TY 2012 Form 990

(A) Name and business address	(B) Description of services	(C) Compensation
PITTS MANAGEMENT ASSOCIATES INC, 7946 GOODWOOD BLVDBATON ROUGELA70806	DAILY MANAGEMENT SVC	7,439,118
HEALTHCARE INFORMATION CONSULTANTS, 8005 HORIZON POINT DRIVEMILLERSVILLEMD21108	CONSULTING SERVICES	1,708,473
EPSTEIN BECKER GREEN PC, 1227 25TH STREET NWWASHINGTONDC20037	LEGAL SERVICES	714,887
NIXON PEABODY LLP, 50 JERICHO QUADRANGLE SUITE 300JERICHONY11753	LEGAL SERVICES	640,610
FAR ROCKAWAY HYPERBARIC LLC, C/O CENTER FOR WOUND HEALING PO BOLAURELNY11948	WOUND CARE SERVICES	625,001
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 36

Do not include amounts reported on lines 6b, 7b, 8b, 9b, and 10b of Part VIII.	(A) Total expenses	(B) Program service expenses	(C) Management and general expenses	(D) Fundraising expenses
1	Grants and other assistance to governments and organizations in the United States. See Part IV, line 21	0
2	Grants and other assistance to individuals in the United States. See Part IV, line 22	0
3	Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16	0
4	Benefits paid to or for members	0
5	Compensation of current officers, directors, trustees, and key employees ....	1,348,939		1,348,939	0
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	92,500,310	85,100,285	7,400,025
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	5,698,527	5,242,645	455,882
9	Other employee benefits .......	19,101,224	17,573,126	1,528,098
10	Payroll taxes ...........	7,046,000	6,482,320	563,680
11	Fees for services (non-employees):
a	Management ......	7,772,000		7,772,000
b	Legal .........	1,893,000	1,741,560	151,440
c	Accounting ...........	307,000	282,440	24,560
d	Lobbying ...........	20,000	18,400	1,600
e	Professional fundraising services. See Part IV, line 17	0
f	Investment management fees ......	0
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) ........	9,828,000	9,041,760	786,240
12	Advertising and promotion ....	78,000	71,760	6,240
13	Office expenses .......	460,000	423,200	36,800
14	Information technology ......	559,000	514,280	44,720
15	Royalties ..	0
16	Occupancy ...........	3,918,000	3,604,560	313,440
17	Travel ............	71,000	65,320	5,680
18	Payments of travel or entertainment expenses for any federal, state, or local public officials ......	0
19	Conferences, conventions, and meetings ....	71,000	65,320	5,680
20	Interest ...........	339,000	311,880	27,120
21	Payments to affiliates .......	0
22	Depreciation, depletion, and amortization .....	6,549,000	6,025,080	523,920
23	Insurance ..............	4,969,000	4,571,480	397,520
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	MEDICAL SUPPLIES	8,634,000	7,943,280	690,720
b	OTHER MATERIALS & EXPENSES	9,301,000	8,556,920	744,080
c	PURCHASE SERVICE EXPENSE	9,750,000	8,970,000	780,000
d	DRUGS	4,124,000	3,794,080	329,920
e	All other expenses
25	Total functional expenses. Add lines 1 through 24e	194,338,000	170,399,696	23,938,304	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 .............	7,948,000	1	2,390,000
2	Savings and temporary cash investments .........	260,000	2	426,000
3	Pledges and grants receivable, net ...........	0	3	0
4	Accounts receivable, net .............	25,450,000	4	21,549,000
5	Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of Schedule L ..................
		0	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
		0	6	0
7	Notes and loans receivable, net .............	0	7	0
8	Inventories for sale or use ..............	283,000	8	349,000
9	Prepaid expenses and deferred charges ..........	4,825,000	9	10,393,000
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	154,115,000
b	Less: accumulated depreciation .....	10b	113,585,000	39,630,000	10c	40,530,000
11	Investments—publicly traded securities ..........	0	11	0
12	Investments—other securities. See Part IV, line 11 .....	0	12	0
13	Investments—program-related. See Part IV, line 11 .....	0	13	0
14	Intangible assets ...............	0	14	0
15	Other assets. See Part IV, line 11 ...........	57,900,000	15	66,999,000
16	Total assets. Add lines 1 through 15 (must equal line 34)......	136,296,000	16	142,636,000
	17	Accounts payable and accrued expenses .........	27,804,000	17	35,649,000
18	Grants payable .................	0	18	0
19	Deferred revenue ................	0	19	0
20	Tax-exempt bond liabilities .............	0	20	0
21	Escrow or custodial account liability. Complete Part IV of Schedule D..	0	21	0
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..........	0	22	0
23	Secured mortgages and notes payable to unrelated third parties ..	4,654,000	23	5,290,000
24	Unsecured notes and loans payable to unrelated third parties ....	0	24	0
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D....................	79,862,000	25	77,427,000
26	Total liabilities. Add lines 17 through 25.........	112,320,000	26	118,366,000
		Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets ..............	22,468,000	27	22,396,000
28	Temporarily restricted net assets ...........	100,000	28	466,000
29	Permanently restricted net assets ...........	1,408,000	29	1,408,000
	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 ...........	23,976,000	33	24,270,000
34	Total liabilities and net assets/fund balances ........	136,296,000	34	142,636,000

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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

Episcopal Health Services Inc

Employer identification number

11-1665825

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:
Software Version:

- 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

Episcopal Health Services Inc

Employer identification number

11-1665825

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 Episcopal Health Services Inc

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 Episcopal Health Services Inc

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
Episcopal Health Services Inc

Employer identification number

11-1665825

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:
Software Version:

- 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

Episcopal Health Services Inc

Employer identification number

11-1665825

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

20,042

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

20,042

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
SCHEDULE C SUPPLEMENTAL INFO	FORM 990, SCHEDULE C, PART II-B, LINE 1(i)	Episcopal Health Services Inc. pays dues to The Healthcare Association of New York State (HANYS) and The Greater New York Hospital Association (GNYHA). In accordance with section 6033 (e) of the Internal Revenue Code, and as reported by HANYS and GNYHA a portion of these dues payments are attributable to lobbying activities. The lobbying activity costs attributable in 2012 to HANYS and GNYHA annual dues payments was $16,253, and $3,789 respectively.

