Department of the Treasury Internal Revenue Service
Public Charity Status and Public Support
Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.
Attach to Form 990 or Form 990-EZ. See separate instructions.
OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
Northwestern Memorial Healthcare Group
Employer identification number
36-4724966
Part I
Reason for Public Charity Status
(All organizations must complete this part.) See instructions
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
11
e
By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons other than foundation managers and other than one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2).
f
If the organization received a written determination from the IRS that it is a Type I, Type II or Type III supporting organization, check this box
..................................................
g
Since August 17, 2006, has the organization accepted any gift or contribution from any of the following persons?
(i) a person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
and (iii) below, the governing body of the the supported organization?
................
11g(i)
(ii)
a family member of a person described in (i) above?
......................
11g(ii)
(iii)
a 35% controlled entity of a person described in (i) or (ii) above?
................
11g(iii)
h
Provide the following information about the supported organization(s).
(i) Name of supported organization
(ii) EIN
(iii) Type of organization (described on lines 1- 9 above or IRC section (see instructions))
(iv) Is the organization in col. (i) listed in your governing document?
(v) Did you notify the organization in col. (i) of your support?
(vi) Is the organization in col. (i) organized in the U.S.?
(vii) Amount of support?
Yes
No
Yes
No
Yes
No
Total
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2011
Schedule A (Form 990 or 990-EZ) 2011
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) 2007
(b) 2008
(c) 2009
(d) 2010
(e) 2011
(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) 2007
(b) 2008
(c) 2009
(d) 2010
(e) 2011
(f) Total
7
Amounts from line 4..
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
9
Net income from unrelated business activities, whether or not the business is regularly carried on..
10
Other income. (Explain in Part IV.) Do not include gain or loss from the sale of capital assets..
11
Total support (Add lines 7 through 10).
12
Gross receipts from related activities, etc. (See instructions.)
..................
12
13
First Five Years
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here..........................................
Section C. Computation of Public Support Percentage
14
Public Support Percentage for 2010 (line 6 column (f) divided by line 11 column (f))
.........
14
15
Public Support Percentage for 2009 Schedule A, Part II, line 14
...............
15
16a
33 1/3% support test—2011.
If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization
......................
b
33 1/3% support test—2010.
If the organization did not check the box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization
.....................
17a
10%-facts-and-circumstances test—2011.
If the organization did not check a box on line 13, 16a, or 16b and line 14
is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here. Explain
in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly supported
organization
..................................................
b
10%-facts-and-circumstances test—2010.
If the organization did not check a box on line 13, 16a, 16b, or 17a and line
15 is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here.
Explain in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly supported organization
..............................................
18
Private Foundation
If the organization did not check a box on line 13, 16a, 16b, 17a or 17b, check this box and see
instructions
...................................................
Schedule A (Form 990 or 990-EZ) 2011
Schedule A (Form 990 or 990-EZ) 2011
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) 2007
(b) 2008
(c) 2009
(d) 2010
(e) 2011
(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) 2007
(b) 2008
(c) 2009
(d) 2010
(e) 2011
(f) Total
9
Amounts from line 6...
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
11
Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
12
Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)
13
Total support (Add lines 9, 10c, 11 and 12.).
14
First Five Years
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here.............................................
Section C. Computation of Public Support Percentage
15
Public Support Percentage for 2011 (line 8 column (f) divided by line 13 column (f))
.........
15
16
Public support percentage from 2010 Schedule A, Part III, line 15
...............
16
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2011 (line 10c column (f) divided by line 13 column (f))
......
17
18
Investment income percentage from 2010 Schedule A, Part III, line 17
.............
18
19a
33 1/3% support tests—2011.
If the organization did not check the box on line 14, and line 15 is more than 33 1/3% and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
..........
b
33 1/3% support tests—2010.
If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
....
20
Private Foundation
If the organization did not check a box on line 14, 19a or 19b, check this box and see instructions
.....
Schedule A (Form 990 or 990-EZ) 2011
Schedule A (Form 990 or 990-EZ) 2011
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
Listed below are THOSE gROUP MEMBERS THAT ARE NEITHER A HOSPITAL NOR A COOPERATIVE HOSPITAL SERVICE ORGANIZATION DESCRIBED IN SECTION 170(B)(1)(a)(III) nORTHWESTERN mEMORIAL fOUNDATION, tYPE 7, 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) lAKE fOREST HEALTH & fITNESS iNSTITUTE, TYPE 9, AN ORGANIZATION THAT NORMALLY RECEIVES: (1) MORE THAN 33 1/3% 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 33 1/3% 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)
Schedule A (Form 990 or 990-EZ) 2011
Additional Data
Software ID:
Software Version:
-
TIN:
SCHEDULE O (Form 990 or 990-EZ)
Department of the Treasury Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ
Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
Attach to Form 990 or 990-EZ.
OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
Northwestern Memorial Healthcare Group
Employer identification number
36-4724966
Identifier
Return Reference
Explanation
Conflict of Interest
Part VI Section B Question 12 c
Northwestern Memorial HealthCare (NMHC) maintains both a Conflict of Interest Policy and an Intermediate Sanctions Policy. These policies have been approved by its Board of Directors and apply to all entities, directors, officers, employees and transactions which take place within the NMHC system. The policies were written to assist board members and management with the identification of those transactions that warrant attention and consideration to ensure proper adherence to the tax laws impacting tax-exempt organizations. The conflict of interest policy requires completion of an annual certification which affirms that such person has received, read and understands the conflict of interest policy, has agreed to comply, has disclosed any matters required to be disclosed under the policy, and agrees to report any changes promptly to the Chief Integrity Executive. Once the annual certifications are complete, the Chief Integrity Executive reviews the disclosures for compliance with the policy.
COMPENSATION POLICY
Part VI Section B Question 15 a and b
AS A MEMBER OF THE NORTHWESTERN MEMORIAL HEALTHCARE ORGANIZATION, NMHC IS INCLUDED IN THE OVERALL Board-led executive compensation review and approval process. THE PROCESS FOR DETERMINING EXECUTIVE COMPENSATION AT NORTHWESTERN MEMORIAL COMPLIES WITH IRS GUIDELINES FOR TAX-EXEMPT ORGANIZATIONS; IS DETERMINED BY A SEPARATE SUBCOMMITTEE OF THE BOARD OF DIRECTORS WHOSE MEMBERS ARE ALL INDEPENDENT AND NON-PAID; AND IS ANNUALLY EVALUATED IN THE CONTEXT OF COMPENSATION DATA GATHERED BY EXTERNAL CONSULTANTS FROM A PEER GROUP COMPRISED OF similarly situated healthcare organizations. IN ADDITION, a significant portion of compensation is at risk and is payable only upon achievement of substantial goals. THE BOARD PLACES A HIGH PRIORITY ON ITS ABILITY TO RECRUIT AND RETAIN A STRONG LEADERSHIP TEAM TO ENSURE WE SERVE OUR MISSION AND ACHIEVE OUR GOALS. THE OFFICERS OF NORTHWESTERN MEMORIAL HEALTHCARE ALSO FULFILL OFFICER AND EXECUTIVE FUNCTIONS FOR NMHC'S SUBSIDIARIES.
Governing Documents Disclosure
Part VI Section C Question 19
THE CORPORATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. THE CONSOLIDATED FINANCIAL STATEMENTS OF NORTHWESTERN MEMORIAL HEALTHCARE AND SUBSIDIARIES ARE AVAILABLE on the websites for Northwestern memorial Hospital and Northwestern Lake Forest Hospital. The financial statements are also available FROM THE ILLINOIS ATTORNEY GENERAL'S OFFICE AS PART OF ITS ANNUAL COMMUNITY BENEFITS REPORT and through the ELECTRONIC MUNICIPAL MARKET ACCESS SYSTEM OF THE MUNICIPAL SECURITIES RULEMAKING BOARD.
