CHAR500

Send with fee and attachments to,
NYS Office of the Attorney General
Charities Bureau Registration Section
120 Broadway

NYS Annual Filing for Charitable Organizations
www.CharitiesNYS.com

2016
Open to Public
Inspection

New York, NY 10271

1. General Information
12

/

31

/ 2016

For Fiscal Year Be innin

mm/dd/

Check if Applicable:

Name of Organization: MONTEFIORE MEDICAL CENTER

Employer Identification Number (EIN):

Mailing Address:

NY Registration Number:

Address Change
Name Change

01- /

01

/ 2016 and Endin

mm/dd/

13-1740114

Initial Filing

111 EAST 210TH STREET

Final Filing

City / State / Zip:

Amended Filing

BRONX,

Reg ID Pending

Website:

10-63-91
Telephone:

NY 10467-2401

(914)

WWW.MONTEFIORE.ORG
Check your organization's

registration category:

349-8455

Email:

1_E-1 7A only

~ EPTL only

ERESNICK@MONTEFIORE.ORG
~ DUAL (7A & EPTL)

Confirm your Registration Category in the
~ EXEMPT Charities Registry at www.CharitiesNYS com.

2. Certification
See instructions for certification requirements. Improper certification is a violation of law that may be subject to penalties.
We certify under penalties of perjury that we reviewed this report, including all attachments, and to the best of our knowledge and belief,

they are true, correct and complete in accordance with the laws of the State of New York applicable to this report.
President or Authorized Officer: ~

c.

£~

n>LrLLEEN M. BLYE. EXEC V.P & C.F.0. ~L66-

~pnature

n~

Print Name and Title
EVAN RESNICK,

Chief Financial Officer or TreasurerT

Sign ur

V.P.

FINANCE

V

Date

tilioll-7

Print Name and Title

Date

3. Annual Reporting Exemption
Check the exemption(s) that apply to your filing. If your organization is claiming an emmption under one category (7A or EPTL only filers) or both
categories (DUAL filers) that apply to your registration, complete only parts 1, 2, and 3, and submit the certified Char500 No fee, schedules, or additional
attachments are required. If you cannot claim an exemption or are a DUAL filer that claims only one exemption, you must file applicable schedules and

attachments and pay applicable fees.
El

~

3a. 7A filina exemotion: Total contributions from NY State including residents, foundations, government agencies, etc. did not exceed $25,000
ansi the organization did not engage a professional fund raiser (PFR) or fund raising counsel (FRC) to solicit contributions during the fiscal year.
Or the organization qualifies for another 7A exemption (see instructions).
3 b. EPTL filing exemption: Gross receipts did not exceed $25,000 and the market value of assets did not exceed $25,000 at any time during

the fiscal year

4. Schedules and Attachments
See the following page

for a checklist of
schedules and
attachments to
complete your filing.

~ Yes

~ No

4a. Did your organization use a professional fund raiser, fund raising counsel or commercial co-venture
for fund raising activity in NY State? If yes, complete Schedule 4a.

~ Yes

~ No

4b. Did the organization receive government grants? If yes, complete Schedule 4b.

5. Fee
See the checklist on the
next page to calculate your

fee(s).Indicate fee(s)you

7A filing fee:

EPTL filing fee:

Total fee:

25.

Make a single check or money order

25.

are submitting here:

CHAR500 Annual Filing for Charitable Organizations (Updated December 2016)

payable to:

'1QeoatimROLQL,Jigir
Page 1

6J35501.000

06002L 0114

V 16-7F

PAGE 4

1

 CHAR500
Annual Filing Checklist

-

Simply submit the certified CHAR500 with no fee, schedule, or additional attachments IF:
Your organization is registered as 7A only and you marked the 7A filing exemption in Part 3.
- Your organization is registered as EPTL only and you marked the EPTL filing exemption in Part 3.
- Your organization is registered as DUAL and you marked both the 7A and EPTL filing exemption in Part 3.

[Ehecklist-of-Scheduiesand-Attachments
Check the schedules you must submit with your CHAR500 as described in Part 4:
n

If you answered 'yes" in Part 4a, submit Schedule 4a Professional Fund Raisers (PFR), Fund Raising Counsel (FRC), Commercial Co-Venturers (CCV)

 3E1

If you answered "yes" in Part 4b, submit Schedule 4b: Government Grants

Check the financial attachments you must submit with your CHAR500:

[X-~

IRS Form 990, 990-EZ, or 990-PF, and 990-T if applicable

[YEI All additional IRS Form 990 Schedules, including Schedule B (Schedule of Contributors).
E-1

Our organization was eligible for and filed an IRS 990-N e-postcard. We have included an IRS Form 990-EZ for state purposes only.

I f you are a 7A only or DUAL filer, submit the applicable independent Certified Public Accountant's Review or Audit Report:

E-1

Review Report if you received total revenue and support greater than $250,000 and up to $750,000.

 TI

Audit Report if you received total revenue and support greater than $750,000

Fl

No Review Report or Audit Report is required because total revenue and support is less than $250,000

~

We are a DUAL filer and checked box 3a, no Review Report or Audit Report is required

[Ealculate Y0urfee
IS_my_Registation Category 7A. EPTL. DUAL or EXEMPT?

For 7A and DUAL filers , calculate the 7A fee:
E-1

$0, if you checked the 7A exemption in Part 3a

1-*]

$25, if you did not check the 7A exemption in Part 3a

Organizations are assigned a Registration Category upon
registration with the NY Charities Bureau:
7A filers are registered to solicit contributions in New York
under Article 7-A of the Executive Law ("7A")

For EPTL and DUAL filers, calculate the EPTL fee:

EPTL filers are registered under the Estates, Powers & Trusts
Law ("EPTL") because they hold assets and/or conduct
activites for charitable purposes in NY.

Fill

$0, if you checked the EPTL exemption in Part 3b

~-~

$25. if the NET WORTH is less than $50,000

1~-1

$50, if the NET WORTH is $50,000 or more but less than $250,000

~

$100, if the NET WORTH is $250,000 or more but less than $1,000,000

EXEMPT filers have registered with the NY Charities Bureau
and meet conditions in Schedule E - Registration
Exemption for Charitable Organizations. These

~

$250, if the NET WORTH is $1,000,000 or more but less than $10,000,000

organizations are not required to file annual financial reports
but may do so voluntarily.

 ~1

$750, if the NET WORTH is $10,000,000 or more but less than $50,000,000

Fl

$1500, if the NET WORTH is $50,000,000 or more

DUAL filers are registered under both 7A and EPTL.

Confirm your Registration Category and learn more about NY
law at www.CharitiesNYS.com.

Where do I find my organization's NET WORTH?_

Send Your-Filing
Send your CHAR500, all schedules and attachments, and total fee to:
NYS Office of the Attorney General
Charities Bureau Registration Section
120 Broadway
New York, NY 10271

Total Liabilities (Part 11, line 23(b)).

CHAR500 Annual Filing for Charitable Organizations (Updated December 2016)
6J 3551 1.000

06002L 0114

NET WORTH for fee purposes is calculated on:
- IRS From 990 Part 1, line 22
- IRS Form 990 EZ Part I line 21
- IRS Form 990 PF, calculate the difference between
Total Assets at Fair Market Value (Part 11, line 16(c)) and

V 16-7.6F

Page 2
PAGE 3

 2016

CHAR500
Schedule 4a: Professional Fund Raisers, Fund Raising Counsels, Commercial Co-Venturers
www.CharitiesNYS.com

Open to Public
Inspection

If you checked the box in question 4a in Part 4 on the CHAR500 Annual Filing for Charitable Organizations, complete this schedule for EACH Professional
Fund Raiser (PFR), Fund Raising Counsel (FRC) or Commercial Co-Venturer (CCV) that the organization engaged for fund raising activity in NY State. The
PFR or FRC should provide its NY Registration Number to you. Include this schedule with your certified CHAR500 NYS Annual Filing for Charitable
Or anizations and use additional a es if necessa

1. Organization Information
NY Registration Number:
10-63-91

Name of Organization:

MONTEFIORE MEDICAL CENTER

2. Professional Fund Raiser, Fund Raising Counsel, Commercial Co-Venturer Information
Fund Raising Professional type:

[~ 

Professional Fund Raiser

E-1

Fund Raising Counsel

1-1 Commercial Co-Venturer

Name of FRP:

NY Registration Number:

Mailing Address:

Telephone:

City / State / Zip:

3. Contract Information
Contract Start Date:

Contract End Date:

4. Description of Services
Services provided by FRP

5. Description of Compensation
Amount Paid to FRP:

Compensation arrangement with FRP:

6. Commercial Co-Venturer (CCV) Report
E-1 Yes El No If services were provided by a CCV, did the CCV provide the charitable organization with the interim or closing report(s) required by
Section 173(a) part 3 of the Executive Law Article 7A?

Definitions
A Professional Fund Raiser (PFR), in addition to other activities, conducts solicitation of contributions and/or handles the donations (Article 7A, 171-a.4)
A Fund Raising Counsel (FRC) does not solicit or handle contributions but limits activities to advising or assisting a charitable organization to perform
such functions for itself (Article 7A, 171-a.9).
A Commercial Co-Venturer (CCV) is an individual or for-profit company that is regularly and primarily engaged in trade or commerce other than raising

funds for a charitable organization and who advertises that the purchase or use of goods, services, entertainment or any other thing of value will benefit a
charitable organization (Article 7A, 171-a.6).

CHAR500 Schedule 48: Professional Fund Raisers, Fund Raising Counsels, Commercial Co-Venturers (Updated December 2016)

Page 1

SJ3552 1.000

06002L 0114

V 16-7.6F

PAGE 4

 CHAR500

2016
Open to Public
Inspection

Schedule 4b: Government Grants
www.CharitiesNYS.com

If you checked the box in question 4b in Part 4 on the CHAR500 Annual Filing for Charitable Organizations, complete this schedule and list EACH
government grant. Use additional pages if necessary. Include this schedule with your certified CHAR500 NYS Annual Filing for Charitable Organizations.

1. Organization Information
NY Registration Number:

Name of Organization

10-63-91

MONTEFIORE MEDICAL CENTER

2. Government Grants
Amount of Grant

Name of Government Agency
1.

2.

1

FEDERAL-HEALTH CARE INNOVATION AWARDS

2

FEDERAL-CONSOLIDATED HEALTH CENTERS

3.3
FEDERAL-ALLERGY & INFECTIOUS DISEASE RESEARCH

4
5
6
7

8

9.
10

11

12
13

14

15

FEDERAL-SPECIAL SUPPLEMENTAL NUTRITION PROG

FEDERAL-COORDINATED SERV & ACCESS TO RESEARCH
FEDERAL-OCCUPATIONAL SAFETY & HEALTH PROGRAM

6

8

FEDERAL-0/P EARLY INTERVENTION SERV-HIV

INFANT HOME VISITING PROG

FEDERAL-AIDS EDUCATION AND TRAINING CENTERS

9
10.

11.

PEDERAL-OTHERS

12.

NYS-WIC PROGRAM

13

NYS-SCHOOL HEALTH PROGRAM
MYS-DOH-CLINICAL RESEARCH INVESTIGATOR PROG

14.

15.

MYS-NURSE FAMILY PARTNERSHIP PROGRAM

3,413,637.

2,462,686.

2,336,800.
2,007,715.

1,492,008.
1,246,198.

1,237,286.
826,724.

535,786.
10,635,872.

3,056,102.
2,471,253.

630,166.
501,910.

Total:

Total Government Grants:

CHAR500 Schedule 4b: Government Grants (Updated December 2016)
6J 3553 1.000

06002L 0114

5

7

FEDERAL-CANCER TREATMENT RESEARCH

FEDERAL-MATERNAL,

4

4,400,935.

V 16-7.6F

Page 1
PAGE 5

 CHAR500

2016
Open to Public
Inspection

Schedule 4b: Government Grants
www.CharitiesNYS.com

If you checked the box in question 4b in Part 4 on the CHAR500 Annual Filing for Charitable Organizations, complete this schedule and list EACH
government grant Use additional pages if necessary. Include this schedule with your certified CHAR500 NYS Annual Filing for Charitable Organizations.

1. Organization Information
NY Registration Number:

Name of Organization:

2. Government Grants
Amount of Grant

Name of Government Agency
1.
2

3
4

5

6
7.

8

9.

10

1

NYS-REGIONAL LEAD RESOURCE CENTER

2

NYS-AIDS PREVENTION SERVICES
NYS-ADOLESCENT/YOUNG ADULTS HIV SPEC CARE

3
4

NYS-OB/GYN GENETIC SERV PROGRAM

5

NYS-HCV CARE & TREATMENT

6

NYS-HIV PRIMARY CARE & RETENTION

7

NYS-OTHERS

8

NYC-DOSA

9

NYC-METHADONE PROGRAM

10.

NYC-INSPIRE GRANT

11.

11

12.

12

13

13

14.

14

15.

15.

Total Government Grants:

Total:

NYC-SCHOOL HEALTH PROGRAM

CHAR500 Schedule 4b: Government Grants (Updated December 2016)

314,209.
237,541.

226,968.
214,870.

157,555.
148,946.
543,917.

2,785,667.

1,802,783.
1;294,951.

935,957.

45,918,442.

Page 1

6J 3553 1.000

06002L 0114

V 16-7.6F

PAGE 6

 Exempt Organization Declaration and Signature for
Electronic Filing

8453-EO

Form

Forcatendar year 2016, ortax year beginning

, 2016, and ending

OMB No. 1545-1879

2@16

, 20

For use with Forms 990, 990-EZ, 990-PF, 1120-POL, and 8868

Departmint of the Treasury

Internal Revenue Ser,Ice

Name of exempt organization

Employer identification number

13-1740114

MONTEFIORE MEDICAL CENTER
~~!~

Type of Return and Return Information (Whole Dollars Only)

Check the box for the type of return being filed with Form 8453-EO and enter the applicable amount, if any, from the return. If you

check the box on line la, 2a, 3a, 4a, or Sa below and the amount on that line of the return being filed with this form was blank, then
leave line lb, 20,30,4b, or 50, whichever is applicable, blank ((jo not enter -0-). If you entered * on the return, then enter -0- on the
applicable line below. Do not complete more than one line in Part I.
la
2a
3a
4a
53

Form
Form
Form
Form
Form

990 check here h El b Total revenue, ifany (Form 990, Part VIll, column (A), line 12). . .
990-EZ check here ~
~ b Total revenue, if any (Form 990-EZ. line 9) ...........
1120-POL check here i
~ b Total tax (Form 1120-POL, line 22) ............
990-PF check here ~ _~ b Tax based on investment income (Form 990-PF, Part VI, line 5)
8868 check here I  X  b Balancedue (Form 8868, line 3c) .., .., ..... ,,....

5b

0.

Declaration of Officer

liliti
6

1b
2b
3b
40

I authorize the U.S. Treasury and its designated Financial Agent to initiate an Automated Clearing House (ACH) electronic funds

withdrawal (direct debit) entry to the financial institution account indicated in the tax preparation software for payment of the
organization's federal taxes owed on this return, and the financial institution to debit the entry to this account. To revoke a payment,
1 must contact the U.S. Treasury Financial Agent at 1-888-353-4537 no later than 2 business days prior to the payment (settlement)

date. I also authorize the financial institutions involved in the processing of the electronic payment of taxes to receive confidential
information necessary to answer inquiries and resolve issues related to the payment.
~

If a copy of this return is being filed with a state agency(ies) regulating charities as part of the IRS Fed/State program, I certify that I
executed the electronic disclosure consent contained within this return allowing disclosure by the IRS of this Form 990/990-EZ/990PF (as specifically identified in Part I above) to the selected state agency(ies)

Under penalties of perjury. I declare that I am an officer of the above named organization and that I have examined a copy of the

organization's 2016 electronic return and accompanying schedules and statements, and to the best of my knowledge and belief, they are true,

correct, and complete. I further declare that the amount in Part I above is the amount shown on the copy of the organization's electronic
return. I consent to allow my intermediate service provider, transmitter, or electronic return originator (ERO) to send the organization's return
to the IRS and to receive from the IRS (a) an acknowledgement of receipt or reason for rejection of the transmission, (b) the reason for any

delay in processing the return or refund, and (c) the date of any refund.

Sign

~~ C. QL~--..

Here

,

1 </b ~f

Signature of officer

113.Ul~1

EXEC v. p. & C.F.0.
~ Title-

Date

Declaration of Electronic Return Originator (ERO) and Paid Preparer (see instructions)

I declare that I have reviewed the above organization's return and that the entries on Form 8453-EO are complete and correct to the best of
my knowledge. If I am only a collector, I am not responsible for reviewing the return and only declare that this form accurately reflects the data
on the return The organization officer will have signed this form before I submit the return. I will give the officer a copy of all forms and
information to be filed with the IRS, and have followed all other requirements in Pub. 4163, Modernized e-File (MeF) Information for Authorized
IRS e-me Providers for Business Returns. If I am also the Paid Preparer, under penalties of perjury I declare that I have examined the above

organization's return and accompanying schedules and statements, and to the best of my knowledge and belief, they are true, correct, and
complete This Paid Preparer declaration is based on all information of which I have any knowledge.

ERO's

Use
Only

8.»'0

ERO's

signature F
Firm's name (or

.8%64*A
, ERNST & YOUNG U.S.

yours if self.employed), ~

address, and ZIP code

Date

11/11/17

Check if

Check if

also paid
reparer

selfemployed

X

LLP

ERO's SSN or PTIN

P00032493
EN 34-6565596
Phone no 212-773-3000

r 5 TIMES SQUARE NEW YORK NY 10036-6527

Under penalties of perjury, I declare that I have examined the above return and accompanying schedules and statements. and to the best of my knowledge

and belief. they are true, correct, and complete. Declaration of preparer is based on all information of which the preparer has any knowledge.

Paid
Preparer
Use Only

PAnt/Type preparers name

Preparers signature

Date

Check

if

PnN

self-em lo ed
Firm's name I
Firm's address ~

Firm's EIN

Phone no.

Form 8453-EO (2016)

For Privacy Act and Paperwork Reduction Act Notice, see back of form.

JSA
BE16751.000

06002L 0114

V 16-7F

PAGE 1

 Fofm

C Name of organization

13-1740114

MONTEFIORE MEDICAL CENTER
Doing business as

Na~ change

Number and street (or P.O. boxifmail is not delivered to street address)

Fin.Ifitvrn/

W-nated
Amind"

(914)

G Gross receipts $

NY 10467-2401

F Name and address 01 prindpal omcer

J
K

Form of organization:

~•

349-8455

City or town, state or province, country, and ZIP or foreign postal code

STEVEN SAFYER, M.D.
Pending
111 EAST 210TH STREET BRONX, NY 10467-2401
Tax-exempt status:
4947(a)(1) or
X 501 c)(3)
501(C) (
)4 (insert no.)
Website: i WWW. MONTEFIORE. ORG

1

E Telephone number

Room/suite

111 EAST 210TH STREET
BRONX,

f*tuin
Apphcallon

, 20
0 Employer identification number

chang,

Initial .tt,n

X

Corporation

Trust

Yes

H(b) A,I .11

Yes

suboia,nates kWed7

H(C) Group exemption number

i

NY

Summary
TO TEACH,

TO DI SCOVER AND TO

Activities & Governance

ADVANCE THE HEALTH OF THE COMMUNITIES WE SERVE.
Check this box h ~ if the organization discontinued its operations or disposed of more than 25% of its net assets
3
Number of voting members of the governing body (Part VI, line la)
4
lb)
line
VI,
(Part
body
Number of independent voting members of the governing

2

3

4
5

8
9

Contributions and grants (Part VIll, line lh) ...................
Program service revenue (Part VIll, line 2g) ...................

10
12

Investment income (Part VIll, column (A), lines 3,4, and ld)
Other revenue (Part Vill, column (A), lines 5,6d, Bc, 9c, 10c, andlle)
Total revenue - add lines 8 throu h11 must ual Part Vill, column A , line 12 .

13

Grants and similar amounts paid (Part IX, column (A), lines 1-3) .........

14

Benefits paid to or for members (Part IX, column (A), line 4) ...........

43.

22,780.
1,914.
26,775,679.

7b

-9,266,895.
Current Year

77,080,919.

81,552,673.

3,294,882,160. 3,471,345,329.
19,431,075.
37,287,043.
15,397,778.
14,422,867.
3,428,144,743. 3,583, 255,101.
2,254,471.
1,905,002.

0.

0.

2,158,870,070. 2,244,717,916.

Salaries, other compensation, employee benefits (Part IX, column (A), lines 5-10).
9 16 a Professional fundraising fees (Part IX, column (A), line 1 le)
4,372,061.
b Total fundraising expenses (Part IX, column (D), line 25) ~
UJ
17 Other expenses (Part IX, column (A). lines 118-11 d, 11 f-24e) ,,*,,..,,,,,
~ 15

0.

0.

1,230,745,298. 1,321,752,056.

Total expenses. Add lines 13-17 (must equal Part IX, column (A), line 25) ..........
Revenue less e enses. Subtract line 18 from line 12 ....................

18
19

44.

5
6

Total number of individuals employed in calendar year 2016 (Part V. line 28) o ~00
6 Total number of volunteers (estimate if necessary)
7a Total unrelated business revenue from Pan VIll, column (C). line 12

11

3,391,520,370. 3,568,724,443.
14,530,658.

36,624,373.

End of Year

Beginning of Current Year

EC
20
~
und Bala

No
NO

L Year of formation: 1884 M State of legal domicile:

b Net unrelated business taxable incomefrom Form 990-T, line 34 ........................
Prior Year

8

X

If -No.- attach a tist. (soe instructions)

527

Other I

Association

3,588,491,139.

H(a) 15 Ihis a group return for
subordlnates?

Briefly describe the organization's mission or most significant activities: TO HEAL,

1

Revenue

....

, 2016, and ending

A For the 2016 calendar year, or tax year beginning

Addr*Ss

2@16

Under section 501 (c), 527, or 4947(a)(1) of the Internal Revenue Code (except private foundations)
II Do not enter social security numbers on this form as It may be made public.
h Information about Form 990 and its instructions is at www.irs.gov/form990.

Department olthe Treasury
internal Revenue Sen,ice

B ch,ck d.*a.

OMB No. 1545·0047

Return of Organization Exempt From Income Tax

990

Total assets (Part X, line 16)

3,278,415,680. 3,212,796,276.

21

Total liabilities (Part X, line 26)

22

Net assets or fund balances. Subtract line 21 from line 20. . . . . . . . . . . . . . . . . .

2,425,626,135. 2,389,589,418.
823,206,858.
852,789,545.

Signature Block
Under penalties of perjury, I declare that I have examined this return, induding accompanying schedules and statements, and to the best of my knowledge and belief, it is

true, correct, and complete. Declaration of preparer (other than officer) is based on all in formation of which preparer has any knowledge

Sign
Here

,

Date

Signature of omcer

EXEC V.P.

& C.F.0.

~ *1:,5nt name andmle
PrintfType preparers name

Paid
Preparer
Use Only

CHRISTOPHER B BOGGS

0.-----

5*61*~ d. **

Firm'sname hERNST & YOUNG U.S. LLP
Firm'S address ~•5 TIMES SQUARE NEW YORK,

Date

11/11/17

Check

if

self-employed

PTIN

P00032493

FimMEIN h34-6565596

NY 10036-6527

May the IRS discuss this return with the preparer shown above? (see instructions) . For Papenvork Reduction Act Notice, see the separate Instructions.

Phone no.

212-773-3000

X Yes

No

Form 990 (2016)

JSA
6E 1010 1.000

06002L 0114

V 16-7F

PAGE 2

 13-1740114

MONTEFIORE MEDICAL CENTER

j

page 2

Form 990 (2016)

1

Statement of Program Service Accomplishments
Check if Schedule O contains a response or note to any line in this Part 111
Briefly describe the organization's mission:

ATTACHMENT 1

2

3

Did the organization undertake any significant program services during the year which were not listed on the

Fl Yes
prior Form 990 or 990-EZ?
0.
Schedule
on
lf'"Yes," describe these new services
Did the organization cease conducting, or make significant changes in how it conducts, any program

FYI No

 ~1 Yes 1-Yl No
If'Yes," describe these changes on Schedule 0
Describe the organization's program service accomplishments for each of its three largest program services, as measured by
expenses Section 501(c)(3) and 501(c)(4) organizations are required to report the amount of grants and allocations to others,

services?
4

the total expenses, and revenue, if any, for each program service reported.
4a (Co(le:

) (Expenses $ 2,778,791,476. including grants of $

105 737.

)(Revenue$_

3,250,271,253 L_)

) (Revenue $ _

221.073.104.

~

972.

~

ATTACHMENT 2

4b (Code:

) (Expenses $

359,417,270. including grants of $

1 015 974.

4c (Code:

) (Expenses $

96,967,884. including grants of $

793 695.

4d Other program services (Describe in Schedule 0.)
including grants of $
(Expenses $
3,235,176,630.
4e Total program service expenses ~

)(Revenue$

)

(Revenue $

)
Form 990 (2016)

JSA
6E 1020 1.000

06002L 0114

V 16-7.6F

PAGE 2

 MONTEFIORE MEDICAL CENTER

13-1740114
page 3

Form 990 (2016)

Checklist of Re uired Schedules

No

Yes

1

Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? /f "Yes,"

2
3

Is the organization required to complete Schedule B, Schedule of Contributors (see instructions)?.........
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to

2

candidates for public office? /f "Yes, "comp/ete Schedu/e C Part / ···············...........

3

1

4

election in effect during the tax yeaf? /f'Yes,"comp/ete Schedu/e CPart H.....................
5

X

Section 501(c)(3) organizations. Did the organization engage in lobbying activities, or have a section 501(h)

4

Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues,

assessments , or similar amounts as defined in Revenue Procedure 98- 19 ? /f 'Yes," complete Schedule C,

6

7
8

9

10

Did the organization maintain any donor advised funds or any similar funds or accounts for which donors

have the right to provide advice on the distribution or investment of amounts in such funds or accounts? /f

6

Did the organization receive or hold a conservation easement, including easements to preserve open space,

the environment, historic land areas , or historic structures? /f "Yes," complete Schedule D, Part 11

Did the organization maintain collections of works of art, historical treasures, or other similar assets? /f "Yes, "
complete Schedule D, Part 111
Did the organization report an amount in Part X, line 21, for escrow or custodial account liability, serve as a
custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or
debt negotiation services? /f'Yes," complete Schedu/e D, Part /V

Did the organization, directly or through a related organization, hold assets in temporarily restricted
endowments , permanent endowments, or quasi-endowments? /f "Yes," complete Schedule D, Part V.

If the organization's answer to any of the following questions is "Yes," then complete Schedule D, Parts VI,
11
VII, VIll, IX, or X as applicable.
a Did the organization report an amount for land, buildings, and equipment in Part X, line 10? /f "Yes,"
complete Schedule D, Part VI
b Did the organization report an amount for investments-other securities in Part X, line 12 that is 5% or more
of its total assets reported in Part X , line 16? /f "Yes, " comp/ete Schedu/e D, Part VII
c Did the organization report an amount for investments-program related in Part X, line 13 that is 5% or more
of its total assets reported in Part X , line 16? /f 'Yes," complete Schedule D, Part Vill . . . . . . . . . . . . . . . .
d Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets
reported in Part X, line 16? /f'Yes," comp/ete Schedule D, Part IX

. .
e Didtheorganizationreportanamountforotherliabilitiesin Part X, line 25? /f "Yes, " complete Schedule D, Part X . . . .
addresses
that
footnote
a
include
year
tax
the
for
f Did the organization's separate or consolidated financial statements
the organization' s liability for uncertain tax positions under FIN 48 (ASC 740)? /f 'Yes," complete Schedule D, Part X
12 a Did the organization obtain separate , independent audited financial statements for the tax year'? if "Yes,' complete
b Was the organization included in consolidated, independent audited financial statements for the tax year? /f

"Yes," and if the organization answered "No" to line 12a, then completing Schedule D, Parts XI and XII is optional

13 Isthe organizationaschool described insection 170(b)(1)(A)(ii)? /f"Yes,"comp/ete Schedu/e E. .........
14a Did the organization maintain an office, employees, or agents outside of the United States?. ...........
b Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking,
fundraising, business, investment, and program service activities outside the United States, or aggregate
foreign investments valued at $ 100 , 000 or more? /f "Yes," complete Schedule F, Parts I and IV
15 Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or other assistance to or
for any foreign organization? /f "Yes, " comp/ete Schedu/e F, Parts // and /V
16 Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or other
assistance to or for foreign individuals ? /f "Yes," complete Schedule F, Parts 111 and IV
17 Did the organization report a total of more than $15,000 of expenses for professional fundraising services on
Part IX, column (A), lines 6 and lle? if'Yes,"complete Schedu/e G, Part/ (see instructions). ...........
18 Did the organization report more than $15,000 total of fundraising event gross income and contributions on
Part VIll, lines 1 c and 8a? /f "Yes, " comp/ete Schedule G, Part //
19 Did the organization report more than $15,000 of gross income from gaming activities on Part VIll, line 9a?
If "Yes " com lete Schedule G Part 111

7

8

9

X

10

1la

X

1lb

X
X

llc

1ld
11 e

X
X

1lf

12a

12b

X

X

13

14a

X

14b

X

15

X

16
17

18

X

Form 990 (2016)

JSA
6E 1021 1.000

06002L 0114

V 16-7.6F

PAGE 3

 MONTEFIORE MEDICAL CENTER

13-1740114
page 4

Form 990 (2016)

Checklist of Re uired Schedules continued

23

Did the organization operate one ormore hospital facilities? /f"Yes,"comp/ete Schedu/e H. ............ 20a
If "Yes" to line 20a, did the organization attach a copy of its audited financial statements to this return?......20b
Did the organization report more than $5,000 of grants or other assistance to any domestic organization or
21
domestic government on Part IX, column (A), line 1 ? /f "Yes," complete Schedule 1, Parts l and ll
on
individuals
domestic
for
or
to
assistance
other
or
Did the organization report more than $5,000 of grants
Part IX, column (A), line 2?if 'Yes,"complete Schedu/e /,Parts/and///........................22
Did the organization answer 'Yes" to Part Vll, Section A, line 3, 4, or 5 about compensation of the

24 a

employees'? lf "Yes," complete Schedule J
Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than

20a
b
21
22

organization's current and former officers, directors, trustees, key employees, and highest compensated

X
X

X

23

$ 100 , 000 as of the last day of the year , that was issued after December 31 , 2002 ? /f 'Yes," answer lines 24b

through 24d and complete Schedule K. If "No," go to line 258............................. 24a
b
c

No

Yes

X

Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?....... 24b
Did the organization maintain an escrow account other than a refunding escrow at any time during the year

X
X

24c
24d
......
year?
the
during
time
any
at
outstanding
bonds
for
issuer
of'
behalf
"on
an
as
Did the organization act

to defease any tax-exempt bonds?
d
25 a

Section 501(c)(3), 501(c)(4), and 501(c)(29) organizations. Did the organization engage in an excess benefit

transaction with a disqualified person during the yeaf? If "Yes," complete Schedule L, Part I .

26

Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior
year, and that the transaction has not been reponed on any of the organization's prior Forms 990 or 990-EZ?
If "Yes," complete Schedule L, Part I
Did the organization report any amount on Part X, line 5,6, or 22 for receivables from or payables to any

27

.....,...,.......,
disqualified persons? /f "Yes, " complete Schedule L, Part //
Did the organization provide a grant or other assistance to an officer, director, trustee, key employee,

b

current or former officers, directors, trustees, key employees, highest compensated employees, or

X

25b

X

26

X

substantial contributor or employee thereof, a grant selection committee member, or to a 35% controlled

28

a
b

c

29
30
31
32

33
34

35 a
b
36

25a

entity orfamilymemberofanyofthesepersons? /f'Yes,"comp/ete Schedu/e L, Part W...............27
Was the organization a party to a business transaction with one of the following parties (see Schedule L,
Part IV instructions for applicable filing thresholds, conditions, and exceptions):
28a
A current or former officer, director, trustee, or key employee? /f "Yes," comp/ete Schedule L, Part /V .......
complete
"Yes,"
/f
?
A family member of a current or former officer, director , trustee , or key employee

X

28b

X

Schedule L, Part IV.
An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof)
was anofficer, director, trustee, ordirect orindirect owner? if "Yes,"complete Schedu/e L, Part /V......... 28c
Did the organization receive more than $25,000 in non-cash contributions? /f "Yes, " complete Schedu/e M..,.29
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified
30
conservation contributions? /f'Yes," comp/ete Schedu/e M
N,
Schedule
complete
"Yes,"
/f
Did the organization liquidate , terminate , or dissolve and cease operations?
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? /f 'Yes, "
complete Schedule N, Part 11
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations
sections 301.7701-2 and 301.7701-3? /f "Yes,"comp/ete Schedu/e R Part /
Was the organization related to any tax-exempt or taxable entity? / f 'Yes," complete Schedule R, Part 11, 111,

33

or/V, and Part V,/inel......................···························· 34
35a
Did the organization have a controlled entity within the meaning of section 512(b)(13)?
a
with
transaction
any
in
engage
or
from
If "Yes" to line 35a, did the organization receive any payment
35b
controlled entity within the meaning of section 512 ( b )( 13 )? /f "Yes, " complete Schedule R, Part V, line 2
non-charitable
exempt
an
to
transfers
any
make
Section 501(c)(3) organizations. Did the organization

related organization? /f "Yes, " comp/ete Schedu/e R Part V, hne 2 ..........................

36

37

Did the organization conduct more than 5% of its activities through an entity that is not a related organization
and that is treated as a partnership for federal income tax purposes? /f "Yes, " complete Schedule R,

37

38

Part VI
Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 1lb and
19? Note. All Form 990 filers are re uired to com lete Schedule O

38

X

X

X
X
X
X

Form 990 (2016)

JSA
6E 1030 1.000

06002L 0114

V 16-7.6F

PAGE 4

 13-1740114

MONTEFIORE MEDICAL CENTER

Page 5

Form 990 (2016)

Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a res onse or note to an line in this Part V .
Yes

1 a Enter the number reported in Box 3 of Form 1096. Enter * if not applicable ..........

la

No

707

0.
b Enter the number of Forms W-26 included in line la. Enter -0- if not applicable.........lb
c Did the organization comply with backup withholding rules for reportable payments to vendors and ---

1c

reportable gaming (gambling) winnings to prize winners?
2 a Enter the number of employees reported on Form W-3, Transmittal of Wage and Tax

Statements, filed for the calendar year ending with or within the year covered by this return..

2a

22,780

b If at least one is reported on line 2a, did the organization file all required federal employment tax returns?
Note . If the sum of lines la and 2a is greater than 250 , you may be required to e-file (see instructions)

2b

3a Did the organization have unrelated business gross income of $1,000 or more during the yeaR ..........

3a

b If " Yes ," has it filed a Form 990-T for this year? /f "No " to line 3b, provide an explanation in Schedule 0........
4a At any time during the calendar year, did the organization have an interest in, or a signature or other authority

3b

over, a financial account in a foreign country (such as a bank account, securities account, or other financial
account)?

X

X

X

4a

b If "Yes," enter the name of the foreign country: I
See instructions for filing requirements for FinCEN Form 114, Report of Foreign Bank and Financial Accounts

(FBAR)

5a
b
c
6a

Was the organization a party to a prohibited tax shelter transaction at any time during the tax year?. . . . . . . . .
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
If "Yes" to line 58 or 5b, did the organization file Form 8886-T?.
Does the organization have annual gross receipts that are normally greater than $100,000, and did the

gifts were not tax deductible?.
Organizations that may receive deductible contributions under section 170(c).
a Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods

and services provided to the payor?
b If "Yes," did the organization notify the donor of the value of the goods or services provided? ............
c Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was
required to file Form 8282?
7d
d If "Yes," indicate the number of Forms 8282 filed during the year
e Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?

8

Sa

Sb
5C

X

organization solicit any contributions that were not tax deductible as charitable contributions? ........... 6a

b If "Yes," did the organization include with every solicitation an express statement that such contributions or
7

~

6b

7a
7c

--1
7f

g If the organization received a contribution of qualified intellectual property. did the organization file Form 8899 as required?
h If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C?

7

Sponsoring organizations maintaining donor advised funds. Did a donor advised fund maintained by the

X

7e

f Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract? .....

sponsoring organization have excess business holdings at any time during the yeaf?

X

7b

7h

8

j

Sponsoring organizations maintaining donor advised funds.
a Did the sponsoring organization make any taxable distributions under section 4966?................. 9a
b Did the sponsoring organization make a distribution to a donor, donor advisor, or related person?..........9b
10 Section 501(c)(7) organizations. Enter:
9

a Initiation fees and capital contributions included on Part VIll, line 12 .............. 10a

11

b Gross receipts, included on Form 990, Part VIll, line 12, for public use of club facilities. ....
Section 501(c)(12) organizations. Enter:
a Gross income from members or shareholders
b Gross income from other sources (Do not net amounts due or paid to other sources

1 Ob

1la
11b

against amounts due or received from them )

12 a Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?
blf "Yes," enter the amount of tax-exempt interest received or accrued during the year. .....12b
13 Section 501(c)(29) qualified nonprofit health insurance issuers.

12a

13a
a Is the organization licensed to issue qualified health plans in more than one state? ..................
Note. See the instructions for additional information the organization must report on Schedule O.
b Enter the amount of reserves the organization is required to maintain by the states in which

the organization is licensed to issue qualified health plans

13b

13c
14a
.............
year?
tax
the
14 a Did the organization receive any payments for indoor tanning services during
14b
0
Schedule
in
"
lanation
"No
ex
/f
an
rovide
ments?
a
these
b If "Yes " has it filed a Form 720 to re ort
c Enter the amount of reserves on hand

Form 990 (2016)

JSA

6E 1040 1.000

06002L 0114

X

V 16-7.6F

PAGE 5

 Form 990 (2016)

page 6

13-1740114

MONTEFIORE MEDICAL CENTER

Governance, Management, and Disclosure For each "Yes " response to lines 2 through 7b below, and for a "No"
response to line Ba, 80, or 100 below, describe the circumstances, processes, or changes in Schedule O. See instructions.
Check if Schedule 0 contains a response or note to any line in this Part VI ........................ X
Section A. Governin Bod and Mana ement
No

Yes

la Enter the number of voting members of the governing body at the end of the tax year .....

la

4
-

If there are material differences in voting rights among members of the governing body, or if the governing

body delegated broad authority to an executive committee or similar committee, explain in Schedule 0

b Enter the number of voting members included in line 1 a, above, who are independent .....

1b

4

Did any officer, director, trustee, or key employee have a family relationship or a business relationship with

2

any other officer, director, trustee, or key employee?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2X

Did the organization delegate control over management duties customarily performed by or under the direct

3

X

supervision of officers, directors, or trustees, or key employees to a management company or other person? .

4

Did the organization make any significant changes to its governing documents since the prior Form 990 was filed?......

5

Did the organization become aware during the year of a significant diversion of the organization's assets?....

6
7a

Did the organization have members or stockholders?
Did the organization have members, stockholders, or other persons who had the power to elect or appoint

one or more members of the governing body?
b

Are any governance decisions of the organization reserved to (or subject to approval by) members,

stockholders, or persons other than the governing body?

4

X

5

6

X

7a

X

7b

X

8a

X

8b

X

Did the organization contemporaneously document the meetings held or written actions undertaken during

8

the year bythe following:
a The governing body?. .................................................
b Each committee with authority to act on behalf of the governing body?
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at
9

9
the or anization's m ailin address? /f 'Yes," rowde the names and addresses in Schedu/e O ...........
Section B. Policies This Section B re uests information about olicies not re uired b the Internal Revenue Code.
10a
b
11 a

Did the organization have local chapters, branches, or affiliates?
If 'Yes," did the organization have written policies and procedures governing the activities of such chapters,

affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes? . . .

Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form? .

b Describe in Schedule O the process, if any, used by the organization to review this Form 990
12a Did the organization have a written conflict of interest policy? /f "No, " go to /ine 13
b Were officers, directors, or trustees, and key employees required to disclose annually interests that could give

rise to conflicts? ....................................................
c

13
14
15

Did the organization regularly and consistently monitor and enforce compliance with the policy? /f "Yes,"
describe in Schedule 0 how this was done
Did the organization have a written whistleblower policy?
Did the organization have a written document retention and destruction policy?..................
Did the process for determining compensation of the following persons include a review and approval by

X
Yes

No

10a X
1 Ob
1la

X
X

IIJ
12a X
12b X

12c X
13 X
14

X

independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision? --~

a The organization's CEO, Executive Director, or top management official
b Other officers or key employees of the organization
I f "Yes" to line 15a or 15b, describe the process in Schedule 0 (see instructions)
16 a

Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement

with a taxable entity during the year'?
b

15a

15b

16a X

If "Yes," did the organization follow a written policy or procedure requiring the organization to evaluate its

participation in joint venture arrangements under applicable federal tax law, and take steps to safeguard the - 16b X
organization's exempt status with respect to such arrangements?
Section C. Disclosure
17
18

19

List the states with which a copy of this Form 990 is required to be filed hNY
only)
501(c)(3)s
Section 6104 requires an organization to make its Forms 1023 (or 1024 if applicable), 990, and 990-T (Section
apply.
that
all
Check
available
these
made
you
how
Indicate
available for public inspection.
F-1 Other (explain in Schedule 0)
FY  Upon request
Fl Own website  ~  Another's website
Describe in Schedule 0 whether (and if so, how) the organization made its governing documents, conflict of interest policy, and

financial statements available to the public during the tax year.
20

possesses the organization's books and records: 4
State the name, address, and telephone number of the person who
914-349-8455
10591-6301
EVAN RESNICK 555 SOUTH BROADWAY BLDG A FL 1 TARRYTOWN,

NY

JSA
6E 1042 1 000

06002L 0114

V 16-7.6F

PAGE 6

 page 7

13-1740114

MONTEFIORE MEDICAL CENTER

Form 990 (2016)

Compensation of Officers, Directors, Trustees, Key Employees, Highest Compensated Employees, and
Independent Contractors

Check if Schedule 0 contains a response or note to any line in this Part VII ......................

EJ

Officers, Directors, Trustees, Ke Em lo ees, and Hi hest Com ensated Em lo ees
Section A.
1 a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the

organization's tax year.
• List all of the organization's current officers, directors, trustees (whether individuals or organizations), regardless of amount of
compensation. Enter -0- in columns (D), (E), and (F) if no compensation was paid.
. List all of the organization's current key employees, if any. See Instructions for definition of "key employee "
• List the organization's five current highest compensated employees (other than an officer, director, trustee, or key employee)
who received reportable compensation (Box 5 of Form W-2 and/or Box 7 of Form 1099-MISC) of more than $100,000 from the

organization and any related organizations.

• List all of the organization's former officers, key employees, and highest compensated employees who received more than

$100,000 of reportable compensation from the organization and any related organizations.

• List all of the organization's former directors or trustees that received, in the capacity as a former director or trustee of the

organization, more than $10,000 of reportable compensation from the organization and any related organizations.
List

persons

in

the

following

order:

individual

trustees

or

directors;

institutional

trustees;

officers;

key

highest

employees;

compensated employees; and former such persons
~~  Check this box if neither the organization nor any related organization compensated any current officer, director, or trustee.
(C)
(A)

Name and Title

(8)

Position

Average

(do not check more than one
box, unless person is both an
officer and a director/trustee)

