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. Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
NORTHERN WESTCHESTER HOSPITAL CENTER FOUNDATION INC
Employer identification number
13-4067064
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 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 monetary support
Yes
No
Yes
No
Yes
No
Total
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990EZ.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2013
Schedule A (Form 990 or 990-EZ) 2013
Page 2
Part II
Support Schedule for Organizations Described in Sections 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) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(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) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(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. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)..
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 2013 (line 6, column (f) divided by line 11, column (f))
.........
14
15
Public support percentage for 2012 Schedule A, Part II, line 14
...............
15
16a
33 1/3% support test—2013.
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—2012.
If the organization did not check a 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—2013.
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—2012.
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) 2013
Schedule A (Form 990 or 990-EZ) 2013
Page 3
Part III
Support Schedule for Organizations Described in Section 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) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2,209,551
3,727,387
2,447,931
9,104,857
5,645,566
23,135,292
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..
603,902
603,902
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.
2,813,453
3,727,387
2,447,931
9,104,857
5,645,566
23,739,194
7a
Amounts included on lines 1, 2, and 3 received from disqualified persons...
289,537
677,993
204,578
2,672,746
261,455
4,106,309
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.
0
c
Add lines 7a and 7b..
289,537
677,993
204,578
2,672,746
261,455
4,106,309
8
Public support (Subtract line 7c from line 6.)
19,632,885
Section B. Total Support
Calendar year (or fiscal year beginning in)
(a) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(f) Total
9
Amounts from line 6...
2,813,453
3,727,387
2,447,931
9,104,857
5,645,566
23,739,194
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
32,557
17,114
6,660
13,931
44,302
114,564
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
32,557
17,114
6,660
13,931
44,302
114,564
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.)..
2,846,010
3,744,501
2,454,591
9,118,788
5,689,868
23,853,758
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 2013 (line 8, column (f) divided by line 13, column (f))
.........
15
82.310 %
16
Public support percentage from 2012 Schedule A, Part III, line 15
...............
16
78.910 %
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2013 (line 10c, column (f) divided by line 13, column (f))
......
17
0.480 %
18
Investment income percentage from 2012 Schedule A, Part III, line 17
.............
18
1.710 %
19a
33 1/3% support tests—2013.
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—2012.
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) 2013
Schedule A (Form 990 or 990-EZ) 2013
Page 4
Part IV
Supplemental Information.
Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; and 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) 2013
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.
Information about Schedule O (Form 990 or 990-EZ) and its instructions is at
www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
NORTHERN WESTCHESTER HOSPITAL CENTER FOUNDATION INC
Employer identification number
13-4067064
Return Reference
Explanation
FORM 990, PART I, LINE 1
THE FOUNDATION IS THE FUNDRAISING ARM OF THE NORTHERN WESTCHESTER HOSPITAL ASSOCIATION (NWH). THE FOUNDATION SUPPORTS NWH THROUGH ANNUAL FUNDRAISING PROGRAMS INCLUDING: SPECIAL EVENTS; DIRECT MAIL; PLANNED GIVING; MAJOR DONOR SOLICITATION; AND PRIVATE, CORPORATE AND GOVERNMENT GRANTS.
FORM 990, PART III, LINE 1
THE FOUNDATION IS THE FUNDRAISING ARM OF THE NORTHERN WESTCHESTER HOSPITAL ASSOCIATION (NWH). THE FOUNDATION SUPPORTS NWH THROUGH ANNUAL FUNDRAISING PROGRAMS INCLUDING: SPECIAL EVENTS; DIRECT MAIL; PLANNED GIVING; MAJOR DONOR SOLICITATION; AND PRIVATE, CORPORATE AND GOVERNMENT GRANTS.
FORM 990, PART III, LINE 4A
THE FOUNDATION'S PRIMARY EXEMPT PURPOSE IS TO SOLICIT CONTRIBUTIONS FROM PATRONS THROUGH FUND-RAISING EVENTS, DIRECT CONTRIBUTIONS & PLEDGES. IN THE LAST FEW YEARS, FUNDS RAISED BY THE FOUNDATION HAVE MADE POSSIBLE: - THE NEW DAVID AND MARY BOIES EMERGENCY DEPARTMENT - THE NEW CANCER TREATMENT AND WELLNESS CENTER - THE NEW DA VINCI ROBOTIC SURGICAL SYSTEM - AN ENDOWMENT FOR THE CONTINUED EDUCATION AND TRAINING OF NURSES, PHYSICIANS AND OTHER HEALTH CARE PROFESSIONALS AND MUCH MORE. THE FUNDS COLLECTED THROUGH THESE PROCESSES ARE DISTRIBUTED ACCORDING TOTHE DONORS' INTENTIONS, TO THE NORTHERN WESTCHESTER HOSPITAL ASSOCIATION TO ASSIST WITH THE VARIOUS ONGOING RESEARCH PROJECTS, COMMUNITY OUTREACH PROGRAMS AND OTHER CHARITABLE ENDEAVORS AS ESTABLISHED BY ITS BOARD OF DIRECTORS.
FORM 990, PART VI, SECTION A, LINE 6
NORTHERN WESTCHESTER HOSPITAL ASSOCIATION IS THE PARENT COMPANY OF NORTHERN WESTCHESTER HOSPITAL CENTER FOUNDATION.
FORM 990, PART VI, SECTION A, LINE 7A
NORTHERN WESTCHESTER HOSPITAL ASSOCIATION MAY ELECT ONE OR MORE MEMBERS OF THE GOVERNING BODY OF NORTHERN WESTCHESTER HOSPITAL CENTER FOUNDATION.
FORM 990, PART VI, SECTION A, LINE 7B
DECISIONS MADE BY NORTHERN WESTCHESTER HOSPITAL CENTER FOUNDATION MAY BE SUBJECT TO APPROVAL BY NORTHERN WESTCHESTER HOSPITAL ASSOCIATION.
FORM 990, PART VI, SECTION B, LINE 11
THE FOUNDATION'S FORM 990 IS REVIEWED IN DETAIL BY THE FOUNDATION'S ASSOCIATE VICE PRESIDENT, TREASURER AND BY THE DIRECTOR OF FINANCE OF NORTHERN WESTCHESTER HOSPITAL ASSOCIATION, THE FOUNDATION'S PARENT ORGANIZATION. PRIOR TO ITS FILING, A COPY OF THE FORM WAS PROVIDED TO EACH OF THE FOUNDATION'S BOARD MEMBERS FOR REVIEW AND COMMENT THE FORM 990 WAS PRESENTED TO THE FULL BOARD AT THE ANNUAL BOARD MEETING ON OCTOBER 23, 2014 AND APPROVED AT THE SAME MEETING FOR FILING WITH THE INTERNAL REVENUE SERVICE.
FORM 990, PART VI, SECTION B, LINE 12C
THE FOUNDATION OPERATES UNDER THE CONFLICT OF INTEREST POLICY OF ITS PARENT ORGANIZATION, NORTHERN WESTCHESTER HOSPITAL ASSOCIATION. ALL OFFICERS, DIRECTORS AND KEY EMPLOYEES OF THE FOUNDATION ARE REQUIRED TO COMPLETE AN ANNUAL CONFLICT OF INTEREST QUESTIONNAIRE, IN THEIR CAPACITY AS AN EMPLOYEE OF THE HOSPITAL OR AS A BOARD MEMBER TO THE FOUNDATION. CONCERNS PRESENTED BY THE RESPONSES TO THE CONFLICT OF INTEREST POLICY ARE DISCLOSED TO THE BOARD WITH THE INTERESTED PARTY RECUSED FROM DISCUSSING THE MATTER.
FORM 990, PART VI, SECTION B, LINE 15
THE FOUNDATION'S TOP MANAGEMENT OFFICIAL IS COMPENSATED BY THE FOUNDATION'S PARENT ORGANIZATION, NORTHERN WESTCHESTER HOSPITAL ASSOCIATION. ALL COMPENSATION PAID FOR SERVICES RENDERED ON BEHALF OF THE FOUNDATION IS PAID BY THE PARENT, AND THEREFORE THE PROCESSES USED TO DETERMINE COMPENSATION OF THE TOP MANAGEMENT OFFICIAL OFFICERS AND OTHER KEY EMPLOYEES OF THE FOUNDATION HAVE BEEN DISCLOSED ON THE PARENT'S FORM 990.
FORM 990, PART VI, SECTION C, LINE 19
THE TAXPAYER MAKES ITS FORM 990 AND FORM 1023 AVAILABLE TO THE PUBLIC BY RETAINING A COPY OF EACH AT THE ADDRESS LISTED ON PAGE 1 OF THIS RETURN. ANY INDIVIDUAL REQUESTING A COPY OF THESE DOCUMENTS IS PROVIDED THAT COPY ON THE SAME BUSINESS DAY. THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND CONSOLIDATED FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST AND AT MANAGEMENT'S DISCRETION. THE ORGANIZATION DOES NOT OBTAIN SEPARATE AUDITED FINANCIAL STATEMENTS.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.