2013-11-13T14:56:11-06:00 2012-12-31 861065772 DELOITTE TAX LLP TWO JERICHO PLAZA JERICHO NY 11753 990 2012-01-01 131740274 CALVARY HOSPITAL INC CALV 7185182069 1740 EASTCHESTER ROAD BRONX NY 104612392 ANDREW V GRECO 7185182069 2013-11-13 1 CHRISTINE KAWECKI P00743140 5169187000 2013-11-13 2012 2016-02-25 16:41:14Z ANDREW V GRECO 1740 EASTCHESTER ROAD BRONX NY 104612392 113865814 0 0928 X WWW.CALVARYHOSPITAL.ORG X 1899 NY SEE SCHEDULE O. 15 15 1039 150 0 0 8967700 6767700 100576500 101211500 2386500 2207100 858132 813100 112788832 110999400 0 0 0 0 78363000 82709900 0 0 0 32817400 51833000 111180400 134542900 1608432 -23543500 104925700 105173900 45965300 68240400 58960400 36933500 X CALVARY HOSPITAL IS A FULLY ACCREDITED ACUTE CARE SPECIALITY HOSPITAL EXCLUSIVELY PROVIDING PALLIATIVE CARE FOR ADVANCED CANCER PATIENTS IN THE UNITED STATES. 0 0 101885862 80262500 SEE SCHEDULE O. 16289601 18817600 SEE SCHEDULE O. 2460737 1341300 SEE SCHEDULE O. 3291600 1120636 ADVANCED CANCER CARE OUTPATIENT/OTHER PROGRAMS THE OUTPATIENT CLINIC PROVIDES CARE THROUGH A MULTIDISCIPLINARY APPROACH, WHICH ENCOMPASSES THE PHYSICAL, EMOTIONAL AND SPIRITUAL NEEDS OF THE PATIENT AND THEIR FAMILY. THE AIM OF THE CLINIC IS TO PROVIDE COMPREHENSIVE HEALTH CARE FOR THE ADVANCED CANCER PATIENT. OUTPATIENT SERVICES 1. THE OUTPATIENT CLINIC SPECIALIZES IN PAIN CONTROL, WOUND CARE AND OTHER SERVICES SPECIFIC TO THE ADVANCED CANCER PATIENT.2. EACH' PATIENT IS ASSIGNED A PRIMARY PHYSICIAN, REGISTERED NURSE, SOCIAL WORKER AND DIETITIAN.3. THE SERVICES OF PASTORAL CARE, THERAPEUTIC RECREATION, RADIOLOGY, LABORATORY, ENTEROSTOMAL THERAPY AND OTHER SERVICES ARE AVAILABLE IF NEEDED.4. THE OUTPATIENT NURSES PROVIDE ADDITIONAL SUPPORT TO PATIENTS AND FAMILIES THROUGH FREQUENT TELEPHONE CALLS.5. ASSISTANCE WITH TRANSPORTATION ARRANGEMENTS WILL BE PROVIDED IF NEEDED.6. TWENTY-FOUR HOUR TELEPHONE COVERAGE WITH A NURSE AND PHYSICIAN FOR ADVICE OR REASSURANCE IS AVAILABLE.7. CONSULTATION WITH MEDICAL SPECIALISTS CAN BE ARRANGED AND COORDINATED.8. COORDINATION OF SERVICES IS PROVIDED AMONG THE PATIENT'S PHYSICIAN, HOME CARE AGENCY AND OTHER PROVIDERS TO ASSURE APPROPRIATE AND CONTINUAL CARE. 3291600 1120636 123927800 1 1 0 1 0 0 0 0 0 1 1 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 62 0 1 1039 1 0 0 0 0 0 0 0 0 0 0 0 X 15 15 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X ANDREW GRECO 7185182069 1740 EASTCHESTER ROAD BRONX NY 104612069 MANFRED ALTSTADT 2.00 X 0 0 0 JOHN P BERTSCH 2.00 X 0 0 0 JOHN A DECINA 2.00 X 0 0 0 THOMAS J FAHEY JR MD 2.00 X 0 0 0 THOMAS G FERRARA 2.00 X 0 0 0 TERENCE GALLAGHER 2.00 X 0 0 0 STEVEN J GOLUB 2.00 X 0 0 0 EDWARD D HEBEN 2.00 X 0 0 0 MSGR EDWARD H BARRY 2.00 X 0 0 0 SCOTT LARUE 2.00 X 0 650469 202022 RENA M MURTHA RN 2.00 X 0 0 0 AMIT SIKDAR 2.00 X 0 0 0 MINTO L SOARES 2.00 X 0 0 0 JOSEPH A TARANTINO 2.00 X 0 0 0 ANNE COTE TAYLOR 2.00 X 0 0 0 MICHAEL J BRESCIA MD 36.00 X 448526 0 24405 FRANK A CALAMARI 36.00 X 932645 0 38418 CHRISTOPHER COMFORT MD 36.00 X 401371 0 52297 RICHARD KUTILEK 36.00 X 517955 0 46649 ANDREW V GRECO 36.00 X 262361 0 53081 SALLY UMBRO RN 36.00 X 224891 0 41618 ANTHONY TARANTO 36.00 X 177159 0 46334 NANCY D'AGOSTINO RN 36.00 X 225548 0 49983 SREENIVASA PATIBANDLA MD 36.00 X 372715 0 27570 ALMA CARRINGTON MD 36.00 X 268805 0 35918 ROBERT BRESCIA MD 36.00 X 324954 0 39818 DEVMANI JAITLY MD 36.00 X 494642 0 52297 GAIL CHRZANOWSKI MD 36.00 X 295888 0 44149 4947460 650469 754559 124 0 1 0 NICHOLSON & GALLOWAY INC 261 GLEN HEAD RD GLEN HEAD NY 11545 MASONRY RESTORATION ROOFING & WATERPROOF 926450 MBL CONSTRUCTION CORP 2620 ST RAYMOND AVENUE BRONX NY 10461 CONSTRUCTIONS 894781 FARRELL MEDIA GROUP 887 KINDERKAMACK ROAD 1ST FI RIVEREDGE NJ 07661 ADVERTISING/MEDIA PLANNING 791130 AMERICAN TRAVELER PO BOX 93201 ATLANTA GA 31193 STAFF TRAVEL NURSE 672935 C&C HOMECARE 125 NEWTON ROAD SUITE 300 PLAINVIEW NY 11803 HOME HEALTH CARE PROVIDER, HOME MEDICAL 670945 51 3255000 3512700 6767700 MEDICARE REVENUE 900099 79255995 79255995 MEDICAID REVENUE 900099 15297346 15297346 PATIENT SERVICE REVENU 900099 6658159 6658159 101211500 833700 833700 42000 0 42000 42000 42000 4239814 2866414 1373400 1373400 1373400 PARKING LOT REVENUE 