hours per
week (list an

hours for
related

~~~9~

~~

~1

92

'<

~'5

3

&

3

organizations 22·
below dotted ~E
line)
2

1 ODED ABOODI
VICE CHAIRMAN & TREASURER
2 JAY B ABRAMSON
TRUSTEE
3 MARGARET HAYES ADAME

TRUSTEE
4 GEORGE ASCH
TRUSTEE
5 JOSEPH W BARTLETT
TRUSTEE
6 PATRICIA BAUMAN
TRUSTEE
7 JAMES M BUTLER
TRUSTEE
8 GEORGE CAMPBELL, JR. , PH. D
TRUSTEE (EMERITUS 6/14/16)
9 BRUCE DONIGER
TRUSTEE
10 RUTH L GOTTESMAN, ED.D.
TRUSTEE
11 BARRY W GRAY
TRUSTEE
12 PATRICIA GREEN
TRUSTEE
13 THOMAS L HARRISON
TRUSTEE
14 JOHN HEFFER
TRUSTEE

.75
1.75
.75
1.75
.50
1.50
.50
1.00
.50
1.00

Z

S
0
5

f

-

3 fR
·3 % 8

2

(D)

(E)

(F)

Reportable

Reportable

Estimated

compensation
from
the

compensation from
related
organizations

organization

(W-2/1099-MISC)

amount of
other
compensation
from the
organization
and related
organizations

(W-2/1099-MISC)

CD

X

X

0

X
X

0

0

0

X

0

0

0

X

0

0

0

X

0

0

0

1.00

X

0

0

0

.50
1.50
.50

X

0

0

0

1.00

X

0

0

0

.50
1.00

X
0

.50
1.00

.75
2.25
.50
1.00
.50

X

.50
1.00
.75

X

0

0

1.75

X

0

0

0
Form 990(2016)

JSA

6E 1041 1 000

06002L 0114

V 16-7.6F

PAGE 7

 13-1740114

MONTEFIORE MEDICAL CENTER

page 8

Form 990 (2016)

Section A. Officers, Directors, Trustees , Ke Em lo ees , and Hi hest Com ensated Em lo ees continued
(A)

(8)

(C)

(D)

(E)

(F)

Name and title

Average

Position

Reportable

Reportable

hours per
week (list any
hours for

(do not check more than one
box, unless person is both an
officer and a director/trustee

compensation
from
the

compensation from
related
organizations

Estimated
amountof

organization

(W-2/1099-MISC)

organizations Sl

s

n 5

5

below dotted
line)

LEWIS HENKIND

1.75

16)

SECRETARY
HELEN A JOHNSON

TRUSTEE

1.75

18)

19)
20)
21)

22)
23)

24)

FS

&

3

1

(w-2/1099-MISC)

X

0.

0.

X

0.

0.

X

0.

0.

0

.75

.50

DAVID B KEIDAN

TRUSTEE

1.00

ALAN M KLEIN

1.00

TRUSTEE
STACEY R LANE
TRUSTEE
JAY B LANGNER
TRUSTEE/CHAIRMAN EMERITUS
MARGARET S NATHAN

2.50

X

0.

0.

.75
1.75
.50

X

0.

0.

1.00

X

0.

0.

TRUSTEE

1.00

X

0.

0.

X

0.

0.

X

0.

0.

.50
.50

PETER J NEUPELD
TRUSTEE
GAYLE F ROBINSON

1.00

.50
.50
1.00
.50

JON W ROTENSTREICH

TRUSTEE
25)

i

.75

15)

17)

R

other
compensation
from the
organization
and related
organizations

HON FELICE K SHEA

0.

1b
c
d
2

0.

0.

Sub.total ,
,
,
,
9,505,085. 13,186,738.
Total from continuation sheets to Part VII, Section A
9,505,085. 13,186,738.
Total add lines lb and lc
more than $100,000 of
received
Total number of individuals (including but not limited to those listed above) who

reportable compensation from the organization I

0.
2,266,204.
2,266,204.

4904

Yes No
3
4

Did the organization list any former officer, director, or trustee, key employee, or highest compensated

3

employee on line la? If "Yes," complete Schedule J for such individual

For any individual listed on line la, is the sum of reportable compensation and other compensation from the

organization and related organizations greater than $ 150 , 000 ? /f "Yes," complete Schedule J for such

4

individual
5

X

----1

Did any person listed on line 1 a receive or accrue compensation from any unrelated organization or individual
for services rendered tothe or anization? /f«Yes,"com /ete Schedu/e J forsuch erson ,..,,.......,...

5

Section B. Independent Contractors

1

Complete this table for your five highest compensated independent contractors that received more than $100,000 of

compensation from the organization. Report compensation for the calendar year ending with or within the organization's tax

year.
(A)
Name and business address

(8)

(C)

Description of services

Compensation

ATTACHMENT 5

2

Total number of independent contractors (including but not limited to those listed above) who received

more than $100,000 in compensation from the organization i

329
Form 990 (2016)

JSA
GE 1055 2000

06002L 0114

V 16-7.6F

PAGE 8

 13-1740114

MONTEFIORE MEDICAL CENTER

page 8

Form 990 (2016)

Section A. Officers , Directors , Trustees , Ke Em lo ees , and Hi hest Com ensated Em lo ees continued
(A)
Name and title

26)

'

EDWIN H STERN,

(B)

(C)

(D)

Average

Position

Reportable

hours per
week (list any
hours for

(do not check more than one
box, unless person is both an

compensation
from
the
organization

officer and a director/trustee

related

R~

~

* 8

32

organizations

S&

Ef

N

~S

below dotted
line)

0 ~

~

s

vi
&

Zi

(F)

(E)
Reportable

Estimated

compensation from
related
organizations
(W-2/1099-MISC)

(W-2/1099-MISC)

~ ~

amountof
other
compensation
from the
organization
and related
organizations

3

.50

III

TRUSTEE

1.00

27)

DAVID A TANNER

4.00

CHAIRMAN
CYNTHIA KING VANCE

4.25

28)

TRUSTEE

1.75

X

0.

X

0.

X

0.

X

0.

.75

.50

29)

JIDE J ZEITLIN

TRUSTEE
JENNIE EMIL

1.00

30)

TRUSTEE

1.00

X

0.

31)

JONATHAN A LIPTON

.50
1.00

X

0.

32)

TRUSTEE
ZITA G ROSENTHAL

.50

.50

0.
33)
34)
35)

,

36)

TRUSTEE

.50
1.00
.50
1.50
.50
1.00

MELISSA CERIALE
TRUSTEE

2.50

GREGG S HYMOWITZ
TRUSTEE
NATHAN GANTCHER
TRUSTEE
CATHERINE KLEMA

X

0.

X

0.

X

0.

X

0.

1.00
0

0

i

1 b Sub-total
c Total from continuation sheets to Part VII, Section A

d Total add lines lb and lc ............................,
2

Total number of individuals (including but not limited to those listed above) who received more than $100,000 of

reportable compensation from the organization ~

4904

Yes No
3
4

Did the organization list any former officer, director, or trustee, key employee, or highest compensated

employee on line la? If 'Yes," complete Schedule J for such individual

IIJ
3

For any individual listed on line la, is the sum of reportable compensation and other compensation from the

organization and related organizations greater than $ 150 , 000 ? /f «Yes," complete Schedule J for such
individual

4

X

--1

5 Did any person listed on line 1 a receive or accrue compensation from any unrelated organization or individual
5
for services rendered tothe or anization? if'Yes,"com lete Schedule J forsuch erson ................
Contractors
Section B. Independent
1 Complete this table for your five highest compensated independent contractors that received more than $100,000 of
compensation from the organization. Report compensation for the calendar year ending with or within the organization's tax

year.
(A)
Name and business address

2

(8)

(C)

Description of services

Compensation

Total number of independent contractors (including but not limited to those listed above) who received

more than $100,000 in compensation from the organization I

Form 990 (2016)

JSA
6E 1055 2.000

06002L 0114

V 16-7.6F

PAGE 9

 13-1740114

MONTEFIORE MEDICAL CENTER

page 8

Form 990 (2016)

Section A. Officers, Directors, Trustees , Ke Em lo ees , and Hi hest Com ensated Em lo ees continued
(A)

(B)

(C)

(D)

(E)

(F)

Name and title

Average

Position

Reportable

Reportable

hours per
week (list any
hours for

(do not check more than one
box, unless person is both an
officer and a director/trustee

compensation
from
the

compensation from
related
organizations

Estimated
amountof
other

o

organization

(W-2/1099-MISC)

i

(W-2/1099-MISC)

related

0-

5

0

n 9

5£

=

~ ~

~

organizations 2 &
below dotted

2

E

~

M I

~

~ S

4E

~ m8

":

38)

MARK MLOTEK
TRUSTEE (RESIGNED 6/14/16)
BARRY S BLATTMAN

39)

TRUSTEE
MARK E BROSSMAN

37)

40)
41)

42)
43)
44)
45)

46)
47)

TRUSTEE
MATTHEW H NORD
TRUSTEE
MICHAEL A STOCKER, M.D.
TRUSTEE
ROGER EINIGER
TRUSTEE
JOEL BRAUN
TRUSTEE (ELECTED 10/18/16)
EMANUEL CHIRRICO
TRUSTEE (ELECTED 10/18/16)
W. NORMAN MILNER
TRUSTEE (ELECTED 2/9/16)

STEVEN SAFYER, M.D.
PRESIDENT & CEO/EX-OFFICIO
JOEL PERLMAN
EXEC VP & CFO(RESIGNED 1-6-16)

3 ,a

m

compensation
from the
organization
and related

organizations

E

i

.50
1.00

X

0.

0.

0

.50
1.00

X

0.

0.

0

X

0.

0.

0

X

0.

0.

0

X

0.

0.

0.

0.

0
0

X

0.

0.

0

X

0.

0.

0

X

0.

0.

0

X

0.

4,327,957.

51,831.

X

0.

1,454,254.

51,654.

.50
1.00
.50
1.00
.75
2.25
.50
1.50

X

.50
1.00
.50
1.00
.50
1.00
27.50
32.50
27.40
32.60

X

1 b Sub-total
c Total from continuation sheets to Part Vll, Section A

d Total add lines lb and lc ............................,

2

3
4

5

of
Total number of individuals (including but not limited to those listed above) who received more than $100,000

reportable compensation from the organization i

4904

Yes No

d
Did the organization list any former officer, director, or trustee, key employee, or highest compensate

employee on line la? /f "Yes," comp/ete Schedu/e J for such individua/ ··················........

from the
For any individual listed on line 1 a, is the sum of reportable compensation and other compensation

organization and related organizations greater than $ 150 , 000? M «Yes," complete Schedule J for such
individual
Did any person listed on line 1 a receive or accrue compensation from any unrelated organization or individual

for services rendered to the or anization? /f "Yes," com /ete Schedu/e J for such erson ................

-3
X

3
-4

X

-li
X

5

Section B. Independent Contractors

1

Complete this table for your five highest compensated independent contractors that received more than $100,000 of
s tax
compensation from the organization. Report compensation for the calendar year ending with or within the organization'

year.
(A)
Name and business address

2

(8)

(C)

Description of services

Compensation

1

Total number of independent contractors (including but not limited to those listed above) who received

more than $100,000 in compensation from the organization ~

JSA
SE 1055 2 000

06002L 0114

V 16-7.6F

Form 990 (2016)

PAGE 10

 13-1740114

MONTEFIORE MEDICAL CENTER

page 8

Form 990 (2016)

Section A. Officers, Directors , Trustees , Ke Em lo ees , and Hi hest Com ensated Em lo ees continued
(A)

(B)

(C)

(D)

(E)

(F)

Name and title

Average

Position

Reportable

Reportable

Estimated

hours per
week (list any

(do not check more than one
box, unless person is both an
officer and a director/trustee

compensation
from
the
organization

compensation from
related
organizations

amount of
other
compensation
from the
organization
and related
organizations

hours for

~~

5

2

5

32

Z'

organizations as

related

S
0

g
9

®
3

~S
M-

1
9

.%

2

below dotted

n E

0

line)

(W-2/1099-MISC)

(W-2/1099-MISC)

n

'

48)

49)

CHRISTOPHER PANCZNER
SENIOR VP & GENERAL COUNSEL
PHILIP O OZUAH, M.D.,__PH-·_I-____

EXECUTIVE VP & COO
50)
51)
52)
53)

COLLEEN M. BLYE
EXEC VP & CFO (ELECTED 1/6/16)
SUSAN GREEN-LORENZEN, RN
SYSTEM SENIOR VP-OPERATIONS
LYNN RICHMOND
EXECUTIVE VICE PRESIDENT
ROBERT MICHLER, M.D.

24.70
35.30
26.30
33.70
27.80
32.20
27.00
33.00
26.30
33.70

55)

DDS

60.00

0.

JOSEPH DE ROSE,

DANIEL GOLDSTEIN,

0

2,492,636.

538,092.

X

0

1,313,840.

429,032.

X

0

1,163,388.

366,879.

X

0

1,393,009.

420,068.

X

3,361,209.

0

51,899.

1,874,323.

0

49,104.

1,455,521.

0

51,281.

1,553,925.

0

49,088.

1,260,107.

0

19,550.

60.00

M.D.

0.

DIR MIN INVASIVE/ROBOTIC SURG
57)

X

0.

CHAIRMAN-RADIATION ONCOLOGY
56)

187,726.

60.00

M.D.

SHALOM KALNICKI,

1,041,654.

0.

CHAIRMAN-DENTISTRY

RICHARD KRAUT,

0

60.00

CHAIR-SURG/CARDIOTHORACIC SURG
54)

X

60.00

M.D.

VICE CHAIR-CARDIOTHORACIC SURG

0.

1 b Sub-total
c Total from continuation sheets to Part VII, Section A

d Total add lines lb and lc ............................,
2

Total number of individuals (including but not limited to those listed above) who received more than $100,000 of
4904
reportable compensation from the organization I

Yes No
3
4

5

Did the organization list any former officer, director, or trustee, key employee, or highest compensated

employee on line la? If "Yes," complete Schedule J for such individual

......
3

For any individual listed on line 1 a, is the sum of reportable compensation and other compensation from the

organization and related organizations greater than $ 150 , 000? M «Yes," complete Schedule J for such
individual

Did any person listed on line 1 a receive or accrue compensation from any unrelated organization or individual
for services rendered to the or anization? lf 'Yes,"com lete Schedu/e J for such erson ................

4

X

......
x
5

Section B. Independent Contractors

1

Complete this table for your five highest compensated independent contractors that received more than $100,000 of
compensation from the organization Report compensation for the calendar year ending with or within the organization's tax

year.

2

(A)

(8)

(C)

Name and business address

Description of services

Compensation

Total number of independent contractors (including but not limited to those listed above) who received

more than $100,000 in compensation from the organization h

Form 990 (2016)

JSA
GE10552 000

06002L 0114

V 16-7.6F

PAGE 11

 13-1740114

MONTEFIORE MEDICAL CENTER

Form 990 (2016)

Page 9

Statement of Revenue

Program Service Revenue and Oth

Contribut'l
mitl'tl,2:::

Check if Schedule O contains a response or note to any line in this Part VIll .

la

1b

e

Government grants (contributions) . .

le

45 918 442

f

All other contributions, gifts, grants,

lf

28 440 086.

and similar amounts not included above

(C)

(D)

Unrelated

Revenue

exempt
function
revenue

business
revenue

excluded from tax
under sections
512-514

2 309 826.

1d

g

Noncash contributions included in lines la-lf $

h

Total. Add lines la-1 f ..........

4

703

752.

77 080 919.

- --

Business Code
037

INPATIENT SERVICES

623000

2 037 149 892.

2

QUIPATIENTSYCS_EXCLUDINGHOME-HEALTH

621400

1 239 601

1 237

c

CONIEEZLMANAGEMENT_ORGANIZATIONSERY.

621999

65 500 863.

d

HOME HEALTH CARE SERVICES

621610

26 577

EUITY__EARNINGS_ON_PROGRAMINVESTMENES

523999

24

2a

b

e

f

All other program service revenue.....
Total. Add lines 2a-2f ...........

3

interest,
(including dividends,
income
Investment
and other similar amounts) ................,

4
5

Income from investment of tax-exempt bond proceeds . I
Royalties
(ii) Personal
(i) Real

6a

Gross rents........
Less: rental expenses...
Rental income or (loss) . .

b

c
d
7a

3

442

3 514

983.

3 471 345

329.

14

539.

328

991 781.

1 609 549.

715.

24 493 148.

41 007

ij

892

26 577 974

24

197 607.

584 680.

77 732 983.

88 322.

14

240 217.

0.
0

~

983

628.

-71 645.

-71 645.

(i) Secunties

(ii) Other

569 190.

651 498.

4 569 190.

533 346.

4

b

Less: cost or other basis

c

and sales expenses ....
Gain or (loss) . ......

d

Net gain or (loss) ..............

Ba

974.

782 287.

77 732

Net rental income or (loss)

Gross amount from sales of

330.

149

-71 645.

assets other than inventory

Other Revenue

.

ic

(B)
Related or

412 565.

Federated campaigns ........la

Membership dues ..........
Fundraising events .........
Related organizations ........

b
c
d

(A)
Total revenue

118 152.

-20.

5 102 536.

4 569 210.

Gross income from fundraising

events (not including $ _ 21309,82§
of contributions reported on line lc).
b
c

9a

See Part IV, line 18
Less: direct expenses . . . . . . . . . . b
Net income or (loss) from fundraising events.

Gross income from gaming activities
See Part IV, line 19

968 635.

1 603 258.

..'

b

sales of inventory, less
returns and allowances.........a
Less: cost of goods sold ······... b

o

c

Net income or (loss) from sales of inventory. .

10a

b
c

d
e

12

0.
13 800.

13 800.

Gross

Miscellaneous Revenue

1la

623.

13 800

Less: direct expenses ..........b
Net income or (loss) from gaming activities.

b
c

-634

-634 623.

0

Business Code

]

CAFETERIA & VENDING INCOME

722514

6 346

PARKING INCOME

812930

6 279 352.

900099

631 689.

SUBPOENA INCOME

Total. Add lines 118-1ld ...

346

115.

6 279 352.
631 689.
2

2 833 090.

All other revenue .......
Total revenue. See instructions

6

115.

833

090.

16 090 246.
3

583

255

101.

3 444

657

952.

26 775 679.

34

207 205

Form 990(2016)

JSA
6E 1051 1.000

06002L 0114

V 16-7.6F

PAGE 12

 13-1740114

MONTEFIORE MEDICAL CENTER

Form 990 (2016)

Page 10

Statement of Functional Ex enses
Section 501(c)(3) and 501(c)(4) organizations must completeallcolumns. Allother organizations mustcompletecolumn (A)
Check if Schedule O contains a response or note to any line in this Part IX
Do not inc/ude amounts reported on lines Gb, 74

ab, 9b, and 10b of Part Vill.

(8)

(A)

Program service

Total expenses

expenses

Grants and other assistance to domestic organizations

1

and domestic governments. See Part IV, line 21 . . . .

and

Grants

2

other

assistance

to

and

Grants

other

assistance

general expenses

to

(D)
Fundraising

expenses

2,148,734.

2,148,734.

!

.'

domestic

individuals. See Part IV, line 22 .........
3

(C)

Management and

0.

foreign

I

organizations, foreign governments, and foreign
individuals. See Part IV, lines 15 and 16
Benefits paid to or for members

4

1

105,737.

105,737.

5 Compensation of current officers, directors,

trustees, and key employees ..........
Compensation not included above, to disqualified

6

persons (as defined under section 4958(0(1)) and
persons descnbed in section 4958(c)(3)(8)

Other salaries and wages

7

section 401(k) and 403(b) employer contributions)

9 Other employee benefits ............
11

0.

1,708,927,634. 1,573,826,166.

132,956,946.

2,144,522.

136,675,760.
283,094,239.
116,020,283.

126,935,684.
257,519,411.
107,333,151.

9,572,484.
25,227,698.
8,544,868.

167,592.
347,130.
142,264.

682,471.
11,711,066.
1,565,864.
909,911.

110,629.
3,803,909.

571,842.
7,907,157.
1,565,864.

Pension plan accruals and contributions (include

8

10

0.

Payroll taxes
Fees for services (non-employees):
a Management

b Legal
c Accounting
d Lobbying

909,911.

e Professional fundraising services. See Part IV, line 17,

f Investment management fees

.........

g Other. (lf line 119 amount exceeds 10% of line 25, column
(A) amount, list line 119 expenses on Schedule 0.) ......

12

Advertising and promotion

13
14
15

Office expenses
Information technology
Royalties

423,477.

38,195,123.

42,364,368.
9,555,041.
21,037,442.
27,911,448.

121,385,919.
9,264,941.

6,135,133.
1,850,473.

114,011.
98,481.

4,555,859.

336,542.

8,415.

117,028,226.
457,763.
133,788,942.

159,816,071.
10,012,804.
155,119,864.
66,183,025.

293,480.
76,454.

0.
127,635,063.
11,213,895.

16 Occupancy
17

2,109,348.

2,109,348.

Travel

Payments of travel or entertainment expenses

18

0.

for any federal, state, or local public officials
Conferences, conventions, and meetings,..,

19

Interest

20
21

23

Insurance
Other

expenses.

132,290,287.
99,026,679.

143,587,739.

Depreciation, depletion, and amortization

24

12,580,597.

0.

Payments to affiliates

22

4,900,816.
12,580,597.

100,686,104.
Itemize

expenses

not

11,297,452.
1,659,425.

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.)

aMEDICAL SUPPLIES
OMEMBERSHIP DUES

c CONTINUINGMEDICALEDUCATION_
d BILLING & COLLECTIONS
e All other expenses
25

Total functional expenses. Add lines 1 through 24e

447,125,760.
41,060,984.
12,466,651.
7,510,996.
4,873,027.

447,125,382.
29,724,965.
12,466,651.

3,568,724,443 .

3,235, 176, 630.

4,591,964.

378.
10,865,062.

470,957.

7,510,996.
195,785.
329,175,752.

4,372,061.

85,278.

26 Joint costs. Complete this line only if the
organization reported in column (ED joint costs

from a combined educational campaign and
fundraising solicitation. Check here i F-1

if

following SOP 98-2 (ASC 958-720) .......

0.
Form 990 (2016)

JSA
6E 1052 1.000

06002L 0114

V 16-7.6F

PAGE 13

 13-1740114

MONTEFIORE MEDICAL CENTER

Page 11

Form 990 (2016)

Balance Sheet
Check if Schedule O contains a res onse or note to an line in this Part X.

1
2
3

Cash - non-interest-bearing
Savings and temporary cash investments
Pledges and grants receivable, net

4
5

Accounts receivable, net
Loans and other receivables from current and former officers, directors,

trustees,

key

employees,

and

highest

compensated

Assets

106,291.
194,727,919.
22,253,619.
249,690,498.

100,121.
280,602,002.
18,281,236.
229,454,410.

1
2
3
4

0.

5

0

0.

6

0.

127,046,563.
28,101,910.
17,370,613.

7
8
9

133,360,297.
31,116,048.
19,521,904.

Loans and other receivables from other disqualified persons (as defined under section

6

Uab ties

(8)
End of year

employees.

Complete Part 11 of Schedule L

4958(f)(1)), persons described in section 4958(c)(3)(8), and contributing employers
and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary
organizations (see instructions). Complete Part 11 of Schedule L

Notes and loans receivable, net
Inventories for sale or use
Prepaid expenses and deferred charges
Land, buildings, and equipment: cost or
10a
other basis. Complete Part VI of Schedule D
1 Ob
..........
depreciation
b Less: accumulated
securities
traded
publicly
Investments
11
12
Investments - other securities. See Part IV, line 11
Investments - program-related. See Part IV, line 11
13
Intangible assets
14

7
8
9
10a

1823803118.

15

Other assets. See Part IV, line 11
Total assets. Add lines 1 throu h 15 muste ual line 34
Accounts payable and accrued expenses

18
19
20
21
22

Grants payable
Deferred revenue
Tax-exempt bond liabilities
Escrow or custodial account liability. Complete Part IV of Schedule D
Loans and other payables to current and former officers, directors,

trustees,

key

employees,

highest

compensated

..........

employees,

26

1,072,543,924.
695,689,804.
260,086,248.
2,273,416.
6,108,882.
540,756,551.
3,278,415,680.
487,707,366.
0.
63,468,251.
669,853,762.
159,818.

10c

11
12
13
14
15
16
17
18
19
20
21

1,036,696,419.
603,869,361.
378,320,171.
2,950,494.
7,037,964.

533,145,291.
3,212,796,276.
516,674,902.
0.
70,130,241.
630,751,697.
163,432.

and

disqualified persons. Complete Part 11 of Schedule L
Secured mortgages and notes payable to unrelated third parties
Unsecured notes and loans payable to unrelated third parties
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
Total liabilities. Add lines 17 through 25

23

j

2860499537.

16
17

24
25

0. 22

0

101,885,745. 23
0. 24

100,693,238.
0

1,102,551,193.
2,425,626,135.

25
26

1,071,175,908.
2,389,589,418.

746,891,479.
74,507,961.
31,390,105.

27
28
29

720,392,510.

X and

Organizations that follow SFAS 117 (ASC 958), check here i

Balances

(A)
Beginning of year

complete lines 27 through 29, and lines 33 and 34.
Unrestricted net assets
Temporarily restricted-net assets
Permanently restricted net assets

27

ssets or Fu

28
~ 29

Organizations that do not follow SFAS 117 (ASC 958), check here

30
31
~ 32

Capital stock or trust principal, or current funds
Paid-in or capital surplus, or land, building, or equipment fund
Retained earnings, endowment, accumulated income, or other funds

2 33
34

Total net assets or fund balances
Total liabilities and net assets/fund balances

I

76,389,606.
26,424,742.

~-~ and

complete lines 30 through 34.

30
31
32
852,789,545.
3,278,415,680.

33
34

823,206,858.
3,212,796,276.
Form 990 (2016)

JSA
6E 1053 1000

06002L 0114

V 16-7.6F

PAGE 14

 MONTEFIORE MEDICAL CENTER

13-1740114
page 12

Form 990 (2016)

Reconciliation of Net Assets

Check if Schedule O containsa res onse ornote toan line inthis Part XI. .........

....... X
3,583,255,101.
3,568,724,443.
14,530,658.
852,789,545.

1
2
3

Total revenue (must equal Part Vlll, column (A), line 12)
Total expenses (must equal Part IX, column (A), line 25)
Revenue less expenses. Subtract line 2 from line 1

4

Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) .....

1
2
3
4

5

Net unrealized gains (losses) on investments

5

9,072,643.

6

Donated services and use of facilities . . . . . . . . . . . . , . . . . , . . . ............

7
8

Investment expenses
Prior period adjustments

6
7
8

9

Other changes in net assets or fund balances (explain in Schedule 0) ................

0.
0.
0.
-53,185,988.

10

823,206,858.

10

Net assets or fund balances at end of year Combine lines 3 through 9 (must equal Part X, line
33, column B

Financial Statements and Reporting

Check if Schedule 0 contains a res onse or note to an line in this Part XII .........
Yes

El Other
Accounting method used to prepare the Form 990: E-1 Cash 1--Fl Accrual
1
If the organization changed its method of accounting from a prior year or checked "Other," explain in
Schedule 0.
2a Were the organization's financial statements compiled or reviewed by an independent accountant?.......
If "Yes," check a box below to indicate whether the financial statements for the year were compiled or

reviewed on a separate basis, consolidated basis, or both:
E-1 Both consolidated and separate basis
E-1 Consolidated basis
E-1 Separate basis
b Were the organization's financial statements audited by an independent accountant? ..............

No

2a

2b

X

2c

X

3a

X

3b

X

If 'Yes," check a box below to indicate whether the financial statements for the year were audited on a

separate basis, consolidated basis, or both:
F-1 Separate basis

~ Consolidated basis

~ Both consolidated and separate basis

c If 'Yes" to line 28 or 2b, does the organization have a committee that assumes responsibility for oversight

of the audit, review, or compilation of its financial statements and selection of an independent accountant?

If the organization changed either its oversight process or selection process during the tax year, explain in
Schedule 0.
3a As a result of a federal award, was the organization required to undergo an audit or audits as set forth in
the Single Audit Act and OMB Circular A-133?
b If "Yes," did the organization undergo the required audit or audits? If the organization did not undergo the
re uired audit or audits, ex lain wh in Schedule 0 and describe an ste s taken to under o such audits

Form 990 (2016)

JSA
6E 1054 1.000

06002L 0114

V 16-7.6F

PAGE 15

 OMB No. 1545-0047

Public Charity Status and Public Support

SCHEDULE A
(Form 990 or 990- EZ)

complete if the organization le a section 501(c)(3) organizatjon or a section 4947(a)(1) nonexempt charitable trust

Department of the Treasury
Internal Revenue Service

i Attach to Form 990 or Form 990-EZ.
i Information about Schedule A ( Form 990 or 990 -EZ) and its instructions is at www.irs.gov/form990.

2@ 16
......

.

Employer identification number

Name of the organization

13-1740114

MONTEFIORE MEDICAL CENTER

Reason for Public Charity Status (All organizations must complete this part.) See instructions.

The
1
2
3
4

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 or 990-EZ).)
 X   A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).
I 1 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: -

5 E-1 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 11.)
6 E-1 A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).
7     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 11 )
8 E-1A community trust described in section 170(b)(1)(A)(vi). (Complete Part 11 )
9 E  An agricultural research organization described in section 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:

fees, and gross
10 Fl An organization that normally receives: (1) more than 331,3% of its support from contributions, membership331/3%ofits

receipts from activities related to its exempt functions - subject to certain exceptions, and (2)nomorethan
511 tax) from businesses
support from gross investment income and unrelated business taxable income (less section
111 )

acquired by the organization after June 30,1975. See section 509(a)(2). (Complete Par't

12 ~ An organization organized and operated exclusively to test for public safety See section 509(a)(4).
11

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).

129
Check the box in lines 12a through 12d that describes the type of supporting organization and complete lines 12e, 12f, and

a

typically by giving
E-1 Type I. A supporting organization operated, supervised, or controlled by its supported organization(s),

b

supporting organization You must complete Part IV, Sections A and B.
), by having
E-1 Type ll. A supporting organization supervised or controlled in connection with its supported organization(s

the supported organization(s) the power to regularly appoint or elect a majority of the directors or trustees of the

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.
with,
~-7 Type 111 functionally integrated. A supporting organization operated in connection with, and functionally integrated
its supported organization(s) (see instructions) You must complete Part IV, Sections A, D, and E

c

)
El Type Ill non-functionally integrated. A supporting organization operated in connection with its supported organization(s

d

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.

111
E-1 Check this box if the organization received a written determination from the IRS that it is a Type 1, Type ll, Type
functionally integrated, or Type 111 non-functionally integrated supporting organization.
f Enter the number of supported organizations.........................................
g Provide the following information about the supported organization(s)
e

(i) Name of supported organization

(11) EIN

(Iii) Type of organization

(iv) Is the organization

(described on lines 1-10
above (see instructions))

listed in your governing
document?

Yes

(v) Amount of monetary

support (see
instructions)

E-3

(vi) Amount of

other suppod (see
instructions)

NO

(A)
(B)

(C)

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

Schedule A (Form 990 or 990-EZ) 2016

JSA

6 E 1210 1.000

06002L 0114

V 16-7.6F

PAGE 16

 13-1740114

MONTEFIORE MEDICAL CENTER

page 2

Schedule A (Form 990 or 990-EZ) 2016

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 Ill. if the organization fails to qualify under the tests listed below, please complete Part 111.)
Section A. Public Su ort
Calendar year (or fiscal year beginning in) I
1

Gifts,

grants,

membership

received.

(Do

(d) 2015

71 529 428

85 320 101.

82 104 450.

81

(f) Total

(e) 2016

313

396

76 668 354.

923.

936

256.

the
for
levied
revenues
organization's benefit and either paid
to or expended on its behalf

Tax

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

(c) 2014

not

include any"unusual grants.")
2

(b) 2013

and

contributions,

fees

(a) 2012

The portion

of total

o

0
71 529 428.

85 320 101.

82

104

450.

81

313

76

923.

668

396

354

936 256.

contributions by

(other
than
a
publicly
or
unit
supported organization) included on
line 1 that exceeds 2% of the amount
person
each
governmental

0

shown on line 11, column (f) .......
6

Public support Subtract line 5 from line 4

Section B. Total Su

ort

Calendar year (or fiscal year beginning in) i
..........

7

Amounts from line 4

8

Gross income from interest, dividends,

9

payments received on securities loans,
rents, royalties and income from similar
sources............
Net

income

from

unrelated

(b) 2013

(c) 2014

(d) 2015

(e) 2016

71 529 428.

85 320 101.

82 104

81 313 923.

76 668 354.

396 936 256.

21 976 403.

22 369 547.

25 296 485.

22 605 763

17 759 729.

110 007 927.

450.

business

Other income. Do not include gain or

11

(Explain in Part VI.) 0
Total support Add lines 7 through 10 . .

13

(f) Total

(a) 2012

activities, whether or not the business
is regularly carried on ..........

10

12

396 936 256.

0

loss from the sale of capital assets

18 030 378

9 367

064.

12 589 698.

71 255 300.

16 090 246.

15 177 914.

578

12

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

199 483.

15 501 179 852.

a section 501(c)(3)
First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as

organization, check this box and stop here ............................................. ,

Section C. Com utation of Public Su ort Percenta e
14 Public support percentage for 2016 (line 6, column (f) divided by line 11, column (f)) ........

14
15

68.65%
70.72 %

Public support percentage from 2015 Schedule A, Part ll, line 14
check
168 331/3% support test -2016. If the organization did not check the box on line 13, and line 14 is 331/3%or more,
this box and stop here. The organization qualifies as a publicly supported organization
or more,
b 331/3% support test -2015. If the organization did not check abox on line 13 or 16a, and line 15 is 331/3%
check this box and stop here. The organization qualifies as a publicly supported organization
16b, and line 14 is
17a 10%-facts-and-circumstances test - 2016. If the organization did not check a box on line 13, 168, or
here. Explain in
stop
and
box
this
10% or more, and if the organization meets the "facts-and-circumstances" test, check
supported
publicly
a
as
qualifies
Part VI how the organization meets the "facts-and-circumstances" test The organization
,

15

,~
,0

im

organization ...........................................................
b 10%-facts=and-circumstances test - 2015. 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 ..................................................... ,
18

El

Private foundation. If the organization did not check a box on line 13,16a, 16b, 17a, or 17b, check this box and see
Schedule A (Form 990 or 990-EZ) 2016

JSA
6E 1220 1.000

06002L 0114

V 16-7.6F

PAGE 17

 13-1740114

MONTEFIORE MEDICAL CENTER

page 3

Schedule A (Form 990 or 990-EZ) 2016

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 Il.
If the organization fails to qualify under the tests listed below, please complete Part ll.)
Section A. Public Su

ort

Calendar year (or fiscal year beginning In) ~
1

Gifts, grants, contributions, and membership fees

2

received. (00 not include any "unusual grants.")
Gross receipts from admissions, merchandise
sold or services performed, or facilities

(a)2012

(b)2013

(c) 2014

(d)2015

(e)2016

(f) Total

(a)2012

(b)2013

(c)2014

(d)2015

(e)2016

(f) Total

furnished in any activity that is related to the

organization's tax-exempt purpose ......
3

Gross receipts from activities that are not an

4

Tax

unrelated trade or business under section 513 .

the
for
levied
revenues
organization's benefit and either paid

to or expended on its behalf .......
The

5

value

of

services

or

facilities

furnished by a governmental unit to the

organization without charge .......
Total. Add lines 1 through 5 .......

6

7a Amounts included on lines 1, 2, and 3

received from disqualified persons ....
included on lines 2 and 3
other than disqualified
received from
persons that exceed the greater of $5,000
or 1% of the amount on line 13 for the year

b Amounts

8

c Add lines 7a and 7b
Public support (Subtract line 7c from

line 6

Section B. Total Su

o rt

Calendar year (or fiscal year beginning in) I
Amounts from line 6
9

10 a 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 1 Ob .........

11

12

Net income from unrelated business

activities not included in line 1 Ob,
whether or not the business is regularly
carried on
Other income. Do not include gain or

loss from the sale of capital assets
13

(Explain in Part VI.)
Total support. (Add lines 9, 10c, 11,

14

year as a section 501(c)(3)
First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax

15

Public support percentage for 2016 (line 8, column (f)divided byline 13, column(f))..,

16

Public support percentage from 2015 Schedule A, Part 111, line 15

and 12.)

.....,
organization, check this box and stop here ..........................................
Section C. Com utation of Public Su ort Percenta e
,..,,.15

%

.......................16

%

,.

Section D. Com utation of Investment Income Percenta e
17
%
Investment income percentage for 2016 (line 10c, column (f) divided by line 13, column (f))
%
18
Investment income percentage from 2015 Schedule A, Part 111, line 17
18
line
and
331/3%,
than
more
is
15
line
and
14,
line
on
box
the
check
19 a 331/3% support tests - 2016. If the organization did not
supported organization I ~
17 is not more than 331/3%, check this box and stop here. The organization qualifies as a publicly
more than 331/3%, and
is
16
line
and
19a,
line
or
14
line
on
box
a
check
b 331/3% support tests - 2015. If the organization did not
organization ~
supported
publicly
a
as
qualifies
organization
The
here.
line 18 is not more than 331/3%, check this box and stop
instructions ~
see
and
box
this
check
19b,
or
19a,
14,
line
on
box
a
check
not
did
Private foundation. If the organization
20

17

Schedule A (Form 990 or 990-EZ) 2016

JSA
6E 1221 1000

06002L 0114

V 16-7.6F

PAGE 18

 MONTEFIORE MEDICAL CENTER

13-1740114
pa e 4

Schedule A (Form 990 or 990-EZ) 2016

Supporting Organizations
(Complete only if you checked a box in line 12 on Part I. Ifyou checked 12a of Part 1, complete Sections A
and B. If you checked 12b of Part 1, complete Sections A and C. If you checked 12c of Part 1, complete
Sections A D and E. If ou checked 12d of Part 1, com lete Sections A and D and com lete Part V.
Section A. All Su ortin Or anizations

Yes No

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

1

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)? /f " Yes," explain in Part VI how the organization determined that the supported

2

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)? /f "Yes," answer

3a

(b) and (c) below.
b

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.
c

4a

b

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 Vl what controls the organization put in place to ensure such use.
Was any supported organization not organized in the United States ("foreign supported organization")? /f
"Yes," and if you checked 12a or 12b in Part 1, answer (b) and (c) below.
Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign
supported organ\zarion'? 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.

c

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 Vl 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.
Sa

c

2
-1

3a
I

3b
3c

4a

4b
,

4c

Did the organization add, substitute, or remove any supported organizations during the tax yeaf? /f "Yes,"
answer (b) and (c) 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)
b

f

1

Type I or Type Il only. Was any added or substituted supported organization part of a class already

1

5a

designated in the organization's organizing document?

5b

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

Sc

Did the organization provide support (whether in the form of grants or the provision of services or facilities) to

6

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? /f "Yes," provide deta#in Part W.
Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor

7

8
9a

b

c

10 a

b

(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? /f "Yes," complete Part / of Schedu/e L (Form 990 or 990-EZ)
Did the organization make a loan to a disqualified person (as defined in section 4958) not described in line 7?
If"Yes," complete Part l of Schedule L (Form 990 or 990-EZ).
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))? /f " Yes," provide detad in Part VL
Did one or more disqualified persons (as defined in line 9a) hold a controlling interest in any entity in which
the supporting organization had an interest? /f "Yes," provide detail in Part Vi.
Did a disqualified person (as defined in line 9a) have an ownership interest in, or derive any personal benefit
from, assets in which the supporting organization also had an interest? /f "Yes," provide detail in Part V/.
Was the organization subject to the excess business holdings rules of section 4943 because of section
4943(f) (regarding certain Type 11 supporting organizations, and all Type 111 non-functionally integrated
supporting organizations)? /f " Yes," answer 10b below.
Did the organization have any excess business holdings in the tax yeaf? (Use Schedule C, Form 4720, to

determine whether the organization had excess business holdings )

7

8

9a
9b

i
9c

1

10a
1 Ob

Schedule A (Form 990 or 990-EZ) 2016

JSA
6E 1229 1.000

06002L 0114

V 16-7.6F

PAGE 19

 13-1740114

MONTEFIORE MEDICAL CENTER

Page 5

Scheditle A (Form 990 or 990-EZ) 2016

SU

ortin Or anizations continued

Yes No
Has the organization accepted a gift or contribution from any of the following persons?

11

a

A person who directly or indirectly controls, either alone or together with persons described in (b) and (c)
1la
1lb

below, the governing body of a supported organization?
b
c

A family member of a person described in (a) above?
A 35 % controlled entit of a erson described in a or b above? /f « Yes " to a b or c

Section B. T

rovide

detail in Part VI.

llc

el Sup ortin Or anizations
Yes N o

Did the directors, trustees, or membership of one or more supported organizations have the power to

1

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

2

organization( s) that operated , supervised , or controlled the supporting organization? # "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. T e 11 Su ortin Or anizations

2

Yes No

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 )? /f "No, " describe in Part VI how control

1

or management of the supporting organization was vested in the same persons that controlled or managed
the supported organization(s)
Section D. All T e 111 Sup ortin Or anizations

Yes No

Did the organization provide to each of its supported organizations, by the last day of the fifth month of the

1

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

2

the organization's governing documents in effect on the date of notification, to the extent not previously
provided?

1

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? /f "No, " explain in Part Vi how

-

the organization maintained a close and continuous working relationship with the supported organization(s).

2

By reason of the relationship described in (2), did the organization's supported organizations have a

3

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. T e 111 Functionall Inte rated Su ortin Or anizations
1

a
b

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. Descnbe in Part Vl how you supported a government entity (see instructions.

c

2

a

Yes No

Activities Test Answer (a) and (b) below.
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? /f "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.
b

a
b

i

23

Did the activities described in (a) constitute activities that, but for the organization's involvement, one or more
of the organization's supported organization(s) would have been engaged in? /f"Yes, " explain in Part Vl the

reasons for the organization's position that its supported organization(s) would have engaged in these
3

3

activities but for the organization's involvement

2b

Parent of Supported Organizations. Answer (a) and (b) be/ow.
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? Prowde details in Part W
Did the organization exercise a substantial degree of direction over the policies, programs, and activities of each
of its su orted or anizations? /f " Yes " describe in Part VI the role la ed b the or anization in this re ard

38

3b

Schedule A (Form 990 or 990.EZ) 2016

JSA
6 E 1230 1.000

06002L 0114

V 16-7.6F

PAGE 20

 13-1740114

MONTEFIORE MEDICAL CENTER

page 6

Schedule A (Form 990 or 990-EZ) 2016

T

e 111 Non-Functionall

Inte rated 509 a 3 Su

ortin Or anizations

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 T e 111 non-functionall inte rated su ortin or anizations must com lete Sections A throu h E.
(B) Current Year
(A) Prior Year
Section A - Adjusted Net Income
(optional)
1

Net short-term ca ital ain
Recoveries of rior- ear distributions
Other ross income see instructions
Add lines 1 throu h 3.
De reciation and de letion
Portion of operating expenses paid or incurred for production or

1
2
3
4
5
6

1
2
3
4
5

collection of gross income or for management, conservation, or
maintenance of property held for production of income (see instructions)

6

7 Other ex enses see instructions

7

8 Acl'usted Net Income subtract lines 5,6 and 7 from line 4

8

(A) Prior Year

Section B - Minimum Asset Amount

(B) Current Year

(optional)

1 Aggregate fair market value of all non-exempt-use assets (see

instructions for short tax ear or assets held for part of year)
a
b
c
d
e

la
1b
lc
ld

Avera e monthl value of securities
Avera e monthl cash balances
Fair market Value of other non-exem t-use assets
Total add lines la, lb, and k
Discount claimed for blockage or other

factors (explain in detail in Part VI):

2 Ac uisition indebtedness a

licable to non-exem t-use assets

2

3 Subtract line 2 from line 1 d

3

4 Cash deemed held for exempt use Enter 1-1/2% of line 3 (for greater amount,
see instructions)
5 Net value of non-exem t-use assets subtract line 4 from line 3

4
5

6 Multi I

line 5 b

6

.035.

7
8

7 Recoveries of prior-year distributions
8 Minimum Asset Amount add line 7 to line 6

Current Year

Section C - Distributable Amount

1
2
3
4
5
6

Ad usted net income for rior ear from Section A, line 8, Column A
Enter 85% of line 1.
Minimum asset amount for rior ear from Section B, line 8, Column A
Entef reater of line 2 or line 3.
Income tax im osed in rior ear
Distributable Amount. Subtract line 5 from line 4, unless subject to

emergenc temporary reduction (see instructions)
7

1
2
3
4
5

6

Check here if the current year is the organization's first as a non-functionally integrated Type 111 supporting organization (see

instructions
Schedule A (Form 990 or 990-EZ) 2016

JSA
6E 1231 1.000

06002L 0114

V 16-7.6F

PAGE 21

 13-1740114

MONTEFIORE MEDICAL CENTER

page 7

Schedule A (Form 990 or 990-EZ) 2016

Type Ill Non-Functionally Integrated 509(a)(3) Supporting Organizations (continued)
Current Year

Section D - Distributions
1 Amounts paid to supported organizations to accomplish exempt purposes
2 Amounts paid to perform activity that directly furthers exempt purposes of supported

organizations, in excess of income from activity
3
4
5
6
7
8

9
10

Administrative expenses paid to accomplish exempt purposes of supported organizations
Amounts paid to acquire exempt-use assets
Qualified set-aside amounts (prior IRS approval required)
Other distributions (describe in Part VI). See instructions.
Total annual distributions. Add lines 1 through 6.
Distributions to attentive supported organizations to which the organization is responsive
(provide details in Part VI). See instructions.

Distributable amount for 2016 from Section C, line 6
Line 8 amount divided by Line 9 amount

(i)

Section E - Distribution Allocations (see instructions)

Excess Distributions

(iii)

(ii)
Underdistributions

Distributable

Pre-2016

Amount for 2016

Distributable amount for 2016 from Section C, line 6

1

Underdistributions, if any, for years prior to 2016
(reasonable cause required-explain in Part VI). See

2

instructions.
Excess distributions carryover, if any, to 2016:

3

a
b
c
d
e

From 2013. .......
From 2014. ....,..
From 2015

f
g
h
i

Total of lines 3a through e
Applied to underdistributions of prior years
Applied to 2016 distributable amount
Carryover from 2011 not applied (see instructions)

j

Remainder. Subtract lines 39, 3h, and 3i from 3f
Distributions for 2016 from
$
Section D, line 7:

a
b
c

Applied to underdistributions of prior years
Applied to 2016 distributable amount
Remainder. Subtract lines 48 and 4b from 4.

4

Remaining underdistributions for years prior to 2016, if

5

any. Subtract lines 39 and 48 from line 2. For result
greater than zero, explain in Part VI. See instructions.

6

Remaining underdistributions for 2016. Subtract lines 3h
and 4b from line 1. For result greater than zero, explain in
Part VI. See instructions.

7

Excess distributions carryover to 2017 Add lines 3j

and 4c
Breakdown of line 7:

8

a
b
c
d
e

Excess
Excess
Excess
Excess

from
from
from
from

2013.
2014.
2015.
2016.
Schedule A (Form 990 or 990-EZ) 2016

JSA
GE1232 1.000

06002L 0114

V 16-7.6F

PAGE 22

 13-1740114

MONTEFIORE MEDICAL CENTER

page 8

Schedule A (Form 990 or 990-EZ) 2016

Supplemental Information. Provide the explanations required by Part ll, line 10; Part Il, line 178 or 17b, Part
Ill, line 12, Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, Sa, 6,9a, 9b, 9c, 118,11 b, and 11 c, 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 lc, 2a, 2b,
38 and 3b, Part V, line 1, Part V, Section B, line le, 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.)

..

FORM 990, SCHEDULE A, PART II

THE SCHEDULE A, PART II SUPPORT SCHEDULE HAS BEEN COMPLETED AND
DEMONSTRATES THAT MONTEFIORE MEDICAL CENTER MEETS THE 170 (B) ( 1) (A) (VI)

PUBLIC SUPPORT TEST AS REQUIRED TO USE THE SCHEDULE B, SPECIAL RULE.
MONTEFIORE MEDICAL CENTER IS NOT CLASSIFIED AS A 170(B)(1)(A) (VI)

ENTITY,

AS IT MEETS ITS PUBLIC CHARITY STATUS REQUIREMENT AS A HOSPITAL UNDER
SECTION 170(B) (1) (A) (III) .

Schedule A (Form 990 or 990-EZ) 2016

JSA
6E 1225 2.000

06002L 0114

V 16-7.6F

PAGE 23

 Political Campaign and Lobbying Activities

SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury

OMB No. 1545-0047

2@16

For Organizations Exempt From Income Tax Under section 501(c) and section 527
i Attach to Form 990 or Form 990-EZ.
i Complete if the organization Is described below.
4 Information about Schedule C ( Form 990 or 990 -EZ ) and its instructions is at www.irs.gov/form990.

Internal Revenue Service
If the organization answered "Yes," on Form 990, Part IV, line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
• Section 501(c)(3) organizations: Complete Parts 1-A and B. Do not complete Part 1-C.
• Section 501(c) (other than section 501(c)(3)) organizations Complete Parts 1-A and C below Do not complete Part 1-8
• Section 527 organizations: Complete Part 1-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

• Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)): Complete Part 11-A. Do not complete Part ll-8
• Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part 11-B Do not complete Part 11-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

• Section 501 (c)(4), (5), or (6) organizations: Complete Part 111.
Name of organization

Employer identification number

13-1740114

MONTEFIORE MEDICAL CENTER

Complete if the or anization 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

1

of "political campaign activities")
Political campaign activity expenditures (see instructions) .....................,$
Volunteer hours for olitical cam ai n activities see instructions

2
3

.

Complete if the organization is exempt under section 501(c)(3).

=

,$

1
2
3
4a
b

Enter the amount of any excise tax incurred by the organization under section 4955
Enter the amount of any excise tax incurred by organization managers under section 4955,.
If the organization incurred a section 4955 tax, did it file Form 4720 for this year?
Was a correction made?
If "Yes " describe in Part IV

1

Enter the amount directly expended by the filing organization for section 527 exempt function

I$
1

-

Enter the amount of the filing organization's funds contributed to other organizations for section

527 exempt function activities
3

-

Total exempt function expenditures. Add lines 1 and 2 Enter here and on Form 1120-POL,

,$

line 17b
4
5

1 No

Complete if the organization is exempt under section 501(c), except section 501(c)(3).

activities
2

N0

Yes

Yes
N0
Did the filing organization file Form 1120-POL for this year?
filing
the
which
to
organizations
political
527
section
all
of
(EIN)
Enter the names, addresses and employer identification number
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

(c) EIN

(b) Address

(d) Amount paid from

(e) Amount of political

contributions received and
promptly and directly
funds. If none, enter -0-.
delivered to a separate
filing organization's

political organization. If

none, enter -0-.
(1)

(2)

(3)
(4)
(5)

(6)
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Schedule C (Form 990 or 990-EZ) 2016

JSA
6E 1264 1.000

06002L 0114

V 16-7.6F

PAGE 28

 Schedule C (Form 990 or 990-EZ) 2016

13-1740114

MONTEFIORE MEDICAL CENTER

page 2

Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under

·

section 501(h)).

A Check I
B Check 4

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)
if the filin or anization checked box A and "limited control" rovisions a I

Limits on Lobbying Expenditures
(The term "expenditures" means amounts paid or incurred.)
la Total lobbying expenditures to influence public opinion (grass roots lobbying) . . . , .

(a) Filing

(b) Affiliated

organization's totals

group totals

b Total lobbying expenditures to influence a legislative body (direct lobbying) ......
c Total lobbying expenditures (add lines la and lb)
d Other exempt purpose expenditures

e Total exempt purpose expenditures (add lines lc and ld) ................
f Lobbying nontaxable amount. Enter the amount from the following table in both

columns.
If the amount on line le, column a or b Is: The lobb in

Not over $500,000
Over $500,000 but not over $1,000,000
Over $1,000,000 but not over $1,500,000
Over $1,500,000 but not over $17,000,000

Over $17,000,000

nontaxable amount Is:

20% of the amount on line le.
$100,000 lus 15% of the excess over $500,000.
$175,000 lus 10% of the excess over $1,000,000.
$225,000 lus 5% of the excess over $1,500,000.
$1,000,000.

'

g Grassroots nontaxable amount (enter 25% of line 1 f) ...................
h Subtract linelg from line 1 a. Ifzero orless, enter -0i Subtractlinelf fromlinelc lf zeroorless, enter -0j If there is an amount other than zero on either line 1 h or line li, did the organization file Form 4720

re ortin section 4911 tax for this eaf?

No

Yes

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

(a) 2013

(b)2014

(c) 2015

(d)2016

(e) Total

beginning in)
2a Lobbying nontaxable amount
b Lobbying ceiling amount

(150% of line 2a, column (e))
c Total lobbying expenditures

d Grassroots nontaxable amount
e Grassroots ceiling amount

(150% of line 2d, column (e))
f Grassroots lobbying expenditures
Schedule C (Form 990 or 990-EZ) 2016

JSA
6E 1265 1.000

06002L 0114

V 16-7.6F

PAGE 29

 13-1740114

MONTEFIORE MEDICAL CENTER

page 3

Schedule C (Form 990 or 990-EZ) 2016

Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768

(election under section 501(h)).

Yes

description of the lobbying activity.

(b)

(a)

For each "Yes," response on lines 1 a through 1 i below, provide in Part IV a detailed

Amount

No

During the year, did the filing organization attempt to influence foreign, national, state or local

1

a

legislation, including any attempt to influence public opinion on a legislative matter or
referendum, through the use of:
Volunteers? ..............................................

b
c
d
e

Paid staff or management (include compensation in expenses reported on lines 1 c through li)?.
Media advertisements?
Mailings to members, legislators, or the public?...........................
Publications, or published or broadcast statements?

f

Grants to other organizations for lobbying purposes?

g

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

h

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

i

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

J
2a

Total. Add lines 1 c through 1 i
Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? ...

b
c
d

X
X

X
X
X
X
909.911 .

X

X

909,911.

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 filin or anization incurred a section 4912 tax, did it file Form 4720 for this eaf? .....
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section
501 c6.
Were substantially all (90% or more) dues received nondeductible by members?

1

Did the organization make only in-house lobbying expenditures of $2,000 or less? ..................
Did the or anization a ree to car over lobb in and olitical cam ai n activit ex enditures from the rior eaf?

2
3

=

a
b

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

c

Total ........................................................

2

No

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 Ill-A, lines 1 and 2, are answered "No," OR (b) Part 111-A, line 3, is

answered "Yes."
Dues, assessments and similar amounts from members ............................

1

Yes

1
2
3

1

2a
2b

2c

3
4

.
Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductibie section 162(e) dues....
the
of
portion
what
3,
line
on
amount
If notices were sent and the amount on line 2c exceeds the

3

5

..................
and political expenditure next yean .............................
...........

4
5

excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying

Taxable amount of lobb in and olitical ex enditures see instructions
Supplemental Information

list), Part ll-A, lines 1 and
Provide the descriptions required for Part 1-A, line 1 , Part 1-8, line 4, Part 1-C, line 5, Part ll-A (affiliated group
information.
additional
any
for
part
this
complete
Also,
2 (see instructions), and Part 11-8, line 1.

SEE PAGE 4

/

JSA
6E 1266 1.000

06002L 0114

V 16-7.6F

Schedule C (Form 990 or 990-EZ) 2016

PAGE 30

 13-1740114

MONTEFIORE MEDICAL CENTER

Page 4

Schedule C (Form 990 or 990-EZ) 2016

SU

lemental Information continued

PART II-B, LINE B
THE MEDICAL CENTER'S TOTAL LOBBYING EXPENDITURES INCLUDED $13,387 OF PAID

STAFF COMPENSATION THAT WAS SPENT ON CALLS, MEETING, LETTERS, MEMOS AND

OTHER COMMUNICATIONS WITH ELECTED AND OTHER GOVERNMENTAL OFFICIALS IN AN

ATTEMPT TO INFLUENCE CERTAIN HEALTH CARE OUTCOMES.

PART II-B, LINE G

THE MEDICAL CENTER'S LOBBYING EXPENDITURES INCLUDED THE FOLLOWING:
1. A PERCENTAGE OF MEMBERSHIP DUES FOR THE FOLLOWING ORGANIZATIONS

THAT ARE USED BY SUCH ORGANIZATIONS FOR LOBBYING EFFORTS:

- GREATER NEW YORK HOSPITAL ASSOCIATION
- AMERICAN HOSPITAL ASSOCIATION
- ASSOCIATION OF AMERICAN MEDICAL COLLEGES

- HEALTH CARE ASSOCIATION OF NYS
- 1199/SEIU - GNYHA HEALTH EDUCATION PROJECT

- SNAHPA - FOCUSED ON 340B ISSUES

2. AMOUNTS PAID TO NATHANSON & HAUCK FOR FEDERAL LOBBYING, MANATT,

PHELPS & PHILLIPS, LLP, NATHANSON & HAUCK, EMPIRE STRATEGIC PLANNING,

INC. AND BROWN & WEINRAUB, PLLC FOR NYS LOBBYING AND TONIO BURGOS &

ASSOCIATES, INC FOR CITY GOVERNMENT LOBBYING RELATED TO REGULATIONS AND

LEGISLATION IMPACTING THE MEDICAL CENTER'S PROGRAMS.

Schedule C (Form 990 or 990-EZ) 2016

JSA
6E 1500 1.000

06002L 0114

V 16-7.6F

PAGE 31

 SCHEDULE D
(Form 990)
Department of the Treasury
Internal Revenue Service
Name of the organization

OMB No. 1545-0047

Supplemental Financial Statements

2@16

4 Complete if the organization answered "Yes" on Form 990,
Part IV, line 6,7,8, 9,10,1la, 1lb, llc, 1ld, 11e, 1lf, 12a, or 12b.
~ Attach to Form 990.

..0

..

.

i Information about Schedule D ( Form 990 ) and its instructions Is at www.irs.gov/form990.
Employer identification number

13-1740114

MONTEFIORE MEDICAL CENTER

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
3
4
5

Aggregate value of contributions to (during year)
Aggregate value of grants from (during year) . .
Aggregate value atendofyear..........
Did the organization inform all donors and donor advisors in writing that the assets held in donor advised

6

Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be used

funds are the organization's property, subject to the organization's exclusive legal control? ...........

E-1 Yes F-1 No

1

only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose
[-3 Yes 0 No
conferrin im ermissible rivate benefit?
Conservation Easements.
Com lete if the or anization answered "Yes" on Form 990 Part IV line 7.
P~ose(s) of conservation easements held by the organization (check all ~ apply)

2

Preservation of a historically important land area
Preservation of land for public use (e g, recreation or education)
Preservation of a certified historic structure
Protection of natural habitat
Preservation of open space
Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation
1 0#21

easement on the last day of the tax year.

a
b
c
d
3

Held at the End ofthe Tax Year

1tr----*2a I
Total number of conservation easements
2b I
Total acreage restricted by conservation easements
.....
(a)
in
included
structure
historic
certified
a
on
Number of conservation easements
1--1----Number of conservation easements included in (c) acquired after 8/17/06, and not on a
historic structure listed in the National Register
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the
tax year I
Number of states where property subject to conservation easement is located I _
handling of
inspection,
monitoring,
periodic
the
regarding
policy
written
a
have
Does the organization

4
5
6

El Yes 0 No
during the year
easements
conservation
enforcing
and
violations,
of
handling
inspecting,
monitoring,
to
devoted
hours
volunteer
Staff and

7

Amount of expenses incurred in monitoring, inspecting, handling of violations, and enforcing conservationeasementsduring the year

violations, and enforcement of the conservation easements it holds?

-

Does each conservationeasementreported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i)
and section 170(h)(4)(B)(ii)? ............................................. El Yes
In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and

8
9

0 No

balance sheet, and include, if applicable, the text of the footnote to the organization's financial statements that describes the
or anization's accountin for conservation easements.
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" on Form 990, Part IV, line 8.

la

b

2

a
b

under SFAS 116 (ASC 958), not to report in its revenue statement and balance sheet

If the organization elected, as permitted
in furtherance of
works ot art, historical treasures, or other similar assets held for public exhibition, education, or research
items
public service, provide, in Part XIII, the text of the footnote to its financial statements that describes these
If the organization elected, as permitted under SFAS 116 (ASC 958), to report in its revenue statement and balance sheet

works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of
public service, provide the following amounts relating to these items:
,$(i) Revenue included in Form 990, Part VIll, line 1
(ii) Assets included in Form 990, Part X .................................... ,$If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 (ASC 958) relating to these items:

,$Revenue included in Form 990, Part VIll, line 1
Assets included in Form 990 Part X ...................................... '

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

Schedule D (Form 990) 2016

JSA
GE1268 1 000

06002L 0114

V 16-7.6F

PAGE 32

 13-1740114

MONTEFIORE MEDICAL CENTER

page 2

Schedule D (Form 990) 2016

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

3

collection items (check all that apply):
a
b
c
4

5

~ EB Loan or exchange programs
Public exhibition
Other
Scholarly research
generations
~ Preservation for future
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
NO
Yes
assets to be sold to raise funds rather than to be maintained as part of the organization's collection? ......

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.
1a
b

Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
If "Yes," explain the arrangement in Part XIII and complete the following table:
Amount

c
d
e
f
2a
b

Beginning balance
Additions during the year
Distributions during the year //////////////////////.......1e
Ending balance .................................... lf
Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability?
If"Yes," explain the arrangement in Part Xlll. Check here if the explanation has been provided on Part Xlll

X

No

Yes

Endowment Funds.

Complete if the organization answered "Yes" on Form 990, Part IV, line 10.
(a) Current year

1 a Beginning of year balance ....
b Contributions ...........
c

(b) Prior year

(c) Two years back

31,390,105.
-4,965,363.

25,350,033.
6,040,072.

25,350,033.

26,424,742.

31,390,105.

25,350,033.

(d) Three years back

(e) Four years back

25,350,033.

25,350,033.

25,350,033.

25,350,033.

Net investment earnings, gains,

and losses

d Grants or scholarships ......
e

Other expenditures for facilities

and programs
f

Administrative expenses.....

g End of year balance ........

Provide the estimated percentage of the current year end balance (line lg, column (a)) held as:
%
a Board designated or quasi-endowment i
b Permanent endowment i 100.0000 %
%
c Temporarily restricted endowment I
The percentages on lines 2a, 2b, and 2c should equal 100%.
3a Are there endowment funds not in the possession of the organization that are held and administered for the

2

organization by:
(i) unrelated organizations ...............................................
(ii) related organizations ................................................
b
4

If "Yes" on line 3a(ii), are the related organizations listed as required on Schedule R?
Describe in Part XIII the intended uses of the or anization's endowment funds.

,~ 1-Yes-No

13a(i)1

IX

=r-Tx36/

1-

Land, Buildings, and Equipment.
10.
Com lete if the or anization answered "Yes" on Form 990 Part iV line lla. See Form 990 Part X line
Description of properly

1a
b

(a) Cost or other basis
(investment)

(b) Cost or other basis

other)

(c) Accumulated

1043076762.

18,845,694.
602,588,634.

1133119687. 775,918,030.
4,808,326.
62,868,760.

357,201,657.
58,060,434.

18,845,694.

Land
Buildings

(d) Book value

de reciation

1645665396.

c Leasehold improvements ..........
d

Equipment

e Other
Total. Add lines la through le

(Column (d) must equal Form 990, Part X, column (B), line 10c.), . . . , ,. h

1 , 036 , 696 , 419 .
Schedule D (Form 990) 2016

JSA
6E 1269 1.000

06002L 0114

V 16-7.6F

PAGE 33

 13-1740114

MONTEFIORE MEDICAL CENTER

page 3

Schedule D (Form 990) 2016

Investments - Other Securities.

Complete if the organization answered "Yes" on Form 990, Part IV, line 11 b. See Form 990, Part X, line 12
(b) Book value

(a) Description of security or category

(including name of security)

(1) Financial derivatives
(2) Closely-held equity interests
(3) Other
161 , 786 , 889 .
115 , 307 , 198 .
28 , 983 , 545 .
71,787,818.
454,721.

(A) MALPRACTICE INSURANCE PROGRAMS
(B) LIMITED PARTNERSHIPS
(C) COLLECTIVE TRUST FUNDS
(D) MANAGED CARE COMPANIES
(E) OTHER INVESTMENTS

(c) Method of valuation:
Cost or end-of-year market value

FM\1
PMV
FMV
COST
COST

(F)
(G)
(H)
Total. (Column (b) must equal Form 990, Part X, col. (8) line 12.) ~

378 , 320 , 171 .

Investments - Program Related.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11 c. See Form 990, Part X, line 13.
(b) Book value

(a) Description of investment

(c) Method of valuation:

Cost or end-of-year market value

1
2
3
4
5
6
7

8
9
Total. (Column (b) must equal Form 990, Part X, col. (8) line 13.) ~

Other Assets.
Complete if the organization answered "Yes" on Form 990, Part IV, line 1 ld. See Form 990, Part X, line 15.
(b) Book value

(a) Description

32,868,262.
499,756,000.
521,029.

1 AMTS DUE FROM AFFILIATES
2 ESTIMATED INSURANCE CLAIMS REC
3 SECURITY DEPOSITS

4
5
6
7

8
9

Total. (Column (b) must equal Form 990, Part X, col. (B) line 15 ).. . . . . . . . . . . , . . . , . . . . . . . . . I

533 , 145 , 291 .

Other Liabilities.
Complete if the organization answered "Yes" on Form 990, Part IV, line 1 l e or 11 f. See Form 990, Part X,

line 25.
(a) Description of liability

1.

 

(b) Book value

(1) Federal income taxes
(2)RETIREE HEALTH LIABILITIES
(3)MALPRACTICE INSURANCE LIABILITIES
(4)EMPLOYEE DEFERRED COMP LIABILITIES
(5) PENSION LIABILITIES
(6)EST INSURANCE CLAIMS LIABILITIES
(7)OTHER LONG-TERM LIABILITIES

151,061,999.
137,971,199.
37,788,898.

15,988,880.
499,756,000.
228,608,932.

(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col (B) line 25.) 4

1 , 071 , 175 , 908 .

the
2. Liability for uncertain tax positions In Part XIII, provide the text of the footnote to the organization's financial statements that reports
in Part Xlll
organization's liability for uncertain tax positions under FIN 48 (ASC 740). Check here if the text of the footnote has been provided
JSA
6E 1270 1.000

06002L 0114

Schedule D (Form 990) 2016

V 16-7.6F

PAGE 34

 13-1740114

MONTEFIORE MEDICAL CENTER

page 4

Schedule O (Form 990) 2016

Reconciliation of Revenue per Audited Financial Statements With Revenue per Return.
Complete if the organization answered "Yes" on Form 990, Part IV, line 12a.
Total revenue, gains, and other support per audited financial statements ................. 1

1

Amounts included on line 1 but not on Form 990, Part Vill, line 12:

2

a Net unrealized gains (losses) on investments ..................
b
c
d
e

Donated services and use of facilities
Recoveries of prior year grants
Other (Describe in Part Xlll.)
Add lines 2a through 2d

2c
2d

2e
3

3

Subtract line 2e from line 1

4

Amounts included on Form 990, Part Vill, line 12, but not on line 1:

a Investment expenses not included on Form 990, Part Vill, line 7b .......
b Other (Describe in Part Xlll.)
c Add lines 4a and 4b

4a
4b
4c

5

Total revenue Add lines 3 and 4c. This must e ual Form 990 Part I line 12

1
2

Total expenses
Amounts included on line 1 but not on Form 990, Part IX, line 25:
Donated services and use of facilities

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
and losses per audited financial statements

a
®00

b Prior year adjustments ..............................

3
4

2a
2b

Other losses
Other (Describe in Part Xlll.)
Add lines 2a through 2d
Subtract line 2e from line 1
Amounts included on Form 990, Part IX, line 25, but not on line 1:

a Investment expenses not included on Form 990, Part VIll, line 7b .......

2a
2b
2c
2d
2e
3
4a

4b
b Other (Describe in Part Xlll.)
4c
c Add lines 4a and 4b
Total ex enses . Add lines 3 and 4c . This must e ual Form 990 Part I line 18
5
lemental Information.
SU
Provide the descriptions required for Part 11, lines 3,5, and 9, Part Ill, lines la and 4, Part IV, lines lb and 2b, Part V, line 4; Part X, line
2, Part XI, lines 2d and #b, and Part Xll, lines 2d and 4b Also complete this part to provide any additional information.
I.

SEE PAGE 5

Schedule D (Form 990) 2016

JSA
6E 1271 1.000

06002L 0114

V 16-7.6F

PAGE 35

 Schedule D (Form 990) 2016

SU

MONTEFIORE MEDICAL CENTER

13-1740114

Page 5

lemental Information continued

SCHEDULE D, PART IV, LINE 2B
MONTEFIORE MEDICAL CENTER HOLDS SECURITY DEPOSITS FROM TENANTS IN ESCROW
PURSUANT TO THE INDIVIDUAL LEASE AGREEMENTS BETWEEN THE TENANTS AND THE
ORGANIZATION.

THESE DEPOSITS ARE RETURNED TO THE TENANTS ONCE THEY

VACATE THEIR RENTAL UNIT LESS ANY AMOUNTS, IF ANY, DUE FROM THE TENANTS
FOR DAMAGES OR UNPAID RENT.

SCHEDULE D, PART V, LINE 4

THE ORGANIZATION'S ENDOWMENTS WERE ESTABLISHED PURSUANT TO DONOR GIFTS

RECEIVED OVER TIME SO THE EARNINGS CAN PROVIDE SUPPORT TO THE MEDICAL
CENTER'S ACTIVITIES, SPECIFICALLY ITS CLINICAL PROGRAMS AND RELATED
RESEARCH AS DESIGNATED BY THE INDIVIDUAL DONORS.

Schedule D (Form 990) 2016

JSA
6E l 226 1 000

06002L 0114

V 16-7.6F

PAGE 36

 SCHEDULE F
(Form 990)
Department of the Treasury
Internal Revenue Service

Statement of Activities Outside the United States

OMB No. 1545-0047

2@16

i Complete if the organization answered "Yes" on Form 990, Part IV, line 14b, 15, or 16.
4 Attach to Form 990.
~ Information about Schedule F ( Form 990 ) and its instructions is at www.irs.gov/form990.

Employer identification number

Name of the organization

13-1740114

MONTEFIORE MEDICAL CENTER

General Information on Activities Outside the United States. Complete if the organization answered "Yes" on

Form 990, Part IV, line 14b
For grantmakers. Does the organization maintain records to substantiate the amount of its grants and other

1

assistance, the grantees' eligibility for the grants or assistance, and the selection criteria used to award the
grants or assistance?

[T] Yes

~ No

2

For grantmakers. Describe in Part V the organization's procedures for monitoring the use of its grants and other
assistance outside the United States

3

Activities per Region. (The following Part 1, line 3 table can be duplicated if additional space is needed.)
(a) Region

(b) Number of

(c)Numberof

oHices in the
region

employees,

agents, and
independent
contractors
in the region

(d) Activities conducted in the

region (by type) (such as,
fundraising, program services,
investments, grants to recipients
located in the region)

(e) If activity listed in (d) is
a program service,
describe specific type of
service(s) in the region

(4 Total

expenditures for
and investments

in the region

9 780.

1

SUB-SAHARAN AFRICA

GRANTMAKING

AIDS PROGRAM

2

SUB-SAHARAN AFRICA

GRANTMAKING

EDUCATIONAL SUPPORT

3

CENTRAL AMERICA CARIBBEAN

INVESTMENTS

95 957.

40 944 656.

4

5

6
7

8
9
10
11
12

13
14
15

16
17
3a
b
c

41

Sub-total

from
continuation
Total
sheets to Part I
Totals add lines 3a and 3b

050

393.

41 050 393.

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

Schedule F (Form 990) 2016

JSA

6E 1274 1.000

06002L 0114

V 16-7.6F

PAGE 37

 page 2

13-1740114

SUB-S

AFRICA

c) Region

EDUCATIONAL

d) Purpose of

72 508

cash grant

e) Amount of

WIRE

disbursemen

(4 Manner of

h) Description

58

iii

1.2.

U>

DITO 910090

000 1 9ZZL39

vsr

£

0

d9'L-9I A

M

se!1!jue JO SUOilezillefJO Je410 Jo Jaquinu lejoi Ja}l·13

OpN

)01101 hOUeleAinbe (e)(0) Kog uoiloes e papiAOJd Sell lesunOO JO ealueif; 041 40!4AA Joi JO 'Shl' 04; Aq

.coN

(i) Method of

BE EDVd

om#

;d ulexe-xe; se pezluSoom 'A.1 junoo u6!mo; 041 Aq se!:liello se pez!u6OOaJ @Je jell j eAoqe peisll suoqezluet3Jo ;ue!d!00J JO Jeq ulnu le;01 Jell,3

organization

r#

9LOZ (066 uuod) d elnpe435

(a) Name of

Grants and Other Assistance to Organizations or Entities Outside the United States. Complete if the organization answered Yes on Form 990,
Part IV, line 15, for any recipient who received more than $5,000. Part 11 can be duplicated if additional space is needed.

Schedule F (Form 990) 2016

MONTEFIORE MEDICAL CENTER

tia

AA
..

 EDUCATIONAL SUPPORT

2 AIDS RESEARCH

~

(a) Type of grant or assistance

SUB-S

SUB-S

AFRICA

AFRICA

b) Region

recipients

c) Number of

7 560

20 548

cash g nt

d) Amou t of

WIRE

WIRE

disbursement

(e) Manner of

Descnption

(h) Meth d of
valuat

ne 16.

page 3

13-1740114

~adnlts~Fift,hue~'~ttanacedti~01'nfli~1~2~SEZ~~ the United States Complete if the organization answered Yes on Form 990 Part IV

Schedule F (Form 990) 2016

MONTEFIORE MEDICAL CENTER

E9'L-9T A

b'./')(0.©06)0.-(V1)./p'k),-cO

6 E 35Vd

,

e8Eft

9&02 (066 uuod) d elnpe435

000 L 9ZZL3

J

DITO 7E0090

.

0529

58

C

 13-1740114

MONTEFIORE MEDICAL CENTER

page 4

Schedule F (Form 990) 2016

Forei n Forms
1

2

3

4

Was the organization a U.S. transferor of property to a foreign corporation during the tax year? /f "Yes,"
the organization may be required to file Forrn 926, Return by a US. Transferor of Property to a Foreign
Corporation (see Instructions for Form 926)

1~ 

Yes

El No

Did the organization have an interest in a foreign trust during the tax year? /f "Yes, " the organization
may be required to separately file Form 3520, Annual Return To Report Transactions With Foreign
Trusts and Receipt of Certain Foreign Gifts, and/or Form 3520-A, Annual Information Return of Foreign
Trust With aU. S. Owner (see Instructions for Forms 3520 and 3520-A, do not file with Form 990) ~

~~ Yes

~

No

Did the organization have an ownership interest in a foreign corporation during the tax year? # "Yes, "
the organization may be required to file Form 5471, Information Return of U.S. Persons With Respect To
Certain Foreign Corporations (see Instructions for Form 5471 )

 ~ 

Yes

El

No

Information Return by a Shareholder of a Passive Foreign Investment Company or Qualified Electing
...........
Fund (see Instructions for Form 8621)

El yes

~

No

Did the organization have an ownership interest in a foreign partnership during the tax year? /f Yes,"
the organization may be required to file Form 8865, Return of U.S. Persons With Respect to Certain
Foreign Partnerships (see Instructions for Form 8865)

 ~  Yes

El

No

Did the organization have any operations in or related to any boycotting countries during the tax year'? H
"Yes," the organization may be required to separately file Form 5713, International Boycott Report (see
' 000 ' 000 ' 0 ·········.
Instructions for Form 5713; do not file with Form 990)

El

1-38

No

Was the organization a direct or indirect shareholder of a passive foreign investment company or a

qualified electing fund during the tax year? /f "Yes," the organization may be required to file Form 8621 ,

5

6

Yes

Schedule F (Form 990) 2016

JSA
6E 1277 1.000

06002L 0114

V 16-7.6F

PAGE 40

 13-1740114

MONTEFIORE MEDICAL CENTER

Page 5

Schedule F (Form 990) 2016

~ -

Supplemental Information

Provide the information required by Part 1, line 2 (monitoring of funds); Part 1, line 3, column (f) (accounting method,
amounts of investments vs expenditures per region), Part ll, line 1 (accounting method), Part Ill (accounting method), and
Part 111, column (c) (estimated number of recipients), as applicable. Also complete this part to provide any additional

information see instructions

PART I, LINE 2

THE ORGANIZATION'S PROCEDURES FOR MONITORING THE USE OF GRANT FUNDS
OUTSIDE THE UNITED STATES INCLUDES REGULAR FINANCIAL REPORTING AND

ANALYSIS AND REVIEW BY MEDICAL CENTER EMPLOYEES ASSOCIATED WITH THE GRANT
PROGRAMS TO CONFIRM FUNDS ARE BEING USED IN ACCORDANCE WITH THE AWARDS.

/

Schedule F (Form 990) 2016

JSA
6E 1502 2.000

06002L 0114

V 16-7.6F

PAGE 41

 Supplemental Information Regarding Fundraising or Gaming Activities

SCHEDULE G

2@16

Complete if the organization answered "Yes" on Form 990, Part IV, lines 17, 18, or 19, or If the
organization entered more than $16,000 on Form 990-EZ, line Ga.

(Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service

OMB No. 1545-0047

...

~ Attach to Form 990 or Form 990.EZ.

I.

.

4 Information about Schedule G (Form 990 or 990 -EZ) and its instructions is at www.irs.gov/form990.
Employer identjfication number

Name of the organization

13-1740114

MONTEFIORE MEDICAL CENTER

Fundraising Activities. Complete if the organization answered "Yes" on Form 990, Part IV, line 17.
Form 990-EZ filers are not required to complete this part.

1

Indicate whether the organization raised funds through anv of the following activities Check all that apply
e n Solicitation of non-government grants
a n Mail solicitations
f ~ ~ Solicitation of government grants
b ~ ~ Internet and email solicitations

c ~

~ Phone solicitations

d 1

1 In-person solicitations

g 1

  Special fundraising events

2a Did the organization have a written or oral agreement with any individual (including officers, directors, trustees,
Fl Yes 1--1 No
or key employees listed in Form 990, Part VII) or entity in connection with professional fundraising services?
fundraiser is to be
the
which
under
agreements
to
pursuant
(fundraisers)
entities
or
individuals
paid
b I f "Yes," list the 10 highest

compensated at least $5,000 by the organization
(i) Name and address of individual

or entity (fundraiser)

(iii) Did fundraiser have

(ii) Activity

custody or control of
contributions?

Yes

(v) Amount paid to

(tv) Gross receipts

(or retained by)

from activity

fundraiser listed in

col. (i)

(vi) Amount paid to

(or retained by)
organization

No

1
2

3
4

5
6
7

8
9
10

Total

3

li

List all states in which the organization is registered or licensed to solicit contributions or has been notified it is exempt from

registration or licensing.

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

Schedule G (Form 990 or 990-EZ) 2016

JSA
6E 1281 1 000

06002L 0114

V 16-7.6F

PAGE 42

 13-1740114

MONTEFIORE MEDICAL CENTER

page 2

Schedule G (Form 990 or 990-EZ) 2016

Fundraising Events. Complete if the organization answered "Yes" on Form 990, Part IV, line 18, or reported more
than $15,000 of fundraising event contributions and gross income on Form 990-EZ, lines 1 and 6b List events with

gross receipts greater than $5,000.

Revenue

Gross receipts

2 Less: Contributions
3 Gross income (line 1 minus

6

(d) Total events

(add col. (a) through
col. (C))

(total number)

(event type)

(event type)

1

(c) Other events

(b) Event #2
GOLF OUTING

(a) Event #1
DINNER DANCE

2,049,685.

831,300.

397,476.

3,278,461.

1,569,685.

513,715.

226,426.

2,309,826.

480,000.

317,585.

171,050.

968,635.

749,843.

338,978.

191,521.

1,280,342.

1,190.

12,190.

45,203.

310,726.

4 Cash prizes

Direct Expenses

5 Noncash prizes

6

RenUfacility costs , I

7

Food and beverages .
11,000.

8 Entertainment
9 Other direct expenses .
10
11

73,072.

192,451.

Direct expense summary. Add lines 4 through 9in column (d)
Net income summary Subtract line 10 from line 3, column (d) ///////////////,////,,

1,603,258 .
-634,623.

Direct Expenses

Revenue

Gaming. Complete if the organization answered "Yes" on Form 990, Part IV, line 19, or reported more
than $15,000 on Form 990-EZ, line 6a.
(b) Pull tabs/instant

(a) Bingo

bingo/progressive bingo

(d) Total gaming (add

(c) Other gaming

col. (a) through col. (c))

1 Gross revenue .
2 Cash prizes .
3 Noncash prizes
4 Renufacility costs '

5 Other direct expenses ........
Yes

6 Volunteer labor

*

Yes

%

No

No

Yes

%

No

7 Direct expense summary Add lines 2 through 5 in column (d)

8 Net gaming income summary. Subtract line 7 from line 1, column (d) ........
9

Enter the state(s) in which the organization conducts gaming activities:
a Is the organization licensed to conduct gaming activities in each of these states?
b If "No," explain:

10a Were any of the organization's gaming licenses revoked, suspended or terminated during the tax year?.
b If "Yes," explain:

Yes

No

Yes

No

Schedule G (Form 990 or 990-EZ) 2016

JSA
6E 1282 1.000

06002L 0114

V 16-7.6F

PAGE 43

'

 13-1740114

MONTEFIORE MEDICAL CENTER

page 3

Schedule G (Form 990 or 990-EZ) 2016

Does the organization conduct gaming activities with nonmembers?
Is the organization a grantor, beneficiary or trustee of a trust or a member of a partnership or other entity

11
12

a
b
14

No

E-1 yes Fl No

formed to administer charitable gaming?
13

Yes

Indicate the percentage of gaming activity conducted in:
13a
The organization's facility
13b
An outside facility
and
books
events
gaming/special
organization's
the
prepares
who
person
the
of
address
and
Enter the name

%
%

records:

Name l
Address h

15 a

b

Does the organization have a contract with a third party from whom the organization receives gaming

revenue? ........................................................ Fl Yes [3 No
If "Yes," enter the amount of gaming revenue received by the organization h $ ______________

amount of gaming revenue retained by the third party I $ -________-__
c

and the

----

If "Yes," enter name and address of the third party:

Namel

--------------------------

Address i__

-------------------

-------------------------

-------------------

Gaming manager information:

16

Name ~

---------------------------------- -----------------

--------------

Gaming manager compensation I $

---------------

Description of services provided 4
E-1 Director/officer
17

a

b

El Employee

-----------------

---------------------

Fl independent contractor

Mandatory distributions:
to
Is the organization required under state law to make charitable distributions from the gaming proceeds
F7 Yes E-~No
.
...,...
,..,...
.......
,,..,..
retain the stategaming license?, .,..,.........
organizations
exempt
other
to
distributed
be
to
law
state
Enter the amount of distributions required under

or spent in the organization's own exempt activities during the tax year I $
Supplemental Information. Provide the explanation required by Part 1, line 2b, columns (iii) and (v), and
Part 111, lines 9, 9b, 10b, 15b, 15(, 16, and 17b, as applicable. Also provide any additional information

(see instructions)

Schedule G (Form 990 or 990-EZ) 2016

JSA
6E 1503 1.000

06002L 0114

V 16-7.6F

PAGE 44

 OMB No. 1545-0047

Hospitals

SCHEDULE H
(Form 990)

2@16

~ Complete if the organization answered "Yes" on Form 990, Part IV, question 20.
I Attach to Form 990.
Department of the Treasury
Internal Revenue Service
Name of the organization

..0

..

0

i Information about Schedule H ( Form 990 ) and its instructions is at www.irs.gov/form990.
Employer identification number

13-1740114

MONTEFIORE MEDICAL CENTER

Financial Assistance and Certain Other Communi

Benefits at Cost
Yes No

la Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a ........lax
1b X
b If "Yes," was it a written policy?
of
application
describes
best
following
If the organization had multiple hospital facilities, indicate which of the
2

the financial assistance policy to its various hospital facilities during the tax year

F7 Applied uniformly to most hospital facilities

APPlied uniformly to all hospital facilities

X

Generally tailored to individual hospital facilities
Answer the following based on the financial assistance eligibility criteria that applied to the largest number of

3

111

the organization's patients during the tax year.

a 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 :
 ~X~ 

100%

~~

150%

~-~ 200%

Other

b Did the organization use FPG as a factor in determining eligibility for providing discounted care? If 'Yes,"
indicate which of the following was the familv income limit for eligibility for discounted care: ........... ..
~ 200%

 ~  250%

~  300%

~

350%

3a X

%

~

400%

 ~ 

Other

500.0000

..
3b X

%

c 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

4

tax year provide for free or discounted care to the "medically indigent"?

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

Sa

b If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? ..............
If "Yes" to line Sb, as a result of budget considerations, was the organization unable to provide free or

c

discounted care to a patient who was eligible for free or discounted care?
6a Did the organization prepare a community benefit report during the tax year?
b If "Yes," did the organization make it available to the public?

7

Financial Assistance and
Means-Tested Government
Programs
a

Financial Assistance at cost
(from Worksheet 1)

b

. . . .

d

activities or
programs
(optional)

(b) Persons

served
(optional)

(c) Total community

benefit expense

5b X

SC
6a X

X

(d) Direct offsetting

revenue

(e) Net community

benefit expense

..
(f) Percent

of total

expense

48,663,924.

10,360,690.

38,303,234.

1.08

1,260,297,630.

990,511,063.

269,786,567.

7.62

1,308,961,554.

1,000,871,753.

308,089,801.

8.70

87,140,189.

24,870,676.

62,269,513.

1.76

325,302,398.

220,585,353.

104,717,045.

2.96

108,664,469.
34,114,872.

61,787,572.
18,892,772.

46,876,897.
15,222,100.

1.32
.43

24,941,188.
254,026,743.

.70
7.17

562,116,544.

15.87

Medicaid (from Worksheet 3,

column a) ........
C

(a) Number of

X

X

6b X

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

4

Sa

Costs of other means-tested

government programs (from

Worksheet 3, column b) .
Total Financial Assistance and

Means-Tested Government
Programs ... .....

Other Benefits
e

Community health improvement

services and community benefit
operations (from Worksheet 4) .
f

Health professions education

(from Worksheet 5) ....
g

Subsidized health services (from

Worksheet 6) ........
h

Research (from Worksheet 7)

1

Cash and in.kind contributions
for community benefit (from

Worksheet 8) ........

j

Total. Other Benefits ....

24,941,188.

580,163,116.
1,889,124,670.

k Total. Add lines 7d and 7. .
For Paperwork Reduction Act Notice, see the Instructjons for Form 990.
JSA 6E 1284 1.000

06002L 0114

326,136,373.
1,327,008,126.

Schedule H (Form 990) 2016

V 16-7.6F

PAGE 45

 13-1740114

MONTEFIORE MEDICAL CENTER

page 2

Schedule H (Form 990) 2016

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

(b) Persons

(c) Total community

activities or
programs
(optional)

served
(optional)

building expense

Ph sical im rovements and housin

1

(d) Direct offsetting

(e) Net community

(f) Percent of

revenue

building expense

total expense

443,558.

443,558.

.01

2 Economic develo ment
3 Communi

su

ort

4 Environmental im rovements

10,576.
293,662.

28,500.
314,209.

699,533.

76,071.

623,462.

.02

1,447,329.

418,780.

1,067,020.

.03

6 Leadership development and
training for community members
6 Coalition building

7 Community health improvement

advocacy
8 Workforce development

9 Other
10 Total

Bad Debt Medicare & Collection Practices
Section A. Bad Debt Expense
1 Did the organization report bad debt expense in accordance with Healthcare Financial Management Association

Statement No. 15?
.........................
Enter the amount of the organization's bad debt expense. Explain in Part VI the

2

2

methodology used bythe organization to estimate this amount

Yes

No

x

1

27,021,027.
b
I

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

3

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

3

15,349,191 .

Provide in Part VI the text of the footnote to the organization's financial statements that describes bad debt

4

expense or the page number on which this footnote is contained in the attached financial statements.

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

..........5

375,627,782.

295,752,485.
Enter Medicare allowable costs of care relating to payments on line 5 ..........6
79,875,297.
Subtract line 6 from line 5. This is the surplus (or shortfall)
as community
treated
be
should
7
Describe in Part VI the extent to which any shortfall reported in line
reported
amount
the
determine
to
used
source
or
benefit Also describe in Part VI the costing methodology
used:
on line 6. Check the box that describes the method

6
7
8

F7 Cost accounting system

En Cost to charge ratio

I

 TI Other

Section C. Collection Practices
9a Did the organization have a written debt collection policy during the tax year?.....................

9a

X

9b

X

b 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 . . . . . . . .

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

(a) Name of entity

(b) Description of primary

activity of entity

(c) Organization's

profit % or stock
ownership %

(d) Officers, directors,

(e) Physicians'

trustees, or key
employees' profit %
or stock ownership %

profit % or stock
ownership %

1
2
3
4

5
6
7

8
9
10
11
12
13

Schedule H (Form 990) 2016

JSA

6E 1285 1.000

06002L 0114

V 16-7.6F

PAGE 46

 13-1740114

MONTEFIORE MEDICAL CENTER

page 3

Schedule H (Form 990) 2016
ER-othe

ER-24 hours

BRONX

Research facility

subordinate hospital organization that operates the hospital
facility)
1 MONTEFIORE MEDICAL CENTER
111 EAST 210TH STREET

Critical access hospita

1

Name, address, primary website address, and state license
number (and if a group return, the name and EIN of the

Teaching hospital

How manyhospital facilities did the organization operate during

the tax year?

Children's hospita

(list in order of size, from largest to smallest - see instructions)

lelidsoll pasu@011

Information
eo,Sins 9 leolpaw leJauag

Facili

Section A, Hospital Facilities

Facility

reporting

Other (describe)

group

NY 10467

WWW.MONTEFIORE.ORG
7000006H

XXXX

XX

2

3

4

5

6

7

8

9

10

JSA
6 E 1286 1000

06002L 0114

Schedule H (Form 990) 2016

V 16-7.6F

PAGE 47

 MONTEFIORE MEDICAL CENTER

13-1740114
page 4

Schedule H (Form 990) 2016

Facili

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)

Name of hospital facility or letter of facility reporting group MONTEFIORE MEDICAL CENTER

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

1
Yes

Community Health Needs Assessment
Was the hospital facility first licensed, registered, or similarly recognized by a state as a hospital facility in the
1

current tax year or the immediately preceding tax yeaf?
Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or

2

the immediately preceding tax year'? If "Yes," provide details of the acquisition in Section C ............
3

a
b
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
If "Yes," indicate what the CHNA report describes (check all that apply)
~A definition of the community served by the hospital facility
~ X~ Demographics of the community
IXI Existing health care facilities and resources within the community that are available to respond to the

No

IJ
1X
2X
3

X

5

X

health needs of the community
d
e

f

~ How data was obtained
~ X1 The significant health needs of the community

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

g

Ex7 The process for identifying and prioritizing community health needs and services to meet the

h
i

X The process for consulting with persons representing the community's interests
X The impact of any actions taken to address the significant health needs identified in the hospital

community health needs

facility's prior CHNA(s)
~ Other (describe in Section C)
Indicate the tax year the hospital facility last conducted a CHNA: 20 16
In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent

j
4
5

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 ..........

6a
b

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 CHNAconducted 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?
If "Yes," indicate how the CHNA report was made widely available (check all that apply)

7

SEE PART V -

fi~ Hospital facility's website (list url):

b
c

    Other website (list url):
~ x! Made a paper copy available for public inspection without charge at the hospital facility

d

9

a

X

8

X

10

X

1-  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
Indicate the tax year the hospital facility last adopted an implementation strategy: 201 6

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

10

6b
7

SECTION C-

a

8

6a

If "yes," (list url): SEE_PARTE-_SECTIONE

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

Ill
--1
1 Ob
~

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

11

such needs are not being addressed.
12 a

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)?

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

12a

X

12b

If "Yes" to line 12b, what is the total amount of section 4959 excise tax the organization reported on Form

4720 for all of its hos ital facilities?
JSA
6E 1287 1.000

06002L 0114

$
Schedule H (Form 990) 2016

V 16-7.6F

PAGE 48

 Schedule H (Form 990) 2016

MONTEFIORE MEDICAL CENTER

Page 5

13-1740114

Facili Information continued
Financial Assistance Polic FAP
Name of hospital facility or letter of facility reporting group MONTEFIORE MEDICAL CENTER
Yes

13
a

b

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 freeordiscounted care?
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 100.0000 %
and FPG family income limit for eligibility for discounted care of 500.0000 %
Income level other than FPG (describe in Section C)

No

-li
13

X

14

X

15

X

16

X

V - SECTION C
The FAP application form was widely available on a website (list url): SEE PART
PART V - SEC IO
SEE
url):
(list
website
A plain language summary of the FAP was widely available on a

C

Assetlevel

g
h
14
15

Medical indigency
Insurance status
Underinsurance status
Residency
Other (describe in Section C)
Explained the basis for calculating amounts charged to patients?.........................
Explained the method for applying for financial assistance?
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)
a

x

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

application
b

~

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

d I Fl

Provided the contact information of nonprofit organizations or government agencies that may be

c

sources of assistance with FAP applications

e
16

a

 ~  Other (describe in Section C)
Was widely publicized within the community served by the hospital facility?

If "Yes," indicate how the hospital facility publicized the policy (check all that apply):
~X  The FAP was widely available on a website (list url):SEE_PaRT-V -_ SECTION C

b
c

121
~ X~

d

I xI

e

F~ 

The FAP application form was available upon request and without charge (in public locations in the

f

1-Fl

A plain language summary of the FAP was available upon request and without charge (in public

The FAPwas available upon request and without charge (in public locations in the hospital facility and

by mail)

hospital facility and by mail)
locations in the hospital facility and by mail)
g

Fil

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

h

FYI

i

~

;

Fl

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) 2016

JSA
6E 1323 1.000

06002L 0114

V 16-7.6F

PAGE 49

 MONTEFIORE MEDICAL CENTER

13-1740114

page 6

Schedule H (Form 990) 2016

Facili
Billin

Information continued

and Collections

Name of hospital facility or letter of facility reporting group MONTEFIORE MEDICAL CENTER

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

17

may take upon nonpayment?

Yes

17

No

X

Check all of the following actions against an individual that were permitted under the hospital facility's

18

policies during the tax year before making reasonable dfforts to determine the individual's eligibility under the

a
b
c

d
e
f

19

a
b
c

de
20

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:

~

X

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):
a

EX)

b
c
d

X
x

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
Made a reasonable effort to orally notify individuals about the FAP and FAP application process
Processed incomplete and complete FAP applications
Made presumptive eligibility determinations

Other (describe in Section C)

e

None of these efforts were made
f
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
21

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

a
b
c

d

21

X

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)
E-1 Other (describe in Section C)
Schedule H (Fonn 990) 2016

JSA
6E 1324 1.000

06002L 0114

V 16-7.6F

PAGE 50

 page 7

Schedule H (Form 990) 2016

Facili

Information continued

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)
MONTEFIORE MEDICAL CENTER
Name of hospital facility or letter of facility reporting group

22

a

Yes

No

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
E-1 The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service

during a prior 12-month period
b

1-71

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
c

 ~ 

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
d
23

24

~ 

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
X
23
individuals who had insurance covering such care?
--C
Section
in
explain
If "Yes,"
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 " ex lain in Section C.

24

--=
Schedule H (Form 990) 2016

06002L 0114

JSA
6E 1332 1.000

V 16-7.6F

 13-1740114

MONTEFIORE MEDICAL CENTER

page 8

Schedule H (Form 990) 2016

Facility Information (continued)
Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines

2,3£ 5, 63,6b, ld, 11,13b, 13h, 15e, 16£ 18e, 19e, 20e, 21c, 21 d, 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.

SCHEDULE H, PART V, SECTION B, LINES 3&6

THE NEEDS ASSESSMENT WAS CONDUCTED WITH THE FIVE HOSPITAL DIVISIONS THAT
COMPRISE MONTEFIORE MEDICAL CENTER:

- MOSES DIVISION, WEILER DIVISION,

WAKEFIELD DIVISION, HUTCH DIVISION AND THE CHILDREN'S HOSPITAL DIVISION

,

AT MONTEFIORE.

IN ADDITION, MONTEFIORE IS A MEMBER OF THE GREATER NEW YORK HOSPITAL
ASSOCIATION WHICH PROVIDES RESOURCES FOR MEMBER HOSPITALS TO UTILIZE IN
ASSESSING THE NEEDS OF THE HOSPITAL COMMUNITIES FROM A COMMUNITY-WIDE

PERSPECTIVE.

SCHEDULE H, PART V, LINE 5
THE PROCESS FOR PREPARING THE 2016-2018 COMMUNITY HEALTH NEEDS ASSESSMENT

WAS A INTER-ORGANIZATIONAL AND COMMUNITY COLLABORATIVE PROCESS, INITIATED

WITH THE GOAL OF DEVELOPING AN ASSESSMENT THAT WAS REFLECTIVE OF THE
NEEDS OF THE COMMUNITY. INPUT FROM THE COMMUNITY WAS ACHIEVED VIA THREE

PRIMARY DATA STRATEGIES USED TO TRIANGULATE THE IDENTIFICATION OF
COMMUNITY HEALTH PRIORITIES IN THE BRONX,

INCLUDING:

1) THE 2014

COMMUNITY HEALTH NEED ASSESSMENT (CHNA) CONDUCTED BY THE NEW YORK ACADEMY
OF MEDICINE (NYAM),

2) THE NEW YORK CITY COMMUNITY CONSULTATIONS,

IMPLEMENTED BY THE NEW YORK CITY DEPARTMENT OF HEALTH AND MENTAL HYGIENE,
AND 3) A SURVEY OF BRONX RESIDENTS IMPLEMENTED IN COLLABORATION WITH THE

WESTCHESTER COUNTY DEPARTMENT OF HEALTH TO SUPPORT THE CSPS/CHNAS FOR
HOSPITALS IN WESTCHESTER COUNTY.

Schedule H (Form 990) 2016
JSA

6E 1331 3.000

06002L 0114

V 16-7.6F

PAGE 52

 13-1740114

MONTEFIORE MEDICAL CENTER

page 8

Schedule H (Form 990) 2016

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, 20e, 21c, 2ld, 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 CA, 1," "A, 4," "B, 2," "B, 3," etc.) and name of hospital facility.

SCHEDULE H, PART V, SECTION B, LINE 7A
THE CHNA IS AVAILABLE ON THE HOSPITAL FACILITY'S WEBSITE:

URL:
HTTPS://WWW.MONTEFIORE.ORG/DOCUMENTS/COMMUNITYSERVICES/COMMUNITY-HEALTH-NE
EDS-ASSESSMENT-MMC.PDF

SCHEDULE H, PART V, SECTION B, LINE 10A

THE HOSPITAL FACILITY'S MOST RECENT ADOPTED IMPLEMENTATION STRATEGY IS
POSTED ON THE WEBSITE:

URL:
HTTPS://WWW.MONTEFIORE.ORG/DOCUMENTS/COMMUNITYSERVICES/COMMUNITY-HEALTH-NE
EDS-ASSESSMENT-MMC.PDF

SCHEDULE H, PART V, SECTION B, LINE 11

A REVIEW OF THE RESULTS FROM THE PRIMARY AND SECONDARY DATA COLLECTION IN

THE MEDICAL CENTER'S MOST RECENT CONDUCTED CHNA ILLUMINATED TWO MAJOR
CATEGORIES OF HEALTH NEEDS THAT WERE IMPORTANT ACROSS THE POPULATION
SURVEYED, REFLECTED IN THE DATA AS CRITICAL, AND IN ALIGNMENT WITH THE
NEW YORK STATE PREVENTION AGENDA.
(1) PREVENTING CHRONIC DISEASE AND

THE TWO PRIORITY AREAS IDENTIFIED WERE
(2) PROMOTING HEALTHY WOMEN ,

INFANTS AND

CHILDREN.

)

AS PART OF THE SUBMISSION FOR THE NEW YORK STATE HEALTH IMPROVEMENT PLAN
FOR 2016-2018, REQUIRED BY THE NEW YORK STATE DEPARTMENT OF HEALTH,

MONTEFIORE HAS ELECTED TO RETAIN THESE TWO PRIORITY AREAS, PREVENT

Schedule H (Form 990) 2016

JSA
6 E 1331 3.000

06002L 0114

V 16-7.6F

PAGE 53

 13-1740114

MONTEFIORE MEDICAL CENTER

page 8

Schedule H (Form 990) 2016

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, 20e, 21c, 2ld, 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.

CHRONIC DISEASE AND PROMOTE HEALTHY WOMEN, INFANTS AND CHILDREN AND HAS
SELECTED THREE BROAD FOCUS AREAS TO IMPLEMENT PROGRAMS.

THESE BROAD

(2)INCREASE

FOCUS AREAS ARE (1)REDUCING OBESITY IN CHILDREN AND ADULTS,

ACCESS TO HIGH QUALITY CHRONIC DISEASE PREVENTIVE CARE AND MANAGEMENT IN
BOTH CLINICAL AND COMMUNITY SETTINGS AND (3)

IMPROVING MATERNAL AND

INFANT HEALTH.

ACROSS THESE FOCUS AREAS, VARIOUS GOALS, WITH SPECIFIC INTERVENTIONS,
PERFORMANCE MEASURES AND TIME FRAMES, WERE DELINEATED;
- CREATE COMMUNITY ENVIRONMENTS THAT PROMOTE AND SUPPORT HEALTHY FOOD

AND BEVERAGE CHOICES AND PHYSICAL ACTIVITY;

- INCREASE SCREENING RATES FOR CARDIOVASCULAR DISEASE, DIABETES AND
BREAST, CERVICAL AND COLORECTAL CANCERS, ESPECIALLY AMONG DISPARATE

POPULATIONS.

- REDUCE PREMATURE BIRTHS.

,

SCHEDULE H, PART V, SECTION B, LINE 13 H

FAMILY SIZE IS FACTORED INTO THE ELIGIBILITY CRITERIA FOR FINANCIAL

ASSISTANCE.

SCHEDULE H, PART V, SECTION B, LINES 16A-16C

THE FAP INFORMATION CAN BE FOUND ON THE WEBSITE:

HTTPS://WWW.MONTEFIORE.ORG/FINANCIAL-AID-POLICY

Schedule H (Form 990) 2016

JSA
6E1 331 3 000

06002L 0114

V 16-7.6F

PAGE 54

 13-1740114

MONTEFIORE MEDICAL CENTER

Page 9

Schedule H (Form 990) 2016

Facili 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 yeaf?

Type of Facility (describe)

Name and address
i

156

HOSPITAL OUTPATIENT DEPT

GREENE MEDICAL ARTS PAVILLION

3400 BAINBRIDGE AVENUE
BRONX
2 HUTCHINSON CAMPUS

NY

10467

SPECIALTY CARE EXTENSION

1250 WATERS PLACE
NY 10461
BRONX
3 MMG - MAP GREENE MEDICAL ARTS PAVILION

PRIMARY CARE PRACTICE

3400 BAINBRIDGE AVENUE
NY
BRONX
4 CERTIFIED HOME HEALTH AGENCY

10467
CERTIFIED HOME HEALTH CARE
AGENCY

1 FORDHAM PLAZA
NY 10458
s MMC-MONTEFIORE EINS CTR FR CANCER CARE
BRONX

SPECIALTY CARE EXT CLINIC

1695 EASTCHESTER ROAD
NY 10461
BRONX
6 MMG-COMPREHENSIVE FAMILY CARE CTR

PRIMARY CARE EXTENSION CLINIC

1621 EASTCHESTER RD
NY 10461
BRONX
7 MMG-COMPREHENSIVE HEALTH CARE CTR

PRIMARY CARE EXTENSION CLINIC

305 EAST 161ST STREET
BRONX

NY 10451
SPECIALTY CARE PRACTICE

8 CENTER FOR ORTHOPAEDIC SPECIALITIES

1250 WATERS PLACE
NY 10461
BRONX
9 MONTEFIORE ADVANCED IMAGING MAP

SPECIALTY CARE EXT CLINIC

3400 BAINBRIDGE AVENUE
BRONX

NY 10467
PRIMARY CARE PRACTICE

10 MMG-BRONX EAST

2300 WESTCHESTER AVENUE
BRONX

NY 10462
Schedule H (Form 990) 2016

JSA
6 E 1325 1 000

06002L 0114

V 16-7.6F

PAGE 55

 13-1740114

MONTEFIORE MEDICAL CENTER

Page 9

Schedule H (Form 990) 2016

Facili 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?

Type of Facility (describe)

Name and address
1

PRIMARY CARE EXTENSION CLINIC

MMG-FAMILY HEALTH CENTER

ONE FORDHAM PLAZA
BRONX
2 MMG-GRAND CONCOURSE

NY 10458
PRIMARY CARE PRACTICE

2532 GRAND CONCOURSE
NY 10458
BRONX
3 MMC-CENTER FOR RADIATION THERAPY

SPECIALTY CARE EXT CLINIC

1625 POPLAR STREET
NY 10461
BRONX
4 MONTEFIORE ADVANCED IMAGING MMP

SPECIALTY CARE EXT CLINIC

1635 POPLAR STREET
NY 10461
BRONX
s MMG-UNIVERSITY AVENUE FAMILY PRACTICE

PRIMARY CARE EXTENSION CLINIC

105 WEST 188TH STREET
BRONX
6 MMG-FAMILY CARE CENTER

NY

10468

PRIMARY CARE EXTENSION CLINIC

3444 KOSSUTH AVE
BRONX
7 MMG-CROSS COUNTY

NY

10467
PRIMARY CARE PRACTICE

1010 CENTRAL PARK AVE
YONKERS
8 CARDIOLOGY ASSOCIATES

NY

10704

SPECIALTY CARE PRACTICE

3201 GRAND CONCOURSE
BRONX
9 SCARSDALE WOMEN'S CENTER

NY 10468
SPECIALTY CARE PRACTICE

1075 CENTRAL PARK AVENUE
NY 10583
SCARSDALE
10 MMP-OUTPATIENT REHABILITATION SERVICES

SPECIALTY CARE EXT CLINIC

1500 BLONDELL AVENUE
BRONX

NY

10461
Schedule H (Form 990) 2016

JSA
6E 1325 1.000

06002L 0114

V 16-7.6F

PAGE 56

 13-1740114

MONTEFIORE MEDICAL CENTER

Page 9

Schedule H (Form 990) 2016

Facili 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?

Type of Facility (describe)

Name and address
1 MONTEFIORE DPT OF CARDIOTHORACIC SURGERY

SPECIALTY CARE PRACTICE

1575 BLONDELL AVENUE
NY 10461
BRONX
2 SUBSTANCE ABUSE TREATMENT PROG UNIT 3

SUBSTANCE USE DISORDERS CLINIC

2058 JEROME AVENUE
NY
BRONX
3 MMG-WEST FARMS FAMILY PRACTICE

10453

PRIMARY CARE EXTENSION CLINIC

1055 EAST TREMONT AVENUE
BRONX
4 MMG-WILLIAMBRIDGE

NY 10460
PRIMARY CARE EXTENSION CLINIC

3011 BOSTON ROAD
BRONX
s MMG-CO-OP CITY

NY

10469

PRIMARY CARE EXTENSION CLINIC

2100 BARTOW AVENUE
BRONX

NY 10475
PRIMARY CARE PRACTICE

6 MMG-CO-OP CITY

115 DREISER LOOP
NY 10475
BRONX
7 SO BRONX HEALTH CTR FOR CHILD & FAMILIES

PRIMARY CARE EXTENSION CLINIC

871 PROSPECT AVENUE
NY 10459
BRONX
8 MONTEFIORE WAKEFIELD MENTAL HLTH CLINIC

MENTAL HEALTH EXT CLINIC

4401 BRONX BOULEVARD
NY 10470
9 HARTSDALE FAMILY AND FETAL MEDICINE INST

BRONX

SPECIALTY CARE PRACTICE

141 S CENTRAL AVE
HARTSDALE
10 MMG-ASTOR AVE PEDIATRICS

NY 10530

PRIMARY CARE PRACTICE

1500 ASTOR AVENUE
BRONX

NY

10469
Schedule H (Form 990) 2016

JSA
6E 1325 1.000

06002L 0114

V 16-7.6F

PAGE 57

 13-1740114

MONTEFIORE MEDICAL CENTER

Page 9

Schedule H (Form 990) 2016

Facili 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'?

Type of Facility (describe)

Name and address
i

PRIMARY CARE EXTENSION CLINIC

MMG MARBLE HILL FAMILY PRACTICE

5525 BROADWAY
NY 10463
BRONX
2 TARRYTOWN CARDIOLOGY ASSOCIATES

SPECIALTY CARE PRACTICE

150 WHITE PLAINS ROAD
TARRYTOWN
3 MMG-EASTCHESTER

NY 10591
PRIMARY CARE PRACTICE

440 WHITE PLAINS ROAD
NY 10709
EASTCHESTER
4 MMG-CASTLE HILL FAMILY PRACTICE

PRIMARY CARE EXTENSION CLINIC

2175 WESTCHESTER AVENUE
BRONX
s MMG-WHITE PLAINS RD

NY 10462

PRIMARY CARE PRACTICE

2100 WHITE PLAINS ROAD
NY 10462
BRONX
6 SUBSTANCE ABUSE TREATMENT CENTER UNIT 1

SUBSTANCE USE DISORDERS CLINIC

3550 JEROME AVENUE
NY 10467
BRONX
7 MONTEFIORE MED PARK ORTHODONTIC CENTER

SPECIALTY CARE EXT CLINIC

1625 POPLAR STREET
BRONX
8 LARCHMONT WOMEN'S CENTER

NY 10461
SPECIALTY CARE PRACTICE

2345 BOSTON POST ROAD
LARCHMONT

NY 10538
PRIMARY CARE PRACTICE

9 MMG-RIVERDALE

3510 JOHNSON AVENUE
NY 10463
BRONX
10 MONTEFIORE EAST TREMONT FAMILY PRACTICE

PRIMARY CARE PRACTICE

3101 E TREMONT AVENUE
BRONX

NY

10461
Schedule H (Form 990) 2016

JSA
GE 1325 1.000

06002L 0114

V 16-7.6F

PAGE 58

 13-1740114

MONTEFIORE MEDICAL CENTER

Page 9

Schedule H (Form 990) 2016

Facili 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'?

Type of Facility (describe)

Name and address

SPECIALTY CARE PRACTICE

1 MONTEFIORE EASTERN VASCULAR ASSOCIATES

3219 EAST TREMONT AVENUE
NY 10461
BUTLER CHILD ADVOCACY CENTER

BRONX
2 J.E.& Z.B.

SPECIALTY CARE EXT CLINIC

3314 STEUBEN AVENUE
NY 10467
BRONX
3 NY CHILDREN'S HEALTH PROJECT

HOMELESS SHELTER EXT CLINIC

853 LONGWOOD AVENUE
BRONX
4 MSHP -

NY 10459

SCHOOL HEALTH CLINIC

STEVENSON HIGH SCHOOL

1980 LAFAYETTE AVENUE
NY 10461
BRONX
5 MSHP-DE WITT CLINTON HIGH SCHOOL

SCHOOL HEALTH CLINIC

100 W. MOSHOLU PARKWAY SO.
BRONX
6 MSHP-HERBERT H.

NY 10468
LEHMAN CAMPUS

SCHOOL HEALTH CLINIC

3000 EAST TREMONT AVENUE
NY 10461
BRONX
7 MONTEFIORE MEDICAL SPECIALISTS

SPECIALTY CARE PRACTICE

495 CENTRAL PARK AVENUE
YONKERS
8 MSHP-P.S.

NY 10704

SCHOOL HEALTH CLINIC

8

3010 BRIGGS AVENUE
BRONX
9 INST FR WOMEN'S HLTH,

NY 10458
GENETICS & HUM REP

SPECIALTY CARE PRACTICE

1695 EASTCHESTER ROAD
BRONX
10 MSHP-EVANDER CHILDS CAMPUS

NY 10461
SCHOOL HEALTH CLINIC

800 EAST GUN HILL ROAD
BRONX

NY

10467
Schedule H (Form 990) 2016

JSA
6E 1325 1.000

06002L 0114

V 16-7.6F

PAGE 59

 13-1740114

MONTEFIORE MEDICAL CENTER

Page 9

Schedule H (Form 990) 2016

Information continued

Facili
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 yeaf?

Name and address
1 MSHP-JOHN PHILIP SOUSA M.S.

Type of Facility (describe)
SCHOOL HEALTH CLINIC

142

3750 BAYCHESTER AVENUE
NY 10466

BRONX

2 MONTEFIORE DIVISION OF GASTROENTEROLOGY

SPECIALTY CARE PRACTICE

1500 WATERS PLACE
BRONX
3 MSHP-P.S.

NY

10461

SCHOOL HEALTH CLINIC

105

725 BRADY AVENUE
BRONX
4 MSHP-WALTON CAMPUS

NY

10462

SCHOOL HEALTH CLINIC

2780 RESERVOIR AVENUE
NY
BRONX
5 MSHP-THEODORE ROOSEVELT CAMPUS

10468

SCHOOL HEALTH CLINIC

500 EAST FORDHAM ROAD
NY

BRONX
6 MSHP-P.S.

1861 ANTHONY AVENUE
BRONX
7 MSHP-M.S.

10458
i

SCHOOL HEALTH CLINIC

28

NY 10457
SCHOOL HEALTH CLINIC

45

2502 LORRILARD AVENUE
BRONX
8 MSHP-P.S.

NY

10458

SCHOOL HEALTH CLINIC

55

450 ST PAULS PLACE
NY

BRONX
9 MSHP-P.S.

10456

SCHOOL HEALTH CLINIC

85

2400 MARION AVENUE
10

NY 10458
BRONX
PREV PROG
POISONING
SAFE HOUSE FOR LEAD

SPECIALTY CARE EXT CLINIC

91 EAST MOSHOLU PARKWAY
BRONX

NY

10467
Schedule H (Form 990) 2016

JSA
6E 1325 1.000

06002L 0114

V 16-7.6F

PAGE 60

 13-1740114

MONTEFIORE MEDICAL CENTER

Page 9

Schedule H (Form 990) 2016

Facili

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?

Type of Facility (describe)

Name and address
1

SCHOOL HEALTH CLINIC

MSHP-SOUTH BRONX CAMPUS

701 ST. ANNS AVENUE, 3RD FLOOR
BRONX
2 MSHP-I.S.

NY

10455

SCHOOL HEALTH CLINIC

217 ENTRADA

977 FOX STREET
NY 10459
BRONX
3 MONTEFIORE WAKEFIELD CHEM DEP 0/P PROG

SUBSTANCE USE DISORDERS CLINIC

4401 BRONX BOULEVARD
BRONX
4 MSHP-P.S./M.S.

NY 10470

SCHOOL HEALTH CLINIC

95

3961 HILLMAN AVENUE
NY 10463
BRONX
5 MSHP-BRONX REGIONAL HIGH SCHOOL

SCHOOL HEALTH CLINIC

1010 REV J.A. POLITE AVENUE
NY 10459
BRONX
6 CENTER FOR CHILD HEALTH AND RESILIENCY

PRIMARY CARE EXTENSION CLINIC

890 PROSPECT AVENUE
BRONX
7 MONTEFIORE DENTAL CENTER

NY 10459

SPECIALTY CARE PRACTICE

951 PROSPECT AVENUE
BRONX
8 MSHp-MOTT HAVEN H.S.

NY

10459

SCHOOL HEALTH CLINIC

CAMPUS

730 CONCOURSE VILLAGE EAST
BRONX

NY

10451

SPECIALTY CARE EXT CLINIC

9 MONTEFIORE STD INITIATIVE

3230 BAINBRIDGE AVENUE
NY 10467
BRONX
10 MSHP-WILLIAM HOWARD TAFT CAMPUS

SCHOOL HEALTH CLINIC

240 EAST 172ND STREET
BRONX

NY 10457
Schedule H (Form 990) 2016

JSA
GE 1325 1 000

06002L 0114

V 16-7.6F

PAGE 61

 13-1740114

MONTEFIORE MEDICAL CENTER

Page 9

Schedule H (Form 990) 2016

..
Facili 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?

Type of Facility (describe)

Name and address
1 MSHP-P.S.

SCHOOL HEALTH CLINIC

64

1425 WALTON AVENUE
NY 10452
BRONX
CTR
DIALYSIS
CHILD
2 MONTEFIORE GOTTSCHO

CHRONIC DIALYSIS EXT CLINIC

FROST VALLEY YMCA CAMP
NY 12725
CLARYVILLE
3 SARATOGA INTERFAITH FAMILY SHELTER

HOMELESS SHELTER EXT CLINIC

175-15 ROCKAWAY BOULEVARD
QUEENS
4 HELP BRONX CROTONA

NY

11434

HOMELESS SHELTER PT CLINIC

785 CROTONA PARK NORTH
NY 10460
BRONX
s NEW DAY DOMESTIC VIOLENCE SHELTER

HOMELESS SHELTER PT CLINIC

P.O. BOX 6310
NY 10451
BRONX
6 AMERICAN RED CROSS FAMILY SHELTER/ICAHN

HOMELESS SHELTER EXT CLINIC

4 EAST 28TH STREET
NEW YORK
7 MONTEFIORE BREAST CENTER

NY 10016
IMAGING CENTER

1500 BLONDELL AVENUE
NY
BRONX
8 WOMEN IN NEED-SUZANNE ' S PLACE

10461

HOMELESS SHELTER EXT CLINIC

25 JUNIUS STREET
BROOKLYN

NY 11212

HOMELESS SHELTER EXT CLINIC

9 SAINT JOHN'S FAMILY SHELTER

1630 SAINT JOHN'S PLACE
NY
BROOKLYN
10 WELLNESS CENTER AT PORT MORRIS

11233

SUBSTANCE USE DISORDERS CLINIC

804 EAST 138TH STREET
BRONX

NY

10454
Schedule H (Form 990) 2016

JSA
6E 1325 1.000

06002L 0114

V 16-7.6F

PAGE 62

 13-1740114

MONTEFIORE MEDICAL CENTER

Page 9

Schedule H (Form 990) 2016

Facili 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 yeaf?

Type of Facility (describe)
HOMELESS SHELTER EXT CLINIC

Name and address
1 STREETWORK'S PROJECT DROP-IN CENTER

209 W 125TH STREET
NY 10016
NEW YORK
z WELLNESS CENTER AT WATERS PLACE

SUBSTANCE USE DISORDERS CLINIC

1510 WATERS PLACE
NY 10461
BRONX
3 WAKEFIELD-DEPT OF OPHTHALMOLOGY

SPECIALTY CARE

4141 CARPENTER AVENUE
BRONX
4 WELLNESS CENTER AT MELROSE

NY 10466
SUBSTANCE USE DISORDERS CLINIC

260 EAST 161ST STREET
NY 10451
BRONX
s WAKEFIELD-DEPT OF ORTHROPEDIC SURGERY

SPECIALTY CARE

4141 CARPENTER AVENUE
NY
BRONX
6 MONTEFIORE RIVERDALE PRACTICE

10466

SPECIALTY CARE PRACTICE

3333 HENRY HUDSON PARKWAY
BRONX

NY

10463

SPECIALTY CARE PRACTICE

7 MONTEFIORE WELLNESS CENTER

1180 MORRIS PARK AVENUE
NY 10461
BRONX
8 RIVERDALE MEDICAL ASSOCIATES

SPECIALTY CARE PRACTICE

2711 HENRY HUDSON PARKWAY
BRONX

NY

10463
IMAGING CENTER

9 NEUROSCIENCE CENTER

3316 ROEHAMBEAU AVENUE
NY 10467
BRONX
CTR
RESEARCH
io MONTEFIORE GENERAL CLINICAL

CLINIC RESEARCH EXT CLINIC

1300 MORRIS PARK AVENUE
BRONX

NY

10461
Schedule H (Form 990) 2016

JSA
6E 1325 1 000

06002L 0114

V 16-7.6F

PAGE 63

 13-1740114

MONTEFIORE MEDICAL CENTER

Page 9

Schedule H (Form 990) 2016

Facili 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
Type of Facility (describe)

Name and address
i

CLINICAL RESEARCH EXT CLINIC

GENERAL CLINICAL RESEARCH CENTER

111 E. 210TH STREET-MRT
BRONX

NY 10467

2 MONTEFIORE-EINSTEIN CTR FOR CANCER CARE

CANCER SERVICES

1521 JARRETT PLACE
NY 10461
BRONX
3 MONTEFIORE CARDIOLOGY @ 1628 EASTCHESTER

SPECIALTY PRACTICE

1628 EASTCHESTER ROAD
NY 10461
BRONX
4 MONTEFIORE JARRETT PEDIATRIC DENTAL CTR

DENTAL CENTER

1516 JARRETT AVENUE
NY 10456
BRONX
s MONTEFIORE DEPARTMENT OF DENTISTRY

DENTAL CENTER

3332 ROCHAMBEAU AVENUE
NY 10467
BRONX
6 MONTEFIORE ADVANCED IMAGING GUNHILL

IMAGING CENTER

200 EAST GUNHILL ROAD
NY 10467
BRONX
7 MONTEFIORE,WAKEFIELD CHILD PSYCH CTR

MENTAL HEALTH CLINIC

4141 CARPENTER AVENUE
BRONX
8 ADOLESCENT AIDS PROGRAM

NY 10466
PEDIATRIC SPECIALTY CENTER

3415 WAYNE AVENUE
NY 10467
BRONX
9 MONTEFIORE DEPARTMENT OF NEUROLOGY

SPECIALTY CENTER

140 LOCKWOOD AVENUE
NY 10801
NEW ROCHELLE
io MONTEFIORE DEPARTMENT OF NEUROSURGERY

SPECIALTY CENTER

3316 ROCHAMBEAU AVENUE
BRONX

NY 10467
Schedule H (Form 990) 2016

JSA
6E 1325 1.000

06002L 0114

V 16-7.6F

PAGE 64

 13-1740114

MONTEFIORE MEDICAL CENTER

Page 9

Schedule H (Form 990) 2016

Facili 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 yean

Type of Facility (describe)

Name and address
1

EINS/MONTEFIORE AUTISM EVAL & TREAT CTR

SPECIALTY CENTER

6 EXECUTIVE PLAZA
YONKERS
2 WOMEN'S MEDICAL ASSOCIATES

NY

10701
WOMEN'S HEALTH CENTER

1180 MORRIS PARK AVENUE
' BRONX
3 CENTENNIAL WOMEN'S CENTER

NY

10461

WOMEN'S HEALTH CENTER

3332 ROCHAMBEAU AVE
BRONX
4 RIVERDALE WOMEN'S CENTER

NY 10467
WOMEN'S HEALTH CENTER

3333 HENRY HUDSON PARKWAY
NY 10463
BRONX
s DEPT OF OB & GYN/WOMEN'S HEALTH

WOMEN'S HEALTH CENTER

4170 BRONX BOULEVARD
BRONX
6 WOODLAWN WOMEN'S CENTER

NY

10466
WOMEN'S HEALTH CENTER

4350 VAN CORTLANDT PK EAST
BRONX

NY 10470
WOMEN'S HEALTH CENTER

7 GENETICS & PERINATAL CONSULTANTS OF NY

700 WHITE PLAINS ROAD
NY 10583
SCARSDALE
8 MONTEFIORE CHILD/ADOL MENTAL HLTH CLINIC

MENTAL HELATH CLINIC

3340 BAINBRIDGE AVENUE
NY 10467
BRONX
9 MONTEFIORE RIVERDALE CARDIOLOGY PRACTICE

:
SPECIALTY CARE PRACTICE

2711 HENRY HUDSON PARKWAY
io

NY 10463
BRONX
REHABILITATION MEDICINE PRIVATE PRACTICE

SPECIALTY CARE PRACTICE

3329 BAINBRIDGE AVENUE
BRONX

NY 10467
Schedule H (Form 990) 2016

JSA
6E 1325 1.000

06002L 0114

V 16-7.6F

PAGE 65

 13-1740114

MONTEFIORE MEDICAL CENTER

Page 9

Schedule H (Form 990) 2016

Facili

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 yeaf?

Type of Facility (describe)

Name and address

SPECIALTY CARE PRACTICE

1 MONTEFIORE DIVISION OF DERMATOLOGY

3514 BAINBRIDGE AVENUE
BRONX

NY 10467

SPECIALTY CARE PRACTICE

2 SLEEPWAKE DISORDERS

3411 WAYNE AVENUE
NY 10467
BRONX
3 MONTEFIORE BEHAVIORAL HEALTH CTR AT WS

MENTAL HEALTH CLINIC

2527 GLEBE AVENUE
NY 10461
BRONX
4 ADVANCED ONCOLOGY ASSOCIATES

SPECIALTY CARE PRACTICE

50 GUION PLACE
NY 10801
NEW ROCHELLE
s ADVANCED ONCOLOGY ASSOCIATES
ASHFORD AVENUE
18
NY 10522
DOBBS FERRY
6 ADVANCED ONCOLOGY ASSOCIATES

SPECIALTY CARE PRACTICE

SPECIALTY CARE PRACTICE

75 EAST GUN HILL ROAD
NY
BRONX
7 ADVANCED ONCOLOGY ASSOCIATES

10467

SPECIALTY CARE PRACTICE

1578 WILLIAMSBRIDGE ROAD
NY
BRONX
8 ADVANCED ONCOLOGY ASSOCIATES

10461

SPECIALTY CARE PRACTICE

984 NORTH BROADWAY
NY 10701
YONKERS
OFF
9 BRONX RIVER MEDICAL ASSOCIATES-BX

SPECIALTY CARE PRACTICE

60 EAST 208TH STREET
NY 10467
BRONX
OFFICE
ASSOC-YONKERS
10 BRONX RIVER MEDICAL

SPECIALTY CARE PRACTICE

1915 CENTRAL PARK AVENUE
YONKERS

NY

10710
Schedule H (Form 990) 2016

JSA
6E 1325 1.000

06002L 0114

V 16-7.6F

PAGE 66

 13-1740114

MONTEFIORE MEDICAL CENTER

Page 9

Schedule H (Form 990) 2016

Facili

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?

Type of Facility (describe)
SPECIALTY CARE PRACTICE

Name and address
1 MMC-WAKEFIELD CARDIOVASCULAR CENTER

4256 BRONX BOULEVARD
BRONX
2 RIDGE HILL CARDIOLOGY

NY 10466
SPECIALTY CARE PRACTICE

73 MARKET STREET, SUITE 178B
YONKERS
3 BRONX CARDIAC

NY

10710

SPECIALTY CARE PRACTICE

2814 MIDDLETOWN ROAD
NY 10461
BRONX
4 WESTCHESTER HEART SPECIALIST

SPECIALTY CARE PRACTICE

150 LOCKWOOD AVENUE
NEW ROCHELLE
s WILLIAMSBRIDGE CARDIOLOGY

NY 10810
SPECIALTY CARE PRACTICE

1578 WILLIAMSBRIDGE ROAD
NY 10461
6 CARDIOVASCULAR ASSOCIATES OF WESTCHESTER

BRONX

SPECIALTY CARE PRACTICE

140 LOCKWOOD AVENUE
NEW ROCHELLE
7 MMG-VIA VERDE

NY

10801

PRIMARY CARE EXTENSION CTR

730 BROOK AVENUE
BRONX
8 MSHP-MORRIS CAMPUS

NY 10455

SCHOOL HEALTH CLINIC

1110 BOSTON ROAD
NY 10456
BRONX
9 MSHp-NEW SETTLEMENT COMMUNITY CAMPUS

SCHOOL HEALTH CLINIC

1501 JEROME AVENUE
BRONX
10 BROADWAY DENTAL CENTER

NY 10452
DENTAL CENTER

5500 BROADWAY, SUITE 102
BRONX

NY 10463
Schedule H (Form 990) 2016

JSA
6 E 1325 1.000

06002L 0114

V 16-7.6F

PAGE 67

 13-1740114

MONTEFIORE MEDICAL CENTER

Page 9

Schedule H (Form 990) 2016

Facili

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 yeaf?

Type of Facility (describe)

Name and address

MENTAL HEALTH CLINIC

1 MONTEFIORE MOSES OP MENTAL HLTH CLINIC

111 EAST 210TH STREET
NY 10467
BRONX
BARNABAS
ST
AT
ONC
RAD
2 MONTEFIORE

RADIATION ONCOLOGY PRACTICE

4487 THIRD AVENUE, LEVEL B
NY
BRONX
3 MME PLASTIC SURGERY PRACTICE

10466
SPECIALTY CARE PRACTICE

182 210TH STREET
NY 10467
BRONX
4 ROSE KENNEDY CHILD EVALUATION & REHAB CT

1225 MORRIS PARK AVENUE
BRONX
s CHRISTOPHER COLUMBUS CAMPUS

DEVELOPMENTAL DISABILITY
CLINIC

NY 10461
SCHOOL HEALTH CLINIC

925 ASTOR AVENUE
BRONX
6 BOYNTON FAMILY RESIDENCE

NY

10469
INC.)

(AGUILA,

HOMELESS SHELTER EXT.

CLINIC

1056 BOYNTON AVENUE
NY
BRONX
'7 LONG TERM HEALTH CARE PROGRAM

10472
LONG TERM HEALTH CARE AGENCY

ONE FORDHAM PLAZA
NY 10458
BRONX
8 MMC PEDIATRIC-FAMILY IMMUNOLOGY CLINIC

SPECIALTY CARE EXT CLINIC

1621 EASTCHESTER ROAD
NY 10461
9 MMC PEDIATRICS-WINTHROP-PEDS GEN SURG

BRONX

SPECIALTY CARE PRACTICE

120 MINEOLA BOULEVARD
NY 11501
MINEOLA
10 MMC PEDIATRICS CARDIOLOGY AT MNR

SPECIALTY CARE PRACTICE

16 GUION PLACE
NEW ROCHELLE

NY

10801
Schedule H (Form 990) 2016

JSA
6 E 1325 1.000

06002L 0114

V 16-7.6F

PAGE 68

 13-1740114

MONTEFIORE MEDICAL CENTER

Page 9

Schedule H (Form 990) 2016

Facili 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 yeaf?

Type of Facility (describe)
SPECIALTY CARE PRACTICE

Name and address
1 AOA

1624 CROSBY AVENUE
NY 10461
BRONX
2 BRONX RIVER MEDICAL ASSOCIATES-YONKERS

SPECIALTY CARE PRACTICE

1915 CENTRAL PARK AVENUE
NY 10710
YONKERS
3 SOUND SHORE CARDIOLOGY ASSOCIATES

SPECIALTY CARE PRACTICE

175 MEMORIAL HIGHWAY, SUITE 1-1
NY 10801
NEW ROCHELLE
4 SOUND SHORE CARDIOLOGY ASSOCIATES

SPECIALTY CARE PRACTICE

933 MAMARONECK AVENUE
NY 10543
MAMARONECK
s MMC ORTHOPEDICS MANHATTAN PRACTICE

SPECIALTY CARE PRACTICE

73 EAST 71ST STREET
NY 10021
NEW YORK
6 MMC ORTHOPEDICS MANHATTAN PRACTICE

SPECIALTY CARE PRACTICE

215 EAST 73RD STREET
NEW YORK
7 MMC UROLOGY - ADDISON HALL

NY 10021
SPECIALTY CARE PRACTICE

457 WEST 57TH STREET
NEW YORK
8 MMC UROLOGY

NY 10019
-

SPECIALTY CARE PRACTICE

CLINICA MODELO

3050 CORLEAR AVENUE
NY 10463
BRONX
9 MONTEFIORE REHABILITATION-PT AND SPEECH

SPECIALTY CARE PRACTICE

3199 BAINBRIDGE AVENUE
BRONX
io MMC TRANSPLANT HEPATOLOGY

NY 10467
SPECIALTY CARE PRACTICE

3100 BROADWAY
FAIRLAWN

NJ 07410
Schedule H (Form 990) 2016

JSA
6E 1325 1.000

06002L 0114

V 16-7.6F

PAGE 69

 13-1740114

MONTEFIORE MEDICAL CENTER

Page 9

Schedule H (Form 990) 2016

Facili 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 yeaf?

Type of Facility (describe)

Name and address
1

SPECIALTY CARE PRACTICE

MMC TRANSPLANT HEPATOLOGY

170 MAPLE AVENUE
NY 10601
WHITE PLAINS
2 MMC ABDOMINAL TRANSPLANT AT ST JOHNS

SPECIALTY CARE PRACTICE

967 BROADWAY
YONKERS
3 MMC TRANSPLANT HEPATOLOGY

NY

10701
SPECIALTY CARE PRACTICE

60 WEST 68TH STREET
NEW YORK
4 MMC COLLEGE EYE INSTITUTE

NY

10023

SPECIALTY CARE PRACTICE

1180 MORRIS PARK AVENUE
BRONX

NY

10461
SPECIALTY CARE PRACTICE

s MMC GENERAL SURGERY PRACTICE

3736 HENRY HUDSON PARKWAY
NY 10463
BRONX
6 MMC DIABETES PREVENTION PROGRAM

SPECIALTY CARE PRACTICE

3514 DEKALB AVENUE
BRONX

NY

10467

7

8

9

10
Schedule H (Form 990) 2016

JSA
6E 1325 1.000

06002L 0114

V 16-7.6F

PAGE 70

 13-1740114

MONTEFIORE MEDICAL CENTER

Page 10

Schedule H (Form 990) 2016

Supplemental Information
Provide the following information.
1 Required descriptions. Provide the descriptions required for Part 1, lines 3c, 68, and 7, Part Il and Part Ill, 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

PART I, LINE 7 TABLE:

THE FINANCIAL ASSISTANCE AND CERTAIN OTHER COMMUNITY BENEFITS AT COST
TABLE IS BASED ON THE MEDICAL CENTER'S ACTIVITIES ONLY.

ACTIVITES OF THE DISREGARDED ENTITIES

SINCE THE

(MAINLY THE CARE MANAGEMENT

COMPANY, LLC) ARE QUITE UNIQUE AND NOT REPRESENTATIVE OF A HOSPITAL

FACILITY, THE ACTIVITIES FROM THESE ENTITIES WERE EXCLUDED FROM
CONSIDERATION IN THE TABLE.

FORM 990,

PART IX,

LINE 25,

COLUMN A

EXPENSES USED TO CALCULATE THE BENEFIT PERCENTAGES WAS ADJUSTED TO

EXCLUDE THE DISREGARDED ENTITIES SINCE ONLY THE HOSPITAL FACILITY
ACTIVITIES WERE REPORTED.

1.

PART I, LINE 7:

THE COST-TO-CHARGE RATIO METHODOLOGY WAS UTILIZED TO CALCULATE THE AMOUNT
INCLUDED IN THE TABLE.

THE CALCULATION OF THIS RATIO WAS DERIVED FROM

RATIO OF PATIENT CARE COST-TO-CHARGE.

Schedule H (Form 990) 2016

JSA
6 E 1327 2.000

06002L 0114

V 16-7.6F

PAGE 71

 13-1740114

,

MONTEFIORE MEDICAL CENTER

Page 10

Schedule H (Form 990) 2016

Supplemental Information
Provide the following information.
1 Required descriptions. Provide the descriptions required for Part 1, lines 3c, 6a, and 7, Part Il and Part Ill, 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 (eg, 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

1. PART II - COMMUNITY BUILDING ACTIVITIES:
THE MEDICAL CENTER IS ACTIVELY INVOLVED WITH COMMUNITY-BASED

ORGANIZATIONS AND SPECIAL COMMUNITY HEALTH PROGRAMS AS PART OF ITS
MISSION TO ADVANCE THE HEALTH OF THE COMMUNITIES IT SERVES.

THE MEDICAL

CENTER'S COMMUNITY BUILDING ACTIVITIES INCLUDE COMMUNITY SUPPORT OF THE
BRONX AIDS VOLUNTEERS ORGANIZATION, THE LEAD POISONING PREVENTION PROGRAM
AND RECRUITMENT OF MUCH NEEDED MEDICAL PROFESSIONALS TO THE HEALTH
PROFESSIONAL SHORTAGE AREAS

(HPSA) OF THE BRONX, AMONG OTHER

INITIATIVES.

MONTEFIORE'S LEAD POISONING PREVENTION PROGRAM IS A DESIGNATED NEW YORK

STATE RESOURCE CENTER FOR LEAD POISONING PREVENTION, AND CONSISTS OF A
MULTIDISCIPLINARY TEAM IN MEDICINE, RESEARCH, SOCIAL SERVICES,
ENVIRONMENTAL INVESTIGATION AND PUBLIC ADVOCACY.

IT SERVES AS A REFERRAL

CENTER FOR THE MEDICAL MANAGEMENT OF LEAD POISONING, LINKS FAMILIES TO

SAFE HOUSING DURING HOME ABATEMENT PROCEDURES, PROVIDES BILINGUAL

EDUCATIONAL WORKSHOPS, ADVOCATES FOR LEAD POISONED CHILDREN DURING LOCAL
AND STATE LEGISLATIVE REVIEWS AND COLLABORATES WITH CITY AND PRIVATE

AGENCIES IN ENVIROMNENTAL INTERVENTION.

Schedule H (Form 990) 2016

JSA
6E 1327 2.000

06002L 0114

V 16-7.6F

PAGE 72

 13-1740114

MONTEFIORE MEDICAL CENTER

Page 10

Schedule H (Form 990) 2016

Supplemental Information
Provide the following information
1 Required descriptions. Provide the descriptions required for Part I, lines 3c, 68, and 7, Part Il and Part Ill, 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 (eg, 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 repon

PROJECT BRAVO IS A HOSPITAL-BASED VOLUNTEER PROGRAM MANAGED BY
MONTEFIORE'S AIDS CENTER THAT PROVIDES SUPPORT TO HIV AND AIDS PATIENTS.
THE ·PROGRAM RENDERS OUTREACH SERVICES IN THE COMMUNITY,

PROVIDES FRIENDLY

VISITS TO HOSPITALIZED PATIENTS AND STAFFS THE BRAVO FOOD PANTRY.

1.

PART III,

SECTION A,

LINE 2:

THE COST OF BAD DEBT EXPENSE IS ESTIMATED BASED ON THE BAD DEBT PROVISION
AT CHARGE, APPLIED TO THE RATIO OF TOTAL PATIENT CARE EXPENSES TO TOTAL
CHARGES FOR ALL SERVICES RENDERED.

ANY PAYMENTS OR DISCOUNTS ARE

EXCLUDED FROM BAD DEBT EXPENSE.

1.

PART III, SECTION A., LINE 3

THE ESTIMATED AMOUNT OF THE ORGANIZATIONS'S BAD DEBT EXPENSE (AT COST)

ATTRIBUTED TO PATIENTS UNDER THE ORGANIZATION'S CHARITY CARE POLICY WAS

BASED ON RESULTS OF PREDICTIVE ANALYSIS.

BAD DEBT SHOULD BE INCLUDED AS A COMMUNITY BENEFIT BECAUSE THE
ORGANIZATION PROVIDES MUCH NEEDED HEALTH CARE SERVICES INDISCRIMINATELY
TO THE COMMUNITY-AT-LARGE WITHOUT REGARD TO WHETHER OR NOT THE PATIENT

Schedule H (Form 990) 2016

JSA
6E 1327 2.000

06002L 0114

V 16-7.6F

PAGE 73

 13-1740114

MONTEFIORE MEDICAL CENTER

Page 10

Schedule H (Form 990) 2016

Supplemental Information
Provide the following information.
1 Required descriptions. Provide the descriptions required for Part 1, lines 3c, 68, and 7, Part Il and Part Ill, 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 (eg ,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.

HAS INSURANCE OR IF THE BILL WILL EVER BE PAID.

1. PART III, SECTION A., LINE 4

AS REPORTED IN MONTEFIORE MEDICAL CENTER'S AUDITED FINANCIAL STATEMENTS,
BAD DEBT EXPENSE IS DESCRIBED AS FOLLOWS:

"THE COLLECTION OF PATIENT

SERVICE REVENUE DUE FROM PATIENTS, INCLUDING COPAYMENTS AND DEDUCTIBLES,

FROM THOSE WHO ARE INELIGIBLE FOR CHARITY CARE, IS SUBJECT TO
UNCERTAINTY.

THE MEDICAL CENTER RECORDS BAD DEBT EXPENSE IN THE PERIOD

SERVICES ARE RENDERED BASED ON PAST EXPERIENCE, TO ACCOUNT FOR AMOUNTS
THAT PATIENTS MAY ULTIMATELY BE UNABLE OR UNWILLING TO PAY.

FOR SELF-PAY

PATIENTS, WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS
WITH COPAYMENTS AND DEDUCTIBLES AFTER THIRD-PARTY COVERAGE, THE MEDICAL

CENTER RECORDS AN ESTIMATE FOR BAD DEBT EXPENSE IN THE CURRENT PERIOD
BASED ON PAST EXPERIENCE.

AMOUNTS ULTIMATELY WRITTEN OFF AS

UNCOLLECTIBLE AND RECOVERIES OF SUCH AMOUNTS ARE DEDUCTED FROM, OR ADDED
TO,

THE ALLOWANCE FOR DOUBTFUL ACCOUNTS" .

Schedule H (Form 990) 2016

JSA
6E 1327 2.000

06002L 0114

V 16-7.6F

PAGE 74

 13-1740114

MONTEFIORE MEDICAL CENTER

page 10

Schedule H (Form 990) 2016

Supplemental Information
Provide the following information.

1 Required descriptions. Provide the descriptions required for Part 1, lines 3c, 6a, and 7, Part Il and Part Ill, 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

1. PART III, SECTION B, LINE 8:
MEDICARE ALLOWABLE COSTS REPORTED ON PART III, LINE 6, PER SCHEDULE H

INSTRUCTIONS, WERE DERIVED USING THE MEDICARE COST REPORT COST-FINDING
METHODOLOGY, WHICH APPORTIONS ROUTINE COSTS TO MEDICARE USING DAYS AND
ANCILLARY COSTS TO MEDICARE USING DEPARTMENTAL RATIOS OF COSTS TO CHARGES
(RCCS). THE FOLLOWING TABLE REPRESENTS A RECONCILIATION OF MEDICARE

REVENUE AND COSTS INCLUDED ON LINES 5, 6, AND 7 IN PART III TO THE TOTAL
ACTUAL MEDICARE REVENUE AND COSTS OF THE MEDICAL CENTER.

AS HIGHLIGHTED

IN THIS TABLE, INCLUDING THE ADJUSTMENTS DESCRIBED BELOW WOULD HAVE
RESULTED IN A MEDICARE SHORTFALL OF $576,030.

REVENUE

ALLOWABLE

COSTS
PART 111,

LINES 5-7:

$375,627,782

SURPLUS
(SHORTFALL)

$295,752,485

$79,875,297

11,355,029

(11,355,029)

ADD: COSTS NOT INCLUDED
IN MEDICARE COST REPORT:

-

ADD:

MEDICARE DME:

30,496,573

61,296,139

(30,799,566)

ADD:

EMP PHYS SERV:

43,237,000

68,930,890

(25,693,890)

Schedule H (Form 990) 2016

JSA
6E 1327 2.000

06002L 0114

V 16-7.6F

PAGE 75

 13-1740114

MONTEFIORE MEDICAL CENTER

Page 10

Schedule H (Form 990) 2016

Supplemental Information
Provide the following information

1 Required descriptions. Provide the descriptions required for Part 1, lines 3c, 68, and 7, Part Il and Part Ill, 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 (eg, 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.
ADD:

6,571,000

19,173,842

(12,602,842)

$455,932,355

$456,508,385

($576,030)

MED SUBSID HLTH SERV:

MEDICARE SHORTFALL:

MEDICARE REVENUE AND ALLOWABLE COSTS REPORTED IN PART III, SECTION B,
WERE DERIVED FROM THE MEDICARE COST REPORT . HOWEVER , LINES 5 , 6 , AND

7

IN PART III DO NOT INCLUDE CERTAIN MEDICARE REVENUE AND COSTS, AND DOES

NOT PRESENT THE ENTIRE FINANCIAL IMPACT OF THE MEDICAL CENTER'S
PARTICIPATION IN THE MEDICARE PROGRAM.

IN ADDITION,

THE MEDICARE COST

REPORT COST-FINDING METHODOLOGY IS INCONSISTENT WITH THE REST OF SCHEDULE
H, WHEREBY COSTS ARE CALCULATED USING THE MEDICAL CENTER'S OVERALL RATIO
OF COSTS TO CHARGES

(RCC) FROM WORKSHEET 2. ACCORDINGLY, THE MEDICARE

SURPLUS REFLECTED IN PART III, LINE 7 BEFORE THE ADJUSTMENTS DESCRIBED
BELOW IS SIGNIFICANTLY OVERSTATED.

FOR EXAMPLE,

PART III EXCLUDES

CERTAIN MEDICAL CENTER EXPENSES THAT ARE NOT PART OF THE MEDICARE COST

FINDING PROCESS. THESE COSTS INCLUDE CERTAIN CONSULTING AND MARKETING

EXPENSES, COSTS RELATED TO NURSE PRACTITIONERS, NURSE MIDWIVES, PHYSICIAN
ASSISTANTS, AND HOSPITALISTS WHO BILL THE MEDICARE PROGRAM FOR PART B

SERVICES AND PHYSICIAN COSTS EXCEEDING THE MEDICARE REASONABLE

Schedule H (Form 990) 2016

JSA
6E 1327 2.000

06002L 0114

V 16-7.6F

PAGE 76

 13-1740114

MONTEFIORE MEDICAL CENTER

Page 10

Schedule H (Form 990) 2016

Supplemental Information
Provide the following information.
1 Required descriptions. Provide the descriptions required for Part 1, lines 3c, 6a, and 7, Part 11 and Part 111, 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 (eg, 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
COMPENSATION EQUIVALENT (RCE)

LIMITS.

INCLUDING THE MEDICARE SHARE OF

THESE COSTS WOULD HAVE REDUCED THE MEDICARE SURPLUS ON LINE 7 BY

$11,355,029.
PART III ALSO EXCLUDES MEDICARE REVENUE AND ALLOWABLE COSTS FROM THE
MEDICARE COST REPORT RELATED TO DIRECT MEDICAL EDUCATION (DME), WHICH

WERE REPORTED IN PART I, LINE 7 F AS REQUIRED BY THE SCHEDULE H
INSTRUCTIONS.

IF THE MEDICARE SHARE OF DME LOSSES HAD BEEN REPORTED IN

PART III, THE MEDICARE SURPLUS ON LINE 7 WOULD HAVE BEEN REDUCED BY
$30,799,566

(SEE ABOVE RECONCILIATION TABLE).

ADDITIONALLY, PART III EXCLUDES MEDICARE REVENUE AND COSTS FOR SERVICES
BILLED FOR THE MEDICAL CENTER'S EMPLOYED PHYSICIANS THAT ARE PART OF THE
RCC CALCULATION IN WORKSHEET 2 BUT ARE NOT REFLECTED IN THE MEDICAL
CENTER'S MEDICARE COST REPORT.

INCLUDING THE MEDICARE LOSSES FROM THE

MEDICAL CENTER'S EMPLOYED PHYSICIAN SERVICES WOULD HAVE REDUCED THE
MEDICARE SURPLUS ON LINE 7 BY AN ADDITIONAL $25,693,890

(SEE ABOVE

RECONCILIATION TABLE).

PART III ALSO EXCLUDED MEDICARE REVENUE AND COSTS FROM THE MEDICARE COST

REPORT ASSOCIATED WITH SUBSIDIZED HEALTH SERVICES WHICH WERE REPORTED IN

Schedule H (Form 990) 2016

JSA
GE 1327 2 000

06002L 0114

V 16-7.6F

PAGE 77

,

 13-1740114

MONTEFIORE MEDICAL CENTER

Page 10

Schedule H (Form 990) 2016

Supplemental Information
Provide the following information.
1 Required descriptions. Provide the descriptions required for Part 1, lines 3c, 6a, and 7, Part Il and Part Ill, 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 (eg, 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
PART I,

LINE 7G AS REQUIRED BY THE SCHEDULE H INSTRUCTIONS.

IF THE

MEDICARE LOSSES FROM THE MEDICAL CENTER'S SUBSIDIZED HEALTH SERVICES HAD
BEEN REPORTED IN PART III, THE MEDICARE SURPLUS IN LINE 7 WOULD HAVE BEEN
REDUCED BY AN ADDITIONAL $12,602,842

(SEE ABOVE RECONCILIATION TABLE).

1. PART III, SECTION C., LINE 9B
FOR PATIENTS WHO ARE KNOWN TO QUALIFY FOR FINANCIAL ASSISTANCE, ALL

COLLECTION ACTIVITY IS HALTED AND THE PATIENT IS REFERRED FOR FINANCIAL
AID.

IF AN ACCOUNT IS IN COLLECTION AND THE PATIENT REQUESTS FINANCIAL

AID OR IF THE AGENCY DETERMINES THAT THE PATIENT IS ELIGIBLE FOR

FINANCIAL ASSISTANCE, THE ACCOUNT IS REFERRED BACK TO THE MEDICAL CENTER
WHERE THE PATIENT IS PROVIDED ASSISTANCE WITH COMPLETING AN APPLICATION

FOR ASSISTANCE.

2.

NEEDS ASSESSMENT:

MONTEFIORE ASSESSES COMMUNITY NEEDS BY:
A)

COMMUNITY ADVISORY BOARDS

THE PRIMARY APPROACH USED TO GAIN INPUT AND COMMUNITY INVOLVEMENT IS

Schedule H (Form 990) 2016

JSA
6E 1327 2.000

06002L 0114

V 16-7.6F

PAGE 78

 13-1740114

MONTEFIORE MEDICAL CENTER

Page 10

Schedule H (Form 990) 2016

Supplemental Information
Provide the following information.

1 Required descriptions. Provide the descriptions required for Part 1, lines 3c, 6a, and 7 Part 11 and Part 111, 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.
THROUGH A VARIETY OF COMMUNITY ADVISORY BOARDS

(CABS).

MONTEFIORE

MEDICAL CENTER WORKS EXTENSIVELY WITH REPRESENTATIVES OF THE COMMUNITIES
THROUGH THE CABS TO IDENTIFY HEALTH CARE NEEDS AND DETERMINE THE
APPROPRIATE CONFIGURATION OF SERVICES.

ON A REGULAR BASIS,

MONTEFIORE

REPORTS TO THESE VARIOUS COMMUNITY GROUPS ON THE MEDICAL CENTER' S

PERFORMANCE AND SERVICES, THE STATUS OF PROGRAMS, FINANCIAL AND

UTILIZATION STATISTICS, THE PLAN FOR AND IMPLEMENTATION OF COMMUNITY
SERVICES, AND PLANS FOR THE FUTURE.

B)

COMMUNITY SERVICES COMMMITTEE

MONTEFIORE HEALTH SYSTEM HAS A BOARD COMMITTEE, THAT IS FOCUSED ON

COMMUNITY SERVICES. IT IS RESPONSIBLE FOR OVERSEEING MONTEFIORE'S
COMMUNITY SERVICES AND COMMUNITY BENEFIT ACTIVITIES TO ENSURE THEY ARE
FORMULATED TO FACILITATE THE FULFILLMENT OF THE MEDICAL CENTER'S MISSION
AND MEET THE NEEDS OF THE COMMUNITY. THE COMMITTEE MEETS REGULARY TO

BECOME FAMILIAR WITH AND ASSESS MONTEFIORE'S COMMUNITY SERVICE PROGRAMS
AND THE EXTENT TO WHICH THEY ADDRESS AND MAKE A MEANINGFUL IMPACT ON

PRESSING COMMUNITY NEEDS. THE COMMITTEE WORKS CLOSELY WITH MONTEFIORE

Schedule H (Fonn 990) 2016

JSA
GE 1327 2 000

06002L 0114

V 16-7.6F

PAGE 79

 MONTEFIORE MEDICAL CENTER

13-1740114
Page 10

Schedule H (Form 990) 2016

Supplemental Information
Provide the following information.
1 Required descriptions. Provide the descriptions required for Part 1, lines 3c, 6a, and 7, Part Il and Part Ill, 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

LEADERSHIP AND/OR RELEVANT BOARD COMMITTEES THAT ARE RESPONSIBLE FOR

OVERSEEING THE MEDICAL CENTER'S MISSION TO ASSESS AND IMPROVE THE HEALTH
OF THE COMMUNITIES SERVED.

C)

PARTNERSHIPS AND COLLABORATIONS

BEYOND THE FORMAL STRUCTURE THAT MONTEFIORE HAS ESTABLISHED TO GAIN INPUT

FROM THE COMMUNITIES IT SERVES, THE MEDICAL CENTER PARTICIPATES IN A
VARIETY OF ORGANIZED PARTNERSHIPS AND COLLABORATIVES, WORKING WITH OTHER
PROVIDERS IN THE BRONX, THE NYC DEPARTMENT OF HEALTH AND MENTAL HYGIENE,

COMMUNITY-BASED ORGANIZATIONS IN THE BRONX AND MEMBERS OF THE COMMUNITY
IN PLANNING AND DEVELOPING INITIATIVES AIMED AT IMPROVING THE HEALTH OF

PEOPLE IN THE BRONX. EXAMPLES OF SUCH PARTNERSHIPS INCLUDES:

- THE BRONX HEALTH LINK
- THE BRONX RHIO

'

THE BRONX COLLABORATIVE

- THE BRONX BREATHES INITIATIVE
- THE BRONX HIV PLANNING COUNCIL
SOUTH BRONX ENVIRONMENTAL JUSTICE PARTNERSHIP (SBEJP)

Schedule H (Form 990) 2016

JSA
6E 1327 2.000

06002L 0114

V 16-7.6F

PAGE 80

 MONTEFIORE MEDICAL CENTER

13-1740114
Page 10

Schedule H (Form 990) 2016

Supplemental Information
Provide the following information.

1 Required descriptions. Provide the descriptions required for Part 1, lines 3c, 6a, and 7, Part Il and Part Ill, 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 (eg, 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

- CITIWIDE HARM REDUCTION PROGRAM
- BRONX COMMUNITY PALLIATIVE CARE INITIATIVE
BRONX SCIENCE AND HEALTH OPPORTUNITIES PARTNERSHIP
- HISPANIC CENTER OF EXCELLENCE
BRONX CENTER TO REDUCE AND ELIMINATE ETHNIC AND RACIAL HEALTH
DISPARITIES (BRONX CREED).

D) THE OFFICE OF COMMUNITY AND POPULATION HEALTH

MONTEFIORE CONTINUES TO PARTNER WITH A VARIETY OF COMMUNITY-BASED

ORGANIZATIONS TO WORK TO ADVANCE THE HEALTH OF THE COMMUNITY. THE

MONTEFIORE OFFICE OF COMMUNITY AND POPULATION HEALTH WAS SET UP TO
MAXIMIZE THE IMPACT OF THE MEDICAL CENTER'S COMMUNITY SERVICES AND HELPS

TO ASSESS COMMUNITY NEEDS BY ITS VARIOUS INITIATIVES, INCLUDING,
- SUPPORTING AND COORDINATING MONTEFIORE'S DIVERSE PORTFIOLIO OF
COMMUNITY HEALTH IMPROVEMENT PROGRAMS AND ACTIVITIES;

ENHANCING MONTEFIORE'S CAPACITY TO ASSESS AND MEASURE THE HEALTH NEEDS
OF THE COMMUNITIES IT SERVES;

- IDENTIFYING AND SELECTING A LIMITED NUMBER OF TOP-PRIORITY HEALTH

Schedule H (Form 990) 2016

JSA
6E 1327 2.000

06002L 0114

V 16-7.6F

PAGE 81

 MONTEFIORE MEDICAL CENTER

13-1740114
Page 10

Schedule H (Form 990) 2016

Supplemental Information
Provide the following information

1 Required descriptions. Provide the descriptions required for Part 1, lines 3c, 6a, and 7; Part 11 and Part 111, 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 (eg, 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

NEEDS IN THE COMMUNITIES MONTEFIORE SERVES FOR SPECIFIC FOCUS;
LEADING AND COORDINATING MONTEFIORE-WIDE EFFORTS AND WORKING WITH
COMMUNITY PARTNERS TO MEASURABLY IMPROVE THE HEALTH OF THE COMMUNITIES

SERVED;
- THE TO YOUR HEALTH! PROGRAM, A COMMUNITY AND WORKSITE WELLNESS

INITIATIVE SEEKING TO REDUCE THE GROWING BURDEN OF CHRONIC DISEASE IN THE
COMMUNITY THROUGH A NUMBER OF PUBLIC HEALTH PROGRAMS TO EDUCATE PATIENTS,

VISITORS, STAFF AND LOCAL RESIDENTS ON HOW TO LIVE HEALTHIER LIVES.

THROUGH COLLABORATIONS WITH LOCAL COMMUNITY BASED ORGANIZATIONS, THE
OFFICE OF COMMUNITY HEALTH WILL IDENTIFY SPECIFIC INTERVENTIONS THAT CAN

BE WORKED ON BOTH COLLABORATIVELY AND INDEPENDENTLY TO TRANSFORM THE

COMMUNITY HEALTH. USING DATA COLLECTED THROUGH MONTEFIORE, THE DISTRICT

PUBLIC HEALTH OFFICE AND OTHER SOURCES, THE IMPACT ON THE COMMUNITY
HEALTH BY THE PARTICULAR INTERVENTION CAN BE MEASURED AND ANALYZED.

3.

PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE:

ALL INTAKE, REGISTRATION, AND COLLECTION AGENCY STAFF IS TRAINED ON THE

MEDICAL CENTER'S FINANCIAL AID POLICY AND HOW TO PROVIDE PATIENTS WITH

Schedule H (Fonn 990) 2016

JSA
6E 1327 2.000

06002L 0114

V 16-7.6F

PAGE 82

 MONTEFIORE MEDICAL CENTER

13-1740114
Page 10

Schedule H (Form 990) 2016

Supplemental Information
Provide the following information.
1 Required descriptions. Provide the descriptions required for Part 1, lines. 3c, 68, and 7, Part Il and Part Ill, 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 (eg,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.

ASSISTANCE. MONTEFIORE MEDICAL CENTER HAS A POLICY THAT ESTABLISHES

GUIDELINES FOR THE BILLING OFFICE TO FOLLOW WHEN WORKING WITH INDIVIDUALS

WHO ARE HAVING DIFFICULTY PAYING THEIR MEDICAL BILLS.

A REFERRAL IS MADE TO THE MEDICAL CENTER'S FINANCIAL AID OFFICE AND A

FINANCIAL COUNSELOR WILL HELP THE PATIENT APPLY FOR FREE OR LOW-COST
INSURANCE.

IF THE FINANCIAL COUNSELOR DETERMINES THAT THE PATIENT DOES

NOT QUALIFY FOR LOW-COST INSURANCE, THE COUNSELOR WILL HELP THE PATIENT

APPLY FOR A FINANCIAL AID DISCOUNT BASED ON INCOME LEVEL.

THE MEDICAL CENTER MAKES ITS FINANCIAL AID POLICY KNOWN TO THE PUBLIC BY
PROVIDING WRITTEN INFORMATION AVAILABLE IN BOTH ENGLISH AND SPANISH,

INCLUDING BROCHURES AT ALL PATIENT SERVICE AREAS, INFORMATION POSTED ON
THE INTRANET AND INTERNET, AND INFORMATION SENT OUT ON PATIENT'S BILLS.

THERE ARE ALSO SIGNS POSTED AT THE MAIN ENTRANCE TO THE MEDICAL CENTER IN
ENGLISH AND SPANISH ADVISING PATIENTS OF THE ROOM LOCATION FOR FINANCIAL

AID ASSISTANCE.

Schedule H (Form 990)2016

JSA
6 El 327 2.000

06002L 0114

V 16-7.6F

PAGE 83

 MONTEFIORE MEDICAL CENTER

13-1740114
Page 10

Schedule H (Form 990) 2016

Supplemental Information

..

Provide the following information.
1 Required descriptions. Provide the descriptions required for Part 1, lines 3c, 63, and 7, Part Il and Part Ill, 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 (eg, 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.

4.

COMMUNITY INFORMATION:

THE MEDICAL CENTER HAS OUTREACH SERVICES RESPONDING TO THE HEALTH CARE

AND SOCIAL NEEDS THROUGHOUT THE BRONX AND SOUTHERN WESTCHESTER. IT HAS
BECOME A MAJOR COMMUNITY RESOURCE TO A POPULATION WHICH IS AMONG THE

COUNTRY'S MOST ECONOMICALLY AND SOCIALLY DISADVANTAGED AND TO A COMMUNITY
THAT IS FULL OF GREAT CHALLENGES. THE BRONX, WITH ITS 1.4 MILLION
RESIDENTS, IS RANKED THE POOREST URBAN COUNTY IN THE COUNTRY, LEADS THE

NATION IN RATES OF DIABETES AND OBESITY AND OTHER CHRONIC CONDITIONS, AND
LEADS NEW YORK CITY IN A LIST OF SIGNIFICANT MARKERS: PEOPLE IN "FAIR OR
POOR HEALTH",

LOW BIRTH WEIGHT,

TEEN PREGNANCY,

CHILDREN IN POVERTY,

DISABLED INDIVIDUALS AND FAMILIES LIVING BELOW THE POVERTY LEVEL. THE
BRONX HAS A POVERTY RATE OF 27.9%

INCOME OF $35,176

(COMPARED TO 16.8% CITY-WIDE), MEDIAN

(COMPARED TO $51,141 IN BROOKLYN, $60,422 IN QUEENS,

$71,622 IN STATEN ISLAND AND $75,575 IN MANHATTAN) AND ONE OF THE HIGHEST

CHILD POVERTY RATES IN THE UNITED STATES WITH 43% OF BRONX CHILDREN

LIVING BELOW POVERTY; THE NINTH HIGHEST PROPORTION FOR ANY COUNTY IN THE
UNITED STATES, AND THE HIGHEST FOR ANY URBAN COUNTY. THE BRONX IS ALSO
THE YOUNGEST COUNTY IN NEW YORK STATE WITH A MEDIAN AGE OF 33.6 AND 25.3%

Schedule H (Form 990) 2016

JSA
6 E 1327 2.000

06002L 0114

V 16-7.6F

PAGE 84

 MONTEFIORE MEDICAL CENTER

13-1740114
Page 10

Schedule H (Form 990) 2016

Supplemental Information
Provide the following information.
1 Required descriptions. Provide the descriptions required for Part 1, lines k 68, and 7, Part Il and Part Ill, 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 (eg, 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.

OF ITS POPULATION UNDER THE AGE OF 18. THE BRONX HAS THE HIGHEST
PROPORTION OF SINGLE-PARENT HEADED HOUSEHOLDS (19.2%) AMONG COUNTIES IN

THE US. COMMUNITY HEALTH PROFILES OF THE BRONX SHOW POOR HEALTH STATUS,
HIGHER THAN AVERAGE INCIDENCE AND PREVALENCE OF HIV AND TUBERCULOSIS,
POORER THAN AVERAGE BIRTH OUTCOMES, WORSE THAN AVERAGE ACCESS TO PRIMARY

CARE, AND HIGH HOSPITAL ADMISSION RATES FOR DIABETES, CARDIOVASCULAR,

CEREBROVASCULAR, PERIPHERAL VASCULAR AND RENAL DISEASES.

5.

PROMOTION OF COMMUNITY HEALTH:

MONTEFIORE IS A LEADER IN COMMUNITY HEALTH AND HAS A LONG HISTORY OF
DEVELOPING INNOVATIVE APPROACHES TO CARE AND TAILORING PROGRAMS TO BEST
SERVE THE CHANGING NEEDS OF ITS COMMUNITY.

MONTEFIORE EMBRACES ITS

SOCIAL RESPONSIBILITY AND DEFINES ITS ROLE BROADLY, PROMOTING WELLNESS IN
ADDITION TO TREATING DISEASE AND ADDRESSING NEEDS RANGING FAR BEYOND
MEDICAL CARE.

MONTEFIORE EXTENDS THIS RESPONSIBILITY TO THE CARE OF ITS

EMPLOYEES AND MEDICAL STAFF, MANY WHOM LIVE IN THE SURROUNDING COMMUNITY.

THE POPULATION MONTEFIORE SERVES IS ONE OF THE MOST DIVERSE IN THE

Schedule H (Form 990) 2016

JSA
6E 1327 2.000

06002L 0114

V 16-7.6F

PAGE 85

 13-1740114

MONTEFIORE MEDICAL CENTER

Page 10

Schedule H (Form 990)2016

Supplemental Information
Provide the following information.
1 Required descriptions. Provide the descriptions required for Part 1, lines k 68, and 7, Part Il and Part Ill, 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.
NATION.

MONTEFIORE HAS BEEN AN INCUBATOR FOR PROGRAMS THAT IMPROVE

PATIENTS' ACCESS TO CULTURALLY APPROPRIATE SERVICES, AND ITS PROGRESSIVE

FINANCIAL AID POLICY AND ROBUST ENTITLEMENT ENROLLMENT PROGRAM SUPPORT
ACCESS TO CARE FOR THOSE IN NEED.

HISTORICALLY,

MONTEFIORE HAS EMBRACED

COMMUNITY SERVICE AND COMMUNITY HEALTH IMPROVEMENT AS A DELIVERY SYSTEM
CHALLENGE, REACHING OUT TO SERVE THE UNDER-RESOURCED THROUGH ITS
EXTENSIVE PRIMARY CARE DELIVERY SYSTEM, INCLUDING A NUMBER OF
FEDERALLY-QUALIFIED COMMUNITY HEALTH CENTERS (FQHC). IN ADDITION,

MONTEFIORE HAS DEVELOPED A WIDE RANGE OF SERVICES TARGETED TO SPECIFIC
GROUPS IN NEED: THE YOUNG, THE ELDERLY, THE HIV INFECTED AND AFFECTED,

THE MENTALLY ILL, THOSE STRUGGLING WITH SUBSTANCE USE, HOMELESSNESS AND
VIOLENCE AND THOSE LIVING WITH CHRONIC DISEASES. THE MEDICAL CENTER HAS

MAINTAINED AND EXPANDED ITS RANGE OF COMMUNITY SERVICES, REACHING OUT TO
AND SERVING POPULATIONS WITH UNMET HEALTH CARE NEEDS, INCLUDING:

- THOSE WITH POOR ACCESS TO COMPREHENSIVE CARE

- UNDERSERVED, AT-RISK AND HARD TO REACH CHILDREN & THEIR FAMILIES UNDERSERVED AND AT-RISK SENIOR CITIZENS
- THOSE AFFECTED BY CANCER

Schedule H (Form 990) 2016

JSA
6E1 327 2 000

06002L 0114

V 16-7.6F

PAGE 86

 13-1740114

MONTEFIORE MEDICAL CENTER

Page 10

Schedule H (Form 990) 2016

Supplemental Information
Provide the following information
1 Required descriptions. Provide the descriptions required for Part 1, lines 3c, 68, and 7, Part Il and Part Ill, 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 re'port

- THOSE AFFECTED BY THE CONTINUING HIV EPIDEMIC IN THE BRONX
- PERSONS WITH OR AT-RISK FOR TUBERCULOSIS INFECTION
- PERSONS AFFECTED WITH PROBLEMS OF SUBSTANCE ABUSE

- THE HOMELESS
ADULTS AND CHILDREN WITH LIMITED ACCESS TO PRIMARY DENTAL CARE

THOSE AFFECTED BY CHRONIC HEALTH CARE DISEASE SUCH AS CONGESTIVE
HEART FAILURE, DIABETES AND ASTHMA.

THE MEDICAL CENTER RUNS PROGRAMS FOR COMMUNITY HEALTH SERVICES THAT ARE
AMONG THE NATION'S MOST EXTENSIVE PROVIDING PRIMARY CARE TO UNDERSERVED

POPULATIONS INCLUDING:
MONTEFIORE'S NETWORK OF PRIMARY CARE CENTERS IN THE BRONX INCLUDING
SEVERAL FEDERALLY-QUALIFIED HEALTH CARE CENTERS (FQHC)

PROVIDES ACCESS TO

HIGH QUALITY PRIMARY HEALTH CARE SERVICES AND A VARIETY OF PRACTICE-BASED

AND COMMUNITY OUTREACH PROGRAMS TO SOME OF THE NATION'S POOREST AND MOST
UNDERSERVED COMMUNITIES.

MONTEFIORE OPERATES ONE OF THE NATION'S LARGEST PROGRAMS OF
SCHOOL-BASED PRIMARY CARE, SERVING 25,000 STUDENTS AT 23 ELEMENTARY,

Schedule H (Form 990) 2016

JSA
GE 1327 2 000

06002L 0114

V 16-7.6F

PAGE 87

 13-1740114

MONTEFIORE MEDICAL CENTER

Page 10

Schedule H (Form 990) 2016

Supplemental Information
Provide the following information.
1 Required descriptions. Provide the descriptions required for Part 1, lines 3(, 6a, and 7, Part Il and Part Ill, 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 de5cribing how the organization's hospital facilities or

other health care facilities further its exempt purpose by promoting the health of the community (eg, 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

MIDDLE AND HIGH SCHOOLS IN THE BRONX, PROVIDING OVER 90,000 MEDICAL,
MENTAL HEALTH,

DENTAL,

REPRODUCTIVE AND HEALTH PROMOTION SERVICES.

THIS

MODEL PROGRAM IS ABLE TO PROVIDE SERVICES TO ALL STUDENTS IN THESE
SCHOOLS, INCLUDING THE ROUGHLY HALF OF ALL STUDENTS WITHOUT INSURANCE.

MONTEFIORE PROVIDES MUCH NEEDED HEALTH CARE SERVICES TO HOMELESS
CHILDREN AND FAMILIES IN VARIOUS LOCATIONS IN THE BRONX AND THROUGHOUT
NEW YORK.CITY USING A FLEET OF MOBILE MEDICAL UNITS AND A MOBILE DENTAL

UNIT AND USING TEAMS OF PROFESSIONALS PROVIDING SERVICES WITHIN HOMELESS
AND DOMESTIC VIOLENCE SHELTERS.

MONTEFIORE PROVIDES COMPREHENSIVE CARE AND A RANGE OF INNOVATIVE PROGRAMS

FOR HIGH-RISK CHILDREN IN THE BRONX, INCLUDING:
A HIGHLY REGARDED PREVENTION, COUNSELING AND TREATMENT PROGRAM FOR

ABUSED CHILDREN AND THEIR FAMILIES, BASED IN MONTEFIORE'S CHILD ADVOCACY
CENTER.

A NATIONALLY RECOGNIZED LEAD POISONING PREVENTION, SCREENING AND
TREATMENT PROGRAM SERVING POPULATIONS AT HIGHEST RISK FOR LEAD POISONING.

ITS SAFE HOUSE IS A MODEL HOUSING PROGRAM TO SHELTER FAMILIES OF CHILDREN

Schedule H (Form 990) 2016
JSA
6E 1327 2.000

06002L 0114

V 16-7.6F

PAGE 88

 13-1740114

MONTEFIORE MEDICAL CENTER

page 10

Schedule H (Form 990) 2016

Supplemental Information
Provide the following information.
1 Required descriptions. Provide the descriptions required for Part 1, lines 3c, 6a, and 7; Part 11 and Part 111, 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

WITH HIGH LEAD LEVELS WHILE THEIR DWELLINGS ARE MADE LEAD FREE.
- AN INNOVATIVE, MULTI-LEVEL PROGRAM OF CARE FOR CHILDREN WITH AND

AT-RISK FOR OBESITY AND DIABETES, INCLUDING INITIATIVES IN THE

SCHOOL-BASED HEALTH CENTERS, IN THE COMMUNITY-BASED PRIMARY CARE SITES
AND AT THE CHILDREN'S HOSPITAL DIVISION AT MONTEFIORE

(CHAM).

HEALTH PROFESSIONS EDUCATION PROGRAMS FOR HIGH SCHOOL STUDENTS
CONDUCTED IN COLLABORATION WITH AREA HIGH SCHOOLS.

THE MEDICAL CENTER OPERATES ONE OF THE NATION'S LARGEST AND MOST

COMPREHENSIVE PROGRAMS FOR THE DIAGNOSIS, CARE AND ONGOING MANAGEMENT OF

POPULATIONS WITH AND AT-RISK FOR HIV INFECTION, INCLUDING:
A HOSPITAL-BASED, STATE-DESIGNATED COMPREHENSIVE AIDS CENTER THAT

SERVES INDIVIDUALS WITH HIV/AIDS WITH A BROAD PROGRAM OF AMBULATORY AND
INPATIENT CARE.

A COMMUNITY-BASED PROGRAM THAT SERVES INDIVIDUALS WITH HIV/AIDS,

OPERATING IN THE MEDICAL CENTER'S PRIMARY CARE SITES.
LONGSTANDING PROGRAMS FOCUSED ON THE PREVENTION, EARLY IDENTIFICATION

AND ONGOING CARE AND MANAGEMENT OF CHILDREN AND ADOLESCENTS WITH OR AT

Schedule H (Form 990) 2016

JSA
6 El 327 2.000

06002L 0114

V 16-7.6F

PAGE 89

 MONTEFIORE MEDICAL CENTER

13-1740114
Page 10

Schedule H (Form 990) 2016

Supplemental Information
Provide the following information.
1 Required descriptions. Provide the descriptions required for Part 1, lines 3c, 68, and 7, Part Il and Part Ill, 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 sen/es, 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

RISK FOR HIV INFECTION.

AN INNOVATIVE PROGRAM OF OUTREACH HIV PRIMARY AND SPECIALTY CARE

SERVICES, THAT ARE LOCATED IN MONTEFIORE'S SUBSTANCE ABUSE TREATMENT
PROGRAM, WHICH SERVES OPIATE-ADDICTED INDIVIDUALS, HALF OF WHOM ARE
HIV-INFECTED, IN SEVERAL DRUG TREATMENT CENTERS LOCATED THROUGHOUT THE
BRONX.

THIS SERVICE INFRASTRUCTURE HAS PROVEN INVALUABLE IN MOUNTING EFFECTIVE

PUBLIC HEALTH, DIAGNOSIS AND CARE PROGRAMS RESPONDING TO THE TWO OTHER

INFECTIOUS DISEASE EPIDEMICS THAT HAVE ALSO AFFLICTED THE BRONX:

TUBERCULOSIS AND HEPATITIS-C INFECTION.

MONTEFIORE PROVIDES A WIDE RANGE OF ON-SITE AND OUTREACH PROGRAMS TO

SERVE THE BOROUGH'S FRAIL AND AT-RISK ELDERLY, INCLULDING:

- A COMPRHENSIVE, MULTIDISCIPLINARY GERIATRIC AMBULATORY PRACTICE,

INCLUDING GERIATRIC MEDICINE AND GERIATRIC PSYCHIATRY, SOCIAL SERVICES,
PHARMACY AND NUTRITIONAL COUNSELING, WITH SERVICE SITES IN THE EAST AND

WEST BRONX;
AN AGING AND MEMORY CENTER THAT PROVIDES ASSESSMENTS, AMBULATORY CARE

Schedule H (Form 990) 2016

JSA
6E 1327 2.000

06002L 0114

V 16-7.6F

PAGE 90

 MONTEFIORE MEDICAL CENTER

13-1740114
page 10

Schedule H (Form 990) 2016

Supplemental Information
Provide the following information
1 Required descriptions. Provide the descriptions required for Part 1, lines 3c, 68, and 7, Part Il and Part Ill, 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 (eg, 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.

AND HOME VISITS BY GERIATRIC PSYCHIATRISTS;

ONE OF THE NATION'S LARGEST HOSPITAL-BASED HOMECARE PROGRAMS,

PROVIDING IN-HOME SERVICES TO INNER CITY SENIORS LIVING IN NEIGHBORHOODS
THAT ARE AMONG THE COUNTRY'S MOST DISADVANTAGED;
AN EXTENSIVE PROGRAM TO IDENTIFY, PREVENT AND RESPOND TO SUSPECTED
ELDER ABUSE;

PHYSICIAN HOME VISIT PROGRAMS SERVING THE ELDERLY LIVING IN PUBLICLY

SUBSIDIZED HOUSING PROJECTS ACROSS THE BRONX, A PROGRAM MOUNTED IN

,

PARTNERSHIP WITH THE NYC HOUSING AUTHORITY AND LOCAL COMMUNITY AND SOCIAL
SERVICES AGENCIES IN "NATURALLY OCCURRING RETIREMENT COMMUNITIES";

AN INNOVATIVE FEDERALLY-FUNDED DEMONSTRATION PROGRAM THAT USES A

COMBINATION OF CARE AND CASE MANAGEMENT, A PHYSICIAN HOME VISITING

PROGRAM, HOME-BASED TELEMONITORING AND PATIENT/FAMILY SUPPORT TO MANAGE

AND IMPROVE THE CARE AND HEALTH OF SENIORS IDENTIFIED BY CMS AS THEIR
"HIGH-COST BENEFICIARIES"

(MEDICARE BENEFICIARIES WITH COMPLEX MEDICAL

AND PSYCHOSOCIAL NEEDS).

THE DEPARTMENT OF OB-GYN AND WOMEN'S HEALTH IS INVOLVED IN A RANGE OF

Schedule H (Form 990) 2016

JSA
6E 1327 2 000

06002L 0114

V 16-7.6F

PAGE 91

 MONTEFIORE MEDICAL CENTER

13-1740114
Page 10

Schedule H (Form 990) 2016

Supplemental Information
Provide the following information
1 Required descriptions. Provide the descriptions required for Part 1, lines 3c, 6a, and 7, Part Il and Part Ill, 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 El
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 (eg, 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

PROGRAMS FOCUSED ON THE HEALTH NEEDS OF WOMEN IN THE BRONX AND

SURRROUNDING COMMUNITIES THAT INCLUDES PARTNERING WITH NY STATE, NY CITY
AND LOCAL PROVIDERS IN THE DEVELOPMENT OF A REGIONAL PERINATAL SYSTEM IN
THE BRONX, WHICH HAS ONE OF THE COUNTRY'S HIGHEST RATES OF INFANT
MORTALITY AND DISABILITY AND LOW BIRTH WEIGHT.

MONTEFIORE AS A COMMUNITY LEADER IS RESPONDING TO THE UNIQUE AND PRESSING
NEEDS OF ITS COMMUNITY REFLECTED IN VARIOUS OUTREACH PROGRAMS:

THE MONTEFIORE-EINSTEIN CANCER CARE OPERATES THE COMMUNITY OUTREACH

PROGRAM, A RESEARCH BASED CANCER PREVENTION, EDUCATION, AND SUPPORT
PROGRAM THAT PROVIDES SUPPORT AND EDUCATIONAL SERVICES TO PATIENTS,

FAMILIES, STAFF, AND COMMUNITY MEMBERS FACING THE CHALLENGES OF CANCER.

THE CENTER ALSO PARTICIPATES IN CANCER SCREENING, CANCER EDUCATION AND
AWARENESS, AND SUPPORT PROGRAMS.

MONTEFIORE'S COMMUNITY DENTISTRY PROGRAM PROVIDES DENTAL SERVICES TO
A MULTITUDE OF UNDERSERVED AND MEDICALLY COMPROMISED PATIENTS AT ON-SITE

.

DENTAL FACILITIES, ONE COMMUNITY SITE, AND THE INFECTIOUS DISEASE CLINIC
AT THE MOSES DIVISION. A MOBILE DENTAL VAN PROVIDES MOBILE DENTAL

Schedule H (Form 990) 2016

JSA
GE 1327 2 000

06002L 0114

V 16-7.6F

PAGE 92

 13-1740114

MONTEFIORE MEDICAL CENTER

Page 10

Schedule H (Form 990) 2016

Supplemental Information
Provide the following information.

1 Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7, Part Il and Part Ill, 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.

SERVICES TO THE UNDERSERVED AT A VARIETY OF MONTEFIORE PRIMARY CARE SITES
ACROSS THE BRONX.

MONTEFIORE HAS BEEN DESIGNATED BY NY STATE AS ONE OF FOUR DIABETES
CENTERS OF EXCELLENCE IN THE STATE. MONTEFIORE HAS IMPLEMENTED A
COMPREHENSIVE ARRAY OF PROGRAMS RESPONDING TO THE

"NEXT EPIDEMIC"

IN THE

BRONX: THE EXTRAORDINARILY HIGH AND INCREASING RATES OF DIABETES AND

OBESITY AND THE COMMON CARDIOVASCULAR COMPLICATIONS AND COMORBIDITIES.
MONTEFIORE IS TAKING A NETWORK-WIDE QUALITY IMPROVEMENT APPROACH TO

ORGANIZING AND IMPROVING THE PREVENTION, CARE AND MANAGEMENT OF THIS

DISEASE CLUSTER, IN ITS PRIMARY CARE AND SCHOOL-BASED SITES, IN ITS
SPECIALTY SERVICES AND HOSPITAL DIVISIONS.

MONTEFIORE HAS TAKEN A LEADERSHIP POSITION IN NEIGHBORHOOD AND COMMUNITY

DEVELOPMENT, CREATING AND SUPPORTING THE MOSHOLU PRESERVATION CORPORATION
(MPC).

MPC IS A COMMUNITY REDEVELOPMENT CORPORATION THAT HAS

SUCCESSFULLY REHABILITATED HOUSING STOCK IN THE DEPRESSED NEIGHBORHOODS
IN THE NORTHWEST BRONX AND HAS BEEN INVOLVED IN A NUMBER OF ECONOMIC

DEVELOPMENT AND COMMUNITY DEVELOPMENT ACTIVITIES.

Schedule H (Form 990) 2016

JSA
6E 1327 2.000

06002L 0114

V 16-7.6F

PAGE 93

 13-1740114

MONTEFIORE MEDICAL CENTER

page 10

Schedule H (Form 990) 2016

Supplemental Information
Provide the following information.
1 Required descriptions. Provide the descriptions required for Part 1, lines 3c, 6a, and 7, Part Il and Part Ill, 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

THE MEDICAL CENTER OFFICE OF COMMUNITY HEALTH AND WELLNESS IS ACTIVELY

SEEKING TO REDUCE THE GROWING BURDEN OF CHRONIC DISEASES IN THE COMMUNITY

THROUGH A NUMBER OF PUBLIC HEALTH PROGRAMS TO EDUCATE PATIENTS, VISITORS,
STAFF AND LOCAL RESIDENTS ON HOW TO LIVE HEALTHIER LIVES.

THE TO YOUR

HEALTH! PROGRAM OFFERS:

FREE FITNESS AND EXERCISE CLASSES;
- HEALTH SCREENINGS;
- COMMUNITY-BASED HEALTH FAIRS; AND

INFORMATIVE WORKSHOPS TACKLING VARIOUS HEALTH ISSUES, INCLUDING
DIABETES AND NUTRITION.

THE MEDICAL CENTER IS ATTEMPTING TO ADVANCE THE FRONT LINES OF HEALTH IN

THE BRONX BY STRIVING TO MAKE THE BRONX A MORE WHOLESOME PLACE TO LIVE
AND WORK.

RECENT EFFORTS HAVE INCLUDED:

INCREASING ACCESS TO AND USE OF THE BOROUGH'S RIVERS, PARKS AND

GREENWAYS IN PARTNERSHIP WITH THE NEW YORK CITY PARKS DEPARTMENT AND
DEPARTMENT OF TRANSPORTATION, BRONX RIVER ALLIANCE AND THE RAILS TO

Schedule H (Form 990)2016

JSA
GE 1327 2 000

06002L 0114

V 16-7.6F

PAGE 94

 MONTEFIORE MEDICAL CENTER

13-1740114
Page 10

Schedule H (Form 990) 2016

Supplemental Information
Provide the following information.
1 Required descriptions. Provide the descriptions required for Part 1, lines 3c, 68, and 7, Part Il and Part Ill, 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 (eg, 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

TRAILS
- GETTING THE BRONX MOVING BY DEVELOPING BIKE LANES ON BRONX STREETS,
SPONSORING THE

"TOUR DE BRONX'

BICYCLING EVENT,

AND OFFERING VIGOROUS

ZUMBA DANCE CLASSES TO SALSA MUSIC IN THE COMMUNITY;
- IMPROVING BRONX RESIDENTS' ACCESS TO HEALTHY FOOD BY SPONSORING AND
SUPPORTING FARMERS' MARKETS AND GREEN CARTS THROUGHOUT THE BRONX, AND

PARTNERING WITH THE CITY ON ITS HEALTHY BODEGA INITIATIVE;

PROMOTING TOBACCO CESSATION EFFORTS IN THE BRONX, INCLUDING THE

ESTABLISHMENT OF TOBACCO-FREE CAMPUSES AT ALL MONTEFIORE LOCATIONS AND

PARTICIPATION IN THE COALITION FOR A SMOKE FREE BRONX.

6. AFFILIATED HEALTH CARE SYSTEM:

MONTEFIORE MEDICAL CENTER IS AN AFFILIATE OF MONTEFIORE HEALTH SYSTEM,
INC. THE HEALTH SYSTEM IS A LEADER IN COMMUNITY HEALTH AND HAS A LONG

HISTORY OF DEVELOPING INNOVATIVE APPROACHES TO CARE AND CREATING PROGRAMS

TO BEST SERVE THE CHANGING NEEDS OF ITS COMMUNITY. SEE LINE 5, PROMOTION

OF COMMUNITY HEALTH, FOR HOW THE HEALTH SYSTEM ALONG WITH MONTEFIORE

MEDICAL CENTER PROMOTES COMMUNITY HEALTH.

Schedule H (Form 990) 2016

JSA
6E 1327 2.000

06002L 0114

V 16-7.6F

PAGE 95

 MONTEFIORE MEDICAL CENTER

13-1740114
Page 10

Schedule H (Form 990) 2016

Supplemental Information
Provide the following information.

1 Required descriptions. Provide the descriptions required for Part 1, lines 3(, 6a, and 7, Part Il and Part Ill, 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 (eg, 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

7. STATE FILING OF COMMUNITY BENEFIT REPORT:

MONTEFIORE MEDICAL CENTER FILES A COMMUNITY SERVICE PLAN WITH THE STATE

OF NEW YORK.

Schedule H (Form 990) 2016

JSA
6 E 1327 2 000

06002L 0114

f

V 16-7.6F

PAGE 96

 EDULE

Internal Revenue Service

8
•

.

•

.

-

.

.

NY 10458

NY 10456

13-1974191

13-3599121

501(C

501(C

501 C

3

3

186 775

124 660

8 478 818

TEBOIST-ET

1276 FULTON AVENUE BRONX

3 BRONX LEBANON HOSPITAL CENTER

13-1624225

d) Amount of cash

O)/05

LBEGOTE-ET

540 E FORDHAM ROAD BRONX

NY 10468

section

E

0)TOS

2 BRONX AIDS SERVICES INC

1300 MORRIS PARK AVENUE BRONX

~ ALBERT EINSTEIN COLLEGE OF MEDICINE

)

L

E

ODIGLSO-92

or government

b EIN

005

DE

0)ZOS

H.InfaH

XNONS

- aA98 N-HaH.I.nOS 00 E E

'XNOMS IBEI XOR

"O'd

dBOO aZIVO Gl IHO MEAOSdWS nISS 66II

XNONS LS,fa 'IVAO MIOAM353* 00 DE

NOILYHOdHOD NOI.LVAH353-kid n~OHSOW

ISPOT AN

WRESrl* S, NSM(mIHO XNONS

is LaN97.LHOO ZZ

dHOO LNEWdo,alga 3-knfi A-WINd

*HOA MaN 71 HLEI
69 DOT AN

LOOOI AN

NVid

GA78 NHEH.I.nOS SIST

04 u! pms

suoilezlue JO Jal,110 Jo aquinu le}01 Jeju3

Z&

%J

0 t'

6

N,9

39-L-9I A

066 UIJ03 Joi SUO!13nJ}Sul 04; 005 'a,!loN 139 uo! jonpekl )IJOMJeded 10 3

alqe} L eu

g

ALEIJOS NOLLVABaSNOO adI9a•'IIM 8

XNONS

ON I

OOSIONVkid NVS 133-HIS WOS'IOA 558-[

VINMOAITE 30 A.LISki

XNONS 3 SkinOONOO aNVE[D TSB

cash assistance

e) Amount of non

elqel t eu!1 041 ul pals!1 suoileziueSJO JUall,UJBA06 pue (C)(0) 109 UO!:Oes JO JeqUInu le;04 JeJU3
9 EOOT AN 'XHOA MaN LS GNED ISSM OEE

000

£

09&0I AN

L

ITOODLI-ET

0940I

OOS

D IOS

50£09[L-EZ

COBITLE-ET

J)ZOS

E6 D9 E 09- D6

0)ZOS

E

O /05

ISPOI AN

LBE6L0E-CI

EDIDG VD

MMOA MaN 133HLS Hi89I M 0£9

I.NaWdO'laASG JIWONOJa 'InniaAO XNONS

ZEOOI AN

J)ZOS

E

2
000 OI

000 05

005 LI

000 08

E

£608655-Er

5
Ll

J ZOS

H

005

85
E

1 a) Name and address of organization

990, Part IV, line 21, for any recipient that received more than $5,000. Part 11 can be

Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United
Grants and Other Assistance to Domestic Organizations and Domestic Governme

.

OMB No

n
Yp%%to

cash assi

if additional space is needed.
r~

te if the organization answered Yes on Form

0

~ Yes

13 1740114

El No

545-0047

Employe dentification numbe

rants or assistance, and

Form 990 and its nstructions is at www.irs.gov/form990

0

U)
C

2

the selection criteria used to award the grants or assistance? . ,

Does the organization maintain records to substantiate the amou

General Information on Grants and Assistance

I nformat on about Schedule

ro
860 ZE

1

MONTEFIORE MEDLCAL CENTER

9.2.

Complete if the organi za ion nswe ed "Yes" on Form 990 Part IV

ne 21 or 22

Grants an Other Assistance to Organizations,
iduals in the United States

.

RANT SUBRECIPIENT

RANT SUBRECIPIENT

ONTRIBUTIONS GRANT

L 6 30Vd

C

AA
(910Z) (066 uuod) elnpell OS

8 :
.5(n.

d IHSHOSNOd

'.0
.

NOILYNO

N

55

d IHS-HOSNOd

(D

d IHSMOSNOd

C

E0-2
j

d IHSHOSNOd

0

CD

d IHS-HOSNOd

E
0
0)

LN3 Id IDEMEnS 1.NVa

0
E

5

2
d IHSHOSNOd

C

a

e

INEId IJakienS INVH

E

5
U
-C
-

C

€55

DITO 920090

000'L BBEL39

3

 EDULE

0

General Information on Grants and Assistanc

9 2
0

E

(0

OMB No

rants or assistance, the grantees' eligibility for the grants or assistance, and
. .

C
I

.

.

.

.

.
.

NY 12550

NOILVIDOSSY A.LNnOO ME.LS3HJ,LSSM

3.LnLI,LSNI HEDNFO HEENVi-VNVa

06 D

30 000

3

501(C

22-3026263

041 ul pels! SUOileZIUefJO Jall}o Jo Jequlnu 1

UJ

8
#§

19'L-9I A

3

,~m

-

LL'

H /

61

DITO 920090

066 UL,03 Joi suo!;onJ}Sul @41 aas '03!10N 13V uo!1'npahl yJONuaded

alqm L eu

j&

0&

EaIMNOILYN SMEN 70OHOS Z~

Nl.7NOOMS .La<MiS HLBE ISVE

ONI

)[MOA MaN anNEAY XHOA OOEI

cash assistance

e) Amount of non

aiqe; L eu!1 041 ui paisil SuoijezlueSJO jual.UUJeAOS pue (£)(O)Log uoipas Jo iequinu le}01 Jeju3

9EZII AN

5900I AN

ALISE[aAINA 773NMOJ 30 9937700 WDIam,1 77 IEM

NOISOS anNSAV SNICIMOONS OSD

ONI

SITEO VW

'XWOA MaN anNKAV H7HDIS 015

EaLN30 S.LHDIN EHVOIOSW 6

g

Z

9

g

4 YMCA OF GREATER NEW YORK

70 DUBOIS STREET NEWBURGH

25 000

3

501 C

20-8022336

898EGEE-II

NY 10013

0)TOS

BLGEEST-ET

5TH FL NEW YORK

E

O)/05

ODOESZZ-,0

NOLLVaNnOd VSaWONd

XNOMS anN<lAY AV9O 9LLI

DNI

SNIV•Id SJIHM aAV NaiSSHOOSaM EE ZI

ONI

LSDOT AN

NONMaA .LW 133kLLS HI D ISEM LOT

8I00T AN

40901 AN

77INS>[3ad 133*15 NIVW LEOI

)EVOHLMH HEAIN NOSanH

XNOMS anNEAV 97 I H 39.LSVO Z

ONI

H.LrIVEH GOOHHORHDIEN NONMEA 1-W

9950I AN

OSSOI AN

40 WORTH STREET

000

E

O)IOS

ELESOSE-EI

3 ST LUKES CORNWALL HEALTH SYSTEM

15 000

501 C

3

13-5604164

Ir6 9 Er

E

D)IOS

TIOLELI-ET

INC.

89£ LE

E

D ZOS

81£E 99Z-Er

NY 10004

000 OI

D

D /05

BOSSICE-ET

42 BROADWAY NEW YORK

grant

d) Amount of cash

000 01

E

J)ZOS

69£8282-EI

2 NEW YORK HEALTH COLLABORATIVE

5~~n

OOS L

E

o)IOS

AGUDATH ISRAEL OF AMERICA

b) EIN

OOS L

E
56

000 SI

ELDOI AN

N '1

noncash assista

PONSORSHIP

PONSORSHIP

PONSORSHIP

86 30Vd

BEEDEST-[I

or gove

AA
(9kOE) (066 wod) I elnpelloS

d IHS-MOSNOd

O /05

1 a) Name and addmm~~f organization

INVH

.I.Na Id3O3ManS .LNYM

LNSId I 0321805

d IHSHOSNOd

d IHSHOSNOd

d IHSMOSNOd

d IHSHOSNOd

25

d IHSMOSNOd

E MI
E

684

0-9

000 9

N.

0, Part IV, line 21, for any recipient that received more than $5,000. Part 11 can be duplicated if additional space is needed.

Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States
ants and Other Assistance to Domestic Organizations and Domestic Governments. Complete if the organization answered Yes on Form

~ Yes

13 1740114

~ No

545-0047

Employer identification numbe

.

.

d IHS-HOSNOd

vgo'-

the selection criteria used to award the grants or assistance?

Does the organization maintain records to substantiate t

5 .
a .
CD
·

0

1

8*

FIORE MEDICAL CENTER

Form 990 and its nstructions is at www. irs gov/form990

E

A nformat on about Schedule

0

Revenue Service

0
6

Department of the Treasury

6

Complete if the organization nswe ed "Yes" on Form 990, Part IV, line 21

States

Grants and Other Assistance to Organizations

E
0

g

C

~E 0

 SCHEDULE

..
-.

C

.

0

.

ddme ss

NY 10457

NY 10087

25 000

54 348

3

3

501 C

13-1624082

25 000

501 C

3

grant

(if applicable)

501 C

d) Amount of cash

(c) IRC section

13-1740122

13-3833645

b EIN

J /05

0EroDLI-EI

ZI09D90-19

ILDOI

I090T AN

VHMA WA arnrapaAIN

XNOMS anNEAV NOLDNIBW 5295

000I

XOS

O'd

000 OI

005 8

000 6

E
E
E

D)TOS

o)TOS
J)IOS
J)TOS

€9LDBZE-II

5£66ELI-EI
656 LDDE-DO

EELSBOL-EZ

E 9 *0 I AN

6EIGI Fd
9I00T AN

XNOHS HinOS AVMNHYd WVH'Iad 066

VIHd73(*7IHd EINEOF AaNSH OOEE

'121OA MEN H.I.nOS anNEAV >nnfd IBE

LHDIS HOd IHDId

CC

Z ~

N M

d9'L-9 I A

DITO 720090

000 & 89Zl 39

'066 UU03 Joi SU0!lon,nsul all; aas 'a,!loN lov uo!13,1paH )1JoM,aded JO= 

suoilezillefJO Jago JO Jeqwnu lejol Jel

cash assistance

e) Amount of non

elqe} L au!1 041 u, pa}s!i suoileziuefio Juewu~eAoS pue (e)(0) 1.09 uoi~oas Jo ~equinu le}o} Je}

ONI

~;

3SnOH XNONS 0&

Xy¥M .LknfaH 'I¥LINEDNOO

DNI

' XNOMS anNEAV NO.I.Halrn, Er 9

E

NOLLVaNDOA WVHVHSM HI38 6
005'9

elqel L eu!1 04~ u! pels

Z

9

HONVassM S,N3Ha9IHO 392 15 g

SIHdWEW 6 D6 Qdaa

t9 DOI AN

50IBE Nl

SNIVId SLIHM aVOW 15Od LSVE I D

MELN30 rn,OIGEW nflId SOH SNIV'Id 3.LIHM

AN

afl Han O87V WN 30 AINn I

g

4 NEW YORK CITY HEALTH & HOSPITALS CORP

P.O. BOX 27084 NEW YORK

3 MEMORIAL SLOAN KETTERING CANCER CENTER

4422 THIRD AVENUE BRONX

2 ST BARNABAS HOSPITAL

127 SOUTH BROADWAY YONKERS

ST JOSEPH'S HEALTH FUND
NY 10701

of organization

E

J ZOS

LOSODLI-ET

DZO DOI

a) Name r

noncash assista

(g) Description

990, Part IV, lin 21, for any recipient that received more than $5,000. Part 11 can be duplicated if additional space is needed.

E

J 105

YMOA MSN LESMIS HalVM 09I

ISHEAINft 3H1 30 SLNES)3£ 3Hi

LU LU

RANT SUBRECIPIENT

PONSORSHIP

PONSORSHIP

gran

66 30Vd

OOL

E
665 6£

000 OI

1490009-58

0

IEILS

0 IOS

8

ODIXaW MEN
E

LBS

1

El No

545-0047

Grants and Other Assistance to Domestic Organizations and Domestic Governments. Complete if the organization answered Yes on Form

~ Yes

13 1740114

AA
(9t01) (066 uuod) I einpe439

d IHS-HOSNOd

d IHSMOSNOd

d IHS-MOSNOd

d IHS-HOSNOd

IN)Id IDEManS iNVM

SNOILABIMINO

d IHSMOSNOd

1.N3 Id IJaMERS .LNVH

856ZLID-EI

E
O TOS

5
E

O

~

.C

2

.
.

Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States

the selection criteria used to award the grants or assistance? .

OMB No

Employer identification number

nts or assistance, the grantees' eligibility for the grants or assistance, and

Form 990 and its nstructions is at www.irs.gov/form990

-.

Does the organization maintain records to substantiate the am uto

General Information on Grants and Assistance

i nformat on about Schedule

a.
LLE

1

MONTEFIORE MEDICAL CENTER

Name of the organization

(0
•

9IR

E.

0

E
INEId I 03-HanS LNVH

E
Complete if the organization nswe ed "Yes" on Form 990, Part IV, line 21

0
0

Department of the Treasury
Internal Revenue Service

Grants and Other Assistance to Organizations
States
uals in the Un

E

6

26

620

 NY 10550

35 000

3

501 C

13-4197609

cash assistance

e) Amount of non

aiqel L eu

4 HERBERT H LEHMAN COLLEGE FOUNDATION

NY 10036

60E9009-BE

330 WEST 42ND STREET NEW YORK

20 000

3

501 C

25 000

3

91-2049420

501 C

o)ZOS

BESLELT-ET

3 HEALTHCARE INDUSTRY GRANT CORP

NY 10018

90-0910967

grant

d)Amountolcash

E

J)IOS

B0ELE9E-ET

248 WEST 38TH STREET NEW YORK

2 GREATER NYC AFFILIATE-SUSAN G KOMEN FR CURE

~

000 08

L

O)ZOS

9[9IOLI-Er

1 ROOSEVELT S UARE MOUNT VERNON

FRIENDS OF MT VERNON ARTS RECREATION YOUTH

b EIN

000 52

E

D IOS

£6[13ZIE-ZE

organization

005 L

9

J TOS

NOOMS 3AH MANSAV 233153 HDISaM 008

IW

suoilezille JO

quinu le}01 Je}u3

Z

Z&

j~~ ~ ~qwnu lejol Jeju3

XNOME GA98 XNOMS kEED

~ j

0~

6

8

Z

d9'L-9 I A

066 UL,03 Joi suo!;inJ:Sul ell; 005 '00!10N jOV uo! 1,npaa iljohuaded JO:1

04 ui pals

NMDIHOIW 10 A.LISMSAINfl

YJaNONVWVW aVON SkiOWINad

En73 d709 Q003 GEDNIM

AMMDVOHS OS

HOE-knf NNY 1332[-LS EILVIS S COOE

EDSOI AN

'NHOA MEIN MOOqd HiGI

ONI 2131.N30 3-Ent'I) AHO,LY'InEWM H.LMON 320IiaLNOW

60 IBD

hOOOT AN

04; u! pe}sil suoileziueE}JO lueUIU.leAOS pue (C)(0) 109 UO
99D0I AN
C J)/05 65896L0-ZO
elqej t eu

D065

0%[flind .IS SOWOS

ANVE-IV J.3 SM 15 NVMS HinOS 06

" ON I

NA,NOONS anNE,AY HIET

3/HaWWOO JO H38143'HO ALNROJ 3HL

AN

AVMGVOMS 206

adIY dO 1VMENSM 9

DAN 30 NOILVIJOSS,f HiTEH TILNSW SHL

ELSOI AN

ONI

OIZZI AN

6 IZIT

DNI

*MOA MaN HOO'Id H.LE'[

SGOOHHOSHDIaN SddIHd 9

XNOMB 153M aAgE Nknid 6103038 OSE

M

uation

non~shassi

ce

PONSORSHIP

PONSORSHIP

PONSORSHIP

Ch) 0

001 30Vd

9I

000 EI

E

668 095

000 05

868ELL0-06

OZOOI AN

J)ZOS

599L0LE-Er

E

J ZOS
00# OI

E

AN

000 os

EZGOSIE-ET

1 (a) Name

la

AA
(9:02) (066 uuod) elnpa435

183( dO SSaNEAIDHO

990, Part IV, line 21, for any recipient that received more than $5,000. Part 11 can be duplicated if additional space is needed.

Grants and Other Assistance to Domestic Organizations and Domestic Governments. Complete if the organization answered Yes on Form

545-0047

d IHSHOSNOd

d IHSNOSNOd

d IHSMOSNOd

d I H SHOSNOd

dHSNOSNOd

d IHS-MOSNOd

O 105

89D0T

E

.

000 SE

1

.

Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.

the selection criteria used to award the grants or assistance? . . . . . . , . . . . ,
'

2

General Information on Grants and Assistance

E
13 1740114

n

B

Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and

LU

1

Form 990 and its nstructions is at www. irs gov/form990
C

d IHSHOSNOd

BE
I nformat on about Schedule

OMB No

./

MONTEFIORE MEDICAL CENTER

0

2

he organization

6.

3

Name o

E

E

Department of the Treasury
Internal Revenue Service

C

Complete if the organization answe ed "Yes" on Form 990 Part IV

9

n e 21 or 22

Grants and Other Assistance to Organizations,
uals in the United States

0
1.NEId IJaMBOS LNVH

Z

3

DTIO 910090

000 L 981 L 39

<

 EE 2

SE

.

(D
-C
.

I

.

N

fl

&0

WI 53705
39-1805963

501 C

3

section
cash assistance

grant

20 000

e) Amount of non

d) Amount of cash

cash assi

AA

E9'L-9I A

066 Ullod Joi SUO!;in.nsul 041 00$ '03!ZON 139 uo! jinpakl MJOAA.laded JO3

C

Z

0ACO

alqel L Guil aq} u! pals!1 suoijezillefJO Jal,110 JO Jeqwnll lejol Jall,3

aiqel L Bull 041 U! pelsil suo!:eziueSJO }UaLLIUJ~06 pue (£)(0) 1,09 UO!:oes Jo Jaqutnu le}ol ~aiu3

1111 HIGHLAND AVENUE MADISON

UNIVERSITY OF WISCONSIN

b EIN

13 1740114

if additional space is needed.

20

or government

ZE
E

1 a) Name and address of organization

*

RANT SUBRECEPIENT

if the organization answered Yes on Form

B

990, Part IV, line 21, for any recipient that received more than $5,000. Part 11 can b

5

Grants and Other Assistance to Domestic Organizations and Domestic Governme

: I

at

.

Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United

the selection criteria used to award the grants or assistance? . , , . . . . . . .

545-0047

Employer identification number

rants or assistance, and

Form 990 and its nstructions is at www. irs gov/form990

8 :

Does the organization maintain records to substantiate the amount of the grants or assist n

1 Information on Grants and Assistance

I nformat on about Schedule

2 :$8 :a
(D

2

2 2 16

MEDICAL CENTER

0

E

MONTEF

a.

Complete if the organ zation nswe ed "Yes" on Form 990, Part IV, line 2

OMB No

S
20
>
4
0
m

TOI 30Vd

E

6

C

(9t02) (066 uuod) 1 einpelloS

(Form 99

Grants and Other Assistance to Organizations,
uals in the United States

0

9D

SCHEDU E

Z

55

58

9

DITO 910090

000 1 88ZL39

m

 DITO 97.0090

LL

E e CL
0

E

vsr

b) Number of

recipients
(c

Supplementa nformation Provide the nformation required in Part
information.
PART I, LINE 2

a) Type of grant or assistance

5 25

MONTEFIORE MEDICAL CENTER

ne 2 Part
d) Amount of

non.cash ass ance
D Description of non-cash assistance

column (b) and any other additiona
e) Method of valuation (book,
FMV, appraisal. other)

13-1740114

.

d9'L-9 I A

rants and Other Assistance to Domestic Ind ividuals Com plete if the organization answered Yes on Form 990 Part IV ne 22
be duplicated if additional space is neede

53

ZOI 30Vd

a>

000'Z V09 1 39

SHOAVEGNE WVHDOWd H.I.TVEIH AIINnWWOO TVOOEI ANVW S,LI 10

EMOIdaLNOW LHOddnS 0% SNOI.LY'ZINVDMO DNIAHESSG 0% 3GVW aNV SdIHSHOSNOdS

SNOI,InSIMZNOD

DOWd HOPVW AE SGHVMV ~nnIEGEI.:I .:TO SEINn1IaNHdXE

EONVI7dWOO GNY TOH%NOO rni'NHaiNI NO

LE*d SV SNOIMVZINY'DHO SnOINVA 01 iHOddnS SEGIAOHd OSTY HaiNao TVOICEW HHI

SLHOdaH aHL HIIM HEHLEDOZ

AO 37AGEHOS EAILOadSEM HIEHL SEan70NI HOIHM iMOdaH ZIanV 370NIS EEI-V

HYLOONIO GH,LICAV S, LNEId IOEHERS SHZ MEIASH aNY NIVIRO 0% SI HONVI'IdWOO

HOd SaHVMV 'nniaaad zIO S,LNEIdIDEHans DNIHOIINOW Mod HanGEJOHd aHL

C)

U>

.

0

E5
O

(~02) (066 uuod) einpall'S

N

 recipients

b)Number of

(c

N

r'>60~0

C

(0

E

U).E

DITO 920090

EIAMHS

MISSION OF ADVANCING THE HEALTH

WELFARE OF THE COMMUNITIES THAT WE

ne 2 Part

13-1740114

f) Description of non-cash assistance

column b) and any other additiona

FMV. appraisal, other)

e) Method o valuation (book

Complete if the organizat on answered Yes on Form 990 Part IV ne 22

upplemental Information. Provide the nformation required in Part

a) Type of grant or assistance

~antscaanndbeduMZsdta,Zjtnair:plt IsndU:

Form 990) (2016)

4

d9'L-9 I A

Schedule

8

EOI 30Vd

elnpelps

MONTEFIORE MEDICAL CENTER
CL
(9kOE) (066 UL,03)

-

000'Z P09 K 39

5

 SCHEDULE J
(Form 990)
Department of the Treasury

Internal Revenue Service

OMB No. 1545-0047

Compensation Information

2@16

For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
i Complete if the organization answered "Yes" on Form 990, Part IV, line 23.

h Attach to Form 990.

i Information about Schedule J ( Form 990 ) and its instructions is at www. irs.gov/form990.
Employer identification number

Name of the organization

13-1740114

MONTEFIORE MEDICAL CENTER

Questions Regarding Compensation
Yes

1a

Check the appropriate box(es) if the organization provided any of the following to or for a person listed on Form
990, Part VII, Section A, line la. Complete Part 111 to provide any relevant information regarding these items.
El Housing allowance or residence for personal use
~ First-class or charter travel
1   Payments for business use of personal residence
Travel for companions
  Health or social club dues or initiation fees
 
payments
gross-up
and
Tax indemnification
1 Personal services (such as, maid, chauffeur, chef)
X
1
account
spending
Discretionary

b

If any of the boxes on line la 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 111 to

explain

1b

la? ...........................................................

2

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 111.

3

[3E1 Compensation committee

~ Independent compensation consultant
Form 990 of other organizations

1-3il Written employment contract
1-Al Compensation survey or study
  X  Approval by the board or compensation committee

During the year, did any person listed on Form 990, Part VII, Section A, line 1 a, with respect to the filing

4

organization or a related organization:
a
b
c

5

IIJ

Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
directors, trustees, and officers, including the CEO/Executive Director, regarding the items checked on line

2

No

Receive a severance payment or change-of-control payment?
Participate in, or receive payment from, a supplemental nonqualified retirement plan?...............
Participate in, or receive payment from, an equity-based compensation arrangement?...............
If 'Yes" to any of lines 48-c, list the persons and provide the applicable amounts for each item in Part 111

4a
4b

X
X

4c

X

Sa
Sb

X
X

Only section 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 la, did the organization pay or accrue any

compensation contingent on the revenues of
a The organization? ...................................................
b Any related organization? ...............................................
If "Yes" on line Sa or 5b, describe in Part Ill.
For persons listed on Form 990, Part Vll, Section A, line la, did the organization pay or accrue any
6

-

compensation contingent on the net earnings of
a The organization?
b Any related organization? ...............................................
If "Yes" on line 6a or 6b, describe in Part 111
For persons listed on Form 990, Part VII, Section A, line la, did the organization provide any nonfixed
7
payments not described onlinesSand 6? If"Yes," describe in Part Ill.
Were any amounts reported on Form 990, Part VII, paid or accrued pursuant to a contract that was subject
8
to the initial contract exception described in Regulations section 53 4958-4(a)(3)? If 'Yes," describe
in Part 111
If "Yes" on line 8, did the organization also follow the rebuttable presumption procedure described in
9

Regulations section 53.4958-6(c)? ..........................................
For Paperwork Reduction Act Notice, see the Instructions for Form 990.

68

X

6b

X

7

X

8

--1
9

Schedule J (Form 990) 2016

JSA
6E 1290 1.000

06002L 0114

V 16-7.6F

PAGE 104

 2
0

0

~CHAIR-SURG/CARDIOTHORACIC SURG

1 549 814

806 800

136 022

503 897

187 726

21 554

320 100

700 000
0

3 030 728

1 229 380
34 195

0

0

0

860 ZE

0

DE6 96E

OOZ IEE I
0

000 SLE

SL6 6LL I
0

OD8 8EG

GNOWHOIH NNA7

030 9 dA 03XEZL

EAUa 'W Na39900

OIDIddO-X3/030 9 iNEIGISERidt~

'a W 'HEAJVS NHAELS

.I.N3aIS32Id 30IA SAILAJEXa~ ~

000 1 l6ZL39

vsr

60

DITO 920090

9T/9/I aa/11173)

M

d9'L-9 I A

00

C )

n column
Form 990

~02 (066 lulod) r elnpellos

ZLB EDL I

6LL 9ZE I

558 D88
0

0

000 LI

009 98*
0

0

IEB DE

0

88L GLE D

0

*SS IE

00

0

800 LBE

5

0

0

090 EE

nS JIOVMOH.LOIGNVO-MI

'NI31SG7O9 TEIN

ISVANI NIW MI

0 NOLLVI

z
00

II6 SET I

000 LI
)

D#9 EZZ

oss Z

¤Ex

00

LLO EIB I

I

0

L59 6LE

0

00

068 LEE I

0

00

SEO 9EE
SS

0

0

000 LI

0

0

880 ZE

OB

'INOINrnfY WO

40

EZO £09 Z

W

a W

%i

PHILIP

0

0

ELD ZOI I

CHRISTOPHER P

0
0

0

000 OSE

Z

~SENIOR vp &

1 530 267

33 054

333 825

0

0

0

8 DO E

5

22 034

500 704
00
0

351 600

1 370 776
00

0

789 754

2 843
00

000

0

000 LI

5 WEE#aititi

A.

SUSAN GREEN-L

17 000
00

4SYSTEM SENIOR VP-OPERATI

1 923 427
32 104
00

0

IBZ DE

RICHARD KRAUT

00

E08 905 I

3CHAIRMAN -DENTISTRY

17 000

O

ROBERT MICHLER, M.D.

1 505 908

(B)(iHD)

E) Total of columns

3 413 108

0
34 899

0

34 654

0

17 000

O
O

222 034
7 584

O

483 300
11 073

compensation

D) Nontaxable
n
0

748 920
3 342 552

JOEL PERLMAN

compensation

C) Retirement and
other deferred

O

0

1EXEC VP & CFO(RESIGNED 1-6-16)

compensation

(i Bonus & incentive

O

SOI EDVd

-5~

Base

LL

uotiesuadwoo

0

B) Breakdown of W-2 and/o 1099-MISC compensation

E
Uo paJJ@Jap se

individual.

For each individual whose compensation must be reponed on Schedule J, report ompensation from the organization on row (i) and from related organizations, described in the
list any individuals that aren't listed on Form 990, Part Vll.
instructions, on row (ii) Do
for each listed individual must equal the total amount of Form 990, Part Vll, Section A, line la, applicable column (D) and (E) amounts for that
Note: The sum of columns ( )(

page 2

13-1740114

Officers, Directors, Trustees Ke Em lo ees and Hi hest Com ensated Em lo ees. Use du licate co ies if additional s ace is needed

Schedule J (Form 990) 2016

MONTEFIORE MEDICAL CENTER

8

 19'L-9I A

' (I) (S)

SNWA'I00 - II .LEVd 9 ED

DITO 7Z0090

'E SENIE[

000'6909&39

'I LE*d

SPORTATION.
THE CAR SERVICE COSTS WERE INCLUDED IN TAXABLE

TWO OFFICERS AND ONE KEY EMPLOYEE TRAVELED FIRST CLASS AS PROVIDED FOR

INCOME.

INCIDENTAL T

SPORTATION.
A PORTION WAS INCLUDED IN TAXABLE INCOME.

A SECOND OFFICER WAS PROVIDED CAR SERVICE FOR BUSINESS PURPOSES

INCIDENTAL T

2.2M . O-~

.9 C

> m

$SQ et~~anation, or descriptions required for Part

emental Information

dule J (Form 990) 2016

1 ·-t

MONTEFIORE MEDICAL CENTER

ines la, lb, 3,43,4b, 4c, 58,5b, 6a, 6b, 7, and 8, and for Part

ONE OFFICER WAS PROVIDED SERVICES OF A DRIVER FOR BUSINESS PURPOSES

U) 2%
-(0

PART I, LINE lA

0 CIO

90I EDVd

0% SAI.I.VIEN 3%VIHdONddV aNV 375*NOSVEN ZINV SEIEASIEI NOILVSNEdWOD EAILADEXE

WHId DNI%7ASNOO NOIIVSNEdWOO %NEaNEdEaNI

EMASNE 0% SSEOONd DNIXVW-NOISIDEG SLI HLIM 33.I,LIWWOD NOImYSNEdWOO 3H1
SISISSV WHId DNI17nSNOO EHZ

~nf'NOIZVN V dO HONFLSISSY HHL H%IM EAILADEXE HOVE 0% GEGIAOHd SLIdENSE

(II)

NOILVSNEdWOO KO SWHOd CIEIV SEAOHddY aNV SMSIASIH aa,LLIWWOO NOI.IMSNadWOO EH,L
(III)

HWOONI HEIBVXVi NI

ADIEIOd HaiNED InrJIGaw HaGNA

Em

13-1740114

Page 3

Also complete this part

9:02 (066 ullod) r elnpellos

0

GEICInUONI ZON HM3M gEIAYMI HORS 10 ZSOO SH% 'ATDNIGHOJOY 'SHSOdand SSHNISna
HSIN30 'IVJIGEW HOd SYM VEAVHI HORS 7'nf

-5.2 C

 Supplemental Information
lanation, or descriptions required for Part

Schedule J (Form 990) 2016

MONTEFIORE MEDICAL CENTER

22

EZ

(0 C

.BE

-C -0

- m

2 CO

.&2
ines 1 a, 1 b, 3, 43, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part

900 NI NOIZVSNEdWOO 37/ViHOdEM »HHHZO

LEW QON SHV 33ZLIWWOO
(a)
a9 t-9I A

.

*TIO 910090

000 6 909 L 39

vsr

aNY NOILYZINVDHO SHZ 0% EOIAHSS 10 SHWEA , SEAILAJEXH

(V) dO NOILINDOOSH NI GNY 'MVI XYL 'IVHEatzI aHL dO SaqnH SNOILONVS

1NVOIdINDIS aH,L

HH.L

SIVIGEWHEINI SH,L MEaNA GEISITYRO LVH.I. HaNNVW V NI SEAILAJEXE MOINES

HOE SiNHWEDNVHHY iI,sIENES LNEWEMI,LaH 353Hz aaAOHddv aNV aaMEIAEM AUSSEMdxa

SEISI,LSnH,L do CIZIVOEI EIHI do 331,LIWWOO NOI,LVSNEIdWOD EIH,L „ SSEINEIEIEIVNOSVEIH

10 NOILdWASHMd 39/41%REEN. 3HL MOd AdITVRO 0% GEINDISEG MENNVW V NI

NVId iN£WEHIIHH EIAIinDEXEI mfiNSWE'IddnS SHI WOME SNOI,LOSIHISIG SEGREIONI

(III)8

COMPENSATION IS AT RISK IF THE GOALS ESTABLISHED BY THE COMPENSATION

CARE, PATIENT SATISFACTION, COMMUNITY SERVICES AND FINANCIAL PERFORMANCE.

PERFORMANCE. GOALS ARE SET IN ADVANCE IN AREAS SUCH AS QUALITY OF PATIENT

PAY-AT-RISK COMPONENT TO ENSURE THE ALIGNMENT OF PAY AND ORGANIZATIONAL

PERFORMANCE GOALS. THE EXECUTIVES' COMPENSATION PROGRAM HAS A SIGNIFICANT

AND INCENTIVE COMPENSATION IN COLUMN B(II) IS BASED ON THE ACHIEVEMENT OF

BONUS

KET PRACTICES' FOR COMPARABLE POSITIONS

WITH SIMILAR SIZED ORGANIZATIONS AND SCOPE OF RESPONSIBILITIES.

DETERMINED BASED ON COMPETITIVE

THOSE OF OTHER SIMILAR ORGANIZATIONS. BASE SALARIES IN COLUMN B(I) ARE

C

Page 3

13-1740114

Also complete this part

·

8.Q

LOT 30Vd

9:01 (066 uuod) r elnpalloS

1

 emental Information
explanation, or descriptions required for Part

Schedule J (Form 990) 2016

MONTEFIORE MEDICAL CENTER

6E

EEC

EZ

g .5o€-0

- m

-C -0

-9 c
2 (0

. O-2
ines la, lb, 3,4a, 4b, 4c, Sa, 5b, 6a, 6b, 7, and 8, and for Part

' ONI

SHEOIddO 7rni

d9'L-9 I A

' DNI

DITO 710090

000'6 909 L 39

vsr

WEISAS HZTgraH EIHOI,~31NOW zIO ANVdWOO

' WHiSAS HZVIHH OIWEGVJV 3NI JIGEW EHOIAEiNOW HEHLIH

' WEISAS H1TVHH HHOIdELNOW HO

INHHVd EHI

AS GIVd EHY HaiNED 'nf'JIGEW EHOId31NOW &0 SEEAO7dWE AaN

NOIiVZINVDHO atiVIEN WOME NOIiVSNEdWOJ - II LNVd

*£6'96ES - HA~S N3399O0

800'OLES - GNOWHJIH NNAU

518'9IES - NH 'NEZNHHO7 NS)HO NVSRS

L68'98,9 - 'a Hd ' cI'w 'HYOZO '0 dIIIHd

9ZL'OLIS - MENZON*d HEHdOiSIMHO

SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN ACCRUED AND UNPAID SERVICE COSTS:

MONTEFIORE.

DISTRIBUTION OF $1,309,525 BASED ON OVER 30 YEARS OF SERVICE AT

STEVEN SAFYER, M.D. - POOLED SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN

SERVICE FOR THE ORGANIZATION.

ACCORDINGLY, THIS BENEFIT SHOULD BE VIEWED AS APPLYING TO YEARS OF

CHARITABLE MISSION IN A MANNER CONSISTENT WITH FINANCIAL SOLVENCY.

CONTRIBUTIONS TO ENHANCING THE ABILITY OF THE ORGANIZATION TO ACHIEVE ITS

2.2
mc

Also complete this part

Page 3

13-1740114

80I EDVd

9:01 (066 uuod) r elnpellos

U)

g

 lemental Information
~~~anation, or descriptions required for Part

m 990) 2016

MONTEFIORE MEDICAL CENTER

S · E,~

E I Z CO

I >,

ines la, lb, 3,4a, 4b, 4c, Sa, 5b, 6a, 6b, 7, and 8, and for Part

19'L-9 I A

DITO 920090

000'2 909 K 39

vsr

FEES THAT ARE ASSESSED FOR EACH OF THE BENEFITTING ENTITIES.

REIMBURSES THE HEALTH SYSTEMS FOR ITS EXPENSES THROUGH THE MEMBERSHIP

INC., THE PARENT OF MONTEFIORE MEDICAL CENTER. THE ORGANIZATION, IN TURN,

EZ

Also complete this part

Page 3

13-1740114

60I EDVd

3

n E.Q

n. .3 8

~01 (066 uuod) r elnpalloS

6E

22
ro c

-

 d) Date issued

02 07 2008

04 19 2013

10 14 2010

12 29 2015

c) CUSIP #

649903ZD6

000000000

649902V83

000000000

14-6000293

45-4040561

14-6000293

14-6000293

B BUILD NYC RESOURCE CORPORATION

C NEW YORK AUTHORITY OF THE STATE OF NEW YORK

~ DORMITORY AUTHORITY OF THE STATE OF NEW YORK

speajoid luedsun 10410

· tenss, SuipunieJ lueJJnO e Jo ued se penssl spuoq 041 0JaM

M

o: SpJOOm

pue

SMOOq

elenbape

uoil

ue

O

041

asn ssau!sns aleA!Jd

uiejuieul

saoa

'

REFUND PRIOR ISSUE

10,672,137

85,676,529

134,602,903.

593. E UIPMENT LEASING

CONSTRUCTION PROJECT

53,145,000.

15 077

627 406 515.

No

Yes No

ssue

15 077 593

2 690 903
627 406 515

Yes

No
Yes

bJuf,L tina;~*

(g) Defeased

200 195 000

5 11 95

D Description of purpose

93 000 000. FACILITY IMPROVEMENTS

134 395 945

e ssue price

Z X

X

0

:@XXX

U)

d9'L-9 I A

L

o
0 7 ~7:Z

ea~J pe =m z

2 n 4 8

066 UUO:1 Joi SUO!;orulsul all j aas 'amioN JOV uol inpa H

J Aeul lell; sluaLLIeSuen

' ispuoq jdwaxe-xel Aq peoueull AuadoJd peuAAo 4014*

Z:

' ' ' Lapeul ueaq spaeooid Jo uo olle leug 04: seH 91.
tanss, Suipurijai aoileApe ue 60 ued se panss, spuoq aW aJa/\A 9 &

£1·

Zi

le,jue}sqns JO JeaA

. uoijaidwoo

&L

le}!deo 01.

luads Je41O

spe@O0Jd U~J·~saS;jedxa

Speajoid wo4 Sain;!puedxe le}ideo 6u!)IJOM 6

spaeooid woJJ lueweoueque JIP@JO 9
spaaooid woll slsoo aouenssl

'SMOJOS@ SUIpunieJ U! SpaeOOid

9

1 Amount of bonds retired . . ...
2 Amount of bonds legally defeased
Total proceeds of issue . . . . .

Proceeds

A DORMITORY AUTHORITY OF THE STATE OF NEW YORK

Spuni GAJesaJ Ul SpeeOOJd SSOJO

speeooid u.104 }SeJejul pazile:!deo

011 ue Jo Jequlew e JO 'dlilsJauued e u! Jauped e uoilezilleESJO al'J Se/v\

Uoddns

a ssuer name

13-1740114

Employer identification number

X

Jo asn sseulsnq ajeALid u

04

b ssuer EIN

Bond Issues

MONTEFIORE MEDICAL CENTER

seA

he organiza

2@16

545-0047

&>4

OIT EDVd
9&02 (066 uuod) >1 elnpal~15

X

saA

ON

866T

9TS I95 9/I
6IL ZLE D

000 SE

899 EOD I
SaA

SIOE

LLD IED
856 L06 €8

8ID Z65

Name o

X
SaA

SaA

OIOZ

i Attach to Form 990.

S0A

69D 9I0 6I9

8D6 ZZB Z

SIOZ

h nformat on about Schedule K (Form 990) and its instructions is at www.irs.gov/form990

0

II6 Z8

Internal Revenue Service

XXXX

6ED L66 DE

Department of the Treasury

I Complete if the organization answered "Yes" on Form 990, Part IV, line 24a. Provide descriptions
explanations, and any additional information in Part VI.

OMB No

0

660 L95'S

Supplemental nformat on on Tax-Exemp

XXXX

DSL

EDULE K

MORTGAGES & FACILITY IMPROVEMENTS

X

LLE EET 8

E

X

969

g:

5

X

I89 *66 DI

0
X

X

0

X

m

0

X

·E ON

 Jo

esn

ejeA,Jd

ul

hew

jelll sluewaSUell

DITO

ajaw

' - 2.spuoq jdwaxe-xej Aq peoueuu AbledoJd peuMO 4014AA

linsaJ

066 Uuod Joi Suorlinnsu @47 aas '03!JON JOV uo!;3npahl

39'L-9I A

sseuisnq

'011 ue Jo Jaqwew e JO 'dillsieuped e ul Jauped e uoneziueSJO 041 se/\A &

leliuelsqns io JeaA El,

1 Amount of bonds retired.....
2 Amount of bonds legally defeased
12 19 2012

10 29 2014

12 23 2014

12 12 2013

000000000

000000000

000000000

000000000

14-6000293

14-6000293

14-6000293

14-6000293

A DORMITORY AUTHORITY OF THE STATE OF NEW YORK

8 DORMITORY AUTHORITY OF THE STATE OF NEW YORK

C DORMITORY AUTHORITY OF THE STATE OF NEW YORK

~ DORMITORY AUTHORITY OF THE STATE OF NEW YORK

Proceeds
d) Date issued

c) CUSIP #

14 829 671
D Description of purpose

E UIPMENT LEASING

E UIPMENT LEASING

E UIPMENT LEASING

E UIPMENT LEASING

7 417 712

4 949 548

e ssue pnce

24 964 788

32 639 702

17 899 520

24 980 927

19 865 469

ren~ Zy additional i

4 Attach to Form 990.

nformat on about Schedule K ( Form 990) and its instructions is at www. irs gov/form990

b) Issuer EIN

a ssuer name

Bond Issues

MONTEFIORE MEDICAL CENTER

Name of the organization

SaA

*

o

esn ssau!sng aleAL,d

04 voddns o; spiooei pue sMooq ejenbepe ulejuiew uoilezilleSJO all~ seocl Li

UO!laid

tapeul ueeq spaajoid Jo uoileoolle leu!; 041 seH 9:
tensm Bugur,Je eoumpe ue Jo ued se panss! spuoq 041 0Ja/\A 9 &
tensm Su!purym ll,auno e Jo ued se panss! spuoq 041 aja/\A *t

. • .

s

Department of the Treasury
Internal Revenue Service

saA

0

ZIOE

Spaeoold UloJJ SeJnl!puadxe le}!deo

300Jd luadsun JeWO Z &
" ' spaaioid lueds JelllO ti

Spa@00Jd woJJ seingpuadxa leudeo Bul,po/\A

9

- 'SMOJOSe SU!pur,JaJ Ul Spe@00Jd

anssi Jo spaeooJd le}ol

spuni eA.10$0J LI! SpaaoOJd SSOJO

speaooid woJJ isaia}U! pez!1elldeo

speaooJd woll sisoo aouenssi

spaavoid U.104 luauleoueque 1!paJO

line 24a. Provide descriptions
SCHEDULE #1

mpt Bonds

EQUPMENT LEASES

Supplementa nformat on on Tax-E

I Complete if the orgar~~
t~na~~nosn~,ea

SaA

DIOZ.

DBS 958 DZ

S

v *p

SCHEDULE K

III HDVd

~02 (066 uuod) 1 elnpallos

saA

SeA

DIOZ

ZOE 995 ZE

DOZ 80I

LES 908 LI

OOS EL

0

SE6 668 DZ

E66 7.6

DE

=m

U- 1

N

M ·EO O=:d

af

0

X
ZX
ZXX

c -0

.

X

266 08

ssue
13-1740114

E

D96

0

0

0

88L

0

- '-

0

X
X

>4
X

X
=X

ZOL 6£9 ZE

6

M I

LL

t

0%

2 5 Z :g
< n :E

E

2

zxxxx

OES 668 LI

LL

U'
1

LE6 086 DZ

E

0

x
x

x
x
Z
cd
OMB No

g

X
. C

X

545-0047

E

 DTIO

nseJ Aew je41 sjuewaSueJ.Je eseal Aue eial·1

'066 UUOd JOJ Suo!}ennsu all; aas '03!loN J~V uoilinpaH

E9'L-9 I A

Jo asn sseuisnq eleA!!d u

6spuoq }dulaxe-xel Aq paoueull AuedoJd pauMo 40

0-11 ue Jo Jequlew e Jo 'dillsieuved e u! ieuved e uoliezilleSJO 04

bonds legally defeased
sof issue... ...
04

12 03 201

000000000

000000000

14-6000293

14-6000293

d) Date issued

(c) CUSIP #

b ssuer EIN

I Information about Schedule K (Form 990) and

AUTHORITY OF THE STATE OF NEW YORK

a ssuer name

MEDICAL CENTER

Department of h Treasury

SaA

9k

seoa Zi

60Pew uaaq speaooJd Jo uoileoolle leu!; 41 seH

041 uoddns oi sp=ei pue sMooq elenbepe uiejuieut

uo!Jeld woo le! luel

tenss! SuipunieJ lueJJnO e JO Ued se penss! sp

tanss! Sulpuniei eoueApe ue Jo ved se panssi

I Complete if the orgar;~t~;~i
~sn~;arend

saA

SaA

.

IT SYSTEM IMPLEMENTATION

095 000

50 095 000
IT SYSTEM IMPLEMENTATION

972 839

f) Description of purpose

tions is at www. irs gov/form990

990, Pa

Supplemental Informat o n on Tax

seA

S0A

Z&

SCHEDULE K

line 24a. Provide descriptions

mpt Bonds

ON

Yes

ON

EQUIPMENT LEASES - SCHEDULE #2

ZII $(DVd

Yes

No

ssue

b~N~of
OMB No

Yes

() Pooled

financing

545-0047

Employer identification number

13-1740114

No

saA

SeA

spemoid luedsun Ja410

speaooJd WOJ; SaJn}Ipuadxe

SpeaooJd WOJ; seinlipuedxe le:i

.

Y &0

--

9&02 (066 lutod) )¢ elnpelloS

oN

ON

SIOZ

000 000 05

speeooJd woJJ sl

Speaooid U!04 jualueoll

'SMOJOSe SU!.punieJ U!

BA,10503 U! Sp

speaoo.d U.104 }Saialll

<<1-(000-2050

(9
P

0

0

00

A

©

60

*

el

N

8

000 56

IE

2

5

r

O

m

§28

0 U

0

g

8

SEO'

-.S

p

N

(0

5 1 5 .5 q f

Ea E2

EO

u,

0
O

52 * 0014

0

X
X
'4

.LO
.

rl

X
Z><

ZXX

m

>4
X

0

16

,-1
,-1

0
(N

0

U)

0
0

00

izile

0
0

X

LA

8
E

X
X

2X

0

1:

2

0

z

 Continued

bond-financed prope

(D

E

(1)

any research agreements relating to the financed property?. .

5

C

1- 0

0

oes the bond issue meet the private security or payment test?

if)

%

Yes
No

Yes

>4

X

zx

0

x

X

3

X
Z

0

X

X

4X

X

Ple!*

XX

XX

X

XX

pafejue Janss

1-9£09

uuod

pal!J

JanSS!

aln

seH
u

ap,Amd

01 eu

paWJOped

q „seA„ A
941

uo!}ezilleSJO

841

SeH

e,

>4

page 2

X
X

00

X

X

2Pa1euiuue; aSp@4 all; seM e
<,PalmSmwedns e~~~aWse:~ P

yanss1 puoq ellj o; PadseJ Jili~ 0~54 q

elueWUJaA06

tanssi eleJ alqelieA e anss! puoq aq s

A Ued

60}eq03 01 Uo! 1 00*3

' aeA anp Jou ajeclabl
u!Molloi all} P!.P ' L Guil o} „ON„ il
· · · 2,eleqaH aSefuqJV Jo nall u! Aleued

0

d9 L-9 I A

olu

e684!Cliv
a41 alep 041

Weclabl

' 2,Z-941 1 pue ZI,-1,t4 k suolloas suo!jeinfjati Jepun SlualuailnbeJ
m

Pauilenb e

61-9*L L pue ZI.4t41.suo!}Oes

041 41!M @OuepJOOOe U! pelelpaulaJ aie enssi alll Jo spuoq paMenbuou

seM uoileindwoo ajeclei

uo!}onpaH

'

e Jell} ainsue 01 Sainpe00Jd Ue}~IJAA pallsilqeise uoi.jeziueSJO aLll seH

No rebate due? . ..

x

Arbitra e

%>4

c If "Yes" to line 8a, was any remedial action aken pursuan o Regulations

2400

ix

dis osed of...

%

Yes

X

nongovernmental person other than a 501(c)(3) organization since the bonds were issued?
b If "Yes" to line 8a, enter the percentage of bond-financed property sold or

Ba Has there been a sale or disposition of any of the bond-financed property to a

A
pue

another section 501(c)(3) organization, or a state or local government .... ....

Nult tof ur~~atn~dtraodfe finorncteu~irIZ;activ~tyedcarri~jonaby byo~orgar:zzlr~

4870

X

other than a section 501(c)(3) organization or a state or local government ...... I

Enter the percentage of financed property used in a private business use by entities

No

X

outside counsel to

X

d If 'Yes" to line 3c, does the organization routinely engage bond counsel or other

Yes

X

5

n private

X

4

may resu

b If 'Yes to line 38, does the organization rou nely engage bond counsel or othe outside
counse o review any management or service cont acts relating to the financed property?
hat may result in private business use of
c Are there any resea

business use of bond-financed property?, . .

3a Are there any management or service contracts tha

Private Business Use

0
X

DITO 910090

0004 966139

0

EII EDVd

MORTGAGES & FACILITY IMPROVEMENTS
0
X

HON17 97IRREIW

Schedule K (Form 990) 2016

X

=><

9:01 (066 lutod) 1 elnpellos

13-1740114

X
xx

005 SI

MONTEFIORE MEDICAL CENTER

X

0

x

X

XSXX

X

X

 bond-financed property?...

ercentag of financed property used in a private business use by entities

0

A
X

I
•

E
M I
fo

uo!}onpahl

aouepioooe ut paleipaujeJ aje enssi alll JO sp

Yes

No

Yes

No

page 2

0
ZX

X
ZX

0

XS

X

gx

m
XE

X

gx

X

Ple!*

e6eJ}!CIJV

.C

01

eu

OCO"

Ocn
041

JO

Uoileziueflo

0

X

0

X

m
X

0

X
X

X
X

X
X

X
X

id Jo e

041

seH

.CZI-

m

(0

0

(D

E

e,

vsr

0 u ·¤ a,

DITO 920090

000'L 96Zl 39

Epejeuluual aSpe4 04} seM

2,PaleJS@lu,J*Iris eSpall all: SeM

yanss. puoq @41 01 loe

ejuelUUJaA06

¢5= 0

01 BaA„ H

.-N

aP!AOJd

0

d9'L-9 I A

u

0

tanss! elu gqeueA e enss! puoq all: s

A Ued

' taleqah! 06eiliqJV Jo nell ul A#eued
1-8£09 uuod PO!J Jansm 041

4-

peJejue Janss

041 elep 041

Reqakj

C

paillenb e olu

04!lenbuou

C)

61-9*1 1, pue ZI,lt'1/1. suo!1~es suoijelnE}ehl Jepun Slual.UeJ!nbai

0

einsua 01 sejnpejoid ual]1!JM p~1-s~~q~el~se~~u~o! i~z-1

.,-00

line 88 was any remedial action aken pursuant to Regulations

NO

X

non overnmental person other than a 501(c)( or anization since the bonds were issued?
b If "Yes" to line 8a, enter the percentage o bond-financed property sold or

X

si I n of any of the bond-financed property to

Yes

X

been a sale or i

private security or payment test? .,

501(c)(3) organization or a state or ocal governmen

No

SCHEDULE # 1

X

SeM Uolle}ndwoo eleqm

pue

Enter thel~r~~getraodfefino~ncbeudsi~12~eadytiv~tyedc~n read p~invatbey b~~es~guas~zaat~of

other than a section 501(c)(3) organization or a state or local government .....

Enter the

outside counsel to review any research agreements relating to t he financed property. . .

d If "Yes" to line 3c, does the organization routinely engage bond counsel or o er

Yes
X

5

n private

b If "Yes to line 38, does the organization rou nely engage bond counsel or othe outside
counse o review any management or service cont acts relating to the financed property?
n private business use of
c Are there any research agreements hat may resu

may resu

EQUPMENT LEASES

X

4

or service contracts tha

business use of bond-financed property?

3a Are there any managemen

Continued

X

X

DII EDVd

Private Business Use
x

X

9:01 (066 uuod) >, elnpelps

Schedule K (Form 990) 2016

13-1740114

X

seA

MONTEFIORE MEDICAL CENTER

X

X

 Continued
n

private

bond-financed prop

J

C

here been a sale or disposition of any of the bond-financed properly to a
)(3) or anization since the bonds were issued?

oes the bond issue meet the private security or payment test?

. .....

0

x

X

0
6.

C.

.*

*E

. FE

PlaIA

ejeqah!

No

ix

m

x

gx

041

tanp Weqet ON
X

X
X

ell~

DITO 7Z0090

000'1 96ZL39

0 'tpajeuiu,Jel 85pall 041 seM e
tpaje16@juuadns efpall 041 seM p

UoijeziueESJo

E
JO

e,
el·11

seH
e}Uall,WeAOS

'Lanssi mei alqeueA e anss, puoq 04 1 sl

U

'01 eu!1 01 .saA„ il

n

············'0'' pe UIJOijad

A ued w apiAOJd

'0

qm 01 uoil ao

6:eA anp jou a

N

X

E9'L-9 T A

JanSS!

22=2 w

Z O

16
JenSS

Pal'J

p

C

paJellia

1-9€08

'

elep all~

06eniqJV

61-914 L pue ZI-ttt L suolloes suo jelnSati jepun

0

g
m
oill

0

nalty in Lieu of Arbitrage Rebate? . . .

ZX

seM uognndwoo a}eclaJ all

uolionpahl

0

Arbitra e

Yes

m

e

ZE

If "Yes" to line 8a, was any remedial action aken pursuant to Regulations

Yes

X

Paillenb

8 0

rce ag of bond-financed property sold or

c A

pue

result of unrelated trade or b siness activity carried on
another section 501(c)(3) organiza tion or a state or ocal government

Enter the percentage of financed property used In a private~ t~eisrgusnizir~ a

other than a section 501(c)(3) organization or a state or local government .....

Enter the percentage of financed property used in a private business use by en ies

outside counsel to review any research agreements relating to the financed property?. .

d If 'Yes" to line 3c, does the organization routinely engage bond counsel or other

A

5

may resu

SCHEDULE # 2

X

alR 41!Ni aouepioooe ul pejelpaulaJ aie anss! 041 Jo spuoq

4

ha

EQUIPMENT LEASES

b If 'Yes to line 3a, does the organization routinely engage bond counsel or othe outside
counse o review any management or service contracts relating to the financed property?
n private business use of
c Are there any research agreements tha may resu

business use of bond-financed property?. . ,

3a Are there any management or service contracts

Private Business Use

Schedule K (Form 990) 2016

Yes

No

13-1740114

saA

X

Yes

STI EDVd

ON

MONTEFIORE MEDICAL CENTER

SaA

X

No

page 2

9LOZ (066 uuod) 1 einpelloS

oN

0
0

>4

 5

1

xxxpx
16 500
>4
No

Yes

No

No

X

x

m

ax

0 C)

5 7 N

6_-0 2

DITO 720090

0004 91~39

2.82=2
%-g
u, 29
rB92

vsr

.

Yes

Yes
X

Supplemental Information Provide additiona nformation for responses to questions on Schedule K. See instructions

DEFFA BANK

No

>4

ganization established

t
a
h
t
d
e
;
r
u
=
n
M
E
is
ibis=':m ng)33'il

Procedures To Undertake Corrective Action

the

Yes

0

d9'L-9I A

- A

re uirements ofsection 148? ........ .......

eriod?....
to monitor

he fa market value of he GIC satisfied?

ross roceeds invested be ond an available tem ora
the organization established written procedures

Was the re ulato

safe harbo or establishin

Were ross roceeds invested in a uaranteed investment contract GIC ?
Name of rovider

Arbitrage (Continued)

Schedule K (Form 990) 2016

No

13-1740114

No

X

Yes

SIT EDVd

U>

No

Page 3

No

X

9601 (066 uuod) 1 elnpallOS

MONTEFIORE MEDICAL CENTER

X

0

 0

5
•C

X
No

No

X
No

Yes

Yes

X

m

x

x
X

m

ax

Ex

0 01

330¤,
OE

x.a -5

d9'L-9 I A

DITO 920090

000'& BEE 1 39

5-0 m (0
ip*0 9 52

Supplemental Information. Provide additiona nformation for responses to questions on Schedule K. See instructions

u

he

Yes

0

res to ensure that
organization es lished
quirem~an~s ap~ogER is deud and cor ected
mediation isn't avail

Procedures To Undertake Corrective Actio

re uirements of section 148? . .. . . . . .......

eriod? . .
to monitor

safe harbor for establishin the fair market value of the GIC satisfied?

No

X

ross roceeds invested be ond an available tem ora
the organization established written procedures

the re ulato

Yes

No

Yes

No

No

No

X

vsr

Sa Were ross roceeds invested in a uaranteed nvestmen contract GIC ?
Name of rovider.... .....

Arbitrage (Continued)

Page 3

X

LII EDVd

Schedule K (Form 990) 2016

13-1740114

>4

~01 (066 uuod) )1 elnp@409

MONTEFIORE MEDICAL CENTER

X

0

 6
f

0-

0 C)

a>€

U)

000'1 92£k39

2¤.

DITO 920090

No

No

Yes

Yes

No

No

13-1740114

suppieifnEnfontlaj~grt~[vie add~naiatnformat on for responls to questions on Schedule K. See instructions

No

X

d ures to ensure that
ed and corrected t

x

organization e stablished writtenpr

he

Yes

m

E9'L-9 I A

E

Procedures To Undertake Corrective Action

eriod?....
to monitor

No

X

ross roceeds invested be ond an available tem ora
the organization established written procedures
re uirements of section 148? . ,. .

Was the re ulato

safe harbor for establishin the fair market value of the GIC satisfied?

Name of rovider... .........................

Yes

m

vsr

5a Were ross roceeds invested in a uaranteed investment contract GIC ?

Arbitrage (Continued)

Schedule K (Form 990) 2016

MONTEFIORE MEDICAL CENTER

X

Yes

Yes

BII HDVd

X

No

No

Page 3

9:02 (066 uuod) M einpelloS

0
0

 13-1740114

INGS.

A,

LINE 3

COL

A,

LINE 2C

ISSUER NAME: DORMITORY AUTHORITY 6F THE STATE OF NEW YORK

ARBITRAGE - PART IV,

TRANSFERRED OR REPLACEMENT PROCEEDS IN LINE 4.

THE TOTAL PROCEEDS DO NOT EQUAL THE SUMMATION OF LINE 4-12 DUE TO

PROCEEDS - PART II, COL

DUE TO INVESTMENT E

THE TOTAL PROCEEDS DO NOT AGREE TO THE ISSUE PRICE IN PART I, COLUMN(E)

PROCEEDS - PART II, COLUMN A, LINE 3

Supplementa nformation Provide additiona nformation for responses to questions on Schedule K (see instructions) (Continued)

Schedule K Form 990) 2016

MONTEFIORE MEDICAL CENTER

6 II aDVd

Page 4

~01 (066 ullod) 1 elnp@435

'S

900

'II 12(Vd - Saa3002(d

:V NWn'IOO

'II LHVd - SGHa 002id

d9'L-9I A

0004 LLSL339

¥sr

' (asodand

DITO 910090

' 30 IO Z SEINES

aNOS anNHAEH XY,L EWOONI 'ni'NOSHEd EILVIS 000' OIS' 295$ S, ANSVG

'D NWREIOJ

SHEMOHHOR 'nfaaAES Mod DNIDN¥NId GaaIAOHd

'IVMENED)

E ;EINIEI

NMVNG NEHE ZEA ION SVH 3'IEVEIIVAV

SISYS NMOG-MVHG V NO a30SSI SYM %Bia SIHi SY

' I LHVd NI EIDINd anSSI aH.I. O.I. 33HDV .LON Oa SaaEOOMd rIVMO,L aH.L

TYd IONINd rnr~01 SHZ

NWn'IOD

EHL dO

(H)

E EINIV

EIOZ/IE/ZO

: GaWMOdHEid SVM NOI%FLAdWOO ELVEI:EI2( 3HZ HIVa

 13-1740114

IN 2015,

DTIO 9Z0090

000' ~~9 & 39

UNIVERSITY.

d9'L-SI A

MONTEFIORE MEDICAL

CENTER ASSUMED THE REMAINING $16.4 MILLION OF THE DEBT FROM YESHIVA

ORIGINALLY ALLOCATED TO YESHIVA UNIVERSITY.

AMOUNT IN PART II, LINE 3, $19,400,000 REPRESENTS THE AMOUNT OF THE BOND

Supplementa nformation Provide additiona nformation for responses to questions on Schedule K (see instructions) (Continued)

Schedule K (Form 990) 2016

MONTEFIORE MEDICAL CENTER
Page 4

OZI SDTid
9&02 066 uuod) )1 einpellpS

 SCHEDULE M
(Form 990)
Department of the Treasury

Internal Revenue Service
Name of the organization

OMB No. 1545-0047

Noncash Contributions

2@16

i Complete if the organizations answered "Yes" on Form 990, Part IV, lines 29 or 30.

~ Attach to Form 990.
h Information about Schedule M ( Form 990 ) and its instructions is at www. irs.gov/form990.

...

..

0

Employer identificatjon number

13-1740114

MONTEFIORE MEDICAL CENTER

Types of Property

1

Art - Works of art. . . . . . . . . .

2

Art - Historical treasures ......

3
4

Art - Fractional interests ......
Books and publications ......

5

Clothing and household

6

Cars and other vehicles ......

7

Boats and planes. . . . . . . . . .

8
9

Intellectual property ........
Securities - Publicly traded ....

10
11

Securities - Closely held stock . . .
Securities - Partnership, LLC,

(c)

(a)

(b)

Check if

Number of contributions or

applicable

items contributed

17.

(d)

Noncash contribution

amounts reported on

Form 990, Part VIll, line lg

4,703,752.

Method of determining

noncash contribution amounts

CURRENT MARKET VALUE

or trust interests ..........
12

13

Securities - Miscellaneous .....

Qualified conservation
contribution - Historic

14

structures
Qualified conservation

15

contribution - Other ........
Real estate - Residential ......

16

Real estate - Commercial .....

17

18

Real estate - Other .........
Collectibles. . . . . . . . . . . . .

19
20

Food inventory ...........
Drugs and medical supplies ....

21
22

Taxidermy
Historical artifacts .........

23
24

Scientific specimens ........
Archeological artifacts .......

25

Other iC
)
)
Other i<
)
Other )·(
)
Other ~(
Number of Forms 8283 received by the organization during the tax year for contributions for

26
27
28
29

which the Organization completed Form 8283, Part IV, Donee Acknowledgement ..........

29
Yes No

30a During the year, did the organization receive by contribution any property reported in Par't 1, lines 1 through

28, that it must hold for at least three years from the date of the initial contribution, and which isn't required
to be used for exempt purposes for the entire holding period?

31

b If "Yes," describe the arrangement in Part 11.
Does the organization have a gift acceptance policy that requires the review of any nonstandard

30a

31

X

X

32a Does the organization hire or use third parties or related organizations to solicit, process, or sell noncash

contributions?..........................,...,...,..,................. 323
b If "Yes" describe in Part ll.
33 If the organization didn't report an amount in column (c) for a type of property for which column (a) is checked,
describe in Part Il.
Schedule M (Form 990) (2016)

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

JSA
GE 1298 1 000

06002L 0114

V 16-7.6F

PAGE 121

 1311740114

MONTEFIORE MEDICAL CENTER

Page 2

Schedule M (Form 990) (2016)

~ -

Supplemental Information. Provide the information required by Part 1, lines 3Ob, 32b, and 33, and whether
the organization is reporting in Part 1, column (b), the number of contributions, the number of items received,
or a combination of both. Also complete this part for any additional information.

4

Schedule M (Form 990) (2016)

JSA
GE 1 508 2.000

06002L 0114

V 16-7.6F

PAGE 122

 Supplemental Information to Form 990 or 990-EZ

SCHEDULE O

2@16

Complete to provide information for responses to specific questions on
Form 990 or 990-EZ or to provide any additional information.

(Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service

OMB No. 1545-0047

......

iAttach to Form 990 or 990-EZ.
~ Information about Schedule O ( Form 990 or 990 -EZ) and its instructions is at

www. irs.gov/form990.

.

Employer identificatjon number

Name of the organization

13-1740114

MONTEFIORE MEDICAL CENTER

FORM 990, PART VI, SECTION A, LINE 6:
MONTEFIORE HEALTH SYSTEM, INC. IS THE SOLE MEMBER OF MONTEFIORE MEDICAL

CENTER.

FORM 990, PART VI, SECTION A, LINE 7A:
THE BOARD OF TRUSTEES OF MONTEFIORE HEALTH SYSTEM, INC., THE SOLE MEMBER

OF MONTEFIORE MEDICAL CENTER, HAS THE AUTHORITY TO APPOINT THE BOARD OF

TRUSTEES OF MONTEFIORE MEDICAL CENTER.

FORM 990, PART VI, SECTION A, LINE 7B:

THE BOARD OF TRUSTEES OF MONTEFIORE HEALTH SYSTEM, INC., THE SOLE MEMBER

OF MONTEFIORE MEDICAL CENTER, HAS THE AUTHORITY TO APPROVE THE OPERATING

AND CAPITAL BUDGETS OF MONTEFIORE MEDICAL CENTER.

FORM 990, PART VI, SECTION B, LINE 11B:
THE FORM 990 WAS PREPARED BY THE MONTEFIORE'S FINANCE DEPARTMENT WITH THE
ASSISTANCE OF VARIOUS DEPARTMENTS THROUGHOUT THE MEDICAL CENTER.

THE

FORM 990 WAS REVIEWED AND APPROVED BY THE VICE PRESIDENT-FINANCE AND THE

MEDICAL CENTER'S SENIOR LEADERSHIP TEAM INCLUDING THE CHIEF FINANCIAL
OFFICER.

IN ADDITION,

REVIEW THE FORM 990.

AN INDEPENDENT ACCOUNTING FIRM WAS ENGAGED TO
UPON COMPLETION OF THE VARIOUS REVIEWS,

THE FORM

990 WAS PRESENTED TO THE FINANCE COMMITTEE OF THE BOARD OF TRUSTEES FOR
REVIEW AND APPROVAL.

ONCE APPROVED BY THE FINANCE COMMITTEE OF THE BOARD

OF TRUSTEES, THE FORM 990 WAS PROVIDED TO ALL MEMBERS OF MONTEFIORE

For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
JSA
6 El 240229*2.000

06002L 0114

V 16-7.6F

Schedule O (Forrn 990 or 990-EZ) (2016)

PAGE 123

 Page 2

Schedule O (Form 990 or 990-EZ) 2016
Employer Identification number

Name of the organization

13-1740114

MONTEFIORE MEDICAL CENTER

MEDICAL CENTER'S GOVERNING BODY.

FORM 990, PART VI, SECTION B, LINE 12C:

THE ORGANIZATION REGULARLY AND CONSISTENTLY MONITORS AND ENFORCES
COMPLIANCE WITH THE DISCLOSURE POLICY BY MEANS OF A SURVEY DEVELOPED BY
COUNSEL AND APPROVED BY THE LEGAL AND COMPLIANCE COMMITTEES OF THE BOARD
OF TRUSTEES.

THE SURVEY IS SENT TO ALL TRUSTEES,

EMPLOYEES FOR COMPLETION.
COMPLIANCE OFFICER.

OFFICERS AND KEY

ALL SURVEY RESPONSES ARE REVIEWED BY THE

ANY POTENTIAL CONFLICTS IDENTIFIED IN THE RESPONSES

ARE DISCUSSED WITH SENIOR MANAGEMENT AND/OR THE LEGAL AND COMPLIANCE
COMMITTEES OF THE BOARD OF TRUSTEES.

POTENTIAL ACTIONS TO BE TAKEN IN

RESPONSE TO A CONFLICT IS ONE OR MORE OF THE FOLLOWING: 1)DISCLOSURE OF

CONFLICT; 2)INDIVIDUAL RECUSAL FROM DECISIONS FOR TRANSACTIONS WHERE THAT
INDIVIDUAL MAY HAVE A CONFLICT; 3)REQUEST THE INDIVIDUAL TO ALLEVIATE THE

CONFLICT; OR 4)REMOVAL OF THE INDIVIDUAL FROM THE BOARD OF TRUSTEES.

FORM 990, PART VI, SECTION B, LINE 15A & LINE 15B:
ALL OFFICERS AND KEY EMPLOYEES ARE4EMPLOYED AND PAID BY EITHER MONTEFIORE

MEDICINE ACADEMIC HEALTH SYSTEM, INC. OR MONTEFIORE HEALTH SYSTEM, INC.,
,

THE PARENT COMPANY OF MONTEFIORE HEALTH SYSTEM, INC. AND MONTEFIORE

MEDICAL CENTER, RESPECTIVELY.

MONTEFIORE IS COMMITTED TO ENSURING THAT ITS EXECUTIVE COMPENSATION
PROGRAM ADHERES TO THE HIGHEST STANDARDS OF REGULATORY COMPLIANCE AND
BEST CORPORATE GOVERNANCE.

THE MONTEFIORE BOARD OF TRUSTEES HAS CHARGED

THE COMPENSATION COMMITTEE OF THE BOARD (WHICH IS COMPRISED OF

Schedule O (Form 990 or 990.EZ) 2016

JSA
6E 1228 1.000

06002L 0114

V 16-7.6F

PAGE 124

 Page 2

Schedule O (Form 990 or 990-EZ) 2016
Employer identification number

Name of the organization

13-1740114

MONTEFIORE MEDICAL CENTER

INDEPENDENT BOARD MEMBERS WITH NO CONFLICTS OF INTEREST IN REGARDS TO
EXECUTIVE COMPENSATION) WITH MAKING ALL DECISIONS RELATED TO COMPENSATION
FOR OFFICERS AND KEY EMPLOYEES.

ALL DECISIONS MADE BY THE COMPENSATION

COMMITTEE ARE APPROPRIATELY AND TIMELY DOCUMENTED IN MEETING MINUTES. THE

COMPENSATION COMMITTEE'S REVIEW PROCESS FOLLOWS THE INTERMEDIATE
SANCTIONS GUIDELINES FOR QUALIFYING FOR THE REBUTTABLE PRESUMPTION OF
REASONABLENESS.

THE COMMITTEE RETAINS AN INDEPENDENT COMPENSATION

CONSULTANT TO ASSIST IT WITH THIS PROCESS. COMPENSATION LEVELS ARE

l

ESTABLISHED CONSIDERING DATA FOR COMPARABLE ORGANIZATIONS, AN ASSESSMENT
OF MANAGEMENT PERFORMANCE (INCLUDING THE SERVICES PROVIDED TO THE

COMMUNITY), AND OTHER BUSINESS JUDGMENT FACTORS, CONSISTENT WITH
MONTEFIORE'S EXECUTIVE COMPENSATION PHILOSOPHY.

THE COMMITTEE'S

DECISIONS ARE MADE IN THE BEST INTEREST OF MONTEFIORE, AND ARE INTENDED
TO ENSURE THE RECRUITMENT AND RETENTION OF KEY EXECUTIVE TALENT,
CONSISTENT WITH THE MARKET PRACTICES OF OTHER NOT-FOR-PROFIT HEALTHCARE
ORGANIZATIONS OF COMPARABLE SCOPE,

MISSION AND COMPLEXITY.

ON AN ANNUAL

BASIS, THE COMMITTEE PROVIDES THE FULL BOARD OF TRUSTEES WITH A

DESCRIPTION OF THE COMMITTEE'S REVIEW AND APPROVAL PROCESS AND ITS

DECISIONS.

FORM 990, PART VI, SECTION C, LINE 19:
THE CONFLICT OF INTEREST POLICY AND GOVERNING DOCUMENTS ARE MADE
AVAILABLE UPON REQUEST.

Schedule O (Form 990 or 990-EZ) 2016

JSA
6 E 1228 1 000

06002L 0114

V 16-7.6F

PAGE 125

 Page 2

Schedule O (Form 990 or 990-EZ) 2016
Employer identification number

Name of the organization

13-1740114

MONTEFIORE MEDICAL CENTER

FORM 990, PART XI, LINE 9:
THE OTHER CHANGE IN NET ASSETS REDUCTION OF $53,185,988 WAS DUE TO THE

FOLLOWING:
- AFFILIATE EQUITY TRANSFERS

($64,509,889)

DECREASE IN DEFINED PENSION AND OTHER POSTRETIREMENT PLAN LIABILITIES
TO BE RECOGNIZED IN FUTURE PERIODS

- GAIN ON REFINANCING OF FHA DEBT

$6,719,753
$4,604,148

ATTACHMENT 1
FORM 992=PART==LAILINE==1=-=ORGANIZATION='SMISSION

MISSION: TO HEAL, TO TEACH, TO DISCOVER AND TO ADVANCE THE HEALTH OF
THE COMMUNITIES WE SERVE.
VISION: TO BE A PREMIER ACADEMIC MEDICAL CENTER THAT TRANSFORMS
HEALTH AND ENRICHES LIVE.

VALUES: HUMANITY, INNOVATION, TEAMWORK, DIVERSITY AND EQUITY - OUR

VALUES DEFINE OUR PHILOSOPHY OF CARE. THEY SHAPE OUR ACTIONS AND
MOTIVATE AND INSPIRE US TO PURSUE EXCELLENCE AND ACHIEVE OUR GOALS.

SINCE 1884, MONTEFIORE HAS CARED FOR THE CHRONICALLY ILL AND HAS MADE

IT A PRIORITY TO IMPROVE THE QUALITY OF LIFE FOR UNDERSERVED
POPULATIONS.

THIS FOUNDING BELIEF IS THE CORNERSTONE OF OUR MISSION,

VISION AND VALUES.

MONTEFIORE'S MISSION IS ROOTED IN OUR ENDURING

COMMITMENT TO PROVIDE ONE STANDARD OF EXCELLENT CARE TO ALL PATIENTS
- REGARDLESS OF THEIR BACKGROUNDS OR ABILITY TO PAY.

MONTEFIORE, THE UNIVERSITY HOSPITAL FOR ALBERT EINSTEIN COLLEGE OF

Schedule O (Form 990 or 990-EZ) 2016

JSA
6 E 1228 1.000

06002L 0114

V 16-7.6F

PAGE 126

 Page 2

Schedule O (Form 990 or 990-EZ) 2016
Employer Identification number

Name of the organization

'

13-1740114
-AT-TACHMENT 1 (CONT'D)

MONTEFIORE MEDICAL CENTER

FORM 93_Q_PARTHILINE&-ORGANIZATION'SMISSION

MEDICINE, COMBINES NATIONALLY-RENOWNED CLINICAL AND RESEARCH
EXPERTISE WITH COMPASSIONATE, PATIENT-CENTERED CARE. BUILDING UPON

OUR RICH HISTORY OF INNOVATION AND COMMUNITY SERVICE, MONTEFIORE

SEEKS TO ADVANCE HEALTH IN OUR COMMUNITIES AND SERVE AS A NATIONAL
MODEL FOR AN ACCOUNTABLE HEALTH SYSTEM.

ATTACHMENT 2
FORM__991,_PART_liI-PROGRAM-SERVICE, LINE_48

PATIENT CARE
ESTABLISHED IN 1884 AS A HOSPITAL FOR PATIENTS WITH CHRONIC

ILLNESSES, MONTEFIORE IS A FULL-SERVICE INTEGRATED HEALTHCARE
DELIVERY SYSTEM SERVING A LARGE AND COMPLEX URBAN POPULATION, A

DISTINGUISHED ACADEMIC MEDICAL CENTER WITH RENOWNED FACULTY, AN

INNOVATIVE RESEARCH CENTER PIONEERING SCIENTIFIC BREAKTHROUGHS AND
MEDICAL

" FIRSTS" AND AN EXCEPTIONALLY DEDICATED COMMUNITY PARTNER

WITH AN UNPARALLELED ROSTER OF INNOVATIVE PROGRAMS AND SERVICES
THAT ADDRESS NEEDS RANGING FAR BEYOND MEDICAL CARE.

MONTEFIORE'S MISSION IS TO HEAL, TO TEACH, TO DISCOVER AND TO

ADVANCE THE HEALTH OF THE COMMUNITIES IT SERVES. TO THIS MISSION

MONTEFIORE BRINGS A UNIQUE SYNERGY OF STRENGTHS AND RESOURCES. THE
MONTEFIORE DELIVERY SYSTEM OFFERS A FULL RANGE OF HEALTHCARE
SERVICES

(PREVENTIVE,

PRIMARY, SPECIALTY, ACUTE AND POST ACUTE) TO

THE NEARLY 2 MILLION RESIDENTS OF THE BRONX, NEW YORK AND NEARBY
WESTCHESTER COUNTY.

MONTEFIORE ALSO SERVES AS A TERTIARY CARE

Schedule O (Form 990 or 990.EZ) 2016

JSA
6E 1228 1.000

06002L 0114

V

16-7.6F

PAGE 127

 (
Page 2

Schedule 0 (Form 990 or 990-EZ) 2016
Employer identjfication number

Name of the organization

13-1740114

MONTEFIORE MEDICAL CENTER

ATTACHMENT 2

(CONT'D)

REFERRAL CENTER FOR PATIENTS ACROSS THE METROPOLITAN AREA, THE
NATION AND THE WORLD, AND IS KNOWN FOR ADVANCED CARE IN NUMEROUS

SPECIALTIES, INCLUDING CARDIOLOGY AND CARDIAC SURGERY, CANCER
CARE, CHILDREN'S HEALTH, TISSUE AND ORGAN TRANSPLANTATION, WOMEN'S

HEALTH, SURGERY AND SURGICAL SUBSPECIALTIES.

MONTEFIORE COMBINES ITS DEEP COMMITMENT TO THE COMMUNITY WITH

NATIONALLY-RENOWNED EXPERTISE TO REACH PEOPLE AT CONVENIENT
LOCATIONS. THROUGH THE MONTEFIORE SCHOOL HEALTH PROGRAM (THE

LARGEST AND MOST COMPREHENSIVE SCHOOL-BASED HEALTH PROGRAM IN THE
COUNTRY),

PRIMARY CARE AT HOME PROGRAMS, MOBILE MEDICAL AND DENTAL

HEALTH VANS AND HEALTH EDUCATION INITIATIVES, MONTEFIORE PROVIDES
PRIMARY CARE SERVICES IN NON-TRADITIONAL SETTINGS.

MONTEFIORE IS INCREASINGLY RECOGNIZED FOR SUCCESS IN DELIVERING
HIGH-QUALITY CARE TO A LARGE URBAN COMMUNITY, HARNESSING THE POWER

OF HEALTH INFORMATION TECHNOLOGY AND USING CARE MANAGEMENT TOOLS

TO IMPROVE QUALITY, SAFETY AND OUTCOMES WHILE CONTROLLING COSTS.
TO HELP PATIENTS, ESPECIALLY THOSE WITH CHRONIC DISEASES, ACHIEVE

A BETTER QUALITY OF LIFE AND REDUCED HOSPITALIZATIONS, MONTEFIORE

GOES BEYOND THE FRAGMENTED FEE-FOR-SERVICE PAYMENT SYSTEM,

ASSUMING TOTAL RESPONSIBILITY FOR THE QUALITY AND COSTS OF CARE
FOR SOME OF ITS SICKEST PATIENTS. THROUGH THE MONTEFIORE IPA, INC.
(MIPA), THE CARE MANAGEMENT COMPANY, LLC (CMO) AND BRONX

ACCOUNTABLE HEALTHCARE NETWORK IPA, INC., DBA MONTEFIORE

Schedule O (Form 990 or 990-EZ) 2016

JSA
6E 1228 1 000

06002L 0114

V 16-7.6F

PAGE 128

 Page 2

Schedule O (Form 990 or 990-EZ) 2016
Employer identification number

Name of the organization

13-1740114

MONTEFIORE MEDICAL CENTER

ATTACHMENT 2

(CONT'D)

ACCOUNTABLE CARE ORGANIZATION IPA (ACO), A GLOBAL PREPAYMENT

STRATEGY IS USED TO MANAGE CARE OVER THE CONTINUUM, INCLUDING
HOSPITAL CARE, REHABILITATION, OUTPATIENT CARE, PROFESSIONAL

SERVICES, REMOTE PATIENT MONITORING AND OTHER PROGRAMS.

THE CMO AND ACO TAKES A PROACTIVE APPROACH TO CARE MANAGEMENT BY
DEVELOPING STRATEGIES THAT HELP IMPROVE INTEGRATED, ACCOUNTABLE

.

