2024-08-15T14:25:53-05:00 2023-09-30 621517792 PYA P C 2220 SUTHERLAND AVE KNOXVILLE TN 37919 990 2022-10-01 581653541 THE NORTHSIDE HOSPITAL FOUNDATION INC NORT 4048518000 1000 JOHNSON FERRY ROAD NE ATLANTA GA 303421611 SHANNON A BANNA VP FINANCE / CFO 4048518000 2024-08-15 1 0 DEBORAH O ERNSBERGER P00364912 8656730844 2022 2024-08-08 14:25:15Z ROBERT T QUATTROCCHI 1000 JOHNSON FERRY ROAD NE ATLANTA GA 303421611 5531155 0 X HTTPS://GIVE.NORTHSIDE.COM/ X 1991 GA TO BUILD STRONG AND HEALTHY COMMUNITIES BY CONNECTING DONORS, VOLUNTEERS AND RESOURCES. 12 10 0 2020 0 0 3540171 4834845 0 0 78096 258044 -124840 -366083 3493427 4726806 1867502 2419196 0 0 0 0 0 0 173603 719089 1108574 2586591 3527770 906836 1199036 19715882 22331479 1639579 2296854 18076303 20034625 X THE NORTHSIDE HOSPITAL FOUNDATION IS A 501(C)(3) NOT-FOR-PROFIT ORGANIZATION DEDICATED TO NORTHSIDE HOSPITAL AND THE ENRICHMENT OF THE COMMUNITIES WE SERVE. OUR PHILANTHROPIC VISION IS TO BUILD STRONG AND HEALTHY COMMUNITIES BY CONNECTING DONORS, VOLUNTEERS AND RESOURCES. 0 0 3203700 2419196 THE NORTHSIDE HOSPITAL FOUNDATION ("THE FOUNDATION") IS A 501(C)(3) NOT-FOR-PROFIT ORGANIZATION DEDICATED TO NORTHSIDE HOSPITAL AND THE ENRICHMENT OF THE COMMUNITIES WE SERVE. OUR PHILANTHROPIC VISION IS TO BUILD STRONG AND HEALTHY COMMUNITIES BY CONNECTING DONORS, VOLUNTEERS AND RESOURCES.THE FOUNDATION HELPS CONNECT STAFF, PHYSICIANS AND THEIR FAMILIES AND FRIENDS TO COMMUNITY VOLUNTEER OPPORTUNITIES THROUGH ITS COMMUNITY CONNECTION PROGRAM. THE COMMUNITY CONNECTION PROGRAM SUPPORTS NORTHSIDE'S MISSION AND VALUES WHICH ARE ROOTED IN THE IMPORTANCE OF GIVING BACK TO THE COMMUNITIES WE SERVE.THE FOUNDATION CONNECTS DONORS, CHARITABLE FOUNDATIONS, CORPORATIONS AND COMMUNITY VOLUNTEERS TO RAISE FUNDS THROUGH EVENTS, GIVING CAMPAIGNS AND OTHER ACTIVITIES TO SUPPORT ESSENTIAL INITIATIVES SUCH AS STATE-OF-THE-ART TECHNOLOGY, RESEARCH, CLINICAL EDUCATION, COMMUNITY WELLNESS AND CHARITY CARE WHICH DIRECTLY IMPACT THE LIVES OF EACH FAMILY SERVED BY NORTHSIDE HOSPITAL.IN ADDITION, THE FOUNDATION WORKS WITH VOLUNTEERS WHO DONATE THEIR TIME, ENERGY AND TALENTS IN SUPPORT OF NORTHSIDE. IN FY2023, VOLUNTEERS DONATED MORE THAN 15,700 HOURS OF THEIR TIME. THESE COMMUNITY VOLUNTEER GROUPS ORGANIZED SPORTS FUNDRAISING ACTIVITIES AND EVENTS TO BENEFIT NORTHSIDE HOSPITAL'S HEALTH AND WELFARE PROGRAMS AND THE COMMUNITIES IT SERVES. 3203700 1 1 0 0 0 0 0 0 0 1 0 0 0 0 0 1 1 1 0 0 0 0 0 0 1 0 0 1 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 X 12 10 0 0 0 0 0 1 1 1 1 0 0 0 1 1 1 1 1 0 0 0 GA X SHANNON A BANNA 4048518000 1000 JOHNSON FERRY ROAD ATLANTA GA 30342 X ALAN L COBB BOARD CHAIR 1.00 X 0 0 0 ANTHONY J SALVATORE BOARD MEMBER 1.00 1.00 X 0 0 0 BARRY SILVERMAN MD BOARD MEMBER 1.00 X 0 0 0 CINDY FORMICA BOARD MEMBER 1.00 X 0 0 0 GAIL NEELD BOARD VICE CHAIR 1.00 X 0 0 0 GEORGE MCCALLUM BOARD MEMBER 1.00 X 0 0 0 JAMES L DEMING BOARD MEMBER 1.00 X 0 0 0 MARK J SWEENEY BOARD MEMBER 1.00 1.00 X 0 0 0 ROBERT T QUATTROCCHI BOARD MEMBER, CEO NSH, INC 1.00 40.00 X X 0 4966543 33658 ROBERT WHITLEY BOARD MEMBER 1.00 X 0 0 0 RUTH M GOODE BOARD MEMBER 1.00 X 0 0 0 SHANNON BANNA TREASURER & SECRETARY, VP/CFO NSH, INC. 1.00 40.00 X X 0 940609 9967 0 5907152 43625 0 0 1 0 0 972153 3862692 48013 4834845 258044 258044 438266 972153 804349 -366083 -366083 4726806 0 0 -108039 506553 506553 1912643 1912643 650221 650221 10572 456 10116 4342 4342 28278 28278 49908 49908 MISCELLANEOUS 191650 133827 57823 FUNDRAISING EXPENSE 173603 173603 3527770 3203700 150467 173603 7915973 8220691 0 101566 1191607 1908624 19143 19655 10589159 12080943 19715882 22331479 1639579 2296854 1639579 2296854 X 8059719 20506949 10016584 -472324 18076303 20034625 19715882 22331479 X 1199036 -1196544 1955830 X 0 1 X 1 0 X 1780711 1942618 2159827 3540170 4834845 14258171 1780711 1942618 2159827 3540170 4834845 14258171 14258171 210344 157815 191633 286383 258044 1104219 15362390 1157474 0.92810 0.91530 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 10016584 2239159 13773 7568517 4700999 9737244 1982019 151170 1853849 10016584 10495896 1082999 135511 2090526 9623880 10973195 786795 171961 1436055 10495896 10180369 1829101 286184 1322459 10973195 0.37926 0.62074 0 0 0 X 6289433 1196544 366083 1562627 4726806 0 4726806 4331119 804349 804349 3526770 1000 1000 3527770 PART V, LINE 4: NORTHSIDE HOSPITAL, INC. AND THE NORTHSIDE HOSPITAL FOUNDATION, INC. HAVE ENDOWMENT FUNDS THAT CONSIST OF SEVERAL DONOR-RESTRICTED INDIVIDUAL FUNDS ESTABLISHED FOR A VARIETY OF PURPOSES. THE ORGANIZATIONS ADOPTED A POLICY REGARDING THE ENDOWMENTS WHOSE GENERAL PURPOSE IS TO PRESERVE THE CAPITAL AND PURCHASING POWER OF THE ORGANIZATIONS AND TO PRODUCE SUFFICIENT INVESTMENT EARNINGS FOR CURRENT AND FUTURE SPENDING NEEDS. PART X, LINE 2: THE FOUNDATION IS A TAX-EXEMPT ORGANIZATION AND IS NOT SUBJECT TO FEDERAL INCOME TAXES. ACCORDINGLY, NO PROVISION FOR INCOME TAXES IS MADE IN THE ACCOMPANYING FINANCIAL STATEMENTS. PART XI, LINE 2D - OTHER ADJUSTMENTS: FUNDRAISING NET LOSS 366,083. PART XII, LINE 2D - OTHER ADJUSTMENTS: FUNDRAISING EXPENSES 804,349. PART XII, LINE 4B - OTHER ADJUSTMENTS: ROUNDING ADJUSTMENT 1,000. PART V, LINE 1A, COLUMN (B) THE BEGINNING OF YEAR BALANCE IN COLUMN (B) OF $9,737,244 DOES NOT TIE TO THE PRIOR YEAR ENDING BALANCE ON LINE 1G, COLUMN (C) DUE TO AN ADJUSTMENT OF $113,364 AT THE END OF FISCAL YEAR ENDING 9/30/2021. GOLF/SPRING 2023 675835 463885 211950 82334 99043 85223 45943 WINE, WOMEN & SHOES 320543 248294 72249 5344 119516 73003 10750 24625 2 414041 259974 154067 51189 72176 102906 32297 1410419 972153 438266 138867 290735 261132 10750 102865 804349 -366083 1 NORTHSIDE HOSPITAL INC 1000 JOHNSON FERRY ROAD ATLANTA GA 30342 581954432 501(C)(3) 506553 0 GRANTS AND CAPITAL REIMBURSEMENTS 1 MEDICAL EXPENSES PROVIDED 6011 1912643 PART I, LINE 2: THE ORGANIZATION HAS GUIDELINES IN PLACE THAT ARE TO BE USED IN REVIEWING THE ELIGIBILITY OF GRANTEES. ALL GRANTS REQUIRE WRITTEN DOCUMENTATION AND APPROPRIATE LEVELS OF APPROVAL. SCHEDULE I, PART III THE FOUNDATION PROVIDES FINANCIAL ASSISTANCE FOR VARIOUS MEDICAL RELATED EXPENSES FOR PATIENTS WHO MEET CERTAIN ELIGIBILITY REQUIREMENTS TO BE APPROVED FOR ASSISTANCE. 0 1 0 0 0 0 0 0 0 ROBERT T QUATTROCCHI BOARD MEMBER, CEO NSH, INC 0 1487319 0 3450000 0 29224 0 0 0 33658 0 5000201 0 0 SHANNON BANNA TREASURER & SECRETARY, VP/CFO NSH, I 0 647234 0 258060 0 35315 0 0 0 9967 0 950576 0 0 PART I, LINE 4B MR. QUATTROCCHI HAS LED THE ORGANIZATION FOR MORE THAN TWENTY YEARS AS CEO AND FOR SEVENTEEN YEARS AS A SENIOR EXECUTIVE PRIOR TO BECOMING CEO. IN RECOGNITION OF HIS SUCCESSFUL LEADERSHIP AND EXTENDED TENURE, AND TO ENCOURAGE CONTINUATION OF THIS RELATIONSHIP, THE BOARD OF DIRECTORS HAS PROVIDED A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN ("SERP") DESIGNED TO PROVIDE THE CEO WITH A SOURCE OF RETIREMENT INCOME. NORTHSIDE DOES NOT CONSIDER SERP PAYMENTS TO BE DEFERRED COMPENSATION FOR TAX REPORTING PURPOSES. THE SERP PAYMENTS ARE BASED ON A MATHEMATICAL FORMULA, PURSUANT TO A SIGNED CONTRACT, AND ARE REVIEWED AND ASSESSED PERIODICALLY FOR REASONABLENESS BY AN OUTSIDE CONSULTANT. THE COMPENSATION COMMITTEE AND FULL BOARD OF DIRECTORS APPROVE EACH PAYMENT BEFORE PAYMENT IS MADE. HOWEVER, NO FURTHER FUNDING OF THE SERP IS EXPECTED BASED ON ACTUARIAL PROJECTIONS. AS A RESULT, IN ORDER TO ASSIST FURTHER IN THE CEO'S RETENTION, THE COMPANY HAS ESTABLISHED AN ANNUAL RETENTION PROGRAM FOR THE CEO, PROVIDING FOR AN ANNUAL RETENTION INCENTIVE, BUT ONLY IF HE CONTINUES TO BE EMPLOYED ON THE LAST DAY OF EACH FISCAL YEAR, BEGINNING WITH THE FISCAL YEAR ENDING SEPTEMBER 30, 2022. NORTHSIDE DOES NOT CONSIDER THE RETENTION PAYMENTS TO BE DEFERRED COMPENSATION FOR TAX REPORTING PURPOSES. AS AN ADDITIONAL RETENTION INCENTIVE, THE BOARD OF DIRECTORS MAY DEFER A PORTION OF ANY ANNUAL BONUS PAYABLE TO THE CEO CONDITIONING PAYMENT OF THE DEFERRED PORTION ON THE CEO'S CONTINUED EMPLOYMENT. X 2175 X 8 10525 X OTHER 94 35313 0 0 0 FORM 990, PART I, LINE 1 THE NORTHSIDE HOSPITAL FOUNDATION, INC. IS ORGANIZED FOR THE PURPOSES OF SOLICITATION, COLLECTION AND RECEIPT OF GIFTS, GRANTS, AND CONTRIBUTIONS, THE MANAGEMENT OF ASSETS AND INVESTMENTS AND THE DELIVERY AND DISTRIBUTION OF MONEY AND PROPERTY, ALL TO OR FOR THE BENEFIT OF NORTHSIDE HOSPITAL, INC., A NONPROFIT HOSPITAL WHICH IS RECOGNIZED AS A TAX-EXEMPT ORGANIZATION UNDER IRC SECTION 501(C)(3). FORM 990, PART VI, SECTION A, LINE 7A MEMBERS OF THE GOVERNING BODY OF THE NORTHSIDE HOSPITAL FOUNDATION, INC. ARE ELECTED SUBJECT TO THE APPROVAL OF NORTHSIDE HEALTH SERVICES, INC., THE PARENT ENTITY. FORM 990, PART VI, SECTION A, LINE 7B NORTHSIDE HEALTH SERVICES, INC., THE PARENT ENTITY, MUST APPROVE BYLAW REVISIONS AND REVISIONS OF THE ARTICLES OF INCORPORATION FOR THE NORTHSIDE HOSPITAL FOUNDATION, INC. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 WAS PREPARED BY AN UNRELATED AND INDEPENDENT ACCOUNTANT USING DETAILED FINANCIAL STATEMENTS SUPPORTED BY A CONSOLIDATED AUDIT (ALSO PREPARED BY OUTSIDE, INDEPENDENT AUDITORS). NORTHSIDE FINANCIAL LEADERSHIP, INCLUDING THE SENIOR DIRECTOR OF CORPORATE FINANCE AND CFO, PERFORM A DETAILED REVIEW OF THE FORM 990 AND APPROVAL OF THE RETURNS BEFORE THEY ARE FILED. OUTSIDE COUNSEL REVIEWS SECTIONS AT NORTHSIDE'S REQUEST. FORM 990, PART VI, SECTION B, LINE 12C OFFICERS, DIRECTORS AND KEY EMPLOYEES ARE REQUIRED TO COMPLETE AND SIGN A DISCLOSURE QUESTIONNAIRE ANNUALLY, IN ACCORDANCE WITH THE CONFLICT OF INTEREST POLICY. NORTHSIDE'S LEGAL SERVICES DEPARTMENT REVIEWS CONTRACTS WITH OTHER CARE PROVIDERS, EDUCATIONAL INSTITUTIONS, MANUFACTURERS AND PAYORS TO DETERMINE WHETHER CONFLICTS OF INTEREST EXIST AND WHETHER THEY ARE WITHIN LAW AND REGULATION. FORM 990, PART VI, SECTION C, LINE 19 THE CORPORATE GOVERNANCE DOCUMENTS (SPECIFICALLY ALL ARTICLES OF INCORPORATION DOCUMENTS) ARE MADE AVAILABLE ON THE GEORGIA SECRETARY OF STATE WEBSITE. OUR CONFLICT OF INTEREST POLICY IS MADE AVAILABLE ON OUR INTRANET TO NORTHSIDE EMPLOYEES; HOWEVER, NEITHER OUR AUDITED FINANCIAL STATEMENTS NOR OUR CONFLICT OF INTEREST POLICY ARE MADE AVAILABLE TO THE PUBLIC. WHEN AND IF APPROPRIATE REQUESTS ARE MADE BY THE PUBLIC, WE EVALUATE DISCLOSURE ON A CASE BY CASE BASIS. FORM 990, PART VII, SECTION A, SHANNON BANNA AND ROBERT T. QUATTROCCHI, MEMBERS OF THE NORTHSIDE HOSPITAL FOUNDATION, INC.'S BOARD OF DIRECTORS, AND DEBORAH (MITCHAM) BILBRO, FORMER BOARD MEMBER, RECEIVED REPORTABLE RELATED COMPENSATION FOR MANAGEMENT SERVICES THEY PROVIDED TO NORTHSIDE HOSPITAL, INC. THEY DID NOT RECEIVE ANY COMPENSATION FOR SERVING ON THE BOARD OF DIRECTORS OF THE FOUNDATION. FORM 990, PART XI, LINE 9: ROUNDING ADJUSTMENT -1,099. FUNDRAISING AND NONCASH CONTRIBUTIONS -438,266. CHANGE IN NET ASSETS RELEASED FROM RESTRICTIONS 2,395,195. NORTHSIDE HOSPITAL INC 1000 JOHNSON FERRY ROAD ATLANTA GA 30342 581954432 HOSPITAL GA 501(C)(3) LINE 3 NORTHSIDE HEALTH SERVICES INC 0 NORTHSIDE HEALTH SERVICES INC 1000 JOHNSON FERRY ROAD ATLANTA GA 30342 581917328 PARENT HOLDING COMPANY GA 501(C)(3) LINE 12C, III-FI N/A 0 NORTHSIDE SHARES HELP INC 1000 JOHNSON FERRY ROAD ATLANTA GA 30342 581458873 PUBLIC CHARITY, ORGANIZED EMPLOYEE RELIEF FUND GA 501(C)(3) LINE 7 NORTHSIDE HEALTH SERVICES INC 0 GWINNETT HOSPITAL SYSTEM AUXILIARY INC 1000 JOHNSON FERRY ROAD ATLANTA GA 30342 581713644 ADMINISTRATIVE SERVICES GA 501(C)(3) LINE 3 N/A 0 GWINNETT HOSPITAL SYSTEM FOUNDATION INC 1755 NORTH BROWN ROAD STE 100 LAWRENCEVILLE GA 30043 581828486 RAISE FUNDS IN FURTHERANCE OF NORTHSIDE HOSPITAL'S EXEMPT PURPOSE GA 501(C)(3) LINE 7 N/A 0 NORTHSIDE VENTURES INC 1000 JOHNSON FERRY ROAD ATLANTA GA 30342 581954456 LEASING COMPANY GA N/A C 0 GWINNETT MANAGED CARE INC 1000 JOHNSON FERRY ROAD ATLANTA GA 30342 582135759 PROFESSIONAL SERVICES GA N/A C 0 NORTHSIDE HEALTH NETWORK INC 1000 JOHNSON FERRY ROAD ATLANTA GA 30342 843655289 PROFESSIONAL SERVICES GA N/A C 0 SEQUENT HEALTH PHYSICIAN PARTNERS 1000 JOHNSON FERRY ROAD ATLANTA GA 30342 471511997 CLINICALLY INTEGRATED ORGANIZATION GA N/A C 0 0 1 1 0 0 0 0 0 0 0 0 1 0 1 1 1 1 0 0