Form990-PF

Department of the Treasury
Internal Revenue Service
Return of Private Foundation
or Section 4947(a)(1) Trust Treated as Private Foundation
bulletDo not enter Social Security numbers on this form as it may be made public. By law, the IRS cannot redact the information on the form.
bulletInformation about Form 990-PF and its instructions is at www.irs.gov/form990pf.
OMB No. 1545-0052
2013
Open to Public Inspection
For calendar year 2013, or tax year beginning 07-01-2013 , and ending 06-30-2014
Name of foundation
COMMUNITY HEALTH ASSOCIATION INC
 

Number and street (or P.O. box number if mail is not delivered to street address)210 LAKE AVE   Room/suite
City or town, state or province, country, and ZIP or foreign postal code
LEHIGH ACRES, FL33936
A Employer identification number

59-1088536
B Telephone number (see instructions)

(239) 368-7070
C bullet
G Check all that apply:

D 1. bullet
2. bullet
E bullet
H Check type of organization:
I Fair market value of all assets at end
of year (from Part II, col. (c),
line 16)bullet$196,205J Accounting method:
 
(Part I, column (d) must be on cash basis.)
F bullet
Part I Analysis of Revenue and Expenses (The total of amounts in columns (b), (c), and (d) may not necessarily equal the amounts in column (a) (see instructions).) (a) Revenue and
expenses per
books 		(b) Net investment
income 		(c) Adjusted net
income 		(d) Disbursements
for charitable
purposes
(cash basis only)
Revenue 1 Contributions, gifts, grants, etc., received (attach schedule)  
2 Check bullet
3 Interest on savings and temporary cash investments 1,204 1,204  
4 Dividends and interest from securities...... 75,156 75,156  
5a Gross rents.............. 60,750 60,750  
b Net rental income or (loss) 60,750
6a Net gain or (loss) from sale of assets not on line 10 Click to see attachment 2,054,675
b Gross sales price for all assets on line 6a 6,349,964
7 Capital gain net income (from Part IV, line 2)... 1,398,450
8 Net short-term capital gain.........  
9 Income modifications...........  
10a Gross sales less returns and allowances  
b Less: Cost of goods sold....  
c Gross profit or (loss) (attach schedule).....    
11 Other income (attach schedule).......      
12 Total. Add lines 1 through 11........ 2,191,785 1,535,560  
Operating and Administrative Expenses 13 Compensation of officers, directors, trustees, etc. 67,260 33,630   33,630
14 Other employee salaries and wages...... 19,800 0   19,800
15 Pension plans, employee benefits....... 2,435 609   1,826
16a Legal fees (attach schedule)......... Click to see attachment 17,755 8,877   8,878
b Accounting fees (attach schedule)....... Click to see attachment 18,320 4,780   4,780
c Other professional fees (attach schedule).... Click to see attachment 34,043 34,043   0
17 Interest...............        
18 Taxes (attach schedule) (see instructions) Click to see attachment 22,456 1,854   5,563
19 Depreciation (attach schedule) and depletion... 38,994 0  
20 Occupancy..............        
21 Travel, conferences, and meetings.......        
22 Printing and publications..........        
23 Other expenses (attach schedule)....... Click to see attachment 68,453 8,522   59,622
24 Total operating and administrative expenses.
Add lines 13 through 23.......... 289,516 92,315   134,099
25 Contributions, gifts, grants paid........ 6,352,100 6,180,000
26 Total expenses and disbursements. Add lines 24 and 25 6,641,616 92,315   6,314,099
27 Subtract line 26 from line 12:
a Excess of revenue over expenses and disbursements -4,449,831
b Net investment income (if negative, enter -0-) 1,443,245
c Adjusted net income (if negative, enter -0-)...  
For Paperwork Reduction Act Notice, see instructions.
Cat. No. 11289X Form 990-PF (2013)
Form 990-PF (2013)
Page 2
Part II Balance Sheets Attached schedules and amounts in the description column
should be for end-of-year amounts only. (See instructions.)		 Beginning of year End of year
(a) Book Value (b) Book Value (c) Fair Market Value
Assets 1 Cash—non-interest-bearing............... 238,939 195,577 195,577
2 Savings and temporary cash investments.......... 223,880    
3 Accounts receivable bullet  
Less: allowance for doubtful accounts bullet   6,266    
4 Pledges receivable bullet  
Less: allowance for doubtful accounts bullet        
5 Grants receivable.................      
6 Receivables due from officers, directors, trustees, and other
disqualified persons (attach schedule) (see instructions).....      
7 Other notes and loans receivable (attach schedule) bullet  
Less: allowance for doubtful accounts bullet        
8 Inventories for sale or use...............      
9 Prepaid expenses and deferred charges........... 15,315 628 628
10a Investments—U.S. and state government obligations (attach schedule) 49,868    
b Investments—corporate stock (attach schedule)........ 3,275,323    
c Investments—corporate bonds (attach schedule)........      
11 Investments—land, buildings, and equipment: basis bullet  
Less: accumulated depreciation (attach schedule) bullet        
12 Investments—mortgage loans..............      
13 Investments—other (attach schedule)...........      
14 Land, buildings, and equipment: basis bullet  
Less: accumulated depreciation (attach schedule) bullet   656,713 0 0
15 Other assets (describe bullet)      
16 Total assets (to be completed by all filers—see the
instructions. Also, see page 1, item I) 4,466,304 196,205 196,205
Liabilities 17 Accounts payable and accrued expenses.......... 13,816 23,531
18 Grants payable...................   172,100
19 Deferred revenue..................    
20 Loans from officers, directors, trustees, and other disqualified persons    
21 Mortgages and other notes payable (attach schedule)......    
22 Other liabilities (describe bullet) Click to see attachment2,657 Click to see attachment574
23 Total liabilities (add lines 17 through 22).......... 16,473 196,205
Net Assets or Fund Balances bullet
and complete lines 24 through 26 and lines 30 and 31.
24 Unrestricted.................... 4,449,831 0
25 Temporarily restricted................    
26 Permanently restricted................    
bullet
and complete lines 27 through 31.
27 Capital stock, trust principal, or current funds.........    
28 Paid-in or capital surplus, or land, bldg., and equipment fund    
29 Retained earnings, accumulated income, endowment, or other funds    
30 Total net assets or fund balances (see page 17 of the
instructions).................... 4,449,831 0
31 Total liabilities and net assets/fund balances (see page 17 of
the instructions).................. 4,466,304 196,205
Part III Analysis of Changes in Net Assets or Fund Balances
1 Total net assets or fund balances at beginning of year—Part II, column (a), line 30 (must agree
with end-of-year figure reported on prior year’s return)............... 1 4,449,831
2 Enter amount from Part I, line 27a..................... 2 -4,449,831
3 Other increases not included in line 2 (itemize) bullet 3 0
4 Add lines 1, 2, and 3.......................... 4 0
5 Decreases not included in line 2 (itemize) bullet 5 0
6 Total net assets or fund balances at end of year (line 4 minus line 5)—Part II, column (b), line 30. 6 0
Form 990-PF (2013)
Form 990-PF (2013)
Page 3
Part IV
Capital Gains and Losses for Tax on Investment Income
(a) List and describe the kind(s) of property sold (e.g., real estate,
2-story brick warehouse; or common stock, 200 shs. MLC Co.) 		(b) How acquired
P—Purchase
D—Donation 		(c) Date acquired
(mo., day, yr.) 		(d) Date sold
(mo., day, yr.)
1 a AT&T INC P 2013-02-25 2013-08-22
b BHP BILLITON LTD SPON ADR P 2012-07-26 2013-08-22
c PHILIP MORRIS INTL INC P 2012-05-07 2013-08-22
d PHILIP MORRIS INTL INC P 2012-08-15 2013-08-22
e CHINA MOBILE LTD SPON ADR P 2012-07-26 2013-08-23
COMPANHIA DE BEBIDAS DAS AMERS AMBEV *EXCHANGE-EFF-11/2013* P 2012-05-07 2013-08-23
BRITISH AMER TOBACCO PLC GB SPON ADR P 2012-07-31 2013-09-13
VODAFONE GROUP PLC NEW SPON ADR P 2013-06-24 2013-09-13
NESTLE S A SPONSORED ADR REPSTG REG SHS SWITZ ADR P 2008-06-02 2013-09-17
