Form990
Click to see attachment
Department of the Treasury
Internal Revenue Service
Return of Organization Exempt From Income Tax
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except black lung benefit trust or private foundation)

MediumBullet The organization may have to use a copy of this return to satisfy state reporting requirements.
OMB No. 1545-0047
2010
Open to Public Inspection
A For the calendar year, or tax year beginning 10-01-2010 and ending 09-30-2011
BCheck if applicable:
CName of organization
NAPLES COMMUNITY HOSPITAL INC
 
Doing Business As
 
 
Number and street (or P.O. box if mail is not delivered to street address)
PO BOX 413029
 
Room/suite
City or town, state or country, and ZIP + 4
NAPLES, FL341013029
D Employer identification number

59-0694358
E Telephone number

G Gross receipts $ 545,212,185
F Name and address of principal officer:
Vicki D Orr
PO Box 413029
Naples,FL341013029
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
N/A
H(a)
Is this a group return for
affiliates?
H(b)
Are all affiliates included?
If "No," attach a list. (see instructions)
H(c)
Group exemption number MediumBullet  
K Form of organization:
 
L Year of formation: 1957
M State of legal domicile: FL
Part I
Summary
Activities & Governance 1 Briefly describe the organization’s mission or most significant activities: THROUGH THE PROVISION OF CHARITABLE HEALTHCARE, OUR MISSION IS TO PROMOTE, MAINTAIN AND RESTORE HEALTH FOR THOSE WE SERVE.
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a) .... 3 22
4 Number of independent voting members of the governing body (Part VI, line 1b) .... 4 13
5 Total number of individuals employed in calendar year 2010 (Part V, line 2a) ... 5 3,723
6 Total number of volunteers (estimate if necessary) .... 6 1,080
7a Total unrelated business revenue from Part VIII, column (C), line 12 .. 7a 39,420
b Net unrelated business taxable income from Form 990-T, line 34 .. 7b 3,933
Revenues; Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 4,133,425 5,173,672
9 Program service revenue (Part VIII, line 2g) ......... 446,752,069 444,235,124
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 5,763,968 5,852,166
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 11,597,340 12,378,411
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)................... 468,246,802 467,639,373
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 44,000 12,500
14 Benefits paid to or for members (Part IX, column (A), line 4) .... 0 0
15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10) 194,872,211 193,758,219
16a Professional fundraising fees (Part IX, column (A), line 11e).... 0 0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet14,947    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24f).... 248,812,627 242,785,919
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 443,728,838 436,556,638
19 Revenue less expenses. Subtract line 18 from line 12...... 24,517,964 31,082,735
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............ 522,764,681 580,430,393
21 Total liabilities (Part X, line 26)............ 184,292,597 245,108,380
22 Net assets or fund balances. Subtract line 21 from line 20 ..... 338,472,084 335,322,013
Part II
Signature Block
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.
Sign Here
JumboBullet
Signature of officer Date
JumboBullet
Type or print name and title.
Paid Preparer's Use Only Preparer's
signatureBig Right Arrow 		Date
right pointing bullet image Preparer’s taxpayer identification number
(see instructions)
Firm’s name (or yours
if self-employed),
address, and ZIP + 4Big Right Arrow




 		EIN right pointing bullet image
Phone no. right pointing bullet image
May the IRS discuss this return with the preparer shown above? (see instructions) .........
For Privacy Act and Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y
Form 990 (2010)
Form 990 (2010)
Page 2
Part III
Statement of Program Service Accomplishments
Check if Schedule O contains a response to any question in this Part III . . . . . . . . . .
1
Briefly describe the organization’s mission: NAPLES COMMUNITY HOSPITAL, INC. (THE "HOSPITAL") IS A NOT-FOR-PROFIT CORPORATION LOCATED IN COLLIER COUNTY, FLORIDA. THE HOSPITAL CONSISTS OF NAPLES COMMUNITY HOSPITAL, A 420-BED FACILITY, AND NORTH NAPLES HOSPITAL, A 261-BED FACILITY, LOCATED IN SW FLORIDA. THE HOSPITAL IS A SUBSIDIARY OF NCH HEALTHCARE SYSTEM, INC. ("NCHS"), A NOT-FOR-PROFIT CORPORATION. NAPLES COMMUNITY HOSPITAL, INC. PROVIDES INPATIENT AND OUTPATIENT HEALTHCARE SERVICES WITHOUT REGARD TO A PATIENT'S ABILITY TO PAY. THE HOSPITAL ALSO PROVIDES HEALTH ENHANCING EDUCATIONAL PROGRAMS IN ADDITION TO MEDICAL CARE FOR THE BETTERMENT OF THE COMMUNITY. ANY EXCESS REVENUE OVER EXPENSES IS USED TO FUND THE REPLACEMENT AND IMPROVEMENT OF FACILITIES AND TECHNOLOGY ALONG WITH PROGRAMS TO IMPROVE ACCESS TO NEEDED HEALTHCARE SERVICES TO ALL THOSE IN OUR COMMUNITY.
2
Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? ....................
If “Yes,” describe these new services on Schedule O.
3
Did the organization cease conducting, or make significant changes in how it conducts, any program services? ..........................
If “Yes,” describe these changes on Schedule O.
4
Describe the exempt purpose achievements for each of the organization’s three largest program services by expenses.
Section 501(c)(3) and 501(c)(4) organizations and section 4947(a)(1) trusts are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.
4a (Code:   ) (Expenses $ 381,324,248 including grants of $ 12,500 ) (Revenue $ 455,928,244 )
HEALTHCARE SERVICES- NAPLES COMMUNITY HOSPITAL, INC. ("NCH") PROVIDES INPATIENT AND OUTPATIENT HEALTHCARE SERVICES WITHOUT REGARD TO A PATIENT'S ABILITY TO PAY. FROM ITS TWO HOSPITALS, CANCER TREATMENT CENTERS, WOUND CARE CENTERS, AND OUTPATIENT REHABILITATION CENTERS, NCH PROVIDED $71,217,444 OF CHARITY CARE TO PATIENTS WHO WERE UNABLE TO PAY AND NOT COVERED BY ANY GOVERNMENTAL OR PRIVATE INSURANCE PROGRAM. ADDITIONALLY, NCH WROTE OFF $39,154,782 CLASSIFIED AS BAD DEBTS, MUCH OF WHICH REPRESENTED SERVICES DELIVERED TO INDIGENT PATIENTS, WHO DID NOT RECEIVE A CHARITY CARE DETERMINATION IN ACCORDANCE WITH THE STATE'S CRITERIA. THE SERVICES OFFERED AT NCH ARE EXTENSIVE AND INCLUDE MEDICAL, SURGICAL, OBSTETRIC, PEDIATRIC, REHABILITATIVE, PSYCHIATRIC, DIAGNOSTIC, AND EMERGENCY TREATMENT. A TOTAL OF 505 ACTIVE AND ASSOCIATE PHYSICIANS, 2,804 FULL-TIME EQUIVALENT EMPLOYEES, AND 1,080 VOLUNTEERS COMPRISE THE OUTSTANDING MEDICAL TEAM WORKING TOGETHER TO PROVIDE THESE SERVICES. THE TWO HOSPITALS ARE COMPROMISED OF 589 ACUTE CARE BEDS, A 60 BED REHABILITATIVE UNIT, 9 NICU BEDS, AND A 23 BED PSYCHIATRIC UNIT. ADDITIONAL SPECIALTY SERVICES FOR THE CARE OF CERTAIN CRITICAL AND LIFE THREATENING MEDICAL CONDITIONS INCLUDE THE MEDICAL INTENSIVE CARE UNIT, SURGICAL INTENSIVE CARE UNIT, CARDIAC CARE UNIT, CARDIAC CATHERIZATION UNIT, AND INTERMEDIATE CARE UNIT. OTHER SPECIALTIES INCLUDE ONCOLOGY, DIAGNOSTIC SERVICES (CARDIO-DIAGNOSTICS, MAMMOGRAPHY, COMPUTERIZED TOPOGRAPHIC SCANNING (CT), AND MAGNETIC RESONANCE IMAGING (MRI), AND SPECIAL PROCEDURES SUCH AS BIOPSY, ANGIOGRAPHY, AND ANGIOPLASTY). DURING THE 2011 FISCAL YEAR, NCH HAD 31,974 INPATIENT ADMISSIONS RESULTING IN 145,692 DAYS OF CARE. ADDITIONALLY, 87,100 PATIENTS WERE TREATED IN OUR EMERGENCY CARE CENTERS. NAPLES COMMUNITY HOSPITAL, INC. RECEIVES VOLUNTEER ASSISTANCE FOR OPERATING ITS HOSPITALITY, GIFT, AND RETAIL SHOPS. NAPLES COMMUNITY HOSPITAL, INC. ALSO PROVIDES HEALTH ENHANCING EDUCATIONAL PROGRAMS IN ADDITION TO MEDICAL CARE. THESE PROGRAMS INCLUDE: WHITAKER WELLNESS CENTER, BETTER BREATHERS CLUB, MENDED HEARTS, DIABETES EDUCATION PROGRAM, CHILDBIRTH CLASSES, HEALTH FAIRS, AND CAREER DAYS. IN ADDITION, NCH SUPPORTS THE FOLLOWING: NURSES IN THE COLLIER COUNTY PUBLIC SCHOOL SYSTEM, AND ATHLETIC TRAINERS AT THE LOCAL HIGH SCHOOLS AND SPORTING EVENTS.
4b (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4c (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4d Other program services. (Describe in Schedule O.)
(Expenses $   including grants of $   ) (Revenue $   )
4e Total program service expensesMediumBullet$ 381,324,248
Form 990 (2010)
Form 990 (2010)
Page 3
Part IV
Checklist of Required Schedules
Yes
No
1
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If “Yes,” complete Schedule AClick to see attachment.....................
1
Yes
 
2
Is the organization required to complete Schedule B, Schedule of Contributors? Click to see attachment........
2
Yes
 
3
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If “Yes,” complete Schedule C, Part I..........
3
 
No
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities? If “Yes,” complete Schedule C,
Part II.........................
4
 
No
5
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19? If “Yes,” complete Schedule C, Part III........................
5
 
 
6
Did the organization maintain any donor advised funds or any similar funds or accounts where donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If “Yes,” complete
Schedule D, Part IClick to see attachment.......................
6
 
No
7
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas or historic structures? If “Yes,” complete Schedule D, Part IIClick to see attachment...
7
 
No
8
Did the organization maintain collections of works of art, historical treasures, or other similar assets? If “Yes,” complete Schedule D, Part III Click to see attachment....................
8
 
No
9
Did the organization report an amount in Part X, line 21; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If “Yes,”
complete Schedule D, Part IVClick to see attachment...................
9
 
No
10
Did the organization, directly or through a related organization, hold assets in term, permanent,or quasi-endowments? If “Yes,” complete Schedule D, Part VClick to see attachment
10
Yes
 
11
If the organization’s answer to any of the following questions is ‘Yes,’ then complete Schedule D, Parts VI, VII, VIII, IX, or X as applicable:
a
Did the organization report an amount for land, buildings, and equipment in Part X, line10? If “Yes,” complete Schedule D, Part VI.Click to see attachment
11a
Yes
 
b
Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VII.Click to see attachment
11b
 
No
c
Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VIII.Click to see attachment
11c
 
No
d
Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part IX.Click to see attachment
11d
Yes
 
e
Did the organization report an amount for other liabilities in Part X, line 25? If “Yes,” complete Schedule D, Part X.Click to see attachment
11e
Yes
 
f
Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If “Yes,” complete Schedule D, Part X.Click to see attachment
11f
 
No
12a
Did the organization obtain separate, independent audited financial statements for the tax year? If “Yes,” complete Schedule D, Parts XI, XII, and XIII Click to see attachment
12a
 
No
b
Was the organization included in consolidated, independent audited financial statements for the tax year? If “Yes,” and if the organization answered ‘No’ to line 12a, then completing Schedule D, Parts XI, XII, and XIII is optional Click to see attachment
12b
Yes
 
13
Is the organization a school described in section 170(b)(1)(A)(ii)? If “Yes,” complete Schedule E
13
 
No
14a
Did the organization maintain an office, employees, or agents outside of the United States?....
14a
 
No
b
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, and program service activities outside the United States? If “Yes,” complete Schedule F, Part I.........
14b
 
No
15
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or assistance to any organization or entity located outside the U.S.? If “Yes,” complete Schedule F, Part II..
15
 
No
16
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or assistance to individuals located outside the U.S.? If “Yes,” complete Schedule F, Part III..
16
 
No
17
Did the organization report a total of more than $15,000, of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11e? If “Yes,” complete Schedule G, Part IClick to see attachment
17
 
No
18
Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If “Yes,” complete Schedule G, Part II.......... Click to see attachment
18
Yes
 
19
Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If “Yes,” complete Schedule G, Part III................... Click to see attachment
19
 
No
Form 990 (2010)
Form 990 (2010)
Page 4
Part IV
Checklist of Required Schedules (continued)
20a
Did the organization operate one or more hospitals? If “Yes,” complete Schedule H..... Click to see attachment
20a
Yes
 
b
Did the organization attach its audited financial statement to this return? Note: All Form 990 filers that operate one or more hospitals must attach audited financial statements. ..... Click to see list of attachments
20b
Yes
 
21
Did the organization report more than $5,000 of grants and other assistance to governments and organizations in the United States on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II.. Click to see attachment
21
 
No
22
Did the organization report more than $5,000 of grants and other assistance to individuals in the United States on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III..... Click to see attachment
22
Yes
 
23
Did the organization answer “Yes” to Part VII, Section A, questions 3, 4, or 5, about compensation of the organization’s current and former officers, directors, trustees, key employees, and highest compensated employees? If “Yes,” complete Schedule J................ Click to see attachment
23
Yes
 
24a
Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If “Yes,” answer questions 24b–24d and complete Schedule K. If “No,” go to line 25................ Click to see attachment
24a
Yes
 
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
No
c
Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds?......................
24c
 
No
d
Did the organization act as an “on behalf of” issuer for bonds outstanding at any time during the year?...
24d
 
No
25a
Section 501(c)(3) and 501(c)(4) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If “Yes,” complete Schedule L, Part I...... Click to see attachment
25a
 
No
b
Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If “Yes,” complete Schedule L, Part I................ Click to see attachment
25b
 
No
26
Was a loan to or by a current or former officer, director, trustee, key employee, highly compensated employee, or disqualified person outstanding as of the end of the organization’s tax year? If “Yes,” complete Schedule L,
Part II........................... Click to see attachment
26
 
No
27
Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial contributor, or a grant selection committee member, or to a person related to such an individual? If “Yes,” complete Schedule L, Part III............... Click to see attachment
27
 
No
28
Was the organization a party to a business transaction with one of the following parties? (see Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):
a
A current or former officer, director, trustee, or key employee? If “Yes,” complete Schedule L, Part IV ......................... Click to see attachment
28a
Yes
 
b
A family member of a current or former officer, director, trustee, or key employee? If “Yes,”
complete Schedule L, Part IV................... Click to see attachment
28b
Yes
 
c
An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof) was an officer, director, trustee, or owner? If “Yes,” complete Schedule L, Part IV.. Click to see attachment
28c
Yes
 
29
Did the organization receive more than $25,000 in non-cash contributions? If “Yes,” complete Schedule MClick to see attachment
29
Yes
 
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If “Yes,” complete Schedule M............ Click to see attachment
30
 
No
31
Did the organization liquidate, terminate, or dissolve and cease operations? If “Yes,” complete Schedule N,
Part I........................... Click to see attachment
31
 
No
32
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If “Yes,” complete Schedule N, Part II.......................
32
 
No
33
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If “Yes,” complete Schedule R, Part I........ Click to see attachment
33
 
No
34
Was the organization related to any tax-exempt or taxable entity? If “Yes,” complete Schedule R, Parts II, III, IV, and V, line 1..................... Click to see attachment
34
Yes
 
35
Is any related organization a controlled entity within the meaning of section 512(b)(13)? .....
35
 
No
a
Did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If “Yes,” complete Schedule R, Part V, line 2... Click to see attachment
36
Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If “Yes,” complete Schedule R, Part V, line 2........... Click to see attachment
36
 
No
37
Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If “Yes,” complete Schedule R, Part VIClick to see attachment
37
 
No
38
Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11 and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Form 990 (2010)
Form 990 (2010)
Page 5
Part V
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response to any question in this Part V . . . . . . . . . .
Yes
No
1a
Enter the number reported in Box 3 of Form 1096. Enter -0- if not applicable. .......
1a
474
b
Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable.
1b
3
c
Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................
1c
Yes
 
2a
Enter the number of employees reported on Form W-3, Transmittal of Wage and Tax Statements filed for the calendar year ending with or within the year covered by this return .....................
2a
3,723
b
If at least one is reported on line 2a, did the organization file all required federal employment tax returns?

Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file. (see instructions)
2b
Yes
 
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?.............................
3a
Yes
 
b
If “Yes,” has it filed a Form 990-T for this year? If “No,” provide an explanation in Schedule O.....
3b
Yes
 
4a
At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account or securities account)?.......................
4a
 
No
b
If "Yes," enter the name of the foreign country: MediumBullet
See instructions for filing requirements for Form TD F 90-22.1, Report of Foreign Bank and Financial Accounts.
5a
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year?..
5a
 
No
b
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
5b
 
No
c
If “Yes” to line 5a or 5b, did the organization file Form 8886-T? ........
5c
 
 
6a
Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible?..........
6a
 
No
b
If “Yes,” did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible?........................
6b
 
 
7
Organizations that may receive deductible contributions under section 170(c).
a
Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor?....................
7a
Yes
 
b
If “Yes,” did the organization notify the donor of the value of the goods or services provided?.....
7b
Yes
 
c
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282?...........................
7c
 
No
d
If “Yes,” indicate the number of Forms 8282 filed during the year ....
7d
 
e
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?..........................
7e
 
No
f
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract?..
7f
 
No
g
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required?...................
7g
 
 
h
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C?...............
7h
 
 
8
Sponsoring organizations maintaining donor advised funds and section 509(a)(3) supporting organizations. Did the supporting organization, or a donor advised fund maintained by a sponsoring organization, have excess business holdings at any time during the year?................
8
 
 
9
Sponsoring organizations maintaining donor advised funds.
a
Did the organization make any taxable distributions under section 4966?.........
9a
 
 
b
Did the organization make a distribution to a donor, donor advisor, or related person?......
9b
 
 
10
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on Part VIII, line 12 ...
10a
 
b
Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
10b
 
11
Section 501(c)(12) organizations. Enter:
a
Gross income from members or shareholders .........
11a
 
b
Gross income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them.) ........
11b
 
12a
Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?
12a
 
 
b
If “Yes,” enter the amount of tax-exempt interest received or accrued during the year.
12b
 
13
Section 501(c)(29) qualified nonprofit health insurance issuers.
a
Is the organization licensed to issue qualified health plans in more than one state?
Note. All 501(c)(29) organizations must list in Schedule O each state in which they are licensed to issue qualified health plans, the amount of reserves required by each state, and the amount of reserves the organization allocated to each state.
13a
 
 
b
Enter the aggregate amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans.
13b
 
c
Enter the aggregate amount of reserves on hand.
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
 
b
If "Yes," has it filed a Form 720 to report these payments? If “No,” provide an explanation in Schedule O..
14b
 
 
Form 990 (2010)
Form 990 (2010)
Page 6
Part VI
Governance, Management, and Disclosure For each “Yes” response to lines 2 through 7b below, and for a “No” response to lines 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.
Check if Schedule O contains a response to any question in this Part VI . . . . . . . . . .
Section A. Governing Body and Management
Yes
No
1a
Enter the number of voting members of the governing body at the end of the tax year ..............
1a
22
b
Enter the number of voting members included in line 1a, above, who are independent .................
1b
13
2
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................
2
Yes
 
3
Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? ..
3
 
No
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed?
4
 
No
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
 
No
6
Does the organization have members or stockholders? ................
6
Yes
 
7a
Does the organization have members, stockholders, or other persons who may elect one or more members of the governing body? .........................
7a
Yes
 
b
Are any decisions of the governing body subject to approval by members, stockholders, or other persons? ..
7b
Yes
 
8
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a
The governing body? .........................
8a
Yes
 
b
Each committee with authority to act on behalf of the governing body? ............
8b
Yes
 
9
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If “Yes,” provide the names and addresses in Schedule O .....
9
 
No
Section B. Policies (This Section B requests information about policies not required by the Internal
Revenue Code.)
Yes
No
10a
Does the organization have local chapters, branches, or affiliates? ............
10a
 
No
b
If “Yes,” does the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with those of the organization? ....
10b
 
 
11a
Has the organization provided a copy of this Form 990 to all members of its governing body before filing the form?
11a
Yes
 
b
Describe in Schedule O the process, if any, used by the organization to review the Form 990. .....
12a
Does the organization have a written conflict of interest policy? If “No,” go to line 13.......
12a
Yes
 
b
Are officers, directors or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ...........................
12b
Yes
 
c
Does the organization regularly and consistently monitor and enforce compliance with the policy? If “Yes,” describe in Schedule O how this is done ....................
12c
Yes
 
13
Does the organization have a written whistleblower policy? ...............
13
Yes
 
14
Does the organization have a written document retention and destruction policy? .........
14
Yes
 
15
Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
a
The organization’s CEO, Executive Director, or top management official ...........
15a
Yes
 
b
Other officers or key employees of the organization ................
15b
Yes
 
If "Yes" to line a or b, describe the process in Schedule O. (See instructions.)
16a
Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? ......................
16a
 
No
b
If “Yes,” has the organization adopted a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and taken steps to safeguard the organization’s exempt status with respect to such arrangements? ............
16b
 
 
Section C. Disclosure
17
List the States with which a copy of this Form 990 is required to be filedMediumBullet
FL
18
Section 6104 requires an organization to make its Form 1023 (or 1024 if applicable), 990, and 990-T (501(c)(3)s only) available for public inspection. Indicate how you make these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how), the organization makes its governing documents, conflict of interest policy, and financial statements available to the public.
20
State the name, physical address, and telephone number of the person who possesses the books and records of the organization: MediumBullet
VICKI ORR CFOASST TREASURER
350 SEVENTH STREET NORTH
NAPLES,FL341023029
(239) 513-7630
Form 990 (2010)
Form 990 (2010)
Page 7
Part VII
Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
Check if Schedule O contains a response to any question in this Part VII . . . . . . . . . .
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization’s tax year.
RoundBullet List all of the organization’s current officers, directors, trustees (whether individuals or organizations), regardless of amount
of compensation, and current key employees. Enter -0- in columns (D), (E), and (F) if no compensation was paid.

RoundBullet List all of the organization’s current key employees, if any. See instructions for definition of "key employee."
RoundBullet List the organization’s five current highest compensated employees (other than an officer, director, trustee or key employee)
who received reportable compensation (Box 5 of Form W-2 and/or Box 7 of Form 1099-MISC) of more than $100,000 from the
organization and any related organizations.

RoundBullet List all of the organization’s former officers, key employees, or highest compensated employees who received more than $100,000
of reportable compensation from the organization and any related organizations.

RoundBullet List all of the organization’s former directors or trustees that received, in the capacity as a former director or trustee of the
organization, more than $10,000 of reportable compensation from the organization and any related organizations.

List persons in the following order: individual trustees or directors; institutional trustees; officers; key employees; highest
compensated employees; and former such persons.
Check this box if neither the organization nor any related organizations compensated any current or former officer, director, or trustee.
(A)
Name and Title 		(B)
Average hours per week (describe hours for related organizations in Schedule O) 		(C)
Position (check all that apply) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(1) Joseph I Perkovich
Chairman
 .5 X   X       0 0 0
(2) Mariann MacDonald
1st Vice Chairman
 .5 X   X       0 0 0
(3) Ambassador Francis Rooney
2nd Vice Chairman
 .5 X   X       0 0 0
(4) Thomas J Gazdic
Secretary/Treasurer
 .5 X   X       0 0 0
(5) William Allyn
Trustee
 .5 X           0 0 0
(6) Jay H Baker
Trustee
 .5 X           0 0 0
(7) Kenneth Bookman MD
Trustee
 .5 X           0 144,916 8,879
(8) Susan L Dalton
Trustee
 .5 X           0 0 0
(9) Paul Dernbach MD
Trustee
 .5 X           85,500 0 0
(10) Alberto M de la Rivaherrera MD
Trustee
 .5 X           0 0 0
(11) Michael Feuer
Trustee
 .5 X           0 0 0
(12) Terrance Flynn
Trustee
 .5 X           0 0 0
(13) Daniel Gill
Trustee
 .5 X           0 0 0
(14) Kay Gow
Trustee
 .5 X           0 0 0
(15) Joann Jenner
Trustee
 .5 X           77,422 0 18,575
(16) Amy Jewell RN
Trustee
 .5 X           30,423 0 6,972
(17) Kim Ciccarelli Kantor
Trustee
 .5 X           0 0 0
Form 990 (2010)
Form 990 (2010)
Page 8
Part VII
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)
(A)
Name and Title 		(B)
Average hours per week (describe hours for related organizations in Schedule O) 		(C)
Position (check all that apply) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(18) Hermes Koop MD
Trustee
 .5 X           5,250 0 0
(19) John Lewis MD
Trustee
 .5 X           0 0 0
(20) Frank Linsalata
Trustee
 .5 X           0 0 0
(21) Admiral Paul D Miller
Trustee
 .5 X           0 0 0
(22) Robert Moses
Trustee
 .5 X           0 0 0
(23) Wayne Mullican
Trustee
 .5 X           0 0 0
(24) Karli Sander
Trustee
 .5 X           48,284 0 1,912
(25) Scot C Schultz MD
Trustee
 .5 X           0 0 0
(26) Norman Thomson MD
Trustee
 .5 X           0 0 0
(27) Carl E Westman
Trustee
 .5 X           0 0 0
(28) Gregory Wilkerson RN
Trustee
 .5 X           64,057 0 10,986
(29) Allen S Weiss MD
President/CEO/Trustee
 40.0 X   X       643,511 0 55,504
(30) Kevin D Cooper
General Counsel/Chief of Staff
 40.0     X       374,799 0 18,113
(31) Phillip Dutcher
COO, NCH Healthcare System Inc
 40.0     X       376,608 0 10,431
(32) Aurora Estevez MD
Chief Medical Officer
 40.0     X       394,146 0 18,216
(33) Vicki D Orr
CFO/Assistant Treasurer
 40.0     X       369,494 0 31,028
(34) Elizabeth Martin
Assistant Secretary
 40.0     X       59,103 0 14,080
(35) BRIAN SETTLE TERM 9302011
Chief Human Resources Officer
 40.0     X       254,326 0 23,972
(36) SUSAN WOLFF TERM 9302011
Chief Information Officer
 40.0     X       261,411 0 17,919
(37) William Edwards Term 06411
Chief Administrative Officer
 1.0     X       0 107,111 6,012
(38) Michele Thoman
CNO
 40.0     X       242,658 0 22,465
(39) Michael Riley
Chief Strategy Officer
 40.0     X       189,961 0 29,055
(40) James K Martin
Chief Development Officer
 1.0     X       0 298,520 13,603
(41) Zach Bostock Start 091911
Chief Administrative Officer
 1.0     X       0 0 0
(42) Gary Parsons MD
Chief Medical Officer NCHMD
 1.0     X       0 153,351 3,326
(43) Bedalin Helvink MD
Medical Dir/Behavior Health
 40.0         X   202,238 0 28,907
(44) Samuel T Pinosky MD
Physician/Behavior Health
 40.0         X   201,254 0 13,922
(45) James Bates
Dir Radiology/COO NDIC
 40.0         X   184,250 0 28,700
(46) Patricia Read
Administrative Director
 40.0         X   166,656 0 21,558
(47) Benjamin Gyimah
Lead Nuclear Medicine Tech
 40.0         X   158,258 0 27,235
(48) Gail Dolan
FORMER COO, N NAPLES HOSPITAL
 0.0           X 247,560 0 12,247
1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)............MediumBullet 4,637,169 703,898 443,617
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 in reportable compensation from the organizationMediumBullet109
Yes
No
3
Did the organization list any former officer, director or trustee, key employee, or highest compensated employee on line 1a? If “Yes,” complete Schedule J for such individual .............
3
Yes
 
4
For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If “Yes,” complete Schedule J for such individual...........................
4
Yes
 
5
Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If “Yes,” complete Schedule J for such person .....
5
 
