Department of the Treasury Internal Revenue Service
Public Charity Status and Public Support
Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.
Attach to Form 990 or Form 990-EZ. See separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
HANOVER HOSPITAL INC
Employer identification number
23-1360851
Part I
Reason for Public Charity Status
(All organizations must complete this part.) See instructions
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
11
e
By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons other than foundation managers and other than one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2).
f
If the organization received a written determination from the IRS that it is a Type I, Type II or Type III supporting organization, check this box
..................................................
g
Since August 17, 2006, has the organization accepted any gift or contribution from any of the following persons?
(i) a person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
and (iii) below, the governing body of the the supported organization?
................
11g(i)
(ii)
a family member of a person described in (i) above?
......................
11g(ii)
(iii)
a 35% controlled entity of a person described in (i) or (ii) above?
................
11g(iii)
h
Provide the following information about the supported organization(s).
(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
Total
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 2
Part II
Support Schedule for Organizations Described in IRC 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi) (Complete only if you checked the box on line 5, 7, or 8 of Part I or if the
organization failed to qualify under Part III. If the organization fails to
qualify under the tests listed below, please complete Part III.)
Section A. Public Support
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.
Section B. Total Support
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).
12
Gross receipts from related activities, etc. (See instructions.)
..................
12
13
First Five Years
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here..........................................
Section C. Computation of Public Support Percentage
14
Public Support Percentage for 2010 (line 6 column (f) divided by line 11 column (f))
.........
14
15
Public Support Percentage for 2009 Schedule A, Part II, line 14
...............
15
16a
33 1/3% support test—2010.
If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization
......................
b
33 1/3% support test—2009.
If the organization did not check the box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization
.....................
17a
10%-facts-and-circumstances test—2010.
If the organization did not check a box on line 13, 16a, or 16b and line 14
is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here. Explain
in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly supported
organization
..................................................
b
10%-facts-and-circumstances test—2009.
If the organization did not check a box on line 13, 16a, 16b, or 17a and line
15 is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here.
Explain in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly supported organization
..............................................
18
Private Foundation
If the organization did not check a box on line 13, 16a, 16b, 17a or 17b, check this box and see
instructions
...................................................
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 3
Part III
Support Schedule for Organizations Described in IRC 509(a)(2) (Complete only if you checked the box on line 9 of Part I or if the organization
failed to qualify under Part II. If the organization fails to qualify under
the tests listed below, please complete Part II.)
Section A. Public Support
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.)
Section B. Total Support
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.).
14
First Five Years
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here.............................................
Section C. Computation of Public Support Percentage
15
Public Support Percentage for 2010 (line 8 column (f) divided by line 13 column (f))
.........
15
16
Public support percentage from 2009 Schedule A, Part III, line 15
...............
16
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2010 (line 10c column (f) divided by line 13 column (f))
......
17
18
Investment income percentage from 2009 Schedule A, Part III, line 17
.............
18
19a
33 1/3% support tests—2010.
If the organization did not check the box on line 14, and line 15 is more than 33 1/3% and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
..........
b
33 1/3% support tests—2009.
If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
....
20
Private Foundation
If the organization did not check a box on line 14, 19a or 19b, check this box and see instructions
.....
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 4
Part IV
Supplemental Information.
Supplemental Information. Complete this part to provide the explanation required by Part II, line 10; Part II, line 17a or 17b; or Part III, line 12. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
Explanation
Schedule A (Form 990 or 990-EZ) 2010
Additional Data
Software ID:
Software Version:
-
TIN:
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.
Attach to Form 990 or 990-EZ.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
HANOVER HOSPITAL INC
Employer identification number
23-1360851
Identifier
Return Reference
Explanation
FORM 990, PART VI, SECTION B, LINE 11
REVIEW OF THE DRAFT OF THE FORM 990 IS PERFORMED BY MANAGEMENT WITH THE OUTSIDE ACCOUNTING FIRM. ALL MEMBERS OF THE BOARD OF DIRECTORS ARE GIVEN A FINAL COPY OF THE FORM 990 PRIOR TO FILING WITH THE IRS. THE FINAL SUBMISSION IS REVIEWED BY THE FINANCE COMMITTTEE AFTER IT IS FILED SO THAT THEIR QUESTIONS AND CONCERNS MAY BE ADDRESSED.
