, LINE 4, PROGRAM SERVICESNCHMD, INC. ("NCH PHYSICIAN GROUP") PROVIDES OUTPATIENT HEALTHCARE SERVICES WITHOUT REGARD TO A PATIENT'S ABILITY TO PAY. DURING 2017, NCHMD, INC. PROVIDED $2,692,333 OF CHARITY CARE TO PATIENTS WHO WERE UNABLE TO PAY AND NOT COVERED BY ANY GOVERNMENTAL OR PRIVATE INSURANCE PROGRAM. ADDITIONALLY, NCHMD, INC. WROTE OFF $1,777,899 CLASSIFIED AS BAD DEBTS. THE SERVICES OFFERED WITHIN THE NCH PHYSICIAN GROUP ARE EXTENSIVE AND INCLUDE A VARIETY OF MEDICAL SPECIALTIES SUCH AS CARDIOLOGY, PULMONARY, FAMILY MEDICINE, PEDIATRICS, INTERNAL MEDICINE, RADIOLOGY AND URGENT CARE. A TOTAL OF 565 FULL-TIME EQUIVALENT EMPLOYEES, WHICH INCLUDE 245 LICENSED INDEPENDENT PRACTITIONERS, COMPRISE THE OUTSTANDING MEDICAL TEAM WORKING TOGETHER TO PROVIDE THESE SERVICES IN 2017.
FORM 990, PART VI, SECTION A, LINE 6GOVERNING BODY AND MANAGEMENT NCH HEALTHCARE SYSTEM,INC. IS THE SOLE CORPORATE MEMBER OF THE ORGANIZATION.
FORM 990, PART VI, SECTION A, LINE 7AGOVERNING BODY AND MANAGEMENT NCH HEALTHCARE SYSTEM, INC. SOLE MEMBER OF THIS ORGANIZATION, ELECTS THIS ORGANIZATION'S DIRECTORS.
FORM 990, PART VI, SECTION A, LINE 7BGOVERNING 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 11BREVIEW 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 TAX RETURN IS REVIEWED BY THE NCH HEALTHCARE SYSTEM CHIEF OF STAFF AND CHIEF FINANCIAL OFFICER. THE TAX RETURN IS THEN REVIEWED BY THE CHAIRMAN OF THE NCH FINANCE COMMITTEE AND OUTSIDE COUNSEL FOR THE BOARD. PRIOR TO BOARD APPROVAL, THE 990 IS PROVIDED TO ALL OF THE 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 (EXECUTIVE COMMITTEE) PRIOR TO FILING WITH THE IRS.
FORM 990, PART VI, SECTION B, LINE 12CCONFLICT 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 MAJORITY 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 15COMPENSATION 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 APPROPIATE COMPARABILITY DATA, AND CONTEMPORANEOUS DOCUMENTATION OF THE PROCESS).
FORM 990, PART VI, SECTION C, LINE 19DOCUMENTS 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 IX, LINE 9, OTHER EMPLOYEE BENEFITSBENEFIT EXPENSES CONTAIN A NON-CASH PAYMENT TRANSFER FROM NAPLES COMMUNITY HOSPITAL OF $2,215,181.
FORM 990, PART XI, LINE 9:TRANSFERS FROM AFFILIATES 37,923,569.

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (5 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtPublic Charity StatusPublicCharityStatusTxtDirect Controlling NADirectControllingNACdControlled OrganizationControlledOrganizationIndBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Txt
NCH HEALTHCARE SYSTEM INC
PO BOX 413029NAPLESFL34101592314655HOLDING COFL501(C) (3)LINE 12B, IIN/A0
NAPLES COMMUNITY HOSPITAL INC
PO BOX 413029NAPLESFL34101590694358HEALTHCAREFL501(C) (3)LINE 30NCH SYSTEM
MARCO ISLAND HOSPITAL INC
40 HEATHWOOD DRIVEMARCO ISLANDFL34145592315435HEALTHCAREFL501(C) (3)LINE 30NCH SYSTEM
COMMUNITY HOME SERVICES INC
PO BOX 413029NAPLESFL34101592440516SUPPORT ORG.FL501(C) (3)LINE 12B, II0NCH SYSTEM
COLLIER HEALTH CARE INC
PO BOX 413029NAPLESFL34101650244276HEALTHCAREFL501(C) (3)LINE 30NCH SYSTEM

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (4 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtEntity TypeEntityTypeTxtControlled OrganizationControlledOrganizationInd
HEALTH RESOURCES CORPORATION
350 7TH STREET NORTHNAPLESFL34102592568003HOLDING COMPANYFLNCH SYSTEMC0
AMBULATORY SURGICAL CARE CENTER INC
350 7TH STREET NORTHNAPLESFL34102592568029OUTPAT. SURGERYFLHRCC0
COMMUNITY HOME CARE INC
350 7TH STREET NORTHNAPLESFL34102592372966HOME HEALTHFLHRCC0
COMMUNITY IMAGING INC
350 7TH STREET NORTHNAPLESFL34102592446336RADIOLOGY LABFLHRCC0
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts RyltsYes (1)ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth OrgYes (1)GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth OrgYes (1)GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth Org0LoansOrGuaranteesFromOthOrgInd
Div Related Organization0DivRelatedOrganizationInd
Asset Sale To Other Org0AssetSaleToOtherOrgInd
Asset Purchase From Other Org0AssetPurchaseFromOtherOrgInd
Asset ExchangeYes (1)AssetExchangeInd
Rental Of Facilities To Oth OrgYes (1)RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth OrgYes (1)RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth OrgYes (1)PerformOfServicesForOthOrgInd
Perform Of Services By Other OrgYes (1)PerformOfServicesByOtherOrgInd
Sharing Of FacilitiesYes (1)SharingOfFacilitiesInd
Paid Employees SharingYes (1)PaidEmployeesSharingInd
Reimbursement Paid To Other OrgYes (1)ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other OrgYes (1)ReimbursementPaidByOtherOrgInd
Transfer To Other OrgYes (1)TransferToOtherOrgInd
Transfer From Other OrgYes (1)TransferFromOtherOrgInd