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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. THE TRUST IS OWNED BY NCH AND IS SUBJECT TO THE RISK OF CREDITORS OF NCH. CONSEQUENTLY, DEPOSITS MADE TO THE TRUSTS REMAIN AS ASSETS OF NCH UNTIL THE PARTICIPANT VESTS IN ACCORDANCE WITH THE PLAN. THE SERP HAS BEEN DISCONTINUED WITH THE EXCEPTION OF DR. ALLEN WEISS, PRESIDENT & CEO, WHO IS NO LONGER RECEIVING CONTRIBUTIONS TO THE PLAN, BUT WHOSE PLAN CONTINUES TO REALIZE INVESTMENT INCOME/LOSSES ON PREVIOUS CONTRIBUTIONS WHICH HAVE BEEN REPORTED ON PRIOR YEAR FORMS 990. THE ACCOUNT OF ALLEN S. WEISS, M.D. REALIZED INVESTMENT LOSS OF $70,508 FOR CALENDAR YEAR 2011. 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 720159 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, LINE 6,7A,B 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 2011 FORM 990 FOR THE FISCAL YEAR ENDING SEPTEMBER 30, 2012 WAS REVIEWED AND APPROVED BY THE CHAIRMAN OF THE NCH FINANCE COMMITTEE, SENIOR LEADERSHIP TEAM AND OUTSIDE COUNCIL 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, INC. 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 5 TRANSFERS FROM AFFILIATES $14,957,694 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:THOMAS J. GAZDIC TITLE:TRUSTEE HOURS:2 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:KEVIN D. COOPER TITLE:GENERAL COUNSEL/CHIEF OF STAFF HOURS:44 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:MICHELE THOMAN TITLE:CNO, NCH HEALTHCARE SYSTEM HOURS:44 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:MARIANN MACDONALD TITLE:TRUSTEE HOURS:2 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:ALLEN S. WEISS, M.D. TITLE:PRESIDENT/CEO HOURS:44 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:PHILLIP DUTCHER TITLE:COO, NCH HEALTHCARE SYSTEM HOURS:44 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:AURORA ESTEVEZ, M.D. TITLE:CMO, NCH HEALTHCARE SYSTEM HOURS:44 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:VICKI D. ORR TITLE:CFO,NCH HEALTHCARE SYSTEM HOURS:44 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:ELIZABETH MARTIN TITLE:ASSISTANT SECRETARY HOURS:44 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:MICHAEL RILEY TITLE:CHIEF STRATEGY OFFICER HOURS:44 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:JAMES K. MARTIN TITLE:CHIEF DEVELOPMENT OFFICER HOURS:44 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:GARY PARSONS, M.D. TITLE:CHIEF MEDICAL OFFICER HOURS:5 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:ZACHARY BOSTOCK TITLE:CHIEF ADMINISTRATIVE OFFICER HOURS:5 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:JOHN MCGIRL TITLE:CHIEF HUMAN RESOURCE OFFICER HOURS:44 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:HELEN THOMPSON TITLE:CHIEF INFORMATION OFFICER HOURS:44 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:RENEE M. THIGPEN TITLE:INTERIM CHIEF HR OFFICER HOURS:44 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 COUNSELING & EMPLOYEE ASSISTANCE PROGRAM 350 7TH STREET NORTH NAPLES FL 34102 650374989 EMPLOYEE ASSIST FL NCH SYSTEM C CORP HEALTH RESOURCES CORPORATION 350 7TH STREET NORTH NAPLES FL 34102 592568003 HOLDING COMPANY FL NCH SYSTEM C CORP AMBULATORY SURGICAL CARE CENTER INC 350 7TH STREET NORTH NAPLES FL 34102 592568029 OUTPAT. 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