2024-08-15T14:17:52-05:00 2023-09-30 621517792 PYA P C 2220 SUTHERLAND AVE KNOXVILLE TN 37919 990 2022-10-01 581917328 NORTHSIDE HEALTH SERVICES INC NORT 4048518000 1000 JOHNSON FERRY ROAD NE ATLANTA GA 303421611 SHANNON A BANNA VP FINANCE / CFO 4048518000 2024-08-15 1 0 DEBORAH O ERNSBERGER P00364912 8656730844 2022 2024-08-08 14:25:15Z ROBERT T QUATTROCCHI 1000 JOHNSON FERRY ROAD NE ATLANTA GA 303421611 61018 0 X N/A X 1990 GA TO PROVIDE STRATEGIC MANAGEMENT AND OVERSIGHT TO THE HOSPITAL SYSTEM. 10 6 0 0 0 0 0 0 0 0 0 0 -310 -169113 -310 -169113 0 0 0 0 0 0 0 0 0 0 0 0 0 -310 -169113 18418790 24991847 18418790 24970589 0 21258 X NORTHSIDE HEALTH SERVICES, INC. IS ORGANIZED FOR THE PURPOSE OF SUPPORTING THE NORTHSIDE HOSPITAL SYSTEM. NORTHSIDE HEALTH SERVICES, INC. IS THE PARENT ENTITY OF NORTHSIDE HOSPITAL, INC. AND AFFILIATED ORGANIZATIONS AND PROVIDES STRATEGIC MANAGEMENT AND OVERSIGHT SERVICES TO THE HOSPITAL SYSTEM. 0 0 NORTHSIDE HEALTH SERVICES, INC. IS ORGANIZED FOR THE PURPOSE OF SUPPORTING THE NORTHSIDE HOSPITAL SYSTEM. NORTHSIDE HEALTH SERVICES, INC. IS THE PARENT ENTITY OF NORTHSIDE HOSPITAL, INC. AND AFFILIATED ORGANIZATIONS AND PROVIDES STRATEGIC MANAGEMENT AND OVERSIGHT SERVICES TO THE HOSPITAL SYSTEM. 1 0 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 0 0 0 0 0 0 1 1 1 0 0 0 1 2 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 10 6 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 1 1 1 GA X SHANNON A BANNA 4048518000 1000 JOHNSON FERRY ROAD ATLANTA GA 30342 X ROBERT T QUATTROCCHI PRESIDENT & CEO NSH, INC. 1.00 40.00 X X 0 4966543 33658 DALE M BEARMAN MD CHAIR 1.00 1.00 X 0 0 0 MARK J SWEENEY VICE-CHAIR AND SECRETARY 1.00 1.00 X 0 0 0 ANTHONY J SALVATORE TREASURER 1.00 1.00 X 0 0 0 THURBERT E BAKER BOARD MEMBER 1.00 1.00 X 0 0 0 CARLTON BUCHANAN MD BOARD MEMBER 1.00 1.00 X 0 0 0 J MICHAEL LEVENGOOD BOARD MEMBER 1.00 1.00 X 0 0 0 BARBARA PARE' BOARD MEMBER 1.00 1.00 X 0 0 0 WAYNE SIKES BOARD MEMBER 1.00 1.00 X 0 0 0 JOSEF VENABLE MD BOARD MEMBER 1.00 1.00 X 0 0 0 JORGE J HERNANDEZ VP/ASST. SECRETARY 1.00 40.00 X 0 960219 22992 SHANNON BANNA VP/CFO NSH, INC./ASST. TREASURER 1.00 40.00 X 0 940609 9967 0 6867371 66617 0 0 1 0 0 251389 230131 21258 21258 21258 PASSTHROUGH INVESTMENT 531390 -190371 -190371 -190371 -169113 -169113 0 0 0 0 0 0 13903817 181707 9058307 13722110 9360483 11269737 18418790 24991847 18418790 24970589 18418790 24970589 X 0 0 0 0 0 21258 0 21258 18418790 24991847 X -169113 190371 X 0 1 X 1 0 X X 1 NORTHSIDE HOSPITAL INC 581954432 3 1 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 X 1 1 PART IV, SECTION E, LINE 3A THE BOARD OF NORTHSIDE HEALTH SERVICES, INC., BY AFFIRMATIVE VOTE OF THE MAJORITY OF THE DIRECTORS THEN IN OFFICE, SHALL ELECT THE DIRECTORS OF NORTHSIDE HOSPITAL, INC., IN ACCORDANCE WITH THE PROVISIONS OF THE ARTICLES OF INCORPORATION AND BYLAWS OF NORTHSIDE HOSPITAL, INC. REGARDING COMPOSITION, SELECTION AND TERMS OF OFFICE OF ITS DIRECTORS. PART IV, SECTION E, LINE 3B THE PURPOSE OF THE BOARD OF DIRECTORS OF NORTHSIDE