900099 246375 246375 CAFETERIA 900099 187699 187699 EMERGENCY PREPAREDNESS 900099 61736 61736 275290 268800 6490 771100 110999400 101542036 0 2689664 5499997 3648888 1851109 53069303 49354330 3714973 7334000 6755366 578634 12720200 11716608 1003592 4086400 3763993 322407 918500 918500 351300 351300 497900 497900 7867600 7779500 88100 1143300 1053096 90204 2520500 2321639 198861 2179300 2007359 171941 207500 191129 16371 4213900 3881434 332466 174000 174000 ARCHDIOCESAN PENSION WI 20965600 20965600 0 OTHER ANCILLARY MEDICAL 5935000 5935000 0 0 MAINTENANCE AND REPAIRS 1530400 1409655 120745 0 FOOD EXPENSE 996100 996100 0 0 2332100 2148103 183997 134542900 123927800 10615100 0 -1953400 -1599700 6253600 6394800 23083500 22415300 193699 186943 585301 342577 82826500 65871100 16202600 16955400 16776100 17304800 21964000 22100000 21820300 21073780 104925700 105173900 15005800 16186100 30959500 52054300 45965300 68240400 X 30427200 11133300 26698100 23964000 1835100 1836200 58960400 36933500 104925700 105173900 X -23543500 2239900 -723300 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 18209 18209 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: CALVARY HOSPITAL, INC. DOES NOT ENGAGE IN ANY DIRECT LOBBYING ACTIVITIES; HOWEVER, IT DOES BEAR INDIRECT COSTS THAT HAVE LOBBYING IMPLICATIONS. THE $18,209 REPORTED ON PART II-B, LINE 1(I) REPRESENTS THAT PORTION OF ITS MEMBERSHIP DUES THE HOSPITAL PAYS TO THE HOSPITAL ASSOCIATION OF NEW YORK STATE (HANYS) AND THE GREATER NEW YORK HOSPITAL ASSOCIATION (GNYHA) THAT RELATES TO LOBBYING EXPENSES. THIS AMOUNT HAS BEEN DETERMINED IN ACCORDANCE WITH MEDICARE PROVIDER REIMBURSEMENT MANUAL, PART I, SECTION 2139. 28533200 1612400 821000 5166400 25800200 25734400 2031600 2502900 1735700 28533200 22916700 1901600 2815700 1899600 25734400 20492500 1747600 2610800 1934200 22916700 20492500 20492500 0.00000 0.07100 0.92900 0 0 538000 538000 30551300 22358700 8192600 3690300 2797200 893100 48046900 40715200 7331700 16955400 BENEFICIAL INTEREST IN NET ASSETS OF CALVARY FUND 22100000 F 22100000 DUE FROM THIRD PARTIES 878600 HELD IN ESCROW UNDER PLEDGE SECURITY AGREEMENT 6004335 SELF INSURANCE FUND ASSETS 2223000 EQUIPMENT ESCROW FUND 8744100 DONOR RESTRICTED ASSETS 1592700 DEFERRED COMPENSATION ASSET 1334500 OTHER ASSETS 251800 DUE FROM AFFILIATES 44745 21073780 ACCRUED PENSION LIABILITY 28462800 DUE TO THIRD PARTIES 1914700 MALPRACTICE LIABILITY 711200 ARCHDIOCESAN WITHRAWAL FEE PAYABLE 20965600 52054300 118405700 2239900 5166400 7406300 110999400 0 110999400 140432600 5889700 5889700 134542900 0 134542900 PART XI, LINE 2D - OTHER ADJUSTMENTS: NET ASSETS RELEASED FROM RESTRICTIONS 1,842,000. PART XII, LINE 2D - OTHER ADJUSTMENTS: NET ASSETS RELEASED FROM RESTRICTION 5,166,400. PENSION RELATED ADJUSTMENTS 859,300. BENEFICIAL INTEREST IN NET ASSETS OF CALVARY FUND, INC. -136,000. 1 1 X 1 X 300.000000000000 1 X 1 1 0 1 1 38773 38773 0.00030 3785430 3785430 0.02810 3824203 3824203 0.02840 3824203 3824203 0.02840 19 358478 358478 0.00270 1 2000 2000 0.00000 2 11800 11800 0.00010 1 12854 12854 0.00010 385132 385132 0.00290 23 770264 770264 0.00580 1 754500 41166689 55831208 -14664519 X 1 1 2 1 CALVARY HOSPITAL INC

1740 EASTCHESTER ROAD BRONX NY 10461

X X X LONG-TERM CARE HOSPITAL 2 CALVARY HOSPITAL INC (BROOKLYN CAMPUS)

150 55TH STREET BROOKLYN NY 11220

X X X CALVARY HOSPITAL INC 1 1 1 300.000000000000 1 300.000000000000 1 X X 1 1 X X 0 0 X 0 X X 0 0 PART I, LINE 3C: CALVARY HOSPITAL INC. USES THE FEDERAL POVERTY GUIDELINES (FPG) TO DETERMINE ELIGIBILITY FOR DISCOUNTED CARE TO LOW-INCOME PATIENTS. PART I, LINE 6A: CALVARY HOSPITAL, INC. IS REQUIRED TO PREPARE AN ANNUAL COMMUNITY SERVICE PLAN (CSP) A.K.A., THE COMPREHENSIVE COMMUNITY SERVICE PLAN FOR THE NYS DEPARTMENT OF HEALTH. THIS REPORT IS FILED WITH THE NYS DOH. THE COMMUNITY SERVICE PLAN IS AVAILABLE ON THE ORGANIZATION'S WEB SITE (WWW.CALVARYHOSPITAL.ORG). ADDITIONALLY, CALVARY POSTS INFORMATION REGARDING FINANCIAL ASSISTANCE PROGRAMS AND HAS A CALENDAR ON PROGRAMMATIC INFORMATION AS IT BECOMES AVAILABLE REGARDING BEREAVEMENT GROUPS AND SUPPORT NETWORKS ON THE ORGANIZATION'S WEB SITE. PART I, LINE 7: CALVARY HOSPITAL, INC. HAS UTILIZED NET REALIZABLE VALUE OF THE SERVICES RENDERED FOR THE CHARITY CARE AMOUNT LISTED ON PART I LINE 7. CALVARY UTILIZED THE AMOUNT REPORTED IN ITS COST REPORT PREPARED FOR THE NYS DOH. PART I, LINE 7G: CALVARY HOSPITAL, INC. HAS INCLUDED CHARITY CARE SERVICES IN THE AMOUNT OF $38,772 ON THE FORM 990, PART VIII LINE 2G. THIS AMOUNT IS EXCLUDED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN SCHEDULE H, PART I, LINE 7(F) AS PER THE INSTRUCTIONS.CALVARY HOSPITAL, INC. IS A NOT-FOR PROFIT SPECIALTY HOSPITAL THAT PROVIDES SERVICES FOR THE CARE OF TERMINALLY ILL CANCER PATIENTS. CALVARY HOSPITAL, INC. IS OPERATED IN CONNECTION WITH THE ROMAN CATHOLIC ARCHDIOCESE OF NEW YORK.THE MISSION OF CALVARY HOSPITAL, INC. IS AS FOLLOWS, FROM ITS INCEPTION IN 1899, CALVARY HOSPITAL HAS BEEN FAITHFULLY DEVOTED TO PROVIDING PALLIATIVE CARE TO ADULT PATIENTS IN THE ADVANCED STAGES OF CANCER, ADDRESSING THE SYMPTOMS OF THE DISEASE, NOT ITS CURE. A VOLUNTARY, NOT-FOR-PROFIT HOSPITAL, OPERATED IN CONNECTION WITH THE ARCHDIOCESE OF NEW YORK, CALVARY CONTINUES TO EMBODY THIS TRADITION OF CARING THROUGH THE SERVICES AND PROGRAMS OFFERED BY AND THROUGH THE DEDICATION AND CONCERN SHOWN BY ITS STAFF MEMBERS.THE HOSPITAL WILL CONTINUE TO BE FAITHFUL TO THIS TRADITION THROUGH A TWOFOLD COMMITMENT. CALVARY WILL STRIVE PRIMARILY TO EXPAND ITS PROGRAMS AND SERVICES TO MEET THE EMERGING PHYSICAL, PSYCHOSOCIAL, AND SPIRITUAL NEEDS OF BOTH PATIENTS AND FAMILIES THROUGH THE PROVISION OF ACUTE INPATIENT, OUTPATIENT, HOME CARE, HOSPICE, AND SATELLITE SERVICES. IN ADDITION, THROUGH THE PALLIATIVE CARE INSTITUTE THE HOSPITAL ENDEAVORS TO TRANSMIT TO OTHER HEALTH CARE PROFESSIONALS, THROUGH RESEARCH AND EDUCATION, THE KNOWLEDGE AND COMPETENCE WHICH IT HAS DEVELOPED IN THE CARE OF THE ADVANCED CANCER PATIENT. THROUGH THIS TWOFOLD COMMITMENT, CALVARY HOSPITAL WILL DEEPEN AND STRENGTHEN THE PHILOSOPHY OF COMPASSIONATE CARE WHICH HAS BEEN THE CORNERSTONE OF ITS PROGRAM OF SERVICE, AND WILL OFFER TO THOSE IN OUR EXPANDED COMMUNITY AND OTHERS, A TRADITION OF SUCCESSFUL EXPERIENCE IN THE CARE OF THE ADVANCED CANCER PATIENT.CALVARY HOSPITAL IS THE ONLY FULLY ACCREDITED ACUTE CARE SPECIALTY HOSPITAL EXCLUSIVELY PROVIDING PALLIATIVE CARE FOR ADVANCED CANCER PATIENTS IN THE UNITED STATES. WITH 225 BEDS IN THE BRONX AND BROOKLYN AND MORE THAN 1029 EMPLOYEES, CALVARY SERVES MORE THAN 5,500 PATIENTS ANNUALLY. CALVARY PROVIDES PALLIATIVE CARE, WHICH IS THE ACTIVE TREATMENT OF THE SYMPTOMS, NOT THE CURE OF THE DISEASE, IN ORDER TO MAKE OUR PATIENTS AS COMFORTABLE AS POSSIBLE. CALVARY'S PROGRAMS INCLUDE INPATIENT CARE CASE MANAGEMENT OUTPATIENT CARE, HOSPICE, HOME CARE AND SUPPORT PROGRAMS FOR FAMILIES AND FRIENDS.AS CALVARY APPROACHES THE FUTURE WITH A SENSE OF HOPE AND PROMISE, CALVARY IS EVER MINDFUL OF THE LEGACY OF OUR FOUNDERS, THE WOMEN OF CALVARY, TO PROVIDE COMPREHENSIVE CARE WHILE RECOGNIZING THE INDIVIDUALITY AND DIGNITY OF EVERY PATIENT. AT THE SAME TIME, CALVARY WILL CONTINUE TO DEVELOP NEW PROGRAMS AND SERVICES TO MEET THE NEEDS OF TODAY'S WORLD. PART I LINE 7 COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990.PART IX LINE 25 COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING. THE PERCENTAGE IN THIS COLUMN IS $XX,XXX. PART II: CALVARY HOSPITAL MAKES A NUMBER OF DIFFERENT SUPPORT GROUPS AVAILABLE TO THE COMMUNITY. THESE SUPPORT GROUPS ARE ADVERTISED ON CALVARY HOSPITAL'S WEBSITE, WWW.CALVARYHOSPITAL.ORG, ON ITS CALENDAR OF EVENTS. ALL GROUPS ARE FREE AND ARE OPEN TO THE COMMUNITY.CALVARY HOSPITAL PROVIDES BEREAVEMENT SUPPORT FOR ADULTS WHO HAVE LOST LOVED ONES AT CALVARY HOSPITAL OR CALVARY@HOME, AND THOSE FROM THE COMMUNITY AT LARGE WHO HAVE LOST SOMEONE BECAUSE OF ILLNESS ACCIDENTS VIOLENCE, OR ANY OTHER CAUSE. GROUPS ARE OFFERED IN THE BRONX AND BROOKLYN.THE HOSPITAL OFFERS AGE-APPROPRIATE SUPPORT GROUPS FOR CHILDREN, AGES 6 THROUGH 11, AND FOR ADOLESCENTS, AGES 12 TO 18.CALVARY IN TOUCH, A BI-MONTHLY NEWSLETTER ABOUT BEREAVEMENT ISSUES IS AVAILABLE THROUGH THE HOSPITAL'S WEBSITE. THESE COMMUNITY SUPPORT GROUPS INCLUDE BUT ARE NOT LIMITED TO:- SUPPORT GROUPS FOR BEREAVED PARENTS- PRECIOUS MOMENTS SUPPORT GROUP FOR CHILDREN AGES 6 TO 11- TEEN BEREAVEMENT GROUP- DEATH OF A