2020-10-27T14:48:10-05:00 2018-12-31 390859910 BAKER TILLY VIRCHOW KRAUSE LLP 1570 FRUITVILLE PIKE SUITE 400 LANCASTER PA 17601 990 2018-01-01 743177454 RICHMOND MEDICAL CENTER RICH 7188182036 355 BARD AVENUE STATEN ISLAND NY 10310 DANIEL J MESSINA PRESIDENT & CEO 7188182036 2020-03-10 1 KERRI N BOGDA CPA P00760402 7177404863 96.89.178.154 2020-03-10 09:07:33 ED P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 AE0C272A69DD34E2EDF3B6A185DE1CF90EACE8A4 2018 2021-01-29 14:40:06Z X RICHMOND UNIVERSITY MEDICAL CENTER DANIEL J MESSINA 355 BARD AVENUE STATEN ISLAND NY 10310 358181467 0 X WWW.RUMCSI.ORG X 2007 NY PROVISION OF HEALTH CARE SERVICES TO THE PUBLIC 21 16 2738 50 1979 979 15836915 25070118 323511304 315315484 115837 491941 11910015 16046850 351374071 356924393 0 0 0 0 218061784 219275642 0 0 0 122650567 123586400 340712351 342862042 10661720 14062351 207563449 255798298 129471367 165020416 78092082 90777882 X THE MEDICAL CENTER IS A NOT-FOR-PROFIT HEALTH CARE PROVIDER SERVING THE ETHNICALLY DIVERSE COMMUNITY OF STATEN ISLAND AND ITS NEIGHBORS. WE PROVIDE PREMIER QUALITY PATIENT CARE THROUGH A FULL SPECTRUM OF EMERGENT, ACUTE, PRIMARY, BEHAVIORAL HEALTH AND EDUCATIONAL SERVICES. WE DO THIS IN AN ENVIRONMENT THAT PROMOTES THE HIGHEST SATISFACTION AMONG PATIENTS, FAMILIES, PHYSICIANS AND STAFF. 0 0 293396270 0 315315484 RICHMOND UNIVERSITY MEDICAL CENTER (RUMC OR THE MEDICAL CENTER) IS A 448 LICENSED BED, ACUTE CARE HOSPITAL SERVING NEARLY 500,000 RESIDENTS OF STATEN ISLAND, NEW YORK. THE MAIN CAMPUS IS LOCATED IN THE WEST BRIGHTON SECTION OF STATEN ISLAND.RUMC PROVIDES VARIOUS INPATIENT AND OUTPATIENT SERVICES, INCLUDING: MEDICAL/SURGICAL, PEDIATRICS, OBSTETRICS/GYNECOLOGY, NICU, A DESIGNATED STROKE CENTER, A LEVEL 1 TRAUMA CENTER, BEHAVIORAL HEALTH SERVICES, EMERGENCY SERVICES AND CLINIC SERVICES. THE MEDICAL CENTER ALSO PROVIDES AN ARRAY OF COMMUNITY OUTREACH SERVICES INCLUDING HEALTH EDUCATION, FREE AND LOW COST SCREENINGS AND IMMUNIZATIONS, A WIC PROGRAM, AND VARIOUS OTHER OUTPATIENT SERVICES.THE MEDICAL CENTER PROVIDES FOR THE HEALTHCARE NEEDS OF STATEN ISLAND'S MOST INDIGENT AND MARGINALIZED RESIDENTS. BASED ON COST, IN 2018, APPROXIMATELY $5,101,000 IN CHARITY CARE WAS PROVIDED TO PATIENTS WHO MEET CERTAIN NYS DEPARTMENT OF HEALTH AND SENIOR SERVICES CRITERIA. THESE PATIENTS RECEIVED SERVICES WITHOUT CHARGE OR AT AMOUNTS LESS THAN ESTABLISHED RATES. THE MEDICAL CENTER ALSO PROVIDED COMMUNITY BENEFITS BY PROVIDING SERVICES TO MEDICAID PATIENTS AT RATES THAT WERE BELOW THE COSTS FOR PROVIDING SUCH SERVICES. IN 2018, INPATIENT VOLUME EXCEEDED 15,000 INPATIENT DISCHARGES ACCOUNTING FOR OVER 79,000 PATIENT DAYS. OUTPATIENT VOLUME EXCEEDED 58,000 EMERGENCY ROOM VISITS AND OVER 190,000 OTHER OUTPATIENT VISITS. THE LARGEST PROGRAM SERVICES BY EXPENSES ARE: MEDICAL / SURGICAL, BEHAVIORAL HEALTH AND OBSTETRICS / GYNECOLOGY.MEDICAL / SURGICALTHE MEDICAL CENTER PROVIDED COMPREHENSIVE INPATIENT AND OUTPATIENT MEDICAL/SURGICAL SERVICES TO THOUSANDS OF PATIENTS IN 2018. DURING THE YEAR, THE MEDICAL CENTER PERFORMED OVER 1,600 INPATIENT AND 6,000 OUTPATIENT SURGERIES MEDICAL/SURGICAL SERVICES INCLUDE ENDOSCOPY, PAIN MANAGEMENT, VASCULAR SURGERY, UROLOGIC SURGERY, SPORTS MEDICINE, JOINT REPLACEMENT, AND ARTHROSCOPIC SURGERY. BEHAVIORAL HEALTHBEHAVIORAL HEALTH SERVICES AT THE MEDICAL CENTER TREATED THOUSANDS OF ADULTS AND CHILDREN IN 2018. DURING THE YEAR, BEHAVIORAL HEALTH INPATIENT DISCHARGES TOTALED OVER 1,300 AND ACCOUNTED FOR MORE THAN 14,000 PATIENT DAYS. INPATIENT SERVICES INCLUDED A PSYCHIATRIC UNIT, A CHILD AND ADOLESCENT PROGRAM SERVICES. BEHAVIOR HEALTH OUTPATIENT CARE IS AVAILABLE THROUGH THE COMPREHENSIVE PSYCHIATRIC EMERGENCY PROGRAM (CPEP), WHICH PROVIDES IMMEDIATE ACUTE PSYCHIATRIC CARE WITH AN EXTENDED OBSERVATION BED UNIT AND A MOBILE OUTREACH TEAM. OTHER OUTPATIENT SERVICES INCLUDE A CONTINUING DAY TREATMENT PROGRAM, SUBSTANCE ABUSE OUTPATIENT CLINICS, A SUBSTANCE ABUSE CRISIS CENTER, A GAMBLERS TREATMENT CENTER AND AN ONGOING EVALUATION AND REFERRAL SERVICE. 293396270 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 209 0 2738 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 21 16 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 1 0 NY X JOSEPH SAPORITO SR VP CFO 7188182036 355 BARD AVENUE STATEN ISLAND NY 10310 KATHRYN KRAUSE ROONEY ESQ CHAIRPERSON 1.00 X X 0 0 0 RONALD PURPORA VICE CHAIR 1.00 X X 0 0 0 CATHERINE M PAULO ESQ SECRETARY 1.00 X X 0 0 0 GINA GUTZEIT TREASURER & FINANCE CHAIR 1.00 X X 0 0 0 DANIEL MESSINA PRESIDENT & CEO 37.50 2.00 X X 834610 0 185096 PIETRO CARPENITO MD TRUSTEE 37.50 X 482796 0 77288 REV DR TONY BAKER SR TRUSTEE 1.00 X 0 0 0 KATHERINE ANNE CONNORS TRUSTEE 1.00 X 0 0 0 THOMAS DELMASTRO TRUSTEE 1.00 X 0 0 0 SARA WARREN GARDNER MPH TRUSTEE 1.00 X 0 0 0 JAMES P MOLINARO TRUSTEE 1.00 X 0 0 0 JILL O'DONNELL-TORMEY PHD TRUSTEE 1.00 X 0 0 0 DENNIS W QUIRK TRUSTEE 1.00 X 0 0 0 JOHN C SANTORA TRUSTEE 1.00 1.00 X 0 0 0 JOHN VINCENT SCALIA SR TRUSTEE 1.00 X 0 0 0 PANKAJ R PATEL TRUSTEE/CHAIR OF PSYCHIATRY 40.00 1.00 X 81150 0 0 SAMALA SWAMY MD TRUSTEE 40.00 X 189995 0 0 ALAN BERNIKOW TRUSTEE 1.00 X 0 0 0 STEVEN KLEIN TRUSTEE 1.00 X 0 0 0 ALLAN WEISSGLASS TRUSTEE 1.00 X 0 0 0 MARIANNE LABARBERA MD TRUSTEE/PRES MED STAFF 40.00 X 138928 0 398 FRANK SCAFURI MD TRUSTEE (UNTIL 06/18) 1.00 X 0 0 0 MITCHELL FOGEL MD SENIOR VP/CHAIR OF MEDICIN 40.00 X 470054 0 69737 JOSEPH SAPORITO SENIOR VP & CFO 37.50 2.00 X 528066 0 73907 ROSEMARIE STAZZONE SENIOR VP NURSING & CNO 37.50 X 570084 0 58486 RICHARD SALHANY SENIOR VP PROFESSIONAL SER 37.50 1.00 X 416209 0 65361 MICHAEL L MORRETTI CHAIRMAN OF OB/GYN 37.50 X 832740 0 43337 LOREN HARRIS MD MEDICAL CHAIRMAN 40.00 X 755465 0 25825 ELI SERUR PHYSICIAN 40.00 X 982471 0 43228 DOUGLAS COHEN MD PHYSICIAN 40.00 X 741222 0 43228 VLADIMIR RUBINSHTEY PHYSICIAN 37.50 X 619822 0 37837 XIN Y LI PHYSICIAN 40.00 X 509689 0 37837 PHILLIP OTTERBECK PHYSICIAN 40.00 1.00 X 519999 0 20325 8673300 0 781890 446 0 1 0 RICHMOND EMERGENCY ASSOCIATES 3 CENTURY DRIVE PARSIPPANY NJ 07054 EMERGENCY ROOM DOCTOR STAFFING 1862430 RESTORIX HEALTH 445 HAMILTON AVE 800 WHITE PLAINS NY 10601 WOUND CARE SERVICES 876868 DIALYSIS CLINICAL INC (DCI) 800 CASTLETON AVE STATEN ISLAND NY 10310 ACUTE SERVICES FEES 840415 NEXERA CONSULTING 555 WEST 57TH ST 15TH FLOOR NEW YORK NY 10019 PURCHASING SERVICES 531215 RN STAFFING SOLUTIONS LLC 1672 VICTORY BLVD STATEN ISLAND NY 10314 STAFFING 516425 28 2084608 22770685 214825 25070118 NET PATIENT SERVICE REVENUES 621990 308016144 308016144 NYS DOH PUBLIC POOL REV 621990 7299340 7299340 315315484 267705 1979 265726 1715311 1257074 458237 458237 458237 214236 10000 0 0 214236 10000 224236 224236 VENDOR REBATES AND REFUNDS 900099 6898462 6898462 OTHER PROGRAM INCOME 900099 3246022 3246022 STUDENT SERVICES INCOME 900099 2651182 2651182 2792947 2792947 15588613 356924393 315315484 1979 16536812 5900291 5049469 850822 158599544 135729490 22870054 13732273 11752079 1980194 28784703 24633949 4150754 12258831 10491108 1767723 421111 360387 60724 242394 207441 34953 29290 29290 26986160 23094756 3891404 816983 699174 117809 2442741 2090498 352243 3300 2824 476 4590723 3928741 661982 59634 51035 8599 289817 248025 41792 943876 807769 136107 9170681 7848269 1322412 4273718 3657448 616270 MEDICAL SUPPLIES 37100535 31750638 5349897 BAD DEBT EXPENSE 22088239 18903115 3185124 REPAIRS & MAINTENANCE 5477317 4687488 789829 LICENSES & FEES 2381083 2037731 343352 6268798 5364836 903962 342862042 293396270 49465772 0 7208327 9639555 24821462 18783650 36008990 47504977 6048655 10707496 6288940 6209659 1767629 1326305 129832433 52814194 77117592 77018239 50000 50000 616628 72560 47635226 84485857 207563449 255798298 41953297 46948709 3981568 3699195 50580000 10807030 4456040 72729472 59336472 129471367 165020416 X 73340992 87155525 4406443 3277710 344647 344647 78092082 90777882 207563449 255798298 X 14062351 -92674 -1283877 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 29290 29290 0 PART II-B, LINE 1: THE HOSPITAL PAID THE FOLLOWING DUES TO NATIONAL AND STATE HOSPITAL ASSOCIATIONS, OF WHICH A PERCENTAGE WAS ALLOCABLE TO LOBBYING COSTS: HANYS - $81,039 (DUES) X 17.51% (APPROX. LOBBYING PERCENTAGE) = $14,190 GNYHA - $15,100 (DUES) X 100% (APPROX. LOBBYING PERCENTAGE) = $15,100 344647 344647 344647 344647 344647 344647 344647 344647 344647 344647 0.00000 1.00000 0.00000 0 0 4471164 4471164 47842635 10996919 36845716 4481165 774190 3706975 49842842 33234980 16607862 23194627 7808105 15386522 77018239 SECURITY DEPOSITS 323777 INSURANCE RECOVERIES RECEIVABLE 15136334 SERP PENSION ASSET 837221 DUE FROM AFFILIATES 39412750 BENEFICIAL INTEREST IN NET ASSETS OF FOUNDATION 2687103 BOND RESERVE FUNDS 16488811 CAPITALIZED INTEREST 4569389 DEFERRED BOND ISSUANCE COSTS 5030472 84485857 ESTIMATED 3RD PARTY PAYOR SETTLEMENTS 12653249 ESTIMATED MEDICAL MALPRACTICE CLAIMS 25158093 SERP LIABILITY 881579 ACCRUED NYSNA PENSION LIABILITY 19310652 CAPITAL LEASES 521532 DUE TO AFFILIATES 811367 59336472 334716677 -92674 -23372116 -23464790 358181467 -1257074 -1257074 356924393 322030877 1257074 1257074 320773803 22088239 22088239 342862042 PART V, LINE 4: THE ENDOWMENT FUND, ALSO KNOWN AS THE BELL SOCIETY ENDOWMENT FUND, IS INTENDED TO BENEFIT THE WORK OF THE MEDICAL CENTER. NO OTHER RESTRICTIONS HAVE BEEN PLACED ON THE USE OF THE INTEREST THAT IS EARNED ON THE PRINCIPAL BALANCE. PART XI, LINE 2D - OTHER ADJUSTMENTS: BAD DEBT EXPENSE NETTED AGAINST REVENUES ON FINANCIALS -22,088,239. PENSION LIABILITY ADJUSTMENT 43,143. CHANGE IN BENEFICIAL INTEREST IN THE FOUNDATION -1,138,514. GAIN ON TERMINATION OF LEASE 238,255. LOSS ON EXTINGUISHMENT OF DEBT -426,761. PART XI, LINE 4B - OTHER ADJUSTMENTS: RENTAL EXPENSES -1,257,074. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES 1,257,074. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE NETTED AGAINST REVENUES ON FINANCIALS 22,088,239. 1 1 X 1 X 1 X 1 1 0 1 1 7964250 2911423 5052827 0.01580 91455683 77666444 13789239 0.04300 99419933 80577867 18842066 0.05880 36189708 12148088 24041620 0.07490 26204716 16619865 9584851 0.02990 62394424 28767953 33626471 0.10480 161814357 109345820 52468537 0.16360 0 5940501 1782150 64630426 52362300 12268126 X 1 1 1 1 RICHMOND MEDICAL CENTER 355 BARD AVENUE STATEN ISLAND NY 10310 7004010H X X X X RICHMOND MEDICAL CENTER 1 0 0 1 X X X X X X X 16 1 0 0 1 X WWW.RUMCSI.ORG/COMMUNITYHEALTHNEEDSASSESSMENT X 1 16 1 WWW.RUMCSI.ORG/COMMUNITYHEALTHNEEDSASSESSMENT 0 1 X 100.000000000000 300.000000000000 X X 1 1 X X X X 1 X RUMCSI.ORG/UPLOADS/PUBLIC/DOCUMENTS/FINANCIAL%20ASSISTANCE%20POLICY%20WEBSI X RUMCSI.ORG/UPLOADS/PUBLIC/DOCUMENTS/INITIAL%20APPLICATION.PDF X RUMCSI.ORG/FINANCIALASSISTANCESUMMARY X X X 1 X 0 X X 1 X 0 0 RICHMOND MEDICAL CENTER PART V, SECTION B, LINE 5: COMMUNITY INPUT WAS A SIGNIFICANT ASPECT OF THE COMMUNITY HEALTH NEEDS ASSESSMENT. RUMC COLLABORATED WITH THE NEW YORK CITY DEPARTMENT OF HEALTH AND MENTAL HYGIENE TO OBTAIN COMMUNITY MEMBER INPUT. THE HEALTH DEPARTMENT HELD COMMUNITY CONSULTATIONS IN NEIGHBORHOODS ACROSS THE CITY, INCLUDING STATEN ISLAND, BETWEEN OCTOBER 2015 AND MARCH 2016. THEY SPOKE WITH MORE THAN 800 NEW YORKERS ABOUT TAKE CARE NEW YORK 2020 (TCNY 2020) GOALS AND LOCAL PRIORITIES FOR CHANGE. TAKE CARE NEW YORK 2020 IS THE CITY'S PLAN TO IMPROVE RESIDENT HEALTH AND ADDRESS HEALTH DISPARITY. THE INPUT RECEIVED AT THE COMMUNITY CONSULTATIONS WILL HELP RUMC COLLABORATE WITH THE HEALTH DEPARTMENT AND THE COMMUNITY TO PLAN FOR ACTION.TO AUGMENT THE COMMUNITY CONSULTATIONS, AN ONLINE KEY INFORMANT SURVEY WAS CONDUCTED IN AUGUST 2016 TO SOLICIT INPUT FROM COMMUNITY LEADERS REPRESENTING THE BROAD INTERESTS OF THE COMMUNITY, INCLUDING EXPERTS IN PUBLIC HEALTH AND INDIVIDUALS REPRESENTING MEDICALLY UNDERSERVED, LOW-INCOME, AND MINORITY POPULATIONS. KEY INFORMANTS WERE ASKED A SERIES OF QUESTIONS ABOUT THEIR PERCEPTIONS OF HEALTH NEEDS IN THE COMMUNITY, HEALTH DRIVERS, BARRIERS TO CARE, QUALITY AND RESPONSIVENESS OF HEALTH PROVIDERS, AND RECOMMENDATIONS FOR COMMUNITY HEALTH IMPROVEMENT.AT EACH COMMUNITY CONSULTATION HOSTED BY THE HEALTH DEPARTMENT, PARTICIPANTS WERE ASKED TO RANK THE INDICATORS OUTLINED IN THE TCNY 2020 PLAN ACCORDING TO ORDER OF IMPORTANCE FOR THE LOCAL COMMUNITY, WHERE THE #1 RANK REPRESENTS THE MOST IMPORTANT INDICATOR. ADDITIONALLY, PARTICIPANTS WERE ENGAGED IN DISCUSSIONS ABOUT THE HEALTH GOALS OF THE LOCAL COMMUNITY AND LOCAL ASSETS THAT CAN HELP ACHIEVE THOSE GOALS. RICHMOND MEDICAL CENTER PART V, SECTION B, LINE 11: RUMC COMPLETED A COMMUNITY HEALTH NEEDS ASSESSMENT WHICH HAS IDENTIFIED THE PREVENTION AND MANAGEMENT OF CHRONIC DISEASE AND ITS UNDERLYING CAUSES AS THE SINGLE MOST IMPORTANT HEALTH NEED FACING THE BOROUGH OF STATEN ISLAND WHERE SIGNIFICANT DISPARITIES EXIST ACROSS ETHNICITIES DUE TO SOCIOECONOMIC FACTORS. THE DECISION WAS SUPPORTED BY SURVEY RESPONDENTS WHO WERE QUERIED AS TO THEIR PREFERENCE FOR ADDRESSING THE 5 PRIORITY AREAS OUTLINED IN THE STATE'S PREVENTION AGENDA. RUMC HAS DECIDED TO ALIGN ITS INTERVENTIONS WITH THOSE RECOMMENDED BY THE NYS PREVENTION AGENDA 2013 - 2017 AND NYC TAKE CARE NEW YORK IN DEVELOPING ITS IMPLEMENTATION STRATEGY. TOWARD THAT END WE FEEL WE HAVE ADDRESSED THE HIGH PRIORITY AREAS NEEDS AREAS AND THE PLAN AND OUR INTERVENTIONS ARE DISCUSSED MORE FULLY IN PART VI. RUMC LEADERSHIP RECOGNIZES THAT THE HOSPITAL CAN HAVE THE GREATEST IMPACT ON THE COMMUNITY BY FOCUSING HEALTH IMPROVEMENT EFFORTS ON THE MOST PRESSING NEEDS IDENTIFIED FROM THE CHNA RESEARCH. RUMC WILL CONTINUE EXISTING EFFORTS AND WILL LEND SUPPORT TO OTHER LEAD ORGANIZATIONS, BUT WILL NOT DEVELOP A SPECIFIC FOCUS FOR THE FOLLOWING NEW YORK STATE PREVENTION AGENDA PRIORITIES:- PROMOTE A HEALTHY AND SAFE ENVIRONMENT- PROMOTE HEALTHY WOMEN, INFANTS, AND CHILDREN- PREVENT SEXUALLY TRANSMITTED DISEASES, VACCINE-PREVENTABLE DISEASES AND HEALTHCARE-ASSOCIATED INFECTIONS PART I, LINE 7: THE COSTS ASSOCIATED WITH CHARITY CARE AND MEANS TESTED GOVERNMENT PROGRAMS WERE DETERMINED USING THE RATIO OF PATIENT CARE COSTS TO PATIENT CHARGES UTILIZING WORKSHEET 2 OF THE INSTRUCTIONS FOR SCHEDULE H (FORM 990). THE COSTS ASSOCIATED WITH "OTHER BENEFITS" WERE DETERMINED USING THE ACTUAL COSTS INCURRED BY THE PROGRAM USING AN INDIRECT OVERHEAD ALLOCATION, ADJUSTED FOR THE ACTUAL LOCATION OF THE PROGRAM. PART I, LINE 7G: THE ORGANIZATION DID NOT INCLUDE ANY COSTS ATTRIBUTABLE TO A PHYSICIAN CLINIC IN THE AMOUNT REPORTED FOR SUBSIDIZED HEALTH SERVICES ON PART I, LINE 7G. PART I, LN 7 COL(F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 24, BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $22,088,239. PART III, LINE 2: THE COSTS ASSOCIATED WITH BAD DEBT EXPENSE WERE DETERMINED USING THE RATIO OF PATIENT CARE COSTS TO PATIENT CHARGES UTILIZING WORKSHEET 2 OF THE INSTRUCTIONS FOR SCHEDULE H (FORM 990). PART III, LINE 3: THE COSTING METHODOLOGY USED TO ESTIMATE THE AMOUNT OF BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE CHARITY CARE POLICY WAS THE RATIO OF APPROVED CHARITY CARE APPLICATIONS TO TOTAL APPLICATIONS APPLIED TO SELF PAY BAD DEBTS ASSOCIATED WITH PATIENTS WHO DID NOT ADEQUATELY COMPLETE THE CHARITY CARE PAPERWORK. WE BELIEVE THAT A PORTION OF OUR BAD DEBT RESULTS FROM SERVICES PROVIDED TO PATIENTS WHO MEET THE CHARITY CARE GUIDELINES BUT WERE UNWILLING OR UNABLE TO PROVIDE THE APPROPRIATE DOCUMENTATION TO ALLOW THAT CLASSIFICATION. THESE SHOULD BE CONSIDERED COMMUNITY BENEFIT AS WE ARE STILL PROVIDING SERVICES TO THESE PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. PART III, LINE 4: ACCOUNTS RECEIVABLE, PATIENTS, ARE REPORTED AT NET REALIZABLE VALUE. ACCOUNTS ARE WRITTEN OFF WHEN THEY ARE DETERMINED TO BE UNCOLLECTIBLE BASED UPON MANAGEMENT'S ASSESSMENT OF INDIVIDUAL ACCOUNTS. IN EVALUATING THE COLLECTABILITY OF PATIENT ACCOUNTS RECEIVABLE, THE MEDICAL CENTER ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE (WHICH INCLUDES PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE MEDICAL CENTER ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS, IF NECESSARY. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS, THE MEDICAL CENTER RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE BILLED RATES AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. PART III, LINE 8: MEDICARE COSTS WERE DETERMINED USING THE RATIO OF PATIENT CARE COSTS TO PATIENT CHARGES UTILIZING WORKSHEET 2 OF THE INSTRUCTIONS FOR SCHEDULE H (FORM 990). PART III, LINE 9B: ALL PATIENTS WITH SELF PAY BALANCES RELATED TO SERVICES RENDERED AT RICHMOND UNIVERSITY MEDICAL CENTER ARE GIVEN THE OPPORTUNITY TO ADDRESS THEIR RESPONSIBILITY THROUGH A PAYMENT ARRANGEMENT OR A REDUCED FEE, BASED ON THE CRITERIA OF OUR FINANCIAL ASSISTANCE PROGRAM. A SLIDING FEE SCALE IS UTILIZED AND IS BASED UPON FAMILY INCOME AND NUMBER OF FAMILY MEMBERS. ALL PATIENTS WILL RECEIVE STATEMENTS AND/OR LETTERS AND ARE GIVEN THE OPPORTUNITY TO SATISFY THEIR OBLIGATION TO THE FACILITY PRIOR TO TRANSFER TO A COLLECTION AGENCY AND WRITE-OFF TO A BAD DEBT. PATIENTS WHO CANNOT AFFORD TO PAY ARE OFFERED INSTALLMENT PAYMENTS OR A REDUCTION IN BALANCE THROUGH THE FINANCIAL ASSISTANCE PROGRAM (FAP). PART VI, LINE 2: RICHMOND UNIVERSITY MEDICAL CENTER'S (RUMC) BOARD, ADMINISTRATION AND STAFF FUNCTION FROM AN UNDERSTANDING THAT HEALTH IS THE CORNERSTONE OF A PRODUCTIVE AND POSITIVE QUALITY-OF-LIFE FOR EVERY STATEN ISLANDER. AS SUCH, OUR FOCUS IS NOT ONLY ON HEALING THE SICK, BUT ALSO UNDERSTANDING THE ROOT CAUSE OF CONDITIONS AFFECTING STATEN ISLANDERS AND WHAT WE CAN DO TO PREVENT THE DISEASE PROCESSES PREVALENT IN OUR COMMUNITY. RUMC UTILIZES A VARIETY OF SOURCES AND APPROACHES TO IDENTIFY THE HEALTH NEEDS OF THE COMMUNITY WE SERVE.COMMUNITY BENEFIT PLANNING IS FORMULATED AROUND INFORMATION GATHERED FROM CONSOLIDATING DATA FROM NEW YORK STATE AND NEW YORK CITY DEPARTMENTS OF HEALTH AND OBTAINING PERSPECTIVES FROM KEY COMMUNITY ORGANIZATIONS AND STAKEHOLDERS ON THE CRITICAL HEALTHCARE ISSUES FACING STATEN ISLAND. THROUGH DATA OBTAINED FROM THE NEW YORK STATE DEPARTMENT OF HEALTH AND NEW YORK CITY DEPARTMENT OF HEALTH, AS WELL AS COLLABORATIONS WITH HEALTHCARE AND OTHER KEY COMMUNITY STAKEHOLDERS, RUMC COORDINATES A UNIFIED EFFORT TO PROVIDE PROGRAMS THAT IMPACT THE HEALTH AND WELL-BEING OF OUR COMMUNITY. RUMC CONDUCTED A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) IN 2016 TO GUIDE COMMUNITY HEALTH IMPROVEMENT EFFORTS ACROSS OUR PRIMARY SERVICE AREA, STATEN ISLAND. THE 2016 CHNA BUILDS UPON OUR 2013 CHNA AND WAS CONDUCTED IN A TIMELINE CONSISTENT WITH THE REQUIREMENTS SET FORTH BY THE AFFORDABLE CARE ACT FOR NON-PROFIT HOSPITALS AND THE NEW YORK STATE DEPARTMENT OF HEALTH COMMUNITY SERVICE PLAN INITIATIVE. THE PURPOSE OF THE ASSESSMENT WAS TO GATHER INFORMATION ABOUT LOCAL HEALTH NEEDS AND HEALTH BEHAVIORS. WE EXAMINED A VARIETY OF HOUSEHOLD AND HEALTH STATISTICS TO CREATE A FULL PICTURE OF THE HEALTH AND SOCIAL DETERMINANTS ACROSS STATEN ISLAND. THE FINDINGS HELP ENSURE THAT OUR INITIATIVES, ACTIVITIES AND PARTNERSHIPS MEET THE NEEDS OF OUR COMMUNITIES. QUANTITATIVE AND QUALITATIVE METHODS, REPRESENTING BOTH PRIMARY AND SECONDARY RESEARCH, WERE USED TO ILLUSTRATE AND COMPARE HEALTH TRENDS AND DISPARITIES ACROSS STATEN ISLAND. PRIMARY RESEARCH METHODS SOUGHT TO SOLICIT INPUT FROM KEY COMMUNITY STAKEHOLDERS REPRESENTING THE BROAD INTERESTS OF THE COMMUNITY, INCLUDING EXPERTS IN PUBLIC HEALTH AND INDIVIDUALS REPRESENTING MEDICALLY UNDERSERVED, LOW-INCOME, AND MINORITY POPULATIONS. SECONDARY RESEARCH METHODS SOUGHT TO IDENTIFY COMMUNITY HEALTH NEEDS AND TRENDS ACROSS GEOGRAPHIC AREAS AND POPULATIONS. THE FOLLOWING RESEARCH WAS CONDUCTED TO DETERMINE COMMUNITY HEALTH NEEDS: 1) A REVIEW OF PUBLIC HEALTH AND DEMOGRAPHIC DATA PORTRAYING THE HEALTH AND SOCIOECONOMIC STATUS OF THE COMMUNITY; AND 2) A KEY INFORMANT SURVEY WITH 30 COMMUNITY REPRESENTATIVES WAS USED TO SOLICIT FEEDBACK ON COMMUNITY HEALTH PRIORITIES, UNDERSERVED POPULATIONS, AND PARTNERSHIP OPPORTUNITIES. THE 2016 CHNA WAS OVERSEEN BY A STEERING COMMITTEE OF REPRESENTATIVES FROM RUMC AND THE NEW YORK CITY DEPARTMENT OF HEALTH AND MENTAL HYGIENE, WITH INPUT FROM COMMUNITY REPRESENTATIVES AND PARTNERS.RUMC LEADERSHIP REVIEWED FINDINGS FROM THE CHNA RESEARCH, INCLUDING PUBLIC HEALTH AND SOCIOECONOMIC MEASURES AND INPUT RECEIVED FROM KEY INFORMANTS, TO DETERMINE THE HIGHEST PRIORITIES ACROSS STATEN ISLAND AND TO FOCUS COMMUNITY HEALTH IMPROVEMENT EFFORTS. BASED ON THE 2016 CHNA RESEARCH FINDINGS AND EXISTING SERVICES, RESOURCES, AND AREAS OF EXPERTISE, RUMC SELECTED PRIORITIES TO ADDRESS DURING THE NEXT THREE YEAR CYCLE. THE PRIORITIES ARE ALIGNED WITH THE NEW YORK STATE PREVENTION AGENDA AND TAKE CARE NEW YORK 2020. THE RATIONALE AND CRITERIA USED TO SELECT THESE PRIORITIES INCLUDED: A) PREVALENCE OF DISEASE AND NUMBER OF COMMUNITY MEMBERS IMPACTED; B) RATE OF DISEASE IN COMPARISON TO LOCAL AND NATIONAL BENCHMARKS; C) HEALTH DISPARITIES AMONG RACIAL AND ETHNIC MINORITIES; D) EXISTING PROGRAMS, RESOURCES, AND EXPERTISE TO ADDRESS THE ISSUE; E) INPUT FROM REPRESENTATIVES OF UNDERSERVED POPULATIONS; AND F) ALIGNMENT WITH CONCURRENT PUBLIC HEALTH AND SOCIAL SERVICE ORGANIZATION INITIATIVES.PRIORITY I: PREVENT CHRONIC DISEASESCHRONIC DISEASE RATES ARE INCREASING ACROSS THE NATION AND ARE THE LEADING CAUSES OF DEATH AND DISABILITY. THE STATEN ISLAND HEART DISEASE DEATH RATE IS THE HIGHEST OF THE NYC BOROUGHS, AND EXCEEDS THE NATIONAL RATE. HEART DISEASE IS OFTEN A RESULT OF HIGH BLOOD PRESSURE AND HIGH CHOLESTEROL. MORE THAN 25% OF STATEN ISLAND ADULTS REPORT HAVING HIGH BLOOD PRESSURE AND/OR HIGH CHOLESTEROL, A SIMILAR PERCENTAGE TO NYC OVERALL. STATEN ISLAND HAS HIGHER CANCER INCIDENCE AND DEATH RATES COMPARED TO ALL OF NYC. AMONG THE FOUR MOST COMMONLY DIAGNOSED CANCERS (FEMALE BREAST, COLORECTAL, LUNG, AND PROSTATE), STATEN ISLAND INCIDENCE RATES EXCEED NYC FOR ALL CANCER TYPES, EXCEPT PROSTATE. STATEN ISLAND DEATH RATES EXCEED NYC FOR ALL CANCER TYPES, EXCEPT FEMALE BREAST. STATEN ISLAND LUNG CANCER INCIDENCE AND DEATH RATES ARE THE HIGHEST IN COMPARISON TO NYC. CHRONIC LOWER RESPIRATORY DISEASE (CLRD) ENCOMPASSES DISEASES LIKE CHRONIC OBSTRUCTIVE PULMONARY DISORDER, EMPHYSEMA, AND ASTHMA. STATEN ISLAND HAS THE HIGHEST RATE OF CLRD DEATH AMONG NYC BOROUGHS; THE RATE INCREASED 6 POINTS FROM 2008 TO 2014. STATEN ISLAND ALSO HAS THE HIGHEST PERCENTAGE OF ADULTS WITH A CURRENT ASTHMA DIAGNOSIS.CHRONIC DISEASES ARE OFTEN PREVENTABLE THROUGH REDUCED HEALTH RISK BEHAVIORS LIKE SMOKING, INCREASED PHYSICAL ACTIVITY AND GOOD NUTRITION, AND EARLY DETECTION. STATEN ISLAND CONTINUES TO HAVE THE HIGHEST ADULT SMOKING RATE AMONG NYC BOROUGHS, AND EXCEEDS THE HEALTHY PEOPLE 2020 GOAL FOR SMOKING (12%) BY NEARLY 5 POINTS. THE PERCENTAGE OF STATEN ISLAND HIGH SCHOOL STUDENTS WHO REPORT SMOKING CIGARETTES ON ONE OR MORE OF THE PAST 30 DAYS IS THE HIGHEST OF THE FIVE BOROUGHS AND EXCEEDS THE NYC AVERAGE BY NEARLY 4 POINTS. IN STATEN ISLAND, THE PERCENTAGE OF OBESE ADULTS IS ALSO NEARLY 5 POINTS HIGHER THAN THE CITY AVERAGE. TO ADDRESS THESE IDENTIFIED HEALTH RISKS, RUMC IS UNDERTAKING A MULTI-FACETED APPROACH WITH THE GOAL TO INCREASE SCREENING RATES FOR CARDIOVASCULAR DISEASE, DIABETES AND BREAST, CERVICAL AND COLORECTAL CANCERS, ESPECIALLY AMONG DISPARATE POPULATIONS. THIS APPROACH INCLUDES, BUT IS NOT LIMITED TO: A) CONTINUING AS A PARTNER IN THE NEW YORK STATE DEPARTMENT OF HEALTH CANCER SERVICES PROGRAM, OFFERING FREE BREAST, CERVICAL, AND COLORECTAL SCREENINGS TO INDIVIDUALS WHO ARE UNINSURED OR UNDERINSURED; B) CONTINUING TO OFFER THE BREAST HEALTH PATIENT NAVIGATION INITIATIVE, PROVIDING FREE MAMMOGRAPHY EDUCATION AND SCREENINGS AND SUPPORTING WOMEN WHO HAVE ABNORMAL MAMMOGRAPHY FINDINGS AND BARRIERS TO ACCESSING APPROPRIATE CARE (TRANSPORTATION, CHILDCARE, INABILITY TO PAY, ETC.); C) FOSTERING COLLABORATION AMONG COMMUNITY-BASED ORGANIZATIONS AND CLINICIANS TO IDENTIFY UNDERSERVED POPULATIONS AND IMPLEMENT PROGRAMS TO IMPROVE EDUCATION AND ACCESS FOR PREVENTATIVE SERVICES; D) USING MEDIA AND HEALTH COMMUNICATIONS TO BUILD PUBLIC AWARENESS AND DEMAND FOR PREVENTATIVE SERVICES; E) CONTINUE UTILIZING ELECTRONIC HEALTH RECORDS AND THE PATIENT PORTAL TO REMIND PATIENTS OF PREVENTIVE AND FOLLOW-UP CARE SERVICES; F) PARTICIPATING IN COMMUNITY HEALTH AND OUTREACH EVENTS HOSTED BY STATEN ISLAND PARTNER ORGANIZATIONS AND BUSINESSES TO PROMOTE FREE SCREENINGS AND EDUCATION; AND G) PARTNERING WITH THE STATEN ISLAND PERFORMING PROVIDER SYSTEM (SI PPS) TO DEVELOP A PUBLIC CAMPAIGN TO PROMOTE UTILIZATION OF PREVENTIVE CARE SERVICES. IN ADDITION, RICHMOND UNIVERSITY MEDICAL CENTER IS A PARTNER IN THE SI PPS DIABETES MANAGEMENT PROJECT. THE GOAL OF THE PROJECT IS TO ENSURE THAT CLINICAL PRACTICES IN THE COMMUNITY AND AMBULATORY CARE SETTINGS USE EVIDENCE-BASED STRATEGIES TO IMPROVE MANAGEMENT OF DIABETES AND LINK PATIENTS TO SELF-MANAGEMENT PROGRAMS. IN ADDITION TO THE ROBUST ENDOCRINE SERVICES ALREADY OFFERED BY RUMC, RUMC HAS IMPLEMENTED A BARIATRIC PROGRAM THAT INCLUDES BOARD CERTIFIED BARIATRIC SURGEONS AND BARIATRIC SURGERY INTERVENTIONS. BARIATRIC SURGERY IS AN EVIDENCE-BASED PROCEDURE THAT HAS BEEN PROVEN EFFECTIVE IN IMPROVING POPULATION HEALTH WITH REGARD TO OBESITY AND DIABETES.TO REDUCE ILLNESS, DISABILITY, AND DEATH RELATED TO TOBACCO USE AND SECONDHAND SMOKE, RUMC CONTINUES TO OFFER A TOBACCO CESSATION PROGRAM FOR ADULTS AGES 18 YEARS OR OLDER. THE 6-WEEK PROGRAM IS LED BY A LUNG NURSE NAVIGATOR. PARTICIPANTS ARE PROVIDED INFORMATION, INDIVIDUAL COUNSELING, AND COPING MECHANISMS IN ORDER TO BETTER FIGHT THEIR ADDICTION. THE LUNG NURSE NAVIGATOR MAINTAINS CONSTANT CONTACT WITH PARTICIPANTS, OFFERING THEM SUPPORT AND ASSISTANCE WHENEVER THE NEED ARISES. RUMC ALSO CONTINUES TO PROMOTE AND PUBLICIZE THE NYS SMOKERS' QUITLINE, ESPECIALLY AMONG DISPARATE POPULATIONS. PART VI, LINE 3: IN KEEPING WITH ITS CHARITABLE PURPOSES, RUMC PROVIDES HEALTHCARE SERVICES TO ALL INDIVIDUALS IN A NON-DISCRIMINATORY WAY, REGARDLESS OF RACE, COLOR, CREED OR ETHNICITY. RUMC CONTINUES TO PROVIDE REDUCED-FEE OR FREE CARE IN ACCORDANCE TO PUBLIC LAW 2807(K)(9-A). ALTHOUGH NOT REQUIRED BY THIS LAW, WE DO EXTEND THIS POLICY TO INDIVIDUALS WHO MAY NOT BE QUALIFIED BASED ON THE GUIDELINES OF OUR FINANCIAL ASSISTANCE POLICY, BUT DO DEMONSTRATE AN INABILITY TO PAY ALL OF THEIR MEDICAL EXPENSES. AS PART OF BEST-PRACTICE CARE, RUMC IS IN COMMUNICATION WITH LOCAL COMMUNITY-BASED CONSUMER ADVOCATE ORGANIZATIONS TO BE CERTAIN THAT THEY ARE AWARE OF THE PROVISIONS OF OUR FINANCIAL AID POLICY. THE PATIENT ACCESS DEPARTMENT HAS RECEIVED SUMMARY DATA OF THE LAW AND OUR REQUIREMENTS. ASSISTANCE CONTINUES TO BE OFFERED BY OUR FINANCIAL SCREENING STAFF AND MEDICAL APPLICATION OFFICE TO THOSE INDIVIDUALS NOT ELIGIBLE FOR MEDICAID, AS WELL AS FINANCIAL SCREENING STAFF LOCATED IN OUR EMERGENCY DEPARTMENT. RUMC POSTS THE HOSPITAL'S CHARITY CARE POLICY SUMMARY AND FINANCIAL ASSISTANCE CONTACT INFORMATION IN MANY DIFFERENT LANGUAGES (AS DETERMINED BY RUMC'S ANNUAL LANGUAGE NEEDS ASSESSMENT) IN LOCATIONS SUCH AS THE EMERGENCY DEPARTMENT, INTAKE, REGISTRATION AND ADMISSION AREAS. PATIENTS ARE PROVIDED A SUMMARY OF THE POLICY AND FINANCIAL ASSISTANCE CONTACT INFORMATION AS PART OF THE INTAKE PROCESS AND FINANCIAL SCREENING PROCESS. PATIENT BILLS INCLUDE A STATEMENT ON FINANCIAL ASSISTANCE. EVERY PATIENT SEEN IN THE FINANCIAL OFFICE HAS A DISCUSSION ON THE AVAILABILITY OF GOVERNMENT BENEFITS SUCH AS MEDICAID AND AT THE SAME TIME QUALIFICATIONS ON THE HOSPITAL'S FINANCIAL ASSISTANCE PROGRAM. RUMC HAS AN INTERDISCIPLINARY TEAM THAT INTERACTS WITH FINANCIAL ASSISTANCE COUNSELORS SUCH AS SOCIAL WORKERS AND CASE MANAGERS TO IDENTIFY AND ASSIST ELIGIBLE PATIENTS. STAFF TRAINING ON FINANCIAL ASSISTANCE IS DONE ANNUALLY THROUGH AN IN-SERVICE PROGRAM THAT INCLUDES A REVIEW OF HOW TO QUALIFY PATIENTS FOR MEDICAID AND OTHER GOVERNMENT PROGRAMS. ALL THIRD PARTIES THAT WORK FOR RUMC IN THE COLLECTION OF FEES ARE REQUIRED TO FOLLOW THE HOSPITAL'S POLICIES REGARDING PATIENT NOTIFICATION ABOUT THE AVAILABILITY OF FINANCIAL ASSISTANCE. RUMC'S FINANCIAL ASSISTANCE POLICY CLEARLY STATES THAT MEDICAL CARE IS PROVIDED TO INDIVIDUALS IN NEED, REGARDLESS OF THEIR ABILITY TO PAY AND MAKES CERTAIN THAT ALL REQUESTS FOR FINANCIAL ASSISTANCE ARE EVALUATED AND PROCESSED FAIRLY AND CONSISTENTLY WITH DIGNITY, COMPASSION AND IN A RESPECTFUL MANNER, CONSISTENT WITH RUMC MISSION AND VALUES. PART VI, LINE 4: RICHMOND UNIVERSITY MEDICAL CENTER PRIMARILY SERVES STATEN ISLAND, ONE OF FIVE BOROUGHS COMPRISING NEW YORK CITY. STATEN ISLAND'S 2017 POPULATION OF 479,458 REPRESENTS AN INCREASE OF 2.3% FROM THE 2010 CENSUS. OUR POPULATION IS A CROSS MIX OF THE OVERALL POPULATION, HOWEVER WE ARE LOCATED ON THE NORTH SHORE. AS A RESULT, RUMC TREATS A SIGNIFICANTLY HIGHER NUMBER OF THE UNDERSERVED AND UNDER INSURED THAN HEALTHCARE PROVIDERS IN OTHER AREAS OF STATEN ISLAND.THE PRIMARY SERVICE AREA FOR RUMC INCLUDES THE ZIP CODE COMMUNITIES IN ST. GEORGE (10301), PORT RICHMOND (10302); MARINER'S HARBOR (10303); STAPLETON (10304); ROSEBANK (10305), WEST BRIGHTON (10310), AND WILLOWBROOK (10314). COMPARISON OF EACH ZIP CODE SHOWS THAT FIVE OF THE ZIP CODES IN RUMC'S PRIMARY SERVICE AREA HAVE THE HIGHEST NUMBER OF FAMILIES LIVING IN POVERTY (10310, 10303, 10304, 10302, 10301). IN FACT THERE ARE TWICE AS MANY FAMILIES LIVING IN POVERTY IN THE 10310 ZIP CODE THAN COMPARED TO THE BOROUGH OVERALL.STATEN ISLAND RESIDENTS ARE LESS LIKELY TO SPEAK ENGLISH AS THEIR PRIMARY LANGUAGE WHEN COMPARED TO THE NATION, BUT MORE LIKELY WHEN COMPARED TO NEW YORK CITY. THE BOROUGH'S MOST COMMON LANGUAGES, OTHER THAN ENGLISH, ARE INDO-EUROPEAN (12.3%) AND SPANISH (10.5%). RESIDENTS IN ZIP CODES 10305 AND 10303 ARE THE LEAST LIKELY TO SPEAK ENGLISH AS THEIR PRIMARY LANGUAGE (51.9% AND 58.2% RESPECTIVELY). INDO-EUROPEAN LANGUAGES ARE THE SECOND MOST COMMON LANGUAGES IN ZIP CODE 10305, WHILE SPANISH IS THE SECOND MOST COMMON LANGUAGE IN ZIP CODE 10303.STATEN ISLAND HAS A COMPARABLE RACIAL AND ETHNIC MAKEUP TO THE NATION WITH 39.9% OF RESIDENTS IDENTIFYING WITH A RACE OTHER THAN WHITE AND 18.6% OF RESIDENTS IDENTIFYING AS HISPANIC OR LATINO. STATEN ISLAND IS LESS RACIALLY AND ETHNICALLY DIVERSE COMPARED TO NEW YORK CITY OVERALL. THE BOROUGH'S MEDIAN AGE IS OLDER THAN CITY AND NATIONAL MEDIANS.CURRENTLY 15.8% OF STATEN ISLAND'S POPULATION IS 65 YEARS OF AGE AND OLDER. WITH THIS STEADY INCREASE IN POPULATION AND THE RISING TREND IN THE AGING OF STATEN ISLAND'S POPULATION OVERALL, THE COMMUNITY IS EXPERIENCING A RISE IN HEALTHCARE NEEDS AND HEALTHCARE COSTS. AS MORE BABY BOOMERS DEVELOP CHRONIC ILLNESSES, THE DEMAND ON THE HEALTHCARE SYSTEM WILL RISE. WITH THIS IN MIND, RICHMOND UNIVERSITY MEDICAL CENTER RECOGNIZES THAT ITS FOCUS MUST SHIFT TO PREVENTION ISSUES AND KEEPING PEOPLE HEALTHY. PART VI, LINE 5: RICHMOND UNIVERSITY MEDICAL CENTER IS A LICENSED 400-PLUS BED HOSPITAL, ONE OF ONLY TWO PRIVATE HOSPITALS SERVING THE ENTIRE POPULATION OF THE BOROUGH. OUR COMMUNITY OUTREACH INITIATIVES, INCLUDING EDUCATION AND SCREENING, REACH THOUSANDS EACH YEAR. THE HOSPITAL IS THE MAIN SPONSOR AND/OR ACTIVE PARTICIPANT IN SEVERAL ANNUAL HEALTH RELATED EVENTS ON STATEN ISLAND, INCLUDING THE STATEN ISLAND ECONOMIC DEVELOPMENT CORPORATION'S HEALTH AND WELLNESS CONFERENCE HELD EACH FALL. THE CONFERENCE OFFERS THOUSANDS OF RESIDENTS A FORUM TO HAVE ACCESS TO EDUCATIONAL MATERIALS, SPEAK WITH PHYSICIANS AND HEALTHCARE PROFESSIONALS, AND HAVE HEALTH SCREENINGS CONDUCTED ON THE PREMISES. OUR COMMUNITY OUTREACH TEAM, KNOWN AS TRAUMA, ATTENDS OVER 100 COMMUNITY EVENTS EACH YEAR, PROVIDING BROCHURES, EDUCATIONAL MATERIALS, AND HANDS ON TRAINING TO THOUSANDS OF ADULTS AND CHILDREN ANNUALLY. PROGRAMS THEY PROVIDE INCLUDE "STOP THE BLEED", WHICH DISCUSSES HOW TO HANDLE BLEEDING EMERGENCIES, AND HANDS ON CPR WHICH SHOWS PEOPLE THE BASICS OF CARDIOPULMONARY RESUSCITATION. FOR MORE THAN 30 YEARS RUMC'S WIC PROGRAM HAS SUCCESSFULLY SERVED THE POOR WOMEN, INFANTS AND CHILDREN OF STATEN ISLAND. THE MISSION IS TO IMPROVE THE NUTRITION AND HEALTH STATUS OF ELIGIBLE WOMEN, INFANTS AND CHILDREN THROUGH THE PROVISION OF NUTRITIOUS FOODS, NUTRITION EDUCATION, COUNSELING AND LINKING PARTICIPANTS TO HEALTH AND HUMAN SERVICES. WIC SERVICES ASSIST WOMEN AND CHILDREN WHO HAVE LOW INCOME, ARE UNDOCUMENTED CITIZENS, ARE UNINSURED, TEENAGERS, UNWED MOTHERS, VICTIMS OF DOMESTIC VIOLENCE, AND FOSTER CHILDREN. OVER 50% OF THE PEOPLE ACCESSING SERVICES AT THE WIC SITE ARE HISPANIC.RUMC HAS A WELL-ESTABLISHED HISTORY OF WORKING WITH OTHER COMMUNITY MENTAL HEALTH ORGANIZATIONS TO WORK COLLABORATIVELY TO ASSIST THOSE IN THE BOROUGH WITH MENTAL HEALTH ISSUES. AMONG ITS PARTNERS ARE THE STATEN ISLAND MENTAL HEALTH SOCIETY, AND JEWISH BOARD OF FAMILY AND CHILDREN SERVICES. RUMC ALSO MAINTAINS RELATIONSHIPS WITH THE LOCAL COMMUNITY ORGANIZATIONS IN ITS VICINITY AND WITH STATEN ISLAND COMMUNITY BOARD #1. THE COMMUNITY HEALTH ACTION CENTER, STATEN ISLAND CHAMBER OF COMMERCE, PROJECT HOSPITALITY, AND THE PORT RICHMOND COMMUNITY HEALTH CENTER ARE JUST A FEW OF THE LOCAL ORGANIZATIONS RUMC MAINTAINS PARTNERSHIPS WITH. HOSPITAL ADMINISTRATION AND MEMBERS OF THE BOARD OF TRUSTEES VISIT ALBANY ANNUALLY TO LOBBY FOR HEALTHCARE ISSUES AND TO SPEAK WITH STATE HEALTH OFFICIALS.IN ADDITION TO THE COMMUNITY, RUMC MAINTAINS REGULAR COMMUNICATIONS WITH ALL OF STATEN ISLAND'S ELECTED OFFICIALS INCLUDING THE BOROUGH PRESIDENT. THESE PARTNERS ARE MET WITH ON A REGULAR BASIS ALLOWING ADMINISTRATION TO PROVIDE UPDATES ON SERVICE AND SEEK SUPPORT FROM THEM FOR ISSUES IMPORTANT TO THE HOSPITAL. PART VI, LINE 7, REPORTS FILED WITH STATES NY PART VI, LINE 2 CONTINUATION: IN RECENT MONTHS' RUMC HAS ALSO OPENED A STAND-ALONE CENTER FOR CANCER CARE, BRING ALL OF ITS CANCER RESOURCES FOR THE EDUCATION, DIAGNOSIS AND TREATMENT OF CANCER UNDER ONE ROOF. IN A SEPARATE LOCATION ON THE GROUNDS OF THE HOSPITAL, RUMC HAS OPENED A CARDIOPULMONARY REHABILITATION CENTER GIVING PATIENTS ACCESS TO STATE OF THE ART EQUIPMENT AND PROGRAMS SO THEY CAN LEAD HEALTHIER AND MORE PRODUCTIVE LIVES. IN THE COMING MONTHS, RUMC WILL ALSO OPEN A BREAST AND WOMAN'S CARE CENTER AS WELL AS A SEPARATE INSTITUTE FOR WEIGHT LOSS AND METABOLIC SURGERY.PRIORITY II: PROMOTE MENTAL HEALTH AND PREVENT SUBSTANCE ABUSE STATEN ISLAND RESIDENTS ARE PRIMARILY AFFECTED BY SUBSTANCE ABUSE ISSUES RATHER THAN MENTAL HEALTH ISSUES; HOWEVER, THERE IS A STRONG CONNECTION BETWEEN THE TWO CONDITIONS. BOTH ADULTS AND YOUTH IN STATEN ISLAND ARE MORE LIKELY TO ABUSE ALCOHOL. STATEN ISLAND HAS THE HIGHEST PERCENTAGE OF DRIVING DEATHS DUE TO ALCOHOL IMPAIRMENT AMONG ALL NYC BOROUGHS, AND HIGH SCHOOL STUDENTS ARE THE MOST LIKELY TO REPORT CONSUMING ALCOHOL AND BINGE DRINKING. APPROXIMATELY 29% OF STATEN ISLAND HIGH SCHOOL STUDENTS REPORT DRINKING WITHIN THE PAST 30 DAYS. THE DRUG-INDUCED DEATH RATE IN STATEN ISLAND IS THE HIGHEST OF ALL NYC BOROUGHS AND EXCEEDS THE NATIONAL RATE. THE RATE HAS BEEN ON THE RISE SINCE 2007, INCREASING 7 POINTS. AMONG HIGH SCHOOL STUDENTS, STATEN ISLAND HAS THE HIGHEST RATES OF SUBSTANCE ABUSE FOR ALL REPORTED DRUGS (MARIJUANA, COCAINE, HEROIN, ECSTASY, AND PAIN MEDICATION).STATEN ISLAND ADULTS REPORT A LOWER 30-DAY AVERAGE OF POOR MENTAL HEALTH DAYS WHEN COMPARED TO OTHER NYC BOROUGHS AND THE NATION AND ARE LESS LIKELY TO HAVE BEEN DIAGNOSED WITH DEPRESSION. THE STATEN ISLAND SUICIDE AND MENTAL AND BEHAVIORAL DISORDERS DEATH RATES ARE ALSO LOWER THAN BOTH NYC AND NATIONAL RATES AND MEET HEALTHY PEOPLE 2020 GOALS (AS APPLICABLE). HOWEVER, IN A 2013 SURVEY AMONG HIGH SCHOOL STUDENTS, MORE THAN 25% OF STATEN ISLAND STUDENTS REPORTED FEELING SO SAD OR HOPELESS ALMOST EVERY DAY FOR TWO WEEKS OR MORE, THAT THEY STOPPED DOING THEIR USUAL ACTIVITIES; APPROXIMATELY 9% OF STUDENTS ATTEMPTED SUICIDE ONE OR MORE TIMES DURING THE PAST YEAR. THE PERCENTAGES ARE ON PAR WITH NYC OVERALL, BUT NOTEWORTHY. LACK OF BEHAVIORAL HEALTH SERVICES WITHIN STATEN ISLAND WAS IDENTIFIED BY KEY INFORMANTS AS A KEY BARRIER TO RECEIVING TIMELY AND APPROPRIATE CARE.TO HELP PREVENT SUBSTANCE ABUSE AND OTHER MENTAL EMOTIONAL BEHAVIORAL (MEB) DISORDERS, RUMC IS ADDRESSING UNDERAGE DRINKING, AND NON-MEDICAL USE OF PRESCRIPTION DRUGS BY YOUTH. RUMC WILL CONTINUE TO SERVE ON THE BOARD OF ADVISORS FOR THE STATEN ISLAND PARTNERSHIP FOR COMMUNITY WELLNESS AND SUPPORT THEIR INITIATIVE, TACKLING YOUTH SUBSTANCE ABUSE (TYSA). THE TYSA INITIATIVE IS A CROSS-SECTOR COALITION AIMED AT DRIVING MAJOR IMPROVEMENTS IN YOUTH SUBSTANCE ABUSE ON STATEN ISLAND. COMMON GOALS SHARED BY THE INITIATIVE ARE TO REDUCE THE PERCENTAGE OF YOUTH REPORTING ALCOHOL USE IN THE PAST 30 DAYS AND OPIATES EVER BY 2020. AS A PARTNER IN THE INITIATIVE, RUMC WILL SUPPORT ACTIVITIES TO: A) ADVOCATE FOR SYSTEMS-LEVEL CHANGE AT THE LOCAL, STATE, AND FEDERAL LEVEL; B) COLLECT AND SHARE DATA THAT DRIVES INITIATIVES; C) CONNECT THE COMMUNITY WITH NEEDED RESOURCES USING THE STATEN ISLAND DRUG AND ALCOHOL TREATMENT RESOURCE GUIDE AND RUMC BEHAVIORAL HEALTH RESOURCES; D) EDUCATE THE COMMUNITY ON SUBSTANCE ABUSE; AND E) STRENGTHEN PROVIDER AND PATIENT EDUCATION TO ADDRESS PRESCRIPTION DRUG MISUSE AND REDUCE ACCIDENTAL OVERDOSERUMC IS ALSO HELPING TO IDENTIFY AND STRENGTHEN OPPORTUNITIES FOR IMPLEMENTING MEB HEALTH PROMOTION AND MEB DISORDER PREVENTION WITH INDIVIDUALS. RICHMOND UNIVERSITY MEDICAL CENTER CONTINUES TO SERVE ON THE STEERING COMMITTEE OF THE STATEN ISLAND PPS BEHAVIORAL HEALTH INFRASTRUCTURE PROJECT (BHIP). THE GOAL OF BHIP IS TO HELP STRENGTHEN MENTAL HEALTH AND SUBSTANCE ABUSE INFRASTRUCTURE ACROSS SYSTEMS. THE PEER COUNSELOR WARM HANDOFF PROGRAM AT RUMC LAUNCHED IN 2016. THE PROGRAM CONNECTS SUBSTANCE USE DISORDER PATIENTS THAT VISIT THE EMERGENCY DEPARTMENT WITH TIMELY AND APPROPRIATE WITHDRAWAL MANAGEMENT, CARE COORDINATION, AND OTHER TREATMENT SERVICES. RUMC'S SILBERSTEIN OUTPATIENT CHEMICAL DEPENDENCE PROGRAM EXISTS TO REHABILITATE INDIVIDUALS SUFFERING FROM CO-OCCURRING SUBSTANCE USE AND MENTAL HEALTH DISORDERS. SILBERSTEIN PROVIDES IN-HOUSE SERVICES OFFERING SUPPORT TO CLIENTS AND THE COMMUNITY. UP TO 35 WEEKLY GROUP THERAPY SESSIONS ARE HELD AT THE CLINIC, WHILE ALCOHOLICS ANONYMOUS (AA) MEETINGS ARE HOSTED DAILY AND ARE OPEN TO THE PUBLIC. SILBERSTEIN ALSO COLLABORATES WITH OTHER AGENCIES SERVING INDIVIDUALS IN NEED OF SUBSTANCE ABUSE TREATMENT TO IMPROVE SERVICES. PARTNER AGENCIES INCLUDE TREATMENT ALTERNATIVES TO STREET CRIME (TSAC), DRUG TREATMENT COURT, ADMINISTRATION FOR CHILDREN SERVICES (ACS), AND LOCAL AND STATE REHAB, DETOX AND RESIDENTIAL FACILITIES. CLIENTS OF THE SILBERSTEIN CLINIC ARE ALSO TRAINED TO DETECT AND PREVENT AN OPIOID OVERDOSE THROUGH THE USE OF NALOXONE (NARCAN). THE NASAL SPRAY MEDICATION CAN BE ADMINISTERED TO AN OVERDOSING USER DURING AN OVERDOSE EVENT TO BLOCK THE EFFECTS OF OPIOIDS AND RESUSCITATE THE PATIENT. KITS ARE DISTRIBUTED AT SILBERSTEIN AND CLIENTELE ARE EDUCATED ON ADMINISTRATION OF THE ANTIDOTE. X X X X X 0 1 0 0 0 0 0 1 0 DANIEL MESSINA PRESIDENT & CEO 834473 0 0 0 137 0 166351 0 18745 0 1019706 0 0 0 PIETRO CARPENITO MD TRUSTEE 469204 0 0 0 13592 0 52422 0 24866 0 560084 0 13184 0 SAMALA SWAMY MD TRUSTEE 189995 0 0 0 0 0 0 0 0 0 189995 0 0 0 MITCHELL FOGEL MD SENIOR VP/CHAIR OF MEDICIN 469978 0 0 0 76 0 51150 0 18587 0 539791 0 0 0 JOSEPH SAPORITO SENIOR VP & CFO 448184 0 79745 0 137 0 50180 0 23727 0 601973 0 0 0 ROSEMARIE STAZZONE SENIOR VP NURSING & CNO 513581 0 0 0 56503 0 56494 0 1992 0 628570 0 56239 0 RICHARD SALHANY SENIOR VP PROFESSIONAL SER 416072 0 0 0 137 0 40466 0 24895 0 481570 0 0 0 MICHAEL L MORRETTI CHAIRMAN OF OB/GYN 561703 0 270890 0 147 0 24750 0 18587 0 876077 0 0 0 LOREN HARRIS MD MEDICAL CHAIRMAN 755415 0 0 0 50 0 24750 0 1075 0 781290 0 0 0 ELI SERUR PHYSICIAN 982395 0 0 0 76 0 19250 0 23978 0 1025699 0 0 0 DOUGLAS COHEN MD PHYSICIAN 616172 0 125000 0 50 0 19250 0 23978 0 784450 0 0 0 VLADIMIR RUBINSHTEY PHYSICIAN 251364 0 368446 0 12 0 19250 0 18587 0 657659 0 0 0 XIN Y LI PHYSICIAN 272553 0 237124 0 12 0 19250 0 18587 0 547526 0 0 0 PHILLIP OTTERBECK PHYSICIAN 200000 0 319989 0 10 0 19250 0 1075 0 540324 0 0 0 PART I, LINE 4B THE FOLLOWING INDIVIDUALS ACCRUED CONTRIBUTIONS TO A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN DURING 2018: DANIEL MESSINA, PRESIDENT & CEO - $136,101 ROSEMARIE STAZZONE, SENIOR VP NURSING & CNO - $26,244 PIETRO CARPENITO, TRUSTEE - $22,172 RICHARD SALHANEY, SENIOR VP PROFESSIONAL SERVICES - $10,216 JOSEPH SAPORITO, SENIOR VP & CFO - $19,930 THE FOLLOWING INDIVIDUALS RECEIVED DISTRIBUTIONS FROM THE SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN DURING 2018: PIETRO CARPENITO, TRUSTEE - $13,184 ROSEMARIE STAZZONE, SENIOR VP NURSING & CNO - $56,239 PART I, LINE 7 AN ANNUAL INCENTIVE PROGRAM (AIP) HAS BEEN ESTABLISHED AND APPROVED BY THE FACILITY OUTLINING THE COMPONENTS OF THE BONUS PROGRAM. ORGANIZATIONAL GOALS ARE ESTABLISHED ANNUALLY. ADDITIONALLY, ANNUAL GOALS FOR EACH INDIVIDUAL ELIGIBLE FOR THE AIP PROGRAM ARE SET. THE AIP BONUS FOR EACH ELIGIBLE INDIVIDUAL IS BASED ON HOW WELL THE ORGANIZATION MET THE ESTABLISHED ORGANIZATIONAL GOALS, AND HOW WELL THAT INDIVIDUAL MET HIS/HER INDIVIDUALLY ESTABLISHED GOALS. THERE IS ALSO A SMALL PERCENTAGE THAT IS AWARDED AT THE DISCRETION OF THE CEO (OR BOARD COMMITTEE WITH RESPECT TO THE CEO'S BONUS DETERMINATION). THE APPROVAL OF ALL BONUSES ARE DOCUMENTED. A BUILD NYC RESOURCE CORPORATION 2018-12-20 132065000 SEE PART VI 0 0 0 A 47286413 3586063 1084150 6766329 35849871 1 0 0 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 A 0 1 0 0 0 0 0 0 0 SCHEDULE K, PART I BOX F THE PROCEEDS OF THE 2018 BONDS WILL BE USED TO (I) REFINANCE THE MEDICAL CENTER'S EXISTING REVOLVING LOAN PAYABLE, TERM LOAN PAYABLE, AND FIRST MORTGAGE LOAN PAYABLE, (II) FINANCE THE COST OF VARIOUS CAPITAL IMPROVEMENTS TO THE MEDICAL CENTER'S CAMPUS, (III) FUND A DEBT SERVICE RESERVE FUND AND A CAPITALIZED INTEREST FUND, AND (IV) PAY CERTAIN COSTS RELATED TO THE ISSUANCE OF THE 2018 BONDS. SCHEDULE K, PART II LINE 3 TOTAL PROCEEDS OF ISSUE REPORTED IN PART II LINE 3 REPRESENTS THE AMOUNT OF BOND PROCEEDS DRAWN DOWN AS OF 12/31/2018. TOTAL ISSUE PRICE OF THE 2018 BONDS IS REPORTED IN PART I. FORM 990, PART VI, SECTION B, LINE 11B A COPY OF FORM 990 WAS SENT TO MEMBERS OF THE FINANCE COMMITTEE OF THE BOARD FOR REVIEW BEFORE FILING WITH THE IRS. DUE TO TIME CONSTRAINTS FOR THE 2018 TAX YEAR, THE ENTIRE BOARD DID NOT RECEIVE A COPY OF FORM 990 BEFORE IT WAS FILED WITH THE IRS. THE BOARD RECEIVED A COPY OF THE RETURN AFTER IT WAS FILED WITH THE IRS AND HAD A CHANCE TO REVIEW IT IN DETAIL AND POSE QUESTIONS. FORM 990, PART VI, SECTION B, LINE 12C CONFLICT OF INTEREST POLICY FORMS ARE DISTRIBUTED TO ALL TRUSTEES AND TO EMPLOYEES DOWN TO THE DEPARTMENT DIRECTOR LEVEL THROUGH THE PRESIDENT'S OFFICE AND COLLECTED THERE AS WELL. ALL FORMS ARE REVIEWED BY THE COMPLIANCE OFFICER. IF POTENTIAL CONFLICTS ARE IDENTIFIED, THE INDIVIDUAL IS CONTACTED FOR ADDITIONAL INFORMATION. ALL IDENTIFIED CONFLICTS ARE PRESENTED TO THE BOARD OF TRUSTEES' AUDIT AND COMPLIANCE COMMITTEE FOR ACTION WHERE APPLICABLE. A BOARD MEMBER WITH A CONFLICT OF INTEREST WILL ABSTAIN FROM VOTING ON THE MATTER AND WILL BE EXCUSED FROM THE PORTION OF THE MEETING WHERE THE MATTER IS DISCUSSED. FORM 990, PART VI, SECTION B, LINE 15 IN 2009, THE ORGANIZATION'S BOARD ADOPTED A COMPENSATION POLICY (THE "POLICY") FOR COVERED INDIVIDUALS AND TO EMPLOYEES DOWN TO DEPARTMENT DIRECTORS. PURSUANT TO THE POLICY, A COMPENSATION COMMITTEE OF INDEPENDENT DIRECTORS WAS ESTABLISHED TO REVIEW THE COMPENSATION OF ALL EMPLOYEES SPECIFIED AS HAVING A SUBSTANTIAL INFLUENCE OVER THE ORGANIZATION AND WHO RECEIVE REMUNERATION FROM THE ORGANIZATION, INCLUDING, AMONG OTHERS, THE ORGANIZATION'S PRESIDENT AND CHIEF EXECUTIVE OFFICER AND THE ORGANIZATION'S CHIEF FINANCIAL OFFICER. THE COMPENSATION COMMITTEE IS ADVISED BY OUTSIDE COUNSEL AND AN INDEPENDENT COMPENSATION CONSULTANT, EACH OF WHOM OPINE TO THE COMPENSATION COMMITTEE THAT THE LEVEL OF COMPENSATION PAID AND THE PROCESS BY WHICH COMPENSATION IS ESTABLISHED MEET APPLICABLE IRS REASONABLENESS AND "SAFE HARBOR" STANDARDS. THE OUTSIDE COMPENSATION CONSULTANT PROVIDES DATA OF COMPENSATION PROVIDED AT SIMILAR ORGANIZATIONS TO ENSURE THAT THE ORGANIZATION DOES NOT COMPENSATE IN EXCESS OF MARKET NORMS. THIS CONSULTANT WAS ENGAGED EACH YEAR FROM 2009 THROUGH 2012 TO PERFORM THESE SERVICES, AND A MARKET STUDY WAS COMPLETED IN 2015. THE COMPENSATION COMMITTEE OF THE BOARD IS COMPRISED OF INDEPENDENT PERSONS. THIS COMMITTEE REVIEWS EXECUTIVE COMPENSATION ANNUALLY AND RECORDS THEIR REVIEW IN THE MEETING MINUTES. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION WILL MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART VI, LINE 1A THE EXECUTIVE COMMITTEE HAS BROAD AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. THE SCOPE OF THE COMMITTEE'S AUTHORITY IS TO ACT WITH FULL POWER ON THE BEHALF OF THE BOARD OF TRUSTEES. ALL EXECUTIVE COMMITTEE MEMBERS ARE MEMBERS OF THE GOVERNING BODY. THE MEMBERS OF THE EXECUTIVE COMMITTEE ARE AS FOLLOWS: KATHRYN K. ROONEY RONALD PURPORA CATHERINE M. PAULO GINA GUTZEIT DENNIS QUIRK DANIEL J. MESSINA FORM 990, PART XI, LINE 9: PENSION LIABILITY ADUSTMENT 43,143. CHANGE IN BENEFICIAL INTEREST IN THE FOUNDATION -1,138,514. GAIN ON TERMINATION OF LEASE 238,255. LOSS ON EXTINGUISHMENT OF DEBT -426,761. FORM 990 AMENDED RETURN THE FORM 990 IS AMENDED TO REFLECT A CHANGE IN THE REVIEW PROCESS OF THE 990. FOR PART VI QUESTION 11, OUR RESPONSE WAS CHANGED TO NO. OUR PROCESS IS TO HAVE THE 990 REVIEWED IN DETAIL BY THE AUDIT COMMITTEE AND AND APPROVED FINAL COPY PASSED ON TO ALL BOARD MEMBERS BEFORE FILING WITH THE IRS. DUE TO EMPLOYEE TURNOVER AND TIME CONSTRAINTS FOR TAX YEAR 2018, A COPY WAS NOT MADE AVAILABLE TO ALL BOARD MEMBERS UNTIL AFTER IT WAS FILED WITH THE IRS. RICHMOND QUALITY LLC 335 BARD AVENUE STATEN ISLAND NY 10310 471464075 ACCOUNTABLE CARE ORGANIZATION NY 4871914 5437438 RICHMOND MEDICAL CENTER AMBOY MEDICAL PRACTICE PC 355 BARD AVENUE STATEN ISLAND NY 10310 263381883 PHYSICIAN MEDICAL PRACTICE NY 501(C)(3) LINE 12A, I RICHMOND MEDICAL CENTER 1 RICHMOND MEDICAL CENTER FOUNDATION INC 355 BARD AVENUE STATEN ISLAND NY 10310 271059815 SUPPORTING ORGANIZATION NY 501(C)(3) LINE 12A, I RICHMOND MEDICAL CENTER 1 BRIDGE REGIONAL HEALTH SYSTEM 355 BARD AVENUE STATEN ISLAND NY 10310 205171165 HOLDING COMPANY NY N/A C 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 RICHMOND MEDICAL CENTER FOUNDATION INC C 2084608 COST RICHMOND MEDICAL CENTER FOUNDATION INC D 299048 COST AMBOY MEDICAL PRACTICE PC D 39113702 COST FORM 990, PART IV, LINE 35 RICHMOND MEDICAL CENTER (THE "COMPANY") IS AFFILIATED WITH AMBOY MEDICAL PRACTICE, PC ("AMBOY"), A NEW YORK PROFESSIONAL SERVICES CORPORATION, WHICH WAS ESTABLISHED TO PROVIDE PRIMARY CARE SERVICES TO THE COMMUNITY AND HAS ONE SHAREHOLDER, THE CHIEF MEDICAL OFFICER OF THE COMPANY. THE COMPANY AND AMBOY ARE PARTIES TO A CERTAIN STOCK RESTRICTION AGREEMENT (THE "RESTRICTION AGREEMENT") WHICH PROVIDES, AMONG OTHER THINGS, THAT WITHOUT THE CONSENT OF THE COMPANY, THE CHIEF MEDICAL OFFICER MAY NOT TRANSFER HIS/HER STOCK IN AMBOY, OR CAUSE AMBOY TO DISSOLVE, MERGE, ISSUE STOCK, COMMENCE LITIGATION, SELL OR LEASE REAL PROPERTY, BORROW OR LEND MONEY, OR FILE FOR BANKRUPTCY. THE RESTRICTION AGREEMENT ALSO PROVIDES THAT THE CHIEF MEDICAL OFFICER MUST, UPON THE REQUEST OF THE COMPANY, TRANSFER ALL OF HIS/HER STOCK IN AMBOY TO A COMPANY DESIGNEE. DUE TO THESE RESTRICTIONS, AMBOY IS CONSIDERED A CONTROLLED ENTITY WITHIN THE MEANING OF SECTION 512(B)(13).