TY 2021 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/1099-NEC)	(F) Estimated amount of other compensation from the organization and related organizations
(1) GERALD P GALLAGHER...................................................................... NS Pres/CEO/Director	3.0 ................. 41.0	X				0	3,083,846	874,701
(2) Sean O'Grady...................................................................... NS COO/ Director	1.0 ................. 41.0	X				0	2,776,729	450,156
(3) Stephen O Scogna...................................................................... PRESIDENT/SECRETARY/CEO	34.0 ................. 6.0	X	X			2,914,270	0	233,325
(4) Willis Parsons...................................................................... Med Dir GI Center	40.0 ................. 0.0				X	2,073,561	0	40,988
(5) Mahalakshmi Halasyamani MD...................................................................... NS CMO/DIRECTOR	1.0 ................. 40.0	X				0	1,416,051	213,711
(6) Michael C Hartke...................................................................... Executive VP/COO	34.0 ................. 6.0			X		1,459,645	0	113,129
(7) John L Skeans...................................................................... CFO/Treasurer	34.0 ................. 6.0		X			1,077,527	0	99,229
(8) Alan B Loren MD...................................................................... Executive VP - CMO	37.0 ................. 3.0			X		749,676	0	94,967
(9) Glen J Malan...................................................................... VP Info Tech & CIO	37.0 ................. 3.0				X	670,332	0	32,858
(10) Susan E Nelson MD...................................................................... VP Physician Operations	37.0 ................. 3.0				X	644,785	0	47,151
(11) RICH CASEY...................................................................... VP HOSPITAL OPERATIONS	37.0 ................. 3.0				X	579,647	0	68,282
(12) TERRY SOLEM...................................................................... VP HUMAN RESOURCES	37.0 ................. 3.0				X	581,565	0	7,229
(13) Eileen Gillespie Trm 123021...................................................................... Executive VP - PT Serv & CNO	37.0 ................. 3.0			X		471,450	0	73,339
(14) Thomas Oryszczak...................................................................... Exec VP Chief Medical Officer	37.0 ................. 3.0			X		399,033	0	41,440
(15) Catherine Wood MD...................................................................... Phy & Director	1.0 ................. 39.0	X				0	232,270	24,508
(16) KENNETH A SPERO MD...................................................................... DIRECTOR	1.0 ................. 1.0	X				39,000	0	0
(17) Marla F Glabe...................................................................... Director	1.0 ................. 1.0	X				0	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/1099-NEC)
(18) Guy W Eisenhuth........................................................................ Vice Chairperson	10.0 .......................1.0	X	X	0	0	0
(19) Ann K Ford........................................................................ Director	1.0 .......................1.0	X		0	0	0
(20) Diane G Hill........................................................................ Director	1.0 .......................1.0	X		0	0	0
(21) Mary R Sheahen MS RN........................................................................ Chairperson	10.0 .......................1.0	X	X	0	0	0
(22) THOMAS G WISCHHUSEN........................................................................ DIRECTOR	1.0 .......................1.0	X		0	0	0
(23) John L Gatta........................................................................ Director	1.0 .......................1.0	X		0	0	0
(24) Susan M Graunke........................................................................ Director	1.0 .......................1.0	X		0	0	0
(25) Michael D Levon........................................................................ Director	1.0 .......................1.0	X		0	0	0
(26) Nimesh S Jhaveri........................................................................ Director	1.0 .......................1.0	X		0	0	0
(27) MUKESH GANGWAL........................................................................ DIRECTOR	1.0 .......................1.0	X		0	0	0
(28) Ricardo Knight MD........................................................................ DIRECTOR	1.0 .......................1.0	X		0	0	0
(29) Maria Thompson........................................................................ DIRECTOR	1.0 .......................1.0	X		0	0	0

(A) Name and business address	(B) Description of services	(C) Compensation
SPACELABS HEALTHCARE LLC, 35301 SE CENTER ST SNOQUALMIE,WA98065	IT SERV AND SUPPLY	5,224,813
Sodexo Inc Affiliates, PO BOX 360170 PITTSBURGH,PA152516170	Dietary and Biomed	3,727,372
SODEXO CTM INC, 7100 COMMERCE WAY STE 280 BRENTWOOD,TN37027	BIOMED SERVICE	2,864,928
TRAPANI CONSTRUCTION, 1 FREEDOM VALLEY DR ARLINGTON HEIGHTS,IL60004	CONSTRUCTION	2,834,618
KINDRED HOSPITAL REHABILITATION SER, PO BOX 502096 ST LOUIS,MO631502096	REHAB SERVICES	2,819,681
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 111

- TIN:

SCHEDULE A
(Form 990)

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.
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Attach to Form 990 or Form 990-EZ.
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Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2021

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 12, 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 (Form 990).)

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 agricultural research organization described in 170(b)(1)(A)(ix) operated in conjunction with a land-grant college or university or a non-land grant college of agriculture. See instructions. Enter the name, city, and state of the college or university:

An organization that normally receives: (1) more than 33 1/3% of its support from contributions, membership fees, and gross receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 33 1/3% of its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses acquired by the organization after June 30, 1975. See section 509(a)(2). (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 on lines 12a through 12d that describes the type of supporting organization and complete lines 12e, 12f, and 12g.

Type I. A supporting organization operated, supervised, or controlled by its supported organization(s), typically by giving the supported organization(s) the power to regularly appoint or elect a majority of the directors or trustees of the supporting organization. You must complete Part IV, Sections A and B.

Type II. A supporting organization supervised or controlled in connection with its supported organization(s), by having control or management of the supporting organization vested in the same persons that control or manage the supported organization(s). You must complete Part IV, Sections A and C.

Type III functionally integrated. A supporting organization operated in connection with, and functionally integrated with, its supported organization(s) (see instructions). You must complete Part IV, Sections A, D, and E.

Type III non-functionally integrated. A supporting organization operated in connection with its supported organization(s) that is not functionally integrated. The organization generally must satisfy a distribution requirement and an attentiveness requirement (see instructions). You must complete Part IV, Sections A and D, and Part V.

Check this box if the organization received a written determination from the IRS that it is a Type I, Type II, Type III functionally integrated, or Type III non-functionally integrated supporting organization.

Enter the number of supported organizations ...............................

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

(i) Name of supported organization	(ii) EIN	(iv) Is the organization listed in your governing document?		(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)
(i) Name of supported organization	(ii) EIN	Yes	No	(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)


Total

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

Cat. No. 11285F

Schedule A (Form 990) 2021

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 failed to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2017	(b) 2018	(c) 2019	(d) 2020	(e) 2021	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") ..
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) 2017	(b) 2018	(c) 2019	(d) 2020	(e) 2021	(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 VI.)..
11	Total support. Add lines 7 through 10

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

First 5 years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here ........................................ right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2021 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2020 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2021. 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—2020. 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—2021. 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 VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization ..................................................... right arrow

10%-facts-and-circumstances test—2020. 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 VI 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) 2021

Page 3

Part III

Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 10 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) 2017	(b) 2018	(c) 2019	(d) 2020	(e) 2021	(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) 2017	(b) 2018	(c) 2019	(d) 2020	(e) 2021	(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 on 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 VI.) ..
13	Total support. (Add lines 9, 10c, 11, and 12.)..

First 5 years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization,
check this box and stop here............................................. right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2021 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2020 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2021 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2020 Schedule A, Part III, line 17 .............

19a

331/3% support tests—2021. 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—2020. 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) 2021

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 12 of Part I. If you checked box 12a, of Part I, complete Sections A and B. If you checked box 12b, of Part I, complete Sections A and C. If you checked box 12c, of Part I, complete Sections A, D, and E. If you checked box12d, of Part I, complete Sections A and D, and complete Part V.)

Section A. All Supporting Organizations

Yes

Are all of the organization’s supported organizations listed by name in the organization’s governing documents?
If "No," describe in Part VI how the supported organizations are designated. If designated by class or purpose,
describe the designation. If historic and continuing relationship, explain.

Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or (2)? If "Yes," explain in Part VI how the organization determined that the supported organization was described in section 509(a)(1) or (2).

Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer lines 3b and 3c below.

Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the public support tests under section 509(a)(2)? If "Yes," describe in Part VI when and how the organization made the determination.

Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) purposes? If "Yes," explain in Part VI what controls the organization put in place to ensure such use.

Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked box 12a or 12b in Part I, answer lines 4b and 4c below.

Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? If “Yes,” describe in Part VI how the organization had such control and discretion despite being controlled or supervised by or in connection with its supported organizations.

Did the organization support any foreign supported organization that does not have an IRS determination under sections 501(c)(3) and 509(a)(1) or (2)? If “Yes,” explain in Part VI what controls the organization used to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B) purposes.

Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer lines 5b and 5c below (if applicable). Also, provide detail in Part VI, including (i) the names and EIN numbers of the supported organizations added, substituted, or removed; (ii) the reasons for each such action; (iii) the authority under the organization's organizing document authorizing such action; and (iv) how the action was accomplished (such as by amendment to the organizing document).

Type I or Type II only. Was any added or substituted supported organization part of a class already designated in the organization's organizing document?

Substitutions only. Was the substitution the result of an event beyond the organization's control?

Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (i) its supported organizations, (ii) individuals that are part of the charitable class benefited by one or more of its supported organizations, or (iii) other supporting organizations that also support or benefit one or more of the filing organization’s supported organizations? If “Yes,” provide detail in Part VI.

Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (defined in section 4958(c)(3)(C)), a family member of a substantial contributor, or a 35% controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990) .

Did the organization make a loan to a disqualified person (as defined in section 4958) not described on line 7? If “Yes,” complete Part I of Schedule L (Form 990).

Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons, as defined in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or (2))? If “Yes,” provide detail in Part VI.

Did one or more disqualified persons (as defined on line 9a) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.

Did a disqualified person (as defined on line 9a) have an ownership interest in, or derive any personal benefit from, assets in which the supporting organization also had an interest? If “Yes,” provide detail in Part VI.

10a

Was the organization subject to the excess business holdings rules of section 4943 because of section 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer line 10b below.

10a

Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to determine whether the organization had excess business holdings).

10b

Schedule A (Form 990) 2021

Page 5

Part IV

Supporting Organizations (continued)

Yes

Has the organization accepted a gift or contribution from any of the following persons?

A person who directly or indirectly controls, either alone or together with persons described on lines 11b and 11c below, the governing body of a supported organization?

11a

A family member of a person described on 11a above?

11b

A 35% controlled entity of a person described on line 11a or 11b above? If “Yes” to 11a, 11b, or 11c, provide detail in Part VI.

11c

Section B. Type I Supporting Organizations

Yes

Did the officers, directors, trustees, or membership of one or more supported organizations have the power to regularly appoint or elect at least a majority of the organization’s directors or trustees at all times during the tax year? If “No,” describe in Part VI how the supported organization(s) effectively operated, supervised, or controlled the organization’s activities. If the organization had more than one supported organization, describe how the powers to appoint and/or remove directors or trustees were allocated among the supported organizations and what conditions or restrictions, if any, applied to such powers during the tax year.

Did the organization operate for the benefit of any supported organization other than the supported organization(s) that operated, supervised, or controlled the supporting organization? If “Yes,” explain in Part VI how providing such benefit carried out the purposes of the supported organization(s) that operated, supervised or controlled the supporting organization.

Section C. Type II Supporting Organizations

Yes

Were a majority of the organization’s directors or trustees during the tax year also a majority of the directors or trustees of each of the organization’s supported organization(s)? If “No,” describe in Part VI how control or management of the supporting organization was vested in the same persons that controlled or managed the supported organization(s).

Section D. All Type III Supporting Organizations

Yes

Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s tax year, (i) a written notice describing the type and amount of support provided during the prior tax year, (ii) a copy of the Form 990 that was most recently filed as of the date of notification, and (iii) copies of the organization’s governing documents in effect on the date of notification, to the extent not previously provided?

Were any of the organization’s officers, directors, or trustees either (i) appointed or elected by the supported organization(s) or (ii) serving on the governing body of a supported organization? If "No," explain in Part VI how the organization maintained a close and continuous working relationship with the supported organization(s).

By reason of the relationship described in line 2 above, did the organization’s supported organizations have a significant voice in the organization’s investment policies and in directing the use of the organization’s income or assets at all times during the tax year? If "Yes," describe in Part VI the role the organization’s supported organizations played in this regard.

Section E. Type III Functionally-Integrated Supporting Organizations

Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):

The organization satisfied the Activities Test. Complete line 2 below.

The organization is the parent of each of its supported organizations. Complete line 3 below.

The organization supported a governmental entity. Describe in Part VI how you supported a government entity (see instructions)

Activities Test. Answer lines 2a and 2b below.

Yes

Did substantially all of the organization’s activities during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was responsive? If "Yes," then in Part VI identify those supported organizations and explain how these activities directly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these activities constituted substantially all of its activities.

Did the activities described on line 2a, above constitute activities that, but for the organization’s involvement, one or more of the organization’s supported organization(s) would have been engaged in? If "Yes," explain in Part VI the reasons for the organization’s position that its supported organization(s) would have engaged in these activities but for the organization’s involvement.

Parent of Supported Organizations. Answer lines 3a and 3b below.

Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations?If "Yes" or "No", provide details in Part VI.

Did the organization exercise a substantial degree of direction over the policies, programs and activities of each of its supported organizations? If "Yes," describe in Part VI. the role played by the organization in this regard.

Schedule A (Form 990) 2021

Page 6

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations

Check here if the organization satisfied the Integral Part Test as a qualifying trust on Nov. 20, 1970 (explain in Part VI). See instructions. All other Type III non-functionally integrated supporting organizations must complete Sections A through E.

	Section A - Adjusted Net Income		(A) Prior Year	(B) Current Year (optional)
1	Net short-term capital gain	1
2	Recoveries of prior-year distributions	2
3	Other gross income (see instructions)	3
4	Add lines 1 through 3	4
5	Depreciation and depletion	5
6	Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions)	6
7	Other expenses (see instructions)	7
8	Adjusted Net Income (subtract lines 5, 6 and 7 from line 4)	8

	Section B - Minimum Asset Amount		(A) Prior Year	(B) Current Year (optional)
1	Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year):	1
a	Average monthly value of securities	1a
b	Average monthly cash balances	1b
c	Fair market value of other non-exempt-use assets	1c
d	Total (add lines 1a, 1b, and 1c)	1d
e	Discount claimed for blockage or other factors (explain in detail in Part VI):
2	Acquisition indebtedness applicable to non-exempt use assets	2
3	Subtract line 2 from line 1d	3
4	Cash deemed held for exempt use. Enter 0.015 of line 3 (for greater amount, see instructions).	4
5	Net value of non-exempt-use assets (subtract line 4 from line 3)	5
6	Multiply line 5 by 0.035	6
7	Recoveries of prior-year distributions	7
8	Minimum Asset Amount (add line 7 to line 6)	8

	Section C - Distributable Amount		Current Year
1	Adjusted net income for prior year (from Section A, line 8, Column A)	1
2	Enter 85% of line 1	2
3	Minimum asset amount for prior year (from Section B, line 8, Column A)	3
4	Enter greater of line 2 or line 3	4
5	Income tax imposed in prior year	5
6	Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions)	6

Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions)

Schedule A (Form 990) 2021

Page 7

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations(continued)

Section D - Distributions		Current Year
1 Amounts paid to supported organizations to accomplish exempt purposes	1
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity	2
3 Administrative expenses paid to accomplish exempt purposes of supported organizations	3
4 Amounts paid to acquire exempt-use assets	4
5 Qualified set-aside amounts (prior IRS approval required - provide details in Part VI)	5
6 Other distributions (describe in Part VI). See instructions	6
7Total annual distributions. Add lines 1 through 6.	7
8 Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions	8
9 Distributable amount for 2021 from Section C, line 6	9
10 Line 8 amount divided by Line 9 amount	10

Section E - Distribution Allocations (see instructions)		(i) Excess Distributions	(ii) Underdistributions Pre-2021	(iii) Distributable Amount for 2021
1 Distributable amount for 2021 from Section C, line 6
2 Underdistributions, if any, for years prior to 2021 (reasonable cause required-- explain in Part VI). See instructions.
3 Excess distributions carryover, if any, to 2021:
a From 2016.......
b From 2017.......
c From 2018.......
d From 2019.......
e From 2020.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2021 distributable amount
i Carryover from 2016 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from line 3f.
4Distributions for 2021 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2021 distributable amount
c Remainder. Subtract lines 4a and 4b from line 4.
5 Remaining underdistributions for years prior to 2021, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions.
6 Remaining underdistributions for 2021. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions.
7 Excess distributions carryover to 2022. Add lines 3j and 4c.
8 Breakdown of line 7:
a Excess from 2017.....
b Excess from 2018.....
c Excess from 2019.....
d Excess from 2020.....
e Excess from 2021.....

Schedule A (Form 990) (2021)

Schedule A (Form 990) 2021

Page 8

Part VI

Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; Part III, line 12; Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11a, 11b, and 11c; Part IV, Section B, lines 1 and 2; Part IV, Section C, line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 1c, 2a, 2b, 3a and 3b; Part V, line 1; Part V, Section B, line 1e; Part V Section D, lines 5, 6, and 8; and Part V, Section E, lines 2, 5, and 6. Also complete this part for any additional information. (See instructions).

Facts And Circumstances Test

Return Reference	Explanation

Schedule A (Form 990) 2021

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE C
(Form 990)

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

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2021

Open to Public
Inspection

If the organization answered "Yes" on 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" on 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" on Form 990, Part IV, Line 5 (Proxy Tax) (see separate instructions) or Form 990-EZ, Part V, line 35c (Proxy Tax) (see separate instructions), 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. See instructions for definition of “political campaign activities."

Political campaign activity expenditures. See instructions .................................................................... SchCMd Bullet

Volunteer hours for political campaign activities. See instructions ..................................................................

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-.
1
2
3
4
5
6

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

Cat. No. 50084S

Schedule C (Form 990) 2021

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 separate instructions for lines 2a through 2f.)
Lobbying Expenditures During 4-Year Averaging Period
	Calendar year (or fiscal year beginning in)	(a) 2018	(b) 2019	(c) 2020	(d) 2021	(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) 2021

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 on lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.

(a)

Yes|No

(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

7,629

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

7,629

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

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, lines 1 and 2 (see instructions), and Part ll-B, line 1. Also, complete this part for any additional information.

Return Reference	Explanation
Form 990 Schedule C Part II-B, Line 1i	NORTHWEST COMMUNITY HOSPITAL PAYS DUES TO CERTAIN HOSPITAL ASSOCIATIONS WHICH USE A PORTION OF THESE DUES FOR LOBBYING.

Schedule C (Form 990) 2021

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," on 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

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2021

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" on Form 990, Part IV, line 6.

		(a) Donor advised funds	(b) Funds and other accounts
1	Total number at end of year .........
2	Aggregate value of contributions to (during year)
3	Aggregate value of 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" on 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 7/25/06, 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, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, handling of violations, 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" on Form 990, Part IV, line 8.

If the organization elected, as permitted under FASB 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 FASB 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)

Revenue included on 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 FASB ASC 958 relating to these items:

Revenue included on 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) 2021

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" on 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


b	If "Yes," explain the arrangement in Part XIII and complete the following table:		Amount
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, for escrow or custodial account liability? ...

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" on Form 990, Part IV, line 10.

		(a) Current year	(b) Prior year	(c) Two years back	(d) Three years back	(e) Four years back

1a	Beginning of year balance ....	25,360,609	4,796,665	4,435,885	4,243,431	3,941,522
b	Contributions ...	3,000	20,252,500	250,000	260,000	5,000
c	Net investment earnings, gains, and losses	795,191	468,276	261,907	74,854	296,909
d	Grants or scholarships ...
e	Other expenditures for facilities and programs ...	167,870	156,832	151,127	142,400
f	Administrative expenses ....
g	End of year balance ......	25,990,930	25,360,609	4,796,665	4,435,885	4,243,431

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

Board designated or quasi-endowment SchDMd Bullet

86.620 %

Permanent endowment SchDMd Bullet

8.730 %

Term endowment SchDMd Bullet

4.650 %

The percentages on 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" on 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.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11a. See Form 990, Part X, line 10.

Description of property		(a) Cost or other basis (investment)	(b) Cost or other basis (other)	(c) Accumulated depreciation	(d) Book value

1a	Land .....	89,072		89,072
b	Buildings ....	231,864,954	7,530,355	224,334,599
c	Leasehold improvements	1,523,000	443,740	1,079,260
d	Equipment ....	91,655,076	29,074,182	62,580,894
e	Other .....	44,358,314	277,111	44,081,203
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				332,165,028

Schedule D (Form 990) 2021

Page 3

Part VII

Investments - Other Securities.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11b. 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........
(3)Other
(A)
(B)
(C)
(D)
(E)
(F)
(G)
(H)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

Part VIII

Investments - Program Related. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11c. See Form 990, Part X, line 13.

(a) Description of investment	(b) Book value	(c) Method of valuation: Cost or end-of-year market value
(1)INTEREST NET ASSETS - FND	32,158,628	F
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)	32,158,628

Part IX

Other Assets.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11d. See Form 990, Part X, line 15.

(a) Description				(b) Book value

(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........

Part X

Other Liabilities.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.

1.(a) Description of liability	(b) Book value
(1) Federal income taxes	0
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	64,109,340
2. Liability for uncertain tax positions. 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) 2021

Page 4

Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
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 (losses) 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. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
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

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.

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. THE ENDOWMENT FUNDS REPORTED ON THE HOSPITAL'S 990 ARE ALSO REPORTED ON NORTHWEST COMMUNITY HOSPITAL FOUNDATION'S FORM 990, SCHEDULE D.

SCHEDULE D, PART X, LINE 2 - FIN 48 (ASC 740) FOOTNOTE

NORTHSHORE, FPA, RMI, SWEDISH HOSPITAL, SHF, NCH, NCH HOSPITAL, AND NCH FOUNDATION HAVE BEEN DETERMINED TO QUALIFY AS TAX-EXEMPT ORGANIZATIONS UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (IRC). MOST OF THE INCOME RECEIVED BY THE CORPORATION IS EXEMPT FROM TAXATION UNDER SECTION 501(A) OF THE IRC, AS INCOME RELATED TO THE MISSION OF THE ORGANIZATION. ACCORDINGLY, THERE IS NO MATERIAL PROVISION FOR INCOME TAX FOR THESE ENTITIES. SOME OF THE INCOME RECEIVED BY EXEMPT ENTITIES IS SUBJECT TO TAXATION AS UNRELATED BUSINESS INCOME. NORTHSHORE AND ITS SUBSIDIARIES FILE FEDERAL INCOME TAX RETURNS AND RETURNS FOR VARIOUS STATES IN THE U.S. ASC 740-10, Income Taxes, requires that realization of an uncertain income tax position is more likely than not (i.e., greater than 50% likelihood of receiving a benefit) before it can be recognized in the consolidated financial statements. Furthermore, this interpretation prescribes the benefit to be recorded in the consolidated financial statements as the amount most likely to be realized assuming a review by tax authorities having all relevant information and applying current conventions. This interpretation also clarifies the financial statement classification of tax-related penalties and interest and sets forth new disclosures regarding unrecognized tax benefits. No amount was recorded for the three months ended December 31, 2021. For the three months ended December 31, 2021, the Corporation has a net operating loss carryforward of $336,752, which generated assets of $94,968. These assets are offset by a valuation allowance of $93,268.

Schedule D (Form 990) 2021

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" on Form 990, Part IV, question 20.
MediumBullet

Attach to Form 990.
MediumBullet

Go to www.irs.gov/Form990EZ for instructions and the latest information.

OMB No. 1545-0047

2021

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 %

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 criteria used 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		(a) Number of activities or programs (optional)	(b) Persons served (optional)	(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) . . .			1,028,068	0	1,028,068	0.770 %
b	Medicaid (from Worksheet 3, column a) . . . . .			17,828,995	15,515,677	2,313,318	1.730 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .
d	Total Financial Assistance and Means-Tested Government Programs . . . . .			18,857,063	15,515,677	3,341,386	2.500 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).	34	8,127	467,396	18,308	449,088	0.340 %
f	Health professions education (from Worksheet 5) . . .	14	2,153	943,755	0	943,755	0.700 %
g	Subsidized health services (from Worksheet 6) . . . .	1	480	135,287	17,565	117,722	0.090 %
h	Research (from Worksheet 7) .	2	105	44,713	0	44,713	0.030 %
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .	7	762	169,521	0	169,521	0.130 %
j	Total. Other Benefits . .	58	11,627	1,760,672	35,873	1,724,799	1.290 %
k	Total. Add lines 7d and 7j .	58	11,627	20,617,735	15,551,550	5,066,185	3.790 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2021

Schedule H (Form 990) 2021

Page

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.

		(a) Number of activities or programs (optional)	(c) Total community building expense	(d) Direct offsetting revenue	(e) Net community building expense
1	Physical improvements and housing
2	Economic development
3	Community support
4	Environmental improvements
5	Leadership development and training for community members
6	Coalition building
7	Community health improvement advocacy	1	4,768	0	4,768
8	Workforce development	1	387	0	387
9	Other
10	Total	2	5,155	0	5,155

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

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

Yes

Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......

1,196,250

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).....

53,229,400

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

61,247,011

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

-8,017,611

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) 2021

Page

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?1Name, address, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility)					Other (describe)
1	NORTHWEST COMMUNITY HOSPITAL 800 W CENTRAL ROAD ARLINGTON HEIGHTS,IL60005 nch.org 0001701	X	X	X	License Number 0001701

Schedule H (Form 990) 2021

Page 4

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 letter of facility reporting group

Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A):

Yes

Community Health Needs Assessment

Was the hospital facility first licensed, registered, or similarly recognized by a state as a hospital facility in the current tax year or the immediately preceding tax year?........................

Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C...............

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 12......................

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 significant 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

The impact of any actions taken to address the significant health needs identified in the hospital facility's prior CHNA(s)

Other (describe in Section C)

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

In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted .................

Yes

6 a

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C..................................

Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................

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 (list url): NCH.org

Other website (list url):

Made a paper copy available for public inspection without charge at the hospital facility

Other (describe in Section C)

Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. ..............

Yes

Indicate the tax year the hospital facility last adopted an implementation strategy: 20 20

Is the hospital facility's most recently adopted implementation strategy posted on a website?.........

Yes

If "Yes" (list url): NCH.org

If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ......

10b

Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.

12a

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)?...............................

12a

If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........

12b

If "Yes" on line 12b, 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) 2021

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	NORTHWEST COMMUNITY HOSPITAL
Name of hospital facility or letter of facility reporting group

Yes

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 included free or discounted care?

Yes

If “Yes,” indicate the eligibility criteria explained in the FAP:

Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of 200.%
and FPG family income limit for eligibility for discounted care of 600.%

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

Explained the basis for calculating amounts charged to patients?.................

Yes

Explained the method for applying for financial assistance?...................

Yes

If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):

Described the information the hospital facility may require an individual to provide as part of his or her application

Described the supporting documentation the hospital facility may require an individual to submit as part of his or
her application

Provided the contact information of hospital facility staff who can provide an individual with information about the
FAP and FAP application process

Provided the contact information of nonprofit organizations or government agencies that may be sources of
assistance with FAP applications

Other (describe in Section C)

Was widely publicized within the community served by the hospital facility?........

Yes

If "Yes," indicate how the hospital facility publicized the policy (check all that apply):

The FAP was widely available on a website (list url):

NCH.org

The FAP application form was widely available on a website (list url):

NCH.org

A plain language summary of the FAP was widely available on a website (list url):
NCH.org

The FAP was available upon request and without charge (in public locations in the hospital facility and by mail)

The FAP application form was available upon request and without charge (in public locations in the hospital facility
and by mail)

A plain language summary of the FAP was available upon request and without charge (in public locations in the
hospital facility and by mail)

Individuals were notified about the FAP by being offered a paper copy of the plain language summary of the FAP, by
receiving a conspicuous written notice about the FAP on their billing statements, and via conspicuous public displays or
other measures reasonably calculated to attract patients' attention

Notified members of the community who are most likely to require financial assistance about availability of the FAP

The FAP, FAP application form, and plain language summary of the FAP were translated into the primary language(s)
spoken by LEP populations

Other (describe in Section C)

Schedule H (Form 990) 2021

Page 6

Part VFacility Information (continued)

Billing and Collections

	NORTHWEST COMMUNITY HOSPITAL
Name of hospital facility or letter of facility reporting group

Yes

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 all of the actions the hospital facility or other authorized party may take upon nonpayment?..................................

Yes

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 individual’s eligibility under the facility’s FAP:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring, denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

None of these actions or other similar actions were permitted

Did the hospital facility or other authorized party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?............

If "Yes," check all actions in which the hospital facility or a third party engaged:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring , denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 19. (check all that apply):

Provided a written notice about upcoming ECAs (Extraordinary Collection Action) and a plain language summary of the
FAP at least 30 days before initiating those ECAs (if not, describe in Section C)

Made a reasonable effort to orally notify individuals about the FAP and FAP application process (if not, describe in
Section C)

Processed incomplete and complete FAP applications (if not, describe in Section C)

Made presumptive eligibility determinations (if not, describe in Section C)

Other (describe in Section C)

None of these efforts were made

Policy Relating to Emergency Medical Care

Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required 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 Section C)

Other (describe in Section C)

Schedule H (Form 990) 2021

Page 7

Part VFacility Information (continued)

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

	NORTHWEST COMMUNITY HOSPITAL
Name of hospital facility or letter of facility reporting group

Yes

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 a look-back method based on claims allowed by Medicare fee-for-service during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicaid, either alone or in combination with
Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month
period

The hospital facility used a prospective Medicare or Medicaid method

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

If "Yes," explain in Section C.

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

If "Yes," explain in Section C.

Schedule H (Form 990) 2021

Page 8

Part V

Facility Information (continued)

Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16j, 18e, 19e, 20a, 20b, 20c, 20d, 20e, 21c, 21d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference	Explanation
SCHEDULE H- PART V, SECTION B, LINE 3(E)	THE SIGNIFICANT HEALTH NEEDS OF OUR PATIENTS AND COMMUNITY ARE IDENTIFIED THROUGH PRIORITIZED DESCRIPTIONS REFLECTED IN THE CHNA. SCHEDULE H - PART V, SECTION B, LINE 5 AN ONLINE SURVEY WAS IMPLEMENTED AS PART OF THE COMMUNITY HEALTH NEEDS ASSESSMENT PROCESS SPECIFICALLY TO SOLICIT INPUT FROM KEY INFORMANTS; INDIVIDUALS WHO ARE CONSIDERED EXPERTS IN PUBLIC HEALTH. POTENTIAL PARTICIPANTS WERE CHOSEN BECAUSE OF THEIR ABILITY TO IDENTIFY PRIMARY CONCERNS OF THE COMMUNITY, INCLUDING THE MEDICALLY UNDERSERVED, LOW-INCOME AND MINORITY POPULATIONS SERVED BY THE HOSPITAL. IN JANUARY 2021, 44 POTENTIAL KEY INFORMANTS WERE IDENTIFIED WHICH INCLUDED COMMUNITY/BUSINESS LEADERS, PHYSICIANS, OTHER HEALTH PROVIDERS, PUBLIC HEALTH EXPERTS AND SOCIAL SERVICE AGENCIES. A LETTER WAS SENT FROM THE HOSPITAL'S PRESIDENT AND CEO TO THE KEY INFORMANTS TO EXPLAIN THE PURPOSE OF THE SURVEY AND TO INVITE THEM TO PARTICIPATE. A LINK TO THE ONLINE SURVEY WAS THEN EMAILED TO EACH KEY INFORMANT AND WAS OPEN FROM FEBRUARY 1-10, 2021. A REMINDER EMAIL WAS SENT TO ENCOURAGE PARTICIPATION. THE KEY INFORMANTS WERE ASKED A SERIES OF HEALTH RELATED QUESTIONS, AND TO PROVIDE FEEDBACK ON ACCESS TO CARE, BEHAVIORAL HEALTH, CHRONIC DISEASE/HEALTH ISSUES, MODIFIABLE RISK FACTORS AND OTHER CONCERNS. IT ALSO ASKED THEM TO RANK THEIR "TOP THREE HEALTH CONCERNS" FOR THE COMMUNITY. RESULTS FROM THE SURVEY WERE SUMMARIZED IN BOTH A QUANTITATIVE AND QUALITATIVE REPORT AND USED TO IDENTIFY MAJOR HEALTH PROBLEMS, GAPS IN SERVICES AND OTHER FACTORS WHICH MAY CONTRIBUTE TO LESS THAN OPTIMAL HEALTH STATUS FOR THE RESIDENTS OF OUR COMMUNITY. IN ALL, 24 OF THE 44 INVITED PARTICIPANTS TOOK PART IN THE ONLINE KEY INFORMANT SURVEY. THROUGH THIS PROCESS, INPUT WAS GATHERED FROM INDIVIDUALS WHOSE ORGANIZATIONS WORK WITH LOW-INCOME POPULATIONS, MINORITY POPULATIONS (INCLUDING AFRICAN-AMERICANS, ASIANS, EASTERN EUROPEANS, HISPANICS, INDIAN, JAPANESE, POLISH AND RUSSIAN), OR OTHER MEDICALLY UNDERSERVED POPULATIONS (INCLUDING THE DISABLED, THE ELDERLY, THE HOMELESS, MEDICAID/MEDICARE BENEFICIARIES, THE MENTALLY ILL, PREGNANT TEENS, SUBSTANCE ABUSERS, UNDOCUMENTED INDIVIDUALS, UNINSURED/UNDERINSURED RESIDENTS, VETERANS, YOUNG ADULTS AND WOMEN). THE HOSPITAL ALSO SOLICITED INPUT FROM THE COMMUNITY AT LARGE THROUGH AN ONLINE SURVEY. THE SURVEY WAS ANNOUNCED TO THE COMMUNITY THROUGH A PRESS RELEASE, A PAID ADVERTISEMENT IN A LOCAL NEWSPAPER, AND IT WAS FEATURED IN "A HEALTHIER YOU', NCH'S ELECTRONIC COMMUNITY NEWSLETTER. IT WAS ALSO SENT TO VOLUNTEERS, DONORS AND EMPLOYEES ASKING THOSE WHO LIVE IN THE HOSPITAL'S SERVICE AREA TO PARTICIPATE. THE SURVEY LINK WAS ON THE HOSPITAL'S HOME PAGE AND WAS OPEN FROM FEBRUARY 12-22, 2021. MORE THAN 360 PEOPLE PARTICIPATED IN THE SURVEY. THE HOSPITAL ALSO SOLICITED INPUT FROM VULNERABLE POPULATIONS IN THE COMMUNITY THROUGH FOCUS GROUPS. AN INDEPENDENT MODERATOR WAS HIRED TO CONDUCT TWO FOCUS GROUPS IN FEBRUARY 2021: ONE WITH SPANISH-SPEAKING UNDER-RESOURCED COMMUNITY MEMBERS AND ONE WITH ENGLISH-SPEAKING UNDER-RESOURCED COMMUNITY MEMBERS. POTENTIAL PARTICIPANTS WERE GIVEN A SHORT SCREENING QUESTIONNAIRE TO ENSURE THEY LIVED IN THE HOSPITAL'S SERVICE AREA AND SO THAT PARTICIPANTS WOULD VARY IN AGE, GENDER, INSURANCE STATUS, INCOME AND EDUCATIONAL LEVELS. THE FOCUS GROUPS FOLLOWED A GUIDELINE WHICH MIRRORED THE QUESTIONS INCLUDED IN THE COMMUNITY AND KEY INFORMANT SURVEYS SO THAT THE INFORMATION GATHERED COULD BE USED TO COMPARE WITH THE SURVEY RESULTS. THE MODERATOR SUMMARIZED THE RESULTS OF THE FOCUS GROUPS WHICH WERE USED AS ONE OF THE TOOLS IN IDENTIFYING THE MOST PREDOMINANT COMMUNITY NEEDS. NCH ALSO CONDUCTED A FOCUS GROUP IN FEBRUARY 2021 WITH ITS PATIENT FAMILY ADVISORY COUNCIL, WHICH IS COMPRISED OF COMMUNITY MEMBERS WHO USE NCH AS THEIR MEDICAL HOME. THE SAME FORMAT AS THE FOCUS GROUPS DESCRIBED ABOVE WAS USED, AND PROVIDED AN OPPORTUNITY TO GATHER INFORMATION ON THE COMMUNITY'S BELIEFS AND PERCEPTIONS ABOUT THE HEALTH OF ITS COMMUNITY, WHICH SUPPLEMENTED THE DATA COLLECTED IN THE ONLINE COMMUNITY HEALTH SURVEY.
SCHEDULE H - PART V, SECTION B, LINE 7A	https://www.nch.org/wp-content/uploads/2021-CHNA-2.pdf
SCHEDULE H - PART V, SECTION B, LINE 10A	https://www.nch.org/wp-content/uploads/2022-2024-Implementation-Plan.pdf
SCHEDULE H - PART V, SECTION B, LINE 11	TAKING INTO ACCOUNT HOSPITAL RESOURCES AND OVERALL ALIGNMENT WITH THE HOSPITAL'S MISSION, GOALS AND STRATEGIC PRIORITIES - IT WAS DETERMINED THAT NCH WOULD FOCUS THE MAJORITY OF ITS EFFORTS ON DEVELOPING AND/OR SUPPORTING STRATEGIES AND INITIATIVES TO IMPROVE THE FOLLOWING PRIORITY AREAS: BEHAVIORAL HEALTH (MENTAL HEALTH AND SUBSTANCE ABUSE), OBESITY, ACCESS TO CARE FOR THE UNDER-RESOURCED, CANCER (INCLUDING TOBACCO) AND CHRONIC DISEASE (DIABETES, HEART DISEASE, STROKE, AND HIGH BLOOD PRESSURE). KEY INDIVIDUALS THROUGHOUT THE HOSPITAL WERE IDENTIFIED TO SERVE ON ISSUE SPECIFIC COMMITTEES TO DEVELOP IMPLEMENTATION STRATEGIES FOR EACH OF THE PRIORITY AREAS FOR THE HOSPITAL'S FISCAL YEARS 2022 THROUGH 2025. THESE INDIVIDUALS ALSO DEVELOPED METRICS TO MEASURE THE SUCCESS OF THE STRATEGIES WHICH WILL BE MONITORED AND UPDATED ANNUALLY. IMPLEMENTATION STRATEGIES FOR BEHAVIORAL HEALTH INCLUDE FREE, IN PERSON MENTAL HEALTH ASSESSMENTS AND A FREE 24/7 RESOURCE AND REFERRAL PHONE LINE TO ASSIST COMMUNITY MEMBERS IN CRISIS. THE HOSPITAL ALSO CONDUCTS FREE BEHAVIORAL HEALTH ASSESSMENTS AND CARE COORDINATION FOR HOSPITALIZED PATIENTS WITH SUBSTANCE ABUSE DISORDERS AND HAS AN OUTPATIENT ADDICTIONS PROGRAM PROVIDING MEDICATION ASSISTED TREATMENT FOR ALCOHOL, OPIOID, AND OTHER SUBSTANCE USE DISORDERS. IT ALSO INCLUDES UTILIZING THE MENTAL HEALTH FIRST AID PROGRAM TO TRAIN COMMUNITY MEMBERS ON IDENTIFYING AND RESPONDING TO BEHAVIORAL HEALTH ISSUES AND AN ED AMBULATORY DETOX PROGRAM. IMPLEMENTATION STRATEGIES FOR OBESITY INCLUDE A COMPREHENSIVE WEIGHT LOSS CLINIC, OUTPATIENT NUTRITION COUNSELING, A COLLABORATIVE COMMUNITY FOOD PANTRY, LOW COST MEMBERSHIPS AT THE NCH WELLNESS CENTER, AND A FOOD INSECURITY INPATIENT SCREENING PROGRAM WITH ONSITE SUPPORT FROM A FOOD PHARMACY. IMPLEMENTATION STRATEGIES FOR ACCESS TO CARE FOR THE UNDER-RESOURCED INCLUDE A COMMUNITY NURSING AND COMMUNITY HEALTH WORKER PROGRAM. THE HOSPITAL'S DEDICATED CASE MANAGEMENT TEAM ALONG WITH TWO COMMUNITY HEALTH NURSES AND A COMMUNITY HEALTH WORKER PROVIDE OUTREACH AND ASSIST VULNERABLE PATIENTS AND COMMUNITY MEMBERS WITH ACCESSING CARE. THE HOSPITAL ALSO FUNDS A CHARITABLE PRESCRIPTION AND FREE TRANSPORTATION PROGRAM TO FURTHER ASSIST THESE INDIVIDUALS. ACCESS TO ORAL HEALTH CARE FOR THE UNDER-RESOURCED IS ADDRESSED THROUGH A COLLABORATIVE MOBILE DENTAL CLINIC PROGRAM THAT IS OPERATED BY THE HOSPITAL WITH SUPPORT FROM FOUR LOCAL TOWNSHIPS, UNIVERSITY OF CHICAGO DENTAL SCHOOL, HARPER COLLEGE, ADVANTAGE AMBULANCE AS WELL AS PROFESSIONAL VOLUNTEERS. IMPLEMENTATION STRATEGIES FOR CANCER INCLUDE THE GIFT-A-MAMMOGRAM PROGRAM WHICH PROVIDES FREE SCREENINGS AND DIAGNOSTIC TESTING FOR UNDER-RESOURCED PATIENTS. THE HOSPITAL ALSO OFFERS LUNG SCREENINGS AND FREE TOBACCO CESSATION COUNSELING AND SUPPORT GROUPS TO AID WITH LUNG CANCER PREVENTION. TEN FREE SUPPORT GROUPS AND ANNUAL CANCER SURVIVOR EVENTS ARE FACILITATED BY THE HOSPITAL. THE HOSPITAL ALSO ADMINISTERS THE CANCER AND LUNG PATIENT FAMILY ASSISTANCE FUND WHICH PROVIDES ASSISTANCE TO CANCER PATIENTS STRUGGLING TO PAY THEIR RENT, UTILITIES AND OTHER LIVING EXPENSES. LASTLY, THE HOSPITAL DEVELOPED IMPLEMENTATION STRATEGIES TO ADDRESS A NUMBER OF CHRONIC DISEASES INCLUDING DIABETES, HEART DISEASE, STROKE AND HIGH BLOOD PRESSURE. THESE INITIATIVES INCLUDE A PATIENT NAVIGATION PROGRAM TO ASSIST CONGESTIVE HEART FAILURE PATIENTS IN THE COMMUNITY AS WELL AS A COMPREHENSIVE OUTPATIENT CLINIC FOR INDIVIDUALS WITH HEART FAILURE OR AFIB. A STROKE SUPPORT GROUP IS OFFERED TO PROMOTE EMOTIONAL HEALING AFTER DIAGNOSIS. STAFF ALSO PROVIDES EDUCATION IN THE COMMUNITY FOCUSED ON EDUCATION AND PREVENTION OF CHRONIC DISEASE. THE KEY PRIORITY AREAS ALONG WITH THE IMPLEMENTATION STRATEGIES AND METRICS CAN BE FOUND ON THE HOSPITAL'S WEBSITE (NCH.ORG). IN ACKNOWLEDGING THE WIDE RANGE OF HEALTH ISSUES THAT EMERGED FROM THE CHNA PROCESS, THE HOSPITAL DETERMINED IT COULD ONLY EFFECTIVELY FOCUS ON THOSE WHICH IT DEEMED MOST PRESSING, MOST UNDER-ADDRESSED, AND MOST WITHIN ITS ABILITY TO INFLUENCE. THE COMMUNITY HEALTH NEEDS THAT THE HOSPITAL IS UNABLE TO ADDRESS ARE: ACCESS TO SPECIALTY AND VISION CARE FOR THE UNDER RESOURCES, CHILD ABUSE, ELDER ABUSE, DOMESTIC VIOLENCE, DEMENTIA/ALZHEIMERS, TEEN SEXUALITY (PREGNANCY AND STD'S), AND SAFE NEIGHBORHOODS/AFFORDABLE HOUSING. THE HOSPITAL BELIEVES ACCESS TO SPECIALTY AND VISION CARE WILL BE ADDRESSED THROUGH REFERRALS FROM PRIMARY CARE PHYSICIANS. THE HOSPITAL COLLABORATES WITH FOUR LOCAL NOT-FOR-PROFIT COMMUNITY AGENCIES (CHILDREN'S ADVOCACY CENTER, NORTHWEST CASA, CATHOLIC CHARITIES AND WINGS) TO ADDRESS CHILD ABUSE, ELDER ABUSE AND DOMESTIC VIOLENCE. THE HOSPITAL BELIEVES THERE ARE SUFFICIENT COMMUNITY RESOURCES INCLUDING PRIMARY CARE PHYSICIANS TO DIAGNOSE AND NURSING HOMES AND MEMORY CARE FACILITIES TO TREAT DEMENTIA AND ALZHEIMERS. THE HOSPITAL PARTNERS WITH LOCAL SCHOOL DISTRICTS THAT PROVIDE SEX EDUCATION AND SUPPORT SERVICES AND WITH LOCAL COMMUNITY CLINICS WHO ADDRESS PREVENTION AND TREATMENT OF PREGNANCY AND STD'S. THE HOSPITAL IS A HEALTHCARE FACILITY AND IS NOT EQUIPPED TO ADDRESS HOUSING ISSUES. NCH RELIES ON ITS LOCAL MUNICIPALITIES TO ADDRESS THESE CONCERNS. THE HOSPITAL SUPPORTS THE EFFORTS OF OTHERS TO ADDRESS THESE AREAS AND WILL FOCUS ITS LIMITED RESOURCES ON THE MORE PREDOMINANT NEEDS IDENTIFIED. FOR A COMPLETE LIST OF NEEDS AND IMPLEMENTATION STRATEGIES VISIT THE HOSPITAL'S WEBSITE (NCH.ORG).
SCHEDULE H - PART V, SECTION B, LINE 13H	PRESUMED ELIGIBLE PATIENTS RECEIVE 100% FINANCIAL ASSISTANCE FOR THE ACCOUNT BALANCE. A PATIENT MUST PROVIDE DOCUMENTATION LISTING ELIGIBILITY OR QUALIFICATION OR PRINT SCREEN OF WEB PAGE LISTINGS ELIGIBILITY. A PATIENT IS PRESUMED ELIGIBLE IF THEY HAVE ONE OF THE FOLLOWING: - PARTICIPATION IN STATE-FUNDED PRESCRIPTION PROGRAMS; - PARTICIPATION IN WOMEN'S, INFANT'S, AND CHILDREN'S PROGRAMS (WIC); - FOOD STAMP ELIGIBILITY (LINK CARD); - ELIGIBILITY FOR OTHER STATE OR LOCAL ASSISTANCE PROGRAM THAT IS UNFUNDED; - LOW INCOME/SUBSIDIZED HOUSING ARE PROVIDED AS A VALID ADDRESS; - PATIENT IS DECEASED WITH NO KNOWN ESTATE; - AFFILIATION WITH HOMELESS ASSISTANCE ORGANIZATION (I.E. JOURNEYS THE ROAD HOME); - ENROLLED IN SNAP, ILLINOIS FREE BREAKFAST/LUNCH, LOW INCOME HOME ENERGY ASSISTANCE PROGRAM, OR A COMMUNITY-BASED MEDICAL ASSISTANCE PROGRAM WITH LOW-INCOME CRITERIA; - RECEIVING GRANT ASSISTANCE FOR MEDICAL SERVICES; - RECENT PERSONAL BANKRUPTCY, INCARCERATION, RELIGIOUS ORDER AFFILIATION AND VOW OF POVERTY OR ENROLLMENT IN TANF OR IHDA'S RENTAL HOUSING SUPPORT PROGRAM; - A PATIENT WHO HAS BEEN UNRESPONSIVE TO EFFORTS TO APPLY FOR FINANCIAL ASSISTANCE BUT HAS BEEN ASSESSED UNDER THE POST-CARE PROCESS AND MEETS THE CRITERIA; - PATIENT IS MENTALLY OR PHYSICALLY INCAPACITATED AND HAS NO ONE TO ACT ON HIS/HER BEHALF; - PATIENT IS ELIGIBLE FOR SUBSIDIZED SCHOOL LUNCH PROGRAMS; OR - MEDICAID ELIGIBILITY THAT DOES NOT APPLY TO THIS SERVICE (I.E. DHS SOCIAL SERVICES, MOMS AND BABIES). - RELIGIOUS ORDER AFFILIATION AND A VOW OF POVERTY.
SCHEDULE H - PART V, SECTION B, LINE 16	https://www.nch.org/billing-insurance/financial-assistance/

Schedule H (Form 990) 2021

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Part VFacility Information (continued)

Section D. 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?14
Name and address		Type of Facility (describe)
1	NCH Imaging Center 880 W Central Road Arlington Heights,IL60005	Imaging Services
2	NCH Breast Vein care Weight Management 1410 N Arlington Heights Road ARLINGTON HEIGHTS,IL60004	Breast Center, Vein care & Comprehensive Weight Management Services
3	NCH IMMEDIATE CARE & IMAGING CENTER 199 W RAND ROAD MOUNT PROSPECT,IL60056	WALK IN URGENT CARE CENTER, LAB,IMAGING,PHYSICAL THERAPY & HEART CARE SERVICES
4	NCH BEHAVIORAL HEALTH 901 W KIRCHOFF ROAD ARLINGTON HEIGHTS,IL60005	BEHAVIORAL HEALTH SERVICES
5	NCH IMMEDIATE CARE & IMAGING CENTER 21481 N RAND ROAD KILDEER,IL60049	WALK IN URGENT CARE CENTER, LAB, IMAGING, PHYSICAL THERAPY SERVICES
6	NCH Home Health 3040 Salt Creek Lane Arlington Heights,IL60005	Home Healthcare Services
7	NCH Immediate Care & Imaging Center 15 S Mchenry Road Buffalo Grove,IL60089	Walk in Urgent Care Center, Lab, Imaging, Physical Therapy Services
8	NCH IMMEDIATE CARE & IMAGING CENTER 519 S ROSELLE ROAD SCHAUMBURG,IL60193	WALK IN URGENT CARE CENTER LAB, IMAGING, PHYSICAL THERAPY SERVICES
9	NCH CARDIAC PHYSICAL REHABILITATION 900 W CENTRAL ROAD Arlington Heights,IL60005	CARDIAC & PHYSICAL REHABILITATION SERVICES
10	NCH OUTPATIENT CENTER 3300 KIRCHOFF ROAD ROLLING MEADOWS,IL60008	PHYSICAL, OCCUPATIONAL, & SPEECH THERAPY SERVICES
11	NCH Imaging Center 1632 W Central Road Arlington Heights,IL60005	Imaging, Cardiac Diagnostic Services
12	NCH Physical Rehabilitation 1200 W Algonquin Rd Bldg M Palatine,IL60067	Physical Therapy Services
13	NCH Physical Rehabilitation 1051 W Rand Road Arlington Heights,IL60004	Physical Therapy Services
14	NCH Diabetes Services 605 W Central Road Arlington Heights,IL60005	Diabetes Services

Schedule H (Form 990) 2021

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Part VI

Supplemental Information

Provide the following information.

1	Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2	Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs 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.

Form and Line Reference	Explanation
SCHEDULE H - PART I, LINE 3C - CHARITY CARE POLICY	THE HOSPITAL PROVIDES EMERGENT AND MEDICALLY NECESSARY SERVICES TO ALL PATIENTS WITHOUT REGARD TO THE PATIENT'S ABILITY TO PAY. THE WRITTEN CHARITY CARE POLICY IS WIDELY DISTRIBUTED AND COMMUNICATED TO THE COMMUNITY UNDER THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY. THE AMOUNT OF FREE CARE PROVIDED IS DETERMINED BY FINANCIAL NEED AND IS NOT LIMITED BY BUDGETED AMOUNTS. PATIENTS EARNING LESS THAN 200% OF THE FEDERAL POVERTY GUIDELINES RECEIVE FREE CARE AND THOSE BETWEEN 200% AND 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. THE PATIENT'S LIABILITY IS CAPPED AT 25% OF THE FAMILY'S ANNUAL INCOME. PLEASE SEE SCHEDULE H PART V, SECTION B, LINE 13H NARRATIVE FOR MORE DETAIL. SCHEDULE H - PART I, LINE 6A-COMMUNITY BENEFIT REPORT THE HOSPITAL ANNUALLY PRODUCES A COMMUNITY BENEFIT REPORT WHICH HIGHLIGHTS THE COMMUNITY BENEFIT DOLLARS REPORTED IN THE ILLINOIS ATTORNEY GENERAL ANNUAL NONPROFIT HOSPITAL COMMUNITY BENEFITS PLAN REPORT. THIS INCLUDES CHARITY CARE, LANGUAGE ASSISTANT SERVICES, GOVERNMENT SPONSORED INDIGENT HEALTH CARE, DONATIONS, VOLUNTEER SERVICES, EDUCATION, RESEARCH, SUBSIDIZED HEALTH SERVICES AND OTHER COMMUNITY BENEFITS. IT ALSO HIGHLIGHTS THE MOST PREDOMINANT COMMUNITY HEALTH NEEDS IDENTIFIED IN THE MOST RECENT COMMUNITY HEALTH NEEDS ASSESSMENT. COPIES OF THE REPORT ARE PRINTED AND MAILED TO KEY STAKEHOLDERS INCLUDING LOCAL GOVERNMENT, SOCIAL SERVICE AGENCIES, HOSPITAL SUPPORTERS AND MORE. A COPY OF THE REPORT IS ALSO POSTED ON THE HOSPITAL WEBSITE (NCH.ORG) AND IS AVAILABLE IN HARD COPY TO ANYONE WHO REQUESTS ONE.
SCHEDULE H - PART I, LINE 7 - FINANCIAL ASSISTANCE	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 WAS DETERMINED USING WORKSHEET 2 IN THE FORM 990, SCHEDULE H INSTRUCTIONS. PART I, LINES 7E - 7J COSTS WERE DETERMINED USING THE DIRECT AND INDIRECT COSTS FOR SPECIFIC PROGRAMS OR SERVICES. THESE COSTS WERE MAINTAINED/IDENTIFIED IN THE 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 HOSPITAL'S LATEST AVAILABLE MEDICARE COST REPORT. THE "INDIRECT" RATIOS WERE ENTERED INTO CBISA FOR THE CALCULATION OF INDIRECT COSTS. Part I, Line 7g - SUBSIDIZED HEALTH SERVICES THE HOSPITAL PROVIDES A MOBILE DENTAL CLINIC PROGRAM STAFFED BY A HOSPITAL EMPLOYED FULL TIME DENTIST, DENTAL ASSISTANT AND DENTAL HYGENIST WHO ALSO SERVES AS THE 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 AND OTHER DONORS, PROVIDES PREVENTIVE AND RESTORATIVE CARE TO UNINSURED AND UNDERINSURED MEMBERS OF THE COMMUNITY 4-5 DAYS PER WEEK IN A MOBILE DENTAL CLINIC. PART I, LINE 7, Column (F) $4,726,881 of bad debt expense was excluded from total expenses reported on Form 990, Part IX, Line 25, column (A) in the calculation to determine the percentage of net community benefit expenses in relation to total expenses.
SCHEDULE H - PART II, COMMUNITY BUILDING ACTIVITIES	PART II - LINE 7 - ADVOCACY FOR COMMUNITY HEALTH IMPROVEMENT/SAFETY THE HOSPITAL'S VICE PRESIDENT OF OPERATIONS REPRESENTS THE ORGANIZATION THROUGH PARTICIPATION ON THE BOARD OF DIRECTORS FOR HOPEFUL BEGINNINGS/ST. MARY'S SERVICES. THE LOCAL NOT FOR PROFIT ORGANIZATION PROVIDES MATERNITY AND GRIEF COUNSELING AND PARENTING EDUCATION, AS WELL AS GUIDANCE AND SUPPORT FOR FAMILIES SEEKING ADOPTION. THE HOSPITAL'S VICE PRESIDENT AND CHIEF NURSING OFFICER AND VICE PRESIDENT OF HUMAN RESOURCES REPRESENT THE ORGANIZATION ON THE BOARD OF DIRECTORS FOR THE KENNETH YOUNG CENTER (KYC). KYC PARTNERS WITH COMMUNITIES TO PROVIDE SUPPORT FOR PEOPLE OF ALL AGES TO NAVIGATE LIFE'S CHALLENGES THROUGH PERSONALIZED INTERVENTION, TREATMENT AND RECOVERY. SERVICES INCLUDE TREATMENT, RECOVERY AND SUPPORT SERVICES FOR INDIVIDUALS WITH MENTAL ILLNESS AND SERVICE COORDINATION AND IN-HOME SERVICES FOR OLDER ADULTS. THE HOSPITAL'S DIRECTOR OF WOMEN'S AND CHILDREN'S SERVICES REPRESENTS THE ORGANIZATION ON THE BOARD OF DIRECTORS FOR WINGS (WOMEN IN NEED GROWING STRONGER). WINGS PROVIDES A PATHWAY TO INDEPENDENCE FOR ADULTS AND CHILDREN WHO ARE ESCAPING FROM DOMESTIC VIOLENCE AND ABUSE. THEIR GOAL IS TO PROVIDE THE TOOLS AND SUPPORT NECESSARY TO ENSURE THAT VICTIMS CAN ESCAPE THEIR ABUSERS AND BEGIN BUILDING NEW, VIOLENCE-FREE LIVES. PART II - LINE 8 - WORKFORCE DEVELOPMENT THE HOSPITAL HAS A PROGRAM TO ENCOURAGE HIGH SCHOOL STUDENTS TO EXPLORE CAREERS IN HEALTHCARE. THE PROGRAM NORMALLY PROVIDES LOCAL HIGH SCHOOL STUDENTS THE OPPORTUNITY TO SPEND 14 WEEKS IN THE HOSPITAL SHADOWING 14 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. DUE TO COVID RESTRICTIONS THE PROGRAM HAD TO BE CONDUCTED VIRTUALLY. HOSPITAL LEADERS FROM DIFFERENT DEPARTMENTS PROVIDED EDUCATION ABOUT THE DEPARTMENT THEY WORK IN AND ANSWERED QUESTIONS ABOUT PURSUING CAREERS. SCHEDULE H - PART III, BAD DEBT, MEDICARE & COLLECTION PRACTICES SECTION A, LINE 2 BAD DEBT EXPENSE WAS REPORTED AT COST USING A COST-TO-CHARGE METHODOLOGY. THE SCHEDULE H, WORKSHEET 2, RATIO OF PATIENT CARE COST-TO-CHARGES CALCULATED TO REPORT CHARITY CARE ON PART I, LINE 7A WAS MULTIPLIED BY THE COST-TO-CHARGE RATIO TO DETERMINE THE BAD DEBT EXPENSE AT COST. DISCOUNTS AND PAYMENTS ON PATIENT ACCOUNTS ARE EXCLUDED FROM BAD DEBT EXPENSE IN ORDER TO REFLECT THE EXPECTED AMOUNT TO BE PAID. SECTION A, LINE 4 PATIENT ACCOUNTS RECEIVABLE FINANCIAL STATEMENT FOOTNOTE - PATIENT SERVICE REVENUE AND PATIENT ACCOUNTS RECEIVABLE ARE REPORTED AT THE AMOUNT THAT REFLECTS THE CONSIDERATION TO WHICH THE CORPORATION EXPECTS TO BE ENTITLED IN EXCHANGE FOR PROVIDING CARE. PART III, SECTION B, LINE 8 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 THE HOSPITAL IN PROVIDING THESE SERVICES IS A BENEFIT TO THE MEMBERS OF THE COMMUNITY WE SERVE. PART III SECTION C. COLLECTION PRACTICES, LINE 9B IT IS THE POLICY OF THE HOSPITAL TO OFFER PATIENTS A PAYMENT PLAN OR FINANCIAL ASSISTANCE WHEN IT BECOMES KNOWN OR SUSPECTED THAT A PATIENT NEEDS SUCH ASSISTANCE. FINANCIAL COUNSELORS CONTACT AND WORK WITH THE PATIENT OR THEIR FAMILY TO HELP DETERMINE IF THERE ARE ANY THIRD PARTY 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, SPANISH, RUSSIAN, POLISH, GERMAN, JAPANESE AND TRANSLATION SERVICES ARE PROVIDED IN MANY LANGUAGES. IN ADDITION, ALL PATIENT BILLS AND STATEMENTS INCLUDE INFORMATION ABOUT HOW TO APPLY FOR FINANCIAL ASSISTANCE AND THE INFORMATION IS ALSO POSTED ON THE HOSPITAL'S WEBSITE (NCH.ORG). 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.) 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.
SCHEDULE H - PART VI, LINE 2 - NEEDS ASSESSMENT	THE FY 2021 COMMUNITY HEALTH NEEDS ASSESSMENT WAS CONDUCTED INDEPENDENTLY BY THE HOSPITAL INSTEAD OF BEING OUTSOURCED TO A VENDOR. THE HOSPITAL BELIEVED CONDUCTING ITS OWN ASSESSMENT WOULD YIELD MORE MEANINGFUL RESULTS AND A CLEARER SNAPSHOT OF THE COMMUNITY IT SERVES. THE ASSESSMENT WAS COMPRISED OF DATA COLLECTED FROM QUANTITATIVE, QUALITATIVE OR A COMBINATION OF BOTH RESOURCES. THE HOSPITAL CONTRACTED WITH SG2, AN INDUSTRY LEADER IN HEALTHCARE ANALYTICS AND CONSULTING, FOR QUANTITATIVE DATA. SG2 PROVIDED COMPREHENSIVE DEMOGRAPHIC INFORMATION OF THE HOSPITAL'S SERVICE AREA. THEY ALSO PROVIDED POPULATION GROWTH PROJECTIONS FOR THE COMMUNITY BY TOWN, AGE, GENDER, ETHNICITY/RACE, INCOME AND EDUCATION. IN ADDITION, THEY FORECASTED THE PROJECTED GROWTH OF CHRONIC DISEASE AREAS IN THE OUTPATIENT SETTING FOR THE HOSPITAL'S SERVICE AREA. CHANGES IN COMMUNITY DEMOGRAPHICS HAVE A DIRECT CORRELATION WITH HEALTHCARE NEEDS AND HOW TO ADDRESS THEM. ADDITIONAL QUANTITATIVE DATA WAS COLLECTED THROUGH SPARKMAP (SPARKMAP.ORG), WHICH IS A PRODUCT OF THE CENTER FOR APPLIED RESEARCH AND ENGAGEMENT SYSTEMS AND HOSTED BY THE UNIVERSITY OF MISSOURI. SPARKMAP USES LOCATION-SPECIFIC DATA TO CREATE MAPS AND COMMUNITY ASSESSMENTS THAT INFORM, GUIDE AND TRANSFORM THE WORK OF HEALTHCARE ORGANIZATIONS. THE GOAL OF SPARKMAP IS TO INCREASE THE IMPACT OF THOSE WORKING TOWARD HEALTHY, EQUITABLE AND SUSTAINABLE COMMUNITIES. THE WEB PORTAL ALLOWS ACCESS TO DATA IN MULTIPLE CATEGORIES WHICH CAN BE USED TO EXPLORE COMMUNITY HEALTH. CUSTOM TOOLS ALLOW THE USER TO FILTER DATA BY ZIP CODE AND CREATE A REPORT SPECIFICALLY FOR ITS COMMUNITY. IT ALSO ALLOWS THE USER TO CREATE A CUSTOM REPORT WHICH HIGHLIGHTS ITS COMMUNITIES GREATEST AREAS OF CONCERN. THE LAST SOURCE OF QUANTITATIVE DATA WAS FROM THE 2020 COUNTY HEALTH RANKINGS AND ROADMAPS REPORT (COUNTYHEALTHRANKINGS.ORG), A COLLABORATION BETWEEN THE ROBERT WOOD JOHNSON FOUNDATION AND THE UNIVERSITY OF WISCONSIN POPULATION HEALTH INSTITUTE. THE REPORT RANKED U.S. COUNTIES IN EVERY STATE ON VARIOUS HEALTH OUTCOMES, HEALTH FACTORS, SOCIAL AND ECONOMIC CONDITIONS, AND THE PHYSICAL ENVIRONMENT. THE MAJOR GOAL OF THE RANKINGS IS TO RAISE AWARENESS ABOUT THE MANY FACTORS THAT INFLUENCE HEALTH AND THAT HEALTH VARIES FROM PLACE TO PLACE. ALTHOUGH THE RANKINGS PROVIDE VALUABLE COUNTY-WIDE INFORMATION IT DOES NOT EXAMINE DATA AT THE SUB-COUNTY LEVEL. COOK COUNTY IS UNIQUE IN THAT IT IS THE SECOND-MOST POPULOUS COUNTY IN THE UNITED STATES AFTER LOS ANGELES COUNTY, CALIFORNIA. THERE ARE 130 INCORPORATED MUNICIPALITIES PARTIALLY OR WHOLLY WITHIN COOK COUNTY, THE LARGEST OF WHICH IS CHICAGO, WHICH IS HOME TO APPROXIMATELY 54% OF THE POPULATION OF THE COUNTY. THE COOK COUNTY DEPARTMENT OF PUBLIC HEALTH RECOGNIZES THE UNIQUENESS OF THE COUNTY AND IDENTIFIED INDICATORS FROM THE RANKINGS FOR WHICH LOCAL DATA EXISTED AND CREATED A REPORT SPECIFICALLY FOR SUBURBAN COOK COUNTY. TWO DIFFERENT SURVEYS WERE DEVELOPED TO COLLECT A COMBINATION OF BOTH QUANTITATIVE AND QUALITATIVE DATA. NCH DEVELOPED A COMPREHENSIVE ONLINE COMMUNITY HEALTH SURVEY IN ORDER TO TAKE INTO ACCOUNT INPUT FROM PERSONS WHO REPRESENT THE BROAD INTERESTS OF THE COMMUNITY SERVED BY THE HOSPITAL. THE SURVEY ASKED PARTICIPANTS TO SHARE THEIR BELIEFS AND PERCEPTIONS ABOUT ACCESS TO CARE, BEHAVIORAL HEALTH, CHRONIC DISEASE/HEALTH ISSUES, MODIFIABLE RISK FACTORS/BEHAVIORS AND OTHER CONCERNS. IT ALSO ASKED THE PARTICIPANTS TO RANK THEIR "TOP THREE HEALTH CONCERNS" FOR THE COMMUNITY. THE COMMUNITY WAS INVITED TO PARTICIPATE IN THE ONLINE SURVEY THROUGH A MEDIA RELEASE AND A PAID ADVERTISEMENT IN A LOCAL NEWSPAPER, THE HOSPITAL'S ELECTRONIC COMMUNITY NEWSLETTER "A HEALTHIER YOU", THE HOSPITAL'S ELECTRONIC VOLUNTEER AND EMPLOYEE NEWSLETTERS, SOCIAL MEDIA AND THROUGH AN EMAIL ANNOUNCEMENT BY THE HOSPITAL'S FOUNDATION TO ALL DONORS. THE SURVEY LINK, LOCATED ON THE HOME PAGE OF THE HOSPITAL'S WEBSITE (NCH.ORG), WAS OPEN FROM FEBRUARY 12 TO 22, 2021 AND 364 PEOPLE RESPONDED. THE MAJORITY OF THE RESPONDENTS WERE CAUCASIAN (99%), FEMALE (71%) AND OLDER ADULTS (15% AGE 55-64, 36% AGE 65-74, AND 32% AGE 75 OR OLDER). THE MAJORITY (73%) HAD ATTAINED A COLLEGE DEGREE (ASSOCIATES OR HIGHER) AND HAD EITHER MEDICARE (63%) OR PRIVATE INSURANCE (34%). THE MAJORITY (72%) LIVE IN THE HOSPITAL'S PRIMARY SERVICE AREA AND THE REMAINDER (28%) LIVE IN THE HOSPITAL'S SECONDARY SERVICE AREA. RESULTS FROM THE SURVEY WERE SUMMARIZED IN A QUANTITATIVE/QUALITATIVE REPORT. IN ADDITION, AN ONLINE SURVEY FOR KEY INFORMANTS WAS CONDUCTED SPECIFICALLY TO SOLICIT INPUT FROM KEY INFORMANTS AS DESCRIBED IN PART V, SECTION B, QUESTION 5. QUALITATIVE DATA WAS PRIMARY COLLECTED THROUGH FOCUS GROUPS. THE HOSPITAL REALIZED THE IMPORTANCE OF GATHERING OPINIONS AND FEEDBACK FROM VULNERABLE POPULATIONS IN THE COMMUNITY WHO HAVE SOME OF THE GREATEST HEALTHCARE NEEDS. AN INDEPENDENT MODERATOR WAS HIRED TO CONDUCT TWO FOCUS GROUPS IN FEBRUARY 2021: ONE WITH SPANISH- SPEAKING UNDER-RESOURCED COMMUNITY MEMBERS AND ONE WITH ENGLISH-SPEAKING UNDER-RESOURCED COMMUNITY MEMBERS. THESE FOCUS GROUPS WERE HELD AT THE COMMUNITY RESOURCE CENTER IN PALATINE, LOCATED IN THE HOSPITAL'S PRIMARY SERVICE AREA. POTENTIAL PARTICIPANTS WERE GIVEN A SHORT SCREENING QUESTIONNAIRE TO ENSURE THEY LIVED IN THE HOSPITAL'S SERVICE AREA AND SO THAT PARTICIPANTS WOULD VARY IN AGE, GENDER, INSURANCE STATUS, INCOME AND EDUCATIONAL LEVELS IF POSSIBLE. THE FOCUS GROUPS FOLLOWED A GUIDELINE WHICH MIRRORED QUESTIONS INCLUDED IN THE COMMUNITY AND KEY INFORMANT SURVEYS SO THAT THE INFORMATION GATHERED COULD BE USED TO COMPARE WITH THE SURVEY RESULTS. THE MODERATOR SUMMARIZED THE RESULTS OF THE FOCUS GROUPS WHICH WERE USED AS ONE OF THE TOOLS IN IDENTIFYING THE MOST PREDOMINANT COMMUNITY NEEDS. THE HOSPITAL ALSO CONDUCTED A FOCUS GROUP VIRTUALLY IN FEBRUARY 2021 WITH ITS PATIENT FAMILY ADVISORY COUNCIL, WHICH IS COMPRISED OF COMMUNITY MEMBERS WHO USE THE HOSPITAL AS THEIR MEDICAL HOME. THE SAME FORMAT AS THE FOCUS GROUPS DESCRIBED ABOVE WAS USED, AND PROVIDED AN OPPORTUNITY TO GATHER ADDITIONAL INFORMATION ON THE COMMUNITY'S BELIEFS AND PERCEPTIONS ABOUT THE HEALTH OF ITS COMMUNITY, WHICH SUPPLEMENTED THE DATA COLLECTED IN THE ONLINE COMMUNITY HEALTH SURVEY. IN MARCH 2021, THE HOSPITAL CONVENED AN INTERNAL, MULTIDISCIPLINARY COMMITTEE THAT MET MULTIPLE TIMES TO REVIEW THE RESULTS OF THE CHNA, AFFIRM AND PRIORITIZE NEEDS AND TO IDENTIFY THE MOST QUALIFIED INTERNAL AND EXTERNAL PERSONS TO DEVELOP IMPLEMENTATION PLANS TO ADDRESS EACH PRIORITY NEED. REPRESENTATIVES FROM THE FOLLOWING HOSPITAL DEPARTMENTS SERVED ON THE COMMITTEE: BEHAVIORAL HEALTH, CARE COORDINATION, COMMUNITY BASED CARE, COMMUNITY SERVICES, COMPLIANCE, DIABETES SERVICES, EMERGENCY DEPARTMENT, EMS, FOUNDATION, GUEST SERVICES, IMMEDIATE CARE CENTERS, MEDICAL GROUP, NURSING EXCELLENCE, PATIENT ACCESS SERVICES, PATIENT EXPERIENCE, AND RESEARCH. IN ADDITION, THE CHAIR OF THE COMMUNITY HEALTH AND OUTREACH COMMITTEE OF THE HOSPITAL'S BOARD OF DIRECTORS PARTICIPATED IN THE COMMITTEE. THE COMMITTEE MEMBERS WERE PROVIDED WITH AN OVERVIEW OF THE COMMUNITY HEALTH NEEDS ASSESSMENT PROCESS AND RECEIVED A SUMMARY AND COMPARISON DOCUMENT WHICH WAS USED AS A TOOL TO REVIEW ALL OF THE QUANTITATIVE AND QUALITATIVE FINDINGS. THE FINDINGS FROM THE FOCUS GROUPS, COMMUNITY SURVEY AND KEY INFORMANT SURVEY WERE COMPARED AND THE SECONDARY DATA PROVIDED SUPPLEMENTAL INFORMATION. THE MOST COMMON THEMES AND COMMENTS FROM THE NARRATIVE PORTION OF THE SURVEYS WERE ALSO HIGHLIGHTED IN THE DOCUMENT. IN ADDITION, THE COMMITTEE WAS GIVEN WEB ACCESS TO THE COMPLETE SURVEY RESULTS, FOCUS GROUPS SUMMARIES AND ALL SECONDARY DATA. THE COMMITTEE WAS GIVEN TIME TO REVIEW THE SUMMARY AND COMPARISON DOCUMENT AND TO ACCESS THE ADDITIONAL RESOURCES AND THEN RECONVENED TO RANK OR PRIORITIZE THE ISSUES. THE COMMITTEE USED MAGNITUDE, IMPACT/SERIOUSNESS, FEASIBILITY AND CONSEQUENCES OF INACTION AS THE CRITERIA TO IDENTIFY WHICH HEALTH NEEDS WOULD BE ADDRESSED OVER THE NEXT THREE YEARS. TAKING INTO ACCOUNT HOSPITAL RESOURCES AND OVERALL ALIGNMENT WITH THE HOSPITAL'S MISSION, GOALS AND STRATEGIC PRIORITIES - IT WAS DETERMINED THAT NCH WOULD FOCUS THE MAJORITY OF ITS EFFORTS ON DEVELOPING AND/OR SUPPORTING STRATEGIES AND INITIATIVES TO IMPROVE THE FOLLOWING PRIORITY AREAS: BEHAVIORAL HEALTH (MENTAL HEALTH AND SUBSTANCE ABUSE), OBESITY, ACCESS TO CARE FOR THE UNDER-RESOURCED, CANCER (INCLUDING TOBACCO) AND CHRONIC DISEASE (DIABETES, HEART DISEASE, STROKE, AND HIGH BLOOD PRESSURE). INTERNAL COMMITTEES WERE FORMED TO DEVELOP IMPLEMENTATION PLANS FOR EACH OF THE PRIORITY AREA AS DESCRIBED IN PART V, SECTION C, QUESTION 11. THE COMMUNITY HEALTH NEEDS ASSESSMENT AND IMPLEMENTATION PLAN WAS REVIEWED AND APPROVED BY THE COMMUNITY HEALTH AND OUTREACH COMMITTEE OF THE BOARD ON JUNE 15, 2021 AND PRESENTED TO THE ENTIRE BOARD OF DIRECTORS ON JUNE 28, 2021. THE COMMUNITY HEALTH NEEDS ASSESSMENT AND IMPLEMENTATION PLAN WAS POSTED ON THE HOSPITAL'S WEBSITE, (NCH.ORG) ON
SCHEDULE H - PART VI, LINE 3 - PATIENT EDUCATION OF ELIG. FOR ASSISTANCE	THE FINANCIAL ASSISTANCE PROGRAM AT THE HOSPITAL IS COMMUNICATED WIDELY TO PATIENTS AND VISITORS IN ENGLISH AND SPANISH USING THE FOLLOWING METHODS: 1. SIGNAGE IN ENGLISH AND SPANISH IS POSTED THROUGHOUT THE ORGANIZATION AT ALL ACCESS POINTS, INCLUDING THE EMERGENCY DEPARTMENT AND OUTPATIENT REGISTRATION AREAS. THESE AREAS ALSO STOCK AND MAKE AVAILABLE A BROCHURE, PRINTED IN ENGLISH AND SPANISH, DESCRIBING THE HOSPITAL'S POLICY. THE HOSPITAL PROVIDES A COMPREHENSIVE LANGUAGE ASSISTANCE PROGRAM WHICH INCLUDES VIDEO REMOTE AND IN-PERSON TRANSLATORS WHO CAN ASSIST THOSE WHO NEED ADDITIONAL INFORMATION ON FINANCIAL ASSISTANCE. 2. IN FY 2021 THE INFORMATION BELOW WAS POSTED ON THE HOSPITAL WEBSITE. "FINANCIAL ASSISTANCEOTHER RELATED TERMS CAN ALSO BE SEARCHED FOR FROM ANY PAGE OF THE HOSPITAL WEBSITE TAKING USERS TO THE INFORMATION INCLUDING APPLICATIONS FOR FINANCIAL ASSISTANCE (AVAILABLE IN ENGLISH, SPANISH, GERMAN, POLISH, JAPANESE, AND RUSSIAN), FINANCIAL ASSISTANCE POLICIES, AND WAYS TO REACH THE NCH FINANCIAL COUNSELOR BY EMAIL, PHONE OR IN PERSON. PATIENT FINANCIAL ASSISTANCE PAGE: TO APPLY FOR PATIENT FINANCIAL ASSISTANCE AT NCH, PLEASE PRINT THE FINANCIAL ASSISTANCE APPLICATION (TAMBIEN DISPONIBLE EN ESPAOL) AND COMPLETE ALL NECESSARY FIELDS. PLEASE BE SURE TO PROVIDE ALL REQUESTED DOCUMENTATION TO BE CONSIDERED FOR FINANCIAL ASSISTANCE. NORTHWEST COMMUNITY HOSPITAL IS A CHARITABLE ORGANIZATION AND PROVIDES FINANCIAL ASSISTANCE TO THOSE WHO ARE ELIGIBLE. THE DAY SURGERY CENTER IS A FOR-PROFIT ORGANIZATION AND ALSO PROVIDES FINANCIAL ASSISTANCE TO THOSE WHO ARE ELIGIBLE. MAIN FEES AND BILL PAYMENT PAGE: FOR FAMILIES WITHOUT INSURANCE WHO NEED HELP WITH MEDICAL BILLS, WE ACCEPT ILLINOIS PUBLIC AID. IN ADDITION, YOU MAY QUALIFY FOR FINANCIAL ASSISTANCE FOR MEDICAL BILLS THROUGH NORTHWEST COMMUNITY HOSPITAL. NORTHWEST COMMUNITY HOSPITAL IS A CHARITABLE ORGANIZATION AND PROVIDES FINANCIAL ASSISTANCE TO THOSE WHO ARE ELIGIBLE. THE DAY SURGERY CENTER IS A FOR-PROFIT ORGANIZATION AND ALSO PROVIDES FINANCIAL ASSISTANCE TO THOSE WHO ARE ELIGIBLE. 3. EACH PATIENT INVOICE OR OTHER SUMMARY OF CHARGES TO A PATIENT SHALL INCLUDE WITH IT OR ON IT A STATEMENT REGARDING HOW A PATIENT MAY APPLY FOR CONSIDERATION UNDER THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY. THE PATIENT IS PROVIDED A CONTACT NUMBER FOR FINANCIAL ASSISTANCE AND OUR WEBPAGE TO DOWNLOAD AN APPLICATION. 4. 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.
SCHEDULE H - PART VI, LINE 4 - COMMUNITY INFORMATION	NORTHWEST COMMUNITY HOSPITAL IS LOCATED IN ARLINGTON HEIGHTS, ILLINOIS, A SUBURB LOCATED APPROXIMATELY 25 MILES NORTHWEST OF CHICAGO. IT'S PRIMARY SERVICE AREA CONSISTS OF ARLINGTON HEIGHTS AND THE SURROUNDING SUBURBS OF MT. PROSPECT, PALATINE, AND ROLLING MEADOWS. THE HOSPITAL'S SECONDARY SERVICE AREA IS COMPRISED OF BARRINGTON, BUFFALO GROVE, DEERFIELD, DES PLAINES, ELK GROVE VILLAGE, HANOVER PARK, HOFFMAN ESTATES, ISLAND LAKE, LAKE ZURICH/KILDEER, MUNDELEIN, NORTHBROOK, PROSPECT HEIGHTS, ROSELLE, ROUND LAKE, SCHAUMBURG, STREAMWOOD, VERNON HILLS, WAUCONDA AND WHEELING. THE POPULATION OF THE HOSPITAL'S TOTAL SERVICE AREA IS APPROXIMATELY 977,610 AND IS PROJECTED TO REMAIN RELATIVELY STABLE WITH A SLIGHT DECLINE IN THE PRIMARY SERVICE AREA (-.06%) AND NO PROJECTED GROWTH IN THE SECONDARY SERVICE AREA. THE HIGHEST UTILIZERS OF HEALTH CARE SERVICES ARE PATIENTS AGED 65 TO 84, AND THIS AGE GROUP IS EXPECTED TO GROW 14.8% IN THE HOSPITAL'S PRIMARY SERVICE AREA AND 18.2% IN THE HOSPITAL'S SECONDARY AREA. THE HOSPITAL'S TOTAL SERVICE AREA IS PREDOMINATELY NON-HISPANIC WHITE (61%), FOLLOWED BY HISPANIC (19%) AND ASIAN (15%). THE NUMBER OF BLACK AND WHITE NON-HISPANIC POPULATION IS PROJECTED TO DECREASE 1.4% AND 5.3% RESPECTIVELY. THE POPULATIONS THAT ARE PROJECTED TO HAVE THE LARGEST GROWTH ARE THE ASIAN/PACIFIC ISLANDERS (10.7%) AND HISPANIC (6.8%) POPULATIONS. HOUSEHOLDS IN THE UPPER INCOME BRACKETS, $200K AND HIGHER, ARE PROJECTED TO INCREASE BY 24.5% WHILE INCOME BRACKETS LESS THAN $100K ARE PROJECTED TO DECREASE BY 5 15.3%. THE MAJORITY, 68.9% OF PERSONS LIVING IN THE HOSPITAL'S SERVICE AREA, HAVE SOME COLLEGE EDUCATION AND THIS IS NOT PROJECTED TO CHANGE SIGNIFICANTLY OVER THE NEXT FIVE YEARS. ALTHOUGH THE HOSPITAL'S SERVICE AREA IS DOMINATED BY COMMERCIAL INSURANCE, THERE ARE STILL A SUBSTANTIAL NUMBER OF INDIVIDUALS ON MEDICAID (24,068) OR UNINSURED (14,420). THE HOSPITAL'S SERVICE AREA PROJECTIONS PREDICT NOTABLE GROWTH IN THE FOLLOWING CHRONIC DISEASES: DIABETES, HYPERTENSION, OSTEOARTHRITIS AND PERSISTENT MOOD DISORDERS BY PERSONS 65 AND OLDER. ALTHOUGH THE HOSPITAL'S SERVICE AREA EXCEEDS STATE AND NATIONAL AVERAGES FOR ANNUAL AVERAGE INCOME, THERE ARE STILL MANY SIGNIFICANT POCKETS OF VULNERABLE POPULATIONS BASED ON INCOME AND ATTAINMENT OF A HIGH SCHOOL DEGREE. IN ADDITION, THE ENTIRE PRIMARY SERVICE AREA AND A SIGNIFICANT PORTION OF THE SECONDARY SERVICE AREA HAVE BEEN DESIGNATED AS A MEDICALLY-UNDERSERVED POPULATION. THE HOSPITAL WORKS CLOSELY WITH TWO FEDERALLY QUALIFIED HEALTH CENTERS AND A COUNTY RUN PRIMARY CARE CLINIC, ALL LOCATED IN THE HOSPITAL'S SERVICE AREA. THERE ARE NO OTHER HOSPITALS IN THE PRIMARY SERVICE AREA AND THREE IN THE SECONDARY SERVICE AREA OF THE HOSPITAL.
SCHEDULE H - PART VI, LINE 5 - PROMOTION OF COMMUNITY HEALTH	THE HOSPITAL FURTHERS ITS EXEMPT PURPOSE BY PROMOTING THE HEALTH OF ITS COMMUNITY IN MANY WAYS AS FOLLOWS: (1) A MAJORITY OF THE HOSPITAL'S BOARD OF DIRECTORS IS COMPRISED OF PERSONS WHO LIVE OR WORK IN THE HOSPITAL'S PRIMARY SERVICE AREA AND ARE NOT EMPLOYEES OR CONTRACTORS OF THE HOSPITAL, NOR FAMILY MEMBERS. (2) THE 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, COMPRISED OF BOARD MEMBERS, SENIOR EXECUTIVES, PHYSICIANS, COMMUNITY MEMBERS AND STAFF, 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, AND OTHER COMMUNITY HEALTH IMPROVEMENT INITIATIVES. (4) NORTHSHORE UNIVERSITY HEALTH SYSTEM, THE SOLE OWNER OF NORTHWEST COMMUNITY HOSPITAL (NCH), MAINTAINED AN AVERAGE OF 373 DAYS CASH OR CASH EQUIVALENT ON HAND IN THE HEALTH SYSTEM, FOR FUNDING NCH'S CAPITAL IMPROVEMENTS IN TECHNOLOGY, FACILITIES OR PATIENT CARE EQUIPMENT, AND SUPPORTING HOSPITAL OPERATIONS OR COMMUNITY OUTREACH INITIATIVES. (5) THE HOSPITAL HAS DEDICATED STAFF THAT SERVE AS MEMBERS, CHAIRPERSONS, OFFICERS, AND BOARD MEMBERS OF LOCAL AND NATIONAL ORGANIZATIONS DEVOTED TO IMPROVING THE HEALTH AND WELLBEING OF COMMUNITY MEMBERS. THESE ORGANIZATIONS INCLUDE: THE CHICAGO DENTAL SOCIETY, HARPER COLLEGE EDUCATIONAL FOUNDATION, KENNETH YOUNG CENTER BOARD OF DIRECTORS, PARTNERS FOR OUR COMMUNITIES BOARD OF DIRECTORS, ST. MARY'S SERVICES HOPEFUL BEGINNINGS BOARD OF DIRECTORS, UNITED PALATINE AND ARLINGTON HEIGHTS ROTARY CLUB. (6) COLLABORATIVE PARTNERSHIPS ARE THE FOUNDATION TO MANY OF THE HOSPITAL'S COMMUNITY HEALTH INITIATIVES AIMED TO IMPROVE THE HEALTH AND WELL-BEING OF THE COMMUNITY. THESE PARTNERSHIPS INCLUDE A COLLABORATION WITH GREATER FAMILY HEALTH AND COOK COUNTY HEALTH AND HOSPITAL SYSTEM TO BRING PRIMARY CARE SERVICES FOR THE UNINSURED AND UNDERINSURED TO THE COMMUNITY. THE HOSPITAL ALSO PARTNERS WITH ELK GROVE, PALATINE, SCHAUMBURG, AND WHEELING TOWNSHIPS ON A MOBILE DENTAL CLINIC PROGRAM WHICH PROVIDES ORAL HEALTH CARE SERVICES TO COMMUNITY MEMBERS WHO LACK ACCESS DUE TO FINANCIAL CHALLENGES. NORTHWEST COMMUNITY HEALTHCARE, AN AFFILIATE OF THE HOSPITAL, ALSO PARTNERS WITH PARTNERS FOR OUR COMMUNITIES (POC), A LOCAL 501(C) (3) ORGANIZATION, TO OPERATE AND RUN THE COMMUNITY RESOURCE CENTER WHICH PROVIDES DIRECT SERVICES, REFERRALS, AND OTHER ASSISTANCE TO THE UNDER-RESOURCED. THE HOSPITAL OWNS AND MAINTAINS THE BUILDING AND PROVIDES FREE OR LOW-COST RENT TO LOCAL NOT FOR PROFIT AGENCIES, INCLUDING: ALL SAINTS LUTHERAN CHURCH, ASIAN HUMAN SERVICES, THE CENTER-RESOURCES FOR TEACHING AND LEARNING (ECDEC PROGRAM), COMMUNITY CONSOLIDATED SCHOOL DISTRICT 15, HARPER COLLEGE, HIAS CHICAGO, PALATINE TOWNSHIP SENIOR CITIZENS COUNCIL, PALATINE POLICE DEPARTMENT, PALATINE PARK DISTRICT, PALATINE PUBLIC LIBRARY, PATH (PALATINE ASSISTING THROUGH HOPE), AND WINGS (WOMEN IN NEED GROWING STRONGER). SOME OF THE MANY PROGRAMS AND SERVICES 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, RECREATION AND A FOOD AND CLOTHING PANTRY. IN ADDITION TO THE COMMUNITY RESOURCE CENTER, THE HOSPITAL WORKS WITH POC ON MANY COLLABORATIVE HEALTH INITIATIVES INCLUDING THE COMMUNITY HEALTH WORKER (CHW) PROGRAM WHICH PROVIDES HEALTH EDUCATION AND SUPPORT FOR THE LATINO POPULATION. THIS PROGRAM IDENTIFIES LATINA WOMEN WHO DEMONSTRATE THE POTENTIAL TO BECOME LEADERS IN THE COMMUNITY WHO THEN RECEIVE LEADERSHIP TRAINING AND EDUCATION ON SPECIFIC HEALTH TOPICS. THE CHW MEETS PATIENT'S BEDSIDE AND THEN PROVIDES POST DISCHARGE SUPPORT TO HELP THEM UNDERSTAND AND COMPLY WITH DISCHARGE INSTRUCTIONS WHICH CAN OFTEN BE DIFFICULT DUE TO ECONOMIC AND LANGUAGE BARRIERS. THE HOSPITAL AND SCHAUMBURG TOWNSHIP ALSO COLLABORATIVELY PROVIDE THE SERVICES OF TWO COMMUNITY HEALTH NURSES; ONE OF WHICH IS BILINGUAL IN SPANISH. THESE OUTREACH PROFESSIONALS FOCUS ON HELPING VULNERABLE POPULATIONS (UNDER-RESOURCED AND SENIORS) NAVIGATE HEALTHCARE RESOURCES, PROVIDE HEALTH EDUCATION AND CHRONIC DISEASE MANAGEMENT, AND HELP PATIENTS OBTAIN LOW-COST PRESCRIPTIONS. THE HOSPITAL ALSO DEDICATES RESOURCES TO ENHANCE ITS HEALTH AND WELLNESS OFFERINGS FOR OLDER ADULTS IN THE COMMUNITY. A FULL-TIME SENIOR SERVICES SPECIALIST COORDINATES AND PROMOTES HEALTH AND WELLNESS PROGRAMS HELD ON THE HOSPITALS CAMPUS, THE ARLINGTON HEIGHTS SENIOR CENTER AND OTHER LOCATIONS IN THE HOSPITAL'S SERVICE AREA. THE SENIOR SERVICES SPECIALIST SITS ON THE BOARD OF THE PALATINE TOWNSHIP SENIOR CITIZENS COUNCIL AND PARTICIPATES IN VARIOUS COMMITTEES, ALL WHICH ASSIST IN CONTRIBUTING TO THE IMPROVEMENT OF SERVICES AND RELATIONSHIPS WITH SENIORS. THE SENIOR SERVICES SPECIALIST IS ALSO A TRAINED SENIOR HEALTH INSURANCE PROGRAM COUNSELOR (SHIP), AND PROVIDES FREE MEDICARE EDUCATION TO SENIORS. THROUGHOUT THE YEAR THE HOSPITAL OFFERED FREE SHIP MEDICARE COUNSELING TO SENIORS IN THE SURROUNDING COMMUNITIES THROUGH ONE ON ONE COUNSELING EITHER IN-PERSON, VIA EMAIL, OR OVER THE PHONE, BASED ON THE INDIVIDUALS COMFORT LEVEL AND AVAILABILITY TO BE DONE SAFELY. THOSE BECOMING NEWLY ELIGIBLE TO MEDICARE WERE PROVIDED INFORMATION AND TOOLS TO ASSIST THEM IN UNDERSTANDING MEDICARE, AND CURRENT MEDICARE BENEFICIARIES WHERE SHOWN THE OPTIONS THEY HAVE EACH YEAR WHILE KEEPING THEIR INDIVIDUAL NEEDS IN MIND. SHIP COUNSELING WAS OFFERED ON THE HOSPITALS CAMPUS AND AT THE ARLINGTON HEIGHTS SENIOR CENTER AND THE LUTHER VILLAGE SENIOR RESIDENTIAL COMMUNITY. (7) THE HOSPITAL OPERATES AN EMERGENCY DEPARTMENT THAT IS OPEN 24 HOURS A DAY, SEVEN DAYS A WEEK AND SERVES ALL PERSONS REGARDLESS OF THEIR ABILITY TO PAY. (8) THE HOSPITAL PARTICIPATES IN BOTH THE MEDICARE AND MEDICAID GOVERNMENT SPONSORED HEALTHCARE PROGRAMS. THE HOSPITAL CONTRACTS WITH GREAT LAKES 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. (9) THE 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 THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY IS WIDELY DISTRIBUTED AND COMMUNICATED TO THE COMMUNITY. (10) THE HOSPITAL, PART OF NORTHSHORE UNIVERSITY HEALTHSYSTEM, HAS A 509-BED HOSPITAL ON THE ARLINGTON HEIGHTS CAMPUS WITH A LEVEL II TRAUMA CENTER, LEVEL III NEONATAL INTENSIVE CARE UNIT AND DEDICATED PEDIATRIC EMERGENCY DEPARTMENT. THROUGHOUT THE NORTHWEST SUBURBS, THE HOSPITAL HAS 23 DOCTOR'S OFFICES; FIVE IMMEDIATE CARE CENTERS; SEVEN PHYSICAL REHABILITATION SITES; AND 13 LAB LOCATIONS. HEADQUARTERED IN EVANSTON, NORTHSHORE IS A FULLY INTEGRATED HEALTHCARE DELIVERY SYSTEM THAT INCLUDES 6 HOSPITALS-EVANSTON, GLENBROOK, HIGHLAND PARK, SKOKIE, SWEDISH AND NOW NORTHWEST COMMUNITY HOSPITAL. TOGETHER, THE NORTHSHORE SYSTEM PROVIDES CLINICAL EXCELLENCE AND COMMUNITY-FOCUSED CARE ACROSS CHICAGOLAND. NORTHSHORE CONSISTENTLY RANKS AS A TOP 15 MAJOR TEACHING HOSPITAL IN THE UNITED STATES, WITH AN ESTABLISHED REPUTATION FOR EXCEPTIONAL PATIENT CARE AND IS A NATIONAL PIONEER IN THE IMPLEMENTATION OF ADVANCED HEALTH INFORMATION TECHNOLOGY. THE HOSPITAL IS RECOGNIZED FOR THE FOLLOWING DISTINCTIONS AND ACCREDITATIONS: HEALTHGRADES TOP HONORS: AMERICA'S 100 BEST HOSPITALS AWARD; TOP 5% IN THE NATION FOR OVERALL CLINICAL EXCELLENCE; BEST SPECIALTY IN 2021; AMERICA'S 100 BEST HOSPITALS FOR CARDIAC CARE; AMERICA'S 100 BEST HOSPITALS FOR CORONARY INTERVENTION; AMERICA'S 100 BEST HOSPITALS FOR CRITICAL CARE; AMERICA'S 100 BEST HOSPITALS FOR GASTROINTESTINAL CARE; AMERICA'S 100 BEST HOSPITALS FOR GENERAL SURGERY; AMERICA'S 100 BEST HOSPITALS FOR PULMONARY CARE ; AMERICA'S 100 BEST HOSPITALS FOR STROKE CARE; TOP 5% IN THE NATION IN 2019 FOR CARDIOLOGY SERVICES; CRITICAL CARE; GI MEDICAL TREATMENT; NEUROSCIENCES; PULMONARY SERVICES; TREATMENT OF STROKE. U.S. NEWS & WORLD REPORT 2021 HIGH-PERFORMING HOSPITAL RECOGNITION IN: COLON CANCER SURGERY; COPD; HEART FAILURE; HIP REPLACEMENT; OTHER RECOGNITION: MAGNET RECOGNITION FOR NURSING EXCELLENCE (4 TIMES -- CONSECUTIVELY SINCE 2006); COMMISSION ON CANCER OUTSTANDING ACHIEVEMENT AWARD, NAPBC ACCREDITED B
SCHEDULE H - PART VI, LINE 6 - AFFILIATED HEALTH CARE SYSTEM	NORTHSHORE UNIVERSITY HEALTHSYSTEM ACQUIRED NORTHWEST COMMUNITY HEALTHCARE AND SUBSIDIARIES ON 1/1/2021. NORTHSHORE UNIVERSITY HEALTHSYSTEM (NORTHSHORE) IS A COMPREHENSIVE, FULLY INTEGRATED, HEALTHCARE DELIVERY SYSTEM THAT INCLUDES FOUR HOSPITALS, AS WELL AS NUMEROUS OUTPATIENT DEPARTMENTS AND CLINICS. IN ADDITION TO THE HOSPITAL ORGANIZATION, THERE ARE THE FOLLOWING AFFILIATES THAT HELP TO MEET THE NEEDS OF THE COMMUNITY: NORTHSHORE UNIVERSITY HEALTHSYSTEM FOUNDATION - THE NORTHSHORE UNIVERSITY HEALTHSYSTEM FOUNDATION (FOUNDATION) SEEKS TO OBTAIN THE PHILANTHROPIC SUPPORT REQUIRED TO ENSURE THAT NORTHSHORE CAN PROVIDE MEDICAL CARE, ADVANCED RESEARCH, AND STATE-OF-THE-ART FACILITIES AND EQUIPMENT. THE FOUNDATION BUILDS RELATIONSHIPS WITH INDIVIDUALS AND THE COMMUNITY TO INCREASE AWARENESS OF NORTHSHORE'S HIGH-QUALITY SERVICES AND GIVING OPPORTUNITIES. NORTHSHORE UNIVERSITY HEALTHSYSTEM RESEARCH INSTITUTE - THE NORTHSHORE UNIVERSITY HEALTHSYSTEM RESEARCH INSTITUTE (RESEARCH INSTITUTE) WAS ORGANIZED IN 1996 TO PROVIDE A MEANS FOR INTEGRATING LEADING-EDGE RESEARCH INTO IMPROVED CLINICAL CARE. THE RESEARCH INSTITUTE ALSO CREATES AN ENVIRONMENT TO RECRUIT AND RETAIN EXTERNALLY-FUNDED RESEARCH LEADERSHIP IN ORDER TO ACHIEVE THE MISSION AND GOALS OF THE ORGANIZATION THE RESEARCH INSTITUTE NOW HOUSES MORE THAN 210 PRINCIPAL INVESTIGATORS WHO CURRENTLY OCCUPY 95,000 NET SQUARE FEET OF RESEARCH SPACE AND WORK ON 1,200 ACTIVE RESEARCH PROTOCOLS. THE RESEARCH INSTITUTE BUILDS ON NORTHSHORE'S PROMISE TO DELIVER EXCELLENCE IN ALL ASPECTS OF PATIENT CARE. EFFORTS ARE DIRECTED TO RESEARCH INITIATIVES THAT MAKE A DIFFERENCE ACROSS MULTIPLE DISCIPLINES. FROM ONCOLOGY AND NEUROLOGY TO ORTHOPAEDICS AND CARDIOVASCULAR CARE, THE RESEARCH INSTITUTE FOCUSES ON AREAS OF INQUIRY THAT HAVE THE POTENTIAL TO MAKE THE GREATEST IMPACT ON IMPROVING AND SAVING LIVES. NORTHSHORE OFFERS SOME 1,000 ACTIVE CLINICAL TRIALS OF VARIOUS TYPES, FROM INNOVATIVE SURGICAL PROCEDURES TO THE LATEST DRUG THERAPIES. NORTHSHORE'S CLINICAL RESEARCH PORTFOLIO FOCUSES ON A RANGE OF CONDITIONS, INCLUDING CANCER, NEUROLOGIC DISORDERS AND STROKE, CARDIOVASCULAR DISORDERS, AND A WIDE RANGE OF PEDIATRIC AND GYNECOLOGIC CONDITIONS. ADDITIONALLY, MAJOR CLINICAL TRIAL PROGRAMS IN ADVANCED IMAGING AND MEDICAL GENETICS ARE ALSO OFFERED. THE RESEARCH INSTITUTE IS ALSO A MEMBER OF THE ILLINOIS PRECISION MEDICINE CONSORTIUM (IPMC), WHICH IS PART OF A NATIONAL LANDMARK LONGITUDINAL ALL OF US RESEARCH PROGRAM (AOURP) COHORT PROGRAM TO IMPROVE THE ABILITY TO PREVENT AND TREAT DISEASE BASED ON INDIVIDUAL LIFESTYLE, ENVIRONMENT, AND GENETICS. NORTHSHORE WILL ENROLL OVER 9,000 NORTHSHORE PATIENTS IN THE STUDY, AND PARTICIPANTS IN NORTHSHORE'S AOURP WILL BE ASKED TO SHARE A WIDE-RANGE OF HEALTH, ENVIRONMENTAL, AND LIFESTYLE INFORMATION. THE NORTHSHORE PROGRAM FOR PERSONALIZED CANCER CARE (PPCC) IS PIONEERING NEW STRATEGIES IN CANCER CARE. THE PPCC UNIQUELY FOCUSES ON THE GENETIC PATTERN OF AN INDIVIDUAL'S HEREDITARY DNA TO DERIVE A PERSONALIZED CANCER RISK ASSESSMENT PROFILE. BASED ON THE INHERITED RISK OF DEVELOPING A GIVEN CANCER, THE PPCC IS BEGINNING TO IMPLEMENT PERSONALIZED CANCER CARE STRATEGIES THAT ENCOMPASS THE ENTIRE SPECTRUM OF DISEASE. THE PPCC BELIEVES THIS APPROACH WILL LEAD TO MORE EFFICIENT USE OF HEALTH CARE RESOURCES BY TARGETING PREVENTION AND SCREENINGS TOWARD INDIVIDUALS AT GREATER RISK OF DEVELOPING CANCER, EARLIER CANCER DETECTION, AND, ULTIMATELY AND MOST IMPORTANTLY, REDUCED CANCER DEATHS AND SUFFERING. NORTHSHORE UNIVERSITY HEALTHSYSTEM HOME AND HOSPICE SERVICES - NORTHSHORE UNIVERSITY HEALTHSYSTEM HOME AND HOSPICE SERVICES (HOME AND HOSPICE) OFFERS THE FULL SPECTRUM OF HOME AND HOSPICE CARE, INCLUDING SKILLED NURSING, PHYSICAL AND OCCUPATIONAL THERAPY, AND HOME MEDICAL EQUIPMENT. THE HOME AND HOSPICE CAREGIVERS REPRESENT A WIDE RANGE OF MEDICAL SPECIALTIES AND WORK WITH THE PATIENT, FAMILY, AND PHYSICIAN TO TAILOR HOME CARE TO MEET THE INDIVIDUAL NEEDS OF EACH PATIENT. NORTHSHORE UNIVERSITY HEALTHSYSTEM FACULTY PRACTICE ASSOCIATES (FPA) REPRESENTS ABOUT 900 PHYSICIANS WITH OVER 140 OFFICES IN VIRTUALLY EVERY SPECIALTY ALL ON STAFF AT NORTHSHORE HOSPITALS. THE PRIMARY FUNCTION AND ACTIVITY OF FPA IS TO EMPLOY, SUPERVISE, AND CONDUCT EMPLOYMENT-RELATED ACTIVITIES WITH RESPECT TO PHYSICIANS WHO PROVIDE PROFESSIONAL HEALTH CARE SERVICES DIRECTLY FOR NORTHSHORE PATIENTS. FPA PHYSICIANS ALSO CONDUCT MEDICAL EDUCATION AND RESEARCH ACTIVITIES ON BEHALF OF NORTHSHORE. RADIATION MEDICINE INSTITUTE -RADIATION MEDICINE INSTITUTE (RMI) EMPLOYS, SUPERVISES, AND CONDUCTS EMPLOYMENT-RELATED ACTIVITIES WITH RESPECT TO PHYSICIANS WHO PROVIDE PROFESSIONAL HEALTH CARE SERVICES DIRECTLY FOR NORTHSHORE PATIENTS. RMI PHYSICIANS ALSO CONDUCT MEDICAL EDUCATION AND RESEARCH ACTIVITIES ON BEHALF OF NORTHSHORE. NORTHWEST COMMUNITY HEALTHCARE AND SUBSIDIARIES (HEALTHCARE), A NOT-FOR PROFIT ENTITY, WAS ESTABLISHED TO OWN, OPERATE, CONTROL, AND OTHERWISE COORDINATE THE DELIVERY OF HEALTHCARE WITHIN THE SERVICE AREA OF NORTHWEST COMMUNITY HOSPITAL (THE HOSPITAL), AND COORDINATE THE ACTIVITIES OF THE VARIOUS CORPORATIONS AFFILIATED WITH HEALTHCARE. THE HOSPITAL, LOCATED IN ARLINGTON HEIGHTS, ILLINOIS, IS A 496-BED ACUTE CARE FACILITY PROVIDING INPATIENT, OUTPATIENT, AND EMERGENCY CARE SERVICES PRIMARILY TO RESIDENTS OF ARLINGTON HEIGHTS AND THE SURROUNDING COMMUNITIES. SUBSIDIARIES OF HEALTHCARE INCLUDE THE HOSPITAL, NORTHWEST COMMUNITY HOSPITAL FOUNDATION (THE FOUNDATION), CENTRAL INSURANCE COMPANY, LTD. (CICL), AND NORTHWEST COMMUNITY HEALTHCARE PHO, LLC (PHO). HEALTHCARE'S OTHER SUBSIDIARIES INCLUDE NORTHWEST COMMUNITY HEALTH SERVICES, INC. (HEALTH SERVICES), NPC-CYBERKNIFE, LLC (CYBERKNIFE), NORTHWEST COMMUNITY DAY SURGERY CENTER II, LLC (DSC-II), NORTHWEST ENDO CENTER LLC (ENDO), NORTHWEST COMMUNITY FOOT AND ANKLE CENTER, LLC (FOOT), AND ENVISION MEDICAL IMAGING, LLC (ENVISION). CICL IS A CAPTIVE INSURANCE COMPANY ESTABLISHED JANUARY 1, 2013, TO PROVIDE GENERAL AND PROFESSIONAL LIABILITY COVERAGE AND WORKERS' COMPENSATION COVERAGE FOR THE RISKS OF HEALTHCARE. CICL IS A FOREIGN CORPORATION ORGANIZED IN THE CAYMAN ISLANDS THAT DOES NOT TAX ITS ACTIVITIES. HEALTH SERVICES OWNS AND OPERATES PHYSICIAN PRACTICES WITHIN THE HOSPITAL'S GEOGRAPHIC AREA. THE NCH MEDICAL GROUP (NCHMG) MULTI-SPECIALTY PHYSICIAN PRACTICE (THAT WAS ESTABLISHED IN 2010) HAS OFFICES IN ARLINGTON HEIGHTS, BUFFALO GROVE, MT. PROSPECT, LAKE ZURICH, PALATINE, AND SCHAUMBURG, ILLINOIS. CYBERKNIFE WAS FORMED IN JUNE 2006 FOR THE PURPOSE OF PURCHASING AND OWNING A STEREOTACTIC RADIOSURGERY SYSTEM AND LEASING IT TO THE HOSPITAL. CYBERKNIFE IS A LIMITED LIABILITY CORPORATION THAT IS OWNED BY HEALTHCARE (74% AT December 31, 2021) AND PHYSICIAN INVESTORS (26% AT DECEMBER 31, 2021). HEALTHCARE CONSOLIDATES CYBERKNIFE, AS HEALTHCARE OWNS A MAJORITY OF THE UNITS OUTSTANDING. DSC-II WAS FORMED IN 2014 FOR THE PURPOSE OF OWNING AND OPERATING AN AMBULATORY SURGERY CENTER. DSC-II IS A LIMITED LIABILITY COMPANY THAT IS OWNED BY HEALTHCARE (53.75% AT DECEMBER 31, 2021) AND PHYSICIAN INVESTORS (46.25% AT DECEMBER 31, 2021). HEALTHCARE CONSOLIDATES DSC-II, AS HEALTHCARE OWNS A MAJORITY OF THE UNITS OUTSTANDING. ENDO WAS ESTABLISHED IN DECEMBER 2015 AND BEGAN OPERATIONS IN MARCH 2017. ENDO IS A LIMITED LIABILITY CORPORATION THAT IS OWNED BY HEALTH SERVICES (51% AT DECEMBER 31, 2021) AND PHYSICIAN INVESTORS (49% AT DECEMBER 31, 2021). HEALTH SERVICES CONSOLIDATES ENDO BECAUSE IT OWNS A CONTROLLING INTEREST. FOOT WAS ESTABLISHED AND BEGAN OPERATIONS IN JULY 2017. FOOT IS A LIMITED LIABILITY CORPORATION THAT IS 100% OWNED BY HEALTH SERVICES INC. ENVISION WAS ESTABLISHED AND BEGAN OPERATIONS IN JULY 2018. ENVISION IS A LIMITED LIABILITY CORPORATION THAT IS OWNED BY HEALTH SERVICES (51% AT DECEMBER 31, 2021) AND PHYSICIAN INVESTORS (49% AT DECEMBER 31, 2021). HEALTH SERVICES CONSOLIDATES ENVISION BECAUSE IT OWNS A CONTROLLING INTEREST.
SCHEDULE H - PART VI, LINE 7 - STATE FILING OF COMMUNITY BENEFIT REPORT	NORTHWEST COMMUNITY HOSPITAL FILES AN ANNUAL NONPROFIT HOSPITAL COMMUNITY BENEFITS PLAN REPORT WITH THE ILLINOIS ATTORNEY GENERAL'S OFFICE IN ACCORDANCE WITH ILLINOIS LAW.

Schedule H (Form 990) 2021

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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," on Form 990, Part IV, line 21 or 22.
lBullet

Attach to Form 990.
lBullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2021

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 Domestic Organizations and Domestic Governments. Complete if the organization answered "Yes" on 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 section (if applicable)	(d) Amount of cash grant	(h) Purpose of grant or assistance
(1) Shelter Inc 1616 N ARLINGTON HTS RD ARLINGTON HEIGHTS,IL60004	23-7399596	501(c)(3)	10,000	Sponsor
(2) WINGS PO BOX 95615 Palatine,IL60095	75-0800699	501(c)(3)	10,000	Sponsor
(3) Partners for Our Communities 1585 N Rand Rd Palatine,IL60074	36-3881109	501(c)(3)	10,000	Sponsor
(4) St Mary's Service 510 N PLUM GROVE RD PALATINE,IL60067	36-2167889	501(c)(3)	10,000	SPONSOR
(5) KENNETH YOUNG CENTER 1001 ROHLWING RD ELK GROVE VILLAGE,IL60007	23-7181444	501(c)(3)	7,500	Sponsor

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) 2021

Page 2

Part III

Grants and Other Assistance to Domestic Individuals. Complete if the organization answered "Yes" on 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 noncash assistance	(e) Method of valuation (book, FMV, appraisal, other)	(f) Description of noncash assistance

(1) Health Initiatives	16	11,836
(2) Community Assistance	2	435
(2)
(3)
(4)
(5)
(6)
(7)

Part IV

Supplemental Information. Provide the information required in Part I, line 2; Part III, column (b); and any other additional information.

Return Reference

Explanation

Form 990, Schedule I, Part I, Line 2 - Org. Proc. for Monitoring 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) 2021

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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" on Form 990, Part IV, line 23.
SchJMediumBullet

Attach to Form 990.
SchJMediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2021

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 on 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 on 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
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked on 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 on 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), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.

For persons listed on 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," on line 5a or 5b, describe in Part III.

For persons listed on 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," on line 6a or 6b, describe in Part III.

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

Yes

Were any amounts reported on 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" on 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) 2021

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 on 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, 1099-MISC compensation, and/or 1099-NEC			(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation in column (B) reported as deferred on 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)
1Stephen O Scogna PRESIDENT/SECRETARY/CEO	(i) (ii)	910,711 ------------- 0	974,551 ------------- 0	1,029,008 ------------- 0	199,260 ------------- 0	34,065 ------------- 0	3,147,595 ------------- 0	807,123 ------------- 0
2John L Skeans CFO/Treasurer	(i) (ii)	442,703 ------------- 0	322,721 ------------- 0	312,103 ------------- 0	67,882 ------------- 0	31,347 ------------- 0	1,176,756 ------------- 0	53,756 ------------- 0
3Michael C Hartke Executive VP/COO	(i) (ii)	555,044 ------------- 0	525,480 ------------- 0	379,121 ------------- 0	81,440 ------------- 0	31,689 ------------- 0	1,572,774 ------------- 0	67,050 ------------- 0
4Alan B Loren MD Executive VP - CMO	(i) (ii)	515,235 ------------- 0	155,726 ------------- 0	78,715 ------------- 0	75,964 ------------- 0	19,003 ------------- 0	844,643 ------------- 0	61,681 ------------- 0
5Susan E Nelson MD VP Physician Operations	(i) (ii)	363,661 ------------- 0	118,990 ------------- 0	162,134 ------------- 0	37,773 ------------- 0	9,378 ------------- 0	691,936 ------------- 0	28,939 ------------- 0
6Glen J Malan VP Info Tech & CIO	(i) (ii)	346,813 ------------- 0	162,876 ------------- 0	160,643 ------------- 0	28,225 ------------- 0	4,633 ------------- 0	703,190 ------------- 0	27,671 ------------- 0
7TERRY SOLEM VP HUMAN RESOURCES	(i) (ii)	150,501 ------------- 0	0 ------------- 0	431,064 ------------- 0	5,763 ------------- 0	1,466 ------------- 0	588,794 ------------- 0	26,586 ------------- 0
8Eileen Gillespie Trm 123021 Executive VP - PT Serv & CNO	(i) (ii)	323,638 ------------- 0	99,567 ------------- 0	48,245 ------------- 0	53,276 ------------- 0	20,063 ------------- 0	544,789 ------------- 0	39,437 ------------- 0
9RICH CASEY VP HOSPITAL OPERATIONS	(i) (ii)	294,241 ------------- 0	142,582 ------------- 0	142,824 ------------- 0	37,844 ------------- 0	30,438 ------------- 0	647,929 ------------- 0	24,308 ------------- 0
10Willis Parsons Med Dir GI Center	(i) (ii)	1,816,977 ------------- 0	254,604 ------------- 0	1,980 ------------- 0	13,050 ------------- 0	27,938 ------------- 0	2,114,549 ------------- 0	0 ------------- 0
11GERALD P GALLAGHER NS Pres/CEO/Director	(i) (ii)	0 ------------- 1,389,035	0 ------------- 1,685,590	0 ------------- 9,221	0 ------------- 832,681	0 ------------- 42,020	0 ------------- 3,958,547	0 ------------- 792,990
12Mahalakshmi Halasyamani MD NS CMO/DIRECTOR	(i) (ii)	0 ------------- 730,813	0 ------------- 678,200	0 ------------- 7,038	0 ------------- 210,044	0 ------------- 3,667	0 ------------- 1,629,762	0 ------------- 308,000
13Sean O'Grady NS COO/ Director	(i) (ii)	0 ------------- 957,077	0 ------------- 965,560	0 ------------- 854,092	0 ------------- 416,530	0 ------------- 33,626	0 ------------- 3,226,885	0 ------------- 1,284,790
14Catherine Wood MD Phy & Director	(i) (ii)	0 ------------- 118,343	0 ------------- 112,637	0 ------------- 1,290	0 ------------- 6,560	0 ------------- 17,948	0 ------------- 256,778	0 ------------- 0
15Thomas Oryszczak Exec VP Chief Medical Officer	(i) (ii)	371,997 ------------- 0	25,669 ------------- 0	1,367 ------------- 0	13,050 ------------- 0	28,390 ------------- 0	440,473 ------------- 0	0 ------------- 0

Schedule J (Form 990) 2021

Page 3

Part III

Supplemental Information

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.

Return Reference

Explanation

COMPENSATION DETERMINATION PROCESS FOR TOP MANAGEMENT OFFICIALS

FORM 990, SCHEDULE J, LINE 3 THE COMPENSATION COMMITTEE OF THE PARENT CORPORATION (HEALTHCARE) ANNUALLY REVIEWS AND MAKES RECOMMENDATIONS TO THE BOARD REGARDING THE COMPENSATION OF THE 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 FORM 990, SCHEDULE J, LINE 4A IN 2021, THE FOLLOWING INDIVIDUAL RECEIVED a SEVERANCE PAYMENT AS PART OF Their COMPENSATION ARRANGEMENT: Terry Solem $380,672. FORM 990, SCHEDULE J, LINE 4B A SERP PLAN WAS CREATED AND WAS EFFECTIVE ON JANUARY 1, 2014. BENEFITS UNDER THE SERP VEST IN THE AMOUNT CREDITED TO HIS OR HER ACCOUNT BALANCE ON JANUARY 1 OF THE FIFTH PLAN YEAR FOLLOWING THE YEAR FOR WHICH A CONTRIBUTION WAS CREDITED TO THE PARTICIPANT'S ACCOUNT. HOWEVER, PARTICIPANT WILL AUTOMATICALLY VEST IN HIS OR HER ACCOUNT BALANCE IN THE EVENT OF INVOLUNTARY SEPARATION FROM SERVICE OR HIS OR HER ATTAINMENT OF AGE 65 WHILE STILL EMPLOYED BY NCH. PARTICIPANTS WHO VOLUNTARILY RESIGN OR ARE TERMINATED WITH CAUSE BEFORE THE VESTING PERIOD ARE NO LONGER ELIGIBLE FOR THE AMOUNT ACCRUED. THE FOLLOWING INDIVIDUALS PARTICIPATED IN THE SERP AND HAD VESTED BENEFITS EARNED AND PAID DURING 2021 WHICH ARE REPORTED IN COLUMN (B): STEPHEN O. SCOGNA $ 1,025,313 MICHAEL C. HARTKE $ 376,573 JOHN SKEANS $ 308,323 ALAN B. LOREN, MD $ 73,297 Eileen Gillespie $ 42,990 SUSAN E. NELSON, MD $ 158,446 GLEN J. MALAN $ 157,745 TERRY SOLEM $ 39,530 RICH CASEY $ 140,087 Sean O'Grady $ 846,030 THE FOLLOWING INDIVIDUALS PARTICIPATED IN THE SERP AND EARNED UNVESTED BENEFITS DURING 2021 WHICH ARE REPORTED IN COLUMN (C): STEPHEN O. SCOGNA $ 186,210 MICHAEL C. HARTKE $ 68,390 JOHN L. SKEANS $ 54,832 ALAN B. LOREN, MD $ 62,914 Eileen Gillespie $ 40,226 SUSAN E. NELSON, MD $ 29,518 GLEN J. MALAN $ 28,225 RICH CASEY $ 24,794 GERALD P. GALLAGHER $ 823,981 Mahalakshmi Halasyamani,MD $ 201,344 Sean O'Grady $ 407,830

NON-FIXED COMP PAYMENTS

FORM 990, SCHEDULE J, 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. THRESHOLD MEASURES, WHICH CONSTITUTE THE MINIMUM REQUIREMENTS, MUST BE ACHIEVED IN ORDER TO HAVE AN INCENTIVE PAYOUT. AWARD OPPORTUNITY LEVELS VARY AS A PERCENT OF BASE SALARY. ACTUAL AMOUNTS AWARDED ARE BASED ON A COMBINATION OF DEFINED TARGETS. MAXIMUM PAYABLE IS 150% OF THE TARGET. AMOUNTS TO BE PAID ARE SUBJECT TO APPROVAL OF THE COMPENSATION COMMITTEE OF NORTHWEST COMMUNITY HEALTHCARE, THE SOLE MEMBER OF THE HOSPITAL. The Compensation Committee retains the discretion to recommend for Board approval adjustments to payouts (either higher or lower) at plan cycle end, to reflect extraordinary performance or unanticipated circumstances.

Schedule J (Form 990) 2021

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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 Ⅵ, line 24a. Provide descriptions,
explanations, and any additional information in Part Ⅵ.
SchKMediumBullet

Attach to Form 990.
SchKMediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2021

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 FINANCIAL AUTHORITY	86-1091967		12-01-2011	53,100,000	SEE PART VI		X		X		X
B	ILLINOIS FINANCIAL AUTHORITY	86-1091967	45200FNU9	10-07-2008	86,820,000	SEE PART VI		X		X		X
C	ILLINOIS FINANCIAL AUTHORITY	86-1091967	45204EDN5	06-15-2016	157,336,237	SEE PART VI		X		X		X

Part Ⅱ

Proceeds

	A		B		C		D
	1 Amount of bonds retired ..................	18,100,000		39,750,000		6,805,000
2 Amount of bonds legally defeased ..............	0		0		0
3 Total proceeds of issue ..................	53,100,000		86,820,000		157,336,237
4 Gross proceeds in reserve funds .............	0		0		0
5 Capitalized interest from proceeds .............	0		0		0
6 Proceeds in refunding escrows ...............	0		0		155,497,835
7 Issuance costs from proceeds ...............	434,279		598,075		1,838,402
8 Credit enhancement from proceeds .............	0		93,000		0
9 Working capital expenditures from proceeds .............	0		0		0
10 Capital expenditures from proceeds .............	0		86,128,925		0
11 Other spent proceeds .............	52,665,721		0		0
12 Other unspent proceeds .............	0		0		0
13 Year of substantial completion .............	2011		2008
	Yes	No	Yes	No	Yes	No	Yes	No
14 Were the bonds issued as part of a current refunding issue of tax-exempt bonds (or, if issued prior to 2020, a current refunding issue)? ........	X		X			X
15 Were the bonds issued as part of an advance refunding issue of taxable bonds (or, if issued prior to 2020, 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

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

Cat. No. 50193E

Schedule K (Form 990) 2021

Page 2

Part Ⅲ

Private Business Use

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? .............						X
2 Are there any lease arrangements that may result in private business use of bond-financed property? ...............						X
3a Are there any management or service contracts that may result in private business use of bond-financed property? .............						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?						X
c Are there any research agreements that may result in private business use of bond-financed property? .............						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
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, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate? ...		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 "Yes" to 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

Schedule K (Form 990) 2021

Page 3

Part Ⅳ

Arbitrage (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
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 the hedge terminated? ........
5a Were gross proceeds invested in a guaranteed investment contract (GIC)?		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
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
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. Provide additional information for responses to questions on Schedule K. (See instructions).

Return Reference	Explanation

Schedule K (Form 990) 2021

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SCHEDULE O
(Form 990)

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 990-EZ or to provide any additional information.
MediumBullet

Attach to Form 990 or 990-EZ.
MediumBullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2021

Open to Public
Inspection

Name of the organization

Northwest Community Hospital

Employer identification number

36-2340313

Return Reference	Explanation
CHANGE OF ACCOUNTING PERIOD	NORTHWEST COMMUNITY HOSPITAL (NCH) IS FILING A SHORT PERIOD RETURN FOR OCTOBER 1, 2021 THROUGH DECEMBER 31, 2021 IN ORDER TO CHANGE ITS TAX PERIOD YEAR END FROM SEPTEMBER 30TH TO DECEMBER 31ST. NCH HAS NOT CHANGED ITS ACCOUNTING PERIOD IN THE PREVIOUS 10-CALENDAR-YEAR PERIOD SO THE CHANGE IS AUTOMATIC. Form 990, Part III, Line 4D - Desc. of Other Program Services INCLUDES REVENUE, EXPENSES, AND GRANTS OF $75,771 FROM ALL OTHER PROGRAM SERVICE SPECIALTIES ALONG WITH REFERENCE LAB REVENUE, CAPITATION REVENUE, INTERCOMPANY RENTS AND OTHER RENTAL INCOME NOT DESCRIBED ON FORM 990, PART III, LINES 4A-4C.
Form 990, Part VI, Section A. Line 6 - Desc. of Members	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.
Form 990, Part VI, Section A. Line 7a - Power to elect members	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.
Form 990, Part VI, Section A. Line 7b - Governance Decisions	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.
Form 990, Part VI, Section B. Line 11b - Review of Form 990	A COPY OF FORM 990 WAS MADE AVAILABLE TO THE MEMBERS OF HOSPITAL'S BOARD PRIOR TO FILING. THE BOARD HAS BEEN ASSIGNED THE RESPONSIBILITY OF REVIEWING FORMS 990 FOR ALL AFFILIATES OF NCH. SPECIFIC SECTIONS OF THE TAX RETURN ARE ALSO REVIEWED BY HUMAN RESOURCES, LEGAL, AND COMPLIANCE.
Form 990, Part VI, Section B. Line 12c - Conflict of Interest	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.
Form 990, Part VI, Section B Line 15a & 15b - Comp. Determination	The Compensation Committee of the Board of Directors (the "Committee") of Northwest Community Healthcare, which is the parent corporation of Northwest Community Hospital and who has identical board members as Northwest Community Healthcare, is responsible for preparing the total compensation paid to the Organization's senior executives (collectively, "Executives") to ensure that compensation paid to such Executives is reasonable and does not result in excessive and inappropriate benefit to private individuals. The Committee shall, on an annual basis, review and recommend to the Board for approval executive compensation consistent with the process described below. This process is intended to result in compensation decisions that are consistent with the Organization's fulfillment of its mission as set forth in the Organization's Articles of Incorporation, as well as the Organization's compensation philosophy and related principles set forth in this document. The Compensation philosophy is intended to result in the determination and payment of total compensation, including benefits, for Executives based on the following objectives: Compensation that is objectively fair and reasonable compared to similar executives at similar institutions; Compensation that contributes to the attraction and retention of qualified and talented individuals in Executive positions; Compensation that rewards the attainment of performance goals and expectations; and Compensation that reinforces the commitment to the Organization's mission, purpose and values. In assessing the reasonableness of an Executive's total compensation, the Committee shall endeavor to set base salary at or near the market 60th percentile. The Committee shall target total compensation, including but not limited to, salary, any bonus or incentive payments and deferred and noncash compensation, as well as all compensatory benefits such as payments to medical, dental, life, annuity, retirement and disability benefit plans, and any fringe benefits such as housing, automobile, and computer allowances to approximate the market 75th percentile. The Committee shall conduct an annual performance review of the CEO, the results of which shall be used in determining a reasonable total compensation for him or her. The CEO will formulate a compensation recommendation for each Executive who reports to him or her. The CEO will present compensation recommendations based on an evaluation of each Executive's job performance in accordance with criteria established by him or her. When reviewing or assessing the total compensation of any Executive, the Committee shall obtain sufficient information, taking into consideration the knowledge and expertise of its members, to determine whether total compensation of each Executive is reasonable (i.e., whether such compensation is comparable to that of similar executives at similar institutions). To assist in the determination of reasonable compensation, the Committee will select and engage a qualified independent compensation consultant ("Consultant") to annually review and analyze the total compensation, including benefits, of each Executive. The terms of the Consultant's engagement shall provide that the Consultant is to report to the Committee, and that the Consultant shall have no reporting responsibilities to any Executive with respect to any engagement in connection with the executive total compensation program. The Committee shall instruct the Consultant to compile appropriate comparability data, which may include compensation and benefits paid by similarly situated organizations for positions that are functionally comparable to those of each Executive. The Committee shall direct the Consultant to analyze a number of different variables in assessing comparability, including but not limited to organizational size, geographic location, the nature of the services provided, the level of experience and specific responsibilities of the position considered, and the components of the compensation offered. If a Consultant is retained, the Consultant should be directed to provide written analysis and recommendations with respect to a reasonable total compensation for each Executive. The Committee may additionally request that the Consultant be available to present a written analysis and recommendations and to take questions from Board or Committee members. In addition to the reports and analyses of the Consultant, the Committee shall also consider additional comparability data, including but not limited to: the availability of similar services in the geographic area, current compensation surveys compiled by independent firms, and actual written offers from similar institutions competing for services of the applicable Executive.
Form 990, Part VI, Section C. Line 19 - Availability of Documents	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 NORTHSHORE UNIVERSITY HEALTHSYSTEM 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.
Form 990 Part IX, Line 5 & 7	Compensation of current officers, directors, trustees and key employees and Other Salaries and Wages. Wages reported on the respective lines are for THE THREE MONTH PERIOD, OCTOBER 1 THROUGH DECEMBER 31, 2021, while the wages reported on Form 990 Part VII are reported based upon the calendar year form W2. The allocations between program expenses and management and general expenses have been adjusted to reflect the differences in the short period wages and the 2021 Form W2 wages.
Form 990, Part XI, Line 9	RECONCILIATION OF NET ASSETS - OTHER CHANGES IN NET ASSETS TRANSFER TO AFFILIATES ($ 24,863) PERIODIC PENSION COST $ 4,205,649 PENSION EXPENSE $ 377,187 NET ASSETS RELEASED FROM TEMP RESTRICTED ($ 3,812,067) ____________________________________________________________ TOTAL OTHER CHANGES IN NET ASSETS $ 745,906

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

Cat. No. 51056K

Schedule O (Form 990) 2021

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" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBullet

Attach to Form 990.
MediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2021

Open to Public Inspection

Name of the organization

Northwest Community Hospital

Employer identification number

36-2340313

Part I

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

(a) Name, address, and EIN (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

Part II

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

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled 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 3040 SALT CREEK LN ARLINGTON HTS,IL60005 36-3125209	SUPPORT ORG.	IL	501(c)(3)	12B	NWC Hlthcare		No
(2)NORTHWEST COMMUNITY HOSPITAL FOUNDATION 3040 SALT CREEK LN ARLINGTON HTS,IL60005 36-3125193	FUNDRAISING	IL	501(c)(3)	7	NWC Hlthcare		No
(3)NORTHSHORE UNIVERSITY HEALTHSYSTEM 1301 CENTRAL STREET EVANSTON,IL60201 36-2167060	HOSPITAL	IL	501(c)(3)	3	na		No
(4)NORTHSHORE UNIVERSITY HEALTHSYSTEM FPA 1301 CENTRAL STREET EVANSTON,IL60201 36-3738206	HEALTHCARE	IL	501(C)(3)	12 TYPE I	NS UNIV HS		No
(5)HEALTHCARE FOUNDATION OF HIGHLAND PARK 610 CENTRAL AVE HIGHLAND PARK,IL60035 36-3196647	FUNDRAISING	IL	501(C)(3)	12 TYPE II	NA		No
(6)SWEDISH COVENANT HEALTH 5145 N CALIFORNIA AVE CHICAGO,IL60625 36-2179813	HOSPITAL	IL	501(C)(3)	3	NS UNIV HS		No
(7)SWEDISH COVENANT HOSPITAL FOUNDATION 5145 N CALIFORNIA AVE CHICAGO,IL60625 20-5055155	FUNDRAISING	IL	501(C)(3)	7	SWEDISH CONV		No
(8)RADIATION MEDICINE INSTITUTE 1301 CENTRAL STREET EVANSTON,IL60201 36-3815543	HEALTHCARE	IL	501(C)(3)	12 TYPE I	NS UNIV HS		No

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

Cat. No. 50135Y

Schedule R (Form 990) 2021

Page 2

Part III

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

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?		(k) Percentage ownership
(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 V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No	(k) Percentage ownership
(1) NPC-CYBERKNIFE LLC 3040 SALT CREEK LN ARLINGTON HTS,IL60005 20-4462828	EQUIPMENT LEASING	IL	na
(2) NWC Day Surgery 3040 SALT CREEK LN ARLINGTON HTS,IL60005 30-0798249	OUTPATIENT CARE	IL	na
(3) NW ENDO CENTER LLC 3040 SALT CREEK LN ARLINGTON HTS,IL60005 81-2338623	SURGICAL CARE	IL	na
(4) ENVISION MED IMG 8930 WAUKEGAN RD STE 130 MORTON GROVE,IL60053 82-2067179	IMAGING SERVICES	IL	na
(5) RAVINE WAY SURGERY CENTER LLC 24001 RAVINE WAY GLENVIEW,IL60025 20-1245279	HEALTHCARE	IL	na

Part IV

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

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(h) Percentage ownership	(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	(h) Percentage ownership	Yes	No
(1) NORTHWEST COMMUNITY HEALTH SERVICES INC 800 WEST CENTRAL ROAD ARLINGTON HEIGHTS,IL60005 36-3312906	HEALTHCARE SERV	IL	NWC HEALTHCARE	C Corp					No
(2) CENTRAL INSURANCE COMPANY LTD PO Box 10233 Grand Cayman KY1-1002 CJ 98-1109518	INSURANCE	CJ	NWC Healthcare	C Corp					No
(3) NORTHSHORE PHYSICIAN ASSOCIATES INC 1301 CENTRAL STREET EVANSTON,IL60201 36-3648026	HEALTHCARE	IL	NS UNIV HS	C Corp					No
(4) NORTHSHORE PHYSICIAN ASSOCIATES VALUE BA 1301 CENTRAL STREET EVANSTON,IL60201 82-2268872	HEALTHCARE	IL	NS FPA	C Corp					No
(5) NORTHSHORE UNIVERSITY HEALTHSYSTEM INSUR GOVERNORS SQUARE BLDG 4 GRAND CAYMAN CJ 98-0419452	INSURANCE	CJ	NS UNIV HS	C Corp					No
(6) SWEDISH CONVENANT MGMT SERVICES INC 5145 N CALIFORNIA AVE CHICAGO,IL60625 36-4073303	PHYS PRACT MGMT	IL	SWEDISH CONV	C CORP					No
(7) SWEDISH CONVENANT PHYS PARTNERS LTD 5145 N CALIFORNIA AVE CHICAGO,IL60625 36-3120220	PHYS PRACT MGMT	IL	SWEDISH CONV	C CORP					No

Schedule R (Form 990) 2021

Page 3

Part V

Transactions With Related Organizations. Complete if the organization answered "Yes" on 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) .......................

Yes

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) ...................

Yes

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

Yes

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

Yes

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) ............................

Yes

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 related organization	(b) Transaction type (a-s)	(c) Amount involved	(d) Method of determining amount involved

Schedule R (Form 990) 2021

Page 4

Part VI

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

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

(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(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 V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?		(k) Percentage ownership
(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 V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No	(k) Percentage ownership

Schedule R (Form 990) 2021

Page 5

Part VII

Supplemental Information

Provide additional information for responses to questions on Schedule R. See instructions.

Return Reference	Explanation

Schedule R (Form 990) 2021

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: NCH OPERATES AN ACUTE 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	14
5	Total number of individuals employed in calendar year 2021 (Part V, line 2a) ......	5	4,688
6	Total number of volunteers (estimate if necessary) .............	6	187
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	362,599
b	Net unrelated business taxable income from Form 990-T, Part I, line 11 .........	7b	0

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	4,384,639	0
9	Program service revenue (Part VIII, line 2g) .........	531,877,295	147,582,274
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	39,575	0
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	3,378,533	1,054,195
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	539,680,042	148,636,469
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	136,498	75,771
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)	261,289,092	67,999,566
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)....	263,413,068	70,679,282
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	524,838,658	138,754,619
19	Revenue less expenses. Subtract line 18 from line 12.......	14,841,384	9,881,850
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	476,057,362	446,659,874
21	Total liabilities (Part X, line 26).............	416,176,266	376,151,022
22	Net assets or fund balances. Subtract line 21 from line 20.....	59,881,096	70,508,852

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 14,796,283 including grants of $ 0 ) (Revenue $ 16,346,690 )
	INFECTIOUS DISEASE NORTHWEST COMMUNITY HOSPITAL'S INFECTIOUS DISEASE DEPARTMENT PROVIDED QUALITY, PATIENT CENTERED, COMPASSIONATE CARE, REGARDLESS OF ABILITY TO PAY. IN THE THREE MONTH PERIOD, OCTOBER 1 THROUGH DECEMBER 31, 2021 THE INFECTIOUS DISEASE SERVICE LINE INCURRED APPROXIMATELY 14,600 CASES AT A COST OF APPROXIMATELY 14,800,000.

4b	(Code: ) (Expenses $ 14,150,510 including grants of $ 0 ) (Revenue $ 14,932,380 )
	CARDIOLOGY NORTHWEST COMMUNITY HOSPITAL'S (HOSPITAL) CARDIAC SERVICE LINE PROVIDED QUALITY, PATIENT CENTERED, COMPASSIONATE CARE, REGARDLESS OF ABILITY TO PAY, TO APPROXIMATELY 14,300 INPATIENT AND OUTPATIENT CASES DURING OCTOBER 1 THROUGH DECEMBER 31, 2021. 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 APPROXIMATELY $14,200,000. 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 HAS BEEN RECOGNIZED AS AN ACCREDITED ECHO LAB BY THE INTERSOCIETAL COMMISSION FOR THE ACCREDITATION OF ECHOCARDIOGRAPHY LABORATORIES (ICAEL) SINCE 2000. NCH PROVIDES THE FULL SCOPE ON NON INVASIVE CARDIAC DIAGNOSTIC TESTING AT MULTIPLE SITES IN THE COMMUNITY INCLUDING THE ATHERTON HEART FAILURE CLINIC WHICH OPENED IN 2014. THE CLINIC PROVIDES A TRANSITIONAL CARE MODEL THAT IS BASED ON PATIENTS WITH HEART FAILURE BEING SEEN IN THE CLINIC BY ADVANCED CARE PRACTITIONERS AND CARDIOLOGISTS WITH 24 HOURS OF HOSPITAL DISCHARGE. THE MULTIDISCIPLINARY TEAM INCLUDING DIETICIANS, SOCIAL WORKERS, PHARMACISTS AND NURSES PROVIDE ONGOING CARE TO PATIENTS AND THEIR FAMILIES IN THE COMMUNITY SETTING ENSURING CARE IS DELIVERED IN THE APPROPRIATE SETTING AND REDUCING AVOIDABLE RE-ADMISSIONS TO THE ACUTE CARE SETTING. NCH HAS EXPERIENCED A SIGNIFICANT DECREASE IN HOSPITAL READMISSIONS FOR BOTH THE HEART FAILURE AND ACUTE MI PATIENT POPULATIONS DIRECTLY RELATED TO STRATEGIES DURING THE HOSPITALIZATION AND IN THE POST ACUTE CARE SETTING. TELEHEALTH MEDICINE AND HOME HEALTH ARE INTEGRAL PARTS OF THE POST ACUTE CARE MODEL NCH HAS IMPLEMENTED FOR CARDIAC PATIENTS. IN ADDITION, NCH HAS ONE OF THE LARGEST CARDIAC AND PULMONARY REHAB PROGRAMS IN THE STATE OF ILLINOIS THAT HAS FURTHER ASSISTED CARDIAC AND PULMONARY PATIENTS IN RETURNING AND MAINTAINING AN OPTIMAL STATE OF HEALTH FOLLOWING A CARDIAC EVENT. IN MAY 2019, NCH OPENED ITS NEW HYBRID CARDIAC CATHETERIZATION LAB, OFFERING STATE OF THE ART COMBINATION CARDIAC CATH LAB AND OPERATING SUITE FOR PERFORMING MINIMALLY INVASIVE ADVANCED CARDIAC PROCEDURES AND ENDOVASCULAR INTERVENTIONS. THE CARDIAC DEPARTMENT ALSO PROVIDES MULTIPLE SCREENING AND EDUCATION PROGRAMS. EDUCATIONAL PRESENTATIONS BY CARDIOLOGISTS AND STAFF, HEALTHY COOKING DEMONSTRATIONS AND HEALTH SCREENINGS.

4c	(Code: ) (Expenses $ 11,287,208 including grants of $ 0 ) (Revenue $ 11,570,748 )
	ORTHOPEDICS NORTHWEST COMMUNITY HOSPITAL'S (HOSPITAL) ORTHOPEDIC SERVICE LINE PROVIDES QUALITY, PATIENT CENTERED, COMPASSIONATE CARE FOR PATIENTS, REGARDLESS OF ABILITY TO PAY, WHO ARE IN NEED OF SPECIALIZED ORTHOPEDIC MEDICAL CARE AND SURGICAL PROCEDURES. PATIENTS HAVE ACCESS TO SUPERIOR QUALITY CARE AND BENEFIT FROM THE LATEST TECHNOLOGIES AND ADVANCED PAIN MANAGEMENT TECHNIQUES. PHYSICIANS ARE BOARD CERTIFIED. PREOPERATIVE EDUCATION, CARE PROVISION ON A DEDICATED ORTHOPEDIC UNIT WITH SPECIALTY NURSES AND EXTENSIVE POST SURGICAL REHABILITATION AND HOME CARE SERVICES ARE INCLUDED IN OUR ORTHOPEDIC SERVICES. HOSPITAL'S ORTHOPEDIC SERVICE LINE TEAM IS LED BY AN EXPERT BOARD CERTIFIED ORTHOPEDIC SURGEON. THE ORTHOPEDIC DEPARTMENT PERFORMS GREATER THAN 800 ELECTIVE JOINT PROCEDURES A YEAR. QUALITY CARE, EXCELLENCE IN PATIENT EXPERIENCE AND FAVORABLE OUTCOMES MAKES HOSPITAL A TOP CHOICE IN THE CHICAGO LAND AREA. IN THE THREE MONTH PERIOD, OCTOBER 1 THROUGH DECEMBER 31, 2021, THE ORTHOPEDIC SERVICE LINE INCURRED APPROXIMATELY 7,500 PATIENT CASES AT A COST OF APPROXIMATELY $11,300,000.

4d	Other program services (Describe in Schedule O.)
	(Expenses $ 73,465,689 including grants of $ 75,771 ) (Revenue $ 104,732,456 )
4e	Total program service expenses113,699,690

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	11,660,491	7,508,896	2,415,013

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c
d	Related organizations		1d
e	Government grants (contributions)		1e

f	All other contributions, gifts, grants, and similar amounts not included above		1f

g	Noncash contributions included in lines 1a - 1f:$		1g

h Total. Add lines 1a-1f.......		0

		Business Code
2a	NET PATIENT SERVICES	622110	138,939,739	138,939,739	0	0
b	REFERENCE LAB	621511	5,931,955	5,810,236	121,719	0
c	CAPITATION REVENUE	622110	2,159,795	2,159,795	0	0
d	HOSPICE REVENUE	622110	115,750	115,750	0	0
e	INTERCOMPANY RENTS	532000	333,252	333,252	0	0
f	All other program service revenue.		101,783	101,783		0
g	Total. Add lines 2a–2f .....		147,582,274

3 Investment income (including dividends, interest, and othersimilar amounts) ......			0
4 Income from investment of tax-exempt bond proceeds			0
5 Royalties...........			0
		(ii) Personal	(i) Real
6a	Gross rents		447,216	6a
b	Less: rental expenses		315,143	6b
c	Rental income or (loss)	0	132,073	6c
d	Net rental income or (loss).......			132,073	0	0	132,073
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory			7a
b	Less: cost or other basis and sales expenses			7b
c	Gain or (loss)			7c
d	Net gain or (loss).........			0
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ....
			8a	0
b	Less: direct expenses ...		8b	0
c	Net income or (loss) from fundraising events..			0
9a	Gross income from gaming activities. See Part IV, line 19 ...
			9a	0
b	Less: direct expenses ...		9b	0
c	Net income or (loss) from gaming activities..			0
10a	Gross sales of inventory, less returns and allowances ..
			10a	72,638
b	Less: cost of goods sold ..		10b	54,852
c	Net income or (loss) from sales of inventory..			17,786	0	0	17,786
Business Code			Miscellaneous Revenue
11a	CAFETERIA		722212	336,485	0	0	336,485
b	JOINT VENTURE MANAGEMENT FEE		541611	315,521	0	169,257	146,264
c	OUTPATIENT PHARMACY		446110	72,078	0	71,623	455
d	All other revenue ....			180,252	0		180,252
e	Total. Add lines 11a–11d ......			904,336
12	Total revenue. See instructions.....			148,636,469	147,460,555	362,599	813,315

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 ....	63,500	63,500
2	Grants and other assistance to domestic individuals. See Part IV, line 22 ...........	12,271	12,271
3	Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16. .............	0
4	Benefits paid to or for members .......	0
5	Compensation of current officers, directors, trustees, and key employees ...........	7,727,030		7,727,030
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .........	0
7	Other salaries and wages........	47,208,886	47,208,886	0	0
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	1,900,081	1,632,824	267,257	0
9	Other employee benefits .......	7,220,070	6,204,529	1,015,541	0
10	Payroll taxes ...........	3,943,499	3,388,825	554,674	0
11	Fees for services (non-employees):
a	Management ......	0
b	Legal .........	0
c	Accounting ...........	57,501	0	57,501	0
d	Lobbying ...........	7,629	0	7,629	0
e	Professional fundraising services. See Part IV, line 17	0
f	Investment management fees ......	0
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	10,475,368	3,202,035	7,273,333	0
12	Advertising and promotion ....	366,747	0	366,747	0
13	Office expenses .......	1,737,497	1,248,180	489,317	0
14	Information technology ......	3,084,667	2,650,792	433,875	0
15	Royalties ..	0
16	Occupancy ...........	2,077,251	1,728,193	349,058	0
17	Travel ............	36,334	7,234	29,100	0
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .	0
19	Conferences, conventions, and meetings ....	76,179	76,179	0	0
20	Interest ...........	1,173,110	1,173,110	0	0
21	Payments to affiliates .......	0
22	Depreciation, depletion, and amortization ..	9,826,814	6,149,486	3,677,328	0
23	Insurance ...	3,813,965	3,707,670	106,295	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	16,771,864	16,771,864	0	0
b	ILLINOIS PROVIDER TAX	6,429,132	6,429,132	0	0
c	PHARMACEUTICALS	5,464,221	5,464,221	0	0
d	BAD DEBT - PATIENT SERVICES	4,726,881	4,726,881	0	0
e	All other expenses	4,554,122	1,853,878	2,700,244
25	Total functional expenses. Add lines 1 through 24e	138,754,619	113,699,690	25,054,929	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).

1	Cash–non-interest-bearing ........			24,527,929	1	12,799,925
2	Savings and temporary cash investments .........			0	2	0
3	Pledges and grants receivable, net ......			0	3	0
4	Accounts receivable, net .............			59,426,409	4	53,714,292
5	Loans and other receivables from any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .......
				0	5	0
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), and persons described in section 4958(c)(3)(B) ...
				0	6	0
7	Notes and loans receivable, net ...........			0	7	0
8	Inventories for sale or use ............			10,126,040	8	9,558,715
9	Prepaid expenses and deferred charges ......			4,321,852	9	4,247,038
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	369,490,416
b	Less: accumulated depreciation	10b	37,325,388	339,593,982	10c	332,165,028
11	Investments—publicly traded securities .			0	11	0
12	Investments—other securities. See Part IV, line 11 .....			0	12	0
13	Investments—program-related. See Part IV, line 11 ..			35,970,695	13	32,158,628
14	Intangible assets ...............			75,000	14	75,000
15	Other assets. See Part IV, line 11 ...........			2,015,455	15	1,941,248
16	Total assets. Add lines 1 through 15 (must equal line 33)...			476,057,362	16	446,659,874

17	Accounts payable and accrued expenses .....	81,013,058	17	72,108,223
18	Grants payable ...	0	18	0
19	Deferred revenue .........	0	19	5,269,844
20	Tax-exempt bond liabilities .........	235,406,040	20	234,663,615
21	Escrow or custodial account liability. Complete Part IV of Schedule D	0	21	0
22	Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .........
		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	99,757,168	25	64,109,340
26	Total liabilities. Add lines 17 through 25..	416,176,266	26	376,151,022

	Organizations that follow FASB ASC 958, check here and complete lines 27, 28, 32, and 33.
27	Net assets without donor restrictions ..........	46,890,229	27	57,517,985
28	Net assets with donor restrictions ...........	12,990,867	28	12,990,867
	Organizations that do not follow FASB ASC 958, check here and complete lines 29 through 33.
29	Capital stock or trust principal, or current funds .....		29
30	Paid-in or capital surplus, or land, building or equipment fund ...		30
31	Retained earnings, endowment, accumulated income, or other funds		31
32	Total net assets or fund balances ...........	59,881,096	32	70,508,852
33	Total liabilities and net assets/fund balances ........	476,057,362	33	446,659,874