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
BROOKDALE HOSPITAL MEDICAL CENTER
Employer identification number
11-1631746
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)
(ii)
A family member of a person described in (i) above?
......................
11g(ii)
(iii)
A 35% controlled entity of a person described in (i) or (ii) above?
................
11g(iii)
h
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.
0
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...
0
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
0 %
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.)
0
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
0 %
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
0 %
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:
13000178
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
BROOKDALE HOSPITAL MEDICAL CENTER
Employer identification number
11-1631746
Return Reference
Explanation
Pt VI, Line 11b
THE FORM 990 AND APPROPRIATE SCHEDULES, AS REQUIRED
Pt VI, Line 11b
IS PREPARED BY OUTSIDE ACCOUNTANTS AND REVIEWED INTERNALLY BY MANAGEMENT
Pt VI, Line 11b
AND COUNSEL, AT WHICH TIME IT IS CONSIDERED THE FINAL DRAFT. THE FINAL DRAFT OF THE
Pt VI, Line 11b
FORM 990 IS THEN FILED WITH THE IRS.
Pt XI
LINE 9 OTHER CHANGES IN NET ASSETS OR FUND BALANCES IS AS FOLLOWS:
Pt XI
FORGIVENESS OF DEBT - AFFILIATE 70,278,392
Pt XI
PENSION CHANGES NOT NET PERIODIC COST 22,092,483
Pt XI
GRANTS FOR CAPITAL PURPOSES 4,010,029
Pt XI
TOTAL OTHER CHANGES 96,380,904
Pt VI, Line 12c
DISCLOSURE IN ACCORDANCE WITH THE CONFLICT OF INTEREST POLICY
Pt VI, Line 12c
BY EMPLOYEES THAT SATISFY THE CRITERIA TO BE CONSIDERED AN
Pt VI, Line 12c
"INTERESTED PERSON" IS SUBMITTED UPON HIRING AND ANNUALLY
Pt VI, Line 12c
THEREAFTER. THE AUDIT & COMPLIANCE COMMITTEE REVIEWS THE
Pt VI, Line 12c
SUBMISSIONS FOR CONFLICTS AND THE CORPORATE COMPLIANCE DEPARTMENT MONITORS COMPLIANCE.
Pt VI, Line 7a
IN MARCH 2012, GRANT THORNTON WAS ENGAGED BY THE ORGANIZATION TO PROVIDE INTERIM
Pt VI, Line 7a
AND CRISIS MANAGEMENT SERVICES. COMMENCING APRIL 26, 2012 GRANT THORNTON'S
Pt VI, Line 7a
MANAGEMENT SERVICES INCLUDED THE CHIEF EXECUTIVE AND RESTRUCTURING OFFICER, CHIEF
Pt VI, Line 7a
OPERATING OFFICER AND CHIEF FINANCIAL OFFICER POSTIONS, AS WELL AS MULTIPLE OTHER
Pt VI, Line 7a
MANAGEMENT POSITIONS IN FINANCE, OPERATIONS, AND IT. DURING 2013, THE SERVICE OF
Pt VI, Line 7a
CHIEF FINANCIAL OFFICER WAS PROVIDED BY JAMES PORTER OF GRANT THORNTON.
Pt VI, Line 7a
STARTING IN DECEMBER 2012, THE HOSPITAL RETAINED TONEYKORF PARTNERS,LLC.
Pt VI, Line 7a
FOR THE SERVICES OF CHIEF EXECUTIVE OFFICER AND CHIEF OPERATING OFFICER,
Pt VI, Line 7a
PROVIDED BY MARK TONEY AND STEVEN KORF, RESPECTIVELY. THESE POSITIONS ALL
Pt VI, Line 7a
INDICATED IN PART VII SECTION A FOR OFFICERS, DIRECTORS, TRUSTEES, KEY EMPLOYEES
Pt VI, Line 7a
AND HIGHEST COMPENSATED EMPLOYEES. ANY AMOUNTS PAID IN CONNECTION WITH THE ABOVE
Pt VI, Line 7a
SERVICES ARE PAID DIRECTLY TO GRANT THORNTON OR TONEYKORF PARTNERS, LLC. RESPECTIVELY
Form 990, Part IX, Line 24f
SUPPLIES 16736643. 13375778. 3343944. 16921. TELEPHONE 993539. 793841. 198460. 1238. POSTAGE AND SHIPPING 190166. 152010. 38003. 153. EQUIPMENT RENTAL AND MAINTENANCE 4156604. 3323830. 830957. 1817. PRINTING AND PUBLICATIONS 223629. 178903. 44726. 0. PURCHASED FOOD AND SERVICES 4105786. 4105786. 0. 0. EQUIPMENT CONTRACTS 3296696. 3296696. 0. 0. SECURITY SERVICES 131872. 105498. 26374. 0. WASTE REMOVAL 517988. 517988. 0. 0. DUES AND LICENSES 435148. 348118. 87030. 0. BANK CHARGES 78159. 0. 78159.
Pt VI, Line 2
ALEX ROVT, CHAIRMAN AND TRUSTEE, IRINA BENFIELD, TRUSTEE,
Pt VI, Line 2
AND STEPHEN PLOTNICK, TRUSTEE, ALL HAVE A BUSINESS RELATIONSHIP
Pt VI, Line 2
WITH EACH OTHER.
Pt VI, Line 15a
Form 990, part VI, Section B, Line 15: Executive Compensation Policy - The
Pt VI, Line 15a
Hospital's bylaws prohibit Trustees from receiving
Pt VI, Line 15a
any compensation for services performed in their capacity
Pt VI, Line 15a
as a Trustee. Also pursuant to the Hospital's bylaws
Pt VI, Line 15a
a Trustee serving in another capacity may receive reasonable
Pt VI, Line 15a
compensation therefore as authorized by the Board of Trustees.
Pt VI, Line 15a
It is the hospital's practice to target total executive
Pt VI, Line 15a
compensation (base salary, incentive compensation and benefits)
Pt VI, Line 15a
as the median of the relevant marketplace for similarly
Pt VI, Line 15a
situated executives, with appropriate adjustments for
Pt VI, Line 15a
special skill, experience, competence and performance.
Pt VI, Line 15a
The CEO, or a special committee of the Board of Trustees,
Pt VI, Line 15a
as appropriate, would recommend a reasonable compensation
Pt VI, Line 15a
level after review of appropriate market data, and where
Pt VI, Line 15a
appropriate, consultation with an independent compensation
Pt VI, Line 15a
consultant in a manner that complies with the intermediate
Pt VI, Line 15a
sanction regulations and other relevant federal and state
Pt VI, Line 15a
requirements.
Pt VI, Line 7b
BROOKDALE HEALTH SYSTEM, INC., AS SOLE MEMBER OF THE ORGANIZATION,
Pt VI, Line 7b
HAS THE AUTHORITY TO APPOINT AND REMOVE THE TRUSTEES OF THE ORGANIZATION,
Pt VI, Line 7b
AND OTHER AUTHORITIES AS DELINEATED IN THE BYLAWS OF THE ORGANIZATION.
Pt VI, Line 3
IN MARCH 2012, GRANT THORNTON WAS ENGAGED BY THE ORGANIZATION TO PROVIDE INTERIM
Pt VI, Line 3
AND CRISIS MANAGEMENT SERVICES. COMMENCING APRIL 26, 2012 GRANT THORNTON'S
Pt VI, Line 3
MANAGEMENT SERVICES INCLUDED THE CHIEF EXECUTIVE AND RESTRUCTURING OFFICER, CHIEF
Pt VI, Line 3
OPERATING OFFICER AND CHIEF FINANCIAL OFFICER POSTIONS, AS WELL AS MULTIPLE OTHER
Pt VI, Line 3
MANAGEMENT POSTIONS IN FINANCE, OPERATIONS, AND IT. DURING 2013, THE SERVICE OF
Pt VI, Line 3
CHIEF FINANCIAL OFFICER WAS PROVIDED BY JAMES PORTER OF GRANT THORNTON. STARTING
Pt VI, Line 3
IN DECEMBER 2012, THE HOSPITAL RETAINED TONEYKORF PARTNERS, LLC. FOR THE SERVICES
Pt VI, Line 3
OF CHIEF EXECUTIVE OFFICER AND CHIEF OPERATING OFFICER, PROVIDED BY MARK TONEY
Pt VI, Line 3
AND STEVEN KORF, RESPECTIVELY. THESE POSITIONS ALL INDICATED IN PART VII SECTION A
Pt VI, Line 3
FOR OFFICERS, DIRECTORS, TRUSTEES, KEY EMPLOYEES AND HIGHEST COMPENSATED
Pt VI, Line 3
EMPLOYEES. ANY AMOUNTS PAID IN CONNECTION WITH THE ABOVE SERVICES ARE PAID
Pt VI, Line 3
DIRECTLY TO GRANT THORNTON OR TONEYKORF PARTNERS, LLC RESPECTIVELY.
Pt VI, Line 6
BROOKDALE HEALTH SYSTEM INC., A NEW YORK NOT FOR PROFIT ORGANIZATION, IS THE SOLE MEMBER OF THE ORGANIZATION
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.