TY 2010 Form 990

(A) Name and Title	(B) Average hours per week (describe hours for related organizations in Schedule O)	(C) Position (check all that apply)
(1) M Shan Atkins Director	1.0	X	0	0
(2) James H Bishop Director	1.0	X	350	0
(3) Beth A Brooks Director	1.0	X	0	0
(4) Craig E Christell Director	1.0	X	550	0
(5) Dale J Garber Director	1.0	X	0	0
(6) Louis A Gatta Director	1.0	X	550	0
(7) Charles A Hempfling Director	1.0	X	750	0
(8) Diane G Hill Director	1.0	X	550	401
(9) Francis J Lamberta MD Director/Med Staff Pres. 2011	1.0	X	350	0
(10) Robert J Longo MD Director	1.0	X	350	0
(11) Allen S Malmed MD Director/Med Staff Pres. 2010	10.0	X	48,550	0
(12) Louis J Marsico Director	1.0	X	550	0
(13) Ali N Shariatzadeh MD Director 2010	10.0	X	350	0
(14) Donald D Torisky Director 2010	1.0	X	750	0
(15) Marla E Glabe Director	1.0	X	0	0
(16) Mary R Sheahen Director	1.0	X	350	0
(17) William D Soper MD Director	1.0	X	0	0

(A) Name and Title	(B) Average hours per week (describe hours for related organizations in Schedule O)	(C) Position (check all that apply)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(18) Daniel P DiCaro Chairperson 2010	1.0	X	X				550	0	0
(19) Max Brittain Jr Vice Chair 2010; Chair 2011	10.0	X	X				550	0	0
(20) Thomas P MacCarthy Vice Chairperson 2011	10.0	X	X				350	0	0
(21) Bruce K Crowther PRESIDENT/CEO/SECRETARY	26.0	X	X				573,021	0	218,463
(22) Michael B Zenn Exec Vice Pres/COO/Treas. 2010	31.0		X				639,498	163	81,911
(23) Stephen O Scogna EXEC VICE PRES/CFO/TREAS. 2011	31.0		X				0	0	0
(24) Mark Lusson Exec VP Human Resources	40.0			X			291,773	0	63,908
(25) Mary Stack VP Performance Improvement	40.0			X			169,224	0	42,722
(26) Robert Klasek VP Facilities Management	40.0			X			150,676	0	37,841
(27) Gary Skiba VP Operational Services	40.0			X			168,119	0	36,390
(28) Dale Beatty Exec VP Patient Services & CNO	38.0			X			272,752	0	37,913
(29) Leighton Smith MD Exec VP Medical Affairs	40.0			X			483,902	0	78,607
(30) GEORGE MORRIS VP Info Technology & CIO	40.0			X			212,991	0	44,240
(31) LAURA POLLACK VICE PRESIDENT GROWTH	40.0			X			142,665	0	38,451
(32) Ann Sayvetz General Counsel	40.0			X			250,702	0	28,330
(33) Michael C Hartke Exec VP Clinics Regional Servs	40.0			X			355,659	38,562	30,119
(34) Willis G Parsons MD Med Dir GI Center	40.0				X		1,735,307	0	16,642
(35) Malcolm Bilimoria MD Gastroenterology Physician	40.0				X		1,439,819	0	37,765
(36) Rameez Alasadi MD Gastroenterology Physician	40.0				X		733,332	0	26,520
(37) Tahseen Mohammed MD Medical Dir M H Youth Servs	40.0				X		294,293	0	27,868
(38) Sonia Mehta MD Exec Med Dir Immed Care OHS	40.0				X		312,872	0	36,865
(39) Gail A Finn Vice President/ CFO	0.0					X	256,289	0	14,404
(40) Dawn Walden VP Revenue Cycle Management	40.0					X	135,715	0	32,432
(41) Angela Stefaniu VP Mktg Business Development	40.0					X	226,434	0	44,484

(A) Name and business address	(B) Description of services	(C) Compensation
Deloitte Consulting LLP 111 South Wacker Dr CHICAGO,IL60606	CONSULTING SERVICES	2,941,870
Siemens Medical Solutions USA Inc Dept CH 14195 PALATINE,IL60055	IT SUPPORT	2,178,414
Finelight Inc 1801 South Liberty Drive Suite 300 BLOOMINGTON,IN47403	MARKETING	1,869,827
HLS-Wheeling LLC 13028 Collection Center Dr CHICAGO,IL60693	LAUNDRY SERVICES	1,794,848
Transcend Services Inc Dept 40089 PO Box 740209 ATLANTA,GA30374	MED. TRANSCRIPTION	1,581,436
2 Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 in compensation from the organization 88

Do not include amounts reported on lines 6b, 7b, 8b, 9b, and 10b of Part VIII.	(A) Total expenses	(B) Program service expenses	(C) Management and general expenses	(D) Fundraising expenses
1	Grants and other assistance to governments and organizations in the U.S. See Part IV, line 21	2,958,497	2,958,497
2	Grants and other assistance to individuals in the U.S. See Part IV, line 22	0
3	Grants and other assistance to governments, organizations, and individuals outside the U.S. See Part IV, lines 15 and 16	0
4	Benefits paid to or for members	0
5	Compensation of current officers, directors, trustees, and key employees ....	4,277,503		4,277,503
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....	0
7	Other salaries and wages	184,665,591	149,061,791	35,603,800
8	Pension plan contributions (include section 401(k) and section 403(b) employer contributions) ....	11,424,292	8,945,227	2,479,065
9	Other employee benefits .......	29,228,060	22,794,764	6,433,296
10	Payroll taxes ...........	13,028,675	10,394,517	2,634,158
11	Fees for services (non-employees):
a	Management ......	0
b	Legal .........	810,970	23,706	787,264
c	Accounting ...........	338,071		338,071
d	Lobbying ...........	30,000		30,000
e	Professional fundraising. See Part IV, line 17..	0
f	Investment management fees ......	176,215		176,215
g	Other ..........	25,615,079	11,473,517	14,141,562
12	Advertising and promotion ....	1,826,109	7,220	1,818,889
13	Office expenses .......	80,653,525	76,217,639	4,435,886
14	Information technology ......	6,499,159	5,061,262	1,437,897
15	Royalties ..	0
16	Occupancy ...........	9,817,170	8,825,108	992,062
17	Travel ............	516,077	293,237	222,840
18	Payments of travel or entertainment expenses for any federal, state, or local public officials ......	0
19	Conferences, conventions, and meetings ....	286,877	229,226	57,651
20	Interest ...........	8,193,608	8,193,608
21	Payments to affiliates .......	0
22	Depreciation, depletion, and amortization .....	40,268,458	30,997,149	9,271,309
23	Insurance ..............	6,942,266	6,724,572	217,694
24	Other expenses. Itemize expenses not covered above. (Expenses grouped together and labeled miscellaneous may not exceed 5% of total expenses shown on line 25 below.)
a	Bad Debt	41,968,664	41,968,664
b	Illinois provider tax	11,676,136	11,676,136
c	Dues	316,243	42,370	273,873
d	Other	464,151	12,335	451,816
e
f	All other expenses
25	Total functional expenses. Add lines 1 through 24f	481,981,396	395,900,545	86,080,851	0
26	Joint costs. Check here if following SOP 98-2 (ASC 958-720). Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation

Part X Balance Sheet
	1	Cashnon-interest-bearing ..........	16,891,000	1	15,555,289
2	Savings and temporary cash investments .......	2,397,078	2	3,112,463
3	Pledges and grants receivable, net .........		3
4	Accounts receivable, net .........	51,457,091	4	55,078,694
5	Receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
	Schedule L ..........	90,465	5	94,386
6	Receivables from other disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B). Complete Part II of
	Schedule L ..........		6
7	Notes and loans receivable, net .............	283,430	7	305,372
8	Inventories for sale or use ..............	4,483,867	8	4,752,063
9	Prepaid expenses and deferred charges ............	9,536,463	9	6,193,121
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	645,198,526
b	Less: accumulated depreciation. .....	10b	245,766,920	407,905,178	10c	399,431,606
11	Investments—publicly traded securities ..........	104,611,294	11	94,056,794
12	Investments—other securities. See Part IV, line 11 ......		12
13	Investments—program-related. See Part IV, line 11 ..	5,433,417	13	5,753,291
14	Intangible assets .........		14
15	Other assets. See Part IV, line 11 ...........	7,856,247	15	7,076,204
16	Total assets. Add lines 1 through 15 (must equal line 34)...	610,945,530	16	591,409,283
	17	Accounts payable and accrued expenses .	64,574,817	17	65,928,264
18	Grants payable ..........		18
19	Deferred revenue ..........	6,463,988	19	3,090,185
20	Tax-exempt bond liabilities ..........	288,780,000	20	283,300,000
21	Escrow or custodial account liability. Complete Part IV of Schedule D..		21
22	Payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
	persons. Complete Part II of Schedule L..........		22
23	Secured mortgages and notes payable to unrelated third parties ..		23
24	Unsecured notes and loans payable to unrelated third parties ....		24
25	Other liabilities. Complete Part X of Schedule D.....	80,898,436	25	87,991,814
26	Total liabilities. Add lines 17 through 25.....	440,717,241	26	440,310,263
		Organizations that follow SFAS 117, check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets .....	164,794,872	27	145,345,729
28	Temporarily restricted net assets .....	4,475,858	28	4,793,222
29	Permanently restricted net assets .....	957,559	29	960,069
	Organizations that do not follow SFAS 117, check here and complete lines 30 through 34.
30	Capital stock or trust principal, or current funds .....		30
31	Paid-in or capital surplus, or land, building or equipment fund .....		31
32	Retained earnings, endowment, accumulated income, or other funds		32
33	Total net assets or fund balances .....	170,228,289	33	151,099,020
34	Total liabilities and net assets/fund balances .....	610,945,530	34	591,409,283

- TIN:

SCHEDULE A
(Form 990 or 990EZ)

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. right arrow

See separate instructions.

OMB No. 1545-0047

2010

Open to Public
Inspection

Name of the organization

Northwest Community Hospital

Employer identification number

36-2340313

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.)

A church, convention of churches, or association of churches. section 170(b)(1)(A)(i).

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E.)

A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).

A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital's name, city, and state:

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in

section 170(b)(1)(A)(iv). (Complete Part II.)

A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in

section 170(b)(1)(A)(vi). (Complete Part II.)

A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)

An organization that normally receives: (1) more than 331/3% of its support from contributions, membership fees, and gross

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.)

An organization organized and operated exclusively to test for public safety. Seesection 509(a)(4).

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box that describes the type of supporting organization and complete lines 11e through 11h.

Type I

Type II

Type III - Functionally integrated

Type III - Other

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).

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 ..................................................

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

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)

Provide the following information about the supported organization(s).

(i) Name of supported organization	(ii) EIN	(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?
(i) Name of supported organization	(ii) EIN	Yes	No	Yes	No	Yes	No	(vii) Amount of support?


Total

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

Cat. No. 11285F

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).

Gross receipts from related activities, etc. (See instructions.) ..................

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.......................................... right arrow

Section C. Computation of Public Support Percentage

Public Support Percentage for 2010 (line 6 column (f) divided by line 11 column (f)) .........

Public Support Percentage for 2009 Schedule A, Part II, line 14 ...............

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 ...................... right arrow

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 ..................... right arrow

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 .................................................. right arrow

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 .............................................. right arrow

Private Foundation If the organization did not check a box on line 13, 16a, 16b, 17a or 17b, check this box and see
instructions ................................................... right arrow

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.).

Section C. Computation of Public Support Percentage

Public Support Percentage for 2010 (line 8 column (f) divided by line 13 column (f)) .........

Public support percentage from 2009 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2010 (line 10c column (f) divided by line 13 column (f)) ......

Investment income percentage from 2009 Schedule A, Part III, line 17 .............

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 .......... right arrow

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 .... right arrow

Private Foundation If the organization did not check a box on line 14, 19a or 19b, check this box and see instructions ..... right arrow

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 B
(Form 990, 990-EZ,
or 990-PF)

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

Attach to Form 990, 990-EZ, or 990-PF.

OMB No. 1545-0047

2010

Name of organization

Northwest Community Hospital

Employer identification number

36-2340313

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

4947(a)(1) nonexempt charitable trust not treated as a private foundation

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

4947(a)(1) nonexempt charitable trust treated as a private foundation

501(c)(3) taxable private foundation

Check if your organization is covered by the General Rule or a Special Rule.
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.

General Rule

For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, $5,000 or more (in money or
property) from any one contributor. Complete Parts I and II.

Special Rules

For a section 501(c)(3) organization filing Form 990 or 990-EZ, that met the 33¹/3% support test of the regulations
under sections 509(a)(1) and 170(b)(1)(A)(vi), and received from any one contributor, during the year, a contribution of the
greater of (1) $5,000 or (2) 2% of the amount on (i) Form 990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts I and II.

For a section 501(c)(7), (8), or (10) organization filing Form 990, or 990-EZ, that received from any one contributor,
during the year, aggregate contributions of more than $1,000 for use exclusively for religious, charitable,
scientific, literary, or educational purposes, or the prevention of cruelty to children or animals. Complete Parts I, II, and
III.

For a section 501(c)(7), (8), or (10) organization filing Form 990, or 990-EZ, that received from any one contributor,
during the year, contributions for use exclusively for religious, charitable, etc., purposes, but these contributions did
not aggregate to more than $1,000. If this box is checked, enter here the total contributions that were received during
the year for an exclusively religious, charitable, etc., purpose. Do not complete any of the parts unless the General Rule
applies to this organization because it received nonexclusively religious, charitable, etc., contributions of $5,000 or more
during the year. ......................... Arrow Bullet

Caution. An Organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2 of its Form 990, or check the box in the heading of its
Form 990-EZ, or on line 2 of its Form 990-PF, to certify that it does not meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).

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

Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2010)

Name of organization Northwest Community Hospital
Schedule B (Form 990, 990-EZ, or 990-PF) (2010) Page 1 of 1 of Part I
Part I	Contributors (see Instructions)
(a) No.	(b) Name, address, and ZIP + 4	(c) Aggregate contributions	(d) Type of contribution
RESTRICTED	RESTRICTED RESTRICTED RESTRICTED RESTRICTED, RESTRICTED RESTRICTED	$RESTRICTED	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Aggregate contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Aggregate contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Aggregate contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Aggregate contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Aggregate contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2010)

Name of organization Northwest Community Hospital
Schedule B (Form 990, 990-EZ, or 990-PF) (2010) Page 1 of 1 of Part II
Part II	Noncash Property (see Instructions)
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
Schedule B (Form 990, 990-EZ, or 990-PF) (2010)

Schedule B (Form 990, 990-EZ, or 990-PF) (2010)

Page 1 of 1 of Part III

Name of organization
Northwest Community Hospital

Employer identification number

36-2340313

Part III

Exclusively religious, charitable, etc., individual contributions to section 501(c)(7), (8), or (10) organizations
aggregating more than $1,000 for the year. (Complete columns (a) through (e) and the following line entry.)
For organizations completing Part III, enter the total of exclusively religious, charitable, etc.,
contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet

(a) No.
from
Part I

(b)
Purpose of gift

(d)
Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a) No.
from
Part I

(b)
Purpose of gift

(d)
Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a) No.
from
Part I

(b)
Purpose of gift

(d)
Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a) No.
from
Part I

(b)
Purpose of gift

(d)
Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

Schedule B (Form 990, 990-EZ, or 990-PF) (2010)

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527
SchCMd Bullet

Complete if the organization is described below.
SchCMd Bullet

Attach to Form 990 or Form 990-EZ. SchCMd Bullet

See separate instructions.

OMB No. 1545-0047

2010

Open to Public
Inspection

If the organization answered “Yes,” to Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet

Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet

Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet

Section 527 organizations: Complete Part I-A only.
If the organization answered “Yes,” to Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet

Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)) Complete Part II-A. Do not complete Part II-B.
Round Bullet

Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered “Yes,” to Form 990, Part IV, Line 5 (Proxy Tax) or Form 990-EZ, Part V, line 35a (Proxy Tax), then
Round Bullet

Section 501(c)(4), (5), or (6) organizations: Complete Part III.

Name of the organization

Northwest Community Hospital

Employer identification number

36-2340313

Part I-A

Complete if the organization is exempt under section 501(c) or is a section 527 organization.

Provide a description of the organization's direct and indirect political campaign activities on behalf of or in opposition to candidates for public office in Part IV.

Political expenditures .................................... SchCMd Bullet

Volunteer hours ........................................

Part I-B

Complete if the organization is exempt under section 501(c)(3).

Enter the amount of any excise tax incurred by the organization under section 4955 ......... SchCMd Bullet

Enter the amount of any excise tax incurred by organization managers under section 4955 ...... SchCMd Bullet

If the organization incurred a section 4955 tax, did it file Form 4720 for this year? ..............

Yes No

Was a correction made? .........................................

Yes No

If "Yes," describe in Part IV.

Part I-C

Complete if the organization is exempt under section 501(c) except section 501(c)(3).

Enter the amount directly expended by the filing organization for section 527 exempt function activities SchCMd Bullet

Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt funtion activities .................................... SchCMd Bullet

Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b.. SchCMd Bullet

Did the filing organization file Form 1120-POL for this year? ..........................

Yes No

Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.

(a) Name	(b) Address	(c) EIN	(d) Amount paid from filing organization's funds. If none, enter -0-.	(e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.

For Privacy Act and Paperwork Reduction Act Notice, see the instructions for Form 990.

Cat. No. 50084S

Schedule C (Form 990 or 990-EZ) 2010

Page 2

Part II-A

Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).

A Check if the filing organization belongs to an affiliated group.
B Check if the filing organization checked box A and "limited control" provisions apply.

Limits on Lobbying Expenditures (The term "expenditures" means amounts paid or incurred.)		(b) Affiliated Group Totals
1a	Total lobbying expenditures to influence public opinion (grass roots lobbying) ......
b	Total lobbying expenditures to influence a legislative body (direct lobbying) .......
c	Total lobbying expenditures (add lines 1a and 1b) ...................
d	Other exempt purpose expenditures ........................
e	Total exempt purpose expenditures (add lines 1c and 1d) ...............
f	Lobbying nontaxable amount. Enter the amount from the following table in both columns.
	If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:
	Not over $500,00020% of the amount on line 1e.
	Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.
	Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.
	Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.
	Over $17,000,000$1,000,000.

g	Grassroots nontaxable amount (enter 25% of line 1f) .................
h	Subtract line 1g from line 1a. If zero or less, enter -0-. ................
i	Subtract line 1f from line 1c. If zero or less, enter -0-. ................
j	If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting section 4911 tax for this year? ......................................	Yes No

4-Year Averaging Period Under Section 501(h) (Some organizations that made a section 501(h) election do not have to complete all of the five columns below. See the instructions for lines 2a through 2f on page 4.)
Lobbying Expenditures During 4-Year Averaging Period
	Calendar year (or fiscal year beginning in)	(a) 2007	(b) 2008	(c) 2009	(d) 2010	(e) Total

2a	Lobbying non-taxable amount

b	Lobbying ceiling amount (150% of line 2a, column(e))

c	Total lobbying expenditures

d	Grassroots non-taxable amount

e	Grassroots ceiling amount (150% of line 2d, column (e))

f	Grassroots lobbying expenditures

Schedule C (Form 990 or 990-EZ) 2010

Page 3

Part II-B

Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).

(a)

Yes

(b)

Amount

During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:

Volunteers? .........................................

Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ....

Media advertisements? ....................................

Mailings to members, legislators, or the public? .........................

Publications, or published or broadcast statements? .......................

Grants to other organizations for lobbying purposes? .......................

Yes

30,000

Direct contact with legislators, their staffs, government officials, or a legislative body? ........

Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ......

Other activities? If "Yes," describe in Part IV ..........................

Yes

52,045

Total. lines 1c through 1i ...................................

82,045

Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....

If "Yes," enter the amount of any tax incurred under section 4912 .................

If "Yes," enter the amount of any tax incurred by organization managers under section 4912 .....

If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? .......

Part III-A

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).

Yes

Were substantially all (90% or more) dues received nondeductible by members? ................

Did the organization make only in-house lobbying expenditures of $2,000 or less? ................

Did the organization agree to carryover lobbying and political expenditures from the prior year? ..........

Part III-B

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) if BOTH Part III-A, lines 1 and 2 are answered “No” OR if Part III-A, line 3 is answered “Yes”.

Dues, assessments and similar amounts from members .....................

Section 162(e) non-deductible lobbying and political expenditures (do not include amounts of political
expenses for which the section 527(f) tax was paid).

Current year .........................................

Carryover from last year ....................................

Total ...........................................

Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .

If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ................................

Taxable amount of lobbying and political expenditures (see instructions) ..............

Part IV

Supplemental Information

Complete this part to provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; and Part ll-B, line 1i.
Also, complete this part for any additional information.

Identifier	Return Reference	Explanation
Lobbying Activities	Part II-B, Line 1F	Northwest Community Hospital pays dues to certain hospital associations which use a portion of these dues for lobbying.

Schedule C (Form 990 or 990EZ) 2010

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," to Form 990,
Part IV, line 6, 7, 8, 9, 10, 11, or 12.
SchDMd Bullet

Attach to Form 990. SchDMd Bullet

See separate instructions.

OMB No. 1545-0047

2010

Open to Public Inspection

Name of the organization

Northwest Community Hospital

Employer identification number

36-2340313

Part I

Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" to Form 990, Part IV, line 6.

		(a) Donor advised funds	(b) Funds and other accounts
1	Total number at end of year .......
2	Aggregate contributions to (during year) ...
3	Aggregate grants from (during year) ...
4	Aggregate value at end of year .......

Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ............

Yes No

Did the organization inform all grantees, donors, and donor advisors in writing that grant funds may be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit. ...................................

Yes No

Part II

Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.

Purpose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e.g., recreation or pleasure) Preservation of an historically importantly land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

Complete lines 2a–2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.


a	Total number of conservation easements .......................	2a
b	Total acreage restricted by conservation easements ..................	2b
c	Number of conservation easements on a certified historic structure included in (a) .....	2c
d	Number of conservation easements included in (c) acquired after 8/17/06 ........	2d

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the taxable year SchDMd Bullet

Number of states where property subject to conservation easement is located SchDMd Bullet

Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................

Yes No

Staff and volunteer hours devoted to monitoring, inspecting and enforcing conservation easements during the year SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year SchDMd Bullet

Does each conservation easement reported on line 2(d) above satisfy the requirements of section
170(h)(4)(B)(i) and 170(h)(4)(B)(ii)? ....................................

Yes No

In Part XIV, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" to Form 990, Part IV, line 8.

If the organization elected, as permitted under SFAS 116, not to report in its revenue statement and balance sheet works of
art, historical treasures, or other similar assets held for public exhibition, education or research in furtherance of public service,
provide, in Part XIV, the text of the footnote to its financial statements that describes these items.

If the organization elected, as permitted under SFAS 116, to report in its revenue statement and balance sheet works of art,
historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service,
provide the following amounts relating to these items:

(i)

Revenues included in Form 990, Part VIII, line 1 ........................ SchDMd Bullet

(ii)

Assets included in Form 990, Part X .............................. SchDMd Bullet

If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 relating to these items:

Revenues included in Form 990, Part VIII, line 1 .......................... SchDMd Bullet

Assets included in Form 990, Part X ............................... SchDMd Bullet

For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990

Cat. No. 52283D

Schedule D (Form 990) 2010

Page 2

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)

Using the organization’s accession and other records, check any of the following that are a significant use of its collection
items (check all that apply):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIV.

During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?........

Yes No

Part IV

Escrow and Custodial Arrangements. Complete if the organization answered "Yes" to Form 990,
Part IV, line 9, or reported an amount on Form 990, Part X, line 21.

Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................

Yes No

If "Yes," explain the arrangement in Part XIV and complete the following table:


c	Beginning balance .................................	1c
d	Additions during the year ..............................	1d
e	Distributions during the year .............................	1e
f	Ending balance ...................................	1f

Did the organization include an amount on Form 990, Part X, line 21? .....................

Yes No

If “Yes,” explain the arrangement in Part XIV.

Part V

Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.

		(a)Current Year	(b)Prior Year	(c)Two Years Back
1a	Beginning of year balance ....	2,248,734	2,160,499	2,131,037
b	Contributions ........	169,337	9,266	39,825
c	Investment earnings or losses ...	-10,576	78,969	-10,363
d	Grants or scholarships .....
e	Other expenditures for facilities and programs ........	87,845
f	Administrative expenses ....
g	End of year balance ......	2,319,650	2,248,734	2,160,499

Provide the estimated percentage of the year end balance held as:

Board designated or quasi-endowment: SchDMd Bullet

51.000 %

Permanent endowment: SchDMd Bullet

49.000 %

Term endowment: SchDMd Bullet

0 %

Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes

(i) unrelated organizations ........................

3a(i)

(ii) related organizations ........................

3a(ii)

Yes

If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........

Yes

Describe in Part XIV the intended uses of the organization's endowment funds.

Part VI

InvestmentsLand, Buildings, and Equipment. See Form 990, Part X, line 10.

Description of investment		(b)Cost or other basis (other)	(c) Accumulated depreciation	(d) Book value
1a	Land .................	1,789,072		1,789,072
b	Buildings ................	307,048,484	98,457,960	208,590,524
c	Leasehold improvements ............	213,114,236	90,707,544	122,406,692
d	Equipment ................	105,980,254	48,206,919	57,773,335
e	Other .................	17,266,480	8,394,497	8,871,983
Total. Add lines 1a-1e. (Column (d) should equal Form 990, Part X, column (B), line 10(c).)........				399,431,606

Schedule D (Form 990) 2010

Page 3

Part VII

InvestmentsOther Securities. See Form 990, Part X, line 12.

(a) Description of security or category (including name of security)		(b)Book value	(c) Method of valuation: Cost or end-of-year market value
(1)Financial derivatives
(2)Closely-held equity interests
Other








Total. (Column (b) should equal Form 990, Part X, col.(B) line 12.)

Part VIII

InvestmentsProgram Related. See Form 990, Part X, line 13.

(a) Description of investment type		(b) Book value	(c) Method of valuation: Cost or end-of-year market value









Total. (Column (b) should equal Form 990, Part X, col.(B) line 13.)

Part IX

Other Assets. See Form 990, Part X, line 15.

(a) Description				(b) Book value









Total. (Column (b) should equal Form 990, Part X, col.(B) line 15.)...........

Part X

Other Liabilities. See Form 990, Part X, line 25.

1.(a) Description of Liability		(b) Amount
Federal Income Taxes		0
PENSION OBLIGATION		53,071,853
DUE TO THIRD-PARTY PAYORS		30,447,201
INTEREST RATE SWAP LIABILITY		2,127,017
ASSET RETIREMENT OBLIGATION		1,046,437
DUE TO AFFILIATES		145,868
SHORT TERM CAPITAL LEASE OBLIGATION		250,257
LONG TERM CAPITAL LEASE OBLIGATION		903,181


Total. (Column (b) should equal Form 990, Part X, col.(B) line 25.)		87,991,814
2. Fin 48 (ASC 740) Footnote. In Part XIV, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC740).

Schedule D (Form 990) 2010

Page 4

Part XI Reconciliation of Change in Net Assets from Form 990 to Financial Statements
1	Total revenue (Form 990, Part VIII, column (A), line 12) ....................	1
2	Total expenses (Form 990, Part IX, column (A), line 25) .....................	2
3	Excess or (deficit) for the year. Subtract line 2 from line 1 .............	3
4	Net unrealized gains (losses) on investments ..........................	4
5	Donated services and use of facilities .............................	5
6	Investment expenses ...................................	6
7	Prior period adjustments ..................................	7
8	Other (Describe in Part XIV) .................................	8
9	Total adjustments (net). Add lines 4 - 8 .............................	9
10	Excess or (deficit) for the year per financial statements. Combine lines 3 and 9 .........	10

Part XII Reconciliation of Revenue per Audited Financial Statements With Revenue per Return
1	Total revenue, gains, and other support per audited financial statements .......		1
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains on investments ..........	2a
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIV): ............	2d
e	Add lines 2a through 2d .....................		2e
3	Subtract line 2e from line 1.....................		3
4	Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b .	4a
b	Other (Describe in Part XIV): ...........	4b
c	Add lines 4a and 4b.......................		4c
5	Total Revenue. Add lines 3 and 4c. (This should equal Form 990, Part I, line 12.) ......		5

Part XIII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return
1	Total expenses and losses per audited financial statements .............		1
2	Amounts included on line 1 but not on Form 990, Part IX, line 25:
a	Donated services and use of facilities ..........	2a
b	Prior year adjustments ..............	2b
c	Other losses ................	2c
d	Other (Describe in Part XIV): ............	2d
e	Add lines 2a through 2d......................		2e
3	Subtract line 2e from line 1.....................		3
4	Amounts included on Form 990, Part IX, line 25, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b ..	4a
b	Other (Describe in Part XIV): ............	4b
c	Add lines 4a and 4b.......................		4c
5	Total expenses. Add lines 3 and 4c. (This should equal Form 990, Part I, line 18.) ......		5

Part XIV

Supplemental Information

Complete this part to provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b;
Part V, line 4; Part X; Part XI, line 8; Part XII, lines 2d and 4b; and Part XIII, lines 2d and 4b. Also complete this part to provide any additional information.

Identifier	Return Reference	Explanation
TRANSFER AND IMPAIRMENT OF GOODWILL	SCHEDULE D, SUPPLEMENTAL INFORMATION	DURING FY 2011, THE HOSPITAL PURCHASED CERTAIN BUSINESS LINES FROM NORTHWEST COMMUNITY HEALTH SERVICES, INC. NEW ACCOUNTING GUIDANCE REQUIRED AN IMPAIRMENT TEST WHICH RESULTED IN THE WRITE-OFF OF GOODWILL IN ITS ENTIRETY ($6,748,415). SEE THE AUDITED FINANCIAL STATEMENTS FOR MORE INFORMATION.
DESCRIPTION OF INTENDED USES OF ENDOWMENT FUNDS	SCHEDULE D, PART V, LINE 4	ENDOWMENT FUNDS ARE CREATED ACCORDING TO HOSPITAL NEEDS AND DESIGNATION OR PREFERENCES OF THE DONOR(S) SUPPORTING THE ENDOWMENT FUND. SCHOLARSHIP FUNDS, CONTINUED EDUCATION, OR FUNDS FOR PATIENT CARE IN A HOSPITAL DEPARTMENT DESIGNATED BY THE ENDOWMENT FUND ARE EXAMPLES OF FUND USES.

Schedule D (Form 990) 2010

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE H
(Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

Complete if the organization answered "Yes" to Form 990, Part IV, question 20.
MediumBullet

Attach to Form 990. MediumBullet

See separate instructions.

