Bonita Community Health Center: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization
Bonita Community Health Center (EIN 59-3544102)
Tax period
2012-10-01 to 2013-09-30
Filed
2014-08-15
IRS object ID
201422279349301952
Schema version
2012v2.1
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)
Timestamp2014-08-15T09:43:23-05:00Timestamp
Tax Period End Date2013-09-30TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN410746749EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1CLIFTONLARSONALLEN LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line14099 TAMIAMI TRAIL N STE 300AddressLine1
CityNAPLESCity
StateFLState
ZIP Code34103ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2012-10-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN593544102EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1BONITA COMMUNITY HEALTH CENTER INCBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlBONINameControl
Phone2399491050Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line13501 HEALTH CENTER BLVDAddressLine1
CityBONITA SPRINGSCity
StateFLState
ZIP Code34135ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameSARA M MCCALLUMName
TitleCEOTitle
Phone2399491050Phone
Date Signed2014-08-13DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameAMELIA COOPER CPAName
PTINP00437898PTIN
Phone2392628686Phone
Date Prepared2014-07-21DatePrepared
FieldValueIRS element (for citing)
Tax Year2012TaxYear
Build TS2015-11-30 17:44:51ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonSARA M MCCALLUMNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line13501 HEALTH CENTER BLVDAddressLine1
CityBONITA SPRINGSCity
StateFLState
ZIP Code34135ZIPCode
FieldValueIRS element (for citing)
Gross Receipts9572216GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.BONITAHEALTHCENTER.COMWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1998YearFormation
State Legal DomicileFLStateLegalDomicile
Activity Or Mission DescriptionTO PROVIDE QUALITY AND COMPREHENSIVE HEALTHCARE IN A CARING ENVIRONMENT TO THE COMMUNITIES OF BONITA SPRINGS AND ESTERO.ActivityOrMissionDescription
Nbr Voting Members Governing Body8NbrVotingMembersGoverningBody
Nbr Independent Voting Members0NbrIndependentVotingMembers
Total Nbr Employees108TotalNbrEmployees
Total Nbr Volunteers29TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year2433812ContributionsGrantsPriorYear
Contributions Grants Current Year2287391ContributionsGrantsCurrentYear
Program Service Revenue Prior Year6111170ProgramServiceRevenuePriorYear
Program Service Revenue CY6192446ProgramServiceRevenueCY
Investment Income Prior Year12113InvestmentIncomePriorYear
Investment Income Current Year-1591InvestmentIncomeCurrentYear
Other Revenue Prior Year-330375OtherRevenuePriorYear
Other Revenue Current Year23629OtherRevenueCurrentYear
Total Revenue Prior Year8226720TotalRevenuePriorYear
Total Revenue Current Year8501875TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year3542083SalariesEtcPriorYear
Salaries Etc Current Year3715443SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year4396253OtherExpensePriorYear
Other Expenses Current Year3970043OtherExpensesCurrentYear
Total Expenses Prior Year7938336TotalExpensesPriorYear
Total Expenses Current Year7685486TotalExpensesCurrentYear
Revenues Less Expenses Prior Year288384RevenuesLessExpensesPriorYear
Revenues Less Expenses CY816389RevenuesLessExpensesCY
Total Assets BOY17561485TotalAssetsBOY
Total Assets EOY17730392TotalAssetsEOY
Total Liabilities BOY25259143TotalLiabilitiesBOY
Total Liabilities EOY24611661TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY-7697658NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY-6881269NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionOUR MISSION IS TO PROVIDE QUALITY AND COMPREHENSIVE HEALTHCARE IN A CARING ENVIRONMENT TO THE COMMUNITIES OF SOUTHWEST FLORIDA THROUGH THE COLLECTIVE EFFORTS OF LEE MEMORIAL HEALTHCARE SYSTEM AND THE NCH HEALTHCARE SYSTEM.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense6319927Expense
