Department of the Treasury Internal Revenue Service
Public Charity Status and Public Support
Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.
Attach to Form 990 or Form 990-EZ. See separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
New York Eye and Ear Infirmary
Employer identification number
13-5562304
Part I
Reason for Public Charity Status
(All organizations must complete this part.) See instructions
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
11
e
By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons other than foundation managers and other than one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2).
f
If the organization received a written determination from the IRS that it is a Type I, Type II or Type III supporting organization, check this box
..................................................
g
Since August 17, 2006, has the organization accepted any gift or contribution from any of the following persons?
(i) a person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
and (iii) below, the governing body of the the supported organization?
................
11g(i)
(ii)
a family member of a person described in (i) above?
......................
11g(ii)
(iii)
a 35% controlled entity of a person described in (i) or (ii) above?
................
11g(iii)
h
Provide the following information about the supported organization(s).
(i) Name of supported organization
(ii) EIN
(iii) Type of organization (described on lines 1- 9 above or IRC section (see instructions))
(iv) Is the organization in col. (i) listed in your governing document?
(v) Did you notify the organization in col. (i) of your support?
(vi) Is the organization in col. (i) organized in the U.S.?
(vii) Amount of support?
Yes
No
Yes
No
Yes
No
Total
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 2
Part II
Support Schedule for Organizations Described in IRC 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi) (Complete only if you checked the box on line 5, 7, or 8 of Part I or if the
organization failed to qualify under Part III. If the organization fails to
qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year(or fiscal year beginning in)
(a) 2006
(b) 2007
(c) 2008
(d) 2009
(e) 2010
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....
2
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......
3
The value of services or facilities furnished by a governmental unit to the organization without charge..
4
Total. Add lines 1 through 3..
5
The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included
on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
6
Public Support. Subtract line 5 from line 4.
Section B. Total Support
Calendar year(or fiscal year beginning in)
(a) 2006
(b) 2007
(c) 2008
(d) 2009
(e) 2010
(f) Total
7
Amounts from line 4..
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
9
Net income from unrelated business activities, whether or not the business is regularly carried on..
10
Other income. (Explain in Part IV.) Do not include gain or loss from the sale of capital assets..
11
Total support (Add lines 7 through 10).
12
Gross receipts from related activities, etc. (See instructions.)
..................
12
13
First Five Years
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here..........................................
Section C. Computation of Public Support Percentage
14
Public Support Percentage for 2010 (line 6 column (f) divided by line 11 column (f))
.........
14
15
Public Support Percentage for 2009 Schedule A, Part II, line 14
...............
15
16a
33 1/3% support test—2010.
If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization
......................
b
33 1/3% support test—2009.
If the organization did not check the box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization
.....................
17a
10%-facts-and-circumstances test—2010.
If the organization did not check a box on line 13, 16a, or 16b and line 14
is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here. Explain
in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly supported
organization
..................................................
b
10%-facts-and-circumstances test—2009.
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 IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly supported organization
..............................................
18
Private Foundation
If the organization did not check a box on line 13, 16a, 16b, 17a or 17b, check this box and see
instructions
...................................................
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 3
Part III
Support Schedule for Organizations Described in IRC 509(a)(2) (Complete only if you checked the box on line 9 of Part I or if the organization
failed to qualify under Part II. If the organization fails to qualify under
the tests listed below, please complete Part II.)
Section A. Public Support
Calendar year(or fiscal year beginning in)
(a) 2006
(b) 2007
(c) 2008
(d) 2009
(e) 2010
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2
Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......
3
Gross receipts from activities that are not an unrelated trade or business under section 513..
4
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5
The value of services or facilities furnished by a governmental unit to the organization without charge..
6
Total. Add lines 1 through 5.
7a
Amounts included on lines 1, 2, and 3 received from disqualified persons...
b
Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c
Add lines 7a and 7b..
8
Public Support (Subtract line 7c from line 6.)
Section B. Total Support
Calendar year (or fiscal year beginning in)
(a) 2006
(b) 2007
(c) 2008
(d) 2009
(e) 2010
(f) Total
9
Amounts from line 6...
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
11
Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
12
Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)
13
Total support (Add lines 9, 10c, 11 and 12.).
14
First Five Years
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here.............................................
Section C. Computation of Public Support Percentage
15
Public Support Percentage for 2010 (line 8 column (f) divided by line 13 column (f))
.........
15
16
Public support percentage from 2009 Schedule A, Part III, line 15
...............
16
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2010 (line 10c column (f) divided by line 13 column (f))
......
17
18
Investment income percentage from 2009 Schedule A, Part III, line 17
.............
18
19a
33 1/3% support tests—2010.
If the organization did not check the box on line 14, and line 15 is more than 33 1/3% and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
..........
b
33 1/3% support tests—2009.
If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
....
20
Private Foundation
If the organization did not check a box on line 14, 19a or 19b, check this box and see instructions
.....
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 4
Part IV
Supplemental Information.
Supplemental Information. Complete this part to provide the explanation required by Part II, line 10; Part II, line 17a or 17b; or Part III, line 12. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
Explanation
Schedule A (Form 990 or 990-EZ) 2010
Additional Data
Software ID:
10000105
Software Version:
2010v3.2
-
TIN:
SCHEDULE O (Form 990 or 990-EZ)
Department of the Treasury Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ
Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
Attach to Form 990 or 990-EZ.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
New York Eye and Ear Infirmary
Employer identification number
13-5562304
Identifier
Return Reference
Explanation
SCHEDULE H, PART VI QUESTION 5 (CONT.)
State University of New York - sends Medical Billers and Medical Assistants as part of their program to be placed in the Operating Rooms, Recover and Ambulatory Surgery areasTHE NEW YORK CENTER FOR EMPLOYMENT TRAINING- Adult students are retrained in another field of study who desire to reenter the work force. They are trained in computers, offered a Medical Assistant/Billing program and are given assistance to complete their high school education. Most of these adults are on public assistance and were displaced from their original jobs.THE WOOD TOBE-COBURN SCHOOL- Students have enrolled in this program for Medical Assistants and are required to commit to 350 hours. These students, already high school graduates, are placed in the Ambulatory Surgery Center and the inpatient unit.XAVIER H.S. Students in their senior year are required to contribute 100 hours of community service in their community in order to graduate. They usually volunteer one day a week for 6 hours a day.BMCC- CONTINUING EDUCATION AND WORKFORCE DEVELOPMENT-Students are high school graduates who are seeking medical careers. As a result they take Medical Assistant, Medical Billing and Office Management Courses so that they can find employment in a hospital environment. These students are required to volunteer 100 hours per semester. HOSTOS COMMUNITY COLLEGE-Students volunteer for one semester- 2 days a week for 8 hours each day. These are students whose major is Business Management. They are placed in Admitting, Quality and Medical Affairs.MAGNET HIGH SCHOOL- High School students who volunteer after school in the Registration and Admission areas. MANDEL MEDICAL ASSISTANT PROGRAMS- Students perform an internship of 240 hours in the Operating Rooms, Recovery, Ambulatory Surgery, Retina and patient care units.New affiliations for 2010:berkeley college HEALTH CARE ADMINISTRATION- ASSIGNMENTS DESIGNED FOR STUDENTS TO TAKE ADVANTAGE OF THEIR COMPUTER SKILLS, CUSTOMER SERVICE SKILLS AND OFFICE MANAGEMENT.BORICUA COLLEGE HEALTH CARE ADMINISTRATION - ASSIGNMENTS DESIGNED FOR STUDENTS TO TAKE ADVANTAGE OF THEIR COMPUTER SKILLS, CUSTOMER SERVICE SKILLS AND OFFICE MANAGEMENT.Brooklyn Tech & Stuyvesant High Schools Community Service Site - FOR 12TH GRADERS WHO MUST CONTRIBUTE 75 HOURS TO GRADUATE.CALIBER TRAINING INSTITUTE (CTI) TRAINING SITE - 300 HRS (OR 4 MONTHS) OF INTERNSHIP IN CLINICAL FACILITIES SUCH AS OPERATING ROOMS, AMBULATORY SURGERY CENTER, POST ANESTHESIA CARE UNIT (RECOVERY) AND INPATIENT FLOOR. Contemporary Guidance Services - Program to provide competitive employment experience for the developmentally disabled.Democracy Prep - Charter School for grades 6-12 in Harlem.Dominican High School - 11th and 12th graders who must contribute 100 hours in order to graduate.HOSTOS COLLEGE TRAINING SITE - STUDENTS RECEIVE ONE SEMESTER CREDIT FOR WORK IN ACCOUNTING OR NURSING DEPARTMENTS, DEPENDING ON MAJOR.MANHATTAN & STATEN ISLAND HEALTH EDUCATION CENTER INTERNSHIPS FOR H.S. SENIORS - STUDENTS ARE PLACED IN AREAS WHERE THEY ARE EXPOSED TO THEIR CAREER CHOICES.PABLO NERUDA ACADEMY - ALTERNATIVE SCHOOL BASED IN BRONX, STUDENTS BILINGUAL IN SPANISH AND ENGLISH HAVE OPPORTUNITY TO EXPLORE MEDICAL CAREERS WITH SPECIAL INTEREST IN HELPING THEIR OWN COMMUNITIES UPON GRADUATION.SUNY/EDUCATION OPPORTUNITY CENTER FOR BRONX/BROOKLYN - STUDENTS RECEIVE INTENSIVE TRAINING IN TECHNICAL, INTERPERSONAL AND COMMUNICATION SKILLS TO MAKE THEM MORE COMPETITIVE IN JOB MARKET. PLACEMENT FOR 7-10 MONTHS AS INTERNS IN MEDICAL/CLERICAL ASSIGNMENTS, USUALLY IN DEPT. OF OTOLARYNGOLOGY.
SCHEDULE H, PART VI QUESTION 5 (CONT.)
GOOD SHEPHERD SERVICES- LEARNING TO WORK-Students in this program had problems in their regular high schools and are taught to be responsible young people with a second chance at getting a diploma. Students are required to volunteer at least 9 hours each week and attend school at night. Students also have to maintain an 80 average. Upon completion of this program they are given their diplomas.HIGH SCHOOL FOR HEALTH PROFESSIONS AND HUMAN SERVICES- ROTATIONS THROUGH different careers in the medical field OVER A PERIOD OF A YEAR.HUNTER COLLEGE- Students in the Nutrition Program volunteer in our Food Services Department with REGISTERED DieticiaN FOR 150-200 hours EXPERIENCE. INSTITUTE FOR COLLABORATIVE EDUCATION-(ICE) - Students in their senior year who have all their academic requirements but want to explore the medical field. They are placed here Tuesday through Friday for 6 hours each day in the Ambulatory Surgery Center, Recovery and O.R., WITH ADDITIONAL REQUIREMENT TO KEEP A JOURNAL AND REPORT ON EXPERIENCE.L.I.USEMESTER ROTATION IN CLINICAL SPEECH PATHOLOGY SERVICE, FOR GRADUATE STUDENTS.MANHATTAN COMPREHENSIVE NIGHT AND DAY SCHOOL- ALTERNATIVE HIGH SCHOOL FOR STUDENTS WHO MUST LIVE INDEPENDENTLY AND SUPPORT THEMSELVES. RECENT IMMIGRANTS FROM places such as the Dominican Republic, India, Bangladesh and Taiwan, Africa, etc., who are learning English along with the rest of the academic requirements. Most of these students range in ages from 18-21 years, UP TO AGE 25. MANHATTAN VILLAGE ACADEMY H.S. - The goal is to familiarize youngsters with careers in hospitals and expose them to professional environments. Students are required to keep a journal of their experiences for the 2 years they are with us. M.O.T.C. - MANHATTAN OCCUPATIONAL TRAINING CENTER - NYEE is a training site for this school which is designed for high school youngsters with special needs. They volunteer five days a week for five hours each day in Food Services, Medical Records and the 7th Floor inpatient unit.New York University.-PRE-MEDICAL students commit to volunteer for one semester and are PLACED IN RECOVERY ROOM, CLINICS, OR PEDIATRIC UNITS.RETIRED SENIOR VOLUNTEER PROGRAM (R.S.V.P.) Program is designed for adults who are retired and interested in volunteering in hospitals, schools and churches. The programs intention is to UTILIZE SKILLS OF OLDER INDIVIDUALS WHILE ACCOMMODATING VISUAL AND MOBILITY PROBLEMS. SAINT NICHOLAS - The Summer Youth Employment program in Brooklyn which runs for 6 weeks beginning in July. BILINGUAL (SPANISH-ENGLISH) TEENAGERS INTERESTED IN HEALTH CAREERS. SCHOOL OF THE FUTURE- High School students are required to volunteer at least one semester for 6 hours each day in the clinics.