Schedule C (Form 990 or 990EZ) 2012

Additional Data

Software ID:
Software Version:

- 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

Episcopal Health Services Inc

Employer identification number

11-1665825

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 ....	1,408,000	1,408,000	1,408,000	1,408,000	1,408,000
b	Contributions ........
c	Net investment earnings, gains, and losses	5	8	8	11	5,000
d	Grants or scholarships .....
e	Other expenditures for facilities and programs ........	5	8	8	11	5,000
f	Administrative expenses ....
g	End of year balance ......	1,408,000	1,408,000	1,408,000	1,408,000	1,408,000

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 .................	929,000		929,000
b	Buildings ................	46,839,000	32,920,000	13,919,000
c	Leasehold improvements ............	2,914,000	2,363,000	551,000
d	Equipment ................	100,492,000	78,302,000	22,190,000
e	Other .................	2,941,000	0	2,941,000
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......				40,530,000

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) ASSETS WHOSE USE IS LIMITED				6,770,000
(2) DUE FROM THIRD-PARTY PAYORS				7,394,000
(3) HEALTHFIRST INVESTMENT				10,305,000
(4) INV IN & HLD BY CAPTIVE INS CO				24,120,000
(5) OTHER ASSETS				1,475,000
(6) PHSP INVESTMENT - COST				4,833,000
(7) INSURANCE RECOVERABLE				8,093,000
(8) MACLEAN ASSETS HELD FOR SALE				4,009,000

Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........				66,999,000

Part X

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

1.(a) Description of liability		(b) Book value
Federal income taxes		0
DUE TO THIRD PARTY PAYORS		28,495,000
OTHER LIABILITIES		3,319,000
PROFESSIONAL & SELF INSURED LI		43,390,000
MACLEAN LIABILITIES HELD FOR SALE		2,223,000





Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)		77,427,000
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
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
e	Add lines 2a through 2d .....................		2e
3	Subtract line 2e from line 1.....................		3
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

Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return
1	Total expenses and losses per audited financial statements ...........		1
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
e	Add lines 2a through 2d......................		2e
3	Subtract line 2e from line 1.....................		3
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

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 V, LINE 4 - INTENDED USES OF ENDOWMENT FUND		INCOME FROM ENDOWMENT FUNDS ARE TO BE USED TO FURTHER SUPPORT THE MISSION OF THE ORGANIZATION. ENDOWMENT FUND ASSETS ARE REQUIRED TO BE HELD IN PERPETUITY BY DONOR RESTRICTION.

Schedule D (Form 990) 2012

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE F(Form 990)

Department of the Treasury
Internal Revenue Service

Statement of Activities Outside the United States

Complete if the organization answered "Yes" to Form 990,Part IV, line 14b, 15, or 16. Right pointing arrow large image

Attach to Form 990. Right pointing arrow large image

See separate instructions.

OMB No. 1545-0047

2012

Open to Public Inspection

Name of the organization
Episcopal Health Services Inc

Employer identification number

11-1665825

Part I

General Information on Activities Outside the United States. Complete if the organization answered “Yes” to Form 990, Part IV, line 14b.

For grantmakers. 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

For grantmakers. Describe in Part V the organization’s procedures for monitoring the use of grant funds outside
the United States.

Activites per Region. (The following Part I, line 3 table can be duplicated if additional space is needed.)

(a) Region		(d) Activities conducted in region (by type) (e.g., fundraising, program services, investments, grants to recipients located in the region)	(e) If activity listed in (d) is a program service, describe specific type of service(s) in region	(f) Total expenditures for and investments in region
	Central America and the Caribbean	Investments	CAPTIVE INSURANCE CO.	32,213,000
















3a	Sub-total .....			32,213,000
b	Total from continuation sheets to Part I ...
c	Totals (add lines 3a and 3b)			32,213,000

For Paperwork Reduction Act Notice, see the Instructions for Form 990.Cat. No. 50082W Schedule F (Form 990) 2012

Schedule F (Form 990) 2012

Page 2

Part II

Grants and Other Assistance to Organizations or Entities Outside the United States. Complete if the organization answered “Yes” to Form 990, Part IV, line 15, for any recipient who received more than $5,000. Part II can be duplicated if additional space is needed.

1 (a) Name of organization		(b) IRS code section and EIN (if applicable)	(c) Region	(d) Purpose of grant	(e) Amount of cash grant	(f) Manner of cash disbursement	(g) Amount of of non-cash assistance	(h) Description of non-cash assistance	(i) Method of valuation (book, FMV, appraisal, other)

Enter total number of recipient organizations listed above that are recognized as charities by the foreign country, recognized as tax-exempt by the IRS, or for which the grantee or counsel has provided a section 501(c)(3) equivalency letter .... MediumBullet

Enter total number of other organizations or entities ....................... MediumBullet

Schedule F (Form 990) 2012

Schedule F (Form 990) 2012Page 3

Part III

Grants and Other Assistance to Individuals Outside the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 16.

Part III can be duplicated if additional space is needed.

(a) Type of grant or assistance		(b) Region	(c) Number of recipients	(d) Amount of cash grant	(e) Manner of cash disbursement	(f) Amount of non-cash assistance	(g) Description of non-cash assistance	(h) Method of valuation (book, FMV, appraisal, other)

Schedule F (Form 990) 2012

Page 4

Part IV

Foreign Forms

Schedule F (Form 990) 2012

Page 5

Part V

Supplemental Information
Complete this part to provide the information required by Part I, line 2 (monitoring of funds); Part I, line 3, column (f) (accounting method; amounts of investments vs. expenditures per region); Part II, line 1 (accounting method); Part III (accounting method); and Part III, column (c) (estimated number of recipients), as applicable. Also complete this part to provide any additional information (see instructions).

Identifier	ReturnReference	Explanation
SCHEDULE F, PART I, LINE 3, COLUMN F	ACTIVITIES PER REGION	THE HOSPITAL IS A PARTIAL OWNER OF CAPTIVE FOREIGN INSURANCE COMPANIES. THE HOSPITAL'S INVESTMENTS IN THE FOREIGN INSURANCE COMPANIES ARE REPORTED AT FAIR MARKET VALUE OR COST.

Schedule F (Form 990) 2012

Additional Data

Software ID:
Software Version:

- 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

Episcopal Health Services Inc

Employer identification number

11-1665825

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 300 %

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: .........

Yes

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? ......

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) ..	3,216,912	3,053,269	163,643	0.080 %
b	Medicaid (from Worksheet 3, column a) ....	70,300,979	56,289,455	14,011,524	7.210 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) .
d	Total Financial Assistance and Means-Tested Government Programs .	73,517,891	59,342,724	14,175,167	7.290 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4) ..
f	Health professions education (from Worksheet 5) ..	18,113,629	14,856,462	3,257,167	1.680 %
g	Subsidized health services (from Worksheet 6) ..	19,753,909	6,794,371	12,959,538	6.670 %
h	Research (from Worksheet 7)
i	Cash and in-kind contributions for community benefit (from Worksheet 8)
j	Total. Other Benefits ..	37,867,538	21,650,833	16,216,705	8.350 %
k	Total. Add lines 7d and 7j .	111,385,429	80,993,557	30,391,872	15.640 %

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	76,767	76,767	0.040 %
4	Environmental improvements
5	Leadership development and training for community members
6	Coalition building
7	Community health improvement advocacy
8	Workforce development
9	Other
10	Total	76,767	76,767	0.040 %

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. ......

