TY 2012 Form 990

(A) Name and Title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)
(1) MARC BAEZ........................................................................ SECRETARY	3.0 .......................	X	X	0	0
(2) DARREL SUPAK........................................................................ CHAIRMAN	3.0 .......................	X	X	0	0
(3) JOAN FARROW........................................................................ DIRECTOR UNTIL 8/22/12	3.0 .......................1.0	X		0	0
(4) GERALD SKODA........................................................................ DIRECTOR	3.0 .......................	X		0	0
(5) RICHARD LANDER........................................................................ DIRECTOR	3.0 .......................	X		0	0
(6) JACQUELINE RICCIANI........................................................................ DIRECTOR	3.0 .......................	X		0	0
(7) JOSEPH LOUGHLIN........................................................................ VICE CHAIRMAN	3.0 .......................	X	X	0	0
(8) ANDREW PAVLOFF........................................................................ TREASURER	3.0 .......................	X	X	0	0
(9) BARBARA BLAKEY........................................................................ DIRECTOR	3.0 .......................	X		0	0
(10) MICHAEL WASCHITZ........................................................................ DIRECTOR	3.0 .......................	X		0	0
(11) LUIS RODRIGUES MD........................................................................ DIRECTOR	3.0 .......................	X		0	0
(12) TIMOTHY RYDELL MD........................................................................ DIRECTOR FROM 8/4/12 - 8/22/12	3.0 .......................	X		0	0
(13) ALLAN SCOTT........................................................................ DIRECTOR UNITL 7/30/12	1.0 .......................	X		0	0
(14) JEFFREY GRAY........................................................................ DIRECTOR UNTIL 08/04/12	1.0 .......................	X		0	0
(15) FREDERICK H KURIGER........................................................................ CEO EFFECTIVE 12/30/2011	40.0 .......................		X	268,696	27,030
(16) BARBARA GENTILE........................................................................ CNO	.......................40.0		X	121,811	27,829
(17) PETER PANZARINO........................................................................ CHIEF MEDICAL OFFICER	36.0 .......................		X	273,205	30,649

(A) Name and Title	(B) Average hours per week (list any hours for related organizations below dotted line)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)
(18) MITCHELL AMADO........................................................................ VP FINANCE/CFO	10.0 .......................50.0	X			0	468,106	73,474
(19) JOSEPH M ANESI........................................................................ VP/GENERAL COUNSEL	10.0 .......................50.0	X			0	275,245	44,311
(20) SCOTT BATULIS........................................................................ PRESIDENT	10.0 .......................50.0	X			0	979,959	60,774
(21) DEBORAH CARR........................................................................ VP HUMAN RESOURCES	10.0 .......................50.0	X			0	240,266	63,798
(22) STEPHEN SUGRUE........................................................................ VP COMPLIANCE	10.0 .......................50.0	X			0	201,534	50,697
(23) ROSEMARY A BACZEWSKI........................................................................ VP QUALITY	10.0 .......................50.0	X			0	192,423	28,049
(24) JEFFREY F LIETO........................................................................ CHIEF PHYSICIAN STRATEGY OFF.	10.0 .......................50.0	X			0	353,572	42,788
(25) SYED S RAB........................................................................ VP/CIO UNTIL 3/9/12	20.0 .......................40.0	X			0	134,043	14,281
(26) JOHN LYNCH........................................................................ VP/CIO	10.0 .......................50.0	X			0	173,626	0
(27) ROSEMARY FRADO........................................................................ VO PLANN. & MKTS UNTIL 5/18/12	10.0 .......................50.0	X			0	259,985	24,525
(28) MOHAMMAD S KHAN........................................................................ PHYSICIAN	40.0 .......................		X		293,807	0	32,067
(29) ABDUL SHAHZAD........................................................................ PHYSICIAN	40.0 .......................		X		443,215	0	32,821
(30) IRVELYNE CAMILLE........................................................................ PHYSICIAN	40.0 .......................		X		252,051	0	21,855
(31) FLORENCE JEAN-LOUIS........................................................................ PHYSICIAN	40.0 .......................		X		199,051	0	26,960
(32) KHORSHEDA B ALI........................................................................ PHYSICIAN	40.0 .......................		X		253,014	0	35,333
(33) STEVEN T RUWOLDT........................................................................ CEO UNTIL APRIL 2011	40.0 .......................			X	138,462	0	0

(A) Name and business address	(B) Description of services	(C) Compensation
WILLIAM H LANE, 113 COURT STREETBINGHAMTONNY13901	CONSTRUCTION SERV.	1,196,834
MCKESSON INFORMATION SOLUTIONS, POBOX 98347CHICAGOIL606938347	COMPUTER SERVICES	1,291,284
MORRISON MANAGEMENT SOLUTIONS, PO BOX 102289ATLANTAGA30368	FOOD SERVICE	1,393,597
WESTAGE MANAGEMENT LLC, 200 BUSINESS CTR SUITE 123FISHKILLNY12524	CONSTRUCTION SERVICE	567,843
CRYSTAL RUN HEALTHCARE LLP, 155 CRYSTAL RUN ROADMIDDLETOWNNY10940	MEDICAL SERVICES	1,730,750
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 45

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 ....	749,221	678,875	70,346	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) ....	94,525	85,650	8,875
7	Other salaries and wages	41,317,253	37,437,869	3,879,384
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	2,623,170	2,376,874	246,296
9	Other employee benefits .......	7,912,533	7,169,605	742,928
10	Payroll taxes ...........	3,202,252	2,901,584	300,668
11	Fees for services (non-employees):
a	Management ......	8,913,267	3,944,266	4,969,001
b	Legal .........	299,502		299,502
c	Accounting ...........	253,570		253,570
d	Lobbying ...........	17,608		17,608
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) ........	6,857,581	5,046,226	1,811,355
12	Advertising and promotion ....	181,749	6,066	175,683
13	Office expenses .......	465,638	393,984	71,654
14	Information technology ......	0
15	Royalties ..	0
16	Occupancy ...........	2,504,926	2,453,335	51,591
17	Travel ............	43,170	31,876	11,294
18	Payments of travel or entertainment expenses for any federal, state, or local public officials ......	0
19	Conferences, conventions, and meetings ....	0
20	Interest ...........	1,696,241	1,422,171	274,070
21	Payments to affiliates .......	0
22	Depreciation, depletion, and amortization .....	4,040,642	3,387,775	652,867
23	Insurance ..............	452,249	452,249
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	10,108,522	10,028,793	79,729
b	BAD DEBTS	5,293,901	5,293,901	0
c	POSTAGE AND SHIPPING	121,708	66,775	54,933
d	OTHER EXPENSES	2,710,292	2,212,219	498,073
e	All other expenses
25	Total functional expenses. Add lines 1 through 24e	99,859,520	85,390,093	14,469,427	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 .............	7,307,533	1	4,990,421
2	Savings and temporary cash investments .........	2,411,639	2	2,565,882
3	Pledges and grants receivable, net ...........	2,691,414	3	536,506
4	Accounts receivable, net .............	10,693,689	4	12,866,917
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 ..............	1,223,827	8	1,360,073
9	Prepaid expenses and deferred charges ..........	1,164,303	9	131,381
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	121,597,712
b	Less: accumulated depreciation .....	10b	96,894,361	25,859,140	10c	24,703,351
11	Investments—publicly traded securities ..........	14,523,696	11	13,767,860
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 ...........	8,478,361	15	9,665,252
16	Total assets. Add lines 1 through 15 (must equal line 34)......	74,353,602	16	70,587,643
	17	Accounts payable and accrued expenses .........	14,262,337	17	15,781,764
18	Grants payable .................	0	18	0
19	Deferred revenue ................	0	19	0
20	Tax-exempt bond liabilities .............	38,059,926	20	34,506,040
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 ..	356,972	23	0
24	Unsecured notes and loans payable to unrelated third parties ....	1,456,844	24	1,455,390
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....................	11,120,535	25	12,270,653
26	Total liabilities. Add lines 17 through 25.........	65,256,614	26	64,013,847
		Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets ..............	4,585,888	27	3,545,640
28	Temporarily restricted net assets ...........	3,052,395	28	1,069,451
29	Permanently restricted net assets ...........	1,458,705	29	1,958,705
	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 ...........	9,096,988	33	6,573,796
34	Total liabilities and net assets/fund balances ........	74,353,602	34	70,587,643

- TIN:

SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service

Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.

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

See separate instructions.

OMB No. 1545-0047

2012

Open to Public
Inspection

Name of the organization

CATSKILL REGIONAL MEDICAL CENTER

Employer identification number

14-6049030

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

CATSKILL REGIONAL MEDICAL CENTER

Employer identification number

14-6049030

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 CATSKILL REGIONAL MEDICAL CENTER

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 CATSKILL REGIONAL MEDICAL CENTER

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
CATSKILL REGIONAL MEDICAL CENTER

Employer identification number

14-6049030

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

CATSKILL REGIONAL MEDICAL CENTER

Employer identification number

14-6049030

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

17,608

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

17,608

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

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

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

If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? .......

Part III-A

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).

Yes

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

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

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

Part III-B

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2, are answered “No” OR (b) Part III-A, line 3, is answered “Yes."

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

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

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

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

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

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

If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ................................

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

Part IV

Supplemental Information

Complete this part to provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; Part II-A (affiliated group list); Part II-A, line 2; and Part ll-B, line 1. Also, complete this part for any additional information.

Identifier	Return Reference	Explanation
PART II-B, LINE 1I		PERCENTAGE OF DUES PAID TO THE HOSPITAL ASSOCIATION OF NEW YORK (HANYS), NORTHERN METROPOLITAN HOSPITAL ASSOCIATION (NORMET) AND 1199 SEIU ALLOCATED TO LOBBYING.

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

CATSKILL REGIONAL MEDICAL CENTER

Employer identification number

14-6049030

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 ....	1,458,705	1,457,705	1,457,705	1,457,705	1,457,705
b	Contributions ........	500,000	1,000
c	Net investment earnings, gains, and losses
d	Grants or scholarships .....
e	Other expenditures for facilities and programs ........
f	Administrative expenses ....
g	End of year balance ......	1,958,705	1,458,705	1,457,705	1,457,705	1,457,705

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

Board designated or quasi-endowment SchDMd Bullet

0 %

Permanent endowment SchDMd Bullet

100.000 %

Temporarily restricted endowment SchDMd Bullet

0 %

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)

Yes

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

Yes

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 .................	888,426		888,426
b	Buildings ................	30,731,995	25,499,668	5,232,327
c	Leasehold improvements ............	12,338,732	2,774,624	9,564,108
d	Equipment ................	56,021,578	48,547,814	7,473,764
e	Other .................	21,616,981	20,072,255	1,544,726
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......				24,703,351

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) DEFERRED FINANCING FEES				782,451
(2) INTEREST IN CRMC FOUNDATION				2,721,178
(3) INSURANCE RECEIVABLE				3,607,530
(4) THIRD PARTY RECEIVABLE				2,492,008
(5) OTHER RECEIVABLE				62,085




Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........				9,665,252

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		5,792,233
ESTIMATED MALPRACTICE LIABILITY		6,140,883
OTHER LIABILITY		337,537






Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)		12,270,653
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	97,368,192
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains on investments ..........	2a	-77,798
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIII.) ............	2d	505,100
e	Add lines 2a through 2d .....................			2e	427,302
3	Subtract line 2e from line 1.....................			3	96,940,890
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	96,940,890

Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return
1	Total expenses and losses per audited financial statements ...........			1	99,891,384
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	31,864
e	Add lines 2a through 2d......................			2e	31,864
3	Subtract line 2e from line 1.....................			3	99,859,520
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	99,859,520

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
SCHEDULE D PART V	LINE 4	INTENDED USE OF ENDOWMENT FUNDS. THIS FUND, IF ANY, CAN BE USED TO PURCHASE PATIENT EQUIPMENT.
SCHEDULE D PART X	LINE 2 - FIN 48 FOOTNOTE	THE CENTER IS A NOT-FOR-PROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (THE CODE) AND IS EXEMPT FROM FEDERAL, STATE, AND LOCAL INCOME TAXES PURSUANT TO SECTION 501(A) OF THE CODE. THERE ARE CERTAIN TRANSACTIONS THAT COULD BE DEEMED "UNRELATED BUSINESS INCOME" AND WOULD RESULT IN A TAX LIABILITY. MANAGEMENT REVIEWS TRANSACTIONS TO ESTIMATE POTENTIAL TAX LIABILITIES USING A THRESHOLD OF MORE-LIKELY THAN-NOT OF BEING SUSTAINED. IT IS MANAGEMENT'S ESTIMATION THAT THERE ARE NO MATERIAL TAX LIABILITIES THAT NEED TO BE RECORDED.
SCHEDULE D PART XI	LINE 2D	SPECIAL EVENTS DIRECT EXPENSES: $31,864 CHANGE IN THE INTEREST IN NET ASSETS OF THE CRMC FOUNDATION,INC: $473,236
SCHEDULE D PART XII		LINE 2D: SPECIAL EVENTS DIRECT EXPENSES: $31,864

Schedule D (Form 990) 2012

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE G (Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information Regarding
Fundraising or Gaming Activities

Complete if the organization answered "Yes" to Form 990, Part IV, lines 17, 18, or 19, or if the organization entered more than $15,000 on Form 990-EZ, line 6a. Form 990-EZ filers are not required to complete this part. right arrow

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
CATSKILL REGIONAL MEDICAL CENTER

Employer identification number

14-6049030

Part I

Fundraising Activities. Complete if the organization answered "Yes" to Form 990, Part IV, line 17.

Indicate whether the organization raised funds through any of the following activities. Check all that apply.

a	Mail solicitations	e	Solicitation of non-government grants
b	Internet and email solicitations	f	Solicitation of government grants
c	Phone solicitations	g	Special fundraising events
d	In-person solicitations

Did the organization have a written or oral agreement with any individual (including officers, directors, trustees

or key employees listed in Form 990, Part VII) or entity in connection with professional fundraising services?

Yes

If “Yes,” list the ten highest paid individuals or entities (fundraisers) pursuant to agreements under which the fundraiser is
to be compensated at least $5,000 by the organization.

(i) Name and address of individual or entity (fundraiser)	(iii) Did fundraiser have custody or control of contributions?
	Yes	No










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

List all states in which the organization is registered or licensed to solicit funds or has been notified it is exempt from registration or licensing.

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

Cat. No. 50083H

Schedule G (Form 990 or 990-EZ) 2012

Page 2

Part II

Fundraising Events. Complete if the organization answered "Yes" to Form 990, Part IV, line 18, or reported more than $15,000 of fundraising event contributions and gross income on Form 990-EZ, lines 1 and 6b. List events with gross receipts greater than $5,000.

		(a) Event #1 BERN MEMORIAL (event type)	(b) Event #2 RISE (event type)	(c) Other events 5 (total number)	(d) Total events (add col. (a) through col. (c))
1	Gross receipts . . .	80,746	9,583	27,325	117,654
2	Less: Contributions . .	61,286	9,583	7,975	78,844
3	Gross income (line 1 minus line 2) . . .	19,460		19,350	38,810
4	Cash prizes . . .
5	Noncash prizes . .	3,608		630	4,238
6	Rent/facility costs . .	12,740			12,740
7	Food and beverages .	490		2,354	2,844
8	Entertainment . . .
9	Other direct expenses .	620		11,422	12,042
10	Direct expense summary. Add lines 4 through 9 in column (d) ...........				31,864
11	Net income summary. Combine line 3, column (d), and line 10. ..........				6,946

Part III

Gaming. Complete if the organization answered "Yes" to Form 990, Part IV, line 19, or reported more than $15,000 on Form 990-EZ, line 6a.

(a) Bingo

(b) Pull tabs/Instant
bingo/progressive bingo

(c) Other gaming

(d) Total gaming (add col.(a) through col.(c))

Gross revenue . . . .

Cash prizes . . . .

Non-cash prizes . . .

Rent/facility costs . . .

Other direct expenses . .

Volunteer labor . . .