OMB No. 1545-0047

2010

Open to Public Inspection

Name of the organization

Northwest Community Hospital

Employer identification number

36-2340313

Part I

Charity Care and Certain Other Community Benefits at Cost

Yes

Does the organization have a charity care policy? If "No," skip to question 6a...........

Yes

If "Yes," is it a written policy? .......................

Yes

If the organization has multiple hospitals, indicate which of the following best describes application of the charity care policy to the various hospitals.

Applied uniformly to all hospitals Applied uniformly to most hospitals Generally tailored to individual hospitals

Answer the following based on the charity care eligibility criteria that applies to the largest number of the organization's patients.

Does the organization use Federal Poverty Guidelines (FPG) to determine eligibility for providing free care to low

income individuals? If "Yes," indicate which of the following is the FPG family income limit for eligibility for free care:

Yes

100% 150% 200% Other

Does the organization use FPG to determine eligibility for providing discounted care to low income individuals? If

"Yes," indicate which of the following is the family income limit for eligibility for discounted care: .....

Yes

200% 250% 300% 350% 400% Other

If the organization does not use FPG to determine eligibility, describe in Part VI the income based criteria for determining eligibility for free or discounted care. Include in the description whether the organization uses an asset test or other threshold, regardless of income, to determine eligibility for free or discounted care.

Does the organization's policy provide free or discounted care to the "medically indigent"? ......

Yes

Does the organization budget amounts for free or discounted care provided under its charity care policy? ...

Yes

If "Yes," did the organization's charity care expenses exceed the budgeted amount?.........

If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discounted
care to a patient who was eligibile for free or discounted care?...............

Does the organization prepare an annual community benefit report?.............

Yes

If "Yes," does the organization make it available to the public? ..............

Yes

Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.

Charity Care and Certain Other Community Benefits at Cost

	(c) Total community benefit expense	(d) Direct offsetting revenue	(e) Net community benefit expense	(f) Percent of total expense
a Charity care at cost (from Worksheets 1 and 2) ..	6,886,446	0	6,886,446	1.570 %
b Unreimbursed Medicaid (from Worksheet 3, column a) .	39,525,477	26,631,340	12,894,137	2.930 %
c Unreimbursed costs—other means-tested government programs (from Worksheet 3, column b) ....	0	0	0	0 %
dTotal Charity Care and Means-Tested Government Programs .....	46,411,923	26,631,340	19,780,583	4.500 %
Other Benefits e Community health improvement services and community benefit operations (from (Worksheet 4) ....	1,303,050	66,579	1,236,471	0.280 %
f Health professions education (from Worksheet 5) ..	1,102,861	546,292	556,569	0.130 %
g Subsidized health services (from Worksheet 6) ..	306,964	52,482	254,482	0.060 %
h Research (from Worksheet 7)	28,000	0	28,000	0.010 %
i Cash and in-kind contributions to community groups (from Worksheet 8) ..	612,877	0	612,877	0.140 %
jTotal Other Benefits ...	3,353,752	665,353	2,688,399	0.620 %
kTotal. Add lines 7d and 7j. ..	49,765,675	27,296,693	22,468,982	5.120 %

For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2010

Schedule H (Form 990) 2010

Page 2

Part II

Community Building Activities Complete this table if the organization conducted any community building activities.

		(a) Number of activities or programs (optional)	(b) Persons served (optional)	(c) Total community building expense	(d) Direct offsetting revenue	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing
2	Economic development
3	Community support
4	Environmental improvements
5	Leadership development and training for community members
6	Coalition building
7	Community health improvement advocacy
8	Workforce development
9	Other
10	Total

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

Does the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................

Enter the amount of the organization's bad debt expense (at cost).....

11,730,242

Enter the estimated amount of the organization's bad debt expense (at cost) attributable to patients eligible under the organization's charity care policy ..

1,055,722

Provide in Part VI the text of the footnote to the organization's financial statements that describes bad debt expense. In addition, describe the costing methodology used in determining the amounts reported on lines 2 and 3, and rationale for including a portion of bad debt amounts as community benefit.

Section B. Medicare

Enter total revenue received from Medicare (including DSH and IME).....

157,977,945

Enter Medicare allowable costs of care relating to payments on line 5.....

201,103,780

Subtract line 6 from line 5. This is the surplus or (shortfall)........

-43,125,835

Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.
Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.
Check the box that describes the method used:

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

Does the organization have a written debt collection policy? ...............

Yes

If "Yes," does the organization's collection policy contain provisions on the collection practices to be followed for patients who are known to qualify for charity care or financial assistance? Describe in Part VI......

Yes

Part IV

Management Companies and Joint Ventures

(a) Name of entity	(b) Description of primary activity of entity	(c) Organization's profit % or stock ownership %	(d) Officers, directors, trustees, or key employees' profit % or stock ownership%	(e) Physicians' profit % or stock ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13

Schedule H (Form 990) 2010

Page 3

Part VFacility Information

Section A. Hospital Facilities (list in order of size, measured by total revenue per facility, from largest to smallest) How many hospital facilities did the organization operate during the tax year?1 Name and address		Other (Describe)
1	Northwest Community Hospital 800 W Central Road Arlington Heights,IL60005	X	X	X

Schedule H (Form 990) 2010

Page 4

Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)

Name of Hospital Facility:Northwest Community Hospital

Line Number of Hospital Facility (from Schedule H, Part V, Section A):1

				Yes	No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2010)
1	During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. .....................		1
	If “Yes,” indicate what the Needs Assessment describes (check all that apply):
	a	A definition of the community served by the hospital facility
	b	Demographics of the community
	c	Existing health care facilities and resources within the community that are available to respond to the health needs of the community
	d	How data was obtained
	e	The health needs of the community
	f	Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
	g	The process for identifying and prioritizing community health needs and services to meet those needs
	h	The process for consulting with persons representing the community’s interests
	i	Information gaps that limit the hospital facility’s ability to assess all of the community’s health needs
	j	Other (describe in Part VI)
2	Indicate the tax year the hospital facility last conducted a Needs Assessment: 20
3	In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted.		3
4	Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................		4
5	Did the hospital facility make its Needs Assessment widely available to the public? ...........		5
	If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
	a	Hospital facility’s website
	b	Available upon request from the hospital facility
	c	Other (describe in Part VI)
6	If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
	a	Adoption of an implementation strategy to address the health needs of the hospital facility’s community
	b	Execution of the implementation strategy
	c	Development of a community benefit plan for the facility
	d	Participation in community-wide community benefit plan
	e	Inclusion of a community benefit section in operational plans
	f	Adoption of a budget for provision of services that address the needs identified in the CHNA
	g	Prioritization of health needs in the community
	h	Prioritization of services that the hospital facility will undertake to meet health needs in its community
	i	Other (describe in Part VI)
7	Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed together with the reasons why it has not addressed such needs.		7
Financial Assistance Policy
	Did the hospital facility have in place during the tax year a written financial assistance policy that:
8	Explains eligibility criteria for financial assistance, and whether such assistance includes free or discounted care?		8
9	Used federal poverty guidelines (FPG) to determine eligibility for providing free care to low incomeindividuals?..		9
	If “Yes,” indicate the FPG family income limit for eligibility for free care: %

Schedule H (Form 990) 2010

Page 5

Part VFacility Information (continued)

				Yes	No
10	Used FPG to determine eligibility for providing discounted care to low income individuals?.........		10
	If “Yes,” indicate the FPG family income limit for eligibility for discounted care: %
11	Explained the basis for calculating amounts charged to patients?.................		11
	If “Yes,” indicate the factors used in determining such amounts (check all that apply):
	a	Income level
	b	Asset level
	c	Medical indigency
	d	Insurance status
	e	Uninsured discount
	f	Medicaid/Medicare
	g	State regulation
	h	Other (describe in Part VI)
12	Explained the method for applying for financial assistance?...................		12
13	Included measures to publicize the policy within the community served by the hospital facility?.......		13
	If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
	a	The policy was posted at all times on the hospital facility’s web site
	b	The policy was attached to all billing invoices
	c	The policy was posted in the hospital facility’s emergency rooms or waiting rooms
	d	The policy was posted in the hospital facility’s admissions offices
	e	The policy was provided, in writing, to patients upon admission to the hospital facility
	f	The policy was available upon request
	g	Other (describe in Part VI)
Billing and Collections
14	Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy that explained actions the hospital facility may take upon non-payment?........		14
15	Check all of the following collection actions against a patient that were permitted under the hospital facility's policies at any time during the tax year:
	a	Reporting to credit agency
	b	Lawsuits
	c	Liens on residences
	d	Body attachments or arrests
	e	Other (describe in Part VI)
16	Did the hospital facility engage in or authorize a third party to engage in any of the following collection actions during the tax year?...................................		16
	If “Yes,” check all collection actions in which the hospital facility or a third party engaged (check all that apply):
	a	Reporting to credit agency
	b	Lawsuits
	c	Liens on residences
	d	Body attachments
	e	Other (describe in Part VI)
17	Indicate which actions the hospital facility took before initiating any of the collection actions checked in question 16 (check all that apply):
	a	Notified patients of the financial assistance policy upon admission
	b	Notified patients of the financial assistance policy prior to discharge
	c	Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
	d	Documented its determination of whether a patient who applied for financial assistance under the financial assistance policy qualified for financial assistance
	e	Other (describe in Part VI)

Schedule H (Form 990) 2010

Page 6

Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
				Yes	No
18	Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?..........		18
	If “No,” indicate the reasons why (check all that apply):
	a	The hospital facility did not provide care for any emergency medical conditions
	b	The hospital facility did not have a policy relating to emergency medical care
	c	The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
	d	Other (describe in Part VI)
Charges for Medical Care
19	Indicate how the hospital facility determined the amounts generally billed to individuals who had insurance covering emergency or other medically necessary care (check all that apply):
	a	The hospital facility used the lowest negotiated commercial insurance rate for those services at the hospital facility
	b	The hospital facility used the average of the three lowest negotiated commercial insurance rates for those services at the hospital facility
	c	The hospital facility used the Medicare rate for those services
	d	Other (describe in Part VI)
20	Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?.........		20
	If “Yes,” explain in Part VI.
21	Did the hospital facility charge any of its patients an amount equal to the gross charge for services provided to that patient?...................................		21
	If “Yes,” explain in Part VI.

Schedule H (Form 990) 2010

Page 7

Part VFacility Information (continued)

Section C. Other Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility (list in order of size, measured by total revenue per facility, from largest to smallest) How many non-hospital facilities did the organization operate during the tax year?11
Name and address		Type of Facility (Describe)
1	NCH MENTAL HEALTH & YOUTH CENTER 901 W KIRCHOFF ROAD ARLINGTON HEIGHTS,IL60005	IN & OUT MENTAL HEALTH AND YOUTH SUBSTANCE ABUSE TREATMENT
2	NCH MENTAL HEALTH & YOUTH CENTER 901 W KIRCHOFF ROAD ARLINGTON HEIGHTS,IL60005	IN & OUT MENTAL HEALTH AND YOUTH SUBSTANCE ABUSE TREATMENT
3	NCH MENTAL HEALTH & YOUTH CENTER 901 W KIRCHOFF ROAD ARLINGTON HEIGHTS,IL60005	IN & OUT MENTAL HEALTH AND YOUTH SUBSTANCE ABUSE TREATMENT
4	NCH MENTAL HEALTH & YOUTH CENTER 901 W KIRCHOFF ROAD ARLINGTON HEIGHTS,IL60005	IN & OUT MENTAL HEALTH AND YOUTH SUBSTANCE ABUSE TREATMENT
5	NCH MENTAL HEALTH & YOUTH CENTER 901 W KIRCHOFF ROAD ARLINGTON HEIGHTS,IL60005	IN & OUT MENTAL HEALTH AND YOUTH SUBSTANCE ABUSE TREATMENT
6	NCH MENTAL HEALTH & YOUTH CENTER 901 W KIRCHOFF ROAD ARLINGTON HEIGHTS,IL60005	IN & OUT MENTAL HEALTH AND YOUTH SUBSTANCE ABUSE TREATMENT
7	NCH MENTAL HEALTH & YOUTH CENTER 901 W KIRCHOFF ROAD ARLINGTON HEIGHTS,IL60005	IN & OUT MENTAL HEALTH AND YOUTH SUBSTANCE ABUSE TREATMENT
8	NCH MENTAL HEALTH & YOUTH CENTER 901 W KIRCHOFF ROAD ARLINGTON HEIGHTS,IL60005	IN & OUT MENTAL HEALTH AND YOUTH SUBSTANCE ABUSE TREATMENT
9	NCH MENTAL HEALTH & YOUTH CENTER 901 W KIRCHOFF ROAD ARLINGTON HEIGHTS,IL60005	IN & OUT MENTAL HEALTH AND YOUTH SUBSTANCE ABUSE TREATMENT
10	NCH MENTAL HEALTH & YOUTH CENTER 901 W KIRCHOFF ROAD ARLINGTON HEIGHTS,IL60005	IN & OUT MENTAL HEALTH AND YOUTH SUBSTANCE ABUSE TREATMENT
11	NCH MENTAL HEALTH & YOUTH CENTER 901 W KIRCHOFF ROAD ARLINGTON HEIGHTS,IL60005	IN & OUT MENTAL HEALTH AND YOUTH SUBSTANCE ABUSE TREATMENT

Schedule H (Form 990) 2010

Page 8

Part VI

Supplemental Information

Complete this part to provide the following information.

1	Required descriptions. Provide the description required for Part I, lines 3c, 6a, and 7; Part II; Part III, lines 4, 8, and 9b; and Part V, Section B, lines 1j, 2, 4c, 6i, 7, 11i, 13i, 17l, 18l, 19e, 21d, 25, and 26.
2	Community health needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any community health needs assessments reported in Part V, Section B.
3	Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4	Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5	Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6	Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7	State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.

