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
ANTELOPE VALLEY HOSPITAL FOUNDATION
 
Employer identification number

95-2975107
Return Reference Explanation
FORM 990, PART VI, SECTION A, LINE 8B THE FOUNDATION DOES NOT HAVE A COMMITTEE WITH THE AUTHORITY TO ACT ON BEFALF OF THE BOARD OF DIRECTORS.
FORM 990, PART VI, SECTION B, LINE 11 THE EXECUTIVE BOARD AND THE EXECUTIVE DIRECTOR WILL REVIEW THE TAX RETURN AND WILL BE PRESENTED TO THE BOARD FOR APPROVAL PRIOR TO SUBMISSION TO THE INTERNAL REVENUE SERVICE.
FORM 990, PART VI, SECTION B, LINE 15 ANTELOPE VALLEY HOSPITAL FOUNDATION RELIED ON A RELATED ORGANIZATION, ANTELOPE VALLEY HEALTHCARE DISTRICT, TO ESTABLISH COMPENSATION AND BENEFITS FOR THE CEO. THE BOARD OF DIRECTORS REVIEWED AND APPROVED ALL ELEMENTS OF THE CEO'S COMPENSATION. THE CFO'S COMPENSATION WAS DETERMINED VIA A COMPENSATION STUDY AND APPROVED BY THE CEO.
FORM 990, PART VI, SECTION C, LINE 19 AVAILABLE UPON REQUEST.
FORM 990, PART XI, LINE 9: SPECIAL EVENT GROSS RECEIPTS -50,503.
990, PART VII, SECTION A AND PART IX, STATEMENT OF FUNCTIONAL EXPENSES EMPLOYEES COMPENSATED BY RELATED ORGANIZATION: OFFICERS AND EMPLOYEES ARE EMPLOYED AND COMPENSATED BY ANTELOPE VALLEY HEALTHCARE DISTRICT (AVHD). AVHD REPORTS 100% OF THE INDIVIDUAL'S COMPENSATION ON W-2'S ISSUED BY AVHD. HOWEVER, SOME OF THESE EMPLOYEES ARE ASSIGNED DUTIES TO OTHER RELATED ORGANIZATIONS (SEE SCHEDULE R FOR ADDITIONAL INFORMATION REGARDING THE RELATED ORGANIZATIONS). AS A RESULT OF THESE ASSIGNMENTS, WAGE AND BENEFIT COSTS ARE ALLOCATED TO RELATED ORGANIZATIONS. THE WAGE AND BENEFIT COSTS ALLOCATED TO EACH ORGANIZATION ARE REPORTED ON FORM 990, PART IX, STATEMENT OF FUNCTIONAL EXPENSES FOR EACH INDIVIDUAL AS BEING COMPENSATED DIRECTLY FROM THE FILING ORGANIZATION AND THE BALANCE OF COMPENSATION IS REPORTED AS COMPENSATION FROM RELATED ORGANIZATIONS.
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

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