TY 2012 Form 990

(A) Name and Title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)
(1) Raymond Sweeney........................................................................ Trustee	2.00 .......................0.00	X	0
(2) Anne Phillips........................................................................ Trustee	1.00 .......................0.00	X	0
(3) Quintin Bullock PhD........................................................................ Trustee	1.00 .......................0.00	X	0
(4) Emile Walraven........................................................................ Trustee	1.00 .......................0.00	X	0
(5) Brian McDonald MD........................................................................ Trustee	2.00 .......................0.00	X	12,450
(6) Richard Toll MD........................................................................ Trustee	1.00 .......................0.00	X	80,730
(7) Stephen Pagano........................................................................ Trustee	1.00 .......................0.00	X	0
(8) Laura Schweitzer PhD........................................................................ Trustee/Sec	1.00 .......................0.00	X	0
(9) Sarah Schermerhorn........................................................................ Trustee	2.00 .......................0.00	X	0
(10) John A Nolan MD........................................................................ Trustee	1.00 .......................0.00	X	17,316
(11) Robert Murray........................................................................ Treas/Trustee	1.00 .......................0.00	X	0
(12) Deborah Mullaney........................................................................ Sec/Vice Chair	5.00 .......................0.00	X	0
(13) Judith B McIlduff........................................................................ Trustee	2.00 .......................0.00	X	0
(14) Michael Idelchik........................................................................ Trustee	1.00 .......................0.00	X	0
(15) Robert Kennedy MD........................................................................ Trustee	2.00 .......................0.00	X	0
(16) Patrick Kehoe........................................................................ Trustee	1.00 .......................0.00	X	0
(17) Ernest Lee MD........................................................................ Trustee	1.00 .......................0.00	X	43,700

(A) Name and Title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(18) Carolyn Jones........................................................................ Trustee/Treas	2.00 .......................0.00	X				0	0
(19) D Joseph Gersuk........................................................................ Trustee	1.00 .......................0.00	X				0	0
(20) Thomas Donovan........................................................................ Trustee	1.00 .......................0.00	X				0	0
(21) William B Faubion........................................................................ Trustee	2.00 .......................0.00	X				0	0
(22) Michael Cocca........................................................................ Trustee	2.00 .......................0.00	X				0	0
(23) Cristine Cioffi........................................................................ Chairman	5.00 .......................0.00	X				0	0
(24) Mark Breslin PE........................................................................ V Chair/Trustee	1.00 .......................0.00	X				0	0
(25) Linda Breault........................................................................ Trustee	1.00 .......................0.00	X				0	0
(26) Daniel J Rinaldi........................................................................ CFO	55.00 .......................5.00		X			321,959	20,704
(27) Paul A Milton........................................................................ EVP/COO	55.00 .......................5.00		X			322,583	31,243
(28) James W Connolly........................................................................ President & CEO	55.00 .......................5.00		X			587,041	43,504
(29) Kelli Valenti........................................................................ VP Strategic Planning	55.00 .......................0.00			X		164,884	19,534
(30) Anoush Koroghlian - Scott........................................................................ VP Legal Affairs	55.00 .......................0.00			X		204,658	12,251
(31) David Snyder........................................................................ Vice President Information Services	55.00 .......................0.00			X		206,089	29,321
(32) Wendy Rosher........................................................................ Vice President Clinical Services	55.00 .......................0.00			X		221,056	31,382
(33) Donald J McLaughlin........................................................................ Vice President Facility and Support	55.00 .......................0.00			X		177,500	29,289
(34) Cecilia A Lynch........................................................................ Vice President, Nursing/CNO	55.00 .......................5.00			X		215,890	27,519
(35) David M Liebers MD........................................................................ Vice President, Medical Affairs/CMO	55.00 .......................0.00			X		302,933	36,325
(36) Patti S Hammond........................................................................ Vice President, Physician Relations	55.00 .......................0.00			X		233,787	26,951
(37) Joseph Giansante........................................................................ Vice President, Human Resources	55.00 .......................0.00			X		233,763	32,054
(38) Terence Clarke MD........................................................................ MD Surgery	50.00 .......................0.00				X	644,038	72,607
(39) Max S Laguerre MD........................................................................ Rad. Oncologist	50.00 .......................0.00				X	468,219	18,885
(40) Robert McKay MD........................................................................ M.D. Surgery	50.00 .......................0.00				X	547,291	80,899
(41) Herbert Reich MD........................................................................ M.D. Cardiac Surg	50.00 .......................0.00				X	522,965	101,242
(42) Paul Spurgas MD........................................................................ M.D. Neurosurgery	50.00 .......................0.00				X	957,875	18,019

(A) Name and business address	(B) Description of services	(C) Compensation
Turner Construction Company22 Corporate Woods BlvdAlbanyNY12211	Construction	2,515,845
Strategic Solutions MC400 Clifton Corporate ParkwayClifton ParkNY12065	Billing Service	866,080
Smith & Jones297 River StreetTroyNY12180	Marketing	2,102,769
OB Hospitalist Group10 Centimeters DriveMauldinSC29662	Physician Service	1,072,705
Envision Architects PC52 James StreetAlbanyNY12207	Architectrual Svc	869,991
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 40

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	38,913	38,913
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 ....	3,686,418	154,196	3,532,222
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	176,666,280	161,062,253	15,604,027
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	6,587,057	5,990,589	596,468
9	Other employee benefits .......	14,915,932	13,585,192	1,330,740
10	Payroll taxes ...........	12,618,491	11,308,706	1,309,785
11	Fees for services (non-employees):
a	Management ......	2,224,226	2,224,226
b	Legal .........	280,482		280,482
c	Accounting ...........	238,032		238,032
d	Lobbying ...........	48,970		48,970
e	Professional fundraising services. See Part IV, line 17	0
f	Investment management fees ......	210,745		210,745
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) ........	3,359,399	3,299,240	60,159
12	Advertising and promotion ....	2,240,042	8,568	2,231,474
13	Office expenses .......	62,500,211	60,464,883	2,035,328
14	Information technology ......	6,244,322		6,244,322
15	Royalties ..	0
16	Occupancy ...........	9,309,048	8,131,620	1,177,428
17	Travel ............	1,237,377	798,408	438,969
18	Payments of travel or entertainment expenses for any federal, state, or local public officials ......	0
19	Conferences, conventions, and meetings ....	0
20	Interest ...........	371,909	371,909
21	Payments to affiliates .......	0
22	Depreciation, depletion, and amortization .....	13,959,372	12,492,357	1,467,015
23	Insurance ..............	5,010,396		5,010,396
24	Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a	NYS Assessment	1,941,310		1,941,310
b	Equip Rental/Maint	9,944,080	8,323,176	1,620,904
c	Bad Debt Expense	14,152,292	14,152,292
d	Purchased Services	17,948,545	15,446,274	2,502,271
e	All other expenses	3,346,622	946,607	2,400,015
25	Total functional expenses. Add lines 1 through 24e	369,080,471	318,799,409	50,281,062	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 if following SOP 98-2 (ASC 958-720).

Part X Balance Sheet Check if Schedule O contains a response to any question in this Part X ...............
	1	Cashnon-interest-bearing .............	10,970	1	13,145
2	Savings and temporary cash investments .........	10,940,255	2	14,494,525
3	Pledges and grants receivable, net ...........	328,379	3	22,243
4	Accounts receivable, net .............	36,728,375	4	37,274,181
5	Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of Schedule L ..................
			5	0
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L
			6	0
7	Notes and loans receivable, net .............	44,233	7	310,900
8	Inventories for sale or use ..............	5,142,782	8	5,018,169
9	Prepaid expenses and deferred charges ..........	1,197,612	9	1,710,375
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	366,105,977
b	Less: accumulated depreciation .....	10b	224,868,383	93,374,596	10c	141,237,594
11	Investments—publicly traded securities ..........	56,869,401	11	53,353,491
12	Investments—other securities. See Part IV, line 11 .....		12	0
13	Investments—program-related. See Part IV, line 11 .....		13	0
14	Intangible assets ...............		14	0
15	Other assets. See Part IV, line 11 ...........	19,798,290	15	22,798,961
16	Total assets. Add lines 1 through 15 (must equal line 34)......	224,434,893	16	276,233,584
	17	Accounts payable and accrued expenses .........	30,418,391	17	37,048,792
18	Grants payable .................		18
19	Deferred revenue ................	3,467,257	19	756,910
20	Tax-exempt bond liabilities .............	29,818,673	20	26,458,684
21	Escrow or custodial account liability. Complete Part IV of Schedule D..	118,964	21	114,354
22	Loans and other payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
	persons. Complete Part II of Schedule L..........		22
23	Secured mortgages and notes payable to unrelated third parties ..	9,730,497	23	37,799,216
24	Unsecured notes and loans payable to unrelated third parties ....		24
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....................	56,763,526	25	60,512,142
26	Total liabilities. Add lines 17 through 25.........	130,317,308	26	162,690,098
		Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets ..............	77,487,333	27	97,941,345
28	Temporarily restricted net assets ...........	11,421,977	28	10,152,542
29	Permanently restricted net assets ...........	5,208,275	29	5,449,599
	Organizations that do not follow SFAS 117 (ASC 958), check here 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 ...........	94,117,585	33	113,543,486
34	Total liabilities and net assets/fund balances ........	224,434,893	34	276,233,584

- TIN:

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.

Attach to Form 990 or Form 990-EZ. right arrow

See separate instructions.

OMB No. 1545-0047

2012

Open to Public
Inspection

Name of the organization

Ellis Hospital

Employer identification number

14-1338428

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.)

A church, convention of churches, or association of churches described in section 170(b)(1)(A)(i).

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E.)

A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).

A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital's name, city, and state:

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in

section 170(b)(1)(A)(iv). (Complete Part II.)

A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in section 170(b)(1)(A)(vi). (Complete Part II.)

A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)

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

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.)

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

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box that describes the type of supporting organization and complete lines 11e through 11h.

Type I

Type II

Type III - Functionally integrated

Type III - Non-functionally integrated

By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons other than foundation managers and other than one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2).

If the organization received a written determination from the IRS that it is a Type I, Type II, or Type III supporting organization, check this box ..................................................

Since August 17, 2006, has the organization accepted any gift or contribution from any of the
following persons?

(i) A person who directly or indirectly controls, either alone or together with persons described in (ii)

Yes

and (iii) below, the governing body of 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)

Provide the following information about the supported organization(s).

(i) Name of supported organization	(ii) EIN	(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 monetary support
(i) Name of supported organization	(ii) EIN	Yes	No	Yes	No	Yes	No	(vii) Amount of monetary support


Total

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

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2012

Page 2

Part II

Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part 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) 2008	(b) 2009	(c) 2010	(d) 2011	(e) 2012	(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) 2008	(b) 2009	(c) 2010	(d) 2011	(e) 2012	(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. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)..
11	Total support (Add lines 7 through 10).

