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
2012
Open to Public
Inspection
Name of the organization
Pediatric Interim Care Center The Newborn Nursery
 
Employer identification number

91-1485176
Identifier Return Reference Explanation
  Form 990, Part VI, Section A, line 6 PICC is owned by two shareholders.
  Form 990, Part VI, Section A, line 7a The two members have the rights to amend the by-laws, to elect the Board of Directors, to dissolve the company and to remove a board member.
  Form 990, Part VI, Section A, line 7b The Board of Directors is accountable to the members.
  Form 990, Part VI, Section A, line 8b There are no committes with authority to act on behalf of the governing body.
  Form 990, Part VI, Section B, line 11 Form 990 is reviewed by the Executive Director and the Board of Directors prior to filing.
  Form 990, Part VI, Section B, line 12c All Board Members are required to complete a Conflict of Interest Disclosure Questionnaire annually.
  Form 990, Part VI, Section B, line 15 The Board of Directors has the power to increase compensation of the Executive Director. This has been done in the past by a review of activities by a Board member, and a compensation comparison done to determine proper level of compensation.
  Form 990, Part VI, Section C, line 19 All documents are available upon request.
  Form 990, Part XII, Line 2c: The audit committee process has not changed.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2012

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