Revenue6216075Revenue
DescriptionBONITA COMMUNITY HEALTH CENTER, INC. ("BCHC") IS A NONPROFIT ORGANIZATION WHICH MEANS REVENUE GENERATED GETS REINVESTED BACK INTO THE COMMUNITY IN TERMS OF IMPROVED EQUIPMENT, SERVICES, AND FACILITIES. BCHC DEVELOPS AND PROVIDES AN OPERATION OF COMPREHENSIVE DIAGNOSTIC TREATMENT AND SURGICAL HEALTHCARE FACILITY SERVING THE BONITA SPRINGS AND ESTERO COMMUNITIES. EXAMPLES INCLUDE URGENT CARE CLINIC, RADIOLOGY SERVICES, AND A REHABILITATION CENTER. CONTINUED ON SCHEDULE OEQUIPPED WITH THE LATEST TECHNOLOGY, OUR STATE-OF-THE-ART CENTER PROVIDES A WIDE SPECTRUM OF HEALTH SERVICES AND PROGRAMS. IN ADDITION TO A WALK-IN CLINIC, PHYSICIAN REFERRAL AND PATIENT EDUCATION AREAS, THE BONITA COMMUNITY HEALTH CENTER OFFERS A ONE-STOP CENTER THAT CATERS TO ALL FACETS OF HEALTHCARE. THERE ARE OVER 50 PRIMARY AND SPECIALTY CARE PHYSICIANS UNDER ONE ROOF SERVING APPROXIMATELY 35,000 PATIENTS THROUGHOUT THE COMMUNITY.Description
Total Program Service Expense6319927TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote1ReportFin48Footnote
Independent Audit Financial Stmt1IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt0ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital0Hospital
Grants To Organizations0GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds1TaxExemptBonds
Invest Tax Exempt Bonds0InvestTaxExemptBonds
Escrow Account0EscrowAccount
On Behalf Of Issuer0OnBehalfOfIssuer
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With109621NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees108NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members8NbrVotingGoverningBodyMembers
Number Independent Voting Members0NumberIndependentVotingMembers
Family Or Business Relationship1FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders0MembersOrStockholders
Election Of Board Members0ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
States Where Copy Of Return Is FiledFLStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonGENE HIGGINS CFONamePerson
Telephone Number2399491050TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line13501 HEALTH CENTER BLVDAddressLine1
CityBONITA SPRINGSCity
StateFLState
ZIP Code34135ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (10 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficer
DAVID CATO
DIRECTOR2.00X022911911456
PHILLIP DUTCHER
DIRECTOR2.00X046814910388
NOBLE ARRINGTON
VICE CHAIRMAN2.00X015866328757X
KEVIN NEWINGHAM
CHAIR2.00X025527211909X
KEVIN D COOPER
DIRECTOR2.00X046309633284
SUZANNE BRADACH
DIRECTOR2.00X01885559428
MICHAEL RILEY
SECRETARY/TREASURER2.00X023432531934X
DR AVRA BOWERS
DIRECTOR2.00X029226414613
SARA MCCALLUM
CEO40.0014749106085X
BERTRAND GENE HIGGINS
CFO40.00110511011023X
FieldValueIRS element (for citing)
Total Reportable Comp From Org258002TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs2289443TotalReportableCompFrmRltdOrgs
Total Other Compensation168877TotalOtherCompensation
Number Individuals GT100 K2NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (4 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
NAPLES RADIOLOGY
P O BOX 8089NAPLESFL34101RADIOLOGY SERVICES400913
LEE MEMORIAL HEALTH SYSTEMS
636 DEL PRADO BLVDCAPE CORALFL33990PHYSICIAN SERVICES304784
NAPLES COMMUNITY HOSPTAL
P O BOX 413001NAPLESFL34101PHYSICIAN SERVICES226391
CORONET CLEARING SERVICES LTD
1876 SW 11TH TERRACE 204MIAMIFL33135JANITORIAL SERVICES108645
FieldValueIRS element (for citing)
Number Of Contractors GT100 K4NumberOfContractorsGT100K
Related Organizations2287391RelatedOrganizations
Total Contributions2287391TotalContributions

Program Service Revenue ProgramServiceRevenue

FieldValueIRS element (for citing)
DescriptionPATIENT SERVICESDescription
Business Code990999BusinessCode
Total Revenue Column6192446TotalRevenueColumn
Related Or Exempt Function Income6192446RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue6192446TotalProgramServiceRevenue

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real1091379Real

Less Rental Expenses LessRentalExpenses

FieldValueIRS element (for citing)
Real1067750Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real23629Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column23629TotalRevenueColumn
Related Or Exempt Function Income23629RelatedOrExemptFunctionIncome

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Other1000Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Other2591Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Other-1591Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column-1591TotalRevenueColumn
Exclusion-$1,591ExclusionAmount

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column8501875TotalRevenueColumn
Related Or Exempt Function Income6216075RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion-$1,591ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total281271Total
Management And General281271ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total2865480Total
Program Services2270194ProgramServices
Management And General595286ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total14285Total
Program Services12526ProgramServices
Management And General1759ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total280867Total
Program Services221741ProgramServices
Management And General59126ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total273540Total
Program Services220130ProgramServices
Management And General53410ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total9949Total
Program Services6666ProgramServices
Management And General3283ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total19351Total
Program Services12965ProgramServices
Management And General6386ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total738817Total
Program Services657547ProgramServices
Management And General81270ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total149148Total
Program Services132742ProgramServices
Management And General16406ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total174845Total
Program Services135999ProgramServices
Management And General38846ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total87545Total
Program Services58655ProgramServices
Management And General28890ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total190457Total
Program Services186175ProgramServices
Management And General4282ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total2789Total
Program Services1869ProgramServices
Management And General920ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total357820Total
Program Services262510ProgramServices
Management And General95310ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total466606Total
Program Services416293ProgramServices
Management And General50313ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total89575Total
Program Services83615ProgramServices
Management And General5960ManagementAndGeneral

Other Expenses OtherExpenses (3 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
SUPPLIES6421506421482
EQUIPMENT SERVICE CONTR43198541596216023
LEASE ON EQUIPMENT4107124059604752

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total198294Total
Program Services176230ProgramServices
Management And General22064ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total7685486Total
Program Services6319927ProgramServices
Management And General1365559ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY4513BOY
EOY4120EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY333170BOY
EOY797867EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY355635BOY
EOY318976EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY104854BOY
EOY102229EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY105590BOY
EOY105505EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis26973658LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec10749128LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY16455271BOY
EOY16224530EOY

Intangible Assets IntangibleAssets

FieldValueIRS element (for citing)
BOY154836BOY
EOY131316EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY47616BOY
EOY45849EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY17561485BOY
EOY17730392EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY587451BOY
EOY527491EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY14944000BOY
EOY14486666EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY9623488BOY
EOY9492127EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY104204BOY
EOY105377EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY25259143BOY
EOY24611661EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY-7697658BOY
EOY-6881269EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY-7697658BOY
EOY-6881269EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY17561485BOY
EOY17730392EOY
FieldValueIRS element (for citing)
Reconcilation Revenue Expenses816389ReconcilationRevenueExpenses
Reconcilation Other Changes0ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited

FS Audited Basis FSAuditedBasis

FieldValueIRS element (for citing)
Financial Statement SeparateXFinancialStatementSeparate
FieldValueIRS element (for citing)
Audit Committee1AuditCommittee
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule D IRS990ScheduleD

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis2520020OtherCostOrOtherBasis
Book Value2520020BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis13277676OtherCostOrOtherBasis
Depreciation4116033Depreciation
Book Value9161643BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis5868703OtherCostOrOtherBasis
Depreciation1965737Depreciation
Book Value3902966BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis4831464OtherCostOrOtherBasis
Depreciation4278702Depreciation
Book Value552762BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis475795OtherCostOrOtherBasis
Depreciation388656Depreciation
Book Value87139BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings16224530TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities (4 entries)

DescriptionDescriptionAmountAmount
INTEREST PAYABLE$54,121
TENANT DEPOSITS$9,560
DUE TO NAPLES RADIOLOGY$28,358
OTHER DEPOSITS$13,338
FieldValueIRS element (for citing)
Total Of Amounts105377TotalOfAmounts
Footnote In Part XIIIXFootnoteInPartXIII
Tot Revenue Etc Audited Fincl Stmt7283825TotRevenueEtcAuditedFinclStmt
Other Revenues1067750OtherRevenues
Revenue Not Rptd F9901067750RevenueNotRptdF990
Revenue Subtotal6216075RevenueSubtotal
Other Revenues Not Included2285800OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt2285800RevenueNotRptdOnFinStmt
Total Revenue Per Form9908501875TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt8753236TotExpensesEtcAuditedFinclStmt
Other Expenses Included1067750OtherExpensesIncluded
Expenses Not Rptd F9901067750ExpensesNotRptdF990
Expenses Subtotal7685486ExpensesSubtotal
Expenses Not Rptd On Fin Stmt0ExpensesNotRptdOnFinStmt
Total Expenses Per Form9907685486TotalExpensesPerForm990

Form990 Schedule D Part XIII Form990ScheduleDPartXIII (4 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48:PART X, LINE 2:THE ORGANIZATION HAS BEEN RECOGNIZED BY THE INTERNAL REVENUE SERVICE (IRS) AS A NOT-FOR-PROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (THE CODE) AND IS EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. SHOULD THAT STATUS BE CHALLENGED IN THE FUTURE, THE ORGANIZATION'S 2010 TO 2012 TAX YEARS ARE OPEN FOR EXAMINATION BY THE IRS.
PART XI, LINE 2D - OTHER ADJUSTMENTS:RENTAL EXPENSES REPORTED ON PART VIII LINE 6(B) 1,067,750.
PART XI, LINE 4B - OTHER ADJUSTMENTS:CAPITAL CONTRIBUTIONS INCLUDED ON PART VIII LINE 1(D) 2,287,391. OTHER NON-OPERATING GAINS AND LOSSES INCLUDED IN PART VIII -1,591.
PART XII, LINE 2D - OTHER ADJUSTMENTS:RENTAL EXPENSES REPORTED ON PART VIII LINE 6(B) 1,067,750.

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Written Employment ContractXWrittenEmploymentContract
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan0SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (9 entries)

TitleTitleBase Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
DAVID CATO
DIRECTOR0229119000000011456024057500
PHILLIP DUTCHER
DIRECTOR0387396063753017000098000588047853700
NOBLE ARRINGTON
VICE CHAIRMAN0153474015140367506323022434018742000
KEVIN NEWINGHAM
CHAIR02381810001709100011909026718100
KEVIN D COOPER
DIRECTOR038234306375301700009800023484049638000
SUZANNE BRADACH
DIRECTOR018855500000009428019798300
MICHAEL RILEY
SECRETARY/TREASURER02175660167590008808023126026625900
DR AVRA BOWERS
DIRECTOR0292264000000014613030687700
SARA MCCALLUM
CEO147491000000060850153576000

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd

Issuer Name IssuerName

FieldValueIRS element (for citing)
Business Name Line1LEE COUNTY IDATE HEALTHCARE FACILITIES BONDS 2012BusinessNameLine1
FieldValueIRS element (for citing)
Issuer EIN591793462IssuerEIN
Date Issued2012-05-10DateIssued
Issue Price15094000IssuePrice
Description Of PurposeTO REPAY BONDS PREVIOUSLY OBTAINED BY THE ORGANIZATION.DescriptionOfPurpose
Defeased0Defeased
On Behalf Of Issuer0OnBehalfOfIssuer
Pool Financing0PoolFinancing

Form990 Schedule K Part II Form990ScheduleKPartII

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Total Proceeds15094000TotalProceeds
Other Spent Proceeds15094000OtherSpentProceeds
Current Refunding0CurrentRefunding
Advance Refunding0AdvanceRefunding
Final Allocation Made0FinalAllocationMade
Adequate Books And Recds Maintaind0AdequateBooksAndRecdsMaintaind

Form990 Schedule K Part III Form990ScheduleKPartIII

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Owning Bond Financed Property0OwningBondFinancedProperty
Any Lease Arrangements0AnyLeaseArrangements
Mngment Cntrct Bond Financd Prprty0MngmentCntrctBondFinancdPrprty
Any Research Agreements0AnyResearchAgreements
Bond Iss Meet Prvt Security Pay Test0BondIssMeetPrvtSecurityPayTest
Change In Use Bond Financed Prop0ChangeInUseBondFinancedProp
Non Qualified Bond Remed Procdrs1NonQualifiedBondRemedProcdrs

Form990 Schedule K Part IV Form990ScheduleKPartIV

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Form8038 T Filed0Form8038TFiled
Rebate Not Due Yet0RebateNotDueYet
Exception To Rebate1ExceptionToRebate
No Rebate Due0NoRebateDue
Variable Rate Issue0VariableRateIssue
Hedge Identified In Books And Recds0HedgeIdentifiedInBooksAndRecds
Gross Proceeds Invested In GIC0GrossProceedsInvestedInGIC
Gross Proceeds Invested0GrossProceedsInvested
Written Proc To Monitor Reqs1WrittenProcToMonitorReqs

Form990 Schedule K Part V Form990ScheduleKPartV

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Proc To Undertk Corrective Action1ProcToUndertkCorrectiveAction

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (5 entries)

Return ReferenceReturnReferenceExplanationExplanation
FORM 990, PART VI, SECTION A, LINE 2NOBLE ARRINGTON, KEVIN COOPER, MICHAEL RILEY, AND PHILLIP DUTCHER HAVE A BUSINESS RELATIONSHIP. SUSANNE BRADACH, KEVIN NEWINGHAM, DAVID CATO, AND DR. AVRA BOWERS HAVE A BUSINESS RELATIONSHIP.
FORM 990, PART VI, SECTION B, LINE 11THE ORGANIZATION SENDS A PDF COPY OF THE ENTIRE FORM 990 TO THE BOARD OF DIRECTORS FOR REVIEW. ANY FEEDBACK IS SENT TO THE CFO FOR DISCUSSION PRIOR TO FILING WITH THE IRS.
FORM 990, PART VI, SECTION B, LINE 12CTHE CONFLICT OF INTEREST POLICY IS REVIEWED BY THE BOARD EVERY YEAR AND SIGNED BY THE CHAIRPERSON. IT STATES A FULL DISCLOSURE OF ALL FACTS PERTAINING TO ANY TRANSACTION THAT IS SUBJECT TO A CONFLICT OF INTEREST SHALL BE MADE.
FORM 990, PART VI, SECTION B, LINE 15THE CEO PAY IS DETERMINED BASED ON MARKET SURVEYS AND IS APPROVED BY THE LMHS BOARD OF DIRECTORS. COMPENSATION PROCESS FOR OFFICERS PAY IS DETERMINED BASED ON MARKET SURVEYS AND APPROVAL BY THE CEO.
FORM 990, PART VI, SECTION C, LINE 19THE ORGANIZATION DOES MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC.

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (2 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusDirect Controlling Entity NADirectControllingEntityNAControlled OrgControlledOrg
NCH HEALTHCARE SYSTEM INC
PO BOX 413029NAPLESFL341013029592314655HOLDING COMPANYFL501(C)(3)LINE 8N/A0
LEE MEMORIAL HEALTH SYSTEM
2776 CLEVELAND AVENUEFORT MYERSFL33901590714812ACUTE CARE HOSPITALFLN/A0
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org0GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org1GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org1LoansOrGuaranteesFromOtherOrg
Dividends Related Organization0DividendsRelatedOrganization
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs1RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs1PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs1PerformOfServicesByOtherOrgs
Sharing Of Facilities0SharingOfFacilities
Sharing Of Paid Employees1SharingOfPaidEmployees
Reimbursement Paid To Other Org1ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (9 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolved
LEE MEMORIAL HEALTH SYSTEM
C1288730
NCH HEALTHCARE SYSTEM
C998661
LEE MEMORIAL HEALTH SYSTEM
L304784
NCH HEALTHCARE SYSTEM
L226391
LEE MEMORIAL HEALTH SYSTEM
J392549
NCH HEALTHCARE SYSTEM
J98293
LEE MEMORIAL HEALTH SYSTEM
E11989397
NCH HEALTHCARE SYSTEM
E11989396
LEE MEMORIAL HEALTH SYSTEM
P65896

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