NESTLE S A SPONSORED ADR REPSTG REG SHS SWITZ ADR P 2012-06-05 2013-09-17
CISCO SYSTEMS INC P 2012-05-04 2013-10-23
CISCO SYSTEMS INC P 2012-08-01 2013-10-23
ORACLE CORP P 2007-01-16 2013-10-23
PEPSICO INC P 2012-08-15 2013-10-23
AMAZON.COM INC P 2011-02-09 2014-05-07
AMER EXPRESS CO P 2012-07-26 2014-05-07
AMER EXPRESS CO P 2013-02-25 2014-05-07
APPLE INC P 2012-07-25 2014-05-07
APPLE INC P 2013-02-20 2014-05-07
APPLE INC P 2013-05-01 2014-05-07
BANK OF AMER CORP P 2013-05-10 2014-05-07
BANK OF AMER CORP P 2013-08-22 2014-05-07
BARCLAYS BANK PLC FL ENHANCED EUROPE 50 ETN P 2013-05-22 2014-05-07
BARCLAYS BANK PLC FL ENHANCED EUROPE 50 ETN P 2013-08-22 2014-05-07
BARCLAYS BK PLC FL ENHANCED GLOBAL HIGH YLDETN P 2013-05-21 2014-05-07
BASF SE SPON ADR P 2013-02-25 2014-05-07
BERKSHIRE HATHAWAY INC NEWCLB P 2012-07-25 2014-05-07
BERKSHIRE HATHAWAY INC NEWCLB P 2013-08-23 2014-05-07
BHP BILLITON LTD SPON ADR P 2012-07-26 2014-05-07
CHEVRON CORP P 2012-07-31 2014-05-07
CISCO SYSTEMS INC P 2012-08-01 2014-05-07
CITIGROUPINC P 2013-05-10 2014-05-07
CITIGROUPINC P 2013-08-23 2014-05-07
COCA COLA CO COM P 2012-05-24 2014-05-07
COMCAST CORP NEW CL A P 2012-08-01 2014-05-07
DAIMLER AG SPON ADR P 2013-09-13 2014-05-07
EXXON MOBIL CORP P 2012-07-25 2014-05-07
FL ENHANCED BIG CAP GROWTH ETN P 2013-05-20 2014-05-07
GENL ELECTRIC CO P 2011-01-14 2014-05-07
GENL ELECTRIC CO P 2011-04-27 2014-05-07
GENL ELECTRIC CO P 2012-06-05 2014-05-07
GLAXO SMITHKLINE PLC ADR P 2002-09-19 2014-05-07
GLAXO SMITHKLINE PLC ADR P 2011-04-28 2014-05-07
GOOGLE INC CL A P 2011-05-17 2014-05-07
GOOGLE INC CLC P 2011-05-17 2014-05-07
HOME DEPOT INC P 2012-07-26 2014-05-07
HSBC HOLDINGS PLC NEW GB SPON ADR P 2012-05-04 2014-05-07
HSBC HOLDINGS PLC NEW GB SPON ADR P 2012-07-27 2014-05-07
INTEL CORP P 2013-02-25 2014-05-07
INTL BUSINESS MACH P 2011-05-17 2014-05-07
INTL BUSINESS MACH P 2012-07-25 2014-05-07
JOHNSON & JOHNSON COM P 2008-05-02 2014-05-07
JOHNSON & JOHNSON COM P 2011-04-27 2014-05-07
JOHNSON & JOHNSON COM P 2012-06-05 2014-05-07
JPMORGAN CHASE & CO P 2012-05-07 2014-05-07
JPMORGAN CHASE & CO P 2012-07-25 2014-05-07
LLOYDS BANKING GROUP PLC SPON ADR P 2013-10-23 2014-05-07
LOREAL CO ADR FRANCE ADR P 2012-05-07 2014-05-07
LVMH MOET HENNESSY LOUIS NEW ADR P 2012-05-07 2014-05-07
LVMH MOET HENNESSY LOUIS NEW ADR P 2012-08-10 2014-05-07
MCDONALDSCORP P 2013-02-25 2014-05-07
MICROSOFT CORP P 2008-03-18 2014-05-07
NOVARTIS AG SPON ADR P 2012-08-15 2014-05-07
NOVO NORDISK ADR DENMARK ADR P 2012-05-21 2014-05-07
NOVO NORDISK ADR DENMARK ADR P 2013-06-24 2014-05-07
ORACLE CORP P 2007-11-16 2014-05-07
ORACLE CORP P 2008-06-05 2014-05-07
PEPSICO INC P 2012-08-15 2014-05-07
PFIZER INC P 2011-03-14 2014-05-07
PFIZER INC P 2012-08-01 2014-05-07
PROCTER & GAMBLE CO P 2002-09-30 2014-05-07
PROCTER & GAMBLE CO P 2012-06-05 2014-05-07
PROCTER & GAMBLE CO P 2012-10-24 2014-05-07
PROCTER & GAMBLE CO P 2013-02-25 2014-05-07
QUALCOMM INC P 2011-03-15 2014-05-07
QUALCOMM INC P 2012-05-07 2014-05-07
ROYAL BANK OF CANADA CAD P 2012-08-15 2014-05-07
SANOFI SPON ADR P 2011-03-02 2014-05-07
SAP AG SPON ADR P 2012-05-07 2014-05-07
SCHLUMBERGER LTD NETHERLANDS ANTILLES P 2005-10-17 2014-05-07
SCHLUMBERGER LTD NETHERLANDS ANTILLES P 2008-06-05 2014-05-07
SIEMENS A G SPON ADR P 2013-10-23 2014-05-07
TOYOTA MOTOR CORP NEW JAPAN SPON ADR P 2012-08-01 2014-05-07
UBSAG REGSORD CHF P 2013-09-17 2014-05-07
UNTD TECHNOLOGIES CORP P 2002-06-19 2014-05-07
UNTD TECHNOLOGIES CORP P 2013-09-13 2014-05-07
VISA INC CLA P 2012-05-04 2014-05-07
WALT DISNEY CO (HOLDINGCO) DISNEY COM P 2012-07-26 2014-05-07
WELLS FARGO CO NEW P 2010-08-06 2014-05-07
WELLS FARGO CO NEW P 2012-07-25 2014-05-07
VANGUARD 500 INDEX FUND P 2012-12-31 2014-05-12
US TREASURY NOTE 04.500% DUE 05/15/17 P 2007-05-15 2014-03-28
(e) Gross sales price (f) Depreciation allowed
(or allowable) 		(g) Cost or other basis
plus expense of sale 		(h) Gain or (loss)
(e) plus (f) minus (g)
a 19,040   20,402 -1,362
b 18,870   19,006 -136
c 21,457   22,586 -1,129
d 28,189   31,156 -2,967
e 20,312   21,576 -1,264
19,430   23,270 -3,840
30,858   31,573 -715
25,130   20,428 4,702
49,406   36,530 12,876
10,055   8,421 1,634
20,036   17,132 2,904
5,183   3,684 1,499
31,619   20,107 11,512
24,989   21,844 3,145
57,618   36,227 21,391
36,013   23,859 12,154
48,075   34,755 13,320
47,003   45,394 1,609
19,039   14,480 4,559
11,304   8,377 2,927
28,307   24,796 3,511
23,488   23,079 409
41,447   31,715 9,732
78,187   59,153 19,034
150,248   120,015 30,233
28,208   24,956 3,252
31,341   21,008 10,333
24,446   22,330 2,116
22,571   20,804 1,767
37,166   32,570 4,596
26,484   18,641 7,843
23,446   24,511 -1,065
20,980   22,556 -1,576
27,716   25,730 1,986
51,739   33,517 18,222
46,438   38,858 7,580
38,242   31,465 6,777
95,144   76,837 18,307
35,546   25,333 10,213
31,596   24,658 6,938
8,294   5,748 2,546
24,893   16,487 8,406
29,042   22,999 6,043
28,750   14,559 14,191
28,319   14,514 13,805
52,132   35,100 17,032
38,947   34,563 4,384
17,956   14,794 3,162
39,924   31,133 8,791
32,230   28,923 3,307
18,959   19,186 -227
44,950   30,661 14,289
41,953   27,510 14,443
8,990   5,616 3,374
28,083   22,011 6,072
31,292   20,594 10,698
41,029   39,862 1,167
32,047   22,400 9,647
39,564   33,742 5,822
25,142   21,306 3,836
46,204   43,994 2,210
52,718   39,216 13,502
45,345   30,902 14,443
39,438   25,940 13,498
20,376   14,002 6,374
19,735   9,981 9,754
15,386   8,704 6,682
38,562   32,584 5,978
51,163   34,514 16,649
27,482   22,626 4,856
20,362   11,151 9,211
11,810   8,880 2,930
12,136   10,168 1,968
8,308   7,864 444
34,656   22,939 11,717
27,486   21,384 6,102
40,107   31,904 8,203
60,734   40,826 19,908
40,736   32,692 8,044
26,104   10,679 15,425
7,618   7,761 -143
41,938   40,048 1,890
45,764   32,467 13,297
52,103   52,270 -167
58,119   19,103 39,016
27,897   25,878 2,019
62,081   35,424 26,657
56,829   34,403 22,426
44,892   25,224 19,668
31,155   21,033 10,122
1,933,740   1,247,038 686,702
55,118   49,868 5,250
Complete only for assets showing gain in column (h) and owned by the foundation on 12/31/69 (l) Gains (Col. (h) gain minus
col. (k), but not less than -0-) or
Losses (from col.(h))
(i) F.M.V. as of 12/31/69 (j) Adjusted basis
as of 12/31/69 		(k) Excess of col. (i)
over col. (j), if any
a       -1,362
b       -136
c       -1,129
d       -2,967
e       -1,264
      -3,840
      -715
      4,702
      12,876
      1,634
      2,904
      1,499
      11,512
      3,145
      21,391
      12,154
      13,320
      1,609
      4,559
      2,927
      3,511
      409
      9,732
      19,034
      30,233
      3,252
      10,333
      2,116
      1,767
      4,596
      7,843
      -1,065
      -1,576
      1,986
      18,222
      7,580
      6,777
      18,307
      10,213
      6,938
      2,546
      8,406
      6,043
      14,191
      13,805
      17,032
      4,384
      3,162
      8,791
      3,307
      -227
      14,289
      14,443
      3,374
      6,072
      10,698
      1,167
      9,647
      5,822
      3,836
      2,210
      13,502
      14,443
      13,498
      6,374
      9,754
      6,682
      5,978
      16,649
      4,856
      9,211
      2,930
      1,968
      444
      11,717
      6,102
      8,203
      19,908
      8,044
      15,425
      -143
      1,890
      13,297
      -167
      39,016
      2,019
      26,657
      22,426
      19,668
      10,122
      686,702
      5,250
2 Capital gain net income or (net capital loss) Bracket If gain, also enter in Part I, line 7
If (loss), enter -0- in Part I, line 7		 Bracket 2 1,398,450
3 Net short-term capital gain or (loss) as defined in sections 1222(5) and (6):
If gain, also enter in Part I, line 8, column (c) (see instructions). If (loss), enter -0-
in Part I, line 8 . . . . . . . . . . . . . . . . 		Bracket 3  
Part V
Qualification Under Section 4940(e) for Reduced Tax on Net Investment Income
(For optional use by domestic private foundations subject to the section 4940(a) tax on net investment income.)

If section 4940(d)(2) applies, leave this part blank.
Was the foundation liable for the section 4942 tax on the distributable amount of any year in the base period?
If "Yes," the foundation does not qualify under section 4940(e). Do not complete this part.
1 Enter the appropriate amount in each column for each year; see page 18 of the instructions before making any entries.
(a)
Base period years Calendar
year (or tax year beginning in) 		(b)
Adjusted qualifying distributions 		(c)
Net value of noncharitable-use assets 		(d)
Distribution ratio
(col. (b) divided by col. (c))
2012 189,682 4,313,494 0.043974
2011 164,189 4,134,559 0.039711
2010 180,460 4,225,975 0.042703
2009 205,187 4,049,804 0.050666
2008 225,065 3,671,006 0.061309
2 Total of line 1, column (d) ...................... 2 0.238363
3 Average distribution ratio for the 5-year base period—divide the total on line 2 by 5, or by
the number of years the foundation has been in existence if less than 5 years. . . 		3 0.047673
4 Enter the net value of noncharitable-use assets for 2013 from Part X, line 5..... 4 4,092,073
5 Multiply line 4 by line 3....................... 5 195,081
6 Enter 1% of net investment income (1% of Part I, line 27b)........... 6 14,432
7 Add lines 5 and 6......................... 7 209,513
8 Enter qualifying distributions from Part XII, line 4.............. 8 6,315,154
If line 8 is equal to or greater than line 7, check the box in Part VI, line 1b, and complete that part using a 1% tax rate. See
the Part VI instructions.
Form 990-PF (2013)
Form 990-PF (2013)
Page 4
Part VI
Excise Tax Based on Investment Income (Section 4940(a), 4940(b), 4940(e), or 4948—see page 18 of the instructions)
1a Bulletand enter “N/A" on line 1. Bracket
Date of ruling or determination letter:   (attach copy of letter if necessary–see instructions)
b 1 14,432
hereBulletand enter 1% of Part I, line 27b...................
c All other domestic foundations enter 2% of line 27b. Exempt foreign organizations enter 4% of Part I, line 12, col. (b)
2 Tax under section 511 (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-) 2 0
3 Add lines 1 and 2............................ 3 14,432
4 Subtitle A (income) tax (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-). 4 0
5 Tax based on investment income. Subtract line 4 from line 3. If zero or less, enter -0- ..... 5 14,432
6 Credits/Payments:
a 2013 estimated tax payments and 2012 overpayment credited to 2013 6a 1,131
b Exempt foreign organizations—tax withheld at source....... 6b
c Tax paid with application for extension of time to file (Form 8868) 6c 13,301
d Backup withholding erroneously withheld ........... 6d  
7 Total credits and payments. Add lines 6a through 6d.............. 7 14,432
8 Enter any penalty for underpayment of estimated tax. if Form 2220 is attached. Click to see attachment 8  
9 Tax due. If the total of lines 5 and 8 is more than line 7, enter amount owed.......Bullet 9 0
10 Overpayment. If line 7 is more than the total of lines 5 and 8, enter the amount overpaid...Bullet 10  
11 Enter the amount of line 10 to be: Credited to 2014 estimated taxBullet   RefundedBullet 11  
Part VII-A
Statements Regarding Activities
1a
During the tax year, did the foundation attempt to influence any national, state, or local legislation or did
Yes
No
it participate or intervene in any political campaign? ....................
1a
 
No
b
Did it spend more than $100 during the year (either directly or indirectly) for political purposes (see page 19 of
the instructions for definition)?............................
1b
 
No
If the answer is "Yes" to 1a or 1b, attach a detailed description of the activities and copies of any materials
published or distributed by the foundation in connection with the activities.
c
Did the foundation file Form 1120-POL for this year?.....................
1c
 
No
d
Enter the amount (if any) of tax on political expenditures (section 4955) imposed during the year:
(1) On the foundation. bullet$ 0(2) On foundation managers.bullet$ 0
e
Enter the reimbursement (if any) paid by the foundation during the year for political expenditure tax imposed
on foundation managers.bullet$ 0
2
Has the foundation engaged in any activities that have not previously been reported to the IRS?.......
2
 
No
If "Yes," attach a detailed description of the activities.
3
Has the foundation made any changes, not previously reported to the IRS, in its governing instrument, articles
of incorporation, or bylaws, or other similar instruments? If "Yes," attach a conformed copy of the changes....
3
 
No
4a
Did the foundation have unrelated business gross income of $1,000 or more during the year?........
4a
 
No
b
If "Yes," has it filed a tax return on Form 990-T for this year?...................
4b
 
 
5
Was there a liquidation, termination, dissolution, or substantial contraction during the year?.........
5
Yes
 
If "Yes," attach the statement required by General Instruction T.Click to see list of attachments
6
Are the requirements of section 508(e) (relating to sections 4941 through 4945) satisfied either:
  • By language in the governing instrument, or
  • By state legislation that effectively amends the governing instrument so that no mandatory directions
    • that conflict with the state law remain in the governing instrument?................
    6
    Yes
     
    7
    Did the foundation have at least $5,000 in assets at any time during the year? If "Yes," complete Part II, col. (c), and Part XV.
    7
    Yes
     
    8a
    Enter the states to which the foundation reports or with which it is registered (see instructions)
    bulletFL
    b
    If the answer is "Yes" to line 7, has the foundation furnished a copy of Form 990-PF to the Attorney
    General (or designate) of each state as required by General Instruction G? If "No," attach explanation .
    8b
    Yes
     
    9
    Is the foundation claiming status as a private operating foundation within the meaning of section 4942(j)(3)
    or 4942(j)(5) for calendar year 2013 or the taxable year beginning in 2013 (see instructions for Part XIV)?
    If "Yes," complete Part XIV.............................
    9
     
    No
    10
    Did any persons become substantial contributors during the tax year? If "Yes," attach a schedule listing their names and addresses.
    10
     
    No
    11
    At any time during the year, did the foundation, directly or indirectly, own a controlled entity within the
    meaning of section 512(b)(13)? If "Yes," attach schedule. (see instructions) .............
    11
     
    No
    12
    Did the foundation make a distribution to a donor advised fund over which the foundation or a disqualified person had
    advisory privileges? If "Yes," attach statement (see instructions).................
    12
     
    No
    13
    Did the foundation comply with the public inspection requirements for its annual returns and exemption application?
    13
    Yes
     
    Website addressbulletN/A
    14
    The books are in care ofbulletJON OLLIFF Telephone no.bullet (239) 368-7070
    Located atbullet210 LAKE AVENUELEHIGH ACRESFL ZIP+4bullet33936
    15
    Section 4947(a)(1) nonexempt charitable trusts filing Form 990-PF in lieu of Form 1041.........bullet
    and enter the amount of tax-exempt interest received or accrued during the year ......bullet
    15  
    16 At any time during calendar year 2013, did the foundation have an interest in or a signature or other authority over YesNo
    a bank, securities, or other financial account in a foreign country?
    16   No
    See instructions for exceptions and filing requirements for Form TD F 90-22.1. If "Yes", enter the name of the
    foreign country bullet  
    Form 990-PF (2013)
    Form 990-PF (2013)
    Page 5
    Part VII-B
    Statements Regarding Activities for Which Form 4720 May Be Required
    File Form 4720 if any item is checked in the "Yes" column, unless an exception applies.
    Yes
    No
    1a
    During the year did the foundation (either directly or indirectly):
    (1) Engage in the sale or exchange, or leasing of property with a disqualified person?
    (2) Borrow money from, lend money to, or otherwise extend credit to (or accept it from)
    a disqualified person?.........................
    (3) Furnish goods, services, or facilities to (or accept them from) a disqualified person?
    (4) Pay compensation to, or pay or reimburse the expenses of, a disqualified person?
    (5) Transfer any income or assets to a disqualified person (or make any of either available
    for the benefit or use of a disqualified person)?.................
    (6) Agree to pay money or property to a government official? (Exception. Check "No"
    if the foundation agreed to make a grant to or to employ the official for a period
    after termination of government service, if terminating within 90 days.).........
    b
    If any answer is "Yes" to 1a(1)–(6), did any of the acts fail to qualify under the exceptions described in Regulations
    section 53.4941(d)-3 or in a current notice regarding disaster assistance (see page 20 of the instructions)?...
    1b
     
    No
    .........bullet
    c
    Did the foundation engage in a prior year in any of the acts described in 1a, other than excepted acts,
    that were not corrected before the first day of the tax year beginning in 2013?.............
    1c
     
    No
    2
    Taxes on failure to distribute income (section 4942) (does not apply for years the foundation was a private
    operating foundation defined in section 4942(j)(3) or 4942(j)(5)):
    a
    At the end of tax year 2013, did the foundation have any undistributed income (lines 6d
    and 6e, Part XIII) for tax year(s) beginning before 2013?...............
    If "Yes," list the years bullet20, 20, 20, 20
    b
    Are there any years listed in 2a for which the foundation is not applying the provisions of section 4942(a)(2)
    (relating to incorrect valuation of assets) to the year’s undistributed income? (If applying section 4942(a)(2)
    to all years listed, answer "No" and attach statement—see instructions.) ..............
    2b
     
     
    c
    If the provisions of section 4942(a)(2) are being applied to any of the years listed in 2a, list the years here.
    bullet20, 20, 20, 20
    3a
    Did the foundation hold more than a 2% direct or indirect interest in any business enterprise at
    any time during the year?.........................
    b
    If "Yes," did it have excess business holdings in 2013 as a result of (1) any purchase by the foundation
    or disqualified persons after May 26, 1969; (2) the lapse of the 5-year period (or longer period approved
    by the Commissioner under section 4943(c)(7)) to dispose of holdings acquired by gift or bequest; or (3)
    the lapse of the 10-, 15-, or 20-year first phase holding period? (Use Schedule C, Form 4720, to determine
    if the foundation had excess business holdings in 2013.)....................
    3b
     
     
    4a
    Did the foundation invest during the year any amount in a manner that would jeopardize its charitable purposes?
    4a
     
    No
    b
    Did the foundation make any investment in a prior year (but after December 31, 1969) that could jeopardize its
    charitable purpose that had not been removed from jeopardy before the first day of the tax year beginning in 2013?
    4b
     
    No
    5a
    During the year did the foundation pay or incur any amount to:
    (1) Carry on propaganda, or otherwise attempt to influence legislation (section 4945(e))?
    (2) Influence the outcome of any specific public election (see section 4955); or to carry
    on, directly or indirectly, any voter registration drive?...............
    (3) Provide a grant to an individual for travel, study, or other similar purposes?
    (4) Provide a grant to an organization other than a charitable, etc., organization described
    in section 509(a)(1), (2), or (3), or section 4940(d)(2)? (see instructions)........
    (5) Provide for any purpose other than religious, charitable, scientific, literary, or
    educational purposes, or for the prevention of cruelty to children or animals?........
    b
    If any answer is "Yes" to 5a(1)–(5), did any of the transactions fail to qualify under the exceptions described in
    Regulations section 53.4945 or in a current notice regarding disaster assistance (see instructions)? ......
    5b
     
     
    .........bullet
    c
    If the answer is "Yes" to question 5a(4), does the foundation claim exemption from the
    tax because it maintained expenditure responsibility for the grant?............
    If "Yes," attach the statement required by Regulations section 53.4945–5(d).
    6a
    Did the foundation, during the year, receive any funds, directly or indirectly, to pay premiums on
    a personal benefit contract?........................
    b
    Did the foundation, during the year, pay premiums, directly or indirectly, on a personal benefit contract?....
    6b
     
    No
    If "Yes" to 6b, file Form 8870.
    7a
    At any time during the tax year, was the foundation a party to a prohibited tax shelter transaction?
    b
    If yes, did the foundation receive any proceeds or have any net income attributable to the transaction? ....
    7b
     
     
    Form 990-PF (2013)
    Form 990-PF (2013)
    Page 6
    Part VIII
    Information About Officers, Directors, Trustees, Foundation Managers, Highly Paid Employees,
    and Contractors
    1 List all officers, directors, trustees, foundation managers and their compensation (see instructions).
    (a) Name and address (b) Title, and average
    hours per week
    devoted to position     		(c) Compensation
     (If not paid, enter
    -0-)     		(d) Contributions to
    employee benefit plans
    and deferred compensation     		(e) Expense account,
    other allowances
    LARRY TURBEVILLE SECRETARY
    2.00     		0 0 0
    642 PARKDALE BLVD
    LEHIGH ACRES,FL33974
    JON R OLLIFF DDS TREASURER
    2.00     		0 0 0
    210 LAKE AVENUE N
    LEHIGH ACRES,FL33936
    DARWIN RICHARDS CHAIRMAN
    20.00     		19,800 0 0
    214 LINCOLN AVE SE
    LEHIGH ACRES,FL33936
    ORVILLE KURTZ 1ST VICE CHAIRMAN
    2.00     		0 0 0
    306 MCARTHUR AVE
    LEHIGH ACRES,FL33936
    HUGH VANHOOSE EXECUTIVE DIRECTOR
    32.00     		67,260 0 0
    19002 CYPRESS VIEW DRIVE
    FORT MYERS,FL33967
    2 Compensation of five highest-paid employees (other than those included on line 1—see instructions). If none, enter “NONE."
    (a) Name and address of each employee paid more than $50,000 (b) Title, and average
    hours per week
    devoted to position     		(c) Compensation (d) Contributions to
    employee benefit
    plans and deferred
    compensation     		(e) Expense account,
    other allowances
    NONE
    Total number of other employees paid over $50,000...................bullet 0
    3 Five highest-paid independent contractors for professional services (see instructions). If none, enter "NONE".
    (a) Name and address of each person paid more than $50,000 (b) Type of service (c) Compensation
    NONE
    Total number of others receiving over $50,000 for professional services.............bullet0
    Part IX-A
    Summary of Direct Charitable Activities
    List the foundation’s four largest direct charitable activities during the tax year. Include relevant statistical information such as the number of organizations and other beneficiaries served, conferences convened, research papers produced, etc. Expenses
    1 COMMUNITY HEALTH CARE CENTER THAT PROVIDES BELOW MARKET RATE OR NOMINAL RENT TO FOUR 501(C)(3) ORGANIZATIONS 134,099
    2  
    3  
    4  
    Form 990-PF (2013)
    Form 990-PF (2013)
    Page 7
    Part IX-B
    Summary of Program-Related Investments (see instructions)
    Describe the two largest program-related investments made by the foundation during the tax year on lines 1 and 2. Amount
    1  
    2  
    All other program-related investments. See page 24 of the instructions.
    3  
    Total. Add lines 1 through 3.........................bullet0
    Part X
    Minimum Investment Return (All domestic foundations must complete this part. Foreign foundations,
    see instructions.)
    1
    Fair market value of assets not used (or held for use) directly in carrying out charitable, etc.,
    purposes:
    a
    Average monthly fair market value of securities...................
    1a
     
    b
    Average of monthly cash balances.......................
    1b
     
    c
    Fair market value of all other assets (see instructions)................
    1c
     
    d
    Total (add lines 1a, b, and c).........................
    1d
     
    e
    Reduction claimed for blockage or other factors reported on lines 1a and
    1c (attach detailed explanation) .............
    1e
     
    2
    Acquisition indebtedness applicable to line 1 assets..................
    2
     
    3
    Subtract line 2 from line 1d.........................
    3
     
    4
    Cash deemed held for charitable activities. Enter 1 1/2% of line 3 (for greater amount, see
    instructions) .............................
    4
     
    5
    Net value of noncharitable-use assets. Subtract line 4 from line 3. Enter here and on Part V, line 4
    5
     
    6
    Minimum investment return. Enter 5% of line 5..................
    6
     
    Part XI
    Distributable Amount bullet and do not complete this part.)
    1
    Minimum investment return from Part X, line 6....................
    1
    204,604
    2a
    Tax on investment income for 2013 from Part VI, line 5......
    2a
    14,432
    b
    Income tax for 2013. (This does not include the tax from Part VI.)...
    2b
     
    c
    Add lines 2a and 2b............................
    2c
    14,432
    3
    Distributable amount before adjustments. Subtract line 2c from line 1............
    3
    190,172
    4
    Recoveries of amounts treated as qualifying distributions................
    4
    0
    5
    Add lines 3 and 4............................
    5
    190,172
    6
    Deduction from distributable amount (see instructions).................
    6
    0
    7
    Distributable amount as adjusted. Subtract line 6 from line 5. Enter here and on Part XIII,
    line 1................................
    7
    190,172
    Part XII
    Qualifying Distributions (see instructions)
    1
    Amounts paid (including administrative expenses) to accomplish charitable, etc., purposes:
    a
    Expenses, contributions, gifts, etc.—total from Part I, column (d), line 26 ..........
    1a
     
    b
    Program-related investments—total from Part IX-B..................
    1b
     
    2
    Amounts paid to acquire assets used (or held for use) directly in carrying out charitable, etc.,
    purposes...............................
    2
     
    3
    Amounts set aside for specific charitable projects that satisfy the:
    a
    Suitability test (prior IRS approval required)....................
    3a
     
    b
    Cash distribution test (attach the required schedule) .................
    3b
     
    4
    Qualifying distributions. Add lines 1a through 3b. Enter here and on Part V, line 8, and Part XIII, line 4
    4
     
    5
    Foundations that qualify under section 4940(e) for the reduced rate of tax on net investment
    income. Enter 1% of Part I, line 27b (see instructions).................
    5
     
    6
    Adjusted qualifying distributions. Subtract line 5 from line 4..............
    6
     
    Note: The amount on line 6 will be used in Part V, column (b), in subsequent years when calculating whether the foundation qualifies for
    the section 4940(e) reduction of tax in those years.
    Form 990-PF (2013)
    Form 990-PF (2013)
    Page 8
    Part XIII
    Undistributed Income (see instructions)
    (a)
    Corpus     		(b)
    Years prior to 2012     		(c)
    2012     		(d)
    2013
    1 Distributable amount for 2013 from Part XI, line 7 190,172
    2 Undistributed income, if any, as of the end of 2013:
    a Enter amount for 2012 only....... 0
    b Total for prior years:20, 20, 20 0
    3 Excess distributions carryover, if any, to 2013:
    a From 2008.......  
    b From 2009....... 36,263
    c From 2010....... 180,460
    d From 2011....... 164,189
    e From 2012....... 189,682
    fTotal of lines 3a through e......... 570,594
    4Qualifying distributions for 2013 from Part
    XII, line 4: bullet$ 6,315,154
    a Applied to 2012, but not more than line 2a 0
    b Applied to undistributed income of prior years
    (Election required—see instructions)......     		0
    c Treated as distributions out of corpus (Election
    required—see instructions).........     		Click to see attachment0
    d Applied to 2013 distributable amount..... 190,172
    e Remaining amount distributed out of corpus 6,124,982
    5 Excess distributions carryover applied to 2013. 0 0
    (If an amount appears in column (d), the
    same amount must be shown in column (a).)
    6Enter the net total of each column as
    indicated below:
    a Corpus. Add lines 3f, 4c, and 4e. Subtract line 5 6,695,576
    b Prior years’ undistributed income. Subtract
    line 4b from line 2b ...........     		0
    c Enter the amount of prior years’ undistributed
    income for which a notice of deficiency has
    been issued, or on which the section 4942(a)
    tax has been previously assessed......     		0
    d Subtract line 6c from line 6b. Taxable amount
    —see instructions ...........     		0
    e Undistributed income for 2012. Subtract line
    4a from line 2a. Taxable amount—see
    instructions .............     		0
    f Undistributed income for 2013. Subtract
    lines 4d and 5 from line 1. This amount must
    be distributed in 2014 ..........     		0
    7 Amounts treated as distributions out of
    corpus to satisfy requirements imposed by
    section 170(b)(1)(F) or 4942(g)(3) (see
    instructions) .............     		0
    8Excess distributions carryover from 2008 not
    applied on line 5 or line 7 (see instructions) ...     		0
    9Excess distributions carryover to 2014.
    Subtract lines 7 and 8 from line 6a ......     		6,695,576
    10 Analysis of line 9:
    a Excess from 2009.... 36,263
    b Excess from 2010.... 180,460
    c Excess from 2011.... 164,189
    d Excess from 2012.... 189,682
    e Excess from 2013.... 6,124,982
    Form 990-PF (2013)
    Form 990-PF (2013)
    Page 9
    Part XIV
    Private Operating Foundations (see instructions and Part VII-A, question 9)
    1a If the foundation has received a ruling or determination letter that it is a private operating
    foundation, and the ruling is effective for 2013, enter the date of the ruling.......bullet
     
    b Check box to indicate whether the organization is a private operating foundation described in section or
    2a Enter the lesser of the adjusted net
    income from Part I or the minimum
    investment return from Part X for each
    year listed ..........     		Tax year Prior 3 years (e) Total
    (a) 2013 (b) 2012 (c) 2011 (d) 2010
             