No
Section B. Independent Contractors
1
Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization.
(A)
Name and business address 		(B)
Description of services 		(C)
Compensation
CERNER CORPORATION
PO BOX 412702
KANSAS CITY,MO64141 		IT SUPPORT 10,528,015
PRECYSE SOLUTIONS
DEPT 1736 PO BOX 11407
BIRMINGHAM,AL35246 		MEDICAL RECORDS SUPP 2,496,088
SODEXHO INC
PO BOX 536922
ATLANTA,GA303536922 		FOOD/ENVIRONMENTAL 2,491,108
MEDS MONTI ELIGIBILITYDENIAL SOLUT
100 TREEMONTE DR
ORANGE CITY,FL32763 		PROF SERV COLLECTION 2,217,837
AMN HEALTHCARE INC
2735 COLLECTION CENTER DR
CHICAGO,IL60693 		AGENCY LABOR 1,910,619
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 in compensation from the organization MediumBullet91
Form 990 (2010)
Form 990 (2010)
Page 9
Part VIII
Statement of Revenue
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512, 513, or 514
Contributions, gifts, grants and other similar amounts 1a Federated campaigns..1a  
b Membership dues....1b  
c Fundraising events....1c 1,202,991
d Related organizations...1d  
e Government grants (contributions)1e  
f All other contributions, gifts, grants, and
similar amounts not included above1f 		3,970,681
g Noncash contributions included in lines 1a-1f:$ 678,148
h Total. Add lines 1a-1f.......MediumBullet 5,173,672
Program Service Revenue Business Code
2a NET PATIENT SERVICE REVENUES 622,110 444,235,124 444,235,124    
b
c
d
e
f All other program service revenue .        
g Total. Add lines 2a–2f........MediumBullet 444,235,124
Other Revenue 3 Investment income (including dividends, interest
and other similar amounts).....MediumBullet 4,966,587   1,900 4,964,687
4 Income from investment of tax-exempt bond proceeds..MediumBullet 31,876     31,876
5 Royalties............MediumBullet 0      
(i) Real (ii) Personal
6a Gross Rents 833,739  
b Less: rental expenses 122  
c Rental income or (loss) 833,617  
d Net rental income or (loss).......MediumBullet 833,617     833,617
(i) Securities (ii) Other
7a Gross amount from sales of assets other than inventory 77,676,177 43,125
b Less: cost or other basis and sales expenses 76,620,285 245,314
c Gain or (loss) 1,055,892 -202,189
d Net gain or (loss)..........MediumBullet 853,703     853,703
8a Gross income from fundraising events (not including
$ 1,202,991
of contributions reported on line 1c). See Part IV, line 18 ...
a 521,245
b Less: direct expenses ...b 707,091
c Net income or (loss) from fundraising events..MediumBullet -185,846   -185,846
9a Gross income from gaming activities.
See Part IV, line 19 ...
a  
b Less: direct expenses ...b  
c Net income or (loss) from gaming activities...MediumBullet 0      
10a Gross sales of inventory, less
returns and allowances .
a  
b Less: cost of goods sold ..b  
c Net income or (loss) from sales of inventory..MediumBullet 0      
Miscellaneous Revenue Business Code
11a DIETARY SERVICES 900,099 2,342,665 2,342,665    
b WELLNESS CENTER 900,099 3,256,425 3,256,425    
c SCHOOL NURSE 900,099 2,315,777 2,315,777    
d All other revenue .... 3,815,773 3,778,253 37,520  
e Total. Add lines 11a–11d ......MediumBullet 11,730,640
12 Total revenue. See Instructions....MediumBullet 467,639,373 455,928,244 39,420 6,498,037
Form 990 (2010)
Form 990 (2010)
Page 10
Part IX
Statement of Functional Expenses
Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A) but are not required to complete columns (B), (C), and (D).
Do not include amounts reported on lines 6b,
7b, 8b, 9b, and 10b of Part VIII. 		(A)
Total expenses 		(B)
Program service expenses 		(C)
Management and general expenses 		(D)
Fundraising expenses
1 Grants and other assistance to governments and organizations in the U.S. See Part IV, line 21 0  
2 Grants and other assistance to individuals in the U.S. See Part IV, line 22 12,500 12,500
3 Grants and other assistance to governments, organizations, and individuals outside the U.S. See Part IV, lines 15 and 16 0  
4 Benefits paid to or for members 0  
5 Compensation of current officers, directors, trustees, and key employees .... 4,105,489 0 4,105,489 0
6 Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .... 0      
7 Other salaries and wages 160,840,728 139,931,434 20,897,679 11,615
8 Pension plan contributions (include section 401(k) and section 403(b) employer contributions) .... 5,072,061 4,412,693 658,891 477
9 Other employee benefits ....... 12,246,760 10,654,681 1,590,286 1,793
10 Payroll taxes ........... 11,493,181 9,999,068 1,493,051 1,062
11 Fees for services (non-employees):        
a Management ...... 678,719 590,486 88,233 0
b Legal ......... 966,760 841,081 125,679 0
c Accounting ........... 712,725 620,071 92,654 0
d Lobbying ........... 0     0
e Professional fundraising. See Part IV, line 17.. 0  
f Investment management fees ...... 0      
g Other .......... 34,806,628 30,281,766 4,524,862 0
12 Advertising and promotion .... 2,004,335 1,743,771 260,564 0
13 Office expenses ....... 101,044,889 87,909,054 13,135,835 0
14 Information technology ...... 9,570,200 8,326,074 1,244,126 0
15 Royalties .. 0      
16 Occupancy ........... 10,896,389 9,479,858 1,416,531 0
17 Travel ............ 279,621 243,270 36,351 0
18 Payments of travel or entertainment expenses for any federal, state, or local public officials ...... 0      
19 Conferences, conventions, and meetings .... 0      
20 Interest ........... 7,237,031 6,296,217 940,814 0
21 Payments to affiliates ....... 0      
22 Depreciation, depletion, and amortization ..... 29,256,065 25,452,777 3,803,288 0
23 Insurance .............. 6,113,495 5,318,741 794,754 0
24 Other expenses. Itemize expenses not covered above. (Expenses grouped together and labeled miscellaneous may not exceed 5% of total expenses shown on line 25 below.)
a OTHER MISC. EXPENSES 64,280 55,924 8,356 0
b BAD DEBT EXPENSE 39,154,782 39,154,782 0 0
c
d
e
f All other expenses        
25 Total functional expenses. Add lines 1 through 24f 436,556,638 381,324,248 55,217,443 14,947
26 Joint costs. Check here MediumBullet if following
SOP 98-2 (ASC 958-720). Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation 		       
Form 990 (2010)
Form 990 (2010)
Page 11
Part X Balance Sheet
(A)
Beginning of year 		(B)
End of year
Assets 1 Cash—non-interest-bearing .......... 34,408,687 1 59,960,259
2 Savings and temporary cash investments ....... 4,205,403 2 4,732,782
3 Pledges and grants receivable, net ......... 6,840,666 3 7,535,758
4 Accounts receivable, net ......... 49,352,281 4 58,628,726
5 Receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
Schedule L ..........   5  
6 Receivables from other disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B). Complete Part II of
Schedule L ..........   6  
7 Notes and loans receivable, net .............   7  
8 Inventories for sale or use .............. 7,886,256 8 8,135,773
9 Prepaid expenses and deferred charges ............ 2,342,943 9 2,600,404
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 557,477,438
b Less: accumulated depreciation. ..... 10b 311,681,690 225,727,112 10c 245,795,748
11 Investments—publicly traded securities .......... 63,010,044 11 64,515,542
12 Investments—other securities. See Part IV, line 11 ......   12  
13 Investments—program-related. See Part IV, line 11 ..   13  
14 Intangible assets ......... 5,437,800 14 4,631,657
15 Other assets. See Part IV, line 11 ........... 123,553,489 15 123,893,744
16 Total assets. Add lines 1 through 15 (must equal line 34)... 522,764,681 16 580,430,393
Liabilities 17 Accounts payable and accrued expenses . 46,321,058 17 41,836,228
18 Grants payable ..........   18  
19 Deferred revenue .......... 785,079 19 400,138
20 Tax-exempt bond liabilities .......... 98,519,649 20 170,497,704
21 Escrow or custodial account liability. Complete Part IV of Schedule D..   21  
22 Payables to current and former officers, directors, trustees, key
employees, highest compensated employees, and disqualified
persons. Complete Part II of Schedule L..........   22  
23 Secured mortgages and notes payable to unrelated third parties ..   23  
24 Unsecured notes and loans payable to unrelated third parties ....   24  
25 Other liabilities. Complete Part X of Schedule D..... 38,666,811 25 32,374,310
26 Total liabilities. Add lines 17 through 25..... 184,292,597 26 245,108,380
Net Assets or Fund Balance Organizations that follow SFAS 117, check here MediumBullet and complete lines 27 through 29, and lines 33 and 34.
27 Unrestricted net assets ..... 319,914,977 27 315,534,621
28 Temporarily restricted net assets ..... 6,937,702 28 8,433,484
29 Permanently restricted net assets ..... 11,619,405 29 11,353,908
Organizations that do not follow SFAS 117, check here MediumBullet and complete lines 30 through 34.
30 Capital stock or trust principal, or current funds .....   30  
31 Paid-in or capital surplus, or land, building or equipment fund .....   31  
32 Retained earnings, endowment, accumulated income, or other funds   32  
33 Total net assets or fund balances ..... 338,472,084 33 335,322,013
34 Total liabilities and net assets/fund balances ..... 522,764,681 34 580,430,393
Form 990 (2010)
Form 990 (2010)
Page 12
Part XI
Reconcilliation of Net Assets
Check if Schedule O contains a response to any question in this Part XI . . . . . . . . . .
1
Total revenue (must equal Part VIII, column (A), line 12) . . .
1
467,639,373
2
Total expenses (must equal Part IX, column (A), line 25) . . . . .
2
436,556,638
3
Revenue less expenses. Subtract line 2 from line 1 . . . .
3
31,082,735
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) . .
4
338,472,084
5
Other changes in net assets or fund balances (explain in Schedule O) . . . .
5
-34,232,806
6
Net assets or fund balances at end of year. Combine lines 3, 4, and 5 (must equal Part X, line 33, column (B)) . . . . . .
6
335,322,013
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response to any question in this Part XII . . . . . . . . . .
Yes
No
1
Accounting method used to prepare the Form 990:  
If the organization changed its method of accounting from a prior year or checked "Other," explain in
Schedule O.
2a
Were the organization’s financial statements compiled or reviewed by an independent accountant?..
2a
 
No
b
Were the organization’s financial statements audited by an independent accountant?........
2b
Yes
 
c
If “Yes,” to 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant?
If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O............................
2c
Yes
 
d
If “Yes” to line 2a or 2b, check a box below to indicate whether the financial statements for the year were issued on a separate basis, consolidated basis, or both:
3a
As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A-133? ................
3a
 
No
b
If “Yes,” did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits. ..
3b
 
 
Form 990 (2010)
Additional Data


Software ID:  
Software Version:  
Form 990, Special Condition Description:
Special Condition Description
SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service
Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.
right arrow Attach to Form 990 or Form 990-EZ. right arrow See separate instructions.
OMB No. 1545-0047
2010
Open to Public
Inspection
Name of the organization
NAPLES COMMUNITY HOSPITAL INC
 
Employer identification number

59-0694358
Part I
Reason for Public Charity Status (All organizations must complete this part.) See instructions
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
11
e
f
g
(i) a person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
and (iii) below, the governing body of the the supported organization? ................
11g(i)
 
 
(ii) a family member of a person described in (i) above? ......................
11g(ii)
 
 
(iii) a 35% controlled entity of a person described in (i) or (ii) above? ................
11g(iii)
 
 
h
(i)
Name of supported organization 		(ii)
EIN 		(iii)
Type of organization (described on lines 1- 9 above or IRC section (see instructions)) 		(iv)
Is the organization in col. (i) listed in your governing document? 		(v)
Did you notify the organization in col. (i) of your support? 		(vi)
Is the organization in col. (i) organized in the U.S.? 		(vii)
Amount of support?
Yes No Yes No Yes No
Total                  

For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 2
Part II
Support Schedule for Organizations Described in IRC 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year(or fiscal year beginning in) (a) 2006 (b) 2007 (c) 2008 (d) 2009 (e) 2010 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....            
2 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......            
3 The value of services or facilities furnished by a governmental unit to the organization without charge..            
4 Total. Add lines 1 through 3..            
5 The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..            
6 Public Support. Subtract line 5 from line 4.            
Section B. Total Support
Calendar year(or fiscal year beginning in) (a) 2006 (b) 2007 (c) 2008 (d) 2009 (e) 2010 (f) Total
7 Amounts from line 4..            
8 Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..            
9 Net income from unrelated business activities, whether or not the business is regularly carried on..            
10 Other income. (Explain in Part IV.) Do not include gain or loss from the sale of capital assets..            
11 Total support (Add lines 7 through 10).            
12
12
 
13
Section C. Computation of Public Support Percentage
14
14
 
15
15
 
16a
b
17a
b
18
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 3
Part III
Support Schedule for Organizations Described in IRC 509(a)(2)
(Complete only if you checked the box on line 9 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)
Section A. Public Support
Calendar year(or fiscal year beginning in) (a) 2006 (b) 2007 (c) 2008 (d) 2009 (e) 2010 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .            
2 Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......            
3 Gross receipts from activities that are not an unrelated trade or business under section 513..            
4 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...            
5 The value of services or facilities furnished by a governmental unit to the organization without charge..            
6 Total. Add lines 1 through 5.            
7a Amounts included on lines 1, 2, and 3 received from disqualified persons...            
b Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.            
c Add lines 7a and 7b..            
8 Public Support (Subtract line 7c from line 6.)            
Section B. Total Support
Calendar year (or fiscal year beginning in) (a) 2006 (b) 2007 (c) 2008 (d) 2009 (e) 2010 (f) Total
9 Amounts from line 6...            
10a Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..            
b Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.            
c Add lines 10a and 10b.            
11 Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.            
12 Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)            
13 Total support (Add lines 9, 10c, 11 and 12.).            
14
Section C. Computation of Public Support Percentage
15
15
 
16
16
 
Section D. Computation of Investment Income Percentage
17
17
 
18
18
 
19a
b
20
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 4
Part IV
Supplemental Information. Supplemental Information. Complete this part to provide the explanation required by Part II, line 10; Part II, line 17a or 17b; or Part III, line 12. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
 
Explanation
 
 
 
 
Schedule A (Form 990 or 990-EZ) 2010

Additional Data


Software ID:  
Software Version:  
Schedule B
(Form 990, 990-EZ,
or 990-PF)
Department of the Treasury
Internal Revenue Service
Schedule of Contributors
Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
OMB No. 1545-0047
2010
Name of organization
NAPLES COMMUNITY HOSPITAL INC
 
Employer identification number

59-0694358
Organization type (check one):
Filers of:
Section:
Form 990 or 990-EZ





Form 990-PF




Check if your organization is covered by the General Rule or a Special Rule.  
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.
General Rule—
Special Rules
......................... Arrow Bullet   $    
Caution. An Organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2 of its Form 990, or check the box in the heading of its
Form 990-EZ, or on line 2 of its Form 990-PF, to certify that it does not meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).
For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.
Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2010)

Schedule B (Form 990, 990-EZ, or 990-PF) (2010)
Page 1 of 1 of Part I
Name of organization
NAPLES COMMUNITY HOSPITAL INC
  		Employer identification number

59-0694358
Part I
Contributors (see Instructions)
     
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Aggregate contributions		 (d)
Type of contribution
RESTRICTED
RESTRICTED
 

     
RESTRICTED
RESTRICTED  
RESTRICTED, RESTRICTED   RESTRICTED

$RESTRICTED




(Complete Part II if there is
a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Aggregate contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is
a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Aggregate contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is
a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Aggregate contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is
a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Aggregate contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is
a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Aggregate contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is
a noncash contribution.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2010)

Schedule B (Form 990, 990-EZ, or 990-PF) (2010)
Page 1 of 1 of Part II
Name of organization
NAPLES COMMUNITY HOSPITAL INC
  		Employer identification number

59-0694358
Part II
Noncash Property (see Instructions)
     
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
Schedule B (Form 990, 990-EZ, or 990-PF) (2010)

Schedule B (Form 990, 990-EZ, or 990-PF) (2010)
Page 1 of 1 of Part III
Name of organization
NAPLES COMMUNITY HOSPITAL INC
  		Employer identification number

59-0694358
Part III
Exclusively religious, charitable, etc., individual contributions to section 501(c)(7), (8), or (10) organizations
aggregating more than $1,000 for the year. (Complete columns (a) through (e) and the following line entry.)
For organizations completing Part III, enter the total of exclusively religious, charitable, etc.,
contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet $  
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
Schedule B (Form 990, 990-EZ, or 990-PF) (2010)

Additional Data


Software ID:  
Software Version:  
SCHEDULE D
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Financial Statements
SchDMd Bullet Complete if the organization answered "Yes," to Form 990,
Part IV, line 6, 7, 8, 9, 10, 11, or 12.
SchDMd Bullet Attach to Form 990. SchDMd Bullet See separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
NAPLES COMMUNITY HOSPITAL INC
 
Employer identification number

59-0694358
Part I
Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" to Form 990, Part IV, line 6.
(a) Donor advised funds (b) Funds and other accounts
1 Total number at end of year .......    
2 Aggregate contributions to (during year) ...    
3 Aggregate grants from (during year) ...    
4 Aggregate value at end of year .......    
5
Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ............
6
Did the organization inform all grantees, donors, and donor advisors in writing that grant funds may be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit. ...................................
Part II
Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.
1
Purpose(s) of conservation easements held by the organization (check all that apply).
2
Complete lines 2a–2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.
Held at the End of the Year
a Total number of conservation easements ....................... 2a  
b Total acreage restricted by conservation easements .................. 2b  
c Number of conservation easements on a certified historic structure included in (a) ..... 2c  
d Number of conservation easements included in (c) acquired after 8/17/06 ........ 2d  
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the taxable year SchDMd Bullet  
4
Number of states where property subject to conservation easement is located SchDMd Bullet  
5
Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................
6
Staff and volunteer hours devoted to monitoring, inspecting and enforcing conservation easements during the year SchDMd Bullet  
7
Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year SchDMd Bullet $  
8
Does each conservation easement reported on line 2(d) above satisfy the requirements of section
170(h)(4)(B)(i) and 170(h)(4)(B)(ii)? ....................................
9
In Part XIV, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" to Form 990, Part IV, line 8.
1a
If the organization elected, as permitted under SFAS 116, not to report in its revenue statement and balance sheet works of
art, historical treasures, or other similar assets held for public exhibition, education or research in furtherance of public service,
provide, in Part XIV, the text of the footnote to its financial statements that describes these items.
b
If the organization elected, as permitted under SFAS 116, to report in its revenue statement and balance sheet works of art,
historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service,
provide the following amounts relating to these items:
(i)
Revenues included in Form 990, Part VIII, line 1 ........................SchDMd Bullet $  
(ii)
Assets included in Form 990, Part X ..............................SchDMd Bullet $  
2
If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 relating to these items:
a
Revenues included in Form 990, Part VIII, line 1 ..........................SchDMd Bullet $  
b
Assets included in Form 990, Part X ...............................SchDMd Bullet $  
For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990
Cat. No. 52283D
Schedule D (Form 990) 2010

Schedule D (Form 990) 2010
Page 2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3
Using the organization’s accession and other records, check any of the following that are a significant use of its collection
items (check all that apply):
a
d
b
e
 
c
4
Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIV.
5
During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?........
Part IV
Escrow and Custodial Arrangements. Complete if the organization answered "Yes" to Form 990,
Part IV, line 9, or reported an amount on Form 990, Part X, line 21.
1a
Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................
b
If "Yes," explain the arrangement in Part XIV and complete the following table:
Amount
c Beginning balance ................................. 1c  
d Additions during the year .............................. 1d  
e Distributions during the year ............................. 1e  
f Ending balance ................................... 1f  
2a
Did the organization include an amount on Form 990, Part X, line 21? .....................
b
If “Yes,” explain the arrangement in Part XIV.
Part V
Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.
(a)Current Year (b)Prior Year (c)Two Years Back (d)Three Years Back (e)Four Years Back
1a Beginning of year balance .... 11,619,405 10,901,463 11,163,827
b Contributions ........ 69,635 161,158 -10,509
c Investment earnings or losses ... -175,132 716,784 -91,855
d Grants or scholarships ..... 0 0 0
e Other expenditures for facilities
and programs ........ 		160,000 160,000 160,000
f Administrative expenses .... 0 0 0
g End of year balance ...... 11,353,908 11,619,405 10,901,463
2
Provide the estimated percentage of the year end balance held as:
a
Board designated or quasi-endowment: SchDMd Bullet0 %
b
Permanent endowment: SchDMd Bullet100.000 %
c
Term endowment: SchDMd Bullet0 %
3a
Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes
No
(i) unrelated organizations ........................
3a(i)
 
No
(ii) related organizations ........................
3a(ii)
 
No
b
If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........
3b
 
 
4
Describe in Part XIV the intended uses of the organization's endowment funds.
Part VI
Investments—Land, Buildings, and Equipment. See Form 990, Part X, line 10.
Description of investment (a) Cost or other basis (investment) (b)Cost or other basis (other) (c) Accumulated depreciation (d) Book value
1a Land .................   14,426,300 14,426,300
b Buildings ................   274,051,581 130,159,396 143,892,185
c Leasehold improvements ............   6,554,924 4,791,260 1,763,664
d Equipment ................   235,295,668 176,731,034 58,564,634
e Other .................   27,148,965   27,148,965
Total. Add lines 1a-1e. (Column (d) should equal Form 990, Part X, column (B), line 10(c).)........SchDMdBullet 245,795,748
Schedule D (Form 990) 2010

Schedule D (Form 990) 2010
Page 3
Part VII
Investments—Other Securities. See Form 990, Part X, line 12.
(a) Description of security or category
(including name of security)		 (b)Book value (c) Method of valuation:
Cost or end-of-year market value
(1)Financial derivatives    
(2)Closely-held equity interests    
Other








Total. (Column (b) should equal Form 990, Part X, col.(B) line 12.)Small Bullet  
Part VIII
Investments—Program Related. See Form 990, Part X, line 13.
(a) Description of investment type (b) Book value (c) Method of valuation:
Cost or end-of-year market value








Total. (Column (b) should equal Form 990, Part X, col.(B) line 13.)Small Bullet  
Part IX
Other Assets. See Form 990, Part X, line 15.
(a) Description (b) Book value
(1) ASSETS LIMITED AS TO USE 114,556,757
(2) UNAMORTIZED BOND ISSUE COSTS 1,811,281
(3) UNAMORTIZED BOND DISCOUNTS 1,138,840
(4) INSURANCE POLICY 371,819
(5) OTHER ASSETS 1,356,225
(6) DEPOSITS 831,907
(7) THIRD-PARTY RECEIVABLE 3,826,915


Total. (Column (b) should equal Form 990, Part X, col.(B) line 15.)...........Small Bullet 123,893,744
Part X
Other Liabilities. See Form 990, Part X, line 25.
1.(a) Description of Liability (b) Amount
Federal Income Taxes 0
SELF-INSURANCE LIABILITIES 9,430,612
ACCRUED INTEREST 3,614,962
THIRD PARTY SETTLEMENT PAYABLE 0
DUE TO RELATED ORGANIZATIONS 15,642,115
PUBLIC MEDICAL FUND PAYABLE 2,764,488
OTHER LIABILITIES 922,133



Total. (Column (b) should equal Form 990, Part X, col.(B) line 25.)Small Bullet 32,374,310
2. Fin 48 (ASC 740) Footnote. In Part XIV, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC740).
Schedule D (Form 990) 2010

Schedule D (Form 990) 2010
Page 4
Part XI Reconciliation of Change in Net Assets from Form 990 to Financial Statements
1 Total revenue (Form 990, Part VIII, column (A), line 12) .................... 1  
2 Total expenses (Form 990, Part IX, column (A), line 25) ..................... 2  
3 Excess or (deficit) for the year. Subtract line 2 from line 1 ............. 3  
4 Net unrealized gains (losses) on investments .......................... 4  
5 Donated services and use of facilities ............................. 5  
6 Investment expenses ................................... 6  
7 Prior period adjustments .................................. 7  
8 Other (Describe in Part XIV) ................................. 8  
9 Total adjustments (net). Add lines 4 - 8 ............................. 9  
10 Excess or (deficit) for the year per financial statements. Combine lines 3 and 9 ......... 10  
Part XII Reconciliation of Revenue per Audited Financial Statements With Revenue per Return
1 Total revenue, gains, and other support per audited financial statements ....... 1  
2 Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a Net unrealized gains on investments .......... 2a  
b Donated services and use of facilities ......... 2b  
c Recoveries of prior year grants ........... 2c  
d Other (Describe in Part XIV): ............ 2d  
e Add lines 2a through 2d ..................... 2e  
3 Subtract line 2e from line 1..................... 3  
4 Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b . 4a  
b Other (Describe in Part XIV): ........... 4b  
c Add lines 4a and 4b....................... 4c  
5 Total Revenue. Add lines 3 and 4c. (This should equal Form 990, Part I, line 12.) ...... 5  
Part XIII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return
1 Total expenses and losses per audited financial statements ............. 1  
2 Amounts included on line 1 but not on Form 990, Part IX, line 25:
a Donated services and use of facilities .......... 2a  
b Prior year adjustments .............. 2b  
c Other losses ................ 2c  
d Other (Describe in Part XIV): ............ 2d  
e Add lines 2a through 2d...................... 2e  
3 Subtract line 2e from line 1..................... 3  
4 Amounts included on Form 990, Part IX, line 25, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b .. 4a  
b Other (Describe in Part XIV): ............ 4b  
c Add lines 4a and 4b....................... 4c  
5 Total expenses. Add lines 3 and 4c. (This should equal Form 990, Part I, line 18.) ...... 5  
Part XIV
Supplemental Information
Complete this part to provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b;
Part V, line 4; Part X; Part XI, line 8; Part XII, lines 2d and 4b; and Part XIII, lines 2d and 4b. Also complete this part to provide any additional information.
Identifier Return Reference Explanation
INTENDED USE OF THE ORGANIZATION'S ENDOWMENT FUNDS FORM 990, SCHEDULE D, PART V ALL ENDOWMENTS FUNDS MAINTAINED BY NAPLES COMMUNITY HOSPITAL, INC. ARE USED IN FURTHERANCE OF THE ORGANIZATION'S TAX-EXEMPT PURPOSES.
Schedule D (Form 990) 2010

Additional Data


Software ID:  
Software Version:  




SCHEDULE G
(Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
Supplemental Information Regarding
Fundraising or Gaming Activities
Complete if the organization answered "Yes" to Form 990, Part IV, lines 17, 18, or 19,
or if the organization entered more than $15,000 on Form 990-EZ, line 6a.
right arrow Attach to Form 990 or Form 990-EZ. right arrow See separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
NAPLES COMMUNITY HOSPITAL INC
 
Employer identification number

59-0694358
Part I
Fundraising Activities. Complete if the organization answered "Yes" to Form 990, Part IV, line 17.
1
Indicate whether the organization raised funds through any of the following activities. Check all that apply.
a e
b f
c g
d
2a
Did the organization have a written or oral agreement with any individual (including officers, directors, trustees
or key employees listed in Form 990, Part VII) or entity in connection with professional fundraising services?
b
If “Yes,” list the ten highest paid individuals or entities (fundraisers) pursuant to agreements under which the fundraiser is
to be compensated at least $5,000 by the organization. Form 990-EZ filers are not required to complete this table.
(i) Name and address of individual
or entity (fundraiser) 		(ii) Activity (iii) Did fundraiser have custody or control of contributions? (iv) Gross receipts
from activity 		(v) Amount paid to
(or retained by)
fundraiser listed in
col. (i) 		(vi) Amount paid to
(or retained by)
organization
Yes No
Total .................right arrow      
3
List all states in which the organization is registered or licensed to solicit funds or has been notified it is exempt from registration or licensing.
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50083H
Schedule G (Form 990 or 990-EZ) 2010
Schedule G (Form 990 or 990-EZ) 2010
Page 2
Part II
Fundraising Events. Complete if the organization answered "Yes" to Form 990, Part IV, line 18, or reported more than $15,000 on Form 990-EZ, line 6a. List events with gross receipts greater than $5,000.
(a) Event #1

HOSPITAL BALL
(event type) 		(b) Event #2

MAGNOLIA BALL
(event type) 		(c) Other Events

0
(total number) 		(d) Total Events
(Add col. (a) through col. (c))
VerticalRevenue 1 Gross receipts . . . 644,725 1,079,511   1,724,236
2 Less: Charitable
contributions . . . 		261,123 941,868   1,202,991
3 Gross income (line 1
minus line 2) . . . 		383,602 137,643   521,245
VerticalDirectExpenses 4 Cash prizes . . .        
5 Non-cash prizes . .        
6 Rent/facility costs . .        
7 Food and beverages . .        
8 Entertainment . . .        
9 Other direct expenses . 301,272 405,819   707,091
10 Direct expense summary. Add lines 4 through 9 in column (d) ........... right arrow 707,091
11 Net income summary. Combine lines 3 and 10 in column (d)............ right arrow -185,846
Part III
Gaming. Complete if the organization answered "Yes" to Form 990, Part IV, line 19, or reported more than $15,000 on Form 990-EZ, line 6a.
VerticalRevenue (a) Bingo (b) Pull tabs/Instant
bingo/progressive bingo 		(c) Other gaming (d) Total gaming (Add col. (a) through col. (c))
1 Gross revenue . . . .        
VerticalDirectExpenses 2 Cash prizes . . . .        
3 Non-cash prizes . . .        
4 Rent/facility costs . . .        
5 Other direct expenses . .        
6 Volunteer labor . . .
 