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

First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization, check this box and stop here........................................ right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2012 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2011 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2012. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization ....................... right arrow

33 1/3% support test—2011. If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2012. If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain
in Part IV how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization ..................................................... right arrow

10%-facts-and-circumstances test—2011. If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part IV how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly
supported organization ................................................ right arrow

Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ..................................................... right arrow

Schedule A (Form 990 or 990-EZ) 2012

Page 3

Part III

Support Schedule for Organizations Described in Section 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) 2008	(b) 2009	(c) 2010	(d) 2011	(e) 2012	(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) 2008	(b) 2009	(c) 2010	(d) 2011	(e) 2012	(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.)..

First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here............................................. right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2012 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2011 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2012 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2011 Schedule A, Part III, line 17 .............

19a

33 1/3% support tests—2012. If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ........ right arrow

33 1/3% support tests—2011. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ..... right arrow

Private foundation. If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions ..... right arrow

Schedule A (Form 990 or 990-EZ) 2012

Page 4

Part IV

Supplemental Information. Complete this part to provide the explanations required by Part II, line 10; Part II, line 17a or 17b; and 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) 2012

Additional Data

Software ID:	12000229
Software Version:	2012v2.0

- TIN:

Schedule B
(Form 990, 990-EZ,
or 990-PF)

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

Attach to Form 990, 990-EZ, or 990-PF.

OMB No. 1545-0047

2012

Name of the organization

Ellis Hospital

Employer identification number

14-1338428

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

4947(a)(1) nonexempt charitable trust not treated as a private foundation

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

4947(a)(1) nonexempt charitable trust treated as a private foundation

501(c)(3) taxable private foundation

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

For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, $5,000 or more (in money or
property) from any one contributor. Complete Parts I and II.

Special Rules

For a section 501(c)(3) organization filing Form 990 or 990-EZ that met the 33¹/3% support test of the regulations
under sections 509(a)(1) and 170(b)(1)(A)(vi) and received from any one contributor, during the year, a contribution of the
greater of (1) $5,000 or (2) 2% of the amount on (i) Form 990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts I and II.

For a section 501(c)(7), (8), or (10) organization filing Form 990 or 990-EZ that received from any one contributor,
during the year, total contributions of more than $1,000 for use exclusively for religious, charitable,
scientific, literary, or educational purposes, or the prevention of cruelty to children or animals. Complete Parts I, II, and
III.

For a section 501(c)(7), (8), or (10) organization filing Form 990 or 990-EZ that received from any one contributor,
during the year, contributions for use exclusively for religious, charitable, etc., purposes, but these contributions did
not total to more than $1,000. If this box is checked, enter here the total contributions that were received during
the year for an exclusively religious, charitable, etc., purpose. Do not complete any of the parts unless the General Rule
applies to this organization because it received nonexclusively religious, charitable, etc., contributions of $5,000 or more
during the year ......................... 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) (2012)

Schedule B (Form 990, 990-EZ, or 990-PF) (2012)

Page 2

Name of organization Ellis Hospital

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	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2012)

Schedule B (Form 990, 990-EZ, or 990-PF) (2012)

Page 3

Name of organization Ellis Hospital

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) (2012)

Schedule B (Form 990, 990-EZ, or 990-PF) (2012)

Page 4

Name of organization
Ellis Hospital

Employer identification number

14-1338428

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

(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

(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

(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

(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) (2012)

Additional Data

Software ID:	12000229
Software Version:	2012v2.0

- TIN:

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

2012

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, Part V, line 35c (Proxy Tax), then
Round Bullet

Section 501(c)(4), (5), or (6) organizations: Complete Part III.

Name of the organization

Ellis Hospital

Employer identification number

14-1338428

Part I-A

Complete if the organization is exempt under section 501(c) or is a section 527 organization.

Provide a description of the organization’s direct and indirect political campaign activities in Part IV.

Political expenditures .................................... SchCMd Bullet

Volunteer hours ........................................

Part I-B

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

Enter the amount of any excise tax incurred by the organization under section 4955 ......... SchCMd Bullet

Enter the amount of any excise tax incurred by organization managers under section 4955 ...... SchCMd Bullet

If the organization incurred a section 4955 tax, did it file Form 4720 for this year? ..............

Yes No

Was a correction made? .........................................

Yes No

If "Yes," describe in Part IV.

Part I-C

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

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

Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ................................... SchCMd Bullet

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

Did the filing organization file Form 1120-POL for this year? ..........................

Yes No

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

Cat. No. 50084S

Schedule C (Form 990 or 990-EZ) 2012

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 SchCMd Bullet

if the filing organization belongs to an affiliated group (and list in Part IV each affiliated group member's name, address, EIN, expenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet

if the filing organization checked box A and "limited control" provisions apply.

Limits on Lobbying Expenditures (The term "expenditures" means amounts paid or incurred.)		(b) Affiliated group totals
1a	Total lobbying expenditures to influence public opinion (grass roots lobbying) ......
b	Total lobbying expenditures to influence a legislative body (direct lobbying) .......
c	Total lobbying expenditures (add lines 1a and 1b) ...................
d	Other exempt purpose expenditures ........................
e	Total exempt purpose expenditures (add lines 1c and 1d) ...............
f	Lobbying nontaxable amount. Enter the amount from the following table in both columns.
	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) .................
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? ......................................	Yes No

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) 2009	(b) 2010	(c) 2011	(d) 2012	(e) Total

2a	Lobbying nontaxable amount

b	Lobbying ceiling amount (150% of line 2a, column(e))

c	Total lobbying expenditures

d	Grassroots nontaxable amount

e	Grassroots ceiling amount (150% of line 2d, column (e))

f	Grassroots lobbying expenditures

Schedule C (Form 990 or 990-EZ) 2012

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

(b)

Amount

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:

Volunteers? .........................................

Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ....

Media advertisements? ....................................

Mailings to members, legislators, or the public? .........................

Publications, or published or broadcast statements? .......................

Grants to other organizations for lobbying purposes? .......................

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

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

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

Yes

48,970

Total. Add lines 1c through 1i ...............................

48,970

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

If "Yes," enter the amount of any tax incurred under section 4912 .................

If "Yes," enter the amount of any tax incurred by organization managers under section 4912 .....

If the 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

Were substantially all (90% or more) dues received nondeductible by members? ................

Did the organization make only in-house lobbying expenditures of $2,000 or less? ................

Did the organization agree to carry over lobbying and political expenditures from the prior year? ..........

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."

Dues, assessments and similar amounts from members .....................

Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political
expenses for which the section 527(f) tax was paid).

Current year .........................................

Carryover from last year ....................................

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

Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .

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

Taxable amount of lobbying and political expenditures (see instructions) ..............

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, line 5; Part II-A (affiliated group list); Part II-A, line 2; and Part ll-B, line 1. Also, complete this part for any additional information.

Identifier	Return Reference	Explanation
Part II-B, Line 1i	Part II-B, Line 1i - Other Activities Description	Ellis Hospital pays dues to the Healthcare Association of New York State, Iroquois Healthcare Alliance, and American Hospital Association. The portion of the dues that were attributable to lobbying activities are shown on form 990, Part IX, Line 11 D and above in Schedule C, Part II-B, Line 1i.

Schedule C (Form 990 or 990EZ) 2012

Additional Data

Software ID:	12000229
Software Version:	2012v2.0

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

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

2012

Open to Public Inspection

Name of the organization

Ellis Hospital

Employer identification number

14-1338428

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 ........

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

Yes No

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

Yes No

Part II

Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.

Purpose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e.g., recreation or education) Preservation of an historically important land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

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.


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

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the tax year SchDMd Bullet

Number of states where property subject to conservation easement is located SchDMd Bullet

Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................

Yes No

Staff and volunteer hours devoted to monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet

Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .......................................

Yes No

In Part XIII, 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.

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 XIII, the text of the footnote to its financial statements that describes these items.

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

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:

Revenues included in Form 990, Part VIII, line 1 .......................... SchDMd Bullet

Assets included in Form 990, Part X ............................... SchDMd Bullet

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

Cat. No. 52283D

Schedule D (Form 990) 2012

Page 2

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)

Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.

During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?........

Yes No

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.

Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................

Yes No

If "Yes," explain the arrangement in Part XIII and complete the following table:


c	Beginning balance .................................	1c
d	Additions during the year ..............................	1d
e	Distributions during the year .............................	1e
f	Ending balance ...................................	1f

Did the organization include an amount on Form 990, Part X, line 21? .....................

Yes No

If “Yes,” explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ........

Part V

Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.

		(a)Current year	(b)Prior year	b (c)Two years back	(d)Three years back	(e)Four years back
1a	Beginning of year balance ....	5,208,275	3,969,599	3,919,510	3,819,437	4,143,281
b	Contributions ........
c	Net investment earnings, gains, and losses	241,324	1,238,676	50,089	100,073	-323,844
d	Grants or scholarships .....
e	Other expenditures for facilities and programs ........
f	Administrative expenses ....
g	End of year balance ......	5,449,599	5,208,275	3,969,599	3,919,510	3,819,437

Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:

Board designated or quasi-endowment SchDMd Bullet

Permanent endowment SchDMd Bullet

100.000 %

Temporarily restricted endowment SchDMd Bullet

The percentages in lines 2a, 2b, and 2c should equal 100%.

Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes

(i) unrelated organizations ........................

3a(i)

(ii) related organizations ........................

3a(ii)

If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........

Describe in Part XIII 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		(b)Cost or other basis (other)	(c) Accumulated depreciation	(d) Book value
1a	Land .................	4,296,826		4,296,826
b	Buildings ................	130,328,030	67,739,702	62,588,328
c	Leasehold improvements ............	1,316,425	1,047,225	269,200
d	Equipment ................	214,843,961	156,081,456	58,762,505
e	Other .................	15,320,735		15,320,735
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......				141,237,594

Schedule D (Form 990) 2012

Page 3

Part VII

InvestmentsOther 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
Other








Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

Part VIII

InvestmentsProgram 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.)

Part IX

Other Assets. See Form 990, Part X, line 15.

(a) Description				(b) Book value
(1) Unexpende Lease Proceeds				905,889
(2) Security Deposits				183,980
(3) Rent receivable				157,999
(4) Miscellaneous receivables				214,620
(5) Meaningful Use Receivable				2,696,916
(6) Interest in Net Assets of Foundation				15,505,677
(7) Grant receivable				638,808
(8) Due from Foundation				61,739
(9) DSH for OP Mental Health				84,938
(10) Deferred financing costs				2,560,869
(11) Accrued interest receivable				-212,474
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........				22,798,961

Part X

Other Liabilities. See Form 990, Part X, line 25.

1.(a) Description of liability		(b) Book value
Federal income taxes
Retainage payable		1,103,935
Miscellaneous payables		193,255
Estimated self-insurance		14,529,230
Estimated payables to 3rd Party Payers		2,794,795
Employee withholdings		685,323
Claims payable		1,535,653
Asset retirement obligation		798,898
Accrued vacation payable		10,150,317
Accrued sick payable		6,770,695
Accrued post retirement benefits		294,485
Accrued pension		21,516,827
Accrued interest payable		138,729
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)		60,512,142
2. Fin 48 (ASC 740) Footnote. In Part XIII, 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 (ASC 740). Check here if the text of the footnote has been provided in Part XIII .....................................................

Schedule D (Form 990) 2012

Page 4

Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return
1	Total revenue, gains, and other support per audited financial statements .......			1	374,143,335
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 XIII.) ............	2d	-5,721,564
e	Add lines 2a through 2d .....................			2e	-5,721,564
3	Subtract line 2e from line 1.....................			3	379,864,899
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 XIII.) ...........	4b
c	Add lines 4a and 4b.......................			4c
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......			5	379,864,899

Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return
1	Total expenses and losses per audited financial statements ...........			1	354,717,434
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 XIII.) ............	2d	-14,363,037
e	Add lines 2a through 2d......................			2e	-14,363,037
3	Subtract line 2e from line 1.....................			3	369,080,471
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 XIII.) ............	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	369,080,471

Part XIII

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, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.

Identifier	Return Reference	Explanation
Part X	Part X : FIN48 Footnote	The organization's audited financial statements do not report any liability or have any footnote reporting the organization's liability for uncertain tax positions under FIN48.
Part V, Line 4	Part V, Line 4: Intended uses of the endowment fund.	Permanently Restricted Net Assets (Endowment Funds) are investments to be held in perpetuity, the income from which is expendable to support health care services (reported as Other Operating Revenue). These Net Assets amounted to $687,674 at 12/31/2012. The remaining amount of $4,761,925 are Net Assets held by the Foundation (including $1,232,187 for beneficial interest in perpetual trusts). Grand total was $5,449,599.
Part IV, Line 2b	Part IV, Line 2b: Explanation of escrow account liability	The Ellis Residential and Rehabilitation Center residents spending account is included in line 2 and line 21 on Schedule X. The total is $13,164. These funds belong to the residents and are deposited and disbursed by the Ellis Residential and Rehabilitation Director's designee. The Ellis Hospital Accounting Department is responsible for tracking the funds.Medical/Dental Staff Dues Account is included in line 2 and line 21 on Schedule X. The total is $101,190. This fund contains deposits and disbursements as directed by the Medical/Dental Staff appointed officers. The Ellis Hospital Accounting department is responsible for depositing and disbursing the funds on the Medical/Dental officer's behalf. The accounting department also issues IRS form 1099 based on the disbursements.

Schedule D (Form 990) 2012

Additional Data

Software ID:	12000229
Software Version:	2012v2.0

- TIN:

SCHEDULE H (Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

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

2012

Open to Public Inspection

Name of the organization

Ellis Hospital

Employer identification number

14-1338428

Part I

Financial Assistance and Certain Other Community Benefits at Cost

Yes

Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a ...

Yes

If "Yes," was it a written policy? .......................

Yes

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.

Applied uniformly to all hospital facilities Applied uniformly to most hospital facilities Generally tailored to individual hospital facilities

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.

Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?

If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:

Yes

100% 150% 200% Other 30000.0000000 %

Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate

which of the following was the family income limit for eligibility for discounted care: .........

200% 250% 300% 350% 400% Other %

If the organization used factors other than FPG in determining 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, as a factor in determining eligibility for free or discounted care.

Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? ..............

Yes

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

Yes

If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? ......

Yes

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

Did the organization prepare a community benefit report during the tax year? ..........

Yes

If "Yes," did the organization make it available to the public? ..............

Yes

Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.

Financial Assistance and Certain Other Community Benefits at Cost

Financial Assistance and Means-Tested Government Programs		(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) ..	8,668,977	5,571,878	3,097,099	0.840 %
b	Medicaid (from Worksheet 3, column a) ....	68,458,363	53,256,182	15,202,181	4.120 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) .
d	Total Financial Assistance and Means-Tested Government Programs .	77,127,340	58,828,060	18,299,280	4.960 %
Other Benefits		267,911	9,964	257,947	0.070 %
e	Community health improvement services and community benefit operations (from Worksheet 4) ..	267,911	9,964	257,947	0.070 %
f	Health professions education (from Worksheet 5) ..	10,211,814	3,989,749	6,222,065	1.690 %
g	Subsidized health services (from Worksheet 6) ..	1,261,387		1,261,387	0.340 %
h	Research (from Worksheet 7)
i	Cash and in-kind contributions for community benefit (from Worksheet 8)	315,140		315,140	0.090 %
j	Total. Other Benefits ..	12,056,252	3,999,713	8,056,539	2.190 %
k	Total. Add lines 7d and 7j .	89,183,592	62,827,773	26,355,819	7.150 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2012

Schedule H (Form 990) 2012

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.

		(c) Total community building expense	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing
2	Economic development
3	Community support	2,238	2,238
4	Environmental improvements
5	Leadership development and training for community members
6	Coalition building	48,111	48,111	0.010 %
7	Community health improvement advocacy
8	Workforce development	1,409	1,409
9	Other
10	Total	51,758	51,758	0.010 %

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................

Yes

Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......

3,929,000

Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......

268,000

Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.

Section B. Medicare

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

73,597,306

Enter Medicare allowable costs of care relating to payments on line 5.....

78,290,584

Subtract line 6 from line 5. This is the surplus (or shortfall)........

-4,693,278

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:

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

Did the organization have a written debt collection policy during the tax year? ..........

Yes

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

Yes

Part IV

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

(a) Name of entity	(b) Description of primary activity of entity	(c) Organization's profit % or stock ownership %
1Visiting Nurse Svc Assoc	serves home health needs	100.000 %
2
3
4
5
6
7
8
9
10
11
12
13

Schedule H (Form 990) 2012

Page

Part VFacility Information

Section A. Hospital Facilities (list in order of size from largest to smallest—see instructions) How many hospital facilities did the organization operate during the tax year?1 Name, address, and primary website address						Other (Describe)
1	Ellis Hospital 1101 Nott Street Schenectady,NY12308	X	X	X	X	82 Bed Skilled Nursing Facility

Schedule H (Form 990) 2012

Page

Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)

	1
Name of hospital facility or facility reporting group

For single facility filers only: line Number of Hospital Facility (from Schedule H, Part V, Section A)

Yes

Community Health Needs Assessment (Lines 1 through 8c are optional for tax years begining on or before March 23, 2012)

During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 9....................

If “Yes,” indicate what the CHNA report describes (check all that apply):

A definition of the community served by the hospital facility

Demographics of the community

Existing health care facilities and resources within the community that are available to respond to the health needs of the community

How data was obtained

The health needs of the community

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

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

The process for consulting with persons representing the community’s interests

Information gaps that limit the hospital facility’s ability to assess the community’s health needs

Other (describe in Part VI)

Indicate the tax year the hospital facility last conducted a CHNA: 20

In conducting its most recent CHNA, did the hospital facility take into account input from representatives of the community served by the hospital facility, including those with special knowledge of or expertise in public health? 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 ....................

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI................................

Did the hospital facility make its CHNA report widely available to the public? .............

If “Yes,” indicate how the CHNA report was made widely available (check all that apply):

Hospital facility’s website

Available upon request from the hospital facility

Other (describe in Part VI)

If the hospital facility addressed needs identified in its most recently conducted CHNA, indicate how (check all that apply to date):

Adoption of an implementation strategy that addresses each of the community health needs identified through the CHNA

Execution of the implementation strategy

Participation in the development of a community-wide plan

Participation in the execution of a community-wide plan

Inclusion of a community benefit section in operational plans

Adoption of a budget for provision of services that address the needs identified in the CHNA

Prioritization of health needs in its community

Prioritization of services that the hospital facility will undertake to meet health needs in its community

Other (describe in Part VI)

Did the hospital facility address all of the needs identified in its most recently conducted CHNA? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs ........

Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)? ...........................

If "Yes" to line 8a, did the organization file Form 4720 to report the section 4959 excise tax? ......

If "Yes" to line 8b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $

Schedule H (Form 990) 2012

Page

Part VFacility Information (continued)

Financial Assistance Policy			Yes	No
9	Did the hospital facility have in place during the tax year a written financial assistance policy that:
	Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care?	9	Yes
10	Used federal poverty guidelines (FPG) to determine eligibility for providing free care?...........	10	Yes
	If "Yes," indicate the FPG family income limit for eligibility for free care: 300.0000% If "No," explain in Part VI the criteria the hospital facility used.
11	Used FPG to determine eligibility for providing discounted care?.................	11		No
	If “Yes,” indicate the FPG family income limit for eligibility for discounted care: % If "No," explain in Part VI the criteria the hospital facility used.
12	Explained the basis for calculating amounts charged to patients?.................	12	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)
13	Explained the method for applying for financial assistance?...................	13	Yes
14	Included measures to publicize the policy within the community served by the hospital facility?.......	14	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 website
b	The policy was attached to 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 on admission to the hospital facility
f	The policy was available upon request
g	Other (describe in Part VI)
Billing and Collections
15	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?.......	15	Yes
16	Check all of the following 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)
17	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?..........	17	Yes
	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)

Schedule H (Form 990) 2012

Page

Part VFacility Information (continued)

Indicate which efforts the hospital facility made before initiating any of the actions listed in line 17 (check all that apply):

Notified individuals of the financial assistance policy on admission

Notified individuals of the financial assistance policy prior to discharge

Notified individuals of the financial assistance policy in communications with the patients regarding the patients’ bills

Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy

Other (describe in Part VI)

Policy Relating to Emergency Medical Care

Yes

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?..........

Yes

If “No,” indicate why:

The hospital facility did not provide care for any emergency medical conditions

The hospital facility’s policy was not in writing

The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)

Other (describe in Part VI)

Charges to Individuals Eligible for Assistance under the FAP (FAP-Eligible Individuals)

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.

The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged

The hospital facility used the average of its three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged

The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged

Other (describe in Part VI)

During the tax year, did the hospital facility charge any FAP-eligible individuals 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? ............................

If “Yes,” explain in Part VI.

During the tax year, did the hospital facility charge any FAP-eligible individuals an amount equal to the gross charge for any service provided to that individual? .........................

If “Yes,” explain in Part VI.

Schedule H (Form 990) 2012

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?13
Name and address		Type of Facility (describe)
1	Medical Center of Clifton Park 103 Sitterly Road Clifton Park,NY12065	24/7 emergent care, lab, medical imaging, primary care and specialty services
2	Ellis Hospital Rehabilitation Services 650 McClellan Street Schenectady,NY12304	Physical Therapy Services
3	Ellis Hospital PROS Program 216 Lafayette Street Schenectady,NY12308	Mental Health Services
4	Ellis Hospital Collage Social Program 1328 State Street Schenectady,NY12308	Mental Health Services
5	Ellis Hospital Neurology 1201 Nott Street Schenectady,NY12308	Outpatient Neurology
6	Ellis Hospital Primary Care 1201 Nott Street Schenectady,NY12308	Primary Care Services
7	Mobile Mammography Van 2210 Troy Road Niskayuna,NY12309	Mammography Services
8	Pelvic Health Center 930 Albany Shaker Road Latham,NY12110	Pelvic Health Services
9	Ellis Hospital Bariatric Center 1405 Fulton Avenue Schenectady,NY12308	Bariatric Care Services
10	Glenville Healthcare Center 460 Saratoga Road Glenville,NY12302	Primary Care Services
11	Ellis Hospital Mental Health Clinic 216 Lafayette Street Schenectady,NY12305	Mental Health Services
12	Bellevue Womans Center 2210 Troy Rd Niskayuna,NY12309	Maternity and Womens' Hospital
13	Ellis Health Center 600 McClellan Street Schenectady,NY12304	Medical Home and 24/7 Emergency Department

Schedule H (Form 990) 2012

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; Part V, Section A; and Part V, Section B, lines 1j, 3, 4, 5c, 6i, 7, 10, 11, 12h, 14g, 16e, 17e, 18e, 19c, 19d, 20d, 21, and 22.
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.
8	Facility reporting group(s). If applicable, for each hospital facility in a facility reporting group provide the descriptions required for Part V, Section B, lines 1j, 3, 4, 5c, 6i, 7, 10, 11, 12h, 14g, 16e, 17e, 18e, 19c, 19d, 20d, 21, and 22.

Identifier	ReturnReference	Explanation
	Part VI - Additional Information	Part VI, Line 7-In accordance with NYS regulations, Ellis follows a triennial community service plan, along with annual updates. Ellis will also submit a community health needs assessment (CHNA) in 2013 as required by applicable regulations
	Part VI - Affilated Health Care System Roles and Promotion	Not Applicable
	Part VI - Explanation Of How Organization Furthers Its Exempt Purpose	Ellis Medicine furthers its exempt purpose by promoting the health of the community through:A volunteer Board of Trustees that is comprised of community members, medical staff members and hospital administrators who serve three year terms, up to a three term maximum. Currently, the Ellis Board is comprised of 22 trustees 17 non-physician citizens of the community, four physicians, and one senior hospital administrator (the hospitals President and CEO). Ellis does not have a parent corporation.An open medical staff consisting of approximately 700 affiliated physicians and other providers. Medical privileges at Ellis Hospital are available to all qualified physicians in the area. Approximately 220 physicians and other providers are employed by Ellis, including 30 residents participating in the Family Medicine Residency and three in the General Dental Residency. Ellis medical staff is led by a Medical-Dental Executive Committee (MDEC). The MDEC plays an integral part in the hospitals corporate structure and daily operations. The MDEC and the department chairs, who oversee specific clinical services, work collaboratively with the hospitals volunteer Board of Trustees, administrators, and staff to ensure the highest quality of care is delivered to patients and that the community's healthcare needs are met with excellence. Physicians also serve as members of the hospitals Board of Trustees, and they are directly involved in the hospitals annual budget process: they rank and prioritize all capital items in the hospitals capital budget and they sign off on volume projections for the hospitals annual operating budget.Operation of two, full service, fully staffed emergency rooms on two separate Schenectady campuses, both of which are open 24 hours-a-day, seven days-a-week, 365 days-a-year, along with 24/7 emergent care services now available for the first time in Southern Saratoga County. Ellis emergency rooms care for all those in need of emergency care regardless of their ability to pay. Similarly, Ellis Hospitals admission policy is not restrictive. Ellis does not deny admission to any patient based on his/her ability to pay. The work of The Foundation for Ellis Medicine, a 501 (c) (3) tax-exempt charitable organization whose sole purpose is to encourage philanthropic support for Ellis Hospital. The Ellis Hospital Foundation was established in 1982 and is governed by a separate board of trustees. Funds raised through the Foundations activities are used to assist the hospital in acquiring state-of-the-art medical equipment and support a wide range of health care programs and services. *Reinvesting its surplus funds to expand/replace/modernize its facilities and medical equipment; support programs/activities aimed at improving quality of care and patient safety; train and educate its medical and nursing staffs; and to improve the overall delivery of and accessibility to health care services in the community.Ellis Medicine demonstrates leadership as a charitable institution by organizing and participating in communitywide efforts for the needy; reaching out to the underserved to provide needed primary and preventative healthcare services and health education, especially through its Medical Home; attracting and using funds to serve the needy; participating in Medicaid and other federal, state, and local healthcare reimbursement programs for the needy such as Child Health Plus; and formally planning for and providing charity care and maintaining a policy of administering care to all persons in need.Ellis Medicine is accountable to the community by having a volunteer governing board comprised of members of the Schenectady community; inviting and responding to community input and involvement in planning and review of hospital activities; voluntarily disclosing information to the public on hospital services, financial status, community benefit activities and charity care; and advocating for healthcare cost containment and promoting the efficient use of healthcare resources within the community.
	Part VI - Community Building Activities	Ellis Medicine (the trade name for Ellis Hospital) successfully restructured healthcare services following the New York State-mandated hospital consolidation in Schenectady in 2007-2008, and has since been working to improve the efficiency and effectiveness of services to its community by aligning its innovative approaches to community health with the services provided by other local community-based public and not-for-profit organizations. Ellis is now the sole acute care hospital in Schenectady County, and is one of the largest primary care providers, having assumed responsibility for the services of two former hospitals which closed during the States rightsizing process. In this important role, Ellis has engaged the community and developed coalitions with community partners in order to ensure access to a full range of healthcare services, with special attention paid to disadvantaged members of our community. Ellis has undertaken and is planning a number of significant capital projects to consolidate care, enhance access to care, and improve the overall quality, efficiency, and cost-effectiveness of our local healthcare system. One of Ellis Medicines key community building activities is Care Central, a community-focused, multi-partner, care management program built from Ellis innovative Medical Home, which is a central location for primary care and outpatient services on a single campus aimed at improving access to healthcare, especially among the uninsured and underinsured. The Ellis Medical Home offers primary care (adult and pediatric), dental care, outpatient child/adolescent mental health services, diabetes education, and emergency services along with a number of outpatient services such as medical imaging, laboratory, a sleep disorders center, wound care, and day surgery. The Medical Home features specially trained Health Services Navigators, one an Ellis employee and the other contracted from Schenectady County Public Health Services, and a Community Services Navigator, a counselor employed by the local community action agency, who help patients connect to the healthcare and social services programs they need, including Medicaid facilitated enrollment services, and a free Community Shuttle which provides transportation from a number of community sites including homeless shelters and soup kitchens to the healthcare campus. The Medical Home is an effective partnership among Ellis Medicine and numerous community groups, including the Schenectady Community Action Program, the Salvation Army, the City Mission, YWCA, YMCA, Schenectady City School District, and Schenectady County Public Health Services, among other social service and community agencies.The success of the Medical Home in building community coalitions helped lead to a successful application by a community partnership for designation by the New York State Department of Health as one of the first three upstate Medicaid Health Homes. The Health Home program, which was established by the Patient Protection and Affordable Care Act (PPACA) of 2010 and conforming State law, is intended to provide a comprehensive array of healthcare and community support services to Medicaid patients with designated high-cost conditions. New York State has chosen to initially focus on patients with multiple chronic conditions, behavioral health issues, and/or HIV/AIDS. A coalition of over 40 healthcare and community agencies led by Ellis, the Visiting Nurse Service of Schenectady and Saratoga Counties, Inc., and Hometown Health (the Schenectady FQHC) now provides comprehensive care management services to high risk Medicaid patients in Schenectady County.A third component of Care Central is a Medicare Community-based Care Transitions Program (CCTP) which serves patients discharged from ten different hospitals in a ten-county region. Ellis is the largest participating hospital.Another example of Ellis coalition building activities is its participation in the Schenectady County Public Health Services federally funded Strategic Alliance for Health (SAH), which brings together a host of healthcare and community organizations to address chronic disease and to promote disease prevention and wellness. An Ellis representative participates in regular meetings of the SAH board. Ellis also works closely with the Schenectady County Public Health Services and the Healthy Capital District Initiative (HCDI) to assess community needs and to develop the State-required Community Service Plan (CSP) to identify health priorities. (These activities are described further on Line 2.)Additionally, Ellis partners with a number of community partners, such as the American Cancer Society and the YWCA, to provide health screenings to uninsured and underinsured populations in our service area. Ellis provides office space and other in-kind support for the State-sponsored Schenectady County Cancer Services Program. In collaboration with community partners, Ellis offers outpatient smoking cessation courses and sponsors peer-driven mental health and cancer patient support groups. And, Ellis cooperates with community groups to facilitate access to healthy foods for people through the community. In past years, acting in collaboration with the Schenectady County Planning Department and the Cooperative Extension, Ellis hosted a weekly Farmers Market in the parking lot of the Ellis Health Center during the summer months. Starting in 2013, physicians at the Family Health Center will be prescribing fresh vegetables to at-risk patients as part of a foundation-funded grant program. The prescription will constitute a voucher for no-charge locally-grown vegetables which will be distributed at a farm stand to be located at the Ellis Health Center.Medical residents from the Ellis Family Medicine Residency donate their time and expertise to staff two free community-based medical clinics. A weekly clinic at the Schenectady City Mission serves uninsured, homeless individuals in the City of Schenectady. And a rural seasonal clinic provides care to uninsured migrant workers in collaboration with the Columbia County Department of Health.Ellis staffs a Green Team that works to promote recycling and other eco-friendly practices throughout the organization. Ellis staff members also sit on numerous community boards and healthcare coalitions to target improvements in such areas as diabetes, long term care, cancer, hospital readmission rates, and healthy living.
	Part VI - Community Information	In accordance with industry standards, Ellis Hospitals community is defined as the hospitals Primary and Secondary Service Areas, accounting for 80% of the hospitals discharge volume. These include all or portions of Schenectady, Saratoga, Albany, Fulton, and Montgomery counties and are comprised of 22 zip codes. Since the State-mandated consolidation of Schenectadys hospitals, Ellis has become the sole provider of acute hospital care in Schenectady County, and it is the largest hospital within its Service Areas.The Primary Service Area is focused on the City of Schenectady, an older industrial city with a population of about 60,000, a substantial decline from the 1940 high of over 90,000. According to the City of Schenectadys 2010-2014 Consolidated Plan, 67% of households in the city are considered low or moderate income, while the poverty rate in the Hamilton Hill neighborhood, adjacent to Ellis Hospital, is over 28%. Nearly all (95%) of the Citys housing stock was built before 1978, and Schenectady neighborhoods have been identified as having among the highest concentration of elevated blood levels for lead in New York State.An impact of the level of poverty in the City of Schenectady has been the extent to which Ellis patients are either covered by government health programs or are uninsured. During 2012, Medicare patients accounted for 41.1% of inpatient discharges, 30.3% of outpatient visits, and 35.9% of net patient revenues. Medicaid covered 22.0% of inpatient discharges, 20.0% of outpatient visits, and 15.7% of net patient revenues. Uninsured patients accounted for 3.2% of inpatient discharges and 5.3% of outpatient visits. Overall, uninsured or government insured patients made up 66.3% of inpatient discharges and 55.6% of outpatient visits, while generating 54.3% of net patient revenues before bad debts.There is one Medically Underserved Population (MUP) within Ellis Primary Service Area. The homebound population of Schenectady County is designated MUP 06211. In response, physicians on the staff of the Ellis Family Health Center make house calls, and residents in the hospitals Family Medicine Residency may include house calls in their training. The Secondary Service Area is a much wider geographic area, including rural and farming communities, as well as affluent suburbs. Overall, the combined Service Areas represent a study in contrasts. A nearly equal number of people have incomes below $25,000 as above $100,000. Health status variations are similarly dramatic. For example, according to the New York State Department of Health the rates of asthma-related hospital admissions per 10,000 people vary from 458 in the 12307 ZIP code to 49 in the 12309 ZIP code, a distance of about five miles.Overall census data for the combined Service Areas for 2012 estimate a total population of 363,289. This is projected to increase to 372,181 by 2017. The 2012 median income was $56,774, while the mean income was $70,024, demonstrating the impact of outliers. The gender distribution is 49% male and 51% female. The area is fairly well educated, with 31% of the population having a bachelors degree or more. There will, however, likely be increased need for healthcare services as the community ages. The greatest change in population from 2012 to 2017 is expected to be in the over 55 age range (14% increase), while decreases are expected in the number of children aged 0-17 (2%) and in adults in the 35-54 age range (8%).
	Part VI - Patient Education of Eligibility for Assistance	Ellis Medicine provides financial assistance information about programs available to assist patients in paying for their bills, including discount programs and charity care, on its external website (www.ellismedicine.org) (specifically at http://www.ellismedicine.org/financial-assistance/faqs.aspx), in readily available and publicly distributed brochures, and through flyers and posters visible throughout the organization. Applications for financial assistance are available online at the Ellis website. Additionally, Ellis employs Financial Advocates who assist patients in determining the availability of and their eligibility for free or low-cost care, and then assist them with completing the necessary paperwork. Since 2009, Ellis Medicine has included affirmative financial assistance outreach as part of the innovative Medical Home through which it aims to increase access to care and provide healthcare navigation services to patients (especially the underserved and uninsured / underinsured), including education about and assistance with charity care and financial assistance services. Medicaid Facilitated Enrollers from HCDI and from Fidelis (a not-for-profit Medicaid Managed Care Organization) are located on-site at Ellis facilities.Additionally, Ellis publicizes its Financial Call Center & Information Line (sharing with our 3,300 employees; our local, state and federal lawmakers offices in case they receive constituent inquiries related to hospital costs and/or financial services at Ellis; and the general public), highlighting a number to call (518-243-1695) through which patients can receive information about how much their care will cost at Ellis Medicine as a way to be transparent and helpful in providing this information, as more and more patients are paying higher deductibles and are concerned about the cost to them out-of-pocket. This is particularly significant in Ellis Primary Service Area, as the largest local employer has converted to a high-deductible health insurance plan for most of its employees.Ellis has also participated in health fairs and employer information functions to advise small businesses and their employees of Ellis Financial Call Center & Information Line. Ellis Call Center has trained specialists who can help enroll qualifying patients in Financial Assistance programs, estimate a patients out-of-pocket expenses based on their medical plan, provide pricing for procedures and tests at Ellis Medicine and assist patients in completing Medicaid applications when applicable. Ellis Information Line helps with physician referrals, scheduling outpatient testing and providing general information about programs and services at Ellis Medicine.
	Part VI - Needs Assessment	Ellis Medicine assesses the healthcare needs of its community through analysis of federal, State and local healthcare data, through collaboration with healthcare and community partners, and through the engagement of the public in meetings and surveys. Ellis files a Community Service Plan (http://www.ellismedicine.org/pdf/CommunityServicePlan.pdf) with the New York State Department of Health, along with annual Plan Updates, as required of all hospitals in New York State. Ellis has begun working with community partners in preparation for Community Health Needs Assessment (CHNA) and Implementation Plan reporting which will be required for the tax year 2013. The Schenectady community intends to use this opportunity to develop a comprehensive, multi-agency, plan for a full range of coordinated services. As the basis for the CHNA, Ellis engaged an epidemiologist who has designed a comprehensive health needs survey which will be administered door-to-door in the City of Schenectady, the area of highest need, by Community Health Workers (CHW) and student volunteers. Ellis participates as a dues-paying member of the Healthy Capital District Initiative (HCDI), a State-recognized regional health planning and research agency. HCDI members include county health departments from New Yorks Capital Region (Albany, Schenectady and Rensselaer Counties), local hospitals and FQHCs, not-for-profit health insurers, and other healthcare and community partners. HCDI coordinates regional needs assessments and collaborative responses to identified service gaps. Ellis is represented on the Board of HCDI, where an Ellis representative attends bi-monthly meetings, and Ellis has provided staff expertise for various workgroups. HCDI also serves as a Medicaid Facilitated Enroller for Schenectady County.HCDI published a report on an intensive study of Emergency Department (ED) utilization in the three-county region. Ellis participated by distributing HCDIs surveys to patients in both Emergency Departments, and by assigning staff to work on several HCDI workgroups. The analysis found that nearly half of ED visits could have been treated in a primary care setting or prevented by appropriate primary care, and also found that an unusually large share of Ellis ED visits were by uninsured patients as compared with other hospitals in the area. In response, Ellis has increased efforts to make primary care services available in Schenectady, and has met with Schenectady County officials and community organizations to develop ways to encourage uninsured patients to obtain Medicaid coverage. The Ellis Family Health Center, a primary care clinic which largely serves uninsured and Medicaid patients, provided over 35,000 patient visits in 2012.As part of the 2013 CHNA process, HCDI will update its Community Health Profile (last published in 2009) through which multiple data sources were analyzed to identify and rank the top health concerns in Albany, Schenectady and Rensselaer Counties. In preparing the 2009 document, a public health forum, How Healthy Is the Capital District? was held at a local television station, allowing audience and call-in participation during the hour-long broadcast. Additionally, a public survey of community members was also administered. Of the more than 1,100 community members surveyed, 41.6% of respondents resided in Schenectady County. The main issues covered by the survey included access to care, health insurance coverage, barriers to healthcare, Emergency Department utilization, and chronic disease experiences.In addition to this Capital Region-wide effort, Ellis has long worked with Schenectady County Public Health Services to identify health priorities and strategies to address them. From this process, Ellis produces a State-required Community Service Plan and the County Public Health Service produces its separate State-required Community Health Assessment. In accordance with New York State law, Ellis filed a three year (2010-2012) Community Service Plan with the State Department of Health in September 2009, and then filed annual updates to the Plan in September 2010, September 2011, and September 2012. Following review, the New York State Department of Health has accepted each of Ellis updates without requiring any revisions.Finally, Ellis holds regular meetings in the community and has engaged the Siena Research Institute to conduct periodic public surveys regarding local health concerns and priorities. During 2012, Ellis conducted 12 community outreach meetings between community groups, such as neighborhood associations, service clubs, and senior citizens organizations, and Ellis executives. In addition, the CEO and CFO met with the Mayor of the City of Schenectady. The most recent Siena Survey was conducted in late 2010 to assess community satisfaction with overall healthcare services and with specialty care services. The survey found that 79% of Schenectady residents are satisfied or very satisfied with the overall healthcare system in the community. The largest categories of service for which patients travel outside the community are oncology (26%) and general surgery (24%). The results of these surveys and the public input via community meetings provide feedback from the general public about hospital services/health needs/health concerns. Ellis also holds regular meetings with employees and physicians, and administers annual satisfaction surveys to its employees and physicians.
Number of Hospital Faciltiy - 1	Part V, Line 20d - Other Billing Determination of Individuals Without Insurance	All uninsured patients are automatically eligible for a reduction of charges to the reimbursement rate from Ellis' highest volume health maintenance organization. Uninsured patients with incomes at or below 300% FPG are eligible to recieve charity (free) care.
	Part III, Line 9b - Provisions On Collection Practices For Qualified Patients	Ellis Hospital does not use presumptive eligibility for charity care. All patients eligible for charity care must submit an application which is then reviewed by Ellis to verify charity care eligibility. Without a submitted application, charity care is not approved and patients are subject to routine collection efforts as outlined in Ellis' collection policies. However, once approved for charity care, patients balances are eliminated and no collection efforts take place.
	Part III, Line 8 - Explanation Of Shortfall As Community Benefit	The costing methodology used to determine Medicare allowable cost reported on Part III, line 6 is the ratio of costs to charges. Consistent with the charitable health care mission of Ellis Hospital, Ellis provides care for all patients covered by Medicare who seek medical care. Such care is provided regardless of whether the reimbursement provided for such services meets or exceeds the cost incurred by Ellis to provide such services. As a result, Ellis views any shortfall reported in Line 7 as an additional item of community benefit provided by the organization.
	Part III, Line 4 - Bad Debt Expense	The following footnote related to bad debt expense is included in the audited financial statements.The Hospital grants credit without collateral to patients, most of whom are local residents and are insured under third party payor agreements. Additions to the the allowance for doubtful accounts are made by means of the provision for bad debts. Accounts written off as uncollectible are deducted from the allowance. The amount of the provision for bad debts is based upon management's assessment of historical expected net collections, business and economic conditions, trends in Federal and state governmental health care coverage, and other collection indicators. Services rendered to individuals when payment is expected and ultimately not recieved are written off to the allowance for doubtful accounts.The Bad Debt Expense included on form 990, Part IX, line 25, column (A) but removed from the percent of expense on Schedule H, Line 7 a through k, column (F) was $14,152,292.
	Part III, Line 2 - Methodology Used To Estimate Bad Debt Expense	The costing methodology used in determining the amounts on Part III, Section A, lines 2 and 3, is Ellis's cost to charge ratio.
	Part I, Line 3c - Charity Care Eligibility Criteria (FPG Is Not Used)	All uninsured patients are automatically eligible for a reduction of charges to the reimbursement rate from Ellis' highest volume health maintenance organization. Uninsured patients with incomes at or below 300% FPG are eligible to receive charity (free) care.