	Yes
	No

	Yes
	No

	Yes
	No

Direct expense summary. Add lines 2 through 5 in column (d) ........... right arrow

Net gaming income summary. Combine lines 1 and 7 in column (d) .......... right arrow

Enter the state(s) in which the organization operates gaming activities:

Is the organization licensed to operate gaming activities in each of these states? ............

YesNo

If "No," explain:

10a

Were any of the organization's gaming licenses revoked, suspended or terminated during the tax year? .....

YesNo

If "Yes," explain:

Schedule G (Form 990 or 990-EZ) 2012

Page 3

Does the organization operate gaming activities with nonmembers? .................

YesNo

Is the organization a grantor, beneficiary or trustee of a trust or a member of a partnership or other entity

formed to administer charitable gaming? ..........................

YesNo

Indicate the percentage of gaming activity operated in:

The organization's facility ......................

13a

An outside facility ........................

13b

Enter the name and address of the person who prepares the organization's gaming/special events books and records:

Name

Address

15a

Does the organization have a contract with a third party from whom the organization receives gaming

revenue? ......................................

YesNo

If "Yes," enter the amount of gaming revenue received by the organization right arrow

$ and the

amount of gaming revenue retained by the third party right arrow

$ .

If "Yes," enter name and address of the third party:

Name

Address

Gaming manager information:

Name

Gaming manager compensation right arrow

Description of services provided right arrow

Director/officer Employee Independent contractor

Mandatory distributions:

Is the organization required under state law to make charitable distributions from the gaming proceeds to

retain the state gaming license? ............................

YesNo

Enter the amount of distributions required under state law distributed to other exempt organizations or spent

in the organization's own exempt activities during the tax year right arrow

Part IV

Supplemental Information. Complete this part to provide the explanations required by Part I, line 2b, columns (iii) and (v), and Part III, lines 9, 9b, 10b, 15b, 15c, 16, and 17b, as applicable. Also complete this part to provide any additional information (see instructions).

Identifier	Return Reference	Explanation

Schedule G (Form 990 or 990-EZ) 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

CATSKILL REGIONAL MEDICAL CENTER

Employer identification number

14-6049030

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 %

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) ..	4,225,579	81,874	4,143,704	4.150 %
b	Medicaid (from Worksheet 3, column a) ....	25,793,807	19,769,115	6,024,692	6.030 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) .
d	Total Financial Assistance and Means-Tested Government Programs .	30,019,386	19,850,989	10,168,396	10.180 %
Other Benefits		24,342		24,342	0.020 %
e	Community health improvement services and community benefit operations (from Worksheet 4) ..	24,342		24,342	0.020 %
f	Health professions education (from Worksheet 5) ..	50,024		50,024	0.020 %
g	Subsidized health services (from Worksheet 6) ..	4,801,678	2,594,696	2,206,982	2.210 %
h	Research (from Worksheet 7)
i	Cash and in-kind contributions for community benefit (from Worksheet 8)	19,635		19,635	0.020 %
j	Total. Other Benefits ..	4,895,679	2,594,696	2,300,983	2.270 %
k	Total. Add lines 7d and 7j .	34,915,065	22,445,685	12,469,379	12.450 %

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
1	Physical improvements and housing
2	Economic development
3	Community support
4	Environmental improvements
5	Leadership development and training for community members
6	Coalition building	20,370	20,370
7	Community health improvement advocacy
8	Workforce development
9	Other
10	Total	20,370	20,370

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. ......

2,162,699

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. ......

162,784

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).....

26,746,149

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

32,587,293

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

-5,841,144

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?2 Name, address, and primary website address						Other (Describe)
1	CATSKILL REGIONAL MEDICAL CTR-HARRIS 68 HARRIS-BUSHVILLE ROAD HARRIS,NY12742	X	X		X	SOLE COMMUNITY HOSP.
2	CATSKILL REGIONAL MEDICAL CTR-GROVER ROUTE 97 CALLICOON,NY12723	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)

	CATSKILL REGIONAL MEDICAL CTR-HARRIS
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: 200.% 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: 201.% 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		No
	If “Yes,” check all actions in which the hospital facility or a third party engaged:
a	Reporting to credit agency
b	Lawsuits
c	Liens on residences
d	Body attachments
e	Other similar actions (describe in Part VI)

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 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)

	CATSKILL REGIONAL MED CTR-GROVER HER
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

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 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: 200.% 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: 201.% 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		No
	If “Yes,” check all actions in which the hospital facility or a third party engaged:
a	Reporting to credit agency
b	Lawsuits
c	Liens on residences
d	Body attachments
e	Other similar actions (describe in Part VI)

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

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)

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?
Name and address		Type of Facility (describe)
1
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
PART VI - SUPPLEMENTAL INFORMATION		PART I LINE 7 - COSTING METHODOLOGY USED TO CALCULATE THE AMOUNT REPORTED ON THE PART I, LINE 7 TABLE WAS THE RATIO OF COST TO CHARGES. BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COL. (A) BUT EXCLUDED FOR PURPOSES OF CALCULATING FINANCIAL ASSISTANCE AND CERTAIN OTHER COMMUNITY BENEFITS AT COST WAS $5,293,901. PART I LINE 7G - CATSKILL REGIONAL MEDICAL CENTER (CRMC) IS REPORTING AS SUBSIDIZED HEALTH SERVICES THE LOSSES FROM VARIOUS PHYSICIAN CLINICS NECESSARY TO PROMOTE HEALTH IN OUR RURAL AREA. WITHOUT THESE CLINICS, THE ACCESS TO HEALTH SERVICES WOULD BE EXTREMELY LIMITED OR NON-EXISTENT. PART II - COMMUNITY BUILDING ACTIVITIES: CRMC ESTABLISHED A MULTIDISCIPLINARY COMMUNITY ADVISORY BOARD THAT IS COMPRISED OF 33 CONSUMER AND PROVIDER REPRESENTATIVES WHO CONTINUE MEETING QUARTERLY TO PROVIDE FEEDBACK ON HOSPITAL PERFORMANCE, AS WELL AS TO PROVIDE INPUT ON SULLIVAN COUNTY COMMUNITY HEALTH NEEDS, ISSUES AND PRIORITIES. THE HOSPITAL ADVISORY BOARD IDENTIFIED THE PREVENTION, CARE AND TREATMENT OF CHRONIC DISEASES INCLUDING DIABETES AND CARDIOVASCULAR, AS WELL AS BEHAVIORAL HEALTH ISSUES INCLUDING MENTAL HEALTH AND SUBSTANCE ABUSE, AS THE HIGHEST PRIORITY OF UNMET HEALTH CARE NEEDS THROUGHOUT SULLIVAN COUNTY. PART III LINE 2 - BAD DEBT EXPENSES - COSTING METHODOLOGY USED TO CALCULATE BAD DEBT EXPENSES WAS THE RATIO OF COST TO CHARGES. PART III LINE 3 - ESTIMATE BAD DEBT EXPENSE OF 2,325,483 - COSTING METHODOLOGY USED TO CALCULATE BAD DEBT EXPENSES WAS THE RATIO OF COST TO CHARGES AND RATIO OF FINANCIAL APPLICATIONS SUBMITTED WITH AN INCOMPLETE STATUS PART III LINE 4 (AFS FOOTNOTE 2 PAGE 12) - CRMC PROVIDES CHARITY CARE TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS CHARITY CARE POLICY, TO PATIENTS WHO ARE UNINSURED, AND TO PATIENTS WHO ARE UNDERINSURED AT AMOUNTS LESS THAN ITS ESTABLISHED RATES. BECAUSE CRMC DOES NOT PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE, THEY ARE NOT REPORTED AS REVENUE. FEDERAL AND STATE LAW REQUIRES THAT HOSPITALS PROVIDE EMERGENCY SERVICES REGARDLESS OF A PATIENT'S ABILITY TO PAY. UNINSURED PATIENTS SEEN IN THE EMERGENCY DEPARTMENT, INCLUDING PATIENTS SUBSEQUENTLY ADMITTED FOR INPATIENT SERVICES, OFTEN DO NOT PROVIDE NECESSARY INFORMATION TO ALLOW CRMC TO QUALIFY SUCH PATIENTS FOR CHARITY CARE. UNCOLLECTIBLE AMOUNTS DUE FROM SUCH UNINSURED PATIENTS REPRESENT A SUBSTANTIAL PORTION OF THE PROVISION FOR BAD DEBTS REFLECTED IN THE ACCOMPANYING STATEMENTS OF OPERATIONS. PART III LINE 6 - MEDICARE ALLOWABLE COST WERE CALCULATED USING THE MEDICARE REIMBURSEMENT METHODOLOGY AS REQUIRED FOR THE MEDICARE 2552 ANNUAL COST REPORT. PART III, LINE 8 - MEDICARE INDIVIDUALS UTILIZE HOSPITAL SERVICES AS A PRIMARY CARE PROVIDER HOWEVER, MEDICARE REIMBURSEMENT DOES NOT COVER THE ACTUAL OPERATING COSTS FOR PROVIDING CARE FOR MEDICARE PATIENTS. THEREFORE, ANY SHORTFALL REPORTED ON SCHEDULE H, PART III, LINE 7, SHOULD BE TREATED AS COMMUNITY BENEFIT AS IT IS THE HOSPITAL'S MISSION TO PROVIDE QUALITY CARE TO ALL PATIENTS REGARDLESS OF THEIR INSURANCE COVERAGE AND ABILITY TO PAY. THE COSTING METHODOLOGY USED TO CALCULATE THE AMOUNTS REPORTED ON WAS THE COST TO CHARGE RATIO. PART III LINE 9B - ALL PATIENTS WHO ARE UNCERTAIN ABOUT THEIR ABILITY TO PAY FOR THE HOSPITAL SERVICES THEY RECEIVE ARE ENCOURAGED TO APPLY FOR FINANCIAL ASSISTANCE. CRMC SHALL ENSURE THAT NOTIFICATION OF THE FINANCIAL ASSISTANCE POLICY BE INSERTED IN RELEVANT BILLINGS. PATIENTS WHO HAVE NOT RECEIVED FINANCIAL ASSISTANCE AND DO NOT PAY THEIR BILLS ARE EVENTUALLY SUBJECT TO A COLLECTION PROCESS THAT MAY INVOLVE THE USE OF AN OUTSIDE COLLECTION AGENCY AND MAY AFFECT THE PATIENT'S PERSONAL CREDIT RATING. IN ADDITION, THE PATIENT MUST CONSENT TO APPLY FOR MEDICAID COVERAGE AND TAKE ALL STEPS NECESSARY TO PREPARE A COMPLETE AND ACCURATE MEDICAID APPLICATION. CONSIDERATION WILL BE GIVEN TO PROVIDING FINANCIAL ASSISTANCE ON A CASE BY CASE BASIS TO PATIENTS WHO HAVE EXHAUSTED THEIR INSURANCE BENEFITS AND/OR WHO EXCEED FINANCIAL ELIGIBILTY CRITERIA BUT FACE EXTRAORDINARY MEDICAL COSTS. FINANCIAL ASSISTANCE IS NOT A SUBSITUTE FOR EMPLOYER-SPONSORED, PUBLIC, OR INDIVIDUALLY PURCHASED INSURANCE. PATIENTS WHO DO NOT PAY THEIR BIILS WHO HAVE BEEN NOTIFIED OF THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY AND EITHER FAIL TO APPLY FOR ASSISTANCE OR APPLIED FOR ASSISTANCE BUT HAVE BEEN DETERMINED INELIGIBLE FOR ASSISTANCE, EVENTUALLY MAY BE SUBJECT TO A COLLECTION PROCESS THAT MAY INVOLVE THE USE OF AN OUTSIDE COLLECTION AGENCY AND MAY AFFECT THE PATIENT'S PERSONAL CREDIT RATING. SECTION A PART V THE POLICIES FOR BOTH HOSPITAL FACILITIES ARE THE SAME AND THE DISCLOSURE RELATES TO BOTH CATSKILL REGIONAL MEDICAL CENTER - HARRIS AND CATSKILL REGIONAL MEDICAL CENTER - GROVER SECTION B PART V LINE 12H: OTHER FACTORS - CALCULATION OF FINANCIAL ASSISTANCE ELIGIBILITY WAS BASED ON FAMILY SIZE. SECTION B LINE 18E: OTHER BILLING AND COLLECTIONS EFFORTS - FINANCIAL ASSISTANCE POLICY POSTED ON CRMC WEBSITE. SECTION B PART V LINE 20D: THE HOSPITAL FACILITY USED PERCENTAGE OF MEDICAID RATES WHEN CALCULATING THE MAXIMUM AMOUNTS THAT CAN BE CHARGED. PART VI, LINE 2: NEEDS ASSESSMENT: A COMMUNITY NEEDS ASSESSMENT WAS CONDUCTED COLLABORATIVELY WITH SULLIVAN COUNTY PUBLIC HEALTH SERVICES, THE LOCAL HEALTH DEPARTMENT. PUBLIC PARTICIPATION WAS SOUGHT THROUGH A MULTITUDE OF VEHICLES INCLUDING FOUR COMMUNITY HEALTH FORUMS CONDUCTED IN CONJUNCTION WITH SULLIVAN COUNTY PUBLIC HEALTH SERVICES. CRMC AND THE SULLIVAN COUNTY PUBLIC HEALTH DEPARTMENT JOINTLY CONTRACTED WITH NEW YORK MEDICAL COLLEGE TO CARRY OUT A REGIONAL NEEDS ASSESSMENT SURVEY OF HEALTH CARE PROVIDERS IN THE COUNTY. CRMC RECEIVED HEALTH CARE PROVIDER INPUT AND FEEDBACK FROM MEMBERS OF THE SULLIVAN COUNTY RURAL HEALTH NETWORK. PART VI, LINE 3: PATIENT EDUCATION OF ELIGIBILTY FOR ASSISTANCE: HOSPITAL POSTS SIGNS DESCRIBING THE FINANCIAL ASSISTANCE PROGRAM. ALL PATIENTS WITH NO INSURANCE ARE ASKED TO APPLY FOR MEDICARE AND/OR FINANCIAL ASSISTANCE. PART VI, LINE 4: COMMUNITY INFORMATION: THE CATSKILL REGIONAL MEDICAL CENTER'S SERVICE AREA FOR COMMUNITY/LOCAL HEALTH PLANNING INCLUDES ALL FIFTEEN TOWNSHIPS WITHIN RURAL SULLIVAN COUNTY, NEW YORK. THE HOSPITAL'S SERVICE AREA WITHIN SULLIVAN COUNTY IS INTO PRIMARY AND SECONDARY SERVICE AREAS. THE PRIMARY SERVICE AREAS ARE THOSE SULLIVAN COUNTY TOWNSHIP AND ZIP CODES WHICH ARE EITHER CLOSER TO CRMC THAN ANY OTHER HOSPITAL FACILITY OR WHERE CRMC HAS A PREDOMINANT MARKET SHARE. THE SULLIVAN COUNTY TOWNSHIPS IN THE PRIMARY SERVICE AREA ARE BETHEL, CALLICOON, COCHECTON, DELAWARE, FALLSBURG, FORESTBURGH, FREMONT, LIBERTY, NEVERSINK, ROCKLAND, THOMPSON AND TUSTEN. THE FOLLOWING DEMOGRAPHICS CHARACTERIZE SULLIVAN COUNTY'S RURAL SERVICE AREA: (1) EXTENSIVE AND GROWING GERIATRIC POPULATION; (2) HIGHER PROPORTIONS OF BLACK AND HISPANIC POPULATIONS WHEN COMPARED WITH MOST UPSTATE NEW YORK RURAL COMMUNITIES; (3) VILLAGES OF MONTICELLO AND LIBERTY SURROUNDED BY GEOGRAPHICALLY DISPERSED RURAL POPULATIONS; (4) ECONOMIC BASE PREDOMINANTELY COMPRISED OF AGRICULTURE AS WELL AS SERVICES FOCUSING UPON HEALTH CARE, TOURISM, GOVERNMENT AND EDUCATION AND; (5) EXTENSIVE MEDICALLY INDIGENT POPULATION WITH HIGH PROPORTION OF INDIVIDUALS EITHER ON MEDICAID OR TOTALLY LACKING HEALTH INSURANCE COVERAGE. PART VI, LINE 5: OTHER INFORMATION: CRMC HAS SHOWN ITS ONGOING COMMITMENT TOWARDS ENHANCING THE HEALTH STATUS OF SULLIVAN COUNTY IN SEVERAL WAYS. THE OVERWHELMING MAJORITY OF CRMC'S BOARD OF DIRECTORS ARE COMPRISED OF LOCAL HEALTH CARE CONSUMERS WHO PROVIDE EXPERTISE IN IDENTIFYING SULLIVAN COUNTY HEALTH CARE NEEDS AND PRIORITIES. CRMC'S MEDICAL STAFF IS AN OPEN MEDICAL STAFF WHEREBY ANY JUSTIFIED SULLIVAN COUNTY PHYSICIAN IS ENCOURAGED TO APPLY, AND OVER 90% OF LOCAL PHYSICIAN RETAIN MEDICAL STAFF MEMBERSHIP. THE HOSPITAL'S HEALTH SCIENCE LIBRARY SUBSIDIZED FROM CRMC OPERATIONAL FUNDING PROVIDES BOTH COMMUNITY HEALTH EDUCATION TO SULLIVAN COUNTY CONSUMERS AND PATIENTS, AS WELL AS MEDICAL EDUCATION TO LOCAL PHYSICIANS. PART VI, LINE 6: AFFILIATED HEALTH CARE SYSTEM: The Greater Hudson Valley Health System (GHVHS) is currently the active parent company for two member hospitals-Catskill Regional Medical Center and Orange Regional Medical Center. The GVHS is dedicated to developing specialty services, medical programs and needed healthcare services that allow residents to remain close to home to receive quality care. Providing healthcare to nearly 450,000 residents in Orange, Sullivan and Ulster Counties, the GHVHS was designed to improve the quality, stability and efficiency of healthcare services in the mid-Hudson and Catskill regions. Services provided by more than 3,300 employed professionals and over 850 medical staff members, makes the GHVHS one of the largest healthcare providers in the tri-county area. The System has three hospital campuses plus several outpatient facilities, offering a broad spectrum of care. Catskill Regional Medical Center has two hospital facilities serving patien

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

CATSKILL REGIONAL MEDICAL CENTER

Employer identification number

14-6049030

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

Yes

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

Yes

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)FREDERICK H KURIGERCEO EFFECTIVE 12/30/2011	(i) (ii)	245,801 0	0 0	22,895 0	13,982 0	13,048 0	295,726 0	0 0
(2)PETER PANZARINOCHIEF MEDICAL OFFICER	(i) (ii)	234,943 0	37,500 0	762 0	14,429 0	16,220 0	303,854 0	0 0
(3)MITCHELL AMADOVP FINANCE/CFO	(i) (ii)	0 382,388	0 38,880	0 46,838	0 50,200	0 23,274	0 541,580	0 0
(4)JOSEPH M ANESIVP/GENERAL COUNSEL	(i) (ii)	0 248,627	0 25,994	0 624	0 24,711	0 19,600	0 319,556	0 0
(5)SCOTT BATULISPRESIDENT	(i) (ii)	0 630,021	0 207,821	0 142,117	0 40,000	0 20,774	0 1,040,733	0 0
(6)DEBORAH CARRVP HUMAN RESOURCES	(i) (ii)	0 196,066	0 21,244	0 22,956	0 42,323	0 21,475	0 304,064	0 0
(7)STEPHEN SUGRUEVP COMPLIANCE	(i) (ii)	0 170,962	0 17,407	0 13,165	0 25,923	0 24,774	0 252,231	0 0
(8)ROSEMARY A BACZEWSKIVP QUALITY	(i) (ii)	0 165,542	0 9,208	0 17,673	0 14,156	0 13,893	0 220,472	0 0
(9)JEFFREY F LIETOCHIEF PHYSICIAN STRATEGY OFF.	(i) (ii)	0 330,714	0 0	0 22,858	0 22,014	0 20,774	0 396,360	0 0
(10)MOHAMMAD S KHANPHYSICIAN	(i) (ii)	279,368 0	0 0	14,439 0	15,000 0	17,067 0	325,874 0	0 0
(11)ABDUL SHAHZADPHYSICIAN	(i) (ii)	426,077 0	0 0	17,138 0	15,000 0	17,821 0	476,036 0	0 0
(12)IRVELYNE CAMILLEPHYSICIAN	(i) (ii)	234,997 0	0 0	17,054 0	15,000 0	6,855 0	273,906 0	0 0
(13)FLORENCE JEAN-LOUISPHYSICIAN	(i) (ii)	183,866 0	0 0	15,185 0	12,109 0	14,851 0	226,011 0	0 0
(14)KHORSHEDA B ALIPHYSICIAN	(i) (ii)	235,924 0	0 0	17,090 0	15,000 0	20,333 0	288,347 0	0 0
(15)STEVEN T RUWOLDTCEO UNTIL APRIL 2011	(i) (ii)	138,462 0	0 0	0 0	0 0	0 0	138,462 0	0 0
(16)JOHN LYNCHVP/CIO	(i) (ii)	0 156,544	0 16,742	0 340	0 0	0 0	0 173,626	0 0
(17)ROSEMARY FRADOVO PLANN. & MKTS UNTIL 5/18/12	(i) (ii)	0 115,575	0 70,704	0 73,706	0 15,122	0 9,403	0 284,510	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
LINE 4A		FILING ORGANIZATION: STEVEN T. RUWOLDT, FORMER CEO, RECEIVED $138,462, IN SEVERANCE COMPENSATION IN 2012. PART I, LINE 4B THE FOLLOWING PAYMENTS WERE MADE FROM GHVHS, A RELATED TAX EXEMPT ORGANIZATION: PART I, LINE 4B: NONQUALIFIED PAYMENT MITCHELL AMADO 23,353 JOSEPH M ANESI 22 SCOTT BATULIS 118,375 ROSEMARY FRADO 33,254 JAMES OXLEY,MD 11,604

Schedule J (Form 990) 2012

Additional Data

Software ID:
Software Version:

- TIN:

Schedule K
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Information on Tax Exempt Bonds

Complete if the organization answered "Yes" to Form 990, Part IV, line 24a. Provide descriptions,
explanations, and any additional information in Part VI.
SchKMediumBullet

Attach to Form 990. SchKMediumBullet

See separate instructions.

OMB No. 1545-0047

2012

Open to Public
Inspection

Name of the organization
CATSKILL REGIONAL MEDICAL CENTER

Employer identification number
14-6049030

Part I

Bond Issues

(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	(g) Defeased		(h) On behalf of issuer		(i) Pool financing
(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	Yes	No	Yes	No	Yes	No
A	DORMITORY AUTHORITY STATE OF NY	14-6000293		12-16-2004	54,518,326	REFINANCING OF MORTGAGE LOAN		X		X		X

Part II

Proceeds

	A		B		C		D
	1 Amount of bonds retired . . . . . . . . . . . . . .	17,955,000
2 Amount of bonds legally defeased . . . . . . . . . . .	0
3 Total proceeds of issue . . . . . . . . . . . . . .	54,518,326
4 Gross proceeds in reserve funds . . . . . . . . . . . .	5,140,500
5 Capitalized interest from proceeds . . . . . . . . . . .	0
6 Proceeds in refunding escrows . . . . . . . . . . . .	47,070,653
7 Issuance costs from proceeds . . . . . . . . . . . .	1,060,221
8 Credit enhancement from proceeds . . . . . . . . . . .	558,296
9 Working capital expenditures from proceeds . . . . . . . . .	0
10 Capital expenditures from proceeds . . . . . . . . . . .	0
11 Other spent proceeds . . . . . . . . . . . . . .	47,759,309
12 Other unspent proceeds . . . . . . . . . . . . . .	0
13 Year of substantial completion . . . . . . . . . . . .	2004
	Yes	No	Yes	No	Yes	No	Yes	No
14 Were the bonds issued as part of a current refunding issue? . . . . .	X
15 Were the bonds issued as part of an advance refunding issue? . . . . .		X
16 Has the final allocation of proceeds been made? . . . . . . . .	X
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? . . . . . . . . . . . . . .	X

Part III

Private Business Use

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? . . . . . . .		X
2 Are there any lease arrangements that may result in private business use of bond-financed property? . . . . . . . . .		X

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

Cat. No. 50193E

Schedule K (Form 990) 2012

Page 2

Part III

Private Business Use (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
3a Are there any management or service contracts that may result in private business use of bond-financed property? . . . . . . . . . . . .		X
b If "Yes" to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property? . . . . . . . . . . . . . . . .
c Are there any research agreements that may result in private business use of bond-financed property? . . . . . . . . . . . . . . .		X
d If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property? .
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government . .	0%		%		%		%
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government . . . . . . .	%		%		%		%
6 Total of lines 4 and 5 . . . . . . . . . . . . . . .	%		%		%		%
7 Does the bond issue meet the private security or payment test? . . . . .	X
8a Has there been a sale or disposition of any of the bond financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were issued?. . . . . . . . . . . . . . . . .		X
b If “Yes” to line 8a, enter the percentage of bond-financed property sold or disposed of.	%		%		%		%
c If “Yes” to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? . . . . . . . . . . . . .		X
9 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under Regulations sections 1.141-12 and 1.145-2?		X

Part IV

Arbitrage

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Has the issuer filed Form 8038-T? . . . . .		X
2 If "No" to line 1, did the following apply? . . . .
a Rebate not due yet? . . . . . . . .	X
b Exception to rebate? . . . . . . . .
c No rebate due? . . . . . . . . . .
If you checked "No rebate due" in line 2c, provide in Part VI the date the rebate computation was performed
3 Is the bond issue a variable rate issue? . . . .	X
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?		X
b Name of provider . . . . . . . . .	0
c Term of hedge . . . . . . . . . .
d Was the hedge superintegrated? . . . . . .		X
e Was a hedge terminated? . . . . . . .		X

Schedule K (Form 990) 2012

Page 3

Part IV

Arbitrage (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
5a Were gross proceeds invested in a guaranteed investment contract (GIC)? . . . . . . . . .		X
b Name of provider . . . . . . . . .	0
c Term of GIC . . . . . . . . . .
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? . . . . .
6 Were any gross proceeds invested beyond an available temporary period? . . . . . . . .		X
7 Has the organization established written procedures to monitor the requirements of section 148? . . .		X

Part V

Procedures To Undertake Corrective Action

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations?		X

Part VI

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

Identifier	Return Reference	Explanation

Schedule K (Form 990) 2012

Additional Data

Software ID:
Software Version:

- TIN:

Schedule L
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Transactions with Interested Persons

Complete if the organization answered
"Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c,
or Form 990-EZ, Part V, line 38a or 40b.
MediumBullet

Attach to Form 990 or Form 990-EZ. MediumBullet

See separate instructions.

OMB No. 1545-0047

2012

Open to Public Inspection

Name of the organization

CATSKILL REGIONAL MEDICAL CENTER

Employer identification number

14-6049030

Part I

Excess Benefit Transactions (section 501(c)(3) and section 501(c)(4) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.

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

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

Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ....... Bullet Image

Part II

Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990-EZ, Part V, line 38a, or Form 990, Part IV, line 26; or if the organization reported an amount on Form 990, Part X, line 5, 6, or 22

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






Total ...... $

Part III

Grants or Assistance Benefitting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of assistance	(d) Type of assistance	(e) Purpose of assistance

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

Cat. No. 50056A

Schedule L (Form 990 or 990-EZ) 2012

Page 2

Part IV

Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of transaction	(d) Description of transaction	(e) Sharing of organization's revenues?
(a) Name of interested person		(c) Amount of transaction	(d) Description of transaction	Yes	No
(1) JUDITH SKORDINSKI	SEE SCHEDULE L PART V	94,525	EMPLOYMENT		No
(2) JOSEPH LOUGHLIN	SEE SCHEDULE L PART V	110,802	CONTRACTED SERVICES		No
(3) TIMOTHY RYDELL JEFFREY GRAY	SEE SCHEDULE L PART V	1,730,750	MEDICAL SERVICES		No

Part V

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

Identifier	Return Reference	Explanation
PART IV	COLUMN B	JUDITH SKORDINSKI IS A FAMILY MEMBER OF LOUIS RODRIGUES. JOSEPH LOUGHLIN - BUSINESS RELATIONSHIP WITH M.L. ZAGER P.C. - OWNS 50% OF THE LAW FIRM. TIMOTHY RYDELL AND JEFFREY GRAY - PARTNERS IN CRYSTAL RUN HEALTHCARE LLP.

Schedule L (Form 990 or 990-EZ) 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

CATSKILL REGIONAL MEDICAL CENTER

Employer identification number

14-6049030

Identifier	Return Reference	Explanation
FORM 990 PART III - ORGANIZATION'S MISSION	LINE 1:	THE CATSKILL REGIONAL MEDICAL CENTER (CRMC) MISSION STATEMENT IS TO IMPROVE THE HEALTH OF OUR COMMUNITY BY PROVIDING EXCEPTIONAL HEALTH CARE. CRMC'S VISION IS THAT WE ARE CARING PROFESSIONALS DRIVEN BY STANDARDS OF EXCELLENCE WHO GO ABOVE AND BEYOND TO PROVIDE AN EXCEPTIONAL PATIENT CARE EXPERIENCE. CRMC'S VALUES REFLECT OUR MISSION AND VISION BY FOCUSING ON PATIENTS AND FAMILIES FIRST, HONESTY, INTEGRITY AND TRANSPARENCY IN ACTION, OPERATIONAL EXCELLENCE, TEAMWORK, COLLABORATION AND COMMUNICATION, ACCOUNTABILITY AND AN IMPECCABLE HEALING ENVIRONMENT.
FORM 990 PART III - OTHER PROGRAM SERVICES DESCRIPTIONS	LINE 4D:	EXPENSES ARE INCURRED WHILE PROVIDING OTHER SERVICES SUCH AS LONG TERM CARE, MENTAL HEALTH CARE, AMBULATORY SERVICES, ADULT DAY CARE PROGRAM AND A 24/7 EMERGENCY ROOM TO 38,518 RESIDENTS AND VISITORS IN THE SURROUNDING COMMUNITY.
FORM 990 PART VI - BUSINESS AND FAMILY RELATIONSHIPS	LINE 2	JOSEPH LOUGHLIN - BUSINESS RELATIONSHIP WITH M.L. ZAGER P.C. - OWNS 50% OF THE LAW FIRM. JOSEPH LOUGHLIN AND JOAN FARROW - FAMILY RELATIONSHIP. TIMOTHY RYDELL AND JEFFREY GRAY - BUSINESS RELATIONSHIP, PARTNERS IN CRYSTAL RUN HEALTHCARE LLP. JOAN FARROW AND JOSEPH LOUGHLIN - FAMILY RELATIONSHIP.
FORM 990 PART VI, LINE 4		THE BYLAWS OF ORANGE REGIONAL MEDICAL CENTER AND ITS AFFILIATED HOSPITAL, CATSKILL REGIONAL MEDICAL CENTER, WERE REVISED IN 2012 TO: (A)ELIMINATE ALL COMMITTEES AT THE HOSPITAL LEVEL OTHER THAN GOVERNANCE AND PERFORMANCE IMPROVEMENT; AND (B) REDUCE THE MINIMUM NUMBER OF DIRECTORS TO 3. CURRENTLY, THE BYLAWS OF CRMC'S SOLE MEMBER AND CORPORATE PARENT, GREATER HUDSON VALLEY HEALTH SYSTEM (GHVHS), INC., WERE REVISED TO: (A) STREAMLINE THE DIRECTOR NOMINATION PROCESS; (B) EXPAND THE MAXIMUM NUMBER OF DIRECTORS TO 30; AND (C) ESTABLISH THREE GROUPS OF DIRECTORS WITH STAGGERED TERMS. IN ADDITION, TO FURTHER CENTRALIZE THE GOVERNANCE OF GHVHS AND THE TWO HOSPITALS OF WHICH GHVHS IS THE SOLE MEMBER (ORANGE REGIONAL MEDICAL CENTER AND CATSKILL REGIONAL MEDICAL CENTER), THE FOLLOWING COMMITTEES WERE AUTHORIZED IN THE GHVHS BYLAWS (IN ADDITION TO THE PRE-EXISTING EXECUTIVE, AUDIT & COMPLIANCE, STRATEGIC PLANNING AND GOVERNANCE COMMITTEES): FINANCE COMMITTEE, PERFORMANCE IMPROVEMENT COMMITTEE, BIOTHICS COMMITTEE AND INSTITUTIONAL REVIEW BOARD.
FORM 990 PART VI	LINE 6 - MEMBERS OR STOCKHOLDERS	GREATER HUDSON VALLEY HEALTH SYSTEM INC, AN ORGANIZATION EXEMPT FROM INCOME TAX UNDER IRC SECTION 501 (C)(3) IS THE SOLE MEMBER OF CATSKILL REGIONAL MEDICAL CENTER.
FORM 990 PART VI	LINE 7A AND 7B - ELECTION OF MEMBERS	GREATER HUDSON VALLEY HEALTH SYSTEM, INC., AS SOLE MEMBER, APPROVES ALL APPOINTMENTS TO THE CRMC BOARD OF DIRECTORS UPON RECOMMENDATION FROM CRMC BOARD OF DIRECTORS. GREATER HUDSON VALLEY HEALTH SYSTEM'S BOARD OF DIRECTORS APPROVES DECISIONS OF CATSKILL REGIONAL MEDICAL CENTER'S BOARD OF DIRECTORS INCLUDING: " APPOINTMENT OF DIRECTORS " APPROVAL OF CERTIFICATE OF NEED APPLICATIONS " APPROVAL OF ANNUAL STRATEGIC PLAN " APPROVAL OF AMENDMENTS TO THE BYLAWS OR CERTIFICATE OF INCORPORATION " APPROVAL OF OPERATING AND CAPITAL BUDGETS " APPROVAL OF ANY BORROWINGS, GUARANTEES OR LEASES VALUED IN EXCESS OF $5 MILLION EACH OR IN THE ANNUAL AGGREGATE " APPROVAL OF ANY MERGER, CONSOLIDATION OR NON-JUDICIAL DISSOLUTION " APPROVAL OF ANY AFFILIATION OR MANAGEMENT CONTRACT WITH ANOTHER ENTITY
FORM 990 PART VI	LINE 11A - BOARD REVIEW OF FORM 990	THE FORM 990 IS PREPARED BY THE FINANCE DEPARTMENT AND SUBMITTED TO CRMC'S TAX PREPARER FOR PROCESSING. THE INITIAL DRAFT RETURN PROVIDED BY THE TAX PREPARER IS REVIEWED BY MEMBERS OF EXECUTIVE MANAGEMENT, THE CORPORATE COMPLIANCE OFFICER, AND THE AUDIT AND COMPLIANCE COMMITTEE OF THE BOARD OF DIRECTORS. THE FINAL VERSION OF THE ORGANIZATION'S FORM 990 IS PROVIDED TO ALL VOTING MEMBERS OF THE BOARD OF DIRECTORS PRIOR TO SUBMISSION TO THE INTERNAL REVENUE SERVICE.
FORM 990 PART VI	LINE 12C - EXPLANATION OF MONITORING AND ENFORCEMENT OF CONFLICTS	CATSKILL REGIONAL MEDICAL CENTER'S CONFLICT OF INTEREST (COI) POLICY APPLIES TO ALL DIRECTORS, COMMITTEE MEMBERS AND ALL EMPLOYEES WHO ARE IN A POSITION TO INFLUENCE ANY SUBSTANTIVE BUSINESS DECISION BY THE HOSPITAL OR ANY ENTITY CONTROLLED BY THE HOSPITAL. THE HOSPITAL HAS INSTITUTED A CORPORATE COMPLIANCE PROGRAM TO ENSURE THAT ALL OF ITS BUSINESS PRACTICES ARE IN COMPLIANCE WITH APPLICABLE CIVIL AND CRIMINAL LAWS, RULES AND REGULATIONS. THE CONFLICT POLICY REQUIRES ALL DIRECTORS AND COVERED EMPLOYEES TO READ AND UNDERSTAND THE POLICY AND REVIEW IT AT LEAST ANNUALLY IN ORDER TO BE ALERT TO SITUATIONS THAT COULD CREATE A CONFLICT OF INTEREST OR OTHERWISE BE CONTRARY TO HOSPITAL POLICY. THEY ARE ALSO REQUIRED ANNUALLY TO SIGN A CONFLICTS POLICY DISCLOSURE FORM. THE COMPLIANCE OFFICER MONITORS THE COI DISCLOSURES, AND IS PRESENT AT ALL BOARD MEETINGS TO ASSIST WITH ANY POTENTIAL CONFLICT ISSUES AND PROVIDE ADVICE ON ABSTENTION, RECUSAL, ETC. A SUMMARY OF THE COI DISCLOSURES IS PRODUCED FOR THE BOARD, AS IS ANNUAL UPDATES TO THE COI POLICY.
FORM 990 PART VI	LINE 15A/B - COMPENSATION REVIEW & APPROVAL PROCESS FOR OFFICERS & KEY EMP	IN DETERMINING COMPENSATION FOR CEO, CRMC UTILIZES ONE OR MORE OF THE FOLLOWING - A COMPENSATION COMMITTEE MADE UP OF INDEPENDENT MEMBERS OF THE EXECUTIVE COMMITTEE OF THE BOARD, AN INDEPENDENT COMPENSATION CONSULTANT, AND COMPENSATION SURVEYS OR STUDIES. THESE SURVEYS INCLUDE HEALTHCARE PROVIDERS WITH COMPARABLE NET REVENUE AND IN COMPARABLE GEOGRAPHIC REGIONS. FOLLOWING THE RECOMMENDATIONS OF THE BOARD OF DIRECTORS, CRMC LOOKS TO HIRE AT APPROXIMATELY THE 50TH PERCENTILE OF THE MARKET. THIS IS DETERMINED BY USING THE PREVIOUSLY MENTIONED DATA RESOURCES. BASED UPON PARAMETERS DETERMINED BY THE COMPENSATION COMMITTEE, THE CEO IS PERMITTED TO MAKE COMPENSATION DECISIONS FOR SALARIES WITHIN THE 50TH-75TH PERCENTILE. ANY PROPOSED SALARY ABOVE THE 75TH PERCENTILE WOULD REQUIRE PRIOR COMMITTEE APPROVAL. A FULL REVIEW OF CEO SALARY WAS PERFORMED IN 2010 AND UPDATED IN 2011 BASED ON THESE PARAMETERS. IN ADDITION, THE CHIEF EXECUTIVE OFFICER AND HIS COMPENSATION MUST BE APPROVED BY THE COMPENSATION COMMITTEE. THE REVIEW PROCESS IS DOCUMENTED CONTEMPORANEOUSLY IN THE MINUTES OF THE COMPENSATION COMMITTEE.
FORM 990. PART VI	LINE 19 - OTHER ORGANIZATION DOCUMENTS PUBLICLY AVAILABLE	ONCE A REQUEST IS MADE FOR THE CATSKILL REGIONAL MEDICAL CENTER TAX RETURN, A COPY IS SENT TO THE PERSON(S) REQUESTING THE DATA OR AS REQUIRED FOR VARIOUS STATE AND FEDERAL FILINGS THROUGH THE ADMINISTRATION OFFICE.
PART XI - RECONCILIATION OF NET ASSETS	LINE 9 - OTHER CHANGES IN NET ASSETS OR FUND BALANCES:	CHANGE IN THE INTEREST IN NET ASSETS OF THE CRMC FOUNDATION, INC : 473,236
SCHEDULE K	PART I - BOND ISSUES CUSIP #'S:	64983TW25; 64983TW33; 64983TW41; 64983TW58; 6498TW66; 64983TW74; 64983TW82; 64983TW90; 64983TX24; 64983TX32; 64983TX40.

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

CATSKILL REGIONAL MEDICAL CENTER

Employer identification number

14-6049030

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) CRMC FOUNDATION INC PO BOX 800 HARRIS,NY12742 14-1742176	SUPPORT ORG.	NY	501(C)(3)	11 TYPE 1	NA		No
(2) ORANGE REGIONAL MEDICAL CENTER 60 PROSPECT AVENUE MIDDLETOWN,NY10940 14-1364536	HEALTHCARE	NY	501(C)(3)	3	GHVHS		No
(3) GREATER HUDSON VALLEY HEALTH SYSTEM C/O ORMC 60 PROSPECT MIDDLETOWN,NY10940 06-1488219	HEALTHCARE	NY	501(C)(3)	11-TYPE I	NA		No

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) EAST MAIN STREET MANAGEMENT 60 PROSPECT AVENUE MIDDLETOWN,NY10940 20-3168346	ADMIN. SERVIC	NY	ORMC	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) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

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

Yes

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

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

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

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

Yes

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

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

If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.

(a) Name of other organization	(b) Transaction type (a-s)	(c) Amount involved	(d) Method of determining amount involved

Schedule R (Form 990) 2012

Page 4

Part VI

Unrelated Organizations Taxable as a Partnership (Complete if the organization answered "Yes" to Form 990, Part IV, line 37.)

Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.

(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(e) Are all partners section 501(c)(3) organizations?		(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

Schedule R (Form 990) 2012

Page 5

Part VII

Supplemental Information

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

Identifier	Return Reference	Explanation

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: TO IMPROVE THE HEALTH OF OUR COMMUNITY BY PROVIDING EXCEPTIONAL HEALTH CARE.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	10
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	8
5	Total number of individuals employed in calendar year 2011 (Part V, line 2a) ......	5	1,002
6	Total number of volunteers (estimate if necessary) .............	6	143
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	568,598
b	Net unrelated business taxable income from Form 990-T, line 34 .........	7b	89,594

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	7,708,071	1,405,522
9	Program service revenue (Part VIII, line 2g) .........	101,071,562	95,205,019
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	182,996	260,500
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	77,359	69,849
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)...................	109,039,988	96,940,890
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)	56,047,999	55,898,954
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)....	44,048,275	43,960,566
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	100,096,274	99,859,520
19	Revenue less expenses. Subtract line 18 from line 12.......	8,943,714	-2,918,630
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	74,353,602	70,587,643
21	Total liabilities (Part X, line 26).............	65,256,614	64,013,847
22	Net assets or fund balances. Subtract line 21 from line 20.....	9,096,988	6,573,796

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 37,698,652 including grants of $ 0 ) (Revenue $ 47,117,503 )
	EXPENSES INCURRED WHILE PROVIDING INPATIENT MEDICAL SURGICAL SERVICES, OBSTETRICS, NEWBORN CARE SERVICES, AND BIO-CHEMICAL DEPENDENCY CARE SERVICES TO 4,568 PATIENTS IN THE SURROUNDING COMMUNITY.

4b	(Code: ) (Expenses $ 10,809,215 including grants of $ 0 ) (Revenue $ 4,946,807 )
	CRMC PROVIDES OUTPATIENT CLINICAL SERVICES THROUGHOUT ITS CLINICS SPECIALIZED IN CARDIOLOGY, ENDOCRINOLOGY, WOUND CARE, ONCOLOGY/ HEMATOLOGY, FAMILY HEALTH AND WOMEN'S HEALTH SERVICES. EXPENSES INCURRED WHILE PROVIDING 17,767 CLINICAL SERVICES TO PATIENTS.

4c	(Code: ) (Expenses $ 12,193,614 including grants of $ 0 ) (Revenue $ 10,783,323 )
	CRMC PROVIDES REFERRED AMBULATORY SERVICES SUCH AS LABORATORY, IMAGING, CANCER SCREENING, CARDIAC CARE, AND REHABILITATION THERAPY SERVICES TO PATIENTS IN THE SURROUNDING COMMUNITY. EXPENSES INCURRED WHILE PROVIDING 47,242 REFERRED AMBULATORY SERVICES.

4d	Other program services (Describe in Schedule O.)
	(Expenses $ 24,688,612 including grants of $ ) (Revenue $ 32,357,386 )
4e	Total program service expenses85,390,093

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)............	2,243,312	3,278,759	637,241

				(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		78,844
d	Related organizations...1d		40,484
e	Government grants (contributions)1e		1,267,259

f	All other contributions, gifts, grants, and similar amounts not included above1f		18,935

g	Noncash contributions included in lines 1a-1f:$
h	Total. Add lines 1a-1f.......			1,405,522
			Business Code
2a	INPATIENT REVENUE		623990	39,830,763	39,830,763
b	SNU INPATIENT REVENUE		623000	5,896,241	5,896,241
c	PSYCH INPATIENT REVENUE		623000	4,143,305	4,143,305
d	INDIGENT CARE POOL REVENUE		623000	6,971,701	6,971,701
e	OUTPATIENT REVENUE		621990	33,294,163	32,725,565	568,598
f	All other program service revenue .			5,068,846	5,068,846
g	Total. Add lines 2a–2f........			95,205,019
3	Investment income (including dividends, interest, and other similar amounts).......			167,457			167,457
4	Income from investment of tax-exempt bond proceeds..			0
5	Royalties...........			0
		(i) Real	(ii) Personal
6a	Gross rents	55,788
b	Less: rental expenses	2,761
c	Rental income or (loss)	53,027	0
d	Net rental income or (loss).......			53,027			53,027
		(i) Securities	(ii) Other
7a	Gross amount from sales of assets other than inventory	20,850,624	113,221
b	Less: cost or other basis and sales expenses	20,861,299	9,503
c	Gain or (loss)	-10,675	103,718
d	Net gain or (loss)..........			93,043			93,043
8a	Gross income from fundraising events (not including $ 78,844 of contributions reported on line 1c). See Part IV, line 18 ..
	a		38,810
b	Less: direct expenses ...b		31,864
c	Net income or (loss) from fundraising events..			6,946			6,946
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	REBATES & REFUNDS		900099	9,876			9,876
b
c
d	All other revenue ....
e	Total. Add lines 11a–11d ......			9,876
12	Total revenue. See Instructions......			96,940,890	94,636,421	568,598	330,349


				(A) Beginning of year		(B) End of year
1	Cashnon-interest-bearing .............			7,307,533	1	4,990,421
2	Savings and temporary cash investments .........			2,411,639	2	2,565,882
3	Pledges and grants receivable, net ...........			2,691,414	3	536,506
4	Accounts receivable, net .............			10,693,689	4	12,866,917
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 ..............			1,223,827	8	1,360,073
9	Prepaid expenses and deferred charges ..........			1,164,303	9	131,381
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	121,597,712
b	Less: accumulated depreciation .....	10b	96,894,361	25,859,140	10c	24,703,351
11	Investments—publicly traded securities ..........			14,523,696	11	13,767,860
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 ...........			8,478,361	15	9,665,252
16	Total assets. Add lines 1 through 15 (must equal line 34)......			74,353,602	16	70,587,643
17	Accounts payable and accrued expenses .........			14,262,337	17	15,781,764
18	Grants payable .................			0	18	0
19	Deferred revenue ................			0	19	0
20	Tax-exempt bond liabilities .............			38,059,926	20	34,506,040
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 ..			356,972	23	0
24	Unsecured notes and loans payable to unrelated third parties ....			1,456,844	24	1,455,390
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....................			11,120,535	25	12,270,653
26	Total liabilities. Add lines 17 through 25.........			65,256,614	26	64,013,847
	Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets ..............			4,585,888	27	3,545,640
28	Temporarily restricted net assets ...........			3,052,395	28	1,069,451
29	Permanently restricted net assets ...........			1,458,705	29	1,958,705
	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 ...........			9,096,988	33	6,573,796
34	Total liabilities and net assets/fund balances ........			74,353,602	34	70,587,643