BUSINESS RELATIONSHIPS
FORM 990 SECTION VI QUEStion 2
Group/NMF Terry Savage and Dennis S. Chookaszian are directors on NMF's Board. They are also directors of the Chicago Mercantile Exchange. Judy Greffin and Andrea Redmond are Board members of NMF. Judy Greffin is an officer and Andrea Redmond is a board member of allstate corporation. Michael a. Ruchim MD, M. Christine stock md and nancy sassower are Directors at Northwestern memorial Foundation. They are also directors at Northwestern Healthcare corporation. Nancy W. sassower MD is also an officer of Northwestern healthcare corporation. GROUP/NMH gary A. Noskin and Jeffery l. Glassroth are directors of Northwestern memorial Hospital. They are also directors of Northwestern Healthcare Corporation. Donald Thompson and Miles white are Directors at Northwestern memorial Hospital. Mr. Thompson is an officer and a Board member and MR. white is also a director at McDonald's Corporation. Donald Thompson, John A. Canning Jr. and Anne Pramaggiore are Directors at Northwestern memorial Hospital. mr. Thompson and mr. Canning are also directors at Exelon corporation and Ms. Pramaggiore is an officer of commonwealth Edison, a subsidiary. Peter J. McCanna, Douglas M. Young and Carol M. Lind are officers of Northwestern Memorial HealthCare, Northwestern memorial Hospital, Northwestern memorial Foundation, and Northwestern Lake Forest Hospital. Douglas M. Young and Peter J. mcCanna are also officers at Northwestern memorial Physicians group. Peter J. mcCanna is an officer of Northwestern Memorial Insurance Company. Douglas M. Young and Carol M. lind are directors and officers of Northwestern Memorial Insurance Company. GROUP/NMPG Jeffery D. Kopin and Daniel M. Derman are Directors of Northwestern memorial Physician Group. Andrew palumbo and Daniel M. derman MD are officers of Northwestern memorial Physicians group. These individuals are also partners in a partnership and greater than 10% owners in an LLC.
REVIEW FORM 990
FORM 990, PART VI, SECTION A, QUESTION 11
The Form 990 ("Form") was GENERATED internally by the finance department with support from various departments within the organization. Various sections of the Form were reviewed by senior management of Northwestern Memorial HealthCare ("NMHC"), as the parent organization, and various committees. As examples, the Chief Integrity Executive reviewed disclosures for related party transactions, the Tax and Regulatory Review Committee reviewed the community benefit report that describes the exempt purpose achievements, and lobbying expenditures were reviewed by the VP External Affairs. The Executive Compensation Subcommittee of the Board of Directors of NMHC was provided the compensation disclosures. The organization then worked with a national, independent public accounting firm as the paid preparer of the Form 990 filing. The final Form was reviewed by members of the Finance department prior to review by the NMHC Vice President, Finance and Interim Chief Financial Officer. Prior to filing, the completed Form 990 was provided to the Board of Directors through a secure website.