Identifier	ReturnReference	Explanation
PART I, LINE 3C		CHARITY CARE POLICY THE HOSPITAL PROVIDES EMERGENT AND MEDICALLY NECESSARY SERVICES TO ALL PATIENTS WITHOUT REGARD TO THE PATIENT'S ABILITY TO PAY. THE WRITTEN CHARITY CARE POLICY IS WIDELY DISTRIBUTED AND COMMUNICATED TO THE COMMUNITY. UNDER THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY, THE AMOUNT OF FREE CARE PROVIDED IS DETERMINED BY FINANCIAL NEED AND IS NOT LIMITED BY BUDGETED AMOUNTS. PATIENTS EARNING LESS THAN 200% OF THE FEDERAL POVERTY GUIDELINES RECEIVE FREE CARE AND THOSE BETWEEN 200% AND 400% OF THE GUIDELINES RECEIVE DISCOUNTED CARE ON A SLIDING SCALE. THE FINANCIAL ASSISTANCE PROGRAM LOOKS AT BOTH THE CURRENT INCOME AND THE INCOME FROM THE PREVIOUS YEAR (AS DISPLAYED IN TAX DOCUMENTS) AND THEN CALCULATES POTENTIAL BENEFITS BASED UPON EACH VARIABLE, OFFERING ITS PATIENT'S THE MOST GENEROUS BENEFIT. THIS POLICY ACKNOWLEDGES THE FRAGILE NATURE OF EMPLOYMENT AND THE IMPACT OF PREVIOUS YEAR HARDSHIPS. CONSISTENT WITH THE ILLINOIS UNINSURED PATIENT DISCOUNT ACT, PATIENTS WITHOUT INSURANCE COVERAGE ARE ELIGIBLE FOR A DISCOUNT IF THEIR INCOME IS AT OR BELOW 600% OF THE FEDERAL POVERTY GUIDELINES. OF THE REMAINING BALANCE, THE PATIENT'S LIABILITY IS CAPPED AT 25% OF THE FAMILY'S ANNUAL INCOME.
PART I, LINE 6A		COMMUNITY BENEFIT REPORT THE HOSPITAL'S COMMUNITY BENEFIT ACTIVITIES ARE INCLUDED IN AN ANNUAL REPORT ISSUED BY NORTHWEST COMMUNITY HEALTHCARE, THE SOLE CORPORATE MEMBER OF THE HOSPITAL.
PART I, LINE 7		COSTING METHODOLOGY THE FOLLOWING METHODOLOGIES WERE USED TO DETERMINE THE AMOUNTS REPORTED IN THE TABLE FOR LINE 7: PART I, LINES 7A - 7D, RATIO OF COST TO CHARGES AS DETERMINED USING WORKSHEET 2 IN THE FORM 990, SCHEDULE H INSTRUCTIONS. PART I, LINES 7E - 7I, COSTS WERE DETERMINED USING THE DIRECT COSTS FOR THE SPECIFIC PROGRAM OR SERVICE FROM THE HOSPITAL'S GENERAL LEDGER SYSTEM, WHICH ADDRESSES ALL PATIENT SEGMENTS. PART I, LINE 7G: SUBSIDIZED HEALTH SERVICES THE HOSPITAL HAS NOT INCLUDED ANY COSTS RELATED TO A PHYSICIAN CLINIC AS PART OF SUBSIDIZED HEALTH SERVICES. PART IV, LINE 7, COLUMN (F): BAD DEBT EXPENSE THE AMOUNT OF BAD DEBT EXPENSE INCLUDED IN PART IX, LINE 25, COLUMN (A) THAT WAS EXCLUDED FROM THE CALCULATION OF THIS PERCENTAGE WAS $41,968,664.
PART III, LINE 1		BAD DEBT EXPENSE THE HOSPITAL RECORDS BAD DEBT EXPENSE IN ACCORDANCE WITH GENERALLY ACCEPTED ACCOUNTING PRINCIPLES (GAAP). HFMA STATEMENT 15 IS FOLLOWED TO THE EXTENT THAT IT ALIGNS WITH THE GUIDELINES PER GAAP.
PART III, LINE 4		BAD DEBT EXPENSE NORTHWEST COMMUNITY HOSPITAL IS INCLUDED IN THE AUDITED FINANCIAL STATEMENTS OF NORTHWEST COMMUNITY HEALTHCARE (NCH) AND SUBSIDIARIES. THE TEXT OF THE FOOTNOTE REFERENCING BAD DEBT EXPENSE IN THE FY 2011 AUDIT IS AS FOLLOWS: "[NCH] EVALUATES THE COLLECTABILITY OF ITS ACCOUNTS RECEIVABLE BASED ON THE LENGTH OF TIME THE RECEIVABLE IS OUTSTANDING, PAYOR CLASS AND THE ANTICIPATED FUTURE COLLECTIBLE AMOUNTS BASED ON HISTORICAL EXPERIENCE. ACCOUNTS RECEIVABLE ARE CHARGED TO THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS WHEN THEY ARE DEEMED UNCOLLECTIBLE." WRITE-OFFS ARE SHOWN NET OF CONTRACTUALS AND DISCOUNTS. THE HOSPITAL'S BAD DEBT EXPENSE AS REPORTED ON LINES 2 AND 3 WAS DETERMINED USING THE COST TO CHARGE RATIO CALCULATED USING WORKSHEET 2 IN THE FORM 990, SCHEDULE H INSTRUCTIONS. FOR FY 2011, THE HOSPITAL RECORDED PROVISIONS FOR BAD DEBT EXPENSE OF $11,730,242 (AT CHARGES) OF WHICH IT IS ESTIMATED THAT 9% OF THIS AMOUNT WOULD HAVE BEEN REPORTED AS CHARITY IF THE PATIENT WOULD HAVE FULLY COMPLETED THE CHARITY APPLICATION PROCESS. THIS ESTIMATE IS BASED ON PATIENTS WHO BEGAN THE FINANCIAL ASSISTANCE PROCESS BUT DID NOT RESPOND TO THE HOSPITAL'S REQUEST FOR ADDITIONAL INFORMATION AND/OR COMPLETE THE APPLICATION FOR DETERMINATION. THESE PATIENTS WERE DEEMED VIABLE CANDIDATES TO RECEIVE FINANCIAL ASSISTANCE FOR THEIR SERVICES BY THE HOSPITAL'S FINANCIAL COUNSELORS. THE FINANCIAL COUNSELORS FOLLOWED UP IN WRITING AND BY PHONE IN AN ATTEMPT TO OBTAIN THE NECESSARY INFORMATION FOR THE FINANCIAL ASSISTANCE DETERMINATION.
PART III, LINE 8		MEDICARE SHORTFALL THE MEDICARE SHORTFALL REPORTED IN PART III, LINE 7 SHOULD BE TREATED AS COMMUNITY BENEFIT BECAUSE: (A) WITHOUT THE MEDICARE PROGRAM, IT IS LIKELY THAT MANY OF THESE INDIVIDUALS WOULD QUALIFY FOR CHARITY CARE OR MEDICAID; (B) BY THE HOSPITAL ACCEPTING PAYMENT BELOW COST TO TREAT THESE PATIENTS, THE BURDENS OF GOVERNMENT ARE RELIEVED WITH RESPECT TO THESE INDIVIDUALS; (C) THERE IS A SIGNIFICANT POSSIBILITY THAT CONTINUED REDUCTIONS IN MEDICARE REIMBURSEMENT MAY ACTUALLY REDUCE ACCESS TO CARE FOR THESE INDIVIDUALS; AND (D) THE AMOUNT SPENT BY THE HOSPITAL TO COVER THE MEDICARE SHORTFALL IS MONEY NOT AVAILABLE TO OTHER COMMUNITY NEEDS.
Part III, LINE 9B		COLLECTION PRACTICES IT IS THE POLICY OF THE HOSPITAL TO OFFER PATIENTS A PAYMENT PLAN OR FINANCIAL ASSISTANCE WHEN IT BECOMES KNOWN OR SUSPECTED THAT A PATIENT NEEDS SUCH ASSISTANCE. FINANCIAL COUNSELORS CONTACT AND WORK WITH THE PATIENT OR THEIR FAMILY TO HELP DETERMINE IF THERE ARE ANY THIRD PARTY PAYORS WHICH MAY BE AVAILABLE TO HELP THE PATIENT MEET THEIR OBLIGATIONS, SUCH AS MEDICAID, COBRA, WORKERS COMPENSATION, OR SPECIALIZED GRANT PROGRAMS. IF NO THIRD PARTY PROGRAMS ARE IDENTIFIED, THE FINANCIAL COUNSELORS WORK WITH THE PATIENT TO HELP THEM APPLY FOR CHARITY DISCOUNTS OR PAYMENT PLANS. FORMS ARE AVAILABLE IN ENGLISH AND SPANISH, AND TRANSLATION SERVICES ARE PROVIDED IN MANY LANGUAGES. IN ADDITION, ALL PATIENT BILLS AND STATEMENTS INCLUDE INFORMATION ABOUT HOW TO APPLY FOR FINANCIAL ASSISTANCE AND THE INFORMATION IS ALSO POSTED ON THE HOSPITAL'S WEBSITE. COLLECTION ACTIVITY WILL BE SUSPENDED DURING THE CONSIDERATION OF A COMPLETED FINANCIAL ASSISTANCE APPLICATION OR AN APPLICATION FOR ANY OTHER HEALTHCARE BRACKET (I.E, MEDICARE, MEDICAID, ETC.). A NOTE IS ENTERED INTO THE PATIENT'S ACCOUNT TO SUSPEND COLLECTION ACTIVITY UNTIL THE FINANCIAL ASSISTANCE PROCESS IS COMPLETED. ACCOUNTS IN THE FINANCIAL ASSISTANCE PROCESS WILL BE MONITORED AND, UPON THE DECISION TO APPROVE OR DENY FINANCIAL ASSISTANCE, THE PATIENT'S ACCOUNT WILL BE UPDATED. IF THE FINANCIAL ASSISTANCE APPLICATION IS APPROVED WITH A PERCENTAGE LESS THAN 100% OR DENIED, THE PATIENT'S ACCOUNT WILL BE NOTED AND THE HOSPITAL WILL RESUME THE SELF PAY COLLECTION ACTIVITY IN COMPLIANCE WITH ITS SELF PAY FOLLOW-UP PROCEDURES.
Part VI, LINE 2		NEEDS ASSESSMENT IN 2010, THE HOSPITAL PARTICIPATED IN A REGIONAL COMMUNITY HEALTH NEEDS ASSESSMENT OFFERED BY THE METROPOLITAN CHICAGO HEALTHCARE COUNCIL (MCHC) IN PARTNERSHIP WITH PROFESSIONAL RESEARCH CONSULTANTS (PRC). THE ASSESSMENT CONSISTED OF A 30-MINUTE TELEPHONE HEALTH SURVEY THAT WAS CONDUCTED IN ENGLISH AND SPANISH. OVER 1,200 SURVEYS WERE CONDUCTED, WITH 240 IN THE NORTHWEST REGION OF THE COUNTY, WHERE THE HOSPITAL IS LOCATED. CAREFUL CONSIDERATION WAS TAKEN TO ENSURE THAT THE DEMOGRAPHICS OF THOSE PARTICIPATING IN THE SURVEY MIRRORED THE DEMOGRAPHICS OF THE COMMUNITY. THE GOAL OF THE SURVEY WAS TO TARGET ACTUAL HEALTH STATUS, BEHAVIOR AND EXPERIENCES, RATHER THAN PERCEPTIONS. ISSUES ADDRESSED INCLUDED SELF-REPORTED HEALTH STATUS, PHYSICAL HEALTH STATUS, MENTAL HEALTH STATUS, DEATH AND DISABILITY, INFECTION AND CHRONIC DISEASE, BIRTHS, CHILDREN'S HEALTH STATUS, MODIFIABLE HEALTH RISKS, ACCESS TO HEALTHCARE, HEALTH EDUCATION AND OUTREACH, AND HEALTH INFORMATION SOURCES. THE ASSESSMENT ALSO INTEGRATED THE MOST RECENT SECONDARY PUBLIC HEALTH DATA TO COMPLEMENT THE PRIMARY TELEPHONE SURVEY DATA. A HOSPITAL TEAM COMPRISED OF REPRESENTATIVES FROM COMMUNITY SERVICES, IMMEDIATE CARE/WELLNESS, FINANCE, NURSING AND MARKETING DEPARTMENTS THEN REVIEWED RESULTS FOR THE HOSPITAL'S PRIMARY AND SECONDARY SERVICE AREA AND COMPARED IT TO LOCAL, STATE, AND NATIONAL DATA AS WELL AS HEALTHY PEOPLE BENCHMARKS. COMMUNITY HEALTH IMPROVEMENT PLANS WERE DEVELOPED AND PRESENTED TO THE COMMUNITY HEALTH AND OUTREACH COMMITTEE, A COMMITTEE OF THE BOARD OF DIRECTORS, FOR FINAL APPROVAL. THE MOST PREDOMINANT FINDING WAS THE DIFFICULTY THE COMMUNITY HAS IN ACCESSING HEALTHCARE SERVICES WHICH INCLUDES PRIMARY, ORAL, AND BEHAVIORAL HEALTH SERVICES, AS WELL AS PRESCRIPTION MEDICATION. ASSESSMENT FINDINGS SHOWED THAT 39.2% OF THOSE SURVEYED HAD DIFFICULTY ACCESSING PRIMARY HEALTH CARE IN THE PAST YEAR, 22.4% HAD NOT SEEN A DENTIST IN THE PAST YEAR, AND 16.5% OF THE SURVEYED POPULATION REPORTED SKIPPING PRESCRIPTIONS TO SAVE ON COSTS. ANOTHER MAJOR CONCERN AND FOCUS OF THE COMMUNITY HEALTH IMPROVEMENT PLANS WAS IN RESPONSE TO THE STARTLING OBESITY RATES, WITH 48.2% OF THE HOSPITAL'S SERVICE AREA BEING OVERWEIGHT OR OBESE. THROUGHOUT FY 2011, THE HOSPITAL'S COMMUNITY SERVICES DEPARTMENT, WITH OVERSIGHT FROM THE COMMUNITY HEALTH AND OUTREACH COMMITTEE, CONTINUALLY REVIEWED THE IDENTIFIED HEALTH CONCERNS AND THE COMMUNITY HEALTH IMPROVEMENT PLANS THAT WERE IMPLEMENTED TO ADDRESS THE NEEDS. MEASUREMENT TOOLS WERE DEVELOPED FOR ALL PROGRAMS AND MONITORED REGULARLY TO ENSURE THEIR IMPACT AND EFFECTIVENESS. ALSO IN 2011, THE HOSPITAL WAS GIVEN THE OPPORTUNITY TO PROVIDE SUGGESTIONS AND FEEDBACK TO MCHC ON THE 2010 ASSESSMENT TOOL WHICH WILL BE INCORPORATED INTO THE NEXT ASSESSMENT THEY CONDUCT IN 2012. THE HOSPITAL HAS ALREADY COMMITTED TO PARTICIPATING IN THE NEXT ASSESSMENT AND WILL USE THE FINDINGS OF THAT ASSESSMENT TO MAKE ANY MODIFICATIONS NEEDED TO THE CURRENT COMMUNITY HEALTH IMPROVEMENT PLAN. PART VI, LINE 3 PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE THE FINANCIAL ASSISTANCE PROGRAM AT NORTHWEST COMMUNITY HOSPITAL IS COMMUNICATED WIDELY TO PATIENTS AND VISITORS IN ENGLISH AND SPANISH USING THE FOLLOWING METHODS: (1) SIGNAGE IN ENGLISH AND SPANISH IS POSTED THROUGHOUT THE ORGANIZATION AT ALL ACCESS POINTS, INCLUDING THE EMERGENCY DEPARTMENT AND OUTPATIENT REGISTRATION AREAS. THESE AREAS ALSO STOCK AND MAKE AVAILABLE A BROCHURE, PRINTED IN ENGLISH AND SPANISH, DESCRIBING THE HOSPITAL'S POLICY. A FULL-TIME INTERPRETATION SERVICE DEPARTMENT IS AVAILABLE TO ASSIST THOSE WHO NEED ADDITIONAL INFORMATION IN OTHER LANGUAGES. IN 2011 THE HOSPITAL RESPONDED TO OVER 18,000 IN-PERSON REQUESTS AND 4,700 TELEPHONIC REQUESTS IN 45 DIFFERENT LANGUAGES. (2) EACH PAGE OF THE HOSPITAL'S WEBSITE (WWW.NCH.ORG) CONTAINS THE FOLLOWING FOOTNOTE: "NORTHWEST COMMUNITY HOSPITAL IS A CHARITABLE ORGANIZATION AND PROVIDES FINANCIAL ASSISTANCE TO THOSE WHO ARE ELIGIBLE. FOR MORE INFORMATION, CLICK HERE." A LINK TAKES VISITORS TO A SUBSEQUENT PAGE THAT DESCRIBES FINANCIAL ASSISTANCE/CHARITY CARE AND PROVIDES A PHONE NUMBER TO CONTACT AN NORTHWEST COMMUNITY HOSPITAL FINANCIAL COUNSELOR. APPLICATIONS FOR FINANCIAL ASSISTANCE, IN ENGLISH AND SPANISH, ARE AVAILABLE FOR DOWNLOAD ON THE HOSPITAL WEBSITE. (3) ALL EXTERNAL HOSPITAL PUBLICATIONS INCLUDE THE FOLLOWING NOTE: "NORTHWEST COMMUNITY HOSPITAL IS A CHARITABLE ORGANIZATION AND PROVIDES FINANCIAL ASSISTANCE TO PEOPLE WHO ARE ELIGIBLE. FOR MORE INFORMATION PLEASE CALL 847.618.4542 OR VISIT OUR WEBSITE AT WWW.NCH.ORG." (4) INFORMATION ON FINANCIAL ASSISTANCE IS INCLUDED WITH EVERY PATIENT BILL. (5) FINANCIAL COUNSELORS PROVIDE FINANCIAL ASSISTANCE INFORMATION TO PATIENTS DURING THEIR REGISTRATION AND WORK WITH PATIENTS IDENTIFIED AT REGISTRATION OR AFTER ADMISSION TO HELP THEM GET THE ASSISTANCE THEY NEED, ANSWER QUESTIONS, SET UP PAYMENT PLANS AND FACILITATE APPLICATIONS FOR GOVERNMENT PROGRAMS SUCH AS MEDICAID. PART VI, LINE 4 COMMUNITY INFORMATION NORTHWEST COMMUNITY HOSPITAL IS LOCATED IN ARLINGTON HEIGHTS, ILLINOIS, A SUBURB LOCATED APPROXIMATELY 25 MILES NORTHWEST OF CHICAGO. ITS PRIMARY SERVICE AREA CONSISTS OF ARLINGTON HEIGHTS AND THE SURROUNDING SUBURBS OF MT. PROSPECT, PALATINE, AND ROLLING MEADOWS. THE HOSPITAL'S SECONDARY SERVICE AREA IS COMPRISED OF BARRINGTON, BUFFALO GROVE, DES PLAINES, ELK GROVE VILLAGE, HOFFMAN ESTATES, LAKE ZURICH, PROSPECT HEIGHTS, SCHAUMBURG AND WHEELING. THESE AREAS HAVE A COMBINED POPULATION OF APPROXIMATELY 659,000 PEOPLE. THIS NUMBER HAS REMAINED FAIRLY STABLE AND GROWTH OVER THE NEXT 5 YEARS IS EXPECTED TO BE RELATIVELY FLAT. THE HOSPITAL'S TOTAL SERVICE AREA IS PREDOMINATELY CAUCASIAN (70%), FOLLOWED BY HISPANIC (13.9%), ASIAN (12.3%) AND ALL OTHER (3.8%). THE HISPANIC POPULATION IS EXPECTED TO GROW BY 12.1% AND THE ASIAN POPULATION 10.5% OVER THE NEXT 5 YEARS. OF INDIVIDUALS LIVING IN THE HOSPITAL'S TOTAL SERVICE AREA, 8.7% ARE ON MEDICAID AND, PENDING HEALTHCARE REFORM, THIS IS EXPECTED TO GROW BY 18.4% OVER THE NEXT FIVE YEARS. OVER THE PAST 10 YEARS, THERE HAS BEEN A DECIDED SHIFT IN THE AGE OF THOSE LIVING IN THE HOSPITAL'S SERVICE AREA. A PORTION OF THE 18-44 AGE GROUP MOVED INTO THE 45-64 AGE GROUP, RESULTING IN A 19.2% INCREASE. FURTHERMORE, IT IS ESTIMATED THAT IN THE NEXT 5 YEARS, THE AREA WILL SEE FURTHER MIGRATION INTO THE 65+ AGE GROUP. THERE ARE FOUR OTHER HOSPITALS LOCATED IN THE HOSPITAL'S SERVICE AREA. THE ENTIRE PRIMARY SERVICE AREA AND A SIGNIFICANT PORTION OF THE SECONDARY SERVICE AREA HAVE BEEN DESIGNATED AS A MEDICALLY-UNDERSERVED AREA. THE HOSPITAL SUPPORTS BOTH A FEDERALLY QUALIFIED HEALTH CENTER LOCATED ACROSS THE STREET FROM THE HOSPITAL, AND A COUNTY RUN PRIMARY CARE CLINIC, ALSO LOCATED IN THE HOSPITAL'S PRIMARY SERVICE AREA. PART VI, LINE 5 PROMOTION OF COMMUNITY HEALTH THE HOSPITAL PROMOTES THE HEALTH OF ITS COMMUNITY IN MANY WAYS AS FOLLOWS: (1) A MAJORITY OF THE HOSPITAL'S BOARD OF DIRECTORS IS COMPRISED OF PERSONS WHO LIVE OR WORK IN THE HOSPITAL'S PRIMARY SERVICE AREA AND ARE NOT EMPLOYEES OR CONTRACTORS OF THE HOSPITAL. (2) A STANDING COMMUNITY HEALTH AND OUTREACH COMMITTEE OF THE HOSPITAL BOARD PROVIDES OVERSIGHT IN MONITORING AND EVALUATING THE EFFECTIVENESS OF ITS COMMUNITY BENEFIT PLAN, INCLUDING CHARITY CARE, COMMUNITY HEALTH EDUCATION, COMMUNITY MEDICAL/DENTAL CLINICS, AND COMMUNITY HEALTH IMPROVEMENT INITIATIVES. (3) MEDICAL STAFF PRIVILEGES ARE EXTENDED TO ALL QUALIFIED PHYSICIANS IN THE HOSPITAL'S COMMUNITY FOR SOME OF ITS DEPARTMENTS. (4) THE HOSPITAL MAINTAINS ANY SURPLUS FUNDS IN THE HOSPITAL ITSELF OR AT NORTHWEST COMMUNITY HEALTHCARE (A 501(C)(3) SUPPORTING ORGANIZATION AND SOLE MEMBER OF THE HOSPITAL) FOR FUNDING CAPITAL IMPROVEMENTS IN TECHNOLOGY, FACILITIES OR PATIENT CARE EQUIPMENT, AND SUPPORTING HOSPITAL OPERATIONS OR COMMUNITY OUTREACH INITIATIVES. (5) THE HOSPITAL HAS DEDICATED STAFF THAT SERVE AS MEMBERS, CHAIRPERSONS, OFFICERS, AND BOARD MEMBERS OF LOCAL AND NATIONAL ORGANIZATIONS DEVOTED TO IMPROVING THE HEALTH AND WELLBEING OF COMMUNITY MEMBERS. THESE ORGANIZATIONS INCLUDE: WINGS (WOMEN IN NEED GROWING STRONGER), NORTHWEST SUBURBAN ALLIANCE ON DOMESTIC VIOLENCE, HARPER COLLEGE NURSING ADVISORY COMMITTEE, METROPOLITAN CHICAGO HEALTHCARE COUNCIL HEALTH CARE WORKFORCE ADVISORY INSTITUTE, SUSAN G. KOMEN FOUNDATION, NORTHERN FOX VALLEY ONCOLOGY NURSING SOCIETY CHAPTER, CHICAGO DENTAL SOCIETY, HOSPICE OF NORTHEASTERN ILLINOIS, HEALTHWORLD, BRIDGE YOUTH AND FAMILY SERVICES, LITTLE CITY FOUNDATION HUMAN RIGHTS COMMITTEE, AS WELL AS LOCAL BOARD OF HEALTH DEPARTMENTS AND ROTARY CLUBS. (6) THE HOSPITAL HAS DEDICATED STAFF THAT ASSIST WITH ADVOCACY INITIATIVES TO PROMOTE COMMUNITY, STATE, AND NATIONAL EFFORTS TO IMPROVE THE HEALTH OF THE POPULATION. THIS INCLUDES THE OBESITY EPIDEMIC THROUGH THE EFFORTS OF THE ILLINOIS ALLIANCE TO PREVENT OBESITY AS WELL AS CANCER RESEARCH AND PREVENTION THROUGH THE AMERICAN CANCER SOCIETY. (7) COLLABORATIVE