Schedule H (Form 990) 2012

Additional Data

Software ID:	12000229
Software Version:	2012v2.0

- TIN:

Schedule I
(Form 990)

Department of the Treasury
Internal Revenue Service

Grants and Other Assistance to Organizations,
Governments and Individuals in the United States

Complete if the organization answered "Yes," to Form 990, Part IV, line 21 or 22.
lBullet

Attach to Form 990

OMB No. 1545-0047

2012

Open to Public
Inspection

Name of the organization
Ellis Hospital

Employer identification number
14-1338428

Part I

General Information on Grants and Assistance

Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ....................................

Yes No

Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.

Part II

Grants and Other Assistance to Governments and Organizations in the United States. Complete if the organization answered "Yes" to
Form 990, Part IV, line 21, for any recipient that received more than $5,000. Part II can be duplicated if additional space is needed.

(a) Name and address of organization or government	(b) EIN	(c) IRC Code section if applicable	(d) Amount of cash grant	(e) Amount of non-cash assistance	(f) Method of valuation (book, FMV, appraisal, other)	(g) Description of non-cash assistance	(h) Purpose of grant or assistance

Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................ Bullet Image

Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image

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

Cat. No. 50055P

Schedule I (Form 990) 2012

Page 2

Part III

Grants and Other Assistance to Individuals in the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 22.
Part III can be duplicated if additional space is needed.

(a)Type of grant or assistance	(b)Number of recipients	(c)Amount of cash grant	(d)Amount of non-cash assistance	(e)Method of valuation (book, FMV, appraisal, other)	(f)Description of non-cash assistance
(1) School of Nursing Scholarship	103	4,750	34,163	FMV	Tuition Reduction

Part IV

Supplemental Information.

Complete this part to provide the information required in Part I, line 2, Part III, column (b), and any other additional information.

