Attach to Form 990 or Form 990-EZ.
See separate instructions.| (i) Name of supported organization |
(ii) EIN |
(iii) Type of organization (described on lines 1- 9 above or IRC section (see instructions)) |
(iv) Is the organization in col. (i) listed in your governing document? |
(v) Did you notify the organization in col. (i) of your support? |
(vi) Is the organization in col. (i) organized in the U.S.? |
(vii) Amount of support? |
|||
|---|---|---|---|---|---|---|---|---|---|
| Yes | No | Yes | No | Yes | No | ||||
| (1)
SW Gen Hlth Cntr |
340753531 | 3 | Yes | Yes | Yes | 0 | |||
| (2)
SW Com Foundation |
341455135 | 11 | Yes | Yes | Yes | 0 | |||
| Total | |||||||||
| Calendar year(or fiscal year beginning in) | (a) 2006 | (b) 2007 | (c) 2008 | (d) 2009 | (e) 2010 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .... | ||||||
| 2 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf....... | ||||||
| 3 | The value of services or facilities furnished by a governmental unit to the organization without charge.. | ||||||
| 4 | Total. Add lines 1 through 3.. | ||||||
| 5 | The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f).. | ||||||
| 6 | Public Support. Subtract line 5 from line 4. | ||||||
| Calendar year(or fiscal year beginning in) | (a) 2006 | (b) 2007 | (c) 2008 | (d) 2009 | (e) 2010 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | ||||||
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | ||||||
| 9 | Net income from unrelated business activities, whether or not the business is regularly carried on.. | ||||||
| 10 | Other income. (Explain in Part IV.) Do not include gain or loss from the sale of capital assets.. | ||||||
| 11 | Total support (Add lines 7 through 10). | ||||||






| Calendar year(or fiscal year beginning in) | (a) 2006 | (b) 2007 | (c) 2008 | (d) 2009 | (e) 2010 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") . | ||||||
| 2 | Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose...... | ||||||
| 3 | Gross receipts from activities that are not an unrelated trade or business under section 513.. | ||||||
| 4 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf... | ||||||
| 5 | The value of services or facilities furnished by a governmental unit to the organization without charge.. | ||||||
| 6 | Total. Add lines 1 through 5. | ||||||
| 7a | Amounts included on lines 1, 2, and 3 received from disqualified persons... | ||||||
| b | Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year. | ||||||
| c | Add lines 7a and 7b.. | ||||||
| 8 | Public Support (Subtract line 7c from line 6.) | ||||||
| Calendar year (or fiscal year beginning in) | (a) 2006 | (b) 2007 | (c) 2008 | (d) 2009 | (e) 2010 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | ||||||
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | ||||||
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | ||||||
| c | Add lines 10a and 10b. | ||||||
| 11 | Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on. | ||||||
| 12 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.) | ||||||
| 13 | Total support (Add lines 9, 10c, 11 and 12.). | ||||||




| Facts And Circumstances Test |
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| Explanation |
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| Software ID: | 10000149 |
| Software Version: | 2010.2.15 |
Attach to Form 990 or 990-EZ.| Identifier | Return Reference | Explanation |
|---|---|---|
| Form 990 Part VI | 7a | The Health Center recieves support from six communities. The tax levy communities of Berea, Brook Park, Columbia Township, Middlebur Hts., Olmsted Falls, and Strongsville. Each of the six communities has the right to elect or appoint four trustees to the Board. |
| Form 990 Part VI | 11b | The 990 is reviewed internally by the CEO, CFO, and Controller. It is presented and reviewed at the Audit Committee of the Board of Trustees Governing Board meeting on October 12, 2011. The return is distributed electronically to the entire board and reviewed at the board meeting. |
| Form 990 Part VI | 12c | Southwest has a written conflict of interest policy that requires our officers, directors, and employees to annually disclose potential conflicts of themselves and their family members on a questionnaire distributed by the Compliance Officer. If a designated person discloses in writing a circumstance that falls within the terms and conditions of Southwests policy, such disclosures shall be reviewed by Southwests Corporate Compliance Officer and, as applicable, Southwests Legal Councel to determine the appropriate course of action. In some cases, the Governance and Ethics Committees of the Health Center may be included in the review. |
| Form 990 Part VI | 15a | The CEO and other officers receive all compensation from Southwest General Health Center. Southwest has a CEO Oversight Board committee that annually reviews the CEOs salary. The committee uses an outside consultant to perform a salary survey using data about similarly situated executives in other organizations. Documentation for these decisions are currently kept by Southwest General Health Centers Human Resources department. |
| Form 990 Part VI | 15b | Executive Salary actions are reviewd with the CEOOversight Board Committee. |
| Form 990 Part VI | 19 | Board of Trustee lists, Mission and Vision statement. and the annual report is available on our website at swgeneral.com. The 990 is available upon request. |
| Form 990 Part VII | 1 | Thomas Selden, President and CEO of Southwest General Health Center is also on the Board of Southwest Community Health System and Southwest Community Health Foundation. An average of two hours per week are devoted to System and an average of one hour per week is devoted to Foundation, both are related non profit organizations. |
| Form 990 Part VII | 35 | Mary Ann Freas, Sr. Vice President and CFO of Southwest General Health Center spends an average of two hours per week devoted to System and an average of one hour per week devoted to Foundation, both are related non profit organizations. |
| Form 990 Part VI | 36 | Susan Scheutzow Chief Legal Councel of Southwest General Health Center spends an average of two hours per week devoted to System and an average of one hour per week devoted to Foundation, both are related non profit organizations. |
| Form 990 Part VII | 37 | Kelly Linson, Vice President and Chief Accounting Officer of Southwest General Health Center spends an average of two hours per week devoted to System and an average of one hour per week devoted to Foundation, both are related non profit organizations. |
| Software ID: | 10000149 |
| Software Version: | 2010.2.15 |