Department of the Treasury Internal Revenue Service
Public Charity Status and Public Support
Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.
Attach to Form 990 or Form 990-EZ. See separate instructions. Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
New York Downtown Hospital
Employer identification number
13-3049852
Part I
Reason for Public Charity Status
(All organizations must complete this part.) See instructions.
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
11
e
By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons other than foundation managers and other than one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2).
f
If the organization received a written determination from the IRS that it is a Type I, Type II, or Type III supporting organization, check this box
..................................................
g
Since August 17, 2006, has the organization accepted any gift or contribution from any of the following persons?
(i) A person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
and (iii) below, the governing body of the supported organization?
................
11g(i)
No
(ii)
A family member of a person described in (i) above?
......................
11g(ii)
No
(iii)
A 35% controlled entity of a person described in (i) or (ii) above?
................
11g(iii)
No
h
Provide the following information about the supported organization(s).
(i) Name of supported organization
(ii) EIN
(iii) Type of organization (described on lines 1- 9 above or IRC section (see instructions))
(iv) Is the organization in col. (i) listed in your governing document?
(v) Did you notify the organization in col. (i) of your support?
(vi) Is the organization in col. (i) organized in the U.S.?
(vii) Amount of monetary support
Yes
No
Yes
No
Yes
No
Total
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990EZ.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2013
Schedule A (Form 990 or 990-EZ) 2013
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) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(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) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(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).
12
Gross receipts from related activities, etc. (see instructions)
..................
12
13
First five years.
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here.................................................
Section C. Computation of Public Support Percentage
14
Public support percentage for 2013 (line 6, column (f) divided by line 11, column (f))
.........
14
15
Public support percentage for 2012 Schedule A, Part II, line 14
...............
15
16a
33 1/3% support test—2013.
If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization
.......................
b
33 1/3% support test—2012.
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
.....................
17a
10%-facts-and-circumstances test—2013.
If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain
in Part IV how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization
.....................................................
b
10%-facts-and-circumstances test—2012.
If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part IV how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported organization
................................................
18
Private foundation.
If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions
.....................................................
Schedule A (Form 990 or 990-EZ) 2013
Schedule A (Form 990 or 990-EZ) 2013
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) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(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) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(f) Total
9
Amounts from line 6...
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
11
Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
12
Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)
..
13
Total support. (Add lines 9, 10c, 11, and 12.)..
14
First five years.
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here.............................................
Section C. Computation of Public Support Percentage
15
Public support percentage for 2013 (line 8, column (f) divided by line 13, column (f))
.........
15
16
Public support percentage from 2012 Schedule A, Part III, line 15
...............
16
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2013 (line 10c, column (f) divided by line 13, column (f))
......
17
18
Investment income percentage from 2012 Schedule A, Part III, line 17
.............
18
19a
33 1/3% support tests—2013.
If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
........
b
33 1/3% support tests—2012.
If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
.....
20
Private foundation.
If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions
.....
Schedule A (Form 990 or 990-EZ) 2013
Schedule A (Form 990 or 990-EZ) 2013
Page 4
Part IV
Supplemental Information.
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) 2013
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.
Attach to Form 990 or 990-EZ.
Information about Schedule O (Form 990 or 990-EZ) and its instructions is at
www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
New York Downtown Hospital
Employer identification number
13-3049852
Return Reference
Explanation
SCHEDULE J AND PART VII
ON JULY 1, 2013, NEW YORK DOWNTOWN HOSPITAL CEASED OPERATING AS A SEPaRATE LICENSED FACILITY. The new york downtown hospital policies contained in schedule o apply to the period january 1, 2013 - june 30, 2013. Certain officers and key employees of the New York Presbyterian Hospital that are identified in part VII as officers or trustees of New York Downtown Hospital are responsible for executing the mission and management of the New York Presbyterian Hospital (NYP) and its affiliated entities. Compensation for 2013 of these upper level executives includes the payout of an annual incentive plan and a long-term incentive plan. This performance-oriented program conditions payments upon the achievement of multiple individual and group performance measures. Measures to monitor performance include: operational and financial strength, patient quality and safety, patient satisfaction, advancement of patient care, and people development and partnership. Incentive awards may only be granted if the organization achieves a financial surplus. Even if all relevant performance measurements are achieved, the NYP Board of Trustees retains full discretion to make or not make any incentive awards, or to reduce the amount of any incentive award. This initiative is critical to assuring that NYP has the requisite leadership to create and manage a highly motivated and engaged workforce, to drive superior performance throughout the organization and to achieve top tier medical center status. As a separate matter, due to restrictions imposed by the Internal Revenue Code, upper level executives are limited in the amount of benefits received under a tax-qualified retirement plan. Like many employers, NYP supplements these executives' pension benefits through a supplemental ("nonqualified") retirement plan. The supplemental executive retirement plan (SERP) is subject to a multi-year vesting requirement (commencing after five years of participation in the SERP, in prorated amounts through age 65) which places an executive's supplemental retirement benefit at risk of forfeiture if the vesting requirements are not satisfied. Once vested, however, provisions of the Internal Revenue Code require that the vested executive include in current income the value of his or her vested supplemental retirement benefit. Notwithstanding the legal requirement to recognize the vested value of the supplemental retirement benefit as current income, the supplemental retirement benefit will not be distributed to the executive until the executive actually retires from NYP (although, as permitted by the Internal Revenue Code, the supplemental retirement plan will effect a distribution of an amount necessary to satisfy the executive's tax liability resulting from the income recognition upon vesting). As noted, this supplemental retirement benefit will not be distributed to the executive until the executive actually retires from NYP. There are constantly changing legal, tax, accounting, and public disclosure rules for a SERP (supplemental executive retirement plan) in not-for-profit organizations. The executive Compensation Committee continuously monitors these changes and incorporates any changes into the overall SERP plan design. As in past years, the executive Compensation Committee of NYP requires a third party complete a review of the organization's compensation program to ensure its effectiveness in terms of government regulations, market conditions and the need to continually elevate organizational performance. The report also serves to meet the regulatory obligations to ensure that all elements of the executive compensation programs are reasonable. The individuals listed in part VII that are compensated by New York Presbyterian Hospital devote an average of sixty hours per week to perform their responsibilities for the New York Presbyterian Hospital and other related organizations in the aggregate. Other Program Service Revenue FORM 990, PART III, LINE 4D TOTAL FACULTY PRACTICE REVENUE $ 6,024,647 - PROVIDE EMERGENT AND OFFICE MEDICAL SERVICES TO APPROXIMATELY 50,000 PATIENTS PER YEAR IN LOWER MANHATTAN. PROMOTE THE AVAILABILITY OF HIGH QUALITY PROFESSIONAL MEDICAL SERVICES FOR THE PATIENTS OF NEW YORK DOWNTOWN HOSPITAL, A TEACHING HOSPITAL. PROVIDE MEDICAL CARE TO ALL SICK AND INJURED WHO MAY COME TO THE FACILITY FOR DIAGNOSIS, TREATMENT AND CARE WITHOUT REGARD TO RACE, COLOR, CREED, SEX, AGE OR THE ABILITY TO PAY FOR SERVICES AND PARTICULARLY TO PROVIDE SUCH MEDICAL CARE TO ALL PERSONS; ALSO EMERGENCY SERVICES $ 1,356,340 & ALL OTHER REVENUE $147,472. Members Part VI, Section A, Line 6 & 7a The New York Downtown Hospital (the "Organization") is a membership corporation, whose members are appointed by New York-Presbyterian Healthcare System, Inc. ("System Inc"). System, Inc. is a tax-exempt organization whose members are appointed by New York- Presbyterian Foundation, Inc., which is also a tax-exempt organization. The members of the Organization elect the Organization's board of trustees. DESCRIPTION OF THE PROCESS TO REVIEW FORM 990 FORM 990, PART VI, LINE 11 THE REVIEW PROCESS FOR THIS ENTITY HAS CHANGED DUE TO THE MERGER OF NEW YORK DOWNTOWN HOSPITAL AND NEW YORK PRESBYTERIAN HOSPITAL ON JULY 1, 2013. THE BOARD AS SHOWN ON PART VII Ceased to exist as did this entity. FINANCE COORDINATED AND COMPLETED ALL OF THE INFORMATION REQUIRED FOR FORM 990 ACCESSING VARIOUS RESOURCES INCLUDING LEGAL, HUMAN RESOURCES, DEVELOPMENT, AND OTHER DEPARTMENTS AS NEEDED. New York Presbyterian Hospitals SENIOR FINANCE EXECUTIVES COMPLETE A REVIEW OF THE RETURN IN CONJUNCTION WITH ERNST & YOUNG U.S. LLP, PAID PREPARER, PRIOR TO SUBMISSION TO THE CHAIRMAN OF THE AUDIT AND CORPORATE COMPLIANCE COMMITTEE OF THE BOARD of the new york presbyterian hospital. THE CHAIRMAN OF THE AUDIT AND CORPORATE COMPLIANCE COMMITTEE CONDUCTed A DETAILED REVIEW. UPON COMPLETION OF THE AUDIT CHAIRMAN'S REVIEW AND APPROVAL, THE new york downtown hospital will file the final 990. DESCRIPTION OF PROCESS TO MONITOR TRANSACTIONS FOR CONFLICTS OF INTEREST FORM 990, PART VI, LINE 12C Below is the conflict of interest policy used by the New York Downtown Hospital. The new york downtown hospital merged with the new york presbyterian hospital on 7/1/2013. As a result any conflicts determined to be reported will be shown on the New York and Presbyterian 990 for the period 1/1/2013 - 12/31/2013. ON AN ANNUAL BASIS, ALL BOARD MEMBERS, OFFICERS AND KEY EMPLOYEES COMPLETE A CONFLICT OF INTEREST QUESTIONNAIRE AND THE RESPONSES ARE REVIEWED AND ANALYZED IN THE CONTEXT OF A CONFLICT OF INTEREST POLICY THAT IS CONSISTENT WITH IRS GUIDANCE BY NEW YORK DOWNTOWN HOSPITAL'S CHIEF COMPLIANCE OFFICER. IF A CONFLICT OR POTENTIAL CONFLICT IS IDENTIFIED, FURTHER FACTUAL INQUIRY IS MADE, INCLUDING AN INTERVIEW. ALL OF THE INFORMATION COLLECTED IS THEN PRESENTED TO THE EXECUTIVE COMPLIANCE COMMITTEE AND/OR THE AUDIT AND COMPLIANCE COMMITTEE REGARDING THE ACTION REQUIRED TO BE TAKEN. IF A CONFLICT IS FOUND TO EXIST, THE CONFLICTED EMPLOYEE WILL BE REQUIRED TO RECUSE THEMSELVES FROM VOTING ON OR INFLUENCING THE VOTE ON ANY MATTERS MADE RELATIVE TO THE IDENTIFIED CONFLICT. Compensation Discription FORM 990, PART VI, LINES 15A & 15B NEW YORK DOWNTOWN HOSPITAL USED THE FOLLOWING SOURCES TO EVALUATE APPROPRIATE COMPENSATION PACKAGES FOR SENIOR MANAGEMENT/EXECUTIVE EMPLOYEES: CONTACTING OTHER HUMAN RESOURCE DEPARTMENTS FROM OTHER HOSPITALS to COMPARe COMPENSATION AND BENEFITS FOR COMPARABLE POSITIONS, PUBLISHED DATA SOURCES SUCH AS American healthcare human resource association's SURVEY AND THE GUIDESTAR NONPROFIT COMPENSATION REPORT, AND CONTRACTING OUTSIDE CONSULTING FIRMs SUCH AS LAWRENCE ASSOCIATES AND CAMMACK LARHETTE CONSULTING TO COMPLETE a MARKET SURVEY. THE MARKET DATA IS REVIEWED ALONG WITH THE EXISTING INTERNAL COMPENSATION of SIMILAR SITUATED EMPLOYEES TO DETERMINE THE EXECUTIVE COMPENSATION FOR A PARTICULAR POSITION. THE PEOPLE who undergo EXECUTIVE COMPENSATION REVIEWS ARE SVPS, CEO AND ALL EMPLOYED PHYSICIANS. THE REVIEW HAPPENS ON INITIAL EMPLOYMENT AND THEN UPON RENEWAL OF ANY EMPLOYMENT AGREEMENT. AVAIL OF GOV DOCS,CONFLICT OF INTEREST POLICY,&FIN STMTS TO GEN PUBLIC FORM 990, PART VI, LINE 19 GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND THE FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC AND ALL VENDORS UPON REQUEST. OTHER CHANGES IN NET ASSETS FORM 990, PART XI, LINE 9 CHANGE IN ACCRUED PENSION & POSTRETIREMENT BENEFITS TO BE RECOGNIZED IN FUTURE PERIODS: $ 1,315,753 Change due to the merger of the New York Downtown Hospital and the New York Presbyterian Hospital: $ (53,875,683) Total Part XI, Line 9: $(52,559,930)
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.