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.
MediumBullet Information about Schedule O (Form 990 or 990-EZ) and its instructions is at
www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public
Inspection
Name of the organization
Northwest Community Hospital Foundation
 
Employer identification number

36-3125193
Return Reference Explanation
DESCRIPTION OF CLASSES OF MEMBERS OR STOCKHOLDERS Form 990, Part V, Line 6 NORTHWEST COMMUNITY HEALTHCARE (NCH) IS THE SOLE CORPORATE MEMBER OF NORTHWEST COMMUNITY HOSPITAL FOUNDATION (FOUNDATION). AS SUCH, IT ELECTS OR APPOINTS THE MEMBERS OF FOUNDATION'S GOVERNING BODY AND APPROVES SIGNIFICANT DECISIONS.
DESCRIPTION OF CLASSES OF PERSONS AND THE NATURE OF THEIR RIGHTS Form 990, Part VI, Line 7a NCH IS THE SOLE CORPORATE MEMBER OF FOUNDATION. AS SUCH, IT ELECTS OR APPOINTS THE MEMBERS OF THE GOVERNING BODY OF FOUNDATION PERIODICALLY OR AS VACANCIES ARISE.
DESCR CLASSES OF PERSONS, DECISIONS REQUIRING APPR & TYPE OF VOTING RIGHTS Form 990, Part VI, Line 7b NCH IS THE SOLE CORPORATE MEMBER OF FOUNDATION. AS SUCH, IT MUST APPROVE CERTAIN ACTIONS OF FOUNDATION. ACTION IS TAKEN BY A MAJORITY VOTE OF THE NCH BOARD WITH A QUORUM PRESENT. NCH MUST APPROVE THE FOLLOWING TYPES OF DECISIONS BY FOUNDATION: VOLUNTARY DISSOLUTION, MERGER, CONSOLIDATION OR SALE OR TRANSFER OF 10% OR MORE OF FOUNDATION'S ASSETS; SALE OF REAL PROPERTY OR INTEREST THEREIN; CREATION OF A SUBSIDIARY OR AFFILIATE; ANNUAL AND LONG-TERM CAPITAL AND OPERATING BUDGETS; AMENDMENT, ALTERATION OR REPEAL OF FOUNDATION'S ARTICLES OF INCORPORATION OR BYLAWS; SELECTION OF AUDITORS; AND APPOINTMENT, REMOVAL AND EVALUATION OF FOUNDATION'S TRUSTEES.
DESCRIBE THE PROCESS USED BY MANAGEMENT &/OR GOVERNING BODY TO REVIEW 990 Form 990, Part VI, Line 11b A COPY OF FORM 990 WAS MADE AVAILABLE TO THE MEMBERS OF THE AUDIT AND COMPLIANCE COMMITTEE OF THE NCH BOARD OF DIRECTORS AND THE MEMBERS OF FOUNDATION'S BOARD OF DIRECTORS PRIOR TO FILING. NCH IS THE SOLE CORPORATE MEMBER OF FOUNDATION. THE AUDIT AND COMPLIANCE COMMITTEE HAS BEEN ASSIGNED THE RESPONSIBILITY OF REVIEWING FORMS 990 FOR ALL AFFILIATES OF NCH.
DESCRIPTION OF PROCESS TO MONITOR TRANSACTIONS FOR CONFLICTS OF INTEREST Form 990, Part VI, Line 12c EACH YEAR, THE CONFLICT OF INTEREST POLICY AND QUESTIONNAIRE IS SENT TO DIRECTORS, OFFICERS AND KEY EMPLOYEES. EACH RESPONSE IS REVIEWED BY THE GENERAL COUNSEL AND THOSE IN WHICH ANY ACTUAL OR APPARENT CONFLICT WITH THE PRESENT ROLE IS DISCLOSED, IS REVIEWED BY THE CEO AND BOARD CHAIRPERSON. IN THE CASE OF ANY CONFLICT INVOLVING AN ENTITY OR PARTY WITH WHICH FOUNDATION IS DEALING OR COMPETING, THE PERSON WITH THE CONFLICT MAY NOT PARTICIPATE IN ANY DECISIONS REGARDING THAT PARTY. INDIVIDUALS WHO ARE INDEPENDENT CONTRACTORS, OFFICERS, TRUSTEES, OR EMPLOYEES OF OTHER HEALTH CARE FACILITIES IN NORTHWEST COMMUNITY HOSPITAL'S SERVICE AREA MAY NOT SERVE ON ANY NCH'S OR ANY RELATED ORGANIZATION BOARD OR BOARD COMMITTEE. IN ADDITION, THE POLICY INCLUDES A SAMPLE CONFLICT OF INTEREST DISCLOSURE LETTER TO BE USED IF CONFLICT ARISES AFTER SUBMISSION OF THE ANNUAL QUESTIONNAIRE AND BEFORE THE NEXT. SUCH DISCLOSURE LETTERS WOULD BE REVIEWED AS NOTED ABOVE AT THE TIME THEY ARE RECEIVED.
COMPENSATION DETERMINATION PROCESS FOR TOP MANAGEMENT OFFICIAL Form 990, Part VI, Line 15 THE COMPENSATION AND GOVERNANCE COMMITTEE OF THE NCH BOARD IS RESPONSIBLE FOR APPROVING THE COMPENSATION OF THE OFFICERS OF FOUNDATION BASED ON RECOMMENDATIONS FROM THE PRESIDENT/CEO. THE REVIEW UTILIZES COMPARISONS TO STUDIES FROM THE METROPOLITAN CHICAGO HEALTHCARE COUNCIL AND OTHER SOURCES. THE PROCESS IS DOCUMENTED IN THE MINUTES OF THE COMPENSATION AND GOVERNANCE COMMITTEE.
AVAIL OF GOV DOCS, CONFLICT OF INTEREST POLICY, & FIN STMTS TO GEN PUBLIC Form 990, Part VI, Line 19 GOVERNING DOCUMENTS AND THE CONFLICT OF INTEREST POLICY ARE NOT MADE PUBLIC. FOUNDATION'S FINANCIAL STATEMENTS ARE INCLUDED IN THE ANNUAL CONSOLIDATED AUDIT REPORT OF NORTHWEST COMMUNITY HEALTHCARE AND SUBSIDIARIES. THESE CONSOLIDATED FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC VIA THE MUNICIPAL SECURITIES RULEMAKING BOARD'S ELECTRONIC MUNICIPAL MARKET ACCESS (EMMA) WEBSITE AT WWW.EMMA.MSRB.ORG.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2013

Additional Data


Software ID:  
Software Version: