TY 2014 Form 990 Schedule O

efile Public Visual Render ObjectId: 201641379349306734 - Submission: 2016-05-16 TIN: 31-1156690

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 990-EZ or to provide any additional information.
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Attach to Form 990 or 990-EZ.
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Information about Schedule O (Form 990 or 990-EZ) and its instructions is at
www.irs.gov/form990.

OMB No. 1545-0047

2014

Open to Public
Inspection

Name of the organization

HOLZER HEALTH SYSTEM

Employer identification number

31-1156690

Return Reference	Explanation
FORM 990, PART VI, SECTION A, LINE 3	HOLZER HEALTH SYSTEM PAYS BERKELEY RESEARCH GROUP, LLC FOR CFO SERVICES BY DAN JANICAK. THE CONTRACT WITH THE MANAGEMENT COMPANY IS $35,000 PER MONTH STARTING MAY 2014. THE SAME MANAGEMENT COMPANY IS USED FOR EMPLOYING THE EXECUTIVE V.P. FOR INTERIM CHIEF NURSING OFFICER, BARBARA CAMPFIELD (SERVES ON THE BOARD). THE CONTRACT WITH THE MANAGEMENT COMPANY IS $35,000 STARTING IN MAY 2014.
FORM 990, PART VI, SECTION B, LINE 11	THE CONTROLLER AND THE CFO REVIEW FORM 990 AND A COPY WILL BE PROVIDED TO ALL BOARD MEMBERS PRIOR TO FILING.
FORM 990, PART VI, SECTION B, LINE 12C	THE ORGANIZATION FOLLOWS THE ADOPTED POLICIES OF HOLZER MEDICAL CENTER- JACKSON AND HOLZER HOSPITAL FOUNDATION, RELATED TAX-EXEMPT ORGANIZATIONS. CONFLICT OF INTEREST STATEMENTS ARE COMPLETED ANNUALLY BY ALL BOARD MEMBERS AND OFFICERS, AND ARE REVIEWED BY THE CONFLICT OF INTEREST REVIEW COMMITTEE. MEMBERS OF THE BOARD ARE AWARE THAT THEY SHOULD DISCLOSE CONFLICTS WHEN THEY ARISE, AND MEMBERS ABSTAIN FROM PARTICIPATING IN DISCUSSIONS OR VOTING ON MATTERS WHERE A CONFLICT IS PRESENT.
FORM 990, PART VI, SECTION B, LINE 15	THE HOLZER HEALTH SYSTEM BOARD APPROVES COMPENSATION OF THE CEO AND OTHER OFFICERS. THE BOARD UTILIZES WAGE RECOMMENDATIONS FROM AN UNRELATED CONSULTANT TO DETERMINE THE COMPENSATION. THE CEO MAY BE INVOLVED IN DETERMINING OTHER OFFICERS' COMPENSATION, HOWEVER THE ULTIMATE DECISION RESTS WITH THE BOARD. THE PROCESS WAS LAST UNDERTAKEN DURING MARCH 2015.
FORM 990, PART VI, SECTION C, LINE 19	THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. THE ORGANIZATION DOES NOT HAVE ITS OWN CONFLICT OF INTEREST POLICY.
FORM 990, PART IX, LINE 11G	OUTSIDE SERVICES: PROGRAM SERVICE EXPENSES 4,196,862. MANAGEMENT AND GENERAL EXPENSES 12,163,646. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 16,360,508. CONTRACT LABOR: PROGRAM SERVICE EXPENSES 41,246. MANAGEMENT AND GENERAL EXPENSES 4,484,211. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,525,457. OTHER FEES: PROGRAM SERVICE EXPENSES 255,438. MANAGEMENT AND GENERAL EXPENSES 779,179. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,034,617.
FORM 990, PART XI, LINE 9:	TRANSFERS TO/FROM AFFILIATES 34,126,471.
FORM 990, PART XI, LINE 2C	THE AUDIT OVERSIGHT PROCESS AND THE PROCESS OF SELECTION OF AN INDEPENDENT ACCOUNTANT HAVE NOT CHANGED FROM THE PRIOR YEAR.
FORM 990, PART VI, LINE 16	THE ORGANIZATION DOES NOT HAVE IN PLACE A WRITTEN POLICY TO EVALUATE ITS PARTICIPATION IN JOINT VENTURES, HOWEVER IT MAKES SURE TO TAKE THE NECESSARY PRECAUTIONS TO SAFEGUARD ITS TAX-EXEMPT STATUS. IN ADDITION, LEGAL COUNSEL IS CONSULTED BEFORE CONSIDERING A NEW JOINT VENTURE.

