Form990
Click to see attachment
Department of the Treasury
Internal Revenue Service
Return of Organization Exempt From Income Tax
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except private foundations)
MediumBullet Do not enter Social Security numbers on this form as it may be made public. By law, the IRS
generally cannot redact the information on the form.
MediumBullet Information about Form 990 and its instructions is at www.IRS.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
A For the 2013 calendar year, or tax year beginning 01-01-2013 , 2013, and ending 12-31-2013
BCheck if applicable:
CName of organization
FAXTON ST LUKE'S HEALTHCARE
 
Doing Business As
 
 
Number and street (or P.O. box if mail is not delivered to street address)
PO BOX 479
 
Room/suite
City or town, state or province, country, and ZIP or foreign postal code
UTICA, NY13502
D Employer identification number

16-1576637
E Telephone number

G Gross receipts $ 278,694,369
F Name and address of principal officer:
LOUIS AIELLO
PO BOX 479
UTICA,NY13502
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
FAXTONSTLUKES.COM
H(a)
Is this a group return for
subordinates?
H(b)
Are all subordinates
included?
If "No," attach a list. (see instructions)
H(c)
Group exemption number MediumBullet  
K Form of organization:
 
L Year of formation: 2000
M State of legal domicile: NY
Part I
Summary
Activities & Governance 1 Briefly describe the organization’s mission or most significant activities: TO PROVIDE THE HIGHEST QUALITY HEALTH CARE IN OUR REGION. FSLH IS A PRIVATE, NOT-FOR-PROFIT, ACUTE-CARE HOSPITAL, GOVERNED BY A BOARD OF MANAGERS WHO SERVE WITHOUT COMPENSATION OF ANY KIND. THE HOSPTIAL HAS 319 MEDICAL, 26 REHABILITATION AND 26 PSYCHIATRIC PATIENT BEDS, A FULL RANGE OF OUTPATIENT SERVICES AND IS FULLY ACCREDITED BY THE JOINT COMMISSION AS A HEALTHCARE ORGANIZATION.
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a) ........ 3 15
4 Number of independent voting members of the governing body (Part VI, line 1b) ..... 4 10
5 Total number of individuals employed in calendar year 2013 (Part V, line 2a) ...... 5 2,750
6 Total number of volunteers (estimate if necessary) ............. 6 366
7a Total unrelated business revenue from Part VIII, column (C), line 12 ........ 7a 874,767
b Net unrelated business taxable income from Form 990-T, line 34 ......... 7b -182,398
Revenues Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 10,302,476 3,225,425
9 Program service revenue (Part VIII, line 2g) ......... 278,712,198 263,667,802
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 4,516,903 6,226,214
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 7,016,475 5,473,213
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)................... 300,548,052 278,592,654
Expenses; 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) 151,011,056 152,675,214
16a Professional fundraising fees (Part IX, column (A), line 11e)..... 0 0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet0    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e).... 137,196,256 130,078,958
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 288,207,312 282,754,172
19 Revenue less expenses. Subtract line 18 from line 12....... 12,340,740 -4,161,518
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 276,712,719 268,563,979
21 Total liabilities (Part X, line 26)............. 137,852,757 127,755,036
22 Net assets or fund balances. Subtract line 21 from line 20..... 138,859,962 140,808,943
Part II
Signature Block
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.
Sign Here
JumboBullet
Signature of officer Date
JumboBullet
Type or print name and title
Paid Preparer Use Only
Print/Type preparer's name
Preparer's signature
Date
PTIN
Firm's name MediumBullet

Firm's EIN MediumBullet
Firm's address MediumBullet



Phone no.
May the IRS discuss this return with the preparer shown above? (see instructions) ............
For Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y
Form 990 (2013)
Form 990 (2013)
Page 2
Part III
Statement of Program Service Accomplishments
Check if Schedule O contains a response or note to any line in this Part III ..............
1
Briefly describe the organization’s mission: FAXTON ST LUKES HEALTHCARE, INCS MISSION IS TO PROVIDE THE HIGHEST QUALITY HEALTH CARE IN OUR REGION.
2
Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? ......................
If "Yes," describe these new services on Schedule O.
3
Did the organization cease conducting, or make significant changes in how it conducts, any program services? ............................
If "Yes," describe these changes on Schedule O.
4
Describe the organization’s program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.
4a (Code:   ) (Expenses $ 123,971,405 including grants of $   ) (Revenue $ 112,676,184 )
INPATIENT/ACUTE CARE SERVICES - FSLH IS A FULL SERVICE GENERAL HOSPTIAL WITH 320 LICENSED BEDS. THE HOSPTIAL PROVIDES A FULL RANGE OF ANCILLARY SERVICES, INCLUDING MATERNITY AND NEWBORN CARE SERVICES. DISBURSEMENTS MADE BY THE HOSPTIAL ARE EXCLUSIVELY FOR SERVICES AND MATERIALS USED IN PERMFORMING THE HOSPITAL'S EXEMPT FUNCTIONS. FSLH PROVIDES CARE TO EVERYONE REGARDLESS OF RACE, RELIGION OR ABILITY TO PAY.
4b (Code:   ) (Expenses $ 32,929,745 including grants of $   ) (Revenue $ 42,678,409 )
AMBULATORY/OUTPATIENT SURGERY - FSLH HAS A FULL RANGE OF AMBULATORY SURGERY SERVICES ON ITS CAMPUS FOR PATIENTS THAT DO NOT REQUIRE OVERNIGHT OR LONG INPATIENT STAYS. FSLH PROVIDES SERVICES TO EVERYONE REGARDLESS OF RACE, RELIGION OR ABILITY TO PAY.
4c (Code:   ) (Expenses $ 17,350,464 including grants of $   ) (Revenue $ 19,702,347 )
THE CANCER CARE PROGRAM AT FSLH INCLUDES RADIATION MEDICINE, OUTPATIENT INFUSION, BREAST CARE, PALLIATIVE CARE, AND INTEGRATIVE MEDICINES, AS WELL AS TUMOR REGISTRY AND CLINICAL TRIALS. FSLH PROVIDES SERVICES TO EVERYONE REGARDLESS OF RACE, RELIGION OR ABILITY TO PAY.
(Code:   ) (Expenses $ 63,839,798 including grants of $   ) (Revenue $ 93,209,308 )
OTHER PROGRAM SERVICES PROVIDED AT FSLH ARE: RADIOLOGY, PRIMARY CARE, DIALYSIS, THERAPY, EMERGENT AND URGENT CARE, ORTHOPEDIC, LABOR AND DELIVERY, PSYCHIATRIC, EDUCATION, DIAGNOSTIC AND DENTAL. FSLH PROVIDES SERVICES TO EVERYONE REGARDLESS OF RACE, RELIGION OR ABILITY TO PAY.
4d Other program services (Describe in Schedule O.)
(Expenses $ 63,839,798 including grants of $   ) (Revenue $ 93,209,308 )
4e Total program service expensesMediumBullet238,091,412
Form 990 (2013)
Form 990 (2013)
Page 3
Part IV
Checklist of Required Schedules
Yes
No
1
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If "Yes," complete Schedule AClick to see attachment........................
1
Yes
 
2
Is the organization required to complete Schedule B, Schedule of Contributors (see instructions)? Click to see attachment...
2
Yes
 
3
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If "Yes," complete Schedule C, Part IClick to see attachment..........
3
 
No
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities, or have a section 501(h) election in effect during the tax year? If "Yes," complete Schedule C, Part IIClick to see attachment........
4
Yes
 
5
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19? If "Yes," complete Schedule C,
Part IIIClick to see attachment............................
5
 
No
6
Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If "Yes," complete Schedule D, Part IClick to see attachment........................
6
 
No
7
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas, or historic structures? If "Yes," complete Schedule D, Part IIClick to see attachment...
7
 
No
8
Did the organization maintain collections of works of art, historical treasures, or other similar assets? If "Yes," complete Schedule D, Part III Click to see attachment....................
8
 
No
9
Did the organization report an amount in Part X, line 21 for escrow or custodial account liability; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If "Yes," complete Schedule D, Part IVClick to see attachment..............
9
 
No
10
Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments, permanent endowments, or quasi-endowments? If "Yes," complete Schedule D, Part VClick to see attachment......
10
Yes
 
11
If the organization’s answer to any of the following questions is "Yes," then complete Schedule D, Parts VI, VII, VIII, IX, or X as applicable.
a
Did the organization report an amount for land, buildings, and equipment in Part X, line 10?
If "Yes," complete Schedule D, Part VI.Click to see attachment...................
11a
Yes
 
b
Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VIIClick to see attachment.......
11b
Yes
 
c
Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VIIIClick to see attachment.......
11c
 
No
d
Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part IXClick to see attachment............
11d
Yes
 
e
Did the organization report an amount for other liabilities in Part X, line 25? If "Yes," complete Schedule D, Part XClick to see attachment
11e
Yes
 
f
Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If "Yes," complete Schedule D, Part XClick to see attachment.........................
11f
Yes
 
12a
Did the organization obtain separate, independent audited financial statements for the tax year?
If "Yes," complete Schedule D, Parts XI and XII Click to see attachment.................
12a
Yes
 
b
Was the organization included in consolidated, independent audited financial statements for the tax year? If "Yes," and if the organization answered "No" to line 12a, then completing Schedule D, Parts XI and XII is optional Click to see attachment
12b
Yes
 
13
Is the organization a school described in section 170(b)(1)(A)(ii)? If "Yes," complete Schedule E....
13
 
No
14a
Did the organization maintain an office, employees, or agents outside of the United States?.....
14a
 
No
b
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, investment, and program service activities outside the United States, or aggregate foreign investments valued at $100,000 or more? If "Yes," complete Schedule F, Parts I and IV.........
14b
 
No
15
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or other assistance to or for any foreign organization? If “Yes,” complete Schedule F, Parts II and IV
15
 
No
16
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or other assistance to or for foreign individuals? If “Yes,” complete Schedule F, Parts III and IV...
16
 
No
17
Did the organization report a total of more than $15,000 of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11e? If "Yes," complete Schedule G, Part I (see instructions)....
17
 
No
18
Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If "Yes," complete Schedule G, Part II............
18
 
No
19
Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If "Yes," complete Schedule G, Part III...................
19
 
No
20a
Did the organization operate one or more hospital facilities? If "Yes," complete Schedule H.... Click to see attachment
20a
Yes
 
b
If "Yes" to line 20a, did the organization attach a copy of its audited financial statements to this return?
20b
Yes
 
Form 990 (2013)
Form 990 (2013)
Page 4
Part IV
Checklist of Required Schedules (continued)
21
Did the organization report more than $5,000 of grants or other assistance to any domestic organization or government on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II...
21
 
No
22
Did the organization report more than $5,000 of grants or other assistance to individuals in the United States on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III........
22
 
No
23
Did the organization answer "Yes" to Part VII, Section A, line 3, 4, or 5 about compensation of the organization’s current and former officers, directors, trustees, key employees, and highest compensated employees? If "Yes," complete Schedule J....................... Click to see attachment
23
Yes
 
24a
Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If “Yes,” answer lines 24b through 24d and complete Schedule K. If “No,” go to line 25a................ Click to see attachment
24a
Yes
 
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
No
c
Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds?......................
24c
 
No
d
Did the organization act as an "on behalf of" issuer for bonds outstanding at any time during the year?...
24d
 
No
25a
Section 501(c)(3) and 501(c)(4) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If "Yes," complete Schedule L, Part I........
25a
 
No
b
Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If "Yes," complete Schedule L, Part I...................
25b
 
No
26
Did the organization report any amount on Part X, line 5, 6, or 22 for receivables from or payables to any current or former officers, directors, trustees, key employees, highest compensated employees, or disqualified persons? If so, complete Schedule L, Part II....................
26
 
No
27
Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial contributor or employee thereof, a grant selection committee member, or to a 35% controlled entity or family member of any of these persons? If "Yes," complete Schedule L, Part III.........
27
 
No
28
Was the organization a party to a business transaction with one of the following parties (see Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):
a
A current or former officer, director, trustee, or key employee? If "Yes," complete Schedule L, Part IV ..........................
28a
 
No
b
A family member of a current or former officer, director, trustee, or key employee? If "Yes,"
complete Schedule L, Part IV.....................
28b
 
No
c
An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof) was an officer, director, trustee, or direct or indirect owner? If "Yes," complete Schedule L, Part IV...
28c
 
No
29
Did the organization receive more than $25,000 in non-cash contributions? If "Yes," complete Schedule M..Click to see attachment
29
Yes
 
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If "Yes," complete Schedule M............. Click to see attachment
30
 
No
31
Did the organization liquidate, terminate, or dissolve and cease operations? If "Yes," complete Schedule N,
Part I...........................
31
 
No
32
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If "Yes," complete Schedule N, Part II......................
32
 
No
33
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If "Yes," complete Schedule R, Part I........ Click to see attachment
33
Yes
 
34
Was the organization related to any tax-exempt or taxable entity? If "Yes," complete Schedule R, Part II, III, or IV, and Part V, line 1........................ Click to see attachment
34
Yes
 
35a
Did the organization have a controlled entity within the meaning of section 512(b)(13)?
35a
 
No
b
If ‘Yes’ to line 35a, did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If "Yes," complete Schedule R, Part V, line 2...
35b
 
 
36
Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If "Yes," complete Schedule R, Part V, line 2............. Click to see attachment
36
 
No
37
Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If "Yes," complete Schedule R, Part VIClick to see attachment
37
 
No
38
Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11b and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Form 990 (2013)
Form 990 (2013)
Page 5
Part V
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response or note to any line in this Part V ..............
Yes
No
1a
Enter the number reported in Box 3 of Form 1096 Enter -0- if not applicable ..
1a
701
b
Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable .
1b
0
c
Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................
1c
Yes
 
2a
Enter the number of employees reported on Form W-3, Transmittal of Wage and
Tax Statements, filed for the calendar year ending with or within the year covered by this return ..................
2a
2,750
b
If at least one is reported on line 2a, did the organization file all required federal employment tax returns?
Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file (see instructions)
2b
Yes
 
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?...
3a
Yes
 
b
If “Yes,” has it filed a Form 990-T for this year? If “No” to line 3b, provide an explanation in Schedule O...
3b
Yes
 
4a
At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account, securities account, or other financial account)?..........................
4a
Yes
 
b
If "Yes," enter the name of the foreign country: MediumBulletNL
See instructions for filing requirements for Form TD F 90-22.1, Report of Foreign Bank and Financial Accounts.
5a
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year?..
5a
 
No
b
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
5b
 
No
c
If "Yes," to line 5a or 5b, did the organization file Form 8886-T? ............
5c
 
 
6a
Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible as charitable contributions?...
6a
 
No
b
If "Yes," did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible?........................
6b
 
 
7
Organizations that may receive deductible contributions under section 170(c).
a
Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor?....................
7a
 
No
b
If "Yes," did the organization notify the donor of the value of the goods or services provided?.....
7b
 
 
c
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282?...........................
7c
 
No
d
If "Yes," indicate the number of Forms 8282 filed during the year ....
7d
 
e
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?............................
7e
 
No
f
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract?..
7f
 
No
g
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required?............................
7g
 
 
h
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C?..........................
7h
 
 
8
Sponsoring organizations maintaining donor advised funds and section 509(a)(3) supporting organizations. Did the supporting organization, or a donor advised fund maintained by a sponsoring organization, have excess business holdings at any time during the year?............
8
 
 
9
Sponsoring organizations maintaining donor advised funds.
a
Did the organization make any taxable distributions under section 4966?..........
9a
 
 
b
Did the organization make a distribution to a donor, donor advisor, or related person?.......
9b
 
 
10
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on Part VIII, line 12 ...
10a
 
b
Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
10b
 
11
Section 501(c)(12) organizations. Enter:
a
Gross income from members or shareholders .........
11a
 
b
Gross income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them.) ..........
11b
 
12a
Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?
12a
 
 
b
If "Yes," enter the amount of tax-exempt interest received or accrued during the year. ....................
12b
 
13
Section 501(c)(29) qualified nonprofit health insurance issuers.
a
Is the organization licensed to issue qualified health plans in more than one state?
Note. See the instructions for additional information the organization must report on Schedule O.
13a
 
 
b
Enter the amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans ....
13b
 
c
Enter the amount of reserves on hand ............
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
No
b
If "Yes," has it filed a Form 720 to report these payments? If "No," provide an explanation in Schedule O..
14b
 
 
Form 990 (2013)
Form 990 (2013)
Page 6
Part VI
Governance, Management, and Disclosure For each "Yes" response to lines 2 through 7b below, and for a "No" response to lines 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.
Check if Schedule O contains a response or note to any line in this Part VI ..............
Section A. Governing Body and Management
Yes
No
1a
Enter the number of voting members of the governing body at the end of the tax year .....................
1a
15
If there are material differences in voting rights among members of the governing body, or if the governing body delegated broad authority to an executive committee or similar committee, explain in Schedule O.
b
Enter the number of voting members included in line 1a, above, who are independent ...................
1b
10
2
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................
2
 
No
3
Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? .
3
 
No
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed? ...........................
4
 
No
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
 
No
6
Did the organization have members or stockholders? ................
6
Yes
 
7a
Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or more members of the governing body? ....................
7a
Yes
 
b
Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body? ...................
7b
 
No
8
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a
The governing body? .........................
8a
Yes
 
b
Each committee with authority to act on behalf of the governing body? ............
8b
Yes
 
9
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If "Yes," provide the names and addresses in Schedule O.......
9
 
No
Section B. Policies (This Section B requests information about policies not required by the Internal Revenue Code.)
Yes
No
10a
Did the organization have local chapters, branches, or affiliates? ............
10a
 
No
b
If "Yes," did the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes?
10b
 
 
11a
Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form? ............................
11a
Yes
 
b
Describe in Schedule O the process, if any, used by the organization to review this Form 990. .....
12a
Did the organization have a written conflict of interest policy? If "No," go to line 13.......
12a
Yes
 
b
Were officers, directors, or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ..........................
12b
Yes
 
c
Did the organization regularly and consistently monitor and enforce compliance with the policy? If "Yes," describe in Schedule O how this was done.......................
12c
Yes
 
13
Did the organization have a written whistleblower policy? ...............
13
Yes
 
14
Did the organization have a written document retention and destruction policy? .........
14
Yes
 
15
Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
a
The organization’s CEO, Executive Director, or top management official ...........
15a
Yes
 
b
Other officers or key employees of the organization ................
15b
Yes
 
If "Yes" to line 15a or 15b, describe the process in Schedule O (see instructions).
16a
Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? ......................
16a
Yes
 
b
If "Yes," did the organization follow a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and take steps to safeguard the organization’s exempt status with respect to such arrangements? ............
16b
Yes
 
Section C. Disclosure
17
List the States with which a copy of this Form 990 is required to be filedMediumBullet
NY
18
Section 6104 requires an organization to make its Form 1023 (or 1024 if applicable), 990, and 990-T (501(c)(3)s only) available for public inspection. Indicate how you made these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how) the organization made its governing documents, conflict of interest policy, and financial statements available to the public during the tax year.
20
State the name, physical address, and telephone number of the person who possesses the books and records of the organization:
MediumBulletLOUIS AIELLOPO BOX 479UTICANY13502 (315) 624-6143
Form 990 (2013)
Form 990 (2013)
Page 7
Part VII
Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
Check if Schedule O contains a response or note to any line in this Part VII ..............
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization’s tax year.
RoundBullet List all of the organization’s current officers, directors, trustees (whether individuals or organizations), regardless of amount
of compensation. Enter -0- in columns (D), (E), and (F) if no compensation was paid.

RoundBullet List all of the organization’s current key employees, if any. See instructions for definition of "key employee."
RoundBullet List the organization’s five current highest compensated employees (other than an officer, director, trustee or key employee)
who received reportable compensation (Box 5 of Form W-2 and/or Box 7 of Form 1099-MISC) of more than $100,000 from the
organization and any related organizations.

RoundBullet List all of the organization’s former officers, key employees, or highest compensated employees who received more than $100,000
of reportable compensation from the organization and any related organizations.

RoundBullet List all of the organization’s former directors or trustees that received, in the capacity as a former director or trustee of the
organization, more than $10,000 of reportable compensation from the organization and any related organizations.

List persons in the following order: individual trustees or directors; institutional trustees; officers; key employees; highest
compensated employees; and former such persons.
Check this box if neither the organization nor any related organization compensated any current officer, director, or trustee.
(A)
Name and Title 		(B)
Average hours per week (list any hours for related organizations below dotted line) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; OfficerInd; Key Employee; Highest compensated employee; FormerOfcrDirectorTrusteeInd;
(1) RICHARD TANTILLO........................................................................
CHAIR
 2.00
.......................1.00 		X   X       0 0 0
(2) GREGORY B MCLEAN........................................................................
VICE CHAIR
 2.00
.......................1.00 		X   X       0 0 0
(3) TODD HUTTON PHD........................................................................
SECRETARY
 2.00
.......................1.00 		X   X       0 0 0
(4) STEPHEN SWEET........................................................................
TREASURER
 2.00
.......................1.00 		X   X       0 0 0
(5) DOMENIC P AIELLO MD........................................................................
BOARD MEMBER
 1.00
.......................   		X           0 0 0
(6) ESTHER BANKERT PHD RN........................................................................
BOARD MEMBER
 1.00
.......................   		X           0 0 0
(7) MARIA GESUALDO DO........................................................................
BOARD MEMBER
 1.00
.......................   		X           0 0 0
(8) KAREN LEACH........................................................................
BOARD MEMBER
 1.00
.......................   		X           0 0 0
(9) JOAN COMPSON........................................................................
BOARD MEMBER
 1.00
.......................   		X           0 0 0
(10) BONNIE WOODS........................................................................
BOARD MEMBER
 1.00
.......................   		X           0 0 0
(11) WILLIAM PARKER MD........................................................................
BOARD MEMBER/PHYSICIAN
 41.00
.......................   		X           176,985 0 20,070
(12) JOHN SPERLING MD........................................................................
MEDICAL STAFF PRESIDENT/PHYSICIAN
 42.00
.......................   		X           398,219 0 12,750
(13) LEROY COOLEY MD........................................................................
BOARD MEMBER/PHYSICIAN
 41.00
.......................   		X           488,968 0 21,794
(14) ROGER MCREYNOLDS........................................................................
BOARD MEMBER/VICE PRESIDENT
 41.00
.......................   		X   X       225,426 0 26,274
(15) SCOTT H PERRA FACHE........................................................................
PRESIDENT/CEO
 40.00
.......................5.00 		X   X       689,230 0 39,303
(16) MICHAEL J HAILE FHFMA........................................................................
SENIOR VP/CFO
 40.00
.......................3.00 		    X       424,694 0 39,303
(17) DANIEL KOPP MD........................................................................
SENIOR VP/CHIEF MEDICAL OFFICER
 40.00
.......................   		    X       335,724 0 21,745
Form 990 (2013)
Form 990 (2013)
Page 8
Part VII
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)
(A)
Name and Title 		(B)
Average hours per week (list any hours for related organizations below dotted line) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; OfficerInd; Key Employee; Highest compensated employee; FormerOfcrDirectorTrusteeInd;
(18) WALEED ALBERT MD........................................................................
INTERIM CHIEF MEDICAL OFFICER
 40.00
.......................   		    X       39,317 0 3,050
(19) MICHAEL TREVISANI MD........................................................................
SENIOR VP/CHIEF MEDICAL OFFICER
 40.00
.......................   		    X       9,000 0 0
(20) PATRICIA ROACH MS RN CNAA........................................................................
SENIOR VP/CHIEF NURSING OFFICER
 40.00
.......................   		    X       304,088 0 44,117
(21) KEVIN MAHONEY........................................................................
VP/CHIEF INFORMATION OFFICER
 40.00
.......................   		    X       145,618 0 20,826
(22) ANTHONY SCIBELLI........................................................................
SENIOR VP/COO
 40.00
.......................   		    X       233,866 0 26,445
(23) DEBRA ALTDOERFFER........................................................................
VP COMMUNICATIONS AND MARKETING
 40.00
.......................   		    X       134,550 0 27,113
(24) REGINA RYBKA-LAGATTUTA........................................................................
VP HUMAN RESOURCES
 40.00
.......................   		    X       159,193 0 29,005
(25) MADANA MOHANA VALLEM MD........................................................................
PHYSICIAN
 40.00
.......................   		        X   499,981 0 25,014
(26) KENNETH ORTEGA MD........................................................................
PHYSICIAN
 40.00
.......................   		        X   499,172 0 21,794
(27) JORGE FERREIRO MD........................................................................
PHYSICIAN
 40.00
.......................   		        X   404,032 0 25,014
(28) MARK WILLIAMS MD........................................................................
PHYSICIAN
 40.00
.......................   		        X   355,503 0 19,726
(29) MARGARET ALBANESE MD........................................................................
PHYSICIAN
 40.00
.......................   		        X   349,416 0 22,073
(30) KEITH FENSTEMACHER........................................................................
FORMER PRESIDENT/CEO
 0.00
.......................   		          X 207,868 0 0
1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)............MediumBullet 6,080,850 0 445,416
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organizationMediumBullet133
Yes
No
3
Did the organization list any former officer, director or trustee, key employee, or highest compensated employee on line 1a? If "Yes," complete Schedule J for such individual ..............
3
Yes
 
4
For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If "Yes," complete Schedule J for such individual...........................
4
Yes
 
5
Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If "Yes," complete Schedule J for such person ........
5
 
No
Section B. Independent Contractors
1
Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization. Report compensation for the calendar year ending with or within the organization’s tax year.
(A)
Name and business address 		(B)
Description of services 		(C)
Compensation
XEROX CONSULTING CO INC45 GLOVER AVENUENORWALKCT06856 IT CONSULTING SERVICES 3,546,857
ECLIPSYS SOLUTION CORP3 RAVINIA DRIVEATLANTAGA30346 IT CONSULTING SERVICES 2,433,856
DHP MANAGEMENT SERVICES INC265 BROOKVIEW CENTRE WAYKNOXVILLETN37919 PHYSICIAN/MEDICAL SERVICES 1,784,986
NEW YORK RADIATION THERAPY MGT2234 COLONIAL BLVDFORT MEYERSFL33907 RADIATION THERAPY MNGMT SERVICES 1,630,800
YONKERS RADIATION MEDICAL PRACTICE PC2234 COLONIAL BLVDFORT MEYERSFL33907 RADIATION THERAPY MNGMT SERVICES 1,533,303
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet158
Form 990 (2013)
Form 990 (2013)
Page 9
Part VIII
Statement of Revenue
Check if Schedule O contains a response or note to any line in this Part VIII .............
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512-514
Contributions, Gifts, GrantAmt and OtherAmt Similar Amounts 1a Federated campaigns..1a  
b Membership dues....1b  
c Fundraising events....1c  
d Related organizations...1d 2,218,274
e Government grants (contributions)1e 624,339
f All other contributions, gifts, grants, and
similar amounts not included above1f 		382,812
g Noncash contributions included in lines
1a-1f:$ 		18,249
h Total. Add lines 1a-1f.......MediumBullet 3,225,425
Program Service RevenueAmt Business Code
2a ACUTE CARE 622200 112,676,184 112,676,184    
b OUTPATIENT SURGERY 622200 42,678,409 42,678,409    
c CANCER CARE PROGRAM 622200 19,702,347 19,702,347    
d RENAL DIALYSIS 622200 17,570,093 17,570,093    
e MATERNAL AND CHILDCARE 622200 10,224,211 10,224,211    
f All other program service revenue . 60,816,558 60,693,420 123,138  
g Total. Add lines 2a–2f........MediumBullet 263,667,802
OtherAmt RevenueAmt 3 Investment income (including dividends, interest, and other similar amounts).......MediumBullet 6,327,929     6,327,929
4 Income from investment of tax-exempt bond proceeds..MediumBullet        
5 Royalties...........MediumBullet        
(i) Real (ii) Personal
6a Gross rents 739,084  
b Less: rental expenses 0  
c Rental income or (loss) 739,084  
d Net rental income or (loss).......MediumBullet 739,084   739,084  
(i) Securities (ii) Other
7a Gross amount from sales of assets other than inventory    
b Less: cost or other basis and sales expenses 101,715  
c Gain or (loss) -101,715  
d Net gain or (loss)..........MediumBullet -101,715     -101,715
8a Gross income from fundraising events (not including
$  
of contributions reported on line 1c). See Part IV, line 18 ..
a  
b Less: direct expenses ...b  
c Net income or (loss) from fundraising events..MediumBullet      
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...MediumBullet        
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..MediumBullet        
Miscellaneous Revenue Business Code
11a MEDICARE/MEDICAID HEALTH IT 900099 1,662,451 1,662,451    
b NEW HARTFORD SCANNER PARTNERSHIP 900099 889,980 889,980    
c EMS EDUCATION 611600 428,315 428,315    
d All other revenue .... 1,753,383 1,740,838 12,545  
e Total. Add lines 11a–11d ...... MediumBullet 4,734,129
12 Total revenue. See Instructions......MediumBullet 278,592,654 268,266,248 874,767 6,226,214
Form 990 (2013)
Form 990 (2013)
Page 10
Part IX
Statement of Functional Expenses
Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A).Check if Schedule O contains a response or note to any line in this Part IX ...............
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    
2 Grants and other assistance to individuals in the United States. See Part IV, line 22    
3 Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16    
4 Benefits paid to or for members    
5 Compensation of current officers, directors, trustees, and key employees .... 6,526,266 3,867,432 2,658,834  
6 Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....        
7 Other salaries and wages 117,631,979 101,031,727 16,600,252  
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) .... 7,091,052 5,991,108 1,099,944  
9 Other employee benefits ....... 12,498,992 10,560,183 1,938,809  
10 Payroll taxes ........... 8,926,925 7,542,205 1,384,720  
11 Fees for services (non-employees):        
a Management ...... 785,708 597,816 187,892  
b Legal ......... 412,780   412,780  
c Accounting ........... 175,969   175,969  
d Lobbying ........... 69,994   69,994  
e Professional fundraising services. See Part IV, line 17    
f Investment management fees ......        
g Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) ........ 29,742,255 22,629,762 7,112,493  
12 Advertising and promotion .... 366,184 278,616 87,568  
13 Office expenses ....... 1,050,282 799,120 251,162  
14 Information technology ...... 5,520,972 4,200,700 1,320,272  
15 Royalties ..        
16 Occupancy ........... 6,802,840 5,176,025 1,626,815  
17 Travel ............        
18 Payments of travel or entertainment expenses for any federal, state, or local public officials ......        
19 Conferences, conventions, and meetings .... 555,909 422,970 132,939  
20 Interest ........... 2,410,519 1,834,073 576,446  
21 Payments to affiliates .......        
22 Depreciation, depletion, and amortization ..... 17,351,199 11,999,929 5,351,270  
23 Insurance .............. 3,969,367 3,020,142 949,225  
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 41,149,139 41,149,139    
b BAD DEBT 8,319,156 8,319,156    
c ALL OTHER 5,221,598 3,972,917 1,248,681  
d SERVICE CONTRACTS 3,268,068 2,486,550 781,518  
e All other expenses 2,907,019 2,211,842 695,177  
25 Total functional expenses. Add lines 1 through 24e 282,754,172 238,091,412 44,662,760 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 MediumBullet if following SOP 98-2 (ASC 958-720).        
Form 990 (2013)
Form 990 (2013)
Page 11
Part X Balance Sheet Check if Schedule O contains a response or note to any line in this Part X ..............
(A)
Beginning of year 		(B)
End of year
Assets 1 Cash–non-interest-bearing ............. 555,458 1 -1,761,475
2 Savings and temporary cash investments ......... 2,354,731 2 1,850,793
3 Pledges and grants receivable, net ...........   3  
4 Accounts receivable, net ............. 43,268,140 4 39,306,028
5 Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
Schedule L ..................
  5  
6 Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L
  6  
7 Notes and loans receivable, net .............   7  
8 Inventories for sale or use .............. 5,680,657 8 5,258,877
9 Prepaid expenses and deferred charges .......... 2,953,940 9 3,525,990
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 299,606,014
b Less: accumulated depreciation ..... 10b 203,203,669 93,838,605 10c 96,402,345
11 Investments—publicly traded securities ..........   11  
12 Investments—other securities. See Part IV, line 11 ..... 64,303,042 12 78,778,046
13 Investments—program-related. See Part IV, line 11 ..... 11,089,415 13 11,555,669
14 Intangible assets ............... 272,866 14 1,698,467
15 Other assets. See Part IV, line 11 ........... 52,395,865 15 31,949,239
16 Total assets. Add lines 1 through 15 (must equal line 34)...... 276,712,719 16 268,563,979
Liabilities 17 Accounts payable and accrued expenses ......... 35,640,839 17 32,805,396
18 Grants payable .................   18  
19 Deferred revenue ................   19  
20 Tax-exempt bond liabilities ............. 6,580,000 20 6,370,000
21 Escrow or custodial account liability. Complete Part IV of Schedule D..   21  
22 Loans and other payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
persons. Complete Part II of Schedule L..........   22  
23 Secured mortgages and notes payable to unrelated third parties .. 24,590,044 23 27,940,334
24 Unsecured notes and loans payable to unrelated third parties ....   24  
25 Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D.................... 71,041,874 25 60,639,306
26 Total liabilities. Add lines 17 through 25......... 137,852,757 26 127,755,036
Net Assets or Fund Balance Organizations that follow SFAS 117 (ASC 958), check here MediumBullet and complete lines 27 through 29, and lines 33 and 34.
27 Unrestricted net assets .............. 131,290,205 27 132,570,667
28 Temporarily restricted net assets ........... 3,041,593 28 3,710,112
29 Permanently restricted net assets ........... 4,528,164 29 4,528,164
Organizations that do not follow SFAS 117 (ASC 958), check here MediumBullet 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 ........... 138,859,962 33 140,808,943
34 Total liabilities and net assets/fund balances ........ 276,712,719 34 268,563,979
Form 990 (2013)
Form 990 (2013)
Page 12
Part XI
Reconcilliation of Net Assets
Check if Schedule O contains a response or note to any line in this Part XI ..............
1
Total revenue (must equal Part VIII, column (A), line 12) ............
1
278,592,654
2
Total expenses (must equal Part IX, column (A), line 25) ............
2
282,754,172
3
Revenue less expenses. Subtract line 2 from line 1 ..............
3
-4,161,518
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) ..
4
138,859,962
5
Net unrealized gains (losses) on investments ...............
5
3,353,445
6
Donated services and use of facilities .................
6
 
7
Investment expenses .....................
7
 
8
Prior period adjustments .....................
8
 
9
Other changes in net assets or fund balances (explain in Schedule O) ........
9
2,757,054
10
Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line 33, column (B))
10
140,808,943
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response or note to any line in this Part XII .............
Yes
No
1
Accounting method used to prepare the Form 990:  
If the organization changed its method of accounting from a prior year or checked "Other," explain in
Schedule O.
2a
Were the organization’s financial statements compiled or reviewed by an independent accountant?
2a
 
No
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were compiled or reviewed on a separate basis, consolidated basis, or both:
b
Were the organization’s financial statements audited by an independent accountant?
2b
Yes
 
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were audited on a separate basis, consolidated basis, or both:
c
If "Yes," to line 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant?
2c
Yes
 
If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O.
3a
As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A-133?
3a
 
No
b
If "Yes," did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits.
3b
 
 
Form 990 (2013)
Form 990, Special Condition Description:
Special Condition Description
Additional Data


Software ID:  
Software Version:  
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.
right arrow Attach to Form 990 or Form 990-EZ. right arrow See separate instructions.
right arrow 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
FAXTON ST LUKE'S HEALTHCARE
 
Employer identification number

16-1576637
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
f
g
(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) right arrow (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) right arrow (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
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.................................................right arrow
Section C. Computation of Public Support Percentage
14
14
 
15
15
 
16a
b
17a
b
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 ..................................................... right arrow
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) right arrow (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) right arrow (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
Section C. Computation of Public Support Percentage
15
15
 
16
16
 
Section D. Computation of Investment Income Percentage
17
17
 
18
18
 
19a
b
20
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:  
Schedule B
(Form 990, 990-EZ,
or 990-PF)
Department of the Treasury
Internal Revenue Service
Schedule of Contributors
Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
Arrow Bullet Information about Schedule B (Form 990, 990-EZ, or 990-PF) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
Name of the organization
FAXTON ST LUKE'S HEALTHCARE
 
Employer identification number

16-1576637
Organization type (check one):
Filers of:
Section:
Form 990 or 990-EZ





Form 990-PF




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
Special Rules
......................... 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 its Form 990PF, Part I, line 2, 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) (2013)

Schedule B (Form 990, 990-EZ, or 990-PF) (2013)
Page 2
Name of organization
FAXTON ST LUKE'S HEALTHCARE
  		Employer identification number

16-1576637
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, RESTRICTEDRESTRICTED

$RESTRICTED


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

   
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

   
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

   
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

   
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

   
 
 

$  


(Complete Part II for noncash contributions.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2013)

Schedule B (Form 990, 990-EZ, or 990-PF) (2013)
Page 3
Name of organization
FAXTON ST LUKE'S HEALTHCARE
  		Employer identification number

16-1576637
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) (2013)

Schedule B (Form 990, 990-EZ, or 990-PF) (2013)
Page 4
Name of organization
FAXTON ST LUKE'S HEALTHCARE
  		Employer identification number

16-1576637
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 (c) Use 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 (c) Use 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 (c) Use 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 (c) Use 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) (2013)

Additional Data


Software ID:  
Software Version:  
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.SchCMd Bullet Information about Schedule C (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
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
FAXTON ST LUKE'S HEALTHCARE
 
Employer identification number

16-1576637
Part I-A
Complete if the organization is exempt under section 501(c) or is a section 527 organization.

1
Provide a description of the organization’s direct and indirect political campaign activities in Part IV.
2
Political expenditures ....................................SchCMd Bullet
$  
3
Volunteer hours ........................................
 

Part I-B
Complete if the organization is exempt under section 501(c)(3).
1
Enter the amount of any excise tax incurred by the organization under section 4955 .........SchCMd Bullet
$  
2
Enter the amount of any excise tax incurred by organization managers under section 4955 ......SchCMd Bullet
$  
3
If the organization incurred a section 4955 tax, did it file Form 4720 for this year? ..............
4a
Was a correction made? .........................................
b
If "Yes," describe in Part IV.
Part I-C
Complete if the organization is exempt under section 501(c), except section 501(c)(3).
1
Enter the amount directly expended by the filing organization for section 527 exempt function activities SchCMd Bullet
$  
2
Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ...................................SchCMd Bullet

$  
3
Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b..SchCMd Bullet

$  
4
Did the filing organization file Form 1120-POL for this year? ..........................
5
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) 2013

Schedule C (Form 990 or 990-EZ) 2013
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 Bulletexpenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet
Limits on Lobbying Expenditures
(The term "expenditures" means amounts paid or incurred.) 		(a) Filing
organization's
totals 		(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? ......................................

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) 2010 (b) 2011 (c) 2012 (d) 2013 (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) 2013


Schedule C (Form 990 or 990-EZ) 2013
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)
No
Yes
(b)
Amount
1
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:
a
Volunteers? .........................................
 
No
b
Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ....
 
No
c
Media advertisements? ....................................
 
No
 
d
Mailings to members, legislators, or the public? .........................
 
No
 
e
Publications, or published or broadcast statements? .......................
 
No
 
f
Grants to other organizations for lobbying purposes? .......................
 
No
 
g
Direct contact with legislators, their staffs, government officials, or a legislative body? ........
 
No
 
h
Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ......
 
No
 
i
Other activities? ..........................
Yes
 
69,994
j
Total. Add lines 1c through 1i ...............................
69,994
2a
Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....
 
No
b
If "Yes," enter the amount of any tax incurred under section 4912 .................
 
c
If "Yes," enter the amount of any tax incurred by organization managers under section 4912 .....
 
d
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
No
1
Were substantially all (90% or more) dues received nondeductible by members? ................
1
 
 
2
Did the organization make only in-house lobbying expenditures of $2,000 or less? ................
2
 
 
3
Did the organization agree to carry over lobbying and political expenditures from the prior year? ..........
3
 
 
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."
1
Dues, assessments and similar amounts from members .....................
1
 
2
Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political
expenses for which the section 527(f) tax was paid).
a
Current year .........................................
2a
 
b
Carryover from last year ....................................
2b
 
c
Total ............................................
2c
 
3
Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .
3
 
4
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? ................................
4
 
5
Taxable amount of lobbying and political expenditures (see instructions) ..............
5
 
Part IV
Supplemental Information
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.
Return Reference Explanation
PART II-B, LINE 1: PARTICIPATION IS BASED ON THE MEMBERSHIP DUES PAID TO HANYS, AMERICAN HOSPITAL ASSOCIATION AND IROQUOIS HEALTHCARE ASSOCIATION AS INDICATED ON LINE 2. THE FOLLOWING NARRATIVES, DESCRIBING THESE ACTIVITIES, WERE TAKEN DIRECTLY FROM THEIR RESPECTIVE WEBSITES: 1. HANYS IS PROUD TO BE THE ONLY ASSOCIATION THAT REPRESENTS AND ADVOCATES ON BEHALF OF ALL NEW YORK'S HOSPITALS AND HEALTH SYSTEMS AT ALL LEVELS OF THE FEDERAL AND STATE GOVERNMENT. HANYS HAS ACCESS TO POLICY LEADERS, REGARDLESS OF THEIR POLITICAL AFFILIATION AND IS AN INTEGRAL PLAYER IN HEALTH POLICY DISCUSSIONS. HANYS ALSO COMMUNICATES MEMBERS CONCERNS AND POSITIONS TO NEW YORK AND NATIONAL MEDIA IN SUPPORT OF THE ASSOCIATIONS LEGISLATIVE AND REGULATORY INTITIATIVES. 2. THE AMERICAN HOSPITAL ASSOCIATION (AHA) IS THE NATIONAL ORGANIZATION THAT REPRESENTS AND SERVES ALL TYPES OF HOSPITALS, HEALTH CARE NETWORKS AND THEIR PATIENTS AND COMMUNITIES. NEARLY 5,000 HOSPITALS, HEALTH CARE SYSTEMS, NETWORKS AND OTHER PROVIDERS OF CARE AND 43,000 INDIVIDUAL MEMBERS COME TOGETHER TO FORM THE AHA. THROUGH OUR REPRESENTATION AND ADVOCACY ACTIVITIES, AHA ENSURES THAT MEMBERS PERSPECTIVES AND NEEDS ARE HEARD AND ADDRESSED IN NATIONAL HEALTH POLICY DEVELOPMENT, LEGISLATIVE AND REGULATORY DEBATES AND JUDICIAL MATTERS. OUR ADVOCACY EFFORTS INCLUDE THE LEGISLATIVE AND EXECUTIVE BRANCHES AND INCLUDE THE LEGISLATIVE AND REGULATORY ARENAS. FOUNDED IN 1898, THE AHA PROVIDES EDUCATION FOR HEALTH CARE LEADERS AND IS A SOURCE OF INFORMATION ON HEALTH CARE ISSUES AND TRENDS. 3.IROQUOIS IS THE REGIONAL VOICE IN ALBANY AND WASHINGTON FOR UPSATE HOSPITALS AND HEALTH CARE SYSTEM MEMBERS. IROQUOIS PROMOTES A BROADER UNDERSTANDING OF, AND BUILDS SUPPORT FOR, THE HEALTH CARE SYSTEMS SERVING UPSTATE NEW YORK. IROQUOIS PROVIDES REPRESENTATION AND ADVOCACY AT THE STATE LEVEL BY EFFECTIVELY LOBBYING THE STATE LEGISLATURE, AND ESTABLISHING CLOSE WORKING RELATIONSHIPS WITH THE GOVERNORS OFFICE, STATE AGENCY OFFICIALS, AND REGULATORY REPRESENTATIVES. IROQUOIS INFLUENCES PUBLIC POLICY DEVELOPMENT THROUGH BOTH LEGISLATIVE AND REGULATORY ADVOCACY EFFORTS. REGIONAL ACTIVITIES, SUCH AS HOSTING LEGISLATORS AND MEETING WITH LOCAL OFFICIALS, ARE CRITICAL TO MAINTAINING A UNIFIED VOICE FOR LEGISLATIVE AND REGULATORY ACTION. IROQUOIS CONTINUES TO WORK WITH THE CUOMO ADMINISTRATION TO ADDRESS ISSUES AFFECTING UPSTATE HOSPITALS, REVIEW THE EXECUTIVE BUDGET PROPOSAL AND ALSO WORK WITH THE STATE LEGISLATURE. ALL OF OUR ADVOCACY EFFORTS FOCUS ON THE SIMPLE TRUTH THAT HOSPTIALS EXIST TO SERVE. THEIR ABILITY TO SERVE WELL REQUIRES A RELATIONSHIP WITH THEIR COMMUNITIES BUILT ON TRUST AND COMPASSION. TO SERVE COMMUNITIES WELL, HOSPTIALS MUST ALSO MANAGE RESOURCES IN CHALLENGING ENVIRONMENT. THE HOSPITAL INDUSTRY FACES MANY CHALLENGES.
Schedule C (Form 990 or 990EZ) 2013

Additional Data


Software ID:  
Software Version:  

SCHEDULE D
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Financial Statements
SchDMd Bullet 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. SchDMd Bullet Information about Schedule D (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
FAXTON ST LUKE'S HEALTHCARE
 
Employer identification number

16-1576637
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 ........    
5
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? ............
6
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? ...................................
Part II
Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.
1
Purpose(s) of conservation easements held by the organization (check all that apply).
2
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.
Held at the End of the 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  
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the tax year SchDMd Bullet  
4
Number of states where property subject to conservation easement is located SchDMd Bullet  
5
Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................
6
Staff and volunteer hours devoted to monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet  
7
Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet $  
8
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)? .......................................
9
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.
1a
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.
b
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 $  
2
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:
a
Revenues included in Form 990, Part VIII, line 1 ..........................SchDMd Bullet $  
b
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) 2013

Schedule D (Form 990) 2013
Page 2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3
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):
a
d
b
e
 
c
4
Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.
5
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?........
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.
1a
Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................
b
If "Yes," explain the arrangement in Part XIII and complete the following table:
Amount
c Beginning balance ................................. 1c  
d Additions during the year .............................. 1d  
e Distributions during the year ............................. 1e  
f Ending balance ................................... 1f  
2a
Did the organization include an amount on Form 990, Part X, line 21? .....................
b
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 .... 7,569,758 8,060,784 9,098,945 7,020,434 6,333,673
b Contributions ........          
c Net investment earnings, gains, and losses 790,043 39,708 -1,071,182 2,522,730 1,370,443
d Grants or scholarships .....          
e Other expenditures for facilities
and programs ........ 		4,185,466 530,734 -33,021 444,219 683,682
f Administrative expenses ....          
g End of year balance ...... 4,174,335 7,569,758 8,060,784 9,098,945 7,020,434
2
Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:
a
Board designated or quasi-endowment SchDMd Bullet0 %
b
Permanent endowment SchDMd Bullet60.000 %
c
Temporarily restricted endowment SchDMd Bullet40.000 %
The percentages in lines 2a, 2b, and 2c should equal 100%.
3a
Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes
No
(i) unrelated organizations ........................
3a(i)
 
No
(ii) related organizations ........................
3a(ii)
Yes
 
b
If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........
3b
Yes
 
4
Describe in Part XIII the intended uses of the organization's endowment funds.
Part VI
Land, Buildings, and Equipment. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11a. See Form 990, Part X, line 10.
Description of property (a) Cost or other basis (investment) (b)Cost or other basis (other) (c) Accumulated depreciation (d) Book value
1a Land .................   2,159,447 2,159,447
b Buildings ................   112,451,276 75,270,832 37,180,444
c Leasehold improvements ............   4,684,409 1,218,478 3,465,931
d Equipment ................   172,773,301 123,331,943 49,441,358
e Other .................   7,537,581 3,382,416 4,155,165
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......SchDMdBullet 96,402,345
Schedule D (Form 990) 2013

Schedule D (Form 990) 2013
Page 3
Part VII
Investments—Other Securities. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11b. 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    
(3)Other
(A) MUTUAL FUNDS INVESTMENT 		38,646,440 F

(B) COMMON STOCK INVESTMENT 		5,085,322 F

(C) CORPORATE OBLIGATIONS 		34,985,552 F

(D) CASH AND CASH EQUIVALENTS 		60,732 F





Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)Small Bullet 78,778,046
Part VIII
Investments—Program Related. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11c. See Form 990, Part X, line 13.
(a) Description of investment (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.)Small Bullet  
Part IX
Other Assets. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11d. See Form 990, Part X, line 15.
(a) Description (b) Book value
(1) OTHER ASSETS 4,588,858
(2) DUE FROM AFFILIATES 1,005,866
(3) UNAMORTIZED DEBT ISSUANCE COSTS 447,139
(4) WC INSURANCE RECEIVABLE LT, NET 6,204,887
(5) G&P INSURANCE RECEIVABLE LT, NET 12,818,689
(6) ESTIMATED THIRD PARTY PAYOR SETTLEMENTS, NET 6,883,800



Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........Small Bullet 31,949,239
Part X
Other Liabilities. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.
1.(a) Description of liability (b) Book value
Federal income taxes  
2006 SERIES TAXABLE BONDS 10,475,000
CAPITAL LEASE OBLIGATIONS 15,716,609
UNREALIZED LOSS ON INTEREST RATE SWAPS 3,851,739
WC INSTURANCE RECEIVABLE ST/LT 3,627,030
G&P INSURANCE RECEIVABLE ST/LT 19,701,546
ESTIMATED SELF INSURED LIABILITIES 7,267,382



Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)Small Bullet 60,639,306
2. Liability for uncertain tax positions 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) 2013

Schedule D (Form 990) 2013
Page 4
Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return Complete if the organization answered 'Yes' to Form 990, Part IV, line 12a.
1 Total revenue, gains, and other support per audited financial statements ....... 1 277,642,568
2 Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a Net unrealized gains on investments .......... 2a  
b Donated services and use of facilities ......... 2b  
c Recoveries of prior year grants ........... 2c  
d Other (Describe in Part XIII.) ............ 2d -950,086
e Add lines 2a through 2d ..................... 2e -950,086
3 Subtract line 2e from line 1..................... 3 278,592,654
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 0
5 Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ...... 5 278,592,654
Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' to Form 990, Part IV, line 12a.
1 Total expenses and losses per audited financial statements ........... 1 281,804,086
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 -950,086
e Add lines 2a through 2d...................... 2e -950,086
3 Subtract line 2e from line 1..................... 3 282,754,172
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 0
5 Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ...... 5 282,754,172
Part XIII
Supplemental Information
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.
Return Reference Explanation
PART V, LINE 4: PERMANENT ENDOWMENT FUNDS ARE TO BE HELD IN PERPETUITY, THE INCOME FROM WHICH IS TO BE USED TO SUPPORT CHARITY CARE, HEALTH CARE SERVICES, SCHOLARSHIPS AND FACILITY MAINTENANCE. TEMPORARY ENDOWMENT FUNDS ARE DONOR CONTRIBUTIONS RESTRICTED BY THE DONORS FOR SPECIFIC PURPOSES.
PART X, LINE 2: PART X, LINE 2: FSLH IS A NOT-FOR-PROFIT CORPORATION AND HAS BEEN RECOGNIZED AS TAX-EXEMPT PURSUANT TO SECTION 501C(3) OF THE INTERNAL REVENUE CODE. THE STANDARDS FOR ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES IS TO ESTABLISH A RECOGNITION THRESHOLD AND MEASUREMENT FOR INCOME TAX POSITIONS RECOGNIZED IN A HOSPITALS FINANCE STATEMENTS. THESE STANDARDS HAD NO IMPACT ON THE ACCOMPANYING CONSOLIDATATED FINANCIAL STATEMENTS. THE TAX YEARS OPEN TO EXAMINATION BY FEDERAL AND STATE TAXING AUTHORITIES ARE 2010-2013.
PART XI, LINE 2D - OTHER ADJUSTMENTS: LEGAL EXPENSE CREDIT FOR HAMELIN LAWSUIT -950,086.
PART XII, LINE 2D - OTHER ADJUSTMENTS: LEGAL EXPENSE CREDIT FOR HAMELIN LAWSUIT -950,086.
Schedule D (Form 990) 2013

Additional Data


Software ID:  
Software Version:  




SCHEDULE H (Form 990)
Department of the Treasury
Internal Revenue Service
Hospitals
MediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, question 20.
MediumBullet Attach to Form 990. MediumBullet See separate instructions.
MediumBullet Information about Schedule H (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
FAXTON ST LUKE'S HEALTHCARE
 
Employer identification number

16-1576637
Part I
Financial Assistance and Certain Other Community Benefits at Cost
Yes
No
1a
Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a ...
1a
Yes
 
b
If "Yes," was it a written policy? .......................
1b
Yes
 
2
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.
3
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.
a
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:
3a
Yes
 
b
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: .........
3b
Yes
 
%
c
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.
4
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"? ..............

4

Yes

 
5a
Did the organization budget amounts for free or discounted care provided under its financial assistance policy during the tax year? ............................

5a

Yes

 
b
If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? ......
5b
 
No
c
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? ..............
5c
 
 
6a
Did the organization prepare a community benefit report during the tax year? ..........
6a
Yes
 
b
If "Yes," did the organization make it available to the public? ..............
6b
Yes
 
Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.
7
Financial Assistance and Certain Other Community Benefits at Cost
Financial Assistance and
Means-Tested
Government Programs
 (a) Number of activities or programs (optional) (b) Persons served (optional) (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) .. 		    1,634,794 417,766 1,217,028 0.450 %
b Medicaid (from Worksheet 3,
column a) .... 		    50,043,609 32,402,538 17,641,071 6.450 %
c Costs of other means-tested
government programs (from
Worksheet 3, column b) . 		           
d Total Financial Assistance
and Means-Tested
Government Programs . 		    51,678,403 32,820,304 18,858,099 6.900 %
Other Benefits
     1,155,042 0 1,155,042 0.420 %
e Community health
improvement services and
community benefit operations
(from Worksheet 4) ..
f Health professions education
(from Worksheet 5) .. 		    1,196,495 865,683 330,812 0.120 %
g Subsidized health services
(from Worksheet 6) .. 		    14,675,606 11,258,280 3,417,326 1.260 %
h Research (from Worksheet 7)     152,552 19,745 132,807 0.050 %
i Cash and in-kind
contributions for community
benefit (from Worksheet 8) 		    41,477   41,477 0.010 %
j Total. Other Benefits ..     17,221,172 12,143,708 5,077,464 1.860 %
k Total. Add lines 7d and 7j .     68,899,575 44,964,012 23,935,563 8.760 %
For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2013
Schedule H (Form 990) 2013
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.
(a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community building expense (d) Direct offsetting
revenue 		(e) Net community building expense (f) Percent of total expense
1 Physical improvements and housing            
2 Economic development            
3 Community support 27 519 2,094 160 1,934 0 %
4 Environmental improvements            
5 Leadership development and training for community members 35 973 8,064 1,795 6,269 0 %
6 Coalition building 15 73 408 0 408 0 %
7 Community health improvement advocacy 293 2,065 367,865 334,333 33,532 0.010 %
8 Workforce development 83 52 11,122 3,780 7,342 0 %
9 Other            
10 Total 453 3,682 389,553 340,068 49,485 0.010 %
Part III
Bad Debt, Medicare, & Collection Practices
Section A. Bad Debt Expense
Yes
No
1
Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................
1
Yes
 
2
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
3,222,774
3
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. ......
3
1,185,075
4
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
5
Enter total revenue received from Medicare (including DSH and IME).....
5
112,611,427
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
131,737,899
7
Subtract line 6 from line 5. This is the surplus (or shortfall)........
7
-19,126,472
8
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:
Section C. Collection Practices
9a
Did the organization have a written debt collection policy during the tax year? ..........
9a
Yes
 
b
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.......................

9b

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 %
11 NEW HARTFORD SCANNER
  		MEDICAL IMAGING SERVICES 60.000 % 0 % 40.000 %
22 MOHAWK VALLEY HEART INSTITUTE (MVHI)
  		CARDIAC SURGICAL SERVICES 30.000 % 0 % 0 %
33 MOHAWK VALLEY ENDOSCOPY CENTER
  		ENDOSCOPY SERVICES 20.000 % 0 % 60.000 %
4
5
6
7
8
9
10
11
12
13
Schedule H (Form 990) 2013
Schedule H (Form 990) 2013
Page
Part VFacility Information
Section A. Hospital Facilities
(list in order of size from largest to smallest—see instructions)
How many hospital facilities did the organization operate during the tax year?1
Name, address, primary website address, and state license number 		Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital ResearchGrp Facility ER-24Hours ER-Other Other (Describe) Facility reporting group
1 FAXTON ST LUKES HEALTHCARE INC
PO BOX 479
UTICA,NY13503
FAXTONSTLUKES.COM
17-30-91 		X X   X     X   DENTAL CLINIC;DIAGNOSTICS;MEDICAL IMAGING;DIALYSIS; L&D; URGENT CARE  
Schedule H (Form 990) 2013
Schedule H (Form 990) 2013
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)
FAXTON ST LUKES HEALTHCARE INC
Name of hospital facility or facility reporting group  
If reporting on Part V, Section B for a single hospital facility only: line number of
hospital facility (from Schedule H, Part V, Section A) 		1
Yes No
Community Health Needs Assessment (Lines 1 through 8c are optional for tax years begining on or before March 23, 2012)
1 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.................... 1 Yes  
If "Yes," indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
2 Indicate the tax year the hospital facility last conducted a CHNA: 20 13
3 In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests 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 .................... 3 Yes  
4 Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Part VI................................ 4 Yes  
5 Did the hospital facility make its CHNA report widely available to the public? ............. 5 Yes  
If "Yes," indicate how the CHNA report was made widely available (check all that apply):
a
b
c
d
6 If the hospital facility addressed needs identified in its most recently conducted CHNA, indicate how (check all that apply as of the end of the tax year):
a
b
c
d
e
f
g
h
i
7 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 ........ 7   No
8a 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)? ........................... 8a   No
b If "Yes" to line 8a, did the organization file Form 4720 to report the section 4959 excise tax? ...... 8b    
c 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) 2013
Schedule H (Form 990) 2013
Page
Part VFacility Information (continued)

Financial Assistance Policy Yes No
9 Did the hospital facility have in place during the tax year a written financial assistance policy that:
Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 9 Yes  
10 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 10 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 300.000000000000%
If "No," explain in Part VI the criteria the hospital facility used.
11 Used FPG to determine eligibility for providing discounted care?................. 11 Yes  
If "Yes," indicate the FPG family income limit for eligibility for discounted care: 300.000000000000%
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
b
c
d
e
f
g
h
i
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
b
c
d
e
f
g
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 individual’s eligibility under the facility’s FAP:
a
b
c
d
e
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 individual’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
b
c
d
e
Schedule H (Form 990) 2013
Schedule H (Form 990) 2013
Page
Part VFacility Information (continued)

18 Indicate which efforts the hospital facility made before initiating any of the actions listed in line 17 (check all that apply):
a
b
c
d
e
Policy Relating to Emergency Medical Care
Yes No
19 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?.......... 19 Yes  
If "No," indicate why:
a
b
c
d
Charges to Individuals Eligible for Assistance under the FAP (FAP-Eligible Individuals)
20 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.
a
b
c
d
21 During the tax year, did the hospital facility charge any FAP-eligible individual 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? ............................ 21   No
If "Yes," explain in Part VI.
22 During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ......................... 22 Yes  
If "Yes," explain in Part VI.
Schedule H (Form 990) 2013
Schedule H (Form 990) 2013
Page
Part V
Facility Information (continued)
Section C. Supplemental Information for Part V, Section B.Provide descriptions required for Part V, Section B, lines 1j, 3, 4, 5d, 6i, 7, 10, 11, 12i, 14g, 16e, 17e, 18e, 19c, 19d, 20d, 21, and 22. If applicable, provide separate descriptions for each facility in a facility reporting group, designated by "Facility A," "Facility B," etc.
Form and Line Reference Explanation
FAXTON ST LUKES HEALTHCARE, INC. PART V, SECTION B, LINE 3: ON MONDAY, MAY 20, 2013 MEMBERS OF THE FSLH HEALTH CARE TEAM, ALONG WITH AREA HOSPITALS, HEALTHCARE ORGANIZATIONS AND AGENCIES PARTICIPATED IN A HEALTH ASSESSMENT INITIATIVE. THE PROGRAM, LED BY THE ONEIDA COUNTY HEALTH DEPARTMENT, USED THE MOBILIZING FOR ACTION THROUGH PLANNING AND PARTNERSHIPS FRAMEWORK (MAPP) TO CONDUCT THE CHNA ACTIVITIES. THE ASSESSMENT RESULTS WERE COMBINED WITH POPULATION TO IDENTIFY THE TOP TWO PRIORITY* AGENDA INITIATIVES FOR 2014 THROUGH 2017. THE TOP TWO PRIORITIES* FOR ONEIDA COUNTY AND PARTICIPATING HEALTH CARE ORGANIZATIONS ARE SMOKING CESSATION AND INCREASED BREAST FEEDING. THE NEW YORK STATE PREVENTION AGENDA (THE PREVENTION AGENDA) SERVES AS A GUIDE TO HEALTH DEPARTMENTS AND HOSPITALS AS THEY DEVELOP THE CHNA REQUIRED BY THE PATIENT PROTECTION AND AFFORDABLE CARE ACT (PPACA). THE COMMUNITY SERVICE PLANS, REQUIRED ANNUALLY BY NEW YORK STATE DEPARTMENT OF HEALTH (DOH), ALSO REFLECT THE COLLABORATIVE WORK OF THE COUNTY AND HOSPITALS AS PART OF THEIR COMMUNITY HEALTH IMPROVEMENT PLAN (CHIP). FSLH PARTICIPATED IN THE NEEDS ASSESSMENT FOR HERKIMER COUNTY WHICH WAS HELD ON THURSDAY, MARCH 28, 2013. NEARLY 15 PERCENT OF THE PATIENTS SERVED BY FSLH LIVE IN HERKIMER COUNTY. THE HERKIMER COUNTY CNA THAT WAS DEVELOPED IS A COLLABORATIVE EFFORT OF HERKIMER COUNTY PUBLIC HEALTH, HERKIMER COUNTY7 HEALTHNET, MEMBERS OF THE CNY MPH, AREA HOSPITALS AND AGENCIES.
FAXTON ST LUKES HEALTHCARE, INC. PART V, SECTION B, LINE 4: OTHER REPRESENTATIVES INCLUDED FSLH, SEMC, ROME MEMORIAL HOSPITAL, ONEIDA COUNTY HEALTH DEPARTMENT AND A NUMBER OF COMMUNITY AGENCIES.
FAXTON ST LUKES HEALTHCARE, INC. PART V, SECTION B, LINE 7: THE PREVENTION AGENDA IDENTIFIES FIVE PRIORITY AREAS, FOCUS AREAS WITHIN EACH PRIORITY AREA, AND ESTABLISHES GOALS FOR EACH PRIORITY AREA. INDICATORS ARE USED TO MEASURE PROGRESS TOWARD ACHIEVING THE GOALS, INCLUDING REDUCTIONS IN HEALTH DISPARITIES AMONG RACIAL, ETHNIC, AND SOCIOECONOMIC GROUPS AND PERSONS WITH DISABILITIES. THE FIVE PRIORITY AREAS ARE:1. PREVENT CHRONIC DISEASES*- REDUCE OBESITY IN CHILDREN AND ADULTS- REDUCE ILLNESS, DISABILITY AND DEATH RELATED TO TOBACCO USE AND SECONDHAND SMOKE EXPOSURE *- INCREASE ACCESS TO HIGH-QUALITY CHRONIC DISEASE PREVENTIVE CARE AND MANAGEMENT IN CLINICAL AND COMMUNITY SETTINGS.2. PROMOTE A HEALTHY AND SAFE ENVIRONMENT- OUTDOOR AIR QUALITY- WATER QUALITY- BUILT ENVIRONMENT- INJURIES, VIOLENCE AND OCCUPATIONAL HEALTH3. PROMOTE HEALTHY WOMEN, INFANTS AND CHILDREN* - MATERNAL AND INFANT HEALTH*- CHILD HEALTH- REPRODUCTIVE, PRECONCEPTION AND INTER-CONCEPTION HEALTH.4. PROMOTE MENTAL HEALTH AND PREVENT SUBSTANCE ABUSE- PROMOTE MENTAL, EMOTIONAL AND BEHAVIORAL WELL-BEING IN COMMUNITIES- PREVENT SUBSTANCE ABUSE AND OTHER MENTAL EMOTIONAL BEHAVIORAL DISORDERS- STRENGTHEN INFRASTRUCTURE ACROSS SYSTEMS.5. PREVENT HIV, SEXUALLY TRANSMITTED DISEASES, VACCINE-PREVENTABLE DISEASES AND HEALTHCARE-ASSOCIATED INFECTIONS- PREVENT HIV AND STDS- PREVENT VACCINE-PREVENTABLE DISEASES- PREVENT HEALTH CARE-ASSOCIATED INFECTIONS.*INDICATES THE TWO PRIORITY/FOCUS AREAS SELECTED BY ONEIDA COUNTY HEALTH DEPARTMENT, FSLH AND PARTICIPATING HOSPITALS AND HEALTH AGENCIES.
FAXTON ST LUKES HEALTHCARE, INC. PART V, SECTION B, LINE 20D: FOR PATIENTS WITH NO INSURANCE, FSLH SCREENS FOR FINANCIAL ASSISTANCE ELIGIBILITY AND HELPS WITH ANY OF THE APPLICATIONS. IF PATIENT DOES NOT QUALIFY OR COOPERATE WITH THE PROCESS, THE ORGANIZATION BILLS BASED ON GROSS CHARGES AND 20% PROMPT PAY DISCOUNT.
FAXTON ST LUKES HEALTHCARE, INC. PART V, SECTION B, LINE 22: FOR PATIENTS WITH NO INSURANCE, FSLH SCREENS FOR FINANCIAL ASSISTANCE ELIGIBILITY AND HELPS WITH ANY OF THE APPLICATIONS. IF PATIENT DOES NOT QUALIFY OR COOPERATE WITH THE PROCESS, THE ORGANIZATION BILLS BASED ON GROSS CHARGES AND 20% PROMPT PAY DISCOUNT.
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
Schedule H (Form 990) 2013
Schedule H (Form 990) 2013
Page
Part VFacility Information (continued)

Section D. 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?19
Name and address Type of Facility (describe)
1 ACP ORTHOPEDIC GROUP
1903 SUNSET AVE
UTICA,NY13502 		PHYSICIAN OFFICE
2 ACP SURGICAL GROUP
1656 CHAMPLIN AVE PROF OFFICE BLDNG
UTICA,NY13502 		PHYSICIAN OFFICE
3 WOMEN'S MEDICAL IMAGING CENTER
106 BUSINESS PARK DRIVE
UTICA,NY13502 		RADIOLOGY SERVICES
4 ACP MOHAWK VALLEY MEDICAL (HERKIMER)
201 EAST STATE STREET
HERKIMER,NY13350 		PHYSICIAN OFFICE
5 HERKIMER DIALYSIS CENTER
201 EAST STATE STREET
HERKIMER,NY13350 		DIALYSIS SITE
6 ONEIDA DIALYSIS CENTER
221 BROAD STREET
ONEIDA,NY13421 		DIALYSIS SITE
7 DENTAL HEALTH CENTER
1714 BURRSTONE ROAD
NEW HARTFORD,NY13413 		DENTAL CLINIC
8 ACP NEW HARTFORD MEDICAL OFFICE
8411 SENECA TURNPIKE
NEW HARTFORD,NY13413 		PHYSICIAN OFFICE
9 ACP WASHINGTON MILLS MEDICAL OFFICE
3946 ONEIDA STREET
NEW HARTFORD,NY13413 		PHYSICIAN OFFICE
10 MASONIC CARE COMMUNITY DIALYSIS
2150 BLEEKER STREET
UTICA,NY13501 		DIALYSIS SITE
11 ROME DIALYSIS CENTER
91 PERIMETER ROAD SUITE 140
ROME,NY13440 		DIALYSIS SITE
12 ACP BARNEVELD MEDICAL OFFICE
7980 STATE RT 12
BARNEVELD,NY13304 		PHYSICIAN OFFICE
13 ACP WHITESBORO MEDICAL OFFICE
37 MAIN STREET
WHITESBORO,NY13492 		PHYSICIAN OFFICE
14 ACP BOONVILLE MEDICAL OFFICE
13460 STATE ROUTE 12
BOONVILLE,NY13309 		PHYSICIAN OFFICE
15 ACP NORTH UTICA PRIMARY CARE OFFICE
35 RIVERSIDE DRIVE
UTICA,NY13502 		PHYSICIAN OFFICE
16 HAMILTON DIALYSIS CENTER
10 EATON STREET
HAMILTON,NY13346 		DIALYSIS SITE
17 ACP WATERVILLE MEDICAL OFFICE
MADISON ST BUS PARK 358 MADISON AVE
WATERVILLE,NY13480 		PHYSICIAN OFFICE
18 ACP NEUROSURGERY
1656 CHAMPLIN AVE PROF OFFICE BLDNG
UTICA,NY13502 		PHYSICIAN OFFICE
19 ROME RADIATION SATELLITE
91 PERIMETER ROAD SUITE 130
ROME,NY13440 		RADIATION SITE
Schedule H (Form 990) 2013
Schedule H (Form 990) 2013
Page
Part VI
Supplemental Information
Provide the following information.
1 Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2 Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs 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.
Form and Line Reference Explanation
FAXTON ST LUKES HEALTHCARE, INC. PART V, SECTION B, LINE 3: ON MONDAY, MAY 20, 2013 MEMBERS OF THE FSLH HEALTH CARE TEAM, ALONG WITH AREA HOSPITALS, HEALTHCARE ORGANIZATIONS AND AGENCIES PARTICIPATED IN A HEALTH ASSESSMENT INITIATIVE. THE PROGRAM, LED BY THE ONEIDA COUNTY HEALTH DEPARTMENT, USED THE MOBILIZING FOR ACTION THROUGH PLANNING AND PARTNERSHIPS FRAMEWORK (MAPP) TO CONDUCT THE CHNA ACTIVITIES. THE ASSESSMENT RESULTS WERE COMBINED WITH POPULATION TO IDENTIFY THE TOP TWO PRIORITY* AGENDA INITIATIVES FOR 2014 THROUGH 2017. THE TOP TWO PRIORITIES* FOR ONEIDA COUNTY AND PARTICIPATING HEALTH CARE ORGANIZATIONS ARE SMOKING CESSATION AND INCREASED BREAST FEEDING. THE NEW YORK STATE PREVENTION AGENDA (THE PREVENTION AGENDA) SERVES AS A GUIDE TO HEALTH DEPARTMENTS AND HOSPITALS AS THEY DEVELOP THE CHNA REQUIRED BY THE PATIENT PROTECTION AND AFFORDABLE CARE ACT (PPACA). THE COMMUNITY SERVICE PLANS, REQUIRED ANNUALLY BY NEW YORK STATE DEPARTMENT OF HEALTH (DOH), ALSO REFLECT THE COLLABORATIVE WORK OF THE COUNTY AND HOSPITALS AS PART OF THEIR COMMUNITY HEALTH IMPROVEMENT PLAN (CHIP). FSLH PARTICIPATED IN THE NEEDS ASSESSMENT FOR HERKIMER COUNTY WHICH WAS HELD ON THURSDAY, MARCH 28, 2013. NEARLY 15 PERCENT OF THE PATIENTS SERVED BY FSLH LIVE IN HERKIMER COUNTY. THE HERKIMER COUNTY CNA THAT WAS DEVELOPED IS A COLLABORATIVE EFFORT OF HERKIMER COUNTY PUBLIC HEALTH, HERKIMER COUNTY7 HEALTHNET, MEMBERS OF THE CNY MPH, AREA HOSPITALS AND AGENCIES.
FAXTON ST LUKES HEALTHCARE, INC. PART V, SECTION B, LINE 4: OTHER REPRESENTATIVES INCLUDED FSLH, SEMC, ROME MEMORIAL HOSPITAL, ONEIDA COUNTY HEALTH DEPARTMENT AND A NUMBER OF COMMUNITY AGENCIES.
FAXTON ST LUKES HEALTHCARE, INC. PART V, SECTION B, LINE 7: THE PREVENTION AGENDA IDENTIFIES FIVE PRIORITY AREAS, FOCUS AREAS WITHIN EACH PRIORITY AREA, AND ESTABLISHES GOALS FOR EACH PRIORITY AREA. INDICATORS ARE USED TO MEASURE PROGRESS TOWARD ACHIEVING THE GOALS, INCLUDING REDUCTIONS IN HEALTH DISPARITIES AMONG RACIAL, ETHNIC, AND SOCIOECONOMIC GROUPS AND PERSONS WITH DISABILITIES. THE FIVE PRIORITY AREAS ARE:1. PREVENT CHRONIC DISEASES*- REDUCE OBESITY IN CHILDREN AND ADULTS- REDUCE ILLNESS, DISABILITY AND DEATH RELATED TO TOBACCO USE AND SECONDHAND SMOKE EXPOSURE *- INCREASE ACCESS TO HIGH-QUALITY CHRONIC DISEASE PREVENTIVE CARE AND MANAGEMENT IN CLINICAL AND COMMUNITY SETTINGS.2. PROMOTE A HEALTHY AND SAFE ENVIRONMENT- OUTDOOR AIR QUALITY- WATER QUALITY- BUILT ENVIRONMENT- INJURIES, VIOLENCE AND OCCUPATIONAL HEALTH3. PROMOTE HEALTHY WOMEN, INFANTS AND CHILDREN* - MATERNAL AND INFANT HEALTH*- CHILD HEALTH- REPRODUCTIVE, PRECONCEPTION AND INTER-CONCEPTION HEALTH.4. PROMOTE MENTAL HEALTH AND PREVENT SUBSTANCE ABUSE- PROMOTE MENTAL, EMOTIONAL AND BEHAVIORAL WELL-BEING IN COMMUNITIES- PREVENT SUBSTANCE ABUSE AND OTHER MENTAL EMOTIONAL BEHAVIORAL DISORDERS- STRENGTHEN INFRASTRUCTURE ACROSS SYSTEMS.5. PREVENT HIV, SEXUALLY TRANSMITTED DISEASES, VACCINE-PREVENTABLE DISEASES AND HEALTHCARE-ASSOCIATED INFECTIONS- PREVENT HIV AND STDS- PREVENT VACCINE-PREVENTABLE DISEASES- PREVENT HEALTH CARE-ASSOCIATED INFECTIONS.*INDICATES THE TWO PRIORITY/FOCUS AREAS SELECTED BY ONEIDA COUNTY HEALTH DEPARTMENT, FSLH AND PARTICIPATING HOSPITALS AND HEALTH AGENCIES.
FAXTON ST LUKES HEALTHCARE, INC. PART V, SECTION B, LINE 20D: FOR PATIENTS WITH NO INSURANCE, FSLH SCREENS FOR FINANCIAL ASSISTANCE ELIGIBILITY AND HELPS WITH ANY OF THE APPLICATIONS. IF PATIENT DOES NOT QUALIFY OR COOPERATE WITH THE PROCESS, THE ORGANIZATION BILLS BASED ON GROSS CHARGES AND 20% PROMPT PAY DISCOUNT.
FAXTON ST LUKES HEALTHCARE, INC. PART V, SECTION B, LINE 22: FOR PATIENTS WITH NO INSURANCE, FSLH SCREENS FOR FINANCIAL ASSISTANCE ELIGIBILITY AND HELPS WITH ANY OF THE APPLICATIONS. IF PATIENT DOES NOT QUALIFY OR COOPERATE WITH THE PROCESS, THE ORGANIZATION BILLS BASED ON GROSS CHARGES AND 20% PROMPT PAY DISCOUNT.
Schedule H (Form 990) 2013
Additional Data


Software ID:  
Software Version:  
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, line 23.
SchJMediumBullet Attach to Form 990. SchJMediumBullet See separate instructions.
SchJMediumBullet Information about Schedule J (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
FAXTON ST LUKE'S HEALTHCARE
 
Employer identification number

16-1576637
Part I
Questions Regarding Compensation
Yes
No
1a
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.
b
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....
1b
 
 
2
Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked in line 1a? ..
2
 
 
3
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.
4
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:
a
Receive a severance payment or change-of-control payment? ................
4a
Yes
 
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........
4b
 
No
c
Participate in, or receive payment from, an equity-based compensation arrangement? .........
4c
 
No
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.
5
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:
a
The organization? ...........................
5a
Yes
 
b
Any related organization? .........................
5b
 
No
If "Yes," to line 5a or 5b, describe in Part III.
6
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:
a
The organization? ...........................
6a
Yes
 
b
Any related organization? .........................
6b
 
No
If "Yes," to line 6a or 6b, describe in Part III.
7
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 ............
7
 
No
8
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 .............................
8
 
No
9
If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................
9
 
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50053T
Schedule J (Form 990) 2013

Schedule J (Form 990) 2013
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
(i) Base compensation (ii) Bonus & incentive compensation (iii) Other reportable compensation
(1)WILLIAM PARKER MDBOARD MEMBER/PHYSICIAN (i)
(ii)		 171,272
0 		4,000
0 		1,713
0 		11,026
0 		9,044
0 		197,055
0 		0
0
(2)JOHN SPERLING MDMEDICAL STAFF PRESIDENT/PHYSICIAN (i)
(ii)		 293,812
0 		100,946
0 		3,461
0 		12,750
0 		0
0 		410,969
0 		0
0
(3)LEROY COOLEY MDBOARD MEMBER/PHYSICIAN (i)
(ii)		 443,968
0 		45,000
0 		0
0 		12,750
0 		9,044
0 		510,762
0 		0
0
(4)ROGER MCREYNOLDSBOARD MEMBER/VICE PRESIDENT (i)
(ii)		 198,425
0 		22,200
0 		4,801
0 		9,921
0 		16,353
0 		251,700
0 		0
0
(5)SCOTT H PERRA FACHEPRESIDENT/CEO (i)
(ii)		 475,000
0 		115,000
0 		99,230
0 		22,950
0 		16,353
0 		728,533
0 		0
0
(6)MICHAEL J HAILE FHFMASENIOR VP/CFO (i)
(ii)		 321,000
0 		56,300
0 		47,394
0 		22,950
0 		16,353
0 		463,997
0 		0
0
(7)DANIEL KOPP MDSENIOR VP/CHIEF MEDICAL OFFICER (i)
(ii)		 317,167
0 		0
0 		18,557
0 		5,392
0 		16,353
0 		357,469
0 		0
0
(8)PATRICIA ROACH MS RN CNAASENIOR VP/CHIEF NURSING OFFICER (i)
(ii)		 243,878
0 		42,000
0 		18,210
0 		22,394
0 		21,723
0 		348,205
0 		0
0
(9)KEVIN MAHONEYVP/CHIEF INFORMATION OFFICER (i)
(ii)		 143,981
0 		0
0 		1,637
0 		7,199
0 		13,627
0 		166,444
0 		0
0
(10)ANTHONY SCIBELLISENIOR VP/COO (i)
(ii)		 201,832
0 		21,900
0 		10,134
0 		10,092
0 		16,353
0 		260,311
0 		0
0
(11)DEBRA ALTDOERFFERVP COMMUNICATIONS AND MARKETING (i)
(ii)		 120,678
0 		13,000
0 		872
0 		10,760
0 		16,353
0 		161,663
0 		0
0
(12)REGINA RYBKA-LAGATTUTAVP HUMAN RESOURCES (i)
(ii)		 158,892
0 		0
0 		301
0 		7,283
0 		21,722
0 		188,198
0 		0
0
(13)MADANA MOHANA VALLEM MDPHYSICIAN (i)
(ii)		 499,981
0 		0
0 		0
0 		12,750
0 		12,264
0 		524,995
0 		0
0
(14)KENNETH ORTEGA MDPHYSICIAN (i)
(ii)		 447,747
0 		47,861
0 		3,564
0 		12,750
0 		9,044
0 		520,966
0 		0
0
(15)JORGE FERREIRO MDPHYSICIAN (i)
(ii)		 278,324
0 		122,144
0 		3,564
0 		12,750
0 		12,264
0 		429,046
0 		0
0
(16)MARK WILLIAMS MDPHYSICIAN (i)
(ii)		 278,325
0 		76,368
0 		810
0 		12,750
0 		6,976
0 		375,229
0 		0
0
(17)MARGARET ALBANESE MDPHYSICIAN (i)
(ii)		 339,745
0 		6,107
0 		3,564
0 		12,750
0 		9,323
0 		371,489
0 		0
0
(18)KEITH FENSTEMACHERFORMER PRESIDENT/CEO (i)
(ii)		 207,868
0 		0
0 		0
0 		0
0 		0
0 		207,868
0 		0
0
Schedule J (Form 990) 2013

Schedule J (Form 990) 2013
Page 3
Part III
Supplemental Information
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.
Return Reference Explanation
PART I, LINE 4A DR DANIEL L KOPP RECEIVED A SEVERANCE PAYMENT OF $209,333.28 IN 2013; THIS AMOUNT IS INCLUDED IN THE BASE COMPENSATION AMOUNT REPORTED IN J-PART II, AS WELL AS FORM 990 PAGE 7.
PART I, LINE 5 THE INCENTIVE COMPENSATION, REPORTED FOR PHYSICIANS, IS A CALCULATION OF RELATIVE VALUE UNITS (RVU); RELATING TO THE REVENUES GENERATED BY THE SERVICES THEY PROVIDE.
PART I, LINE 6 AN INCENTIVE COMPENSATION PLAN EXISTS FOR THE EXECUTIVE STAFF OF FSLH. COMPENSATION IS BASED ON PERFORMANCE RELATIVE, IN PART, TO THE ORGANIZATION NET EARNINGS TARGETS, AS WELL AS, VARIOUS OTHER QUALITY RELATED PERFORMANCE TARGETS. THE INCENTIVES ARE ONLY PAID OUT UPON ACHIEVEMENT OF THESE SET TARGETS. DURING 2013, $287,700 OF INCENTIVE COMPENSATION WAS PAID OUT UNDER THIS PLAN RELATING TO THE 2012 FISCAL YEAR. $230,844 HAS BEEN ACCRUED FOR THE 2013 FISCAL YEAR TO BE PAID OUT IN 2014.
Schedule J (Form 990) 2013

Additional Data


Software ID:  
Software Version:  
Schedule K
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Information on Tax Exempt Bonds
SchKMediumBullet 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.
SchKMediumBulletInformation about Schedule K (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public
Inspection
Name of the organization
FAXTON ST LUKE'S HEALTHCARE
 
Employer identification number
16-1576637
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
Yes No Yes No Yes No
A ONEIDA COUNTY INDUSTRIAL DEVELOPMENT AUTHORITY
  		16-6158201 682465AB5 06-26-2006 7,705,000 WINDOW WALL REPLACEMENT, ED PROJECT, AC WING REHAB   X   X   X
Part II
Proceeds
A B C D
1 Amount of bonds retired . . . . . . . . . . . . . .        
2 Amount of bonds legally defeased . . . . . . . . . . .        
3 Total proceeds of issue . . . . . . . . . . . . . . 7,705,000      
4 Gross proceeds in reserve funds . . . . . . . . . . . .        
5 Capitalized interest from proceeds . . . . . . . . . . .        
6 Proceeds in refunding escrows . . . . . . . . . . . .        
7 Issuance costs from proceeds . . . . . . . . . . . . 319,348      
8 Credit enhancement from proceeds . . . . . . . . . . .        
9 Working capital expenditures from proceeds . . . . . . . . .        
10 Capital expenditures from proceeds . . . . . . . . . . . 7,385,652      
11 Other spent proceeds . . . . . . . . . . . . . .        
12 Other unspent proceeds . . . . . . . . . . . . . .        
13 Year of substantial completion . . . . . . . . . . . . 2008
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) 2013
Schedule K (Form 990) 2013
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 . . SchKMediumBullet        
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 . . . . . . . SchKMediumBullet        
6 Total of lines 4 and 5 . . . . . . . . . . . . .        
7 Does the bond issue meet the private security or payment test? . . . . .   X            
8a Has there been a sale or disposition of any of the bond financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were issued?. . . . . . . . . . . . . . . . .   X            
b If "Yes" to line 8a, enter the percentage of bond-financed property sold or disposed of.        
c If "Yes" to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? . . . . . . . . . . . . .                
9 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under
Regulations sections 1.141-12 and 1.145-2? . . . . . . . 		  X            
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? . . . . . . . .   X            
c No rebate due? . . . . . . . .   X            
If you checked "No rebate due" in line 2c, provide in
Part VI the date the rebate computation was performed
3 Is the bond issue a variable rate issue? . . . . 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 . . . . . . . . . BANK OF AMERICA
  		 
  		 
  		 
 
c Term of hedge . . . . . . . . . . 24.800000000000      
d Was the hedge superintegrated? . . . .   X            
e Was the hedge terminated? . . . . . .   X            
Schedule K (Form 990) 2013
Schedule K (Form 990) 2013
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 . . . . . . . . .  
  		 
  		 
  		 
 
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
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. Provide additional information for responses to questions on Schedule K (see instructions).
Return Reference Explanation
SCHEDULE K; PART VI; PROCEDURES TO UNDERTAKE CORRECTIVE ACTION THE ORGANIZATION HAS NO WRITTEN POLICY; THE CFO OF THE ORGANIZATION IS RESPONSIBLE FOR COMPLIANCE WITH FEDERAL TAX REQUIREMENTS RELATED TO BOND ISSUES.
Schedule K (Form 990) 2013

Additional Data


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SCHEDULE M
(Form 990)

Department of the Treasury
Internal Revenue Service
Noncash Contributions
Right pointing arrow large imageComplete if the organizations answered "Yes" on Form 990, Part IV, lines 29 or 30.
Right pointing arrow large image Attach to Form 990.
Right pointing arrow large imageInformation about Schedule M (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
FAXTON ST LUKE'S HEALTHCARE
 
Employer identification number

16-1576637
Part I
Types of Property
(a)
Check if applicable 		(b)
Number of contributions or items contributed 		(c)
Noncash contribution amounts reported on
Form 990, Part VIII, line 1g 		(d)
Method of determining
noncash contribution amounts
1 Art—Works of art ....        
2 Art—Historical treasures .        
3 Art—Fractional interests ..        
4 Books and publications ..      
5 Clothing and household
goods ....... 		     
6 Cars and other vehicles ..        
7 Boats and planes ....        
8 Intellectual property ...        
9 Securities—Publicly traded .        
10 Securities—Closely held stock .        
11 Securities—Partnership, LLC,
or trust interests .... 		       
12 Securities—Miscellaneous ..        
13 Qualified conservation
contribution—Historic
structures ..... 		       
14 Qualified conservation
contribution—Other ... 		       
15 Real estate—Residential .        
16 Real estate—Commercial ..        
17 Real estate—Other ...        
18 Collectibles .....        
19 Food inventory ...        
20 Drugs and medical supplies .        
21 Taxidermy ......        
22 Historical artifacts ....        
23 Scientific specimens ..        
24 Archeological artifacts ...        
25 Other Right pointing arrow large image ( DISCOUNT ON C ) X 3 308,341  
26 Other Right pointing arrow large image ( MEDICAL SUPPL ) X 1 74,461  
27 Other Right pointing arrow large image ( FURNITURE/MED ) X 1 18,249  
28 Other Right pointing arrow large image ( )
29
Number of Forms 8283 received by the organization during the tax year for contributions
for which the organization completed Form 8283, Part IV, Donee Acknowledgement ...
29
0
Yes
No
30a
During the year, did the organization receive by contribution any property reported in Part I, lines 1 through 28, that
it must hold for at least three years from the date of the initial contribution, and which is not required to be used
for exempt purposes for the entire holding period? ..................
30a
 
No
b
If "Yes," describe the arrangement in Part II.
31
Does the organization have a gift acceptance policy that requires the review of any non-standard contributions?
31
 
No
32a
Does the organization hire or use third parties or related organizations to solicit, process, or sell noncash
contributions? ..........................
32a
 
No
b
If "Yes," describe in Part II.
33
If the organization did not report an amount in column (c) for a type of property for which column (a) is checked,
describe in Part II.
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 51227J
Schedule M (Form 990) (2013)
Schedule M (Form 990) (2013)
Page 2
Part II
Supplemental Information. Provide the information required by Part I, lines 30b,
32b, and 33, and whether the organization is reporting in Part I, column (b), the number of contributions, the number of items received, or a combination of both. Also complete this part for any additional information.
Return Reference Explanation
Schedule M (Form 990) (2013)
Additional Data


Software ID:  
Software Version:  
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.
MediumBullet 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
FAXTON ST LUKE'S HEALTHCARE
 
Employer identification number

16-1576637
Return Reference Explanation
FORM 990, PART III, LINE 2 OPENING OF URGENT CARE FOR INNER CITY IN NOVEMBER 2013, FSLH OPENED GENESEE URGENT CARE LOCATED AT 1904 GENESEE STREET IN UTICA, NEW YORK. THE LOCATION IS OPEN SEVEN DAYS A WEEK AND PROVIDES EASY ACCESS AND SERVICES TO THE UNDERSERVED IN THE UTICA AREA. FSLH ALSO OWNS AND OPERATES AN URGENT CARE CENTER AT THE FAXTON CAMPUS, 1676 SUNSET AVENUE IN UTICA. IT IS ANTICIPATED THE FAXTON AND GENESEE URGENT CARE CENTERS WILL SEE A COMBINED 20,000 PATIENT VISITS ANNUALLY.
FORM 990, PART VI, SECTION A, LINE 6 MOHAWK VALLEY NETWORK, INC IS THE SOLE MEMBER OF THE CORPORATION.
FORM 990, PART VI, SECTION A, LINE 7A MOHAWK VALLEY NETWORK, INC APPOINTS THE DIRECTORS AND GOVERNING BODY OF THE ORGANIZATION. THE BOARD OF DIRECTORS ARE LISTED IN SECTION VII.
FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 AND FORM 990T WERE REVIEWED AT A MEETING ON 10/15/2014 WITH THE EXECUTIVE COMMITTEE AND ON 10/23/2014 WITH THE BOARD OF DIRECTORS.
FORM 990, PART VI, SECTION B, LINE 12C CONFLICT OF INTEREST POLICY: THE PURPOSE OF THE POLICIES AND DIRECTIVES SET OUT IN THIS POLICY STATEMENT IS TO ASSURE THAT THE BUSINESS CONDUCTED BY THE ORGANIZATION IS CONDUCTED FREE FROM THE POSSIBLE INFLUENCE OF CONFLICTS OF INTEREST OF INTERESTED PERSONS. THIS POLICY EXISTS TO PROTECT THE ORGANIZATIONS INTEREST WHEN IT IS CONTEMPLATING ENTERING INTO A TRANSACTION OR ARRANGEMENT THAT MIGHT BENEFIT THE PRIVATE INTEREST OF AN INTERESTED PERSON IN THE ORGANIZATION. INTERESTED PERSONS MAY NOT ENTER INTO ANY EMPLOYMENT TRANSACTION OR OTHER ARRANGEMENT THAT MAY CAUSE OR BE PERCEIVED TO CAUSE A CONFLICT OF INTEREST. INTERESTED PERSONS MUST REVIEW THIS POLICY ANNUALLY AND COMPLETE THE ACKNOWLEDGEMENT AND DISCLOSURE FORM ANNUALLY. THE COMPLIANCE OFFICER AND/OR THE COMPLIANCE COMMITTEE WILL REVIEW ALL ANNUAL ACKNOWLEDGEMENT AND DISCLOSURE FORMS AND ANY CONFLICTS OR POTENTIAL CONFLICTS IDENTIFIED. WHEN A POTENTIAL CONFLICT IS IDENTIFIED, THE COMPLIANCE OFFICER WILL ENSURE APPROPRIATE ACTIONS ARE TAKEN TO RESOLVE THE CONFLICT. THIS POLICY IS INTENDED TO SUPPLEMENT BUT NOT REPLACE ANY APPLICABLE FEDERAL AND STATE LAWS GOVERNING CONFLICTS OF INTEREST APPLICABLE TO NONPROFIT AND CHARITABLE CORPORATIONS.
FORM 990, PART VI, SECTION B, LINE 15 THE BOARDS EXECUTIVE COMPENSATION COMMITTEE, HAS ADOPTED AND FOLLOWS A PROCESS FOR REVIEWING AND DETERMINING THE COMPENSATION OF THE CEO AND THE EXECUTIVE MANAGEMENT TEAM. THE EXECUTIVE MANAGEMENT TEAM CONSISTS OF THE FOLLOWING POSITIONS: SENIOR VICE PRESIDENT/CHIEF OPERATING OFFICER SENIOR VICE PRESIDENT/CHIEF FINANCIAL OFFICER SENIOR VICE PRESIDENT/CHIEF MEDICAL OFFICER SENIOR VICE PRESIDENT/CHIEF NURSING OFFICER THE COMMITTEE HAS ENGAGED AN INDEPENDENT COMPENSATION CONSULTANT TO PROVIDE INFORMATION AND ADVICE TO COMMITTEE, INCLUDING BUT NOT LIMITED, PROVIDING INDEPENDENT COMPENSATION COMPARABILITY DATA FOR FUNCTIONALLY COMPARABLE POSITIONS IN SIMILARLY SITUATED HOSPITALS. THE DATA IS PROVIDED ON AN ANNUAL BASIS AND IS REVIEWED BY THE COMMITTEE, ALONG WITH OTHER INFORMATION, PRIOR TO APPROVING ANY CHANGES TO COMPENSATION. THE INDEPENDENCE OF THE COMMITTEES MEMBERS IS REVIEWED AND VERIFIED PRIOR TO THE START OF THE ANNUAL COMPENSATION REVIEW PROCESS. SHOULD A CONFLICT PRESENT, THOSE INDIVIDUALS WITH ACTUAL OR PERCEIVED CONFLICTS ABSTAIN FROM VOTING UNTIL SUCH TIME AS THE CONFLICT CAN BE RESOLVED OR A REPLACEMENT MEMBER IS APPOINTED TO THE COMMITTEE. THE COMMITTEES DELIBERATIONS AND DECISIONS ARE GUIDED BY A WRITTEN COMPENSATION PHILOSOPHY AND DOCUMENTED THROUGH WRITTEN MINUTES TAKEN DURING EACH MEETING. THE MINUTES INCLUDE, AMONG OTHER THINGS, THE WRITTEN MATERIALS DISTRIBUTED OR PRESENTED DURING THE MEETING AND THE SPECIFIC DECISIONS TAKEN AT THE MEETING.
FORM 990, PART VI, SECTION C, LINE 19 POLICY: IT IS THE POLICY OF THIS HOSPITAL TO MAKE AVAILABLE TO ANYONE WHO ASKS, A COPY OF ITS ANNUAL REPORT TO THE INTERNAL REVENUE SERVICE (IRS) ON FORM 990, AND ITS EXEMPT STATUS FORM. IN ACCORDANCE WITH THE LAW, FORM 990 FOR A GIVEN YEAR, WILL BE MADE AVAILABLE FOR PUBLIC INSPECTION FOR A THREE-YEAR PERIOD.PURPOSE: THE PURPOSE OF THIS POLICY IS TO COMPLY WITH IRS LAW, WHICH APPLIES FOR TAX YEARS BEGINNING AFTER JUNE 8, 1999 SPECIAL INSTRUCTIONS: A. A COPY OF THE ABOVE NAMED DOCUMENTS, WILL BE MADE AVAILABLE FOR INSPECTION BY A REQUESTER, IN A DESIGNATED ROOM, IN THE FINANCE DEPARTMENT OF THE HOSPITAL. B. THE DOCUMENTS WILL BE MADE AVAILABLE, IMMEDIATELY, TO ANYONE WHO APPEARS IN PERSON DURING USUAL BUSINESS HOURS. FOR WRITTEN REQUESTS FOR COPIES OF DOCUMENTS, RESPONSE WILL BE PROVIDED WITHIN THIRTY (30) DAYS OF RECEIPT OF PAYMENT OF REASONABLE COPYING FEES*. C. EITHER THE HOSPITAL SENIOR VICE PRESIDENT/CFO, THE CONTROLLER, OR THEIR DESIGNATED REPRESENTATIVE WILL BE PRESENT DURING AN INSPECTION BY A REQUESTER. D. ONLY THE HOSPITAL SENIOR VICE PRESIDENT/CFO, THE CONTROLLER, OR THEIR DESIGNATED REPRESENTATIVE WILL BE PERMITTED TO ANSWER QUESTIONS THAT A REQUESTER MAY HAVE. *SHOULD A REQUESTER ASK THE HOSPITAL FOR A PHOTOCOPY OF ANY OR ALL PARTS OF DOCUMENTS, THE HOSPITAL WILL CHARGE $1.00 FOR THE FIRST PAGE, PLUS $.15 FOR EACH ADDITIONAL PAGE.
FORM 990, PART IX, LINE 11G OTHER FEES: PROGRAM SERVICE EXPENSES 22,629,762. MANAGEMENT AND GENERAL EXPENSES 7,112,493. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 29,742,255.
FORM 990, PART XI, LINE 9: CHANGE IN FV OF INTEREST RATE SWAPS 2,293,094. CHANGE IN INTEREST IN UNRESTRICTED NET ASSETS OF FOUNDATION -204,560. CHANGE IN INTEREST IN TEMPORARILY RESTRICTED NET ASSETS OF FOUNDATION 668,520.
PART XII, LINE 2C THE ORGANIZATION DOES HAVE A COMMITTEE THAT ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF FINANCIAL STATEMENTS AND SELECTION OF AN INDEPENDENT ACCOUNTANT. THE OVERSIGHT AND SELECTION PROCESSES DID NOT CHANGE.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2013

Additional Data


Software ID:  
Software Version:  
SCHEDULE R
(Form 990)
Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
MediumBulletComplete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBulletAttach to Form 990. MediumBullet See separate instructions.
MediumBullet Information about Schedule R (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
FAXTON ST LUKE'S HEALTHCARE
 
Employer identification number

16-1576637
Part I
Identification of Disregarded Entities Complete if the organization answered "Yes" on 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
(1) PARAFFIN LLC
PO BOX 479
UTICA,NY13503
27-1341112 		LABORATORY SERVICES NY 319,688 148,065 FAXTON-ST LUKE'S HEALTHCARE INC
 










Part II
Identification of Related Tax-Exempt Organizations Complete if the organization answered "Yes" on 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?
Yes No
(1) MOHAWK VALLEY NETWORK INC

PO BOX 4308

UTICA,NY13504
22-3124162 		PROMOTE HEALTH CARE NY 501(C)(3) HOSPTIAL N/A
 
No
(2) ST LUKE'S HOME RESIDENTIAL HEALTHCARE FACILITY

PO BOX 6305

UTICA,NY13504
16-1476372 		202 BED RHCF NY 501(C)(3) LINE 9 FAXTON ST LUKE'S HEALTHCARE INC
 
 
No
(3) VISITING NURSE'S ASSOCIATION OF UTICA & ONEIDA COUNTIES

2608 GENESEE STREE

UTICA,NY13502
15-0532259 		HOME HEALTH NURSING NY 501(C)(3) LINE 9 MOHAWK VALLEY NETWORK INC
 
 
No
(4) FAXTON ST LUKE'S HEALTHCARE FOUNDATION

PO BOX 479

UTICA,NY13503
22-3078768 		FUND RAISING NY 501(C)(3) LINE 9 MOHAWK VALLEY NETWORK INC
 
 
No






For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2013
Schedule R (Form 990) 2013
Page 2
Part III
Identification of Related Organizations Taxable as a Partnership Complete if the organization answered "Yes" on 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



 		(e)
Predominant income(related, unrelated, excluded from tax under sections 512-514)

(f)
Share of total income




 		(g)
Share of end-of-year
assets



 		(h)
Disproprtionate allocations?




 		(i)
Code V-UBI
amount in box 20 of
Schedule K-1
(Form 1065)
 		(j)
General or
managing
partner?



 		(k)
Percentage
ownership
Yes No Yes No












Part IV
Identification of Related Organizations Taxable as a Corporation or Trust Complete if the organization answered "Yes" on 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
 		(h)
Percentage
ownership
 		(i)
Section 512(b)(13) controlled entity?
Yes No
(1) SLM CORPORATION

PO BOX 479
UTICA,NY13503
16-1134876 		REAL ESTATE MANAGEMENT NY  
T 61,612 5,019,412 100.000 %   No












Schedule R (Form 990) 2013
Schedule R (Form 990) 2013
Page 3
Part V
Transactions With Related Organizations Complete if the organization answered "Yes" on 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
No
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 . . . . . . . . . . . . . . . . . . . . . . .
1a
 
No
b Gift, grant, or capital contribution to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1b
 
No
c Gift, grant, or capital contribution from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1c
Yes
 
d Loans or loan guarantees to or for related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1d
 
No
e Loans or loan guarantees by related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1e
Yes
 
f Dividends from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1f
 
No
g Sale of assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1g
 
No
h Purchase of assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1h
 
No
i Exchange of assets with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1i
 
No
j Lease of facilities, equipment, or other assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1j
 
No
k Lease of facilities, equipment, or other assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .
1k
Yes
 
l Performance of services or membership or fundraising solicitations for related organization(s) . . . . . . . . . . . . . . . . . . . .
1l
 
No
m Performance of services or membership or fundraising solicitations by related organization(s) . . . . . . . . . . . . . . . . . . . .
1m
 
No
n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) . . . . . . . . . . . . . . . . . . . . .
1n
Yes
 
o Sharing of paid employees with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1o
Yes
 
p Reimbursement paid to related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1p
Yes
 
q Reimbursement paid by related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1q
Yes
 
r Other transfer of cash or property to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1r
 
No
s Other transfer of cash or property from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1s
 
No
2
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 related organization 		(b)
Transaction
type (a-s) 		(c)
Amount involved 		(d)
Method of determining amount involved





Schedule R (Form 990) 2013
Schedule R (Form 990) 2013
Page 4
Part VI
Unrelated Organizations Taxable as a Partnership Complete if the organization answered "Yes" on 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) 		(d)
Predominant income (related, unrelated, excluded from tax under sections 512-514)

(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 V?UBI
amount in box 20
of Schedule K-1
(Form 1065) 		(j)
General or
managing
partner? 		(k)
Percentage
ownership
Yes No Yes No Yes No






























Schedule R (Form 990) 2013
Schedule R (Form 990) 2013
Page 5
Part VII
Supplemental Information
Provide additional information for responses to questions on Schedule R (see instructions).
Return Reference Explanation
PART IV, IDENTIFICATION OF RELATED ORGANIZATIONS TAXABLE AS CORP OR TRUST NAME OF RELATED ORGANIZATION: SLM CORPORATION; DIRECT CONTROLLING ENTITY IS FAXTON ST LUKE'S HEALTHCARE, INC.
Schedule R (Form 990) 2013
Additional Data


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Software Version: