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TAMIAMI TRAIL EAST SUITE 203 NAPLES FL 34112 CLEANING 110303 3 0 PROGRAM SERVICE REVENUES 900099 59487869 59487869 59487869 0 0 0 279273 279273 0 0 0 0 23344 27940 -4596 -4596 -4596 0 0 0 PHYSICIAN ON-CALL REVENUE 900099 802141 802141 PHYSICIAN CONTRACT BUY OUT 900099 100453 100453 MISC RECEIPTS 900099 5478 5478 2943 2943 911015 60394288 60395941 -1653 0 0 0 0 0 0 0 0 4898090 4898090 0 0 0 0 0 0 43662326 40727253 2935073 0 1186619 1106878 79741 0 2107539 1965912 141627 0 2222623 2073263 149360 0 0 0 0 0 49973 0 49973 0 8280 0 8280 0 0 0 0 0 0 0 0 0 0 0 1856403 1486511 369892 0 189255 189255 0 0 1957005 1127335 829670 0 536476 500425 36051 0 0 0 0 0 3552931 3102976 449955 0 110532 109302 1230 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4063150 4062173 977 0 1533012 1494120 38892 0 MEDICAL SUPPLIES 5179059 5177798 1261 0 BAD DEBT EXPENSE 1327649 1327649 0 0 MISCELLANEOUS EXPENSES 2442 2452 -10 0 74443364 69351392 5091972 0 0 0 0 0 0 0 3531114 4224625 0 0 0 0 0 0 481817 671501 162866 283722 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17000 0 10000 0 22579 0 746504 0 0 0 JAN M BARRIOS MD 472280 0 437217 0 17000 0 10360 0 23094 0 959951 0 0 0 GUY R WINZENRIED MD 471251 0 245953 0 17000 0 10373 0 22784 0 767361 0 0 0 CARLO D SANTOS-OCAMPO MD 523279 0 234805 0 17000 0 10205 0 23094 0 808383 0 0 0 SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN PARTICIPATION FORM 990, SCHEDULE J, LINE 4B IN 1996, THE NCH HEALTHCARE SYSTEM, INC. BOARD OF TRUSTEES APPROVED A RECOMMENDATION OF THE EXECUTIVE COMPENSATION COMMITTEE THAT CERTAIN EXECUTIVES OF THE NCH HEALTHCARE SYSTEM WOULD BE PROVIDED WITH A SERP THAT WAS SUPPORTED THROUGH THE USE OF LIFE INSURANCE PROGRAMS. DUE TO CHANGES IN THE IRS TAX CODE, EFFECTIVE OCTOBER 1, 2003, THE FUNDING MECHANISM FOR ACTIVE EMPLOYEES WAS CHANGED FROM USING LIFE INSURANCE TO FUNDING RABBI TRUSTS. HOWEVER, THE PLAN DESIGN WAS NOT CHANGED. DURING FISCAL YEAR 2013, THE TRUST WAS OWNED BY NCH AND WAS SUBJECT TO THE RISK OF CREDITORS OF NCH. CONSEQUENTLY, DEPOSITS MADE TO THE TRUSTS REMAINED AS ASSETS OF NCH UNTIL THE PARTICIPANT VESTS IN ACCORDANCE WITH THE PLAN. THE SERP HAD BEEN DISCONTINUED WITH THE EXCEPTION OF DR. ALLEN WEISS, PRESIDENT & CEO, WHO NO LONGER RECEIVED CONTRIBUTIONS TO THE PLAN, BUT WHOSE PLAN CONTINUED TO REALIZE INVESTMENT INCOME/LOSSES ON PREVIOUS CONTRIBUTIONS WHICH HAVE BEEN REPORTED ON PRIOR YEAR FORMS 990. DURING CALENDAR YEAR 2012, THE ACCOUNT OF DR. ALLEN WEISS MET THE CRITERIA FOR THE SERP PROGRAM AND HE RECEIVED A FINAL DISTRIBUTION IN THE AMOUNT OF $537,124. THIS DISTRIBUTION IS INCLUDED IN SCHEDULE J, PART II, COLUMN B(i). AS OF THE FINAL DISTRIBUTION TO DR. ALLEN WEISS THE RABBI TRUST AND ASSOCIATED SERP PLAN WERE DISCONTINUED. PROVISION OF NON-FIXED PAYMENTS FORM 990, SCHEDULE J, LINE 7 THIS ORGANIZATION IS AN AFFILIATE OF NAPLES COMMUNITY HOSPITAL, INC. ("NCH"). ALL COMPENSATION ARRANGEMENTS ARE DETERMINED AND PAID THROUGH NCH. NCH MAY PROVIDE DISCRETIONARY BONUS AND/OR INCENTIVE COMPENSATION PAYMENTS TO ELIGIBLE EMPLOYEES. PAYMENTS MADE TO ANY DISQUALIFIED PERSON IS APPROVED BY THE NCH COMPENSATION COMMITTEE THROUGH THE PROCESS DESCRIBED IN FORM 990, PART VI, SECTION B, LINE 15. GMANCHOR EAGLEVIEW DEVELOPMENT LL COMMON TRUSTEE/PARTNER 746413 NCHMD LEASES BUILDING false LDCH REAL ESTATE HOLDINGS LLC COMMON TRUSTEE/PARTNER 120610 NCHMD LEASES BUILDING false BUSINESS TRANSACTIONS INVOLVING INTERESTED PARTIES FORM 990, SCHEDULE L, PART IV MARYANN LOMONACO M.D., BOARD TRUSTEE, AND GARY PARSONS M.D., CHIEF MEDICAL OFFICER, HAVE A PARTNERSHIP INTEREST IN GM/ANCHOR EAGLEVIEW DEVELOPMENT, LLC THAT NCHMD LEASES OFFICE SPACE FROM. DAVID LINDNER D.O., BOARD TRUSTEE, HAS A PARTNERSHIP INTEREST IN LDCH REAL ESTATE HOLDINGS THAT NCHMD LEASES OFFICE SPACE FROM. DETAIL OF BUSINESS RELATIONSHIPS FORM 990, PART VI, SECTION A, LINE 2 MARYANN LOMONACO M.D., BOARD TRUSTEE, DAVID LINDNER D.O, BOARD TRUSTEE, AND GARY PARSONS, M.D., CHIEF MEDICAL OFFICER, ARE PARTIAL OWNERS OF OFFICE SPACE LEASED BY NCHMD, INC. GOVERNING BODY AND MANAGEMENT FORM 990, PART VI, SECTION A, LINES 6, 7A & 7B THE BOARD OF DIRECTORS OF NCH HEALTHCARE SYSTEM, INC., SOLE MEMBER OF THIS ORGANIZATION, ELECTS THIS ORGANIZATION'S DIRECTORS. FORM 990 REVIEW PROCESS FORM 990, PART VI, SECTION B, LINE 11 INFORMATION RELATED TO NCHMD, INC.'S ("NCHMD") FORM 990 FILING IS GATHERED BY FINANCE STAFF AND PROVIDED TO PRICEWATERHOUSECOOPERS LLP FOR REVIEW AND RETURN PREPARATION. THE 2012 FORM 990 FOR THE FISCAL YEAR ENDING SEPTEMBER 30, 2013 WAS REVIEWED AND APPROVED BY THE CHAIRMAN OF THE NCH FINANCE COMMITTEE, SENIOR LEADERSHIP TEAM, AND OUTSIDE COUNSEL FOR THE BOARD PRIOR TO FILING WITH THE IRS. CONFLICT OF INTEREST POLICY FORM 990, PART VI, SECTION B, LINE 12 ANNUALLY, ALL NCHMD OFFICERS, DIRECTORS, TRUSTEES, AND KEY EMPLOYEES ARE REQUIRED TO DISCLOSE INTERESTS THAT COULD POTENTIALLY GIVE RISE TO CONFLICTS. COMPENSATION PROCESS FORM 990, PART VI, SECTION B, LINE 15 THIS ORGANIZATION IS AN AFFILIATE OF NAPLES COMMUNITY HOSPITAL, INC. ("NCH"). ALL COMPENSATION ARRANGEMENTS ARE DETERMINED BY AND PAID THROUGH NCH. COMPENSATION ARRANGEMENTS INVOLVING OUR CEO AND SENIOR LEADERSHIP TEAM ARE ESTABLISHED BY NCH PURSUANT TO A PROCESS THAT SATISFIES THE REBUTTABLE PRESUMPTION PROCEDURE AVAILABLE FOR SECTION 4958 EXCESS BENEFIT TRANSACTION TAX PURPOSES (WHICH REQUIRES A REVIEW OF COMPENSATIION DETERMINATIONS BY DISINTERESTED PERSONS, USE OF APPROPRIATE COMPARABILITY DATA, AND CONTEMPORANEOUS DOCUMENTATION OF THE PROCESS). WRITTEN EMPLOYMENT CONTRACTS ARE ALSO UTILIZED. DOCUMENTS AVAILABILITY TO PUBLIC FORM 990, PART VI, SECTION C, LINE 19 THE FORMS 1023 AND 990, GOVERNING DOCUMENTS, AUDITED FINANCIAL STATEMENTS, AND CONFLICT OF INTEREST POLICY OF NCHMD ARE AVAILABLE TO THE PUBLIC UPON REQUEST. FINANCIAL STATEMENTS ARE ALSO AVAILABLE VIA OUR WEBSITE: WWW.NCHMD.ORG. DETAIL OF OTHER CHANGES IN NET ASSETS FORM 990, PART XI, LINE 9 TRANSFERS FROM AFFILIATES $9,726,671 NCH HEALTHCARE SYSTEM INC PO BOX 413029 NAPLES FL 34101 592314655 HOLDING CO FL 501(C)(3) 11,B NA false NAPLES COMMUNITY HOSPITAL INC PO BOX 413029 NAPLES FL 34101 590694358 HEALTHCARE FL 501(C)(3) 3 NCH SYSTEM false MARCO ISLAND HOSPITAL INC PO BOX 413029 NAPLES FL 34101 592315435 HEALTHCARE FL 501(C)(3) 3 NCH SYSTEM false COMMUNITY HOME SERVICES INC PO BOX 413029 NAPLES FL 34101 592440516 SUPPORT ORG. FL 501(C)(3) 11,B NCH SYSTEM false COLLIER HEALTH CARE INC PO BOX 413029 NAPLES FL 34101 650244276 HEALTHCARE FL 501(C)(3) 3 NCH SYSTEM false HEALTH RESOURCES CORPORATION 350 7TH STREET NORTH NAPLES FL 34102 592568003 HOLDING COMPANY FL NCH SYSTEM C CORP false AMBULATORY SURGICAL CARE CENTER INC 350 7TH STREET NORTH NAPLES FL 34102 592568029 OUTPAT. 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