2024-08-12T11:29:31-05:00 2023-09-30 420714325 RSM US LLP 30 SOUTH WACKER DR SUITE 3300 CHICAGO IL 606063392 990 2022-10-01 331075317 NCHMD INC NCHM 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 NCH PHYSICIAN GROUP PAUL HILTZ PO BOX 413029 NAPLES FL 341013029 167699082 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 1019 10 -3591971 0 20261566 72741488 108052859 98178436 848 1162 -1385571 -3228188 126929702 167692898 0 0 0 0 128933448 125832702 0 0 0 28110412 28761749 157043860 154594451 -30114158 13098447 39367117 94177869 25034665 29299382 14332452 64878487 X HELPING EVERYONE LIVE A LONGER, HAPPIER, AND HEALTHIER LIFE. 0 0 35124267 21043341 CARDIOLOGY IS THE LARGEST SERVICE LINE OF THE NCH PHYSICIANS GROUP FOR 2023. 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 37 LICENSED INDEPENDENT PRACTITIONERS AND 68 FULL-TIME EQUIVALENT EMPLOYEES WHO PERFORMED 319,562 RELATIVE VALUE UNITS AND PROVIDED $786,943 OF CHARITY CARE. 29236132 24606894 FAMILY PRACTICE IS THE SECOND LARGEST SERVICE LINE ACCOMPLISHMENT FOR NCH PHYSICIANS GROUP FOR 2023. 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 29 LICENSED INDEPENDENT PRACTITIONERS AND 81 FULL-TIME EQUIVALENT EMPLOYEES WHO PERFORMED 131,733 RELATIVE VALUE UNITS AND PROVIDED $85,444 OF CHARITY CARE. 26978694 16828293 INTERNAL MEDICINE SERVICES WERE NCH PHYSICIAN GROUP'S THIRD LARGEST PROGRAM SERVICE IN 2023. 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 50 LICENSED INDEPENDENT PRACTITIONERS AND 43 FULL-TIME EQUIVALENT EMPLOYEES WHO PERFORMED 70,268 RELATIVE VALUE UNITS, PROVIDED $1,820,183 OF CHARITY CARE. 53583094 35735908 IN PROVIDING THE OTHER SERVICE PROGRAM SERVICE LINES, NCHMD EMPLOYED 72 LICENSED INDEPENDENT PRACTICIONERS AND 202 FTES WHO PERFORMED 647,157 RELATIVE VALUE UNITS AND PROVIDED $1,993,959 OF CHARITY CARE.SERVICE LINE EXPENSES REVENUE ORTHOPEDICS 12,772,891 8,341,522 PULMONARY 11,960,302 5,718,556 GASTROENTEROLOGY 7,036,399 5,687,524 GENERAL SURGERY 4,818,448 4,176,176 URGENT CARE 4,383,953 3,898,432 NEUROSURGERY 2,055,518 1,027,059 PEDIATRICS 2,041,316 1,624,538 PSYCHIATRY 2,007,040 627,519 ENDOCRINOLOGY 1,334,771 872,403 GME 1,054,385 1,271,442 PAIN MANAGEMENT 1,026,997 472,464 RHEUMATOLOGY 774,484 280,969 INFECTIOUS DISEASE 684,269 445,472 LAB AND RADIOLOGY 532,091 357,484 WOUND HEALING 403,052 566,535 NEUROLOGY 347,761 310,943 PRO TIME 286,756 8,311 UROLOGY 66,498 5,721 GERIATRICS 797 - CHRONIC CARE 514 - POST ACUTE -5,149 42,838 53583094 35735908 144922187 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 1 0 0 0 0 1 1 1 0 0 1 82 0 1 1019 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 11 3 0 0 1 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 FL X NOBLE ARRINGTON CHIEF FINANCIAL OFFICER 2396246338 350 SEVENTH STREET NORTH NAPLES FL 34102 PAUL HILTZ PRESIDENT/CEO/TRUSTEE 1.00 44.00 X X 0 1452983 35076 BRYAN MURPHEY MD PHYSICIAN/CHAIRMAN 40.00 0.00 X X 924060 0 65829 ROBERT GROSSMAN MD PHYSCIAN/TRUSTEE 40.00 0.00 X 569894 0 20355 DAVID LINZ MD PHYSICIAN/TRUSTEE 40.00 0.00 X 1102129 0 39242 REBECCA WITHERELL MD PHYSCIAN/TRUSTEE 40.00 0.00 X 429656 0 19513 EMILY ESSERT MD PHYSICIAN/TRUSTEE 40.00 0.00 X 418964 0 35720 KRISTIN MASCOTTI MD TRUSTEE/CMO 1.00 44.00 X X 0 865028 107716 SCOTT LUTGERT TRUSTEE 0.50 2.00 X 0 0 0 KEVIN BEEBE TRUSTEE 0.50 2.00 X 0 0 0 MICHAEL WYNN TRUSTEE 0.50 2.00 X 0 0 0 ANDREW COOPER CHIEF INFORMATION OFFICER 1.00 44.00 X 0 307604 35429 RICK WYLES TERM 0523 CHIEF FINANCIAL OFFICER 1.00 44.00 X 0 792528 31798 ILIA ECHEVARRIA RN 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 JONATHAN KLING RN CHIEF OPERATING OFFICER SYSTEM 1.00 44.00 X 0 661330 96809 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 MARGARET DIMOND TERM 0423 CHIEF ADMINISTRATOR OFFICER 1.00 44.00 X 0 679876 13624 ROBERTO CUBEDDU MD PHYSCIAN 40.00 0.00 X 1771757 0 36324 NOBLE ARRINGTON START 0123 CFO/ASSISTANT TREASURER 1.00 44.00 X 0 231945 35100 ERIN RANEY START 0323 CHIEF ADMINISTRATIVE OFFICER 41.00 4.00 X 188441 0 31683 CARLOS B QUINTERO MD CHIEF QUALITY OFFICER 41.00 4.00 X 646667 0 66181 CARLO SANTOS-OCAMPO MD PHYSICIAN/OFFICER 40.00 0.00 X 1012017 0 38670 HOWARD KAPP MD PHYSICIAN 40.00 0.00 X 2364784 0 27843 DINESH SHARMA MD PHYSICIAN 40.00 0.00 X 2046024 0 36258 JON DOUNCHIS MD PHYSICIAN 40.00 0.00 X 1764387 0 38271 DAVID AXLINE MD PHYSICIAN 40.00 0.00 X 1422376 0 37235 EDISON VALLE GILER MD PHYSICIAN 40.00 0.00 X 1331125 0 35636 MICHAEL RILEY TERM 1120 FORMER CHIEF STRATEGY OFFICER 0.00 0.00 X 0 116598 0 PHILLIP DUTCHER TERM 0721 FORMER CHIEF OPERATING OFFICER 0.00 0.00 X 0 812978 9776 15992281 7906218 1038867 228 1 1 0 SUNNY DAY MATERNAL FETAL MEDICINE 203 8TH AVE S NAPLES FL 34102 SUNNY DAY MFM IS NPG'S CONTRACTED SERVIC 939066 VIRENCE HEALTH TECHNOLOGIES PO BOX 840952 DALLAS TX 752840952 SOFTWARE AND SUPPORT SERVICES 657073 LOCUM-TENENS COM LLC PO BOX 405547 ATLANTA GA 30384 PHYSICIAN STAFFING SERVICES 341912 POPPA CONSTRUCTION 2950 TAMIAMI TRAIL N 200 NAPLES FL 34103 GENERAL CONTRACTOR 267631 ENVERA HEALTH INC 1001 HAXALL POINT 1B RICHMONT VA 23219 COLLECTION RESOURCE 264469 20 72741488 3708148 72741488 OFFICES OF PHYSICIANS 621110 98178436 98178436 98178436 331498 6184 325314 325314 325314 1162 0 1162 1162 1162 MEDICAL DIRECTORSHIP 900099 36000 36000 OUTSOURCING MILLENNIUM 561300 2469 2469 LOSS INVESTMNT PROSCAN 621500 -3591971 -3591971 -3553502 167692898 98214436 -3591971 328945 7397255 7397255 35044 29380 5664 106629254 100677054 5952200 2355707 2232739 122968 4165717 3950756 214961 5249725 4975689 274036 6365058 5157453 1207605 298185 298185 1507551 917037 590514 1597647 1514250 83397 4815882 3699134 1116748 125430 123706 1724 2331054 2235050 96004 4364172 4364172 MEDICAL SUPPLIES 7350877 7350327 550 BAD DEBT 5893 5893 154594451 144922187 9672264 0 54123618 11158831 6494879 1368490 1153260 2260961 2318487 39339887 22547123 18200566 16792764 4454403 4423289 1923866 1923865 0 6947707 39367117 94177869 22235982 18332097 2798683 2858796 0 8108489 25034665 29299382 X 14332452 12296420 52582067 14332452 64878487 39367117 94177869 X 13098447 18095637 19351951 X 0 1 X 1 0 X 3354173 20261566 72741488 96357227 112927917 113273393 124724841 108052859 98178436 557157446 112927917 113273393 128079014 128314425 170919924 653514673 0 0 0 653514673 5990 89775 359590 325314 780669 5990 89775 359590 325314 780669 42000 37500 36000 44517 38469 198486 112975907 113310893 128204789 128718532 171283707 654493828 0.99850 0.99890 0.00120 0.00080 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: MISC ACCOUNTS REC RECEIPTS - 2022 AMOUNT: $ 2,469. EMPLOYEE SALES - 2021 AMOUNT: $ 2,402. MEDICAL DIRECTORSHIP - 2018 AMOUNT: $ 42,000. 2019 AMOUNT: $ 37,500. 2020 AMOUNT: $ 36,000. 2021 AMOUNT: $ 42,115. 