2024-08-12T11:21:47-05:00 2023-09-30 420714325 RSM US LLP 30 SOUTH WACKER DR SUITE 3300 CHICAGO IL 606063392 990 2022-10-01 650244276 COLLIER HEALTH CARE INC COLL 2396246338 PO BOX 413029 NAPLES FL 341013029 NOBLE ARRINGTON CHIEF FINANCIAL OFFICER 2396244005 2024-08-08 1 0 REBEKUH ELEY P01247672 3126343400 2024-08-08 2022 2024-08-08 14:25:15Z PAUL HILTZ PO BOX 413029 NAPLES FL 341013029 0 0 X WWW.NCHMD.ORG X 1986 FL HELPING EVERYONE LIVE A LONGER, HAPPIER, AND HEALTHIER LIFE.OUR VISION IS TO BE A WORLD-CLASS LEADER OF EXCELLENCE IN HEALTHCARE AND TO PROVIDE EXCELLENCE IN EVERY PATIENT EXPERIENCE. 13 11 0 11 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 293505 238181 293505 238181 -293505 -238181 3483256 1441650 476823 463885 3006433 977765 HELPING EVERYONE LIVE A LONGER, HAPPIER, AND HEALTHIER LIFE. 0 0 COLLIER HEALTH CARE, INC. IS IN A TRANSTIONAL PHASE AND FUTURE PLANSFOR THE ENTITY'S PURPOSE ARE BEING EVALUATED. 1 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 13 11 0 0 1 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 FL X NOBLE ARRINGTONCHIEF FINANCIAL OFFICER 2396246338 350 7TH STREET N NAPLES FL 341023029 PAUL HILTZ PRESIDENT/CEO/TRUSTEE 1.00 44.00 X X 0 1452983 35076 KRISTIN MASCOTTI MD CHIEF MEDICAL OFFICER 1.00 44.00 X 0 865028 107716 RICK WYLES TERM 0523 CFO/ASSISTANT TREASURER 1.00 44.00 X 0 792528 31798 PHILLIP DUTCHER TERM 0721 FORMER CHIEF OPERATING OFFICER 0.00 0.00 X 0 812978 9776 JONATHAN KLING CHIEF OPERATING OFFICER SYSTEM 1.00 44.00 X 0 661330 96809 CARLOS B QUINTERO MD CHIEF QUALITY OFFICER 1.00 44.00 X 0 646667 66181 MARGARET DIMOND TERM 1123 CHIEF ADMINISTRATIVE OFFICER 1.00 44.00 X 0 679876 13624 JIM MAHON SENIOR VICE PRESIDENT 1.00 44.00 X 0 592970 12910 RENEE M THIGPEN CHIEF HR OFFICER 1.00 44.00 X 0 532535 32006 GINA TEEGARDEN RN CHIEF NURSING EXECUTIVE 1.00 44.00 X 0 333974 36609 ANDREW COOPER CHIEF INFORMATION OFFICER 1.00 44.00 X 0 307604 35429 ILIA ECHEVARRIA CHIEF NURSING OFFICER NNH 1.00 44.00 X 0 279981 23824 MATTHEW STACELL CHIEF PERFORMANCE MANAGEMENT OFFICER 1.00 44.00 X 0 245888 39430 NOBLE ARRINGTON START 0123 CFO/ASSISTANT TREASURER 1.00 44.00 X 0 231945 35100 ERIN RANEY START 0323 CHIEF ADMINISTRATIVE OFFICER 1.00 44.00 X 0 188441 31683 MICHAEL RILEY TERM 1120 FORMER CHIEF STRATEGY OFFICER 0.00 0.00 X 0 116598 0 SCOTT LUTGERT CHAIRMAN 0.50 2.00 X X 0 0 0 KEVIN BEEBE 1ST VICE CHAIRMAN/SECRETARY 0.50 2.00 X X 0 0 0 MICHAEL WYNN 2ND VICE CHAIRMAN 0.50 2.00 X X 0 0 0 DAVEY SCOON TREASURER 0.50 2.00 X X 0 0 0 JAY BAKER TRUSTEE 0.50 2.00 X 0 0 0 KERRY EDWARDS TRUSTEE 0.50 2.00 X 0 0 0 ALAN EINHORN TRUSTEE 0.50 2.00 X 0 0 0 ANNE MCNULTY TRUSTEE 0.50 2.00 X 0 0 0 BILL PEREZ TRUSTEE 0.50 2.00 X 0 0 0 LAURIE COWAN PHILLIPS TRUSTEE 0.50 2.00 X 0 0 0 JANICE TEAL TRUSTEE 0.50 2.00 X 0 0 0 BLAKE GABLE TRUSTEE 0.50 2.00 X 0 0 0 0 8741326 607971 0 1 1 0 0 0 0 0 0 77966 77966 116382 116382 43833 43833 238181 0 238181 0 546250 403750 706072 118162 2503593 587910 433413 449990 3483256 1441650 445770 457087 31053 6798 476823 463885 X 3006433 977765 3006433 977765 3483256 1441650 X -238181 -1790487 X 0 1 X 1 0 X 572000 572000 2001 2001 0 132071 116161 