HOURS WORKED RELATED COMPANIES
Form 990 Part VII
JULIA L CREAMER, DANIEL M DERMAN MD, STEPHEN C FALK, DEAN M HARRISON, MICHELLE A JANNEY, CAROL M LIND, DEAN L MANHEIMER, THOMAS J MCAFEE, PETER J MCCANNA, DENNIS M MURPHY, CHARLES M WATTS MD, DOUGLAS M YOUNG AND TIMOTHY R ZOPH, ARE ALL EMPLOYEES OF NMHC. THEY GENERALLY WORK MORE THAN 40 HOURS A WEEK AND PERFORM SERVICES FOR VARIOUS NMHC SUBSIDIARIES
Reconciliation Net Assets
Form 990 Part XI Line 5
Post Retirement Benefit Changes (12,028,160) Unrealized Gains 39,060,359 Net assets released 243,284 Change in Value Split Interest Agreements (943,686) Change in Beneficial interests (45,855) Change in interest rate swaps (30,658,253) changes in restricted income 70,514 Miscellaneous (32,978) total (4,334,775)
Group Titles & Compensation Presentation
Form 990, Part VII
Northwestern Memorial HealthCare (NMHC), is the direct parent organization for Northwestern Memorial Hospital (NMH), Northwestern Memorial Foundation (NMF), and Northwestern Lake Forest Hospital (NLFH). NMHC is also the indirect parent for Northwestern Memorial Physicians Group (NMPG), and Lake Forest Health and Fitness Institute (HFI). These six corporations have combined through the election under Regulation 1.6033-2 (d) (5) to report the directors, officers, key employees and five highly compensated employees under the Group Return requirements for Form 990 for the fiscal year ended 8/31/2012. No organization in this Group Return compensates their directors for services performed as directors. Where compensation is reported for a director, the compensation is associated with another position held within the six corporations. Certain individuals hold multiple positions throughout these six corporations. In order to simplify the reporting, their names are listed only once per Form 990, Part VII and Schedule J. Each individual listed has his or her organization's initials listed next to their respective name and the box checked for their position with that corporation. Additional director or officer positions held by each individual are noted below. Thomas A Cole is also the Chair and Director for NMH. John A Canning JR is also the Vice-Chair and Director for NMH. Kent P Dauten is also the current Chair for NMF. Dean M Harrison is director, President and CEO of NMHC and nmh. he is also a Director and CEO of NMF and NLFH. Gary A Noskin MD is also a Director of NMH. Robert L Parkinson JR is also the Chair of NLFH. Homi P Patel is also a Director of NLFH. J Larry Jameson MD is also a Director of NLFH. Maria C Bechily is also a director of NLFH. Daniel M Derman MD is also the President of NMPG. Dennis M Murphy is the Executive Vice President of NMHC. He is also the Executive Vice President and Chief Operating Officer of NMH, as well as Chair of NMPG. Douglas M Young is also the Assistant Treasurer of NMH, NMF, and NLFH, as well as the Secretary & Assistant Treasurer of NMPG and the Treasurer of hfi Stephen C Falk is also President of NMF. Thomas a McAfee is also the President of NLFH, as well as the chair, director and president of hfi. Peter J McCanna is also the Exec VP Admin, CFO & Treasurer of NMH as well as the CFO & Treasurer of NMF, the Treasurer of NMPG & NLFH. Carol L Lind is also the Senior Vice President Senior Counsel & Secretary of NMH and the Secretary of NMF and NLFH. Jennifer S Wooten is also the Assistant Secretary of NMH. Matthew J Flynn is also Senior VP, CFO, & Assistant Secretary of NLFH as well as secretary of HFI. Nancy W Sassower MD is a director of NMF. She is also compensated by NMH for a non-director position. The following are Directors per the listed corporations, they are not compensated as Directors or Officers of any entities; Earl J Barnes, Jeffery D Kopin MD, Peter A Lechman MD, Nancy W Sassower MD, MICHAEL A RUCHIM MD and GARY A NOSKIN MD.
NMHC Departmental Transfers
Form 990, Part III, Question 3
NMHC transferred a number of departments and employees from its subsidiaries to establish a more complete operating entity. Formerly it only had an executive employee roster and utilized departments and their employees from its affiliates. Those departments and employees have now been transferred to NMHC.
Schedule K Supplemental Information
Schedule K Part VI supplemental Information
Part I, Line A, Column F: refund bonds issued on 8/3/95, 5/27/04, 12/19/07 and 1/13/09 Part II, Line 6, Column A the refunded bonds were redeemed on 4/9/09 and 4/20/2009 PArt II, Line 6 Column C the refunded bonds were redeemed on 1/13/09 Part II, Line 3, Column D The difference between Part I, Column e, and Part II, Line 3 is due to investment earnings
Other Program Services
Part III, Line 4d
Revenue in other program services includes non-patient related medical services, Lake Forest Health and Fitness Institute revenue, income associated with services provided to Northwestern Memorial HealthCare which is the parent of this group, and other. Some of the expenses associated with these revenues are included in Form 990 Part III lines 4a - 4c.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.