2022 AMOUNT: $ 36,000. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 2559424 2559424 13658242 4753410 8904832 8851372 6273148 2578224 14210417 11520565 2689852 60432 60432 16792764 SELF INSURANCE CLAIMS 6566938 EXEC LIFE INSURANCE 380769 6947707 ESTIMATED SELF INSURANCE CLAIMS 6566938 LIABILITY OF RESTRICTED FUNDS 1541551 8108489 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 2019. X X X X 1 1 0 0 0 0 0 1 0 HOWARD KAPP MD PHYSICIAN 2098691 0 243307 0 22786 0 12200 0 15643 0 2392627 0 0 0 DINESH SHARMA MD PHYSICIAN 1566310 0 459034 0 20680 0 12200 0 24058 0 2082282 0 0 0 ROBERTO CUBEDDU MD PHYSCIAN 1575987 0 175000 0 20770 0 12200 0 24124 0 1808081 0 0 0 JON DOUNCHIS MD PHYSICIAN 1529146 0 214327 0 20914 0 12200 0 26071 0 1802658 0 0 0 PAUL HILTZ PRESIDENT/CEO/TRUSTEE 0 1018212 0 254760 0 180011 0 12200 0 22876 0 1488059 0 151987 DAVID AXLINE MD PHYSICIAN 1190734 0 209954 0 21688 0 12200 0 25035 0 1459611 0 0 0 EDISON VALLE GILER MD PHYSICIAN 1036806 0 273639 0 20680 0 12200 0 23436 0 1366761 0 0 0 DAVID LINZ MD PHYSICIAN/TRUSTEE 858635 0 222832 0 20662 0 12200 0 27042 0 1141371 0 0 0 CARLO SANTOS-OCAMPO MD PHYSICIAN/OFFICER 840772 0 149557 0 21688 0 12200 0 26470 0 1050687 0 0 0 BRYAN MURPHEY MD PHYSICIAN/CHAIRMAN 774218 0 126720 0 23122 0 42107 0 23722 0 989889 0 0 0 KRISTIN MASCOTTI MD TRUSTEE/CMO 0 691426 0 150480 0 23122 0 90205 0 17511 0 972744 0 0 RICK WYLES TERM 0523 CHIEF FINANCIAL OFFICER 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 RN 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 544548 0 79969 0 22150 0 39163 0 27018 0 712848 0 0 0 MARGARET DIMOND TERM 0423 CHIEF ADMINISTRATOR 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 ROBERT GROSSMAN MD PHYSCIAN/TRUSTEE 438249 0 110983 0 20662 0 12200 0 8155 0 590249 0 0 0 RENEE M THIGPEN CHIEF HR OFFICER 0 361327 0 90024 0 81184 0 12200 0 19806 0 564541 0 55243 EMILY ESSERT MD PHYSICIAN/TRUSTEE 348714 0 49588 0 20662 0 12200 0 23520 0 454684 0 0 0 REBECCA WITHERELL MD PHYSCIAN/TRUSTEE 305614 0 103380 0 20662 0 12200 0 7313 0 449169 0 0 0 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 RN 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 170856 0 17405 0 180 0 7682 0 24001 0 220124 0 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 BRYAN MURPHEY, M.D. CHIEF MEDICAL OFFICER (NCHMD) 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 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. VLADIMIRA KLING FMLY MEMBER/OFFICER 29380 EMPLOYEE 0 FORM 990, SCHEDULE L, PART IV FORM 990, SCHEDULE L, PART IV VLADIMIRA KLING, ARNP. IS THE SPOUSE OF JONATHAN KLING, CHIEF OPERATING OFFICER. X 5 3708148 FMV 0 0 1 0 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 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 XI, LINE 9: TRANSFERS FROM AFFILIATES 18,488,979. PROSCAN NCH IMAGING, INC. INVESTMENT GAIN 862,972. 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 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 UNRELATED -1783300 2078307 0 1 0.51000 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 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 GREATER COLLIER INSURANCE LTD 350 7TH STREET NORTH NAPLES FL 34102 INSURANCE FL N/A C 0 1 1 1 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1 1 NAPLES COMMUNITY HOSPITAL INC Q 55270864 FMV NCH HEALTHCARE SYSTEM INC Q 1362829 FMV