AND AFFORDABLE CARE THROUGHOUT THE HEALTH SYSTEM WITH THE
OBJECTIVE OF REDUCING EXPENSIVE HOSPITAL BASED CARE. OUR APPROACH
TO CARE MANAGEMENT STRESSES THE IMPORTANCE OF EARLY IDENTIFICATION

OF PATIENTS AT RISK WORKING WITH A COLLABORATIVE,

INTERDISCIPLINARY TEAM TO DEVELOP AND OVERSEE INDIVIDUALIZED CARE
PLANS AND PROMOTE PATIENT SELF-MONITORING AND EDUCATION. OUR

STRATEGY EMPHASIZES THE INTERACTION AND COMMUNICATION AMONG
PATIENTS, HEALTHCARE PROVIDERS, CASE MANAGERS, MENTAL HEALTH

AGENCIES AND OTHER ALLIED HEALTH PROFESSIONALS ALONG WITH PROGRAMS
PROVIDED TO REINFORCE HEALTH EDUCATION, PROMOTE COMPLIANCE WITH
TREATMENT AND PREVENTATIVE CARE GUILDLINES, MONITOR HEALTH STATUS,
AND PROMOTE TIMELY INTERVENTION WHEN NEEDED. OUR CARE MANAGEMENT

PROGRAMS ARE DEVELOPED TO ANTICIPATE AN INDIVIDUAL'S HEALTHCARE

NEEDS, TO PROVIDE AND COORDINATE THE SCOPE OF NECESSARY HEALTH

SERVICES AND TO INVOLVE THE PATIENT IN ESTABLISHING GOALS AND
INDIVIDUAL CARE PLANS.

AT THE CENTER OF THE MEDICAL SYSTEM ARE FIVE HOSPITALS WITH A

Schedule O (Form 990 or 990-EZ) 2016

JSA
6E 1228 1000

06002L 0114

V 16-7.6F

PAGE 129

 Page 2

Schedule O (Form 990 or 990-EZ) 2016
Employer Identification number

Name of the organization

13-1740114

MONTEFIORE MEDICAL CENTER

ATTACHMENT 2

TOTAL OF 1,536 BEDS THAT PROVIDE OVER 94,000 INPATIENT DISCHARGES

(CONT'D)

\

ANNUALLY, INCLUDING OVER 5,300 BIRTHS AND MULTIPLE AMBULATORY

SERVICES:
- THE 658 BED HENRY AND LUCY MOSES DIVISION;

THE 421 BED JACK D. WEILER HOSPITAL OF ALBERT EINSTEIN COLLEGE
OF MEDICINE;
THE 136 BED CHILDREN'S HOSPITAL AT MONTEFIORE, RECOGNIZED AS
ONE OF

"AMERICA'S BEST CHILDREN'S HOSPITALS"

IN U.S.

NEWS & WORLD

REPORT'S RANKINGS;
THE 321 BED WAKEFIELD DIVISION (FORMERLY THE NORTH DIVISION

RENAMED TO REFLECT ITS ANCHOR ROLE IN THE COMMUNITY);
MONTEFIORE WESTCHESTER·SQUARE (THE FORMER NEW YORK WESTCHESTER

SQUARE HOSPITAL) OPERATING AS A FREE STANDING EMERGENCY DEPARTMENT

AND AMBULATORY SURGERY FACILITY;
- THE MONTEFIORE HUTCHINSON CAMPUS - THE INNOVATIVE "HOSPITAL
WITHOUT BEDS"

PROVIDING WORLD-CLASS, TREATMENT WITH THE LATEST

TECHNOLOGY AND THE BEST OF MULTIDISCIPLINARY APPROACH TO CARE,
ENABLING PATIENTS TO BE TREATED EFFECTIVELY AND SAFELY WITHOUT
BEING HOSPITALIZED.

MONTEFIORE ALSO OPERATES EXTENSIVE AMBULATORY CARE SERVICES
CONNECTED BY A ROBUST HEALTH INFORMATION TECHNOLOGY SYSTEM THROUGH
A NETWORK OF MORE THAN 150 LOCATIONS - FROM COMMUNITY-BASED

,

AMBULATORY CARE CENTERS TO SCHOOL-BASED HEALTH CENTERS TO MOBILE

CLINICS:

Schedule O (Form 990 0,990-EZ) 2016
JSA
GE 1228 1 000

06002L 0114

V 16-7.6F

PAGE 130

 Page 2

Schedule O (Form 990 or 990-EZ) 2016

Employer identification number

Name of the organization

13-1740114

MONTEFIORE MEDICAL CENTER

ATTACHMENT 2

(CONT'D)

- MONTEFIORE'S EMERGENCY DEPARTMENTS, AMONG THE BUSIEST IN THE
NATION, TREATS MORE THAN 328,000 PATIENTS ANNUALLY;

- THE HOSPITAL BASED CLINICS PROVIDES OVER 346,000 VISITS A
YEAR;

THE PHYSICIAN PRACTICES PROVIDES MORE THAN 1.1 MILLION OFFICE
·

VISITS ANNUALLY;

1

MONTEFIORE MEDICAL GROUP, A NETWORK WITH OVER 350 PRIMARY CARE
PHYSICIANS AT 21 COMMUNITY BASED LOCATIONS THROUGHOUT THE BRONX
AND WESTCHESTER, PROVIDES OVER 788,000 VISITS A YEAR;

MONTEFIORE HOME CARE PROGRAM PROVIDES OVER 191,000 VISITS EACH

YEAR TO HOMEBOUND PATIENTS;
THE MONTEFIORE SCHOOL HEALTH PROGRAM, THE LARGEST IN THE
NATION, WITH 23 SCHOOL-BASED HEALTH CENTERS SERVES MORE THAN

25,000 CHILDREN ANNUALLY;
THE MONTEFIORE SUBSTANCE ABUSE AND TREATMENT PROGRAM OPERATING

11 SITE SUBSTANCE ABUSE TREATMENT PROGRAM OFFERS DRUG TREATMENT
AND REHABILITATION SERVICES AND COMPREHENSIVE PRIMARY CARE TO A

POPULATION OF 4,500 RECOVERING ABUSERS IN COMMUNITIES ACROSS THE
BRONX;

- TARGETED OUTREACH SERVICES TO AT-RISK POPULATIONS INCLUDING

PROGRAMS SERVING THE HOMELESS AND VICTIMS OF DOMESTIC VIOLENCE,
MOTHERS AT RISK OF PREMATURE BIRTH, AS WELL AS SERVICES TO
HOMEBOUND AND/OR FRAGILE SENIORS IN COMMUNITY-BASED SETTINGS

THROUGHOUT THE BRONX.

Schedule O (Form 990 or 990-EZ) 2016

JSA
6E 1228 1.000

06002L 0114

-

V 16-7.6F

PAGE 131

 Page 2

Schedule O (Form 990 or 990-EZ) 2016
Employer identification number

Name of the organization

13-1740114

MONTEFIORE MEDICAL CENTER

ATTACHMENT 2

(CONT'D)

AT THE INTERSECTION OF ALBERT EINSTEIN COLLEGE OF MEDICINE AND
MONTEFIORE ARE CENTERS OF EXCELLENCE IN CANCER CARE,
CARDIOVASCULAR SERVICES, THE CHILDREN'S HOSPITAL, TRANSPLANTATION
AND NEUROSCIENCES.

IN THESE CENTERS,

RENOWNED INVESTIGATORS AND

MULTIDISCIPLINARY CLINICAL TEAMS COLLABORATE TO DEVELOP AND
DELIVER THE ADVANCED, INNOVATIVE CARE AVAILABLE ONLY AT PREMIER

ACADEMIC MEDICAL CENTERS AND THE SEAMLESS CONTINUUM OF SERVICES
THAT ENSURES AN IDEAL PATIENT EXPERIENCE.

MONTEFIORE MEDICAL CENTER IS GUIDED BY A MISSION TO PROVIDE HIGH

QUALITY CARE FOR ALL ITS PATIENTS, INCLUDING THOSE IN OUR SERVICE
AREA WHO LACK HEALTH INSURANCE COVERAGE AND WHO CANNOT PAY FOR ALL
OR PART OF THE ESSENTIAL CARE THEY RECEIVE.

THE MEDICAL CENTER IS

COMMITTED TO MAINTAINING CHARITY CARE POLICIES THAT ARE CONSISTENT

WITH ITS MISSION AND VALUES OF ADVANCING THE HEALTH OF THE

COMMUNITIES THAT IT SERVES IN PROVIDING ONE STANDARD OF EXCELLENT

CARE TO ALL PATIENTS REGARDLESS OF THEIR BACKGROUND OR ABILITY TO

PAY.

FOR MORE THAN 100 YEARS, MONTEFIORE HAS BEEN A LEADER IN
INNOVATIONS, NEW TREATMENTS, NEW PROCEDURES AND NEW APPROACHES TO

PATIENT CARE THAT HAS PRODUCED STELLAR OUTCOMES AND HELPED TO

RAISE THE BAR FOR MEDICAL CENTERS IN THE REGION AND NATIONALLY. AS

MONTEFIORE BUILDS ON THIS MOMENTUM AND THESE ACCOMPLISHMENTS, WE

CONTINUE TO STRIVE TO ADVANCE THE PRACTICE OF MEDICINE AND SET THE

Schedule O (Form 990 or 990-EZ) 2016

JSA
6 El 228 1 000

06002L 0114

V 16-7.6F

PAGE 132

 Page 2

Schedule O (Form 990 or 990-EZ) 2016
Employer Identification number

Name of the organization

13-1740114

MONTEFIORE MEDICAL CENTER

ATTACHMENT 2

(CONT'D)

STANDARDS FOR EXCELLENCE.

ATTACHMENT 3
-FORM_191,_PART_LLIz__PROGRAM_SERVICE,_LINE_48
MEDICAL EDUCATION & RESEARCH

MEDICAL EDUCATION
MONTEFIORE IS THE UNIVERSITY HOSPITAL FOR ALBERT EINSTEIN COLLEGE

OF MEDICINE, ONE OF THE NATION'S PREMIER INSTITUTIONS FOR MEDICAL
EDUCATION,

BASIC RESEARCH AND CLINICAL INVESTIGATIONS.

THIS

STRONG ALIGNMENT ENABLES MONTEFIORE TO ADVANCE CLINICAL AND
TRANSLATIONAL RESEARCH RESULTS MORE RAPIDLY TO THE BEDSIDE AND TO
THE MEDICAL COMMUNITY, AND EDUCATE THE NEXT GENERATION OF
PHYSICIANS, HEALTHCARE LEADERS AND INVESTIGATORS.

IN PLACE ARE EXTENSIVE TRAINING PROGRAMS FOR MEDICAL STUDENTS,
RESIDENTS AND FELLOWS. ANNUALLY, OVER 1,400 RESIDENTS AND FELLOWS

ARE TRAINED IN MORE THAN 150 ACCREDITED RESIDENCY AND FELLOWSHIP

PROGRAMS MAKING MONTEFIORE THE SECOND LARGEST RESIDENCY PROGRAM IN
THE COUNTRY.

MONTEFIORE AND EINSTEIN'S PARTNERSHIP PROVIDES

RESIDENTS AND FELLOWS WITH AN EXCEPTIONAL ENVIRONMENT FOR RESEARCH

TRAINING AND PARTICIPATION IN BASIC, TRANSLATIONAL AND CLINICAL

ACTIVITIES. MONTEFIORE PROVIDES THE DOCTORS OF TOMORROW A UNIQUE
OPPORTUNITY FOR EDUCATION AND TRAINING IN ONE OF THE MOST DIVERSE
URBAN AREAS IN THE COUNTRY CARING FOR A GLOBAL POPULATION WHERE
THE DISEASE BURDEN IS HIGH AND THE NEED FOR QUALITY CARE IS GREAT.

Schedule O (Form 990 or 990-EZ) 2016

JSA
6E 1228 1 000

06002L 0114

V 16-7.6F

PAGE 133

 Page 2

Schedule O (Form 990 or 990-EZ) 2016
Employer identification number

Name of the organization

13-1740114

MONTEFIORE MEDICAL CENTER

ATTACHMENT 3

(CONT'D)

MONTEFIORE IS DEDICATED TO CULTIVATING THE ETHICAL AND

PROFESSIONAL DEVELOPMENT OF ALL OF ITS TRAINEES. MONTEFIORE'S
PHYSICIANS ARE AT THE FOREFRONT OF THEIR FIELDS, ACTIVELY

MENTORING AND CULTIVATING A NEW GENERATION OF PHYSICIANS AND

SCIENTISTS COMMITTED TO OUR MISSION AND VALUES OF ADVANCING THE
FRONT LINE OF HEALTH AND LEADING THE WAY IN TWENTY-FIRST CENTURY
MEDICINE AND PATIENT CARE. MONTEFIORE TRAINING EXPERIENCE -

CLINICALLY ADVANCED AND GROUNDED IN OUR ORGANIZATIONAL VALUES OF

HUMANITY, INNOVATION, TEAMWORK AND EQUITY - EXTENDS TO ALL
DISCIPLINES.

IN 2016,

OVER 1,600 UNDERGRADUATE AND GRADUATE

NURSING STAFF TRAINED AT MONTEFIORE AS DID HUNDREDS OF SOCIAL
WORKERS, NUTRITIONISTS AND PHARMACISTS.

MONTEFIORE TRAINING ALSO EXTENDS BEYOND THE GRADUATE LEVEL. THE
CENTER FOR CONTINUING MEDICAL EDUCATION (CCME) AT MONTEFIORE

MEDICAL CENTER AND ALBERT EINSTEIN COLLEGE OF MEDICINE, FOUNDED IN
1976, IS ACCREDITED BY THE ACCREDITATION COUNCIL FOR CONTINUING
MEDICAL EDUCATION (ACCME). THE CENTER HAS PROVIDED HUNDREDS OF CME

ACTIVITIES AND CME CREDITS TO THOUSANDS OF PRACTITIONERS.

RECOGNIZING THE VITAL IMPORTANCE OF DEVELOPING AND EMBRACING
INNOVATIVE TECHNIQUES AND TREATMENTS, MONTEFIORE IS COMMITTED TO

THE UTILIZATION OF RESOURCES FOR THE ADVANCEMENT OF PHYSICIANS'

EDUCATION AND DELIVERY OF CARE.

Schedule O (Form 990 or 990-EZ) 2016

JSA
6 E 1228 1.000

06002L 0114

V 16-7.6F

PAGE 134

 Page 2

Schedule O (Form 990 or 990-EZ) 2016
Employer Identification number

Name of the organization

13-1740114

MONTEFIORE MEDICAL CENTER

ATTACHMENT 3

(CONT'b)

RESEARCH

MONTEFIORE'S LARGE BIOMEDICAL AND CLINICAL RESEARCH INITIATIVES

INCLUDE INQUIRY INTO A RANGE OF MEDICAL AND HEALTH CARE DELIVERY

ISSUES, INCLUDING BASIC RESEARCH INTO THE FUNDAMENTAL PROCESS OF
DISEASE AND ITS TREATMENT IN HUMANS, CLINICAL TRIALS AND RELATED

CLINICAL RESEARCH AND RESEARCH INTO THE ORGANIZATION AND

MANAGEMENT OF HEALTH CARE SERVICES. MONTEFIORE IS AMONG 60
ACADEMIC MEDICAL CENTERS NATIONWIDE TO BE AWARDED THE PRESTIGIOUS
CLINICAL AND TRANSLATIONAL SCIENCE AWARD (CTSA) BY THE NATIONAL

INSTITUTES OF HEALTH

(NIH). THE NATIONAL INSTITUTES OF HEALTH,

ALONG WITH OTHER FEDERAL, STATE AND OTHER FUNDING, SUPPORTS

RESEARCH IN SUCH AREAS AS AIDS, ONCOLOGY, PEDIATRICS,

ANESTHESIOLOGY, EMERGENCY MEDICINE, NEUROLOGY, PATHOLOGY, SOCIAL
MEDICINE AND OTHER CLINICAL PROGRAMS. MONTEFIORE AND EINSTEIN ARE
ALIGNED AROUND SHARED GOALS, WITH SPECIAL EMPHASIS ON ADVANCING

CLINICAL AND TRANSLATIONAL RESEARCH TO ACCELERATE THE PACE AT
WHICH NEW DISCOVERIES BECOME THE TREATMENTS AND THERAPIES OF
TODAY.

SINCE 1963, MONTEFIORE HAS SERVED AS THE UNIVERSITY HOSPITAL OF
EINSTEIN, A POWERFUL COLLABORATION BETWEEN TWO OF THE NATION'S
PRE-EMINENT MEDICAL INSTITUTIONS THAT FOSTERS THE CREATION OF
KNOWLEDGE BY ATTRACTING WORLD-RENOWNED LEADERS IN THEIR FIELDS AND

PROMOTING OPPORTUNITIES FOR BASIC TRANSLATIONAL AND CLINICAL
RESEARCH. THIS BOND WAS STRENGTHEN FURTHER BY THE SEPTEMBER 9,

2015 AGREEMENT WITH YESHIVA UNIVERSITY WHERE MONTEFIORE ASSUMED
Schedule O (Form 990 or 990-EZ) 2016

JSA
6E 1228 1 000

06002L 0114

V 16-7.6F

PAGE 135

 Page 2

Schedule O (Form 990 or 990-EZ) 2016
Employer identification number

Name of the organization

13-1740114

MONTEFIORE MEDICAL CENTER

ATTACHMENT 3

(CONT'D)

OPERATIONAL AND FINANCIAL CONTROL OF THE ALBERT EINSTEIN COLLEGE
OF MEDICINE.

RECENTLY,

MONTEFIORE AND EINSTEIN HAVE SUCCESSFULLY

COLLABORATED TO SECURE A NATIONAL INSTITUTE OF HEALTH FUNDED $22.5
MILLION CLINICAL AND TRANSLATIONAL SCIENCE AWARD TO CREATE A

RESEARCH INFRASTRUCTURE TO SUPPORT AND PROMOTE CLINICAL AND

TRANSLATIONAL RESEARCH. MONTEFIORE RESEARCHERS ARE CURRENTLY

INVOLVED IN MORE THAN 400 CLINICAL TRIALS AND RESEARCH STUDIES,
HELPING TO TRANSLATE SCIENTIFIC BREAKTHROUGHS INTO CUTTING EDGE
DIAGNOSTICS AND INNOVATIVE TREATMENTS.

ATTACHMENT 4
-FORM_191,_PARTIII-_PROGRAM_SERVICE,_LINE__45~

COMMUNITY SERVICES

SERVICES TO THE COMMUNITY ARE AN EXPLICIT AND ESSENTIAL COMPONENT
OF MONTEFIORE'S MISSION AND ONE OF ITS MOST VALUED TRADITIONS. THE

MEDICAL CENTER HAS A LONG HISTORY OF REACHING BEYOND THE WALLS OF

ITS HOSPITALS TO IDENTIFY AND MEET THE NEEDS OF ITS COMMUNITY AND
HAS BEEN A NATIONAL LEADER IN ORGANIZING AND EXPANDING
COMMUNITY-BASED SERVICES. MONTEFIORE'S COMMITMENT TO THE COMMUNITY

HAS REQUIRED A MULTIFACETED, CONTINUALLY EVOLVING RESPONSE, IN
WHICH THE UNIQUE CAPACITIES OF THE ACADEMIC MEDICAL CENTER ARE

MOBILIZED TO IMPROVE THE LIVES OF THE PEOPLE AND THE COMMUNITIES

SERVED-NOT JUST MEDICALLY, BUT SOCIALLY, ECONOMICALLY AND
ENVIRONMENTALLY, WHEREVER AND WHENEVER RESOURCES CAN MAKE A

DIFFERENCE. THE MEDICAL CENTER HAS MAINTAINED AND EXPANDED ITS

Schedule O (Form 990 0,990-EZ) 2016

JSA
6E 1228 1.000

06002L 0114

V 16-7.6F

PAGE 136

 Page 2

Schedule O (Form 990 or 990-EZ) 2016
Employer identification number

Name of the organization

13-1740114

MONTEFIORE MEDICAL CENTER

ATTACHMENT 4

(CONT'D)

RANGE OF COMMUNITY SERVICES, REACHING OUT TO AND SERVING UN-MET

HEALTH NEEDS, INCLUDING THOSE WITH POOR ACCESS TO COMPREHENSIVE
PRIMARY CARE, AT-RISK AND HARD TO REACH CHILDREN AND THEIR

FAMILIES, UNDERSERVED AND AT-RISK SENIOR CITIZENS, THOSE AFFECTED
BY CANCER, THOSE AFFECTED BY THE CONTINUING HIV EPIDEMIC IN THE

BRONX, PERSONS WITH OR AT-RISK FOR TUBERCULOSIS INFECTION, PERSONS
AFFECTED WITH PROBLEMS OF SUBSTANCE ABUSE, THE HOMELESS, ADULTS
AND CHILDREN WITH LIMITED ACCESS TO PRIMARY DENTAL CARE AND THOSE
AFFECTED BY CHRONIC HEALTH CARE DISEASES SUCH AS CONGESTIVE HEART
FAILURE, DIABETES AND ASTHMA.

EMBRACING ITS SOCIAL RESPONSIBILITY TO THE COMMUNITY, MONTEFIORE
IS NATIONALLY KNOWN AS A PIONEER IN PROGRAMS THAT ARE TAILORED TO
THE SPECIFIC NEEDS OF THE COMMUNITY. MONTEFIORE HAS BEEN IN THE

VANGUARD OF INTERVENTION TO COMBAT SUCH CONDITIONS AS HIV DISEASE,
TUBERCULOSIS AND LEAD POISONING PREVENTION.

MONTEFIORE HAS

SHARPENED THE FOCUS ON SUCH ISSUES AS CHILDHOOD OBESITY, DIABETES,

IMPROVING COMMUNITY ACCESS TO FRESH, HEALTHY FOODS AT GREEN
MARKETS AND REDUCING HEALTHCARE DISPARITIES.

MONTEFIORE IS
*

ALIGNING COMPONENTS OF THE DELIVERY SYSTEM TO HELP IMPROVE PUBLIC

OUTCOMES AND BUILDING BEHAVIORAL AND POPULATION-BASED RESEARCH TO
IDENTIFY BEST PRACTICES.

THE COMMUNITY SERVED BY MONTEFIORE, BY SEVERAL MEASURES, FACES
MANY CHALLENGES.

IT IS RANKED THE POOREST URBAN COUNTY IN THE

COUNTRY, LEADS THE NATION IN RATES OF DIABETES AND OBESITY AND
Schedule O (Form 990 or 990-EZ) 2016

JSA
6 E 1 228 1.000

06002L 0114

V 16-7.6F

PAGE 137

 Page 2

Schedule O (Form 990 or 990-EZ) 2016
Employer identification number

Name of the organization

13-1740114

MONTEFIORE MEDICAL CENTER

ATTACHMENT 4

(CONT'D)

OTHER CHRONIC CONDITIONS AND LEADS NEW YORK CITY IN A HOST OF
SIGNIFICANT MARKERS:

PEOPLE IN "FAIR OR POOR HEALTH",

LOW BIRTH

WEIGHT, TEEN PREGNANCY, CHILDREN IN POVERTY, DISABLED INDIVIDUALS

AND FAMILIES LIVING BELOW THE POVERTY LINE. MONTEFIORE IS
CONTINUOUSLY WORKING TO HELP THE COMMUNITY MAINTAIN A SENSE OF

SECURITY AND ECONOMIC STABILITY, AS WELL AS TO IMPROVE SUCH
QUALITY-OF-LIFE FUNDAMENTALS AS EDUCATION AND AFFORDABLE HOUSING.

MONTEFIORE SEEKS TO ADVANCE LIFE IN THE BRONX BEYOND THE
TRADITIONAL BOUNDS OF HEALTHCARE, BY LEADING DEVELOPMENT EFFORTS,

PROMOTING SAFE AND PRODUCTIVE NEIGHBORHOODS AND TAKING A
LEADERSHIP ROLE IN COMMUNITY BUSINESS DEVELOPMENT. MONTEFIORE IS
AN ADVOCATE AND PARTNER WITH OUR NEIGHBORS IN THE BRONX, HELPING

TO SUSTAIN THE COMMUNITY THAT SUSTAINS US.

ATTACHMENT 5
990

PART VII-

COMPENSATION OF THE FIVE HIGHEST PAID IND.

CONTRACTORS

DESCRIPTION OF SERVICES

NAME AND ADDRESS

EPIC SYSTEMS CORPORATION

COMPENSATION

IT CLINICAL/BILL SYS

21,269,084.

IT CONSULTING

16,982,846.

TEMPORARY NURSES

16,305,411.

TEMPORARY NURSES

15,218,246.

P.O. BOX 88314
MILWAUKEE, WI 53288-0314
OPTIMUM HEALTHCARE IT,

LLC

P.O. BOX 741383
ATLANTA, GA 30384-1383
FASTAFF,

INC.

P.O. BOX 911452
DENVER, CO 80291-1452
CROSS COUNTRY STAFFING,

INC.

P.O. BOX 404674
ATLANTA, GA 30384

Schedule O (Form 990 or 990-EZ) 2016

JSA
GE1228 1.000

06002L 0114

V 16-7.6F

PAGE 138

 Page 2

Schedule O (Form 990 or 990-EZ) 2016
Employer Identification number

Name of the organization

13-1740114
_ATTACHMENT 5 (CONT' D)

MONTEFIORE MEDICAL CENTER

990

PART VII- COMPENSATION OF THE FIVE HIGHEST PAID IND.

DESCRIPTION OF SERVICES

NAME AND ADDRESS

QUEST DIAG NICHOLS INSTITUTE,

CONTRACTORS

OUTSIDE LAB SERVICES

INC.

COMPENSATION

5,835,861.

12436 COLLECTION CENTER DRIVE
CHICAGO, IL 60693-2436

Schedule O (Form 990 0,990-EZ) 2016

JSA
GE1228 1.000

06002L 0114

V 16-7.6F

PAGE 139

 000'l ZOel39

DITO 710090

CAle XNOMS DEID

AYMOVOMS HinOS 555

7'IIHNOD 15"3 00/

WaQSAS HL,nfaH EMOIdaLNOW

15*3 rIVAO MIOA213533 00,£

NOIJYMOdHOO NOIL¥AM)532[d rrIOHSOW

ONI

9

Hs,LN,0 ShnfO ABO.I.VInm,nf HLHON akiOIdaI.NOW Z

'XNONS

'XNOMS

'XNOHA

anNaAV ENAVM OSDE

II NOILDES ONISAOH dSOH 3~0Iial.NOW

~

f

Z

111 EAS

65896LO ZO
IGSOI AN

98*DELE EI

L9#01 AN

EGEST9I-OZ

NMOLAMH,fl

99D0I AN

066 lu-103 JO; SU0!1'n.Ilsul all; aas '33!loN 134 uo!;onpek; 1,JOM.aded Joi

d9'L-9 I A

SEDIAHES SWY

AMES ZMOddOS

SSDIAHSS DVIG

AN

ONI

' XNOMS

3nNSAY ENAVM ZIDE

133315 HLOTE 1533 III

ON ~ 6600 'IVILNSCISSM OWW

47 3389736
HUDSON VALLEY COLLABORATIVE,
BRONX, NY 10467
OTH STREET

OTON ACQUISITION
L.L.C

e, address, and EIN (if applicable) of disregarded entity

27 3994795

PERFORM P

omicile (state

13 337 306

13 826 507

38432436

65 693 474

MMC

MMC
Direct c ntrolling

OMB No

545-0047

Employer identification number

13 1740114

End-of-y~ar assets

13-1740114

Tota ncome

Related Organizations and Unrelated Partnerships

~ Complete if the organization answered "Yes" on Form 990, Part IV, line 33,34,350,36,

~ Attach to Form 990.

I nformation about Schedule R (Form 990) and its nstructions is at www.irs.gov/form990.

Identification of Disregarded Entities. Complete if the org

MONTEFIORE

BRONX, NY 10467

13 3991307
MANAGEMENT COMPANY, L.L.C.
2 CMO THE
NY
10467
BRONX
STREET
210TH
111 EAS
45 3962827
IATIVES, LLC
NY
10467
BRONX
OTH STREET

1

111 EAST

Clm

MONTEFIORE MEDICAL CENTER

D ZOS
AN

AN

69D0T

LBEGOIE-ET
L 9 DOT AN

ID909IL-EE

I

SCHEDULE R

E

J IOS

O IOS

E

E

DNISAOH EEViS

'XNOMS

MONTEFIORE MEDICAL CENTER

ODI EDVd

II HdAL FIZI
I HdAI VZI

J IOS
AN

69D0T AN

ONI

uo!}eziue610 pelelai JO N13 pue ssaJppe '@lue N

L940I AN 'XNOHEI

ILZE*GI-I6

ZZEOEDE EI

d

~01 (066 UIJOJ) ki alnpa435

OWW

E

0 IOS

HES ALINOWWOO

7

3%VISH TVHH

DNISAOH ESVZS

AN

AN

0 ZOS

0 ZOS

E

V<

M

-

DWW II HdAZ FIZI

I adAL VEI

4!Alloe AJeul,Jd

ES
0

01*1

*:unoo 16!aJO o
Wels) ap luop ie63-1

=0

ue!1005 epoo ;dulexa

00
9 '02

4- m

sniels A,peip Oilqnd

~$

((e)(0)&09 UO!;oas ;1)