SPOUSE BEREAVEMENT GROUP- DEATH OF A PARENT BEREAVEMENT GROUP- CAMP COURAGEOUS DAY CAMP FOR BEREAVED CHILDREN GROUPS ARE OPEN TO ALL, ARE FREE OF CHARGE, AND ARE LED BY CALVARY HOSPITAL STAFF. REGISTRATION IN ADVANCE OF PARTICIPATION IS REQUIRED.CALVARY HOSPITAL ALSO MAKES AVAILABLE A NUMBER OF DIFFERENT WELLNESS ACTIVITIES TO THE COMMUNITY. THESE WELLNESS ACTIVITIES INCLUDE BUT ARE NOT LIMITED TO YOGA CLASSES AND RECREATIONAL THERAPY. CALVARY HOSPITAL'S THERAPEUTIC RECREATION AND "MUSIC THERAPY PROGRAMS WERECREATED TO GIVE PATIENTS A SENSE OF ACCOMPLISHMENT AND TO RELIEVE THE SUFFERING OF OUR PATIENTS AND THEIR FAMILIES. THERAPEUTIC RECREATION ACTIVITIES INCLUDES DRAWING, SCULPTURE, AND CERAMICS PROJECTS; HORTICULTURE; A GAMES AND DISCUSSION HOUR; AND HOLIDAY PARTIES. MUSIC THERAPY OFTEN HELPS SOOTHE PATIENTS AND HELPS THEM FOCUS ON LIFE. OUR BOARD CERTIFIED MUSIC THERAPISTS USE MUSIC THERAPY INTERVENTIONS TO SOOTHE PATIENTS, RELIEVE ANXIETY, REMINISCE, AND EASE PAIN AND SUFFERING. MUSIC THERAPY INTERVENTIONS MAY ALSO PROVIDE RELEASE IN THE LAST HOURS OR MOMENTS OF LIFE. PATIENTS RECEIVING MUSIC THERAPY SOMETIMES WRITE SONGS ASSISTED BY THE MUSIC THERAPISTS TO LEAVE FOR LOVED ONES, OR FIND OTHER WAYS TO OPEN THEIR HEARTS THROUGH MUSIC. OUR CLINICIANS REPORT THAT IN SOME CASES, THE ONLY TIME A PATIENT LAUGHS OR SMILES IS DURING A MUSIC THERAPY SESSION. WE ALSO FIND THAT MUSIC THERAPY IS AVAILABLE AT BOTH INPATIENT LOCATIONS AND IS ALSO ONE OF THE SERVICES WE OFFER THROUGH CALVARY@HOME.IN KEEPING WITH OUR MISSION TO SHARE OUR KNOWLEDGE AND EXPERIENCE WITH OTHERS, CALVARY OFFERS INTERNSHIP PROGRAMS IN THE FOLLOWING AREAS:PALLIATIVE CARE AND MUSIC THERAPY, WHICH IS RECOGNIZED AS A NATIONAL CLINICAL TRAINING SITE BY THE AMERICAN MUSIC THERAPY ASSOCIATION. THROUGH ITS EDDIE HIGGINS SCHOLARSHIP PROGRAM, CALVARY HOSPITAL PROVIDES LEADERSHIP DEVELOPMENT AND TRAINING. THE EDDIE HIGGINS SCHOLARSHIP IS NAMED AFTER A CHERISHED MEMBER OF THE CALVARY FAMILY WHO CAME TO THE HOSPITAL AS A YOUNG BOY. EDDIE WAS HOSPITALIZED INTERMITTENTLY FOR 15 YEARS AT CALVARY UNTIL HIS DEATH IN 1982 AT THE AGE OF 29. EDDIE IS REMEMBERED FOR HIS LOVE OF GOD AND HIS REMARKABLE COURAGE DESPITE HIS ILLNESS. CALVARY HAS GIVEN THE ANNUAL SCHOLARSHIP SINCE 1985. CALVARY HOSPITAL IS VERY ACTIVE IN THE COMMUNITY AND PARTICIPATES IN ANNUAL EVENTS SUCH AS THE COMMUNITY COLUMBUS DAY PARADE AND THE ANNUAL ORCHARD BEACH BREAST CANCER WALK. PART III, LINE 4: THE CALVARY HOSPITAL, INC. AUDITED FINANCIAL STATEMENTS DO NOT CONTAIN A FOOTNOTE REGARDING BAD DEBT.COSTING METHODOLOGY USED FOR BAD DEBT:THE METHODOLOGY USED IN DETERMINING THE AMOUNTS REPORTED IN LINE 2 IS BASED ON THE HOSPITAL'S COLLECTION/BAD DEBT WRITE-OFF POLICY WHICH STATESTHAT ALL REASONABLE EFFORTS WILL BE MADE TO OBTAIN PAYMENTS AND TO SETTLE PATIENT ACCOUNTS RECEIVABLE ON A CONSISTENT BASIS. COLLECTION EFFORTS AREMADE ON THE NET REALIZABLE AMOUNT. PART III, LINE 8: CALVARY HOSPITAL INC. HAS REPORTED A SHORTFALL IN PART III SECTION B LINE 7. THE EXPENSES, REVENUES AND SHORTFALL REPORTED IN PART III LINES 5-7 WERE DEVELOPED FROM THE 2010 CALVARY HOSPITAL, INC. COST REPORTS FILED WITH THE NYS DOH AND NATIONAL GOVERNMENT SERVICES (MEDICARE INTERMEDIARY). PART III, LINE 9B: CALVARY HOSPITAL, INC. 'S FINANCIAL ASSISTANCE POLICY CONTAINS PROVISIONS ON THE COLLECTION PRACTICES ON THE COLLECTION PRACTICES TO BE FOLLOWED FOR PATIENTS WHO ARE KNOWN TO QUALIFY FOR FINANCIAL ASSISTANCE.CALVARY HOSPITAL'S COLLECTION: BAD DEBT WRITE-OFFS POLICY INDICATES THAT ALL REASONABLE EFFORTS WILL BE MADE BY PATIENT ACCOUNTS REPRESENTATIVES TOOBTAIN PAYMENT AND TO SETTLE PATIENT ACCOUNTS RECEIVABLE ON A CONSISTENT BASIS. THE PATIENT ACCOUNTING SYSTEM WILL BEAR ENTRIES OF SUCH ATTEMPTS,INCLUDING THE DATE AND THE REPRESENTATIVE'S INITIALS. ACCOUNTS RESISTING SETTLEMENT MAY BE REFERRED TO A COLLECTION AGENCY. CALVARY HOSPITAL INC. PART V, SECTION B, LINE 14G: THE HOSPITAL PUBLISHES AVAILABILITY OF CHARITY CARE IN THE NEW YORK TIMES. CALVARY HOSPITAL INC. PART V, SECTION B, LINE 19C: THE HOSPITAL DOES NOT HAVE EMERGENCY ROOM. CALVARY HOSPITAL INC. PART V, SECTION B, LINE 20D: 15% OF GROSS CHARGES WHICH IS BELOW OUR LOWEST PAYER. PART VI, LINE 2: CALVARY HOSPITAL IS THE ONLY FULLY ACCREDITED ACUTE CARE SPECIALTY HOSPITAL EXCLUSIVELY PROVIDING PALLIATIVE CARE FOR ADULT ADVANCED CANCER PATIENTS IN THE UNITED STATES LOCATED IN THE BRONX AND BROOKLYN.CALVARY HOSPITAL USES A VARIETY OF METHODS AND SERVICES TO GATHER COMMUNITY INPUT ASSESS THE NEEDS OF THE COMMUNITY, AND TO ASSURE INPUT IN THE COMMUNITY SERVICE PLAN. SOME OF THESE METHODS ARE:A. COMMUNITY OUTREACH SERVICES -COMMUNITY OUTREACH SERVICES FUNCTIONS AS A LIAISON WITH THE COMMUNITY, REFERRERS, PHYSICIANS, PATIENTS, AND FAMILIES AND FACILITATES ADMISSION TO CALVARY HOSPITAL. THE DEPARTMENT OUTREACHES THROUGH THE TRI-STATE REGION AND EDUCATES THE HEALTH CARE AND PATIENT COMMUNITIES AS TO THE CONTINUUM OF SERVICES CALVARY PROVIDES (INPATIENT, OUTPATIENT, HOME CARE, HOSPICE NURSING HOME HOSPICE, AND WOUND CARE). THROUGH ON-SITE VISITS, PUBLIC PRESENTATIONS AND PARTICIPATION IN COMMUNITY AND PROVIDER ACTIVITIES, THEOUTREACH STAFF CONTINUALLY ASSESSES THE NEEDS OF THE COMMUNITY. B. PROFESSIONAL ADVISORY BOARD -THE PROFESSIONAL ADVISORY BOARD WAS ESTABLISHED IN 1992 TO OBTAIN INPUT FROM THE COMMUNITY. THE ADVISORY BOARD MEETS AT LEAST ANNUALLY AND IS COMPRISED OF PHYSICIANS NURSES, AND SOCIAL WORKERS, REPRESENTING HOSPITALS, AND HOME CARE AGENCIES, AS WELL AS THE COMMUNITY. THIS GROUP HAS CONTRIBUTED A VARIETY OF IDEAS FOR ENHANCING SERVICES TO THE COMMUNITY.C. COMMUNITY PLANNING BOARDEACH YEAR THE HOSPITAL INVITES THE HEALTH COMMITTEE OF COMMUNITY PLANNING BOARD *11 AND *10 TO VISIT THE HOSPITAL AND MEET WITH SENIOR STAFF.D. OUTREACH REPRESENTATION (OPEN HOUSE) FOR HEALTH CARE PROFESSIONALS -COMMUNITY OUTREACH HOSTS OPEN HOUSES AT BOTH THE BRONX AND BROOKLYN LOCATIONS TO PROVIDE INFORMATION TO AND RECEIVE INFORMATION FROM ITS REFERRERS. CALVARY HOSPITAL, INC. ALSO HAS PUBLIC PARTICIPATION IN THE EXTENDED. COMMUNITY THROUGH PARTICIPATION IN:- GREATER NEW YORK HOSPITAL ASSOCIATION- HOSPITAL ASSOCIATION OF NEW YORK STATE- AMERICAN HOSPITAL ASSOCIATION- NEW YORK CITY DEPARTMENT OF HEALTH- NEW YORK STATE DEPARTMENT OF HEALTH- CATHOLIC HEALTHCARE ASSOCIATION- CMS THROUGH ONGOING PARTICIPATION IN THE GROUPS ABOVE, CALVARY HOSPITAL CONTINUALLY MONITORS THE TRENDS IN THE HEALTHCARE NEEDS OF THE LARGER COMMUNITY. ALTHOUGH THE NATURE OF ITS SERVICES IS LIMITED BY ITS SPECIALIZED MISSION, CALVARY HAS IDENTIFIED A VARIETY OF ACTIVITIES TO PARTICIPATE IN IMPROVING THE HEALTH OF ITS EXTENDED COMMUNITY. PART VI, LINE 3: EACH PERSON REQUESTING CALVARY'S SERVICES MUST BE MADE AWARE OF CALVARY'S UNCOMPENSATED (FREE) SERVICES OR DISCOUNTED SERVICES PROGRAM AS FOLLOWS:1. DISTRIBUTE AN INDIVIDUAL NOTICE TO EACH PERSON WHO IS SEEKING SERVICES ON BEHALF OF HIMSELF OR ANOTHER. THIS NOTICE IS PASSED TO THE INDIVIDUALUSUALLY AT THE POINT OF ADMISSION OR REGISTRATION WHEN FINANCIAL ARRANGEMENTS ARE BEING DISCUSSED. THE "NOTICE OF AVAILABILITY OF UNCOMPENSATED (FREE) SERVICES OR DISCOUNTED SERVICES" IS UPDATED ANNUALLY.2. POST SIGNS PROVIDED BY THE DEPARTMENT OF HEALTH AND HUMAN SERVICES CONSPICUOUSLY IN THE ADMITTING OFFICE, BUSINESS OFFICE, CLINICS, HOME HEALTH AGENCY, AND HOSPICE AREAS. THE SIGNS ARE TO BE IN ENGLISH AND SPANISH. ADDITIONALLY, CALVARY HAS ACCESS TO A LANGUAGE TELEPHONE SERVICE THAT ADDS 58 ADDITIONAL LANGUAGES TO ENGLISH AND SPANISH. 3. PUBLISH NOTICE OF HILL-BURTON UNCOMPENSATED SERVICES OBLIGATION ANNUALLY IN LOCAL NEWSPAPER IN SERVICE AREA (NEW YORK TIMES LEGAL). PART VI, LINE 4: CALVARY HOSPITAL'S MAIN CAMPUS IS LOCATED IN THE BRONX, NY. THE BRONX IS CONSIDERED THE PRIMARY COMMUNITY FOR THE PURPOSES OF PUBLIC HEALTH PLANNING, AND 48% OF ITS EMPLOYEES RESIDE IN THE PRIMARY SERVICE AREA. IN ADDITION, AS A TERTIARY REFERRAL CENTER FOR ADVANCED DISEASE, CALVARY HOSPITAL SERVES THE ENTIRE TRI-STATE REGION. THE SECONDARY SERVICE IS DETERMINED BASED ON CURRENT REFERRAL PATTERNS.THE PRIMARY REFERRAL SOURCES FOR ADMISSIONS CONTINUE TO BE THE ACUTE CARE HOSPITALS. CURRENTLY 85% OF ADMISSIONS ARE REFERRED BY HOSPITALS LOCATEDWITHIN THE BOROUGHS OF NEW YORK CITY, ROCKLAND, AND WESTCHESTER COUNTIES, LONG ISLAND, AND THE STATES OF NEW JERSEY AND CONNECTICUT. OTHER REFERRALSOURCES ARE CALVARY HOSPITAL HOME CARE, HOSPICE, AND OTHER HOME CARE AND HOSPICE AGENCIES. CALVARY OUTPATIENT SERVICES, FAMILIES, PHYSICIANS,NURSING HOMES, AND COMMUNITY AGENCIES.IN 2001, CALVARY EXPANDED ITS SERVICES WITH THE OPENING OF CALVARY HOSPITAL - THE BROOKLYN CAMPUS, AT LUTHERAN MEDICAL CENTER. REPORTS FILED WITH STATES PART VI, LINE 7 NY X X 0 1 X X X X 0 1 0 0 0 0 0 0 0 SCOTT LARUE 0 561169 0 89300 0 0 0 177900 0 24122 0 852491 0 89300 MICHAEL J BRESCIA MD 373746 0 9425 0 65355 0 16170 0 8235 0 472931 0 0 0 FRANK A CALAMARI 433358 0 11000 0 488287 0 27570 0 10848 0 971063 0 0 0 CHRISTOPHER COMFORT MD 331393 0 8450 0 61528 0 27570 0 24727 0 453668 0 0 0 RICHARD KUTILEK 256105 0 6600 0 255250 0 27570 0 19079 0 564604 0 0 0 ANDREW V GRECO 242366 0 6250 0 13745 0 27570 0 25511 0 315442 0 0 0 SALLY UMBRO RN 215331 0 5469 0 4091 0 24758 0 16860 0 266509 0 0 0 ANTHONY TARANTO 163735 0 4159 0 9265 0 21607 0 24727 0 223493 0 0 0 NANCY D'AGOSTINO RN 216073 0 5458 0 4017 0 25257 0 24726 0 275531 0 0 0 SREENIVASA PATIBANDLA MD 164908 0 4123 0 203684 0 27570 0 0 0 400285 0 0 0 ALMA CARRINGTON MD 211132 0 5359 0 52314 0 27570 0 8348 0 304723 0 0 0 ROBERT BRESCIA MD 298206 0 7650 0 19098 0 27570 0 12248 0 364772 0 0 0 DEVMANI JAITLY MD 244414 0 5573 0 244655 0 27570 0 24727 0 546939 0 0 0 GAIL CHRZANOWSKI MD 219706 0 5573 0 70609 0 27570 0 16579 0 340037 0 0 0 PART I, LINE 1A EFFECTIVE JUNE 1, 1998, THE HOSPITAL ESTABLISHED THE CALVARY HOSPITAL SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP) TO PROVIDE PENSION BENEFITS FOR WAGES EARNED BY CERTAIN PHYSICIANS AND SENIOR EXECUTIVE STAFF WITH COMPENSATION IN EXCESS OF THE IRS LIMITS AND ALSO ESTABLISHED THE CALVARY HOSPITAL KEY EMPLOYEE SHARE OPTION PLAN (KEYSOP) TO PROVIDE ADDITIONAL AND ALTERNATIVE FORMS OF COMPENSATION TO KEY EMPLOYEES. PRIOR TO 2002, THE HOSPITAL UTILIZED THE KEYSOP TO FUND THE SERP. AS A RESULT OF THE IRS 457 REGULATIONS WHICH WERE ISSUED DURING 2002, THE UTILIZATION OF THE KEYSOP TO FUND THE SERP BECAME UNFEASIBLE. AFTER CONSIDERATION OF VARIOUS REPLACEMENT OPTIONS, IN 2003, CALVARY HOSPITAL CHOSE THE TAX GROSS-UP OPTION, WHEREBY, INDIVIDUAL PARTICIPANTS' DEFERRALS WOULD BE GROSSED-UP TO DUPLICATE THE BENEFITS HE WOULD RECEIVE IN A TAX-DEFERRED ARRANGEMENT AND PAID THEM OUT DIRECTLY TO THE PARTICIPANTS. THE FOLLOWING EXECUTIVES RECEIVED TAX GROSS-UP PAYMENTS IN 2010 IN ORDER TO DUPLICATE A TAX DEFERRED VEHICLE: (THE AMOUNTS WERE CALCULATED BY DELOITTE CONSULTING LLP UTILIZING EXPECTED TAX RATES TO CALCULATE THE NET AMOUNTS.) THE FOLLOWING TAX EXECUTIVES ALSO RECEIVED KEYSOP DIVIDENDS AS TAX GROSS-UP PAYMENTS IN 2012: - FRANK A. CALAMARI - RICHARD KUTILEK THE ORGANIZATION PROVIDED SOCIAL CLUB DUES IN 2012 FOR FRANK CALAMARI AND THE DUES WERE INCLUDED AS TAXABLE COMPENSATION. PART I, LINE 4B THE FOLLOWING CALVARY HOSPITAL OFFICERS PARTICPATE IN A NOW-DEFUNCT SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN: FRANK CALAMARI, MICHAEL BRESCIA, AND RICHARD KUTILEK. SCHEDULE J, PART I, LINE 4B: SCOTT LARUE PARTICIPATED IN A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN. CATHOLIC HEALTH CARE SYSTEM D/B/A ARCHCARE CONTRIBUTED $16,500 TO THE PLAN IN 2012. PART I, LINE 7 THE FOLLOWING CATHOLIC HEALTH CARE SYSTEM D/B/A ARCHCARE EMPLOYEE RECEIVED A BOARD DISCRETIONARY BONUS IN THEIR 2012 W-2: - SCOTT LARUE, $89,300 ORGANIZATION'S MISSION FORM 990, PART I, LINE 1 CALVARY HOSPITAL IS A FULLY ACCREDITED ACUTE CARE SPECIALITY HOSPITAL EXCLUSIVELY PROVIDING PALLIATIVE CARE FOR ADVANCES CANCER PATIENTS IN THE UNITED STATES. ADVANCED CANCER CARE INPATIENT FORM 990, PART III, LINE 4A CALVARY SERVES ABOUT 30% OF ALL INDIVIDUALS WHO DIE OF CANCER IN THE NEW YORK METROPOLITAN AREA EACH YEAR. PATIENTS ARE REFERRED TO CALVARY FROM EVERY MAJOR HOSPITAL AND MEDICAL CENTER IN NEW YORK CITY. IN 2012, CALVARY CARED FOR MORE THAN 5,300 PATIENTS AND FAMILIES AS INPATIENTS IN OUR 200-BED BRONX CAMPUS AND OUR 25-BED SATELLITE AT LUTHERAN MEDICAL CENTER IN BROOKLYN, AS OUTPATIENTS, THROUGH OUR CENTER FOR CURATIVE AND PALLIATIVE WOUND CARE; AND THROUGH HOSPICE AND HOME CARE. THE AVERAGE LENGTH OF INPATIENT STAY IS 25.4 DAYS. HOSPICE PROGRAM FORM 990, PART III, LINE 4B CALVARY HOSPITAL HOSPICE IS A MEDICARE-CERTIFIED HOSPICE PROGRAM, WHICH PROVIDES AN INTERDISCIPLINARY CARE TEAM FOR PATIENTS WITH A TERMINAL PROGNOSIS FOR ALL END-STAGE DISEASES. CALVARY HOSPITAL HOSPICE EMBRACES AND IMPLEMENTS THE BASIC ASSUMPTIONS OF THE HOSPICE CONCEPT, INCLUDING THE FOLLOWING: - HOSPICE PROVIDES PALLIATIVE MEDICAL CARE, TREATING THE PHYSICAL, EMOTIONAL AND SPIRITUAL PAIN OF THE PATIENT AND FAMILY. - HOSPICE TREATS THE PATIENT AND LOVED ONES TOGETHER AS A WHOLE UNIT OF CARE AND OFFERS BEREAVEMENT COUNSELING FOR SURVIVING CAREGIVERS AFTER THE PATIENT'S DEATH. - HOSPICE PATIENTS REMAIN IN THE FAMILIAR, COMFORTING SURROUNDINGS OF HOME, WHETHER IT'S A PRIVATE RESIDENCE, NURSING HOME, HOSPITAL OR AN ASSISTED LIVING FACILITY. - HOSPICE CARE PROVIDES THE FOLLOWING FOUR LEVELS OF CARE: ROUTINE CARE, GENERAL INPATIENT CARE (IF NEEDED), CONTINUOUS CARE (DURING A CRISIS), AND RESPITE CARE. HOSPICE SERVICES - NURSING CARE, AS NECESSARY TO MAINTAIN THE PATIENT AT HOME - 24 HOURS A DAY, 7 DAYS A WEEK ON-CALL NURSE PHYSICIAN SERVICES - MEDICAL SOCIAL SERVICES - PASTORAL CARE - COUNSELING SERVICES - NUTRITIONAL COUNSELING - SHORT-TERM INPATIENT AND RESPITE CARE - MEDICAL SUPPLIES RELATED TO TERMINALLY ILL - PERSONAL CARE PROVIDED BY CERTIFIED HOME HEALTH AIDES - THERAPIES (E.G., PHYSICAL, OCCUPATIONAL AND SPEECH) - MEDICATIONS FOR SYMPTOM MANAGEMENT AND PAIN CONTROL RELATED TO THE TERMINALLY ILL - BEREAVEMENT COUNSELING FOR FAMILY MEMBERS - VOLUNTEER SERVICES HOMECARE PROGRAM FORM 990, PART III, LINE 4C CALVARY'S HOME HEALTH AGENCY SERVES PATIENTS IN THE BRONX, QUEENS, NORTHERN MANHATTAN, AND SOUTHERN WESTCHESTER COUNTY. CALVARY OFFERS HOME CARE TO PATIENTS WITH ALL DIAGNOSES. MOST PATIENTS RETURN TO PRE-ILLNESS FUNCTION AND ARE DISCHARGED TO SELF-CARE WITHIN SIX TO EIGHT WEEKS. ALL OF OUR PATIENTS WHO WE CARE FOR AT HOME GET THE SAME LEVEL OF HIGH-QUALITY AND UNIQUE "CALVARY CARE" AS ALL OF OUR INPATIENTS. THE FOLLOWING SERVICES ARE AVAILABLE TO PATIENTS AND THEIR FAMILIES THROUGH CALVARY'S CERTIFIED HOME HEALTH AGENCY: NURSING SERVICES - OUR COMMUNITY HEALTH NURSES PROVIDE NURSING VISITS TO PATIENTS IN THEIR HOMES. - SPECIALIZED NURSING IS AVAILABLE SUCH AS ENTEROSTOMAL THERAPY. - 24-HOUR TELEPHONE ACCESS TO RN (REGISTERED NURSE) ON-CALL. HOME HEALTH AIDE - PROVIDES ASSISTANCE WITH PERSONAL CARE AND OTHER ACTIVITIES RELATED TO HEALTH CARE. NUTRITIONAL SERVICES - CALVARY'S DIETITIANS ARE AVAILABLE BY PHONE TO HELP IN PLANNING THERAPEUTIC NUTRITIONAL MANAGEMENT. THERAPY SERVICES - PHYSICAL THERAPY - OCCUPATIONAL THERAPY - SPEECH THERAPY MEDICAL CARE - CALVARY HOME CARE STAFF WILL WORK CLOSELY WITH THE PATIENT'S OWN PHYSICIAN TO MEET HOME HEALTH NEEDS. - OUR STAFF HAS EXTENSIVE KNOWLEDGE OF PAIN MANAGEMENT. MEDICAL SOCIAL WORK A FULL RANGE OF SOCIAL WORK SERVICES ARE AVAILABLE TO HELP PATIENTS AND FAMILIES COPE WITH THE PROBLEMS OF ILLNESS. - ASSISTANCE IN MEDICAID APPLICATION - ASSISTANCE IN LONG-TERM PLANNING REFERRING PATIENTS - REFERRALS MAY BE MADE BY PATIENTS FAMILY MEMBERS, FRIENDS, HOSPITALS, CLINICS, PHYSICIANS, OTHER HEALTH CARE PROFESSIONALS AND COMMUNITY AGENCIES. - TO MAKE A REFERRAL OR TO LEARN MORE ABOUT OUR SERVICES, PLEASE CALL (718) 430-9540. PART OF THE CALVARY CONTINUUM FACILITATE ADMISSION TO INPATIENT CARE FOR SYMPTOM MANAGEMENT - REFERRAL TO OUTPATIENT AND WOUND CARE CLINICS - PROVIDE INFORMATION ON CALVARY PROGRAMS INCLUDING BEREAVEMENT SUPPORT FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER OF CALVARY HOSPITAL IS ARCHCARE. FORM 990, PART VI, SECTION A, LINE 7A THE CALVARY HOSPITAL BYLAWS RESERVE CERTAIN RIGHTS TO ARCHCARE AS THE SOLE MEMBER OF THE HOSPITAL. THESE RIGHTS ARE ENUMERATED IN ARTICLE IV AND INCLUDE THE RIGHT TO AMEND THE HOSPITAL'S BYLAWS AND ORGANIZING DOCUMENTS, APPOINT AND REMOVE BOARD MEMBERS AND APPROVE CERTAIN DECISIONS OF THE HOSPITAL'S BOARD OF DIRECTORS, INCLUDING BUT NOT LIMITED TO, THE ADOPTION OF A STRATEGIC PLAN, ACQUISITION OF ANOTHER ORGANIZATION, REAL ESTATE TRANSACTIONS EXCEEDING A CERTAIN DOLLAR THRESHOLD, ADOPTION OF CRITERIA FOR MANAGED CARE CONTRACTING, AND ADOPTION OF SYSTEM-WIDE MEASURES. FORM 990, PART VI, SECTION A, LINE 7B ARCHCARE HAS THE FOLLOWING POWERS AND RIGHTS WHICH ARE VESTED IN ARCHCARE BY LAW, THE CERTIFICATE OF INCORPORATION