6,232,000

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. ......

2,223,824

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).....

72,720,703

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

50,091,009

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

22,629,694

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 %	(d) Officers, directors, trustees, or key employees' profit % or stock ownership %	(e) Physicians' profit % or stock ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13

Schedule H (Form 990) 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
1	St John's Episcopal Hospital 327 Beach 19th Street Far Rockaway,NY11691	X	X	X	X

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)

	St Johns Episcopal Hospital
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.% If "No," explain in Part VI the criteria the hospital facility used.
11	Used FPG to determine eligibility for providing discounted care?.................	11	Yes
	If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 300.% 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?1
Name and address		Type of Facility (describe)
1	BISHOP WALDO MACLEAN NURSING HOME 1711 BROOKHAVEN AVENUE FAR ROCKAWAY,NY11691	SKILLED NURSING FACILITY
2
3
4
5
6
7
8
9
10

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
EXPLANATION OF COSTING METHODOLOGY	SCHEDULE H, PART I, LINE 7	ST. JOHN'S EPISCOPAL HOSPITAL COSTING METHODOLOGY WAS BASED UPON THE 2012 NEW YORK STATE INSTITUTIONAL COST REPORT AND THE 2012 MEDICARE (FORM 2552) COST REPORT. THESE COST REPORTS ARE FILED WITH THE NEW YORK STATE DEPARTMENT OF HEALTH AND THE APPLICABLE CMS INTERMEDIARY, RESPECTIVELY. THE COST-TO-CHARGE RATIO DERIVED FROM WORKSHEET 2, RATIO OF PATIENT CARE COST-TO-CHARGE, WAS USED FOR THE VARIOUS SUB-LINE ITEMS OF LINE #7.
BAD DEBT EXPENSE	SCHEDULE H, PART III, LINE 3	St. John's Hospital utilizes the estimated percentage of patients living at or below the federal poverty level 22% and the self pay percentage 85.1646% to arrive at the amount of bad debt that is potentially attributable to patients eligible under the organization's financial assistance policy.
BAD DEBT EXPENSE	SCHEDULE H, PART III, LINE 4	THE AMOUNT REPORTED ON LINE 2 IS EQUAL TO THE PROVISION FOR BAD DEBTS SHOWN IN THE AUDITED FINANCIAL STATEMENTS ("AFS"). THE EXPLANATION OF THE METHODOLOGY USED TO ESTIMATE IS EXCERPTED BELOW: Accounts receivable are also reduced by an allowance for doubtful accounts. In evaluating the collectability of accounts receivable, the Corporation analyzes its past history and identifies trends for each of its major payer sources of revenue to estimate the appropriate allowance for doubtful accounts and provision for bad debts. Management regularly reviews data about these major payer sources of revenue in evaluating the sufficiency of the allowance for doubtful accounts. For receivables associated with services provided to patients who have third-party coverage, the Corporation analyzes contractually due amounts and provides an allowance for doubtful accounts and a provision for bad debts, if necessary (for example, for payers who are known to be having financial difficulties that make the realization of amounts due unlikely). For receivables associated with self-pay patients, which includes both patients without insurance and patients with deductible and copayment balances due for which third-party coverage exists for part of the bill, the Corporation records a significant provision for bad debts in the period of service on the basis of its past experience, which indicates that many patients are unable or unwilling to pay the portion of their bill for which they are financially responsible. The difference between discounted rates and the amounts actually collected after all reasonable collection efforts have been exhausted is charged to the allowance for doubtful accounts.
MEDICARE REVENUE	SCHEDULE H, PART III, LINE 5	Included in the calculation of the Medicare revenue of $72,720,703 is $14,463,008 of Disproportionate Share (DSH) payments and $11,055,122 of Indirect Medical Education (IME) payments which total $25,518,130 Resulting in true patient service revenue of $47,202,573.
MEDICARE REVENUE	SCHEDULE H, PART III, LINE 5 & 6	Pursuant to the instructions included in Medicare Revenue Received on Part III Section B Line 5 is Reimbursement for Indirect Medical Education (IME) of $10.3 million. There are $0 cost included in Part III Line 6 Medicare Allowable Cost related to IME.
MEDICARE SURPLUS/SHORTFALL	SCHEDULE H, PART III, LINE 7	The Medicare surplus shown of $22,629,694 includes the additional items of Medicare revenue detailed in the explanation for Line 5 above without inclusion of additional costs related to them. Had these amounts not been received the operating Medicare shortfall would have been $2,888,436. Losses on treating Medicare beneficiaries should be included as a community benefit in their entirety. St. John's Episcopal Hospital incurred this operating Medicare loss of $2.9 million to deliver care to Medicare patients. This represents the amount by which costs to deliver care to Medicare recipients exceeds the level of payment. St. John's Episcopal Hospital bears the burden of not only providing the best and most advanced medical care possible to the community, but also doing so with no recourse to obtain payment for the cost of providing care in excess of the Medicare payment. As Medicare revenue declines and the cost to provide cutting edge care to the community increases, the Hospital will carry the burden as a participating provider and a charitable organization. Like all patients those on Medicare, the majority of whom are elderly OR disabled, are not turned away, so St. John's Episcopal Hospital will continue to bear the loss in providing the best care possible to the local community.
COSTING METHODOLOGY	SCHEDULE H, PART III, LINE 8	the Medicare revenue and allowable costs shown in Part III Section B Lines 5 and 6, respectively, were derived from the as-filed 2012 CMS-2552 (Medicare Cost Report). Medicare revenue is based on the Medicare Provider Statistical and Reimbursement Report and Medicare costs were developed utilizing a ratio of Medicare allowable costs to charges methodology.
COLLECTION PRACTICES TO BE FOLLOWED RELATIVE TO PATIENTS THAT QUALIFY FOR	FINANCIAL ASSISTANCE - SCHEDULE H, PART III, LINE 9B	The charity care and financial assistance policies of St. John's Episcopal Hospital (which are further summarized in Schedule H Part VI Line 3) ensure that every effort is made to identify patients that are eligible for financial assistance and/or charity care. Included below is a summary of the billing and collection procedures followed by St. John's Episcopal Hospital: - The forced sale of or foreclosure on the patient's primary residence is prohibited - Sending an account to collection if the patient has submitted a completed application for financial assistance, including any required documentation, while the application is pending is prohibited - Provide written notification to a patient at least 30 days before an account is sent to collection (written notice can be included on a bill). - Require the collection agency to have the hospital's written consent prior to starting a legal action for collection. - Require all hospital staff that interacts with patients or have responsibility for billing and collection to be trained in the hospital's policies. - Have a way of measuring the hospital's compliance with its policies. - Require any collection agency under contract with the hospital to follow the hospital's financial assistance policy and provide information to patients on how to apply, where appropriate. - Prohibit collection activity if the patient is determined eligible for Medicaid for the services that were rendered and the hospital is able to collect Medicaid payment.
NEEDS ASSESSMENT	SCHEDULE H, PART VI LINE 2	St. John's Episcopal Hospital (the "Hospital" or "St. John's") is a 257 licensed bed acute care hospital located in Far Rockaway, New York. St. John's, together with the Bishop Henry B. Hucles Nursing Home, Inc.; the Bishop Waldo MacLean Nursing Home; St. John's Emergency Services PC; St. John's Medical Services PC, form the patient care services of Episcopal Health Services, Inc., which is sponsored by the Episcopal Diocese of Long Island. This discussion relates to the Hospital only as required in Form 990 Schedule H. As the result of several meetings with community groups, a comprehensive Community Health Needs Assessment (CHNA) for the Hospital community was developed. The document addresses only St. John's, as the aforementioned nursing homes are currently involved in a transaction that will ultimately transfer ownership to an unrelated third party. The report fulfills the requirements of the new Federal statute established within the Patient Protection and Affordable Care Act (PPACA) requiring non-profit hospitals to conduct CHNAs every three years. The CHNA process undertaken by the Hospital utilized extensive input from persons who represent the broad interests of the community. In addition, this document satisfies the requirements set forth by the New York State Department of Health (DOH) relative to the preparation of a three year Community Service Plan (CSP). The overlapping nature of these requirements enabled the Hospital to complete one comprehensive document. New York's relevant statute, Section 2803-1 of the Public Health Law, requires voluntary non-profit hospitals to submit a comprehensive CSP to the State Department of Health (DOH) every three years that includes a solicitation of the views of the communities served by the Hospital on service priorities; demonstrates the Hospital's operational and financial commitment to meet community health needs; provision of charity care; and improving access by the underserved, among other elements. In submitting their CSPs, hospitals are required to take steps that include: - Reaffirming organizational mission statements; - Defining the service area used for community and local health planning and describing the methods used to determine such service area; - Identifying all participants involved in assessing community health needs and describing and summarizing the hospital's public input sessions; - Discussing the identified public health priorities, including the criteria used to select priorities and the status of priorities; - Establishing an evolving plan of action; and - Disseminating a written summary of the CSP to the public through various channels. The statutory CSP requirements were recently enhanced by DOH's Prevention Agenda initiative, a