Schedule H (Form 990) 2010

Additional Data

Software ID:
Software Version:

- TIN:

Schedule I
(Form 990)

Department of the Treasury
Internal Revenue Service

Grants and Other Assistance to Organizations,
Governments and Individuals in the United States

Complete if the organization answered "Yes," to Form 990, Part IV, line 21 or 22.
lBullet

Attach to Form 990

OMB No. 1545-0047

2010

Open to Public
Inspection

Name of the organization
Northwest Community Hospital

Employer identification number
36-2340313

Part I

General Information on Grants and Assistance

Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ....................................

Yes No

Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.

Part II

Grants and Other Assistance to Governments and Organizations in the United States. Complete if the organization answered "Yes" to
Form 990, Part IV, line 21 for any recipient that received more than $5,000. Check this box if no one recipient received more than $5,000. Use
Part IV and Schedule I-1 (Form 990) if additional space is needed ......................... lBullet

(a) Name and address of organization or government	(b) EIN	(c) IRC Code section if applicable	(d) Amount of cash grant	(e) Amount of non-cash assistance	(f) Method of valuation (book, FMV, appraisal, other)	(g) Description of non-cash assistance	(h) Purpose of grant or assistance
(1) AMERICAN CANCER SOCIETY1114 N ARLINGTON HTS RD ARLINGTON HTS,IL60067	13-1788491	501(c)(3)	10,000				RELAY FOR LIFE
(2) AMERICAN HEART ASSOCIATIONPO BOX 4002902 DES MOINES,IA50340	13-5613797	501(c)(3)	5,300				CHICAGO HEARTWALK
(3) HEKTOEN INSTITUTE LLC2240 W OGDEN AVE CHICAGO,IL60612	36-6006541	501(c)(3)	95,405				VISTA CLINIC SUPPORT
(4) SPECIAL LEISURE SERVICES FOUNDATION3000 W CENTRAL STE 205 ROLLING MEADOWS,IL60008	36-3145710	501(c)(3)	15,000				SPECIAL OLYMPICS
(5) NORTHWEST COMMUNITY HEALTHCARE800 WEST CENTRAL RD ARLINGTON HTS,IL60005	36-3125209	501(c)(3)	2,750,000				NET ASSET PAID
(6) GLOBUS RELIEF1775 W 1500 SOUTH SALT LAKE CITY,UT84104	84-1369453	501(C)(3)		237,911	FMV	MEDICAL SUPPLIES	MISSION TRIPS
(7) AMHE INCORPORATED1166 EASTERN PKWY BROOKLYN,NY11213	23-7357680	501(C)(3)		159,687	FMV	MEDICAL SUPPLIES

Enter total number of section 501(c)(3) and government organizations ......................... Bullet Image

Enter total number of other organizations ................................ . Bullet Image

For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50055P

Schedule I (Form 990) 2010

Page 2

Part III

Grants and Other Assistance to Individuals in the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 22.
Use Schedule I-1 (Form 990) if additional space is needed.

(a)Type of grant or assistance	(b)Number of recipients	(c)Amount of cash grant	(d)Amount of non-cash assistance	(e)Method of valuation (book, FMV, appraisal, other)	(f)Description of non-cash assistance

Part IV

Supplemental Information. Complete this part to provide the information required in Part I, line 2, and any other additional information.

Identifier	Return Reference	Explanation
Form 990, Schedule I	Description of Organization's Procedures for Monitoring the Use of Grants	Grants in support of Northwest Community Hospital's (HOSPITAL) mission are monitored by Northwest Community's Finance Committee and Board of Directors as part of the monthly review of Hospital's financial results. Significant grants to unrelated 501(c)(3) or governmental organizations are approved by Hospital's commmunity services department and are monitored through ongoing interactions with officials of those recipients regarding program services provided in Hospital's service area.

Schedule I (Form 990) 2010

Additional Data

Software ID:
Software Version:

- TIN:

Schedule J
(Form 990)

Department of the Treasury
Internal Revenue Service

Compensation Information

For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet

Complete if the organization answered "Yes" to Form 990,
Part IV, question 23.
SchJMediumBullet

Attach to Form 990. SchJMediumBullet

See separate instructions.

OMB No. 1545-0047

2010

Open to Public Inspection

Name of the organization

Northwest Community Hospital

Employer identification number

36-2340313

Part I

Questions Regarding Compensation

Yes

Check the appropiate box(es) if the organization provided any of the following to or for a person listed in Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.

First-class or charter travel Housing allowance or residence for personal use

Travel for companions Payments for business use of personal residence

Tax idemnification and gross-up payments Health or social club dues or initiation fees

Discretionary spending account Personal services (e.g., maid, chauffeur, chef)

If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement orprovision of all the expenses described above? If "No," complete Part III to explain....

Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
officers, directors, trustees, and the CEO/Executive Director, regarding the items checked in line 1a? ....

Indicate which, if any, of the following the organization uses to establish the compensation of the
organization's CEO/Executive Director. Check all that apply.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

Form 990 of other organizations Approval by the board or compensation committee

During the year, did any person listed in Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:

Receive a severance payment or change-of-control payment? ...............

Yes

Participate in, or receive payment from, a supplemental nonqualified retirement plan? ........

Participate in, or receive payment from, an equity-based compensation arrangement? ........

If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.

Only 501(c)(3) and 501(c)(4) organizations only must complete lines 5-9.

For persons listed in form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:

The organization? ...........................

Yes

Any related organization? .........................

If "Yes," to line 5a or 5b, describe in Part III.

For persons listed in form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:

The organization? ...........................

Any related organization? .........................

If "Yes," to line 6a or 6b, describe in Part III.

For persons listed in Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............

Were any amounts reported in Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regs. section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................

If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................

For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990

Cat. No. 50053T

Schedule J (Form 990) 2010

Page 2

Part II

Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use Schedule J-1 if additional space needed.

For each individual whose compensation must be reported in Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.

Note. The sum of columns (B)(i)-(iii) must equal the applicable column (D) or column (E) amounts on Form 990, Part VII, line 1a.

