TY 2014 Form 990

(A) Name and Title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)
(1) Linda Breault........................................................................ Trustee	2.00 .......................0.00	X	0	0
(2) Janet Sapio-Mayta........................................................................ Trustee	3.00 .......................0.00	X	0	0
(3) Cristine Cioffi........................................................................ Trustee	3.00 .......................0.00	X	0	0
(4) Michael Cocca........................................................................ Trustee	2.00 .......................0.00	X	0	0
(5) William B Faubion........................................................................ Treasurer	3.00 .......................0.00	X	0	0
(6) Thomas Donovan........................................................................ Trustee	2.00 .......................0.00	X	0	0
(7) D Joseph Gersuk........................................................................ Trustee	2.00 .......................0.00	X	0	0
(8) Carolyn Jones........................................................................ Trustee	3.00 .......................0.00	X	0	0
(9) Ernest Lee MD........................................................................ Trustee	1.00 .......................0.00	X	286,208	4,981
(10) Patrick Kehoe........................................................................ Trustee	2.00 .......................0.00	X	0	0
(11) Robert Kennedy MD........................................................................ Trustee	2.00 .......................0.00	X	0	0
(12) Michael Idelchik........................................................................ Trustee	0.50 .......................0.00	X	0	0
(13) Robert Joy MD........................................................................ Trustee	3.00 .......................0.00	X	15,000	0
(14) Deborah Mullaney........................................................................ Chairman	7.00 .......................0.00	X	0	0
(15) John K Tobison........................................................................ Trustee	2.00 .......................0.00	X	0	0
(16) Barbara Zittel........................................................................ Trustee	3.00 .......................0.00	X	0	0
(17) Sarah Schermerhorn........................................................................ Trustee	2.00 .......................0.00	X	0	0

(A) Name and Title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(18) Laura Schweitzer PhD........................................................................ Secretary	2.00 .......................0.00	X				0	0
(19) Stephen Pagano........................................................................ Vice Chair	1.50 .......................0.00	X				0	0
(20) Richard Toll MD........................................................................ Trustee	1.00 .......................0.00	X				5,796	0
(21) Brian McDonald MD........................................................................ Trustee	2.00 .......................0.00	X				50,400	0
(22) Emile Walraven........................................................................ Trustee	2.00 .......................0.00	X				0	0
(23) Judith McIlduff........................................................................ Trustee	0.50 .......................0.00	X				0	0
(24) Raymond Sweeney........................................................................ Trustee	1.00 .......................0.00	X				0	0
(25) James W Connolly........................................................................ President & CEO	55.00 .......................5.00		X			646,764	42,108
(26) Paul A Milton........................................................................ EVP/COO	55.00 .......................5.00		X			370,652	38,333
(27) Daniel J Rinaldi........................................................................ CFO	55.00 .......................5.00		X			250,081	10,875
(28) Marc Mesick........................................................................ CFO	55.00 .......................5.00		X			188,823	12,364
(29) Joseph Giansante........................................................................ Vice President, Human Resources	55.00 .......................0.00			X		251,815	34,638
(30) Patti S Hammond........................................................................ Vice President, Physician Relations	55.00 .......................0.00			X		115,373	10,734
(31) David M Liebers MD........................................................................ CMO/VP Quality Services/Med Affairs	55.00 .......................0.00			X		341,457	38,579
(32) Cecilia A Lynch........................................................................ Vice President, Nursing/CNO	55.00 .......................5.00			X		69,246	3,617
(33) Donald J McLaughlin........................................................................ Vice President Facility and Support	55.00 .......................0.00			X		189,867	31,106
(34) Wendy Rosher........................................................................ Vice President Clinical Services	55.00 .......................0.00			X		246,536	35,234
(35) David Snyder........................................................................ Vice President Information Services	55.00 .......................0.00			X		235,637	145,698
(36) Anoush Koroghlian - Scott........................................................................ VP Legal Affairs & General Counsel	55.00 .......................0.00			X		232,962	14,930
(37) Kelli Valenti........................................................................ VP Strategic Planning/Progam Dev	55.00 .......................0.00			X		191,847	33,250
(38) Roger Barrowman........................................................................ VP/CEO- Ellis Med Group	55.00 .......................0.00			X		433,474	38,217
(39) Kathleen Hale........................................................................ CNO	55.00 .......................0.00			X		214,476	31
(40) Terence Clarke MD........................................................................ Surgeon	50.00 .......................0.00				X	678,296	77,608
(41) Frank Genovese MD........................................................................ Neurosurgeon	50.00 .......................0.00				X	715,462	47,933
(42) Chanderdeep Singh MD........................................................................ Cardiothoracic Sur	50.00 .......................0.00				X	548,355	79,896
(43) Herbert Reich MD........................................................................ Surgeon-Cardiothor	50.00 .......................0.00				X	637,388	75,173
(44) Paul Spurgas MD........................................................................ Neurosurgeon	50.00 .......................0.00				X	838,895	40,408

(A) Name and business address	(B) Description of services	(C) Compensation
Clarus Linen Systems - Atlas 60 Grider Street Buffalo,NY14215	Linen / Laundry Svc	1,965,440
Smith & Jones 297 River Street Troy,NY12180	Marketing	1,083,068
OB Hospitalist Group 10 Centimeters Drive Mauldin,SC29662	Medical	1,109,636
Staff Care PO Box 281923 Atlanta,GA303841923	Staffing Agency	980,348
Schenectady Pulmonary 124 Rosa Rd Suite 382 Schenectady,NY12308	Physician Service	1,172,393
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 61

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 domestic organizations and domestic governments. See Part IV, line 21 ....	0
2	Grants and other assistance to domestic individuals. See Part IV, line 22 ....	55,697	55,697
3	Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16 ............	0
4	Benefits paid to or for members ....	0
5	Compensation of current officers, directors, trustees, and key employees ....	4,824,964	274,985	4,549,979
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....	0
7	Other salaries and wages ....	180,849,345	161,053,436	19,795,909
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	7,336,022	6,590,769	745,253
9	Other employee benefits .......	12,192,461	10,869,983	1,322,478
10	Payroll taxes ...........	13,186,694	11,493,011	1,693,683
11	Fees for services (non-employees):
a	Management ......	1,508,023	1,508,023
b	Legal .........	374,177		374,177
c	Accounting ...........	212,996		212,996
d	Lobbying ...........	47,962		47,962
e	Professional fundraising services. See Part IV, line 17	0
f	Investment management fees ......	320,148		320,148
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) ....	6,942,329	6,336,240	606,089
12	Advertising and promotion ....	1,602,629	3,112	1,599,517
13	Office expenses .......	62,502,054	60,252,401	2,249,653
14	Information technology ......	3,920,104		3,920,104
15	Royalties ..	0
16	Occupancy ...........	10,144,120	8,826,726	1,317,394
17	Travel ............	1,341,934	1,075,516	266,418
18	Payments of travel or entertainment expenses for any federal, state, or local public officials ......	0
19	Conferences, conventions, and meetings ....	0
20	Interest ...........	1,144,457	1,144,457
21	Payments to affiliates .......	0
22	Depreciation, depletion, and amortization .....	16,543,343	14,634,255	1,909,088
23	Insurance ..............	4,440,347		4,440,347
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	Purchased Services	17,137,109	12,662,722	4,474,387
b	Equip Rental/Maint	12,878,484	8,856,356	4,022,128
c	Bad Debt Expense	8,164,980	8,164,980
d	Other Fees-Non Medical	3,083,273	690,572	2,392,701
e	All other expenses	3,602,994	278,944	3,324,050
25	Total functional expenses. Add lines 1 through 24e	374,356,646	314,772,185	59,584,461	0
26	Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here if following SOP 98-2 (ASC 958-720).