 
 
7 Direct expense summary. Add lines 2 through 5 in column (d) ........... right arrow  
8 Net gaming income summary. Combine lines 1 and 7 in column (d) .......... right arrow  
9
Enter the state(s) in which the organization operates gaming activities:
a
Is the organization licensed to operate gaming activities in each of these states? ............
b
If "No," Explain:
 
10a
Were any of the organization's gaming licenses revoked, suspended or terminated during the tax year? .....
b
If "Yes," Explain:
 
11
Does the organization operate gaming activities with nonmembers? .................
12
Is the organization a grantor, beneficiary or trustee of a trust or a member of a partnership or other entity
formed to administer charitable gaming? ...........................
Schedule G (Form 990 or 990-EZ) 2010
Schedule G (Form 990 or 990-EZ) 2010
Page 3
13
Indicate the percentage of gaming activity operated in:
a
The organization's facility ......................
13a
 
b
An outside facility ........................
13b
 
14
Provide the name and address of the person who prepares the organization's gaming/special events books and records:
Name right arrow
Address right arrow
15a
Does the organization have a contract with a third party from whom the organization receives gaming
revenue? ......................................
b
If "Yes," enter the amount of gaming revenue received by the organization right arrow $   and the
amount of gaming revenue retained by the third party right arrow $   .
c
If "Yes," enter name and address:
Name right arrow
Address right arrow
 
 
16
Gaming manager information:
Name right arrow
Gaming manager compensation right arrow $  
Description of services provided right arrow
 
17
Mandatory distributions:
a
Is the organization required under state law to make charitable distributions from the gaming proceeds to
retain the state gaming license? ............................
b
Enter the amount of distributions required under state law distributed to other exempt organizations or spent
in the organization's own exempt activities during the tax year right arrow$  
Part IV
Complete this part to provide additional information for responses to quuestion on Schedule G (see instructions.)
Identifier ReturnReference Explanation
Schedule G (Form 990 or 990-EZ) 2010
Additional Data


Software ID:  
Software Version:  
SCHEDULE H
(Form 990)
Department of the Treasury
Internal Revenue Service
Hospitals
MediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, question 20.
MediumBullet Attach to Form 990. MediumBullet See separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
NAPLES COMMUNITY HOSPITAL INC
 
Employer identification number

59-0694358
Part I
Charity Care and Certain Other Community Benefits at Cost
Yes
No
1a
Does the organization have a charity care policy? If "No," skip to question 6a...........
1a
Yes
 
b
If "Yes," is it a written policy? .......................
1b
Yes
 
2
If the organization has multiple hospitals, indicate which of the following best describes application of the charity care policy to the various hospitals.
3
Answer the following based on the charity care eligibility criteria that applies to the largest number of the organization's patients.
a
Does the organization use Federal Poverty Guidelines (FPG) to determine eligibility for providing free care to low
income individuals? If "Yes," indicate which of the following is the FPG family income limit for eligibility for free care:
3a
Yes
 
b
Does the organization use FPG to determine eligibility for providing discounted care to low income individuals? If
"Yes," indicate which of the following is the family income limit for eligibility for discounted care: .....
3b
Yes
 
c
If the organization does not use FPG to determine eligibility, describe in Part VI the income based criteria for determining eligibility for free or discounted care. Include in the description whether the organization uses an asset test or other threshold, regardless of income, to determine eligibility for free or discounted care.
4
Does the organization's policy provide free or discounted care to the "medically indigent"? ......
4
Yes
 
5a
Does the organization budget amounts for free or discounted care provided under its charity care policy? ...
5a
Yes
 
b
If "Yes," did the organization's charity care expenses exceed the budgeted amount?.........
5b
 
No
c
If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discounted
care to a patient who was eligibile for free or discounted care?...............
5c
 
 
6a
Does the organization prepare an annual community benefit report?.............
6a
Yes
 
6b
If "Yes," does the organization make it available to the public? ..............
6b
Yes
 
Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.
7
Charity Care and Certain Other Community Benefits at Cost
Charity Care and
Means-Tested Government Programs		 (a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community benefit expense (d) Direct offsetting revenue (e) Net community benefit expense (f) Percent of total expense
a Charity care at cost (from
Worksheets 1 and 2) .. 		    24,755,651 0 24,755,651 6.230 %
b Unreimbursed Medicaid (from
Worksheet 3, column a) . 		    36,175,664 1,749,608 34,426,056 8.660 %
c Unreimbursed costs—other means-tested government programs (from Worksheet 3, column b) ....            
dTotal Charity Care and
Means-Tested Government Programs ..... 		    60,931,315 1,749,608 59,181,707 14.890 %
Other Benefits
e Community health improvement
services and community
benefit operations (from
(Worksheet 4) .... 		    614,741 0 614,741 0.150 %
f Health professions education
(from Worksheet 5) .. 		    85,588 0 85,588 0.020 %
g Subsidized health services
(from Worksheet 6) .. 		           
h Research (from Worksheet 7)            
i Cash and in-kind contributions
to community groups
(from Worksheet 8) .. 		           
jTotal Other Benefits ...     700,329 0 700,329 0.170 %
kTotal. Add lines 7d and 7j. ..     61,631,644 1,749,608 59,882,036 15.060 %
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 2
Part II
Community Building Activities Complete this table if the organization conducted any community building activities.
(a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community building expense (d) Direct offsetting
revenue 		(e) Net community building expense (f) Percent of total expense
1 Physical improvements and housing            
2 Economic development            
3 Community support     465,888   465,888 0.120 %
4 Environmental improvements            
5 Leadership development and training for community members     80,853   80,853 0.020 %
6 Coalition building            
7 Community health improvement advocacy            
8 Workforce development     4,244   4,244  
9 Other            
10 Total     550,985   550,985 0.140 %
Part III
Bad Debt, Medicare, & Collection Practices
Section A. Bad Debt Expense
Yes
No
1
Does the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................
1
Yes
 
2
Enter the amount of the organization's bad debt expense (at cost).....
2
10,563,526
3
Enter the estimated amount of the organization's bad debt expense (at cost) attributable to patients eligible under the organization's charity care policy ..
3
1,721,855
4
Provide in Part VI the text of the footnote to the organization's financial statements that describes bad debt expense. In addition, describe the costing methodology used in determining the amounts reported on lines 2 and 3, and rationale for including a portion of bad debt amounts as community benefit.
Section B. Medicare
5
Enter total revenue received from Medicare (including DSH and IME).....
5
236,064,179
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
238,107,607
7
Subtract line 6 from line 5. This is the surplus or (shortfall)........
7
-2,043,428
8
Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.
Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.
Check the box that describes the method used:
Section C. Collection Practices
9a
Does the organization have a written debt collection policy? ...............
9a
Yes
 
b
If "Yes," does the organization's collection policy contain provisions on the collection practices to be followed for patients who are known to qualify for charity care or financial assistance? Describe in Part VI......
9b
Yes
 
Part IV
Management Companies and Joint Ventures
(a) Name of entity (b) Description of primary
activity of entity 		(c) Organization's
profit % or stock
ownership % 		(d) Officers, directors,
trustees, or key
employees' profit %
or stock ownership% 		(e) Physicians'
profit % or stock
ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 3
Part VFacility Information
Section A. Hospital Facilities
(list in order of size, measured by total revenue per facility, from largest to smallest)
How many hospital facilities did the organization operate during the tax year?1
Name and address 		Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital Research Facility ER-24Hours ER-Other Other (Describe)
1 NAPLES COMMUNITY HOSPITAL
350 7TH STREET NORTH
NAPLES,FL34102 		X                
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 4
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
Name of Hospital Facility:NAPLES COMMUNITY HOSPITAL
Line Number of Hospital Facility (from Schedule H, Part V, Section A):1

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2010)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet those needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess all of the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Development of a community benefit plan for the facility
d Participation in community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the CHNA
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed together with the reasons why it has not addressed such needs. 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explains eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8    
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care to low incomeindividuals?.. 9    
If “Yes,” indicate the FPG family income limit for eligibility for free care:   %
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 5
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care to low income individuals?......... 10    
If “Yes,” indicate the FPG family income limit for eligibility for discounted care:   %
11 Explained the basis for calculating amounts charged to patients?................. 11    
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12    
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13    
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted at all times on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy that explained actions the hospital facility may take upon non-payment?........ 14    
15 Check all of the following collection actions against a patient that were permitted under the hospital facility's policies at any time during the tax year:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments or arrests
e Other (describe in Part VI)
16 Did the hospital facility engage in or authorize a third party to engage in any of the following collection actions during the tax year?................................... 16    
If “Yes,” check all collection actions in which the hospital facility or a third party engaged (check all that apply):
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other (describe in Part VI)
17 Indicate which actions the hospital facility took before initiating any of the collection actions checked in question 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether a patient who applied for financial assistance under the financial assistance policy qualified for financial assistance
e Other (describe in Part VI)
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 6
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18    
If “No,” indicate the reasons why (check all that apply):
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility did not have a policy relating to emergency medical care
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Charges for Medical Care
19 Indicate how the hospital facility determined the amounts generally billed to individuals who had insurance covering emergency or other medically necessary care (check all that apply):
a The hospital facility used the lowest negotiated commercial insurance rate for those services at the hospital facility
b The hospital facility used the average of the three lowest negotiated commercial insurance rates for those services at the hospital facility
c The hospital facility used the Medicare rate for those services
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20    
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its patients an amount equal to the gross charge for services provided to that patient?................................... 21    
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 7
Part VFacility Information (continued)

Section C. Other Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility
(list in order of size, measured by total revenue per facility, from largest to smallest)
How many non-hospital facilities did the organization operate during the tax year?  
Name and address Type of Facility (Describe)
1
2
3
4
5
6
7
8
9
10
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 8
Part VI
Supplemental Information
Complete this part to provide the following information.
1 Required descriptions. Provide the description required for Part I, lines 3c, 6a, and 7; Part II; Part III, lines 4, 8, and 9b; and Part V, Section B, lines 1j, 2, 4c, 6i, 7, 11i, 13i, 17l, 18l, 19e, 21d, 25, and 26.
2 Community health needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any community health needs assessments reported in Part V, Section B.
3 Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4 Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5 Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6 Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7 State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.
Identifier ReturnReference Explanation
SUPPLEMENTAL DISCLOSURES   PART I, LINE 3C N/A PART I, LINE 6A NAPLES COMMUNITY HOSPITAL, INC. IS AN AFFILIATE OF NCH HEALTHCARE SYSTEM, INC. ("NCHS"). NCHS PREPARES A COMMUNITY BENEFIT REPORT ANNUALLY AND INCLUDES THIS REPORT WITH ITS FORM 990 TAX RETURN FILING. THE COMMUNITY BENEFIT REPORT PREPARED INCLUDES ALL ORGANIZATIONS OF THE SYSTEM, INCLUDING NAPLES COMMUNITY HOSPITAL, INC. BAD DEBT EXPENSE, COSTING METHODOLOGY USED PART I, LINE 7 THE BAD DEBT EXPENSE AMOUNT INCLUDED ON FORM 990, PART IX, COLUMN 25(A) WAS $39,154,782 FOR THE YEAR ENDED SEPTEMBER 30, 2011. THIS AMOUNT HAS BEEN SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGES REPORTED ON THE SCHEDULE H, PART I, LINE 7 TABLE. THE COSTING METHODOLOGY USED IN CALCULATING THE AMOUNTS REPORTED ON THE LINE 7 TABLE ARE BASED ON A COST TO CHARGE RATIO. THE COST TO CHARGE RATIO WAS DERIVED FROM WORKSHEET 2.
BAD DEBT EXPENSE PART III, SECTION A, LINE 4 UNCOMPENSATED CARE REPRESENTS EITHER CHARGES FOREGONE OR CHARGES IN EXCESS OF PAYMENT RECEIVED FOR SERVICES PROVIDED TO PATIENTS WHO ARE NOT COVERED UNDER CONTRACTS WITH THIRD-PARTY PAYORS. THE MAJOR COMPONENTS OF UNCOMPENSATED CARE ARE CATEGORIZED AS CHARITY, WELFARE, AND BAD DEBT. CHARITY CARE REPRESENTS SERVICES AND SUPPLIES FURNISHED AT NO CHARGE TO PATIENTS WHO HAVE QUALIFIED UNDER THE INCOME CRITERIA PROMULGATED BY THE STATE OF FLORIDA. PATIENTS WHO WOULD OTHERWISE BE DEEMED AS CHARITY CARE CAN SOMETIMES QUALIFY UNDER THE COLLIER COUNTY WELFARE PROGRAM. PAYMENTS UNDER THE COUNTY WELFARE PROGRAM ARE LIMITED BY THE AMOUNT APPROPRIATED BY THE COUNTY. FINALLY, BAD DEBTS REPRESENT CHARGES DEEMED UNCOLLECTIBLE DUE TO EITHER (A) A PATIENT'S INABILITY TO QUALIFY AS CHARITY, WELFARE, OR MEDICAID, YET CLEAR FINANCIAL INDICATIONS EXIST THAT DEMONSTRATE AN INABILITY TO PAY, OR (B) A PATIENT'S REFUSAL TO PAY FOR SERVICES PROVIDED AND THE HOSPITAL'S DECISION TO CEASE FURTHER COLLECTION EFFORTS. THE COSTING METHODOLOGY USED IN DETERMINING THE AMOUNTS REPORTED ON LINES 2 AND 3 ARE BASED ON A COST TO CHARGE RATIO.
COSTING METHODOLOGY, MEDICARE SHORTFALL PART III, SECTION B, LINE 8 THE COSTING METHODOLOGY USED IN DETERMINING THE AMOUNT REPORTED ON LINE 6 IS BASED ON A COST TO CHARGE RATIO. THE COST TO CHARGE RATIO WAS DERIVED FROM WORKSHEET 2. CONSISTENT WITH THE CHARITABLE HEALTHCARE MISSION OF NAPLES COMMUNITY HOSPITAL, INC. AND THE COMMUNITY BENEFIT STANDARD SET FORTH IN IRS REVENUE RULING 69-545, THE HOSPITAL PROVIDES CARE FOR ALL PATIENTS COVERED BY MEDICARE SEEKING MEDICAL CARE. SUCH CARE IS PROVIDED REGARDLESS OF WHETHER THE REIMBURSEMENT PROVIDED FOR SUCH SERVICES MEETS OR EXCEEDS THE COSTS INCURRED BY THE HOSPITAL TO PROVIDE SUCH SERVICES. AS A RESULT, NAPLES COMMUNITY HOSPITAL, INC. VIEWS ANY SHORTFALL REPORTED IN LINE 7 AS AN ADDITIONAL ITEM OF COMMUNITY BENEFIT PROVIDED BY THE ORGANIZATION.
COLLECTION PRACTICES PART III, LINE 9B NAPLES COMMUNITY HOSPITAL, INC. PROVIDES CARE WITHOUT CHARGE OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATES TO PATIENTS WHO MEET SPECIFIC CRITERIA UNDER THE STATE'S CHARITY CARE GUIDELINES. BECAUSE NAPLES COMMUNITY HOSPITAL, INC. DOES NOT PURSUE COLLECTION OF ACCOUNTS DETERMINED TO QUALIFY AS CHARITY CARE, THESE AMOUNTS ARE NOT REPORTED AS REVENUE.
NEEDS ASSESSMENT PART VI, LINE 2 THE ORGANIZATION ASSESSES THE HEALTH CARE NEEDS OF THE COMMUNITIES IT SERVES IN VARIOUS WAYS. IN 2011, WE PARTICIPATED IN THE 2011 COLLIER COUNTY SUSTAINING EXCELLENCE CONFERENCE. THIS CONFERENCE PARTNERED KEY PARTICIPANTS FROM THE COUNTY, INCLUDING THE COLLIER COUNTY PUBLIC SCHOOLS, COLLIER COUNTY HEALTH DEPARTMENT, COLLIER COUNTY PARKS AND RECREATION DEPARTMENT, UNITED WAY OF COLLIER COUNTY, YMCA, POLICE, EMS AND FIRE DEPARTMENTS, NUTRITION FOOD SERVICE COMPANIES, PINE RIDGE MEDICAL CENTER AND NAPLES COMMUNITY HOSPITAL. THE GROUP FOCUSED ON HEALTH AND COMMUNITY ISSUES IN COLLIER COUNTY AND FLORIDA, SUCH AS TOBACCO USE, ADULT OBESITY, BINGE DRINKING, UNSAFE SEX, ACCESS TO CARE, QUALITY OF CARE, EDUCATION, UNEMPLOYMENT, CHILDREN IN POVERTY, INADEQUATE SOCIAL SUPPORT, COMMUNITY SAFETY, BUILT ENVIRONMENT AND MORBIDITY. THE GROUP WAS ABLE TO FOCUS ON SOLUTIONS TO SOME OF THE ISSUES DISCUSSED, AS WELL AS CREATE OPPORTUNITIES TO BETTER SERVE THE COMMUNITY'S NEEDS.
INFORMATION REGARDING PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE PART VI, LINE 3 NAPLES COMMUNITY HOSPITAL, INC. RECOGNIZES ITS RESPONSIBILITY TO COMMUNICATE ITS FINANCIAL POLICIES AND EXPECTATIONS TO PATIENTS. THE HOSPITAL INFORMS AND EDUCATES PATIENTS BY PROVIDING PATIENTS WITH THE NCH HEALTHCARE SYSTEM PATIENT RIGHTS AND RESPONSIBILITIES. INCLUDED IN THESE RIGHTS IS THE RIGHT TO BE GIVEN, UPON REQUEST, FULL MEDICAL INFORMATION AND FINANCIAL COUNSELING. IN ADDITION, A PATIENT REPRESENTATIVE WILL CONTACT PATIENTS PRIOR TO SERVICES TO EVALUATE THE PATIENT'S ABILITY TO PAY. THIS PROCESS INCLUDES OBTAINING THE PATIENT'S CURRENT FINANCIAL INFORMATION, OBTAINING A CREDIT REPORT AND REVIEWING THE PATIENT'S PAYMENT HISTORY WITH NAPLES COMMUNITY HOSPITAL, INC. PERSONS REQUIRING ASSISTANCE WITH THE UNFUNDED PORTION OF THEIR BILLS ARE ENCOURAGED TO REQUEST A CHARITY EVALUATION. NCH ALSO PROVIDES ASSISTANCE FOR PATIENTS TO APPLY FOR MEDICAID COVERAGE OR OTHER STATE OR LOCAL ASSISTANCE PROGRAMS WHICH MAY ASSIST WITH PAYMENT FOR MEDICAL SERVICES.
COMMUNITY INFORMATION PART VI, LINE 4 NAPLES COMMUNITY HOSPITAL, INC. SERVES A DIVERSE AND SEASONAL COMMUNITY. THE POPULATION IS APPROXIMATELY 402,816. THE MEDIAN AGE OF RESIDENTS IS 46.9. THE ESTIMATED MEDIAN HOUSEHOLD INCOME IS $70,881. THE UNEMPLOYMENT RATE IS APPROXIMATELY 10.7%. THE PERCENTAGE OF RESIDENTS BELOW THE POVERTY LEVEL IS APPROXIMATELY 12.2%.
INFORMATION REGARDING PROMOTION OF COMMUNITY HEALTH PART VI, LINE 5 NAPLES COMMUNITY HOSPITAL, INC. PROVIDES HEALTH-ENHANCING EDUCATIONAL PROGRAMS AND RESOURCES IN PROMOTING THE HEALTH OF OUR COMMUNITY. THE TYPES OF PROGRAMS/RESOURCES PROVIDED INCLUDE: HEALTH SEMINARS, COMMUNITY HEALTH FAIRS & TESTING, RN'S EDUCATING FUTURE PATIENTS, SUPPORTING THE NEIGHBORHOOD HEALTH CLINIC, PHYSICIAN LED ACCESS NETWORK OF COLLIER COUNTY, HEART PROGRAMS, CANCER SURVIVAL AWARENESS, SUPPORT OF PATIENT FAMILIES,THE SPIRIT OF WOMEN, DR. JOHN BRIGGS WELLNESS CENTER, AS WELL AS THE SHARING OF SPACE AT NO COST TO NEEDY, NOT-FOR-PROFIT ORGANIZATIONS. THE ORGANIZATION ALSO SPONSORS AND SUPPORTS THE CLINICAL NURSING SCHOOLS IN OUR COMMUNITY. THE ORGANIZATION'S CIVIC INVOLVEMENT INCLUDES OPENING OUR DOORS TO THE COLLIER COUNTY SUPERVISOR OF ELECTIONS FOR BOTH VOTER REGISTRATION AND TO ACT AS A POLLING PLACE. NUMEROUS NCH STAFF VOLUNTEER TO MAN THE POLLS. IN ADDITION, MEMBERS OF NCH MANAGEMENT SERVE ON COMMUNITY BOARDS IN VARIOUS CAPACITIES. THE HOSPITALS HAVE ALWAYS PROVIDED EXEMPLARY PASTORAL CARE SERVICES. NCH IS ENCOURAGING THEIR OWN HEALTHCARE PROFESSIONAL BY SPONSORING CAREER DAYS, JOB SHADOWING, AND LECTURES AT LOCAL MIDDLE AND HIGH SCHOOLS ON THE MANY OPPORTUNITIES IN THE HEALTHCARE FIELD. FOR ADDITIONAL COMMUNITY ACTIVITIES THAT NAPLES COMMUNITY HOSPITAL, INC. SUPPORTS, PLEASE REFER TO FORM 990, SCHEDULE O, PART III, PROGRAM SERVICES.
AFFILIATED HEALTHCARE SYSTEM INFORMATION PART VI, LINE 6 NAPLES COMMUNITY HOSPITAL, INC. IS AN AFFILIATE OF THE NCH HEALTHCARE SYSTEM, INC. NCH HEALTHCARE SYSTEM, INC. PROVIDES HEALTH-ENHANCING EDUCATIONAL PROGRAMS AND RESOURCES IN PROMOTING THE HEALTH OF OUR COMMUNITY. IN ADDITION TO NAPLES COMMUNITY HOSPITAL, INC., THE NCH HEALTHCARE SYSTEM ALSO INCLUDES THE FOLLOWING NON-PROFIT ORGANIZATIONS: > MARCO ISLAND HOSPITAL, INC., OPERATES AN 11 1/2-HOUR/7-DAYS A WEEK URGENT CARE FACILITY AND SERVICES PATIENTS WITHOUT REGARD TO THEIR ABILITY TO PAY. DURING FYE 09/30/11, 8,054 PATIENTS WERE TREATED. OF THESE PATIENTS, 10.62% WERE CLASSIFIED AS MEDICAID, CHARITY, OR BAD DEBTS. > COLLIER HEALTH CARE, INC. OWNS AND LEASES HEALTHCARE FACILITIES IN NAPLES AND IMMOKALEE, FLORIDA. THIS ORGANIZATION ALSO OPERATES CHILDREN'S MEDICAL SERVICES, A PROGRAM SERVING CHRONICALLY ILL AND SPECIAL NEEDS CHILDREN UNDER TITLE V AND THE FLORIDA KIDCARE PROGRAM THROUGH TITLE XXI. > NCHMD, INC. OWNS AND OPERATES PHYSICIAN MEDICAL PRACTICES IN COLLIER AND LEE COUNTY, FLORIDA.
STATE FILING OF COMMUNITY BENEFIT REPORT 990 SCHEDULE H, PART VI FL,
Schedule H (Form 990) 2010
Additional Data


Software ID:  
Software Version:  
Schedule I
(Form 990)
Department of the Treasury
Internal Revenue Service
Grants and Other Assistance to Organizations,
Governments and Individuals in the United States
Complete if the organization answered "Yes," to Form 990, Part IV, line 21 or 22.
lBullet Attach to Form 990
OMB No. 1545-0047
2010
Open to Public
Inspection
Name of the organization
NAPLES COMMUNITY HOSPITAL INC
 
Employer identification number
59-0694358
Part I
General Information on Grants and Assistance
1
Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ....................................
2
Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.
Part II
Grants and Other Assistance to Governments and Organizations in the United States. Complete if the organization answered "Yes" to
Form 990, Part IV, line 21 for any recipient that received more than $5,000. Check this box if no one recipient received more than $5,000. Use
Part IV and Schedule I-1 (Form 990) if additional space is needed ......................... lBullet
(a) Name and address of organization
or government		 (b) EIN (c) IRC Code section
if applicable		 (d) Amount of cash grant (e) Amount of non-cash
assistance		 (f) Method of valuation
(book, FMV, appraisal,
other)		 (g) Description of
non-cash assistance		 (h) Purpose of grant
or assistance






















2
Enter total number of section 501(c)(3) and government organizations ......................... Bullet Image
 
3
Enter total number of other organizations ................................ . Bullet Image
 
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2010

Schedule I (Form 990) 2010
Page 2
Part III
Grants and Other Assistance to Individuals in the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 22.
Use Schedule I-1 (Form 990) if additional space is needed.
(a)Type of grant or assistance (b)Number of
recipients		 (c)Amount of
cash grant		 (d)Amount of
non-cash assistance		 (e)Method of valuation (book,
FMV, appraisal, other)		 (f)Description of non-cash assistance
(1) EDUCATIONAL SCHOLARSHIPS 5 12,500   N/A N/A













Part IV
Supplemental Information. Complete this part to provide the information required in Part I, line 2, and any other additional information.
Identifier Return Reference Explanation
PROCEDURES FOR MONITORING THE USE OF GRANT FUNDS FORM 990, SCHEDULE I, PART I, LINE 2 NAPLES COMMUNITY HOSPITAL, INC. MAKES SCHOLARSHIPS AVAILABLE TO STUDENTS VIA THE NCH HEALTHCARE SYSTEM SCHOLARSHIP PROGRAM. THE PURPOSE OF THIS SCHOLARSHIP IS TO HELP ENCOURAGE STUDENTS TO ENTER THE HEALTHCARE FIELD. THE PROGRAM IS OPEN TO STUDENTS STUDYING IN CERTAIN AREAS OF HEALTHCARE. AS DETAILED BELOW, APPLICANTS WISHING CONSIDERATION FOR THE SCHOLARSHIP PROGRAM MUST SUBMIT A COMPLETED SCHOLARSHIP APPLICATION AND ATTACH THE FOLLOWING INFORMATION: 1. A ONE PAGE TYPEWRITTEN, DOUBLE-SPACED ESSAY ON WHY THE APPLICANT HAS CHOSEN HEALTHCARE AS A CAREER PATH. 2. TWO PROFESSIONAL LETTERS OF REFERENCE. 3. HIGH SCHOOL TRANSCRIPT AND ANY ADDITIONAL TRANSCRIPTS. 4. AN ACCEPTANCE LETTER FROM THE APPLICANT'S ACCREDITED SCHOOL STATING THE APPLICANT'S ENROLLMENT IN THE NURSING, PHYSICAL THERAPY, SPEECH THERAPIST, OCCUPATIONAL THERAPIST, OR SURGICAL TECH. THE FOLLOWING GUIDELINES APPLY: 1. SCHOLARSHIP STUDENTS MUST APPLY YEARLY BY MAY FOR THE WINTER SEMESTER AND OCTOBER FOR THE SPRING SEMESTER. 2.SCHOLARSHIP STUDENTS MUST SUBMIT GRADES AFTER EACH SEMESTER AND REMAIN IN GOOD STANDING TO PROGRESS IN THEIR MAJOR. 3.THE MAXIMUM AMOUNT OF FUNDING EACH YEAR FOR THE MASTER'S PROGRAM WILL NOT EXCEED $7,000; BACCALAUREATE PROGRAM WILL NOT EXCEED $4,000; FOR AN ASSOCIATES PROGRAM WILL NOT EXCEED $3,000. 4. THE SURGICAL SCHOLARSHIP IS A MAXIMUM AMOUNT OF $5,000 FOR THE PROGRAM. 5. A LIMITED NUMBER OF SCHOLARSHIPS ARE GRANTED. IF AN INDIVIDUAL IS CONSIDERED FOR THE SCHOLARSHIP PROGRAM, SUCH INDIVIDUAL WILL HAVE A PANEL INTERVIEW AND A POSSIBLE JOB SHADOWING OPPORTUNITY. A DECISION WHETHER OR NOT AN INDIVIDUAL HAS BEEN ACCEPTED WILL BE MADE SHORTLY THEREAFTER THE PANEL INTERVIEW.
Schedule I (Form 990) 2010


Additional Data


Software ID:  
Software Version:  


Schedule J
(Form 990)
Department of the Treasury
Internal Revenue Service
Compensation Information
For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet Complete if the organization answered "Yes" to Form 990,
Part IV, question 23.
SchJMediumBullet Attach to Form 990. SchJMediumBullet See separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
NAPLES COMMUNITY HOSPITAL INC
 
Employer identification number

59-0694358
Part I
Questions Regarding Compensation
Yes
No
1a
Check the appropiate box(es) if the organization provided any of the following to or for a person listed in Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.
b
If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement orprovision of all the expenses described above? If "No," complete Part III to explain....
1b
Yes
 
2
Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
officers, directors, trustees, and the CEO/Executive Director, regarding the items checked in line 1a? ....
2
Yes
 
3
Indicate which, if any, of the following the organization uses to establish the compensation of the
organization's CEO/Executive Director. Check all that apply.
4
During the year, did any person listed in Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:
a
Receive a severance payment or change-of-control payment? ...............
4a
Yes
 
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan? ........
4b
Yes
 
c
Participate in, or receive payment from, an equity-based compensation arrangement? ........
4c
 
No
If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.
Only 501(c)(3) and 501(c)(4) organizations only must complete lines 5-9.
5
For persons listed in form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:
a
The organization? ...........................
5a
 
No
b
Any related organization? .........................
5b
 
No
If "Yes," to line 5a or 5b, describe in Part III.
6
For persons listed in form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:
a
The organization? ...........................
6a
 
No
b
Any related organization? .........................
6b
 
No
If "Yes," to line 6a or 6b, describe in Part III.
7
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............
7
Yes
 
8
Were any amounts reported in Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regs. section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................
8
 
No
9
If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................
9
 
 
For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990
Cat. No. 50053T
Schedule J (Form 990) 2010

Schedule J (Form 990) 2010
Page 2
Part II
Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use Schedule J-1 if additional space needed.
For each individual whose compensation must be reported in Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.

Note. The sum of columns (B)(i)-(iii) must equal the applicable column (D) or column (E) amounts on Form 990, Part VII, line 1a.
(A) Name (B) Breakdown of W-2 and/or 1099-MISC compensation (C) Retirement and other deferred compensation (D) Nontaxable
benefits		 (E) Total of columns
(B)(i)-(D) 		(F) Compensation
reported in prior
Form 990 or
Form 990-EZ
(i) Base compensation (ii) Bonus & incentive compensation (iii) Other reportable compensation
(1) Kenneth Bookman MD (i)
(ii)		 0
100,723 		0
40,068 		0
4,125 		0
4,059 		0
4,820 		0
153,795 		0
0
(2) Allen S Weiss MD (i)
(ii)		 598,143
0 		28,868
0 		16,500
0 		40,671
0 		14,833
0 		699,015
0 		0
0
(3) Kevin D Cooper (i)
(ii)		 343,159
0 		15,140
0 		16,500
0 		9,800
0 		8,313
0 		392,912
0 		0
0
(4) Gail Dolan (i)
(ii)		 146,283
0 		11,650
0 		89,627
0 		6,785
0 		5,462
0 		259,807
0 		0
0
(5) Phillip Dutcher (i)
(ii)		 361,468
0 		15,140
0 		0
0 		9,800
0 		631
0 		387,039
0 		0
0
(6) Aurora Estevez MD (i)
(ii)		 360,652
0 		16,994
0 		16,500
0 		9,800
0 		8,416
0 		412,362
0 		0
0
(7) Vicki D Orr (i)
(ii)		 337,854
0 		15,140
0 		16,500
0 		9,800
0 		21,228
0 		400,522
0 		0
0
(8) BRIAN SETTLE TERM 9302011 (i)
(ii)		 226,108
0 		11,718
0 		16,500
0 		9,800
0 		14,172
0 		278,298
0 		0
0
(9) SUSAN WOLFF TERM 9302011 (i)
(ii)		 232,727
0 		12,184
0 		16,500
0 		9,800
0 		8,119
0 		279,330
0 		0
0
(10) Michele Thoman (i)
(ii)		 232,585
0 		10,073
0 		0
0 		6,743
0 		15,722
0 		265,123
0 		0
0
(11) Michael Riley (i)
(ii)		 189,893
0 		68
0 		0
0 		7,753
0 		21,302
0 		219,016
0 		0
0
(12) James K Martin (i)
(ii)		 0
208,452 		0
90,068 		0
0 		0
1,177 		0
12,426 		0
312,123 		0
0
(13) Gary Parsons MD (i)
(ii)		 0
69,158 		0
80,068 		0
4,125 		0
1,467 		0
1,859 		0
156,677 		0
0
(14) Bedalin Helvink MD (i)
(ii)		 202,170
0 		68
0 		0
0 		8,223
0 		20,684
0 		231,145
0 		0
0
(15) Samuel T Pinosky MD (i)
(ii)		 201,186
0 		68
0 		0
0 		946
0 		12,976
0 		215,176
0 		0
0
(16) James Bates (i)
(ii)		 164,133
0 		20,117
0 		0
0 		6,990
0 		21,710
0 		212,950
0 		0
0
(17) Patricia Read (i)
(ii)		 161,674
0 		4,982
0 		0
0 		6,642
0 		14,916
0 		188,214
0 		0
0
(18) Benjamin Gyimah (i)
(ii)		 155,289
0 		2,969
0 		0
0 		5,963
0 		21,272
0 		185,493
0 		0
0
Schedule J (Form 990) 2010

Schedule J (Form 990) 2010
Page 3
Part III
Supplemental Information
Complete this part to provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 4c, 5a, 5b, 6a, 6b, 7, and 8. Also complete this part for any additional information.
Identifier Return Reference Explanation
DETAIL OF SEVERANCE PAYMENTS FORM 990, SCHEDULE J, PART I, LINE 4A GAIL DOLAN, COO, NORTH NAPLES HOSPITAL, RESIGNED 08/30/10 AND RECEIVED A SEVERANCE PAYMENT OF $73,126 FOR CALENDAR YEAR 2010. WILLIAM EDWARDS, CHIEF ADMINISTRATIVE OFFICER, NCHMD, INC., RESIGNED 6/4/11 AND RECEIVED A SEVERANCE PAYMENT OF $146,505 FOR CALENDAR YEAR 2011.
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 INCOME OF $30,871 FOR THE CALENDAR YEAR 2010. THIS INVESTMENT INCOME IS INCLUDED IN SCHEDULE J, PART II, COLUMN C.
PROVISIONS OF NON-FIXED PAYMENTS FORM 990, SCHEDULE J, LINE 7 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.
PROVISION OF HOUSING ALLOWANCE FORM 990, SCHEDULE J, PART I, LINE 1A HOUSING WAS PROVIDED FOR OUR CHIEF DEVELOPMENT OFFICER, JAMES MARTIN. THE VALUE OF SUCH HOUSING ($4,500) WAS INCLUDED AS A COMPONENT OF HIS REPORTABLE COMPENSATION LISTED ON FORM 990, PART VII.
Schedule J (Form 990) 2010

Additional Data


Software ID:  
Software Version:  
Schedule K
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Information on Tax Exempt Bonds
SchKMediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, line 24a. Provide descriptions,
explanations, and any additional information in Schedule O (Form 990).
SchKMediumBullet Attach to Form 990. SchKMediumBullet See separate instructions.
OMB No. 1545-0047
2010
Open to Public
Inspection
Name of the organization
NAPLES COMMUNITY HOSPITAL INC
 
Employer identification number
59-0694358
Part I
Bond Issues
(a) Issuer Name (b) Issuer EIN (c) CUSIP # (d) Date Issued (e) Issue Price (f) Description of Purpose (g) Defeased (h) On
Behalf of
Issuer 		(i) Pool
financing
Yes No Yes No Yes No
A COLLIER CTY INDUSTRIAL DEVLMT ATHRTY- SERIES 2004
  		59-1695679 194641AF3 08-31-2004 38,000,000 NEW NORTH NAPLES PATIENT TOWER   X   X   X
B COLLIER CTY INDUSTRIAL DEVLMT ATHRTY- SERIES 2010
  		59-1695679   12-30-2010 30,000,000 NEW CAPITAL EQUIPMENT   X   X   X
C COLLIER CTY INDUSTRIAL DEVLMT ATHRTY- SERIES 2011
  		59-1695679 194641AK2 04-01-2011 102,115,000 REFINANCING & NEW CAPITAL EQUIP   X   X   X
Part II
Proceeds
A B C D
1 Amount of bonds retired. . . . . 0 0 0  
2 Amount of bonds defeased . . . . 0 0 0  
3 Total proceeds of issue . . . . 39,032,139 30,020,079 100,967,621  
4 Gross proceeds in reserve funds . . 0 11,445,099 21,843,044  
5 Capitalized interest from proceeds. 0 0 0  
6 Proceeds in refunding escrow. . . . . 0 0 49,222,562  
7 Issuance costs from proceeds . . . 504,750 159,198 1,414,549  
8 Credit enhancement from proceeds. 0 0 0  
9 Working capital expenditures from proceeds . . 0 0 0  
10 Capital expenditures from proceeds . . 38,527,389 18,395,703 28,471,956  
11 Other spent proceeds . . 0 0 0  
12 Other unspent proceeds. . . 0 20,079 15,510  
13 Year of substantial completion . . . 2007 2013 2013
Yes No Yes No Yes No Yes No
14 Were the bonds issued as part of a current refunding issue?   X   X X      
15 Were the bonds issued as part of an advance refunding issue?   X   X X      
16 Has the final allocation of proceeds been made? . . X     X   X    
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? . X   X   X      
Part III
Private Business Use
A B C D
Yes No Yes No Yes No Yes No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? . . .   X   X   X    
2 Are there any lease arrangements that may result in private business use of bond-financed property? . . . . .   X   X   X    
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50193E
Schedule K (Form 990) 2010
Schedule K (Form 990) 2010
Page 2
Part III
Private Business Use (Continued)
A B C D
Yes No Yes No Yes No Yes No
3a Are there any management or service contracts that may result in private business use?   X   X   X    
b Are there any research agreements that may result in private business use of bond-financed property? . .   X   X   X    
c Does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts or research agreements relating to the financed property? .   X   X   X    
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government . . . . . . . . . . . . . SchKMediumBullet 0 % 0 % 0 %  
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government . SchKMediumBullet 0 % 0 % 0 %  
6 Total of lines 4 and 5 . . .. . . . . . 0 % 0 % 0 %  
7 Has the organization adopted management practices and procedures to ensure the post-issuance compliance of its tax-exempt bond liabilities? X   X   X      
Part IV
Arbitrage
A B C D
Yes No Yes No Yes No Yes No
1 Has a Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate, been filed with respect to the bond issue? . . .   X   X   X    
2 Is the bond issue a variable rate issue?   X   X   X    
3a Has the organization or the governmental issuer entered into a hedge with respect to the bond issue?   X   X   X    
b Name of provider .  
  		 
  		 
  		 
 
c Term of hedge . .        
d Was the hedge superintegrated? .   X   X   X    
e Was a hedge terminated? .   X   X   X    
4a Were gross proceeds invested in a GIC? .   X   X   X    
b Name of provider .  
  		 
  		 
  		 
 
c Term of GIC . .        
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? .                
5 Were any gross proceeds invested beyond an available temporary period? .   X   X   X    
6 Did the bond issue qualify for an exception to rebate? . . . X   X   X      
Schedule K (Form 990) 2010

Schedule K (Form 990) 2010
Page 3
Part V
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule K (see instructions).
Identifier Return Reference Explanation
ADDITIONAL DETAIL FOR PROCEEDS OF ISSUES FORM 990, SCHEDULE K, PART II, LINE 3 FOR COLLIER COUNTY INDUSTRIAL DEVELOPMENT AUTHORITY- SERIES 2004, THE TOTAL PROCEEDS OF ISSUE REPORTED INCLUDES $1,032,139 IN ORIGINAL ISSUE PREMIUMS. FOR COLLIER COUNTY INDUSTRIAL DEVELOPMENT AUTHORITY- SERIES 2010, THE TOTAL PROCEEDS OF ISSUE REPORTED INCLUDES $20,079 IN INVESTMENT EARNINGS. FOR COLLIER COUNTY INDUSTRIAL DEVELOPMENT AUTHORITY- SERIES 2011, THE TOTAL PROCEEDS OF ISSUE REPORTED INCLUDES $1,159,176 IN NET ORIGINAL ISSUE DISCOUNTS AND $11,797 IN INVESTMENT EARNINGS.
Schedule K (Form 990) 2010

Additional Data


Software ID:  
Software Version:  

Schedule L
(Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
Transactions with Interested Persons
MediumBullet Complete if the organization answered
"Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c,
or Form 990-EZ, Part V lines 38a or 40b.
MediumBullet Attach to Form 990 or Form 990-EZ. MediumBulletSee separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
NAPLES COMMUNITY HOSPITAL INC
 
Employer identification number

59-0694358
Part I
Excess Benefit Transactions (section 501(c)(3) and section 501 (c)(4) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.
1(a) Name of disqualified person (b) Description of transaction (c) Corrected?
Yes No





2
Enter the amount of tax imposed on the organization managers or disqualified persons during the year under section 4958. ......................... Bullet Image$
 
3
Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ....... Bullet Image$
 

Part II
Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 26, or Form 990-EZ, Part V, line 38a.
(a) Name of interested person and purpose (b) Loan to or from the organization? (c)Original principal amount (d)Balance due (e) In default? (f) Approved by board or committee? (g)Written agreement?
To From Yes No Yes No Yes No
Total ...............Small Bullet $  
Part III
Grants or Assistance Benefitting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.
(a) Name of interested person (b)Relationship between interested person and the organization (c)Amount of grant or type of assistance
For Privacy Act and Paperwork Reduction Act Notice, see the
Instructions for Form 990 or 990-EZ.
Cat. No. 50056A
Schedule L (Form 990 or 990-EZ) 2010
Schedule L (Form 990 or 990-EZ) 2010
Page 2
Part IV
Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.
(a) Name of interested person (b) Relationship between interested person and the organization (c) Amount of transaction (d) Description of transaction (e) Sharing of organization's revenues?
Yes No
(1) KATHRYN HOUSER FAMILY MEMBER OF TRUSTEE 75,462 PAYMENT OF COMPENSATION   No
(2) DIANNE GARRISON FAMILY MEMBER OF TRUSTEE 121,155 PAYMENT OF COMPENSATION   No
(3) GULF COAST CARDIOTHORACIC COMMON TRUSTEE/PARTNER 230,317 PURCHASE OF MEDICAL SERVICES   No
(4) CANDACE S SETTLE FAMILY MEMBER OF OFFICER 39,260 PAYMENT OF COMPENSATION   No
(5) JEFFERY SANDER FAMILY MEMBER OF OFFICER 80,281 PAYMENT OF COMPENSATION   No
(6) GRAY ROBINSON PA COMMON TRUSTEE/PARTNER 108,295 PAYMENT OF LEGAL SERVICES   No
(7) JODI S COOPER FAMILY MEMBER OF OFFICER 121,416 PAYMENT OF COMPENSATION   No
(8) JAMES ORR MD FAMILY MEMBER OF OFFICER 444,561 RECEIPT OF RENTAL INCOME   No
Part V
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule L (see instructions).
Identifier Return Reference Explanation
BUSINESS TRANSACTIONS INVOLVING INTERESTED PERSONS FORM 990, SCHEDULE L, PART IV KATHRYN HOUSER, RN AND DIANNE GARRISON, RN ARE SIBLINGS OF BOARD TRUSTEE JOANN JENNER. BOARD TRUSTEE SCOT SCHULTZ, M.D. IS A PARTNER OF GULF COAST CARDIOTHORACIC. CANDACE SETTLE, PHYSICAL THERAPIST ASSISTANT, IS THE SPOUSE OF OFFICER BRIAN SETTLE, CHIEF HUMAN RESOURCES OFFICER. JEFFREY SANDER, RN IS THE SPOUSE OF BOARD TRUSTEE KARLI SANDER. BOARD TRUSTEE, CARL WESTMAN, IS A PARTNER AT GRAY ROBINSON, PA. JODI COOPER, DIRECTOR OF THE LABORATORY, IS THE SPOUSE OF OFFICER KEVIN COOPER, GENERAL COUNSEL/CHIEF OF STAFF. JAMES ORR, M.D. IS THE SPOUSE OF VICKI ORR, CFO/ASSISTANT TREASURER. HE HAS A MINORITY EQUITY INTEREST IN 21ST CENTURY ONCOLOGY WHICH PAYS NCH RENTAL INCOME FOR THE LUTGERT EAST BUILDING.
Schedule L (Form 990 or 990-EZ) 2010

Additional Data


Software ID:  
Software Version:  




SCHEDULE M
(Form 990)

Department of the Treasury
Internal Revenue Service
NonCash Contributions
Right pointing arrow large imageComplete if the organization answered "Yes" on Form 990, Part IV, lines 29 or 30.
Right pointing arrow large image Attach to Form 990.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
NAPLES COMMUNITY HOSPITAL INC
 
Employer identification number

59-0694358
Part I
Types of Property
(a)
Check if applicable 		(b)
Number of Contributions or items contributed 		(c)
Contribution amounts reported on
Form 990, Part VIII, line 1g 		(d)
Method of determining
contribution amounts
1 Art—Works of art ....        
2 Art—Historical treasures .        
3 Art—Fractional interests ..        
4 Books and publications .. X 550 FMV
5 Clothing and household
goods ....... 		X 568,254 FMV
6 Cars and other vehicles .. X 3 4,600 FMV
7 Boats and planes ....        
8 Intellectual property ...        
9 Securities—Publicly traded . X 1 6,170 FMV
10 Securities—Closely held stock .        
11 Securities—Partnership, LLC,
or trust interests .... 		       
12 Securities—Miscellaneous .. X 9 85,500 FMV
13 Qualified conservation
contribution—Historic
structures ..... 		       
14 Qualified conservation
contribution—Other ... 		       
15 Real estate—Residential .        
16 Real estate—Commercial ..        
17 Real estate—Other ...        
18 Collectibles .....        
19 Food inventory ...        
20 Drugs and medical supplies .        
21 Taxidermy ......        
22 Historical artifacts ....        
23 Scientific specimens ..        
24 Archeological artifacts ...        
25 Other Right pointing arrow large image ( 2 NIGHT STAY RITZ CARLTON RESORT ) X 1 2,900 FMV
26 Other Right pointing arrow large image ( HOSTING GIFTS, HOSTS DINNER, KICKOFF BREAKFAST ) X 1 5,974 FMV
27 Other Right pointing arrow large image ( FGCU BASKETBALL GAME ) X 1 500 FMV
28 Other Right pointing arrow large image ( CHEF DINNER FOR 10 ) X 1 2,700 FMV
Other Right pointing arrow large image ( LUXURY SUITE AND DALLAS COWBOYS GAME ) X 1 1,000 FMV
29
Number of Forms 8283 received by the organization during the tax year for contributions
for which the organization completed Form 8283, Part IV, Donee Acknowledgement ...
29
3
Yes
No
30a
During the year, did the organization receive by contribution any property reported in Part I, lines 1-28 that it
must hold for at least three years from the date of the initial contribution, and which is not required to be used
for exempt purposes for the entire holding period? ..................
30a
 
No
b
If "Yes," describe the arrangement in Part II.
31
Does the organization have a gift acceptance policy that requires the review of any non-standard contributions?
31
Yes
 
32a
Does the organization hire or use third parties or related organizations to solicit, process, or sell non-cash
contributions? ............................
32a
 
No
b
If "Yes," describe in Part II.
33
If the organization did not report revenues in column (c) for a type of property for which column (a) is checked,
describe in Part II.
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 51227J
Schedule M (Form 990) 2010
Schedule M (Form 990) 2010
Page 2
Part II
Supplemental Information. Complete this part to provide the information required by Part I, lines 30b,
32b, and 33. Also complete this part for any additional information.
Identifier Return Reference Explanation
Schedule M (Form 990) 2010
Additional Data


Software ID:  
Software Version:  
SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
MediumBullet Attach to Form 990 or 990-EZ.
OMB No. 1545-0047
2010
Open to Public
Inspection
Name of the organization
NAPLES COMMUNITY HOSPITAL INC
 
Employer identification number

59-0694358
Identifier Return Reference Explanation
DETAIL OF BUSINESS RELATIONSHIPS FORM 990, PART VI, SECTION A, LINE 2 ALBERTO M. DE LA RIVAHERRERA, M.D. AND JOHN LEWIS, M.D. ARE MINORITY PARTNERS OF EMERGENCY PHYSICIANS OF NAPLES.
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 11A INFORMATION RELATED TO NAPLES COMMUNITY HOSPITAL INC.'S ("NCH") FORM 990 FILING IS GATHERED BY FINANCE STAFF AND PROVIDED TO PRICEWATERHOUSECOOPERS LLP FOR REVIEW AND RETURN PREPARATION. THE 2010 FORM 990 FOR THE FISCAL YEAR ENDING SEPTEMBER 30, 2011 WAS REVIEWED AND APPROVED BY THE CHAIRMAN OF THE NCH AUDIT AND FINANCE COMMITTEES, RESPECTIVELY, 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 NCH 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 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 COMPENSATION 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 NAPLES COMMUNITY HOSPITAL, 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 TO RELATED ORGANIZATIONS $(29,705,975) CHANGE IN NET UNREALIZED GAINS AND LOSSES (4,526,831) ------------ TOTAL OTHER CHANGES IN NET ASSETS $(34,232,806)
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Joseph I. Perkovich TITLE:Chairman HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Mariann MacDonald TITLE:1st Vice Chairman HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Ambassador Francis Rooney TITLE:2nd Vice Chairman HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Thomas J. Gazdic TITLE:Secretary/Treasurer HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:William Allyn TITLE:Trustee HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Jay H. Baker TITLE:Trustee HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Kenneth Bookman, M.D. TITLE:Trustee HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Susan L. Dalton TITLE:Trustee HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Paul Dernbach, M.D. TITLE:Trustee HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Alberto M. de la Rivaherrera, M.D. TITLE:Trustee HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Michael Feuer TITLE:Trustee HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Terrance Flynn TITLE:Trustee HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Daniel Gill TITLE:Trustee HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Kay Gow TITLE:Trustee HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Joann Jenner TITLE:Trustee HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Amy Jewell, R.N. TITLE:Trustee HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Kim Ciccarelli Kantor TITLE:Trustee HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Hermes Koop, M.D. TITLE:Trustee HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:John Lewis, M.D. TITLE:Trustee HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Frank Linsalata TITLE:Trustee HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Admiral Paul D. Miller TITLE:Trustee HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Robert Moses TITLE:Trustee HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Wayne Mullican TITLE:Trustee HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Karli Sander TITLE:Trustee HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Scot C. Schultz, M.D. TITLE:Trustee HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Norman Thomson, M.D. TITLE:Trustee HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Carl E. Westman TITLE:Trustee HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Gregory Wilkerson, R.N. TITLE:Trustee HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Allen S. Weiss, M.D. TITLE:President/CEO/Trustee HOURS:5
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Kevin D. Cooper TITLE:General Counsel/Chief of Staff HOURS:5
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Phillip Dutcher TITLE:COO, NCH Healthcare System Inc HOURS:5
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Aurora Estevez, M.D. TITLE:Chief Medical Officer HOURS:5
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Vicki D. Orr TITLE:CFO/Assistant Treasurer HOURS:5
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Elizabeth Martin TITLE:Assistant Secretary HOURS:5
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:BRIAN SETTLE (TERM 9/30/2011) TITLE:Chief Human Resources Officer HOURS:5
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:SUSAN WOLFF (TERM 9/30/2011) TITLE:Chief Information Officer HOURS:5
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:William Edwards (Term 06/4/11) TITLE:Chief Administrative Officer HOURS:44
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Michele Thoman TITLE:CNO HOURS:5
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Michael Riley TITLE:Chief Strategy Officer HOURS:5
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:Zach Bostock (Start 09/19/11) TITLE:Chief Administrative Officer HOURS:44
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Gary Parsons, M.D. TITLE:Chief Medical Officer NCHMD HOURS:44
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2010

Additional Data


Software ID:  
Software Version:  
SCHEDULE R
(Form 990)
Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
MediumBulletComplete if the organization answered "Yes" to Form 990, Part IV, line 33, 34, 35, 36, or 37.
MediumBulletAttach to Form 990. MediumBullet See separate instructions.

OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
NAPLES COMMUNITY HOSPITAL INC
 
Employer identification number

59-0694358
Part I
Identification of Disregarded Entities (Complete if the organization answered "Yes" on Form 990, Part IV, line 33.)
(a)
Name, address, and EIN of disregarded entity


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Total income
(e)
End-of-year assets


 		(f)
Direct controlling
entity

















Part II
Identification of Related Tax-Exempt Organizations (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.)
(a)
Name, address, and EIN of related organization


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Exempt Code section
(e)
Public charity status
(if section 501(c)(3))

 		(f)
Direct controlling
entity

 		(g)
Section 512(b)(13) controlled organization
Yes No
(1) NCH HEALTHCARE SYSTEM INC

PO BOX 413029

NAPLES,FL34101
59-2314655 		HOLDING CO FL 501(C)(3) 11,B NA
 
 
 
(2) NCHMD INC

PO BOX 413029

NAPLES,FL34101
33-1075317 		HEALTHCARE FL 501(C)(3) 9 NCH SYSTEM
 
 
 
(3) COLLIER HEALTH CARE INC

PO BOX 413029

NAPLES,FL34101
65-0244276 		HEALTHCARE FL 501(C)(3) 3 NCH SYSTEM
 
 
 
(4) COMMUNITY HOME SERVICES INC

PO BOX 413029

NAPLES,FL34101
59-2440516 		SUPPORT ORG FL 501(C)(3) 11,B NCH SYSTEM
 
 
 
(5) MARCO ISLAND HOSPITAL INC

40 HEATHWOOD DRIVE

MARCO ISLAND,FL34145
59-2315435 		HEALTHCARE FL 501(C)(3) 3 NCH SYSTEM
 
 
 




For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2010
Schedule R (Form 990) 2010
Page 2
Part III
Identification of Related Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.)
(a)
Name, address, and EIN of
related organization



 		(b)
Primary activity




 		(c)
Legal
domicile
(state or foreign
country)


 		(d)
Direct controlling
entity



 		(e)
Predominant income(related, unrelated, excluded from tax under sections 512-514)

(f)
Share of total income




 		(g)
Share of end-of-year
assets



 		(h)
Disproprtionate allocations?




 		(i)
Code V—UBI
amount in box 20 of
Schedule K-1
(Form 1065)
 		(j)
General or
managing
partner?



 		(k)
Percentage
ownership
Yes No Yes No












Part IV
Identification of Related Organizations Taxable as a Corporation or Trust (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.)
(a)
Name, address, and EIN of related organization



 		(b)
Primary activity



 		(c)
Legal domicile
(state or
foreign
country)
 		(d)
Direct controlling
entity


 		(e)
Type of entity
(C corp, S corp,
or trust)

 		(f)
Share of total income



 		(g)
Share of
end-of-year
assets

 		(h)
Percentage
ownership
(1) COUNSELING & EMPLOYEE ASSISTANCE PROGRAM
350 7TH STREET NORTH
NAPLES,FL34102
65-0374989 		EMPLOYEE ASSIST FL NCH SYSTEM
  		C CORP      
(2) HEALTH RESOURCES CORPORATION
350 7TH STREET NORTH
NAPLES,FL34102
59-2568003 		HOLDING COMPANY FL NCH SYSTEM
  		C CORP      
(3) AMBULATORY SURGICAL CARE CENTER INC
350 7TH STREET NORTH
NAPLES,FL34102
59-2568029 		OUTPAT. SURGERY FL HRC
  		C CORP      
(4) COMMUNITY HOME CARE INC
350 7TH STREET NORTH
NAPLES,FL34102
59-2372966 		HOME HEALTH FL HRC
  		C CORP      
(5) COMMUNITY IMAGING INC
350 7TH STREET NORTH
NAPLES,FL34102
59-2446336 		RADIOLOGY LAB FL HRC
  		C CORP      
(6) GULFCOAST LINEN SERVICE INC
350 7TH STREET NORTH
NAPLES,FL34102
65-0214546 		LINEN SERVICE FL HRC
  		C CORP      


Schedule R (Form 990) 2010
Schedule R (Form 990) 2010
Page 3
Part V
Transactions With Related Organizations (Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35, 35A, or 36.)
Note. Complete line 1 if any entity is listed in Parts II, III or IV.
Yes
No
1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?
a Receipt of (i) interest (ii) annuities (iii) royalties (iv) rent from a controlled entity . . . . . . . . . . . . . . . . . . . . . . .
1a
Yes
 
b Gift, grant, or capital contribution to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1b
Yes
 
c Gift, grant, or capital contribution from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1c
Yes
 
d Loans or loan guarantees to or for other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1d
 
No
e Loans or loan guarantees by other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1e
 
No
f Sale of assets to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1f
 
No
g Purchase of assets from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1g
 
No
h Exchange of assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1h
Yes
 
i Lease of facilities, equipment, or other assets to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1i
Yes
 
j Lease of facilities, equipment, or other assets from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .
1j
Yes
 
k Performance of services or membership or fundraising solicitations for other organization(s) . . . . . . . . . . . . . . . . . . . . . .
1k
Yes
 
l Performance of services or membership or fundraising solicitations by other organization(s) . . . . . . . . . . . . . . . . . . . . . .
1l
Yes
 
m Sharing of facilities, equipment, mailing lists, or other assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1m
Yes
 
n Sharing of paid employees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1n
Yes
 
o Reimbursement paid to other organization for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1o
Yes
 
p Reimbursement paid by other organization for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1p
Yes
 
q Other transfer of cash or property to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1q
Yes
 
r Other transfer of cash or property from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1r
Yes
 
2
If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.
(a)
Name of other organization 		(b)
Transaction
type(a-r) 		(c)
Amount involved 		(d)
Method of determining amount involved
(1)
(2)
(3)
(4)
(5)
(6)
Schedule R (Form 990) 2010
Schedule R (Form 990) 2010
Page 4
Part VI
Unrelated Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 37.)
Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.
(a)
Name, address, and EIN of entity 		(b)
Primary activity 		(c)
Legal domicile
(state or foreign
country) 		(d)
Are all
partners
section
501(c)(3)
organizations? 		(e)
Share of
end-of-year
assets 		(f)
Disproprtionate allocations? 		(g)
Code V—UBI
amount in box
20 of Schedule K-1
(Form 1065) 		(h)
General or
managing
partner?
Yes No Yes No Yes No






























Schedule R (Form 990) 2010
Schedule R (Form 990) 2010
Page 5
Part VII
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule R (see instructions).
Identifier Return Reference Explanation
Additional Data


Software ID:  
Software Version: