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.
MediumBullet Attach to Form 990 or 990-EZ.
MediumBullet Go to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2017
Open to Public
Inspection
Name of the organization
COMMUNITY HOSPITAL HEALTH SERVICES
FOUNDATION
Employer identification number

31-1181991
Return Reference Explanation
FORM 990, PART VI, SECTION B, LINE 11B IN THE EVENT THERE IS NOT A TIMELY BOARD MEETING FOR CONTEMPORANEOUS REVIEW, FORM 990 IS FORWARDED VIA ELECTRONIC MAIL OR U.S. MAIL TO EACH BOARD MEMBER FOR HIS/HER REVIEW PRIOR TO FILING WITH THE INTERNAL REVENUE SERVICE. FORM 990 IS ALSO REVIEWED AND DISCUSSED BY THE EXECUTIVE COMMITTEE AND/OR THE FINANCE COMMITTEE PRIOR TO FILING. BOTH COMMITTEES HAVE AUTHORITY TO ACT ON BEHALF OF THE BOARD TO DIRECT THE EXECUTIVE DIRECTOR TO SIGN AND TO FILE FORM 990.
FORM 990, PART VI, SECTION B, LINE 12C CHF REGULARLY AND CONSISTENTLY MONITORS AND ENFORCES COMPLIANCE WITH ITS CONFLICT OF INTEREST POLICY BY: 1) EACH PERSON NOMINATED TO THE BOARD OF TRUSTEES COMPLETES A CONFLICTS OF INTEREST DISCLOSURE CERTIFICATE; 2) ANNUALLY BY FEBRUARY 15, EACH TRUSTEE COMPLETES A CONFLICTS OF INTEREST DISCLOSURE CERTIFICATE; 3) A SUMMARY OF ALL CONFLICTS DISCLOSED BY TRUSTEES IS DISTRIBUTED TO ALL TRUSTEES AT THE APRIL QUARTERLY MEETING; 4) TRUSTEES WITH A CONFLICT RELATIVE TO SPECIFIC ITEMS OF DELIBERATION ARE ADVISED BY THE CHAIR TO REFRAIN FROM DISCUSSION AND VOTING OR ARE EXCUSED FROM THE MEETING IF THE CONFLICT IS MATERIAL; 5) THE CONTEMPORANEOUS MINUTES OF THE MEETING REFLECT THE NATURE OF THE CONFLICT AND THE FACT THAT THE MEMBER DID NOT PARTICIPATE IN DISCUSSION OR VOTING ON THE ITEM UNDER DELIBERATION.
FORM 990, PART VI, SECTION B, LINE 15A A COMPENSATION COMMITTEE OF 3-4 DISINTERESTED MEMBERS OF THE BOARD OF TRUSTEES IS APPOINTED BY THE CHAIRMAN OF THE BOARD. PROGRESS REPORT ON CEO GOALS IS REVIEWED, PERFORMANCE REVIEW SCORE SHEETS ARE COMPLETED INDIVIDUALLY BY MEMBERS, AND CEO PERFORMANCE IS REVIEWED AND COMPENSATION DETERMINED DURING A MEETING OF THE WHOLE COMMITTEE. COMPENSATION IS SET TAKING INTO ACCOUNT PERFORMANCE (MERIT) AND MARKET RANGES FOR SIMILAR POSITIONS. THERE ARE NO OTHER OFFICERS OR KEY EMPLOYEES RECEIVING COMPENSATION.
FORM 990, PART VI, SECTION C, LINE 18 MOST RECENT FORM 990 PLUS PRIOR TWO FISCAL YEARS' 990S ARE POSTED ON COMMUNITY HOSPITAL HEALTH SERVICES FOUNDATION WEBSITE. REQUESTS FOR A COPY OF THE FORM 990 FOR ANY FISCAL YEAR MAY BE MADE BY TELEPHONE, ELECTRONIC MAIL, U.S. MAIL OR IN PERSON. REQUESTS WILL BE HONORED WITHIN 5 WORKING DAYS. A NOMINAL CHARGE TO COVER THE COST OF COPYING MAY BE MADE.
FORM 990, PART VI, SECTION C, LINE 19 COPIES OF GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS MAY BE REQUESTED BY TELEPHONE, ELECTRONIC MAIL, U.S. MAIL OR IN PERSON; REQUESTS WILL BE HONORED WITHIN 5 WORKING DAYS. A NOMINAL CHARGE MAY BE MADE. AUDITED ANNUAL FINANCIAL STATEMENTS ARE ALSO AVAILABLE ON THE COMMUNITY HOSPITAL HEALTH SERVICES FOUNDATION WEBSITE.
FORM 990, PART XI, LINE 9: SEE SCHEDULE D 1,349,456.
PART XI LINE 2C COMMUNITY HOSPITAL HEALTH SERVICES FOUNDATION HAS NOT CHANGED ITS OVERSIGHT OR SELECTION PROCESS DURING THE TAX YEAR.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2017


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