02

M

Rv W . I

O

0

H

EIH

03 a

O.@

2

~~~

E°'

5

H.0

t

H

A

(0

O

,

ail

b

W

O-

iu

:& 0

~ 16 a,
15 E

2
E

7 = 0
1%

5 i ·E

E
6

Z

t

~

MY W

Y£2

5

8

8

EP
So
@ E.
*E

5

~

CO
U)

(1) wA
C

8
m

A,ua

6

25
1 0
5 92
E6

1

C

0

(D

fo

0~
f

9

UX
C

o

4

e

H

C

E
3°

16

8
C

E
32

O

:

E

LL

.
8
d

a_

0
O

0
0

5
t

0
2

0
N

- u

-0

CS

XXxXx

N
C

f

2

.

X

6

X
5§.8

u

 E) (0 IOS
0960/ AN

NMOLABWL

10

IGSOI AN

6TIO*LI-EI

000'L LOCK39

DITO 77.0090

anNSAV aN\17DIW HiHON OST

AVMGVOHe HinOS 555

9VLId SOH MOVAN 3 Hi

>nnfd S I H-HOW

OVOV aNIDIaaW SHOI33.I.NO

NOILVGNAOi SHOIdaLN

133*,LS HIOIE ISVH

Ma.INS 0 3NVO GaaN31XS Had

ONI

SNIJIGEW dO 3937700 NI31SNIE LHES

SAS HilH

-066 UUO3 JOI SUO!1'n#Sul 041 eas '03!10N PV uo!;3npehl )1Johuaded

d9'L-9I A

rni'1Id SOH

iNSHVd SAS

ONI

ONI

' XNONS

ELGEBSI-LD
I 9 DOT AN

95060EE-LD

' XNOMS

'3973 HDOH MIN

-IVJId SOH NONHSA

-nfiIdSOH 3713HOOM MaN 3-HOIdaLNO

Ce)

uoileziuefuo pajelaJ JO N13 pue 'SS@Jppe 'alueN

exj-xel peleleki Jo uoile 0!J

MEDICAL CENTER

Department of e T asury
Internal Revenu Se

SCHEDULE R

(c)

Legal domicile (state
or foreign country)

(b)

Primary activity

13-1740114

Total~come

Related Organizations and Unrelated Partnerships

I Complete if the organization answered "Yes" on Form 990, Part IV, line 33,34,350,36, or 37

~ Attach to Form 990.

I nformation about Schedule R ( Form 990 ) and its instructions is at wvm.irs.gov/form990

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

Name, address, and EIN (if applicable) of disregarded entity

E

E) (D IOS
7OOHOS GEW

L 9 DOI AN

'3773 HJOM MaN

GE*009I LD
TOBOT AN

'NONHaA

8886162-9D
OSSOI AN

AN

8E69I6Z-9D
TOBOT

956IE67.-9D

0

I*I EDVd

/N II HdAQ SZ
E)(O ZOS
aAILOVNI

SWOH SNISHQN

E)(0 IOS

N

E(0 IOS

TriIdSOH

ANA!1oe AJewud

E(J)IOS

(3)

Anunoo u619,0 0
ejels) aip!wop le69-1

'IYLIdSOH

(p)

uonoes epoo :dwex3

E(J)IOS

((C)(O) 109 uoiloas 11)

Ce)

sniels A,uello o!.Iqnd

01[:lu)

H.1,9

ONOWO

m

W

O :dulaxa-xel palelai aJolll J

MONTEFIORE MEDICAL CENTER

r assets

D ec

OMB No

ontrolling
545-0047

Employer identification number

13 1740114

ON
BulllOJ}l,03 paJIC]

9LOE (066 uuod) Y elnpaLloS

C

U103 SUO!;ez!ueSJO

6

Je~~e} alli Suunp suoliezi

928 i

=(1;

m

<

E
EP

m

X
XES

peq p @sneoaq ,£ eu 'Al yed '066 liliod UO seA peJeA,~Sue uo wz!ue6Jo ell} J! e

o

am

m

2

-Ns<
LL
f

-N.*M-:

go

E./.../.i./

O,

E

* C

C/)

E

SEE*i

S.FE

C

I

2 4

C)

50

..= 0

C

x
0C

 HDEREMaN

000'l Zoel 39

DITO 9E0090

9

~IVL Id SOH 99-VMNMOD 5,31 07 15 Z

133RI%S SIOEIna OL

066 uuod Joi suo!;onnsul 041 aas '03!JON JOV uo!;3npaki 11Jokladed Jo 3
rgeD-OSSET AN

DSOO*ET-DI

anNaA,f NOaNOHVWVW SBL

anNaAV aNV~IGIW H.LHON 09I

~

Z

E

~

NOILMaNDOA 771IdSOH NOVAN ~

EAV SIAVa 9 CTVON LSOd iSV'a ID

NOI,L~GROOd 'IV.LIdSOH SNIVId 31,IHM

.I.33HIS H.LOIZ ,LSVE III

'CO DNISnOH Ad¥LS *003¥

>nnfd SIZI-HOW OOET

ONI 'SNOLLVMEdO 0230 31[OLZE,I,NOW

ONI

aVOM iSOd 1993 ID

MS.I.Nal 'IVOIDXW 7V.I,Id SOH SNI%Mid aLIHM

(a)

Name, address, and EIN if applicable of disregarded entity

(b)

Primary activity

End-of- y~ar assets

Direc

OMB No

Ilin

545-0047

dentification number

13 1740114
Employe

13-1740114

Tota ncome

Organizations and Unrelated Partnerships

I Complete if the organization answered "Yes" on Form 990, Part IV, line 33, 34,35b, 36, or 37
h Attach to Form 990.
Form 990 ) and its instructions is at www.irs.gov/form990
(
R
Schedule
I nformation about

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

su
[ne~IdaReent of th Trea

SCHEDULE R
MONTEFIORE MEDICAL CENTER

MONTEFIORE MEDICAL CENTER

.D.~"

'nfiIdSOH

19'L-9 I A

O ZOS

NOVAN

dSOH EVHEN DiHne NOSHE.I.SVW aSHAINIM aHL

5090I AN 'SNIVId aLIHM

LE66ELI-ET
0960I AN

'XNOMS

'XNOMS

'SNIVId EJ.IHM

DOBSDZE EI
1090T AN

LOSIBEE-ET
~9 DOI AN

9OSESBD LD
I9401 AN

OZ9SLOL-EZ
T090I AN 'SNIVId 31,IHM

OCIODLI-EI

uo!}eziuefuo pajelaJ jo NI3 pue 'ss@Jppe 'aweN

C

ZDZ EDVd

E

(q)

8

9LOE (066 luiod) M alnpa435

SHW

dSOH EVHSH

DNI SIVHGNfIA

O IOS

AN

DNISIVHaNRE

E
O ZOS

AN

E
E

0 IOS
HEILNECO EVHTI2I

SHW

E
AN

dSOH *OVAN
I 36A1 VZ I

O IOS
AN

OWHdM

E

0 ZOS

DNISAOH adVIS

7
O IOS

Co)

a}els) el!0!wop le691

(haunloo US!@JO; JO

uo!pes epoo :dulax)

AJM!;Oe Ajeutud

rniLIdSOH

E

C 0 09 uo Das

E

Al ua

(a)
C=-

snims A1ue40 0!Iqnd

2

25

U

Bu!110nUOO ;0@J!0

..0

m

6
IL

X
O

M

a-(0

E
S

o Jdwaxa-xe} paleleJ aJOUI J

Ee

10 d ex3-xel Pelela~lio u0!leo 41 uapi

ezi e

0

LA-

mv

U
C

8

Z

sue uo!;eziueSJo alll J'Jajee61d~Joo.suo

SA

E

(D

XXX

9

N

M

.

6

.!1 0

>4

0

X

n

E

SS

C

I

2/

.e i

0

:

·~ J

f

m

X
X

S
04 :

*c

I

c.

 AN

ISBD-OSSEI AN

E9Z9ZOE-ZE

/58/-OSSEI AN

56659EI-DI

ISB,-OSSET AN

999*9EI-DI

ISeD-Ogger AN

d9'L-9 I A

GEIDV HOEI TIWOH
DNIAIT ZSSV

DNISIVHGNAd
dWOO DNIG7OH

9DLOZOZ-LE
ISBE-OSSZZ AN

BEL9ZSZ-SD

HDEflaMaN

HDanaMEN

-

C

HDRinaMSN

ONI

Od

000-K LOC&39

DITO 720090

E

133HLS SIOEW

SWOH Naa'IOH HVZ[VS aNY

133MIS SIOEn

3WOH SENHOr e AMVW aNV

zf

Dd

rn/JIGEW FLSIA

133*15 SIO

'SaDIANaS NVIOISAHd VLSIA

' WE,LSAS H,InVEIH TIV

133H1S SIO

NOI,LVaNROd SAS H.L'ni3H 'InfMNHOO S,

HDMOEMEN

Z

uoilezlueSJO patelai ;0 NI 3 pue 'sseppe 'alueN

HDZ[naM)N

ISBD-OSSET ANH DanaM) N

I97.97.OE-ZZ

F

(b)

Primary activity

I Attach to Form 990.

Tota ncome

End-of-year a ssets

Yes

No
Direct controlling

13 1740114
Employer identification numbe

13-1740114

cile (state

~ Complete if the organization answered "Yes" on Form 990, Part IV, line 33, 34,35b, 36, or 37

Related Organizations and Unrelated Partnerships
MONTEFIORE MEDICAL CENTER

MONTEFIORE MEDICAL CENTER

Internal Revenue Service
Name o he organization

SCHEDULE R

I nformation about Schedule R ( Form 990 ) and its instructions is at www.irs.gov/form990.

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

Name, address, and EIN (if applicable) of disregarded entity

O ZOS

0 IOS
AN

HNVOHjrnfaH
3HVOH%,nrEH

(q)

A,0439 AjeuJud

5

o :dwexe-xe} pa

i.~m

E

J IOS

0 IOS

E

0 IOS

E

E

O ZOS

(3)

elels) @1!3!Utop leS@-1

E
1 Idwoo suonez!ue

n

EDZ :EIDVd

SH075

E

uo!gas epoo idwe)(3

2

Jee~A Xe} 0416Uunp SUO

112

E9

9LOZ (066 w.103) M alnpallos

OI

SHOTS
I SdAL VZI

SHD75

SHW

I adAl VET

ad

H075
I adAL VEI

Z

Ce)

c)(0 09 uo oas
0

snieis Aluello 0!lqnd

Al ua
C

C

-NMIWIK~~

-N

0

C
(0

-Eb-

5%

BulliOJJU00 PaJ!0

U)

48

>4

6
UeSJO 04} J'

9-

H075

uot;Oes

B

2

8

2

8000,0,0%280

!5

6
8

CM

.2 2

C

Z

C

0

E
0

v
2:

R

m

3£

g
E
6
LL

CS

=2

E

(D
n

00B

E0

=3

C

Ul

X

g

mEr

X

8

O.N
-C
am

X

C

X

X
X
OMB No 1545-0047

.

im O

f

C

 ,9#Or AN

ONI

tIIO 910090

000 & 80£K 3

XNOVe 133MLS HiOIZ LSVS III

XNOMB 13

gS HLOTE ISVE Irr

ANVdWOO %1NVanSNI EMOIda.I.NOW

Sakin.LNEA

L 9*01 AN
ONI

related organization

country)

(state or
Legal
domicile
Direct c ntrolling

s
Share of end-01-

year assets

Share of tota

ncome

Yes No
m.,

Code V-UBI
amo nt in box O
o Schedule K-

Yes No
General or
ng
ma
pa

ship Com plete if the organization answered "Yes" on Form 990, Part IV, ne 34

d organizations t~atedasa partnership during the tax y

ry activity

L-9 I A

D6S9CD0-ZE

GESBELI-I9

3797.I.NnODOW XNOMS

'XNOMS 133MIS HI

133WLS HLOTZ LSV3 ITI

NVO WVNOIAVH38 MIRIOIia.I.NOW

YdI XHOMLEN a

L9#OI AN
ONI

AN

Name, address, and EIN of

d9

aAILOVNI

ANVdWOD SWIG"IOH

Taxable

AN

AN

ILS6890-OE

rg

V N

OWW

JOSSY MAOEd 931-NI

LgDOI

XNOMS 13(SH.LS H.LOTE 1593

I ON FdI
69D0I AN

OH ID OWW

LSSM SONIa7OH

SONI

1593 TIT

Vd I SHOIdS.I.NOW EH,L

fication of Related

dHOO O

dHOO 0

AN

ONI

ONI

XNOMS

"ONI

XNONS

because it had one or mo
13-1740114

Percenta

ownership

WXXXXX

L

&

g

,

Z

&

Schedule R (Form 990) 2016

EOO E

VN

OSLESGE-CI

STOOIST-EL
£9 DOT AN

£9#OI AN

uollezlue&10 patelal JO NI 3 pue 'ssaippe 'auueN

MONTEFIORE MEDICAL CENTER

I

0

DDI EDVd

Leg

dMOD D

DOSSV EAOad DaiNI

ANVdWOO DRICI'IOH

AN

AN

VN

V N

[10019I-EL

86RID-E/

E

d300 0

dMOO O

ANVdWOO SNICICIOH

w IJ d

JOSSV HAOId 931.NI

AN

AN

V N

VN

018!Uto

(Aujunoj
us!@Jol

3 i&

H

6300 J

41 lue
6Uliloilu00 13,110

0

E-4

--

dHOD D

(s 'dioo o)

•00-

E

Ig

018

C
(D
>

:~:

52

awoou!

-U)

0000-00I

E
b

X

slasse Je@A-Jo-pue

C>

0

pN,le

d!45.le UMo

C)

X

9:02 (066 wiod) H elnpalloS

(e )( )

CS

Z

00

1

04-Gu#

2
02

umaJOJ

C~

2

@2

U

C
LL

ejoilo aJeVS

CO

(1)

C
6-

LL

O
E
0

a-(0

t
t

0
0

 dN00 0

d300 3

V N

V N

V N

AN

AN

AN

AN

DNISAOH

AMES 32IVOHI.793H

ANES 3-HVOH.I.mfaH

aAIXOVNI

/090/ AN

IOSOI AN

92949IE-SD

DOSTEOZ-94

£49IEEE-Er

ES'L-9I A

dMOO D

V N

BLEZZEE-92

Te DDEOD-Er

DITO 920090

YdI X37TYA NOSCAH

~

Z

£

,

9

9

Z

000 L 80£1

dHOO anNEAV SIAVD

SNIVId 3.LIHM GYON I,SOd JSV) 17 anNaA,f SIAVa

SNIVId 31IHM a,YOM LSOd LSVEI I I

AN ,io 53/IAH35 790Ia,W GO078 aNY waiNVD

I090I AN

SNIVEId 31IHM GVOW LSOd LSVE ID

Od AASS JILSONDVIa rr~JIG3W SNIV-Id EXIHM

T090I AN

'nOIGEW aN,nHDIH

SNOIMAONNI SMOIKE.I.NOW

JNI

XNOMS 1331115 H.LOI Z .LSVS III

ONI

XNOMS 133-2115 H.LOI Z ISVS III

Od

VOYAN aNV'IDIW HINON 09T

-dMOD I.NaWdOQEA30 MaIAONO'I 8

SNIV7d ELIHM CIVOW ,LSOd I,SYS LV anNEAV SLAVa

AN

0960 I AN

L 9*OI

L 9 DO I AN

related organization

Name, address, and EIN of

foreign
country)

(state or
domicile
Legal

,lated organizatio

sections
income
Share of tota

S

assets

13-17.40114

e if the organization answered Yes' on Form 990, Part IV, ne 34

ted as a partnership u ring the tax year.

Direct c ntrolling

r

fication of Related Organizations Taxabl~ase~ Partnership Com p

bec use it had one or m

5

0r690TS-LD

LBOBLGE-BE

Schedule R (Form 990) 2016

SDI 30Vd

dHOO J

USIaJO; 30 elels

0-

AMES 339/HirniSH

3AILOVNI

AN

AN

V N

V N

37\IIOVNI

dMOO J

dHOO D

AN

4!;U@

Ce)

uo enueSJO pae@JPN13 pue sswppe alueN

V N

0 '800 S 'dioo O)

(q)

A#Alioe Aleut!Jd

dHOO O

awoout

(A,junoo

slasse Je@A-10-pua

a

Jau,Ao

el!0!U,Op 10601

(p)

4'-9/

Bu!110J}UOO PH!0

JeeA xel 04: Sulmp }SnA Jo UoqeJOdiOO e se pejeeJ; SuoileziueSJO pajeleJ eJOw JO el,0 pell 31 esneo@q

9

E.0

Alqua Jo adAi

O

u a)

~E m s

r40; ;0 @JeVS

0

5

0

C

-0

Elj Z

A p@JaMSUe uo!}ezluef~Jo 04} 11 eleld woo 'isrul Jo uoneJod.loo e se elqexel suoneziue[3Jo pele'ekl Jo uolleo

0

Z
2

MONTEFIORE MEDICAL CENTER

ownership

(k)

Percentage

n.

2%

S

xXxxxXX

9&01 (066 UJJ03) 21 alnp@435

N

 dhOO D

V N

VN

AN

AN

ANES 3HVOHirIVEH

ANES SADHL'IVaH

I,Sna.L 31·13 H HVHD

NOILVMOdMOO H/95

HDMnEMaN 133MLS SIOEna OL

9

~

,

£

&

-' (0

DITO 920090

ISBD-OSEET AN

.Lsnal MaaNIVWS-a 3'IEV.LIknf}40

ecause it had one or mo

ss, and EIN of

organization

;Uapl

9

(5)

SNIVId aLIHM aVOH .I.SOd ISVJ .LV anNHAV SIAVa

SaDIAHES TOICaW SNIV-Id 31IHM

XNOMS LaSHIS HLOTE ISVEC III

SNIVId 3LIHM aVON ,LSOd 1533 I D

SSLVI JOSSV 'IVE[OIA,fHaa AlISMSIAINA

00 .I.NaW)DYNYW SNIV'Id ELIHM

SNIV'Id EXIHM ONON LSOd ISVE ID
ONI

u0!lezlueSJO pelelai JO NI3 pue ssaJppe 'auteN

I090I AN

1090T AN

DNI

EgDOI AN

SaDIANSS NVIDISAHd SNInd 31IHM

/090I AN

SNIV'Id 31.IHM aVOH .I.SOd .LSVE %3 anNSAY SIAVa

ID9TEEE-EI

ZE69L9[-ET

IBLLLBE-EI

ESI69ES-/8

I090I

SI960ES-Ze
AN

I9959LI-DI

39'L-9I A

.Snai

V N

AN

CO

country)

(state or
Legal

dom icite
Primary activity

Direct c ntrolling

tota
income

0

Share end-olyear assets

Yes No
.*m~-'

13-1740114

Taxa~~esal: Partnership Complete if the organization answered "Yes" on Form 990, Part IV, ine 34
ted as a partnership during the tax year.
ne

MONTEFIORE MEDICAL CENTER

tification of Related

Schedule R (Fonn 990) 2016

9/I aDVd

9t01 (066 Uuod) ki elnpalloS

dHOO O

V N

RALLOVNI

dMOO O

HAIIDMNI

aAILOYNI

AHES INEWEDYNVW

AN

AN

AN

M N

V N

F N

daOD J

dBOO J

/

§

N

Z¤

dHOO D

5

E

E

AUA!}De AJew!Jet

52

.= 0

SU!110Jwoo pa a

mv

EW

5 -/1

O.E

@Wooul

.N 2

C

mo},0 @Je49

-0 0 -

diqsfau/~o siesse JeaA-p-pue
VS
amuewed

2O

C >,

~5 ~5 i

iueSJo pejeleJ ejow Jo euo pell 1! esne
le66J ne~J~an;1~%TZ'~t;E.'2~f~*~17°'jez
O e se elqexel suo!}ez!ue[}JO pajelek, Jo u O

6 22

¢0

m

31

Elig .

9
0

6 LUJo=1 uo &@A, paJaMsue

6-

S

&2 C~

g

u6!aJOJ

E 5,

:
m

m

es No

XXXXXXX

ownership

.0.
page 2

gi

 or IV of this schedule
Note: Complete line 1 if any entity is
of the following ransactions with one or more related organizations sted in Parts
any
in
engage
on
1 During the tax year, did the organizat
a Receipt of (i) interest, (ii) annuities, (iii) royalties, or (iv) rent from a controlled en y

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

Yes No

ixx

32823!  :pf=#  5=852 1-- 14:35
E
0

S Uolleziue 10 pa}elaJ UIOJ;

Ua 01

Jo 45eo JO Joisue. 1 Jel]10

LSOO
LSOD

LSOO
LSOO

ZSOO

94* *DS IDZ

665 8/5 D

6II LIO S
SIS I9
00# SLI
668 59Z I

,-1
4
4
4

ON dHOO TWILNEGISEM JWW

HEgNED ENVO AMOLV7QRWY HIHON EMOIdELNOW

I

INW 77IHNOD

W

H

E9'L-9 I A

ONI

DNI

O.d

ON Vd I ENVO rnrHOIAVHES EMOIdELNOW

M

II NOILDES DNISAOH TrgIdSOH EMOIda,LNOW

I

N

DNI

ONI

&
ONI

¥dI HHOIda.LNOW HHi

uoileziueSJo pajele o OWEN

(e)

s

s)uoqeziueSJO pajeleJ 01 AUadoid Jo 4seo Jo JaisueJ} Jell}0 1

Aoo Sulpnlou eu s!41 0}aidwoo 15nul 04M uo uoljewloiul Joi suolioni }sul eq} eas „'$0A„ sl eAoqe e41 Jo Aue oj JaMsue allj J

1500

d

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

sesued)(a Joi (S)uoilezilleSJO pejelei o} pied jueulasinqu,!eki

sesuedxe Joi (s)uoilezlueSJo pejelai Aq pied juawasinquliehl b

Z

k Lease of facilities, equipmen or other assets from related organization(s
Performance of services or membership or fundraising so citations for related organization(s
m Performance of services or membership or fundraising so citations by related organization(s)
n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s

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

'(s)uotieziueSJo pe}elaJ 41!M Slesse Jo 06ueLIOXE]

Dividends from related organization(s
Sale of assets to related organization(s
Purchase of assets from related organization(s).

c Gift, grant, or capital contribution from related organization(s) . . .
d Loans or oan guarantees to or for related organization(s
e Loans or oan guarantees by related organization(s

g
paAIOAU! lu nOUIV

V?

Transactions With Related Organizations. Com plete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36.

page 3

ixx

9t02 (066 luiod) M @inpalloS

~

Schedule R (Form 990) 2016

13-1740114

ixxx

-1

DITO 920090

000'L 60£L39

~

LDI EDVd

MONTEFIORE MEDICAL CENTER

X
XX7
paAZOAUI ;UnOWe

C

XX
X7XXXXX-1
6u!.u!.uualap Jo POVBIN

.

X

 J

a
b
c
d
e

Lease of fac ties, equipment, or other assets from related organization(s
Performance of services or membership or fundraising solicitations for related organization(s
Pe ormance of se Ices r membe ship or undraising solicitations by related organization(s)

Dividends from related organization(s
Sale of assets to related organization(s
Purchase of assets from related organization(s). . .
Exchange of assets with related organization(s). . .
Lease of facilities, equipment, or other assets to re ated organization(s

~~ng lists or other assets with related organization(s) . .
Sharing of facilities equipme
d organization(s) //....
~
w~h
employees
paid
of
Sharing

V?

0DB ZID
d9'L-9 I A

I

ON

dHOD 'IVILNEGISEM OWW
ONI

I

ON

DTIO 97.0090

000'& 60CL39

dHOO TYI,LNEGISHH OWW

INW 77IHNOD

NOI%YHOdMOO NOIIVANESENd nqOHSOW

ONI

II NOILDES DNISAOH TVIIdSOH HHOIdE.INOW

NOILYHOdHOD OWW

Z

1

During the tax year, did the organization engage in any of the following transactions with one or more re ated organizations sted in Parts
Receipt of (i) interest, (ii) annuities, (iii) royalties, or (iv) rent from a controlled en y
Gift, grant, or capital contribution to related organization(s
Gift, grant, or capital contribution from related organization(s
Loans or loan guarantees to or for related organization(s
Loans or loan guarantees by related organization(s) . .

or IV of this schedule

LSOD

EGL

ONI

uoqeziueajo paleta o aweN

(e)

s

J

b

NO(DS

page 3

Yes No

8 DZ EDVd

Note: Complete line 1 if any entity is listed in Parts

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

LSOD

9EI 285
EGI

I.D.~N

ISOO

000 68* 2

JO 4seo JO Jaisue.4 JaWO

514; ejeldwoo }Snlu 04AA UO Uoile U,IJOiu! Joi SUO!}On.nSU! 041 eas „'sek, sl eAOqe ell JO Aue 0} JeAASUe 041 4

ue 03

U

9&02 (066 u,JOJ) 11 elnpallos

QSOD

565

Z

ISOJ

000 059 L
OII

LSOO

paAiOAU! Junolliv

eu

S Uollezille JO pejelai UIOJJ

(s)uo!}eziueSJO pajel@J oj Avadoid JO 4SeO 10 Jaisue.4 Jall}0

sesuacke Joi (5)uollezilleSJO pelelei Aq p!.ed luewasinquliehl

sesuacke joi (s)uoijeziueESJo pajelei o; pled juewesinqlulati d

*-Ego

i
UnOLUe

d ilsuoile aJ peJeAOO 6U pn OU

t

sploilsailll uolloesueJ pue

0

42
paAFAU

Schedule R (Form 990) 2016

13-1740114

/#562/-p
Sulu!Uual@P JO PoltaIN

MONTEFIORE MEDICAL CENTER

22232

44000

 1500

LSOO
ISOJ

566 LID
LSB L9*

DEO 565 8
OOZ ZIB II

o Sharing of paid employees with related o ga

iSOO

68E LIS 9

k Lease of fac es equipmen or other assets from re ated organization(s
Performance of services or membership or fundraising solicitations for related organization(s
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

1SOO

Dividends from related organization(s ..///..
Sale of assets to related organization(s) . . . . ...
Purchase of assets from related organization(s). . .
Exchange of assets with related organization(s). . ,
Lease of facilities, equipment, or other assets to re ated organization(s

C

ONI

ONI

ONI

1SVE SDNIaqOH ID OWW

ISHM SDNIG7OH ID OWW

DITO 920090

0004 60£139

Vd I NHOMZEN EHYD 37/ViNROJOY XNOMB

531VIDOSS* rnYMOIAVHEIEI A1ISECE<AINA

ONI

M3,LNHO EINVO AHOIVEIREWY HLHON 3HOILIa,INOW

&

NMYMM J

i9'L-9 I A

ONI

II NOI%OSS DNISnOH InriIdSOH aMOIdaLNOW

J

s

N
ONI

Aue 01 JaMSUe 84 JI

Jo 4Ses JO JaiSLIeil Jal.110

SeA Sl eAOqe 04} J

Ve OJ

0

uogeziueSJo pejela o auleN

5141 ejeldwoo Jsnul 04AA UO UOileu,Joiul Joi suo!:onJ }Sul all ees

' ' 'S Uoilezille JO pajeleJ UJOJJ

s)uoilez!ueffo pejeleJ 01 Apedo.Id JO 4seo Jo Jeisue.4 Jell:0

sesuecb~a Joi (s)uolieziueSJo pejelai Aq pled luewasinqwiehl b

'sasuadxe Joi ( s)uojeziue[3Jo pejele~ oj pled juewesinqullehl d

C

S

8D8 E88

9

g

1-Il

LSOJ

d Loans or oan guarantees to or for related organization(s
e Loans or loan guarantees by related organization(s) , ,

la

1..........

pAU ;UnOUIV

eu

roya es or v ren from a controlled en ty
annu es
of (i) interest
grant, or capital contribution to re ated organization(s
, grant, or capital contribu on from related organ,zation(s

V?

C

0 loesueil p e sdILISUOIlelai p@JeAOO 6UlpnIOU

or IV of this schedule
Note: Complete line 1 if any entity is listed in Parts
of the following transactions with one or more re ated organizations sted in Parts
any
in
1 Durin he tax year, did the organiza on engage

Transactions With Related Organizations. Com plete if the organization answered "Yes" on Form 990, Part IV, line 34,35b, or 36.

=-

page 3

9:02 (066 Utiod) 21 ainpa435

Cm'l

,-

6#I 30Vd

Schedule R (Form 990) 2016

i
lil
119-Eco 1
paAIOAU! lu nowe

13-1740114

MUPM

splolls@ 41

MONTEFIORE MEDICAL CENTER

0-

Buiuiuualap Jo Poll'0'~ 

Z

001010010

 V?

QSOD
ISOO

EES

995 LIO I
EEL

D89 Z

0
4
4
A

*89 L

1500

C

965 /09 9

c

iSOO

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

c

885 7.7.Z

2

1500

n Sharing of facilities, equipmen mailing lists, or other assets with related organization(s
o Sharing of paid employees with related organization(s) //....

0

118 095 9T

2

10 4Seo JO JeJSUe.1 1 30410

ONI

HEuNaD ENVO GSaNSZXE HEAJYHOS

J

s

9

P

£

Z

&

to J

DIIO 77.0090

0004 60£139

SNOIZYHEIdO 023IEIJ 3HOIECEILNOW

TigIdSOH NONHEA LNROW EHOIdaiNOW

ONI

milIdSOH a~~HHOOM MEN EMOIdaZNOW

Vd I XHOMiEN 3213 37/ViNOODDY XNOMS

HELNED ENVO AMOLVIASWY HIHON HHOIESINOW
d9'L-9 I A

ONI

UoileziueSJo pawl@J Jo awe N

M UO UOIJBUIJOJU JOJ SUOIJOIU}SUI 041 aaS „'SaA„ S! 0Aoqe all} Jo Aue 01 JaMSUB 841 JI

pa 01

(s)uoi:eziueSJO pejelm 01 Auadoid JO 4seo Jo Jeisue.11 Jell}0
'S uoilezille 10 paleleJ UIOJJ

' ' '

d

sesuedxe ioi (s)uolleziueSJo peleleJ Aq pied ualuesJnqulleH b

'Sesuadxe Joi (5)uoileziueSJO pejeleJ o} pied uewasinqwieh'

Z

1 ~r~oermaracce ofsen~cu~smo~~~eo~~ershiapsoretfunrdor~ismgtes~l~al~~sifonrrelated organizationis

C

ISOD

Dividends from related organization(s
Sale of assets to related organization(s
Purchase of assets from related organization(s)
Exchange of assets with related organization(s
Lease of fac es equipment, or other assets to related organization(s

or IV of this schedule
Note Comp e e line 1 if any entity is listed in Parts
of the following transactions with one or more related organizations sted in Parts
any
1 During the tax year, did the organization engage in
a Receipt of (i) interest, (ii) annuities, (iii) royalties, or (iv) rent from a contro ed entity
b Gift, grant, or capital contribution to related organization(s) .
c Gift, grant, or capital contribution from related organization(s
d Loans or oan guarantees to or for related organization(s
e Loans or oan guarantees by related organization(s) . .

Transactions With Related Organizations. Com plete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36.

EC

paAimui junowy

E

No

page 3

9t02 (066 u,Jod) 21 @inpatps

i.i.~N

g

OSI aDVd

Schedule R (Form 990) 2016

5

p@ApAW lu noule

13-1740114

:235
6uiu!U.LI@lap 10 po41~K

MONTEFIORE MEDICAL CENTER

i-Ego

E

8

E

 annu es
Receipt of (i) interest
Gift, grant, or capita contribution to rel
Gift, grant, or capita contribution from
Loans or oan guarantees o or for relat
Loans or loan guarantees by related organizatio

roya es or v ren from a controlled en y

Dividends from related organization(s......
Sale of ass

2E

m=

O. W.J

J

(D

(D

Xi

&9

-1

facilities, equipment, or other assets from related organization(s

erformance of services or membership or fundraising solicitations by related organization(s
facilities, equipment, mailing lists, or other assets with related organization(s) , .
of paid employees with related organization(s) ..../.../

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

%6

0-Z
elutoiu! Jo; SuoipnJ}SU! 04} aas

s uolieziue

U104

0 01

30 4seo JO Ja#Slleil Jall}0

0

c

-

U)

E

V?

1503
609 LL9 ZI

ONI

ONI

WaiSAS HM'nraH HHOIdEQNOW

WELSAS HLTVEH SHOIdELNOW

d9'L-9 I A

9

P

E

Z

&

DITO 710090

000'& 60£ & 39

. 5

ISI EDVd

WaiSAS HiTYEH OIWEaVOY ENIJIGEW SHOIES.I.NOW

HaLNED TVOIGEW 'nriIdSOH SNIVId EMIHM

'nflIdSOH NONHEA ZNROW EHOIdELNOW

TVQIdSOH 3773HDOM MEN EHOIdELNOW

EL9 6Z6 S

0

1SOD

C

SLE BES SZ

0

LSOO

E

OOL Z65 GE

8

iSOO

Dom

89L SES

E

LSOO

c

E9D E8E

8

LSOO

uoyeziuedio pa~ele o aweN

5

oj Aue(joid Jo liseo Jo Jaisuen Je410 J

aW„ sl @Aoqe 841 Jo Aue 0, Je/Asue 841 J

I

sesued)(a Joi (s)uoileziueSJo pejelei Aq pied jualuesinqwieti b

#f

0)

Z

0- U) U)

4_Ego

d

o

'Sesueace Joi (5)uoileziueSJO pelelai o} pied lueulasinquilehl

O.C

c a ge~ assets wi re
ties equipment, or other assets to related organization(s

:28

page 3

=
9t02 (066 U1103) ki elnpell:)5

.

oi}eziueES op

1

During the tax year, did the organization engage in any of the fo owing transactions with one or more related organizations sted in Parts

or IV of this schedule

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

E.D.~N

Schedule R (Form 990) 2016

13-1740114

C

paAI~~ ;UnOLUv

0)

EC.

a),cppr powal'11

U>

3 7
0Aul Junowe

16 2.0
2#&16.

7
sploqsailll uot}Oesuen pue

lili

7
u

MONTEFIORE MEDICAL CENTER

Z

 ISOO
1SOD

LSOO

000 BID
LSD ODD D

LEI 96E 6
9I0 06Z 9

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

LSOD

pa OJ

JO 45€0 JO JaiSLIeil Je410

(s)uoilezluef)Jo paleleJ o} 4'adoid Jo 4SeO JO Jeisue.,1 JeWO
s uoilezlue JO pajele WOJJ

29'L-9I

ONI
ONI
DNI
ONI

ONI

WHiSAS HQUVEH EMOIAHSNOW

W31SAS HZ'-IMSH SHOIdE,LNOW

WHiSAS HinfaH HHOIdELNOW

WEQSAS HirnrEH HHOIdE,I.NOW

WELSAS HMTYEH EHOIdaLNOW

WELSAS HirnfEH EMOIda,INOW

9

to

P

E

Z

&

ONI

uoqeziue6Jo pa:ela O alueN

(e)

s

J

b

sasuacke Joi (s)uoileziueSJo pejelej 01 pled Jualuesjnquliahl d

Sesued)(e Joi (S)uoijezilleSJO pajelei Aq pied juewesinquliabl

s!41 eleldwoo :snu, 04'V~ UO UOI}eLUJO;U JO; SU0110nJ}SU! 041 eas „'seA„ sl eAoqe 941 Jo Aue 01 JeAASUe 94 1 J

"

Z

k Lease of fac es, equipment, or other assets from related organization(s),..
Perf rmance of se Ices r memb rship r und aising solicit ions fo related organization(s
m Performance of services or membership or fundrais ing s o licit a tions b related organization(s)

1.-/I

SBS 9EE ZII

Dividends from related organization(s
Sale of assets to related organization(s
Purchase of assets from related organization(s). . .
Exchange of assets with related organization(s). . .
Lease of facilities, equipment, or other assets to re ated organization(s

V?

I.

iSOO

0

I.

IZ8 08I L

0

1

LSOO

(1)

I.

(s-e) adA:

0

Il

uotpesueJl

(0

.-

papul JunOW¥

eu

Note Comp e e line 1 if any entity is listed in Parts 11,111, or IV of this schedule
During the ax year, did the organizat on engage in any of the following transactions with one or more related organizations sted in Parts
1
a Receipt of i) interest, (ii) annuities, (iii) royalties, or (iv) rent from a controlled en y
b Gift, grant or capital contribution to related organization(s)...,........
c Gift, grant or capital contribution from related organization(s
d Loans or loan guarantees to or for related organization(s
e Loans or loan guarantees by related organization(s) . .

Transactions With Related Organizations. Com plete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36.

-

22=

page 3

9101 (066 UIJo:1) H elrIP@435

!~1~1

Schedule R (Form 990) 2016

13-1740114

1.-

splollsmll Uotioesuen pue SdillsUOI}eleJ peJeAOO 6U!pnlou

7
71
Illi~
ESI SDVd

MONTEFIORE MEDICAL CENTER

7
al

»ac,9

DTIO 9Z0090

000'L 60CL 39

<
0

 ...

es equipment, or other assets from related organization(s

es, equipment, or other assets to related organization(s).

rmance of services or membership or fundraising solicitations for related organization(s
ormance of services or membership or fundraising solicitations by related organization(s)
ailing lists, or other assets with related organization(s
ing of fac
ing of paid employees with ated organization(s

k Lease of fac

Lease of fac

rchase of assets from related organization(s)
hange of assets with related organization(s

Sale of assets to related organization( S).

ESI 39Vd

idends from related organization(s.,..

82# L69 ZE

d Loans or oan guarantees to or for related organization(s
e Loans or oan guarantees by related organization(s

LSOO

page 3

9KOZ (066 UIJO:1) 21 alnpallos

E66

9

iSOD

96D ESS D
8LL

QSOD

(e)
ONI
ONI

aNIOIGEW dO 3939900 NIELSNIE iHEarnt'

EINIOIGEIW 10 39£q~OD NI31SNIEI QUECEIYV

aNIJIGEIW dO EDEI77O3 NIEIXSNIEI QHECE<~V

d9'L-9I A

9

P

E

Z

i

0 5

DTIO 77.0090

900'L 60£L39

WELSAS H%TWSH JIWEDVOY ENIDIGEW SHOIAH,INOW

WHMSAS HQ'nraH DIWEGVJV ENIJIGEW HHOIKEINOW

aNIJIGEW d0 3937700 NIHQSNIS %Haarni

ONI

uogeziuemo pajela o auleN

Z

s

s! eAOCIe eln JO Aue 01 Jamsue 041 J

Ue OJ

Jo 4Seo JO Jaisue.1 Jal]10

Sillj eleldwoo }snul 04AA UO UolleU,Joiu! JOJ SUO!}onJ}SU! 041 eas „'

s uoileziue jo pajele

4

01 Avedo d Jo LISe JO Je S eJ} Jell}

d

-

"

sesuacke 101 (s)uoljeziueESJo paje e Aq p ed juawasJnqull

0

0

s)uoliezlueESJO pal

'sesuad)ca Joi (s)uoijeziueSJO pejeleJ o} pled jueulasinqlulaki

(D

C

=

ZEE 996 9I

Eco

...c.c

0

0

iSOD

0- 0- U) U)

6

OOZ 58

tr*M

p-

1SOJ

0- UJ

p-

99E 9SE 8

2

1
ISOJ

0

==Al:=55°-

paAFAU~vunOUJV

eu

b Gift, grant, or capital contribution to related organization(s
c Gift, grant, or capital contribution from related organization(s

V?

pl---

sploilseJLI} UolloesueJi pue Sd!4SUOIje eJ peJeAOO 6UlpnlOu

or IV of this schedule
Note Complete line 1 if any entity is listed in Parts
of the following ransactions with one or more related organizations sted in Parts
any
in
engage
on
1 During the tax year, did the organiza
royalties, or v rent from a controlled en y
annu es
a Receipt of (i) interest

Transagtions With Related Organizations. Complete if the organization answered "Yes" on Form 990, Part IV, line 34,35b, or 36.

1-

-1
paAIOAUI junotlle

Schedule R (Form 990) 2016

13-1740114

7
Buiullul@lap 10 po410'Al

MONTEFIORE MEDICAL CENTER

-7

mAo<

 Z

k Lease of fac ties equipment, or other assets from related organization(s
Performance of services or membership or fundraising solicitations for related organization(s
m Performance of services or membership or fundraising solicitations by related organization(s)
n Sharing of fac ties, equipmen mailing lists, or other assets with re ated organization(s
o Sharing of paid employees with related organization(s) ......,

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

ividends from related organization s
ale of assets to related organ ization(s)... .
urchase of assets from related organization(s

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

b Gift, grant, or capital contribution to related organization(s
c Gift, grant, or capital contribution from re ated organization(s

Note: Complete line 1 if any entity is sted in Parts

V?

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

13-1740114

or IV of this schedule
During the tax year, did the organizat on engage in any of the following transactions with one or more re ated organizations sted in Parts
1
roya es or v ren from a controlled en y
annu es
a Receipt of (i) interes

!~ 1~1

69'L-9I A

DITO 720090

0004 60£l 39

EINIJIG;EIW LIO GIDEI~TOO NIEIZSNIEC 12(ECEI7V

s

J

r=f960(05

DSI EDVd

page 3

9:01 (066 Ul,03) 11 elnpe439

ONI

88£ SE

66I

LSOO

ENIJIGHW 10 3939903 NISLSNIE LHESTV

ANVdWOD DNISAOH diVIS WOJEY
DNI

DNI

10 4Seo JO Jaisue.4 *410

OEZ LIO I

MSOD

(e)

ue OJ

SBA SI BAOqe all}JO Aue 01 JeAASue 041 Jl

uoileziuealo pejela o aule N

as

S uoilezille 10 pajel@J LUO.4

s)uoijezueESJo pejelai ol AUadold Jo 4SeO JO Jeislle.4 JeWO

sesuecb(a Joi (s)uoileziuef}Jo pejelei Aq p!ed juewasinqwiehl b
'sesuacke Joi (s)uoijeziueSJo pejelaJ oi pled juewesjnqullek, d

aNIDIGEW dO 3939903 NIalSNIE ZHESrnf

D00 OOE Z

DE

ONI

ISOD

L90 *62

pAU! ;UnOUIV

LSOO

pMpAU! lunolue

0 0 0-

Bu!uillueleP Jo Po41@IN

Schedule R (Form 990) 2016

MONTEFIORE MEDICAL CENTER
.

splollseJilluoijoesue4 ped LISUO e eJ paJeAOO 6UlpnlOul eul Slill eleidwoo }snut OLIM UO UOileWJOJU Joi SUO 10nJ }SU all}

6~852 -- 42 i

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

13-1740114
page 4

country)

P ed~ninant

t~a

unrela

»E

sections 512-514)

E

E9'L-9 I A

000'LOLCL3

pM'OusN23$8~

DITO 720090

Name, address and EIN 01 entity

Yes

No

o ~Zs,
Yes

No

allocatior.7

Disproportiona

Yes

No

partner?

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

iMM

Schedule R (Form 990) 2016

MONTEFIORE MEDICAL CENTER

E

S S I EDVd

g

9:01 (066 uuod) M elnpe435

E53

 MONTEFIORE MEDICAL CENTER

13-1740114

Page 5

Schedule R (Form 990) 2016

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

Schedule R (Form 990) 2016
6E15102000

06002L 0114

V 16-7.6F

PAGE 156

 Form

Exempt Organization Business Income Tax Return
(and proxy tax under section 6033(e))

990-T

'20
, 2016, and ending
/form990t.
*AMw.irs.gov
at
available
Is
instructions
Its
and
-T
990
I Information about Form

For calendar year 2016 or other tax year beginning
Depanment of the Treasufy
internal Reinue Semce

Check

Name of organization (

MONTEFIORE MEDICAL CENTER

8 Exempt under section

Print

)

or

408(e) ~220(e) Type
408A

 

2@16
pen o u K nspectton or

(Employees' trust, see instructions)

address changed

X 501(C )(3

.

501 0 3 0 arlizations Onl
is a 501(c)(3)
i Do not enter SSN numbers on this form as it may be made public if our or anization
identification number
Employer
D
.)
instructions
see
and
changed
box if name

Check box tf

A

OMB No. 1545-0687

 530(a)

13-1740114

Number, street, and room or suite no. If a P.O. box. see instructions

Unrelated business activity codes

E

(See Instructions.)

111 EAST 210TH STREET
City or town, state or province, country, and ZIP or foreign postal code

529(a)

BRONX,

C Book value of all assets

at end of year

F

621990

NY 10467-2401

3212796276. G Check or anization t

h

X

Other trust
401 a trust
501 c trust
ES
h CARE MANAGEMENT & OTHER HEALTH RELATED SERVIC

501 c cor oration

H Describe the or anization's rimar unrelated business activi

.......
During the tax year, was the corporation a subsidiary in an affiliated group or a parent-subsidiary controlled group?

1

If "Yes," enter the name and identif in

1a

Telephone number h 914-34 9-8455
(B) Expenses
(A) Income

b

Unrelated Trade or Business Income
Gross receipts or sales
Less returns and allowances

c Balance 4

1c

2

2

3
4a

Gross profit Subtract line 2 from linelc
Capital gain net income (attach Schedule D)

3

b

4b

c

Capital loss deduction for trusts

4c

(C) Net

1,609,549.
-20.

1,609,549.

-20.

673,002.

ATCH 1

673,002.

12

24,493,148 .

ATCH 2

13

26,775,679.

24,493,148.
26,775,679.

5

5

6

Rent income (Schedule C)

6

7

Unrelated debt-financed income (Schedule E) .......

7

8

Inrerest, annuities. royalties, ane rents from controlled org 8nizations (Schecule F)

8

9

Investment income 01 a section 501(c)(7), (9), or (17) organization (Schedule G)

9

Exploited exempt activity income (Schedule I)
Advertising income (Schedule J)
Other income (See instructions; attach schedule)
Total. Combine lines 3 throu h 12 .............

10

13

No

1,609,549.

4a

Net gain (loss) (Form 4797. Pan ll, line 17) (attach Form 4797). .

Income (loss) from partnerships and S corporations (attach statement)

12

X

1,609,549.

Cost of goods sold (Schedule A, line 7) ...........

10
11

Yes

number of the arent cor oration. ~

J The books are in care of I EVAN RESNICK

'.

621500

Group exemption number (See instructions.) ~

11

(Except for contributions,
Deductions Not Taken Elsewhere (See instructions for limitations on deductions.)

deductions must be directl connected with the unrelated business income.

16

Compensation of officers, directors, and trustees (Schedule K)
Salaries and wages ...,,..,...,.......,,,....,.................,.
Repairs and maintenance

17

Bad debts

18

Interest (attach schedule)

19

Taxes and licenses

20

Charitable contributions (See instructions for limitation rules)
Depreciation (attach Form 4562)
Less depreciation claimed on Schedule A and elsewhere on return .......

14
15

21
22

22a

26
27
28
29

Total deductions. Add lines 14 through 28

24

25

30

line 29 from line 13
Unrelated business taxable income before net operating loss deduction. Subtract

31

Net operating loss deduction (limited to the amount on line 30)

32
33
34

line 30
Unrelated business taxable income before specific deduction. Subtract line 31 from
..
)
exceptions
for
instructions
33
Specific deduction (Generally 51,000, but see line
32,
line
than
greater
is
33
line
If
32.
line
from
33
line
Subtract
Unrelated business taxable income.

enter the smaller of zero or line 32

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

For Paperwork Reduction Act Notice, see Instructions.
6X2740 1

6%OO2LJS6114

18,779,520.
887,037.

19

...................
897,166.
21

Depletion
Contributions to deferred compensation plans
Employee benefit programs
. ., . ., . . . . . . . . . . .
Excess exempt expenses (Schedule l),... . ., . . . , ., . , . . . , .,
Excess readership costs (Schedule J)
Other deductions (attach schedule) .................... .ATTACHMENT. 3 .....

23

15

V 16-7.6F

20

22b

897,166.

24

5,773,269.
26

28

9,705,582.
36,042,574.

30

-9,266,895.

-9,266,895.
33

34

-9,266,895.
Form 990-T (2016)

 Form 990-T (2016)

page 2

13-1740114

MONTEFIORE MEDICAL CENTER

Tax Com utation
Organizations Taxable as Corporations.

35

See instructions for tax computation

Controlled group

members (sections 1561 and 1563) check here ~ ~ See Instructions and:
a Enter your share of the $50,000, $25,000, and $9,925,000 taxable income brackets (in that order):

(2) $

(1)1$

1

(3) $

$

b Enter organization's share of: (1) Additional 5% tax (notmorethan $11,750). ., , ,, ,
(2) Additional 3% tax (not more than $100,000)

c Income tax on the amount on line 34
36 Trusts Taxable at Trust Rates.

$

I 35c
See

instructions

the amount on line 34 from:  ~-~ Tax rate schedule or

for

tax

computation.

Income

tax

~ Schedule D (Form 1041)

on
i 36

i 37
Proxy tax. See instructions
Alternative minimum tax
Tax on Non-Compliant Facility Income. See instructions .............................39
Total. Add lines 37,38 and 39 to line 35c or 36, whichever applies ........................ 40

37
38
39

40

Tax and Pa ments
4 la

41 a Foreign tax credit (corporations attach Form 1118; trusts attach Form 1116). ....

b Other credits (see instructions) ........................... 4lb
c General business credit. Attach Form 3800 (see instructions) ............

41c

d Credit for prior year minimum tax (attach Form 8801 or 8827). .... ..... ..

4!d

41e

e Total credits. Add lines 4la through 4 ld

42
43
44

Subtract line 4 le from line 40

42

Other taxes Check if from: ~ Form 4255 ~ Form 8611 ~ Form 8697 L_1 Form 8866 LJother (attach schedule) .

43

Total tax. Add lines 42 and 43

44

0.

45 a Payments: A 2015 overpayment credited to 2016 ................. 45a
b 2016 estimated tax payments ........................... 45b
c Tax deposited with Form 8868...........................
d Foreign organizations: Tax paid or withheld at source (see instructions) .......

45c
4 Sd

e Backup withholding (see instructions) ....................... 45e
f Credit for small employer health insurance premiums (Attach Form 8941) ...... 451
~ Form 2439
g Other credits and payments:
Total I 45
~ Form 4136
Other

46

,...

46

Total payments. Add lines 45a through 45g

47

Estimated tax penalty (see instructions). Check if Form 2220 is attached..................i~47
Tax due. If line 46 is less than the total of lines 44 and 47, enter amount owed ................. , 48
~ 49
Overpayment If line 46 is larger than the total of lines 44 and 47, enter amount overpaid . . . . . . ......
Refunded $ 50
Enter the amount of line 49 you want: Credited to 2017 estimated tax ~

48
49
50

Statements Re ardin Certain Activities and Other Information see instructions
51

52

53

At any time during the 2016 calendar year. did the organization have an interest in or a signature or other authority
over a financial account (bank, securities, or other) in a foreign country? If YES, the organization may have to file
FinCEN Form 114, Report of Foreign Bank and Financial Accounts If YES, enter the name of the foreign country

Yes

No

here i

X

During the tax year, did the organization receive a distribution from, or was it the grantor of, or transferor to, a foreign trust?.... .
If YES, see instructions for other forms the organization may have to file
Enter the amount of tax-exem t interest received or accrued dunn the tax ear ~ $

X

Undef Penalties of perjury. I declare thet I have examined this return, induding accompanying schedules and statements. and to the best of my knowledge and belief. il 1/

true forrect, and complete. Declaration of preparer (other than taxpayer) is based on all in formalion of which preparer has any knowledge.

May the IRS discuss this return

~ EXEC V.P.
Signature or officer
PrinUType preparef's name

Paid

Pneparer
Use Only

6~*04 g. »'9+
NY 10036-6527

ith the preparer shown below
(see instructions)?

Title

Date

CHRISTOPHER B BOGGS
h ERNST & YOUNG U.S . LLP
Firm's name
Firm's address ~ 5 TIMES SQUARE, NEW YORK,

& C.F.0.

Date

11/11/17

Check

if

self-employed

No

Yes

PTIN

P00032493

Finn'sEIN I 34-65655 9 6
Phone no.

212-773-3000
Form 990-T (2016)

JSA
6X 2741 1 000

06002L 0114

V 16-7F

PAGE 3

 13-1740114

MONTEFIORE MEDICAL CENTER

page 3

Form 990 - T ( 2016 )

Schedule A - Cost of Goods Sold. Enter method of inventor valuation h
Inventory at beginning of year ,

1

Purchases
Cost of labor

2
3
4a

1

6

Inventory at end of year ,,, ~ ~ . ~ , ~

2
3

7

Cost of goods
6 from line 5

Enter

Parll, line 2.,..,

Additional section 263A costs

8

(attach schedule)

4a
b Other costs (attach schedule) . 4b
Total. Add lines 1 through 4b .

5

sold.

Do

the

property

rules

of

produced

7

.

..

section

or

6

Subtract line
here and in
(with

263A

acquired

for

respect

resale)

to

Yes

apply
X

to the organization?

5

No

Schedule C - Rent Income (From Real Property and Personal Property Leased With Real Property)
(see instructions)
1. Description of property
(1)

(2)
(3)
(4)

2. Rent received or accrued
(a) From personal property (if the percentage of rent

for personal property is more than 10% but not
more than 50%)

(b) From real and personal property (if the

percentage of rent for personal property exceeds
50% or if the rent is based on profit or income)

3(a) Deductions directly connected with the income
in columns 2(a) and 2(b) (attach schedule)

(1)

(2)
(3)
(4)

Total
Total
(c) Total income. Add totals of columns 2(a) and 2(b) Enter
here and on page 1. Part 1, line 6, column (A) .. . . . I

(b) Total deductions.

Enter here and on page 1,
Part l. line 6, column (B) i

Schedule E - Unrelated Debt-Financed Income see instructions
2. Gross income from or
1. Description of debt-financed property

3. Deductions directly connected with or allocable to
debt-financed property

allocable to debt-financed
property

(a) Straight line depreciation

(attach schedule)

(attach schedule)

6. Column
4 divided

7. Gross income reportable
(column 2 x column 6)

(column 6 x total of columns
3(a) and 3(b))

Enter here and on page 1,

Enter here and on page 1,
Part 1, line 7, column (B)

(b) Other deductions

(1)

(2)
(3)
(4)
4. Amount of average

acquisition debt on or
allocable to debt-financed
propeny (attach schedule)

6. Average adjusted basis

of or allocable to
debt-financed property
(attach schedule)

by column 5

8. Allocable deductions

%
%
%
%

(1)
(2)
(3)
(4)

Part 1, line 7, column (A).

Totals
Total dividends-recelved deductions included in column 8.

Form 990-T (2016)

JSA
6X27421.000

06002L 0114

V 16-7.6F

 Form 990-T (2016)

13-1740114

MONTEFIORE MEDICAL CENTER

Page 4

Schedule F - Interest, Annuities, Royalties, and Rents From Controlled Organizations (see instructions)
Exempt Controlled Organizations

1. Name of controlled

organization

2. Employer
identification number

3. Net unrelated income

4. Total of specified

(loss) (see instructions)

payments made

6. Part of column 4 that is

6. Deductions directjy

included in the controlling
organization's gross income

connected with income
in column 5

(1)

(2)
(3)
(4)

Nonexempt Controlled Organizations
7. Taxable Income

9. Total of specified

8. Net unrelated income

payments made

(loss) (see instructions)

11. Deductions directly
connected with income in
column 10

10. Part of column 9 that is

included in the controlling
organization's gross income

(1)

(2)
(3)
(4)

Addcolumns6 andll.

Add columns 5 and 10.

Enter here and on page 1,

Enter here and on page 1,

Part 1, line 8, column (8).

Part 1, line 8, column (A).

Totals

anization (see instructions)
Schedule G- Investment Income of a Section 501 c 7, 9,or 17 Or
s
3. Deduction

1. Description of income

directly connected
(attach schedule)

2. Amount of income

4. Set-asides
(attach schedule)

5. Total deductions

and set-asides (col. 3
plus col. 4)

(1)

(2)
(3)
Enter here and on page 1,
Part 1, line 9, column (B).

Enter here and on page 1,
Pan I, line 9, column (A).

Totals

Schedule 1 - Ex loited Exem t Activi

1. Description of exploited activity

Income Other Than Advertisin Income see instructions

2. Gross
unrelated
business income
from trade or
business

4. Net income (loss)

3. Expenses
directly

connected with
production of
unrelated
business income

from unrelated trade
or business (column
2 minus column 3).
If a gain, compute

cols. 5 through 7.

6 . Gross income
from activity that
is not unrelated
business income

7. Excess exempt

6. Expenses
attributable to

column 5

expenses
(column 6 minus
column 5, but not
more than

column 4),

(1)

(2)
(3)
(4)
Enter here and on
page 1, Part I

line 10. col (A).

Enter here and

Enter here and on
page 1, Part 1,
line 10. col. (B)

on page 1,

Part Il. line 26.

Totals

Schedule J - Advertisin Income (see instructions)
Income From Periodicals Re orted on a Consolidated Basis
7. Excess readership

4. Advertising

1. Name of periodical

2. Gross
advertising

income

gain or (loss) (col.

3. Direct

advertising costs

2 minus col. 3). If
a gain, compute
cots. 5 through 7.

6. Circulation

6. Readership

income

costs

costs (column 6
minus column 5, but
not more than

column 4).

(1)

(2)
(3)
(4)
Totals (carry to Part Il, line (5))

Form 990-T (2016)

JSA
SX2743 1 000

06002L 0114

V 16-7.6F

 13-1740114

MONTEFIORE MEDICAL CENTER

Form 990-T (2016)

Page 5

income From Periodicals Reported on a Separate Basis (For each periodical listed in Part 11, fill in columns

2 through 7 on a line-by-line basis.)

4. Advertising

2. Gross
1. Name of periodical

gain or (loss) (col.

3. Direct

2 minus col. 3). If

advertising
income

advertising costs

Enter here and on

Enter here and on
page 1, Part 1,
line 11, col (8)

a gain, compute
cols. 5 through 7.

6. Circulation

6. Readership

income

costs

7. Excess readership
costs (column 6
minus column 5. but
not more than

column 4).

(1)

(2)
(3)
(4)
Totals from Part I.
page 1, Parti,
line 11, col (A)

Enter here and

on page 1,
Part Il, line 27.

Totals, Part ll (lines 1.5) ....h

Schedule K - Com ensation of Officers Directors and Trustees see instructions
3. Percent of
1.Name

2. Title

time devoted to
business

4. Compensation attnbutable to
unrelated business

%
%
%
%

(1)
(2)

(3)
Total. Enter hereandon

a el. Partll, line 14.

Form 990-T (2016)

JSA
SX2744 1.000

06002L 0114

V 16-7.6F

 13-1740114

MONTEFIORE MEDICAL CENTER

ATTACHMENT 1

FORM 990T

LINE 5 -INCOME

(LOSS)

FROM PARTNERSHIPS

ARCLIGHT ENERGY PARTNERS FUND V, LP
BIOMEDICAL RESEARCH ALLIANCE OF NEW YORK, LLC
GNYHA PURCHASING ALLIANCE
MIDOCEAN PARTNERS III, LP
EMINENCE PARTNERS, LP
NB CO-INVESTMENT PARTNERS, LP
NB SECONDARY OPPORTUNITIES FUND, LP
TRILANIC CAPITAL PARTNERS IV ONSHORE AIV(A),LP
CERBERUS INSTITUTIONAL PARTNERS V, LP
INCOME

(LOSS)

-3,830.
572,314.
12,366.
36,022.
-27,502.
2,395.
82,515.
-1,273.
-5.
673,002.

FROM PARTNERSHIPS

ATTACHMENT 1
06002L 0114

V 16-7.6F

 13-1740114

MONTEFIORE MEDICAL CENTER

ATTACHMENT 2

PART I - LINE 12 - OTHER INCOME
24,493,148.

CONTRACT MANAGEMENT ORGANIZATION SERVICES

PART I - LINE 12 - OTHER INCOME

-

24,493,148.

ATTACHMENT 2
06002L 0114

V 16-7.6F

 13-1740114

MONTEFIORE MEDICAL CENTER

-ATTACHMEN-T_@-

FORM 990T

PART II

LINE 28

TOTAL OTHER DEDUCTIONS

LABORATORY PROCESSING SUPPLIES & REAGENTS
CONTRACT MANAGEMENT ORGANIZATION EXPENSES

PART

II

- LINE 28 - OTHER DEDUCTIONS

i

853,452.
8,852,130.
9,705,582.

ATTACHMENT 3
06002L 0114

V 16-7.6F

 $

5

5

5

S

5

S

$

$

$

$

0

(969'*00'BL)

-

(614'Z£9'61)
(006'999'61)

(999' L 19'61)
(194'££4'61)

(Zot'Otg'90
(969'400'9&)
(66€'910'LI)

S

(119'019)
(6,2'9L)

(090'£19)
(ZOZ'909)

(961'696)

(096'194'01)

5

(621'Ct,L'l)

(490.49£)

999791

$

5

1

S

(6£1'961'ZE)

S

(991'494'E)

0
e
e
e
e
e

(17,015,399)

(16,409,030)

(15,419,426)

(14,459,682)

(9,955,844)

(4,810,668)

20Z2lzrOT

NOL Remaindin

$

€A

(104'019'9

(294'£04'61)

(999'LLB'60

(006'999'60

(6*C/£9'60

(096'194'01)

(6£1'96CZE)

$

0

Amount Used

1

(414'089'*Z)

$

(,99.99£9)

S

(900'9£4'0£)

$

(969'991'6)

0

e

NOL Created

(*14'099'tz)

$

1

0

e

Amount Expired

0

(4,810,668)

0
(5,145,176)

0

(4,810,668)

0
(4,503,838)

0

(9,955,844)

0
(959,744)

0
(14,459,682)

0
0

(989,604)

$

0
(15,419,426)

(900'9£4,0£)

0
0

Year End

0
0

(606,369)

(£06'ZOZ'60

0
0
0

1 Center

0
G
0

9001

ZOOZ

9001

(papuawv) 6001

(papuawv) OLOZ

LLOZ

ZIOE

CLOZ

*toz

SLOZ

9101

r,zr:tv-~rrica

0

Form 990T, Line 31 - Net Operating Loss

0

Tax Year

0

2000

0

2001

0

2002

0

2003

0

2004

(16,409,030)

0

2005

/9

00000000000

\

 13-1740114

MONTEFIORE MEDICAL CENTER

FEDERAL ELECTIONS
FORM & LINE/INSTRUCTION REFERENCE:
REGULATION REFERENCE:

REV.

PROC.

FORM 990-T
2015-20 STATEMENT

STATEMENT ATTACHED TO AND MADE PART OF FORM 990-T

CHANGES IN METHOD OF ACCOUNTING PURSUANT TO REV. PROC. 2015-20 FOR THE
TAX YEAR ENDED 2015
N 4.01 OF REV.
THE ABOVE REFERENCED TAXPAYER IS WITHIN THE SCOPE OF SECTIO
URES
PROCED
FIED
SIMPLI
THE
PROC. 2015-20 AND IS CHOOSING TO FOLLOW
TING METHOD
ACCOUN
MAKING
WHEN
0
PROVIDED IN SECTION 5 OF REV. PROC. 2015-2
TAX
ITS
FOR
TIONS
REGULA
TY
CHANGES TO COMPLY WITH THE TANGIBLE PROPER
YEARS ENDED DECEMBER 31,

2014 AND LATER.

SPECIFICALLY,

THE TAXPAYER WILL

D CHANGES WITH AN
MAKE THE APPLICABLE TANGIBLE PROPERTY ACCOUNTING METHO
ONLY AMOUNTS PAID
NT
ACCOU
INTO
TAKES
THAT
ADJUSTMENT UNDER SECTION 481(A)
OR AFTER
OR INCURRED, AND DISPOSITIONS, IN TAXABLE YEARS BEGINNING ON
JANUARY 1,

2014.

ACCORDINGLY,

THE TAXPAYER WILL NOT FILE FORM 3115,

OF THE APPLICABLE TPR
APPLICATION FOR CHANGE IN ACOUNTING METHOD, FOR ANY SECTI
ON 5.01 OF REV.
SEE
METHOD CHANGES COVERED BY REV. PROC. 2015-20.
PROC. 2015-20.

06002L 0114

V 16-7.6F

 Form

OMB No. 1545-0172

Depreciation and Amortization

4562

2@16

(Including Information on Listed Property)
~ Attach to your tax return.

Department of the Treasury
internal Revenue Ser,Ice

Attachment
Sequence No

~ Information about Form 4562 and Its separate Instructions is at www. irs.gov/form4562.

179

Identifying number

Name(s) shown on return

13-1740114

MONTEFIORE MEDICAL CENTER

Business or activity to which this form relates

GENERAL DEPRECIATION

Election To Expense Certain Property Under Section 179
Note: If you have any listed property, complete Part V before you complete Part I.

1

1

Maximum amount (see instructions)

2

Total cost of section 179 property placed in service (see instructions)

3

.
Threshold cost of section 179 property before reduction in limitation (see instructions) ..............

2

3
4

Reduction in limitation. Subtract line 3 from line 2. If zero or less, enter -0-

4

5

Dollar limilation for tax year. Subtract line 4 from hne 1. If zeroor less. enter -0.. 11 married filing

5

see instructans . . . . . . . . . . . . . . . . . . . . . .
(a) Description of property

se aratel

6

(b) Cost (business use only)

(c) Elected cost

7
Listed property. Enler the amount from line 29
8 Total elected cost of section 179 property. Add amounts in column (c). lines 6 and 7
9 Tentative deduction. Enter the smaller of line 5 or line 8
10 Carryover of disallowed deduction from line 13 of your 2015 Form 4562
than zero) or line 5 (see instructions)
11 Business income limitation Enter the smaller of business income (not less
line 11
than
more
12 Section 179 expense deduction Add lines 9 and 10, but don't enter
13
*
,..
12
line
less
10,
13 Carryover of disallowed deduction to 2017. Add lines 9 and
V.
Part
use
Instead,
Note: Don't use Part 11 or Part 111 below for listed properly
7

8

10
11

property.) (See instructions.)
Special Depreciation Allowance and Other Depreciation (Don't include listed

property) placed in service
Special depreciation allowance for qualified property (other than listed

14

during the tax year (see instructions)

15

15
16

Property subject to section 168(f)(1) election
Other depreciation (including ACRS)

17

.................
MACRS deductions for assets placed in service in tax years beginning before 2016

.......................................16

897,166.

MACRS Depreciation (Don't include listed property.) (See instructions.)
Section A

17

the tax year into one or more general
If you are electing to group any assets placed in service during

18

....
asset accounts, check here ...................................

the General Depreciation System
Section 8 - Assets Placed in Service During 2016 Tax Year Using
(b) Month and year

(a) Classification of property

19a
b
c
d
e
f
g
h

placed in
service

(c) Basis for depreciation

(business/investment use
only - see instructions)

3-year property
5-year properly
7-year property
10-year properly
15-year property
20-year property
25-year property

27.5 yrs.
275 yrs.

(e) Convention

(f) Method

MM

S/L
S/L

(9) Depreciation deduction

S/L
S/L
39 yrs
S/L
the Alternative Depreciation System
Section C - Assets Placed in Service During 2016 Tax Year Using

12 yrs
40 yrS

b 12-year
c 40-year

Summa

MM
MM
MM

S/L

20a Class life

23

period

25 yrs.

Residential rental
property
i Nonresidential real
property

21
22

(d) Recovery

MM

(See instructions.)

Listed property, Enter amount from line 28
19 and 20 in column (g), and line 21. Enter here
Total. Add amounts from line 12, lines 14 through 17, lines
ns - see instructions .
and on the appropriate lines of your return. Partnerships and S corporatio
year. enter the
For assets shown above and placed in service during the current

6X2300 2000

06002L 0114

21

22

897,166 .

23

portion of the basis attributable to section 263A costs
JSA For Paperwork Reduction Act Notice, see separate instructions.

S/L
S/L

Form 4562 (2016)

V 16-7.6F

 13-1740114

page 2

Form 4562 (2016)

and property
Listed Property (Include automobiles, certain other vehicles, certain aircraft, certain computers,

used for entertainment, recreation, or amusement )

expense, complete only 24a,
Note: For any vehicle for which you are using the standard mileage rate or deducting lease
applicable.
if
C
Section
and
B,
Section
24b, columns (a throu h (c) of Section A, all of
assen er automobiles.
Section A - De reciation and Other Information Caution: See the instructions for limits for
Yes X No
evidence written?
the
is
X
"Yes,"
If
24b
No
Yes
claimed?
use
tment
business/inves
the
support
to
24a Do you have evidence
(C)

Date placed

Business/
investment use

Type of property (list

in senfice

vehicles first)

25
26

27

Basis for depreciation,
Cousinessfinvestment
use only)

Cd)
Cost or other basis

percentage

(g)

(h)

(i)

Method/

Depreciation

Elected section 179

(f)

(e)

(b)

(a)

Recovery
period

Special depreciation allowance for qualified listed property placed in service during

the tax year and used more than 50% in a qualified business use (see instructions) ......,...25
Property used more than 50% in a qualified business use:
%
%
%
Property used 50% or less in a qualified business use:
%

S/L S/L S/L -

%

28

28 Add amounts in column (h), lines 25 through 27. Enter here and on line 21, page 1 ..........
29

cost

deduction

Convention

*.,,..,..,.,,.,.,,.,....,, 29

Add amounts in column (i), line 26. Enter here and on line 7, page 1

Section B - Information on Use of Vehicles

other "more than 5% owner," or related person. If you provided vehides
Complete this section for vehicles used by a sole proprietor, partner, or
exception 10 completing this section for those vehicles.
to your employees, first answer the questions in Section C to see if you meet an

30
31
32

Total business/investment miles driven during

(a)

(b)

(c)

(d)

(e)

(f)

Vehide 1

Vehide 2

Vehicle 3

Vehicle 4

Vehide 5

Vehicle 6

the year (don't include commuting miles),..
Total commuting miles driven during the year ,
(noncommuting)
personal
other
Total

miles driven
33

Total

miles

driven

during

the

year

Add

lines 30 through 32
34 Was

the

vehicle

available

for

personal

Yes

No

Yes

No

Yes

No

Yes

Yes

No

Yes

No

NO

use during off-duty hours? ............

35 Was the vehicle used primarily by a more

than 5% owner or related person? .......

36

Is

another

vehicle

available

for

personal

Their Employees
Section C - Questions for Employers Who Provide Vehicles for Use by

completing Section B for vehicles used by employees who aren't
Answer these questions to determine if you meet an exception to

more than 5% owners or related persons (see instructions).
37

l use of vehicles, including commuting, by
Do you maintain a written policy statement that prohibits all persona

Yes

No

your employees?

l use of vehicles, except commuting, by your
Do you maintain a written policy statement that prohibits persona
directors, or 1% or more owners
officers,
e
corporat
by
employees? See the instructions for vehicles used
use?
personal
as
s
39 Do you treat all use of vehicles by employee
obtain information from your employees about the
40 Do you provide more than five vehicles to your employees,
38

use of the vehicles, and retain the information received?

41

tration use? (See instructions )
Do you meet the requirements concerning qualified automobile demons
Section B for the covered vehicles
Note: If your answer to 37, 38, 39, 40, or 41 is "Yes," don't complete

Amortization
(a)
Description of costs

(e)
(b)
Date amortization

begins

(c)

(d)

Amortizable amount

Code section

42

ns):
Amortization of costs that begins during your 2016 tax year (see instructio

43
44

Amortization of costs that began before your 2016 tax year
peport
Total. Add amounts in column (f) See the instructions for wflere to

JSA
SX2310 2 000

06002L 0114

V 16-7.6F

Amortization

period or
percentage

Amortization for this year

43
44
Form 4562 (2016)

 (Form 1041)
Department of the Treasury
Internal Revenue SerWce

OMB No. 1545-0092

Capital Gains and Losses

SCHEDULE D

4 Attach to Form 1041, Form 5227, or Form 990-T.
I Use Form 8949 to list your transactions for lines lb, 2, 3, 8b, 9 and 10.

2@16

I Information about Schedule D and its separate instructions Is at www. irs.gov/fonn1041 .

Employer identification number

Name of estate or trust

13-1740114

MONTEFIORE MEDICAL CENTER

Note : Form 5227 filers need to complete only Parts I and ll.

Short-Term Ca ital Gains and Losses - Assets Held One Year or Less
the lines below.

This form may be easier to complete if you round off cents

Ch) Gain or (loss)

(9)

See instructions for how to figure the amounts to enter on

(d)

Proceeds

(sales price)

(e)

Cost
(or other basis)

to whole dollars.

Subtract column (e)

Adjustments

to gain or loss from

Form(s) 8949, Part 1,

line 2, column (g)

from column (d) and
combine the result with
column (g)

1 a Totals for all short-term transactions reported on Form
1099-8 for which basis was reported to the IRS and for

which you have no adjustments (see instructions).

However, if you choose to report all these transactions
on Form 8949, leave this line blank and go to line lb .

1 b Totals for all transactions reported on Form(s) 8949
with Box A checked
2 Totals for all transactions reported on Form(s) 8949
with Box B checked
3 Totals for all transactions reported on Form(s) 8949
with Box C checked

4

Short-term capital gain or (loss) from Forms 4684,6252,6781, and 8824

4

5
6

Net short-term gain or (loss) from partnerships, S corporations, and other estates or trusts
Loss
Short-term capital loss carryover. Enter the amount, if any, from line 9 of the 2015 Capital
. . . . . .
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
,
.
,
,
.
.
.
.,
.
.
.
.
.
.
.
.
.
.
.
.
.
Worksheet,
Carryover
and on
Net short-term capital gain or (loss). Combine lines la through 6 in column (h) Enter here

5

7

line 17, column (3) on the back
Long-Term Capital Gains and Losses - Assets Held More Than One Year

See instructions for how to figure the amounts to enter on
the lines below

This form may be easier to complete if you round off cents

(d)
Proceeds

(sales price)

Ce)

Cost

(or other basis)

to whole dollars.

,

47,157.

6(
7

)
47,157.

Ch) Gain or(loss)

(g)
Adjustments

to gain or loss from

Form(s)8949, Part 11,

line 2, column (g)

Subtract column (e)

from column (d) and
combine the result with
column (g)

Ba Totals for all long-term transactions reported on Form
1099-8 for which basis was reported to the IRS and

for which you have no adjustments (see instructions).

However, if you choose to report all these transactions
on Form 8949, leave this line blank and go to line 8b .

8b Totals for all transactions reported on Form(s) 8949
with Box D checked

9

Totals for all transactions reported on Form(s) 8949
with Box E checked

10 Totals for all transactions reported on Form(s) 8949
with Box F checked

11

Long-term capital gain or (loss) from Forms 2439,4684,6252,6781, and 8824 .....

11

12

Net long-term gain or (loss) from partnerships, S corporations, and other estates or trusts,

12

13

Capital gain distributions. ..............,....................

13

Gain from Form 4797, Part I
Capital Loss
Long-term capital loss carryover Enter the amount, if any, from line 14 of the 2015
Carryover Worksheet
Enter here and on
Net long-term capital gain or (loss). Combine lines 8a through 15 in column (h)

15 (

14

15
16

line 188, column (3) on the back ......·································/

For Paperwork Reduction Act Notice, see the Instructions for Form 1041.

JSA

6F 1210 1.000

06002L 0114

V 16-7F

16

-47,177 .

-47,177.

Schedule D (Form 1041) 2016

 page 2

Schedule D (Form 1041)2016

17
18

Summary of Parts I and 11
Caution : Read the instructions before com leting this part.
17
Net short-term gain or (loss). ,., .................
Net long-term gain or (loss):
a Total for year

(2) Estate's

( see instr .)

or trusts

Total net gain or (loss).Combine lines 17 and 18a...,...,I

(3) Total

47,157.
-47,177.

18a

b Unrecaptured section 1250 gain (see line 18 of the wrksht.) ....
c 28% rate gain ..
19

(1) Beneficiaries'

18b
18c
19

-20.

(2), are net
Note : /f line 19, column (3), is a net gain, enter the gain on Form 1041 , line 4 (or Form 990-T, Part I, line 48). If lines 188 and 19, column
Worksheet. as

Canyover
gains, go to Part V, and don't complete Part IV. If line 19, column (3), is a net loss, complete Part IV and the Capital Loss

necessa

Capital Loss Limitation
20

Enter here and enter as a (loss) on Form 1041, line 4 (or Form 990-T, Part 1, line 4c, if a trust), the smaller of:

a The loss on line 19, column (3) or b

$3,000

20 (

20. )

complete the Capital
Note: If the loss on line 19, column (3), is more than $3,000, or if Form 1041, page 1, line 22 (or Form 990-T. line 34), is a loss,
Loss Car,yover Worksheet in the instructions to figure your capital loss carryover

Tax Computation Usin Maximum Capital Gains Rates

and
Form 1041 filers. Complete this part only if both lines 18a and 19 in column (2) are gains, or an amount is entered in Part I or Part 11
there is an entry on Form 1041, line 2b(2), and Form 1041, line 22, is more than zero
Caution : Skip this part and complete the Schedule D Tax Worksheet in the instructions if:
• Either line 18b, col. (2) orline 18c, col. (2) is more than zero, or
• Both Form 1041, line 2b(1 ), and Form 4952, line 49 are more than zero
Part I of Form
Form 990-T trusts. Complete this part only if both lines 18a and 19 are gains, or qualified dividends are included in income in
if either
instructions
the
in
Worksheet
Tax
D
Schedule
the
complete
and
part
this
Skip
zero.
than
more
is
34,
990-T, and Form 990-T, line

line 18b, col. (2) or line 18c, col. (2) is more than zero
21
22

23

24
25

26
27
28
29

30
31
32
33
34
35
36
37
38
39
40
41
42

Enter taxable income from Form 1041, line 22 (or Form 990-T, line 34). . .
Enter the smaller of line 18a or 19 in column (2)
22
but not less than zero
Enter the estate's or trust's qualified dividends
from Form 1041, line Zb(2) (or enter the qualified
dividends included in income in Part I of Form 990-0,.

23

.,,.
,,,,
,
Add lines 22 and 23
the
enter
4952,
Form
filing
is
If the estate or trust

24

amount from line 4g: otherwise, enter -0-...I

25

21

Subtract line 25 from line 24. If zero or less, enter -0-

26

Subtractline 26 from line 21. lfzeroorless, enter -0-

27

28
Enter the smaller of the amount on line 21 or $2,550 ............
29
Enter the smaller of the amount on line 27 or line 28 ............
Subtract line 29 from line 28. If zero or less, enter -0- This amount is taxed at 0% . ..........
31
Enter the smaller of line 21 or line 26
32
Subtract line 30 from line 26..........................
33
Enter the smaller of line 21 or $12,400
34
Add lines 27 and 30
35
Subtract line 34 from line 33. If zero or less, enter -036
Enter the smaller of line 32 or line 35
Multiply line 36 by 15% (0.15) .......................................
38
Enter the amount from line 31
39
Add lines 30 and 36
40
-0enter
Subtract line 39 from line 38. If zero or less,
Multiply line 40 by 20% (0 20)

,

30

~

37

4

41

Figure the tax on the amount on line 27. Use the 2016 Tax Rate Schedule for Estates

43
44

Add lines 37, 41, and 42

42
43

Figure the tax on the amount on line 21 Use the 2016 Tax Rate Schedule for Estates
and Trusts (see the Schedule G instructions in the instructions for Form 1041 ) ....

44

45

Tax on all taxable income. Enter the smaller of line 43 or line 44 here and on Form 1041, Schedule

and Trusts (see the Schedule G instructions in the instructions for Form 1041) ....

G, line la (or Form 990-T, line 36) ..................................... ~ 45

Schedule D (Form 1041) 2016

JSA
;F 1220 1.000

06002L 0114

V 16-7F

 Form

4626

Department of the Treasury
Internal Revenue Sewice

OMB No. 1545-0123

Alternative Minimum Tax-Corporations

2@16

4 Attach to the corporation's tax return.
h Information about Form 4626 and its separate instructions is at www. irs.gov/form4626.

Employer identification number

Name

13-1740114

MONTEFIORE MEDICAL CENTER

Note·. See the instructions to find out if the corporation is a small corporation exempt from the
alternative minimum tax (AMD under section 55(e).
Taxable income or (loss) before net operating loss deduction . . . .

1

a
b
c
d
e

Adjustments and preferences:
Depreciation of post-1986 property . . . .
Amortization of certified pollution control facilities. . . . .........
. . . . ......
Amortization of mining exploration and development costs
only) . . . . .
companies
holding
(personal
s
expenditure
Amortization of circulation
.
.
loss
or
gain
Adjusted

f

Long-term contracts .

g
h
i
j

Merchant marine capital construction funds. . . . .
Section 833(b) deduction (Blue Cross, Blue Shield, and similar type organizations only)
Tax shelter farm activities (personal service corporations only) . . . . .
Passive activities (closely held corporations and personal service corporations only) .

2

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

Intangible drilling costs

o

Other adjustments and preferences .

.

.

2

.

2j
2k

.

2m
2n
20
3

-9 265 536

4e

o

.

4

Adjusted current earnings (ACE) adjustment:
ACE from line 10 of the ACE worksheet in the instructions . . . . . . . .
Subtract line 3 from line 4a. If line 3 exceeds line 4a, enter the difference as a
negative amount. See instructions . . . .
Multiply line 4b by 75% (0.75) Enter the result as a positive amount. . . . .
Enter the excess, if any, of the corporation's total increases in AMTI from prior
year ACE adjustments over its total reductions in AMTI from prior year ACE
adjustments . See instructions . Note : You must enter an amount on line 4d

(even if line 4b is positive).
e

5
6
7

8
a

.

.

9
10

11
12
13
14

./

.

I

.

4a

-9265,536

4b

o

4c

o

4d

.'.

ACE adjustment.
...
,
• If line 4b is zero or more, enter the amount from line 4c
f
amount
• If line 4b is less than zero, enter the smaller of line 4c or line 4d as a negative
. . . .
Combine lines 3 and 4e. If zero or less, stop here; the corporation does not owe any AMT
. . . .
.
.
.
.
.
.
.
.
Alternative tax net operating loss deduction. See instructions . .
a residual
held
n
Alternative minimum taxable income. Subtract line 6 from line 5. If the corporatio
. . .
.
.
.
.
.
.
.
.
.
.
.
.
interest in a REMIC, see instructions . . . . . . .
8c):
line
on
-0enter
and
8b
and
8a
lines
skip
Exemption phase-out (if line 7 is $310,000 or more,
a
of
Subtract $150,000 from line 7 (if completing this line for a member
8a
controlled group, see instructions). If zero or less, enter -0- . . . . ...

b Multiply line 8a by 25% (0.25) .
c

.

.

.

.

.

.

.

5
6

-9,265,536

7

8b

.

.

-11

2h
21

Pre-adjustment alternative minimum taxable income (AMTI). Combine lines 1 through 20.

d

1 579

.

3

c

-9266895

1

.

n

a
b

2a
2b
2c
2d
2e

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

Depletion ..
1
m Tax-exempt interest income from specified private activity bonds
.

1

group,
Exemption. Subtract line 8b from $40,000 (if completing this line for a member of a controlled

see instructions). If zero or less, enter -0- . . .
Subtract line 8c from line 7. If zero or less, enter -0- .
. . . . . .
Multiply line 9by 20% (0.20)

.8c
9

.

Alternative minimum tax foreign tax credit (AMTFTC). See instructions . .
Tentative minimum tax. Subtract line 11 from line 10.....
Regular tax liability before applying all credits except the foreign tax credit

10

.

.

.

.

.

.

.

.

.
.
.....

.

.

.

.

here and on
Alternative minimum tax. Subtract line 13 from line 12. If zero or less, enter -0-. Enter
. . .
return
tax
Form 1120, Schedule J, line 3, or the a ro riate line of the cor oration's income

For Paperwork Reduction Act Notice, see separate instructions.

Cat. No. 129551

11
12

13
14
Form 4626 (2016)

 MONTEFIORE MEDICAL CENTER
AMT NET OPERATING LOSS SCHEDULE
FOR THE TAX YEAR 2016

Forrn 4626 Alternative Minimum Tax
Year

Federal 99OT

2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016

(4,810,668)
(5,145,176)
(4,503,838)
(959,744)
(989,604)
(606,369)
(989,296)
(805,707)
(623,080)
(384,084)
261,666
(76,249)
(820,811)
(1,743,179)
(2,484,285)
(5,755,584)
(9,266,895)

Net Operating loss to be carried forward to 2017

Form 4626

(4,810,668)
(5,145,176)
(4,503,838)
(959,744)
(989,604)
(606,369)
(989,296)
(805,707)
(623,080)
(384,084)
261,666
(76,249)
(820,811)
(1,743,179)
(2,477,205)
(5,752,380)
(9,265,536)

(39,702,903) (39,691,260)

 Consent Plan and Apportionment Schedule
for a Controlled Group

SCHEDULE 0

(Form 1120)
(Rev. December 2012)
Department of the Treasury
Internal Revenue Ser,ice

OMB No. 1545-0123

1120-RIC.
4 Attach to Form 1120, 1120-C, 1120-F, 1120-FSC, 1120-L, 1120-PC, 1120-REIT, or
120.
about Schedule O ( Form 1120 ) and its Instructions is available at www. irs.gov/form1
4 Information

Employer identification number

Name

13-1740114

MONTEFIORE MEDICAL CENTER
Apportionment Plan Information
Type of controlled group

1

a
b
c
d

[Fl
 
 
 
 
 
 

Parent-subsidiary group
Brother-sister group
Combined group
Life insurance companies only

This corporation has been a member of this group:

2

a ~ For the entire year.

3

, until

  From

b  

This corporation consents and represents to:
an apportionment plan effective for the
a 1-~1 Adopt an apportionment plan. All the other members of this group are adopting

current tax year which ends on

, and for all succeeding tax years

are currently amending a previously adopted
b ~~  Amend the current apportionment plan. All the other members of this group

plan, which was in effect for the tax year ending

, and for all succeeding tax years

All the other members of this group are not adopting
c Fl Terminate the current apportionment plan and not adopt a new plan.

an apportionment plan.

other members of this group are adopting an
d 1~1 Terminate the current apportionment plan and adopt a new plan. All the

apportionment plan effective for the current tax year which ends on
succeeding tax years

, and for all

indicate if the termination of the current apportionment
If you checked box 3c or 3d above, check the applicable box below to

4

Dian was
a ~ Elected by the component members of the group.
  Required for the component members of the group.
b  
below concerning the status of the group's apportionment
If you did not check a box on line 3 above, check the applicable box

5

plan (see instructions)
a ~Y] No apportionment plan is in effect and none is being adopted.
ending _
  An apportionment plan is already in effect. It was adopted for the tax year
b  

, and for

all succeeding tax years
plan for a tax year after the due date
If all the members of this group are adopting a plan or amending the current

6

remaining on the statute of limitations
(including extensions) of the tax return for this corporation, is there at least one year
any resulting deficiency?
g
from the date this corporation filed its amended return for such tax year for assessin
See instructions
a Fl Yes.

(i)

BOnE
extend the statute of limitations for purposes of assessment until

The statute of limitations for this year will expire on
Service to
, this corporation entered into an agreement with the Internal Revenue

b  ~  No. The members may not adopt or amend an apportionment plan

7

applicable box(es) (see instructions).
Required information and elections for component members. Check the

maximum tax rate imposed by section 11 to the entire amount
al-Fl The corporation will determine its tax liability by applying the

of its taxable income

FIFO method (rather than defaulting to the proportionate
b Fl The corporation and the other members of the group elect the

method) for allocating the additional taxes for the group imposed by section 11(b)(1)

c ~-7 The corporation has a short tax year that does not include December 31.
1120.
For Paperwork Reduction Act Notice, see Instructions for Form

JSA
6C 1013 1.000

Schedule O (Form 1120) (Rev. 12-2012)

 membefs name and
employer identification number

VICES PC

6WHITE PLAINS MEDICAL DIAGNOSTIC SER

F NEW YORK

5CANCER AND BLOOD MEDICAL SERVICES 0

8 LONGVIEW DEVELOPMENT CORPORATION

C & SUBS

3MONTEFIORE CONSOLIDATED VENTURES IN

MONTEFIORE INNOVATIONS INC

MONTEF]ORE MEDICAL CENTER

45-3164626

46-2021804

2016-12

2016-12

2016-12

2016-12

2016-12

2016-12

NONE

NONE

NONE

NONE

NONE

Z

SNIVId 3.LIHM

vsr

401

Od 'IVJIGaW aNV'7HOIH

93/IAH35 NVIDISAHd

0

6C 1014 1.000

728539

26-3321278

61

47-5106910

13-1740114

Tax year end
34%

NONE

NONE

NONE

NONE

NONE

NONE

Taxable ncome Amount Allocated to
Each Bracket
columns
c hrough (D)

NONE

3NON

Od

M

19*DEOD-[I

member's tax return.

column (g) for each component member must equal taxable income from Form 1120, page 1, line 30 or the comparable line of such

Page 2

3NON

Z

(Z:OZ-Zt AaM) COZLI U,Joi) 0 alnpallis

Z

Er-9T0E

SI960[S-/8

Od 530 IAM35 'IVOIGJW SNIV-Id 31IHM

00

ET-9I0E

15/69/5-/8

Caution: Each total in Part

Taxable Income Apport onment (See instructions

Schedule O (Form 1120) (Rev. 12-2012)

3NON

9D0'*

aNON

5%%5

Z

3NON

3NON

3NON
0

IC

aNON

ZI-9I0E

DNI 00 1#3&GOVNVW SNIVld 3.LIHM

W

aNON

Z

3NON

Y

Z

f*91[CE-EI

N

2

Z

ZI-9I0Z

r

g

3NON

9[

5

Z

3NON

0

0

Z

SNON

0

9I0'D

Z

 Taxable ncome Amount Allocated to
Each Bracket

Page 2

NC

6 ALBE~TN~ NS~IN COLLEGE OF
MEDI

MMC CORPORATION

MOSHOLU PRESERVATION CORPORATION

MONTEFIORE HEALTH SYSTEM

2THE WINIFRED MASTERSON BURKE
REHABILITATION HOSPITAL

0

1765661

NONE

NONE

2016-12

47-2209056

NONE

NONE

2016-12

2016-12

2016-12

2016-12

2016-12

13-3430322

13-3109387

20-1615393

13-1739937

4

NONE

NONE

NONE

3 985 120

34%

NONE

NONE

NONE

2O

000 1 M009

vsr

401

ONI SEDIAMSS 1.N3W39VNVW HN

dMOO ONIC, Ing DHd M

984910D-Cr

Z[69L9£-EI

ET-9I0E

ZI-970Z

7FildSOH SNIVld 31[HMZ

0-

3NON

3NON

SLCH CORPORATION

3NON

331N33 7V1[03

ON I Untd WOO 30 NVZLASN I EMOId 3.LNOW

OCIODLI-CI
D659[*0-ZE

ZI-9I0E

empl~yer~deemn~ii{sat~oanneuamn~er

columns
hrough (f))

3,985,120

2
(ELOZ-z: 'Aail) Cont luiod) O alnpalps

(e)

E

3NON

3NON

Tax year end

Cau#on: Each total in Part ll, column (g) for each component member must equal taxable income from Form 1120, page 1, line 30 or the comparable line of such
member's tax return.

Taxable Income Apportionment See instructions

Schedule O Form 1120) Rev. 12-2012)

9

EI-9I0E

Z

aNON

Z

7 ,3NON

0

%%%%
zzzz

 DAVIS AVENUE CORP

QUANTUM BIOTHERAPEUTICS LLC

ern'ju:ndeemn~lfic~ltion neu~ber

member's tax return.

Page 2

3 333 643

61-1793667

NONE

2

20 6

NONE

2016-12

Tax y~ end
(Yr- 0)

NONE

NONE

NONE

NON£

NONE

Each Bracket

Taxable ncome Amount Allocated to

NONE

Tota) rt'g'Tns

column (g) for each component member must equal taxable income from Form 1120, page 1, line 30 or the comparable ne of such

Taxable Income Apportionment (See instructions

Caudon: Each total in Part

.

Schedule O Form 1120 Rev. 12-2012)

N

(ZLOZ-Zi Aeki) (OZL & UIJOJ) O elnpalps

r
2

r

MYM

<DI-00

0

000 1 ~0109

vsr

401

0

 20 Rev
2-20 2

VICES PC

~WHITE PLAINS MEDICAL DIAGNOSTIC SER

F NEW YORK

5CANCER AND BLOOD MEDICAL SERVICES 0

8 LONGVIEW DEVELOPMENT CORPORATION

C & SUBS

3MONTEFIORE CONSOLIDATED VENTURES IN

MONTEFIORE INNOVATIONS INC

MONTEFIORE MEDICAL CENTER

000 & 91009

¥sr

 ejoi

0

1

Dd 'IVOI GaW aNV-IHDI H

C)

NONE

NONE

NONE

NONE

NONE

NONE

NONE

NONE

combine nes
b hrough (g

Tota ncome tax

(h)

Page 3

NONE

NONE

NONE

NONE
NONE

NONE

NONE

NONE

NONE

NONE

NONE

NONE

ncome Tax Apportionment

NONE

3N0N

Group members name

ncome Tax Apport onment See ins ructions

989'SL['I

zz

3N0N

E22

SIMON

zzzzz

(ELOZ-z: AaM) (OZLL uuod) o elnpalloS

IVOIGaW SNIV-ld 31IHM

CO

Od SJOI/\835 NVIDISAHd SNIV'ld 31IHM

Od 530IAHES

ONI 00 1.NaWEDVNVW SNIVld 3.LIHM

A

3NON

z

Z

989'SiC'I

3NON

O
3NON

z
3NON

N

z

Z

3NON

i

3NON

Schedule O Form

Z

 2-20 2

Group member's name

NC

MOSHOLU PRESERVATION CORPORATION

MONTEMOKE HEALTH SYSTEM

REHABILITATION HOSPITAL

THE WINIFRED MASTERSON BURKE

TEIN COLLEGE OF

7WHITE PLAINS HOSPITAL MEDICAL CENTER

NONE

NONE

ncome Tax Apport onment See instructions

20 Rev

SLCH CORPORATION

nwrooo

000 1 910109

vsr

401

0

NONE

NONE

NONE

NONE

NONE

17,

354,941

NONE

NONE

NONE

combine nes
b hrough (g

NONE

NONE

NONE

(h)
Tota ncome tax

NONE

NONE

NONE

NONE

ncome Tax Apport onment

Page 3

(ELOZZL 'A,B) (OZ:& uuod) 0 elnpell'S

.

ONI 530IA835 .IN)WaDVNYW HN

da00 ON agIAS JHdM

ONI ANVdWOO 30!nninSNI 3*OI33.[NOW

CO

3NON

40

z
3NON

9

U

3NON

Z

3NON

3NON

M

2222

SNON

Z

R

SNON

Z

9
3NON

-N
0

3:-

SNON

Schedule O Form

2

:p ./

3NON
3NON

S
2222

 2DAVIS AVENUE CORP

QUANTUM BIOTHERAPEUTICS LLC

Group membefs name

rl

LD<DOO

00-& 51009

Tota

NONE

Income Tax Apportionment (See ins ructions)

Schedule O Form 1120) (Rev 12-2012)

NONE

NONE

NONE

NONE

NONE

NONE

ncome Tax Apport onment

NONE

NONE

(h)
ncome tax

NONE

combine nes
b hrough (g

Tota

Page 3

(Z:OE-Zi 'Aell) (01&& uuod) O elnpal435

32

30

 6

5

WHITE PLAINS MANAGEMENT CO INC

VICES PC

WHITE PLAINS MEDICAL DIAGNOSTIC SER

F NEW YORK •

CANCER AND BLOOD MEDICAL SERVICES 0

8 LONGVI EW DEVELOPMENT CORPORATION

C & SUBS

3 MONTEFIORE CONSOLIDATED VENTURES IN

MONTEFIORE, INNOVATIONS INC

ONTEFIORE MEDICAL CENTER

Group membefs name

NONE

earnings credit

b) Accumulated

3NON

E2E2EE222

e) Penalty for failure

NONE

NONE

NONE

NONE

NONE

NONE

NONE

NONE

NONE

Other

NONE

to pay estimated tax

NONE

amount

AMT exemption

(d) Phaseout of

Other Apport onments

NONE

exemption amoun

NONE

NONE

000'Ob

Other Apportionments See instructions

Z

000'oSI

000 1 910139

vsr

401

0L

0

Od 'IVJ I 63W aNV-IHDI H

©0

Dd 53/IAMSS NVIOISAHd SNIvld 31IHM

Od ·SJOIA835 'n,DIaaW SNIrld 3,LIHM

N
Z

aNON

N
ZZ

2E2EE

page 4

(nozz& Aey) (OZL; ul,03) O elnpell 'S

2-2012

8

3NON

20 Rev

Z

3NON

Schedule O (Form

Z

Z

3NON

r
Z

 7

w

TE PLAINS HOSPITAL MEDICAL CENTER

MEDICINE, INC.

ALBERT El NSTE]N COLLEGE OF

MMC CORPORATION

On

000 l 9tolo

Tota

ONI SaOIAMaS .INSW39VNVW HN

CO

dMOD DNIalIng OHdM

ONI ANVdWOO 3/NVHASNI 33OI33.LNOW

6

C

MOSHOLU PRESERVATION CORPORATION

MONTEFIORE HEALTH SYSTEM

REHABILITATION HOSPITAL

2 THE WINIFRED MASTERSON BURKE

SLCH CORPORATION

Group member's name

NONE

earnings credit

b) Accumulated

NONE

exemption amoun

NONE

NONE

3NON

Other Apport onments See instructions

(d) Phaseout of
AMT exemption

Other Apport onments

NONE

50.000

Z

3NON

Rev. 2-2012

Z

ENON

0

Z

(e) Penalty for failure
to pay estimated tax
Other

NONE

NONE

NONE

2%=

page 4

(Z:OZ-Zi AeW) (01:& uuod) 0 ainpa435

E

9

3NON

3NON

Schedule O (Form

I'

0

E

0

ZzzzZZZ

 2 DA

Tota

MWOO>0

J

000'49k01O

S AVENUE CORP

QUANTUM BIOTHERAPEUTICS LLC

Group members name

NONE

NONE

NONE

earnings credn

NONE

exemption amoun

b) Accumulated

Other Apport onments See instructions

Schedule O (Form 120 Rev. 12-2012

<C

amount

NONE

NONE

AMT exemption

(d) Phaseout of

Other Apport onments

NONE

NONE

Othe

e) Penalty for failure

to pay estimated tax

NONE

NONE

page 4

(ZLOZ-Zi AaM) (Ont uuod) O einpaliJS

€

 Form

Return of U.S. Persons With Respect to
Certain Foreign Partnerships

B865

OMB No. 1545-1668

2016

I Attach to your tax return.
b Information about Form 8865 and its separate instructions is at www. irs. gov/form8865.

Information furnished for the foreign partnership's tax year

Depanment of the Treasury
Internal Revenue Service

beginning

JANUARY 1

, 2016, and endin9

DECEMBER 31

Attachment

Sequence No. 118

16

. 20

Filer's identifying number

Name of person filing this return

13-1740114

MONTEFIORE MEDICAL CENTER

A Category of filer (see Categories of Filers in the instructions and check applicable box(es)):

Filer's address (if you are not filing this form with your tax return)

1 El

4 El

30

2~

8 FiNer's tax year beginning

.20

. and endin

.20

Other S

Qualified nonrecourse financing S

C

Filer's share of liabilities: Nonrecourse S

D

If filer is a member of a consolidated group but not the parent, enter the following information about the parent:

EIN

Name
Address

E

Check if an exce ted s ecified forei n financial assets are re orted on this form see instructions

F

Information about certain other partners (see instructions)

El
(4) Check applicable box(es)

(3) Identifying number

(2) Address

(1) Name

Category 2 Ccrstructre o.·,rer

2(a) EIN (if any)

Name and address of foreign partnership

Gl

Category 1

98-1189484
2(b) Reference ID number (see instr.)
CIPS AIV, L.P

190 ELGIN AVENUE, GEORGE ISLANDS
KYl-9005
5 Principal place of
4 Date of

business

organization

6 Principal business

activity code number

523900
NEW YORK
01/01/2014
Provide the following information for the foreign partnership's tax year:
Name, address, and identifying number of agent (if any) in the

H
1

United States

3 Country under whose laws organized
CAYMANISLAND
8a Functional currency
7 Principal business
activity
INVESTMENTS

8b Exchange rate

(see instr.)
1.00

U.S. DOLLAR

2 Check if the foreign partnership must file:
~ Form 1065 or 1065-8
Il Form 8804
~ Form 1042
Service Center where Form 1065 or 1065-8 is filed:

N/A

4 Name and address of person(s) with custody of the books and

Name and address of foreign partnership's agent in country of

3

records of the foreign partnership, and the location of such books
and records, if different

organization, if any

CERBERUS CAPITAL MANAGEMENT, L.P.

N/A

,

.

Were any special allocations made by the foreign partnership?

5

E Yes

ONo

Entities,
Enter the number of Forms 8858, Information Return of U.S. Persons With Respect To Foreign Disregarded

6

How is this partnership classified under the law of the country in which it is organized?

7

8a
b

9

.

.

attached to this return (see instructions)

~ EXEMPTED LIMITED PARTNERSHIP

that is a separate
Does the filer have an interest in the foreign partnership, or an interest indirectly through the foreign partnership,
question Bb. K ~ Yes
unit under Reg. 1.1503(d)-1(b)(4) or part of a combined separate unit under Reg. 1.1503(d)-1(b)(4)(ii)? If "No,"skip
(5)(ii)? i O Yes
1.1503(d)-1(b)
Reg.
in
defined
as
loss
If "Yes," does the separate unit or combined separate unit have a dual consolidated
Does this partnership meet both of the following requirements?
i [] Yes
• The partnership's total receipts for the tax year were less than $250,000 and
~
• The value of the partnership's total assets at the end of the tax year was less than 51 million.
If "Yes," do not complete Schedules L, M-1, and M-2.

Sign Here
Only If You
Are Filing
This Form

Paid

Preparer
Use Only

[] No

and statements. and to the best of my knowledge
Under penalties of perjury, I declare that l have examined this return, including accompanying schedules
on all
and complete. Declaration of preparer (other than general partner or limited liability company member) is based

and belief, it is true, correct.
information of which preparer has any knowledge.

Separately
and Not With
Your Tax
Return.

~ No
Q No

--I
~

Oafe

Signature ol general partner or limited liability company member

Print/Type preparer's name

Firm's name

Preparer's signature

Date

PTIN

Firm's EIN I

4

Phone no.

Firm's address i

For Privacy Act and Paperwork Reduction Act Notice, see the separate instructions.

Check ~ it
self-employed

Cat. No. 25852A

Form 8865 (2016)

 page 2

>orm 6865 (20161

Constructive Ownership of Partnership Interest. Check the boxes that apply to the filer. If you check
box b, enter the name, address, and U.S. taxpayer identifying number (if any) of the person(s) whose

interest you constructively own. See instructions.

~ Ownsa constructive interest

b

a El Owns a direct interest

Identifying number (if any)

Address

Name

Check if

foreign
person

Certain Partners of Foreign Partnership (see instructions)

direct
panner

Check if

Identifying number (if any)

Address

Name

Check if

foreign

person

El No
¤ Yes
Does the partnership have any other foreign person as a direct partner?
p owns a
Affiliation Schedule. List all partnerships (foreign or domestic) in which the foreign partnershi

direct interest or indirectl owns a 10% interest.

Total ordinary

EIN

Address

Name

income or loss

(if any)

Check it
loreign
partnership

NONE

Income Statement-Trade or Business Income

See the instructions for more information.
Caution: Include only trade or business income and expenses on lines la through 22 below.

la

.

ncome

b Less returns and allowances .

Deductions (see instructions fo mitations

la

.

Gross receipts or sales

.

lc

1b

.

2
3
4
5
6
7

....
Cost obgoods sold
Gross profit. Subtract line 2 from line lc .
Ordinary income (loss) from other partnerships, estates, and trusts (attach statement)
Net farm profit (loss) (attach Schedule F (Form 1040))
Net gain (loss) from Form 4797, Part 11, line 17 (attach Form 4797)
. .
Other income (loss) (attach statement)

8

Total income loss). Combine lines 3 throu h7

8

Salaries and wages (other than to partners) (less employment credits)
Guaranteed payments to partners

11

Repairs and maintenance .

12
13

Bad debts
Rent

.

.

..

.

,

Taxes and licenses . .
Interest
16 a Depreciation (if required, attach Form 4562) . .
b Less depreciation reported elsewhere on return
Depletion (Do not deduct oil and gas depletion.)
17
Retirement plans, etc. . . . .
18
Employee benefit programs .
19
Other deductions (attach statement) . . .
20

4
5
6
7

.

9
10

.

2
3

.

...

9
10

11

12
13
14
15

.

14
15

.

.
.

.

168
16b

16c
17
18

.

19
20

21

h 20 .
Total deductions. Add the amounts shown in the far ri ht column for lines 9 throu

.

21

22

from line 8
Ordinary business income loss from trade or business activities. Subtract line 21

22
Form 8865 (2016)

 Transfer of Property to a Foreign Partnership

SCHEDULE O
(Form 8865)
Department of the Treasury
Internal Revenue Service

(under section 60388)

2@16

~ Attach to Form 8865. See instructions for Form 8865.
ov/form8865.
i Information about Schedule 0 (Form 8865) and its separate instructions is at www.irs.g

Filer's identifying number

Name of transferor

13-1740114

MONTEFIORE MEDICAL CENTER

Reference ID number (see instructions)

EIN (if any)

Name of foreign pannership

98-1189484

CIPS AIV L.P.

I~FII

OMBNo. 1545-1668

Transfers Reportable Under Section 60388

Type of

propeny

Cash

(a)
Date of
transfer

(b)

(c)

Number of

Fair market

items

value on date

transferred

of transfer

Cd)
Cost or other
basis

(e)
Section 704(c)
allocation
method

(g)

(f)
Gain recognized on
transfer

Percentage interest

in partnership after
transfer

.00439087

2,704,875

VARIOUS

Stock, notes
receivable and

payable, and other
securities

Inventory

Tangible

property
used in trade
or business
Intangible

property

Other

properly
Supplemental Information Required To Be Reported (see instructions):

~~

Dispositions Reportable Under Section 60388

(a)
Type of
properly

(b)
Date of

original
transfer

(c)
Date of

disposition

(d)
Manner 01

disposition

Ce)
Gain

recognized by
partnership

Depreciation
recapture

recognized
by partnership

(h)

(g)
Gain allocated
to partner

Depreciation

recapture allocated to
panner

N/A

r,~,11"1

904(f)(3) or
Is any transfer reported on this schedule subject to gain recognition under section
El Yes
section 904 5 ?.
,

For Paperwork Reduction Act Notice, see the Instructions for Form 8865.

Cat. No. 25909U

E No

Schedule O (Form 8865) 2016

 Return of U.S. Persons With Respect to
Certain Foreign Partnerships

. 5865

OMB No. 1545-1668

Department of the Treasury
Internal Revenue Service

beginning

Januar 1

, 2016, and ending

13-1740114

MONTEFIORE MEDICAL CENTER

A Category of filer (see Categories of Filers in the instructions and check applicable box(es)):

Filer's address (il you are not filing this form with your tax return)

4 El

30

2~

,20

B Filer's tax year beginning

Qualified nonrecourse financing $

Filer's share of liabilities: Nonrecourse $
If filer is a member of a consolidated group but not the parent, enter the following information about the parent:

D

Attachment

Sequence No. 118

16

, 20

December 31

Filer's identifying number

Name of person filing this return

C

2@16

b Attach to your tax return.
i Information about Form 8865 and its separate instructions is at www. irs.gov/form8865.
Information furnished for the foreign partnership's tax year

.20

, and endin
Other $

EIN

Name
Address

Check jf an exce ted s ecified forei n financial assets are re orted on this form see instructions
Information about certain other partners (see instructions)

E
F

(4) Check applicable box(es)
Category 2 Ccrencke oN=
Category 1

2(a) EIN (if any)

Name and address of foreign partnership

Gl

(3) Identifying number

(2) Address

(1) Name

98-1189556
2(b) Reference ID number (see instr.)
CIP4 AIV, L.P.
C/O CEREBUS CAPITAL MANAGEMENT, L.P.
190 ELGIN AVENUE
GEORGE TOWN, GRAND CAYMAN KYl-9005
5 Principal place of
4 Date of

business

organization

3 Country under whose laws organized
6 Principal business

activity code number

523900
NEW YORK
09/01/2014
Provide the following information for the foreign partnership's tax year:

H

Name, address, and identifying number of agent (if any) in the

1

United States

CAYMANISLANDS
8a Functional currency
7 Principal business

8b Exchange rate

(see instr,)

activity

1.00

U.S. DOLLAR

INVESTMENTS

2 Check if the foreign partnership must file:
~ Form 1065 or 1065-8
C Form 8804
U Form 1042
Service Center where Form 1065 or 1065-8 is filed:

N/A
Name and address of foreign partnership's agent in country of

3

organization, if any

4 Name and address of person(s) with custody of the books and

records of the foreign partnership, and the location of such books
and records, if different

CEREBUS CAPITAL MANAGEMENT, L.P.

N/A

, 0 Yes [3 No

5

Were any special allocations made by the foreign partnership?

6

Entities,
Enter the number of Forms 8858, Information Return of US Persons With Respect To Foreign Disregarded

attached to this return (see instructions)
How is this partnership classified under the law of the country in which it is organized?

7

8a
b

9

A EXEMPTED LIMITED PARTNERSHIP

that is a separate
Does the filer have an interest in the foreign partnership, or an interest indirectly through the foreign partnership,
question Bb. I U Yes
skip
"No,"
If
(4)(ii)?
1.1503(d)-1(b)
Reg.
under
unit
separate
combined
a
of
part
or
(b)(4)
unit under Reg. 1.1503(d)-1
in Reg. 1.1503(d)-1(b)(5)(ii)? ~ ~ Yes
If "Yes," does the separate unit or combined separate unit have a dual consolidated loss as defined

~ No
~ No

Does this partnership meet both of the following requirements?
• The partnership's total receipts for the tax year were less than $250,000 and
• The value of the partnership's total assets at the end of the tax year was less than $1 million.
I f "Yes," do not complete Schedules L, M-1, and M-2.

Sign Here
Only If You
Are Filing

h

[J Yes [J No

~

schedules and statements, and 10 the best of my knowledge
Under penalties of perjury, I declare that I have examined this return, including accompanying or limited liability company member) is based on all
and belief, it is true, correct, and complete. Declaration of preparer (other than general partner

information of which preparer has any knowledge.

This Form
Separately
and Not With
Your Tax
Return.

Paid

Preparer
Use Only

~lill--1-------f--Ill--.
F

Date

Signature of general partner or limited liability company member

Print/Type preparer's name

Preparer's signature

Date

F-1 .
Check U d

PTIN

self-employed
Firm's name

Firm-s EIN ~

i

Phone no.

Firm's address /

For Privacy Act and Paperwork Reduction Act Notice, see the separate instructions.

Cat. No. 25852A

Form 8865 (2016)

 Page 2

Form 886: (2016)

Constructive Ownership of Partnership Interest. Check the boxes that apply to the filer. If you check
box b, enter the name, address, and U.S. taxpayer identifying number (if any) of the person(s) whose
interest you constructively own. See instructions.
a

b

U Owns a direct interest

Identifying number (if any)

Address

Name

~ Ownsa constructive interest

Check if

foreign
person

Certain Partners of Foreign Partnership (see instructions)

.

Does the partnership have any other foreign person as a direct partner?

·

direct
partner

Checkif

Identifying number (if any)

Address

Name

Check il

foreign
person

j No

El Yes

ip owns a
Affiliation Schedule. List all partnerships (foreign or domestic) in which the foreign partnersh

direct interest or indirectl owns a 10% interest.

EIN

Address

Name

(if any)

Total ordinary

income or loss

Check it
foreign

partnership

None

-.

- =

Income Statement-Trade or Business Income

below. See the instructions for more information.
Caution: Include only trade or business income and expenses on lines la through 22

la Gross receipts or sales

DedUCtionS (see instructions fo

mitations

ncome

b

2
3
4
5
6
7

.

la

.
.

Less returns and allowances .
Cost of goods sold

1b

.

Gross profit. Subtract line 2 from line lc
)
Ordinary income (loss) from other partnerships, estates, and trusts (attach statement
1040))
(Form
F
Schedule
(attach
Net farm profit (loss)
Net gain (loss) from Form 4797, Part II, line 17 (attach Form 4797)
Other income (loss) (attach statement)

8
9
10
11
12

.....
Total income (loss). Combine lines 3 throu h7 . .
credits)
nt
employme
(less
partners)
to
than
(other
wages
and
Salaries
Guaranteed payments to partners
Repairs and maintenance .
Bad debts .

13

Rent

14
15
16 a

Taxes and licenses
..........
Interest .
Depreciation (if required, attach Form 4562) .

.

1c
2
3
4
5
6

8
9
10
11
12

13
14

15

.

16a
16b

16c
17
18
19
20

17
18
19
20

Less depreciation reported elsewhere on return
Depletion (Do not deduct oil and gas depiction.)
Retirement plans, etc.
Employee benefit programs
Other deductions (attach statement)

21

9 throu h 20
Total deductions. Add the amounts shown in the far ri ht column for lines

21

22

line 21 from line 8
Ordinary business income (loss from trade or business activities. Subtract

22

b

Form 8865 (2016)

 Transfer of Property to a Foreign Partnership
(under section 60388)

SCHEDULE O
' (Form 8865)
Department of the Treasury
Internal Revenue Service

2016

h Attach to Form 8865. See Instructions for Form 8865.
65.
i Information about Schedule 0 ( Form 8865) and its separate instructions is at www.irs.gov/form88

Filer's Identifying number

.Name 01 transferor

13-1740114

MONTEFIORE MEDICAL CENTER

Reference ID number (see instructions)

EIN (if any)

Name of foreign partnership

98-1189556

CIP4 AIV L.P.

IMM11

OMB No. 1545-1668

Transfers Reportable Under Section 60388
(a)
Date of

Type of

property

transfer

Cash

(b)
Number of

items
transferred

(c)
Fair market

value on date
of transfer

(d)
Cost or other

basis

Ce)
Section 704(c)

allocation
method

(9)
Gain recognized on
transfer

in partnership after

transfer
.00025225

142 344

VARIOUS

Percentage interest

Stock, notes
receivable and
payable, and other
securities

Inventory

Tangible

property
used in trade

or business
Intangible

property

Other
property

Supplemental Information Required To Be Reported (see instructions):

[~

Dispositions Reportable Under Section 60388

(a)
Type of
property

(b)
Date 01
original

transfer

(c)
Date ot

disposition

(d)
Manner of

disposition

(e)
Gain
recognized by

partnership

(h)

Depreciation

(g)

recapture
recognized
by partnership

Gain allocated
to padner

Depreciation

recapture allocated to
panner

N/A

r,1.,Irn

section 904(f)(3) or
Is any transfer reported on this schedule subject to gain recognition under

8865.
For Paperwork Reduction Act Notice, see the Instructions for Form

Cat. No. 25909U

9 No

Schedule O (Form 8865) 2016

 Fonn

Information Return of U.S. Persons With Respect
To Certain Foreign Corporations

5471

(Rev December 2015)

Depanment of the Treasury

Internal Revenue Service

OMB No. 1545-0704

4 For more information about Form 5471 , see www.irs.gov/form5471
for the foreign corporation's annual accounting period (tax year required by
furnished
Information
, and ending 12 31 2016
section 898) (see instructions) beginning 01 01 2016

Attachment

Sequence No. 121

A Identifying number

Name of person filing this return

13-1740114

MANTEFIORE MEDICAL CENTER

8 Category of fiter (See instructions. Check applicable box(es)):
Number. street, and room or suite no. (or P.O. box number if mail is not delivered to street address)

1

111 EAST 210TH STREET
City or town. state, and ZIP code

BRONX,

4

3

re ealed 2

5X

C Enter the total percentage of the foreign corporation's voting

stock you owned at the end of its annual accounting period

NY 10467

. and ending 12

31

25

%

2016

01/01/2016
................
0 Check if any excepted specified foreign financial assets are reported on this form (see instructions) ..............
Filers tax year beginning

E Person(s) on whose behalf this information return is filed:

(4) Check applicable box(es)
(3) Identifying number

(2) Address

(1)Name

Shareholder

Officer

Director

All amounts must be stated in
Important : Fill in all applicable lines and schedules. All information must be in English.
U.S. dollars unless otherwise indicated.
identification number, if any
b(1) Employer

1 a Name and address of foreign corporation

FOREIGNUS

FFH INSURANCE COMPANY LIMITED
P.O. BOX 1760, CHEVRON HOUSE CHURCH STREET
HAMILTON, HM11 BD

b(2) Reference ID number (see instructions)

FFH COMPANY
c

Country under whose laws incorporated

BD
d Date of incorporation

08/11/1982

f Principal business activity
code number

e Principal place of business

BD

524140

h Functional currency

g Principal business activity

INSURANCE

USD

above.
2 Provide the following information for the foreign corporation's accounting period stated
in the
a Name, address, and identifying number of branch office or agent (if any)

United States

(i) Taxable income or (loss)

c Name and address of foreign corporation's statutory or resident agent in country

of incorporation

DYNA MANAGEMENT SERVICES LTD.
141 FRONT STREET, 3RD FLOOR
HAMILTON, BD HM 19

Stock of the Forei n Corporation
(a) Description of each class of stock

For Paperwork Reduction Act Notice, see instructions.

JSA
6 X 1 660 1,000

b If a U.S. income tax return was filed, enter

(ii) U.S. income tax paid
(after all credits)

(or
d Name and address (including corporate department, if applicable) of person

persons) with custody of the books and records of the foreign corporation, and
the location of such books and records. if different

DYNA MANAGEMENT SERVICES LTD.
141 FRONT STREET, 3RD FLOOR,
HAMILTON
HM 19
BD
(b) Number of shares issued and outstanding

8) Beginning of annual

accounting period

(ii) End of annual

accounting period

Form 5471 (Rev. 12-2015)

 page 2

Form 5471 (Rev. 12-2015)

·=

-•

U.S. Shareholders of Foreign Corporation (see instructions)

(a ) Name , address , and identifying

number of shareholder

(b) Description of each dass of stock held by
shareholder, Note : This descnption should

match the corresponding descnption entered in
Schedule A, column a .

(c) Number of

(d) Numberof

shares held at
shares held at
end of annual
beginning of annual
accounting enod accountin period

(e) Pro rata share
of subpaM F

income Center as
a ercentage

Income Statement (see instructions)
S.
all information in functional currency in accordance with U. S. GAAP. Also, report each amount in U.
Report
Important :
U.S.
the
is
currency
functional
the
if
However,
rules).
translation
GAAP
dollars translated from functional currency (using
ns.
dollar, complete only the LES. Dollars column. See instructions for special rules for DASTM corporatio
Functional Currency
la

b

c

1a

Gross receipts or sales
Returns and allowances
Subtract linelbfromline 18

1b
k
2

2

Cost of goods sold

3

Gross profit (subtract line 2 from line lc)

3

4

Dividends

4

5

Interest

Ga
b
7

8

Other income (attach statement) . . . . .

5
6b
7

STATENMENT.1, ,

Total income add lines 3 throu h 8 .................

9
11 a

8
9

Rents

10
1la

Compensation not deducted elsewhere

10

Royalties and license fees

1lb

12

Interest

12

13

Depreciation not deducted elsewhere

14

Depletion

13
14

15

Taxes (exclude provision for income, war profits. and excess profits taxes)

16

Other deductions (attach statement - exclude provision for income, war

b

. . .

17

profits, and excess profits taxes) , ..S.T.A,TEMENT 1 ..,.,
Total deductions add lines 10 throu h 16 ..............

18

Net income or (loss) before extraordinary items, prior period

adjustments. and the provision for income, war profits, and excess
profits taxes (subtract line 17 from line 9)

16

813 585

17

813,585

18

609, 725

Extraordinary items and prior period adjustments (see instructions) , ,

19

20

Provision for income. war profits, and excess profits taxes (see instructions)

, ,

20

21

Current ear net income or loss) erbooks combine lines 18throu h 20 ,..

21

JSA

622 310

1,423,310

15

19

6x 1661 1.000

801,000

Ga

Gross rents
Gross royalties and license fees
Net gain or (loss) on sale of capital assets

U.S. Dollars

609

725

Form 5471 (Rev. 12-2015)

 page 3

Form 5471 (Rev. 12-2015)

Income, War Profits, and Excess Profits Taxes Paid or Accrued see instructions

Amount of tax

(a)

(d)

(c)
Conversion rate

(b)
In foreign currency

Name of country or U.S. possession

In U.S. dollars

1 U.S.
2
3
4
6
7

8

Total

-0

-

Balance Sheet

GAAP. See instructions
Important : Report all amounts in U. S. dollars prepared and translated in accordance with U. S.
for an exception for DASTM corporations.
Assets
1
1
2a
b

3

4
5

Cash
Trade notes and accounts receivable .
Less allowance for bad debts
Inventories
Other current assets (attach statement)
Loans to shareholders and other related persons
Investment in subsidiaries (attach statementL . . .

6

Ba

b
9a

b

accounting period
300 556

accounting pedod

523 921

2b

3
4
5

STATEMEN.T. 2

6
7

5,106,256

13,121,077

14 825,000

5,512,212
13,684 777
14 825,000

Ba

Buildings and other depreciable assets
Less accumulated depreciation
Depletable assets
Less accumulated depletion

8b
9a

9b
10

Land (net of any amortization)

10

(b)

End of annual

2a

2
STATEMENT
......
Other investments (attach statement) ............

7

(a)
Beginning of annual

Intangible assets.

11

1la

a Goodwill
b Organization costs
c Patents. trademarks, and other intangible assets .............

1lb

....

1ld

d Less accumulated amortization for lines 1 la, b and c
12

STATEMENT 2
Other assets (attach statement) .....................

13

Total assets .

llc

119,624

12

13

33,352,889

34,665,534

Accounts payable

14

155,818

125 757

15

Other current liabilities (attach statement) .....

15

16

Loans from shareholders and other related persons ,

16

632,838

3 572,063

17
18

Other liabilities (attach statement) ..........
Capital stock:

Liabilities and Shareholders' Equity
14

STATEMENT 2.

18a

b Common stock

18b
19

20

Paid-in or capital surplus (attach reconciliation)...
Retained earnings

21

Less cost of treasury stock,

22

Total liabilities and shareholders' equity

19

JSA

6 X 1662 1 000

187 200

17

Preferred stock

a

2

6 405,000

6,405,000

20

23,972,033

24,562,714

22

33

352

88 9

34 665 534
Form 5471 (Rev 12-2015)

 page 4

Form 5471 (Rev. 12-2015)

.

Other Information

in any foreign
During the tax year, did the foreign corporation own at least a 10% interest, directly or indirectly,

1

partnership?
If "Yes," see the instructions for required statement.
.................
During the tax year, did the foreign corporation own an interest in any trust? ......
as entities separate
During the tax year, did the foreign corporation own any foreign entities that were disregarded
? ............
from their owners under Regulations sections 301 7701-2 and 301 7701-3 (see instructions)

2
3

.
If "Yes," you are generally required to attach Form 8858 for each entity (see instructions)
t? ..............
During the tax year, was the foreign corporation a participant in any cost sharing arrangemen
sharing arrangement?.
cost
any
in
During the course of the tax year, did the foreign corporation become a participant
in Regulations
defined
as
transaction
During the tax year, did the foreign corporation participate in any reportable

4

5
6

No

El
m
m

gl
gl
gl

85

section 1.6011-4?
I f "Yes," attach Form(s) 8886 if required by Regulations section 1.6011-4(c)(3)(i)(G).
for credit under
During the tax year. did the foreign corporation pay or accrue any foreign tax that was disqualified

7

Yes

section 901(m)?

0

gl

0

gl

909 applies, or treat
During the tax year, did the foreign corporation pay or accrue foreign taxes to which section

8

X

.
foreign taxes that were previously suspended under section 909 as no longer suspended? ............

Current Earnings and Profits (see instructions)
the amounts on lines 1 through 5c in functional currency .
Enter
nt:
Importa

Net adjustments made to line 1 to

2

determine current earnings and profits
according to U.S. financial and tax

Net
Additions

6 09,72 5

1

Current year net income or (loss) per foreign books of account

1

Net

Subtractions

accounting standards (see instructions)·
a Capital gains or losses

b Depreciation and amortization . ....
c Depletion
d Investment or incentive allowance.,,

e Charges to statutory reserves ......
f

Inventory adjustments

g Taxes
h Other (attach statement) .

3

Total net additions

4

Total net subtractions

STMT 3 .

1,120,154

1 120 154

5 a Current earnings and profits Cline 1 plus line 3 minus line 4) ........................
b DASTM gain or (loss) for foreign corporations that use DASTM (see instructions) ..............
c Combine lines 5a and 5b
rate as
d Current earnings and profits in U.S. dollars (line Sc translated at the appropriate exchange

defined in section 989(b) and the related regulations (see instructions))
Enter exchange rate used for line 5d h 1.0000000

-510,429

53

5b
Sc

-510,429

Sd

- 510,429

Summar of Shareholder's Income From Foreign Corporation (see instructions)

Category 4 or 5 filer for whom reporting is furnished on
If item E on page 1 is completed, a separate Schedule I must be filed for each
this Form 5471. This schedule I is being completed for:
Name of U S shareholder I MANTEFIORE MEDICAL CENTER

Identifying number $

13-1740114
1

2

Subpart F income (line 38b, Worksheet A in the instructions)
Earnings invested in U.S property (line 17, Worksheet B in the instructions)

2

3

(line 64, Worksheet C in the instructions)
Previously excluded subpar't F income withdrawn from qualified investments

3

1

4

(line 7b,
Previously excluded export trade income withdrawn from investment in export trade assets
Worksheet D in the instructions)

5

Factoring income

6

Total of lines 1 through 5. Enter here and on your income tax return. See instructions ............

7
8

Dividends received (translated at spot rate on payment date under section 989(b)(1))
Exchange gain or (loss) on a distribution of previously taxed income

Was any income of the foreign corporation blocked?
• Did any such income become unblocked during the tax year (see section 964(b))?
If the answer to either question is 'Yes," attach an explanation.

4
5

6

7
Yes

No

•

JSA
6*1663 1 000

Form 5471 (Rev 12-2015)

 r.1 U
On
S

S

m

o

mP~ional currency

ear deficit in E&P

nN

ut (0)696 UO,1035 Japun pelpssep@J JO

Amounts included under section 951(a

viously taxed (line 1
or line 1 minus line 2b

Total curren and accumulated

b Curren

LIMITED

t: Enter amounts in

INSURANCE COMP

@C

jo suolinquisip len}OV

q

E

E

E

000 & 99911(9

4 217 311

510 429

3 706 882

pos 86 section
959(c 3) balance

a Pos 986
Undis buted Earnings

4£179 utiod Joi SUO!;in.Ilsul 04& ees '00!JON 139 uo!;3npahl }IJOM.laded JO=1

St JaA34014

WOJ; JunO

Jalu3) JeaA Jo pue le eouel

aull snu,w 't, auil snu!

c eu!1) JeeA Jo pue le pexei
Alsno,AaJd ou d93 Jo eoueles

S

q

Jo pue le d93
snld L eu )
pexej klsno!Aajd Jo eoueles e9

d'93 Paxe: Alsno!A@Jduou

es

Z

JO SUOilnqulsip len}OV

4

C

C

3

- mr + A

pre-87 section
959(c 3) balance

Not Previously Taxed

b Pre-1987 E&P

in U S. Property

C Earnings Invested

62

ITE LIZ D

ER

0- N

IZE LIZ D

C

inst

I Attach to Form 547 .

~ Information about Schedule J (Form 5471 ) and

0 --

(E&P)

(ii)

311 000

0 Subpart F Income

Vioonu~ly95T~~c~Etty:~ ~na~~r~~iso~s

FFH COMPANY

545-0704

a

3 395 882

b and (c

combine columns

964(a) E&P

d Total Section

Reference ID numbe see instructions

13-1740114

dentifying number

OMB No

(ZLOZ-Zt Aekl) (WPS wiod) r ainpe435
IIE'906'E000 IIE

Accumulated Earnings and P
of Controlled Forei n C
5
000 IIE

SCHEDULEJ

4
2

2§2

 Transactions Between Controlled Foreign Corporation
and Shareholders or Other Related Persons

SCHEDULE M

(Form 5471)

(Rev. December 2012)
Department of the Treasury
Internal Revenue S ennce
Name of person filing Form 5471

.
I Information about Schedule M ( Form 6471 ) and its instructions is at www.irs. gov/form5471
I Attach to Form 6471.

OMB No. 1545-0704

Identifying number

13-1740114

MONTEFIORE MEDICAL CENTER

EIN (if any)

Name of foreign corporation

Reference ID number (see instructions)

FFH COMPANY

FOREIGNUS

FFH INSURANCE COMPANY LIMITED

for each type of transaction that occurred during
important·. Complete a separate Schedule M for each controlled foreign corporation. Enter the totals
through (f) All amounts must be stated in U.S.
(b)
columns
in
listed
persons
the
and
corporation
foreign
the
between
period
accounting
annual
the
tax year See instructions.
dollars translated from functional currency at the average exchange rate for the foreign corporation's
1.0000
i
schedule
this
USD
throughout
used
rate
Enter the relevant functional currency and the exchange
(c) Any domestic
(a) Transactions

(b) US. person

of
foreign corporation

filing this return

corporation or
padnership controlled
by U.S. person filing

this return

(d) Any other foreign

corporation or
partnership controlled
by U.S. person filing
this return

(e) 10% or more U.S.
shareholder of
controlled foreign

(f) 10% or more U.S.

corporation (other than

shareholder of any
corporation
controlling the

this return)

foreign corporation

the U.S. person filing

1 Sales of stock in trade (inventory)
2 Sales of tangible property other

than stock in trade ......
rights
property
of
(patents, trademarks, etc.)...

3 Sales

4 Platform contribution transaction

payments received ......
5 Cost sharing transaction pay-

ments received ........
6 Compensation received for tech-

nical, managerial, engineering,
construction, or like services . .

7 Commissions received .....
8 Rents,

royalties,

and

license

fees received
9 Dividends

deemed

received (exclude
distributions under

subpart F and distributions of

previously taxed income). . . .

10 Interest received ........
11 Premiums received for insurance

or reinsurance .........
12 Add lines 1 throu h 11 ....
13 Purchases 01 stock in trade (inventory)
14 Purchases of tangible property

other than stock in trade ....
1 5 Purchases

of property

rights

(patents, trademarks, etc ).. .
16 Platform contribution transaction

payments paid ........
1 7 Cost sharing transaction payments paid .

18 Compensation paid for tech-

nical, managerial, engineering,
construction, or like services . .

19 Commissions paid .......
20 Rents, royalties, and license fees paid

21 Dividends paid ........
22 Interest paid
23 Premiums paid for insurance or reinsurance

24 Add lines 13 throu h 23 ....
25 Amounts borrowed (enter the

maximum loan balance during
the year) - see instructions . , ,
26 Amounts

loaned

(enter

the

maximum loan balance during
the year) - see instructions . . .
For Paperwork Reduction Act Notice, see the Instructions for Form 5471.

JSA

6 X 1664 1.000

3,572,063.00

5 512 212.00
Schedule M (Form 5471)(Rev 12-2012)

 FFH INSURANCE COMPANY LIMITED

FORM 5471, PAGE 2 DETAIL

SCH C, LINE 8 - OTHER INCOME
622,310.

OTHER INCOME

-

622,310.

TOTAL

SCH C, LINE 16 - OTHER DEDUCTIONS
----

FULTON - SHARE OF LOSS
LEGAL EXPENSES

MANAGEMENT FEES
SECRETARIAL FEES
GOVERNMENT FEES
ACTUARIAL FEES
AUDIT FEES
TRAVEL
COURIER CHARGES
MISCELLANEOUS EXPENSES

-121,844.
4,519.

478,796.
14,218.
11,160.
161,904.
150,228.
1,409.
116.
113,079.

813,585.
TOTAL

STATEMENT

1

 FFH INSURANCE COMPANY LIMITED
FORM 5471, PAGE 3 DETAIL

SCH F, LINE 6 -

BEGINNING

INVESTMENT IN SUBSIDIARIES
INVESTMENT IN AFFLIATED COMPANIES

13,121,077.

ENDING

13,684,777.
---------------

TOTAL

13,121,077.

13,684,777.

14,825,000.

14,825,000.

14,825,000.

14,825,000.

SCH F, LINE 7 OTHER INVESTMENTS
OTHER INVESTMENTS
TOTAL

SCH F, LINE 12 - OTHER ASSETS
PREPAID EXPENSES
TOTAL

NONE

119,624.

NONE

119,624.

SCH F, LINE 17 - OTHER LIABILITIES
--

OUTSTANDING LOSS RESERVE

--

NONE.

187,200.
-

-

TOTAL

NONE.

187,200.

STATEMENT

2

 FFH INSURANCE COMPANY LIMITED
FORM 5471, PAGE 4 DETAIL

SCH H, LINE 2H OTHER RECONCILING ITEMS

NET ADDITIONS

NET SUBTRACTS
--

INVESTMENT LOSS
REVERSE LOSS & LOSS EXPENSES
RETURN OF CAPITAL DISTRIBUTION
TOTAL

622,310.
121,844.
376,000.

1,120,154.

STATEMENT

3

 Forrn

Information Return of U.S. Persons With Respect
To Certain Foreign Corporations

5471

(Rev. December 2015)
Department of the Treasury
Internal Revenue Service

OMB No. 1545-0704

I For more Information about Form 5471 , see wwn,/.irs.gov/form5471
Information furnished for the foreign corporation's annual accounting period (tax year required by

Attachment

Sequence No. 121

, and ending 12 31 2016

section 898) (see instructions) beginning 01 01 2016

A Identifying number

Name of person filing this return

13-1740114

MONTEFIORE MEDICAL CENTER

Category of filer (See instructions. Check applicable box(es))
Number, street, and room or suite no. (or P.O. box number if mail is not delivered to street address) 8

1

111 EAST 210TH STREET

BRONX,

stock you owned at the end of its annual accounting period

NY 10467

01/01/2016

Filers tax year beginning

5X

4

3

re ealed 2

C Enter the total percentage of the foreign corporation's voting

City or town, state, and ZIP code

25

%

. and ending 12 31 2016

D Check if any excepted specified foreign fnancial assets are reported on this form (see instructions)
E Person(s) on whose behalf this information return is filed:

(4) Check applicable box(es)
(3) Identifying number

(2) Address

(1) Name

Shareholder

Officer

Director

amounts must be stated in
Important: Fill in all applicable lines and schedules. All information must be in English. All

LES. dollars unless otherwise indicated.

b(1) Employer identification number, if any

la Name and address of foreign corporation

FOREIGNUS

FFH INSURANCE CORPORATION
MARS HOUSE, 13 PINE ROAD
BELLEVILLE, BB

b(2) Reference ID number (see instructions)

FFH CORPORATION
c

Country under whose laws incorporated

BB
d Date of incorporation

12/24

1986

f Principal business activity

e Principal place of business

BB

h Functional currency

g Principal business activity

code number

524140

USD

INSURANCE

2 Provide the following information for the foreign corporation's accounting period stated above.
a Name. address, and identifying number of branch office or agent (if any) in the

United States

(i) Taxable income or (loss)

c Name and address of foreign corporation's statutory or resident agent in country

ol incorporation

USA RISK GROUP BARBADOS LTD
FIRST FLOOR
GOLDEN ANCHORAGE COMPLEX
ST. JAMES BB BB24014
SUNSET CREST

-.

· ·

Stock of the Forei n Corporation
(a) Description of each class of stock

For Paperwork Reduction Act Notice, see Instructions.

JSA
6X 1660 1.000

b If a U.S. income tax return was filed. enter:

(ii) U.S, income tax paid

(after all credits)

d Name and address (including corporate department. if applicable) of person (or

persons) with custody of the books and records of the foreign corporation, and
the location of such books and records, if different

DAVID KING & CO.
1ST FLOOR,UNITED INSURANCE CENTRE
LOWER BROAD ST.,
BB

BRIDGETOWN

(b) Number of shares issued and outstanding

6) Beginning of annual

accounting penod

60 End of annual

accounting period

Form 5471 (Rev 12-2015)

 page 2

Form 5471 (Rev, 12-2015)

U.S. Shareholders of Forei n Cor oration (see instructions)

- =

-.

(b) Description of each dass of stock held by
shareholder. Note : This descAption should

( a ) Name . address . and identifying

match the corresponding description entered in

number of shareholder

(c) Number of

(d) Numberof

shares held at

shares held at
end ofannual

beginning of annual
accountin

Schedule A, column a).

enod

Income Statement (see instructions)

(e) Pro rata share
of subpan F

accountin period

income (enter as
a percenta e)

amount in U. S.

Important : Report all information in functional currency in accordance with U. S. GAAP. Also, report each
is the U.S.
dollars translated from functional currency (using GAAP translation rules). However, if the functional currency
s.
corporation
DASTM
for
rules
special
for
s
dollar, complete only the U.S. Dollars column. See instruction
Functional Currency

la

b
c

2
3
4

la

Gross receipts or sales
Returns and allowances
Subtract linelbfromlinela
Cost of goods sold
Gross profit (subtract line 2 from linelc)
Interest

6a
b

Gross rents
Gross royalties and license fees

7

Net gain or (loss) on sale of capital assets

8

Other income (attach statement)

9

Total income add lines 3 throu h 8 .................

126

3

126, 782,000

5

7

52 653 000

9
10

Rents
Royalties and license fees

1lb

12

Interest

13

Depreciation not deducted elsewhere

12
13

14

Depletion

15

Taxes (exclude provision for income, war profits, and excess profits taxes)

16

Other deductions (attach statement - exclude provision for income, war

179,718,000

14
, ,

17

Profits, and excess profits taxes) ...STATEMENT 1...,
Total deductions add lines 10 throu h 16 ..............

18

Net income or (loss) before extraordinary items, prior period

adjustments, and the provision for income, war profits, and excess
profits taxes (subtract line 17 from line 9)

15

16

165 146 000

17

165,146,000

18

14 , 572, 000

19

Extraordinary items and prior period adjustments (see instructions) . .

19

20

Provision for income. war profits, and excess profits taxes (see instructions) ,

0

20

21

Current ear net income or loss

erbooks combine lines 18throu h 20 ...

21

JSA

000

6b

1la

6 X 1661 1 000

283

Ga

Compensation not deducted elsewhere
b

782,000

1c
2

4

Dividends

11 a

126, 782, 000

1b

5

10

U.S. Dollars

14

572

000

Form 5471 (Rev. 12-2015)

 page 3

Form 5471 (Rev. 12-2015)

Income, War Profits, and Excess Profits Taxes Paid or Accrued see instructions

Amount of tax

(a)
Name of country or U.S, possession

1

(b)

(c)

(d)

In foreign currency

Conversion rate

In U.S. dollars

U.S.

2
3
4
5
6
7

8

Total

Balance Sheet
GAAP. See instructions
important: Report all amounts in U.S. dollars prepared and translated in accordance with U.S.
for an exception for DASTM corporations.
(b)

(a)

Assets
1

Beginning 01 annual
2,000
period
accounting
26,37

Cash

1
2a

b

Trade notes and accounts receivable
Less allowance for bad debts

3

Inventories

4

Other current assets (attach statement)

STATEMENT #' ' ~ '

5

Loans to shareholders and other related persons

Investment in subsidiaries (attach statement)

7

Other investments (attach statement) ......................

.....

STATEMENT 2'

3

143,347 000

5

9,334,000

1,147,217,000

119,889,000
9 421,000
1,222,137 000

12

3,720,000

5 126,000

13

1,481, 881, 000

1,523,067,000

6
7

8a

Less accumulated depreciation
Depletable assets
.......
Less accumulated depletion ....................

9a

b

Land (net of any amortization) ,

10

11

8,412 000
158,082,000

4

Ba Buildings and other depreciable assets ......................
9a

accounting penod

2b

6

b

151,891,000

2a

End of annual

8b
9b
10

Intangible assets:
1la

a Goodwill
b Organization costs

1lb

c Patents, trademarks, and other intangible assets .................
d Less accumulated amortization for lines 1 la, b, and c ...............

1ld

Other assets (attach statement)

STATEMENT 2

Total assets .

13

llc

Liabilities and Shareholders' Equity
14

Accounts payable

15

Other current liabilities (attach statement) .....

16

Loans from shareholders and other related persons

17
18

Other liabilities (attach statement)
Capital stock:
Preferred slock

a

b Common stock
19

Paid-in or capital surplus (attach reconciliation) ,,,

20

21

Retained earnings
Less cost of treasury stock

22

Total liabilities and shareholders' equity

j
54,000

57,000

1,388,934,000

1,415,921,000

9,825,000

9,825,000

83,068,000

97,264 000

14

15
16

STATEMENT 2

17
18a
18b

19
2

22

1

481,881,000

1 523,067 000
Form 5471 (Rev. 12-2015)

JSA

6*1662 1.000

 page 4

Form 5471 (Rev. 12-2015)

Other Information
During the tax year, did the foreign corporation own at least a 10% interest, directly or indirectly, in any foreign

1

partnership?
If "Yes," see the instructions for required statement.
During the tax year, did the foreign corporation own an interest in any trust?
During the tax year, did the foreign corporation own any foreign entities that were disregarded as entities separate
from lheir owners under Regulations sections 301,7701-2 and 301 7701-3 (see instructions)?

2

3

If "Yes," you are generally required to attach Form 8858 for each entity (see instructions)

4

During the tax year, was the foreign corporation a participant in any cost sharing arrangement? ...........

5

During the course of the tax year, did the foreign corporation become a participant in any cost sharing arrangement? ....
During the tax year, did the foreign corporation participate in any reportable transaction as defined in Regulations

6

Yes

No

m
0
0

gl
gl
1

85

section 1.6011-4?
I f "Yes," attach Form(s) 8886 if required by Regulations section 1.6011-4(c)(3)(i)(G).
During the tax year, did the foreign corporation pay or accrue any foreign tax that was disqualified for credit under

7

El

section 901(m)?
During the tax year, did the foreign corporation pay or accrue foreign taxes to which section 909 applies, or treat

8

gl
X

foreign taxes thal were previously suspended under section 909 as no longer suspended? .............

Current Earnings and Profits (see instructions)
the amounts on lines 1 through 5c in functional currency.
Enter
:
Important

Net adjustments made to line 1 to

2

Net
Additions

determine current earnings and profits
according to U.S financial and tax

14, 572 00 0

1

Current year net income or (loss) per foreign books of account

1

Net

Subtractions

accounting standards (see instructions):

a Capital gains or losses ..........
b Depreciation and amortization
c Depletion
d Investment or incentive allowance....

e Charges to statutory reserves .......
f Inventory adjustments ..........

g Taxes
h Other (attach statement) · .

3

Total net additions

4

Total net subtractions

STMT 3.

175,610,000
175,610 000

200,193,000

200 193,000
-10,011,000

5 a Current earnings and profits (line 1 plus line 3 minus line 4) ........................ Sa
b DASTM gain or (loss) for foreign corporations that use DASTM (see instructions) ..............
c Combine lines 5a and 5b
d Current earnings and profits in U.S. dollars (line Sc translated at the appropriate exchange rate as

defined in section 989(b) and the related regulations (see instructions))
Enter exchange rate used for line 5d ~

5b
Sc

-10,011,000

Sd

- 10,011,000

1. 0000000

Summar of Shareholder's Income From Foreign Corporation (see instructions)

reporting is furnished on
If item E on page 1 is completed, a separate Schedule I must be filed for each Category 4 or 5 filer for whom
for:
completed
this Form 5471. This schedule I is being
Name of US shareholder I MONTEFIORE MEDICAL CENTER

Identifying number ~

13-1740114

2

Subpart F income (line 38b, Worksheet A in the instructions)
Earnings invested in U.S. property (line 17. Worksheet B in the instructions)

1
2

3

in the instructions)
Previously excluded subpart F income withdrawn from qualified investments (line 6b, Worksheet C

3

1

4

Previously excluded export trade income withdrawn from investment in export trade assets (line 7b,
Worksheet D in the instructions)

4

6

5
Factoring income
6
.....
.
.
.
.
.
.
.
instructions
See
return
Total of lines 1 through 5. Enter here and on your income tax

7
8

Dividends received (translated at spot rate on payment date under section 989(b)(1))
Exchange gain or (loss) on a distribution of previously taxed income

5

Was any income of the foreign corporation blocked?
• Did any such income become unblocked during the tax year (see section 964(b))?
If the answer to either question is "Yes," attach an explanation.

•

7
Yes

No

E~ 73
Form 5471 (Rev 12-2015)

JSA
6 X 1663 1.000

 E
S
O

ER

o

2

0

J

0

=

0

2a or line 1 minus ne 2b

Amounts included under section 95'Ha

2

d93 Paxel Alsno,Aejd

Jo suoileogissepal

E

<C

E25

E~

000 1 5990(9

78 664 000

10 011 000

68 653 000

pos 86 section
959(c 3) balance

a Pos 986
Undistributed Earnings

.:Lt'9 U'Jod Joi suo!}onJ}sul 84; gas '03!}ON 13\1 umpnpabl MioNuaded

q

eg

1-

('alqeolldde El JaA040!4M
qg aull Jo 29 aull UIOJJ luno

Jall13)'JeaA Jo pua }e aouel

qg auil snuiw '4 eull snui

c eull) JeaA jo pue le paxej

Alsno,Aaid ou di93 JO @oueleg

es aull snuiul '17 Bull

snid K eu ) Je@A jo pue le d~93
paxe} Alsno,A@Jd Jo eoueles

2

d'83 Paxe} Alsno!Amd

es

7

0

JO SUOIinq,Jls!P lenjov

p ~ A '1

E&P not reviously taxed

and accumulated

C

u! (0)696 UO,pas Japun pagsse10@J JO

U) Z 50 s z Z Z EL,

rtant: Enter amounts in

INSURANCE CORPORATION

C

959(c 3) balance

pre-87 section

Not Previously Taxed

b Pre-1987 E&P

A

000 D99 8L

MEDI

LL
any

(i,)~r'El!;~~:sn~sp

OMB No

CORPORATION

545-0704

68,653 000

nv~vyd C ) Subparl F Income (combi
ne columns
a (b). and (c

964(a) E&P

d) Total Section

Reference ID number (see instructions

13-1740114

dentifying number

c ~rioonussl:Jxr E& ji;71 sr~Zns
(11 ;~a~rn~ngp~~~ted

EIN

jA'~ :':lt T:;ru

E0

~ Information about Schedule J (For

d Profits (E&P)

0S

000'#99'BL-

0

000 #99 BL

0

&

(-ZLOZ-Zt AaM) (&£1,9 wiod) r ainpet,05

Accumulated Earnings
.
of Controll
E

 Transactions Between Controlled Foreign Corporation
and Shareholders or Other Related Persons 5471 .

SCHEDULE M

(Form 5471)

(Rev. December 2012)
Department of the Treasury
Internal Revenue Service
Name of person filing Form 5471

OMB No. 1545-0704

4 Information about Schedule M ( Form 6471 ) and its instructions is at www.irs.gov/form
i Attach to Form 6471.

Identifying number

13-1740114

MONTEFIORE MEDICAL CENTER

Reference ID number (see instructions)

E I N (if any)

Name of foreign corporation

FFH CORPORATION

FOREIGNUS

FFH INSURANCE CORPORATION

the totals for each type of transaction that occurred during
Important: Complete a separate Schedule M for each controlled foreign corporation Enter
(b) through (f). All amounts must be stated in U.S.

the annual accounting period between the foreign corporation and the persons listed in columns
See instructions
dollars translated from functional currency at the average exchange rate for the foreign corporation's tax year.
Enter the relevant functional currency and the exchange rate used throughout this schedule h
(c) Any domestic
(a) Transactions

(b) U S person

of
foreign corporation

filing this return

corporation or
partnership controlled
by U.S. person filing

this retum

(d) Any other foreign

corporation or
partnership controlled
by U.S. person filing
this return

USD

(e) 10% or more U S.

shareholder of
controlled foreign
corporation (other than
the U.S. person filing

this return)

1.0000000
(f) 10% or more U.S

shareholder of any
corporation
controlling the
foreign corporation

1 Sales of stock in trade (inventory)
2 Sales of tangible properly other

than stock in trade ......
3 Sales

property

of

rights

(patents, trademarks, etc ).. .
4 Platform contribution transaction

payments received ......
5 Cost sharing transaction pay-

ments received........
6 Compensation received for tech-

nical, managerial, engineering,
construction, or like services . .

7 Commissions received .....
8 Rents,

royalties,

and

license

fees received .........
9 Dividends

deemed

received (exclude
distributions under

subpart F and distributions of

previously taxed income). . . .
10 Interest received ........

11 Premiums received for insurance

or reinsurance .........
12 Add lines 1 throu h 11 ....
13

Purchases of stock in trade (inventory)

14 Purchases of tangible property

other than stock in trade ....
15 Purchases

of property rights

(patents, trademarks, etc.)...
16 Platform contribution transaction

payments paid ........
17 Cost sharing transaction payments paid.

18 Compensation paid for tech-

nical, managerial. engineering,
construction, or like services . .

19 Commissions paid .......
20 Rents, royalties, and license fees paid

21 Dividends paid
22 Interest paid
2 3 Premiums paid for insurance or reinsurance

24 Add lines 13 throu h 23 ....
25 Amounts borrowed (enter the

maximum loan balance during
the year) - see instructions . ,
26 Amounts

loaned

(enter

the

maximum loan balance during

the year) - see instructions . ,,
5471.
For Paperwork Reduction Act Notice, see the Instructions for Form

JSA

6X 16641.000

9 421 000.00
Schedule M (Form 5471)(Rev. 12-2012)

 FFH INSURANCE CORPORATION

FORM 5471, PAGE 2 DETAIL

SCH C, LINE 8 - OTHER INCOME
--

52,653,000.

OTHER INVESTMENT INCOME
--

52,653,000.

TOTAL

SCH C, LINE 16 - OTHER DEDUCTIONS
--

167,978,000.
-13,126,000.
10,182,000.
47,996.
11,550.
1,647.
10,050.
-4,290.
14,722.

LOSSES AND LOSS EXPENSES INCURRED
REINSURANCE RECOVERIES
OTHER DEDUCTIONS
MANAGEMENT FEES
AUDIT FEES
SECRETARIAL FEES
GOVERNMENT FEES
LEGAL FEES
TRAVEL

910.

COURIER CHARGES

29,415.

MISCELLANEOUS EXPENSES
--

TOTAL

165,146,000.

STATEMENT

1

 FFH INSURANCE CORPORATION
FORM 5471, PAGE 3 DETAIL

SCH F, LINE 4 OTHER CURRENT ASSETS

BEGINNING

ENDING

-------------

RECOVERABLE LOSSES

143,347,000.

119,889,000.

---------------

TOTAL

143,347,000.

119,889,000.

1,147,217,000.

1,222,137,000.

1,147,217,000.

1,222,137,000.

3,720,000.

5,126,000.

3,720,000.

5,126,000.

1,388,934,000.

1,415,921,000.

1,388,934,000.

1,415,921,000.

SCH F, LINE 6 INVESTMENT IN SUBSIDIARIES
INVESTMENT IN AFFILIATED COMPANIES

TOTAL

SCH F, LINE 12 - OTHER ASSETS
OTHER ASSETS

TOTAL

SCH F, LINE 17 - OTHER LIABILITIES
OTHER LIABILITIES
TOTAL

STATEMENT

2

 FFH INSURANCE CORPORATION
FORM 5471, PAGE 4 DETAIL

SCH H, LINE 2H OTHER RECONCILING ITEMS

NET ADDITIONS

NET SUBTRACTS
--

--

PREMIUM INCOME
OTHER INVESTMENT LOSS
REINSURANCE PREMIMUM CEDED
LOSSES AND LOSS EXPENSES INCURRED
REINSURANCE PREMIUM

TOTAL

134,414,000.
52,653,000.

7,632,000.
167,978,000.

13,126,000.
175,610,000.

200,193,000.
======

STATEMENT

3

 Form

Information Return of U.S. Persons With Respect
To Certain Foreign Corporations

5471

(Rev December 2015)

OMB No. 1545·0704

P For more Information about Form 5471 , see ~n•/w.Irs.gov/form5471

Department of the Treasury

Internal Revenue Service

Information furnished for the foreign corporation's annual accounting period (tax year required by
, and ending 12/31/2016
section 898) (see instructions) beglnnIng01/01/2016

AMachment

Sequence No. 1 21

A Idonufying number

Name of person filing this return

13-1740114

MONTEFIORE MEDICAL CENTER

Number, street, and room or suite no (or P.0 box number d mallis not dellvered to street address) 8 Cotegory of filer (See Instructions Check applicable box(es))

1

111 EAST 210TH STREET

C Enter the total percentage of the foreign corporation's voting

City or town, state. and ZIP code

BRONX,

stock you owned at the end of its annual accounting period

NY 10467

01/01/2016

Fller's tax year beginning

5X

4

3

m ealed 2

20.06

and end,ng 12/31/2016

D Check if any excepted specified foreign financial assets are reported on this form (see Instructjons)
E Person(s) on whose behalf this information return is filed·

(4) Check applicable box(es)
(3) Identifying number

(2) Address

(1)Name

ShBreholdef

Oftlcer

Director

Important : Fill in all applicable lines and schedules. All information must be in English. All amounts must be stated in

U.S. dollars unless otherwise indicated.

b(1) Employer Identification number, if any

10 Name ond address of foreign corporation

NONE

OMEGA SERVICES LIMITED
C/O DYNA MANAGEMENT SERVICES LTD.
P.O. BOX HM 1024, HAMILTON BD HM DX

b(Z) Reference 10 number (see Instructions)

1998
Country under whose Ima incorporated

c

BERMUDA

BERMUDA

05/12/1998
2

f Principal business activity

e Principal place of business

d Date of incorporation

g Pr,nc'pal business activity

h Functional currency

code number

523900

INVESTMENT MANAGEMENT

USD

Provide (he following Information for the foreign corporation's accounting period stated above.
a Nome, oddress, and Identifying number of branch office or agent (if any) In the

b If a U. S. Income tax return was fded, enter:

United States

(li) U.S. Income tax pald

(1) Taxable Income or (1019)

Colter all credils)

N/A
N/A

N/A
c Name and address of lofeign corporatjon'a statutory or resident agent in country
of Incorporation

d Name and address (including corporate department, if applicable) of person (or

persons) with custody of the books end records of the foreign corporation. and

the location of such books and records, H different

DYNA MANAGEMENT SERVICES LTD.
P.O.

BOX HM 1024

SAME AS ITEM 2C

HAMILTON BD HM DX
Stock of the Foreign Corporation
(b) Number of shares Issued and outstanding
(0) Description of each das,of stock

6) Beginning of annual

accounting period

For Paperwork Reduction Act Notice, see Instructions.

JSA
X 1660 1 000

(i,) End of annual

accounting period

Form 5471 (Rev 12·2015)

 page 2

Form 5471 (Rev 12-2015)

-.

·=

U.S. Shareholders of Foreign Corporation (see instructions

(o) Name, address, end identifying

number of shareholder

(b) Description of each class of stock held by

(c) Numberof

(d) Number of

le) Pro rata share

shareholder Note: This doscn'ption shou/d

sheres held al

shares held et

match the corresponding description entered in

beginning olonnua

of Bubpart F
Income Center as

Schedule A. colurnn a .

accountin period

end of annual
accountin penod

e

ercenta e

Income Statement (see instructions)

S.
Important : Report all information in functional currency in accordance with U. S. GAAP. Also, report each amount in U.
U.S.
the
is
currency
functional
the
if
However,
rules).
translation
GAAP
dollars translated from functional currency (using
dollar, complete only the U.S. Dollars column. See instructions for special rules for DASTM corporations,
Functional Currency

Gross receipts or sales
Returns and allowances
Subtract line 1b from line la

la

3

Cost of goods sold
Gross profit (subtract line 2 from line 10

2
3

4

Dividends

4

la
b
c
ncome

2

5

interest

68

Gross rents
Gross royalties and license fees

Deductions

b

1b

k

5
68

6b

7

Net gain or (loss) on sale of capllal assets

7

8

Olher Income (attach statement)
Total Income add lines 3 Ihrou h 8 .................

9
10

10

Compensallon not deducted elsewhere
Rents

1la

Royalties and license fees

1lb

12

Interest

12

13

Depreciation not deducled elsewhere

14

Depletion

15

Taxes (exclude provision for income, war profits. and excess profits taxes)

16

Other deductions (attach statement - exclude provision for Income, war

13
14
.

.

17

To(al deductions add lines 10 throu h 16

18

Net income or (loss) before extraordinary items, prior period
adjustments, and the provision for Income, war profits, and excess

15

16

profits, and excess profits taxes)

Net ncome

8

110

b

profits taxes (subtract line 17 from line 9)

18

19

Extraordinary items and prior period adjustments (see instructions)

19

20

Provision for Income, war proits. and e*cess profits taxes (see Instructions)

21

JSA
X 1 661 1 000

Current

U.S. Dollars

ear net Income or (loss

.*

20

er books combine lines 18 throu h 20) . . .

21

Form 5471 (Rev. 12·2015)

 page 3

Form 5471~(Rev 12-2015)

Income, War Profits, and Excess Profits Taxes Paid or Accrued see instructions
Amount of tax
(8)

1

{d)

(c)
Conversion rate

(b)

Name of country or U.S possession

In foreign currency

In U.S. dollan

U S.

2
4

5
6
7

8

Total

,.

-

Balance Sheet

Important : Report all amounts in U. S. dollars prepared and translated in accordance with U. S. GAAP. See instructions

for an exception for DASTM corporations.
Assets
1

(b)
End of annual
accounting period

Cash

1
2a

b

3

4
5

Trade noles and accounts receivable
Less allowance for bad debts
Inventories
Other current assets (attach statement),,,,*,,.
Loans to shareholders and other related persons .,.

23
2b

3

4
5

6

Investment In subsidiaries (attach statemenl)

6

7

Other investments (attach statement) ........

7

Buildings and olher depreciable assets

8a

8a

b Less accumulated depredation ...........
9a

8b
9a

Depletable assets

b Less accumulated depletion .............
Land (net of any amortization) . . ..........

10

11

(a)
Beginning of annual
accounting period

9b
10

Intangible assets:
a Goodwill

1la

b Organization costs

1lb

llc

Patents, trademarks. and other intangible assets . . .
Less accumulated amortization for lines 118, b, and c.

1ld

12

Other assets (attach statement) ...........

12

13

Total assets

13

c
d

i

Liabilities and Shareholders' Equity
14

Accounts payable

15

Other current liabilities (attach statement)
Loans from shareholders and other related persons .

16

14
15

6

17

Other liabilities (attach statement) .........

17

18

Capital stock:
Preferred stock
Common stock

18a

a

b
19

Pald-in or capital surplus (attach reconclliation)

18b

,,

9

21

Retained earnings
Less cost of treasury stock

20

32

Total liabilities and shareholders equity

22

20

2 --__ __3
Fc·-1 5471

SA

·X 1082 1 000

(Rev. 12·2015)

 page 4

Form 5471 (Rev. 12-2015)

,-

Other information

During the tax year, did the f orelgn corporation own at least a 10% Interest, directly or Indirectly, in any foreign

1

partnership?
If "Yes,- see Ihe Instructions for requjred statemenl
During the tax year, did the foreign corporation own an interest in any trust?
During the lax year, did the foreign corporation own any foreign entities thal were dIsregarded as entities separate

2
3

from their owners under Regulations sections 301.7701-2 and 301.7701-3 (see Instructions)?
If "Yes," you are generally required to attach Form 8858 for each entity (see Instructions).

...........

4
5

During the tax year. was the foreign corporation a participant In any cost sharing arrangement? ..............
During Ihe course of the tax year, did the foreign corporation become a parlicipant in any cost sharing arrangement?. .

6

During the (ax year. did the foreign corporation participate in any reponable transaction as defined in Regulations

section 1.6011-4?
If -Yes,' attach Form(s) 8886 If required by Regulations section 1.6011-4(c)(3)(i)(G).
During the tax year. did the foreign corporation pay or accrue any foreign tax that was disqualified for credit under

7

section 901(m)7

Yes

No

0

X

0

X

U

x

85
0

X

m

El

During Ihe tax year, did the foreign corporation pay or accrue foreign taxes to which section 909 applies, or 1 real

8

X

foreign taxes that were previously suspended under section 909 as no longer suspended? .............

Current Earnings and Profits (see instructions)
Important: Enter the amounts on lines 1 through 5c in functional currency.
Current year net income or (loss) per foreign books 01 account

1

Net adjustments made to line 1 to

2

determine current earnings and profits
according to U.S financial and tax

Net
Additions

1

67,4 61

sa

67, 461

Net
Subtractions

accounting standards (see Instructions):
a Capital gains or losses
b Depreciation and amortlzation
c Depiction

d Investment or Incentive allowance ....
e Charges to stalulory reserves ......
f

Inventory adluslments

g Taxes
h Other (attach statement)

3
4

Total net additions
Total net subtractions

5 a Current earnings and profits Cline 1 plus flne 3 minus line 4)

b DASTM gain or (loss) for foreign corporations thai use DASTM (see Instructions) ..............
c Combine lines 5a and 56
d Current earnings and profits In U.S. dollars (line Sc translated at the approprlale exchange rate as

defined in section 989(b) and the related regulations (see Instructions))
Enter exchange rate used for line 5d ~ 1.00

5b

67,461
67,461

Sd

Summary of Shareholder's Income From Foreign Corporation (see instructions)

is furnished on
If item E on page 1 is completed, a separate Schedule I must be filed for each Category 4 or 5 filer for whom reporting
this Form 5471. This schedule I is being completed for:
Name of U S. shareholder b

MONTEFIORE MEDICAL CENTER

Identifying number I

13-1740114

2

Subparl F Income (line 38b, Worksheet Ain Ihe Instructions)
Earnings Invesled In U.S. property (line 17, Worksheet B In the instructions)

1
2

13, 492
NONE

3

instructions)
Previously excluded subpart F income withdrawn trom qualified investments Cline Sb, Worksheet C in the

3

NONE

4

7b,
Previously excluded export trade Income withdrawn from Inveslmenl In export trade assets (ilne

1

Worksheet D In the Inslructions)

4

NONE

NONE

6

Factoring Income
Tolal of lines 1 through 5. Enter here and on your Income tax return. See Instructions

6
6

13,492

7

Dividends received (translated at spot rate on payment dale under section 989(b)(1))

5

8

Exchange gain or (loss) on a distribution of previously taxed Income ....................

7

NONE

8

NONE
Yes

No

• Was any Income of the foreign corporation blocked?
• Did any such income become unblocked during the tax year (see secllon 964(b))7
if the answer to either question is -Yes," attach an explanation.
Form 5471 (Rev 12·2015)

JSA
e X 16 6 3 1 000

 Balance a be nnin o ear

functional cu ency.

q

Z

e9

q

4

Amounts included under section 95

lus line 2a or line 1 minus line 2b

Total current and accumulated
E&Pnot previously taxed (line 1

ear deficit in E&P

nonpreviously taxed E&P

(.alqeolldde
s! Jajl:n4~15

q9 au!1 JO 99 auil UIOJ

Jalua) UeaA Jo pua le aoueleE]

qg auil snuiw 't, au!1 snuiw

c auil) JeaA Jo pua te paxe1
Aisnoaaid ou dl?3 Jo aoueles

(eg euil snuiul 't, au!1

~~eatieies

sn ~axe)AisneeA~~d

3

b Curren

23 Cunen ear E&P

1

mportant Enter mounts in

OMEGA SERVICES LIMITED

5471

Jo suoqnquisip lenlov

d'93 paxe, Alsno,Aaid

jo suotle0!JISSelial

JO suo!inquisip ten,OV

jeeA JU@J JnO

u (0)696 UO!}Oas Japun payissepaJ JO

000 1 999LX9

a

191 202

67 461

258 663

pre-87 section
959(c 3) balance

Nol Previously Taxed

Undis buled Earnings

(post-86 section
959(c)(3) balance

b Pre-1987 E&P

a Post-1986

c

1998
sections 59(c)(1)

d

670 406

(,70 Subparl F Income

Previousl Taxed E8P (see instructions

M Earnings Invested
In U.S. Property

NONE

OMB No

545-0704

411 743

combine columns
a b and (c

964(a) E&P

(d) Total Seclion

Reference ID number (see ins ructions)

13-1740114

dentifying numbe

, Informa on about Schedule J (F;rT s~~) r;U~ lf:Juctions is at www.irs.gov/form5471

Accumulated Earnings and Profits (E&P)
of Controlled Foreign Corporation

PL,9 uuod Joi suo!}onJ;su eW eeg '90!loN ;OV Uollonpehi )1Jowaded Jod

(E99'852)

SCHEDULEJ

L90 LEL

(ELOZ-EL AaM) (,2,9 Uuod) r ainpalloS

kOE'6LP

£99 BSE

002

ro t

£98 LEL

U

I9 * L9

Z

5

I9 # L 9

5
16

fi N

.EE

 Fotrn

Return by a U.S. Transferor of Property
to a Foreign Corporation

926

¢Ro: Dece.nte, 2013)

0....rnent ./ the lie.,uny
minal Re ,or // Sci ¥. c /

,

U.S. Transferor Information see instructions)

Sequence No. 128

Idontifying number (see instructions)

13-1740114

MONTEFIORE MEDICAL CENTER
a

Attachment

Information about Form 926 and its separate instructions is at www. irs.gov/form926 .
* Attach to your income tax return for the year 01 the transfer or distribution.

Name of transleror

1

OMB No. 1545-0026

If the transferor was a corporation, complete questions la through ld.
If the transfer was a section 361(a) or (b) transfer, was the transferor controlled (under section 368(c)) by 5

~ Yes m No
Yes ~ No

or fewer domestic corporations?
b Did the transferor remain in existence after the transfer?
If not, list the controlling shareholder(s) and their identifying number(s):

Identifying number

Controlling shareholder

C

If the transferor was a member of an affiliated group filing a consolidated return, was it the parent

El Yes 0 No

corporation?
If not, list the name and employer identification number (EIN) of the parent corporation·

EIN of parent corporation

Name of parent corporation

d

Il Yes n No

Have basis adjustments under section 367(a)(5) been made?
If the transferor was a partner in a partnership that was the actual transferor (but is not treated as such under section 367),

2

complete questions 2a through 2d.
a

List the name and EIN of the transferor's partnership:

EIN of partnership

Name of partnership
98-1189484
CIP5 AIV, L.P.
assets?
partnership
of
transfer
the
on
gain
of
share
rata
pro
its
up
pick
partner
the
Did
b
c

Is the pariner disposing of its entire interest in the partnership?

d

Is the partner disposing of an interest in a limited partnership that is regularly traded on an established

securities market?

Transferee Foreign Corporation Information (see instructions)
3

Name of transferee (foreign corporation)

No

El Yes 53

No

No

da identifying number, if any

N/R

PROMONTORIA HOLDING 143 BV
5

El Yes E
~ Yes %

4b Reference ID number

Address (including country)

(see instructions)

OUDE UTRECHTSEWEG 32, BAARN 3743 KN
Country code of country of incorporation or organization (see instructions)
6

Oct

NL
7

Foreign law characterization (see instructions)

CORPORATION
8

Is the transferee foreign corporation a controlled foreign corporation? 1

For Papemork Reduction Act Notice, see separate instructions.

Cat. No. 169820

Il Yes ~ No
Form 926 (Rev 12·2013)

 page 2

Form 926 (Rev 12·2013)

Information Regarding Transfer of Property (see instructions)
Type of

properly

Cash

{a)

(b)

Date of

Description of

transfer

properly

VARIOUS

Fair market value on

Cate Of transfer

1,777,684

(d)

10)

COSI or Other

Gain rocognized on

basis

transfer
'';.-.~r,J,~; ~.

~

Stock ana

securities

Installment
obligations, account
rece,vables or
similar properly

Foreign currency or

other propeny
denominated in
foreign currency

Inventory

Assets subject to

depreciation
recapture (see
Temp. Regs. sec
1 367(a)·AT(b))

Tang,ble propeny

used in trade or
business not listed
under another
category

iniangible properly

Properly to be

leased (as
described,n final
and lemp. Regs

sec. 1367(a)4(c))
Propeny to be sold

(as described in
Temp. Regs. sec.
1 367(a)-4 T(d))

Transiers of 0,1 and

gas working

inieresls (as
described in Temp

Regs sec. 1 367(a)

AT (e))

Other properly

Supplemental Information Required To Be Reported (see instructions).

Form 926 (Rev. 12-2013)

 page 3

Form 926 (Rev. 12·2013)

Additional Information Regarding Transfer of Property (see instructions)
Enter the transferor's interest in the foreign transferee corporation before and after the transfer:

9

(a) Before

0.044 7%

(b) After

0.0405%

, IRC SECTION 351

10

Type of nonrecognition transaction (see instructions)

11

Indicate whether any transfer reported in Part Ill is subject to any of the following:

a Gain recognition under section 904(0(3)
b Gain recognition under section 904(f)(5)(F)
c Recapture under section 1503(d)

d Exchange gain under section 987

12
13

Did this transfer result from a change in the classification of the transferee to that of a foreign corporation?

No

El Yes 81

No

0 Yes IT

No

D Yes El

No

El Yes ®

No

0 Yes El

No

D Yes ~

No

Indicate whether the transferor was required to recognize income under final and Temporary Regulations

sections 1.367(a)-4 through 1.367(a)-6 for any of the following:
a Tainted property .

b Depreciation recapture

ID Yes ® No

c Branch loss recapture
d Any other income recognition provision contained in the above-referenced regulations .

14

0 Yes gl

367(a)(3)?
Did the transferor transfer assets which qualify for the trade or business exception under section

15a Did the transferor transfer foreign goodwill or going concern value as defined in Temporary Regulations
section 1.367(a)-1 T(d)(5)(i i i)?

El Yes El

No

~ Yes ®

No

El Yes IE

No

b If the answer to line 153 is -Yes.- enter the amount of foreign goodwill or going concern value

transferred I
16

$

-

Was cash the only property transferred?

of the
17a Was intangible property (within the meaning of section 936(h)(3)(B)) transferred as a result

transaction?

IE Yes El No

El Yes GE  No

b If 'Yes.- describe the nature of the rights to the intangible property that was transferred as a result of the
transaction:

Form 926 (Rev 12·2013)

 4

Return by a U.S. Transferor of Property
to a Foreign Corporation

926
1/ev Decombe, 2013)
Decanment 01 Ine Ti"wry
Inwindl Re, enu~

,

OMB No. 1545·0026

Information about Form 926 and its separate instructions is at www. irs.gov/form926 .

Attachment

Sequenco No 128

, Attach to your income tax return for the year of the transfer or distribution.

U.S. Transferor Information (see instructions
Identifying number (see ins trucl,ons)

Name of [ranslerof

13-1740114

MONTEFIORE MEDICAL CENTER
If the transferor was a corporation, complete questions la through ld.

1
a

If the transfer was a section 361(a) or (b) transfer, was the transferor controlled (under section 368(c)) by 5

~ Yes m No
Yes ~ No

or fewer domestic corporations?
b Did the transferor remain in existence after the transfer?

If not. list the controlling shareholder(s) and their identifying number(s):
Identifying number

Controlling shareholder

c

If the transferor was a member of an affiliated group filing a consolidated return, was it the parent

Il Yes El

corporation?

No

If not, list the name and employer identification number (EIN) of the parent corporation:

EIN of parent corporation

Name of parent corporation

d

El Yes El

Have basis adjustments under section 367(a)(5) been made?

No

If the transferor was a partner in a partnership that was the actual transferor (but is not treated as such under section 367),

2

complete questions 2a through 2d
a

list the name and EIN olthe transferor's partnership:

EIN of partnership

Name of partnership

98-1189484
CIPS AIV, L.P.
assets?
partnership
of
transfer
the
on
gain
of
share
rata
pro
its
up
pick
b Did the partner
c

d

C Yes Bl No
El Yes gl No

Is the partner disposing of its entire interest in the partnership?

Is the partner disposing of an interest in a limited partnership that Is regularly traded on an established

~ Yes E No

securities market?
Transferee Foreign Corporation Information (see instructions)
3

Name of transferee (foreign corporation)

CIP FIVE MORTGAGE SECURITIES,
5

da identifying number, ic any
N/A

LTD.

4b Relerence ID number

Address (including country)

(see instructions)

00~______-

190 ELGIN AVENUE, GEORGE TOWN, KYl-9005, CJ
Country code of country of incorporation or organization (see instructions)
6

CJ
7

Foreign law characterization (see instructions)

CORPORATION
8

Is the transferee foreign corporation a controlled foreign corporation? .

For Paperwork Reduction Act Notice, see separate instructions.

....

Cat. No. 169820

gl Yes 0 No
Form 926 (Rev. 12·2013)

 page 2

Form 926 (Rev 12·2013)

~j.~~l

Information Regarding Transfer of Property (see instructions)

Type of

property

Cash

(a)

(b)

(c)

(d)

M

Date of

Fair market value on

Cost or other

Gain recognized on

transfer

Description of
properly

VARIOUS

'

date of transfer

1,183,185

basis

transfer

1

Stock and
securities

Installmen:

obligations. account
rece,vatles or

similar propeny

Foreign currency or
other proper'ty

denominated in
loreign currency

Inventory

Assets subject to

depreciation
recapiure (see
Temp, Regs sec.
1.367(a)=T(6))
Tangible properly

used in trade or
business not listed
under another
category

Intangible property

Propeny to be

leased (as
described in final
and lemp. Regs.

sec. 1367(a)-4(c))
Propedy 10 be sold

(as described in
Temp, Regs. sec.
1.367(a)4 T(d ))

Transfers of ott and

gas working

interests (as
described in Temp.
Regs. sec 1.367(a)4 T(e))

Other properly

Supplemental Information Required To Be Reported (see instructions):

Form 926 (Rev. 12-2013)

 -

page 3

Form 926 (Rev 12-2013)

Additional Information Regarding Transfer of Property (see instructions)
Enter the transferors interest in the foreign transferee corporation before and after the transfer:

9

(a) Before

0.4441%

(b) After

0.4391%

, IRC SECTION 351

10

Type of nonrecognition transaction (see instructions)

11

Indicate whether any transfer reported in Part Ill is subject to any of the following:

a Gain recognition under section 904(D(3)

El Yes IE

No

b Gain recognition under section 904(f)(5)(F)

0 Yes IE

No

~ Yes ~

No

El Yes El

No

El Yes E

No

~ Yes ~

No

El Yes IE

No

El Yes IE

No

0 Yes IE

No

El Yes Fl

No

El Yes ~

No

c Recapture under section 1503(d)

.

d Exchange gain under section 987

12
13

Did this transfer result from a change in the classification of the transferee to that of a foreign corporation?
Indicate whether the transferor was required to recognize income under final and Temporary Regulations

sections 1.367(a)-4 through 1.387(a)-6 for any of the following:
a Tainted property .
b Depreciation recapture

c Branch loss recapture
d Any other income recognition provision contained in the above-referenced regulations

14

Did the transferor transfer assets which qualify for the trade or business exception under section 367(a)(3)?

15a Did the transferor transfer foreign goodwill or going concern value as defined in Temporary Regulations
section 1.367(a)-l T(d)(5)(til)?
b If the answer to line 15a is -Yes,' enter the amount of foreign goodwill or going concern value

transferred,
16

3 --------------------------

Was cash the only proper'ty transferred?

17a Was intangible properly (within the meaning of section 936(h)(3)(8)) transferred as a result of the

transaction?

El Yes 0 No

0 Yes @

No

of the
b If -Yes. describe the nature of the rights to the intangible properly that was transferred as a result

transaction

Form 926 (Rev 12-2013)

 r

Return by a U.S. Transferor of Property
to a Foreign Corporation

_„926
IRiv O¢cembe' 7013)
Oloor,niont 01 4 Tie,iury
*. nal Rev*nue Ser.* I

.

OMB No. 1545·0026

Attachment

Information about Form 926 and its separate instructions is at www. irs.gov/form926 .
4 Attach to your income tax return for the year of the transfer or distribution.

Sequence No 128

U. S. Transferor Information (see instructions
Identifying number (see instructions)

Name of Iransiefor

13-1740114

MONTEFIORE MEDICAL CENTER
1

a

If the transferor was a corporation, complete questions la through ld.
If the transfer was a section 361(a) or (b) transfer, was the transferor controlled (under section 368(c)) by 5

or lewer domestic corporations?
b Did the transferor remain in existence after the transfer? .

~ Yes m No
Yes El No

.

If not, list the controlling shareholder(s) and their identifying number(s):
Identifying number

Controlling shareholder

c

If the transferor was a member of an affiliated group filing a consolidated return, was it the parent

C Yes El No

corporation?
If not, list the name and employer identification number (EIN) of the parent corporation:

EIN of parent corporation

Name of parent corporation

d

El Yes El

Have basis adjustments under section 367(a)(5) been made?

No

If the transferor was a partner in a partnership that was the actual transferor (but is not treated as such under section 367),

2

complete questions 28 through 2d.
a

List the name and EIN of the transferor's partnershi

EIN of partnership

Name of partnership

98-1189484
CIPS AIV, L.P.
b Did the partner pick up its pro rata share of gain on the transfer of partnership assets?

EJ Yes ~ No
El Yes E

c

Is the partner disposing or its entire interest in the partnership?

d

Is the partner disposing of an interest in a limited partnership that is regularly traded on an established

No

C Yes %1 No

securities market?

Transferee Foreign Corporation Information (see instructions)
3

4a Identifying number, if any

Name of transferee (foreign corporation)

N/A

BANC OF AMERICA FUNDING 2012-RS LTD
5

4b Reference ID number

Address (including country)

(see instructions)
P.O. BOX 1093, BOUNDARY HALL, GEORGE TOWN, KYl-1102 CJ
Country code of country of incorporation or organization (see instructions)
6

0 0-3

CJ
7

Foreign law characterization (see instructions)

CORPORATION
8

Is the transferee foreign corporation a controlled foreign corporation?

For Paperwork Reduction Act Notice, see separate instructions.

.

Cat. No. 169820

E Yes El No
Form 926 (Rev 12-2013)

 page 2

Form 926 (Rev 12-2013)

Information Regarding Transfer of Property (see instructions)
Tyoe of

properly

Cash

(a)

(b)

Date of

Description of
propeny

transfer

VARIOUS

Fair market value on

date of transfer

(d)

(e)

Coil or other

Gain recognized on

basis

transfer

200,716

1

Slock and

securities

Instailment

ow,galions, account
rece,vables or
similar propeny

Foreign currency of

other propeny
denominated in
foreign currency

Inventory

Assets subject to

depreciation
recapture (see
Temp. Regs. sec.
1,367(aHT(b))

Tangible property

used in trade or
business nol listed
under enother

category

Intang,ble property

Propeny to be

leased (as
described in final
and leme. Regs

sec 1367(8)4(c))
Property to be sold

(as described,n
Temp. Regs. sec.
1,367(a)-4T(d))

Transfers of oil and

gas working

interests (as
described in Ten*

Regs sec 1.367(a)-

47(e))
Other properly

Supplemental Information Required To Be Reported (see instructions)·

Form 926 (Rev 12-2013)

 page 3

Form 926 (Rev. 12·2013)

Additional Information Regarding Transfer of Property (see instructions)
Enter the transferor's interest in the foreign transferee corporation before and after the transfer:

9

(a) Before

0.0000 %

(b) After

0.1402 %
4 IRC SECTION

10

Type of nonrecognition transaction (see instructions)

11

Indicate whether any transfer reported in Part 111 is subject to any of the following

351

a Gain recognition under section 904(0(3)

0 Yes %1

b Gain recognition under section 904(0(5)(F)

El Yes E No

c Recapture under section 1503(d)

No

~ Yes IE No

.

El Yes DE

No

El Yes ~

No

a Tainted properly

El Yes IE

No

b Depreciation recapture

El Yes IE

No

c Branch loss recapture

~ Yes ~ No

d Any other income recognition provision contained in the above-referenced regulations .

El Yes ® No

d Exchange gain under section 987

12

Did this transfer result from a change in the classification of the transferee to that of a foreign corporation?

13

Indicate whether the transferor was required to recognize income under final and Temporary Regulations

sections 1.367(a)-4 through 1.367(a)-6 for any of the following:

14

Did the transteror transfer assets which qualify for the trade or business exception under section 367(a)(3)?

El Yes E

No

15a Did the transferor transfer foreign goodwill or going concern value as defined in Temporary Regulations

Il Yes IE No

section 1.367(a)-1 T(d)(5)(iti)?
b If the answer to line 15a is -Yes,- enter the amount of foreign goodwill or going concern value

transferred,
16

5_ ___________ __

-

Was cash the only properly transferred?

gl Yes El No

17a Was intangible property (within the meaning of section 936(h)(3)(B)) transferred as a result of the

transaction?

El Yes ~

No

b If -Yes.- describe the nature of the rights to the intangible property that was transferred as a result of the

transaction:

Form 926 (Rev 12-2013)

 Return by a U.S. Transferor of Property
to a Foreign Corporation

926

Form

OMB No. 1545-0026

~ Information about Form 926 and its separate instructions is at www.irs.gov /form926.
.
4 Attach to your income tax return for the year of the transfer or distribution

(Rev. December 2013)
Department of the Treasury
Internal Revenue Service

U.S. Transferor Information (see instructions)

Attachment

sequence No. 128

Identifying number (see instructions)

Name of transferor

13-1740114

MONTEFIORE MEDICAL CENTER

If the transferor was a corporation, complete questions la through ld.

1
a

(under section 368(c)) by 5
If the transfer was a section 361(a) or (b) transfer, was the transferor controlled
El Yes El No
.
.
.
ns?
corporatio
or fewer domestic

b

Did the transferor remain in existence after the transfer?

El Yes El No

.

.

If not, list the controlling shareholder(s) and their identifying number(s):
Identifying number

Controlling shareholder

c

consolidated return, was it the parent
If the transferor was a member of an affiliated group filing a
[J Yes [J No

corporation?

corporation:
If not, list the name and employer identification number (EIN) of the parent

EIN of parent corporation

Name of parent corporation

d

E] Yes 0 No

Have basis adjustments under section 367(a)(5) been made? .

transferor (but is not treated as such under section 367),
If the transferor was a partner in a partnership that was the actual

2

complete questions 2a through 2d.
a

List the name and EIN of the transferor's

artnershi :

EIN of partnership

Name of partnership

b
c
d

El Yes Il No
ip assets? .
Did the partner pick up its pro rata share of gain on the transfer of partnersh
El Yes 0 No
Is the partner disposing of its entire interest in the partnership?
ed
establish
an
on
that is regularly traded
Is the partner disposing of an interest in a limited partnership
. El Yes ENo
securities market?

Transferee Foreign Corporation Information (see instructions)

3

4a Identifying number, if any

Name of transferee (foreign corporation)

FFH INSURANCE COMPANY LIMITED

5

4b Reference ID number

Address (including country)

(see instructions)
004

44 CHURCH STREET, HAMILTON HM 12, BERMUDA
6
BD
7

Country code of country of incorporation or organization (see instructions)
Foreign law characterization (see instructions)

CORPORATION
8

Is the transferee foreign corporation a controlled foreign corporation? .

ns.
For Paperwork Reduction Act Notice, see separate instructio

.

.

.

.

.

Cat. No. 169820

.

.

.

.

.

.

~ Yes %1 No

Form 926 (Rev 12-2013)

 Page 2

Form 926 (Rev. 12-2013)

Information Regarding Transfer of Property (see instructions)
Type of
properly

Cash

(a)

Date of

transfer

(b)

Description ol
properly

(d)

(c)

Fair market value on

date of transfer

VARIOUS

Cost Or other

basis

le)
Gain recognized on
transfer

93752292

Stock and

securities

Installment

obligations,
account
receivables or
Similar property
Foreign currency

or other property
denominated in
foreign currency

Inventory

Assets subject to

depreciation
recapture (see
Temp. Regs. sec.
1.367(a)-4T(b))
Tangible property

used in trade or
business not listed
under another
category
Intangible

property
Property to be leased

(as described in final
and temp. Regs. sec.

1.367(a)-4(c))
Property to be

sold (as
described in
Temp. Regs. sec.
1.367(a)-4T(d))
Transfers of oil and

gas working interests
(as described in
Temp. Regs. sec.
1.367(a)-4T(e»

Other property

instructions):
Supplemental Information Required To Be Reported (see

Form 926 (Rev. 12-2013)

 Page 3
Form 926(Rev. 12-2013)

CM¥M

ons)
Additional Information Regarding Transfer of Property (see instructi

and after the transfer:
Enter the transferor's interest in the foreign transferee corporation before

9

%

% (b) After

{a) Before

instructions) I IRC SECTION 351
Type of nonrecognition transaction (see

10

a

any of the following:
Indicate whether any transfer reported in Part 111 is subject to
. .
.
.
Gain recognition under section 904(0(3)

b

Gain recognition under section 904(0(5)(S

c
d

Recapture under section 1503(d)
Exchange gain under section 987

11

.
.

.

.

.

.

.

.

.

.

.

,

Yes

No

.

Yes

No

Yes
Yes

No
No

.

.

0 Yes 0 No
of the transferee to that of a foreign corporation?
Did this transfer result from a change in the classification
ions
Regulat
ary
Tempor
income under final and
Indicate whether the transferor was required to recognize

12

13

g:
sections 1.367(a)-4 through 1.367(a)-6 for any of the followin
a
b
c
d

.
Tainted property
.
.
.
..
.
.
Depreciation recapture
.
~
.
Branch loss recapture.
above-referenced regulations
Any other income recognition provision contained in the

~
0
O
0

.
.
.

.
.

.

~ No
0 No
ENo
~ No

Q Yes ~ No

14

trade or business exception under section 367(a)(3)?
Did the transferor transfer assets which qualify for the

15a

concern value as defined in Temporary Regulations
Did the transferor transfer foreign goodwill or going

b

Yes
Yes
Yes
Yes

section 1.367(a)-IT(d)(5)(iii)?

EJ yes 0 No

t of foreign goodwill or going concern value
If the answer to line 15a is "Yes," enter the amoun

transferred h

S
Q) Yes O No

.

16

Was cash the only property transferred?

17a

of the
of section 936(h)(3)(8)) transferred as a result
Was intangible property (within the meaning
~ Yes Q) No
..
.
.
.
transaction?

b

of the
intangible property that was transferred as a result
If "Yes," describe the nature of the rights to the

transaction:

Form 926 (Rev. 12-2013)

 4

1
CONSOLIDATEDFINANCIAL STATEMENTS

Montefiore Medical Ceriter
Years Ended December 31, 2016 and 2015
With Report of Independent Auditors

Ernst & Young LLP

1

il/

I
*
il /il' l,
.-I

EY

Building a better

working world

 Montefiore Medical Center

Consolidated Financial Statements
Years Ended December 31,2016 and 2015

Contents
Report of Independent Auditors

Consolidated Financial Statements
Consolidated Statements of Financial Position................................................................................3
Consolidated Statements of Operations
Consolidated Statements o f Changes in Net Assets
Consolidated Statements of Cash Flows
Notes to Consolidated Financial Statements...

 EY

Ernst & Young LLP
5 Times Square

Tel: +1 2127733000
Fax: +1212 773 6350

New York, NY 10036-6530

ey.com

Building a better
working world

Report of Independent Auditors
The Board of Trustees
Montefiore Medical Center

We have audited the accompanying consolidated financial statements of Montefiore Medical
Center and its controlled organizations, which comprise the consolidated statements of financial
position as of December 31,2016 and 2015, and the related consolidated statements of operations,
changes in net assets, and cash flows for the years then ended, and the related notes to the
consolidated financial statements.
Management's Responsibility for the Financial Statements

Management is responsible for the preparation and fair presentation of these financial statements
in conformity with U.S. generally accepted accounting principles; this includes the design,
implementation, and maintenance of internal control relevant to the preparation and fair
presentation of financial statements that are free of material misstatement, whether due to fraud or
error.
Auditor's Responsibility

Our responsibility is to express an opinion on these financial statements based on our audits.
We conducted our audits in accordance with auditing standards generally accepted in the
United States. Those standards require that we plan and perform the audit to obtain reasonable
assurance about whether the financial statements are free of material misstatement:
An audit involves performing procedures to obtain audit evidence about the amounts and
disclosures in the financial statements. The procedures selected depend on the auditor's judgment,

including the assessment of the risks of material misstatement of the financial statements, whether
due to fraud or error. In making those risk assessments, the auditor considers internal control

relevant to the entity' s preparation and fair presentation of the financial statements in order to
design audit procedures that are appropriate in the circumstances, but not for the purpose of
expressing an opinion on the effectiveness ofthe entity's internal control. Accordingly, we express
no such opinion. An audit also includes evaluating the appropriateness of accounting policies used

and the reasonableness of significant accounting estimates made by management, as well as
evaluating the overall presentation of the financial statements.
We believe that the audit evidence we have obtained is sufficient and appropriate to provide a basis

for our audit opinion.

1
A member lirm QI Ernst & Y rung Gloval L'imited

 EY

Building a better

working world

Opinion
In our opinion, the financial statements referred to above present fairly, in all material respects,
the consolidated financial position of Montefiore Medical Center and its controlled organizations
at December 31, 2016 and 2015, and the consolidated results of their operations, changes in their
net assets and their cash flows for the years then ended in conformity with U.S. generally accepted

accounting principles.

April 21,2017

2
A member Ii, m 01 Ernst & Young Glebal Limited

 Montefiore Medical Center
Consolidated Statements of Financial Position
December 31
2015
2016
(In Thousands)
Assets

Current assets:
Cash and cash equivalents
Marketable and other securities
Assets limited as to use, current portion
Receivables for patient care, less allowances for doubtful accounts

$

(2016 - $27,431; 2015 - $20,639)
Other receivables
Estimated insurance claims receivable, current portion
Other current assets
Due from members, current portion
Total current assets
Assets limited as to use, net of current portion
Property, buildings and equipment, net
Estimated insurance claims receivable, net of current portion

Other noncurrent assets
Due from members, net of current portion
Total assets

$

$

52,159

99,615
713,828
96,258

224,771
81,747
74,963
51,749
52,007
1,310,044

221,763
87,219
71,220
45,944
72,938
1,408,785

194,269
1,122,239
424,793
259,112
86,878
3,397,335

192,719
1,159,040
403,582
226,507
80,589
3,471,222

138,720
633,928

$

Liabilities and net assets

Current liabilities:
Accounts payable and accrued expenses
Accrued salaries, wages and related items
Malpractice insurance premiums payable, current portion
Estimated insurance claims liabilities, current portion
Long-term debt, current portion
Due to members
Total current liabilities

$

Long-term debt, net of current portion
Noncurrent defined benefit and postretirement health plan liabilities

Professional and other insured liabilities
Employee deferred compensation
Estimated insurance claims liabilities, net of current portion
Estimated third-party payer liabilities
Other noncurrent liabilities
Total liabilities

289,838
269,138
50,848
74,963
65,786
28,928
779,501

$

295,607
248,951
65,776
71,220
59,901
16,239
757,694

753,021
167,051
136,512
37,789
424,793
215,066
84,320
2,598,053

801,864
161,255
134,099
31,616
403,582
292,718
70,802
2,653,630

689,397
78,181
31,704

711,692
74,510
31,390

Commitments and contingencies
Net assets:
Unrestricted
Temporarily restricted
Permanently restricted
Total net assets
Total liabilities and net assets

799,282
$

3,397,335

817,522
$

3,471,222

See accompanying notes.
M

 Montefiore Medical Center

Consolidated Statements of Operations
Year Ended December 31
2015
2016
(In Thousands)

Operating revenue
Net patient service revenue before bad debt expense
Bad debt expense
Net patient service revenue
Grants and contracts

Contributions
Other revenue
Total operating revenue

$ 3,681,067 $ 3,475,823
(46,391)
(49,307)
3,429,432
3,631,760
77,204
89,151
6,376
6,584
159,427
177,839
3,672,439
3,905,334

Operating expenses
Salaries and wages
Employee benefits
Supplies and other expenses
Depreciation and amortization
Interest
Total operating expenses
Excess of operating revenues over operating expenses
before other items
Net realized and changes in net unrealized gains
and losses on marketable and other securities
Malpractice insurance program adjustments associated
with investment earnings shortfall
Gain on debt refinancing
Excess (deficiency) of revenues over expenses
Change in defined benefit pension and other postretirement

plan liabilities to be recognized in future periods
Net assets released from restrictions used for purchases of

property, buildings and equipment
Transfers to members, net
Decrease in unrestricted net assets

$

1,728,174
526,615
1,449,018
148,955
34,589
3,887,351

1,666,288
492,282
1,335,731
141,238
35,489
3,671,028

17,983

1,411

14,009

7,060

(1,209)
4,604
35,387

(20,259)
(11,788)

6,720

23,348

109
(64,511)

71
(107,305)

(22,295) $

(95,674)

See accompanying notes.

4

 Montefiore Medical Center
Consolidated Statements of Changes in Net Assets
Years Ended December 31,2016 and 2015

Temporarily Permanently
Restricted
Unrestricted Restricted

Net Assets

Net_Assets_NELAssets

Total Net

Assets

(In Thousands)

$
Net assets at January 1,2015
Decrease in unrestricted net assets
Restricted gifts, bequests, and
similar items
Restricted investment income

Net assets released from
restrictions
Total changes in net assets
Net assets at December 31,2015
Decrease in unrestricted net assets
Restricted gifts, bequests, and

similar items
Restricted investment income
Net assets released from

restrictions
Total changes in net assets
Net assets at December 31, 2016

807,366 $

72,995 $

25,350 $

(95,674)

-

-

-

5,446
938

6,040
-

905,711

(95,674)
11,486
938

-4,869-4,869
95,6741,5156,04088,119
817,592
31,390
74,510
711,692

(22,295)

-

-

-

5,717

-

1,220

314
-

(22,295)
6,031
1,220

-3,266-3,266
22295367131418,310
1__-689,327_L__-78,181_1-_21,704_3_792,282

See accompanying notes.

5

 Montefiore Medical Center

Consolidated Statements of Cash Flows
Year Ended December 31
2015
2016
Thousands)
(in

Operating activities
Decrease in net assets

$

(18,310) $

(88,119)

148,955
49,307

141,238
46,391

(6,720)
64,511
(4,614)
(9,395)
(27,672)

(23,348)
107,305
(18,094)
11,034
(7,741)

1,284
(502)
1,171

(822)
1,419

(52,315)
(5,769)
20,187
12,516
(57,146)
115,488

(87,672)
39,485
32,970
(4,212)
(28,807)
121,027

Adjustments to reconcile decrease in net assets to net cash provided

by operating activities:
Depreciation and amortization
Bad debt expense

Change in defined benefit pension and other postretirement
plan liabilities to be recognized in future periods
Transfers to members, net
Net realized gains and losses
Change in net unrealized gains and losses
Equity earnings from investments
Write-off of long-term mortgage premium and deferred financing costs

as a result of debt refinancing
Amortization of long-term mortgage premium
Amortization of deferred financing costs
Changes in operating assets and liabilities:
Receivables for patient care
Accounts payable and accrued expenses
Accrued salaries, wages and related items
Noncurrent defined benefit and postretirement health plan liabilities
Net change in all other operating assets and liabilities
Net cash provided by operating activities

Investing activities
Advances to Montefiore Health System, Inc. on MHS Note and other
Payments from Montefiore Health System, Inc. on MHS Note
Decrease in marketable and other securities, net
Decrease (increase) in assets limited to use, net
Net cash provided by (used in) investing activities

(212,190)
(112,154)
(14,214)
(8,336)
1,702
1,948
196,838
93,909
42,54930,656
(58,520)
17,916

Financing activities
Payments of long-term debt
Extinguishment of long-term debt
Proceeds from long-term debt
Payments o f deferred financing costs
Payments to members, net
Net cash used in financing activities

(68,529)
(224,964)
252,090
(3,508)
(49,388)
(94,299)

Acquisition of property, buildings and equipment, net

Net increase in cash and cash equivalents

Cash and cash equivalents at beginning of year
Cash and cash equivalents at end of year

$

39,105
99,615
138,720 $

(52,418)
119,680
(306)
(76,318)
(9,362)

_

53,145
46,470
99,615

See accompanying notes.

6

 Montefiore Medical Center
Notes to Consolidated Financial Statements
December 31,2016

1. Organization and Significant Accounting Policies

Organization
Montefiore Medical Center (the Medical Center) and its controlled organizations comprise an
integrated health care delivery system. The majority of the facilities are located in the Bronx,
New York. The Medical Center is incorporated under New York State Not-for-Profit Corporation
law and provides health care and related services, primarily to residents of the Metropolitan
New York area. The Medical Center is a not-for-profit membership organization whose sole
member is Montefiore Health System, Inc. (MHS). In addition, MHS is the sole member of several
other health care related entities (members). Effective January 1, 2015, Montefiore Medicine
Academic Health System, Inc. (MMAHS) became the sole member of MHS.

The Medical Center, together with its members, comprise an integrated health care delivery system
that provides patient care, teaching, research, community services and care management. The
Medical Center operates many community benefit programs, including wellness programs,
community education programs and health screenings, as well as a variety of community support
services, health professionals' education, school health programs and subsidized health services.
The accompanying consolidated financial statements include the accounts of the Medical Center

and its controlled tax-exempt and taxable organizations.
•
•
•
•
•
•

•

MMC Corporation (MCORP)
Gunhill MRI P.C. (Gunhill)
Mosholu Preservation Corporation (MPC)
CMO The Care Management Company, LLC
(CMO)
Montefiore Proton Acquisition, LLC (MPRO)
MMC Residential Corp. I, Inc. (Housing I)
Montefiore Hospital Housing Section II, Inc.
(Housing II)
Montefiore Hudson Valley Collaborative LLC

•

Montefiore Consolidated Ventures, Inc. (MCV),
which is the parent to the following organizations:
- The Montefiore IPA, Inc. (MIPA)
- Bronx Accountable Healthcare Network IPA, Inc.
-

-

(ACO-IPA)
University Behavioral Associates, Inc. (UBA)
Montefiore Behavioral Care IPA No. 1, Inc.
(MBCIPA)
MMC GI Holdings East, Inc. (GI East)
MMC GI Holdings West, Inc. (GI West)

(MHVC)
•

Montefiore CERC Operations, Inc. (CERC)

For financial statement presentation, the entities described above are collectively termed the
Medical Center, except as explicitly specified. All intercompany accounts and activities have been
eliminated in consolidation.

7

 Montefiore Medical Center

Notes to Consolidated Financial Statements (continued)

1. Organization and Significant Accounting Policies (continued)

Captive insurance companies in which the Medical Center has an equity interest ofmore than 20%,
but less than 50%, are accounted for under the equity method of accounting. In addition,
investments in limited liability companies not wholly owned are recorded under the equity method.

Tax Status: The Medical Center, a section 501 (c)(3 ) organization , is exempt from Federal ,

New York State and local income taxes under Section 501(a) of the Internal Revenue Code, as are
all of the organizations consolidated in these financial statements, except for MCV and its
subsidiaries, which are taxable entities and CMO, MPRO and MHVC which are disregarded
entities for tax purposes. Disregarded entity status provides that the Medical Center is subject to
unrelated business income taxation on income derived from activities not specific to the
Medical Center. Deferred tax assets in the amount of $35.4 million are fully reserved in the
accompanying consolidated financial statements as it was determined to be more likely than not
that these assets will not be realized in the near term. Provisions for income taxes related to the

taxable entities are not material to the consolidated financial statements.

Temporarily and Permanently Restricted Net Assets: Temporarily restricted net assets are those
whose use has been limited by donors to a specific time frame or purpose. Permanently restricted
net assets have been restricted by the donors to be maintained by the Medical Center in perpetuity.
The Medical Center records contributions as temporarily restricted i f they are received with donor
stipulations that limit their use either through purpose or time restrictions.
When donor restrictions expire, that is, when a time restriction ends or a purpose restriction is
accomplished, temporarily restricted net assets are reclassified as unrestricted net assets and
reported as net assets released from restrictions. Donor restricted contributions whose restrictions
are met within the same year as received are classified as unrestricted contributions. Other revenue
for the years ended December 31, 2016 and 2015 includes approximately $3.2 million and

$4.8 million, respectively, of net assets released from restrictions used for operations.

Cash and Cash Equivalents : Cash equivalents include investments in highly liquid debt
instruments with a maturity of three months or less at the time of purchase which are not deemed
to be assets limited as to use or part of the marketable securities portfolio. The Medical Center
maintains cash on deposit with major banks and invests in highly rated commercial paper on an
overnight basis or securities issued by either the United States Government or its agencies with a
maturity of three months or less at the time of purchase. The Medical Center does not hold any
money market funds with significant liquidity restrictions that would be required to be excluded
from cash equivalents.

8

 Montefiore Medical Center

Notes to Consolidated Financial Statements (continued)

1. Organization and Significant Accounting Policies (continued)

At December 31,2016 and 2015, the Medical Center invested excess cash in deposits with major
banks and in money market funds with high credit quality financial institutions.

Revenue and Receivables for Patient Care : Patient accounts receivable for which the
Medical Center receives payment under various formulae or negotiated rates, which cover the
majority of patient services, are stated at the estimated net amount receivable from such payers,
which is generally less than the established billing rates of the Medical Center. Fees for patient
services not covered by payer reimbursement and insurance programs are recorded on a sliding
scale dependent on the individual's ability to pay. For purposes of presentation in the
accompanying consolidated statements of financial position, receivables for patient care are net o f
advances from third-party payers which are directly related to receivables for patient care.
The amount of the allowance for doubtful accounts is based upon management's assessment of

historical and expected net collections, business and economic conditions and other collection
indicators.
Inventories : Inventories, included in other current assets , consist primarily of drugs and supplies,
and are valued at the lower of cost (first-in, first-out method) or market.

Marketable and Other Securities: All marketable and other securities are classified as trading

securities. Marketable securities (excluding alternative investments) are carried at fair value and
generally consist of fixed income securities issued or guaranteed by government entities, money
market funds, mutual funds, fixed income securities issued by corporations, collective trust funds
and equity securities. Marketable securities received as a gift are initially recorded at fair value at
the date of the gift. The carrying amount of alternative investments (nontraditional, not readily
marketable asset classes), some of which are structured such that the Medical Center holds limited
partnership interests, are determined by Medical Center management for each investment, based
upon net asset values derived from the application of the equity method of accounting.
Individual investment holdings within the alternative investments include both non-marketable
and market-traded securities. Valuations of the non-marketable securities are determined by the
investment manager or general partner. These values may be based on historical cost, appraisals,
or other estimates that require varying degrees of judgment. Generally, the carrying amount
reflects net contributions to the investee and an ownership share of realized and unrealized
investment income and expenses. The investments may indirectly expose the Medical Center to
securities lending, short sales of securities, and trading in futures and forwards contracts, options

9

 Montefiore Medical Center
Notes to Consolidated Financial Statements (continued)

1. Organization and Significant Accounting Policies (continued)
and other derivative products. The Medical Center's risk is limited to its carrying value, in addition
to any unfunded commitment. At December 31, 2016, the Medical Center had approximately
$8.2 million of future commitments to invest in alternative investments. Certain investments are
subject to notification periods or restrictions in order to divest. The financial statements of the
investees are audited annually by independent auditors, although the timing for reporting the
results of such audits does not coincide with the Medical Center's annual consolidated financial
statement reporting.
There is uncertainty in the accounting for alternative investments arising from factors such as lack
of active markets (primary or secondary), lack of transparency into underlying holdings and time
lags associated with reporting by the investee companies. As a result, there is at least a reasonable
possibility that estimates will change in the near term.

Investment Gains, Losses and Income : Net realized and unrealized gains and losses on marketable
and other securities and equity in earnings or losses of alternative investments are recorded in
unrestricted net assets unless their use is temporarily or permanently restricted by explicit donor
stipulations or by law. Investment income limited by donor-imposed restrictions is recorded as an
increase in temporarily restricted net assets. Realized gains and losses on sales of marketable and
other securities are based on the average cost method.

Assets Limited as to Use : Assets so classified represent assets whose use is restricted for specific
purposes under terms ofagreements, donor restrictions, or employee deferred compensation plans.

Property, Buildings and Equipment: Property, buildings and equipment purchased are carried at
cost and those acquired by gifts and bequests are carried at fair value established at the date
received. Annual provisions for depreciation are made based upon the straight-line method over
the estimated useful lives of the assets. The carrying amounts of assets and the related accumulated
depreciation are removed from the accounts when such assets are disposed of and any resulting
gain or loss is included in operations in the year of disposal.

Deferred Financing Costs: Deferred financing costs represent costs incurred to obtain financing
for various construction and renovation projects. Amortization o f these costs is determined by the
effective interest method extending over the terms o f the related indebtedness. Deferred financing
costs are included in long-term debt in the accompanying consolidated statements of financial
position.

10

 Montefiore Medical Center
Notes to Consolidated Financial Statements (continued)

1. Organization and Significant Accounting Policies (continued)

Employee Deferred Compensation Plan: Pursuant to various deferred compensation plans in
which certain Medical Center employees or former employees participate, the Medical Center
deposited employee contributions with trustees on behalf of the participating employees. The
Medical Center is not responsible for investment gains or losses incurred. The assets, which are
carried at fair value with a corresponding liability, are restricted for payments under the plans and
may only revert to the Medical Center under certain specified circumstances. The assets are
included in assets limited as to use in the accompanying consolidated statements of financial
position.

Deferred Revenue : Deferred revenue included with other noncurrent liabilities represents amounts

the Medical Center has received for which all obligations have not yet been fulfilled. Accordingly,

such amounts are included within deferred revenue until earned.
Vacation Benefits : These benefits are accrued as earned, except for individuals employed under
certain research grants and contracts.

Premium Revenue and Health Care Service Cost Recognition : Under certain managed care
' contracts, the Medical Center receives from the insurer a m6nthly premium per enrollee during the
term of enrollment. The premium revenue, which is based on individual contracts, is recognized
in the period earned. Under such arrangements, the Medical Center manages and, directly and
through arrangements with other health care providers, delivers health care services to enrollees
in accordance with the terms of the subscriber agreements. The Medical Center reimburses these
providers on either a capitated or negotiated fee-for-service basis. The cost of health care services
is accrued based on processed and unprocessed claims and estimates for medical services, which
have been incurred but not reported. Although it is not possible to measure with certainty the
degree of variability inherent in such an estimate, such estimates are continually monitored and
reviewed by management and independent actuaries, and any adjustments deemed necessary are
reflected in current operations. Health care service costs included in supplies and other expenses
were decreased by approximately $5.0 million for the year ended December 31, 2016 and
increased by approximately $200,000 for the year ended December 31, 2015, reflecting the
difference between claims paid and the liability originally estimated. Premium revenue included
within net patient service revenue in the accompanying consolidated statements of operations
aggregated approximately $546.4 million and $543.1 million for the years ended
December 31, 2016 and 2015, respectively.

11

 Montefiore Medical Center

Notes to Consolidated Financial Statements (continued)

1. Organization and Significant Accounting Policies (continued)

Performance Indicator : The consolidated statements of operations include excess (deficiency) of
revenues over expenses as the performance indicator. Items excluded from excess (deficiency) of
revenues over expenses are change in defined benefit pension and other postretirement plan
liabilities to be recognized in future periods; net assets released from restrictions used for
purchases of property, buildings and equipment; and transfers to members, net.
Transactions deemed by management to be ongoing, major or central to the provision of health
care services are reported as operating revenue and operating expenses and are included in excess
of operating revenues over operating expenses before other items. Peripheral transactions or
transactions of an infrequent nature are excluded from excess ofoperating revenues over expenses
before other items.

Research and Contract Revenue Recognition: The Medical Center is the recipient of various
research awards from various governmental and commercial sources and has various contracts
with governmental agencies. Revenue is recognized only to the extent of expenditures under the
specific contracts or awards. The accompanying consolidated financial statements do not include
amounts related to grants (or portions thereof) that have been awarded to the Medical Center for
which expenditures have not been incurred. Such grant awards approximated $25.2 million and
$33.2 million at December 31, 2016 and 2015, respectively.
Charity Care and Other Community Benefit Programs: The Medical Center is guided by its
mission and charitable purpose to provide charity care and other community benefit programs.
These activities include access to medically necessary treatment for individuals unable to pay for
services, care provided under means-tested government insurance programs that reimburse the
Medical Center at less than the cost ofthe services provided, education for future health providers,
research to advance knowledge and other programs designed to meet local community needs.
The Medical Center is committed to serving all patients in need of health care services. Consistent
with its mission and values, and taking into account an individual's ability to pay for medically
necessary health care services, the Medical Center provides charity care, including free or
discounted care, to all patients not covered by insurance. A key aspect of the policy includes
assisting patients in obtaining insurance they are eligible to receive. Care provided under the
charity care policy is not reported as revenue in the accompanying consolidated statements of
operations. The cost of charity care is estimated based on charges associated with the care
provided, applied to the ratio oftotal patient care expenses to total charges for all services rendered.

12

 Montefiore Medical Center

Notes to Consolidated Financial Statements (continued)

1. Organization and Significant Accounting Policies (continued)

Care provided to patients identified as having the means to pay, but for which payment is not
received, is classified as bad debt expense. The Medical Center uses information from patients and
other sources who are unable to provide financial information, to determine eligibility for charity
care to classify activity between charity care and bad debt expense. Bad debt expense is included
as a deduction from net patient service revenue in the accompanying consolidated statements of
operations.
Medicaid and other means-tested programs comprise approximately one-third of the
Medical Center's patient service revenue. The costs are estimated based on charges for services
provided under the means-tested programs, applied to the ratio of total patient care expenses to
total charges for all services rendered. The unpaid cost presdnted in the table below is based on
estimated total costs, less reimbursement received for the services provided.
The Medical Center operates one of the largest medical residency and health professions training
programs in the United States. The costs of the training programs are included in operating
expenses in the accompanying consolidated statements of operations. The costs presented below
are net of graduate medical education funding from the Medicare and Medicaid programs.

Research and other community benefit program costs include expenses incurred to advance
medical care and clinical knowledge. In addition, the Medical Center fosters community
participation through advisory boards and linkages with community-based groups. It responds to
identified community health related needs by offering specific services including, among others,
wellness programs, community education programs, health screenings, community support
services and subsidized health services. The research and other community benefit program costs
presented below are included in operating expenses in the accompanying consolidated statements
of operations.

13

 Montefiore Medical Center

Notes to Consolidated Financial Statements (continued)

1. Organization and Significant Accounting Policies (continued)
A summary of the costs associated with the provision of charity care and other community benefit

programs is as follows:
Year Ended December 31
2015
2016
(In Thousands)

Charity care, at cost and net of subsidies
Unpaid cost of means-tested government-sponsored
insurance programs
Health professions training, at cost
Community benefit programs
Research

50,064 $

48,305

288,128
38,571
92,299
, 15,574
$
484,636 $

266,263
32,897
89,302

$

15,068
451,835

The New York State Department of Health (NYSDOH) Hospital Indigent Care Pool (the Pool)
was established to provide funds to hospitals for the provision of uncompensated care and is
funded, in part, by a 1% assessment on hospital net inpatient service revenue. For the years ended
December 31, 2016 and 2015, the Medical Center received approximately $8.1 million and
$15.3 million, respectively, in Pool distributions related to charity care. The Medical Center made
payments into the Pool of approximately $19.0 million and $17.7 million for the years ended
December 31,2016 and 2015, respectively, for the 1% assessment.
Program Services: The Medical Center provides health care and related services primarily within
its geographic area. Expenses related to providing these services for the years ended
December 31, 2016 and 2015 are as follows:

2015
(In Thousands)

2016

Health care and related services
Program support and general services

$ 3,529,604 $ 3,353,244
317,784
357,747
$ 3,887,351 $ 3,671,028

14

 Montefiore Medical Center

Notes to Consolidated Financial Statements (continued)

1. Organization and Significant Accounting Policies (continued)

Use of Estimates: The preparation of the consolidated financial statements in conformity with
U.S. generally accepted accounting principles requires management to make estimates and
assumptions that affect the reported amounts of assets, such as estimated uncollectibles for
accounts receivable for services to patients and estimated insurance recoveries receivable, and
liabilities, such as estimated third-party payer liabilities, estimated insurance claims liabilities and
the disclosure of contingent assets and liabilities, at the date of the consolidated financial
statements. Estimates also affect the amounts o f revenue and expenses reported during the period.
Actual results could differ from those estimates. During 2016 and 2015, the Medical Center
recorded net changes in estimates of $46.5 million and $24.9 million, respectively, which
primarily related to changes in previously estimated third-party payer settlements and changes to
estimated liabilities.
Recent Accounting Pronouncements: In May 2014, the Financial Accounting Standards Board
(FASB) issued Accounting Standards Update No . (ASU) 2014-09, Revenue from Contracts with
Customers. The core principle of ASU 2014-09 is that an entity should recognize revenue to depict
the transfer of promised goods or services to customers in an amount that reflects the consideration
to which the entity expects to be entitled in exchange for those goods or services. The guidance in
ASU 2014-09 supersedes the FASB's current revenue recognition requirements and most industryspecific guidance. The provisions ofASU 2014-09, as amended by ASU 2015-04, will be effective
for fiscal years beginning after December 15, 2017, and interim periods within that fiscal year,
with early adoption permitted but not prior to annual periods beginning after December 15, 2016.
The Medical Center is in the process of evaluating the impact of ASU 2014-09 on its consolidated
financial statements.

In August 2014 , the FASB issued ASU 2014- 15 , Presentation of Financial Statements - Going
Concern, that requires management of public and nonpublic companies to evaluate and disclose
where there is substantial doubt about an entity's ability to continue as a going concern. The
Medical Center adopted ASU 2014-15 as of December 31,2016. The Medical Center's adoption
of ASU 2014-15 did not impact the Medical Center's 2016 consolidated financial statements.

In April 2015 , the FASB issued ASU 2015 -05 , Customer 's Accounting for Fees Paid in a Cloud
Computing Arrangement. ASU 2015 -05 provides guidance to customers about whether a cloud
computing arrangement includes a software license. If certain criteria are met, an entity may
account for such an arrangement under the internal use software guidance included in Accounting

Standards Codification (ASC) 350-40 , Internal Use Software, whereby amounts are capitalized . If
such criteria are not met, the cloud computing arrangement is considered a service contract and

15

 Montefiore Medical Center

Notes to Consolidated Financial Statements (continued)

1. Organization and Significant Accounting Policies (continued)
the related costs are expensed as incurred. ASU 2015-05 is effective for public business entities
for fiscal years beginning after December 15, 2015 with the option to apply the guidance
prospectively to all arrangements entered into or materially modified after the effective date or
retrospectively. The Medical Center adopted ASU 2015-05 prospectively as of January 1, 2016
with no impact to the 2016 consolidated financial statements.
Leases, which will require lessees to report
most leases on their balance sheet, but recognize expenses on their income statement in a manner
similar to current accounting. The guidance also eliminates current real estate-specific provisions.
For lessors, the guidance modifies the classification criteria and the accounting for sales-type and
direct financing leases. The provisions of ASU 2016-02 are effective for the Medical Center for
annual periods beginning after December 15, 2018, and interim periods within those years.
Early adoption is permitted. The Medical Center is in the process of evaluating the impact of
ASU 2016-02 on its consolidated financial statements.

In February 2016, the FASB issued ASU 2016-02,

In August 2016 , the FASB issued ASU 2016- 14 , Not-for-Profit Financial Statement Presentation,
which eliminates the requirement for not-for profits (NFPs) to classify net assets as unrestricted,
temporarily restricted and permanently restricted. Instead, NFPs will be required to classify net
assets as net assets with donor restrictions or without donor restrictions. Entities that use the direct
method of presenting operating cash flows will no longer be required to provide a reconciliation
of the change in net assets to operating cash flows. The guidance also modifies required disclosures
and reporting related to net assets, investment expenses and qualitative information regarding
liquidity. NFPs will also be required to report all expenses by both functional and natural
classification in one location. The provisions of ASU 2016-14 are effective for the Medical Center
for annual periods beginning after December 15, 2017, and interim periods thereafter.
Early adoption is permitted. The Medical Center is in the process of evaluating the impact of
ASU 2016-14 on its consolidated financial statements.

In August 2016 , the FASB issued ASU 2016- 15 , Statement of Cash Flows - Classification of
Certain Cash Receipts and Cash Payments, which addresses the following eight specific cash flow
issues in order to limit diversity in practice: debt prepayment or debt extinguishment costs;
settlement of zero-coupon debt instruments or other debt instruments with coupon interest rates
that are insignificant in relation to the effective interest rate of the borrowing; contingent
consideration payments made after a business combination; proceeds from the settlement of
insurance claims; proceeds from the settlement of corporate-owned life insurance policies,
including bank-owned life insurance policies; distributions received from equity method investees;

16

 Montefiore Medical Center

Notes to Consolidated Financial Statements (continued)

1. Organization and Significant Accounting Policies (continued)

beneficial interests in securitization transactions; and separately identifiable cash flows and

application of the predominance principle. The provisions of ASU 2016-15 are effective for the
Medical Center for annual periods beginning after December 15, 2018 and interim periods
thereafter. Early adoption is permitted. The Medical Center is in the process of evaluating the
impact of ASU 2016-15 on its consolidated financial statements.

In November 2016 , the FASB issued ASU 2016- 18 , Statement of Cash Flows - Restricted Cash,
which requires that the statement o f cash flows explain the change during the period in the total of
cash, cash equivalents, and amounts generally described as restricted cash or restricted cash
equivalents. Therefore, amounts generally described as restricted cash and restricted cash
equivalents should be included with cash and cash equivalents when reconciling the beginning-ofperiod and end-of-period total amounts shown on the statement of cash flows. The provisions of
ASU 2016-18 are effective for the Medical Center for annual periods beginning after
December 15, 2018 and interim periods thereafter. Early adoption is permitted. The Medical
Center is in the process of evaluating the impact of ASU 2016-18 on its consolidated financial
statements.
In January 2017 , the FASB issued ASU 2017-07 , Compensation - Retirement Benefits: Improving
the Presentation of Net Periodic Pension Cost and Net Periodic Postretirement Benefit
Cost. ASU 2017-07 addresses how employers that sponsor defined benefit pension and/or other
postretirement benefit plans present the net periodic benefit cost in the income statement.
Employers will be required to present the service cost component of net periodic benefit cost in
the same income statement line item as other employee compensation costs arising from services
rendered during the period. Employers will present the other components of the net periodic benefit
cost separately from the line item that includes the service cost and outside of any subtotal of
operating income, if one is presented. The standard is effective for the Medical Center for fiscal
years beginning after December 15, 2018, and interim periods within annual periods beginning
after December 15,2019. Early adoption is permitted. Adoption of ASU 2017-07 will require the
Medical Center to include the service cost component of net periodic benefit cost related to its
cash balance defined benefit plan and other postretirement benefit plan (aggregate of
approximately $15.1 million for 2016) within salaries and wages on the consolidated statements
of operations and to present all other components (aggregate of approximately $8.8 million for
2016) as a separate line item outside of the excess of operating revenue over operating expenses
before other items. Total net periodic benefit cost is recorded currently as a component of
employee benefits on the consolidated statements of operations.

17

 Montefiore Medical Center

Notes to Consolidated Financial Statements (continued)

1. Organization and Significant Accounting Policies (continued)

Reclassifications: For purposes of comparison, certain reclassifications have been made to the
accompanying 2015 consolidated financial statements to conform to the 2016 presentation.
These reclassifications have no effect on net assets previously reported.

Subsequent Events : Subsequent events have been evaluated through April 21 , 2017 , which is the

date the consolidated financial statements were issued. No subsequent events have occurred that

require disclosure in or adjustment to the consolidated financial statements.
2. Net Patient Service Revenue

The Medical Center has agreements with third-party payers that provide for payments to the
Medical Center at amounts different from its established rates. Net patient service revenue is
reported at estimated net realizable amounts due from third-party payers, patients, and others for
services rendered and includes estimated retroactive revenue adjustments due to future audits,
reviews and investigations. Retroactive adjustments are considered in the recognition of revenue
on an estimated basis in the period that related services are rendered, and such amounts are adjusted
in future periods as adjustments become known or as years are no longer subject to such audits,
reviews, and investigations.

Non-Medicare Reimbursement. InNew York State , hospitals and all non-Medicare payers, except
Medicaid, workers' compensation and no-fault insurance programs, negotiate hospitals' payment
rates. If negotiated rates are not established, payers are billed at hospitals' established charges.
Medicaid, workers' compensation and no-fault payers pay hospital rates promulgated by the
New York State Department of Health. Payments to hospitals for Medicaid, workers'
compensation and no-fault inpatient services are based on a statewide prospective payment system,
with retroactive adjustments.
Outpatient services also are paid based on a statewide prospective system. Medicaid rate
methodologies are subject to approval at the Federal level by the Centers for Medicare and
Medicaid Services (CMS), which may routinely request information about such methodologies
prior to approval. Revenue related to specific rate components that have not been approved by
CMS is not recognized until the Medical Center is reasonably assured that such amounts are
realizable. Adjustments to the current and prior years' payment rates for those payers will continue
to be made in future years.

18

 Montefiore Medical Center

Notes to Consolidated Financial Statements (continued)

2. Net Patient Service Revenue (continued)

Medicare Reimbursement: Hospitals are paid for most Medicare inpatient and outpatient services
under the national prospective payment system and other methodologies of the Medicare program
for certain other services. Federal regulations provide for certain adjustments to current and prior
years' payment rates, based on industry-wide and hospital-specific data. The Medical Center is
paid for services rendered to Medicare beneficiaries on a Periodic Interim Payment (PIP) basis,
plus certain add-ons and other items that are tentatively settled after submission of an annual cost
report by the Medical Center and final settled after audits thereof by the Medicare Administrative
Contractor (MAC) of the submitted cost report. The Medicare cost reports of the Medical Center
have been final settled by the MAC through the year ended December 31, 2001.
Medicare and Medicaid regulations require annual retroactive settlements for cost-based
reimbursements through cost reports filed by the Medical Center. These retroactive settlements are
estimated and recorded in the consolidated financial statements in the year in which they occur.
The estimated settlements recorded at December 31, 2016 and 2015 could differ from actual
settlements based on the results o f cost report audits.

Laws and regulations governing health care programs are extremely complex and are subject to
interpretation. Noncompliance with such laws and regulations could result in repayment of
amounts improperly reimbursed, fines, penalties and exclusion from such programs. In addition,
the classification of patients of the Medical Center and the appropriateness of their admission are
subject to an independent review by a peer review organization. As a result, there is at least a

reasonable possibility that recorded estimates will change by a material amount in the near term.
The Medical Center is not aware of any allegations of noncompliance that could have a material
adverse effect on the accompanying consolidated financial statements and believes that it is in
compliance, in all material respects, with all applicable laws and regulations.
There are various proposals at the federal and state levels that could, among other things,
significantly reduce payment rates or modify payment methods. The ultimate outcome of these

proposals and other market changes, including the potential effects of health care reform that has
been enacted by the Federal and State governments, cannot presently be determined. Future
changes in the Medicare and Medicaid programs and any reduction of funding could have an
adverse effect on the Medical Center.

19

 Montefiore Medical Center

Notes to Consolidated Financial Statements (continued)

2. Net Patient Service Revenue (continued)

Bad Debt Expense : The collection of patient service revenue due from patients, including
copayments and deductibles, from those who are ineligible for charity care, is subject to
uncertainty. The Medical Center records bad debt expense in the period services are rendered based
on past experience, to account for amounts that patients may ultimately be unable or unwilling to
pay. For self-pay patients, which includes both patients without insurance and patients with
copayments and deductibles after third-party coverage, the Medical Center records an estimate for
bad debt expense in the current period based on past experience. Amounts ultimately written off

as uncollectible and recoverids of such amounts are deducted from, or added to, the allowance for
doubtful accounts.
Net patient service revenue, net of contractual allowances and discounts, for the years ended
December 31,2016 and 2015, by major payer source, is as follows:
2015
2016
(In Thousands)
Patient service revenue (net of contractual

allowances and discounts):
Medicaid and Medicaid managed care
Medicare and Medicare managed care
Commercial and managed care
Self-pay and other

Bad debt expense
Net patient service revenue

1,170,216 $
1,187,785
- 1,283,001
40,065
3,681,067
_ _ (49,307)
$ 3,631,760 $

$

1,145,863
1,116,346
1,169,991
43,623
3,475,823

(46,39!1

3,429,432

20

 Montefiore Medical Center

Notes to Consolidated Financial Statements (continued)

3. Marketable and Other Securities and Assets Limited as to Use
The composition o f marketable and other securities and assets limited as to use follows:
December 31
2015
2016
(In Thousands)

Marketable and other securities

$

Assets limited as to use
$
Managed cash and cash equivalents held for investment
Corporate debt
U.S. Treasury securities
U.S. Government agency mortgage-backed securities
U.S. Government agency-backed securities
Equity securities
Non-equity mutual funds
Equity mutual funds
Limited partnerships and other alternative investments
Collective trust funds
Interest and other receivables

$

$

633,928 $
246,428
880,356 $

713,828
288,977
1,002,805

67,871 $
217,303
109,401
51,848
40,167
60,659
155,762
27,163
115,307
28,984
5,891
880,356 $

160,698
285,964
84,748
61,015
20,808
60,751
83,555
24,949
157,776
49,065
13,476
1,002,805

,

The composition of assets limited as to use follows:
December 31
2015
2016
(In Thousands)
Debt-related sinking funds
Donor restricted funds
Managed care cash reserves required by contracts
Lease escrow deposits
Employee deferred compensation plan assets
Marketable securities held as collateral
Total assets limited as to use
Less: current portion of assets limited as to use
Assets limited as to use, net of current portion

$

77,628 $
70,719
47,139
13,153
37,789
246,428

(52,159)
$

194,269 $

80,787
68,614
59,551
44,884
31,616
3,525
288,977

-(96,258
192,719

21

 Montefiore Medical Center

Notes to Consolidated Financial Statements (continued)

3. Marketable and Other Securities and Assets Limited as to Use (continued)
Investment returns for the years ended December 31,2016 and 2015 are comprised as follows:
Year Ended December 31
2015
2016
(In Thousands)

Interest and dividend income
Net realized gains and losses
Change in net unrealized gains and losses

_

12,912 $
4,614
9,395

$

26,921 $

$

14,793
18,094
(11,034)_
21,853

4. Property, Buildings and Equipment
A summary of property, buildings and equipment follows:

December 31
2015
2016
(In Thousands)

40,042
40,214 $
1,591,587
1,629,277
1,100,258
1,281,401
2,731,887
2,950,892

Land and land improvements
Buildings, fixed equipment and improvements
Movable equipment

$

Less accumulated depreciation and amortization

_31,880,709) (1,734,0991
997,788
1,070,183
161,252
52,056
1,159,040
$
$ 1,122,239

Construction-in-progress

Substantially all property, buildings, and equipment are pledged as collateral under various
debt agreements.

22

 Montefiore Medical Center

Notes to Consolidated Financial Statements (continued)

h

5. Operating Leases
Total rental expense included in supplies and other expenses aggregated approximately
$51.5 million and $45.8 million for the years ended December 31, 2016 and 2015, respectively.
Future minimum payments, by year and in the aggregate, under non-cancelable operating leases
with initial or remaining terms of one year or more at December 31, 2016 consisted of the

following (in thousands):
2017
2018
2019
2020
2021
2022 and thereafter(')
Total minimum lease payments

$

$

33,388
29,038
23,629
20,497
20,131
819,075
945,758

c') In September 2015, the Medical Center and Yeshiva University (YU) amended and
restated a lease agreement for the Weiler Hospital campus. Terms of the agreement
include approximately $2.5 million in annual rent, with a 2% increase, compounded

annually through 2114.

23

 Montefiore Medical Center
Notes to Consolidated Financial Statements (continued)

6. Long-Term Debt
A summary of long-term debt follows:

December 31
2015
2016
(In Thousands)
FHA Section 242 insured mortgage loan(a)
FHA Section 241 insured mortgage loan(b)
FHA Section 241 insured mortgage loan(c)
FHA Section 241 insured mortgage loan(d)
FHA Section 241 insured mortgage loance)
HDC residential revenue bonds payable(0
Bank loans payablem)
Housing II mortgages payable(w
Housing I mortgage payable(')
MCORP bonds payable(j)
NYC IDA bonds payable(j)
Build NYC bonds payableck)
Equipment leasing programs(')

$

Ambulatory care center financing(m)
Dormitory Authority mortgage (n)

Other
e, j)
Add long-term mortgage premiums(b.

Less deferred financing costs
Less current portion

$

87,840 $
60,975
59,163
9,708
131,209
5,900
79,470
18,421
1,160
18,190
12,755
73,718
190,692
57,143
15,675
1,931

93,868
69,098
63,550
10,428
136,110
6,200
81,887
18,580
1,239
18,720
13,110
76,705
199,885
57,604
16,444
1,925

1,268
(6,411)
(65,786)
753,021 $

5,297
(8,885)
(59,901)
801,864

24

 Montefiore Medical Center
Notes to Consolidated Financial Statements (continued)

6. Long-Term Debt (continued)

In May 2016, the Medical Center issued Montefiore Medical Center GNMA Collateralized
Taxable Revenue Bonds, Series 2016 (2016 Bonds) in order to refinance two of its FHA insured
mortgage loans (see sections a and e below). As a result of the refinancing, the Medical Center
recorded a gain on refinancing of approximately $4.6 million during 2016.

(a)The Medical Center has a mortgage agreement insured under the provisions of the
Federal Housing Administration (FHA) 242 Program to finance certain construction and
renovation projects. This insured mortgage loan is secured by a first mortgage on
substantially all o f the Medical Center' s real property and unrestricted assets. Prior to
May 2016, the mortgage agreement was with the Dormitory Authority of the State of
New York (the Dormitory Authority) and the interest rate was 4.57% per annum. In
May 2016, the Medical Center issued the 2016 Bonds in order to refinance the mortgage
loan and reduce the interest rate to 2.47%. The 2016 Bonds are secured by fully modified
pass-through mortgage-backed securities guaranteed by the Government National
Mortgage Association (GNMA). Mortgage principal and interest payments are due
monthly through October 1, 2026, at which time any remaining principal and interest is
due. With the exception of certain limited circumstances, the mortgage loan may not be
prepaid prior to March 31, 2026, after which the mortgage may be prepaid without
penalty.

The Medical Center is required to place specified amounts into mortgage reserve funds
and maintain the mortgage reserve funds at specified minimum balances for the FHA
insured mortgage loans. At December 31, 2016, the balance of approximately
$19.8 million of the mortgage reserve fund met the funding requirements and minimum
required mortgage reserve fund balances related to the FHA 242 Program insured

mortgage loan. The funding requirements and the required minimum mortgage reserve
fund balances for the next five years are:
December 31
Minimum
Funding
Balance
_.Requirement
(In Thousands)

2017
2018
2019
2020
2021

$

- $

(2,315)

19,845
19,845
19,845
19,845
17,530

25

 Montefiore Medical Center
Notes to Consolidated Financial Statements (continued)

6. Long-Term Debt (continued)

(b)The Medical Center has a mortgage agreement with the Dormitory Authority, insured
under the provisions of the FHA 241 Program, to finance a construction and renovation
project. The interest rate on the mortgage is 4.55% per annum and principal and interest
payments are due monthly through April 2023, at which time any remaining principal
and interest is due. With the exception o f certain limited circumstances, the loan may not
be prepaid prior to February 1, 2018. Subsequent to February 1,2018, the loan may be
,
prepaid without penalty.

The Medical Center is required to place specified amounts into mortgage reserve funds
and maintain the mortgage reserve funds at specified minimum balances for the
FHA insured mortgage loans. At December 31, 2016, the balance of approximately
$20.9 million of the mortgage reserve fund met the funding requirements and minimum
mortgage reserve fund balances related to the FHA 241 Program insured mortgage loan.
The funding requirements and the required minimum mortgage reserve fund balances for

the next five years are:
December 31
Minimum
Funding
Balance
Requirement
(In Thousands)

2017
2018
2019
2020
2021

$

(3,237) $
(3,145)
(3,145)
(3,145)
(3,237)

17,667
14,522
11,377
8,232
4,995

In connection with this financing, the Medical Center recorded a mortgage premium as a
component of long-term debt related to the termination of a forward starting interest rate
swap agreement. The balance outstanding was approximately $1.1 million and
$1.5 million at December 31, 2016 and 2015, respectively. The mortgage premium is
being amortized over the li fe of the mortgage using the effective interest method.

26

 Montefiore Medical Center

Notes to Consolidated Financial Statements (continued)

6. Long-Term Debt (continued)

(c)The Medical Center has a mortgage agreement insured under the provisions of the
FHA 241 Program to finance a construction and renovation project. The interest rate is
4.22% per annum. Monthly payments of principal and interest will be made through
May 1, 2027, at which time any remaining principal and interest is due. With the
exception of certain limited circumstances, the mortgage loan may not be prepaid prior
to April 30,2021, after which the mortgage may be prepaid without penalty.

The Medical Center is required to place specified amounts into mortgage reserve funds

and maintain the mortgage reserve funds at specified minimum balances for the
FHA insured mortgage loans. At December 31, 2016, the balance of approximately
$14.0 million of the mortgage reserve fund met the funding requirements and minimum
mortgage reserve fund balances related to the FHA 241 Program insured mortgage loan.
The funding requirements and the required minimum mortgage reserve fund balances for
the next five years are:

December 31
Minimum
Funding
BalanceRequirement
(In Thousands)

2017
2018
2019
2020
2021

$

-$
(1,164)
(1,996)

13,969
13,969
13,969
12,805
10,809

(d)The Medical Center has a mortgage agreement insured under the provisions of the
FHA 241 Program to finance a construction and renovation project. The interest rate is
4.22% per annum. Monthly payments of principal and interest will be made through
May 1, 2027, at which time any remaining principal and interest is due. With the
exception of certain limited circumstances, the mortgage loan may not be prepaid prior
to April 30,2021, after which the mortgage may be prepaid without penalty.

27

 Montefiore Medical Center
Notes to Consolidated Financial Statements (continued)

6. Long-Term Debt (continued)

The Medical Center is required to place specified amounts into mortgage reserve funds
and maintain the mortgage reserve funds at specified minimum balances for the
FHA insured mortgage loans. At December 31, 2016, the balance of approximately

$2.3 million of the mortgage reserve fund met the funding requirements and minimum

mortgage reserve fund balances related to the FHA 241 Program insured mortgage loan.
The funding requirements and the required minimum mortgage reserve fund balances for
the next five years are:

December 31
Minimum
Funding

_Reguirement- Balance
(In Thousands)

2017
2018
2019
2020
2021

$

- $

(191)
(327)

2,292
2,292
2,292
2,101
1,774

(e)The Medical Center has a mortgage agreement insured under the provisions of the
FHA 241 Program, to finance a construction and renovation project that was completed
in 2007. Prior to May 2016, the mortgage agreement was with the Dormitory Authority
and the interest rate was 5.37% per annum. In May 2016, the Medical Center issued the
2016 Bonds in order to refinance the mortgage loan and reduce the interest rate to 3.21%.
The 2016 Bonds are secured by fully modified pass-through mortgage-backed securities
guaranteed by GNMA. Mortgage principal and interest payments are due monthly
through April 1,2032, at which time any remaining principal and interest is due.

With the exception of certain limited circumstances, the mortgage loan may not be
prepaid prior to March 31, 2026, after which the mortgage may be prepaid without
penalty.

28

 Montefiore Medical Center
Notes to Consolidated Financial Statements (continued)

6. Long-Term Debt (continued)

In connection with the mortgage agreement, the Medical Center had a bank letter of credit
which was terminated in May 2016. At December 31,2015, the approximate $3.2 million
letter of credit was secured by approximately $3.5 million of marketable securities
included in assets limited as to use in the accompanying consolidated statements of
financial position. There were no drawdowns under the letter of credit during the year
ended December 31, 2015.
In connection with this financing, the Medical Center recorded approximately
$7.6 million of mortgage premium as a component of long-term debt related to the
termination of a forward starting interest rate swap agreement. The balance outstanding
was approximately $3.7 million at December 31, 2015. The remaining balance was
written off in May 2016 in connection with the refinancing of this debt.

The Medical Center is required to place specified amounts into mortgage reserve funds
and maintain the mortgage reserve funds at specified minimum balances for the
FHA insured mortgage loans. At December 31,2016, the Medical Center met the funding
requirements and minimum required mortgage reserve fund balance of $20.6 million
related to the FHA 241 Program insured mortgage loan. The funding requirements and
the required minimum mortgage reserve fund balances for the next five years are:

December 31
Minimum

Funding

-Reguirement Balance
(In Thousands)

2017
2018

2019
2020
2021

$

896 $
-

21,512
21,512

-

21,512

-

21,512
21,512

29

 Montefiore Medical Center

Notes to Consolidated Financial Statements (continued)

6. Long-Term Debt (continued)
cOThe proceeds of New York City Housing Development Corporation (HDC) revenue
bonds were used by the Medical Center for a staff housing project. Interest is payable
monthly at a variable rate (2.09% and 1.39% at December 31, 2016 and 2015,
respectively). Principal is payable annually through May 1, 2030, at increasing annual
amounts ranging from approximately $200,000 to $600,000. The amounts due are
secured by a mortgage and a revenue pledge on the underlying property financed and an
irrevocable direct pay letter of credit issued by a bank in the amount of approximately
$6.0 million, which expires in September 2018. No unreimbursed draws were made
under the direct pay letter of credit during the years ended December 31,2016 and 2015.
The revenue bonds can be prepaid without penalty at the option of the Medical Center.

(z)The Medical Center has a bank loan, of which approximately $7.9 million was
outstanding at December 31,2016. Interest is payable monthly at a fixed rate of 3.43%.
Monthly principal payments of approximately $56,000 are due through the final maturity
date in November 2021, at which time the remaining principal is due.

The Medical Center has a bank loan, of which approximately $4.0 million and
$4.4 million was outstanding at December 31, 2016 and 2015, respectively. Interest is
payable monthly at a variable rate (3.41% and 3.30% at December 31,2016 and 2015,
respectively). Annual principal payments of approximately $364,000 are due through the
final maturity date in February 2019, at which time the remaining principal is due.
The Medical Center has a bank loan agreement, of which approximately $1.6 million and
$1.9 million was outstanding at December 31, 2016 and 2015, respectively. Interest is
payable monthly at a variable rate (2.95% and 2.96% at December 31, 2016 and 2015,
respectively). Annual principal payments of approximately $267,000 are due through the
final maturity date in February 2019, at which time the remaining principal is due.

During 2012, MCORP entered into a loan agreement with a bank to finance certain
leasehold improvements. The balance outstanding at December 31, 2015 was $800,000
and was fully paid during 2016.

30

 Montefiore Medical Center

Notes to Consolidated Financial Statements (continued)

6. Long-Term Debt (continued)

During 2013, MCORP entered into a mortgage loan agreement with a bank for
approximately $38.5 million in order to finance the purchase and renovation of real
estate. At December 31, 2016 and 2015, approximately $35.9 million and $36.9 million
was outstanding, respectively. Interest is payable monthly at a rate of approximately
2.49%. Monthly principal payments of approximately $78,000 commenced April 2014
and extend through March 2020, at which time the remaining principal is due. The
mortgage loan may be prepaid prior to maturity, but may be subject to a prepayment

penalty.
During 2013, the Medical Center entered into a mortgage loan agreement with a bank to
borrow up to $30.0 million in order to finance real estate acquisitions and renovations.
At December 31, 2016 and 2015, approximately $30.0 million was outstanding. Interest
is payable monthly at a rate of 1.67% through February 2018, at which time the
outstanding principal is due. The mortgage loan may be prepaid prior to maturity, but
may be subject to a prepayment penalty.
At December 31, 2015, the Medical Center had a line of credit with a bank aggregating
approximately $8.5 million, which was increased to $30.0 million during 2016. At
December 31,2016, no amounts were outstanding under this line. At December 31,2015,

the outstanding balance was $8.0 million and is included in long-term debt in the
accompanying consolidated statement of financial position. Interest on the line is payable
monthly at a variable rate (2.92% at December 31, 2015). The line of credit expires in
June 2017.
ch)Housing II has primary and subordinate mortgage agreements with HDC.
At December 31, 2016 and 2015, the primary mortgage amount outstanding was
approximately $5.6 million and $5.8 million, respectively. The interest rate is 6.5%, and
principal and interest payments of $44,300 are due monthly through January 1, 2035.
After December 29, 2019, the primary mortgage may be prepaid without penalty if the
subordinate mortgage is no longer outstanding. At December 31, 2016 and 2015, the
subordinate mortgage amount outstanding was approximately $12.8 million and bears
no interest.

31

 Montefiore Medical Center

Notes to Consolidated Financial Statements (continued)
l

6. Long-Term Debt (continued)

The subordinate mortgage is payable in full on April 30,2035. After December 29,2019,
the subordinate mortgage may be prepaid without penalty. The effective interest rate of
the combined obligation is 2.3%, assuming the obligation is prepaid in 2019. If the
mortgages remain outstanding through 2035, the effective interest rate is 1.8%. Housing
II has used 1.8% as the interest rate for the purpose of recognizing interest expense under

the assumption that the mortgages will remain outstanding through 2035.
Substantially all of Housing II's property and equipment rents and profits are collateral
for the mortgages. In addition, any requests for rental increases must be approved by
HDC. During the years ended December 31,2016 and 2015, Housing II maintained the
reserve for replacement account in accordance with HDC requirements. Monthly deposits
aggregating approximately $5,000 are required to be made into this account.
(')Housing I has a mortgage loan agreement with a lender. At December 31,2016 and 2015,
the principal balance outstanding was approximately $1.2 million. The interest rate is
7.6%. Principal and interest payments are due monthly through July 2026. The mortgage
loan may be prepaid upon 30-day notice subject to payment of a prepayment penalty of
at least 1 %. The mortgage loan is secured by a mortgage on the building and underlying
property.

WMCORP financed the acquisition of certain real estate with the proceeds of two
financings: New York City Industrial Development Agency (NYC IDA) revenue bonds
and MCORP taxable bonds. Interest on the NYC IDA bonds has an average coupon rate
of 4.96%, and payments of interest and principal are payable monthly through
October 1,2035. The NYC IDA bonds may be prepaid without penalty. The bonds were
sold at a premium, of which approximately $148,000 and $160,000 was recorded as a
component of the related long-term debt as of December 31,2016 and 2015, respectively,
and is being amortized using the effective interest method over the term of the NYC IDA
bonds. Interest on the MCORP bonds is payable monthly at a variable rate (2.38% and
1.36% at December 31, 2016 and 2015, respectively). Principal is payable monthly
through October 1,2035. The MCORP bonds are subject to prepayment without penalty.
Both bond issues are secured by direct pay letters of credit from a bank in the amounts of
approximately $13.3 million and $18.6 million at December 31,2016, and approximately
$13.6 million and $19.1 million at December 31,2015. The letters of credit are secured
by a mortgage on the properties financed. The letters of credit expire September 25,2018.

32

 Montefiore Medical Center
Notes to Consolidated Financial Statements (continued)

6. Long-Term Debt (continued)

No unreimbursed draws were made under the direct pay letters of credit during the years
ended December 31,2016 and 2015.

(k)During 2013, the Medical Center issued Build NYC Resource Corporation Revenue
Bonds, Series 2013A and Series 2013B (2013 Bonds) of approximately $93.0 million
through Build NYC Resource Corporation, to finance a leasehold renovation project
secured by a leasehold mortgage. At December 31, 2016 and 2015, a total of
approximately $73.7 million and $76.7 million was drawn and outstanding, respectively.
Interest on the 2013 Bonds is payable monthly at variable rates (1.83% and 1.58% at
December 31, 2016 and 2015, respectively). Monthly payments of principal of
approximately $508,000 commenced in April 2015 and extend through the final maturity
date in June 2030. The 2013 Bonds are subject to prepayment without penalty, upon
satisfaction of certain notice provisions.
(')In addition to amounts previously borrowed, the Medical Center borrowed approximately
$14.8 million and $85.0 million during the years ended December 31, 2016 and 2015,
respectively, under equipment leases to finance certain capital projects. The interest rates
associated with the Medical Center's various equipment lease borrowings range from

1.06% to 2.20%.
cm)During 2014, the Medical Center entered into a real estate lease for an ambulatory care
center. The lease was accounted for as a financing transaction; accordingly, an obligation
of approximately $57.1 million and $57.6 million was outstanding at December 31,
2016 and 2015, respectively. Payments of principal and interest commenced in
September 2015 and extend through September 2030.
(n)During 2015, the Medical Center entered into a loan agreement with the Dormitory
Authority in the amount of approximately $16.4 million in connection with the transfer

of a substance abuse treatment facility from Einstein to the Medical Center. The loan is
secured by a mortgage on the facility. Interest payments are due semiannually at rates
ranging from approximately 4.4% to 4.5% and principal payments are due annually,
through February 15, 2030. To the extent that the Medical Center continues to meet
certain conditions, its obligations to make interest and principal payments will be funded
by the New York State Office of Alcoholism and Substance Abuse Services (OASAS)
under a state aid grant lien. During 2016 and 2015, OASAS funded approximately
$770,000 and $390,000, respectively, of principal, interest and fees associated with this
loan.

33

 Montefiore Medical Center

Notes to Consolidated Financial Statements (continued)

6. Long-Term Debt (continued)

The aggregate amount of principal payments required under all long-term indebtedness, including
capital leases and amortization of long-term mortgage premium and deferred financing costs,
exclusive of sinking funds requirements, at December 31,2016 are as follows (in thousands):

2017
2018
2019
2020
2021
2022 and thereafter

$

$

65,786
101,353
72,831
101,892
67,206
409,739
818,807

Substantially all of the Medical Center's property, buildings and equipment and other assets serve
as collateral under the various debt arrangements. In addition, the Medical Center must maintain
certain financial ratios and, among other things, obtain approval to incur additional debt above
specified amounts. The Medical Center was in compliance with such covenants at
December 31,2016 and 2015.
Interest paid during the years ended December 31, 2016 and 2015 amounted to approximately
$32.9 million and $34.1 million, respectively.
7. Temporarily and Permanently Restricted Net Assets

Temporarily restricted net assets are available for the following purposes:

December 31
2015
2016
(In Thousands)

Collateralizing bank financing, teaching and research
Health care related services
Construction and renovation projects
Research
Other

$

37,224 $
22,732
8,763
8,449
1,013

$

78,181 $

37,224
17,994
10,482
8,371
439
74,510

34

 Montefiore Medical Center
Notes to Consolidated Financial Statements (continued)

7. Temporarily and Permanently Restricted Net Assets (continued)

The Medical Center follows the requirements of the New York Prudent Management of
Institutional Funds Act (NYPMIFA) as it relates to its permanently restricted endowments.

The Medical Center' s endowments consist of donor-restricted funds established for a variety
of purposes. As required by U.S. generally accepted accounting principles, net assets associated
with endowment funds are classified and reported based on the existence or absence of
donor-imposed restrictions.

The Medical Center requires the preservation o f the fair value o f the original gift as o f the gift date
of the donor-restricted endowment funds absent explicit donor stipulations to the contrary.
The Medical Center classifies as permanently restricted net assets (a) the original value of gifts
donated to the permanent endowment, (b) the original value of subsequent gifts to the permanent
endowment, and (c) if applicable, any accumulations to the permanent endowment made in
accordance with the direction of the applicable donor gift instrument at the time the accumulation
is added to the fund. The remaining portion of the donor-restricted funds that are not classified in
permanently restricted net assets is classified as temporarily restricted net assets until the purpose
or time restriction expires. Endowment assets include those assets of donor-restricted funds that
the Medical Center must hold in perpetuity or for a donor-specified term.
The Medical Center' s investment and spending policies for endowment assets seek to provide a

predictable stream of funding to programs supported by its endowment, while seeking to maintain
the purchasing power of the endowment assets. Endowment assets include those assets of donorrestricted funds that the Medical Center must hold in peIpetuity or for a donor-specified term.

35

 Montefiore Medical Center
Notes to Consolidated Financial Statements (continued)

7. Temporarily and Permanently Restricted Net Assets (continued)

For the years ended December 31, 2016 and 2015, the Medical Center had the following
endowment-related activities:

2016
Temporarily

Permanently

_Unrestricted-Restricted_Restricted_Total
(In Thousands)

Endowment balance, beginning ofyear
Additions

$

Investment income
Amounts appropriated for

1,836 $
98

31,390 $
314
-

33,226
314
236

13866-204
346
314
32
-

expenditure
Net change in endowment funds
Endowment balance, end of year

- $
138

$-31,868$3L704SI33,572

2015
Temporarily

Permanently

__UnrestricteL__Restricted_Restricted_Total
(In Thousands)

Endowment balance, beginning of year
Additions
Investment income
Amounts appropriated for

expenditure
Net change in endowment funds
Endowment balance, end of year

$

-$
149

1,764 $
122

25,350
6,040
-

$

27,114
6,040
271

14950-199
6,112
6,040
72
-

YIEIZIEIGFin~

Permanently restricted net assets amounted to approximately $31.7 million and $31.4 million at
December 31,2016 and 2015, respectively. At December 31, 2016 and 2015, the fair value of
marketable securities (including reinvested earnings over the life of endowments) exceeded the
amount of permanently restricted net assets at such dates.

36

 Montefiore Medical Center
Notes to Consolidated Financial Statements (continued)

8. Benefit Plans
The Medical Center is a contributing employer to two union multiemployer pension plans. In
addition, the Medical Center also maintains two tax deferred annuity plans under Section 403(b)
of the Internal Revenue Code, as well as two noncontributory defined benefit pension plans.

Contributions to union multiemployer pension plans are made in accordance with contractual
agreements under which contributions are based on a percentage of salaries or a negotiated amount.
Contributions to the non-contributory tax deferred annuity plan are based on percentages of salary.
Contributions to the noncontributory defined benefit plans are based on actuarial valuations.
Benefits under the noncontributory defined benefit plans are based on years of service and salary
levels. The Medical Center' s policy is to contribute amounts sufficient to meet funding
requirements in accordance with the Employee Retirement Income Security Act of 1974 and the
Pension Protection Act of 2006.
Total expense, included in employee benefits expense in the accompanying consolidated

statements of operations for the various pension plans aggregated approximately $137.2 million
and $129.5 million for the years ended December 31,2016 and 2015, respectively. Cash payments
relative to the various pension plans aggregated approximately $136.7 million and $129.8 million
for the years ended December 31,2016 and 2015, respectively.
The Medical Center also sponsors two unfunded defined benefit postretirement health and welfare
plans that cover certain full-time and part-time employees and eligible dependents.
Multiemployer Plans

The Medical Center contributes to two multiemployer defined benefit pension plans under the
terms of collective-bargaining agreements that cover its union-represented employees: New York
State Nurses Association Pension Plan (NYSNA) and the 1199SEIU Healthcare Employees
Pension Fund (1199SEIU). The risks of participating in these multiemployer plans are different

from single-employer plans in the following respects:
•

Assets contributed to a multiemployer plan by one employer may be used to provide

benefits to employees of other participating employers.
•

I f a participating employer stops contributing to the plan, the unfunded obligations of the

plan may be borne by the remaining participating employers.

37

 Montefiore Medical Center

Notes to Consolidated Financial Statements (continued)

8. Benefit Plans (continued)

•

I f an entity of the multiemployer defined benefit pension plan chooses to stop participating

in some o f its multiemployer plans, the entity may be required to pay those plans an amount
based on the underfunded status of the plan, referred to as a withdrawal liability.

The Medical Center' s participation in these plans for the years ended December 31,2016 and 2015
is outlined in the following table. The "EIN/Pension Plan Number" column provides the Employee
Identification Number (EIN) and the three-digit plan numbers. Unless otherwise noted, the most
recent Pension Protection Act zone status available in 2016 and 2015 is for the plan's year end at
December 31, 2015 and 2014, respectively. The zone status is based on information that the
Medical Center received from the plans and is certified by the plans' actuaries. Among other

factors, plans in the red zone are generally less than 65% funded, plans in the yellow zone are less

than 80% funded, and plans in the green zone are at least 80% funded. The "FIP/RP Status
Pending/Implemented" column indicates plans for which a financial improvement plan (FIP) or a
rehabilitation plan (RP) is either pending or has been implemented. The last column lists the

expiration dates of the collective-bargaining agreements to which the plans are subject.

Pension

EIN/
Pension Plan

Fund

Number

Pension Protection

Act Zone Status
January 1,
January 1,
2016

2015

FIP/RP
Status
Pending

Contributions from the
Medical Center

2015

2016

Im lemented

Surcharge

Expiration
Date of
CollectiveBargaining

Inn osed

A reement

No
No

12/312018
9/30/2018

(In Thousands)

NYSNA
1199SEIU

13-6604799/001
13-3604862/001

Green
Green

Green
Green

N/A
N/A

$
$

24,562
55,289

$
$

23,092
52,348

The Medical Center was listed in the plans' Forms 5500 as providing more than 5% of the total
contributions for the following plan years:

Year Contributions to Plan Exceeded More

Than 5% of Total Contributions
Pension Fund

NYSNA

1199SEIU

as of December 31 of the Plan's Year End

2015 and 2014
2015 and 2014

At the date the Medical Center's consolidated financial statements were issued, Forms 5500 were
not available for the plans' year ended in 2016.

38

 Montefiore Medical Center
Notes to Consolidated Financial Statements (continued)

8. Benefit Plans (continued)
Defined Benefit Plans

The Medical Center recognizes the funded status (i.e., the difference between the fair value of plan
assets and the projected benefit obligations) of the defined benefit plans in its consolidated
statements of financial position. Net unrecognized actuarial losses and net unrecognized prior
service costs at the reporting date will be subsequently recognized in the future as net periodic
benefit cost pursuant to the Medical Center' s accounting policy for amortizing such amounts.

Further, actuarial gains and losses that arise in subsequent periods and are not recognized as net
periodic benefit cost in the same periods will be recognized as a component of unrestricted net
assets.
Included in unrestricted net assets at December 31,2016 and 2015 are the following amounts that
have not yet been recognized in net periodic benefit cost:

Postretirement

Pension

2016-20152016___2015
(In Thousands)

Unrecognized actuarial loss
Unrecognized prior service
cost (credit)

$

15,208 $

16,777 $

29,414 $

36,138

2064123,8355,614

1__15,414$_17,189_$25,579_$_30,524

The unrecognized net prior service cost (credit) and actuarial loss included in unrestricted net
assets expected to be recognized as net periodic benefit (credit) cost during the year ending
December 31,2017 are approximately ($1.5) million and $2.9 million, respectively.

39

 Montefiore Medical Center

Notes to Consolidated Financial Statements (continued)

8. Benefit Plans (continued)

The following tables provide a recohciliation of the changes in the defined benefit pension plans'
benefit obligations and fair value of plan assets (where applicable) and postretirement benefit plan
for the years ended December 31,2016 and 2015 and the funded status ofthe defined benefit plans
as of December 31, 2016 and 2015:
Postretirement
Pension
2016201520162015(In Thousands)

Changes in benefit obligation
Benefit obligation at January 1
Service cost
Interest cost
Actuarial gain
Benefit payments, net
Plan amendments
Benefit obligation at
December 31

$

42,242 $
3,548
1,714
(1,268)
(2,617)

149,519 $
11,527
6,390
(3,861)
(6,965)

155,764
11,859
6,121
(18,520)
(5,705)

-716---

L-~iMLI-==11211=L-=15*1LL=~22212=

Change in plan assets
Fair value of plan assets at

January 1

41,797 $
3,398
1,559
(2,502)
(2,726)

$

Actual return on plan assets
.
Employer contributions
Benefit payments, net
Fair value of plan assets at
$
December 31

24,213 $
855

25,468 $
(1,342)

-$
-

-

5,705
6,965
2,813
2,822
2,6172,7266,9655,705

25,271_$_24,213_$-=$-

Funded status
Amounts recognized in the

consolidated statements of
financial position

1.-_118,34§11__-118,02911__fl56,610)1_iLE,5121

At December 31, 2016 and 2015, approximately $7.9 million and $6.3 million, respectively, was
included in accrued salaries, wages and related items in the accompanying consolidated statements

of financial position.
The actuarial gains in 2016 and 2015 are due to an increase in the discount rates.

40

 Montefiore Medical Center
Notes to Consolidated Financial Statements (continued)

8. Benefit Plans (continued)

The accumulated benefit obligation for the Medical Center's defined benefit plans as of
December 31,2016 and 2015 was approximately $28.4 million and $29.0 million, respectively.

The following table provides the components ofthe net periodic benefit cost for the defined benefit
pension plans and postretirement benefit plan for the years ended December 31,2016 and 2015:

(In Thousands)

Service cost
Interest cost
Expected return on plan assets
Amortization of prior service
cost (benefit)
Amortization of net loss
Net periodic benefit cost

$

3,548 $
1,714
(1,722)

3,398
1,559

(1,667)

$

11,527
6,390

-

$

11,859
6,121

-

(1,779)
(1,779)
485
206
58
1,1681,3862,86359

$4,914$_5,161_L__12,001$22,159

Weighted-average assumptions

used to determine benefit
obligations as ofDecember 31
Discount rate
Rate of compensation increase

4.17°/6-4.52% 3.92%-4.45%
3.00%-4.00% 3.00%-4.00%

4.50%
3.00%

4.35%
3.00%

3.92%-4.45% 3.31%-4.06%

4.35%

4.00%

6.50%

-

-

3.00%-4.00% 3.00%-4.00%

-

-

Weighted-average assumptions

used to determine net periodic
benefit cost for the years
ended December 31
Discount rate
Expected long-term rate of return

on plan assets
Rate of compensation increase

6.50%

The overall expected long-term rate of return on plan assets is based on the historical returns of
each asset class weighted by the target asset allocation. The target asset allocation has been selected
consistent with the plan's desired risk and return characteristics. The Medical Center's independent

consulting actuaries review the expected long-term rate periodically and based on the building
block approach, updated the rate for changes in the marketplace.

41

 Montefiore Medical Center

Notes to Consolidated Financial Statements (continued)

8. Benefit Plans (continued)
The Medical Center' s defined benefit pension plan weighted-average asset allocations, by asset
category, are as follows:

\
Equity securities
Fixed income mutual funds
Alternative investments
Equity mutual/common trust funds
Cash and cash equivalents

December 31
2015
2016
-%
23
53
24

100%

6%
6
9
7

72
100%

During 2016, the Medical Center's defined benefit plan assets were transferred from the Health
Services Retirement Plan (which terminated during 2016) to Principal Financial Group.

Defined benefit pension plan assets are carried at fair value and generally consist of fixed income
securities issued or guaranteed by government entities, money market funds, mutual funds, fixed
income securities issued by corporations, equity securities, and alternative investments.
Alternative investments are stated at fair value based upon, as a practical expedient, net asset
values derived from the application of the equity method of accounting. Refer to Note 10 for
additional fair value measurement information related to the defined benefit plan asset categories
noted in the table above.
The target allocations for the defined benefit pension plan's assets are as follows:

U.S. stocks
Non-U.S. stocks
Global stocks
Bonds
Hedge funds
Private equity funds

17-27%
10-20%
6-9%
19-30%
12-22%
0-10%

42

 Montefiore Medical Center

Notes to Consolidated Financial Statements (continued)

8. Benefit Plans (continued)

Assumed health care cost trend rates at December 31 are as follows:

2016

6.95%

7.45%

5.00%
2022-2023

5.00%
2022-2023

Health care cost trend rate
Rate to which the cost trend rate is assumed to decline

(the ultimate trend rate)
Years that the rate reaches the ultimate trend rate

2015

The measurement dates used to determine defined benefit pension and postretirement plan costs
were December 31,2016 and 2015.

During the year ending December 31, 2017, the Medical Center expects to contribute
approximately $4.1 million and $5.7 million to the defined benefit pension and postretirement
plans, respectively.
Expected benefit payments by year as of December 31,2016 follow:
Postretirement
Pension
Un Thousands)

2017
2018
2019
2020
2021
2022-2026

$

4,052 $
5,095
10,337
10,046
7,294
24,334

5,671
6,064
6,464
6,870
7,400
47,105

43

 Montefiore Medical Center

Notes to Consolidated Financial Statements (continued)

8. Benefit Plans (continued)
Assumed health care cost trend rates have a significant effect on the amounts reported for the
defined benefit postretirement plans. A 1% change in assumed health care cost trend rates would

have the following effects relating to the postretirement plans:
2015

2016

1%
1%
1%
1%
Inerease_Decrease
IncrEME___llecrease
(In Thousands)

Effect on total of service and
interest cost components
of net periodic
postretirement health care

benefit cost
Effect on the health care
component of the
accumulated
postretirement benefit
obligation

$

3,464 $

23,980

(2,761) $

(19,747)

3,700 $

23,000

(2,900)

(18,900)

9. Commitments, Contingencies and Other
Litigation

Claims have been asserted against the Medical Center by various claimants arising out of
the normal course of its operations. The claims are in various stages of processing and some
may ultimately be brought to trial. Also, there are known incidents occurring through
December 31, 2016 that may result in the assertion of additional claims, and other claims may be
asserted arising from services provided to patients in the past. Medical Center management and
counsel are unable to conclude about the ultimate outcome of the actions. However, it is the
opinion of Medical Center management, based on prior experience that adequate insurance is
maintained and adequate provisions for professional liabilities, where applicable, have been
established to cover all significant losses and that the eventual liability, if any, will not have a
material adverse effect on the Medical Center's consolidated financial position.

44

 Montefiore Medical Center

Notes to Consolidated Financial Statements (continued)

9. Commitments, Contingencies and Other (continued)
Professional and Other Insured Liabilities

The Medical Center participates in the Federation of Jewish Philanthropies, which is a pooled
insurance program for professional and general liabilities with certain other health care facilities
(the FOJP Program). Participation in this occurrence basis insurance program is through captive
and commercial insurance companies. Participation in the FOJP Program began in April 1977. The
Medical Center's malpractice insurance program offers a deferred premium arrangement in which
36% of the annual premium is paid in the current year and the balance is payable over five years.
Total liabilities associated with the FOJP Program were approximately $187.4 million and
$199.9 million at December 31, 2016 and 2015, respectively. The liabilities principally relate to
the deferred premium arrangement, the participating hospitals' guarantee of certain investment
returns of the captive companies and retroactive premium adjustments.
As of December 31, 2016, the Medical Center retained ownership interests in three captive
insurance companies affiliated with the FOJP Program ranging from 17- 26% ownership.
The Medical Center has recognized its allocated share of the program's accumulated surplus using
the equity method ofaccounting. Such amounts (approximately $161.8 million and $140.3 million
at December 31, 2016 and 2015, respectively) are included in other noncurrent assets in the
accompanying consolidated statements of financial position.
The Medical Center has recognized estimated insurance claims receivable and estimated insurance
claims liabilities of approximately $499.8 million (approximately $75.0 million current and
$424.8 million long-term) and approximately $474.8 million (approximately $71.2 million current
and $403.6 million long-term) at December 31, 2016 and 2015, respectively. Such amounts
represent the actuarially determined present value, discounted at approximately 2.8% at
December 31,2016 and 2015, of insurance claims that are anticipated to be covered by insurance.
The amounts reported in the December 31, 2016 and 2015 consolidated statements of financial
position for estimated insurance claims receivable and estimated insurance claims liabilities reflect
the financial impact of the Medical Center's employed physicians.

During the years ended December 31,2016 and 2015, the Medical Center recorded approximately
$1.2 million and $20.3 million, respectively, of malpractice insurance program adjustments
associated with investment earnings shortfalls. Such amounts were reflected in accounts payable
and accrued expenses (approximately $7.7 million and $7.4 million at December 31, 2016 and
2015, respectively) and professional and other insured liabilities (approximately $15.7 million and
$22.3 million at December 31, 2016 and 2015, respectively) in the consolidated statements of
financial position.

45

 Montefiore Medical Center

Notes to Consolidated Financial Statements (continued)

9. Commitments, Contingencies and Other (continued)
In February 2014, the FOJP program and the various affiliated captive insurance companies began
an internal investigation into several insurance regulatory and related matters that had come to the
attention of the FOJP companies' management. The FOJP companies, at the direction of their
Boards, engaged independent legal counsel and an independent forensic consulting firm to conduct
an investigation into various matters. The FOJP Companies and legal counsel reported the
preliminary investigative findings to the New York State Department of Financial Services (DFS),
the primary State insurance regulator throughout the investigation and its conclusion in 2016. DFS
also is conducting an investigation into the issues that were raised and related matters. The FOJP
companies and DFS are engaged in ongoing discussions regarding the consequences, if any, of
past activities identified in the investigation, appropriate remediation and potential impact on the
future operations of the FOJP companies. As of December 31, 2016, the Medical Center believes
that this matter will not have a material adverse effect on the Medical Center's consolidated
financial position; however, such outcome cannot be assured with certainty at this time.
Additionally, as a result o f the investigation, the Medical Center, together with the other hospitals
affiliated with FOJP, identified an unpaid state tax liability for independently-procured insurance
under Article 33-A ofthe New York Tax Law relating to insurance purchased from three off-shore
captive insurance companies owned by the Medical Center and the other FOJP-affiliated hospitals.

On October 9, 2015, the Medical Center submitted a filing to the New York State Department of
Taxation and Finance (DT&F) to participate in the DT&F's Voluntary Disclosure and Compliance
Program, which would allow the Medical Center to limit the period for which back taxes would
be due and avoid penalties for non-payment. The Medical Center was accepted by the DT&F into
the program with a limited look-back on the taxes owed of three years (2012-2014). The Medical
Center completed a Voluntary Disclosure and Compliance Agreement in March 2016, resulting in
a payment o f approximately $6.7 million (including taxes and interest).
Albert Einstein College of Medicine, Inc. (Einstein)

On September 9, 2015, a controlled member of MMAHS, Einstein, acquired substantially all of
the assets and assumed substantially all ofthe liabilities ofthe Albert Einstein College of Medicine,
a division of YU. In connection with this transaction, Build NYC Resource Corporation loaned to
Einstein, under a loan agreement, the proceeds of $175.0 million Build NYC Resource
Corporation Revenue Bonds. In accordance with their terms, the bonds were tendered by the

46

 Montefiore Medical Center
Notes to Consolidated Financial Statements (continued)

9. Commitments, Contingencies and Other (continued)
original bondholder and remarketed on January 28, 2016. Prior to the remarketing, the required
interest and principal payments on the bonds were guaranteed by the Medical Center. The Medical

Center was not required to make any payments under the guarantee, which terminated upon the
remarketing ofthe bonds on January 28,2016.

In addition, on September 9,2015, Einstein issued to YU a promissory note (the Note) under which
it is obligated to pay to YU 20 annual payments of $12.5 million beginning September 2017,
followed by a final, twenty-first payment of $20.0 million in September 2037. Discounted at 5%,
the present value of the Note is approximately $165.7 million. Pursuant to a guaranty agreement
(Guaranty Agreement), the Medical Center has guaranteed Einstein's obligation to make payments
under the Note. If the Medical Center is required to make payments under the Guaranty
Agreement, Einstein will be obligated to repay the Medical Center, in full, over five years with
interest. The Medical Center' s right to repayment is subordinate in certain respects to Einstein's
obligation to make payments on the Build NYC Resource Corporation Revenue Bonds. At
December 31, 2016, no amounts became due and payable under the Note and, accordingly, no
amounts were paid under the Guaranty Agreement.

The Medical Center has an agreement to provide operating subsidies to Einstein over a five-year
period commencing September 2015 in an aggregate amount of up to $80.0 million. The Medical
Center will provide this subsidy in varying amounts to be funded upon the receipt and approval of
documentation of unreimbursed research expenses incurred. The subsidy will total an amount not
to exceed $10.0 million per year in each of the first two years, and not to exceed $20.0 million per
year in each of the third, fourth and fifth years.

Other
At December 31, 2016 and 2015, approximately 66% and 62%, respectively, of the Medical
Center's employees were covered by collective bargaining agreements. The collective bargaining
agreement with NYSNA will expire in December 2018. The collective bargaining agreement with
1199SEIU will expire in September 2018.

In connection with agreements entered into between MIPA and several health insurance
companies, the Medical Center has agreed to guarantee the performance and payment of certain
hospital, physician and administrative services.

47

 Montefiore Medical Center

Notes to Consolidated Financial Statements (continued)

10. Fair Value Measurements

For assets and liabilities required to be measured at fair value, the Medical Center measures fair
value based on the price that would be received to sell an asset or paid to transfer a liability in an
orderly transaction between market participants at the measurement date. Fair value measurements
are applied based on the unit of account from the Medical Center's perspective.
The unit of account determines what is being measured by re ference to the level at which the asset
or liability is aggregated (or disaggregated) for purposes of applying other accounting
pronouncements.

The Medical Center follows a valuation hierarchy that prioritizes observable and unobservable
inputs used to measure fair value into three broad levels, which are described below:
Level 1 - Quoted prices (unadjusted) in active markets that are accessible at the measurement
date for identical assets or liabilities.

Level 2 - Observable inputs that are based on inputs not quoted in active markets, but
corroborated by market data.

- Level 3 - Unobservable inputs are used when little or no market data is available .
A financial instrument's categorization within the valuation hierarchy is based upon the lowest
level of input that is significant to the fair value measurement. In determining fair value, the
Medical Center uses valuation techniques that maximize the use ofobservable inputs and minimize

the use of unobservable inputs to the extent possible and considers nonperformance risk in its
assessment of fair value.

48

 Montefiore Medical Center
Notes to Consolidated Financial Statements (continued)

10. Fair Value Measurements (continued)

Financial assets carried at fair value, including assets invested in the Medical Center's defined

benefit plan, are classified in the table belowin one of the three categories described above as of
December 31,2016:

___Levell

Total

LevELL_____Leve!_3
(In Thousands)

Assets

Cash and cash equivalents
Managed cash and cash
equivalents held for
investment
Marketable and other
securities:
U.S. non-equity mutual
funds
U.S. equity mutual funds
U.S. Government agency
mortgage-backed

$

backed securities
U.S. equity securities
Corporate debt

138,720

67,871

67,871

,
155,762
27,163

155,762
27,163

securities
U.S. Treasury securities
U.S. Government agendy-

$

$

138,720 $

51,848

51,848
109,401

40,167

40,167
60,659
217,303

109,401

60,659
217,303

Interest and other

receivables
Defined benefit plan assets
Cash and cash equivalents
Equity mutual fundscd)

Fixed income mutual fundsco

5,891--5,891
874,785
309,318
565,467

6,117

-

-

6,117

13,409
13,409
5747--5747-

1___520,740_%_302,318$_-_L__200,058

49

 Montefiore Medical Center

Notes to Consolidated Financial Statements (continued)

10. Fair Value Measurements (continued)

Financial assets carried at fair value, including assets invested in the Medical Center' s defined
benefit plan, are classified in the table below in one of the three categories described above as of
December 31,2015:

Levell_Leve12_Leve13_Total-__
(In Thousands)
Assets

Cash and cash equivalents
Managed cash and cash
equivalents held for
investment
Marketable and other
securities:
U.S. non-equity mutual
funds
U.S. equity mutual funds
U.S. Government agency
mortgage-backed
securities
U.S. Treasury securities
U.S. Government agencybacked securities
U.S. equity securities
Corporate debt
Interest and other
receivables

$

-$

-$

160,698

-

-

160,698

83,555
24,949

-

-

83,555
24,949

-

61,015

-

61,015

84,748

-

-

84,748

60,751
-

20,808
285,964

-

20,808
60,751
285,964

99,615

$

99,615

13,476--13,476895,579
367,787
527,792

Defined benefit plan assets

Cash and cash equivalents
Equity securities(c)
Equity mutual fundscd)

17,310

-

-

17,310

1,425
1,643

-

-

1,425
1,643

-

917,486

1,529--1,529-

Debt securitiesce)

$

549,699 $

367,787 $

50

 Montefiore Medical Center

Notes to Consolidated Financial Statements (continued)

10. Fair Value Measurements (continued)

Investments whose fair value is measured at net asset value as a practical expedient (defined
benefit plan assets):
Hedge funds(a)
Private equity funds(b)
Total financial instruments

2,231
75

'$919,752

(a)Hedge fund investments, consisting primarily of publicly traded equity holdings with both long
and short positions.
(b)Venture capital partnerships.
cc)Includes small and large cap common stock of corporations primarily domiciled in the
United States.
(d)Includes investments in mutual funds that invest primarily in domestic large cap common stocks.

ce)Includes investments in corporate bonds.
co Includes investments in mutual funds that invest primarily in fixed income securities.

At December 31, 2016 and 2015, the Medical Center's alternative investments and collective
trusts, excluding those within the defined benefit plan, are reported using the equity method of
accounting in the amount of approximately $144.3 million and $206.8 million, respectively, and,

therefore, are not included in the tables above.
The following is a description of the Medical Center' s valuation methodologies for assets
measured at fair value. Fair value for Level 1 is based upon quoted market prices. Fair value for
Level 2 is based on quoted prices for similar instruments in active markets, quoted prices for
identical or similar instruments in markets that are not active and model-based valuation
techniques for which all significant assumptions are observable in the market or can be
corroborated by observable market data for substantially the full term of the assets. Inputs are
obtained from various sources, including market participants, dealers and brokers. The methods
described above may produce a fair value that may not be indicative of net realizable value or
reflective of future fair values. Furthermore, while the Medical Center believes its valuation
methods are appropriate and consistent with other market participants, the use of different
methodologies or assumptions to determine the fair value of certain financial instruments could
result in a different estimate of fair value at the reporting date.

51

 Montefiore Medical Center
Notes to Consolidated Financial Statements (continued)

10. Fair Value Measurements (continued)

The carrying values and fair values of the Medical Center's financial instruments that are not
required to be carried at fair value are as follows at December 31:

2015

2016
Fair
Value

Long-term debt

$

817,429 $

Fair
Carrying
Value
Value
(In Thousands)

825,218 $

874,477 $

Carrying
Value

870,650

The fair value of the Medical Center' s bonds payable is based on quoted market prices for the
related bonds. The fair value of other debt is based upon discounted cash flow analyses, using
estimated borrowing rates for similar types of debt. Fair value of bonds payable is classified as
Level 1, while fair value of other debt is classified as Level 2.
11. Concentration of Credit Risk
At December 31,2016 and 2015, excluding investments in bond mutual funds, approximately 24%
and 21%, respectively, of the Medical Center's marketable securities were issued by either the
United States Government or its agencies.

At December 31,2016 and 2015, significant concentrations of receivables for patient care include
approximately 11% and 14% from Medicaid, 10% and 12% from Medicare and 78% and 74%

from commercial and managed care organizations, respectively, o f which 12% and 13% was due
from Blue Cross plans at December 31,2016 and 2015, respectively.

Net patient service revenue from the Medicare and Medicare managed care programs accounted
for approximately 32% for the years ended December 31,2016 and 2015, and net patient service
revenue from the Medicaid and Medicaid managed care programs accounted for approximately
32% and 33% of the Medical Center's net patient service revenue for the years ended
December 31, 2016 and 2015, respectively. No other specific payer exceeded 10% of net patient

service revenue.

52

 Montefiore Medical Center

Notes to Consolidated Financial Statements (continued)

12. Other Revenue

Other revenue included in the consolidated statements of operations for the years ended
December 31,2016 and 2015 consisted of the following:
2015
2016
(In Thousands)

DSRIP revenue
Patient care quality incentive revenue
Staff housing and other rental income
Care management administrative fees
Equity earnings from investments
Continuing Medical Education programs
Interest and dividend income
Behavioral health program revenue
Government Electronic Health Record Incentive Program

$

Parking revenue

Cafeteria revenue
Net assets released from restrictions used for operations

Shared savings revenue
All other

$

18,483 $
18,393
20,000
16,250
27,672
13,925
12,912
9,986
6,699
6,279
6,196
3,157
(7,283)
25,170
177,839 $

6,528
28,891
19,791
15,699
7,741
7,300
14,793
2,522
12,312
6,353
5,932
4,798
11,717
15,050
159,427

New York State distributes federally-funded amounts through a payment mechanism referred to
as the Delivery System Reform Incentive Payment (DSRIP) program. The DSRIP program is a
five-year program intended to promote community-level collaborations to focus on health system
reform and enhance the value provided by the health care system. DSRIP funding is available to
certain hospitals and providers participating in networks (referred to as Performing Provider
Systems, PPS) that are able to establish performance improvement activities in certain predefined
clinical improvement areas. The PPS that the Medical Center coordinates has submitted plans for
clinical improvement projects in order to be eligible for payments under the DSRIP program. The
Medical Center received approximately $25.9 million and $11.7 million during 2016 and 2015,
respectively, and recorded approximately $18.5 million and $6.5 million, respectively, in other
operating revenue during the years ended December 31,2016 and 2015 for amounts received under
the DSRIP program.

53

 Montefiore Medical Center

Notes to Consolidated Financial Statements (continued)

12. Other Revenue (continued)
Certain payments under the DSRIP program are subject to meeting specified performance criteria
and other requirements which may be evaluated in future periods.
The Medical Center receives shared savings revenue from CMS based on the Pioneer Accountable
Care Organization (Medicare Fee For Service) savings. The Medical Center estimated that no
shared savings revenue was earned for performance year 5 (January 1,2016 through December 31,
2016). During 2016, CMS finalized the shared savings calculation for performance year 4
(January 1,2015 through December 31,2015) and determined that the Medical Center did not earn
a shared savings payment. The $12.9 million estimated receivable pertaining to performance year
4 was written off and recognized as a change in estimate during 2016. In addition, the Medical
Center enters into shared savings programs with commercial payers. For the year ended
December 31, 2016, the Medical Center recorded approximately $5.6 million of revenue related
to these programs.
13. Related Party Transactions

The Medical Center purchases various management, administrative and staffing services from
certain of its members. The members charge the Medical Center for such services at cost. For the
year ended December 31, 2016 and 2015, the Medical Center incurred costs of approximately
$137.8 million and $128.4 million, respectively, related to the various services provided by its
members.

54

 Montefiore Medical Center

Notes to Consolidated Financial Statements (continued)

13. Related Party Transactions (continued)

At December 31, 2016 and 2015, amounts due from and due to members were comprised of the
following:
December 31
2015
2016
(In Thousands)

Note due from MHS

$

123,917 $

117,529

-$

1,268
4,454
1,498
538
7,210
138,885
(52,007)
86,878 $

7,379
2,814
817
410
7,195
14,141
3,240
2
153,527
(72,938)
80,589

5,834 $
6,238
12,958
4

16,016
-

Due from:
MHS
Montefiore New Rochelle Hospital
Montefiore Mount Vernon Hospital
Schaffer Extended Care Center
Montefiore HMO, LLC
Montefiore North Ambulatory Care Center, Inc.
Albert Einstein College of Medicine, Inc.
MMAHS
Less current portion
Due from members, net of current portion
Due to:

MHS
Montefiore Mount Vernon Hospital
Montefiore Information Technology, LLC
Montefiore North Ambulatory Care Center, Inc.
Nyack Hospital, Inc.
Albert Einstein College of Medicine, Inc.
MMAHS
Due to members

$

382
3,450

$

62
28,928 $

-

223

16,239

During 2016 and 2015, the Medical Center provided advances to MHS under a note arrangement
(the MHS Note), the proceeds of which were used by MHS to provide loans to several members
to fund their ongoing operations.

55

 Montefiore Medical Center

Notes to Consolidated Financial Statements (continued)

13. Related Party Transactions (continued)

During 2014, the Medical Center advanced approximately $31.0 million to MHS, which MHS
subsequently loaned to White Plains Hospital Center (White Plains) to assist in the development
of certain projects, services and infrastructure under executed loan agreements. On January 1,
2015, MHS became the sole corporate member of White Plains and under the terms of the loan
agreements, the loans were terminated. The amounts advanced to MHS by the Medical Center
were forgiven and recorded as a capital contribution, which reduced unrestricted net assets by
approximately $31.0 million. In addition, during 2016 and 2015, the Medical Center advanced
approximately $39.6 million and $73.8 million, respectively, to MHS which was recorded as a
capital contribution.
During 2016 and 2015, the Medical Center made capital contributions of approximately
$8.3 million and $2.5 million, respectively, to Einstein in accordance with an agreement to provide
operating subsidies to Einstein over a five-year period (see Note 9).
During 2016, the Medical Center forgave the amount owed from Montefiore North Ambulatory
Care Center, Inc. of approximately $16.6 million, recorded within transfers to members, net in the
consolidated statements of operations.

During the year ended December 31, 2016, the Medical Center's performing provider system
(PPS), MHVC, received approximately $59.5 million in DSRIP Value Based Payment Quality
Improvement Program (VBP QIP) funding, all of which was distributed to Montefiore
New Rochelle Hospital, Montefiore Mount Vernon Hospital, Nyack Hospital and St. Luke's
Cornwall Hospital. VBP QIP was created by New York State to provide financially distressed
hospitals and the PPSs with which they are associated the opportunity to collaborate with Medicaid
managed care organizations for the successful implementation of VBP contracts as a means toward
long-term financial sustainability. VBP QIP revenue and related expenditures have no net impact
on the consolidated statements of operations of the Medical Center.

56

 EY I Assurance I Tax I Transactions I Advisory
About EY
EY is a global leader in assurance, tax, transaction and advisory services.
The insights and quality services we deliver help build trust and confidence in
the capital markets and in economies the world over. We develop outstanding
leaders who team to deliver on our promises to all of our stakeholders. In so

doing, we play a critical role in building a better working world for our people,
for our clients and for our communities.
EY refers to the global organization, and may refer to one or more, of the
member firms of Ernst & Young Global Limited, each of which is a separate
legal entity. Ernst & Young Global Limited, a UK company limited by guarantee,
does not provide services to clients. For more information about our

organization, please visit ey.com.
© 2016 Ernst & Young LLR
All Rights Reserved.

ey.com