Identifier	Return Reference	Explanation
Grantmaker's Description of How Grants are Used		The School of Nursing (SON) works with the office of the Vice President for Nursing and the Ellis Hospital Foundation to track awards and to assure that the grants and monies are used for the intended purpose. It is the responsibility of the Ellis Finance Department to release the funds and account for the remaining balance. In the case of the Auer Scholarship, the faculty interviews the potential recipients and makes a recommendation (in rank order) of who should receive the scholarship. The Director of the SON meets with the VP for Nursing and they make a decision on how many scholarships to award to the top candidates. The Finance Department then credits the student tuition receivable account and draws the money from the Scholarship fund. There are scholarship monies that community organizations give. The organizations either send a check or hand it to the student at commencement.

Schedule I (Form 990) 2012

Additional Data

Software ID:	12000229
Software Version:	2012v2.0

- TIN:

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

2012

Open to Public Inspection

Name of the organization

Ellis Hospital

Employer identification number

14-1338428

Part I

Questions Regarding Compensation

Yes

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.

First-class or charter travel Housing allowance or residence for personal use

Travel for companions Payments for business use of personal residence

Tax idemnification and gross-up payments Health or social club dues or initiation fees

Discretionary spending account Personal services (e.g., maid, chauffeur, chef)

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 of the expenses described above? If "No," complete Part III to explain....

Yes

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? .......

Yes

Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

Form 990 of other organizations Approval by the board or compensation committee

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:

Receive a severance payment or change-of-control payment? ................

Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........

Participate in, or receive payment from, an equity-based compensation arrangement? .........

If "Yes" to any of lines 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.

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:

The organization? ...........................

Any related organization? .........................

If "Yes," to line 5a or 5b, describe in Part III.

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:

The organization? ...........................

Yes

Any related organization? .........................

If "Yes," to line 6a or 6b, describe in Part III.

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

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

If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................

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

Cat. No. 50053T

Schedule J (Form 990) 2012

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 (E) amounts for that individual.

(A) Name and Title		(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
(A) Name and Title		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable 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
(1)Wendy RosherVice President Clinical Services	(i) (ii)	197,447	18,918	4,691	12,996	18,386	252,438
(2)Terence Clarke MDMD Surgery	(i) (ii)	557,742	58,700	27,596	61,300	11,307	716,645	49,950
(3)Robert McKay MDM.D. Surgery	(i) (ii)	478,676	33,587	35,028	80,245	654	628,190	57,960
(4)Paul Spurgas MDM.D. Neurosurgery	(i) (ii)	800,656	139,000	18,219	8,958	9,061	975,894
(5)Paul A MiltonEVP/COO	(i) (ii)	287,752	26,430	8,401	9,974	21,269	353,826
(6)Patti S HammondVice President, Physician Relations	(i) (ii)	208,239	21,065	4,483	9,302	17,649	260,738
(7)Max S Laguerre MDRad. Oncologist	(i) (ii)	441,654		26,565	10,000	8,885	487,104
(8)Kelli ValentiVP Strategic Planning	(i) (ii)	146,799	15,314	2,771		19,534	184,418
(9)Joseph GiansanteVice President, Human Resources	(i) (ii)	192,910	21,105	19,748	9,396	22,658	265,817
(10)James W ConnollyPresident & CEO	(i) (ii)	503,023	45,649	38,369	11,149	32,355	630,545
(11)Herbert Reich MDM.D. Cardiac Surg	(i) (ii)	448,204	57,960	16,801	86,935	14,307	624,207
(12)Donald J McLaughlinVice President Facility and Support	(i) (ii)	142,426	17,061	18,013	7,041	22,248	206,789
(13)David SnyderVice President Information Services	(i) (ii)	187,906	17,738	445	8,216	21,105	235,410
(14)David M Liebers MDVice President, Medical Affairs/CMO	(i) (ii)	284,031	18,127	775	10,675	25,650	339,258
(15)Daniel J RinaldiCFO	(i) (ii)	295,798	23,844	2,317	10,000	10,704	342,663
(16)Cecilia A LynchVice President, Nursing/CNO	(i) (ii)	196,431	15,272	4,187	8,618	18,901	243,409
(17)Anoush Koroghlian - ScottVP Legal Affairs	(i) (ii)	172,327	15,300	17,031		12,251	216,909

Schedule J (Form 990) 2012

Page 3

Part III

Supplemental Information

Complete this part to provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II.
Also complete this part for any additional information.

Identifier	Return Reference	Explanation
Sch J, Part III, Additional Information	Part III, Additional Information	Dr. Terence Clarke is a Surgeon employed by Ellis Hospital. In addition to his base salary, he participates in an incentive compensation plan. In Schedule J Column F, the $49,950 represents the incentive compensation he earned in 2011. This amount was included in his 2012 W-2 and is included in column B (ii). This amount was reported as Deferred Compensation in the 2011 990 Schedule J Part II in Column C.Dr. Herbert Reich is a Surgeon employed by Ellis Hospital. In addition to his base salary, he participates in an incentive compensation plan. In Schedule J Column F, the $57960 represents the incentive compensation he earned in 2011. This amount was included in his 2012 W-2 and is included in column B (ii). This amount was reported as Deferred Compensation in the 2011 990 Schedule J Part II in Column C.
Sch J, Part I, Line 1a	Part I, Line 1a: Relevant information in regards to selections on 1a.	Ellis Hospital has a corporate membership at the Mohawk Golf Club that is in the CEO's name, however, the club is used for business purposes and functions only.

Schedule J (Form 990) 2012

Additional Data

Software ID:	12000229
Software Version:	2012v2.0

- TIN:

Schedule K
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Information on Tax Exempt Bonds

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

2012

Open to Public
Inspection

Name of the organization
Ellis Hospital

Employer identification number
14-1338428

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
(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	Yes	No	Yes	No	Yes	No
A	Schen Cnty Cap Res Corp	27-3478847	806418AU3	06-01-2012	15,320,000	Refinance of 1995 Debt		X		X		X
B	Dorm Auth of NYS	14-6000293	64983TQ97	11-23-2004	16,834,363	Construction of new ICU		X		X		X

Part II

Proceeds

	A		B		C		D
	1 Amount of bonds retired . . . . . . . . . . . . . .
2 Amount of bonds legally defeased . . . . . . . . . . .
3 Total proceeds of issue . . . . . . . . . . . . . .	15,320,000		16,834,363
4 Gross proceeds in reserve funds . . . . . . . . . . . .	571,000		1,224,505
5 Capitalized interest from proceeds . . . . . . . . . . .	861,840		861,840
6 Proceeds in refunding escrows . . . . . . . . . . . .
7 Issuance costs from proceeds . . . . . . . . . . . .	306,400		57,858
8 Credit enhancement from proceeds . . . . . . . . . . .	134,554
9 Working capital expenditures from proceeds . . . . . . . . .
10 Capital expenditures from proceeds . . . . . . . . . . .	14,407,431		14,407,431
11 Other spent proceeds . . . . . . . . . . . . . .	14,308,046		282,729
12 Other unspent proceeds . . . . . . . . . . . . . .
13 Year of substantial completion . . . . . . . . . . . .
	Yes	No	Yes	No	Yes	No	Yes	No
14 Were the bonds issued as part of a current refunding issue? . . . . .		X		X
15 Were the bonds issued as part of an advance refunding issue? . . . . .		X		X
16 Has the final allocation of proceeds been made? . . . . . . . .	X		X
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? . . . . . . . . . . . . . .	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
2 Are there any lease arrangements that may result in private business use of bond-financed property? . . . . . . . . .		X		X

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

Cat. No. 50193E

Schedule K (Form 990) 2012

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
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? . . . . . . . . . . . . . . . .
c Are there any research agreements that may result in private business use of bond-financed property? . . . . . . . . . . . . . . .		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
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 . .	%		%		%		%
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 . . . . . . .	%		%		%		%
6 Total of lines 4 and 5 . . . . . . . . . . . . . . .	%		%		%		%
7 Does the bond issue meet the private security or payment test? . . . . .		X
8a Has there been a sale or disposition of any of the bond financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were issued?. . . . . . . . . . . . . . . . .	X
b If “Yes” to line 8a, enter the percentage of bond-financed property sold or disposed of.	%		%		%		%
c If “Yes” to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? . . . . . . . . . . . . .
9 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

Part IV

Arbitrage

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Has the issuer filed Form 8038-T? . . . . .	X			X
2 If "No" to line 1, did the following apply? . . . .
a Rebate not due yet? . . . . . . . .		X		X
b Exception to rebate? . . . . . . . .		X		X
c No rebate due? . . . . . . . . . .		X		X
If you checked "No rebate due" in line 2c, provide in Part VI the date the rebate computation was performed
3 Is the bond issue a variable rate issue? . . . .
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?		X		X
b Name of provider . . . . . . . . .
c Term of hedge . . . . . . . . . .
d Was the hedge superintegrated? . . . . . .
e Was a hedge terminated? . . . . . . .

Schedule K (Form 990) 2012

Page 3

Part IV

Arbitrage (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
5a Were gross proceeds invested in a guaranteed investment contract (GIC)? . . . . . . . . .		X		X
b Name of provider . . . . . . . . .
c Term of GIC . . . . . . . . . .
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? . . . . .
6 Were any gross proceeds invested beyond an available temporary period? . . . . . . . .		X		X
7 Has the organization established written procedures to monitor the requirements of section 148? . . .		X		X

Part V

Procedures To Undertake Corrective Action

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 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?		X		X

Part VI

Supplemental Information. Complete this part to provide additional information for responses to questions on Schedule K (see instructions).

Identifier	Return Reference	Explanation
Supplemental Information	Part VI	The bond issuer, Dormitory Authority of the State of New York, has completed arbitrage rebate calculations for this bond issue as required and it has been determined that no arbitrage rebate exists.

Schedule K (Form 990) 2012

Additional Data

Software ID:	12000229
Software Version:	2012v2.0

- TIN:

Schedule L
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Transactions with Interested Persons

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, line 38a or 40b.
MediumBullet

Attach to Form 990 or Form 990-EZ. MediumBullet

See separate instructions.

OMB No. 1545-0047

2012

Open to Public Inspection

Name of the organization

Ellis Hospital

Employer identification number

14-1338428

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	(c) Description of transaction	(d) Corrected?
1(a) Name of disqualified person	(c) Description of transaction	Yes	No

Enter the amount of tax incurred by organization managers or disqualified persons during the year under section 4958. ........................... Bullet Image

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-EZ, Part V, line 38a, or Form 990, Part IV, line 26; or if the organization reported an amount on Form 990, Part X, line 5, 6, or 22

(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	(d) Loan to or from the organization?		(e)Original principal amount	(f)Balance due	(g) In default?		(h) Approved by board or committee?		(i)Written agreement?
(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	To	From	(e)Original principal amount	(f)Balance due	Yes	No	Yes	No	Yes	No






Total ...... $

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 assistance	(d) Type of assistance	(e) Purpose of assistance

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

Cat. No. 50056A

Schedule L (Form 990 or 990-EZ) 2012

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?
(a) Name of interested person		(c) Amount of transaction	(d) Description of transaction	Yes	No
(1) Sarah Schermerhorn	Trustee	65,437	family member comp		No
(2) Brian McDonald MD	Trustee	601,825	Medical Services		No
(3) Mark Breslin	Trustee	2,515,845	Construction Management		No
(4) John A Nolan MD	Trustee	409,349	Medical Services		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
		Dr. Nolan is a founding member and President of Cardiology Associates of Schenectady (CAS). CAS is a prominent group of 22 cardiologists, with six offices, that provides comprehensive cardiac care to patients in Schenectady, Montgomery, Fulton and Saratoga counties. CAS received payment for the direction of the cardiology program at Ellis Hospital. Ellis Hospital also leased Physicians' Assistants from CAS during 2012.Mr. Breslin serves as Vice President and General Manager for the New York North Business Unit of Turner Construction Company. After going through a selection process, Turner Construction Company was awarded the construction management contract for the new Emergency Renovation Project in 2011. Mr. Breslin recused himself from project-related board votes and did not participate in any discussion of the selection process in 2011. He did not participate in any voting related to the Emergency Renovation Project at Ellis Hospital. In 2012 Turner Construction was paid $2,515,845 for construction services.Dr. Brian McDonald is a partner in physician practice-Schenectady Pulmonary & Critical Care Associates (SPCCA). SPCCA provides 24/7 coverage to Ellis and was paid $601,825 in 2012. Dr. McDonald also individually receives compensation as Chief of Medical Staff Elect. ($12,450) Sarah Schermerhorn's son Paul is an employee of Ellis and his annual salary was $65,436.91. Sarah Schermerhorn did not have any impact in the hiring of Paul and does not have any influence in the determination of his annual salary.

Schedule L (Form 990 or 990-EZ) 2012

Additional Data

Software ID:	12000229
Software Version:	2012v2.0

- TIN:

SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
MediumBullet

Attach to Form 990 or 990-EZ.

OMB No. 1545-0047

2012

Open to Public
Inspection

Name of the organization

Ellis Hospital

Employer identification number

14-1338428

Identifier	Return Reference	Explanation
Form 990, Part XI, Line 9	Other Changes In Net Assets Or Fund Balances - Other Decreases	Pension and Post Retirement = -$4559153
Form 990, Part XI, Line 9	Other Changes In Net Assets Or Fund Balances - Other Increases	Contributed Property Plant and Equipment = $12267000
Form 990, Part XI, Line 9	Other Changes In Net Assets Or Fund Balances - Other Increases	Change in Interest in Foundation = $395085
Form 990, Part XI, Line 9	Other Changes In Net Assets Or Fund Balances - Other Increases	= $0
Form 990, Part VI, Line 19	Form 990, Part VI, Line 19: Other Organization Documents Publicly Available	Corporate Compliance Policies (including Conflicts of Interest Policy) and audited Financial Statements are available to the general public via posting on the Ellis Hospital website: www.ellismedicine.org. In addition, these documents and governing documents are available to the public upon request.
Form 990, Part VI, Line 15a	Form 990, Part VI, Line 15a: Compensation Review & Approval Process - CEO, Top Management	The current Executive Compensation and Executive Incentive/At Risk Compensation plan are in full compliance with all existing rules and regulations applicable to a 501(c) corporation. The following is a summary of each plan:Executive Compensation Plan-The President, and all other corporate officers are governed by our Executive Compensation Program established by the Board of Trustees. A present range is set (less than 50%) based on a comparable salary survey by an external agency. This base salary is reviewed by the Executive Compensation Committee of the Board of Trustees and the full Board of Trustees.Incentive Compensation Plan (ICP)-The ICP program is administered also by the Executive Compensation Committee under the direction of the Board of Trustees. The Plan is based on preset goals and includes corporate qualitative goals, departmental goals, financial benchmarks and individual goals. All payments from this program are based on audited results and reviewed by the Board of Trustees prior to any payments being made. Payments are made annually after the year has been completed.The review of compensation agreements and gathering of comparability data in determining the reasonableness of compensation follow the procedures described in treasury regulation section 53.4958-6.
Form 990, Part VI, Line 12c	Form 990, Part VI, Line 12c: Explanation of Monitoring and Enforcement of Conflicts	Ellis Hospital's Conflict of Interest Policy applies to all Hospital Trustees, Officers, employees, Medical/Dental staff members, Directors, Managers, appointees with administrative and/or decision-making responsibilities, Volunteers or any of these parties' immediate families (collectively called Hospital Agents). The Ellis Hospital Corporate Bylaws require Hospital Agents and other selected individuals as identified by the Vice President, Human Resources and the Corporate Compliance Officer/Director of Internal Audit (CCO), to file a conflict of interest disclosure statement with the Hospital on a annual basis. When the statements are completed they are returned to the CCO. Upon receipt, the CCO will review the disclosure and, if a potential conflict is disclosed, will meet with the Hospital Agent and/or his/her appropriate supervisor to discuss the disclosure and need for action if any. All statements for Trustees are also reviewed by the CCO, and if a potential conflict has been disclosed, he/she will meet with the Board Chairperson to discuss the disclosure and need for action, if any. All potential conflicts involving the Board of Trustees will be summarized by the CCO and reported to the Audit Committee of the Board. This Committee will then share this information with the Board Chairperson. When a potential or actual conflict exists, An interested person may make a presentation to the Board or at a Committee meeting, but after such presentation, he/she shall leave the meeting during the discussion of, and the vote upon, the transaction or arrangement that could constitute the conflict of interest. The Board or Committee members shall determine by a majority vote whether the transaction or arrangement is in the Hospital's best interest.
Form 990, Part VI, Line 11b	Form 990, Part VI, Line 11b: Form 990 Review Process	A copy of the Ellis Hospital's 990 was prepared and submitted for review to the Senior Management team comprised of the Chief Executive Officer, the Chief Operating Officer, Chief Financial Officer, and Vice Presidents. After their review was completed, the Form 990 was sent to each member of the Audit Committee for review. After review by the Audit committee, a copy of the Form 990, including all required schedules, as ultimately filed with the IRS, was given to each voting member of Ellis' Board of Trustees, prior to its filing with the IRS. After review by the Board of Trustees, and upon the recommendation of the Audit Committee, approval is given for filing the return with the IRS.

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

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2012

Additional Data

Software ID:	12000229
Software Version:	2012v2.0

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

Complete if the organization answered "Yes" to Form 990, Part IV, line 33, 34, 35, 36, or 37.
MediumBullet

Attach to Form 990. MediumBullet

See separate instructions.

OMB No. 1545-0047

2012

Open to Public Inspection

Name of the organization

Ellis Hospital

Employer identification number

14-1338428

Part I

Identification of Disregarded Entities (Complete if the organization answered "Yes" to Form 990, Part IV, line 33.)

(a) Name, address, and EIN (if applicable) 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" to 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 entity?
(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	Yes	No
(1) Visiting Nurse Service Assoc of Schen 108 Erie Boulevard Schenectady,NY12305 14-1338478	Home Health Care	NY	501(c)(3)	3	Ellis Hospital	Yes

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

Cat. No. 50135Y

Schedule R (Form 990) 2012

Page 2

Part III

Identification of Related Organizations Taxable as a Partnership (Complete if the organization answered "Yes" to 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	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

Part IV

Identification of Related Organizations Taxable as a Corporation or Trust (Complete if the organization answered "Yes" to 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	(i) Section 512(b)(13) controlled entity?
(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	Yes	No

Schedule R (Form 990) 2012

Page 3

Part V

Transactions With Related Organizations (Complete if the organization answered "Yes" to Form 990, Part IV, line 34, 35b, or 36.)

Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.

Yes

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 or (iv) rent from a controlled entity . . . . . . . . . . . . . . . . . . . . . . .

b Gift, grant, or capital contribution to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

c Gift, grant, or capital contribution from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

d Loans or loan guarantees to or for related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

e Loans or loan guarantees by related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

f Dividends from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

g Sale of assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

h Purchase of assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

i Exchange of assets with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

j Lease of facilities, equipment, or other assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .

k Lease of facilities, equipment, or other assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .

l Performance of services or membership or fundraising solicitations for related organization(s) . . . . . . . . . . . . . . . . . . . .

m Performance of services or membership or fundraising solicitations by related organization(s) . . . . . . . . . . . . . . . . . . . .

n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) . . . . . . . . . . . . . . . . . . . . .

o Sharing of paid employees with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

p Reimbursement paid to related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

q Reimbursement paid by related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

r Other transfer of cash or property to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

s Other transfer of cash or property from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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-s)	(c) Amount involved	(d) Method of determining amount involved

Schedule R (Form 990) 2012

Page 4

Part VI

Unrelated Organizations Taxable as a Partnership (Complete if the organization answered "Yes" to 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)	(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 VUBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

Schedule R (Form 990) 2012

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:	12000229
Software Version:	2012v2.0

1	Briefly describe the organization’s mission or most significant activities: The Mission of Ellis Hospital (d/b/a Ellis Medicine) is to meet the health needs of our community with excellence.Our vision is to be an exceptional healthcare system by providing patient-centered care and collaborating with our physicians.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	22
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	16
5	Total number of individuals employed in calendar year 2011 (Part V, line 2a) ......	5	4,160
6	Total number of volunteers (estimate if necessary) .............	6	281
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	4,871,675
b	Net unrelated business taxable income from Form 990-T, line 34 .........	7b	-1,092,983

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	7,814,743	5,942,872
9	Program service revenue (Part VIII, line 2g) .........	349,905,580	361,268,338
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	3,247,983	3,665,665
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	4,084,275	8,988,024
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)...................	365,052,581	379,864,899
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	41,598	38,913
14	Benefits paid to or for members (Part IX, column (A), line 4).....		0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	205,281,773	214,474,178
16a	Professional fundraising fees (Part IX, column (A), line 11e).....		0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	147,564,099	154,567,380
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	352,887,470	369,080,471
19	Revenue less expenses. Subtract line 18 from line 12.......	12,165,111	10,784,428
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	224,434,893	276,233,584
21	Total liabilities (Part X, line 26).............	130,317,308	162,690,098
22	Net assets or fund balances. Subtract line 21 from line 20.....	94,117,585	113,543,486

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 284,601,137 including grants of $ 38,913 ) (Revenue $ 333,247,246 )
	Health care services: Ellis is a community and teaching hospital with 438 licensed beds (of which 349 were staffed in 2012) across three campuses, including 52 inpatient mental health beds (see item 4B below). The hospital is overseen by a volunteer Board of Trustees drawn from the community. Ellis is the sole provider of acute hospital care in Schenectady County, following state-mandated restructuring which resulted in consolidation of three hospitals into one in 2007-2008. With the mission to meet the health and wellness needs of our community with excellence, Ellis balances state-of-the-art technology and advanced medical procedures with a tradition of community-based caring and a firm commitment to quality.Ellis has earned numerous recognitions for clinical excellence and community service. For six years in a row (2007 2012), Ellis has received recognition from the American Stroke Association (ASA) through the ASAs Gold and Gold Plus Achievement awards. Ellis is recognized for using the ASAs Get with the Guidelines program for improving the quality of care and patient outcomes. Ellis is also a designated Stroke Center by the New York State Department of Health. The hospital has been designated a Center of Excellence by the American Society for Metabolic and Bariatric Surgery. In addition, the Sleep Disorders Center is accredited by the American Academy of Sleep Medicine; the Ellis (Belanger) School of Nursing is accredited by the National League for Nursing Accrediting Commission; the Family Medicine Residency is accredited by both the Accreditation Council for Graduate Medical Education and the American Osteopathic Association; and the Ellis Medicine Glenville Health, Family Practice Associates, and Family Health Center all achieved National Commission on Quality Assurance (NCQA) Patient-Centered Medical Home (PCMH) recognition. During recent years Ellis has received community service awards from the City Mission of Schenectady (Partners Award, specifically recognizing the hospitals free community shuttle, health service navigators, and other services for the underserved), the Schenectady ARC (Employer of the Year, recognizing the hospital for providing employment, with opportunities for growth and meaningful experience, to individuals with developmental disabilities), the Sight Society of Northeastern New York (Hospital of the Year for commitment and compassion to grieving families along with outstanding accomplishments and best practices to facilitate cornea donations), the Goose Hill Neighborhood Association (Community Award for being a good neighbor and proactive communicator), and the Seventh National Learning Congress of the United States Department of Health and Human Services (Silver Medal for organ donation).Ellis operates two Emergency Departments which had 88,119 visits in 2012, the Bellevue Womans Care Center which delivered 2,633 babies in 2012, four primary care practices (in Schenectady (2), Glenville, and Latham), an 82-bed skilled nursing facility and short-stay rehabilitation facility, two off-site blood draw stations, a Bariatric Care location, a Sleep Disorders Center, a Wound Care Center, a Family Medicine Residency including an Osteopathic Residency, a General Dental Residency, and a School of Nursing. Residents enrolled in the Family Medicine Residency and the General Dental Residency provide primary medical and dental care to patients, the majority of whom are uninsured or are participants in government programs such as Medicaid, Family Health Plus, and Child Health Plus through three clinics located at the Ellis Health Center: the Family Health Center, the Pediatric Health Center, and the Dental Health Center. In late 2012, Ellis opened the Medical Center of Clifton Park (MCCP), currently the only 24/7 emergent care facility located in Southern Saratoga County, one of the fastest-growing communities in New York State. Ellis is also the corporate member of the Visiting Nurse Service of Schenectady and Saratoga Counties (VNS), a not-for-profit home health care agency which is the largest State-certified provider of home health care services in Schenectady County. The Ellis Belanger School of Nursing prepares students for licensure as professional Registered Nurses (RN). Ninety-four percent of the schools graduates passed the New York State nursing licensure examination in 2012. Total enrollment in October 2012 was 132 students. The graduates in the Class of 2012 (combined day and evening/weekend programs) were 48, of whom 37 (77%) joined the nursing staff at Ellis upon graduation.Ellis serves the community by addressing identified health care priorities, including access to care and prevention and treatment of chronic diseases, through a variety of programs. Identification of needs includes such mechanisms as the State-mandated three-year Community Service Plan (the 2010-2012 plan was filed in September 2009 and updated in September 2012), the Healthy Capital District Initiative (HCDI) (a three-county health data collection and planning entity which brings together county health departments, hospitals, FQHCs, and not-for-profit insurers), and the Schenectady County Strategic Alliance for Health (a federally-designated and funded collaborative focused on preventing chronic disease and promoting community health). Ellis also collaborates with the Schenectady County Public Health Service, such as cooperation in identifying the health care needs of Schenectadys Indo-Guyanese (West Indian) population through a federal REACH grant. Care Central, a multi-agency provider of care management services led by Ellis and VNS, addresses community health needs through: 1) the Medical Home, an innovative community collaboration which centralizes primary care and outpatient health and community services in one location at the Ellis Health Center campus, featuring health services navigators and a community service navigator, a free community shuttle van, and community-focused programs such as a combined kindergarten registration and immunization event, 2) a Medicaid Health Home which also provides both care management and direct chronic care services to uninsured patients, and 3) a Medicare Community-based Care Transitions Program (CCTP). Community needs are also addressed by such programs as: the Wright Heart Center, which offers complete cardiac care and which has partnered with local volunteer ambulance corps to improve response times through installation of advanced EKG equipment on ambulances and location of AEDs at community sites such as recreation fields, and which also participated with IPRO in a three-year project funded by CMS to evaluate the transition of patients for each level of care and make improvements to reduce hospital readmissions; the Stroke Center, which is the regions most comprehensive source for stroke education; and the Ellis Center for Diabetes, which helps children and adults with diabetes improve their quality of life through education and support, including the areas only summer day camp for children with type 1 diabetes which provides full-tuition scholarships for low-income children.Ellis counted 18,461 inpatient discharges and 557,909 outpatient visits during 2012. In pursuing its mission, the hospital provides services to anyone who walks through its doors, regardless of their ability to pay. In 2012, Ellis provided $34,447,981 in Financial Assistance, consisting of $8,928,000 in Charity Care and $25,519,981 in Uninsured Discounts. Ellis has granted discounted rates to all uninsured patients, without requiring evidence of ability to pay, since November 2009.

4b	(Code: ) (Expenses $ 22,339,891 including grants of $ ) (Revenue $ 21,239,034 )
	Ellis operates a 52-bed (certified and staffed) inpatient mental health unit, along with expanded outpatient services. This is the only inpatient mental health facility in Schenectady County, and is one of only two inpatient units in a 16-county region providing services to adolescents. Ellis mental health services include: inpatient care for adults and adolescents; outpatient child, adolescent, and adult mental health services; crisis intervention, including a 24-hour crisis information hotline; a peer advocacy program; and a support and education group for those suffering from schizophrenia and other major disorders and their families. In response to a nationally-studied Schenectady suicide cluster of teenage African-American females, Ellis moved the outpatient child and adolescent mental health clinic to substantially expanded facilities at the Ellis Health Center, where it is co-located with an office of the Schenectady City School District and the hospitals Medical Home. In 2012, the Ellis mental health programs had 2,288 inpatient discharges and 56,183 outpatient visits.

4c	(Code: ) (Expenses $ 11,858,381 including grants of $ ) (Revenue $ 8,410,574 )
	Long term care: The Ellis Center, an 82-bed skilled nursing facility and short-stay rehabilitation facility specializing in medically complex cases, operates from its renovated facility on the Ellis Health Center campus. The new facility provides residents with more private rooms and such amenities as a cyber-center, a larger hair salon, and a roof-top garden. Inpatient days for 2012 were 28,242. The relocation in 2010 freed up two floors at Ellis Hospital which, while now used for clinical and administrative offices, could be made available for surge capacity in the event of a community disaster or epidemic.

4d	Other program services (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses318,799,409

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)............	6,486,727	631,729

				(A) Total revenue	(B) Related or exempt function revenue	(C) Unrelated business revenue	(D) Revenue excluded from tax under sections 512, 513, or 514
1a	Federated campaigns..1a
b	Membership dues....1b
c	Fundraising events....1c
d	Related organizations...1d
e	Government grants (contributions)1e		4,089,879

f	All other contributions, gifts, grants, and similar amounts not included above1f		1,852,993

g	Noncash contributions included in lines 1a-1f:$
h	Total. Add lines 1a-1f.......			5,942,872
			Business Code
2a	Sunnyview Hosp Svcs		621990	2,645,073		2,645,073
b	Mental Health Services		621990	21,239,034	21,239,034
c	Long Term Care		623000	8,410,574	8,410,574
d	Lab-Physician Referrals		621500	2,039,957		2,039,957
e	General Hospital		621990	326,243,153	326,243,153
f	All other program service revenue .			690,547	690,547
g	Total. Add lines 2a–2f........			361,268,338
3	Investment income (including dividends, interest, and other similar amounts).......			1,144,678			1,144,678
4	Income from investment of tax-exempt bond proceeds..			0
5	Royalties...........			0
		(i) Real	(ii) Personal
6a	Gross rents
b	Less: rental expenses
c	Rental income or (loss)
d	Net rental income or (loss).......			0
		(i) Securities	(ii) Other
7a	Gross amount from sales of assets other than inventory	41,864,298
b	Less: cost or other basis and sales expenses	39,293,709	49,602
c	Gain or (loss)	2,570,589	-49,602
d	Net gain or (loss)..........			2,520,987			2,520,987
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..			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...			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..			0
Miscellaneous Revenue			Business Code
11a	Gain Extinguisment Debt		900099	3,300,510			3,300,510
b	Fd Svc, park,emp pharm,ot			1,568,003			1,568,003
c	Contribution-St. Clare's			1,208,755			1,208,755
d	All other revenue ....			2,910,756	1,628,516	186,645	1,095,595
e	Total. Add lines 11a–11d ......			8,988,024
12	Total revenue. See Instructions......			379,864,899	358,211,824	4,871,675	10,838,528


				(A) Beginning of year		(B) End of year
1	Cashnon-interest-bearing .............			10,970	1	13,145
2	Savings and temporary cash investments .........			10,940,255	2	14,494,525
3	Pledges and grants receivable, net ...........			328,379	3	22,243
4	Accounts receivable, net .............			36,728,375	4	37,274,181
5	Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of Schedule L ..................
					5	0
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L
					6	0
7	Notes and loans receivable, net .............			44,233	7	310,900
8	Inventories for sale or use ..............			5,142,782	8	5,018,169
9	Prepaid expenses and deferred charges ..........			1,197,612	9	1,710,375
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	366,105,977
b	Less: accumulated depreciation .....	10b	224,868,383	93,374,596	10c	141,237,594
11	Investments—publicly traded securities ..........			56,869,401	11	53,353,491
12	Investments—other securities. See Part IV, line 11 .....				12	0
13	Investments—program-related. See Part IV, line 11 .....				13	0
14	Intangible assets ...............				14	0
15	Other assets. See Part IV, line 11 ...........			19,798,290	15	22,798,961
16	Total assets. Add lines 1 through 15 (must equal line 34)......			224,434,893	16	276,233,584
17	Accounts payable and accrued expenses .........			30,418,391	17	37,048,792
18	Grants payable .................				18
19	Deferred revenue ................			3,467,257	19	756,910
20	Tax-exempt bond liabilities .............			29,818,673	20	26,458,684
21	Escrow or custodial account liability. Complete Part IV of Schedule D..			118,964	21	114,354
22	Loans and other payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
	persons. Complete Part II of Schedule L..........				22
23	Secured mortgages and notes payable to unrelated third parties ..			9,730,497	23	37,799,216
24	Unsecured notes and loans payable to unrelated third parties ....				24
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....................			56,763,526	25	60,512,142
26	Total liabilities. Add lines 17 through 25.........			130,317,308	26	162,690,098
	Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets ..............			77,487,333	27	97,941,345
28	Temporarily restricted net assets ...........			11,421,977	28	10,152,542
29	Permanently restricted net assets ...........			5,208,275	29	5,449,599
	Organizations that do not follow SFAS 117 (ASC 958), check here 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 ...........			94,117,585	33	113,543,486
34	Total liabilities and net assets/fund balances ........			224,434,893	34	276,233,584