SCHEDULE H, PART V, SECTION B
PURSUANT TO IRS ANNOUNCEMENT 2011-37 DATED JUNE 9, 2011, SCHEDULE H PART V SECTION B WAS MADE OPTIONAL FOR 2010. HOWEVER, DUE TO LACERTE SOFTWARE DESIGN LIMITATIONS THE PROGRAM ERRONEOUSLY COMPLETED SECTION B AND COULD NOT BE OVERRIDDEN. ACCORDINGLY SECTION B SHOULD BE DISREGARDED.
SCHEDULE H, PART III, LINE 9B (Cont.)
Vendor OutsourcingNew York Eye & Ear uses an outside vendor for follow-up activity on aged accounts. The billing and follow-up managers prepare a file of all accounts meeting these criteria and accounts are then distributed to an outside vendor for follow-up and resolution via FTP. At the time of the referral each account is assigned a vendor collector code enabling the tracking of payment on each account. The billing supervisors create payment reports to ensure that payments are not inappropriately credited to the vendor.Control Objective: To identify accounts to be transferred to outside vendors for follow-up and account resolution.Control Activity: The billing and follow-up managers prepare an account download file for transfer to the outside vendor. The download file includes: Ambulatory Surgery accounts greater than 120 days, Inpatient accounts greater than 120 days, Outpatient accounts greater than 30 days and Referred Ambulatory accounts greater than 30 days.Quality ReviewFormal review of account activity within the billing and follow-up department is not conducted on an account by account basis. Trial balances are assigned to patient accounts staff for account by account review, particularly inpatient and ASU. Outsourcing only occurs if payors have not resolved for payment within the given time frame. Quality reviews are conducted through the regular review of payment and adjustment summary reports. Reports include partial payment and denial payment report.Control Objective: To review account activity on a weekly basis to ensure that staff fulfills written expectations for account resolution.Control Activity: Regular quality reviews are conducted to ensure accuracy and timeliness of account follow-up and resolution.Policies and ProceduresPolicies and procedures exist and are available to staff.Control Objective: Policies and Procedures are documented in writing.Control Activity: Policies and procedures exist and are available to individual staff.Per NYEEIs Policies & Procedures, all patients are treated the sameregardless of financial class, patient status, type of service, etc. We do NOT collect up front for all patients who are presumed to be eligible for CC. Collection is the same for all patients; however, additional assistance and counseling is provided to patients who cannot afford to pay.
Schedule H, Part I, Question 3
NYEEI utilizes Federal Poverty guidelines (FPG's) to determine eligibility for providing free care (100%) and 400% for providing discounted care to low income individuals who present here (see Part V 11(b)). We do not use an asset test or other threshold, regardless of income, to determine eligibility for free or discounted care for any of our annual 250,000 outpatient encounters. Asset levels are documented and submitted as a requirement or NYS medicaid applications.
SCHED H, PART III, SECTION A, Q 4(CONT.)
Non Medicare Payments: The New York Health Care Reform Act of 1996, as updated, governs payments to hospitals in New York State. Under this system, 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 on a prospective basis. Adjustments to current and prior years rates for these payers will continue to be made in the future. Effective December 1, 2009 the New York State Department of Health (DOH) updated the data utilized to calculate the NYS DRG service intensity weights (SIWs) in order to utilize more current data in DOH promulgated rates.There are also various other proposals at the Federal and State level that could, among other things, reduce payment rates. The ultimate outcome of these proposals, regulatory changes, and other market conditions cannot presently be determined.Revenue from the Medicare and Medicaid programs accounted for approximately 24% and 9%, respectively, of the Infirmarys net patient service revenue for the year ended December 31, 2010, and 21% and 8%, respectively, of the Infirmarys net patient service revenue for the year ended December 31, 2009.Laws and regulations governing the Medicare and Medicaid programs are extremely complex and subject to interpretation. As a result, there is at least a reasonable possibility that recorded estimates will change by a material amount in the near term. The Infirmarys Medicare cost reports have been audited and finalized by the Medicare fiscal intermediary through December 31, 2007.The Infirmary grants credit without collateral to its patients, most of whom are local residents and are insured under third-party payer arrangements. The mix of receivables (net of contractual allowances, advances from certain third-parties and allowance for doubtful accounts) from patients and third-party payers at December 31, 2010 and 2009 is as follows:
Form 990, Part VI, Line 19
Form 990, Part VI, Line 19: Other Organization Documents Publicly Available
Upon request, the organization will make available only those documents required to be disclosed under the public inspection laws.
Form 990, Part VI, Line 15b
Form 990, Part VI, Line 15b: Compensation Review and Approval Process for Officers and Key Employees
THE CORPORATION UNDERTAKES A RIGOROUS PROCESS TO ENSURE THAT ITS EXECUTIVE COMPENSATION IS REASONABLE. TOWARD THAT END, THE BOARD OF TRUSTEES HAS A COMPENSATION COMMITTEE OF INDEPENDENT PERSONS THAT HAVE NO PERSONAL INTEREST IN ANY PROPOSED COMPENSATION ARRANGEMENT. THE BOARD ENGAGED AN INDEPENDENT COMPENSATION CONSULTANT WHO CONDUCTED INDEPENDENT RESEARCH AND UTILIZED A WIDE RANGE OF INDUSTRY DATA TO DEVELOP COMPARABILITY OR BENCHMARKING DATA FOR APPROPRIATE LEVELS OF COMPENSATION FOR TOP MANAGEMENT OFFICIALS. THE COMPENSATION COMMITTEE, TAKING THE CONSULTANT'S RECOMMENDATIONS UNDER ADVISEMENT, HELD A MEETING AND AT THAT MEETING DETERMINED TO MAKE RECOMMENDATIONS TO THE BOARD OF TRUSTEES. THE BOARD OF TRUSTEES THEN CONSIDERED AND APPROVED THE RECOMMENDATIONS OF THE COMPENSATION COMMITTEE.
Form 990, Part VI, Line 12c
Form 990, Part VI, Line 12c: Explanation of Monitoring and Enforcement of Conflicts
Compliance officer surveys, reviews and reports to CEO.
Form 990, Part VI, Line 11
Form 990, Part VI, Line 11: Form 990 Review Process
The finance director and CFO undertake a detailed review of the 990. In addition, select board members undertake a review of the organization's Form 990 and then review with the CFO any commentary, observations, and recommendations, as appropriate.
Form 990, Part VI, Line 6
Form 990, Part VI, Line 6: Explanation of Classes of Members or Shareholder
THE NEW YORK EYE AND EAR INFIRMARY'S SOLE CORPORATE MEMBER IS CONTINUUM HEALTH PARTNERS INC.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.