2013-11-15T09:47:58-06:00 2012-12-31 410746749 CLIFTONLARSONALLEN LLP 4099 TAMIAMI TRAIL N STE 300 NAPLES FL 34103 990 2012-01-01 596194413 TELFORD FOUNDATION INC TELF 2396244000 350 7TH ST NORTH NAPLES FL 34102 ALLEN WEISS MD 2396244000 2013-11-14 1 MARTIN REDOVAN CPA P01281045 2392628686 2013-11-14 2012 2016-02-25 16:41:14Z ALLEN WEISS MD 350 7TH ST NORTH NAPLES FL 34102 8269618 0 X N/A X 1966 FL GIFTS TO PRESELECTED CHARITIES 5 0 0 0 0 0 0 0 0 0 1757646 1791703 24617 20617 1782263 1812320 1550000 1472500 0 0 0 0 0 0 0 174298 170713 1724298 1643213 57965 169107 42430889 44823522 0 0 42430889 44823522 TO OPERATE EXCLUSIVELY FOR THE BENEFIT OF CERTAIN DESIGNATED ORGANIZATIONS, ALL OF WHICH ARE PUBLICLY SUPPORTED ORGANIZATIONS. 0 0 1472500 1472500 GRANTS TO DESIGNATED SUPPORTED ORGANIZATIONS. SEE SCHEDULE I. 1472500 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 5 0 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 FL X ALLEN WEISS MD PRESIDENT 2396244000 350 7TH ST NORTH NAPLES FL 34102 JEAN C LOGUE 2.00 X X 0 0 0 WILLIAM LICKERT 1.00 X 0 0 0 F JOSEPH MCMACKIN III 2.00 X X 0 0 0 KEVIN D COOPER ESQ 2.00 X X 0 463095 33284 ALLEN WEISS MD 2.00 X X 0 1333749 26068 0 1796844 59352 0 0 1 0 0 1515517 1515517 6733484 6457298 276186 276186 276186 PROCEEDS FROM ENRON INVESTMENT SE 900099 14654 14654 REFUND TAX WITHHELD ON DIVIDENDS 900099 5742 5742 PROCEEDS FROM RAYTHEON CO SECURIT 900099 221 221 20617 1812320 0 0 1812320 1472500 1472500 1418 1418 156243 156243 2962 2962 10090 10090 1643213 1472500 170713 0 498946 751018 41931943 44072504 42430889 44823522 0 0 X 42430889 44823522 42430889 44823522 42430889 44823522 169107 2223526 0 X X 0 1 X 1 0 X X 0 0 0 NCH HEALTH CARE SYSTEM 592314655 501(C)(3) 1 1 1 368125 THE FIRST PRESBYTERIAN CHURCH OF RICHMOND 616002944 501(C)(3) 1 1 1 147250 PATTIE A CLAY HOSPITAL 610461940 501(C)(3) 1 1 1 147250 THE UNIVERSITY OF KENTUCKY MEDICAL CENTER FOR OVARIAN CANCER RESEARCH 616001218 501(C)(3) 1 1 1 147250 WASHINGTON AND LEE UNIVERSITY 540505977 501(C)(3) 1 1 1 147250 DAVID LAWRENCE FOUNDATION FOR MENTAL HEALTH INC 592206025 501(C)(3) 1 1 1 73625 GREENBRIER HISTORICAL SOCIETY 237015222 501(C)(3) 1 1 1 73625 INTER-VARSITY CHRISTIAN FELLOWSHIP 362171714 501(C)(3) 1 1 1 73625 HAZARD COMMUNITY COLLEGE 611320380 501(C)(3) 1 1 1 73625 TELFORD COMMUNITY CENTER YMCA INC 616000619 501(C)(3) 1 1 1 73625 WORLD VISION INTERNATIONAL 953202116 501(C)(3) 1 1 1 73625 YOUTH HAVEN OF NAPLES INC 237065187 501(C)(3) 1 1 1 73625 12 1472500 0 X 4035846 2223526 2223526 1812320 0 1812320 1643213 0 1643213 0 1643213 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: THE FOUNDATION IS IN COMPLIANCE WITH THE INCOME TAX STANDARD REGARDING THE RECOGNITION AND MEASUREMENT OF UNCERTAIN TAX POSITIONS. THIS GUIDANCE CLARIFIES THE ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES RECOGNIZED IN A FOUNDATION'S FINANCIAL STATEMENTS. THE IMPLEMENTATION OF THIS STANDARD HAD NO IMPACT ON THE FOUNDATION'S FINANCIAL STATEMENTS. THE FOUNDATION'S TAX RETURNS FROM THE TAX YEARS ENDED DECEMBER 31, 2009 THROUGH DECEMBER 31, 2011 ARE OPEN TO EXAMINATION BY THE IRS. 1 NCH HEALTH CARE SYSTEM 350 7TH STREET NORTH NAPLES FL 34102 592314655 501(C)(3) 368125 TO BENEFIT CHARITABLE ORGANIZATION'S EXEMPT PURPOSE THE FIRST PRESBYTERIAN CHURCH OF RICHMOND PO BOX 165 RICHMOND KY 40476 616002944 501(C)(3) 147250 TO BENEFIT CHARITABLE ORGANIZATION'S EXEMPT PURPOSE PATTIE A CLAY HOSPITAL PO BOX 1600 RICHMOND KY 40475 610461940 501(C)(3) 147250 TO BENEFIT CHARITABLE ORGANIZATION'S EXEMPT PURPOSE THE UNIVERSITY OF KENTUCKY MEDICAL CENTER FOR OVARIAN CANCER RESEARCH 800 ROSE STREET LEXINGTON KY 40536 616001218 501(C)(3) 147250 TO BENEFIT CHARITABLE ORGANIZATION'S EXEMPT PURPOSE WASHINGTON AND LEE UNIVERSITY 204 W WASHINGTON ST LEXINGTON VA 24450 540505977 501(C)(3) 147250 TO BENEFIT CHARITABLE ORGANIZATION'S EXEMPT PURPOSE DAVID LAWRENCE FOUNDATION FOR MENTAL HEALTH INC 6075 BARTLEY LANE NAPLES FL 34116 592206025 501(C)(3) 73625 TO BENEFIT CHARITABLE ORGANIZATION'S EXEMPT PURPOSE GREENBRIER HISTORICAL SOCIETY 301 WEST WASHINGTON STREET LEWISBURG WV 24901 237015222 501(C)(3) 73625 TO BENEFIT CHARITABLE ORGANIZATION'S EXEMPT PURPOSE INTER-VARSITY CHRISTIAN FELLOWSHIP 3121 OVERTON DRIVE BIRMINGHAM AL 35209 362171714 501(C)(3) 73625 TO BENEFIT CHARITABLE ORGANIZATION'S EXEMPT PURPOSE HAZARD COMMUNITY COLLEGE ONE COMMUNITY COLLEGE DRIVE HAZARD KY 41701 611320380 501(C)(3) 73625 TO BENEFIT CHARITABLE ORGANIZATION'S EXEMPT PURPOSE TELFORD COMMUNITY CENTER YMCA INC 1100 EAST MAIN STREET RICHMOND KY 40475 616000619 501(C)(3) 73625 TO BENEFIT CHARITABLE ORGANIZATION'S EXEMPT PURPOSE WORLD VISION INTERNATIONAL 34834 WEYERHAEUSER WAY SOUTH FEDERAL WAY WA 98063 953202116 501(C)(3) 73625 TO BENEFIT CHARITABLE ORGANIZATION'S EXEMPT PURPOSE YOUTH HAVEN OF NAPLES INC 5867 WHITAKER ROAD NAPLES FL 34112 237065187 501(C)(3) 73625 TO BENEFIT CHARITABLE ORGANIZATION'S EXEMPT PURPOSE 12 0 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: THE FOUNDATION MONITORS THE RECIPIENTS OF ITS FUNDS ON A REGULAR BASIS. THE FOUNDATION REVIEWS ALL RELEVANT FINANCIAL INFORMATION FOR EACH OF ITS GRANTEES. ALSO, THE FOUNDATION REGULARLY MEETS WITH THE MANAGEMENT OF EACH RECIPIENT ORGANIZATION. 0 1 0 0 0 0 0 0 0 KEVIN D COOPER ESQ 0 382342 0 63753 0 17000 0 9800 0 23484 0 496379 0 0 ALLEN WEISS MD 0 1206453 0 110296 0 17000 0 9800 0 16268 0 1359817 0 0 PART I, LINE 4B DR. ALLEN WEISS, $537,124 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 WAS 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. IN 2012 DR. WEISS BECAME ELIGIBLE FOR THE SERP DISTRIBUTION AND THE NCH BOARD APPROVED THE DISTRIBUTION. THIS SERP DISTRIBUTION WAS $537,124 AND WAS INCLUDED IN THE BASE COMPENSATION FOR CALENDAR YEAR 2012. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 IS PROVIDED TO ALL BOARD MEMBERS FOR REVIEW AND INPUT BEFORE THE RETURN IS FILED WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C ONGOING TRANSACTIONS ARE MONITORED AND RESEARCHED BY THE BOARD OF DIRECTORS. ALL PARTICIPANTS ARE COVERED BY THE POLICY. FORM 990, PART VI, SECTION C, LINE 19 THE FOUNDATION MAKES ITS GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON WRITTEN REQUEST. FORM 990, PART XI, LINE 1: THE FINANCIAL STATEMENTS OF THE FOUNDATION HAVE BEEN PREPARED ON THE MODIFIED CASH BASIS OF ACCOUNTING, WHICH IS A COMPREHENSIVE BASIS OF ACCOUNTING OTHER THAN GENERALLY ACCEPTED ACCOUNTING PRINCIPLES. UNDER THIS METHOD, ACCOUNTING RECOGNITION IS NOT GIVEN TO ACCRUED INTEREST AND DISTRIBUTIONS PAYABLE. THESE AMOUNTS WOULD HAVE BEEN INCLUDED IN THE STATEMENTS OF ASSETS, LIABILITIES, AND NET ASSETS IF PREPARED IN CONFORMITY WITH ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA. NCH HEALTH CARE SYSTEM 350 7TH STREET NORTH NAPLES FL 34102 592314655 CHARITABLE ORGANIZATION FL 501(C)(3) LINE 7 N/A 0 THE FIRST PRESBYTERIAN CHURCH OF RICHMOND PO BOX 165 RICHMOND KY 40475 616002944 CHARITABLE ORGANIZATION KY 501(C)(3) LINE 7 N/A 0 PATTIE A CLAY HOSPITAL PO BOX 1600 RICHMOND KY 40475 610461940 CHARITABLE ORGANIZATION KY 501(C)(3) LINE 7 N/A 0 THE UNIVERSITY OF KENTUCKY MEDICAL CENTER FOR OVARIAN CANCER RESEARCH 800 ROSE STREET LEXINGTON KY 40536 616001218 CHARITABLE ORGANIZATION KY 501(C)(3) LINE 7 N/A 0 WASHINGTON AND LEE UNIVERSITY 204 W WASHINGTON ST LEXINGTON VA 24450 540505977 CHARITABLE ORGANIZATION VA 501(C)(3) LINE 7 N/A 0 DAVID LAWRENCE FOUNDATION FOR MENTAL HEALTH INC 6075 BARTLEY LANE NAPLES FL 34116 592206025 CHARITABLE ORGANIZATION FL 501(C)(3) LINE 7 N/A 0 GREENBRIER HISTORICAL SOCIETY 301 WEST WASHINGTON STREET LEWISBURG WV 24901 237015222 CHARITABLE ORGANIZATION WV 501(C)(3) LINE 7 N/A 0 INTER-VARSITY CHRISTIAN FELLOWSHIP 3121 OVERTON DRIVE BIRMINGHAM AL 35209 362171714 CHARITABLE ORGANIZATION AL 501(C)(3) LINE 7 N/A 0 HAZARD COMMUNITY COLLEGE ONE COMMUNITY COLLEGE DRIVE HAZARD KY 41701 611320380 CHARITABLE ORGANIZATION KY 501(C)(3) LINE 7 N/A 0 TELFORD COMMUNITY CENTER YMCA INC 1100 EAST MAIN STREET RICHMOND KY 23219 616000619 CHARITABLE ORGANIZATION KY 501(C)(3) LINE 7 N/A 0 WORLD VISION INTERNATIONAL 800 WEST CHESTNUT AVENUE MONROVIA CA 91016 953202116 CHARITABLE ORGANIZATION CA 501(C)(3) LINE 7 N/A 0 YOUTH HAVEN OF NAPLES INC 5867 WHITAKER ROAD NAPLES FL 34112 237065187 CHARITABLE ORGANIZATION FL 501(C)(3) LINE 7 N/A 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0