    b 85% of line 2a .........          
    c Qualifying distributions from Part XII,
    line 4 for each year listed .....     		         
    d Amounts included in line 2c not used
    directly for active conduct of exempt activities ...........     		         
    e Qualifying distributions made directly
    for active conduct of exempt activities.
    Subtract line 2d from line 2c ....     		         
    3 Complete 3a, b, or c for the
    alternative test relied upon:
    a “Assets" alternative test—enter:
    (1) Value of all assets ......          
    (2) Value of assets qualifying
    under section 4942(j)(3)(B)(i)    		          
    b “Endowment" alternative test— enter 2/3
    of minimum investment return shown in
    Part X, line 6 for each year listed...     		         
    c “Support" alternative test—enter:
    (1) Total support other than gross
    investment income (interest,
    dividends, rents, payments
    on securities loans (section
    512(a)(5)), or royalties) ....     		         
    (2) Support from general public
    and 5 or more exempt
    organizations as provided in
    section 4942(j)(3)(B)(iii)....     		         
    (3) Largest amount of support
    from an exempt organization    		          
    (4) Gross investment income          
    Part XV
    Supplementary Information (Complete this part only if the organization had $5,000 or more in
    assets at any time during the year—see instructions.)
    1Information Regarding Foundation Managers:
    aList any managers of the foundation who have contributed more than 2% of the total contributions received by the foundation
    before the close of any tax year (but only if they have contributed more than $5,000). (See section 507(d)(2).)
    bList any managers of the foundation who own 10% or more of the stock of a corporation (or an equally large portion of the
    ownership of a partnership or other entity) of which the foundation has a 10% or greater interest.
    2Information Regarding Contribution, Grant, Gift, Loan, Scholarship, etc., Programs:
    Check here bullet
    aThe name, address, and telephone number or e-mail address of the person to whom applications should be addressed:
    JON R OLLIFF
    210 LAKE AVENUE N
    LEHIGH ACRES,FL33936
    (239) 368-7070
    bThe form in which applications should be submitted and information and materials they should include:
    SIMPLE LETTER REQUEST.
    cAny submission deadlines:
    -NONE-
    dAny restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other
    factors:
    -NONE-
    Form 990-PF (2013)
    Form 990-PF (2013)
    Page 10
    Part XV
    Supplementary Information (continued)
    3 Grants and Contributions Paid During the Year or Approved for Future Payment
    Recipient If recipient is an individual,
    show any relationship to
    any foundation manager
    or substantial contributor
    		 Foundation
    status of
    recipient     		Purpose of grant or
    contribution     		Amount
    Name and address (home or business)
    aPaid during the year
    HOPE HOSPICE OF SOUTHWEST FLORIDA
    9470 HEALTH PARK DR
    FORT MYERS,FL33908     		NONE 501(C)(3) EXEMPT PURPOSE 1,775,000
    LEHIGH COMMUNITY SERVICES INC
    201 PLAZA DR SUITE 3
    LEHIGH ACRES,FL33936     		NONE 501(C)(3) EXEMPT PURPOSE 250,000
    UNITED WAY OF LEE COUNTY
    7275 CONCOURSE DR
    FORT MYERS,FL33908     		NONE 501(C)(3) EXEMPT PURPOSE 255,000
    EDISON COLLEGE FOUNDATION
    8099 COLLEGE PKWY
    FORT MYERS,FL339195598     		NONE 501(C)(3) EXEMPT PURPOSE 500,000
    SOUTHWEST FLORIDA COMMUNITY FOUNDATION
    8771 COLLEGE PKWY
    FORT MYERS,FL33919     		NONE 501(C)(3) EXEMPT PURPOSE 1,500,000
    FLORIDA GULF COAST UNIVERSITY
    10501 FGCU BLVD
    FORT MYERS,FL339656565     		NONE 501(C)(3) EXEMPT PURPOSE 1,900,000
    Total .................................bullet 3a 6,180,000
    bApproved for future payment
    LEHIGH COMMUNITY SERVICES INC
    201 PLAZA DR SUITE 3
    LEHIGH ACRES,FL33936     		NONE 501(C)(3) EXEMPT PURPOSE 72,100
    FLORIDA GULF COAST UNIVERSITY
    10501 FGCU BLVD
    FORT MYERS,FL339656565     		NONE 501(C)(3) EXEMPT PURPOSE 100,000
    Total .................................bullet 3b 172,100
    Form 990-PF (2013)
    Form 990-PF (2013)
    Page 11
    Part XVI-A
    Analysis of Income-Producing Activities
    Enter gross amounts unless otherwise indicated. Unrelated business income Excluded by section 512, 513, or 514 (e)
    Related or exempt
    function income
    (See instructions.)
    1Program service revenue: (a)
    Business code     		(b)
    Amount     		(c)
    Exclusion code     		(d)
    Amount
    a
    b
    c
    d
    e
    f
    gFees and contracts from government agencies          
    2 Membership dues and assessments....          
    3
    Interest on savings and temporary cash investments ............     		    14 1,204  
    4 Dividends and interest from securities....     14 75,156  
    5 Net rental income or (loss) from real estate:
    aDebt-financed property......          
    bNot debt-financed property.....     16 60,750  
    6
    Net rental income or (loss) from personal property .............     		         
    7 Other investment income.....          
    8
    Gain or (loss) from sales of assets other than inventory .............     		    18 1,398,450 656,225
    9 Net income or (loss) from special events:          
    10 Gross profit or (loss) from sales of inventory..          
    11 Other revenue: a
    b
    c
    d
    e
    12 Subtotal. Add columns (b), (d), and (e).. 0 1,535,560 656,225
    13Total. Add line 12, columns (b), (d), and (e)..................
    132,191,785
    (See worksheet in line 13 instructions to verify calculations.)
    Part XVI-B
    Relationship of Activities to the Accomplishment of Exempt Purposes
    Line No.
    DownArrow     		Explain below how each activity for which income is reported in column (e) of Part XVI-A contributed importantly to
    the accomplishment of the foundation’s exempt purposes (other than by providing funds for such purposes). (See
    instructions.)
    8 MASS DISPOSITION: DISTRIBUTION OF ASSETS TO CHARITABLE ORGANIZATION
    Form 990-PF (2013)
    Form 990-PF (2013)
    Page 12
    Part XVII
    Information Regarding Transfers To and Transactions and Relationships With Noncharitable Exempt Organizations
    1
    Did the organization directly or indirectly engage in any of the following with any other organization described in section 501(c) of the Code (other than section 501(c)(3) organizations) or in section 527, relating to political
    Yes
    No
    organizations?
    a
    Transfers from the reporting foundation to a noncharitable exempt organization of:
    (1) Cash...................................
    1a(1)
     
    No
    (2) Other assets.................................
    1a(2)
     
    No
    b
    Other transactions:
    (1) Sales of assets to a noncharitable exempt organization....................
    1b(1)
     
    No
    (2) Purchases of assets from a noncharitable exempt organization..................
    1b(2)
     
    No
    (3) Rental of facilities, equipment, or other assets.......................
    1b(3)
     
    No
    (4) Reimbursement arrangements...........................
    1b(4)
     
    No
    (5) Loans or loan guarantees.............................
    1b(5)
     
    No
    (6) Performance of services or membership or fundraising solicitations................
    1b(6)
     
    No
    c
    Sharing of facilities, equipment, mailing lists, other assets, or paid employees..............
    1c
     
    No
    d
    If the answer to any of the above is "Yes," complete the following schedule. Column (b) should always show the fair market value
    of the goods, other assets, or services given by the reporting foundation. If the foundation received less than fair market value
    in any transaction or sharing arrangement, show in column (d) the value of the goods, other assets, or services received.
    (a) Line No. (b) Amount involved (c) Name of noncharitable exempt organization (d) Description of transfers, transactions, and sharing arrangements
    2a
    Is the foundation directly or indirectly affiliated with, or related to, one or more tax-exempt organizations
    described in section 501(c) of the Code (other than section 501(c)(3)) or in section 527?...........
    b
    If "Yes," complete the following schedule.
    (a) Name of organization (b) Type of organization (c) Description of relationship
    Sign Here
    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 taxpayer or fiduciary) is based on all information of which preparer has any knowledge.
    Bullet Bullet
    May the IRS discuss this return
    with the preparer shown below
    (see instr.)?
    Signature of officer or trustee Date Title
    Paid Preparer Use Only Print/Type preparer's name Preparer's Signature Date PTIN
    Firm's namebullet