FORM 990, PART VI, SECTION B, LINE 12C
HH'S CODE OF CONDUCT CONTAINS PRINCIPLES OUTLINING THE POLICY OF HH AND STANDARDS THAT ARE INTENDED TO PROVIDE GUIDANCE TO ALL INDIVIDUALS PARTICIPATING IN HH'S OPERATIONS. THE PRINCIPLES AND STANDARDS SHALL BE DISTRIBUTED AT LEAST ANNUALLY TO ALL DIRECTORS, OFFICERS, EMPLOYEES AND AGENTS OF HH. INDIVIDUALS ARE RESPONSIBLE TO ENSURE THAT THEIR BEHAVIOR AND ACTIVITY IS CONSISTENT WITH THE CODE OF CONDUCT. THE TERM "INDIVIDUALS" INCLUDES DIRECTORS, EMPLOYEES AND AGENTS OF HH AND INCLUDES ANY PERSON WHO FILLS SUCH A ROLE OR PROVIDES SERVICES ON BEHALF OF HH INCLUDING NON-EMPLOYED MEMBERS OF HH'S MEDICAL STAFF PROVIDING SERVICES IN HH, NON-PHYSICIAN PRACTITIONERS EXERCISING PRIVILEGES IN HH, INTERNS AND MEDICAL STUDENTS AND SHALL INCLUDE VOLUNTEERS IN HH. UPON HIRE AND ANNUALLY THEREAFTER, ALL EMPLOYEES MUST COMPLETE OUR COMPLIANCE TRAINING, INCLUDING REVIEW OF OUR CODE OF CONDUCT STATEMENT. A COPY OF THE CODE OF CONDUCT IS LOCATED IN HH'S ADMINISTRATIVE POLICY MANUAL. OUR CODE OF CONDUCT HAS STANDARDS AND POLICIES THAT ADDRESS CONFLICTS OF INTEREST. IT IS EACH EMPLOYEE'S RESPONSIBILITY TO REVIEW AND COMPLY WITH THE CODE OF CONDUCT OR DISCUSS ANY QUESTIONS OR REPORT ANY CONCERNS TO THE CORPORATE DIRECTOR OF COMPLIANCE. INDIVIDUALS ARE INSTRUCTED THAT THEY OWE UNDIVIDED AND UNQUALIFIED LOYALTY TO HH. INDIVIDUALS MAY NOT USE THEIR POSITIONS TO PROFIT PERSONALLY OR TO ASSIST OTHERS IN PROFITING IN ANY WAY AT THE EXPENSE OF HH. INDIVIDUALS ARE EXPECTED TO CONDUCT THEMSELVES SO AS TO AVOID ACTUAL IMPROPRIETY AND/OR APPEARANCE OF IMPROPRIETY IN DEALING WITH HH AND TO AVOID DISCLOSURE OR PRIVATE USE OF THE BUSINESS AFFAIRS OR PLANS OF HH. DETERMINATION OF WHETHER A CONFLICT OF INTEREST EXISTS OR NOT AND THE ASSIGNMENT OF ANY NECESSARY ACTION IS MADE BY THE HH'S AUDIT COMMITTEE, A SUBCOMMITTEE OF OUR BOARD OF DIRECTORS. PARTICIPATION ON BOARD OF DIRECTORS/TRUSTEES: - AN INDIVIDUAL MUST OBTAIN APPROVAL OF HH COMPLIANCE OFFICER PRIOR TO SERVING AS A MEMBER OF THE BOARD OF DIRECTORS/TRUSTEES OF ANY ORGANIZATION WHOSE INTERESTS MAY CONFLICT WITH THOSE OF HH. AN INDIVIDUAL WHO IS ASKED OR SEEKS TO SERVE ON THE BOARD OF DIRECTORS/TRUSTEES OF ANY ORGANIZATION WHOSE INTEREST WOULD NOT IMPACT HH (E.G., CIVIC, CHARITABLE, FRATERNAL, ETC.) WILL NOT BE REQUIRED TO OBTAIN APPROVAL. - INDIVIDUALS SHALL SEEK THE APPROVAL OF HH COMPLIANCE OFFICER PRIOR TO RETAINING ANY FEES OR COMPENSATION (OTHER THAN REIMBURSEMENT FOR EXPENSES) THAT ARE RECEIVED BY THE INDIVIDUAL FOR BOARD SERVICES WHICH MAY HAVE BEEN RENDERED DURING NORMAL PAID WORK TIME AS AN EMPLOYEE OF HH.
FORM 990, PART VI, SECTION B, LINE 15
THE COMPENSATION COMMITTEE, CONSISTING OF INDEPENDENT MEMBERS OF THE HANOVER HOSPITAL BOARD OF DIRECTORS, COMMISSIONED AN INDEPENDENT AGENCY TO ESTABLISH A SALARY RANGE UTILIZING FIVE INDEPENDENT COMPENSATION SURVEYS. THE COMPENSATION OF TOP MANAGEMENT OFFICIALS WAS SET BY THE COMMITTEE UTILIZING THIS DATA AND WAS SUBSEQUENTLY APPROVED BY THE BOARD OF DIRECTORS IN EXECUTIVE SESSION.
FORM 990, PART VI, SECTION C, LINE 18
THE ORGANIZATION MAKES FORMS 1023 AND 990 AVAILABLE TO THE PUBLIC UPON REQUEST.
FORM 990, PART VI, SECTION C, LINE 19
THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST.
BOARD MEMBER COMPENSATED BY RELEATED ORGANIZATION:
PART VII, SECTION A
PAUL F. DENDE, BOARD MEMBER, IS COMPENSATED ENTIRELY BY A RELATED ORGANIZATION, HANOVER HEALTHCARE PLUS. HE WORKS APPROXIMATELY 36 HOURS PER WEEK FOR THAT ORGANIZATION.
CHANGES IN NET ASSETS OR FUND BALANCES:
FORM 990, PART XI, LINE 5:
NET UNREALIZED GAINS ON INVESTMENTS: 3,991,299. NET ASSET TRANSFER TO AFFILIATE -5,110,000. OTHER 33,656. TOTAL TO FORM 990, PART XI, LINE 5: -1,085,045.
OVERSIGHT OF AUDIT:
FORM 990, PART XI, LINE 2C
THERE HAVE BEEN NO CHANGES DURING THE YEAR IN THE PROCESS FOR OVERSIGHT OF THE AUDIT OF THE FINANCIAL STATEMENTS.
FORM 990, SCHEDULE K, PART III, LINE 3
THERE ARE NO MANAGEMENT OR SERVICE CONTRACTS OR RESEARCH AGREEMENTS RELATING TO THE FINANCED PROPERTIES FOR THE 2005 BONDS.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.