HEALTH SERVICES, INC. SHALL BE TO GOVERN THE PROPERTY, AFFAIRS, BUSINESS AND OPERATIONS OF NORTHSIDE HEALTH SERVICES, INC. AND ITS SUPPORTED ORGANIZATION, NORTHSIDE HOSPITAL, INC. 9058307 9058307 4845510 181707 4663803 13722110 DUE FROM AFFILIATE 11035784 CONSTRUCTION IN PROGRESS 233953 11269737 DUE TO AFFILIATE 24970589 24970589 X PART X, LINE 2: NORTHSIDE HOSPITAL, INC., AND SUBSIDIARIES CONSOLIDATED FINANCIAL STATEMENTS AS OF AND FOR THE YEARS ENDED SEPTEMBER 30, 2023 AND 2022, AND INDEPENDENT AUDITOR'S REPORT: NORTHSIDE QUALIFIES AS A TAX-EXEMPT ORGANIZATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. ACCORDINGLY, NO PROVISION FOR INCOME TAXES HAS BEEN RECORDED. 0 1 0 0 0 0 0 1 0 ROBERT T QUATTROCCHI PRESIDENT & CEO NSH, INC. 0 1487319 0 3450000 0 29224 0 0 0 33658 0 5000201 0 0 JORGE J HERNANDEZ VP/ASST. SECRETARY 0 595133 0 331873 0 33213 0 0 0 22992 0 983211 0 0 SHANNON BANNA VP/CFO NSH, INC./ASST. TREASURER 0 647234 0 258060 0 35315 0 0 0 9967 0 950576 0 0 PART I, LINE 4B MR. QUATTROCCHI HAS LED THE ORGANIZATION FOR MORE THAN TWENTY YEARS AS CEO AND FOR SEVENTEEN YEARS AS A SENIOR EXECUTIVE PRIOR TO BECOMING CEO. IN RECOGNITION OF HIS SUCCESSFUL LEADERSHIP AND EXTENDED TENURE, AND TO ENCOURAGE CONTINUATION OF THIS RELATIONSHIP, THE BOARD OF DIRECTORS HAS PROVIDED A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN ("SERP") DESIGNED TO PROVIDE THE CEO WITH A SOURCE OF RETIREMENT INCOME. NORTHSIDE DOES NOT CONSIDER SERP PAYMENTS TO BE DEFERRED COMPENSATION FOR TAX REPORTING PURPOSES. THE SERP PAYMENTS ARE BASED ON A MATHEMATICAL FORMULA, PURSUANT TO A SIGNED CONTRACT, AND ARE REVIEWED AND ASSESSED PERIODICALLY FOR REASONABLENESS BY AN OUTSIDE CONSULTANT. THE COMPENSATION COMMITTEE AND FULL BOARD OF DIRECTORS APPROVE EACH PAYMENT BEFORE PAYMENT IS MADE. HOWEVER, NO FURTHER FUNDING OF THE SERP IS EXPECTED BASED ON ACTUARIAL PROJECTIONS. AS A RESULT, IN ORDER TO ASSIST FURTHER IN THE CEO'S RETENTION, THE COMPANY HAS ESTABLISHED AN ANNUAL RETENTION PROGRAM FOR THE CEO, PROVIDING FOR AN ANNUAL RETENTION INCENTIVE, BUT ONLY IF HE CONTINUES TO BE EMPLOYED ON THE LAST DAY OF EACH FISCAL YEAR, BEGINNING WITH THE FISCAL YEAR ENDING SEPTEMBER 30, 2021. NORTHSIDE DOES NOT CONSIDER THE RETENTION PAYMENTS TO BE DEFERRED COMPENSATION FOR TAX REPORTING PURPOSES. AS AN ADDITIONAL RETENTION INCENTIVE, THE BOARD OF DIRECTORS MAY DEFER A PORTION OF ANY ANNUAL BONUS PAYABLE TO THE CEO CONDITIONING PAYMENT OF THE DEFERRED PORTION ON THE CEO'S CONTINUED EMPLOYMENT AND SATISFACTION OF CERTAIN SPECIFIED ORGANIZATION METRICS. PART II CERTAIN AMOUNTS REPORTED ON SCHEDULE J, PART II, COLUMN (B) MAY INCLUDE AMOUNTS FOR SERVICES PERFORMED IN A PRIOR CALENDAR YEAR BUT NOT DUE AND PAYABLE UNTIL THE ORGANIZATION'S CURRENT TAX YEAR. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 WAS PREPARED BY AN OUTSIDE, INDEPENDENT ACCOUNTING FIRM USING DETAILED FINANCIAL STATEMENTS SUPPORTED BY A CONSOLIDATED AUDIT (ALSO PREPARED BY OUTSIDE, INDEPENDENT AUDITORS). NORTHSIDE FINANCIAL LEADERSHIP, INCLUDING THE SENIOR DIRECTOR OF CORPORATE FINANCE AND CFO, PERFORM A DETAILED REVIEW OF THE FORM 990 AND APPROVAL OF THE RETURN BEFORE IT IS FILED. ADDITIONALLY, OUTSIDE COUNSEL REVIEWS SEVERAL SECTIONS OF THE FORM AT NORTHSIDE'S REQUEST. FORM 990, PART VI, SECTION B, LINE 12C OFFICERS, DIRECTORS AND KEY EMPLOYEES ARE REQUIRED TO COMPLETE AND SIGN A DISCLOSURE QUESTIONNAIRE ANNUALLY, IN ACCORDANCE WITH THE CONFLICT OF INTEREST POLICY. NORTHSIDE'S LEGAL SERVICES DEPARTMENT REVIEWS CONTRACTS WITH OTHER CARE PROVIDERS, EDUCATIONAL INSTITUTIONS, MANUFACTURERS AND PAYORS TO DETERMINE WHETHER CONFLICTS OF INTEREST EXIST AND WHETHER THEY ARE WITHIN LAWS AND REGULATIONS. FORM 990, PART VI, SECTION B, LINE 15 TO ESTABLISH THE COMPENSATION OF THE ORGANIZATION'S CEO AND KEY EMPLOYEES, A COMPENSATION STUDY, INCLUDING PEER ORGANIZATIONS, IS COMPLETED BY AN INDEPENDENT COMPENSATION CONSULTANT. THIS INFORMATION IS SHARED WITH THE COMPENSATION COMMITTEE. INDEPENDENT MEMBERS OF THE COMPENSATION COMMITTEE DELIBERATE AND DETERMINE THE COMPENSATION OF THE CEO AND APPROVE THE COMPENSATION OF OTHER OFFICERS AND KEY EMPLOYEES. RECORDS ARE RETAINED OF THESE DECISIONS. THE CEO'S FINAL WRITTEN EMPLOYMENT CONTRACT MUST BE APPROVED BY THE COMPENSATION COMMITTEE OF THE BOARD. FORM 990, PART VI, SECTION C, LINE 19 THE CORPORATE GOVERNANCE DOCUMENTS (SPECIFICALLY ALL ARTICLES OF INCORPORATION DOCUMENTS) ARE MADE AVAILABLE ON THE GEORGIA SECRETARY OF STATE WEBSITE. OUR CONFLICT OF INTEREST POLICY IS MADE AVAILABLE ON OUR INTRANET TO NORTHSIDE EMPLOYEES. OUR AUDITED FINANCIAL STATEMENTS AND OUR CONFLICT OF INTEREST POLICY ARE AVAILABLE IN ACCORDANCE WITH STATE REQUIREMENTS. WHEN AND IF APPROPRIATE REQUESTS ARE MADE BY THE PUBLIC, WE EVALUATE DISCLOSURE ON A CASE BY CASE BASIS. FORM 990, PART VI, LINE 16B IN LIEU OF ADOPTING A WRITTEN POLICY CONCERNING JOINT VENTURE ARRANGEMENTS, THE ORGANIZATION REQUIRES AND UNDERTAKES A RIGOROUS CASE-BY-CASE EVALUATION OF ITS PARTICIPATION IN ANY PROPOSED JOINT VENTURE ARRANGEMENT UNDER APPLICABLE TAX AND OTHER LAWS AND REGULATIONS. EACH PROPOSED JOINT VENTURE WITH A TAXABLE ENTITY IS REVIEWED UNDER APPLICABLE TAX LAWS, REGULATIONS, AND GUIDELINES BY OUTSIDE LEGAL COUNSEL AND ORGANIZATION PERSONNEL TO CONFIRM THAT THE JOINT VENTURE WOULD BE FORMED, OPERATED AND MANAGED IN A MANNER THAT FURTHERS THE COMMUNITY BENEFIT AND CHARITABLE PURPOSES OF THE ORGANIZATION. JOINT VENTURES WITH TAXABLE ENTITIES ARE REQUIRED TO BE STRUCTURED, INCLUDING THROUGH FINANCIAL AND GOVERNANCE PROVISIONS AND RESERVED POWERS, IN A MANNER TO SAFEGUARD THE ORGANIZATION'S EXEMPT STATUS AND ENSURE THAT THE ORGANIZATION CONTROLS ALL ASPECTS OF THE JOINT VENTURE RELATED TO ITS EXEMPT PURPOSE. FORM 990, PART VII, SECTION A, ROBERT T. QUATTROCCHI, SHANNON BANNA, AND JORGE HERNANDEZ RECEIVED REPORTABLE RELATED COMPENSATION FOR MANAGEMENT SERVICES THEY PROVIDED TO NORTHSIDE HOSPITAL, INC. THEY DID NOT RECEIVE ANY COMPENSATION FOR SERVICE TO NORTHSIDE HEALTH SERVICES, INC. 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