(A) Name		(B) Breakdown of W-2 and/or 1099-MISC compensation			(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation reported in prior Form 990 or Form 990-EZ
(A) Name		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)
(1) Bruce K Crowther	(i) (ii)	571,013 0	0 0	2,008 0	201,820 0	16,643 0	791,484 0	0 0
(2) Michael B Zenn	(i) (ii)	637,690 0	0 0	1,808 163	63,787 0	18,124 0	721,409 163	0 0
(3) Mark Lusson	(i) (ii)	224,424 0	0 0	67,349 0	52,333 0	11,575 0	355,681 0	65,291
(4) Mary Stack	(i) (ii)	167,416 0	0 0	1,808 0	29,016 0	13,706 0	211,946 0	0 0
(5) Dawn Walden	(i) (ii)	108,290 0	0 0	27,425 0	24,421 0	8,011 0	168,147 0	0 0
(6) Angela Stefaniu	(i) (ii)	101,520 0	0 0	124,914 0	24,419 0	20,065 0	270,918 0	60,356
(7) Robert Klasek	(i) (ii)	149,130 0	0 0	1,546 0	26,934 0	10,907 0	188,517 0	0 0
(8) Gary Skiba	(i) (ii)	166,311 0	0 0	1,808 0	24,483 0	11,907 0	204,509 0	0 0
(9) Willis G Parsons MD	(i) (ii)	1,599,548 0	135,759 0	0 0	14,700 0	1,942 0	1,751,949 0	0 0
(10) Malcolm Bilimoria MD	(i) (ii)	1,439,819 0	0 0	0 0	14,700 0	23,065 0	1,477,584 0	0 0
(11) Rameez Alasadi MD	(i) (ii)	665,453 0	67,879 0	0 0	9,900 0	16,620 0	759,852 0	0 0
(12) Tahseen Mohammed MD	(i) (ii)	265,490 0	0 0	28,803 0	14,700 0	13,168 0	322,161 0	0 0
(13) Sonia Mehta MD	(i) (ii)	303,264 0	0 0	9,608 0	9,800 0	27,065 0	349,737 0	0 0
(14) Gail A Finn	(i) (ii)	3,503 0	0 0	252,786 0	13,517 0	887 0	270,693 0	24,710
(15) Dale Beatty	(i) (ii)	254,944 0	0 0	17,808 0	30,312 0	7,601 0	310,665 0	0 0
(16) Leighton Smith MD	(i) (ii)	413,459 0	0 0	70,443 0	64,700 0	13,907 0	562,509 0	0 0
(17) GEORGE MORRIS	(i) (ii)	211,083 0	0 0	1,908 0	27,175 0	17,065 0	257,231 0	0 0
(18) LAURA POLLACK	(i) (ii)	140,807 0	0 0	1,858 0	23,327 0	15,124 0	181,116 0	0 0
(19) Ann Sayvetz	(i) (ii)	248,894 0	0 0	1,808 0	14,611 0	13,719 0	279,032 0	0 0
(20) Michael C Hartke	(i) (ii)	355,412 38,315	0 0	247 247	22,169 2,169	2,893 2,888	380,721 43,619	0 0

Schedule J (Form 990) 2010

Page 3

Part III

Supplemental Information

Complete this part to provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 4c, 5a, 5b, 6a, 6b, 7, and 8. Also complete this part for any additional information.

Identifier	Return Reference	Explanation
OFFICES & POSITIONS FOR WHICH PROCESS WAS USED, & YEAR PROCESS WAS BEGUN	SCHEDULE J, PART I, LINE 3	THE NOMINATION AND COMPENSATION COMMITTEE OF THE NORTHWEST COMMUNITY HEALTHCARE (NCH) BOARD IS RESPONSIBLE FOR SETTING THE COMPENSATION OF THE PRESIDENT/CEO. COMPENSATION IS REVIEWED USING AN EXTERNAL COMPENSATION FIRM, PINP, INC. THE REVIEW ALSO UTILIZES COMPARISONS TO SIMILAR ORGANIZATIONS THROUGH REVIEW OF FORMS 990, USE OF COMPARISON STUDIES FROM THE METROPOLITAN CHICAGO HEALTHCARE COUNCIL AND OTHER SOURCES. THE PROCESS IS DOCUMENTED IN THE MINUTES OF THE NOMINATION AND COMPENSATION COMMITTEE.
SEVERANCE PAYMENTS	SCHEDULE J, PART I, LINE 4A	THE FOLLOWING INDIVIDUALS RECEIVED SEVERANCE PAY DURING THE CALENDAR YEAR 2010 PURSUANT TO A WRITTEN SEPARATION AGREEMENT WITH THE HOSPITAL: GAIL A. FINN: $226,468 ANGELA STEFANIU: $48,314
COMPENSATION BASED ON REVENUES OF THE ORGANIZATION	SCHEDULE J, PART I, LINE 5A	THE FOLLOWING GASTROENTEROLOGISTS RECEIVED BONUS PAYMENTS UNDER THE TERMS OF THEIR WRITTEN EMPLOYMENT CONTRACTS. THE AMOUNTS WERE BASED ON A PERCENTAGE OF PROFESSIONAL COLLECTIONS (I.E. COLLECTIONS FROM THE PHYSICIAN'S PERFORMANCE OF PROFESSIONAL MEDICAL SERVICES) EXCEEDING A SPECIFIED THRESHOLD UNTIL A CAP SPECIFIED IN THE CONTRACT IS REACHED. WILLIS G. PARSONS, MD: $135,759 RAMEEZ ALASADI, MD: $67,879
SUPPLEMENTAL INFORMATION	SCHEDULE J, PART II, COLUMN C	CERTAIN OFFICERS AND KEY EMPLOYEES OF NORTHWEST COMMUNITY HOSPITAL PARTICIPATE IN A SECTION 457(F) DEFERRED COMPENSATION PLAN. CURRENT YEAR DEFERRED AMOUNTS ARE INCLUDED IN PART VII, COLUMN F AND SCHEDULE J, PART II, COLUMN C. CURRENT YEAR DISTRIBUTIONS, INCLUDED IN PART VII, COLUMN D; SCHEDULE J, PART II, COLUMN B(III); AND SCHEDULE J, PART II, COLUMN (F) ARE: GAIL A. FINN: $24,710 MARK LUSSON: $65,291 ANGELA STEFANIU: $60,356

Schedule J (Form 990) 2010

Additional Data

Software ID:
Software Version:

- TIN:

Schedule K
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Information on Tax Exempt Bonds

Complete if the organization answered "Yes" to Form 990, Part IV, line 24a. Provide descriptions,
explanations, and any additional information in Schedule O (Form 990).
SchKMediumBullet

Attach to Form 990. SchKMediumBullet

See separate instructions.

OMB No. 1545-0047

2010

Open to Public
Inspection

Name of the organization
Northwest Community Hospital

Employer identification number
36-2340313

Part I

Bond Issues

(a) Issuer Name		(b) Issuer EIN	(c) CUSIP #	(d) Date Issued	(e) Issue Price	(f) Description of Purpose	(g) Defeased		(h) On Behalf of Issuer		(i) Pool financing
(a) Issuer Name		(b) Issuer EIN	(c) CUSIP #	(d) Date Issued	(e) Issue Price	(f) Description of Purpose	Yes	No	Yes	No	Yes	No
A	ILLINOIS FINANCE AUTHORITY	86-1091967	45200FNR6	09-19-2008	151,075,932	SEE PART V		X		X		X
B	ILLINOIS FINANCE AUTHORITY	86-1091967	45200FNU9	10-17-2008	86,820,000	SEE PART V		X		X		X

Part II

Proceeds

	A		B		C		D
	1 Amount of bonds retired. . . . .	0		0
2 Amount of bonds defeased . . . .	0		0
3 Total proceeds of issue . . . .	151,417,356		86,820,000
4 Gross proceeds in reserve funds . .	0		0
5 Capitalized interest from proceeds.	0		0
6 Proceeds in refunding escrow. . . . .	0		0
7 Issuance costs from proceeds . . .	1,468,340		598,075
8 Credit enhancement from proceeds.	0		93,000
9 Working capital expenditures from proceeds . .	0		0
10 Capital expenditures from proceeds . .	149,949,016		0
11 Other spent proceeds . .	0		86,128,925
12 Other unspent proceeds. . .	0		0
13 Year of substantial completion . . .	2010		2008
	Yes	No	Yes	No	Yes	No	Yes	No
14 Were the bonds issued as part of a current refunding issue?		X	X
15 Were the bonds issued as part of an advance refunding issue?		X		X
16 Has the final allocation of proceeds been made? . .	X		X
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? .	X		X

Part III

Private Business Use

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? . . .		X
2 Are there any lease arrangements that may result in private business use of bond-financed property? . . . . .		X

For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50193E

Schedule K (Form 990) 2010

Page 2

Part III

Private Business Use (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
3a Are there any management or service contracts that may result in private business use?		X
b Are there any research agreements that may result in private business use of bond-financed property? . .		X
c Does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts or research agreements relating to the financed property? .		X
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government . . . . . . . . . . . . .	0 %		0 %
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government .	0 %		0 %
6 Total of lines 4 and 5 . . .. . . . . .	0 %		0 %
7 Has the organization adopted management practices and procedures to ensure the post-issuance compliance of its tax-exempt bond liabilities?	X

Part IV

Arbitrage

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Has a Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate, been filed with respect to the bond issue? . . .		X		X
2 Is the bond issue a variable rate issue?		X	X
3a Has the organization or the governmental issuer entered into a hedge with respect to the bond issue?		X		X
b Name of provider .
c Term of hedge . .
d Was the hedge superintegrated? .
e Was a hedge terminated? .
4a Were gross proceeds invested in a GIC? .		X		X
b Name of provider .
c Term of GIC . .
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? .
5 Were any gross proceeds invested beyond an available temporary period? .		X		X
6 Did the bond issue qualify for an exception to rebate? . . .		X	X

Schedule K (Form 990) 2010

Page 3

Part V

Supplemental Information

Complete this part to provide additional information for responses to questions on Schedule K (see instructions).

Identifier	Return Reference	Explanation
Description of Bonds	Schedule K, Part I	ISSUER NAME: ILLINOIS FINANCE AUTHORITY ISSUER EIN: 86-1091967 CUSIP #: 45200FNR6 ISSUE PRICE: $151,075,932 DESCRIPTION OF PURPOSE: PROCEEDS USED FOR: CONSTRUCTION OF A PATIENT TOWER AND PARKING GARAGE; EXPANSION AND RENOVATION OF THE HOSPITAL'S EMERGENCY DEPARTMENT AND SURGERY SUITES; RELOCATION OF CERTAIN DEPARTMENTS ON THE HOSPITAL'S CAMPUS; AND PURCHASE OF CERTAIN EQUIPMENT USED IN THE HOSPITAL'S BUSINESS. TOTAL PROCEEDS OF ISSUE: THE TOTAL PROCEEDS INCLUDE $341,424 OF INVESTMENT EARNINGS. ISSUER NAME: ILLINOIS FINANCE AUTHORITY ISSUER EIN: 86-1091967 CUSIP #: 45200FNU9 ISSUE PRICE: $86,820,000 DESCRIPTION OF PURPOSE: PROCEEDS WERE USED TO REPAY A TAXABLE LOAN, THE PROCEEDS OF WHICH WERE USED, TOGETHER WITH OTHER FUNDS, TO REDEEM THE AUTHORITY'S SERIES 2002A BONDS (NW COMMUNITY HOSPITAL) IN APRIL 2008.

Schedule K (Form 990) 2010

Additional Data

Software ID:
Software Version:

- TIN:

Schedule L
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Transactions with Interested Persons

Complete if the organization answered
"Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c,
or Form 990-EZ, Part V lines 38a or 40b.
MediumBullet

Attach to Form 990 or Form 990-EZ. MediumBullet

See separate instructions.

OMB No. 1545-0047

2010

Open to Public Inspection

Name of the organization

Northwest Community Hospital

Employer identification number

36-2340313

Part I

Excess Benefit Transactions (section 501(c)(3) and section 501 (c)(4) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.

1(a) Name of disqualified person	(b) Description of transaction	(c) Corrected?
1(a) Name of disqualified person	(b) Description of transaction	Yes	No

Enter the amount of tax imposed on the organization managers or disqualified persons during the year under section 4958. ......................... Bullet Image

Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ....... Bullet Image

Part II

Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 26, or Form 990-EZ, Part V, line 38a.

(a) Name of interested person and purpose	(b) Loan to or from the organization?		(c)Original principal amount	(d)Balance due	(e) In default?		(f) Approved by board or committee?		(g)Written agreement?
(a) Name of interested person and purpose	To	From	(c)Original principal amount	(d)Balance due	Yes	No	Yes	No	Yes	No
(1) James J Smith MD PHYS PRACTICE SUPPT		X	85,793	90,465	Yes		Yes		Yes





Total ............... $				90,465

Part III

Grants or Assistance Benefitting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.

(a) Name of interested person	(b)Relationship between interested person and the organization	(c)Amount of grant or type of assistance

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

Cat. No. 50056A

Schedule L (Form 990 or 990-EZ) 2010

Page 2

Part IV

Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of transaction	(d) Description of transaction	(e) Sharing of organization's revenues?
(a) Name of interested person		(c) Amount of transaction	(d) Description of transaction	Yes	No
(1) ADAM SKIBA	SEE PART V	76,102	SALARY		No
(2) AMY SKIBA	SEE PART V	63,033	SALARY		No
(3) MEGAN STACK-SWEET	SEE PART V	63,882	SALARY		No
(4) CHARLIE CROWTHER	SEE PART V	18,669	SALARY		No

Part V

Supplemental Information

Complete this part to provide additional information for responses to questions on Schedule L (see instructions).

Identifier	Return Reference	Explanation
RELATIONSHIP BETWEEN INTERESTED PERSON AND THE ORGANIZATION	SCHEDULE L, PART IV	ADAM SKIBA IS THE SON OF KEY EMPLOYEE, GARY SKIBA. AMY SKIBA IS THE DAUGHTER OF KEY EMPLOYEE, GARY SKIBA. MEGAN STACK-SWEET IS THE DAUGHTER OF KEY EMPLOYEE, MARY STACK. CHARLIE CROWTHER IS THE SON OF DIRECTOR AND OFFICER, BRUCE K. CROWTHER.

Schedule L (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.
MediumBullet

Attach to Form 990 or 990-EZ.

OMB No. 1545-0047

2010

Open to Public
Inspection

Name of the organization

Northwest Community Hospital

Employer identification number

36-2340313

Identifier	Return Reference	Explanation
DESCRIPTION OF RELATIONSHIPS	FORM 990, PART VI, QUESTION 2	BRUCE K. CROWTHER, DIRECTOR AND CEO, AND JAMES BISHOP, DIRECTOR, SERVE ON THE NORTHWEST COMMUNITY HOSPITAL (HOSPITAL) BOARD AS WELL AS ON THE BOARDS OF WINTRUST FINANCIAL CORPORATION AND BARRINGTON BANK AND TRUST COMPANY NA. MICHAEL ZENN, HOSPITAL OFFICER, AND JAMES BISHOP, HOSPITAL DIRECTOR, SERVE ON THE BOARD OF VILLAGE BANK AND TRUST (A WINTRUST BANK). HOSPITAL DOES NOT TRANSACT ANY BUSINESS WITH WINTRUST FINANCIAL, BARRINGTON BANK, OR VILLAGE BANK AND TRUST.
DESCRIPTION OF CLASSES OF MEMBERS OR STOCKHOLDERS	FORM 990, PART VI, QUESTION 6	NORTHWEST COMMUNITY HEALTHCARE (NCH) IS THE SOLE CORPORATE MEMBER OF NORTHWEST COMMUNITY HOSPITAL (HOSPITAL). AS SUCH, IT ELECTS OR APPOINTS THE MEMBERS OF HOSPITAL'S GOVERNING BODY AND APPROVES SIGNIFICANT DECISIONS.
DESCRIPTION OF CLASSES OF PERSONS AND THE NATURE OF THEIR RIGHTS	FORM 990, PART VI, QUESTION 7A	NCH IS THE SOLE CORPORATE MEMBER OF HOSPITAL. AS SUCH, IT ELECTS OR APPOINTS THE MEMBERS OF THE GOVERNING BODY OF HOSPITAL PERIODICALLY OR AS VACANCIES ARISE.
DESCR CLASSES OF PERSONS, DECISIONS REQUIRING APPR & TYPE OF VOTING RIGHTS	FORM 990, PART VI, QUESTION 7B	NCH IS THE SOLE CORPORATE MEMBER OF HOSPITAL. AS SUCH, IT MUST APPROVE CERTAIN ACTIONS OF HOSPITAL. ACTION IS TAKEN BY A MAJORITY VOTE OF THE NCH BOARD WITH A QUORUM PRESENT. NCH MUST APPROVE THE FOLLOWING TYPES OF DECISIONS BY HOSPITAL: VOLUNTARY DISSOLUTION, MERGER, CONSOLIDATION OR SALE OR TRANSFER OF 10% OR MORE OF THE HOSPITAL'S ASSETS; SALE OF REAL PROPERTY OR INTEREST THEREIN; CREATION OF A SUBSIDIARY OR AFFILIATE; ANNUAL AND LONG-TERM CAPITAL AND OPERATING BUDGETS; AMENDMENT, ALTERATION OR REPEAL OF HOSPITAL'S ARTICLES OF INCORPORATION OR BYLAWS; SELECTION OF AUDITORS; APPOINTMENT, REMOVAL AND EVALUATION OF HOSPITAL DIRECTORS; DEBT OR INDEBTEDNESS, GUARANTEES OR BORROWINGS; APPOINTMENT, COMPENSATION, BENEFITS AND EVALUATION OF OFFICERS; APPOINTMENT AND EMPLOYMENT OF THE PRESIDENT; AND ACTIONS TAKEN BY TRUSTEES OF THE NORTHWEST COMMUNITY HOSPITAL EMPLOYEES RETIREMENT PLAN.
DESCRIBE THE PROCESS USED BY MANAGEMENT &/OR GOVERNING BODY TO REVIEW 990	FORM 990, PART VI, QUESTION 11B	A COPY OF FORM 990 WAS MADE AVAILABLE TO THE MEMBERS OF THE BOARD OF HOSPITAL PRIOR TO FILING. THE AUDIT AND COMPLIANCE COMMITTEE OF THE NCH BOARD REVIEWED FORM 990 FOR AFFILIATES OF NCH PRIOR TO DISTRIBUTION TO THE FULL BOARD.
DESCRIPTION OF PROCESS TO MONITOR TRANSACTIONS FOR CONFLICTS OF INTEREST	FORM 990, PART VI, QUESTION 12C	EACH YEAR, THE CONFLICT OF INTEREST POLICY AND QUESTIONNAIRE IS SENT TO DIRECTORS, OFFICERS AND KEY EMPLOYEES. EACH RESPONSE IS REVIEWED BY THE GENERAL COUNSEL AND THOSE IN WHICH ANY ACTUAL OR APPARENT CONFLICT WITH THE PRESENT ROLE IS DISCLOSED, ARE REVIEWED BY THE PRESIDENT/CEO AND BOARD CHAIRPERSON. IN THE CASE OF ANY CONFLICT INVOLVING AN ENTITY OR PARTY WITH WHICH HOSPITAL IS DEALING OR COMPETING, THE PERSON WITH THE CONFLICT MAY NOT PARTICIPATE IN ANY DECISIONS REGARDING THAT PARTY. INDIVIDUALS WHO ARE INDEPENDENT CONTRACTORS, OFFICERS, DIRECTORS, OR EMPLOYEES OF OTHER HEALTHCARE FACILITIES IN HOSPITAL'S SERVICE AREA MAY NOT SERVE ON NCH'S OR ANY RELATED ORGANIZATION'S BOARD OR BOARD COMMITTEE. IN ADDITION, THE POLICY INCLUDES A SAMPLE CONFLICT OF INTEREST DISCLOSURE LETTER TO BE USED IF A CONFLICT ARISES AFTER SUBMISSION OF THE ANNUAL QUESTIONNAIRE AND BEFORE THE NEXT. SUCH DISCLOSURE LETTERS WOULD BE REVIEWED AS NOTED ABOVE AT THE TIME THEY ARE RECEIVED.
COMPENSATION DETERMINATION PROCESS FOR TOP MANAGEMENT OFFICIAL	FORM 990, PART VI, QUESTION 15A	THE NOMINATION AND COMPENSATION COMMITTEE OF THE NCH BOARD IS RESPONSIBLE FOR SETTING THE COMPENSATION OF THE PRESIDENT/CEO WHO IS THE TOP MANAGEMENT OFFICIAL. COMPENSATION IS REVIEWED USING AN EXTERNAL COMPENSATION FIRM, PINP, INC. THE REVIEW ALSO UTILIZES COMPARISONS TO SIMILAR ORGANIZATIONS THROUGH REVIEW OF FORMS 990, USE OF COMPARISON STUDIES FROM THE METROPOLITAN CHICAGO HEALTHCARE COUNCIL AND OTHER SOURCES. THE PROCESS IS DOCUMENTED IN THE MINUTES OF THE NOMINATION AND COMPENSATION COMMITTEE.
COMPENSATION DETERMINATION PROCESS FOR OFFICERS & KEY EMPLOYEES	FORM 990, PART VI, QUESTION 15B	THE NOMINATION AND COMPENSATION COMMITTEE OF THE NCH BOARD IS RESPONSIBLE FOR APPROVING THE COMPENSATION OF THE OFFICERS AND KEY EMPLOYEES (VICE PRESIDENTS) OF HOSPITAL BASED ON RECOMMENDATIONS FROM THE PRESIDENT/CEO. THE REVIEW UTILIZES COMPARISONS TO STUDIES FROM THE METROPOLITAN CHICAGO HEALTHCARE COUNCIL AND OTHER SOURCES. THE PROCESS IS DOCUMENTED IN THE MINUTES OF THE NOMINATION AND COMPENSATION COMMITTEE.
AVAIL OF GOV DOCS, CONFLICT OF INTEREST POLICY, & FIN STMTS TO GEN PUBLIC	FORM 990, PART VI, QUESTION 19	GOVERNING DOCUMENTS AND THE CONFLICT OF INTEREST POLICY ARE NOT MADE PUBLIC. HOSPITAL'S FINANCIAL STATEMENTS ARE INCLUDED IN THE ANNUAL CONSOLIDATED AUDIT REPORT OF NCH AND SUBSIDIARIES. THE CONSOLIDATED FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC VIA THE MUNICIPAL SECURITIES RULEMAKING BOARD'S ELECTRONIC MUNICIPAL MARKET ACCESS (EMMA) WEBSITE AT WWW.EMMA.MSRB.ORG.
AVERAGE HOURS WORKED	PART VII, SECTION A	THE FOLLOWING INDIVIDUALS ARE EMPLOYEES OF NORTHWEST COMMUNITY HOSPITAL AND GENERALLY WORK 40 HOURS PER WEEK. A PORTION OF THEIR REGULAR WORK WEEK IS SPENT PROVIDING SERVICES TO NORTHWEST COMMUNITY DAY SURGERY CENTER, INC., NCH AND NORTHWEST COMMUNITY HOSPITAL FOUNDATION, WHICH ARE 501(C)(3) AFFILIATES OF HOSPITAL: BRUCE K. CROWTHER (14 HOURS), MICHAEL B. ZENN (9 HOURS), LEIGHTON SMITH, MD (2 HOURS), STEPHEN O. SCOGNA (9 HOURS), AND DALE BEATTY (2 HOURS). STEPHEN O. SCOGNA, NORTHWEST COMMUNITY HOSPITAL CFO, BEGAN HIS EMPLOYMENT IN APRIL OF 2011. AS SUCH, HIS FY2011 COMPENSATION IS APPROPRIATELY INCLUDED ON FORM 990, PART IX; HOWEVER, HE HAD NO CALENDAR YEAR 2010 COMPENSATION TO REPORT ON FORM 990, PART VII.
RECONCILIATION OF NET ASSETS - OTHER CHANGES IN NET ASSETS	FORM 990, PART XI, QUESTION 5	OTHER CHANGES IN NET ASSETS: UNREALIZED LOSS ON INVESTMENTS (1,910,317) INTEREST RATE SWAP LOSS (151,878) PENSION-RELATED CHANGES OTHER THAN NET PERIODIC PENSION COST(9,400,636) RESTRICTED FUNDS TRANSFER - SILVER LINING PROGRAM (34,507) CHANGE IN TEMPORARILY RESTRICTED NET ASSETS 317,364 CHANGE IN PERMANENTLY RESTRICTED NET ASSETS 2,510 ---------- (11,177,464)

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

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2010

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

Complete if the organization answered "Yes" to Form 990, Part IV, line 33, 34, 35, 36, or 37.
MediumBullet

Attach to Form 990. MediumBullet

See separate instructions.

OMB No. 1545-0047

2010

Open to Public Inspection

Name of the organization

Northwest Community Hospital

Employer identification number

36-2340313

Part I

Identification of Disregarded Entities (Complete if the organization answered "Yes" on Form 990, Part IV, line 33.)

(a) Name, address, and EIN of disregarded entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Total income	(e) End-of-year assets	(f) Direct controlling entity
(1) NORTHWEST COMMUNITY PHYSICIANS ASSN LLC 3060 SALT CREEK LANE ARLINGTON HTS,IL60005 51-0457240	PATIENT CARE	IL	3,325,001	628,745	N/A
(2) NCH SERVICE COMPANY LLC 3060 SALT CREEK LANE ARLINGTON HTS,IL60005 26-3791362	PATIENT CARE	IL	1,965,773	465,970	NCPA LLC

Part II

Identification of Related Tax-Exempt Organizations (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.)

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled organization
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No
(1) NORTHWEST COMMUNITY HEALTHCARE 800 WEST CENTRAL ROAD ARLINGTON HTS,IL60005 36-3125209	SUPPORT ORG	IL	501(C)(3)	11 TYPE II	NA
(2) NORTHWEST COMMUNITY DAY SURGERY CTR INC 675 WEST KIRCHOFF ARLINGTON HTS,IL60005 36-3540436	OUTPATIENT	IL	501(c)(3)	3	NCH
(3) NORTHWEST COMMUNITY HOSPITAL FOUNDATION 3060 SALT CREEK LANE ARLINGTON HTS,IL60005 36-3125193	FUNDRAISING	IL	501(c)(3)	7	NCH

For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50135Y

Schedule R (Form 990) 2010

Page 2

Part III

Identification of Related Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.)

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Predominant income(related, unrelated, excluded from tax under sections 512-514)	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity		(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No
(1) NPC-CYBERKNIFE LLC 800 WEST CENTRAL ROAD ARLINGTON HEIGHTS,IL60005 20-4462828	EQUIPMENT LEASING	DE	NA	N/A

Part IV

Identification of Related Organizations Taxable as a Corporation or Trust (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.)

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(h) Percentage ownership
(1) NORTHWEST COMMUNITY HEALTH SERVICES INC 800 WEST CENTRAL ROAD ARLINGTON HEIGHTS,IL60005 36-3312906	HEALTHCARE SVCS	IL	NA	C CORP
(2) NORTHWEST COMMUNITY CAPCO INC 800 WEST CENTRAL ROAD ARLINGTON HEIGHTS,IL60005 36-4027717	MANAGED CARE	IL	NA	C CORP	355,000	801,938	100.000 %
(3) NCH CASUALTY INSURANCE SPC LTD 68 WEST BAY ROAD KY1-1102 GRAND CAYMAN,CAYMEN ISLANDS CJ 98-0442062	INSURANCE	CJ	NA	C CORP
(4) NCH PHYSICIANS COOPERATIVE 800 WEST CENTRAL ROAD ARLINGTON HEIGHTS,IL60005 20-1830299	GROUP PURCHASING	IL	NA	C CORP			100.000 %

Schedule R (Form 990) 2010

Page 3

Part V

Transactions With Related Organizations (Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35, 35A, or 36.)

Note. Complete line 1 if any entity is listed in Parts II, III or IV.

Yes

1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?

a Receipt of (i) interest (ii) annuities (iii) royalties (iv) rent from a controlled entity . . . . . . . . . . . . . . . . . . . . . . .

b Gift, grant, or capital contribution to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

c Gift, grant, or capital contribution from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

d Loans or loan guarantees to or for other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

e Loans or loan guarantees by other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

f Sale of assets to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

g Purchase of assets from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

h Exchange of assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

i Lease of facilities, equipment, or other assets to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .

j Lease of facilities, equipment, or other assets from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

k Performance of services or membership or fundraising solicitations for other organization(s) . . . . . . . . . . . . . . . . . . . . . .

Yes

l Performance of services or membership or fundraising solicitations by other organization(s) . . . . . . . . . . . . . . . . . . . . . .

m Sharing of facilities, equipment, mailing lists, or other assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

n Sharing of paid employees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

o Reimbursement paid to other organization for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

p Reimbursement paid by other organization for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

q Other transfer of cash or property to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

r Other transfer of cash or property from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.

(a) Name of other organization	(b) Transaction type(a-r)	(c) Amount involved
(1) NORTHWEST COMMUNITY CAPCO INC	P	239,609
(1)
(2)
(3)
(4)
(5)
(6)

Schedule R (Form 990) 2010

Page 4

Part VI

Unrelated Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 37.)

Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.

(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Are all partners section 501(c)(3) organizations?		(e) Share of end-of-year assets	(f) Disproprtionate allocations?		(g) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	(h) General or managing partner?
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(e) Share of end-of-year assets	Yes	No	(g) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

Schedule R (Form 990) 2010

Page 5

Part VII

Supplemental Information

Complete this part to provide additional information for responses to questions on Schedule R (see instructions).

Identifier	Return Reference	Explanation

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: NCH operates an acute care hospital in Arlington Heights, IL. The hospital exists to provide quality compassionate healthcare services to the people of the Northwest suburban community of Chicago.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ....	3	18
4	Number of independent voting members of the governing body (Part VI, line 1b) ....	4	17
5	Total number of individuals employed in calendar year 2010 (Part V, line 2a) ...	5	3,860
6	Total number of volunteers (estimate if necessary) ....	6	850
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ..	7a	0
b	Net unrelated business taxable income from Form 990-T, line 34 ..	7b	0

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	58,803,610	1,732,845
9	Program service revenue (Part VIII, line 2g) .........	429,297,770	464,896,764
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	3,115,869	1,384,958
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	6,127,030	6,015,024
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)...................	497,344,279	474,029,591
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	438,997	2,958,497
14	Benefits paid to or for members (Part IX, column (A), line 4) ....	0	0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	236,671,537	242,624,121
16a	Professional fundraising fees (Part IX, column (A), line 11e)....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24f)....	216,879,648	236,398,778
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	453,990,182	481,981,396
19	Revenue less expenses. Subtract line 18 from line 12......	43,354,097	-7,951,805
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16)............	610,945,530	591,409,283
21	Total liabilities (Part X, line 26)............	440,717,241	440,310,263
22	Net assets or fund balances. Subtract line 21 from line 20 .....	170,228,289	151,099,020

Sign Here

	Signature of officer	Date

	Type or print name and title.

Paid Preparer's Use Only	Preparer's signature	Date	Check if self- employed	Preparer’s taxpayer identification number (see instructions)
	Firm’s name (or yours if self-employed), address, and ZIP + 4			EIN
				Phone no.


4a	(Code: ) (Expenses $ 53,227,428 including grants of $ 0 ) (Revenue $ 52,896,610 )
	CARDIAC NORTHWEST COMMUNITY HOSPITAL'S (HOSPITAL) CARDIAC CARE PROGRAM PROVIDED QUALITY, PATIENT-CENTERED COMPASSIONATE CARE, REGARDLESS OF ABILITY TO PAY, TO APPROXIMATELY 32,000 INPATIENTS AND OUTPATIENTS DURING FY 2011. THE TREATMENT WAS PROVIDED IN HOSPITAL'S STATE-OF-THE-ART DIGITAL CARDIAC CATH LAB SUITES, INCLUSIVE OF ITS HIGH TECH OPERATING ROOMS AND PRIVATE FAMILY-CENTERED PATIENT CARE ROOMS. AN ON-CALL TEAM OF NURSES, RADIOLOGY TECHS, OR TECHS, CARDIOLOGISTS AND SURGEONS WERE READILY AVAILABLE 24 HOURS A DAY, 7 DAYS A WEEK, TO PROVIDE EMERGENT CARE TO THOSE WITH CARDIAC DISEASE. THE CARDIAC TEAM WORKS WITH THE EMERGENCY ROOM AND MULTIPLE NEIGHBORING COMMUNITY PARAMEDICS AND EMERGENCY PERSONNEL TO EXCEED THE NATIONAL BENCHMARK OF DOOR TO BALLOON TIME (OR OPEN ARTERY) IN LESS THAN 90 MINUTES FOR PATIENTS PRESENTING IN HOSPITAL'S EMERGENCY ROOM HAVING AN ACUTE MI. HOSPITAL HAS BEEN REPEATEDLY RECOGNIZED FOR ITS COMMITMENT TO QUALITY OUTCOMES AND IS CURRENTLY RECOGNIZED AS AN ACCREDITED CHEST PAIN CENTER BY THE SOCIETY FOR CHEST PAIN CENTERS AND AN ACCREDITED ECHO LAB BY THE INTERSOCIETAL COMMISSION FOR THE ACCREDITATION OF ECHOCARDIOGRAPHY LABORATORIES (ICAEL). IN ADDITION, HOSPITAL HAS ALSO BEEN RECOGNIZED FIVE TIMES BETWEEN 2000 AND 2010 AS A THOMSON REUTERS TOP 100 HEART HOSPITAL FOR PROVIDING EXCELLENCE IN A COST EFFECTIVE MANNER TO MULTIPLE CARDIAC PATIENT POPULATIONS. HOSPITAL HAS ALSO BEEN THE RECIPIENT OF MULTIPLE HEALTHGRADES AWARDS FOR EXCELLENCE IN CARDIAC SERVICES, MOST RECENTLY IN 2010. THE CARDIAC DEPARTMENT ALSO PROVIDES MULTIPLE SCREENING AND EDUCATION PROGRAMS, INCLUDING FREE INDIVIDUAL CONSULTATIONS WITH CARDIAC REHAB PERSONNEL FOR COMMUNITY MEMBERS CONSIDERED TO BE AT RISK FOR DEVELOPING HEART DISEASE BASED ON THEIR COMPLETION OF HOSPITAL'S ON LINE SCREENING TOOL. IN FEBRUARY 2011, HOSPITAL HOSTED A COMMUNITY EVENT WHICH PROVIDED FREE BLOOD PRESSURE, CHOLESTEROL AND BMI SCREENINGS WHICH WERE USED TO CALCULATE AN INDIVIDUAL'S RISKS OF DEVELOPING HEART DISEASE. IN ADDITION, PHYSICIANS PROVIDED EDUCATION ON HEART HEALTH AND WELLNESS. OVER 300 PEOPLE PARTICIPATED IN THE EVENT.

4b	(Code: ) (Expenses $ 41,491,548 including grants of $ 0 ) (Revenue $ 33,649,484 )
	GENERAL SURGERY HOSPITAL'S GENERAL SURGERY PROGRAM PROVIDED QUALITY, PATIENT-CENTERED, COMPASSIONATE CARE, REGARDLESS OF ABILITY TO PAY, TO 3,180 GENERAL SURGICAL PATIENTS (INPATIENT AND OUTPATIENT) DURING FY 2011. PROCEDURES WERE PERFORMED IN STATE-OF-THE-ART OPERATING ROOMS WHICH INCLUDED THREE DEDICATED MINIMALLY INVASIVE SURGERY SUITES. THE GENERAL SURGERY PROGRAM PROVIDED CARE FOR BOTH PEDIATRIC AND ADULT POPULATIONS. IN FY 2011, HOSPITAL PARTNERED WITH CHILDREN'S MEMORIAL HOSPITAL IN CHICAGO TO PLAN FOR A NEONATAL SURGERY PROGRAM TO SUPPORT ITS NEW LEVEL 3 NICU. THE GENERAL SURGERY PROGRAM ALSO INCLUDED DAVINCI ROBOTIC CAPABILITIES AND A DEDICATED PANCREATIC SURGERY PROGRAM. GENERAL SURGERY SERVICES WERE PROVIDED 24 HOURS A DAY, 7 DAYS A WEEK, AND THE PROGRAM WAS DESIGNATED A LEVEL 2 TRAUMA CENTER. HOSPITAL RECEIVED MULTIPLE HEALTHGRADES AWARDS WHICH INCLUDE GI SERVICES. GENERAL SURGERY MORTALITY AND SURGICAL SITE INFECTIONS OBSERVED TO EXPECTED RATIOS WERE IN THE "LOW" RANGE BASED ON HOSPITAL'S CASE MIX INDEX. A MULTIDISCIPLINARY TEAM WORKED TO IMPROVE RESULTS IN THE SURGICAL CARE IMPROVEMENT PROJECT'S CORE MEASURES. AN ADVANCED PRACTICE NURSE WAS HIRED TO OVERSEE SURGICAL OUTCOMES AND IMPROVE PERFORMANCE IN ALL SURGICAL SPECIALTIES. AREAS OF CONCENTRATION INCLUDED: ANTIBIOTICS ADMINISTERED WITHIN 60 MINUTES OF INCISION, APPROPRIATE ANTIBIOTICS ADMINISTERED, ANTIBIOTICS DISCONTINUED WITHIN 24 HOURS, APPROPRIATE HAIR REMOVAL, URINARY CATHETER REMOVED POST-OP DAY 1 OR 2, SURGERY TEMPERATURE MANAGEMENT, BETA BLOCKER PRIOR TO SURGERY AND VTE PROPHYLAXIS. THE MAJORITY OF HOSPITAL'S OUTCOME MEASURES WERE AT OR ABOVE BENCHMARK LEVELS.

4c	(Code: ) (Expenses $ 34,301,326 including grants of $ 0 ) (Revenue $ 27,461,105 )
	ORTHOPEDICS HOSPITAL'S ORTHOPEDIC PROGRAM PROVIDES QUALITY, PATIENT CENTERED COMPASSIONATE CARE, REGARDLESS OF ABILITY TO PAY, 24 HOURS A DAY, 7 DAYS A WEEK TO ADULT AND GERIATRIC PATIENTS REQUIRING ORTHOPEDIC INTERVENTION WITH CASE MANAGEMENT INTEGRATED INTO THE DELIVERY OF CARE. THE UNIT TEAM, PRIMARILY COMPOSED OF REGISTERED NURSES, ASSISTED BY PATIENT CARE TECHNICIANS; PHYSICAL, RESPIRATORY, OCCUPATIONAL AND SPEECH THERAPISTS; DIETITIANS; CHAPLAINS AND PHARMACISTS, PROVIDES EVALUATION AND TREATMENT OF ILLNESS IN THE ACUTE PHASE AND ADVANCED CLINICAL MANAGEMENT OF THE ORTHOPEDIC PATIENT. PATIENT-FOCUSED CARE AND EDUCATION ARE PROVIDED IN RESPONSE TO A NUMBER OF DIAGNOSES, INCLUDING: TOTAL JOINT REPLACEMENT, FRACTURES, NON-HEAD INJURIES, BACK PAIN, AND EPIDURAL INTERVENTION. FORM 990, PART III - OTHER PROGRAM SERVICES, LINE 4D GASTROENTEROLOGY HOSPITAL'S GASTROENTEROLOGY (GI) CENTER PROVIDES QUALITY, PATIENT-CENTERED COMPASSIONATE CARE TO PATIENTS, IN NEED OF DIAGNOSTIC AND THERAPEUTIC ENDOSCOPIC PROCEDURES REGARDLESS OF ABILITY TO PAY, 24 HOURS A DAY, 7 DAYS A WEEK. THE GI CENTER HAS BECOME A REGIONAL REFERRAL CENTER FOR PATIENTS IN NEED OF INTERVENTIONAL PROCEDURES INCLUDING ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY AND ENDOSCOPIC ULTRASOUND. A STATE-OF-THE-ART INTERVENTIONAL SUITE OFFERS PATIENTS ACCESS TO SUPERIOR QUALITY CARE BY PROVIDING DIGITAL IMAGING. HOSPITAL'S INTERVENTIONAL TEAM IS LED BY AN EXPERT INTERVENTIONAL PHYSICIAN AND AN INTERVENTIONAL PROCEDURE CONSULTANT. THIS TEAM PROVIDES SAME-DAY CARE FOR PATIENTS IN AND BEYOND HOSPITAL'S SERVICE AREA WHO ARE IN NEED OF INTERVENTIONAL PROCEDURES. IN FY 2011 THE GI CENTER PROVIDED SERVICE FOR 12,951 PATIENTS. IN ADDITION TO THE PROGRAM SERVICES LISTED ABOVE, HOSPITAL PROVIDES MANY OTHER HEALTHCARE SERVICES ON A DAILY BASIS. THESE ADDITIONAL PROGRAMS INCLUDE CLINICAL EDUCATION AND RESEARCH, NEONATAL CARE, AND EMERGENCY CARE. HOSPITAL IS A SUBSIDIARY ENTITY OF NORTHWEST COMMUNITY HEALTHCARE (NCH). NCH WAS ESTABLISHED TO OWN, OPERATE, CONTROL, AND OTHERWISE COORDINATE THE DELIVERY OF HEALTHCARE WITHIN THE SERVICE AREA OF HOSPITAL AND COORDINATE THE ACTIVITIES OF THE VARIOUS CORPORATIONS AFFILIATED WITH NCH. SUBSIDIARIES OF NCH INCLUDE HOSPITAL, NORTHWEST COMMUNITY HOSPITAL FOUNDATION (FOUNDATION) AND NORTHWEST COMMUNITY DAY SURGERY CENTER, INC., (DAY SURGERY CENTER) WHICH ARE NOT-FOR-PROFIT ENTITIES; NORTHWEST COMMUNITY HEALTH SERVICES, INC., WHICH OWNS AND OPERATES THE NCH MEDICAL GROUP, A MULTI-SPECIALTY PHYSICIAN PRACTICE THAT WAS ESTABLISHED IN 2010 AND NPC-CYBERKNIFE, LLC, WHICH ARE TAXABLE ENTITIES; AND NCH CASUALTY INSURANCE SPC LIMITED (NCHCI), A CAYMAN ISLANDS CORPORATION.

4d	Other program services. (Describe in Schedule O.)
	(Expenses $ 266,880,243 including grants of $ 2,958,497 ) (Revenue $ 350,889,565 )
4e	Total program service expenses$ 395,900,545

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)............	8,900,493	39,126	975,875

				(A) Total revenue	(B) Related or exempt function revenue	(C) Unrelated business revenue	(D) Revenue excluded from tax under sections 512, 513, or 514
1a	Federated campaigns..1a
b	Membership dues....1b
c	Fundraising events....1c
d	Related organizations...1d		1,618,852
e	Government grants (contributions)1e		113,993

f	All other contributions, gifts, grants, and similar amounts not included above1f
g	Noncash contributions included in lines 1a-1f:$
h	Total. Add lines 1a-1f.......			1,732,845
			Business Code
2a	Net patient services		621,110	460,812,809	460,812,809
b	Lab services		621,500	2,492,049	2,492,049
c	Classes and training		900,099	1,068,184	1,068,184
d	Nursing services - Palatine Opportunity Center, Li		900,099	176,364	176,364
e	Research - Hos, GIS		900,099	347,358	347,358
f	All other program service revenue .
g	Total. Add lines 2a–2f........			464,896,764
3	Investment income (including dividends, interest
	and other similar amounts).....			1,776,082			1,776,082
4	Income from investment of tax-exempt bond proceeds..			329			329
5	Royalties............			0
		(i) Real	(ii) Personal
6a	Gross Rents	2,498,292
b	Less: rental expenses	1,146,765
c	Rental income or (loss)	1,351,527
d	Net rental income or (loss).......			1,351,527			1,351,527
		(i) Securities	(ii) Other
7a	Gross amount from sales of assets other than inventory	372,116,417	169,443
b	Less: cost or other basis and sales expenses	372,536,151	141,162
c	Gain or (loss)	-419,734	28,281
d	Net gain or (loss)..........			-391,453			-391,453
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ...
	a
b	Less: direct expenses ...b
c	Net income or (loss) from fundraising events..			0
9a	Gross income from gaming activities. See Part IV, line 19 ...
	a
b	Less: direct expenses ...b
c	Net income or (loss) from gaming activities...			0
10a	Gross sales of inventory, less returns and allowances .
	a		264,132
b	Less: cost of goods sold ..b		269,135
c	Net income or (loss) from sales of inventory..			-5,003			-5,003
Miscellaneous Revenue			Business Code
11a	CAFETERIA		722,210	1,800,186			1,800,186
b	Reinsurance Recovery		900,099	1,685,235			1,685,235
c	Communications		900,099	336,516			336,516
d	All other revenue ....			846,563			846,563
e	Total. Add lines 11a–11d ......			4,668,500
12	Total revenue. See Instructions....			474,029,591	464,896,764	0	7,399,982


				(A) Beginning of year		(B) End of year
1	Cashnon-interest-bearing ..........			16,891,000	1	15,555,289
2	Savings and temporary cash investments .......			2,397,078	2	3,112,463
3	Pledges and grants receivable, net .........				3
4	Accounts receivable, net .........			51,457,091	4	55,078,694
5	Receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
	Schedule L ..........			90,465	5	94,386
6	Receivables from other disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B). Complete Part II of
	Schedule L ..........				6
7	Notes and loans receivable, net .............			283,430	7	305,372
8	Inventories for sale or use ..............			4,483,867	8	4,752,063
9	Prepaid expenses and deferred charges ............			9,536,463	9	6,193,121
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	645,198,526
b	Less: accumulated depreciation. .....	10b	245,766,920	407,905,178	10c	399,431,606
11	Investments—publicly traded securities ..........			104,611,294	11	94,056,794
12	Investments—other securities. See Part IV, line 11 ......				12
13	Investments—program-related. See Part IV, line 11 ..			5,433,417	13	5,753,291
14	Intangible assets .........				14
15	Other assets. See Part IV, line 11 ...........			7,856,247	15	7,076,204
16	Total assets. Add lines 1 through 15 (must equal line 34)...			610,945,530	16	591,409,283
17	Accounts payable and accrued expenses .			64,574,817	17	65,928,264
18	Grants payable ..........				18
19	Deferred revenue ..........			6,463,988	19	3,090,185
20	Tax-exempt bond liabilities ..........			288,780,000	20	283,300,000
21	Escrow or custodial account liability. Complete Part IV of Schedule D..				21
22	Payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
	persons. Complete Part II of Schedule L..........				22
23	Secured mortgages and notes payable to unrelated third parties ..				23
24	Unsecured notes and loans payable to unrelated third parties ....				24
25	Other liabilities. Complete Part X of Schedule D.....			80,898,436	25	87,991,814
26	Total liabilities. Add lines 17 through 25.....			440,717,241	26	440,310,263
	Organizations that follow SFAS 117, check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets .....			164,794,872	27	145,345,729
28	Temporarily restricted net assets .....			4,475,858	28	4,793,222
29	Permanently restricted net assets .....			957,559	29	960,069
	Organizations that do not follow SFAS 117, check here and complete lines 30 through 34.
30	Capital stock or trust principal, or current funds .....				30
31	Paid-in or capital surplus, or land, building or equipment fund .....				31
32	Retained earnings, endowment, accumulated income, or other funds				32
33	Total net assets or fund balances .....			170,228,289	33	151,099,020
34	Total liabilities and net assets/fund balances .....			610,945,530	34	591,409,283