AND THE HOSPITAL BYLAWS. SUCH POWERS AND RIGHTS INCLUDE AMENDMENT TO THE BYLAWS AND CERTIFICATE OF INCORPORATION OF THE HOSPITAL, APPOINTMENT AND REMOVAL OF THE MEMBERS OF THE BOARD OF DIRECTORS AND THE CHAIRMAN OF THE BOARD OF DIRECTORS OF THE HOSPITAL, ADOPTION OF THE HOSPITAL BUDGETS, ADOPTION OR AMENDMENT OF THE BUSINESS AND STRATEGIC PLAN EN TITY, CERTAIN REAL ESTATE AND CAPITAL TRANSACTIONS AND APPROVAL OF MANAGEMENT CONTRACTS SUBJECT TO AGREED-UPON THRESHOLDS, PROGRAM OR SERVICE CHANGES BY THE HOSPITAL, APPROVAL OF ANY MERGER, PURCHASE, JOINT OPERATING AGREEMENT OR OTHER AFFILIATION OR WITHDRAWAL FROM, DISPOSITION OF AN INTEREST IN OR DISSOLUTION OF ANY SUCH AFFILIATION. FORM 990, PART VI, SECTION B, LINE 11 THE 2012 FORM 990 OF CALVARY HOSPITAL WAS PREPARED BY DELOITTE TAX WITH THE ASSISTANCE OF CALVARY ACCOUNTING PERSONNEL. THE DRAFT OF FORM 990 WAS REVIEWED BY DELOITTE TAX, THE CONTROLLER AND CFO OF CALVARY HOSPITAL BEFORE DISTRIBUTION OF THE FULL VERSION OF THE FINAL DRAFT TO THE BOARD. A COPY OF THE FORM 990 DRAFT WAS PROVIDED TO EACH MEMBER OF THE CALVARY HOSPITAL BOARD OF DIRECTORS ON 11/5/13 PRIOR TO ITS FILING WITH THE INTERNAL REVENUE SERVICE IN ELECTRONIC FORMAT FORM 990, PART VI, SECTION B, LINE 12C EACH OFFICER, DIRECTOR, TRUSTEE AND KEY EMPLOYEE IS REQUIRED TO ANNUALLY DISCLOSE ANY CONFLICTS OF INTEREST THAT ARISE BY VIRTUE OF THEIR EMPLOYMENT AND POSITION WITH CALVARY HOSPITAL OR CALVARY FUND. CALVARY MONITORS COMPLIANCE WITH ITS CONFLICT OF INTEREST POLICY THROUGH AN ANNUAL QUESTIONNAIRE SUBMITTED TO THESE INDIVIDUALS. POTENTIAL CONFLICTS ARE INVESTIGATED IMMEDIATELY AND, IF ANY ARE UNCOVERED, THERE ARE POLICIES IN PLACE TO ENSURE THAT THOSE INDIVIDUALS RECUSE THEMSELVES FROM PARTICIPATING IN ANY DECISIONMAKING RELATED TO SUCH CONFLICT. FORM 990, PART VI, SECTION B, LINE 15 CALVARY HOSPITAL, INC UNDERTAKES A RIGOROUS PROCESS TO ENSURE THAT THE EXECUTIVE COMPENSATION IT PAYS TO ITS TOP MANAGEMENT OFFICIALS AND ALL OFFICERS AND KEY EMPLOYEES OF THE ORGANIZATION IS REASONABLE. IN RELEVANT PART, THE BOARD OF DIRECTORS HAS ESTABLISHED A COMPENSATION COMMITTEE COMPRISED OF INDEPENDENT PERSONS THAT HAVE NO PERSONAL INTEREST IN THE PROPOSED COMPENSATION ARRANGEMENT. THE BOARD OF DIRECTORS USES AN INDEPENDENT COMPENSATION CONSULTANT TO HELP ADVISE ON THE APPROPRIATE COMPENSATION LEVELS FOR THE AFOREMENTIONED INDIVIDUALS. THAT COMPENSATION CONSULTANT WILL USE COMPARABILITY OR BENCHMARKLNG DATA (BASED ON INDUSTRY SURVEYS) THAT DOCUMENTS THE COMPENSATION OF PERSONS HOLDING SIMILAR PERSONS IN SIMILAR ORGANIZATIONS. ONCE THE COMPENSATION CONSULTANT HAS MADE ITS RECOMMENDATIONS, THE CALVARY COMPENSATION COMMITTEE MUST APPROVE THE COMPENSATION, WITHOUT INPUT OR VOTING PARTICIPATION BY THE PERSON WHOSE COMPENSATION IS BEING APPROVED OR BY ANY OTHER INDIVIDUAL WITH A CONFLICT OF INTEREST THE FINAL DETERMINATION IS THEN DOCUMENTED IN COMMITTEE MINUTES THOSE MINUTES WILL CONTAIN THE TERMS OF THE PROPOSED COMPENSATION, THE DECISIONS OF THOSE INDIVIDUALS WHO VOTED ON THE COMPENSATION, AND THE COMPARABILITY DATA THAT WAS RELIED UPON. FORM 990, PART VI, SECTION C, LINE 19 CALVARY HOSPITAL MAKES ITS FORM 990 AVAILABLE TO THE PUBLIC BY RETAINING A COPY AT THE ADDRESS LISTED ON PAGE 1 OF THIS RETURN. ANY INDIVIDUAL REQUESTING A COPY OF THESE DOCUMENTS IS PROVIDED THAT COPY ON THE SAME BUSINESS DAY. THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND AUDITED FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST AND AT MANAGEMENT'S DISCRETION. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: CHANGE IN BENEFICIAL TRUST 136,000. PENSION-RELATED ADJUSTMENTS -859,300. CALVARY PALLIATIVE CARE NETWORK LLC 1740 EASTCHESTER ROAD BRONX NY 10461 NY NETWORK INDEPENDENT PRACTICE ASSOCIATION 1740 EATCHESTER ROAD BRONX NY 10461 NY CALVARY NETWORK MANAGEMENT SERVICES LLC 1740 EASTCHESTER ROAD BRONX NY 10461 NY CALVARY FUND INC 1740 EASTCHESTER ROAD BRONX NY 10461 NY 501(C)(3) LINE 11, TYPE I: 509 0 CALVARY HOLDING COMPANY 1740 EASTCHESTER ROAD BRONX NY 10461 NY 501(C)(3) LINE 9: 509(A)(2) 0 ARCHCARE 155 EAST 56TH STREET FLOOR 2 NEW YORK NY 10022 NY 501(C)(3) LINE 9: 509(A)(2) 0 0 0 1 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 0