Form990
Click to see attachment
Department of the Treasury
Internal Revenue Service
Return of Organization Exempt From Income Tax
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except black lung benefit trust or private foundation)

MediumBullet The organization may have to use a copy of this return to satisfy state reporting requirements.
OMB No. 1545-0047
2011
Open to Public Inspection
A For the calendar year, or tax year beginning 01-01-2011 and ending 12-31-2011
BCheck if applicable:
CName of organization
New York Society for the Relief
of the Ruptured and Crippled Maintaining the
Doing Business As
 
 
Number and street (or P.O. box if mail is not delivered to street address)
535 EAST 70TH ST STREET
 
Room/suite
City or town, state or country, and ZIP + 4
NEW YORK, NY10021
D Employer identification number

13-1624135
E Telephone number

G Gross receipts $ 721,196,292
F Name and address of principal officer:
LOUIS SHAPIRO
535 EAST 70TH STREET
NEW YORK,NY10021
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
www.hss.edu
H(a)
Is this a group return for
affiliates?
H(b)
Are all affiliates included?
If "No," attach a list. (see instructions)
H(c)
Group exemption number MediumBullet  
K Form of organization:
 
L Year of formation: 1863
M State of legal domicile: NY
Part I
Summary
Activities & Governance 1 Briefly describe the organization’s mission or most significant activities: TO PROVIDE THE HIGHEST QUALITY PATIENT CARE, IMPROVE MOBILITY, AND ENHANCE THE QUALITY OF LIFE FOR ALL, AND ADVANCE THE SCIENCE OF ORTHOPEDIC SURGERY, RHEUMATOLOGY, AND THEIR RELATED DISCIPLINES.
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a)..... 3 47
4 Number of independent voting members of the governing body (Part VI, line 1b) .... 4 35
5 Total number of individuals employed in calendar year 2011 (Part V, line 2a) ... 5 4,301
6 Total number of volunteers (estimate if necessary) .... 6 352
7a Total unrelated business revenue from Part VIII, column (C), line 12 .. 7a -10,020
b Net unrelated business taxable income from Form 990-T, line 34 .. 7b -15,270
Revenues; Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 44,853,465 62,174,176
9 Program service revenue (Part VIII, line 2g) ......... 574,090,241 618,543,800
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 511,041 3,522,070
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 33,895,459 34,919,858
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)................... 653,350,206 719,159,904
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 0 0
14 Benefits paid to or for members (Part IX, column (A), line 4)..... 0 0
15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10) 313,635,075 350,134,101
16a Professional fundraising fees (Part IX, column (A), line 11e)..... 0 0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet0    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24f).... 286,495,810 301,634,566
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 600,130,885 651,768,667
19 Revenue less expenses. Subtract line 18 from line 12....... 53,219,321 67,391,237
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 791,821,780 940,145,643
21 Total liabilities (Part X, line 26)............. 378,766,335 517,295,872
22 Net assets or fund balances. Subtract line 21 from line 20..... 413,055,445 422,849,771
Part II
Signature Block
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.
Sign Here
JumboBullet
Signature of officer Date
JumboBullet
Type or print name and title.
Paid preparer use only
Print/type preparer's name
 
Preparer's signature
Date
PTIN
Firm's name Right pointing arrowhead image

Firm's EIN Right pointing arrowhead image
Firm's address Right pointing arrowhead image



Phone no.
May the IRS discuss this return with the preparer shown above? See instructions .........bullet
For Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y
Form 990 (2011)
Form 990 (2011)
Page 2
Part III
Statement of Program Service Accomplishments
Check if Schedule O contains a response to any question in this Part III .........
1
Briefly describe the organization’s mission: THE MISSION OF HOSPITAL FOR SPECIAL SURGERY IS TO PROVIDE THE HIGHEST QUALITY PATIENT CARE, IMPROVE MOBILITY, AND ENHANCE THE QUALITY OF LIFE FOR ALL AND TO ADVANCE THE SCIENCE OF ORTHOPEDIC SURGERY, RHEYMATOLOGY, AND THEIR RELATED DISCIPLINES THROUGH RESEARCH AND EDUCATION. WE DO THIS REGARDLESS OF RACE, COLOR, CREED, SEXUAL ORIENTATION, OR ETHNIC ORIGIN.
2
Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? ....................
If “Yes,” describe these new services on Schedule O.
3
Did the organization cease conducting, or make significant changes in how it conducts, any program services? ..........................
If “Yes,” describe these changes on Schedule O.
4
Describe the organization’s program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations and section 4947(a)(1) trusts are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.
4a (Code:   ) (Expenses $ 509,833,258 including grants of $ 0 ) (Revenue $ 614,626,933 )
PATIENT CARE: HOSPITAL FOR SPECIAL SURGERY IS COMMITTED TO PROVIDING WORLD-CLASS CARE TO ITS PATIENTS AND HELPING THEM TO REGAIN THEIR MOBILITY, WHILE ALSO ADVANCING RESEARCH INITIATIVES TO EXPLORE AND IMPROVE TREATMENTS FOR ORTHOPEDIC AND RHEUMATOLOGIC CONDITIONS. IN 2011, HOSPITAL FOR SPECIAL SURGERY OPERATED 188 STAFFED BEDS (172 STAFFED BEDS PRIOR TO SEMPTEMBER 9, 2011) AND 29 OPERATING ROOMS (29 PRIOR TO MARCH 2010). WE PERFORMED 25,709 SURGERIES, AN INCREASE OF 549 OVER THE PRIOR YEAR, WHILE NON-SURGICAL OUTPATIENT VISITS NUMBERED 320,727, 15,658 MORE THAN 2010. HOSPITAL FOR SPECIAL SURGERY PROVIDED INPATIENT CARE TO 13,457 PATIENTS, 78 LESS THAN LAST YEAR. OF THOSE IN 2011, 13,096 WERE SURGICAL. TOTAL AMBULATORY SURGICAL CASES NUMBERED 12,459, AN INCREASE OF 747 FROM 2010. THE HOSPITAL HAS A DIVERSE PATIENT POPULATION SERVING THOSE WITH PUBLIC INSURANCE (MEDICARE AND MEDICAID), PRIVATE INSURANCE (VARIOUS PAYORS) AND THE UNINSURED. THE HOSPITAL MAINTAINS A FINANCIAL ASSISTANCE PROGRAM TO ASSIST THOSE THAT CAN NOT PAY FOR ITS SERVICES AND PROVIDES NUMEROUS OTHER COMMUNITY BENEFIT PROGRAMS. HOSPITAL FOR SPECIAL SURGERY IS ALSO RECOGNIZED AS A MAGNET HOSPITAL FOR EXCELLENCE IN NURSING CARE. THE HOSPITAL IS RECOGNIZED FOR ITS EXCELLENCE IN PATIENT CARE AND IS CONSISTENTLY RANKED BY U.S. NEWS AND WORLD REPORT IN ITS SPECIALTIES.
4b (Code:   ) (Expenses $ 33,443,536 including grants of $ 0 ) (Revenue $ 30,478,492 )
RESEARCH: The Research Division of Hospital for Special Surgery continued its activities in 2011 toward enhancing and expanding our research in musculoskeletal diseases. Research at Hospital for Special Surgery works to advance the understanding and treatment of musculoskeletal disorders through basic, translational and clinical research and education. The goals are to identify genetic, environmental, cellular, structural and molecular mechanisms underlying disorders important in orthopedics, rheumatology and related disciplines and to discover effective approaches for diagnosis prevention, and treatment of these disorders. The Research Division is funded by an operating budget of $32 million, supported in part by approximately $19 million in extramural funds, including $12 million from federal grants. This research resulted in 239 publications from 86 scientists in 2011. Highlights for 2011 include: Translating scientific discoveries into clinical practice, expanding the osteoarthritis (OA) initiative by hosting an international conference on OA, publishing results of our extensive research portfolio in rheumatoid arthritis in leading scientific journals, and expanding our clinical research utilizing data from 44 research registries containing information on more than 75,000 patients.
4c (Code:   ) (Expenses $ 26,849,859 including grants of $ 0 ) (Revenue $ 6,977,203 )
EDUCATION AND ACADEMIC AFFAIRS: The Hospital for Special Surgery Education & Academic Affairs Division continued to make strides towards the mission to be "The Most Trusted Educator" in the field of Musculoskeletal Medicine for patients, physicians, allied health professionals and the general public. In 2011 we strengthened strategic partnerships with our 25 education and academic affairs advisory committees and institutional partners, as well as furthering external community relations, which are now global in scope. The Hospital's Education & Academic Affairs Division trained 42 residents, 82 fellows, and 135 medical students, and credentialed 200 in-rotators and 250 consults. In addition, we reached approximately 40,000 participants through education programs. This is a 30% increase from 2010, in which we disseminated state-of-the-art education programs through our establishment of ACGME Programs, CME accredited activities, Bioskills Education Laboratory sessions, International Learning and Training Center initiatives, Kim Barrett Memorial Medical Library users, and Public and Patient Education constituents. We continue to set the highest standard with our ACCME accredited programs with accreditation and facilitation of 11 live CME and 26 live professional education activities, 19 regularly scheduled sessions and providing 26,575 CME & 245 CEU credits. In 2011, we continued to identify quality performance initiatives that will be integrated into CME programs for our faculty and house staff in 2012.
4d Other program services (Describe in Schedule O.)
(Expenses $   including grants of $   ) (Revenue $   )
4e Total program service expensesMediumBullet$ 570,126,653
Form 990 (2011)
Form 990 (2011)
Page 3
Part IV
Checklist of Required Schedules
Yes
No
1
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If “Yes,” complete Schedule AClick to see attachment.....................
1
Yes
 
2
Is the organization required to complete Schedule B, Schedule of Contributors? Click to see attachment........
2
Yes
 
3
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If “Yes,” complete Schedule C, Part IClick to see attachment..........
3
 
No
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities? If “Yes,” complete Schedule C,
Part IIClick to see attachment.........................
4
Yes
 
5
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19? If “Yes,” complete Schedule C, Part IIIClick to see attachment........................
5
 
No
6
Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If “Yes,” complete Schedule D, Part IClick to see attachment....................
6
 
No
7
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas or historic structures? If “Yes,” complete Schedule D, Part IIClick to see attachment...
7
 
No
8
Did the organization maintain collections of works of art, historical treasures, or other similar assets? If “Yes,” complete Schedule D, Part III Click to see attachment....................
8
 
No
9
Did the organization report an amount in Part X, line 21; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If “Yes,”
complete Schedule D, Part IVClick to see attachment...................
9
 
No
10
Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments, permanent endowments, or quasi-endowments? If “Yes,” complete Schedule D, Part VClick to see attachment
10
Yes
 
11
If the organization’s answer to any of the following questions is ‘Yes,’ then complete Schedule D, Parts VI, VII, VIII, IX, or X as applicable:
a
Did the organization report an amount for land, buildings, and equipment in Part X, line10? If “Yes,” complete Schedule D, Part VI.Click to see attachment
11a
Yes
 
b
Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VII.Click to see attachment
11b
Yes
 
c
Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VIII.Click to see attachment
11c
 
No
d
Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part IX.Click to see attachment
11d
Yes
 
e
Did the organization report an amount for other liabilities in Part X, line 25? If “Yes,” complete Schedule D, Part X.Click to see attachment
11e
Yes
 
f
Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If “Yes,” complete Schedule D, Part X.Click to see attachment
11f
 
No
12a
Did the organization obtain separate, independent audited financial statements for the tax year?
If “Yes,” complete Schedule D, Parts XI, XII, and XIII Click to see attachment
12a
Yes
 
b
Was the organization included in consolidated, independent audited financial statements for the tax year? If “Yes,” and if the organization answered ‘No’ to line 12a, then completing Schedule D, Parts XI, XII, and XIII is optional Click to see attachment
12b
 
No
13
Is the organization a school described in section 170(b)(1)(A)(ii)? If “Yes,” complete Schedule E
13
 
No
14a
Did the organization maintain an office, employees, or agents outside of the United States?....
14a
 
No
b
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, investment, and program service activities outside the United States or aggregate foreign investments valued at $100,000 or more? If “Yes,” complete Schedule F, Part I......... Click to see attachment
14b
Yes
 
15
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or assistance to any organization or entity located outside the U.S.? If “Yes,” complete Schedule F, Part II.. Click to see attachment
15
 
No
16
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or assistance to individuals located outside the U.S.? If “Yes,” complete Schedule F, Part III.. Click to see attachment
16
 
No
17
Did the organization report a total of more than $15,000, of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11e? If “Yes,” complete Schedule G, Part I
17
 
No
18
Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If “Yes,” complete Schedule G, Part II..........
18
 
No
19
Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If “Yes,” complete Schedule G, Part III...................
19
 
No
20a
Did the organization operate one or more hospitals? If “Yes,” complete Schedule H..... Click to see attachment
20a
Yes
 
b
If “Yes” to line 20a, did the organization attach a copy of its audited financial statement to this return? Note. All Form 990 filers that operated one or more hospitals must attach audited financial statements. Click to see list of attachments
20b
Yes
 
Form 990 (2011)
Form 990 (2011)
Page 4
Part IV
Checklist of Required Schedules (continued)
21
Did the organization report more than $5,000 of grants and other assistance to any government or organization in the United States on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II..
21
 
No
22
Did the organization report more than $5,000 of grants and other assistance to individuals in the United States on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III.....
22
 
No
23
Did the organization answer “Yes” to Part VII, Section A, questions 3, 4, or 5, about compensation of the organization’s current and former officers, directors, trustees, key employees, and highest compensated employees? If “Yes,” complete Schedule J................ Click to see attachment
23
Yes
 
24a
Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If “Yes,” answer questions 24b–24d and complete Schedule K. If “No,” go to line 25................ Click to see list of attachments
24a
Yes
 
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
No
c
Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds?......................
24c
 
No
d
Did the organization act as an “on behalf of” issuer for bonds outstanding at any time during the year?...
24d
 
No
25a
Section 501(c)(3) and 501(c)(4) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If “Yes,” complete Schedule L, Part I...... Click to see attachment
25a
 
No
b
Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If “Yes,” complete Schedule L, Part I................ Click to see attachment
25b
 
No
26
Was a loan to or by a current or former officer, director, trustee, key employee, highly compensated employee, or disqualified person outstanding as of the end of the organization’s tax year? If “Yes,” complete Schedule L,
Part II......................... Click to see attachment
26
 
No
27
Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial contributor or employee thereof, a grant selection committee member, or to a 35% controlled entity or family member of any of these persons? If “Yes,” complete Schedule L, Part III......... Click to see attachment
27
 
No
28
Was the organization a party to a business transaction with one of the following parties? (see Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):
a
A current or former officer, director, trustee, or key employee? If “Yes,” complete Schedule L, Part IV ......................... Click to see attachment
28a
 
No
b
A family member of a current or former officer, director, trustee, or key employee? If “Yes,”
complete Schedule L, Part IV................... Click to see attachment
28b
Yes
 
c
An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof) was an officer, director, trustee, or owner? If “Yes,” complete Schedule L, Part IV.. Click to see attachment
28c
Yes
 
29
Did the organization receive more than $25,000 in non-cash contributions? If “Yes,” complete Schedule MClick to see attachment
29
Yes
 
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If “Yes,” complete Schedule M............ Click to see attachment
30
 
No
31
Did the organization liquidate, terminate, or dissolve and cease operations? If “Yes,” complete Schedule N,
Part I...........................
31
 
No
32
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If “Yes,” complete Schedule N, Part II.......................
32
 
No
33
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If “Yes,” complete Schedule R, Part I........ Click to see attachment
33
 
No
34
Was the organization related to any tax-exempt or taxable entity? If “Yes,” complete Schedule R, Parts II, III, IV, and V, line 1..................... Click to see attachment
34
Yes
 
35a
Did the organization have a controlled entity within the meaning of section 512(b)(13)?
35a
Yes
 
b
If ‘Yes’ to line 35a, did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If “Yes,” complete Schedule R, Part V, line 2... Click to see attachment
35b
Yes
 
36
Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If “Yes,” complete Schedule R, Part V, line 2........... Click to see attachment
36
 
No
37
Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If “Yes,” complete Schedule R, Part VIClick to see attachment
37
 
No
38
Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11 and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Form 990 (2011)
Form 990 (2011)
Page 5
Part V
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response to any question in this Part V .........
Yes
No
1a
Enter the number reported in Box 3 of Form 1096. Enter -0- if not applicable. .......
1a
290
b
Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable.
1b
0
c
Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................
1c
Yes
 
2a
Enter the number of employees reported on Form W-3, Transmittal of Wage and Tax Statements filed for the calendar year ending with or within the year covered by this return .....................
2a
4,301
b
If at least one is reported on line 2a, did the organization file all required federal employment tax returns?

Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file. (see instructions)
2b
Yes
 
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?.............................
3a
Yes
 
b
If “Yes,” has it filed a Form 990-T for this year? If “No,” provide an explanation in Schedule O.....
3b
Yes
 
4a
At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account or securities account)?.......................
4a
 
No
b
If "Yes," enter the name of the foreign country: MediumBullet
See instructions for filing requirements for Form TD F 90-22.1, Report of Foreign Bank and Financial Accounts.
5a
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year?..
5a
 
No
b
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
5b
 
No
c
If “Yes” to line 5a or 5b, did the organization file Form 8886-T? ........
5c
 
 
6a
Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible?..........
6a
 
No
b
If “Yes,” did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible?........................
6b
 
 
7
Organizations that may receive deductible contributions under section 170(c).
a
Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor?....................
7a
 
No
b
If “Yes,” did the organization notify the donor of the value of the goods or services provided?.....
7b
 
 
c
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282?...........................
7c
 
No
d
If “Yes,” indicate the number of Forms 8282 filed during the year ....
7d
 
e
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?..........................
7e
 
No
f
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract?..
7f
 
No
g
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required?...................
7g
 
 
h
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C?...............
7h
 
 
8
Sponsoring organizations maintaining donor advised funds and section 509(a)(3) supporting organizations. Did the supporting organization, or a donor advised fund maintained by a sponsoring organization, have excess business holdings at any time during the year?................
8
 
 
9
Sponsoring organizations maintaining donor advised funds.
a
Did the organization make any taxable distributions under section 4966?.........
9a
 
 
b
Did the organization make a distribution to a donor, donor advisor, or related person?......
9b
 
 
10
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on Part VIII, line 12 ...
10a
 
b
Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
10b
 
11
Section 501(c)(12) organizations. Enter:
a
Gross income from members or shareholders .........
11a
 
b
Gross income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them) ........
11b
 
12a
Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?
12a
 
 
b
If “Yes,” enter the amount of tax-exempt interest received or accrued during the year.
12b
 
13
Section 501(c)(29) qualified nonprofit health insurance issuers.
a
Is the organization licensed to issue qualified health plans in more than one state?
Note. All 501(c)(29) organizations must list in Schedule O each state in which they are licensed to issue qualified health plans, the amount of reserves required by each state, and the amount of reserves the organization allocated to each state.
13a
 
 
b
Enter the aggregate amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans.
13b
 
c
Enter the aggregate amount of reserves on hand.
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
 
b
If "Yes," has it filed a Form 720 to report these payments? If “No,” provide an explanation in Schedule O..
14b
 
 
Form 990 (2011)
Form 990 (2011)
Page 6
Part VI
Governance, Management, and Disclosure For each “Yes” response to lines 2 through 7b below, and for a “No” response to lines 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.
Check if Schedule O contains a response to any question in this Part VI .........
Section A. Governing Body and Management
Yes
No
1a
Enter the number of voting members of the governing body at the end of the tax year
If the governing body delegated broad authority to an executive committee or similar committee, explain in Schedule O.
1a
47
b
Enter the number of voting members included in line 1a, above, who are independent .................
1b
35
2
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................
2
Yes
 
3
Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? .
3
 
No
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed?
4
Yes
 
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
 
No
6
Did the organization have members or stockholders? ................
6
Yes
 
7a
Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or more members of the governing body? .................
7a
Yes
 
b
Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body? ............
7b
Yes
 
8
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a
The governing body? .........................
8a
Yes
 
b
Each committee with authority to act on behalf of the governing body? ..........
8b
Yes
 
9
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If “Yes,” provide the names and addresses in Schedule O .....
9
 
No
Section B. Policies (This Section B requests information about policies not required by the Internal
Revenue Code.)
Yes
No
10a
Did the organization have local chapters, branches, or affiliates? ............
10a
 
No
b
If “Yes,” did the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes? ....
10b
 
 
11a
Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form?
11a
Yes
 
b
Describe in Schedule O the process, if any, used by the organization to review the Form 990. .....
12a
Did the organization have a written conflict of interest policy? If “No,” go to line 13.......
12a
Yes
 
b
Were officers, directors or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ........................
12b
Yes
 
c
Did the organization regularly and consistently monitor and enforce compliance with the policy? If “Yes,” describe in Schedule O how this was done ....................
12c
Yes
 
13
Did the organization have a written whistleblower policy? ...............
13
Yes
 
14
Did the organization have a written document retention and destruction policy? .........
14
Yes
 
15
Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
a
The organization’s CEO, Executive Director, or top management official ...........
15a
Yes
 
b
Other officers or key employees of the organization ................
15b
Yes
 
If "Yes," to line 15a or 15b, describe the process in Schedule O (see instructions).
16a
Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? ......................
16a
 
No
b
If “Yes,” did the organization follow a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and take steps to safeguard the organization’s exempt status with respect to such arrangements? ............
16b
 
 
Section C. Disclosure
17
List the States with which a copy of this Form 990 is required to be filedMediumBullet
AL , AK , AZ , AR , CA , CO , CT , DC , FL , GA , HI , IL , KS , KY , LA , ME , MD , MA , MI , MN , MS , NH , NJ , NM , NY , NC , ND , OH , OK , OR , PA , RI , SC , TN , UT , VA , WA , WV , WI
18
Section 6104 requires an organization to make its Form 1023 (or 1024 if applicable), 990, and 990-T (501(c)(3)s only) available for public inspection. Indicate how you made these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how), the organization made its governing documents, conflict of interest policy, and financial statements available to the public during the tax year.
20
State the name, physical address, and telephone number of the person who possesses the books and records of the organization: MediumBullet
MARC GOULD
535 EAST 70TH STREET
NEW YORK,NY10021
(212) 606-1323
Form 990 (2011)
Form 990 (2011)
Page 7
Part VII
Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
Check if Schedule O contains a response to any question in this Part VII .........
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization’s tax year.
RoundBullet List all of the organization’s current officers, directors, trustees (whether individuals or organizations), regardless of amount
of compensation, and current key employees. Enter -0- in columns (D), (E), and (F) if no compensation was paid.

RoundBullet List all of the organization’s current key employees, if any. See instructions for definition of "key employee."
RoundBullet List the organization’s five current highest compensated employees (other than an officer, director, trustee or key employee)
who received reportable compensation (Box 5 of Form W-2 and/or Box 7 of Form 1099-MISC) of more than $100,000 from the
organization and any related organizations.

RoundBullet List all of the organization’s former officers, key employees, or highest compensated employees who received more than $100,000
of reportable compensation from the organization and any related organizations.

RoundBullet List all of the organization’s former directors or trustees that received, in the capacity as a former director or trustee of the
organization, more than $10,000 of reportable compensation from the organization and any related organizations.

List persons in the following order: individual trustees or directors; institutional trustees; officers; key employees; highest
compensated employees; and former such persons.
Check this box if neither the organization nor any related organizations compensated any current or former officer, director, or trustee.
(A)
Name and Title 		(B)
Average hours per week (describe hours for related organizations in Schedule O) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(1) Mathias Bostrom
Ass. Attending -Left in FY2011
 14.41 X           174,686 0 22,570
(2) Mary Crow
Physician-in-Chief
 60.0 X           663,043 0 47,082
(3) Charles Cornell
Attending Physician
 19.31 X           217,026   42,048
(4) Jonathan Deland
Attending Physician
 6.35 X           73,373   32,276
(5) Steven Goldring
Chief Scientific Officer
 60.0 X           599,726   45,294
(6) Gregory Liguori
Medical Director
 38.5 X           509,439   47,127
(7) Thomas Sculco
Surgeon-in-Chief
 54.0 X   X       1,114,308   50,634
(8) Russell Warren
Attending Physician
 5.18 X           77,187 0 28,232
(9) Philip Wilson Jr
Attending Physician
 .86 X           0 87,817 29,637
(10) Atiim Barber
Member - Left in FY2011
 .14 X           0 0 0
(11) James M Benson
Member
 .37 X                
(12) Daniel C Benton
Member
 .21 X                
(13) Richard A Brand MD
Member
 .59 X                
(14) Peter L Briger Jr
Member
 1.15 X                
(15) Michael Brooks
Member
 .75 X                
(16) Kathryne Chenault
Member
 .33 X                
(17) Charles Coleman III
Member
 .96 X                
Form 990 (2011)
Form 990 (2011)
Page 8
Part VII
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)
(A)
Name and Title 		(B)
Average hours per week (describe hours for related organizations in Schedule O) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(18) Leslie Cornfeld
Member
 .89 X                
(19) Cynthia Foster Curry
Member
 1.65 X                
(20) Barrie M Damson
Member
 2.89 X                
(21) James G Dinan
Member
 .88 X                
(22) Anne Ehrenkranz
Member
 .64 X                
(23) Michael Esposito
Member
 .52 X                
(24) Craig Ivey
Member
 .14 X                
(25) Winfield P Jones
Member
 .37 X                
(26) Monica Keany
Member
 .37 X                
(27) Thomas J Kelly
Member
 .93 X                
(28) David H Koch
Member
 .98 X                
(29) Lara Lerner
Member
 .37 X                
(30) Marylin B Levitt
Member
 4.37 X                
(31) Thomas Lister
Member
 .75 X                
(32) Alan S MacDonald
Member
 1.55 X                
(33) David M Madden
Member
 .59 X                
(34) Richard L Menschel
Chairman, Emeritus
 5.74 X                
(35) Carl F Nathan MD
Member
 .37 X                
(36) Dean R O'Hare
Co-Chair
 14.52 X   X            
(37) Aldo Papone
Co-Chair
 14.52 X   X            
(38) Gordon Pattee
Member
 .37 X                
(39) Charlton Reynders Jr
Member - Left in FY2011
 .37 X                
(40) Susan W Rose
Member
 2.66 X                
(41) William R Salomon
Member
 1.65 X                
(42) Jonathan Sobel
Member
 1.85 X                
(43) Deirdre Stanley
Member
 1.26 X                
(44) Robert K Steel
Member
 2.31 X                
(45) Daniel G Tully
Vice Chair
 7.05 X   X            
(46) Mrs Douglas A Warner III
Member
 5.47 X                
(47) Torsten N Wiesel MD
Member
 .59 X                
(48) Kendrick R Wilson III
Member
 7.17 X                
(49) Ellen M Wright
Member
 2.67 X                
(50) Louis A Shapiro
President & Chief Exec Officer
 47.5 X   X       1,227,867 326,967 58,982
(51) Lisa Goldstein
Executive VP & COO
 52.2     X       874,247 130,636 49,482
(52) Stacey Malakoff
Exec VP & Chief Fin Officer
 50.5     X       882,354 165,709 55,133
(53) Constance B Margolin
EXEC VP & CHIEF LEGAL OFFICER
 50.5     X       548,116 96,725 41,609
(54) Deborah Sale
Exec VP - External Affairs
 21.0     X       194,807 361,787 71,512
(55) Ralph Bianco
Vice President
 54.0       X     368,511 40,945 50,441
(56) Stephanie Goldberg
Vice President
 60.0       X     500,099   55,311
(57) Helen Pavlov
RADIOLOGIST IN CHIEF
 60.0       X     1,248,090   63,035
(58) James Farmer
Attending Physician
 60.68         X   1,551,152   45,398
(59) Hollis Potter
Attending Physician
 52.5         X   1,306,485   64,067
(60) Scott Rodeo
Associate Attending Physician
 59.63         X   1,151,679   48,684
(61) Edward Craig
Attending Physician
 48.05         X   1,010,200   73,503
(62) Ernest Sink
Associate Attending Physician
 40.15         X   1,001,538   41,144
1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)............MediumBullet 15,293,933 1,210,586 1,063,201
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organizationMediumBullet718
Yes
No
3
Did the organization list any former officer, director or trustee, key employee, or highest compensated employee on line 1a? If “Yes,” complete Schedule J for such individual .............
3
 
No
4
For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If “Yes,” complete Schedule J for such individual...........................
4
Yes
 
5
Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If “Yes,” complete Schedule J for such person .....
5
 
No
Section B. Independent Contractors
1
Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization. Report compensation for the calendar year ending with or within the organization’s tax year.
(A)
Name and business address 		(B)
Description of services 		(C)
Compensation
SPECIALTY MANAGEMENT
PO BOX 68
GLEN RIDGE,NJ07028 		ENG/MAINT/CONSULTING 1,552,354
PROSKAUER ROSE LLP
ELEVEN TIME SQUARE
NEW YORK,NY10036 		LEGAL SERVICES 1,362,944
PERKINS EASTMAN ARCHITECTS PC
115 5TH AVENUE
NEW YORK,NY10003 		ARCHITECTURAL 1,029,580
CROTHALL HEALTHCARE
955 CHESTERBROOK BLVD STE 300
WAYNE,PA19087 		ENG/HSE KEEPING/CLNG 1,012,219
BILLING SERVICES INC
PO BOX 7025
AMAGANSETT,NY11930 		MEDICAL BILLING 1,009,092
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet92
Form 990 (2011)
Form 990 (2011)
Page 9
Part VIII
Statement of Revenue
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512, 513, or 514
Contributions, Gifts, Grants and Other Similar Amounts 1a Federated campaigns..1a  
b Membership dues....1b  
c Fundraising events....1c  
d Related organizations...1d 898,132
e Government grants (contributions)1e 15,845,180
f All other contributions, gifts, grants, and
similar amounts not included above1f 		45,430,864
g Noncash contributions included in lines 1a-1f:$ 705,726
h Total. Add lines 1a-1f.......MediumBullet 62,174,176
Program Service Revenue Business Code
2a NET INPATIENT REVENUE 622,110 352,222,639 352,222,639    
b NET OUTPATIENT REVENUE 622,110 224,067,174 224,067,174    
c PROFESSIONAL FEES 622,110 42,253,987 42,253,987    
d
e
f All other program service revenue .        
g Total. Add lines 2a–2f........MediumBullet 618,543,800
Other Revenue 3 Investment income (including dividends, interest
and other similar amounts).....MediumBullet 3,054,283     3,054,283
4 Income from investment of tax-exempt bond proceeds..MediumBullet 0      
5 Royalties............MediumBullet 1,030,000     1,030,000
(i) Real (ii) Personal
6a Gross rents    
b Less: rental expenses    
c Rental income or (loss)    
d Net rental income or (loss).......MediumBullet        
(i) Securities (ii) Other
7a Gross amount from sales of assets other than inventory 2,504,175  
b Less: cost or other basis and sales expenses 2,036,388  
c Gain or (loss) 467,787  
d Net gain or (loss)..........MediumBullet 467,787     467,787
8a Gross income from fundraising events (not including
$  
of contributions reported on line 1c). See Part IV, line 18 ...
a  
b Less: direct expenses ...b  
c Net income or (loss) from fundraising events..MediumBullet 0    
9a Gross income from gaming activities.
See Part IV, line 19 ...
a  
b Less: direct expenses ...b  
c Net income or (loss) from gaming activities...MediumBullet 0      
10a Gross sales of inventory, less
returns and allowances .
a  
b Less: cost of goods sold ..b  
c Net income or (loss) from sales of inventory..MediumBullet 0      
Miscellaneous Revenue Business Code
11a RECOVERIES-EXPENSES 622,110 17,215,309 17,215,309    
b RECOVERIES-MD RELATED EXP 622,110 10,652,519 10,652,519    
c MISCELLANEOUS 622,110 6,022,030 5,671,000 -10,020 361,050
d All other revenue ....        
e Total. Add lines 11a–11d ......MediumBullet 33,889,858
12 Total revenue. See Instructions....MediumBullet 719,159,904 652,082,628 -10,020 4,913,120
Form 990 (2011)
Form 990 (2011)
Page 10
Part IX
Statement of Functional Expenses
Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A) but are not required to complete columns (B), (C), and (D).
Check if Schedule O contains a response to any question in this Part IX. .........
Do not include amounts reported on lines 6b,
7b, 8b, 9b, and 10b of Part VIII. 		(A)
Total expenses 		(B)
Program service expenses 		(C)
Management and general expenses 		(D)
Fundraising expenses
1 Grants and other assistance to governments and organizations in the United States. See Part IV, line 21 0  
2 Grants and other assistance to individuals in the United States. See Part IV, line 22 0  
3 Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16 0  
4 Benefits paid to or for members 0  
5 Compensation of current officers, directors, trustees, and key employees .... 9,949,380 3,630,184 6,319,196  
6 Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .... 0      
7 Other salaries and wages 258,370,948 233,468,551 24,902,397  
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) .... 18,040,313 16,366,019 1,674,294  
9 Other employee benefits ....... 45,153,852 39,899,777 5,254,075  
10 Payroll taxes ........... 18,619,608 16,453,042 2,166,566  
11 Fees for services (non-employees):        
a Management ...... 4,525,757 1,623,257 2,902,500  
b Legal ......... 2,378,432   2,378,432  
c Accounting ........... 402,433   402,433  
d Lobbying ........... 48,504   48,504  
e Professional fundraising. See Part IV, line 17.. 0  
f Investment management fees ...... 200,000   200,000  
g Other .......... 9,403,711 8,502,712 900,999  
12 Advertising and promotion .... 7,782,981   7,782,981  
13 Office expenses ....... 17,866,517 13,808,282 4,058,235  
14 Information technology ...... 6,216,285   6,216,285  
15 Royalties .. 0      
16 Occupancy ........... 34,206,061 31,401,295 2,804,766  
17 Travel ............ 1,797,451 1,302,258 495,193  
18 Payments of travel or entertainment expenses for any federal, state, or local public officials ...... 0      
19 Conferences, conventions, and meetings .... 0      
20 Interest ........... 10,050,426 8,807,910 1,242,516  
21 Payments to affiliates ....... 0      
22 Depreciation, depletion, and amortization ..... 37,768,001 33,359,972 4,408,029  
23 Insurance .............. 25,853,414 22,467,559 3,385,855  
24 Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24f. If line 24f amount exceeds 10% of line 25, column (A) amount, list line 24f expenses on Schedule O.)
a MEDICAL SUPPLIES & IMPLANT 107,092,424 107,092,424    
b RESEARCH (NET OF RECOVERIES) 15,539,667 15,539,667    
c BAD DEBT 2,653,621 2,653,621    
d MISCELLANEOUS 17,848,881 13,750,123 4,098,758  
e
f All other expenses        
25 Total functional expenses. Add lines 1 through 24f 651,768,667 570,126,653 81,642,014 0
26 Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here MediumBullet if following SOP 98-2 (ASC 958-720).        
Form 990 (2011)
Form 990 (2011)
Page 11
Part X Balance Sheet
(A)
Beginning of year 		(B)
End of year
Assets 1 Cash—non-interest-bearing .......... 47,756,791 1 43,869,912
2 Savings and temporary cash investments ....... 273,000 2 5,133,849
3 Pledges and grants receivable, net ......... 25,563,894 3 31,516,557
4 Accounts receivable, net ......... 65,155,774 4 78,705,906
5 Receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
Schedule L .......... 0 5 0
6 Receivables from other disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B). Complete Part II of
Schedule L .......... 0 6 0
7 Notes and loans receivable, net ............. 0 7 0
8 Inventories for sale or use .............. 2,664,066 8 4,896,766
9 Prepaid expenses and deferred charges ............ 12,089,551 9 13,354,192
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 753,977,609
b Less: accumulated depreciation. ..... 10b 390,698,818 325,681,651 10c 363,278,791
11 Investments—publicly traded securities .......... 215,140,473 11 219,540,385
12 Investments—other securities. See Part IV, line 11 ...... 64,290,907 12 78,938,634
13 Investments—program-related. See Part IV, line 11 .. 820,000 13 820,000
14 Intangible assets ......... 0 14 0
15 Other assets. See Part IV, line 11 ........... 32,385,673 15 100,090,651
16 Total assets. Add lines 1 through 15 (must equal line 34)... 791,821,780 16 940,145,643
Liabilities 17 Accounts payable and accrued expenses . 60,684,481 17 69,826,536
18 Grants payable .......... 0 18 0
19 Deferred revenue .......... 0 19 0
20 Tax-exempt bond liabilities .......... 207,031,244 20 224,215,661
21 Escrow or custodial account liability. Complete Part IV of Schedule D.. 0 21 0
22 Payables to current and former officers, directors, trustees, key
employees, highest compensated employees, and disqualified
persons. Complete Part II of Schedule L.......... 0 22 0
23 Secured mortgages and notes payable to unrelated third parties .. 20,970,882 23 12,389,774
24 Unsecured notes and loans payable to unrelated third parties .... 0 24 0
25 Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D..... 90,079,728 25 210,863,901
26 Total liabilities. Add lines 17 through 25..... 378,766,335 26 517,295,872
Net Assets or Fund Balance Organizations that follow SFAS 117, check here MediumBullet and complete lines 27 through 29, and lines 33 and 34.
27 Unrestricted net assets ..... 227,555,492 27 218,842,710
28 Temporarily restricted net assets ..... 103,454,592 28 111,136,557
29 Permanently restricted net assets ..... 82,045,361 29 92,870,504
Organizations that do not follow SFAS 117, check here MediumBullet and complete lines 30 through 34.
30 Capital stock or trust principal, or current funds .....   30  
31 Paid-in or capital surplus, or land, building or equipment fund .....   31  
32 Retained earnings, endowment, accumulated income, or other funds   32  
33 Total net assets or fund balances ..... 413,055,445 33 422,849,771
34 Total liabilities and net assets/fund balances ..... 791,821,780 34 940,145,643
Form 990 (2011)
Form 990 (2011)
Page 12
Part XI
Reconcilliation of Net Assets
Check if Schedule O contains a response to any question in this Part XI .........
1
Total revenue (must equal Part VIII, column (A), line 12) ...
1
719,159,904
2
Total expenses (must equal Part IX, column (A), line 25) ....
2
651,768,667
3
Revenue less expenses. Subtract line 2 from line 1 ...
3
67,391,237
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) ..
4
413,055,445
5
Other changes in net assets or fund balances (explain in Schedule O) ...
5
-57,596,911
6
Net assets or fund balances at end of year. Combine lines 3, 4, and 5 (must equal Part X, line 33, column (B)) ....
6
422,849,771
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response to any question in this Part XII .........
Yes
No
1
Accounting method used to prepare the Form 990:  
If the organization changed its method of accounting from a prior year or checked "Other," explain in
Schedule O.
2a
Were the organization’s financial statements compiled or reviewed by an independent accountant?....
2a
 
No
b
Were the organization’s financial statements audited by an independent accountant?........
2b
Yes
 
c
If “Yes,” to 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant? If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O. ...........................
2c
Yes
 
d
If “Yes” to line 2a or 2b, check a box below to indicate whether the financial statements for the year were issued on a separate basis, consolidated basis, or both:
3a
As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A-133? ................
3a
Yes
 
b
If “Yes,” did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits. ..
3b
Yes
 
Form 990 (2011)
Additional Data


Software ID:  
Software Version:  
Form 990, Special Condition Description:
Special Condition Description
SCHEDULE A
(Form 990 or 990EZ)

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.
right arrow Attach to Form 990 or Form 990-EZ. right arrow See separate instructions.
OMB No. 1545-0047
2011
Open to Public
Inspection
Name of the organization
New York Society for the Relief
of the Ruptured and Crippled Maintaining the
Employer identification number

13-1624135
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
f
g
(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
(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) 2011
Schedule A (Form 990 or 990-EZ) 2011
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) 2007 (b) 2008 (c) 2009 (d) 2010 (e) 2011 (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) 2007 (b) 2008 (c) 2009 (d) 2010 (e) 2011 (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
12
 
13
Section C. Computation of Public Support Percentage
14
14
 
15
15
 
16a
b
17a
b
18
Schedule A (Form 990 or 990-EZ) 2011
Schedule A (Form 990 or 990-EZ) 2011
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) 2007 (b) 2008 (c) 2009 (d) 2010 (e) 2011 (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) 2007 (b) 2008 (c) 2009 (d) 2010 (e) 2011 (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
Section C. Computation of Public Support Percentage
15
15
 
16
16
 
Section D. Computation of Investment Income Percentage
17
17
 
18
18
 
19a
b
20
Schedule A (Form 990 or 990-EZ) 2011
Schedule A (Form 990 or 990-EZ) 2011
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) 2011

Additional Data


Software ID:  
Software Version:  
Schedule B
(Form 990, 990-EZ,
or 990-PF)
Department of the Treasury
Internal Revenue Service
Schedule of Contributors
Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
OMB No. 1545-0047
2011
Name of organization
New York Society for the Relief
of the Ruptured and Crippled Maintaining the
Employer identification number

13-1624135
Organization type (check one):
Filers of:
Section:
Form 990 or 990-EZ





Form 990-PF




Check if your organization is covered by the General Rule or a Special Rule.  
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.
General Rule
Special Rules
......................... Arrow Bullet   $    
Caution. An Organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its
Form 990-EZ or on Part I, line 2, of its Form 990-PF, to certify that it does not meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).
For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.
Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2011)

Page 2
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)
Name of organization
New York Society for the Relief
of the Ruptured and Crippled Maintaining the 		Employer identification number

13-1624135
Part I
Contributors (see Instructions). Use duplicate copies of Part I if additional space is needed.
     
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
RESTRICTED
RESTRICTED
 

     
RESTRICTED
RESTRICTED  
RESTRICTED, RESTRICTED   RESTRICTED

$RESTRICTED




(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is a noncash contribution.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

Page 3
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)
Name of organization
New York Society for the Relief
of the Ruptured and Crippled Maintaining the 		Employer identification number

13-1624135
Part II
Noncash Property (see Instructions). Use duplicate copies of Part II if additional space is needed.
     
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions). 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions). 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions). 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions). 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions). 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions). 		(d)
Date received
 
$    
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

Page 4
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)
Name of organization
New York Society for the Relief
of the Ruptured and Crippled Maintaining the 		Employer identification number

13-1624135
Part III
Exclusively religious, charitable, etc., individual contributions to section 501(c)(7), (8), or (10) organizations
that total more than $1,000 for the year. Complete columns (a) through (e) and the following line entry.
For organizations completing Part III, enter the total of exclusively religious, charitable, etc.,
contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet $  
Use duplicate copies of Part III if additional space is needed
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

Additional Data


Software ID:  
Software Version:  
SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527
SchCMd Bullet Complete if the organization is described below.
SchCMd Bullet Attach to Form 990 or Form 990-EZ. SchCMd Bullet See separate instructions.
OMB No. 1545-0047
2011
Open to Public
Inspection
If the organization answered “Yes” to Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet Section 527 organizations: Complete Part I-A only.
If the organization answered “Yes” to Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)) Complete Part II-A. Do not complete Part II-B.
Round Bullet Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered “Yes” to Form 990, Part IV, Line 5 (Proxy Tax) or Form 990-EZ, line 35c (Proxy Tax), then
Round Bullet Section 501(c)(4), (5), or (6) organizations: Complete Part III.
Name of the organization
New York Society for the Relief
of the Ruptured and Crippled Maintaining the
Employer identification number

13-1624135
Part I-A
Complete if the organization is exempt under section 501(c) or is a section 527 organization.

1
Provide a description of the organization’s direct and indirect political campaign activities in Part IV.
2
Political expenditures ....................................SchCMd Bullet
$  
3
Volunteer hours ........................................
 

Part I-B
Complete if the organization is exempt under section 501(c)(3).
1
Enter the amount of any excise tax incurred by the organization under section 4955 .........SchCMd Bullet
$  
2
Enter the amount of any excise tax incurred by organization managers under section 4955 ......SchCMd Bullet
$  
3
If the organization incurred a section 4955 tax, did it file Form 4720 for this year? ..............
4a
Was a correction made? .........................................
b
If "Yes," describe in Part IV.
Part I-C
Complete if the organization is exempt under section 501(c) except section 501(c)(3).
1
Enter the amount directly expended by the filing organization for section 527 exempt function activities SchCMd Bullet
$  
2
Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ...................................SchCMd Bullet

$  
3
Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b..SchCMd Bullet

$  
4
Did the filing organization file Form 1120-POL for this year? ..........................
5
Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.
(a) Name (b) Address (c) EIN (d) Amount paid from filing organization's funds. If none, enter -0-. (e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.










For Privacy Act and Paperwork Reduction Act Notice, see the instructions for Form 990.
Cat. No. 50084S
Schedule C (Form 990 or 990-EZ) 2011

Schedule C (Form 990 or 990-EZ) 2011
Page 2
Part II-A
Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).
A Check expenses, and share of excess lobbying expenditures).Click to see attachment
B Check
Limits on Lobbying Expenditures
(The term "expenditures" means amounts paid or incurred.) 		(a) Filing
organization's
totals 		(b) Affiliated group
totals
1a Total lobbying expenditures to influence public opinion (grass roots lobbying) ...... 0 0
b Total lobbying expenditures to influence a legislative body (direct lobbying) ....... 48,504 186,051
c Total lobbying expenditures (add lines 1a and 1b) ................... 48,504 186,051
d Other exempt purpose expenditures ........................ 651,720,163 659,057,583
e Total exempt purpose expenditures (add lines 1c and 1d) ............... 651,768,667 659,243,634
f Lobbying nontaxable amount. Enter the amount from the following table in both
columns.		 1,000,000 1,000,000
  If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:    
  Not over $500,00020% of the amount on line 1e.    
  Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.    
  Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.    
  Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.    
  Over $17,000,000$1,000,000.    
       
g Grassroots nontaxable amount (enter 25% of line 1f) ................. 250,000 250,000
h Subtract line 1g from line 1a. If zero or less, enter -0-. ................    
i Subtract line 1f from line 1c. If zero or less, enter -0-. ................    
j If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting
section 4911 tax for this year? ......................................

4-Year Averaging Period Under Section 501(h)
(Some organizations that made a section 501(h) election do not have to complete all of the five
columns below. See the instructions for lines 2a through 2f on page 4.)
Lobbying Expenditures During 4-Year Averaging Period
  Calendar year (or fiscal year
beginning in) 		(a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) Total
             
2a Lobbying non-taxable amount 1,000,000 1,000,000 1,000,000 1,000,000 4,000,000
             
b Lobbying ceiling amount
(150% of line 2a, column(e)) 		        6,000,000
             
c Total lobbying expenditures 48,000 74,044 60,006 48,504 230,554
             
d Grassroots nontaxable amount 250,000 250,000 250,000 250,000 1,000,000
             
e Grassroots ceiling amount
(150% of line 2d, column (e))		         1,500,000
             
f Grassroots lobbying expenditures 0 0 0 0 0
Schedule C (Form 990 or 990-EZ) 2011


Schedule C (Form 990 or 990-EZ) 2011
Page 3
Part II-B
Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).
For each “Yes” response to lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.
(a)
Yes
No
(b)
Amount
1
During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:
a
Volunteers? .........................................
 
 
b
Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ....
 
 
c
Media advertisements? ....................................
 
 
 
d
Mailings to members, legislators, or the public? .........................
 
 
 
e
Publications, or published or broadcast statements? .......................
 
 
 
f
Grants to other organizations for lobbying purposes? .......................
 
 
 
g
Direct contact with legislators, their staffs, government officials, or a legislative body? ........
 
 
 
h
Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ......
 
 
 
i
Other activities? ..........................
 
 
 
j
Total. Add lines 1c through 1i ...............................
 
2a
Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....
 
 
b
If "Yes," enter the amount of any tax incurred under section 4912 .................
 
c
If "Yes," enter the amount of any tax incurred by organization managers under section 4912 .....
 
d
If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? .......
 
 
Part III-A
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).
Yes
No
1
Were substantially all (90% or more) dues received nondeductible by members? ................
1
 
 
2
Did the organization make only in-house lobbying expenditures of $2,000 or less? ................
2
 
 
3
Did the organization agree to carry over lobbying and political expenditures from the prior year? ..........
3
 
 
Part III-B
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2 are answered “No” OR (b) Part III-A, line 3 is answered “Yes”.
1
Dues, assessments and similar amounts from members .....................
1
 
2
Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political
expenses for which the section 527(f) tax was paid).
a
Current year .........................................
2a
 
b
Carryover from last year ....................................
2b
 
c
Total ...........................................
2c
 
3
Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .
3
 
4
If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ................................
4
 
5
Taxable amount of lobbying and political expenditures (see instructions) ..............
5
 
Part IV
Supplemental Information
Complete this part to provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, Part II-A; line 5; and Part ll-B, line 1.
Also, complete this part for any additional information.
Identifier Return Reference Explanation
Schedule C (Form 990 or 990EZ) 2011

Additional Data


Software ID:  
Software Version:  

SCHEDULE D
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Financial Statements
SchDMd Bullet Complete if the organization answered "Yes," to Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b
SchDMd Bullet Attach to Form 990. SchDMd Bullet See separate instructions.
OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
New York Society for the Relief
of the Ruptured and Crippled Maintaining the
Employer identification number

13-1624135
Part I
Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" to Form 990, Part IV, line 6.
(a) Donor advised funds (b) Funds and other accounts
1 Total number at end of year .......    
2 Aggregate contributions to (during year) ...    
3 Aggregate grants from (during year) ...    
4 Aggregate value at end of year .......    
5
Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ............
6
Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................
Part II
Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.
1
Purpose(s) of conservation easements held by the organization (check all that apply).
2
Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.
Held at the End of the Year
a Total number of conservation easements ....................... 2a  
b Total acreage restricted by conservation easements .................. 2b  
c Number of conservation easements on a certified historic structure included in (a) ..... 2c  
d Number of conservation easements included in (c) acquired after 8/17/06, and not on a historic structure listed in the National Register .................... 2d  
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the tax year SchDMd Bullet  
4
Number of states where property subject to conservation easement is located SchDMd Bullet  
5
Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................
6
Staff and volunteer hours devoted to monitoring, inspecting and enforcing conservation easements during the year SchDMd Bullet  
7
Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet $  
8
Does each conservation easement reported on line 2(d) above satisfy the requirements of section
170(h)(4)(B)(i) and 170(h)(4)(B)(ii)? ....................................
9
In Part XIV, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" to Form 990, Part IV, line 8.
1a
If the organization elected, as permitted under SFAS 116 (ASC 958), not to report in its revenue statement and balance sheet works of
art, historical treasures, or other similar assets held for public exhibition, education or research in furtherance of public service,
provide, in Part XIV, the text of the footnote to its financial statements that describes these items.
b
If the organization elected, as permitted under SFAS 116 (ASC 958), to report in its revenue statement and balance sheet works of art,
historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service,
provide the following amounts relating to these items:
(i)
Revenues included in Form 990, Part VIII, line 1 ........................SchDMd Bullet $  
(ii)
Assets included in Form 990, Part X ..............................SchDMd Bullet $  
2
If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 (ASC 958), relating to these items:
a
Revenues included in Form 990, Part VIII, line 1 ..........................SchDMd Bullet $  
b
Assets included in Form 990, Part X ...............................SchDMd Bullet $  
For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990
Cat. No. 52283D
Schedule D (Form 990) 2011

Schedule D (Form 990) 2011
Page 2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3
Using the organization’s accession and other records, check any of the following that are a significant use of its collection
items (check all that apply):
a
d
b
e
 
c
4
Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIV.
5
During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?........
Part IV
Escrow and Custodial Arrangements. Complete if the organization answered "Yes" to Form 990,
Part IV, line 9, or reported an amount on Form 990, Part X, line 21.
1a
Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................
b
If "Yes," explain the arrangement in Part XIV and complete the following table:
Amount
c Beginning balance ................................. 1c  
d Additions during the year .............................. 1d  
e Distributions during the year ............................. 1e  
f Ending balance ................................... 1f  
2a
Did the organization include an amount on Form 990, Part X, line 21? .....................
b
If “Yes,” explain the arrangement in Part XIV.
Part V
Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.
(a)Current Year (b)Prior Year (c)Two Years Back (d)Three Years Back (e)Four Years Back
1a Beginning of year balance .... 185,499,953 168,118,173 148,902,627 169,382,764
b Contributions ........ 73,124,871 57,163,090 48,780,653 64,862,396
c Net investment earnings, gains, and losses ... -1,859,184 13,957,679 19,262,521 -28,190,709
d Grants or scholarships .....        
e Other expenditures for facilities
and programs ........ 		52,758,579 53,738,989 48,827,628 57,151,824
f Administrative expenses ....        
g End of year balance ...... 204,007,061 185,499,953 168,118,173 148,902,627
2
Provide the estimated percentage of the year end balance (line 1g) held as:
a
Board designated or quasi-endowment SchDMd Bullet  
b
Permanent endowment SchDMd Bullet46.000 %
c
Temporarily restricted endowment SchDMd Bullet54.000 %
The percentages in lines 2a, 2b, and 2c should equal 100%.
3a
Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes
No
(i) unrelated organizations ........................
3a(i)
Yes
 
(ii) related organizations ........................
3a(ii)
 
No
b
If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........
3b
 
 
4
Describe in Part XIV the intended uses of the organization's endowment funds.
Part VI
Land, Buildings, and Equipment. See Form 990, Part X, line 10.
Description of property (a) Cost or other basis (investment) (b)Cost or other basis (other) (c) Accumulated depreciation (d) Book value
1a Land .................   223,403 223,403
b Buildings ................   466,105,108 206,882,949 259,222,159
c Leasehold improvements ............        
d Equipment ................   282,542,910 183,815,869 98,727,041
e Other .................   5,106,188   5,106,188
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......SchDMdBullet 363,278,791
Schedule D (Form 990) 2011

Schedule D (Form 990) 2011
Page 3
Part VII
Investments—Other Securities. See Form 990, Part X, line 12.
(a) Description of security or category
(including name of security)		 (b)Book value (c) Method of valuation:
Cost or end-of-year market value
(1)Financial derivatives    
(2)Closely-held equity interests    
(3)Other
(A) ALTERNATIVE INVESTMENTS 		78,938,634 F








Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)Small Bullet 78,938,634
Part VIII
Investments—Program Related. See Form 990, Part X, line 13.
(a) Description of investment type (b) Book value (c) Method of valuation:
Cost or end-of-year market value








Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)Small Bullet  
Part IX
Other Assets. See Form 990, Part X, line 15.
(a) Description (b) Book value
(1) INSURANCE CLAIMS RECEIVABLE 64,234,000
(2) DUE FROM AFFILIATES -MRKT SEC. 17,221,089
(3) INT IN HSS FUND, INC.-FASB 136 13,662,212
(4) 457B DEFERRED COMP PLAN ASSETS 3,103,064
(5) DUE FROM AFFILIATES - NET 1,469,286
(6) INTANGIBLE ASSETS 210,000
(7) GOODWILL 191,000


Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........Small Bullet 100,090,651
Part X
Other Liabilities. See Form 990, Part X, line 25.
1.(a) Description of Liability (b) Book value
Federal Income Taxes 0
DEFINED BENEFIT PENSION PLAN 88,911,524
INSURANCE CLAIM LIABILITY 64,234,000
DUE TO THIRD PARTY PAYORS 33,995,623
ACCRUED POST-RETIREMENT HEALTH CARE BENEFITS 5,368,000
CONSTRUCTION PAYABLE 4,323,548
457B DEFERRED COMP PLAN LIABILITIES 3,103,065
EXECUTIVE DEFERRED COMP PLAN RESERVE 915,000
OTHER ACCRUED LIABILITIES 10,013,141

Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)Small Bullet 210,863,901
2. Fin 48 (ASC 740) Footnote. In Part XIV, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC740).
Schedule D (Form 990) 2011

Schedule D (Form 990) 2011
Page 4
Part XI Reconciliation of Change in Net Assets from Form 990 to Financial Statements
1 Total revenue (Form 990, Part VIII, column (A), line 12) .................... 1 719,159,904
2 Total expenses (Form 990, Part IX, column (A), line 25) ..................... 2 651,768,667
3 Excess or (deficit) for the year. Subtract line 2 from line 1 ............. 3 67,391,237
4 Net unrealized gains (losses) on investments .......................... 4 -6,036,563
5 Donated services and use of facilities ............................. 5  
6 Investment expenses ................................... 6  
7 Prior period adjustments .................................. 7  
8 Other (Describe in Part XIV.) ................................. 8 -51,560,348
9 Total adjustments (net). Add lines 4 through 8 ......................... 9 -57,596,911
10 Excess or (deficit) for the year per financial statements. Combine lines 3 and 9 ......... 10 9,794,326
Part XII Reconciliation of Revenue per Audited Financial Statements With Revenue per Return
1 Total revenue, gains, and other support per audited financial statements ....... 1 691,194,094
2 Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a Net unrealized gains on investments .......... 2a  
b Donated services and use of facilities ......... 2b  
c Recoveries of prior year grants ........... 2c  
d Other (Describe in Part XIV.) ............ 2d 46,782,688
e Add lines 2a through 2d ..................... 2e 46,782,688
3 Subtract line 2e from line 1..................... 3 644,411,406
4 Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b . 4a  
b Other (Describe in Part XIV.) ........... 4b 74,748,498
c Add lines 4a and 4b....................... 4c 74,748,498
5 Total Revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ...... 5 719,159,904
Part XIII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return
1 Total expenses and losses per audited financial statements ............. 1 651,768,667
2 Amounts included on line 1 but not on Form 990, Part IX, line 25:
a Donated services and use of facilities .......... 2a  
b Prior year adjustments .............. 2b  
c Other losses ................ 2c  
d Other (Describe in Part XIV.) ............ 2d  
e Add lines 2a through 2d...................... 2e  
3 Subtract line 2e from line 1..................... 3 651,768,667
4 Amounts included on Form 990, Part IX, line 25, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b .. 4a  
b Other (Describe in Part XIV.) ............ 4b  
c Add lines 4a and 4b....................... 4c  
5 Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ...... 5 651,768,667
Part XIV
Supplemental Information
Complete this part to provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b;
Part V, line 4; Part X; Part XI, line 8; Part XII, lines 2d and 4b; and Part XIII, lines 2d and 4b. Also complete this part to provide any additional information.
Identifier Return Reference Explanation
ENDOWMENT FUNDS SCHEDULE D, PART V, LINE 4 THE HOSPITAL'S ENDOWMENTS INCLUDE RESTRICTED (RESEARCH OR SPECIFIC PURPOSE) AND UNRESTRICTED ENDOWMENTS. TEMPORARILY RESTRICTED FUNDS ARE USED FOR RESEARCH, EDUCATION, PATIENT NEEDS, OR RELATED ADMINISTRATIVE ACTIVITIES IN ACCORDANCE WITH DONOR RESTRICTIONS.
FIN 48 SCHEUDLE D, PART X, LINE 2 NO FOOTNOTE REPORTING THE HOSPITAL'S LIABILITY FOR UNCERTAIN TAX POSITIONS UNDER ASC 740 WAS INCLUDED IN THE 2011 FINANCIAL STATEMENTS REPORTING, AS THERE WAS NO LIABILITY FOR UNCERTAIN TAX POSITIONS UNDER ASC 740.
SCHEDULE D, PART XI, LINE 8   REPRESENTS INCREASE IN INTEREST OF HSS FUND, INC. $3,177,347 AND INCREASE IN DEFINED PENSION AND POST RETIREMENT PLAN LIABILITIES ($54,737,695).
SCHEDULE D, PART XII, LINE 2D   REPRESENTS TRANSFERS FROM SPECIAL PURPOSE FUNDS OF $17,911,975, NET ASSETS RELEASED FROM RESTRICTIONS FOR RESEARCH OPERATIONS OF $30,478,492 AND EQUITY EARNING OF ALTERNATIVE INVESTMENTS INCLUDED IN UNRESTRICTED PORTFOLIO NET CHANGE IN UNREALIZED LOSSES ON SECURITIES INCLUDED IN ACCOUNTS MANAGED BY EXTERNAL PARTIES OF ($1,607,779).
SCHEDULE D, PART XII, LINE 4B   REPRESENTS CONTRIBUTIONS TO SPECIFIC PURPOSE FUNDS OF $18,974,688, CONTRIBUTIONS TO ENDOWMENT FUNDS OF $10,825,143, CONTRIBUTIONS TO PLANT REPLACEMENT & REPLACEMENT FUNDS OF $10,028,665, FOUNDATION AND INSTITUTIONAL GRANTS (INCLUDES FUND, INC. CONTRIBUTIONS) OF $17,114,498, GOVERNMENT GRANTS OF $15,845,180, RESTRICTED INVESTMENT INCOME OF $1,802,424, AND RESTRICTED GAIN OF $157,900.
Schedule D (Form 990) 2011

Additional Data


Software ID:  
Software Version:  




SCHEDULE F(Form 990)
Department of the Treasury
Internal Revenue Service
Statement of Activities Outside the United States
Right pointing arrow large image Complete if the organization answered "Yes" to Form 990,Part IV, line 14b, 15, or 16.Right pointing arrow large image Attach to Form 990. Right pointing arrow large image See separate instructions.
OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
New York Society for the Relief
of the Ruptured and Crippled Maintaining the
Employer identification number

13-1624135
Part I
General Information on Activities Outside the United States. Complete if the organization answered
“Yes” to Form 990, Part IV, line 14b.
1
For grantmakers. Does the organization maintain records to substantiate the amount of its grants
and other assistance, the grantees' eligibility for the grants or assistance, and the selection criteria used
to award the grants or assistance? ..............................
2
For grantmakers. Describe in Part V the organization’s procedures for monitoring the use of its grants and other
assistance outside the United States.
3
Activites per Region. (Use Part V if additional space is needed.)
(a) Region (b) Number of offices in the region (c) Number of employees or agents in region or independent contractors (d) Activities conducted in region (by type) (e.g., fundraising, program services, investments, grants to recipients located in the region) (e) If activity listed in (d) is a program service, describe specific type of
service(s) in region		 (f) Total
expenditures for region/investments
in region
Central America and the Caribbean 0 0 Investments   54,884,705
Central America and the Caribbean 0 0 MEDICAL INSURANCE PREMIUM   16,091,734
           
           
           
           
           
           
           
           
           
           
           
           
           
           
           
3a Sub-total ..... 0 0 70,976,439
b Total from continuation sheets to Part I ...      
c Totals (add lines 3a and 3b) 0 0 70,976,439
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.Cat. No. 50082W Schedule F (Form 990) 2011
Schedule F (Form 990) 2011
Page 2
Part II
Grants and Other Assistance to Organizations or Entities Outside the United States. Complete if the organization answered "Yes" to Form 990,
Part IV, line 15, for any recipient who received more than $5,000. Check this box if no one recipient received more than $5,000 ........ MediumBullet
Use Part V if additional space is needed.
1 (a) Name of organization (b) IRS code section
and EIN (if applicable)		 (c) Region (d) Purpose of
grant 		(e) Amount of
cash grant 		(f) Manner of
cash
disbursement 		(g) Amount of
of non-cash
assistance 		(h) Description
of non-cash
assistance 		(i) Method of
valuation
(book, FMV,
appraisal, other)
             
             
             
             
             
             
             
             
             
             
             
             
             
             
             
             
2
Enter total number of recipient organizations listed above that are recognized as charities by the foreign country, recognized as tax-exempt by the IRS, or for which the grantee or counsel has provided a section 501(c)(3) equivalency letter .....MediumBullet
 
3
Enter total number of other organizations or entities ........................MediumBullet
 
Schedule F (Form 990) 2011
Schedule F (Form 990) 2011Page 3
Part III
Grants and Other Assistance to Individuals Outside the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 16.
Use Part V if additional space is needed.
(a) Type of grant or assistance (b) Region (c) Number of recipients (d) Amount of
cash grant 		(e) Manner of cash
disbursement 		(f) Amount of
non-cash
assistance 		(g) Description
of non-cash
assistance 		(h) Method of
valuation
(book, FMV,
appraisal, other)
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
Schedule F (Form 990) 2011
Schedule F (Form 990) 2011
Page 4
Part IV
Foreign Forms
1 Was the organization a U.S. transferor of property to a foreign corporation during the tax year? If "Yes," the organization may be required to file Form 926 (see instructions for Form 926).................
2 Did the organization have an interest in a foreign trust during the tax year? If " Yes," the organization may be required to file Form 3520 and/or Form 3520-A. (see instructions for Forms 3520 and 3520-A)..........
3 Did the organization have an ownership interest in a foreign corporation during the tax year? If "Yes," the organization may be required to file Form 5471, Information Return of U.S. Persons with respect to Certain Foreign Corporations. (see instructions for Form 5471)..............................
4 Was the organization a direct or indirect shareholder of a passive foreign investment company or a qualified electing fund during the tax year? If "Yes," the organization may be required to file Form 8621, Return by a Shareholder of a Passive Foreign Investment Company or Qualified Electing Fund. (see instructions for Form 8621)
5 Did the organization have an ownership interest in a foreign partnership during the tax year? If "Yes," the organization may be required to file Form 8865, Return of U.S. Persons with respect to Certain Foreign Partnerships. (see instructions for Form 8865)....................................
6 Did the organization have any operations in or related to any boycotting countries during the tax year? If "Yes," the organization may be required to file Form 5713, International Boycott Report (see instructions for Form 5713)................................................
Schedule F (Form 990) 2011
Schedule F (Form 990) 2011
Page 5
Part V
Supplemental Information
Complete this part to provide the information required by Part I, line 2 (monitoring of funds); Part I, line 3, column (f) (accounting method; amounts of investments vs. expenditures per region); Part II, line 1 (accounting method); Part III (accounting method); and Part III, column (c) (estimated number of recipients), as applicable. Also complete this part to provide any additional information (see instructions).
Identifier ReturnReference Explanation
Schedule F, Part I, Line 3   Health Education The Hospital reimburses its physicians and scientists for attending conferences, some of which may be outside of the United States.
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
Schedule F (Form 990) 2011
Additional Data


Software ID:  
Software Version:  



SCHEDULE H (Form 990)
Department of the Treasury
Internal Revenue Service
Hospitals
MediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, question 20.
MediumBullet Attach to Form 990. MediumBullet See separate instructions.
OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
New York Society for the Relief
of the Ruptured and Crippled Maintaining the
Employer identification number

13-1624135
Part I
Charity Care and Certain Other Community Benefits at Cost
Yes
No
1a
Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a....
1a
Yes
 
b
If "Yes," was it a written policy? .......................
1b
Yes
 
2
If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.
3
Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.
a
Did the organization use Federal Poverty Guidelines (FPG) to determine eligibility for providing free care?
If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:
3a
Yes
 
b
Did the organization use FPG to determine eligibility for providing discounted care? If "Yes," indicate which of the
following was the family income limit for eligibility for discounted care: ............
3b
Yes
 
c
If the organization did not use FPG to determine eligibility, describe in Part VI the income based criteria for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, to determine eligibility for free or discounted care.
4
Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? ..............

4

Yes

 
5a
Did the organization budget amounts for free or discounted care provided under its financial assistance policy during the tax year? ............................

5a

Yes

 
b
If "Yes," did the organization's financial assistance expenses exceed the budgeted amount?......
5b
Yes
 
c
If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care?...............
5c
 
No
6a
Did the organization prepare a community benefit report during the tax year?...........
6a
Yes
 
b
If "Yes," did the organization make it available to the public? ...............
6b
Yes
 
Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.
7
Financial Assistance and Certain Other Community Benefits at Cost
Financial Assistance
and Means-Tested Government Programs		 (a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community benefit expense (d) Direct offsetting revenue (e) Net community benefit expense (f) Percent of total expense
a Financial Assistance at cost
(from Worksheet 1) .. 		    4,812,617 807,427 4,005,190 0.610 %
b Medicaid (from Worksheet 3, column a) .....     14,120,434 8,780,366 5,340,068 0.820 %
c Costs of other means-tested government programs (from Worksheet 3, column b) .            
dTotal Financial Assistance and
Means-Tested Government Programs ..... 		    18,933,051 9,587,793 9,345,258 1.430 %
Other Benefits
e Community health improvement
services and community
benefit operations (from
(Worksheet 4) .... 		    2,677,371 439,685 2,237,686 0.340 %
f Health professions education
(from Worksheet 5) .. 		    41,619,579 6,977,203 34,642,376 5.310 %
g Subsidized health services
(from Worksheet 6) .. 		           
h Research (from Worksheet 7)     39,649,422 3,225,879 36,423,543 5.590 %
i Cash and in-kind contributions for community benefit (from Worksheet 8) ....            
jTotal Other Benefits ...     83,946,372 10,642,767 73,303,605 11.240 %
kTotal. Add lines 7d and 7j. ..     102,879,423 20,230,560 82,648,863 12.670 %
For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part II
Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.
(a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community building expense (d) Direct offsetting
revenue 		(e) Net community building expense (f) Percent of total expense
1 Physical improvements and housing            
2 Economic development            
3 Community support            
4 Environmental improvements            
5 Leadership development and training for community members            
6 Coalition building            
7 Community health improvement advocacy            
8 Workforce development            
9 Other            
10 Total            
Part III
Bad Debt, Medicare, & Collection Practices
Section A. Bad Debt Expense
Yes
No
1
Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................
1
Yes
 
2
Enter the amount of the organization's bad debt expense........
2
1,106,560
3
Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy .....
3
553,280
4
Provide in Part VI the text of the footnote to the organization's financial statements that describes bad debt expense. In addition, describe the costing methodology used in determining the amounts reported on lines 2 and 3, and rationale for including a portion of bad debt amounts as community benefit.
Section B. Medicare
5
Enter total revenue received from Medicare (including DSH and IME).....
5
118,948,263
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
142,191,173
7
Subtract line 6 from line 5. This is the surplus or (shortfall)........
7
-23,242,910
8
Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:
Section C. Collection Practices
9a
Did the organization have a written debt collection policy during the tax year? ..........
9a
Yes
 
b
If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI.......................

9b

Yes

 
Part IV
Management Companies and Joint Ventures
(see instructions)
(a) Name of entity (b) Description of primary
activity of entity 		(c) Organization's
profit % or stock
ownership % 		(d) Officers, directors,
trustees, or key
employees' profit %
or stock ownership% 		(e) Physicians'
profit % or stock
ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information
Section A. Hospital Facilities
(list in order of size from largest to smallest)
How many hospital facilities did the organization operate during the tax year?1
Name and address 		Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital Research Facility ER-24Hours ER-Other Other (Describe)
1 HOSPITAL FOR SPECIAL SURGERY
535 EAST 70TH STREET
NEW YORK,NY10021 		X X   X   X      
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
HOSPITAL FOR SPECIAL SURGERY
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):1

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet the community health needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Participation in the development of a community-wide community benefit plan
d Participation in the execution of a community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. .... 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 100%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 500.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18   No
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section C. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility
(list in order of size, from largest to smallest)
How many non-hospital health care facilities did the organization operate during the tax year?10
Name and address Type of Facility (describe)
1 HOSPITAL FOR SPECIAL SURGERY
635 MADISON AVENUE
NEW YORK,NY10022 		AFFILIATED PHYSICIAN OFFICE
2 HOSPITAL FOR SPECIAL SURGERY
333 EARLE OVINGTON BLVD
UNIONDALE,NY11553 		AFFILIATED PHYSICIAN OFFICE
3 HOSPITAL FOR SPECIAL SURGERY
143 SOUND BEACH AVE
GREENWICH,CT06870 		AFFILIATED PHYSICIAN OFFICE
4 HOSPITAL FOR SPECIAL SURGERY
429 EAST 75TH STREET
NEW YORK,NY10021 		AFFILIATED DIAGNOSTIC CENTER
5 HOSPITAL FOR SPECIAL SURGERY
475 EAST 72TH STREET
NEW YORK,NY10021 		AFFILIATED OUTPATIENT CLINIC & DIAGNOSTIC
6 HOSPITAL FOR SPECIAL SURGERY
600 HERITAGE DRIVE
JUPITER,FL33458 		AFFILIATED REHABILITATION CENTER
7 HOSPITAL FOR SPECIAL SURGERY
523 EAST 72ND STREET
NEW YORK,NY10021 		AFFILIATED PHYSICIAN OFFICE & DIAGNOSTIC
8 HOSPITAL FOR SPECIAL SURGERY
519 EAST 72ND STREET
NEW YORK,NY10021 		AFFILIATED DIAGNOSTIC CENTER
9 HOSPITAL FOR SPECIAL SURGERY
176-60 UNION TURNPIKE
QUEENS,NY11366 		AFFILIATED DIAGNOSTIC CENTER
10 HOSPITAL FOR SPECIAL SURGERY
510 EAST 73RD STREET
NEW YORK,NY10021 		AFFILIATED REHABILITATION CENTER
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VI
Supplemental Information
Complete this part to provide the following information.
1 Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II; Part III, lines 4, 8, and 9b; and Part V, Section B, lines 1j, 3, 4, 5c, 6i, 7, 9, 10, 11h, 13g, 15e, 16e, 17e, 18d, 19d, 20, and 21.
2 Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any needs assessments reported in Part V, Section B.
3 Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4 Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5 Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6 Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7 State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.
Identifier ReturnReference Explanation
PART I, LINE 3C   FREE CARE IS PROVIDED TO PEDIATRIC PATIENTS FOR CLINIC AND DIAGNOSTIC SERVICES WHOSE FAMILY INCOME IS 100% OR BELOW THE FEDERAL POVERTY GUIDELINES. ADULT PATIENTS WITH FAMILY INCOME 100% OR BELOW THE FEDERAL POVERTY GUIDELINES ARE CHARGED A NOMINAL FEE. DISCOUNTED CARE IS PROVIDED TO ALL OTHER PATIENTS ON A SLIDING SCALE BASIS WHOSE FAMILY INCOME IS AT OR BELOW 500% OF THE FEDERAL POVERTY GUIDELINES.
PART I, LINE 7, COLUMN F   2011 BAD DEBT EXPENSE PRESENTED ON THE 2011 AUDITED FINANCIAL STATEMENTS WAS $2,653,621. THIS INCLUDED A REVERSAL OF $2,375,000 FOR A SPECIFIC CASE THAT WAS EXPECTED TO BE UNCOLLECTIBLE. IN 2011, SUBSEQUENT TO THE ISSUANCE OF THE AUDITED FINANCIAL STATEMENTS, PAYMENT WAS RECEIVED ON THIS SPECIFIC CASE. THEREFORE, FOR PURPOSES OF SCHEDULE H, BAD DEBT EXPENSE HAS BEEN ADJUSTED ACCORDINGLY FOR THE SPECIFIC CASE. ADJUSTED BAD DEBT EXPENSE IS $5,028,621. IN ADDITION, TOTAL OPERATING EXPENSE WAS ADJUSTED ACCORDING TO REFLECT THE .35% ($2,128,987) AND 1% ($3,594,237) TAX ASSESSMENTS IMPOSED BY NEW YORK STATE. AS SUCH, THESE FEES WERE ADJUSTED ACCORDINGLY IN LINE 7 AS WELL AS THE TOTAL OPERATING EXPENSE.
PART III, LINE 4   A COST TO CHARGE RATIO OF 41.70% AS CALCULATED PER THE APPLICABLE FORM 990 INSTRUCTIONS WAS APPLIED TO THE BAD DEBT EXPENSE (AT CHARGES) OF $2,653,621 TO CALCULATE THE BAD DEBT EXPENSE OF $1,106,560 AT COST. THE UNCOMPENSATED CARE TEXT OF THE FOOTNOTE TO THE ORGANIZATION'S FINANCIAL STATEMENT STATES, "AS A MATTER OF POLICY, THE HOSPITAL PROVIDES SIGNIFICANT AMOUNTS OF PARTIALLY OR TOTALLY UNCOMPENSATED PATIENT CARE. FOR ACCOUNTING PURPOSES, SUCH UNCOMPENSATED CARE IS TREATED EITHER AS CHARITY CARE UNDER THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY OR AS BAD DEBT EXPENSE. THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY ENSURES THE PROVISION OF QUALITY HEALTH CARE TO THE COMMUNITY SERVED WHILE CAREFULLY CONSIDERING AND TAKING INTO ACCOUNT THE ABILITY OF THE PATIENT TO PAY. THE HOSPITAL'S FINANCIAL ASSISTANCE PROGRAM'S ELIGIBILITY THRESHOLD IS 500% OF THE FEDERAL POVERTY GUIDELINES, WHICH IS IN EXCESS OF THE NEW YORK STATE MINIMUM REQUIREMENTS OF 300%. THE HOSPITAL HAS DEFINED CHARITY CARE FOR ACCOUNTING AND DISCLOSURE PURPOSES AS THE DIFFERENCE BETWEEN ITS CUSTOMARY CHARGES AND THE DISCOUNTED RATES GIVEN TO PATIENTS IN NEED OF FINANCIAL ASSISTANCE. AS THE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY IS NOT PURSUED, SUCH AMOUNTS ARE NOT REPORTED AS REVENUE. PATIENTS WHO DO NOT QUALIFY FOR DISCOUNTED FEES ARE BILLED AT THE HOSPITAL'S ESTABLISHED CHARGES. UNCOLLECTED BALANCES FOR THESE PATIENTS ARE CATEGORIZED AS BAD DEBTS. TOTAL UNCOMPENSATED CARE IN 2011 AND 2010 FOR ALL PATIENT SERVICES AGGREGATED APPROXIMATELY $6.5 MILLION AND $10.4 MILLION RESPECTIVELY. IN ADDITION, THE HOSPITAL OPERATES ITS CLINICS AT A LOSS, TO HELP MEET THE NEEDS OF LOW INCOME AND UNINSURED INDIVIDUALS, AND ALSO OPERATES NUMEROUS OUTREACH AND EDUCATION PROGRAMS WHICH BENEFIT THE COMMUNITIES IT SERVES."
PART III, LINE 8   OVER 40% OF THE HOSPITAL'S INPATIENT POPULATION IS REPRESENTED BY MEDICARE. THE MEDICARE SHORTFALL OF $23,242,910 AS REPORTED IN PART III, LINE 7 WAS CALCULATED USING MEDICARE COST REPORTING PRINCIPLES AND A COST TO CHARGE RATIO METHODOLOGY. THE MEDICARE SHORTFALL SHOULD BE CONSIDERED AS A COMMUNITY BENEFIT BECAUSE THE HOSPITAL IS PROVIDING CARE TO THESE PATIENTS WITH FULL KNOWLEDGE THAT THE MEDICARE REIMBURSEMENT WILL NOT COVER THE COST OF PROVIDING CARE TO THESE RESIDENTS OF OUR COMMUNITY.
PART III, LINE 9B   SELF PAY BALANCES, INCLUDING THOSE BALANCES DUE AFTER PAYMENT FROM AN INSURANCE CARRIER AND THE PATIENT RESPONSIBILITY PORTION RELATED TO FINANCIAL ASSISTANCE AFTER THE DISCOUNT HAS BEEN APPLIED, ARE HANDLED ACCORDING TO THE FOLLOWING POLICY: ALL PATIENTS ARE BILLED USING STANDARD CYCLES INCLUDING THE ISSUANCE OF A DETAILED BILL, COLLECTION LETTERS AND/OR TELEPHONE CALLS, AND THEN TRANSFER TO A "PRE-COLLECTION STATUS." THESE COLLECTION EFFORTS ARE DOCUMENTED ELECTRONICALLY IN THE PATIENT'S FILE. DURING THE PRE-COLLECTION PHASE, ADDITIONAL TELEPHONE CALLS AND/OR LETTERS ARE MADE TO ATTEMPT TO COLLECT PAYMENT IN FULL. IF UNSUCCESSFUL, THE ACCOUNT IS TRANSFERRED TO A PROFESSIONAL COLLECTION AGENCY, NO LESS THAN 120 DAYS AFTER THE ORIGINAL SELF PAY BILLING DATE. THESE REASONABLE COLLECTION EFFORTS INCLUDE ALL PATIENT ACCOUNTS, FOR BOTH MEDICARE AND NON-MEDICARE PATIENTS. MEDICARE AND NON-MEDICARE ACCOUNTS ARE RECORDED SEPARATELY. ANY PATIENTS EXPRESSING INTEREST IN APPLYING FOR FINANCIAL ASSISTANCE WILL HAVE THEIR BILLS HELD PENDING ELIGIBILITY DETERMINATION. IF PATIENT IS ELIGIBLE, THE ACCOUNT WILL BE REDUCED BASED ON THE APPROPRIATE SLIDING SCALE DISCOUNT AND THE RESULTING BALANCE WILL BE RE-BILLED ACCORDINGLY. PAYMENTS RECEIVED BY THE COLLECTION AGENCY REDUCE THE AMOUNT RECORDED AS BAD DEBT. IT IS THE HOSPITAL'S PRACTICE NOT TO FILE SUIT, ATTACH ASSETS, OR PURSUE LIENS FOR ALL PATIENTS INCLUSIVE OF FAP ELIGIBLE PATIENTS. IN CERTAIN INSTANCES, IN COORDINATION WITH THE HOSPITAL'S INTERNAL LEGAL COUNSEL, THE HOSPITAL MAY TAKE SUCH MEASURES IF DEEMED WARRANTED. PAYMENT ARRANGEMENTS: IF PATIENTS ARE UNABLE TO PAY THE ENTIRE BALANCE IN FULL, PAYMENT ARRANGEMENTS OF MONTHLY PAYMENT WILL BE OFFERED. UNDER SUCH ARRANGEMENTS, ACCOUNTS ARE TYPICALLY PAID IN FULL WITHIN SIX TO TWELVE MONTHS UNLESS OTHERWISE EXTENDED AS PART OF THE FINANCIAL ASSISTANCE PROGRAM. A CONFIRMATION LETTER WILL BE SENT WITHIN 5 DAYS, EXPLAINING THE TERMS OF THE AGREEMENT. IF MONTHLY PAYMENT IS MISSED, THE ACCOUNT WILL PROGRESS TO THE NEXT STAGE IN THE CYCLE.
PART V, LINE 11H   PER HOSPITAL POLICY, ASSETS MAY BE CONSIDERED IN THE CALCULATION UTILIZED IN DETERMINING DISCOUNTS TO PATIENTS. HOWEVER, IN PRACTICE, ASSETS ARE NOT CONSIDERED IN ANY DETERMINATION.
PART V, LINE 13G   INFORMATION ABOUT THE AVAILABILITY OF THE FINANCIAL ASSISTANCE PROGRAM IS POSTED IN SIGNAGE IN ALL AREAS OF THE HOSPITAL AND ANCILLARY SERVICE LOCATIONS WHERE A PATIENT IS REGISTERED FOR SERVICES. IN ADDITION, THE SUMMARY OF THE HOSPITAL'S POLICY IS POSTED ON THE HOSPITAL'S WEBSITE. ANY HOSPITAL BILL RECEIVED BY THE PATIENT FOR SERVICE CONTAINS INFORMATION ON THE AVAILABILITY OF THE FINANCIAL ASSISTANCE PROGRAM. ADDITIONALLY, ANY BILL SENT TO A PATIENT BY THE HOSPITAL OR THE HOSPITAL'S COLLECTION SERVICE CONTAINS INFORMATION ON THE AVAILABILITY OF THE FINANCIAL ASSISTANCE PROGRAM. ALL REGISTRATION, CUSTOMER SERVICE, AND PATIENT ACCOUNTING STAFF ARE TRAINED ON THE AVAILABILITY OF THE PROGRAM AND INSTRUCTED ON HOW AND WHEN TO COMMUNICATE THIS INFORMATION. THE FINANCIAL ASSISTANCE COUNSELOR INFORMS PATIENTS IF THEY QUALIFY FOR FREE OR LOW-COST HEALTH INSURANCE SUCH AS MEDICAID, CHILD HEALTH PLUS, AND FAMILY HEALTH PLUS, AND MAKES THE ELIGIBILITY DETERMINATION FOR THE HSS FINANCIAL ASSISTANCE PROGRAM. THE COUNSELOR ASSISTS THE PATIENT IN FILLING OUT ALL THE FORMS.
PART V, LINE 15   IT IS THE HOSPITAL'S PRACTICE NOT TO FILE SUIT, ATTACH ASSETS, OR PURSUE LIENS AS COLLECTION ACTIONS FOR ALL PATIENTS INCLUSIVE OF FAP ELIGIBLE PATIENTS. IN CERTAIN INSTANCES, IN COORDINATION WITH THE HOSPITAL'S INTERNAL LEGAL COUNSEL, THE HOSPITAL MAY TAKE SUCH MEASURES IF DEEMED WARRANTED.
PART V, LINE 18D   THE HOSPITAL FOR SPECIAL SURGERY IS A SPECIALTY ORTHOPEDIC HOSPITAL AND DOES NOT OPERATE AN EMERGENCY ROOM. THE HOSPITAL IS AFFILIATED WITH THE NEW YORK PRESBYTERIAN HEALTH SYSTEM, WHICH OPERATES A FULL SERVICE HOSPITAL MAINTAINING AN EMERGENCY ROOM LOCATED ADJACENT TO THE HOSPITAL FOR SPECIAL SURGERY.
PART V, LINE 19D & 21   FOR THOSE UNINSURED PATIENTS ELIGIBLE FOR FINANCIAL ASSISTANCE, THE AMOUNTS BILLED TO INDIVIDUALS ARE BASED ON A SLIDING SCALE DISCOUNT FROM THE AMOUNT MEDICAID WOULD HAVE PAID FOR A SIMILAR SERVICE.
NEEDS ASSESSMENT   HOSPITAL FOR SPECIAL SURGERY'S NEEDS ASSESSMENT PROCESS INCORPORATES RELEVANT NATIONAL, STATE, AND CITY HEALTH DATA, GOALS, AND PRIORITIES. THE HOSPITAL UTILIZES THE US GOVERNMENT REPORT, HEALTHY PEOPLE 2010, WHICH SETS BROAD-BASED GOALS AND OBJECTIVES TO EXPAND AMERICANS ACCESS TO CARE, AND TO ELIMINATE HEALTH DISPARITIES BY AGE, GENDER, RACE, OR DISABILITIES, AND PAYS SPECIAL ATTENTION TO INFORMATION REGARDING THE NEEDS OF ALL NEW YORKERS. THE HOSPITAL ROUTINELY CONDUCTS NEEDS ASSESSMENTS AMONG KEY GROUPS IN ITS COMMUNITY, ON WHICH TO BASE MULTI-YEAR PROGRAMS. OTHER NEEDS ASSESSMENT DATA IS GATHERED THROUGH A RIGOROUS EVALUATION PROCESS OF PUBLIC PROGRAMS. ALL HOSPITAL PUBLIC AND PATIENT EDUCATION PROGRAMS, AND DIAGNOSIS-BASED SUPPORT AND EDUCATION GROUPS INCLUDE PARTICIPANT QUESTIONNAIRES, AND THE FEEDBACK FROM THESE ARE TABULATED, EVALUATED, AND USED IN FORMULATING NEW OR REFINED OFFERINGS FOR THE PUBLIC HEALTH. FURTHER, THE HOSPITAL'S SERVICE EXCELLENCE COUNCIL REVIEWS PRESS GANEY MONTHLY PATIENT COMMENTS AND QUARTERLY REPORTS, AND ALONG WITH DEPARTMENTAL MANAGERS AND MULTIDISCIPLINARY TEAMS DEVELOPS IMPROVEMENTS IN SERVICES BASED ON THIS FEEDBACK OF PATIENTS' NEEDS. FINALLY, TO ENSURE THE RANGE OF NEEDS IS INTERPRETED AT THE HIGHEST LEVEL OF MANAGEMENT, THE BOARD OF TRUSTEES RECEIVES AND REVIEWS ONGOING REPORTS THAT INCLUDE RESULTS OF PATIENTS' SATISFACTION SURVEYS AND A SUMMARY OF THE HOSPITAL-WIDE QUALITY ASSESSMENT AND PERFORMANCE IMPROVEMENT PROGRAM.
PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE   INFORMATION ABOUT THE AVAILABILITY OF THE FINANCIAL ASSISTANCE PROGRAM IS POSTED IN SIGNAGE IN ALL AREAS OF THE HOSPITAL AND ANCILLARY SERVICE LOCATIONS WHERE A PATIENT IS REGISTERED FOR SERVICES. ANY HOSPITAL BILL RECEIVED BY THE PATIENT FOR SERVICE CONTAINS INFORMATION ON THE AVAILABILITY OF THE FINANCIAL ASSISTANCE PROGRAM. ADDITIONALLY, ANY BILL SENT TO A PATIENT BY THE HOSPITAL OR THE HOSPITAL'S COLLECTION SERVICE CONTAINS INFORMATION ON THE AVAILABILITY OF THE FINANCIAL ASSISTANCE PROGRAM. ALL REGISTRATION, CUSTOMER SERVICE, AND PATIENT ACCOUNTING STAFF ARE TRAINED ON THE AVAILABILITY OF THE PROGRAM AND INSTRUCTED ON HOW AND WHEN TO COMMUNICATE THIS INFORMATION. THE FINANCIAL ASSISTANCE COUNSELOR INFORMS PATIENTS IF THEY QUALIFY FOR FREE OR LOW-COST HEALTH INSURANCE SUCH AS MEDICAID, CHILD HEALTH PLUS, AND FAMILY HEALTH PLUS, AND MAKES THE ELIGIBILITY DETERMINATION FOR THE HSS FINANCIAL ASSISTANCE PROGRAM. THE COUNSELOR ASSISTS THE PATIENT IN FILLING OUT ALL THE FORMS.
COMMUNITY INFORMATION   THE HOSPITAL FOR SPECIAL SURGERY'S COMMUNITY IS DEFINED BY THE FIVE BOROUGHS. THE SUBURBAN COUNTIES IN NEW YORK, NEW JERSEY AND CONNECTICUT ALSO COMPRISE OUR SECONDARY SERVICE AREA. THE IMMEDIATE COMMUNITY IS DEFINED BY NEW YORK CITY'S COMMUNITY BOARD #8, WHICH EXTENDS FROM 59TH STREET TO 96TH STREET AND EAST FROM FIFTH AVENUE TO THE EAST RIVER. HSS PATIENTS COME FROM MANY COMMUNITIES LOCALLY, REGIONALLY, NATIONALLY, AS WELL AS INTERNATIONALLY.
PROMOTION OF COMMUNITY HEALTH   HOSPITAL FOR SPECIAL SURGERY'S COMMUNITY AND PROFESSIONAL OUTREACH BRINGS INFORMATION TO THE COMMUNITY THROUGH EDUCATIONAL, MULTI-SERVICE SOCIAL SERVICE AGENCIES, FAITH-BASED ORGANIZATIONS, SUPPORT AND EDUCATION GROUPS AND PROGRAMS, COMMUNITY-BASED ORGANIZATIONS, ACADEMIC INSTITUTIONS, HEALTH FAIRS, AND PUBLIC EVENTS, AS WELL AS TO PUBLIC SCHOOLS HEALTH CLINICS, AND COMMUNITY HOSPITALS . WE REACH OUT TO UNDERSERVED POPULATIONS AND SEEK TO SERVE AND COLLABORATE WITH ORGANIZATIONS TO ENGAGE COMMUNITIES AROUND MAJOR HEALTH ISSUES. IN 2011, THE HOSPITAL SPONSORED VARIOUS COMMUNITY OUTREACH PROGRAMS INCLUDING THE OSTEOARTHRITIS WELLNESS INITIATIVE, OSTEOPOROSIS WELLNESS INITIATIVE, LEON ROOT, MD PEDIATRIC OUTREACH PROGRAM, GREENBERG ACADEMY FOR SUCCESSFUL AGING, LUPUSLINE, LANTERN (LUPUS ASIAN NETWORK) THE SLE WORKSHOP, EARLY RHEUMATOID ARTHRITIS AND LIVING WITH RHEUMATOID ARTHRITIS SUPPORT AND EDUCATION GROUPS, VOICES 60+ SENIOR ADVOCACY PROGRAM, AND THE MYOSITIS SUPPORT AND EDUCATION GROUP. THE HOSPITAL ALSO PARTICIPATED AND CO-SPONSORED NUMEROUS COMMUNITY-BASED EVENTS, INCLUDING THOSE WITH THE ARTHRITIS FOUNDATION NORTH EAST REGION AND THE NEW YORK CHAPTER, THE NATIONAL OSTEOPOROSIS FOUNDATION, THE SLE LUPUS FOUNDATION, AND THE ALLIANCE FOR LUPUS RESEARCH'S NYC LUPUS WALK. IN 2011 WE COLLABORATED WITH OVER TWENTY COMMUNITY ORGANIZATIONS TO MEET EDUCATIONAL NEEDS FOR UNDERSERVED COMMUNITIES IN AREAS SUCH AS MUSCULOSKELETAL HEALTH, NUTRITION AND PHYSICAL ACTIVITY, NUTRITION AND REPRODUCTIVE HEALTH, HEALTH RISKS OF OLDER ADULTS (FOR EXAMPLE, FALLS PREVENTION), AND INCREASING AWARENESS OF LUPUS IN CULTURALLY DIVERSE COMMUNITIES. THE HOSPITAL HAD OVER NEARLY 15,000 CONTACTS WITH PATIENTS/PROGRAM PARTICIPANTS THROUGH 125 PROGRAMS AND DISTRIBUTED HEALTH EDUCATION MATERIALS TO OVER 25,000 INDIVIDUALS. THE HOSPITAL IS ALSO PART OF A NATIONAL CLINICAL RESEARCH TRANSLATIONAL CONSORTIUM WHOSE GOAL IS TO ASSESS AND IMPLEMENT THE NEEDS OF UNDERSERVED POPULATIONS IN ORDER TO DEVELOP HEALTH PROGRAMS TO DIVERSE CULTURAL COMMUNITIES IN THE NEW YORK CITY FIVE BOROUGHS. WE ARE ALSO MEMBERS OF NIAMS, NATIONAL MULTICULTURAL OUTREACH INITIATIVE TO REDUCE HEALTH DISPARITIES, THROUGH RELEVANT PUBLIC HEALTH EDUCATIONAL INITIATIVES. AS THE NATION'S LEADING HOSPITAL FOR ORTHOPEDICS AND MUSCULOSKELETAL CARE, THE HSS COMMUNITY IS NATIONAL IN THAT HSS PLAYS A LEADING ROLE IN PROVIDING RESEARCH AND EDUCATION IN THE TREATMENT OF ORTHOPEDIC AND MUSCULOSKELETAL ILLNESS AND CONDITIONS.
STATE FILING OF COMMUNITY BENEFIT REPORT 990 SCHEDULE H, PART VI NY,
Schedule H (Form 990) 2011
Additional Data


Software ID:  
Software Version:  
Schedule J
(Form 990)
Department of the Treasury
Internal Revenue Service
Compensation Information
For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet Complete if the organization answered "Yes" to Form 990,
Part IV, question 23.
SchJMediumBullet Attach to Form 990. SchJMediumBullet See separate instructions.
OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
New York Society for the Relief
of the Ruptured and Crippled Maintaining the
Employer identification number

13-1624135
Part I
Questions Regarding Compensation
Yes
No
1a
Check the appropiate box(es) if the organization provided any of the following to or for a person listed in Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.
b
If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all the expenses described above? If "No," complete Part III to explain....
1b
 
 
2
Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
officers, directors, trustees, and the CEO/Executive Director, regarding the items checked in line 1a? ....
2
 
 
3
Indicate which, if any, of the following the organization uses to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.
4
During the year, did any person listed in Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:
a
Receive a severance payment or change-of-control payment? ...............
4a
 
No
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan? ........
4b
 
No
c
Participate in, or receive payment from, an equity-based compensation arrangement? ........
4c
 
No
If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.
Only 501(c)(3) and 501(c)(4) organizations only must complete lines 5-9.
5
For persons listed in form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:
a
The organization? ...........................
5a
Yes
 
b
Any related organization? .........................
5b
 
No
If "Yes," to line 5a or 5b, describe in Part III.
6
For persons listed in form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:
a
The organization? ...........................
6a
Yes
 
b
Any related organization? .........................
6b
 
No
If "Yes," to line 6a or 6b, describe in Part III.
7
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............
7
 
No
8
Were any amounts reported in Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................
8
 
No
9
If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................
9
 
 
For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990
Cat. No. 50053T
Schedule J (Form 990) 2011

Schedule J (Form 990) 2011
Page 2
Part II
Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.
For each individual whose compensation must be reported in Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.

Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and column (E) for that individual.
(A) Name (B) Breakdown of W-2 and/or 1099-MISC compensation (C) Retirement and other deferred compensation (D) Nontaxable
benefits		 (E) Total of columns
(B)(i)-(D) 		(F) Compensation
reported as deferred
in prior Form 990
(i) Base compensation (ii) Bonus & incentive compensation (iii) Other reportable compensation
(1) Mathias Bostrom (i)
(ii)		 174,686
0 		0
0 		0
0 		16,200
0 		6,370
0 		197,256
0 		0
0
(2) Mary Crow (i)
(ii)		 507,160
0 		152,750
0 		3,133
0 		22,050
0 		25,032
0 		710,125
0 		0
0
(3) Charles Cornell (i)
(ii)		 216,144
  		0
  		882
  		19,800
  		22,248
  		259,074
  		0
 
(4) Steven Goldring (i)
(ii)		 478,431
  		118,209
  		3,086
  		18,375
  		26,919
  		645,020
  		0
 
(5) Gregory Liguori (i)
(ii)		 441,264
  		67,500
  		675
  		22,050
  		25,077
  		556,566
  		0
 
(6) Thomas Sculco (i)
(ii)		 990,153
  		115,000
  		9,155
  		22,050
  		28,584
  		1,164,942
  		0
 
(7) Louis A Shapiro (i)
(ii)		 817,687
204,422 		380,000
95,000 		30,180
27,545 		14,700
3,675 		32,486
8,121 		1,275,053
338,763 		0
0
(8) Lisa Goldstein (i)
(ii)		 602,190
89,983 		251,134
37,526 		20,923
3,127 		19,183
2,867 		23,866
3,566 		917,296
137,069 		0
0
(9) Stacey Malakoff (i)
(ii)		 588,502
103,853 		268,153
47,321 		25,699
14,535 		18,742
3,308 		28,121
4,962 		929,217
173,979 		0
0
(10) Constance B Margolin (i)
(ii)		 387,679
68,414 		145,736
25,718 		14,701
2,593 		18,743
3,307 		16,625
2,934 		583,484
102,966 		0
0
(11) Deborah Sale (i)
(ii)		 133,921
248,713 		60,270
111,930 		616
1,144 		7,718
14,332 		17,312
32,150 		219,837
408,269 		0
0
(12) Ralph Bianco (i)
(ii)		 292,718
32,524 		73,863
8,207 		1,930
214 		19,845
2,205 		25,552
2,839 		413,908
45,989 		0
0
(13) Stephanie Goldberg (i)
(ii)		 355,812
  		144,287
  		0
  		18,375
  		36,936
  		555,410
  		0
 
(14) Helen Pavlov (i)
(ii)		 603,880
  		200,532
  		443,678
  		22,050
  		40,985
  		1,311,125
  		0
 
(15) James Farmer (i)
(ii)		 425,987
  		0
  		1,125,165
  		22,050
  		23,348
  		1,596,550
  		0
 
(16) Hollis Potter (i)
(ii)		 509,307
  		210,000
  		587,178
  		22,050
  		42,017
  		1,370,552
  		0
 
(17) Scott Rodeo (i)
(ii)		 357,214
  		0
  		794,465
  		22,050
  		26,634
  		1,200,363
  		0
 
(18) Edward Craig (i)
(ii)		 261,153
  		0
  		749,047
  		22,050
  		51,453
  		1,083,703
  		0
 
(19) Ernest Sink (i)
(ii)		 288,117
  		0
  		713,421
  		18,375
  		22,769
  		1,042,682
  		0
 
Schedule J (Form 990) 2011

Schedule J (Form 990) 2011
Page 3
Part III
Supplemental Information
Complete this part to provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4c, 5a, 5b, 6a, 6b, 7, and 8. Also complete this part for any additional information.
Identifier Return Reference Explanation
Schedule J, Part I, Line 1A   There was no first class travel reimbursed in 2011. The HSS travel policy states for business class travel prior approval from the CEO is required and usually only approved if the length of the flight is greater than 5 hours. Upgrade to first class occurs only if business class does not exist. With regards to the CEO and Surgeon-in-Chief travel, the CEO and Surgeon-in-Chief have approval from the Compensation Committee of the Board to fly business class if the flight is greater than 5 hours. The Board of Trustees reviews the CEO's and Surgeon-in-Chief' expenses on a quarterly basis. Business class or first class travel are not treated as taxable compensation.
Schedule J, Part I, Line 5A   Certain employed physcians listed on Part VII, Section A, Line 1A receive compensation in part, based on professional service revenue generated from services they personally performed in their individual practices. No physician is paid compensation contingent upon the organization's overall revenue or net earnings.
Schedule J, Part I, Line 6A   Performance based incentive awards are paid to officers and key employees based on a number of important quality, satisfaction, efficiency, and financial measures, of which achieving budget is a factor.
Schedule J (Form 990) 2011

Additional Data


Software ID:  
Software Version:  
Schedule K
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Information on Tax Exempt Bonds
SchKMediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, line 24a. Provide descriptions,
explanations, and any additional information in Part VI.
SchKMediumBullet Attach to Form 990. SchKMediumBullet See separate instructions.
OMB No. 1545-0047
2011
Open to Public
Inspection
Name of the organization
New York Society for the Relief
of the Ruptured and Crippled Maintaining the
Employer identification number
13-1624135
Part I
Bond Issues
(a) Issuer Name (b) Issuer EIN (c) CUSIP # (d) Date Issued (e) Issue Price (f) Description of Purpose (g) Defeased (h) On
Behalf of
Issuer 		(i) Pool
financing
Yes No Yes No Yes No
A DORMITORY AUTHORITY OF THE STATE OF NY
  		14-6000293 64983QPX1 10-20-2005 63,089,225 HOSPITAL EXPANSION & EQUIPMENT   X   X   X
B DORMITORY AUTHORITY OF THE STATE OF NY
  		14-6000293 000000000 12-03-2009 86,880,597 HOSPITAL EXPANSION & EQUIPMENT   X   X   X
C DORMITORY AUTHORITY OF THE STATE OF NY
  		14-6000293 000000000 11-25-2008 4,982,850 TAX EXEMPT EQUIPMENT LEASING   X   X   X
D DORMITORY AUTHORITY OF THE STATE OF NY
  		14-6000293 000000000 10-15-2009 5,980,000 TAX EXEMPT EQUIPMENT LEASING   X   X   X
DORMITORY AUTHORITY OF THE STATE OF NY
  		14-6000293 000000000 10-06-2010 6,700,000 TAX EXEMPT EQUIPMENT LEASING   X   X   X
DORMITORY AUTHORITY OF THE STATE OF NY
  		14-6000293 000000000 07-13-2011 16,000,000 TAX EXEMPT EQUIPMENT LEASING   X   X   X
Part II
Proceeds
A B C D
1 Amount of bonds retired . . . . . . . . . . . . . 7,140,000 0 2,460,645 2,009,097
2 Amount of bonds legally defeased . . . . . . . . . . 0 0 0 0
3 Total proceeds of issue . . . . . . . . . . . . . 64,278,450 86,904,329 4,982,850 5,980,000
4 Gross proceeds in reserve funds . . . . . . . . 4,480,000 6,670,000 0 0
5 Capitalized interest from proceeds . . . . . . . . . . 2,501,910 6,110,242 0 0
6 Proceeds in refunding escrows . . . . . . . . . . . 0 0 0 0
7 Issuance costs from proceeds . . . . . . . . . . . 1,164,214 1,440,616 42,850 50,000
8 Credit enhancement from proceeds . . . . . . . . . . 969,865 1,031,004 0 0
9 Working capital expenditures from proceeds . . . . . . . 0 0 0 0
10 Capital expenditures from proceeds . . . . . . . . . . 53,996,553 70,375,880 4,940,000 5,930,000
11 Other spent proceeds . . . . . . . . . . . 1,165,907 18,252 0 0
12 Other unspent proceeds . . . . . . . . . . . 0 1,258,335 0 0
13 Year of substantial completion . . . . . . . . . . . 2006 2012 2008 2009
Yes No Yes No Yes No Yes No
14 Were the bonds issued as part of a current refunding issue? . . . .   X   X   X   X
15 Were the bonds issued as part of an advance refunding issue? . . . .   X   X   X   X
16 Has the final allocation of proceeds been made? . . . . . . X     X X   X  
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? . . . . . . . . . . . . . X   X   X   X  
Part III
Private Business Use
A B C D
Yes No Yes No Yes No Yes No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? . . . . . . .   X   X   X   X
2 Are there any lease arrangements that may result in private business use of bond-financed property? . . . . . . . . .   X   X   X   X
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50193E
Schedule K (Form 990) 2011
Schedule K (Form 990) 2011
Page 2
Part III
Private Business Use (Continued)
A B C D
Yes No Yes No Yes No Yes No
3a Are there any management or service contracts that may result in private business use of bond-financed property? . . . . . . . . . X   X     X   X
b If ‘Yes’ to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property? . . . . . X   X          
c Are there any research agreements that may result in private business use of bond-financed property? . . . . . . . X   X   X   X  
d If ‘Yes’ to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property? . X   X   X   X  
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government . . SchKMediumBullet 0% 0.00000% 0% 0%
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government . . . . . . . SchKMediumBullet 0.00000% 0.00000%   %   %
6 Total of lines 4 and 5 . . .. . . . . . . . . 0% 0.00000% 0% 0%
7 Does the bond issue meet the private security or payment test? . . . X   X   X   X  
8 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under
Regulations sections 1.141-12 and 1.145-2?
X   X   X   X  
Part IV
Arbitrage
A B C D
Yes No Yes No Yes No Yes No
1 Has a Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate, been filed with respect to the bond issue? . . .   X   X   X   X
2 Is the bond issue a variable rate issue?   X   X   X   X
3a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?   X   X   X   X
b Name of provider . . . . . . . . 0
  		0
  		0
  		 
 
c Term of hedge . . . . . . . .        
d Was the hedge superintegrated? . . . .                
e Was a hedge terminated? . . . . .                
4a Were gross proceeds invested in a guaranteed investment contract (GIC)? . . . . . . X     X   X   X
b Name of provider . . . . . . MBIA INC
  		0
  		0
  		0
 
c Term of GIC . . . . . . . 28.      
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? . . . . . . X              
5 Were any gross proceeds invested beyond an available temporary period? . . . . . .   X   X   X   X
6 Did the bond issue qualify for an exception to rebate? .   X   X   X   X
7 Has the organization established written procedures to monitor the requirements of section 148? . . .   X   X   X   X
Schedule K (Form 990) 2011

Schedule K (Form 990) 2011
Page 3
Part V
Procedures To Undertake Corrective Action
Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations? . . . . . . . . . . . . . .
Part VI
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule K (see instructions).
Identifier Return Reference Explanation
SCHEDULE K, PART I & II 0 FOR THE 2005 & 2009 HOSPITAL EXPANSION & EQUIPMENT ISSUES, TOTAL PROCEEDS (PART II, LINE 3) EXCEEDS THE ISSUE PRICE (PART I, COLUMN C) DUE TO INVESTMENT EARNINGS ON GROSS PROCEEDS HELD IN RESERVE FUNDS INCLUDED IN TOTAL PROCEEDS.
Schedule K (Form 990) 2011

Additional Data


Software ID:  
Software Version:  

Schedule K
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Information on Tax Exempt Bonds
SchKMediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, line 24a. Provide descriptions,
explanations, and any additional information in Part VI.
SchKMediumBullet Attach to Form 990. SchKMediumBullet See separate instructions.
OMB No. 1545-0047
2011
Open to Public
Inspection
Name of the organization
New York Society for the Relief
of the Ruptured and Crippled Maintaining the
Employer identification number
13-1624135
Part I
Bond Issues
(a) Issuer Name (b) Issuer EIN (c) CUSIP # (d) Date Issued (e) Issue Price (f) Description of Purpose (g) Defeased (h) On
Behalf of
Issuer 		(i) Pool
financing
Yes No Yes No Yes No
A DORMITORY AUTHORITY OF THE STATE OF NY
  		14-6000293 64983QPX1 10-20-2005 63,089,225 HOSPITAL EXPANSION & EQUIPMENT   X   X   X
B DORMITORY AUTHORITY OF THE STATE OF NY
  		14-6000293 000000000 12-03-2009 86,880,597 HOSPITAL EXPANSION & EQUIPMENT   X   X   X
C DORMITORY AUTHORITY OF THE STATE OF NY
  		14-6000293 000000000 11-25-2008 4,982,850 TAX EXEMPT EQUIPMENT LEASING   X   X   X
D DORMITORY AUTHORITY OF THE STATE OF NY
  		14-6000293 000000000 10-15-2009 5,980,000 TAX EXEMPT EQUIPMENT LEASING   X   X   X
DORMITORY AUTHORITY OF THE STATE OF NY
  		14-6000293 000000000 10-06-2010 6,700,000 TAX EXEMPT EQUIPMENT LEASING   X   X   X
DORMITORY AUTHORITY OF THE STATE OF NY
  		14-6000293 000000000 07-13-2011 16,000,000 TAX EXEMPT EQUIPMENT LEASING   X   X   X
Part II
Proceeds
A B C D
1 Amount of bonds retired . . . . . . . . . . . . . 7,140,000 0 2,460,645 2,009,097
2 Amount of bonds legally defeased . . . . . . . . . . 0 0 0 0
3 Total proceeds of issue . . . . . . . . . . . . . 64,278,450 86,904,329 4,982,850 5,980,000
4 Gross proceeds in reserve funds . . . . . . . . 4,480,000 6,670,000 0 0
5 Capitalized interest from proceeds . . . . . . . . . . 2,501,910 6,110,242 0 0
6 Proceeds in refunding escrows . . . . . . . . . . . 0 0 0 0
7 Issuance costs from proceeds . . . . . . . . . . . 1,164,214 1,440,616 42,850 50,000
8 Credit enhancement from proceeds . . . . . . . . . . 969,865 1,031,004 0 0
9 Working capital expenditures from proceeds . . . . . . . 0 0 0 0
10 Capital expenditures from proceeds . . . . . . . . . . 53,996,553 70,375,880 4,940,000 5,930,000
11 Other spent proceeds . . . . . . . . . . . 1,165,907 18,252 0 0
12 Other unspent proceeds . . . . . . . . . . . 0 1,258,335 0 0
13 Year of substantial completion . . . . . . . . . . . 2006 2012 2008 2009
Yes No Yes No Yes No Yes No
14 Were the bonds issued as part of a current refunding issue? . . . .   X   X   X   X
15 Were the bonds issued as part of an advance refunding issue? . . . .   X   X   X   X
16 Has the final allocation of proceeds been made? . . . . . . X     X X   X  
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? . . . . . . . . . . . . . X   X   X   X  
Part III
Private Business Use
A B C D
Yes No Yes No Yes No Yes No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? . . . . . . .   X   X   X   X
2 Are there any lease arrangements that may result in private business use of bond-financed property? . . . . . . . . .   X   X   X   X
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50193E
Schedule K (Form 990) 2011
Schedule K (Form 990) 2011
Page 2
Part III
Private Business Use (Continued)
A B C D
Yes No Yes No Yes No Yes No
3a Are there any management or service contracts that may result in private business use of bond-financed property? . . . . . . . . . X   X     X   X
b If ‘Yes’ to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property? . . . . . X   X          
c Are there any research agreements that may result in private business use of bond-financed property? . . . . . . . X   X   X   X  
d If ‘Yes’ to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property? . X   X   X   X  
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government . . SchKMediumBullet 0% 0.00000% 0% 0%
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government . . . . . . . SchKMediumBullet 0.00000% 0.00000%   %   %
6 Total of lines 4 and 5 . . .. . . . . . . . . 0% 0.00000% 0% 0%
7 Does the bond issue meet the private security or payment test? . . . X   X   X   X  
8 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under
Regulations sections 1.141-12 and 1.145-2?
X   X   X   X  
Part IV
Arbitrage
A B C D
Yes No Yes No Yes No Yes No
1 Has a Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate, been filed with respect to the bond issue? . . .   X   X   X   X
2 Is the bond issue a variable rate issue?   X   X   X   X
3a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?   X   X   X   X
b Name of provider . . . . . . . . 0
  		0
  		0
  		 
 
c Term of hedge . . . . . . . .        
d Was the hedge superintegrated? . . . .                
e Was a hedge terminated? . . . . .                
4a Were gross proceeds invested in a guaranteed investment contract (GIC)? . . . . . . X     X   X   X
b Name of provider . . . . . . MBIA INC
  		0
  		0
  		0
 
c Term of GIC . . . . . . . 28.      
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? . . . . . . X              
5 Were any gross proceeds invested beyond an available temporary period? . . . . . .   X   X   X   X
6 Did the bond issue qualify for an exception to rebate? .   X   X   X   X
7 Has the organization established written procedures to monitor the requirements of section 148? . . .   X   X   X   X
Schedule K (Form 990) 2011

Schedule K (Form 990) 2011
Page 3
Part V
Procedures To Undertake Corrective Action
Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations? . . . . . . . . . . . . . .
Part VI
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule K (see instructions).
Identifier Return Reference Explanation
SCHEDULE K, PART I & II 0 FOR THE 2005 & 2009 HOSPITAL EXPANSION & EQUIPMENT ISSUES, TOTAL PROCEEDS (PART II, LINE 3) EXCEEDS THE ISSUE PRICE (PART I, COLUMN C) DUE TO INVESTMENT EARNINGS ON GROSS PROCEEDS HELD IN RESERVE FUNDS INCLUDED IN TOTAL PROCEEDS.
Schedule K (Form 990) 2011

Additional Data


Software ID:  
Software Version:  

Schedule L
(Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
Transactions with Interested Persons
MediumBullet Complete if the organization answered
"Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c,
or Form 990-EZ, Part V lines 38a or 40b.
MediumBullet Attach to Form 990 or Form 990-EZ. MediumBulletSee separate instructions.
OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
New York Society for the Relief
of the Ruptured and Crippled Maintaining the
Employer identification number

13-1624135
Part I
Excess Benefit Transactions (section 501(c)(3) and section 501 (c)(4) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.
1(a) Name of disqualified person (b) Description of transaction (c) Corrected?
Yes No





2
Enter the amount of tax imposed on the organization managers or disqualified persons during the year under section 4958. ......................... Bullet Image$
 
3
Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ....... Bullet Image$
 

Part II
Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 26, or Form 990-EZ, Part V, line 38a.
(a) Name of interested person and purpose (b) Loan to or from the organization? (c)Original principal amount (d)Balance due (e) In default? (f) Approved by board or committee? (g)Written agreement?
To From Yes No Yes No Yes No
Total ...............Small Bullet $  
Part III
Grants or Assistance Benefitting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.
(a) Name of interested person (b)Relationship between interested person and the organization (c)Amount of grant or type of assistance
For Privacy Act and Paperwork Reduction Act Notice, see the
Instructions for Form 990 or 990-EZ.
Cat. No. 50056A
Schedule L (Form 990 or 990-EZ) 2011
Schedule L (Form 990 or 990-EZ) 2011
Page 2
Part IV
Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.
(a) Name of interested person (b) Relationship between interested person and the organization (c) Amount of transaction (d) Description of transaction (e) Sharing of organization's revenues?
Yes No
(1) 143 Sound Beach Avenue Associates SEE PART V 338,083 SEE PART V   No
(2) American Express SEE PART V 40,513,921 SEE PART V   No
(3) Consolidated Edison Company of New SEE PART V 2,666,628 SEE PART V   No
(4) Fortress Investment Group LLC SEE PART V 0 SEE PART V   No
(5) General Electric Company SEE PART V 4,876,892 SEE PART V   No
(6) Goldman Sachs SEE PART V 0 SEE PART V   No
(7) Synthes SEE PART V 2,969,378 SEE PART V   No
(8) Thomson Reuters Healthcare SEE PART V 17,168 SEE PART V   No
(9) Tornier Inc SEE PART V 213,574 SEE PART V   No
Part V
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule L (see instructions).
Identifier Return Reference Explanation
SCHEDULE L, PART IV, (1) - 143 Sound Beach Avenue Associates, L.P.   HSS subleases physician office space from HSS Properties Corporation, an affiliate, which, in turn, leases physician office space from 143 Sound Beach Avenue Associates, L.P. A son of Russell F. Warren, M.D., the former Surgeon-in-Chief of HSS and an elected member of HSS' Board of Trustees, is a part owner of 143 Sound Beach Avenue Associates, L.P., the lessor. HSS Properties Corporation entered into the original lease in October 2000, following a lengthy search for suitable office space in the area, and after an independent valuation of the terms of the lease by a professional, commercial real estate firm confirmed the fair market value of the terms. At that time, Dr. Warren was the Surgeon-in-Chief of HSS and an ex officio member of HSS' Board of Trustees. The potential conflict of interest was disclosed to HSS' Board of Trustees and to the Board of Trustees of HSS Properties Corporation. Dr. Warren recused himself from the review, deliberation and vote. In 2010, HSS Properties renewed the lease through 2021, at a reduced rental rate that reflected a change in the real estate market from the time of the original lease, as confirmed by an independent professional real estate firm. The same due diligence, disclosure and review process (including recusal of Dr. Warren) was followed when the lease was renewed in June 2010. The approvals of the original lease and of the renewal were made by the vote of the disinterested members of the respective Boards of HSS and HSS Properties Corporation AMOUNT OF TRANSACTION: $338,083 DESCRIPTION OF TRANSACTION: HSS Properties Corporation (an affiliate of HSS) made lease payments in 2011 for physician office space it leases that is owned by 143 Sound Beach Avenue Associates, L.P. HSS Properties subleases the space to HSS.
SCHEDULE L, PART IV, (2) - American Express   a. Aldo Papone, Co-Chairman of HSS' Board of Trustees, is currently a senior advisor at American Express. The decision to select American Express for the Buyer Initiated Payment Program (BIPP) was made through a competitive bid process and independent of Mr. Papone. b. Katherine Chenault, a member of HSS' Board of Trustees, is the spouse of Kenneth Chenault, the CEO of American Express. HSS has had a long-standing business relationship with American Express that preceded the date that Mrs.Chenault joined HSS' Board of Trustees AMOUNT OF TRANSACTION: $40,513,921 DESCRIPTION OF TRANSACTION: In 2011, HSS paid its participating vendors $40,513,921 through the American Express Buyer Initiated Payment Program (BIPP) . The BIPP is a program negotiated through the Greater New York Hospital Association (GNYHA). Participating vendors have the benefit of getting paid quicker via use of BIPP and in return the participating vendors pay a fee to American Express. HSS receives a rebate based on its percentage of the total amount spent through the GYNHA program. Separately from the BIPP program, HSS incurred business related charges of $270,665 using HSS' American Express corporate cards.
SCHEDULE L, PART IV, (3) - Consolidated Edison Company of New York   Craig Ivey, a member of HSS' Board of Trustees, is the President of Consolidated Edison Company of New York, Inc. HSS has had a long-standing business relationship with Consolidated Edison Company of New York, Inc. that preceded the date that Mr. Ivey joined HSS' Board of Trustees. AMOUNT OF TRANSACTION: $2,666,628 DESCRIPTION OF TRANSACTION: In 2011, HSS paid Consolidated Edison Company of New York, Inc., $2,666,628 for electrical utility charges.
SCHEDULE L, PART IV, (4) - Fortress Investment Group LLC   Peter Briger, a member of HSS' Board of Trustees and one of two Co-Chairs of HSS' Investment Committee of the Board of Trustees, is the President and a member of the Board of Directors of Fortress Investment Group, LLC. The HSS Investment Committee is comprised of seven members of HSS' Board of Trustees, including Mr. Briger and another HSS Board member, who serve as Co-Chairs of the Investment Committee. All Investment Committee members participate in the deliberation and determination as to where HSS funds will be invested; further, in addition to the seven voting members of the Investment Committee, there are four individuals who attend the Investment Committee meetings as non-voting advisors. HSS does not invest any funds in Fortress. AMOUNT OF TRANSACTION: N/A DISCRIPTION OF TRANSACTION: Neither HSS nor its affiliates invest in Fortress; however, HSS and its affiliates invest a portion of its endowment and pension portfolio in investment funds that may also invest in Fortress and the investment funds in which HSS invests may also receive funds for investment from Fortress.
SCHEDULE L, PART IV, (5) - General Electric Company   Mrs. Douglas A. Warner III, a member of HSS' Board of Trustees, is the spouse of a member of the Board of Directors of General Electric Company (GE). HSS has had a long-standing business relationship with GE that preceded the date that Mrs. Warner joined HSS Board of Trustees, and Mrs. Warner does not have any role in the consideration or acquisition of GE products. AMOUNT OF TRANSACTION: $4,876,892 DESCRIPTION OF TRANSACTION: In 2011, HSS purchased miscellaneous medical equipment from GE.
SCHEDULE L, PART IV, (6) - Goldman Sachs   a. Richard Menschel, a member of HSS' Board of Trustees, is a Senior Director at Goldman Sachs. In 2008, Goldman Sachs engaged HSS to facilitate two of its physicians to see Goldman employee at the firms New York and New Jersey health centers. In November 2009, Goldman Sachs engaged HSS to also provide physical therapy to Goldman Sachs' personnel on the premises of Goldman Sachs facilities in New York and New Jersey. b. Michael Esposito, a member of HSS' Board of Trustees and co-chair of the Finance Committee, is co-head of Global Financial Institutions at Goldman Sachs. In 2008, Goldman Sachs engaged HSS to facilitate two of its physicians to see Goldman employees at the firms New York and New Jersey health centers. In November 2009, Goldman Sachs engaged HSS to also provide physical therapy to Goldman Sachs' personnel on the premises of Goldman Sachs' facilities in New York and New Jersey. Amount of Transaction: N/A Description of Transaction: Reimbursement to HSS is obtained through the customary process of billing the insurance company or the individual receiving physical therapy or other professional services; the physicians bill individually for their services.
SCHEDULE L, PART IV, (7) - Synthes   David Helfet, M.D., Director of the Orthopedic Trauma Service of HSS and an ex-officio, non-voting member of HSS' Board of Trustees, is a Member of the Board of Directors of Synthes. HSS' purchase of products from Synthes is made with independent input and processes in place at HSS. In May 2011, Johnson & Johnson acquired Synthes. As of June 2012, Dr. Helfet is no longer a member of the Board of Directors of Synthes. Amount of Transaction: $2,969,378 Description of Transaction: In 2011, HSS purchased orthopedic implants and other medical devices and supplies from Synthes.
SCHEDULE L, PART IV, (8) - Thomson Reuters Healthcare   Deirdre Stanley, a member of HSS' Board of Trustees, is the General Counsel of Thomson Reuters, the parent company of the Thomson Reuters Healthcare business unit. HSS has had a business relationship with Thomson Reuters Healthcare that preceded the date that Ms. Stanley joined HSS' Board of Trustees. Amount of Transaction: $17,168 Description of Transaction: In 2011, HSS purchased online legal research tools from Westlaw, a Thomson Reuters web based resource company.
SCHEDULE L, PART IV, (9) - Tornier Inc   Jonathan Deland, MD, a member of HSS' Board of Trustees, is a Consultant and Scientific Advisory Board member for Tornier, Inc. In addition, Dr. Deland receives royalties from Tornier, Inc. for the development of an orthopedic device. HSS' Medical Staff does not receive royalty payments for use of products on patients at HSS. HSS' purchase of products from Tornier, Inc. is made with independent input and processes in place at HSS. The purchase of Tornier products preceded the date that Jonathan Deland, M.D. joined HSS' Board of Trustees. Amount of Transaction: $213,574 Description of Transaction: In 2011, HSS purchased orthopedic implants and other medical devices and supplies from Tornier, Inc.
Schedule L (Form 990 or 990-EZ) 2011

Additional Data


Software ID:  
Software Version:  




SCHEDULE M
(Form 990)

Department of the Treasury
Internal Revenue Service
NonCash Contributions
Right pointing arrow large imageComplete if the organization answered "Yes" on Form 990, Part IV, lines 29 or 30.
Right pointing arrow large image Attach to Form 990.
OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
New York Society for the Relief
of the Ruptured and Crippled Maintaining the
Employer identification number

13-1624135
Part I
Types of Property
(a)
Check if applicable 		(b)
Number of Contributions or items contributed 		(c)
Noncash contribution amounts reported on
Form 990, Part VIII, line 1g 		(d)
Method of determining
noncash contribution amounts
1 Art—Works of art ....        
2 Art—Historical treasures .        
3 Art—Fractional interests ..        
4 Books and publications ..      
5 Clothing and household
goods ....... 		     
6 Cars and other vehicles ..        
7 Boats and planes ....        
8 Intellectual property ...        
9 Securities—Publicly traded . X 17 705,726 FMV
10 Securities—Closely held stock .        
11 Securities—Partnership, LLC,
or trust interests .... 		       
12 Securities—Miscellaneous ..        
13 Qualified conservation
contribution—Historic
structures ..... 		       
14 Qualified conservation
contribution—Other ... 		       
15 Real estate—Residential .        
16 Real estate—Commercial ..        
17 Real estate—Other ...        
18 Collectibles .....        
19 Food inventory ...        
20 Drugs and medical supplies .        
21 Taxidermy ......        
22 Historical artifacts ....        
23 Scientific specimens ..        
24 Archeological artifacts ...        
25 Other Right pointing arrow large image ( )
26 Other Right pointing arrow large image( )
27 Other Right pointing arrow large image( )
28 Other Right pointing arrow large image ( )
29
Number of Forms 8283 received by the organization during the tax year for contributions
for which the organization completed Form 8283, Part IV, Donee Acknowledgement ...
29
0
Yes
No
30a
During the year, did the organization receive by contribution any property reported in Part I, lines 1-28 that it
must hold for at least three years from the date of the initial contribution, and which is not required to be used
for exempt purposes for the entire holding period? ..................
30a
 
No
b
If "Yes," describe the arrangement in Part II.
31
Does the organization have a gift acceptance policy that requires the review of any non-standard contributions?
31
Yes
 
32a
Does the organization hire or use third parties or related organizations to solicit, process, or sell noncash
contributions? ............................
32a
Yes
 
b
If "Yes," describe in Part II.
33
If the organization did not report revenues in column (c) for a type of property for which column (a) is checked,
describe in Part II.
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 51227J
Schedule M (Form 990) 2011
Schedule M (Form 990) 2011
Page 2
Part II
Supplemental Information. Complete this part to provide the information required by Part I, lines 30b,
32b, and 33 and whether the organization is reporting in Part I, column (b) the number of contributions, the number of items received, or a combination of both. Also complete this part for any additional information.
Identifier Return Reference Explanation
SCHEDULE M, PART I, LINE 32B   All publicly traded securities are administered and sold through JP Morgan Chase, 1111 Polaris Parkway, Suite 3J, OH1-0634, Columbus, OH 43240.
Schedule M (Form 990) 2011
Additional Data


Software ID:  
Software Version:  
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.
MediumBullet Attach to Form 990 or 990-EZ.
OMB No. 1545-0047
2011
Open to Public
Inspection
Name of the organization
New York Society for the Relief
of the Ruptured and Crippled Maintaining the
Employer identification number

13-1624135
Identifier Return Reference Explanation
FAMILY OR BUSINESS RELATIONSHIPS FROM 990, PART VI, SECTION A - LINE 2 - DANIEL BENTON, TRUSTEE, AND ANNE EHRENKRANZ, TRUSTEE, HAVE A BUSINESS RELATIONSHIP - GORDON PATTEE, TRUSTEE, AND JAMES DINAN, TRUSTEE, HAVE A BUINESS RELATIONSHIP
SIGNIFICANT CHANGES TO GOVERNING DOCUMENTS FORM 990, PART VI, SECTION A, LINE 4 THE ORGANIZATION AMENDED ITS BYLAWS TO INCLUDE A REVISION TO INCREASE THE MAXIMUM NUMBER OF VOTING BOARD MEMBERS (EXCLUDING EX-OFFICO) FROM 40 TO 45.
MEMBERSHIP FROM 990, PART VI, SECTION A - LINE 6 & 7A THE HOSPITAL FOR SPECIAL SURGERY IS A MEMBERSHIP CORPORATION. THERE ARE FIVE MEMBERS OF THE CORPORATION. THREE OF THE FIVE HOSPITAL'S MEMBERS COME FROM THE HOSPITAL'S BOARD OF TRUSTEES (WITH ONE OF THREE ALSO DESIGNATED BY THE HOSPITAL TO SERVE ON THE BOARD OF AN AFFILIATE OF NEW YORK-PRESBYTERIAN HOSPITAL), A FOURTH MEMBER SERVES ON THE BOARD OF THE AFFILIATE OF THE NEW YORK-PRESBYTERIAN HOSPITAL, AND THE FIFTH MEMBER SERVES ON THE BOARD OF TRUSTEES OF WEILL CORNELL MEDICAL COLLEGE. THE FIVE HOSPITAL MEMBERS ELECT THE BOARD OF TRUSTEES OF THE HOSPITAL, UPON THE RECOMMENDATION OF CANDIDATES EITHER BY A MEMBER OR BY THE HOSPITAL BOARD OF TRUSTEES.
REVIEW PROCESS FROM 990, PART VI, SECTION B - LINE 11B PRIOR TO SUBMITTING THE FORM 990 TO THE INTERNAL REVENUE SERVICE (IRS), THERE IS AN ESTABLISHED PROCESS FOR REVIEW OF THE DOCUMENT IN ITS ENTIRETY BY THE GOVERNING BODY WHOSE EVALUATIONS ARE MADE IN THE BEST INTEREST OF HSS. THE FORM 990 IS FIRST REVIEWED WITH THE EXECUTIVE COMPENSATION COMMITTEE OF THE BOARD OF TRUSTEES. THE REVIEWED FORM 990 IS THEN SUBMITTED TO THE FULL BOARD OF TRUSTEES. THE TRUSTEES ARE PROVIDED A COPY OF THE FORM 990 VIA COMPACT DISK PRIOR TO SUBMISSION OF THE FORM. IN ADDITION, SIGNIFICANT AREAS OF FORM 990 ARE DISCUSSED AT A BOARD OF TRUSTEES MEETING.
CONFLICT OF INTEREST POLICY FROM 990, PART VI, SECTION B - LINE 12C ON AN ANNUAL BASIS, FINANCIAL INTEREST DISCLOSURE STATEMENTS ARE SENT TO ALL BOARD MEMBERS, OFFICERS, MEDICAL STAFF, MANAGEMENT, FELLOWS, RESIDENTS, RESEARCH PROFESSIONAL STAFF, IRB MEMBERS, AND OTHER DESIGNATED GROUPS. OUR CONFLICT OF INTEREST POLICY ALSO REQUIRES THAT ANY CHANGES BE COMMUNICATED TO THE OFFICE OF CORPORATE COMPLIANCE WITHIN 30 DAYS. THE INFORMATION RECEIVED IS ENTERED INTO A DATABASE AND REVIEWED FOR POTENTIAL CONFLICT OF INTEREST. THE DATABASE INFORMATION IS ALSO REVIEWED BY THE EXECUTIVE VICE PRESIDENT FOR LEGAL AFFAIRS, THE CHIEF EXECUTIVE OFFICER, AND THE AUDIT AND CORPORATE COMPLIANCE COMMITTEE OF THE BOARD OF TRUSTEES. SUMMARY INFORMATION IS PROVIDED TO SERVICE CHIEFS SO THAT THEY ARE AWARE OF THE FINANCIAL INTERESTS OF THE MEDICAL STAFF WITHIN THEIR SPECIALTY. IN ADDITION TO SENDING DISCLOSURE STATEMENTS DIRECTLY TO THE GROUP NOTED ABOVE, INDUSTRY WEBSITES ARE MONITORED FOR DISCLOSURES RELATED TO EMPLOYEES OF HSS, AND LETTERS ARE SENT TO VENDORS REQUESTING THEY PROVIDE HSS WITH THE INFORMATION ON ANY RELATIONSHIPS THAT THEY HAVE WITH EMPLOYEES OF HSS. THIS INFORMATION IS ENTERED INTO THE DATABASE AS WELL. HSS HAS A CONFLICT OF INTEREST TASK FORCE THAT MEETS THREE TIMES A YEAR, OR AS NECESSARY, TO REVIEW AND UPDATE THE CONFLICT OF INTEREST POLICIES AND PROCEDURES. HSS' POLICY ON CONFLICT OF INTEREST IN DAY-TO-DAY OPERATIONS STATES THAT IF HSS IS CONTEMPLATING A TRANSACTION WHICH MIGHT POSSIBLY BENEFIT (OR APPEAR TO BENEFIT) A COVERED PERSON OR ANY MEMBER OF HIS/HER IMMEDIATE FAMILY THEN THE POTENTIAL BENEFIT OR CONFLICT MUST BE DISCLOSED TO, AND APPROVED BY, A DISINTERESTED OFFICER OF HSS BEFORE THE TRANSACTION MAY PROCEED. ACCORDINGLY, A COVERED PERSON MAY NOT PLACE BUSINESS WITH ANY THIRD PARTY (E.G., A VENDOR, COMPETITOR, OR OTHER ORGANIZATION) IN WHICH THAT PERSON OR ANY MEMBER OF HIS/HER IMMEDIATE FAMILY HAS AN INTEREST UNLESS THAT INTEREST IS DISCLOSED TO, AND THE TRANSACTION IS APPROVED BY, THE VICE PRESIDENT FOR CORPORATE COMPLIANCE ("CORPORATE COMPLIANCE OFFICER").
PROCESS FOR DETERMINING COMPENSATION FROM 990, PART VI, SECTION B - LINE 15A & 15B HSS IS COMMITTED TO ENSURING THAT ITS EXECUTIVE COMPENSATION PROGRAM ADHERES TO THE HIGHEST STANDARDS OF REGULATORY COMPLIANCE AND BEST CORPORATE GOVERNANCE. THE HSS BOARD HAS CHARGED THE COMPENSATION COMMITTEE (WHICH IS COMPOSED OF INDEPENDENT BOARD MEMBERS WITH NO CONFLICTS OF INTEREST IN REGARD TO EXECUTIVE COMPENSATION) WITH MAKING ALL DECISIONS RELATED TO COMPENSATION FOR OFFICERS AND KEY EMPLOYEES. THE COMMITTEE RETAINS AN INDEPENDENT COMPENSATION CONSULTANT TO ASSIST IT IN THIS PROCESS. COMPENSATION LEVELS ARE ESTABLISHED CONSIDERING DATA FOR FUNCTIONALLY COMPARABLE ROLES IN COMPARABLE ORGANIZATIONS, AN ASSESSMENT OF PERFORMANCE, AND OTHER BUSINESS JUDGMENT FACTORS, CONSISTENT WITH HSS'S EXECUTIVE COMPENSATION PHILOSOPHY. THE COMMITTEE'S DECISIONS ARE MADE IN THE BEST INTERESTS OF HSS, AND ARE INTENDED TO ENSURE THE RECRUITMENT AND RETENTION OF KEY EXECUTIVE TALENT, CONSISTENT WITH THE MARKET PRACTICES OF OTHER NOT-FOR-PROFIT HEALTH CARE ORGANIZATIONS OF COMPARABLE SCOPE, MISSION, AND COMPLEXITY. ON AN ANNUAL BASIS (INCLUDING 2011), THE COMMITTEE PROVIDES THE FULL BOARD WITH AN OVERVIEW OF ITS DETERMINATIONS AND PROCESS. HSS ESTABLISHED THIS PROCESS IN AN EFFORT TO COMPLY WITH THE INTERMEDIATE SANCTIONS GUIDELINES FOR QUALIFYING FOR THE REBUTTABLE PRESUMPTION OF REASONABLENESS.
DISCLOSURE GOVERNING DOCUMENTS FROM 990, PART VI, SECTION B - LINE 19 HOSPITAL FOR SPECIAL SURGERY MAKES GOVERNING DOCUMENTS AVAILABLE TO THE GENERAL PUBLIC UPON REQUEST FROM THE DEVELOPMENT OFFICE. CONFLICT OF INTEREST POLICY - HOSPITAL FOR SPECIAL SURGERY MAKES ITS CONFLICT OF INTEREST POLICY AVAILABLE TO THE GENERAL PUBLIC UPON REQUEST FROM THE DEVELOPMENT OFFICE. FINANCIAL STATEMENTS - HOSPITAL FOR SPECIAL SURGERY MAKES ITS AUDITED FINANCIAL STATEMENTS AVAILABLE TO THE GENERAL PUBLIC UPON REQUEST FROM THE DEVELOPMENT OFFICE. HSS ALSO PROVIDES SUMMARIZED FINANCIAL INFORMATION IN ITS ANNUAL REPORT AND WEBSITE. THE ANNUAL REPORT IS DISTRIBUTED THROUGHOUT THE HOSPITAL AND PATIENT WAITING ROOMS, AND ADMINISTRATION OFFICES, AND IS ACCESSIBLE AS A DOWNLOADABLE FILE FROM THE HSS WEBSITE. FOR CALENDAR YEAR 2011, THE ANNUAL REPORT WAS MAILED TO 4,871 DONORS, PUBLIC OFFICIALS, AND OTHER HEALTHCARE PROFESSIONALS AND ORGANIZATIONS.
AVERAGE HOURS PER WEEK DEVOTED TO RELATED ORGANIZATIONS PART VII, SECTION A, COLUMN B MATHIAS BOSTROM - ASSISTANT ATTENDING - .2 HRS/WK HSS FUND INC., .2 HRS/WK HSS PROPERTIES CORP. JONATHAN DELAND - ATTENDING PHYSICIAN - .2 HRS/WK HSS FUND INC., .2 HRS/WK HSS PROPERTIES CORP. GREGORY LIGUORI - MEDICAL DIRECTOR - .2 HRS/WK HSS FUND INC., .2 HRS/WK HSS PROPERTIES CORP. RUSSELL WARREN - ATTENDING PHYSICIAN - .2 HRS/WK HSS FUND INC., .2 HRS/WK HSS PROPERTIES CORP. PHILLIP WILSON, JR. - ATTENDING PHYSICIAN - 6.83 HRS/WK HSS FUND INC., .2 HRS/WK HSS PROPERTIES CORP. ATIIM BARBER - MEMBER - .02 HRS/WK HSS FUND INC., .01 HRS/WK HSS PROPERTIES CORP. JAMES M. BENSON - MEMBER - .04 HRS/WK HSS FUND INC., .02 HRS/WK HSS PROPERTIES CORP. DANIEL C. BENTON - MEMBER - .03 HRS/WK HSS FUND INC., .02 HRS/WK HSS PROPERTIES CORP. RICHARD A. BRAND, MD - MEMBER - .07 HRS/WK HSS FUND INC., .04 HRS/WK HSS PROPERTIES CORP. PETER L. BRIGER, JR. - MEMBER - .14 HRS/WK HSS FUND INC., .07 HRS/WK HSS PROPERTIES CORP. MICHAEL BROOKS - MEMBER - .09 HRS/WK HSS FUND INC., .05 HRS/WK HSS PROPERTIES CORP. KATHRYN CHENAULT - MEMBER - .04 HRS/WK HSS FUND INC., .02 HRS/WK HSS PROPERTIES CORP. CHARLES COLEMAN, III - MEMBER - .11 HRS/WK HSS FUND INC., .06 HRS/WK HSS PROPERTIES CORP. LESLIE CORNFELD - MEMBER - .11 HRS/WK HSS FUND INC., .06 HRS/WK HSS PROPERTIES CORP. CYNTHIA FOSTER CURRY - MEMBER - .2 HRS/WK HSS FUND INC., .1 HRS/WK HSS PROPERTIES CORP. BARRIE M. DAMSON - MEMBER - .35 HRS/WK HSS FUND INC., .18 HRS/WK HSS PROPERTIES CORP., .07 HRS/WK HSS HORIZONS INC. JAMES G. DINAN - MEMBER - .10 HRS/WK HSS FUND INC., .05 HRS/WK HSS PROPERTIES CORP. ANNE EHRENKRANZ - MEMBER - .08 HRS/WK HSS FUND INC., .04 HRS/WK HSS PROPERTIES CORP. MICHAEL ESPOSITO - MEMBER - .06 HRS/WK HSS FUND INC., .03 HRS/WK HSS PROPERTIES CORP. CRAIG IVEY - MEMBER - .02 HRS/WK HSS FUND INC., .01 HRS/WK HSS PROPERTIES CORP. WINFIELD P. JONES - MEMBER - .04 HRS/WK HSS FUND INC., .02 HRS/WK HSS PROPERTIES CORP. MONICA KEANY - MEMBER - .04 HRS/WK HSS FUND INC., .02 HRS/WK HSS PROPERTIES CORP. THOMAS J. KELLY - MEMBER - .11 HRS/WK HSS FUND INC., .06 HRS/WK HSS PROPERTIES CORP. DAVID H. KOCH - MEMBER - .12 HRS/WK HSS FUND INC., .06 HRS/WK HSS PROPERTIES CORP. LARA LEARNER - MEMBER - .04 HRS/WK HSS FUND INC., .02 HRS/WK HSS PROPERTIES CORP. MARYLIN B. LEVITT - MEMBER - .51 HRS/WK HSS FUND INC., .26 HRS/WK HSS PROPERTIES CORP. THOMAS LISTER - MEMBER - .09 HRS/WK HSS FUND INC., .05 HRS/WK HSS PROPERTIES CORP. ALAN S. MACDONALD - MEMBER - .18 HRS/WK HSS FUND INC., .09 HRS/WK HSS PROPERTIES CORP. DAVID M. MADDEN - MEMBER - .07 HRS/WK HSS FUND INC., .04 HRS/WK HSS PROPERTIES CORP. RICHARD L. MENSCHEL - CHAIRMAN, EMERITUS - .68 HRS/WK HSS FUND INC., .34 HRS/WK HSS PROPERTIES CORP. CARL F. NATHAN - MEMBER - .04 HRS/WK HSS FUND INC., .02 HRS/WK HSS PROPERTIES CORP. DEAN R. O'HARE - CO-CHAIR - 1.75 HRS/WK HSS FUND INC., .88 HRS/WK HSS PROPERTIES CORP., .35 HRS/WK HSS HORIZONS INC. ALDO PAPONE - CO-CHAIR - 1.75 HRS/WK HSS FUND INC., .88 HRS/WK HSS PROPERTIES CORP., .35 HRS/WK HSS HORIZONS INC. GORDON PATTEE - MEMBER - .04 HRS/WK HSS FUND INC., .02 HRS/WK HSS PROPERTIES CORP. CHARLTON REYNDERS, JR. - MEMBER - .04 HRS/WK HSS FUND INC., .02 HRS/WK HSS PROPERTIES CORP. SUSAN W. ROSE - MEMBER - .31 HRS/WK HSS FUND INC., .16 HRS/WK HSS PROPERTIES CORP. WILLIAM R. SALOMON - MEMBER - .2 HRS/WK HSS FUND INC., .1 HRS/WK HSS PROPERTIES CORP. JONATHAN SOBEL - MEMBER - .22 HRS/WK HSS FUND INC., .11 HRS/WK HSS PROPERTIES CORP. DEIRDRE STANLEY - MEMBER - .15 HRS/WK HSS FUND INC., .08 HRS/WK HSS PROPERTIES CORP. ROBERT K. STEEL - MEMBER - .27 HRS/WK HSS FUND INC., .14 HRS/WK HSS PROPERTIES CORP. DANIEL G. TULLY - VICE CHAIR - 0.83 HRS/WK HSS FUND INC., .42 HRS/WK HSS PROPERTIES CORP. MRS. DOUGLAS A. WARNER, III - MEMBER - .64 HRS/WK HSS FUND INC., .32 HRS/WK HSS PROPERTIES CORP. TORSTEN N. WIESEL, MD - MEMBER - .07 HRS/WK HSS FUND INC., .04 HRS/WK HSS PROPERTIES CORP. KENDRICK R. WILSON - MEMBER - .84 HRS/WK HSS FUND INC., .42 HRS/WK HSS PROPERTIES CORP. ELLEN M. WRIGHT - MEMBER - .32 HRS/WK HSS FUND INC., .16 HRS/WK HSS PROPERTIES CORP. LOUIS A. SHAPIRO - PRESIDENT & CEO - 9.0 HRS/WK HSS FUND INC., 3.0 HRS/WK HSS PROPERTIES CORP., .5 HRS/WK HSS HORIZONS. LISA GOLDSTEIN - EVP & COO - 6.0 HRS/WK HSS PROPERTIES CORP. STACEY MALAKOFF - EVP & CFO - 1.8 HRS/WK HSS FUND INC., 7.2 HRS/WK HSS PROPERTIES CORP., .5 HRS/WK HSS HORIZONS INC. CONSTANCE B. MARGOLIN-SVP & SECRETARY- 3.0 HRS/WK HSS FUND INC., 6.0 HRS/WK HSS PROPERTIES CORP., .5 HRS/WK HSS HORIZONS. DEBORAH SALE - EVP EXTERNAL AFFAIRS - 36.0 HRS/WK HSS FUND INC., 3.0 HRS/WK HSS PROPERTIES CORP. RALPH BIANCO - VICE PRESIDENT - 6.0 HRS/WK HSS PROPERTIES CORP.
OTHER CHANGES IN NET ASSETS OR FUND BALANCES FORM 990, PART XI, LINE 5 INCLUDES NET UNREALIZED LOSSES ($6,036,563), INCREASE IN INTEREST OF HSS FUND, INC. $3,177,347 AND INCREASE IN DEFINED PENSION AND POST RETIREMENT PLAN LIABILITIES ($54,737,695).
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2011

Additional Data


Software ID:  
Software Version:  
SCHEDULE R
(Form 990)
Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
MediumBulletComplete if the organization answered "Yes" to Form 990, Part IV, line 33, 34, 35, 36, or 37.
MediumBulletAttach to Form 990. MediumBullet See separate instructions.

OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
New York Society for the Relief
of the Ruptured and Crippled Maintaining the
Employer identification number

13-1624135
Part I
Identification of Disregarded Entities (Complete if the organization answered "Yes" on Form 990, Part IV, line 33.)
(a)
Name, address, and EIN of disregarded entity


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Total income
(e)
End-of-year assets


 		(f)
Direct controlling
entity

















Part II
Identification of Related Tax-Exempt Organizations (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.)
(a)
Name, address, and EIN of related organization


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Exempt Code section
(e)
Public charity status
(if section 501(c)(3))

 		(f)
Direct controlling
entity

 		(g)
Section 512(b)(13) controlled organization
Yes No
(1) HOSPITAL FOR SPECIAL SURGERY FUND INC

535 EAST 70TH STREET

NEW YORK,NY10021
13-6714749 		FUNDRAISING NY 501 (C)(3) 7 NA
 
 
No
(2) HSS PROPERTIES CORPORATION

535 EAST 70TH STREET

NEW YORK,NY10021
13-3246249 		REAL ESTATE NY 501 (C)(3) 11B HSS FUND INC
 
Yes
 
(3) HSS HORIZONS INC

535 EAST 70TH STREET

NEW YORK,NY10021
13-4152131 		RESEARCH SUPP NY 501 (C)(3) 11B HSS FUND INC
 
Yes
 
(4) NEW YORK-PRESBYTERIAN FOUNDATION INC

525 EAST 68TH STREET BOX 156

NEW YORK,NY10065
13-4153668 		HLTH CARE ORG NY 501 (C)(3) 11A NA
 
 
No






For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2011
Schedule R (Form 990) 2011
Page 2
Part III
Identification of Related Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.)
(a)
Name, address, and EIN of
related organization



 		(b)
Primary activity




 		(c)
Legal
domicile
(state or foreign
country)


 		(d)
Direct controlling
entity



 		(e)
Predominant income(related, unrelated, excluded from tax under sections 512-514)

(f)
Share of total income




 		(g)
Share of end-of-year
assets



 		(h)
Disproprtionate allocations?




 		(i)
Code V—UBI
amount in box 20 of
Schedule K-1
(Form 1065)
 		(j)
General or
managing
partner?



 		(k)
Percentage
ownership
Yes No Yes No












Part IV
Identification of Related Organizations Taxable as a Corporation or Trust (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.)
(a)
Name, address, and EIN of related organization



 		(b)
Primary activity



 		(c)
Legal domicile
(state or
foreign
country)
 		(d)
Direct controlling
entity


 		(e)
Type of entity
(C corp, S corp,
or trust)

 		(f)
Share of total income



 		(g)
Share of
end-of-year
assets

 		(h)
Percentage
ownership
(1) MIAC
535 EAST 70TH STREET
NEW YORK,NY10021
98-1050215 		SELF-INDEMNITY CJ HSS FUND INC
  		C CORP 0 0 0 %
(2) HSS VENTURES
535 EAST 70TH STREET
NEW YORK,NY10021
06-1624300 		HEALTH CARE NY HSS FUND INC
  		C CORP 0 0 0 %
(3) CHARITABLE TRUST
 
 
INVESTMENT OH NA
  		TRUST      








Schedule R (Form 990) 2011
Schedule R (Form 990) 2011
Page 3
Part V
Transactions With Related Organizations (Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35, 35A, or 36.)
Note. Complete line 1 if any entity is listed in Parts II, III or IV.
Yes
No
1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?
a Receipt of (i) interest (ii) annuities (iii) royalties (iv) rent from a controlled entity . . . . . . . . . . . . . . . . . . . . . . .
1a
 
No
b Gift, grant, or capital contribution to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1b
 
No
c Gift, grant, or capital contribution from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1c
Yes
 
d Loans or loan guarantees to or for related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1d
Yes
 
e Loans or loan guarantees by related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1e
 
No
f Sale of assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1f
 
No
g Purchase of assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1g
 
No
h Exchange of assets with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1h
 
No
i Lease of facilities, equipment, or other assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1i
Yes
 
j Lease of facilities, equipment, or other assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .
1j
Yes
 
k Performance of services or membership or fundraising solicitations for related organization(s) . . . . . . . . . . . . . . . . . . . .
1k
 
No
l Performance of services or membership or fundraising solicitations by related organization(s) . . . . . . . . . . . . . . . . . . . .
1l
Yes
 
m Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) . . . . . . . . . . . . . . . . . . . . .
1m
 
No
n Sharing of paid employees with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1n
 
No
o Reimbursement paid to related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1o
Yes
 
p Reimbursement paid by related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1p
Yes
 
q Other transfer of cash or property to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1q
 
No
r Other transfer of cash or property from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1r
Yes
 
2
If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.
(a)
Name of other organization 		(b)
Transaction
type(a-r) 		(c)
Amount involved 		(d)
Method of determining amount involved
(1) HSS FUND INC

 C 898,132 FMV
(2) HSS FUND INC

 I 497,924 FMV
(3) HSS FUND INC

 L 5,393,004 FMV
(4) HSS FUND INC

 P 2,034,484 FMV
(5) HSS PROPERTIES CORPORATION

 J 21,905,008 FMV
(6) HSS PROPERTIES CORPORATION

 P 4,320,386 FMV
(7) HSS HORIZONS INC

 D 170,126 FMV
(8) MIAC

 O 16,091,734 FMV
(9) CHARITABLE TRUST

 R 1,581,835 FMV
Schedule R (Form 990) 2011
Schedule R (Form 990) 2011
Page 4
Part VI
Unrelated Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 37.)
Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.
(a)
Name, address, and EIN of entity 		(b)
Primary activity 		(c)
Legal domicile
(state or foreign
country) 		(d)
Predominant income(related, unrelated, excluded from tax under sections 512-514)

(e)
Are all
partners
section
501(c)(3)
organizations? 		(f)
Share of total income




 		(g)
Share of
end-of-year
assets 		(h)
Disproprtionate allocations? 		(i)
Code V—UBI
amount in box
20 of Schedule K-1
(Form 1065) 		(j)
General or
managing
partner? 		(k)
Percentage
ownership
Yes No Yes No Yes No






























Schedule R (Form 990) 2011
Schedule R (Form 990) 2011
Page 5
Part VII
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule R (see instructions).
Identifier Return Reference Explanation
Additional Data


Software ID:  
Software Version:  






TY 2011 AffiliatedGroupSchedule
Name:
New York Society for the Relief
of the Ruptured and Crippled Maintaining the
EIN: 13-1624135
Affiliated Group Business Name:
THE HOSPITAL FOR SPECIAL SUR
 
Address. Either US or Foreign Type:
535 EAST 70TH STREET
NEW YORK, NY10021    
EIN:
13-6714749
Electing Organization Checkbox:
Total Grassroots Lobbying:
0
Total Direct Lobbying:
137,547
Total Lobbying Expenditures:
137,547
Other Exempt Purpose Expenditures:
7,337,420
Total Exempt Purpose Expenditures:
7,474,967
Lobbying Nontaxable Amount:
523,748
Grassroots Nontaxable Amount:
130,937
Tot Lobbying Grassroot Minus Non Tx:
0
Tot Lobby Expend Mns Lobbying Non Tx:
0
Share Of Excess Lobbying:
0
Affiliated Group Business Name:
HOSPITAL FOR SPECIAL SURGERY
 
Address. Either US or Foreign Type:
535 EAST 70TH STREET
NEW YORK, NY10021    
EIN:
13-1624135
Electing Organization Checkbox:
Total Grassroots Lobbying:
0
Total Direct Lobbying:
48,504
Total Lobbying Expenditures:
48,504
Other Exempt Purpose Expenditures:
651,720,163
Total Exempt Purpose Expenditures:
651,768,667
Lobbying Nontaxable Amount:
1,000,000
Grassroots Nontaxable Amount:
250,000
Tot Lobbying Grassroot Minus Non Tx:
0
Tot Lobby Expend Mns Lobbying Non Tx:
0
Share Of Excess Lobbying:
0