TY 2012 Form 990

(A) Name and Title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)
(1) Robert J Longo MD........................................................................ Director/MED STAFF PRES	10.0 .......................1.0	X		48,750	0
(2) Louis J Marsico........................................................................ Director	1.0 .......................1.0	X		350	0
(3) Mary R Sheahen........................................................................ Director	1.0 .......................1.0	X		350	0
(4) William D Soper MD........................................................................ Director	1.0 .......................1.0	X		350	0
(5) Raymond Grady........................................................................ Director	1.0 .......................1.0	X		350	0
(6) Cynthia M Valukas MD........................................................................ Director	1.0 .......................1.0	X		350	0
(7) Max Brittain Jr........................................................................ Chairperson	10.0 .......................1.0	X	X	350	0
(8) Thomas P MacCarthy........................................................................ Vice Chairperson	10.0 .......................1.0	X	X	350	0
(9) Bruce K Crowther........................................................................ PRES/CEO/SECRETARY THRU 4/13	10.0 .......................30.0	X	X	899,273	273,974
(10) Stephen O Scogna........................................................................ CFO/TREAS '12;COO/PRES/CEO '13	10.0 .......................30.0	X	X	556,684	141,405
(11) Kirk Clark MD........................................................................ Director	1.0 .......................1.0	X		0	0
(12) Susan E Nelson MD........................................................................ Director	40.0 .......................1.0	X		185,131	102,914
(13) M Shan Atkins........................................................................ Director	1.0 .......................1.0	X		0	0
(14) James H Bishop........................................................................ Director	1.0 .......................1.0	X		350	0
(15) Craig E Christell........................................................................ Director	1.0 .......................1.0	X		350	0
(16) Daniel P DiCaro........................................................................ Director	1.0 .......................1.0	X		350	0
(17) Dale J Garber........................................................................ Director	1.0 .......................1.0	X		0	0

(A) Name and Title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(18) Louis A Gatta........................................................................ Director	1.0 .......................1.0	X					350	0
(19) Marla F Glabe........................................................................ Director	1.0 .......................1.0	X					350	0
(20) Charles A Hempfling........................................................................ Director	1.0 .......................1.0	X					350	0
(21) Diane G Hill........................................................................ Director	1.0 .......................1.0	X					350	0
(22) Francis J Lamberta MD........................................................................ Director	1.0 .......................1.0	X					350	0
(23) MARSHA C LIU........................................................................ EXEC VP/CFO/TREASURER 2013	10.0 .......................30.0	X	X				87,554	20,059
(24) MARK D LUSSON........................................................................ Executive VP Human RESOURCES	0.0 .......................0.0			X			364,425	78,700
(25) DALE E BEATTY........................................................................ Exec VP Patient Services & CNO	0.0 .......................0.0			X			410,873	61,774
(26) Michael C Hartke........................................................................ EXECUTIVE VP/COO	40.0 .......................1.0			X			289,011	89,786
(27) ERIC BENINK MD........................................................................ CHIEF MEDICAL OFFICER	38.0 .......................2.0			X			0	0
(28) KIMBERLY NAGY........................................................................ CHIEF NURSING OFFICER	40.0 .......................0.0			X			0	0
(29) WILLIS G PARSONS MD........................................................................ GASTROENTEROLOGY PHYSICIAN	40.0 .......................0.0				X		1,658,542	16,092
(30) MALCOLM BILIMORIA MD........................................................................ GASTROENTEROLOGY Physician	40.0 .......................0.0				X		1,546,671	30,725
(31) SOTIRIOS MARKULY MD........................................................................ Hospitalist	40.0 .......................0.0				X		279,647	26,328
(32) Mohammed Tahseen MD........................................................................ Psychiatrist	40.0 .......................0.0				X		295,149	37,045
(33) ANDREA BENNET MD........................................................................ Hospitalist	40.0 .......................0.0				X		266,080	27,297
(34) MICHAEL B ZENN........................................................................ Executive VP/COO/TREASURER	0.0 .......................0.0					X	312,468	18,550
(35) Leighton B Smith MD........................................................................ Exec VP Chief Medical Officer	0.0 .......................0.0					X	747,234	13,941
(36) RAMEEZ ALASADI MD........................................................................ GASTROENTEROLOGY Physician	0.0 .......................0.0					X	847,924	45

(A) Name and business address	(B) Description of services	(C) Compensation
NORTHWESTERN MEDICAL FACULTY FOUNDA, 680 N LAKESHORE DR SUITE 1118CHICAGOIL60611	NEURO-VASCULAR SVCS	2,822,766
XTEND HEALTHCARE, 500 W MAIN STREET SUITE 14HENDERSONVILLETX37075	COLLECTION SERVICES	2,275,216
SIEMENS MEDICAL SOLUTIONS, DEPT CH 14195PALATINEIL60055	IT SUPPORT	1,851,309
HLS WHEELING LLC, 13028 COLLECTION CENTER DRCHICAGOIL60693	LAUNDRY SERVICES	1,520,923
GE HEALTHCARE, PO BOX 96483CHICAGOIL60693	EQUIP. MAINTENANCE	1,502,167
2 Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization 103

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 United States. See Part IV, line 21	229,307	229,307
2	Grants and other assistance to individuals in the United States. See Part IV, line 22	0	0
3	Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16	0	0
4	Benefits paid to or for members	0	0
5	Compensation of current officers, directors, trustees, and key employees ....	3,481,016	0	3,481,016	0
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	0	0	0
7	Other salaries and wages	172,984,581	135,377,564	37,607,017	0
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	14,232,610	10,849,718	3,382,892	0
9	Other employee benefits .......	29,190,635	22,189,271	7,001,364	0
10	Payroll taxes ...........	12,176,152	9,494,816	2,681,336	0
11	Fees for services (non-employees):
a	Management ......	0	0	0	0
b	Legal .........	3,137,713	0	3,137,713	0
c	Accounting ...........	221,404	0	221,404	0
d	Lobbying ...........	0	0	0	0
e	Professional fundraising services. See Part IV, line 17	0			0
f	Investment management fees ......	172,860	0	172,860	0
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) ........	27,822,158	12,828,018	14,994,140	0
12	Advertising and promotion ....	1,713,665	6,844	1,706,821	0
13	Office expenses .......	17,710,335	13,961,001	3,749,334	0
14	Information technology ......	8,509,165	5,713,821	2,795,344	0
15	Royalties ..	0	0	0	0
16	Occupancy ...........	8,908,938	7,987,192	921,746	0
17	Travel ............	564,894	319,871	245,023	0
18	Payments of travel or entertainment expenses for any federal, state, or local public officials ......	0	0	0	0
19	Conferences, conventions, and meetings ....	308,734	178,357	130,377	0
20	Interest ...........	8,706,120	8,706,120	0	0
21	Payments to affiliates .......	0	0	0	0
22	Depreciation, depletion, and amortization .....	29,247,883	22,426,368	6,821,515	0
23	Insurance ..............	5,684,238	5,434,511	249,727	0
24	Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a	Medical Supplies	43,546,662	43,546,662	0	0
b	Pharmaceuticals	15,950,492	15,950,492	0	0
c	Bad Debt - Patient Svcs	11,085,099	11,085,099	0	0
d	Illinois Provider Tax	11,676,123	11,676,123	0	0
e	All other expenses	455,693	69,176	386,517
25	Total functional expenses. Add lines 1 through 24e	427,716,477	338,030,331	89,686,146	0
26	Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here if following SOP 98-2 (ASC 958-720).	0

Part X Balance Sheet Check if Schedule O contains a response to any question in this Part X ...............
	1	Cashnon-interest-bearing .............	0	1	0
2	Savings and temporary cash investments .........	30,946,366	2	40,336,464
3	Pledges and grants receivable, net ...........	0	3	0
4	Accounts receivable, net .............	60,733,467	4	63,199,420
5	Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of Schedule L ..................
		98,476	5	18,958
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L
		0	6	0
7	Notes and loans receivable, net .............	0	7	0
8	Inventories for sale or use ..............	5,315,340	8	4,803,892
9	Prepaid expenses and deferred charges ..........	3,627,812	9	5,046,918
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	641,130,089
b	Less: accumulated depreciation .....	10b	266,878,742	382,232,029	10c	374,251,347
11	Investments—publicly traded securities ..........	97,484,804	11	98,835,268
12	Investments—other securities. See Part IV, line 11 .....	0	12	0
13	Investments—program-related. See Part IV, line 11 .....	6,698,999	13	7,231,660
14	Intangible assets ...............	0	14	0
15	Other assets. See Part IV, line 11 ...........	32,112,143	15	31,187,464
16	Total assets. Add lines 1 through 15 (must equal line 34)......	619,249,436	16	624,911,391
	17	Accounts payable and accrued expenses .........	91,828,628	17	85,970,863
18	Grants payable .................	0	18	0
19	Deferred revenue ................	122,193	19	480,851
20	Tax-exempt bond liabilities .............	277,615,000	20	271,665,000
21	Escrow or custodial account liability. Complete Part IV of Schedule D..	0	21	0
22	Loans and other payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
	persons. Complete Part II of Schedule L..........	0	22	0
23	Secured mortgages and notes payable to unrelated third parties ..	0	23	0
24	Unsecured notes and loans payable to unrelated third parties ....	0	24	0
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D....................	87,243,313	25	74,167,679
26	Total liabilities. Add lines 17 through 25.........	456,809,134	26	432,284,393
		Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets ..............	155,741,303	27	185,395,339
28	Temporarily restricted net assets ...........	5,587,588	28	5,995,329
29	Permanently restricted net assets ...........	1,111,411	29	1,236,330
	Organizations that do not follow SFAS 117 (ASC 958), 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 ...........	162,440,302	33	192,626,998
34	Total liabilities and net assets/fund balances ........	619,249,436	34	624,911,391

- 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

2012

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 described in 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. See section 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 - Non-functionally integrated

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


Total

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

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2012

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) 2008	(b) 2009	(c) 2010	(d) 2011	(e) 2012	(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) 2008	(b) 2009	(c) 2010	(d) 2011	(e) 2012	(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).

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 2012 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2011 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2012. 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—2011. 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 ..................... right arrow

17a

10%-facts-and-circumstances test—2012. 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—2011. 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) 2012

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) 2008	(b) 2009	(c) 2010	(d) 2011	(e) 2012	(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) 2008	(b) 2009	(c) 2010	(d) 2011	(e) 2012	(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.)..

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 2012 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2011 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2012 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2011 Schedule A, Part III, line 17 .............

19a

33 1/3% support tests—2012. 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—2011. 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) 2012

Page 4

Part IV

Supplemental Information. Complete this part to 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) 2012

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

2012

Name of the 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, total 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 total 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 on line H of its
Form 990-EZ or on Part I, 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) (2012)

Schedule B (Form 990, 990-EZ, or 990-PF) (2012)

Page 2

Name of organization Northwest Community Hospital

Part I	Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
(a) No.	(b) Name, address, and ZIP + 4	(c) Total 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) Total 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) Total 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) Total 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) Total 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) Total 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) (2012)

Schedule B (Form 990, 990-EZ, or 990-PF) (2012)

Page 3

Name of organization Northwest Community Hospital

Part II	Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
(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) (2012)

Schedule B (Form 990, 990-EZ, or 990-PF) (2012)

Page 4

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
that total 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

$
Use duplicate copies of Part III if additional space is needed.

(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) (2012)

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

2012

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 35c (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 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 function 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 Paperwork Reduction Act Notice, see the instructions for Form 990 or 990-EZ.

Cat. No. 50084S

Schedule C (Form 990 or 990-EZ) 2012

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 SchCMd Bullet

if the filing organization belongs to an affiliated group (and list in Part IV each affiliated group member's name, address, EIN, expenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet

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) 2009	(b) 2010	(c) 2011	(d) 2012	(e) Total

2a	Lobbying nontaxable amount

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

c	Total lobbying expenditures

d	Grassroots nontaxable amount

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

f	Grassroots lobbying expenditures

Schedule C (Form 990 or 990-EZ) 2012

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)).

For each “Yes” response to lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.

(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? .......................

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

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

Other activities? ..........................

Yes

58,602

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

58,602

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 carry over 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) and if either (a) BOTH Part III-A, lines 1 and 2, are answered “No” OR (b) Part III-A, line 3, is answered “Yes."

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

Section 162(e) nondeductible 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; Part II-A (affiliated group list); Part II-A, line 2; and Part ll-B, line 1. Also, complete this part for any additional information.

Identifier	Return Reference	Explanation
LOBBYING ACTIVITIES	PART II-B, LINE 11	NORTHWEST COMMUNITY HOSPITAL PAYS DUES TO CERTAIN HOSPITAL ASSOCIATIONS WHICH USE A PORTION OF THESE DUES FOR LOBBYING.

Schedule C (Form 990 or 990EZ) 2012

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, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b
SchDMd Bullet

Attach to Form 990. SchDMd Bullet

See separate instructions.

OMB No. 1545-0047

2012

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 can 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 education) Preservation of an historically important land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

Complete lines 2a through 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, and not on a historic structure listed in the National Register ....................	2d

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the tax 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 section 170(h)(4)(B)(ii)? .......................................

Yes No

In Part XIII, 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 (ASC 958), 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 XIII, the text of the footnote to its financial statements that describes these items.

If the organization elected, as permitted under SFAS 116 (ASC 958), 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 (ASC 958) 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 Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 52283D

Schedule D (Form 990) 2012

Page 2

Part III

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

Using the organization’s acquisition, 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 XIII.

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 XIII 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 XIII. Check here if the explanation has been provided in Part XIII ........

Part V

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

		(a)Current year	(b)Prior year	b (c)Two years back	(d)Three years back	(e)Four years back
1a	Beginning of year balance ....	2,799,106	2,319,650	2,248,734	2,160,499	2,131,037
b	Contributions ........	4,039	950	169,337	9,266	39,825
c	Net investment earnings, gains, and losses	411,064	478,506	-10,576	78,969	-10,363
d	Grants or scholarships .....
e	Other expenditures for facilities and programs ........	56,673		87,845
f	Administrative expenses ....
g	End of year balance ......	3,157,536	2,799,106	2,319,650	2,248,734	2,160,499

Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:

Board designated or quasi-endowment SchDMd Bullet

51.130 %

Permanent endowment SchDMd Bullet

48.870 %

Temporarily restricted endowment SchDMd Bullet

The percentages in lines 2a, 2b, and 2c should equal 100%.

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 XIII the intended uses of the organization's endowment funds.

Part VI

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

Description of property		(b)Cost or other basis (other)	(c) Accumulated depreciation	(d) Book value
1a	Land .................	1,789,072		1,789,072
b	Buildings ................	298,674,187	107,782,545	190,891,642
c	Leasehold improvements ............	206,573,589	95,989,202	110,584,387
d	Equipment ................	109,598,226	53,563,746	56,034,480
e	Other .................	24,495,015	9,543,249	14,951,766
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......				374,251,347

Schedule D (Form 990) 2012

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) must 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) must 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) must 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) Book value
Federal income taxes		0
Due to third-party payors		52,738,415
Pension obligation		18,926,277
Interest rate swap liability		1,010,804
Asset retirement obligation		833,218
Short term capital lease obligation		300,976
Long term capital lease obligation		301,738
Due to affiliates		56,251


Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)		74,167,679
2. Fin 48 (ASC 740) Footnote. In Part XIII, 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 (ASC 740). Check here if the text of the footnote has been provided in Part XIII .....................................................

Schedule D (Form 990) 2012

Page 4

Part XI 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 XIII.) ............	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 XIII.) ...........	4b
c	Add lines 4a and 4b.......................		4c
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......		5

Part XII 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 XIII.) ............	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 XIII.) ............	4b
c	Add lines 4a and 4b.......................		4c
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......		5

Part XIII

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, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.

Identifier	Return Reference	Explanation
Intended use 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) 2012

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

2012

Open to Public Inspection

Name of the organization

Northwest Community Hospital

Employer identification number

36-2340313

Part I

Financial Assistance and Certain Other Community Benefits at Cost

Yes

Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a ...

Yes

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

Yes

If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.

Applied uniformly to all hospital facilities Applied uniformly to most hospital facilities Generally tailored to individual hospital facilities

Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.

Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?

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

Yes

100% 150% 200% Other 300 %

Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate

which of the following was the family income limit for eligibility for discounted care: .........

Yes

200% 250% 300% 350% 400% Other 600 %

If the organization used factors other than FPG in determining eligibility, describe in Part VI the income based criteria for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.

Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? ..............

Yes

Did the organization budget amounts for free or discounted care provided under its financial assistance policy during the tax year? ............................

Yes

If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? ......

Yes

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

Did the organization prepare a community benefit report during the tax year? ..........

Yes

If "Yes," did 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.

Financial Assistance and Certain Other Community Benefits at Cost

Financial Assistance and Means-Tested Government Programs		(c) Total community benefit expense	(d) Direct offsetting revenue	(e) Net community benefit expense	(f) Percent of total expense
a	Financial Assistance at cost (from Worksheet 1) ..	14,335,940		14,335,940	3.440 %
b	Medicaid (from Worksheet 3, column a) ....	36,395,837	22,614,078	13,781,759	3.310 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) .
d	Total Financial Assistance and Means-Tested Government Programs .	50,731,777	22,614,078	28,117,699	6.750 %
Other Benefits		1,210,426	1,122	1,209,304	0.290 %
e	Community health improvement services and community benefit operations (from Worksheet 4) ..	1,210,426	1,122	1,209,304	0.290 %
f	Health professions education (from Worksheet 5) ..	3,416,065	2,250	3,413,815	0.820 %
g	Subsidized health services (from Worksheet 6) ..	358,310		358,310	0.090 %
h	Research (from Worksheet 7)	203,173	2,000	201,173	0.050 %
i	Cash and in-kind contributions for community benefit (from Worksheet 8)	765,729		765,729	0.180 %
j	Total. Other Benefits ..	5,953,703	5,372	5,948,331	1.430 %
k	Total. Add lines 7d and 7j .	56,685,480	22,619,450	34,066,030	8.180 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2012

Schedule H (Form 990) 2012

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Part II

Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.

		(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	3,103		3,103	0 %
3	Community support	6,458	1,512	4,946
4	Environmental improvements
5	Leadership development and training for community members
6	Coalition building	15,094		15,094	0 %
7	Community health improvement advocacy
8	Workforce development	34,580		34,580	0 %
9	Other
10	Total	59,235	1,512	57,723	0 %

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

Did 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. Explain in Part VI the methodology used by the organization to estimate this amount. ......

11,085,099

Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......

Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.

Section B. Medicare

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

142,557,141

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

185,856,980

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

-43,299,839

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

Did the organization have a written debt collection policy during the tax year? ..........

Yes

If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI.......................

Yes

Part IV

Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)

(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) 2012

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Part VFacility Information

Section A. Hospital Facilities (list in order of size from largest to smallest—see instructions) How many hospital facilities did the organization operate during the tax year?1 Name, address, and primary website address
1	NORTHWEST COMMUNITY HOSPITAL 800 W CENTRAL ROAD ARLINGTON HEIGHTS,IL60005	X	X	X

Schedule H (Form 990) 2012

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Part VFacility Information (continued)

Section B. Facility Policies and Practices

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

	NORTHWEST COMMUNITY HOSPITAL
Name of hospital facility or facility reporting group

For single facility filers only: line Number of Hospital Facility (from Schedule H, Part V, Section A)

Yes

Community Health Needs Assessment (Lines 1 through 8c are optional for tax years begining on or before March 23, 2012)

During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 9....................

Yes

If “Yes,” indicate what the CHNA report describes (check all that apply):

A definition of the community served by the hospital facility

Demographics of the community

Existing health care facilities and resources within the community that are available to respond to the health needs of the community

How data was obtained

The health needs of the community

Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups

The process for identifying and prioritizing community health needs and services to meet the community health needs

The process for consulting with persons representing the community’s interests

Information gaps that limit the hospital facility’s ability to assess the community’s health needs

Other (describe in Part VI)

Indicate the tax year the hospital facility last conducted a CHNA: 20 12

In conducting its most recent CHNA, did the hospital facility take into account input from representatives of the community served by the hospital facility, including those with special knowledge of or expertise in public health? 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 ....................

Yes

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI................................

Did the hospital facility make its CHNA report widely available to the public? .............

Yes

If “Yes,” indicate how the CHNA report was made widely available (check all that apply):

Hospital facility’s website

Available upon request from the hospital facility

Other (describe in Part VI)

If the hospital facility addressed needs identified in its most recently conducted CHNA, indicate how (check all that apply to date):

Adoption of an implementation strategy that addresses each of the community health needs identified through the CHNA

Execution of the implementation strategy

Participation in the development of a community-wide plan

Participation in the execution of a community-wide plan

Inclusion of a community benefit section in operational plans

Adoption of a budget for provision of services that address the needs identified in the CHNA

Prioritization of health needs in its community

Prioritization of services that the hospital facility will undertake to meet health needs in its community

Other (describe in Part VI)

Did the hospital facility address all of the needs identified in its most recently conducted CHNA? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs ........

Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)? ...........................

If "Yes" to line 8a, did the organization file Form 4720 to report the section 4959 excise tax? ......

If "Yes" to line 8b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $

Schedule H (Form 990) 2012

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Part VFacility Information (continued)

Financial Assistance Policy			Yes	No
9	Did the hospital facility have in place during the tax year a written financial assistance policy that:
	Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care?	9	Yes
10	Used federal poverty guidelines (FPG) to determine eligibility for providing free care?...........	10	Yes
	If "Yes," indicate the FPG family income limit for eligibility for free care: 300.% If "No," explain in Part VI the criteria the hospital facility used.
11	Used FPG to determine eligibility for providing discounted care?.................	11	Yes
	If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 600.% If "No," explain in Part VI the criteria the hospital facility used.
12	Explained the basis for calculating amounts charged to patients?.................	12	Yes
	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)
13	Explained the method for applying for financial assistance?...................	13	Yes
14	Included measures to publicize the policy within the community served by the hospital facility?.......	14	Yes
	If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a	The policy was posted on the hospital facility’s website
b	The policy was attached to 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 on admission to the hospital facility
f	The policy was available upon request
g	Other (describe in Part VI)
Billing and Collections
15	Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?.......	15	Yes
16	Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a	Reporting to credit agency
b	Lawsuits
c	Liens on residences
d	Body attachments
e	Other similar actions (describe in Part VI)
17	Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?..........	17		No
	If “Yes,” check all actions in which the hospital facility or a third party engaged:
a	Reporting to credit agency
b	Lawsuits
c	Liens on residences
d	Body attachments
e	Other similar actions (describe in Part VI)

Schedule H (Form 990) 2012

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Part VFacility Information (continued)

Indicate which efforts the hospital facility made before initiating any of the actions listed in line 17 (check all that apply):

Notified individuals of the financial assistance policy on admission

Notified individuals of the financial assistance policy prior to discharge

Notified individuals of the financial assistance policy in communications with the patients regarding the patients’ bills

Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy

Other (describe in Part VI)

Policy Relating to Emergency Medical Care

Yes

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?..........

Yes

If “No,” indicate why:

The hospital facility did not provide care for any emergency medical conditions

The hospital facility’s policy was not in writing

The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)

Other (describe in Part VI)

Charges to Individuals Eligible for Assistance under the FAP (FAP-Eligible Individuals)

Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.

The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged

The hospital facility used the average of its three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged

The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged

Other (describe in Part VI)

During the tax year, did the hospital facility charge any FAP-eligible individuals 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? ............................

Yes

If “Yes,” explain in Part VI.

During the tax year, did the hospital facility charge any FAP-eligible individuals an amount equal to the gross charge for any service provided to that individual? .........................

If “Yes,” explain in Part VI.

Schedule H (Form 990) 2012

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Part VFacility Information (continued)

Section C. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility (list in order of size, from largest to smallest) How many non-hospital health care 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 IMMEDIATE CARE & IMAGING CENTER 199 W RAND ROAD MOUNT PROSPECT,IL60056	WALK IN URGENT CARE CENTER, IMAGING SERVICES & CARDIAC SERVICES
3	NCH IMMEDIATE CARE & IMAGING CENTER 519 S ROSELLE ROAD SCHAUMBURG,IL60193	WALK IN URGENT CARE CENTER, IMAGING SERVICES & OUTPATIENT PHYSICAL MEDICINE SERVICES
4	NORTHWEST COMMUNITY HOSPITAL IMAGING 1450 BUSCH PARKWAY BUFFALO GROVE,IL60089	IMAGING SERVICES
5	NCH IMMEDIATE CARE & IMAGING CENTER 15 S MCHENRY ROAD BUFFALO GROVE,IL60089	WALK IN URGENT CARE CENTER, IMAGING SERVICES & OUTPATIENT PHYSICAL MEDICINE SERVICES
6	NCH CARDIAC & PHYSICAL MEDICINE REHAB 900 W CENTRAL ROAD ARLINGTON HEIGHTS,IL60005	OUTPATIENT CARDIAC REHAB PROGRAM AND PHYSICAL MEDICINE SERVICES
7	NCH HOME HEALTH 3060 SALT CREEK LANE ARLINGTON HEIGHTS,IL60005	HOME HEALTHCARE SERVICES
8	NCH IMMEDIATE CARE CENTER 1201 S RAND ROAD LAKE ZURICH,IL60047	WALK IN URGENT CARE CENTER & OUTPATIENT PHYSICAL MEDICINE SERVICES
9	NCH OUTPATIENT CENTER 3300 KIRCHOFF ROAD ROLLING MEADOWS,IL60008	OUTPATIENT PHYSICAL MEDICINE SERVICES
10	NCH PHYSICAL MEDICINE & REHAB 1590 N ARLINGTON HEIGHTS ROAD ARLINGTON HEIGHTS,IL60005	OUTPATIENT PHYSICAL MEDICINE SERVICES
11	NCH OCCUPATIONAL WELLNESS & REHAB 455 S ROSELLE ROAD SCHAUMBURG,IL60193	OCCUPATIONAL WELLNESS & REHAB

Schedule H (Form 990) 2012

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Part VI

Supplemental Information

Complete this part to provide the following information.

1	Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II; Part III, lines 4, 8, and 9b; Part V, Section A; and Part V, Section B, lines 1j, 3, 4, 5c, 6i, 7, 10, 11, 12h, 14g, 16e, 17e, 18e, 19c, 19d, 20d, 21, and 22.
2	Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any 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.
8	Facility reporting group(s). If applicable, for each hospital facility in a facility reporting group provide the descriptions required for Part V, Section B, lines 1j, 3, 4, 5c, 6i, 7, 10, 11, 12h, 14g, 16e, 17e, 18e, 19c, 19d, 20d, 21, and 22.

Identifier	ReturnReference	Explanation
PART I, LINE 3C	CHARITY CARE POLICY	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 300% OF THE FEDERAL POVERTY GUIDELINES RECEIVE FREE CARE AND THOSE BETWEEN 300% AND 600% OF THE GUIDELINES RECEIVE DISCOUNTED CARE ON A SLIDING SCALE. THE FINANCIAL ASSISTANCE PROGRAM LOOKS AT THE CURRENT INCOME AND THEN CALCULATES THE POTENTIAL BENEFIT. CONSISTENT WITH THE ILLINOIS UNINSURED PATIENT DISCOUNT ACT, PATIENTS WITHOUT INSURANCE COVERAGE ARE ELIGIBLE FOR A 64% DISCOUNT IF THEIR INCOME IS BETWEEN 300% AND 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	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 and indirect costs for specific programs or services. these costs were maintained / identified in hospital's "community benefit inventory for social accountability software" (cbisa). the indirect portion of these costs was calculated utilizing the indirect cost ratio from the hospitals latest available Medicare cost report. this "indirect" ratio was entered into cbisa for the calculation of indirect costs. part i, line 7g: subsidized health services hospital provides a mobile dental clinic program staffed by a hospital employed full time dentist, dental assistant and program manager. evidence based research demonstrates that gum disease and oral health problems are linked to other systemic medical problems such as cardiovascular disease, stroke, and bacterial pneumonia, as well as increased risk of delivering pre-term or low birth-weight babies. the hospital, with financial support from local townships, provides preventative and restorative care to uninsured and underinsured members of the community 4-5 days per week in a traveling dental clinic. PART I, 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 THE NET COMMUNITY BENEFIT EXPENSE WAS $11,085,099.
PART II	COMMUNITY BUILDING ACTIVITIES	economic development hospital's vice president of professional services is a member and active participant of the arlington heights economic alliance. the purpose of the alliance is to provide the business community a strong partnership with the village and to promote a healthy business climate. the alliance is the village board's economic advisory committee on business issues. community support HOSPITAL provided support per the request of the cook county department of public health to assist with a salmonella outbreak at a local food distribution company. the hospital provided assistance with lab testing for employees of the company. coalition building HOSPITAL'S director of corporate accounting represents HOSPITAL through participation in the palatine rotary club in the hospital's primary service area. rotary club members are predominately business and professional leaders who come together to support organizations that address need and disparity in the community. areas addressed include homelessness, mental health issues, cancer, troubled youth, developmentally disabled, domestic violence and many more. workforce development HOSPITAL'S executive director of patient care services participated on the leadership board of the Illinois organization of nurse leaders (ionl). the purpose of ionl is to develop nursing leaders in all healthcare settings. ionl provides direction for achievement of excellence in nursing leadership. it promotes professional development, research and innovation for the advancement of THE nursing practice. ionl encourages development of care delivery systems that are forthright and visionary. the ionl develops strategic initiatives in the area of executive management expertise in healthcare systems. HOSPITAL also has programs to encourage high school students to explore careers in healthcare. the first program provides local high school students the opportunity to spend 14 weeks in the hospital shadowing 16 different departments. as the students rotate through the various departments they are exposed to an array of clinical fields, providing them with an in-depth look at just some of the many career tracks they could pursue. hospital also sponsors an annual healthcare career fair for two local high school districts. at the fair, leaders from various clinical departments provide a brief overview of their specialties, again providing the students with a closer look at potential career tracks they might like to pursue.
PART III, LINE 1	BAD DEBT EXPENSE	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, LINES 2-4	BAD DEBT EXPENSE	HOSPITAL IS SENSITIVE TO THE FINANCIAL HEALTH OF ITS PATIENTS AND RECOGNIZES THAT FAMILY FINANCIAL CONCERNS MAY NOT ALWAYS BE SHARED. AT TIMES, A PATIENT MAY BE RELUCTANT TO COMPLETE A FINANCIAL ASSESSMENT TO DETERMINE THEIR ELIGIBILITY FOR CHARITY CARE. IT IS POSSIBLE THAT BECAUSE OF THESE CIRCUMSTANCES, A PORTION OF BAD DEBT EXPENSE COULD REPRESENT PATIENTS THAT ARE UNABLE TO PAY AND MIGHT QUALIFY FOR FINANCIAL ASSISTANCE, HOWEVER, ACCURATE DATA TO ESTIMATE THIS AMOUNT IS UNAVAILABLE. hospital is included in the audited financial statements of northwest community healthcare (nch) and subsidiaries. the text of the footnote referencing accounts receivable in the fy 2013 audit is as follows: "[nch] analyZes the allowance for uncollectible accounts quarterly using a hindsight calculation that utilizes write-off data for all payOr classes during the previous eighteen month period to estimate the allowance for uncollectible accounts at a point in time. the reserve percentages in the allowance for uncollectible accounts reserve change each month given changes in trends from these analyses or policy changes." accounts receivable are charged to the allowance for uncollectible accounts when they are deemed uncollectible. write-offs are shown net of contractuals and discounts. hospital's bad debt expense as reported on lines 2 and 3 was reported at remaining charges. for fy 2013, the hospital recorded provisions for bad debt expense of $11,085,099. in 2013, the hospital began using a financial tool to determine "presumptive eligibility" for charity care write-offs. this tool utilizes various criteria to help determine patients that would be eligible for financial assistance even if those patients have not completed a financial assistance application. it is believed that all patients who would qualify for charity have been identified and that little to none of the amounts written off as bad debt could be classified as charity as a result of the use of this new financial tool.
PART III, LINE 8	MEDICARE SHORTFALL	the medicare shortfall reported in part iii, line 7 represents the excess cost of providing services to medicare beneficiaries over the payments received from the medicare program. access to quality healthcare is imperative for all medicare recipients, many of whom are living on a fixed income. as such, the costs absorbed by hospital in providing these services is a benefit to the members of the community we serve.
PART III, LINE 9B	COLLECTION PRACTICES	it is the policy of 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 payers 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 hospital's website. collection activity will be suspended during the consideration of a completed financial assistance application or an application for other healthcare bracket (i.e, medicare, medicaid, etc.). the patient's account may be suspended from collection activity until financial assistance can be determined. 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 V, SECTION B, LINE 3	INPUT FROM REPRESENTATIVES FOR THE COMMUNITY HEALTH NEEDS ASSESSMENT	the hospital participated in a regional community health needs assessment (chna) offered by the metropolitan chicago healthcare council (mchc) in partnership with professional research consultants (prc). the chna gathered input from representatives of the community by conducting 30-minute telephone health surveys in english and spanish. 3,710 surveys were conducted in the region which consisted of cook, dupage and lake counties, with 325 in the hospitals immediate service area. careful consideration was taken to ensure that the demographics of those participating in the survey mirrored the demographics of the community. the survey instrument used for the study is based largely on the centers for disease control and prevention (cdc) behavioral risk factor surveillance system (brfss), as well as various other public health surveys and customized questions addressing gaps in indicator data relative to health promotion and disease prevention objectives and other recognized health issues. the final survey instrument was developed by prc, with input from hospital and the other community sponsors. 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. in order to gather input from persons with special knowledge of or expertise in public health, focus groups were held by prc in north cook county. participants included representatives from public health, physicians, and other health professionals, social service providers and other community leaders. the participants were chosen because of their ability to identify primary concerns of the populations with who they work, as well as of the community overall. participants included a representative of public health, as well as several individuals who work with low-income, minority or other medically underserved populations, and those who work with person with chronic disease conditions.
PART V, SECTION B, LINE 5C	CHNA REPORT AVAILABLE TO THE PUBLIC	in addition to posting the chna on hospital's website (www.nch.org) and having copies available upon request, hospital also sent several press releases to local newspapers to inform the community that the report was available.
PART V, SECTION B, LINE 6I	DESCRIPTION OF NEEDS IDENTIFIED IN CHNA REPORT	hospital partners with many not for profit agencies, municipalities, and others to address community health needs identified in the chna. the hospital collaborates with a county health clinic and a federally qualified health center to address the need of improving access to primary and behavioral healthcare for uninsured and underinsured individuals. access to oral health care is addressed through a collaborative mobile dental clinic program that is operated by hospital with support of four local townships, university of chicago dental school, and professional volunteers. in addition, hospital works with local school districts, healthcare organizations, social service organizations and community organizations to address diabetes, nutrition, cancer and other healthcare needs. a complete list of partners is included in the hospitals implementation plan which is posted on the hospital's website (www.nch.org).
PART V, SECTION B, LINE 7	DESCRIPTION OF NEEDS NOT IDENTIFIED IN CHNA REPORT	in acknowledging the wide range of priority health issues that emerged from the chna process, hospital determined that it could only effectively focus on those which it deemed most pressing, most under-addressed, and most within its ability to influence. therefore, hospital selected the top five prioritized needs to focus its efforts and resources on. the only two needs not being addressed include chronic disease (such as arthritis, rheumatism, osteoporosis, and kidney disease) and adult substance abuse. hospital feels that efforts to improve access to primary health services will have a positive impact on early detection of chronic disease and that a separate set of disease specific initiatives is not necessary. for those diagnosed with chronic diseases, hospital provides treatment in its scopes of service regardless of a patient's ability to pay. hospital is recognized for its youth treatment center program for substance abuse and mental health, but refers adult patients to other resources in the community.
PART V, SECTION B, LINE 10	FEDERAL POVERTY GUIDELINES TO DETERMINE ELIGIBILITY FOR FREE CARE	the hospital provides free care for patients earning less than 300% of the federal poverty level.
PART V, SECTION B, LINE 11	FEDERAL POVERTY GUIDELINES TO DETERMINE ELIGIBILITY FOR DISCOUNTED CARE	the hospital provides discounted care for patients earning between 301-600% of the federal poverty level.
PART V, SECTION B, LINE 20	FAP-ELIGIBLE INDIVIDUALS	amounts that can be charged to fap-eligible individuals was calculated using the average discount for all managed care contracts (excluding blue cross plans, and beech street, multiplan, and preferred access network plans).
PART V, SECTION B, LINES 20-21	FAP-ELIGIBLE INDIVIDUALS WITH INSURANCE COVERAGE	individuals are qualified for financial assistance utilizing federal poverty guidelines, family income levels and family size. most individuals who qualify under our financial assistance policy would be billed an amount significantly lower than the amount that would be billed for an individual with insurance coverage. however, in rare instances it is possible that the amount billed to such an individual could be higher than that billed for individuals with insurance coverage.
PART VI, LINE 2	NEEDS ASSESSMENT	the assessment conducted by prc, which was described in part v, line 3 was a data-driven approach to determining the health status of the community and included both quantitative (phone survey) and qualitative (focus group) components. the assessment also integrated the most recent secondary public health data to complement the research of the chna. the data collected for hospital's service area was benchmarked against the secondary data available for the region, state, u.s., healthy people 2020 as well as comparing the data collected against hospital's previous assessment. all quantitative and qualitative data was compiled and presented to hospital in a 213 page document which included a recommendation on areas of concern or opportunity. the chna is conducted every three years. hospital convened an internal, multi-disciplinary committee to review the results of the chna, affirm and prioritize needs, and develop an implementation plan. representatives from the following departments served on the committee: community services, strategic planning, patient access services, finance, clinical resource management, foundation, data governance, nursing, research, and marketing. committee members reviewed the findings and areas of opportunity that were presented by prc. in addition, feedback on community health needs from the community services department and other internal departments was also considered. the committee used the following criteria when prioritizing health issues: magnitude, impact, feasibility and consequences of inaction. the most predominant issue was the difficulty the community has in accessing healthcare services which includes primary, oral, and behavioral health services, as well as prescription medication. other concerns were adult and childhood obesity/obesity and cancer. hospital has identified these concerns as the five main "priority areas", and the majority of hospital's outreach efforts focus on addressing these needs. an implementation plan was developed and was presented for approval to the community health and outreach committee, a committee of the board of directors, as well as to the community benefit regulatory committee, a new committee formed to ensure hospital is meeting all regulatory requirements. both committees unanimously approved the plan which includes measurement indicators and the plan was posted to hospital's website (www.nch.org), which the community was made aware of through press releases. the implementation plan is assessed and updated on hospital's website on an annual basis. as mentioned previously, hospital maintains a full time community services department who is in constant collaboration with community organizations, local government, schools, churches and social service agencies to identify and address unmet needs. the director of the community services department is on the board of directors of the palatine opportunity center, a local not for profit that helps hospital run a community resource center in hospital's primary service area. the resource center houses eleven not-for-profit agencies including cook county health and hospital system and cook county department of public health. providers at this center meet with hospital regularly to review community needs and explore collaborative strategies to address them.
PART V, LINE 14 AND 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 hospital's policy. a full-time interpretation service department is available to assist those who need additional information in other languages. in fy 2013 hospital responded to 16,919 in-person requests and provided telephonic assistance on 64,122 phone calls in 42 different languages. (2) each page of 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 a 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. patients who have indicated that they have met presumptive eligibility criteria, at the point of registration, are provided with unique verbiage on their bill directing them to contact the financial counseling department to pursue assistance through a streamlined process. (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. 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 676,000 people. this number has remained fairly stable and growth over the next 5 years is expected to be relatively flat. hospital's total service area is predominately caucasian (67.1%), followed by hispanic (15.5%), asian (13.1%) and all others (4.2%). the hispanic population is expected to grow by 14.6% and the asian population 7.2% over the next 5 years. of individuals living in hospital's total service area, 15.5% are on medicaid and 5% are uninsured. over the past 10 years, there has been a decided shift in the age of those living in hospital's service area. a portion of the 18-44 age group moved into the 45-64 age group. it is estimated that in the next 5 years, the area will see further migration into the 65+ age group resulting in a 18.1% increase. there are four other hospitals located in 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. hospital supports both a federally qualified health center located across the street from hospital, and a county run primary care clinic, also located in hospital's primary service area.
PART VI, LINE 5	PROMOTION OF COMMUNITY HEALTH	Hospital furthers its exempt purpose by promoting the health of its community in many ways as follows: (1) a majority of hospital's board of directors is comprised of persons who live or work in hospital's primary service area and are not employees or contractors of hospital. (2) hospital extends medical staff privileges to all qualified physicians in its community. (3) a standing community health and outreach committee of the hospital board reviews the community health needs assessment and ensures the implementation plan addresses identified needs. the committee provides oversight in monitoring and evaluating the effectiveness of strategies and initiatives included in the implementation plan. the committee monitors the amount of dollars invested in community benefit including charity care, community health education, community medical/dental clinics, and community health improvement initiatives. (4) hospital maintains any surplus funds in hospital itself or at northwest community healthcare (a 501(c)(3) supporting organization and sole member of hospital) for funding capital improvements in technology, facilities or patient care equipment, and supporting hospital operations or community outreach initiatives. (5) 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), harper college nursing advisory committee, metropolitan chicago healthcare council health care workforce advisory institute, chicago dental society, hospice of northeastern illinois, healthworld, bridge youth and family services, little city foundation human rights committee, as well as local rotary clubs. (6) 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 a cancer research and prevention project through the american cancer society. (7) collaborative partnerships are the foundation to many of hospital's community health initiatives aimed to improve the health and wellbeing of the community. these partnerships include a collaboration with access community health network (a local federally qualified health center), and cook county health and hospital system to bring primary care services for the uninsured and underinsured to the community. in fy 2013, 40,985 patient visits were provided at these clinics and hospital's financial and in-kind support was $149,000. hospital also partners with elk grove, palatine, schaumburg, and wheeling townships on a mobile dental clinic program which provided 2,570 patient visits in fy 2013 with hospital absorbing $130,000 of the total cost. northwest community healthcare, an affiliate of hospital, also partners with the palatine opportunity center (poc), a local 501(c)(3) organization, to operate and run a resource center which provides direct services, referrals, and other assistance to the under-resourced. hospital owns and maintains the building and provides free or low-cost rent to local not for profit agencies, including: preservation for human dignity (phd), the center-resources for teaching and learning (ecdec program), community economic development association (ceda), palatine township senior citizens council, palatine police department, harper college, the cook county department of public health, palatine public library, buehler ymca, path (palatine assisting through hope), as well as the cook county primary care clinic described previously. some of the many programs offered at the resource center include ged and citizenship classes, healthcare services, computer literacy, after-school youth program, bilingual counseling, parenting classes, job placement, career education and recreation. in fy 2013, the poc had 234,250 client visits and hospital's cost to operate the facility was $248,000. in addition to the resource center, hospital works with poc on many collaborative health initiatives including the promotoras de salud program which provides health education to the latino population. this program identifies latina women who demonstrate the potential to become leaders in the community. these women then receive leadership training and education on specific health topics and lead small group presentations and health discussions with members of the community. in fy 2013, more than 500 people participated in classes led by the promotora and sixty-nine percent of the participants had annual household incomes of $25,000 or less and 39 percent had no health insurance. poc and hospital also collaboratively provide the services of a bilingual community health nurse and bilingual behavioral health navigator who focus on helping under-resourced members of the community navigate healthcare resources, provide health education, and help patients obtain low-cost prescriptions. in fy 2013 the part-time community nurse had 1,964 client interactions and the part-time behavioral health navigator had 1296. individuals with intellectual and developmental disabilities are another population that has difficulty accessing primary and oral healthcare services. hospital partners with little city foundation, a local residential organization that serves such individuals, on providing primary healthcare by an advanced practice nurse and oral healthcare by the mobile dental clinic team. (8) hospital operates an emergency department that is open 24 hours a day, 7 days a week and serves all persons regardless of their ability to pay. (9) hospital participates in both the medicare and medicaid government-sponsored healthcare programs. hospital contracts with mira med assistance program to provide assistance to patients, free of charge, throughout the medicaid application process when applying for medical coverage through the illinois medicaid program. the assistance provided is inclusive of completing the application, gathering all of the appropriate additional documents that must be submitted, working with the state on the patient's behalf and, in some cases, working through an appeal process. the cost of providing this service was $94,000 in fy 2013. (10) hospital provides services free or at a reduced rate to individuals with limited financial resources who are unable to access entitlement programs. individuals are eligible for free or discounted medically necessary healthcare services based on established criteria and hospital's financial assistance policy is widely distributed and communicated to the community. (11) hospital is an independent community hospital, that provides acute care and is recognized for the following outstanding services: primary stroke center (designated by joint commission), gastroenterology center (directed by a nationally-renowned gastroenterologist with the only gi teaching gallery in illinois for instructing clinicians), level iii neonatal intensive care unit, specialized cancer services (accredited by the commission on cancer), illinois center for pancreatic and hepatobiliary disease, top hospital based on quality and safety criteria by the leapfrog group, and magnet award for nursing excellence recipient (awarded by the american nurses credentialing center). (12) one of hospital's most significant contributions to the region is the northwest community emergency medical services (ems) system. lAUNCHED in 1972, it was the first ems program in illinois and the first in the nation to serve multiple communities. today hospital continues to serve as the area's ems resource hospital, providing administrative, clinical practice, quality management, and fiscal oversight and education for emergency medical dispatchers (emd), emergency medical responders (emr), emergency medical technicians (emt), paramedics, and emergency communications registered nurses (ecrn) within a 375 square-mile area. the system is a coalition of 6 hospitals and 24 ems provider agencies that employ over 950 paramedics and 400 emts, who respond to more than 64,000 patients each year. on-line medical control is provided by over 250 ecrns. the net cost for ems resource hospital activities in fy 2013 was $1,668,600 and provided training for 1,492 individuals. (13) hospital's competent and committed professional nursing staff provides their time and expertise to serve as clinical preceptors for 430 undergraduate nursing students who come to the organization to complete their clinical practicum requirements. the nursing students come from various colleges and universities, including harper college, elmhurst college, university of illinois-chicago, north park university, chamberlain college, rush university, olivet nazarene university, and loyola university. as many nurses throughout the chicago area continue to pursue educational degrees (bsn and msn), many of these individuals seek hospital as a place to complete their requirements
PART VI, LINE 6	AFFILIATED HEALTH CARE SYSTEM	northwest community hospital (hospital) is one of several affiliates under the common control of northwest community healthcare (nch). nch is a supporting organization that also supports northwest community day surgery center, inc., and northwest community hospital foundation. these 4 entities are 501(c)(3) exempt organizations and together provide the resources and funding to deliver quality healthcare services to the people of the northwest suburban community of chicago. in addition to the charity care that the hospital provided, the day surgery center provided an additional $145,265 in charity care (at cost) in fy 2013. the northwest community hospital foundation's primary function is to stimulate philanthropic giving and obtain charitable gifts in order to meet the changing needs of the community as well as fund community benefit initiatives. northwest community health services, inc., a multi-specialty medical group, is another affiliate of nch. health services owns and operates the nch medical group, a multi-specialty physician practice with offices in arlington heights, buffalo grove, palatine and mt. prospect, illinois. health services also operates "fast care", a clinic that is located centrally in a local grocery store that provides affordable primary healthcare services during convenient hours.
PART VI, LINE 7	STATE FILING COMMUNITY BENEFIT REPORT	northwest community healthcare, the sole corporate member of hospital, files an annual nonprofit hospital community benefits plan report with the illinois attorney general's office in accordance with illinois law. the report is filed on behalf of northwest community healthcare, the hospital, and northwest community day surgery center, inc.

Schedule H (Form 990) 2012

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

2012

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. Part II can be duplicated if additional space is needed.

(a) Name and address of organization or government	(b) EIN	(c) IRC Code section if applicable	(d) Amount of cash grant	(h) Purpose of grant or assistance
(1) AMERICAN CANCER SOCIETY 1114 N ARLINGTON HTS RD ARLINGTON HTS,IL60005	13-1788491	501(c)(3)	15,000	RELAY FOR LIFE
(2) AMERICAN HEART ASSOCIATION 208 S LASALLE STE 1500 CHICAGO,IL60604	13-5613797	501(c)(3)	5,300	METRO CHICAGO HEART WALK
(3) HEKTOEN INSTITUTE LLC 2240 W OGDEN AVENUE CHICAGO,IL60612	36-6006541	501(c)(3)	100,000	VISTA CLINIC SUPPORT
(4) LITTLE CITY FOUNDATION 1760 W ALGONQUIN RD PALATINE,IL60067	36-2434562	501(c)(3)	10,000	ANNUAL SPONSORSHIP
(5) SOLIDARITY BRIDGE 1577 FLORENCE AVE EVANSTON,IL60201	36-4481213	501(c)(3)	23,400	MISSION TRIPS
(6) SPECIAL LEISURE SERVICES FOUNDATION 3000 W CENTRAL RD ROLLING MEADOWS,IL60008	36-3145710	501(c)(3)	15,000	ANNUAL SPONSORSHIP
(7) WINGS PO BOX 95615 PALATINE,IL60095	36-3456061	501(c)(3)	5,400	ANNUAL SPONSORSHIP

Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................ Bullet Image

Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image

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

Cat. No. 50055P

Schedule I (Form 990) 2012

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.
Part III can be duplicated 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, Part III, column (b), 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 COMMUNITY 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) 2012

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

2012

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 or provision of all of 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 filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.

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? .........

Yes

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? ...........................

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

Yes

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

Cat. No. 50053T

Schedule J (Form 990) 2012

Page 2

Part II

Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is 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) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.

(A) Name and Title		(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 as deferred in prior Form 990
(A) Name and Title		(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)	(F) Compensation reported as deferred in prior Form 990
(1)Bruce K CrowtherPRES/CEO/SECRETARY THRU 4/13	(i) (ii)	620,844 0	25,000 0	253,429 0	258,391 0	15,583 0	1,173,247 0	302,620 0
(2)Stephen O ScognaCFO/TREAS '12;COO/PRES/CEO '13	(i) (ii)	396,876 0	158,000 0	1,808 0	121,709 0	19,696 0	698,089 0	0 0
(3)MARK D LUSSONExecutive VP Human RESOURCES	(i) (ii)	254,248 0	25,000 0	85,177 0	67,554 0	11,146 0	443,125 0	83,569 0
(4)DALE E BEATTYExec VP Patient Services & CNO	(i) (ii)	331,594 0	25,000 0	54,279 0	49,180 0	12,594 0	472,647 0	52,471 0
(5)Michael C HartkeEXECUTIVE VP/COO	(i) (ii)	238,688 0	25,000 0	25,323 0	73,090 0	16,696 0	378,797 0	23,515 0
(6)MICHAEL B ZENNExecutive VP/COO/TREASURER	(i) (ii)	0 0	0 0	312,468 0	0 0	18,550 0	331,018 0	0 0
(7)WILLIS G PARSONS MDGASTROENTEROLOGY PHYSICIAN	(i) (ii)	1,014,917 0	643,625 0	0 0	15,000 0	1,092 0	1,674,634 0	0 0
(8)MALCOLM BILIMORIA MDGASTROENTEROLOGY Physician	(i) (ii)	1,546,671 0	0 0	0 0	15,000 0	15,725 0	1,577,396 0	0 0
(9)RAMEEZ ALASADI MDGASTROENTEROLOGY Physician	(i) (ii)	735,847 0	0 0	112,077 0	0 0	45 0	847,969 0	0 0
(10)SOTIRIOS MARKULY MDHospitalist	(i) (ii)	279,047 0	600 0	0 0	20,000 0	6,328 0	305,975 0	0 0
(11)Susan E Nelson MDDirector	(i) (ii)	110,545 0	73,186 0	1,400 0	6,045 0	96,869 0	288,045 0	0 0
(12)Leighton B Smith MDExec VP Chief Medical Officer	(i) (ii)	198,284 0	0 0	548,950 0	0 0	13,941 0	761,175 0	270,999 0
(13)Mohammed Tahseen MDPsychiatrist	(i) (ii)	273,149 0	22,000 0	0 0	17,500 0	19,545 0	332,194 0	0 0
(14)ANDREA BENNET MDHospitalist	(i) (ii)	265,880 0	200 0	0 0	10,600 0	16,697 0	293,377 0	0 0

Schedule J (Form 990) 2012

Page 3

Part III

Supplemental Information

Complete this part to provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II.
Also complete this part for any additional information.

Identifier	Return Reference	Explanation
COMPENSATION DETERMINATION PROCESS FOR TOP MANAGEMENT OFFICIAL	SCHEDULE J, PART I, LINE 3	THE COMPENSATION AND GOVERNANCE COMMITTEE OF THE PARENT CORPORATION (HEALTHCARE) ANNUALLY REVIEWS AND MAKES RECOMMENDATIONS TO THE BOARD REGARDING THE COMPENSATION OF THE PRESIDENT AND THE GUIDELINES FOR COMPENSATION OF THE EXECUTIVE VICE PRESIDENTS, OTHER VICE PRESIDENTS AND OTHER KEY MANAGEMENT OFFICERS AS DETERMINED BY THE BOARD. AN INDEPENDENT REASONABLENESS OPINION IS OBTAINED ANNUALLY REGARDING THE CHIEF EXECUTIVE OFFICER'S COMPENSATION AND THAT OF OTHER EXECUTIVES AS DETERMINED BY THE COMMITTEE.
SEVERANCE PAYMENTS	Schedule J, Part I, Line 4a	In 2012, the following individuals received severence payments as part of their compensation arrangement: Michael B. Zenn $312,468 Leighton B. Smith, MD $235,294 Rameez Alasadi, MD $112,077
Supplemental Nonqualified Retirement Plan	Schedule J, Part I, Line 4b	Bruce Crowther participates in a SERP. This plan was frozen in 2010 and an amendment to the Plan eliminated all future benefit accruals including credited service final average earnings and final average amounts used to calculate plan benefits. Therefore no deferred compensation is recorded for the current year.
NON-FIXED COMP PAYMENTS	SCHEDULE J, PART I LINE 7	THE CEO AND VICE PRESIDENTS OF THE HOSPITAL ARE ELIGIBLE FOR AN ANNUAL INCENTIVE COMPENSATION PAYMENT THAT IS ALIGNED WITH THE STRATEGIC, FINANCIAL, AND OPERATIONAL GOALS OF THE ORGANIZATION. PERFORMANCE MEASURES ARE TRACKED AT THREE LEVELS: THRESHOLD MEASURES, WHICH CONSTITUTE THE MINIMUM REQUIREMENTS THAT MUST BE ACHIEVED IN ORDER TO HAVE AN INCENTIVE PAYOUT; ORGANIZATIONAL MEASURES, CONSISTING OF SPECIFIC BUDGET GOALS FOR OPERATING MARGIN, COST PER CASE, MARKET SHARE, QUALITY, ETC.; AND FUNCTIONAL MEASURES, INCLUDING PERSONAL GOALS THAT ARE QUANTIFIABLE AND TIME-SPECIFIC. WEIGHTING OF THE ORGANIZATIONAL AND FUNCTIONAL MEASURES VARIES BETWEEN EXECUTIVES DEPENDING ON THE RELATIVE IMPORTANCE OF VARIOUS PROJECTS ASSIGNED DURING THE YEAR. ACTUAL AMOUNTS AWARDED ARE BASED ON A COMBINATION OF DEFINED TARGETS (15 - 25% OF BASE PAY) AND DISCRETIONARY AMOUNTS (5 - 10% OF BASE PAY). MAXIMUM PAYABLE IS 150% OF THE TARGET. AMOUNTS TO BE PAID ARE RECOMMENDED BY THE CEO AND SUBJECT TO APPROVAL BY THE NORMINATION AND COMPENSATION COMMITTEE OF NORTHWEST COMMUNITY HEALTHCARE, THE SOLE MEMBER OF THE HOSPITAL.

Schedule J (Form 990) 2012

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 Part VI.
SchKMediumBullet

Attach to Form 990. SchKMediumBullet

See separate instructions.

OMB No. 1545-0047

2012

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	111111111	12-01-2011	53,100,000	SEE PART VI		X		X		X
B	ILLINOIS FINANCE AUTHORITY	86-1091967	45200FNR6	09-19-2008	151,075,932	SEE PART VI		X		X		X
C	ILLINOIS FINANCE AUTHORITY	86-1091967	45200FNU9	10-17-2008	86,820,000	SEE PART VI		X		X		X

Part II

Proceeds

	A		B		C		D
	1 Amount of bonds retired . . . . . . . . . . . . . .	0		0		0
2 Amount of bonds legally defeased . . . . . . . . . . .	0		0		0
3 Total proceeds of issue . . . . . . . . . . . . . .	53,100,000		151,417,356		86,820,000
4 Gross proceeds in reserve funds . . . . . . . . . . . .	0		0		0
5 Capitalized interest from proceeds . . . . . . . . . . .	0		0		0
6 Proceeds in refunding escrows . . . . . . . . . . . .	0		0		0
7 Issuance costs from proceeds . . . . . . . . . . . .	434,279		1,437,934		598,075
8 Credit enhancement from proceeds . . . . . . . . . . .	0		0		93,000
9 Working capital expenditures from proceeds . . . . . . . . .	0		0		0
10 Capital expenditures from proceeds . . . . . . . . . . .	0		149,979,422		86,128,925
11 Other spent proceeds . . . . . . . . . . . . . .	52,665,721		0		0
12 Other unspent proceeds . . . . . . . . . . . . . .	0		0		0
13 Year of substantial completion . . . . . . . . . . . .	2011		2010		2008
	Yes	No	Yes	No	Yes	No	Yes	No
14 Were the bonds issued as part of a current refunding issue? . . . . .	X			X	X
15 Were the bonds issued as part of an advance refunding issue? . . . . .		X		X		X
16 Has the final allocation of proceeds been made? . . . . . . . .	X		X		X
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? . . . . . . . . . . . . . .	X		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		X
2 Are there any lease arrangements that may result in private business use of bond-financed property? . . . . . . . . .		X		X

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

Cat. No. 50193E

Schedule K (Form 990) 2012

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 of bond-financed property? . . . . . . . . . . . .		X		X
b If "Yes" to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property? . . . . . . . . . . . . . . . .
c Are there any research agreements that may result in private business use of bond-financed property? . . . . . . . . . . . . . . .		X		X
d If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property? .
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%		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 . . . . . . .	%		%		%		%
6 Total of lines 4 and 5 . . . . . . . . . . . . . . .	%		%		%		%
7 Does the bond issue meet the private security or payment test? . . . . .		X		X
8a Has there been a sale or disposition of any of the bond financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were issued?. . . . . . . . . . . . . . . . .		X		X
b If “Yes” to line 8a, enter the percentage of bond-financed property sold or disposed of.	%		%		%		%
c If “Yes” to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? . . . . . . . . . . . . .		X		X
9 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under Regulations sections 1.141-12 and 1.145-2?	X		X

Part IV

Arbitrage

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Has the issuer filed Form 8038-T? . . . . .		X		X		X
2 If "No" to line 1, did the following apply? . . . .
a Rebate not due yet? . . . . . . . .	X			X		X
b Exception to rebate? . . . . . . . .		X		X	X
c No rebate due? . . . . . . . . . .		X	X			X
If you checked "No rebate due" in line 2c, provide in Part VI the date the rebate computation was performed
3 Is the bond issue a variable rate issue? . . . .	X			X	X
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?		X		X		X
b Name of provider . . . . . . . . .	0		0		0
c Term of hedge . . . . . . . . . .
d Was the hedge superintegrated? . . . . . .
e Was a hedge terminated? . . . . . . .

Schedule K (Form 990) 2012

Page 3

Part IV

Arbitrage (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
5a Were gross proceeds invested in a guaranteed investment contract (GIC)? . . . . . . . . .		X		X		X
b Name of provider . . . . . . . . .	0		0		0
c Term of GIC . . . . . . . . . .
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? . . . . .
6 Were any gross proceeds invested beyond an available temporary period? . . . . . . . .		X		X		X
7 Has the organization established written procedures to monitor the requirements of section 148? . . .	X		X		X

Part V

Procedures To Undertake Corrective Action

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations?	X		X		X

Part VI

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

Identifier	Return Reference	Explanation
SUPPLEMENTAL INFORMATION	0	SCHEDULE K, PART I, COLUMN (F) BOND A PROCEEDS WERE USED TO REFUND THE 2/13/2002 BOND ISSUANCE. SCHEDULE K, PART I, COLUMN (F) BOND B PROCEEDS WERE 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. SCHEDULE K, PART I, COLUMN (F) BOND C PROCEEDS WERE USED TO REFUND THE 2/13/2002 BOND ISSUANCE. SCHEDULE K, PART IV, LINE 1C BOND B A REBATE CALCULATION WAS CONDUCTED ON APRIL 17, 2014.

Schedule K (Form 990) 2012

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, line 38a or 40b.
MediumBullet

Attach to Form 990 or Form 990-EZ. MediumBullet

See separate instructions.

OMB No. 1545-0047

2012

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

Enter the amount of tax incurred by 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-EZ, Part V, line 38a, or Form 990, Part IV, line 26; or if the organization reported an amount on Form 990, Part X, line 5, 6, or 22

(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	(d) Loan to or from the organization?		(e)Original principal amount	(f)Balance due	(g) In default?		(h) Approved by board or committee?		(i)Written agreement?
(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	To	From	(e)Original principal amount	(f)Balance due	Yes	No	Yes	No	Yes	No
(1) James J Smith MD		Physician Prac Svcs		X	85,793	18,958		No	Yes		Yes





Total ...... $						18,958

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 assistance	(d) Type of assistance	(e) Purpose of assistance

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

Cat. No. 50056A

Schedule L (Form 990 or 990-EZ) 2012

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) SARAH BISHOP	SEE PART V	60,548	SALARY		No
(2) SEE PART V

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	SARAH BISHOP IS THE DAUGHTER OF JAMES H. BISHOP (DIRECTOR). By virtue of being elected as officers of the medical staff, two physicians were elected as directors of the board. The two directors owned more than 5% ownership in their respective practices (Suburban ENT and Advanced Surgical Associates). Unrelated to the directors' tenure on the board, these practices rented office space and purchased answering services from the hospital and provided services to the hospital which totaled $1,297,475.

Schedule L (Form 990 or 990-EZ) 2012

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

2012

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, NORTHWEST COMMUNITY HOSPITAL (HOSPITAL) DIRECTOR AND CEO, AND JAMES H. BISHOP, HOSPITAL DIRECTOR, ARE DIRECTOR AND OFFICER RESPECTIVELY OF WINTRUST FINANCIAL CORPORATION AND BARRINGTON BANK AND TRUST COMPANY NA. MICHAEL B. ZENN, FORMER HOSPITAL OFFICER, AND JAMES H. BISHOP, HOSPITAL DIRECTOR, ARE DIRECTOR AND OFFICER RESPECTIVELY OF VILLAGE BANK & TRUST. 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 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 HOSPITAL'S BOARD 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 SUBMISSION OF THE NEXT ANNUAL QUESTIONNAIRE. 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, LINE 15A	THE COMPENSATION AND GOVERNANCE 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. 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 COMPENSATION AND GOVERNANCE COMMITTEE. COMPENSATION DETERMINATION PROCESS FOR OFFICERS AND KEY EMPLOYEES FORM 990, PART VI, LINE 15B THE COMPENSATION AND GOVERNANCE 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 COMPENSATION AND GOVERNANCE 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. THESE 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.
RECONCILIATION OF NET ASSETS - OTHER CHANGES IN NET ASSETS	FORM 990, PART XI, QUESTION 9	BASIS SWAP GAIN 51,614 PENSION RELATED CHANGES OTHER THAN NET PERIODIC PENSION COST 19,376,505 RESTRICTED FUNDS - SILVER LINING PROGRAM (15,973) CHANGE IN TEMPORARILY RESTRICTED FUNDS 407,742 CHANGE IN PERMANENTLY RESTRICTED FUNDS 124,919 NET ASSETS TRANSFER TO NORTHWEST COMMUNITY HEALTHCARE (4,000,000) =========== TOTAL 15,944,807

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

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2012

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

2012

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" to Form 990, Part IV, line 33.)

(a) Name, address, and EIN (if applicable) 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	2,726,957	612,700	NA
(2) NCH Service Company LLC 3060 Salt Creek Lane Arlington Hts,IL60005 26-3791362	Patient Care	IL	1,764,364	621,014	NCPA LLC

Part II

Identification of Related Tax-Exempt Organizations (Complete if the organization answered "Yes" to 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 entity?
(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		No
(2) Northwest Community Day Surgery Center 675 West Kirchoff Road Arlington HTS,IL60005 36-3540436	Outpatient	IL	501(c)(3)	3	NCH		No
(3) Northwest Community Hospital Foundation 3060 Salt Creek Lane Arlington HTS,IL60005 36-3125193	Fundraising	IL	501(c)(3)	7	NCH		No

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

Cat. No. 50135Y

Schedule R (Form 990) 2012

Page 2

Part III

Identification of Related Organizations Taxable as a Partnership (Complete if the organization answered "Yes" to 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 W CENTRAL RD 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" to 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	(i) Section 512(b)(13) controlled entity?
(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		Yes	No
(1) Northwest Community Health Services Inc 800 West Central Road Arlington Heights,IL60005 36-3312906	healthcare svcs	IL	healthcare svcs	C CORP					No
(2) Northwest Community Capco Inc 800 West Central Road Arlington Heights,IL60005 36-4027717	Managed Care	IL	Hospital	C Corp	583,562	1,095,215	100.000 %		No
(3) NCH Casualty Insurance SPC LTD 68 West Bay Raod KY1-1102 Grand Cayman,cAYMAN ISLANDS CJ 98-0442062	Insurance	CJ	healthcare	C Corp					No
(4) NCH Physicians Cooperative 800 West Central Road Arlington Heights,IL60005 20-1830299	Group Purchasing	IL	Hospital	C Corp	0	0	100.000 %		No
(5) CENTRAL INSURANCE COMPANY LTD 171 ELGIN AVENUE KY1-1002 GEORGE TOWN CJ 98-1109518	INSURANCE	CJ	HEALTHCARE	C CORP

Schedule R (Form 990) 2012

Page 3

Part V

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

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

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 or (iv) rent from a controlled entity . . . . . . . . . . . . . . . . . . . . . . .

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

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

Yes

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

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

f Dividends from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

g Sale of assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

h Purchase of assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

i Exchange of assets with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

Yes

l Performance of services or membership or fundraising solicitations for related organization(s) . . . . . . . . . . . . . . . . . . . .

Yes

m Performance of services or membership or fundraising solicitations by related organization(s) . . . . . . . . . . . . . . . . . . . .

n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) . . . . . . . . . . . . . . . . . . . . .

o Sharing of paid employees with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

p Reimbursement paid to related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

q Reimbursement paid by related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

r Other transfer of cash or property to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

s Other transfer of cash or property from related 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-s)	(c) Amount involved	(d) Method of determining amount involved
(1) Northwest Community Capco Inc	q	1,282,277	Cost

Schedule R (Form 990) 2012

Page 4

Part VI

Unrelated Organizations Taxable as a Partnership (Complete if the organization answered "Yes" to 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)	(e) Are all partners section 501(c)(3) organizations?		(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 entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(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

Schedule R (Form 990) 2012

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 improve the health of the communities we serve and to meet individuals' healthcare needs.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	19
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	15
5	Total number of individuals employed in calendar year 2011 (Part V, line 2a) ......	5	3,825
6	Total number of volunteers (estimate if necessary) .............	6	825
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	1,567,788
b	Net unrelated business taxable income from Form 990-T, line 34 .........	7b

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	1,466,035	1,494,187
9	Program service revenue (Part VIII, line 2g) .........	472,194,812	432,581,609
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	521,265	1,727,907
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	6,907,544	5,914,233
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)...................	481,089,656	441,717,936
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	187,489	229,307
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)	240,095,074	232,064,994
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–24e)....	228,410,407	195,422,176
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	468,692,970	427,716,477
19	Revenue less expenses. Subtract line 18 from line 12.......	12,396,686	14,001,459
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	619,249,436	624,911,391
21	Total liabilities (Part X, line 26).............	456,809,134	432,284,393
22	Net assets or fund balances. Subtract line 21 from line 20.....	162,440,302	192,626,998

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 42,031,410 including grants of $ 0 ) (Revenue $ 43,295,792 )
	Cardiac Northwest community hospital's (hospital) cardiac service line provided quality, patient centered, compassionate care, regardless of ability to pay, to approximately 30,300 inpatients and OUTPATIENTS DURING FY 2013. 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 all at a cost of nearly $42,100,000. 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 Consistently 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. NCH also prides itself on its comprehensive electrophysiology program that provides the most complex ablation procedures for patients with atrial fibrillation and other cardiac arrhythmias. In addition, the hospital has an outpatient device clinic that provides ongoing management and monitoring for patients with pacemakers and implantable defibrillators. The clinic currently services nearly 2,000 patients. Hospital has been repeatedly recognized for its commitment to quality outcomes and has twice been recognized as an accredited chest pain center by the society for chest pain centers. In addition, NCH has been recognized as an accredited echo lab by the intersocietal commission for the accreditation of echocardiography laboratories (icael) since 2000. 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. Every year the hospital hosts community events where blood pressure, cholesterol and BMI screenings are used to calculate an individual's risk of developing heart disease for a minimal fee. In addition, physicians provided education on heart health and wellness.

4b	(Code: ) (Expenses $ 27,605,546 including grants of $ 229,307 ) (Revenue $ 43,134,485 )
	Gastroenterology Hospital's gastroenterology (gi) center provides quality, patient centered, compassionate care for patients, regardless of ability to pay, in need of diagnostic and therapeutic endoscopic procedures. 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. This team provides same-day care for patients in and beyond hospital's service area who are in need of interventional procedures. In FY 2013 the GI center provided service for 29,850 patients.

4c	(Code: ) (Expenses $ 35,432,564 including grants of $ 0 ) (Revenue $ 31,504,306 )
	General Surgery Hospital's general surgery service line provided quality, patient centered, compassionate care, regardless of ability to pay, to 3,264 general surgical patients (inpatient and outpatient) in the main or during FY 2013. Procedures were performed in state-of-the-art operating rooms which include three dedicated minimally invasive surgery suites. the general surgery program provides care for both pediatric and adult populations. In FY 2011, hospital partnered with children's memorial hospital to plan for a neonatal surgery program to support its new level 3 NICU. The general surgery program also includes davinci robotic capabilities and a dedicated pancreatic surgery program. General Surgery services are provided 24 hours a day, 7 days a week, and the program is designated a level 2 trauma center. Hospital has been the recipient of multiple healthgrades awards which include GI services. General surgery mortality and surgical site infections observed-to-expected ratios are in the "low" range based on hospital's case mix index. a multidisciplinary team has 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 include: 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. Form 990, Part III - Other Program Services, Line 4d Form 990, Part III, Line 4d includes revenue and expenses from all other program services not described on Form 990, part III, lines 4a-4c.

4d	Other program services (Describe in Schedule O.)
	(Expenses $ 232,960,811 including grants of $ 0 ) (Revenue $ 314,647,026 )
4e	Total program service expenses338,030,331

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)............	8,800,666	0	938,635

				(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		0
d	Related organizations...1d		1,246,379
e	Government grants (contributions)1e		247,808

f	All other contributions, gifts, grants, and similar amounts not included above1f

g	Noncash contributions included in lines 1a-1f:$		0
h	Total. Add lines 1a-1f.......			1,494,187
			Business Code
2a	Net patient services		621110	408,139,035	408,139,035	0	0
b	Lab services		621500	22,262,251	20,694,463	1,567,788	0
c	MEANINGFUL USE REIMBURSEMENTS		900099	323,806	323,806	0	0
d	Classes and training		900099	1,021,914	1,021,914	0	0
e	Nursing services		900099	165,199	165,199	0	0
f	All other program service revenue .			669,404	669,404		0
g	Total. Add lines 2a–2f........			432,581,609
3	Investment income (including dividends, interest, and other similar amounts).......			1,492,626			1,492,626
4	Income from investment of tax-exempt bond proceeds..			75			75
5	Royalties...........			0
		(i) Real	(ii) Personal
6a	Gross rents	2,697,777
b	Less: rental expenses	1,091,161
c	Rental income or (loss)	1,606,616	0
d	Net rental income or (loss).......			1,606,616			1,606,616
		(i) Securities	(ii) Other
7a	Gross amount from sales of assets other than inventory	122,260,762	609,890
b	Less: cost or other basis and sales expenses	122,618,012	17,434
c	Gain or (loss)	-357,250	592,456
d	Net gain or (loss)..........			235,206			235,206
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		0
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		340,777
b	Less: cost of goods sold ..b		336,219
c	Net income or (loss) from sales of inventory..			4,558			4,558
Miscellaneous Revenue			Business Code
11a	INSURANCE SURPLUS DISTRIBUTION		900099	2,008,442	0	0	2,008,442
b	Cafeteria		722514	1,574,538	0	0	1,574,538
c	MEDICAL RECORDS RELEASE		900099	345,297	0	0	345,297
d	All other revenue ....			374,782	0	0	374,782
e	Total. Add lines 11a–11d ......			4,303,059
12	Total revenue. See Instructions......			441,717,936	431,013,821	1,567,788	7,642,140


				(A) Beginning of year		(B) End of year
1	Cashnon-interest-bearing .............			0	1	0
2	Savings and temporary cash investments .........			30,946,366	2	40,336,464
3	Pledges and grants receivable, net ...........			0	3	0
4	Accounts receivable, net .............			60,733,467	4	63,199,420
5	Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of Schedule L ..................
				98,476	5	18,958
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L
				0	6	0
7	Notes and loans receivable, net .............			0	7	0
8	Inventories for sale or use ..............			5,315,340	8	4,803,892
9	Prepaid expenses and deferred charges ..........			3,627,812	9	5,046,918
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	641,130,089
b	Less: accumulated depreciation .....	10b	266,878,742	382,232,029	10c	374,251,347
11	Investments—publicly traded securities ..........			97,484,804	11	98,835,268
12	Investments—other securities. See Part IV, line 11 .....			0	12	0
13	Investments—program-related. See Part IV, line 11 .....			6,698,999	13	7,231,660
14	Intangible assets ...............			0	14	0
15	Other assets. See Part IV, line 11 ...........			32,112,143	15	31,187,464
16	Total assets. Add lines 1 through 15 (must equal line 34)......			619,249,436	16	624,911,391
17	Accounts payable and accrued expenses .........			91,828,628	17	85,970,863
18	Grants payable .................			0	18	0
19	Deferred revenue ................			122,193	19	480,851
20	Tax-exempt bond liabilities .............			277,615,000	20	271,665,000
21	Escrow or custodial account liability. Complete Part IV of Schedule D..			0	21	0
22	Loans and other payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
	persons. Complete Part II of Schedule L..........			0	22	0
23	Secured mortgages and notes payable to unrelated third parties ..			0	23	0
24	Unsecured notes and loans payable to unrelated third parties ....			0	24	0
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D....................			87,243,313	25	74,167,679
26	Total liabilities. Add lines 17 through 25.........			456,809,134	26	432,284,393
	Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets ..............			155,741,303	27	185,395,339
28	Temporarily restricted net assets ...........			5,587,588	28	5,995,329
29	Permanently restricted net assets ...........			1,111,411	29	1,236,330
	Organizations that do not follow SFAS 117 (ASC 958), 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 ...........			162,440,302	33	192,626,998
34	Total liabilities and net assets/fund balances ........			619,249,436	34	624,911,391