process that asks hospitals to work with local public health departments and community partners to assess community health needs, jointly develop plans to address two or three of the identified needs, and include this collaborative work in the hospital's CSP update submitted to DOH. St. John's has incorporated the Prevention Agenda into its three year plan. To advance the goals of the New York State Prevention Agenda 2013-2017 and Healthy People 2020 in its Service Area, St. John's reached out and partnered with numerous community-based organizations and other stakeholders to identify community health needs and develop plans to address these needs. The participating organizations included: -St. John's Episcopal Hospital Community Advisory Board -Joseph P. Addabbo Family Health Center -NAACP of Rockaway -Rockaway Beach Channel Long Term Recovery -Rockaway United -Community Board 14 -Deerfield Area Civic Association -Rockaway Development and Revitalization Corp. -Visiting Nurse Service of New York -Rockaway Manor Home Care -Queens County Perinatal Council -Doctors of the World -SCO Family of Services -Met Council -Queens Public Library -Lucille Rose Day Care -Safe Space -Rockaway Beach Civic Association -New York State Assemblyman Phillip Goldfeder Two initial community meetings were held to gather input from the public on the health concerns of the community, the application of the New York State Department of Health Prevention Agenda 2013-2017 to their community and their views of health data gathered by the Hospital. At those meetings participants were then asked to give their opinion on the two highest priorities in the Rockaways. In this manner a sampling of the community opinion was conducted. The meetings were held on July 9, 2013 at 6 pm at the Peninsula Preparatory Charter School (34 attendees); and July 16, 2013 at 6 pm at the Knights of Columbus Rockaway Council #2672 (55 attendees). The meetings were publicized through a variety of ways including four full-page color advertisements in the local newspapers, the "Wave", the "Rockaway Pointer", and the "Five Towns Jewish Press"; a community email blast; social media; and the St. John's website.
PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE	SCHEDULE H, PART VI, LINE 3	St. John's Hospital is committed to providing access to quality health care services with compassion, dignity and respect for all patients, particularly the poor and the underserved in our community. Accordingly, St. John's Hospital has implemented a Charity Care and Financial Assistance Process to help facilitate the provision of much needed care. This process includes: - Providing patient care regardless of the ability to pay for services; - Assisting patients who cannot pay for part or all of the care they receive; - Financial counselors will confidentially review the situation to see if patients quality for some form of government or other financial assistance; - Balancing needed financial assistance for some patients with the broader fiscal responsibilities in order to sustain viability and provide the quality and quantity of services residents in the community need; and - Offer installment plans to allow patients to pay over time without the imposition of interest charges.
COMMUNITY INFORMATION	SCHEDULE H, PART VI, LINE 4	The Rockaway Peninsula is a narrow strip of land bordered by the Atlantic Ocean and Jamaica Bay and is a part of Queens County, New York City and also borders Nassau County on Long Island. Superstorm Sandy had a devastating impact on the Rockaway Peninsula. Much of the community was without gas and electric for weeks following the storm. Homes and businesses were in ruin, some claimed by the sea, others by fire, entire blocks in Belle Harbor and Rockaway Park were engulfed in flames, a considerable portion of Breezy Point literally burned to the ground. Debris and sand were everywhere, including the inside of homes. Cars that had been flooded were scattered throughout the streets of the community. The rebuilding has been extremely slow, and is an ongoing process, with many displaced residents having still not returned to their homes. Many nursing homes and adult homes - sources of admissions to the Hospital, as well as other local businesses never reopened. Transportation between the peninsula and the mainland is a long time commitment for residents as the peninsula is connected to New York City by two toll bridges, the Marine Park Bridge and the Cross Bay Bridge, and by the "A" subway line of the New York City Metropolitan Transit Authority, which was out of commission until late Summer 2013. Throughout the two weeks after the storm St. John's was like a beacon in the darkness for Far Rockaway and the surrounding communities. Running on generator power for 12 days, the Hospital was a place where shelter, warmth, light and food could be found. People stopped in to charge cell phones, and found electricity to power much needed medical devices. Many residents lost everything they had, carrying what they could of their prized possessions. Ongoing recovery assistance was also provided by the Hospital. Collections were made to help employees defray some of the costs of recovery, and clothing drives put much needed clothes on the backs of local residents. While "community" can be defined in many ways, the Hospital defined its Service Area as the 6 zip codes from which approximately 70% discharges came, namely Far Rockaway; Inwood; Arverne; Rockaway Beach; Belle Harbor; and Breezy Point. In 2010 the Rockaways had a population totaling over 123,000 with almost 30% of the Service Area's population under the age of 20, and almost 14% over the age of 65. More than 20% live under the federal poverty level, while the overall Queens county rate is just below 14%. The percentage of the Service Area population who are deemed to be minorities is 65.4%, with African Americans comprising 38% of the population. A large population of Hispanics resides in Inwood, which is the most northeast boundary of the Service Area.
PROMOTION OF COMMUNITY HEALTH	SCHEDULE H, PART VI, LINE 5	Overall health status continues to be lacking, with 25% of residents of the Rockaways considering themselves to be in poor or fair health. In addition, 21% of Queens County residents do not have health insurance coverage, which is higher than the statewide rate of 14%. Lack of health insurance is also a significant barrier to accessing health care. Due to these existing demographic factors, St. John's is constantly working to educate and improve the overall health and well being of those that live in the communities we serve. In preparation of the attached Community Health Needs Assessment (CHNA) the Hospital met with community members over the course of several meetings in an effort to determine the health needs and concerns of the areas served. The following are the areas the Hospital has determined to require primary attention: -Prevention of chronic diseases -Community based diabetes program; -Increase cardiovascular screening rates; -Obesity - Creating a community environment that promotes healthy food and beverage choices -Promote mental health and prevent substance abuse In addition to the initiatives outlined in the CHNA, the Hospital has undertaken numerous community focused initiatives. Opened just weeks before Superstorm Sandy, the Belle Harbor Family Practice office was established to service the residents on the western end of the peninsula. The storm effectively wiped out the office, and fortunately it was rebuilt and reopened again on May 1, 2013. Over two dozen health fairs and other events were either sponsored by the Hospital or were participated in throughout 2012. Blood pressure, cholesterol and glucose screenings were among the tests provided to community members attending these events. In addition, presentations were given to further educate residents in the area on health issues affecting them. While health care is the primary service delivered by St. John's it is also important to assist the community in other ways. Annually the Hospital sponsors a children's holiday party where community children meet Santa and are provided toys for the holiday. A community baby shower allows new mothers to receive baskets filled with necessary items for a newborn. Also, Thanksgiving food baskets have been distributed to local families in need allowing them to enjoy a full traditional holiday meal thanks to the generosity of the hospital staff.
EXPLANATION OF HOW ORGANIZATION FURTHERS ITS EXEMPT PURPOSE	SCHEDULE H, PART VI, LINE 5	St. John's Episcopal Hospital plays an important role in the local community as a provider of needed medical services. St. John's is the only hospital on the peninsula and is also the largest non-governmental employer in the local community. In addition to providing high quality medical services, St. John's is also an active member of the local community, participating in various health fairs, screenings, and educational sessions and events to local residents at no cost. Many of the various programs and initiatives that St. John's Hospital has identified to demonstrate our commitment to further its exempt purpose and promote the health care of the local community have been highlighted previously in this form. St. John's Hospital has an active Community Advisory Board comprised of local residents and business people who meet with Hospital leadership quarterly to discuss at a high level the overall operations of the Hospital, demographics and health needs of the Rockaway community. St. John's extends medical staff privileges to all qualified physicians in its community for the various services provided by the Hospital. The Hospital's medical staff is a large diverse group of highly trained professionals numbering approximately 450 members. In addition, St. John's overall responsiveness to the needs of our community is evidenced by our willingness to participate in a range of coalitions, panels, advisory groups, commissions and boards, including Ready Rockaway, which is a coalition of community based organizations that recognize the need for planning for emergencies such as Superstorm Sandy which severely impacted the Rockaway peninsula in October. In addition, St. John's has internal emergency and disaster drills throughout the year to ensure the Hospital is prepared to meet the needs of its local community and the surrounding areas.
AFFILIATED HEALTH CARE SYSTEM ROLES AND PROMOTION	SCHEDULE H, PART VI, LINE 6	NOT APPLICABLE
STATES WHERE COMMUNITY BENEFIT REPORT IS FILED	SCHEDULE H, PART VI, LINE 7	NEW YORK.
Facility Reporting Group(s)	Schedule H, Part VI, Line 8	Not Applicable

