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 ASSOCIATION
Employer identification number
13-1740118
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
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) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(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 2013 (line 8, column (f) divided by line 13, column (f))
.........
15
16
Public support percentage from 2012 Schedule A, Part III, line 15
...............
16
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2013 (line 10c, column (f) divided by line 13, column (f))
......
17
18
Investment income percentage from 2012 Schedule A, Part III, line 17
.............
18
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 ASSOCIATION
Employer identification number
13-1740118
Return Reference
Explanation
FORM 990, PART I, LINE I
ORGANIZATION'S MISSION NWH'S PRIMARY EXEMPT MISSION IS TO PROVIDE THE HIGHEST QUALITY DIAGNOSTIC AND TREATMENT SERVICES FOR OUR COMMUNITY, WHILE ASSURING ACCESS TO A COORDINATED CONTINUUM OF HEALTHCARE SERVICES.
FORM 990, PART III, LINE 1
ORGANZIATION'S MISSION FOUNDED 94 YEARS AGO, NORTHERN WESTCHESTER HOSPITAL (NWH) IS A NOT-FOR-PROFIT, 233-BED ALL PRIVATE ROOM FACILITY LOCATED IN MOUNT KISCO, NEW YORK AND SERVING RESIDENTS OF NORTHERN WESTCHESTER, PUTNAM AND SOUTHERN DUTCHESS COUNTIES IN NEW YORK AND PORTIONS OF FAIRFIELD COUNTY, CT. NWH IS A MEMBER OF THE NEW YORK-PRESBYTERIAN HEALTHCARE SYSTEM AND IS AFFILIATED WITH COLUMBIA COLLEGE OF PHYSICIANS AND SURGEONS AND WEILL-CORNELL MEDICAL COLLEGE. THESE RELATIONSHIPS OFFER PATIENTS ACCESS TO A WIDE RANGE OF ADVANCED EXPERTISE, RESEARCH AND CLINICAL TRIALS IN THEIR COMMUNITY. NWH IS ALSO ONE OF FOUR MEMBERS OF STELLARIS HEALTH NETWORK, WHICH HELPS ACHIEVE OPERATING EFFICIENCIES THAT ENABLE MEMBER HOSPITALS TO ENHANCE DELIVERY OF HIGH QUALITY HEALTH CARE SERVICES.
FORM 990, PART III, LINE 4A
INPATIENT SERVICES: THE HOSPITAL PROVIDES MEDICAL, SURGICAL, OBSTETRIC, NURSERY, NEONATE INTENSIVE CARE AND PEDIATRIC SERVICES. IN 2013, 9,790 PATIENTS WERE TREATED AND DISCHARGED FROM THE HOSPITAL, INCLUDING 1,625 DELIVERIES. THE HOSPITAL'S SPECIAL CARE NURSERY IS CERTIFIED AS A 10-BED LEVEL III NEONATOLOGY UNIT. THIS NURSERY IS STAFFED FULL-TIME BY NEONATOLOGISTS AS WELL AS A TEAM OF HIGHLY SKILLED NEONATAL NURSES. IN RESPONSE TO THE UNMET NEEDS OF THE UNINSURED IN ITS COMMUNITY, THE HOSPITAL ESTABLISHED, IN CONJUNCTION WITH NEW YORK STATE, A PRENATAL CARE PROGRAM. SERVING APPROXIMATELY 200 MOTHERS-TO-BE ANNUALLY, THIS PROGRAM PROVIDES ALL THE MEDICAL NEEDS OF THE EXPECTANT MOTHER. IN 2013, THE HOSPITAL PROVIDED $2,254,100, IN GROSS CHARGES, OF CHARITY CARE FOR PATIENTS RECEIVING INPATIENT SERVICES, AT A COST OF $951,200.
