SCHEDULE O
(Form 990)

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.
Attach to Form 990 or 990-EZ.
Go to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2023
Open to Public
Inspection
Name of the organization
MEMORIAL COMMUNITY HOSPITAL FOUNDATION
CORPORATION
Employer identification number

11-3660156
Return Reference Explanation
FORM 990, PART VI, SECTION A, LINE 3 COMPENSATION OF THE CEO AND CFO OF MEMORIAL COMMUNITY HOSPITAL FOUNDATION (FOUNDATION) AND CEO AND CFO OF MEMORIAL COMMUNITY HOSPITAL (HOSPITAL) IS PROVIDED BY CHI HEALTH. THE CEO AND CFO ARE EMPLOYEES OF CHI HEALTH AND THE HOSPITAL REIMBURSES CHI HEALTH FOR THE CEO'S AND CFO'S COMPENSATION AND BENEFITS. THE HOSPITAL PAYS CHI HEALTH A MANAGEMENT FEE EQUAL TO THE DIRECT COST OF THE CEO'S AND CFO'S COMPENSATION AND BENEFITS PLUS 10% OF THE HOSPITAL'S EARNINGS BEFORE INTEREST, DEPRECIATION, AND AMORTIZATION OR A MAXIMUM OF $500,000 FOR CHI HEALTH'S SUPPORT.
FORM 990, PART VI, SECTION A, LINE 6 MEMORIAL COMMUNITY HOSPITAL FOUNDATION ("FOUNDATION") HAS ONE MEMBER - MEMORIAL COMMUNITY HEALTH SYSTEM, INC. ("MCHS").
FORM 990, PART VI, SECTION A, LINE 7A MCHS IS A 501(C)(3) ORGANIZATION RESPONSIBLE FOR APPOINTING ALL BOARD MEMBERS OF THE FOUNDATION.
FORM 990, PART VI, SECTION B, LINE 11B NO REVIEW WAS OR WILL BE CONDUCTED.
FORM 990, PART VI, SECTION B, LINE 12C EACH BOARD MEMBER ANNUALLY SIGNS A CONFLICT OF INTEREST STATEMENT AND IS GIVEN A COPY OF THE CONFLICT OF INTEREST POLICY. THE CHAIRMAN OF THE BOARD REVIEWS THESE STATEMENTS AND ENSURES THAT BOARD MEMBERS EXCUSE THEMSELVES FROM DISCUSSIONS AT BOARD MEETINGS ON TOPICS WHERE THEY HAVE A CONFLICT OF INTEREST.
FORM 990, PART VI, SECTION B, LINE 15 THE OFFICERS OF THE BOARD ARE NOT COMPENSATED FOR THEIR DUTIES; THEY ARE VOLUNTEERS. THE OFFICERS OF THE CORPORATION (THE EXECUTIVES) ARE COMPENSATED BASED ON RECOMMENDATIONS OF THE COMPENSATION COMMITTEE OF THE BOARD. THE COMPENSATION COMMITTEE OF THE HOSPITAL LOOKS AT COMPARATIVE INDUSTRY SALARY INFORMATION IN SETTING BASE SALARIES, AND REVIEWS AND APPROVES THE INDIVIDUAL GOALS PROPOSED BY THE EXECUTIVE TEAM FOR INCENTIVE COMPENSATION.
FORM 990, PART VI, SECTION C, LINE 19 MEMORIAL COMMUNITY HOSPITAL FOUNDATION'S AUDIT REPORT IS MADE AVAILABLE TO THE PUBLIC. THE CONFLICT OF INTEREST POLICY AND GOVERNING DOCUMENTS ARE NOT AVAILABLE TO THE PUBLIC.
FORM 990, PART VII, SECTION A, LINE 1A MANUELA BANNER-WOLF IS THE CEO OF MEMORIAL COMMUNITY HOSPITAL AND IS PAID BY CHI HEALTH. MEMORIAL COMMUNITY HOSPITAL PAID CHI HEALTH FOR HER SERVICES PROVIDED. THEREFORE, MANUELA BANNER-WOLF SHOWS $0 REPORTABLE COMPENSATION FROM THE FILING ORGANIZATION AND FROM ANY RELATED ORGANIZATION AS THEY WERE DIRECTLY PAID BY CHI HEALTH.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990) 2023


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