15910 587910 CERTIFICATE OF DEPOSIT BOA 449990 F 449990 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 APPROPIATE 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 2019. X X X X 1 1 0 0 0 0 0 1 0 PAUL HILTZ PRESIDENT/CEO/TRUSTEE 0 1018212 0 254760 0 180011 0 12200 0 22876 0 1488059 0 151987 KRISTIN MASCOTTI MD CHIEF MEDICAL OFFICER 0 691426 0 150480 0 23122 0 90205 0 17511 0 972744 0 0 RICK WYLES TERM 0523 CFO/ASSISTANT TREASURER 0 545968 0 135432 0 111128 0 12200 0 19598 0 824326 0 83104 PHILLIP DUTCHER TERM 0721 FORMER CHIEF OPERATING OFFICER 0 27107 0 161040 0 624831 0 7409 0 2367 0 822754 0 0 JONATHAN KLING CHIEF OPERATING OFFICER SYSTEM 0 534984 0 103224 0 23122 0 72794 0 24015 0 758139 0 0 CARLOS B QUINTERO MD CHIEF QUALITY OFFICER 0 544548 0 79969 0 22150 0 39163 0 27018 0 712848 0 0 MARGARET DIMOND TERM 1123 CHIEF ADMINISTRATIVE OFFICER 0 571226 0 0 0 108650 0 921 0 12703 0 693500 0 82652 JIM MAHON SENIOR VICE PRESIDENT 0 400154 0 98984 0 93832 0 12200 0 710 0 605880 0 58500 RENEE M THIGPEN CHIEF HR OFFICER 0 361327 0 90024 0 81184 0 12200 0 19806 0 564541 0 55243 GINA TEEGARDEN RN CHIEF NURSING EXECUTIVE 0 291119 0 20870 0 21985 0 26881 0 9728 0 370583 0 0 ANDREW COOPER CHIEF INFORMATION OFFICER 0 263593 0 36637 0 7374 0 17255 0 18174 0 343033 0 0 ILIA ECHEVARRIA CHIEF NURSING OFFICER NNH 0 239548 0 20490 0 19943 0 11262 0 12562 0 303805 0 0 MATTHEW STACELL CHIEF PERFORMANCE MANAGEMENT OFFICER 0 215247 0 19271 0 11370 0 13096 0 26334 0 285318 0 0 NOBLE ARRINGTON START 0123 CFO/ASSISTANT TREASURER 0 190401 0 20270 0 21274 0 9470 0 25630 0 267045 0 0 ERIN RANEY START 0323 CHIEF ADMINISTRATIVE OFFICER 0 170856 0 17405 0 180 0 7682 0 24001 0 220124 0 0 MICHAEL RILEY TERM 1120 FORMER CHIEF STRATEGY OFFICER 0 106213 0 10385 0 0 0 0 0 0 0 116598 0 0 PART I, LINES 4A-B PART I, LINE 4A: CHIEF OPERATING OFFICER RESIGNED 07/21 AND RECEIVED A SEVERANCE PAYMENT OF $609,999 FOR CALENDAR YEAR 2022. PART I, LINE 4B: THE FOLLOWING EXECUTIVES PARTICIPATED IN A 457(F) SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN: PAUL HILTZ PRESIDENT AND CEO RICK WYLES CHIEF FINANCIAL OFFICER KRISTIN MASCOTTI, M.D. CHIEF MEDICAL OFFICER JONATHAN KLING CHIEF OPERATING OFFICER JIM MAHON SENIOR VICE PRESIDENT RENEE THIGPEN CHIEF HR OFFICER CARLOS QUINTERO, M.D. CHIEF QUALITY OFFICER MARGARET DIMOND CHIEF ADMINISTRATIVE OFFICER GINA TEEGARDEN, R.N. CHIEF NURSING EXECUTIVE ANDREW COOPER CHIEF INFORMATION OFFICER MATTHEW STACELL CHIEF PERFORMANCE MANAGEMENT OFFICER NOBLE ARRINGTON CHIEF FINANCIAL OFFICER ERIN RANEY CHIEF ADMINISTRATIVE OFFICER THE FOLLOWING EXECUTIVES RECEIVED A DISTRIBUTION FROM THE 457(F) SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN IN CALENDAR YEAR 2022. PAUL HILTZ PRESIDENT AND CEO $151,987 RICK WYLES CHIEF FINANCIAL OFFICER $ 83,104 JIM MAHON SENIOR VICE PRESIDENT $ 58,500 RENEE THIGPEN CHIEF HR OFFICER $ 55,243 MARGARET DIMOND CHIEF ADMINISTRATIVE OFFICER $ 82,652 PART I, LINE 7 PROVISION 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. FORM 990, PART VI, SECTION A, LINE 4 BYLAWS AMENDED AND RESTATED NCH HEALTHCARE SYSTEM, INC. AMENDED AND RESTATED ITS BYLAWS IN FISCAL YEAR 2023. ALTHOUGH THIS CHANGE WAS MADE ONLY TO THE NCH HEALTHCARE SYSTEM, INC. BYLAWS THEY DECIDE AND INFLUENCE THE GOVERNANCE OF ALL ENTITIES OF THE SYSTEM. ARTICLE IV COMMITTEES 4.1.2. MARCO ISLAND HEALTHCARE CENTER COMMITTEE IS INCLUDED IN THE LIST OF STANDING COMMITTEES. 4.11. MARCO ISLAND HEALTHCARE CENTER COMMITTEE. THE COMMITTEE SHALL HAVE MINIMUM OF ONE MEMBER OF THE BOARD OF TRUSTEES AND UP TO SIX (6) COMMUNITY MEMBERS WHO RESIDE ON MARCO ISLAND, FLORIDA, WHO SHALL BE APPOINTED ANNUALLY BY THE CHAIR OF THE BOARD OF TRUSTEES WITH THE CONSENT OF THE BOARD OF TRUSTEES. THE COMMITTEE SHALL BE RESPONSIBLE FOR DEVELOPING ACTION PLANS RELATED TO FUND-RAISING INITIATIVES, MARKETING/PUBLIC RELATIONS, AND COMMUNITY RELATIONS THAT SUPPORT THE MARCO HEALTHCARE CENTER AND THE CORPORATION'S HEALTHCARE SERVICES ON MARCO ISLAND, FLORIDA. THIS COMMITTEE SHALL RECEIVE AND CONSIDER REPORTS FROM MANAGEMENT RELATIVE TO THE CORPORATION'S BUSINESS ACTIVITIES AND PLANS FOR MARCO ISLAND, FLORIDA. THE CORPORATION'S CHIEF DEVELOPMENT OFFICER AND CHIEF OPERATING OFFICER (OR THEIR DESIGNEES) SHALL BE EX-OFFICIO, VOTING MEMBERS OF THIS COMMITTEE. FORM 990, PART VI, SECTION A, LINE 6 GOVERNING BODY AND MANAGEMENT NCH HEALTHCARE SYSTEM, INC. IS THE SOLE MEMBER OF THIS 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 COLLIER HEALTH CARE 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 COLLIER HEALTH CARE, INC.'S ("CHI") 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 IV, LINE 20A AND SCHEDULE H, PART I, LINE 3 INAPPLICABILITY OF SCHEDULE H ALTHOUGH COLLIER HEALTH CARE, INC. RECEIVES ITS PUBLIC CHARITY STATUS AS A HOSPITAL, IT IS NOT REQUIRED TO FILE SCHEDULE H OF THE FORM 990, AS THE ORGANIZATION IS NOT REQUIRED TO BE LICENSED, REGISTERED OR SIMILARLY RECOGNIZED BY THE STATE OF FLORIDA AS A HOSPITAL. FORM 990, PART XI, LINE 9: TRANSFER TO RELATED ORGANIZATION -15,441. DEFERRED CAPITAL LEASE REVENUE 24,255. CMS BUILDING DEMOLITION -1,799,301. NCH HEALTHCARE SYSTEM INC PO BOX 413029 NAPLES FL 34101 592314655 HOLDING COMPANY FL 501(C)(3) LINE 12B, II N/A 0 NAPLES COMMUNITY HOSPITAL INC PO BOX 413029 NAPLES FL 34101 590694358 HEALTHCARE FL 501(C)(3) LINE 3 NCH SYSTEM 1 NCHMD INC PO BOX 413029 NAPLES FL 34101 331075317 HEALTHCARE FL 501(C)(3) LINE 10 NCH SYSTEM 1 MARCO ISLAND HOSPITAL INC 40 HEATHWOOD DRIVE MARCO ISLAND FL 34145 592315435 HEALTHCARE FL 501(C)(3) LINE 3 NCH SYSTEM 1 PROSCAN NCH IMAGING LLC 350 7TH STREET NORTH NAPLES FL 34102 861212843 RADIOLOGY SERVICES DE N/A 0 0 NCH-VH JOINT VENTURE LLC 350 7TH STREET NORTH NAPLES FL 34102 874042152 SURGICAL SERVICES KS N/A 0 0 HEALTH RESOURCES CORPORATION 350 7TH STREET N NAPLES FL 34102 592568003 HOLDING COMPANY FL NCH SYSTEM C 1 AMBULATORY SURGICAL CARE CENTER INC 350 7TH STREET N NAPLES FL 34102 592568029 OUTPATIENT SURGERY FL HRC C 1 COMMUNITY HOME CARE INC 350 7TH STREET N NAPLES FL 34102 592372966 HOME HEALTH FL HRC C 1 COMMUNITY IMAGING INC 350 7TH STREET N NAPLES FL 34102 592446336 RADIOLOGY LAB FL HRC C 1 GREATER COLLIER INSURANCE LTD 350 7TH STREET N NAPLES FL 34102 INSURANCE FL N/A C 0 1 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1 1