FORM 990, PART III, LINE 4B
OUTPATIENT SERVICES: THE HOSPITAL OFFERS THE LATEST TECHNOLOGIES IN DIAGNOSTIC TESTING, AMBULATORY SURGERY AND REHABILITATION MEDICINE. IN RESPONSE TO ITS COMMUNITY NEEDS, THE HOSPITAL OPENED ITS CANCER TREATMENT AND WELLNESS CENTER IN 2005. ACCREDITED BY THE AMERICAN COLLEGE OF SURGEONS AS A COMMUNITY HOSPITAL COMPREHENSIVE CANCER PROGRAM, THE CENTER IS DESIGNED AROUND A PATIENT-CENTERED MODEL OF CARE. THE MULTIDISCIPLINARY TEAM OF HEALTHCARE PROFESSIONALS THAT WORK IN THE CENTER HAVE TRAINED AND PRACTICED AT LEADING INSTITUTIONS AND BRING YEARS OF CLINICAL EXPERTISE IN THE DIAGNOSIS, TREATMENT AND PREVENTION OF CANCER TO THE HOSPITAL'S COMMUNITY. IN ADDITION, THE HOSPITAL PROVIDES THE COMMUNITY WITH A WIDE RANGE OF HEALTH EDUCATION PROGRAMS AND SCREENING SERVICES AND IS DEDICATED TO BOARDING THE SCOPE OF WELLNESS AND EDUCATION PROGRAMS OFFERED WITHIN ITS COMMUNITY. IN 2013, $7,843,500, IN GROSS CHARGES, OF CHARITY CARE WAS PROVIDED TO PATIENTS RECEIVING OUTPATIENT SERVICES, AT A COST OF $3,310,000.
FORM 990, PART III LINE 4C
BEHAVIORAL HEALTH: NORTHERN WESTCHESTER HOSPITAL'S DEPARTMENT OF BEHAVIORAL HEALTH UNIT PROVIDES COMPREHENSIVE PSYCHIATRIC CARE IN A PRIVATE, PATIENT-CENTERED ENVIRONMENT. SERVICES PROVIDED IN THIS 15-BED UNIT INCLUDE: - INPATIENT PSYCHIATRIC HOSPITALIZATION FOR ADULTS AGE 18 AND OVER ON A DEDICATED UNIT OF THE HOSPITAL; - EMERGENCY DEPARTMENT COVERAGE 24-HOURS A DAY PROVIDED BY BOARD CERTIFIED PSYCHIATRISTS; - CONSULTATION ON THE MEDICAL AND SURGICAL UNITS OF THE HOSPITAL PROVIDED BY PSYCHIATRIC AND SOCIAL WORK STAFF. IN 2013, 347 PATIENTS WERE TREATED AND DISCHARGED FROM THIS UNIT. THE HOSPITAL PROVIDED $462,600, IN GROSS CHARGES, OF CHARITY CARE FOR PATIENTS RECEIVING BEHAVIORAL HEALTH INPATIENT SERVICES, AT A COST OF $195,200.
FORM 990, PART VI, SECTION A, LINE 2
TRUSTEES ELISA BURNS AND MARSHALL PERIS HAVE A BUSINESS RELATIONSHIP.
FORM 990, PART VI, SECTION A, LINE 6
HEALTHSTAR NETWORK INC, D/B/A STELLARIS HEALTH NETWORK IS THE SOLE MEMBER OF NORTHERN WESTCHESTER HOSPITAL ASSOCIATION.
FORM 990, PART VI, SECTION A, LINE 7A
NORTHERN WESTCHESTER HOSPITAL ASSOCIATION IS AN AFFILIATE AND DIRECT SUBSIDIARY OF HEALTHSTAR NETWORK INC., D/B/A STELLARIS HEALTH NETWORK. EVERY MEMBER OF THE BOARD OF TRUSTEES (GOVERNING BODY) SERVES AT THE RECOMMENDATION OF THE HEALTHSTAR NETWORK, INC. BOARD OF DIRECTORS. PURSUANT TO BOTH THE HOSPITAL'S AND HEALTHSTAR'S BYLAWS, ALL APPOINTMENTS TO THE HOSPITAL'S BOARD ARE FIRST RECOMMENDED BY THE HOSPITAL TO THE HEALTHSTAR NOMINATING COMMITTEE. THE NOMINATING COMMITTEE REVIEWS THE NOMINATION AND THEN RECOMMENDS THE APPOINTMENT TO THE OVERALL HEALTHSTAR BOARD FOR APPROVAL. PURSUANT TO THE RESPECTIVE ORGANIZATIONAL DOCUMENTS OF THE HOSPITAL AND HEALTHSTAR NETWORK, INC., CERTAIN DECISIONS OF THE GOVERNING BOARD MUST BE APPROVED BY THE HEALTHSTAR NETWORK BOARD OF DIRECTORS. SUCH DECISIONS INCLUDE MANAGED CARE CONTRACTING, EXPANSION/SUBTRACTION OF THE HOSPITAL ASSOCIATION'S OPERATIONS, CERTAIN ADMINISTRATIVE PROCEDURES, ETC.
FORM 990, PART VI, SECTION A, LINE 7B
PURSUANT TO THE RESPECTIVE ORGANIZATIONAL DOCUMENTS OF THE HOSPITAL AND HEALTHSTAR NETWORK, INC, CERTAIN DECISIONS OF THE GOVERNING BOARD MUST BE APPROVED BY THE HEALTHSTAR NETWORK BOARD OF DIRECTORS. SUCH DECISIONS INCLUDE MANAGED CARE CONTRACTING, EXPANSION/CONTRACTION OF THE HOSPITAL ASSOCIATION'S OPERATIONS, CERTAIN ADMINISTRATIVE PROCEDURES, ETC.
FORM 990, PART VI, SECTION B, LINE 11
THE ASSOCIATION FORM 990 IS REVIEWED IN DETAIL BY THE ASSOCIATION'S SENIOR VICE PRESIDENT OF FINANCE AND TREASURER, AND BY THE DIRECTOR OF FINANCE OF NORTHERN WESTCHESTER HOSPITAL ASSOCIATION. PRIOR TO ITS FILING, A COPY OF THE FORM WAS REVIEWED WITH THE FINANCE COMMITTEE OF THE BOARD OF TRUSTEES. IN ADDITION, THE FORM 990 WAS PRESENTED TO THE FULL BOARD AT THE MONTHLY 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
EACH OFFICER, DIRECTOR, TRUSTEE AND KEY EMPLOYEE OF THE ASSOCIATION IS REQUIRED TO ANNUALLY DISCLOSE ANY CONFLICTS OF INTEREST THAT ARISE BY VIRTUE OF THEIR EMPLOYMENT AND POSITION WITH THE NORTHERN WESTCHESTER HOSPITAL ASSOCIATION. THE ASSOCIATION MONITORS COMPLIANCE WITH ITS CONFLICT OF INTEREST POLICY THROUGH AN ANNUAL QUESTIONNAIRE SUBMITTED TO THESE INDIVIDUALS. POTENTIAL CONFLICTS ARE INVESTIGATED IMMEDIATELY.
FORM 990, PART VI, SECTION B, LINE 15
THE BOARD OF TRUSTEES OF NORTHERN WESTCHESTER HOSPITAL IS RESPONSIBLE FOR OVERSEEING EXECUTIVE COMPENSATION POLICIES AND PRACTICES, AND FOR SETTING AND APPROVING SPECIFIC COMPENSATION FOR THE CEO. THE BOARD OF TRUSTEES HAS DELEGATED COORDINATION OF THIS PROCESS TO THE PENSION AND COMPENSATION COMMITTEE, WHICH IS A COMMITTEE OF THE BOARD AND WHOSE MEMBERSHIP IS MADE UP OF MEMBERS OF THE BOARD OF TRUSTEES AS WELL AS OUTSIDE NON-BOARD MEMBER EXPERTS. THIRD-PARTY EXPERT TO PROVIDE OBJECTIVE ADVICE AND RELEVANT INDUSTRY AND MARKETPLACE BENCHMARKS FOR COMPENSATION. ANNUALLY, THE COMMITTEE ASSESSES TOTAL COMPENSATION FOR THE CEO AND BASED ON THIS REVIEW MAKES RECOMMENDATIONS TO THE BOARD OF TRUSTEES. THE COMMITTEE ALSO REVIEWS THE COMPENSATION ANALYSIS AND DECISIONS OF THE CEO RELATIVE TO OTHER MEMBERS OF THE EXECUTIVE TEAM. ALL COMPENSATION IS APPROVED BY THE BOARD WITHOUT INPUT OR VOTING PARTICIPATION BY PERSONS WHOSE COMPENSATION IS BEING APPROVED OR BY ANY OTHER INDIVIDUAL WITH A CONFLICT OF INTEREST.
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, FINANCIAL STATEMENTS, AND CONFLICT OF INTEREST POLICY ARE AVAILABLE TO THE PUBLIC UPON REQUEST AND AT MANAGEMENT'S DISCRETION.
FORM 990, PART XI, LINE 9:
ROUNDING -4. PENSION RELATED ADJUSTMENTS 16,393,665.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.