Return Reference

Explanation

FORM 990, PART VI, SECTION A, LINE 3

HOLZER HEALTH SYSTEM PAYS BERKELEY RESEARCH GROUP, LLC FOR CFO SERVICES BY DAN JANICAK. THE CONTRACT WITH THE MANAGEMENT COMPANY IS $35,000 PER MONTH STARTING MAY 2014. THE SAME MANAGEMENT COMPANY IS USED FOR EMPLOYING THE EXECUTIVE V.P. FOR INTERIM CHIEF NURSING OFFICER, BARBARA CAMPFIELD (SERVES ON THE BOARD). THE CONTRACT WITH THE MANAGEMENT COMPANY IS $35,000 STARTING IN MAY 2014.

FORM 990, PART VI, SECTION B, LINE 11

THE CONTROLLER AND THE CFO REVIEW FORM 990 AND A COPY WILL BE PROVIDED TO ALL BOARD MEMBERS PRIOR TO FILING.

FORM 990, PART VI, SECTION B, LINE 12C

THE ORGANIZATION FOLLOWS THE ADOPTED POLICIES OF HOLZER MEDICAL CENTER- JACKSON AND HOLZER HOSPITAL FOUNDATION, RELATED TAX-EXEMPT ORGANIZATIONS. CONFLICT OF INTEREST STATEMENTS ARE COMPLETED ANNUALLY BY ALL BOARD MEMBERS AND OFFICERS, AND ARE REVIEWED BY THE CONFLICT OF INTEREST REVIEW COMMITTEE. MEMBERS OF THE BOARD ARE AWARE THAT THEY SHOULD DISCLOSE CONFLICTS WHEN THEY ARISE, AND MEMBERS ABSTAIN FROM PARTICIPATING IN DISCUSSIONS OR VOTING ON MATTERS WHERE A CONFLICT IS PRESENT.

FORM 990, PART VI, SECTION B, LINE 15

THE HOLZER HEALTH SYSTEM BOARD APPROVES COMPENSATION OF THE CEO AND OTHER OFFICERS. THE BOARD UTILIZES WAGE RECOMMENDATIONS FROM AN UNRELATED CONSULTANT TO DETERMINE THE COMPENSATION. THE CEO MAY BE INVOLVED IN DETERMINING OTHER OFFICERS' COMPENSATION, HOWEVER THE ULTIMATE DECISION RESTS WITH THE BOARD. THE PROCESS WAS LAST UNDERTAKEN DURING MARCH 2015.

FORM 990, PART VI, SECTION C, LINE 19

THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. THE ORGANIZATION DOES NOT HAVE ITS OWN CONFLICT OF INTEREST POLICY.

FORM 990, PART IX, LINE 11G

OUTSIDE SERVICES: PROGRAM SERVICE EXPENSES 4,196,862. MANAGEMENT AND GENERAL EXPENSES 12,163,646. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 16,360,508. CONTRACT LABOR: PROGRAM SERVICE EXPENSES 41,246. MANAGEMENT AND GENERAL EXPENSES 4,484,211. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,525,457. OTHER FEES: PROGRAM SERVICE EXPENSES 255,438. MANAGEMENT AND GENERAL EXPENSES 779,179. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,034,617.

FORM 990, PART XI, LINE 9:

TRANSFERS TO/FROM AFFILIATES 34,126,471.

FORM 990, PART XI, LINE 2C

THE AUDIT OVERSIGHT PROCESS AND THE PROCESS OF SELECTION OF AN INDEPENDENT ACCOUNTANT HAVE NOT CHANGED FROM THE PRIOR YEAR.

FORM 990, PART VI, LINE 16

THE ORGANIZATION DOES NOT HAVE IN PLACE A WRITTEN POLICY TO EVALUATE ITS PARTICIPATION IN JOINT VENTURES, HOWEVER IT MAKES SURE TO TAKE THE NECESSARY PRECAUTIONS TO SAFEGUARD ITS TAX-EXEMPT STATUS. IN ADDITION, LEGAL COUNSEL IS CONSULTED BEFORE CONSIDERING A NEW JOINT VENTURE.

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2014

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