    Firm's addressbullet







         		Firm's EINbullet
    Phone no.
    Form 990-PF (2013)
    Additional Data


    Software ID:  
    Software Version:  


    Form 990PF - Special Condition Description:
    Special Condition Description

    TY 2013 AccountingFeesSchedule
    Name:
    COMMUNITY HEALTH ASSOCIATION INC
    EIN: 59-1088536
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    ACCOUNTING FEES 18,320 4,780   4,780

    TY 2013 DissolutionStmt
    Name:
    COMMUNITY HEALTH ASSOCIATION INC
    EIN: 59-1088536
    Dissolution Name Dissolution Address Explanation Dissolution Amount
    UNITED WAY OF LEE COUNTY 7275 CONCOURSE DR
    FORT MYERS,FL33908     		CASH 255,000
    EDISON COLLEGE FOUNDATION 8099 COLLEGE PKWY
    FORT MYERS,FL339195598     		CASH 500,000
    HOPE HOSPICE OF SOUTHWEST FLORIDA 9470 HEALTH PARK DR
    FORT MYERS,FL33908     		CASH 500,000
    HOPE HOSPICE OF SOUTHWEST FLORIDA 9470 HEALTH PARK DR
    FORT MYERS,FL33908     		LAND 1,275,000
    LEHIGH COMMUNITY SERVICES INC 201 PLAZA DR SUITE 3
    LEHIGH ACRES,FL33936     		CASH 250,000
    SOUTHWEST FLORIDA COMMUNITY FOUNDATION 8771 COLLEGE PKWY
    FORT MYERS,FL33919     		CASH 1,500,000
    FLORIDA GULF COAST UNIVERSITY 10501 FGCU BLVD
    FORT MYERS,FL339656565     		CASH 1,900,000


    TY 2013 DistributionFromCorpusElection
    Name:
    COMMUNITY HEALTH ASSOCIATION INC
    EIN: 59-1088536
    Election:
    THE ORGANIZATION ELECTS TO TREAT THE CURRENT YEAR DISTRIBUTIONS AS BEING MADE OUT OF CORPUS.

    Note: To capture the full content of this document, please select landscape mode (11" x 8.5") when printing.

    TY 2013 GainLossSaleOtherAssetsSch
    Name:
    COMMUNITY HEALTH ASSOCIATION INC
    EIN: 59-1088536
    Name Date Acquired How Acquired Date Sold Purchaser Name Gross Sales Price Basis Basis Method Sales Expenses Total (net) Accumulated Depreciation
    MASS DISPOSITION: DISTRIBUTION OF ASSETS - SCHEDULE MAINTAINED 2012-01 PURCHASED 2014-06   1,275,000 1,635,239   0 656,225 1,016,464

    TY 2013 LiquidationExplanationStmt
    Name:
    COMMUNITY HEALTH ASSOCIATION INC
    EIN: 59-1088536
    Statement:
    ON MAY 15, 2014, THE BOARD OF DIRECTORS ADOPTED A PLAN OF COMPLETE LIQUIDATION. DURING THE FISCAL YEAR ENDED JUNE 30,2014, COMMUNITY HEALTH ASSOCIATION, INC. (CHA) MADE SEVEN DISTRIBUTIONS OF ASSETS FROM SOURCES OTHER THAN CURRENT INCOME. SUCH DISTRIBUTIONS REPRESENT SUBSTANTIALLY ALL OF CHA'S NET ASSETS WITH FINAL DISTRIBUTION MADE BY DECEMBER 31, 2014. A LIST OF THE RECIPIENTS, ADDRESSES AND AMOUNTS ARE INCLUDED IN PART XV. HOPE HOSPICE OF SW FLORIDA ALSO RECEIVED ALL REAL AND PERSONAL PROPERTY VALUED AT $1,275,000 WHICH IS INCLUDED IN THE VALUE OF THE CONTRIBUTION REPORTED. ALL OF THE RECIPIENTS ARE EXEMPT FROM TAXES UNDER IRC SEC. 501(C)(3) AND ARE EITHER PUBLIC CHARITIES OR PRIVATE OPERATING FOUNDATIONS AS DEFINED IN IRC SEC. 4942(J)(3). THEY ARE NOT CONTROLLED (DIRECTLY OR INDIRECTLY) BY CHA OR ANY DISQUALIFIED PERSONS WITH RESPECT TO CHA. FURTHERMORE, NONE OF THE RECIPIENTS ARE UNDER ANY OBLIGATION TO USE THE FUNDS IN A MANNER THAT WILL DIRECTLY BENEFIT CHA. THE DISTRIBUTIONS ARE PART OF AN OVERALL PLAN OF LIQUIDATION AND TERMINATION THAT WILL COMPLETE IN THE SUBSEQUENT SHORT TAX PERIOD ENDED DECEMBER 31, 2014. THE LIQUIDATION PLAN AND OTHER REQUIRED INFORMATION WILL BE ATTACHED TO THE SUBSEQUENT FINAL TAX RETURN.


    TY 2013 LegalFeesSchedule
    Name:
    COMMUNITY HEALTH ASSOCIATION INC
    EIN: 59-1088536
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    ATTORNEY'S FEES 17,755 8,877   8,878


    TY 2013 OtherExpensesSchedule
    Name:
    COMMUNITY HEALTH ASSOCIATION INC
    EIN: 59-1088536
    Description Revenue and Expenses per Books Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    POSTAGE & SHIPPING 166 0   166
    INVESTMENT EXPENSES 3,572 3,572   0
    EQUIPMENT RENTAL 332 50   282
    MEALS AND FOOD 50 13   37
    DUES AND SUBSCRIPTIONS 341 0   341
    OFFICE SUPPLIES 549 83   466
    UTILITIES 7,149 882   6,267
    REPAIRS 7,272 505   6,767
    MAINTENANCE 24,637 1,919   22,718
    OTHER 3,709 926   2,777
    TELEPHONE 3,815 572   3,243
    INSURANCE 16,558 0   16,558
    PENALTIES 303 0   0


    TY 2013 OtherLiabilitiesSchedule
    Name:
    COMMUNITY HEALTH ASSOCIATION INC
    EIN: 59-1088536
    Description Beginning of Year - Book Value End of Year - Book Value
    WITHHELD INCOME TAXES 1,195 225
    ACCRUED PROPERTY TAXES 383 0
    ACCRUED PAYROLL TAXES 1,079 349


    TY 2013 OtherProfessionalFeesSchedule
    Name:
    COMMUNITY HEALTH ASSOCIATION INC
    EIN: 59-1088536
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    INVESTMENT MANAGEMENT FEES 34,043 34,043   0


    TY 2013 TaxesSchedule
    Name:
    COMMUNITY HEALTH ASSOCIATION INC
    EIN: 59-1088536
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    PAYROLL TAXES 7,417 1,854   5,563
    EXCISE TAX 15,039 0   0