Schedule H (Form 990) 2012

Additional Data

Software ID:
Software Version:

- 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

Episcopal Health Services Inc

Employer identification number

11-1665825

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....

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? .......

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

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)ROBERT BLAKEPHYSICIAN	(i) (ii)	173,964 48,712	0 0	144 0	7,000 0	9,160 0	190,268 48,712	0 0
(2)SHELDON MARKOWITZCHAIR - DEPT OF MEDICINE	(i) (ii)	257,329 0	0 0	1,980 0	7,000 0	25,012 0	291,321 0	0 0
(3)MANMOHN MAHADKARCHAIR - DEPT OF OB/GYN	(i) (ii)	239,595 0	0 0	1,980 0	7,000 0	25,012 0	273,587 0	0 0
(4)RAJIV PRASADCHAIR - EMERGENCY SERVICES	(i) (ii)	359,740	0	300	7,000	364	367,404	0
(5)GILBERT MAKABALI MDCHAIRMAN - SURGERY	(i) (ii)	257,780 0	0 0	3,810 0	7,000 0	29,012 0	297,602 0	0 0
(6)ALAN STEINBERG MDCHAIRMAN - PEDIATRICS	(i) (ii)	276,809 0	0 0	1,290 0	7,000 0	21,228 0	306,327 0	0 0
(7)RAYMOND PASTORE MDCHIEF MEDICAL OFFICER	(i) (ii)	273,187 0	0 0	2,472 0	7,000 0	364 0	283,023 0	0 0
(8)LOKESH REDDY MDCHIEF OF PSYCHIATRY	(i) (ii)	289,840 0	0 0	450 0	7,000 0	21,228 0	318,518 0	0 0
(9)James Henry MDCHIEF OF ORTHOPEDICS	(i) (ii)	318,034 0	0 0	690 0	7,000 0	26,328 0	352,052 0	0 0

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
PITTS MANAGEMENT ASSOCIATES		THE CHIEF EXECUTIVE OFFICER IS PROVIDED THROUGH A MANAGEMENT CONTRACT WITH PITTS MANAGEMENT ASSOCIATES (PMA).

Schedule J (Form 990) 2012

Additional Data

Software ID:
Software Version:

- 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

Episcopal Health Services Inc

Employer identification number

11-1665825

Identifier	Return Reference	Explanation
FORM 990, PART VI, LINE 3	DESCRIPTION OF DELEGATED DUTIES TO MANAGEMENT COMPANY	EPISCOPAL HEALTH SERVICES INC. ENGAGED THE SERVICES OF PITTS MANAGEMENT ASSOCIATES INC. (PMA), AN UNRELATED COMPANY, TO PROVIDE DAY-TO-DAY MANAGEMENT CONSULTING SERVICES. REMUNERATION PAID TO PMA DURING 2012 ARE REPORTED IN PART VII, SECTION B - INDEPENDENT CONTRACTORS. THE APPLICABLE NAMES AND TITLES OF PMA PERSONNEL ARE DISCLOSED ON PART VII - SECTION A - OFFICERS, DIRECTORS, TRUSTEES, KEY EMPLOYEES, AND HIGHEST COMPENSATED EMPLOYEES.
FORM 990, PART VI, LINE 8B		THERE ARE NO SEPARATE COMMITTEES WITH AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY.
FORM 990, PART VI, LINE 11B	FORM 990 REVIEW PROCESS	THE FORM 990 AND APPROPRIATE SCHEDULES, AS REQUIRED (FORM 990), IS COMPLETED BY THE ACCOUNTING AND FINANCE STAFF OF THE ORGANIZATION AND REVIEWED INTERNALLY BY MANAGEMENT. IT IS THEN REVIEWED BY OUTSIDE TAX ADVISORS AND ANY NECESSARY ADJUSTMENTS ARE MADE, AFTER WHICH TIME IT IS CONSIDERED AN initial DRAFT. THE DRAFT OF THE FORM 990 IS THEN PRESENTED TO THE EPISCOPAL HEALTH SERVICES AUDIT COMMITTEE (THE COMMITTEE) OF THE BOARD OF TRUSTEES(THE BOARD), WHICH HAS BEEN DELEGATED THE DETAILED REVIEW FUNCTION BY THE BOARD. ONCE THE Committee'S REVIEW IS COMPLETE, THE COMMITTEE RECOMMENDS THE APPROVAL OF THE FORM 990 TO THE BOARD. THE FORM 990 IS THEN PROVIDED TO ALL VOTING MEMBERS OF THE BOARD. UPON APPROVAL BY THE BOARD THE FORM 990 IS THEN UPDATED AS REQUIRED AND THEN SUBMITTED TO THE INTERNAL REVENUE SERVICE.
FORM 990, PART VI, LINE 12C	EXPLANATION OF MONITORING AND ENFORCEMENT OF CONFLICTS	THE HR DEPARTMENT GATHERS ALL ANNUAL CONFLICT OF INTEREST QUESTIONNAIRES AND FORWARDS THEM TO THE CORPORATE COMPLIANCE DEPARTMENT WHERE THEY ARE REVIEWED. WHERE POSITIVE RESPONSES ARE INDICATED ADDITIONAL INFORMATION IS GATHERED TO DETERMINE IF A CONFLICT ACTUALLY EXISTS. IF A CONFLICT EXISTS, APPROPRIATE ACTION IS TAKEN TO ELIMINATE THE CONFLICT, INCLUDING SUCH STEPS AS NOTIFYING THE BOARD, REASSIGNMENT OF RESPONSIBILITIES OR ESTABLISHMENT OF PROTECTIVE AGREEMENTS. IF A MATTER INVOLVES A BOARD MEMBER OR OFFICER, APPROPRIATE ACTION, INCLUDING RECUSAL AND ADDITIONAL DISCLOSURES, WILL BE DETERMINED BY THE BOARD.
FORM 990, PART VI, LINE 15A	COMPENSATION REVIEW & APPROVAL PROCESS FOR CEO, EXEC. DIR., OR TOP MGMT	THE CHIEF EXECUTIVE OFFICER AND OTHER KEY MANAGEMENT OFFICIALS WERE PROVIDED THROUGH A MANAGEMENT CONTRACT WITH PITTS MANAGEMENT ASSOCIATES INC.(PMA).
FORM 990, PART VI, LINE 15B	COMPENSATION REVIEW & APPROVAL PROCESS FOR OFFICERS & KEY EMPLOYEES	THE COMPENSATION OF KEY EMPLOYEES IS DETERMINED AND/OR APPROVED AFTER COMPARISON TO CURRENT COMPENSATION RATES PAID FOR COMPARABLE POSITIONS IN THE ORGANIZATION'S REGION.
FORM 990, PART VI, LINE 19	OTHER ORGANIZATION DOCUMENTS PUBLICLY AVAILABLE	UPON REQUEST, THE ORGANIZATION WILL MAKE AVAILABLE THOSE DOCUMENTS REQUIRED TO BE DISCLOSED UNDER THE PUBLIC INSPECTION LAWS.
FORM 990, PART VII	COMPENSATION EXPLANATION	NELSON TOEBBE EPISCOPAL HEALTH SERVICES INC. ENGAGED THE SERVICES OF PITTS MANAGEMENT ASSOCIATES INC. (PMA). REMUNERATION PAID TO PMA DURING 2012 IS REPORTED IN PART VII, SECTION B INDEPENDENT CONTRACTORS. WILL MOORE EPISCOPAL HEALTH SERVICES INC. ENGAGED THE SERVICES OF PITTS MANAGEMENT ASSOCIATES INC. (PMA). REMUNERATION PAID TO PMA DURING 2012 IS REPORTED IN PART VII, SECTION B INDEPENDENT CONTRACTORS. RICHARD BROWN EPISCOPAL HEALTH SERVICES INC. ENGAGED THE SERVICES OF PITTS MANAGEMENT ASSOCIATES INC. (PMA). REMUNERATION PAID TO PMA DURING 2012 IS REPORTED IN PART VII, SECTION B INDEPENDENT CONTRACTORS.
OTHER CHANGES IN NET ASSETS OR FUND BALANCES	FORM 990, PART XI, LINE 9	CHANGE IN PENSION LIABILITY. . . . . . . . . . . . . . . .$ -410,000 DISCONTINUED OPERATIONS . . . . . . . . . . . . . . . . -3,170,000 Net Assets Released from Temp Restriction. . . . . . . . 85,000 Increase in Temp Restricted net assets. . . . . . . . . . 366,000 TOTAL $ -3,129,000

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:
Software Version:

- 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

Episcopal Health Services Inc

Employer identification number

11-1665825

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) BISHOP HENRY B HUCLES NURSING HOME 700 HICKSVILLE ROAD SUITE 210 Bethpage,NY11714 11-3277961	Nursing/Rehab	NY	501(C)(3)	LINE 9	NA	Yes
(2) CHURCH CHARITY CORPORATION AND SUB 700 HICKSVILLE ROAD SUITE 210 BETHPAGE,NY11714 11-2797706	CHARITY	NY	501(C)(3)		NA	Yes
(3) ST JOHN'S EMERGENCY MEDICAL SERVICE 700 HICKSVILLE ROAD SUITE 210 BETHPAGE,NY11714 26-2884115	ER SERVICES	NY	501(C)(3)	LINE 11A	NA	Yes
(4) ST JOHN'S MEDICAL SERVICE PC 700 HICKSVILLE ROAD SUITE 210 BETHPAGE,NY11714 54-2164621	MEDICAL SVCS	NY	501(C)(3)	LINE 11A	NA	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
(1) BEACH REINSURANCE CORP PO BOX 1109 GRAND CAYMAN CJ	INSURANCE	CJ	CCC	C CORP	0	0		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) . . . . . . . . . . . . . . . . . . . . .

Yes

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

Yes

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) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

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

Yes

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
(1) BISHOP HENRY B HUCLES NURSING HOME INC	O	318,920	COST
(2) BISHOP HENRY B HUCLES NURSING HOME INC	N	2,238,688	COST
(3) ST JOHN'S EMERGENCY MEDICAL SERVICES PC	R	314,833	COST
(4) ST JOHN'S MEDICAL SERVICES PC	S	1,461,707	COST

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:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: TO PROVIDE QUALITY HEALTH CARE THROUGH ITS HOSPITAL, AMBULATORY CARE FACILITIES, NURSING HOMES AND CONTINUING MEDICAL EDUCATION, RECOGNIZING THE EMERGING LIFE-CARE NEEDS OF THE COMMUNITIES SERVED.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	11
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	9
5	Total number of individuals employed in calendar year 2011 (Part V, line 2a) ......	5	1,941
6	Total number of volunteers (estimate if necessary) .............	6	75
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	0
b	Net unrelated business taxable income from Form 990-T, line 34 .........	7b	0

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	1,751,000	2,585,000
9	Program service revenue (Part VIII, line 2g) .........	182,392,000	178,900,000
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	1,054,000	1,242,000
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	7,477,000	14,869,000
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)...................	192,674,000	197,596,000
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	0	0
14	Benefits paid to or for members (Part IX, column (A), line 4).....	0	0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	126,666,000	125,695,000
16a	Professional fundraising fees (Part IX, column (A), line 11e).....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	73,619,000	68,643,000
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	200,285,000	194,338,000
19	Revenue less expenses. Subtract line 18 from line 12.......	-7,611,000	3,258,000
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	136,296,000	142,636,000
21	Total liabilities (Part X, line 26).............	112,320,000	118,366,000
22	Net assets or fund balances. Subtract line 21 from line 20.....	23,976,000	24,270,000

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 170,399,696 including grants of $ ) (Revenue $ 181,499,000 )
	ST.JOHN'S EPISCOPAL HOSPITAL PROVIDED THE FOLLOWING SERVICES TO RESIDENTS OF ITS LOCAL COMMUNITY IN 2012: 11,000 DISCHARGES 61,000 ADULT AND PEDIATRIC MEDICAL AND SURGICAL DAYS OF CARE TO 9,900 PATIENTS. 15,000 DAYS OF BEHAVIORAL HEALTHCARE TO 750 PATIENTS. 680 BABIES WERE DELIVERED. 28,000 PATIENTS WERE TREATED AND RELEASED FROM THE 24 HR EMERGENCY ROOM. 16,000 VISITS TO THE CHRONIC DIALYSIS SERVICE. 99,000 VISITS TO THE AMBULATORY AND BEHAVIORAL HEALTH CLINICS. SERVICE.

4b	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )
	BISHOP CHARLES WALDO MACLEAN NURSING HOME PROVIDED THE FOLLOWING EXEMPT PURPOSE SERVICES IN 2012: 45,500 DAYS OF LONG TERM NURSING HOME CARE WERE FURNISHED TO PATIENTS. In August 2012, EHS entered into asset purchase agreements with unrelated parties to sell Bishop MacLean Nursing Home (the Home) and believes the sale will close in 2013 after the completion of regulatory approvals and other matters. As a result, EHS determined that the criteria for held for sale classification of certain of the Home assets and liabilities were met in August 2012. Under the agreements, assets and liabilities to be transferred or assigned to the buyers include those used in operations and personal properties of the Home facilities. Effective July 1, 2012 the buyers began operating the Homes under an employment agreement intended to capitalize on their specific expertise regarding long term care operation. Managerial oversight by the Board of Trustees has continued from the inception of the employment agreement, and will continue to effective through final closing of the sale. Subsequent to initiation of the employment agreement, the aforementioned asset purchase agreement was entered into shortly afterward, outlining the fundamentals of the proposed transaction.

4c	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4d	Other program services (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses170,399,696

(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)			(D) Reportable compensation from the organization (W- 2/1099-MISC)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(A) Name and Title
(1) REVEREND LAWRENCE C PROVENZANO........................................................................ PRESIDENT & CHAIRMAN	10.0 .......................1.0	X	X		60,000		10,800
(2) MARGARET O CARPENTER........................................................................ SECOND VP	1.0 .......................1.0	X	X
(3) REVEREND JOHN E WALKER III........................................................................ SECRETARY	1.0 .......................0.0	X	X
(4) RONALD O COLE........................................................................ TREASURER	1.0 .......................0.0	X	X		23,175		0
(5) KATHLEEN E LECADRE........................................................................ BOARD MEMBER	1.0 .......................0.0	X
(6) VENERABLE JEROME J NEDELKA........................................................................ CHAIRMAN - PASTORAL CARE	1.0 .......................0.0	X
(7) REVEREND J MASTINE NISBETT........................................................................ BOARD MEMBER	1.0 .......................0.0	X
(8) REVEREND DARRYL F JAMES........................................................................ BOARD MEMBER	1.0 .......................0.0	X
(9) REVEREND THEODORE W BEAN JR........................................................................ BOARD MEMBER	1.0 .......................0.0	X
(10) DANIEL A KASLE........................................................................ BOARD MEMBER	1.0 .......................0.0	X
(11) OWEN C THOMSPON........................................................................ BOARD MEMBER	1.0 .......................0.0	X
(12) NELSON TOEBBE........................................................................ CEO - PITTS MANAGEMENT	40.0 .......................0.0		X
(13) RICHARD BROWN........................................................................ COO - PITTS MANAGEMENT	40.0 .......................0.0		X
(14) WILL MOORE........................................................................ CFO - PITTS MANAGEMENT	37.0 .......................3.0		X
(15) CHERIAN T PALATHRA........................................................................ CONTROLLER	40.0 .......................0.0		X		106,483		25,901
(16) ROBERT BLAKE........................................................................ PHYSICIAN	26.0 .......................14.0			X	174,108	48,712	16,160
(17) SHELDON MARKOWITZ........................................................................ CHAIR - DEPT OF MEDICINE	40.0 .......................0.0			X	259,309	0	32,012

(A) Name and Title	(B) Average hours per week (list any hours for related organizations below dotted line)			(D) Reportable compensation from the organization (W- 2/1099-MISC)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(A) Name and Title
(18) MANMOHN MAHADKAR........................................................................ CHAIR - DEPT OF OB/GYN	40.0 .......................0.0	X		241,575	0	32,012
(19) RAJIV PRASAD........................................................................ CHAIR - EMERGENCY SERVICES	32.0 .......................8.0	X		360,040		7,364
(20) GILBERT MAKABALI MD........................................................................ CHAIRMAN - SURGERY	40.0 .......................0.0		X	261,590	0	36,012
(21) ALAN STEINBERG MD........................................................................ CHAIRMAN - PEDIATRICS	40.0 .......................0.0		X	278,099	0	28,228
(22) RAYMOND PASTORE MD........................................................................ CHIEF MEDICAL OFFICER	38.0 .......................2.0		X	275,659	0	7,364
(23) LOKESH REDDY MD........................................................................ CHIEF OF PSYCHIATRY	40.0 .......................0.0		X	290,290	0	28,228
(24) James Henry MD........................................................................ CHIEF OF ORTHOPEDICS	40.0 .......................0.0		X	318,724	0	33,328

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)............	2,649,052	48,712	257,409

				(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		2,518,000

f	All other contributions, gifts, grants, and similar amounts not included above1f		67,000

g	Noncash contributions included in lines 1a-1f:$
h	Total. Add lines 1a-1f.......			2,585,000
			Business Code
2a	NET PATIENT SERVICE REV		621300	183,650,000	183,650,000
b	PHYSICIAN BILLING REVENUE		621110	1,482,000	1,482,000
c	PROVISION FOR BAD DEBTS		621300	-6,232,000	-6,232,000
d
e
f	All other program service revenue .
g	Total. Add lines 2a–2f........			178,900,000
3	Investment income (including dividends, interest, and other similar amounts).......			1,240,000			1,240,000
4	Income from investment of tax-exempt bond proceeds..			0
5	Royalties...........			0
		(i) Real	(ii) Personal
6a	Gross rents	156,000
b	Less: rental expenses
c	Rental income or (loss)	156,000	0
d	Net rental income or (loss).......			156,000			156,000
		(i) Securities	(ii) Other
7a	Gross amount from sales of assets other than inventory		24,000
b	Less: cost or other basis and sales expenses		22,000
c	Gain or (loss)		2,000
d	Net gain or (loss)..........			2,000			2,000
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	HEALTHFIRST INVEST INCOME		523000	5,131,000			5,131,000
b	I&R AND NON I&R ROTATION INCOME		900099	2,599,000	2,599,000
c	MEDICARE AND MEDICAID HIT REVENUE		900099	5,513,000			5,513,000
d	All other revenue ....			1,470,000			1,470,000
e	Total. Add lines 11a–11d ......			14,713,000
12	Total revenue. See Instructions......			197,596,000	181,499,000		13,512,000


				(A) Beginning of year		(B) End of year
1	Cashnon-interest-bearing .............			7,948,000	1	2,390,000
2	Savings and temporary cash investments .........			260,000	2	426,000
3	Pledges and grants receivable, net ...........			0	3	0
4	Accounts receivable, net .............			25,450,000	4	21,549,000
5	Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of Schedule L ..................
				0	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
				0	6	0
7	Notes and loans receivable, net .............			0	7	0
8	Inventories for sale or use ..............			283,000	8	349,000
9	Prepaid expenses and deferred charges ..........			4,825,000	9	10,393,000
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	154,115,000
b	Less: accumulated depreciation .....	10b	113,585,000	39,630,000	10c	40,530,000
11	Investments—publicly traded securities ..........			0	11	0
12	Investments—other securities. See Part IV, line 11 .....			0	12	0
13	Investments—program-related. See Part IV, line 11 .....			0	13	0
14	Intangible assets ...............			0	14	0
15	Other assets. See Part IV, line 11 ...........			57,900,000	15	66,999,000
16	Total assets. Add lines 1 through 15 (must equal line 34)......			136,296,000	16	142,636,000
17	Accounts payable and accrued expenses .........			27,804,000	17	35,649,000
18	Grants payable .................			0	18	0
19	Deferred revenue ................			0	19	0
20	Tax-exempt bond liabilities .............			0	20	0
21	Escrow or custodial account liability. Complete Part IV of Schedule D..			0	21	0
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..........			0	22	0
23	Secured mortgages and notes payable to unrelated third parties ..			4,654,000	23	5,290,000
24	Unsecured notes and loans payable to unrelated third parties ....			0	24	0
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D....................			79,862,000	25	77,427,000
26	Total liabilities. Add lines 17 through 25.........			112,320,000	26	118,366,000
	Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets ..............			22,468,000	27	22,396,000
28	Temporarily restricted net assets ...........			100,000	28	466,000
29	Permanently restricted net assets ...........			1,408,000	29	1,408,000
	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 ...........			23,976,000	33	24,270,000
34	Total liabilities and net assets/fund balances ........			136,296,000	34	142,636,000

1	Was the organization a U.S. transferor of property to a foreign corporation during the tax year? If “Yes,”the organization may be required to file Form 926, Return by a U.S. Transferor of Property to a Foreign Corporation (see Instructions for Form 926)......................................	Yes	No
2	Did the organization have an interest in a foreign trust during the tax year? If “Yes,” the organizationmay be required to file Form 3520, Annual Return to Report Transactions with Foreign Trusts and Receipt of Certain Foreign Gifts, and/or Form 3520-A, Annual Information Return of Foreign Trust With a U.S. Owner (see Instructions for Forms 3520 and 3520-A).......................................	Yes	No
3	Did the organization have an ownership interest in a foreign corporation during the tax year? If "Yes," the organization may be required to file Form 5471, Information Return of U.S. Persons with Respect to Certain Foreign Corporations. (see Instructions for Form 5471)..............................	Yes	No
4	Was the organization a direct or indirect shareholder of a passive foreign investment company or a qualified electing fund during the tax year? If "Yes," the organization may be required to file Form 8621, Return by a Shareholder of a Passive Foreign Investment Company or Qualified Electing Fund. (see Instructions for Form 8621)	Yes	No
5	Did the organization have an ownership interest in a foreign partnership during the tax year? If "Yes," the organization may be required to file Form 8865, Return of U.S. Persons with Respect to Certain Foreign Partnerships. (see Instructions for Form 8865)....................................	Yes	No
6	Did the organization have any operations in or related to any boycotting countries during the tax year? If "Yes," the organization may be required to file Form 5713, International Boycott Report (see Instructions for Form 5713)................................................	Yes	No