Part X Balance Sheet Check if Schedule O contains a response or note to any line in this Part X ..............
	1	Cash–non-interest-bearing .............	15,377	1	15,792
2	Savings and temporary cash investments .........	17,675,796	2	26,817,361
3	Pledges and grants receivable, net ...........		3	0
4	Accounts receivable, net .............	32,233,432	4	29,834,538
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	0
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L
			6	0
7	Notes and loans receivable, net .............	310,900	7	127,567
8	Inventories for sale or use ..............	5,977,039	8	6,620,973
9	Prepaid expenses and deferred charges ..........	1,583,337	9	1,978,239
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	438,428,017
b	Less: accumulated depreciation .....	10b	257,725,064	162,633,118	10c	180,702,953
11	Investments—publicly traded securities ..........	52,868,438	11	60,245,008
12	Investments—other securities. See Part IV, line 11 .....		12	0
13	Investments—program-related. See Part IV, line 11 .....		13	0
14	Intangible assets ...............		14	0
15	Other assets. See Part IV, line 11 ...........	31,027,238	15	22,372,010
16	Total assets. Add lines 1 through 15 (must equal line 34)......	304,324,675	16	328,714,441
	17	Accounts payable and accrued expenses .........	29,936,205	17	26,332,191
18	Grants payable .................		18
19	Deferred revenue ................	157,619	19	157,619
20	Tax-exempt bond liabilities .............	22,501,438	20	6,598,339
21	Escrow or custodial account liability. Complete Part IV of Schedule D..	100,002	21	106,951
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 ..	58,249,657	23	95,410,665
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....................	41,435,167	25	53,909,401
26	Total liabilities. Add lines 17 through 25.........	152,380,088	26	182,515,166
		Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets ..............	136,965,014	27	130,541,705
28	Temporarily restricted net assets ...........	9,369,152	28	9,904,048
29	Permanently restricted net assets ...........	5,610,421	29	5,753,522
	Organizations that do not follow SFAS 117 (ASC 958), check here and complete lines 30 through 34.
30	Capital stock or trust principal, or current funds ........		30
31	Paid-in or capital surplus, or land, building or equipment fund .....		31
32	Retained earnings, endowment, accumulated income, or other funds		32
33	Total net assets or fund balances ...........	151,944,587	33	146,199,275
34	Total liabilities and net assets/fund balances ........	304,324,675	34	328,714,441

- TIN:

SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service

Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section 4947(a)(1) nonexempt charitable trust.
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Attach to Form 990 or Form 990-EZ.
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Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2014

Open to Public
Inspection

Name of the organization

Ellis Hospital

Employer identification number

14-1338428

Part I

Reason for Public Charity Status (All organizations must complete this part.) See instructions.

The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)

A church, convention of churches, or association of churches described in section 170(b)(1)(A)(i).

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E.)

A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).

A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital's name, city, and state:

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in

section 170(b)(1)(A)(iv). (Complete Part II.)

A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in section 170(b)(1)(A)(vi). (Complete Part II.)

A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)

An organization that normally receives: (1) more than 331/3% of its support from contributions, membership fees, and gross

receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of

its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses

acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)

An organization organized and operated exclusively to test for public safety. See section 509(a)(4).

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box in lines 11a through 11d that describes the type of supporting organization and complete lines 11e, 11f, and 11g.

Type I. A supporting organization operated, supervised, or controlled by its supported organization(s), typically by giving the supported organization(s) the power to regularly appoint or elect a majority of the directors or trustees of the supporting organization. You must complete Part IV, Sections A and B.

Type II. A supporting organization supervised or controlled in connection with its supported organization(s), by having control or management of the supporting organization vested in the same persons that control or manage the supported organization(s). You must complete Part IV, Sections A and C.

Type III functionally integrated. A supporting organization operated in connection with, and functionally integrated with, its supported organization(s) (see instructions). You must complete Part IV, Sections A, D, and E.

Type III non-functionally integrated. A supporting organization operated in connection with its supported organization(s) that is not functionally integrated. The organization generally must satisfy a distribution requirement and an attentiveness requirement (see instructions). You must complete Part IV, Sections A and D, and Part V.

Check this box if the organization received a written determination from the IRS that it is a Type I, Type II, Type III functionally integrated, or Type III non-functionally integrated supporting organization.

Enter the number of supported organizations .............................

Provide the following information about the supported organization(s).

(i)Name of supported organization	(ii) EIN	(iv) Is the organization listed in your governing document?		(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)
(i)Name of supported organization	(ii) EIN	Yes	No	(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)


Total

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

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2014

Page 2

Part II

Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2010	(b) 2011	(c) 2012	(d) 2013	(e) 2014	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....
2	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......
3	The value of services or facilities furnished by a governmental unit to the organization without charge..
4	Total. Add lines 1 through 3
5	The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
6	Public support. Subtract line 5 from line 4.

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2010	(b) 2011	(c) 2012	(d) 2013	(e) 2014	(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 VI.)..
11	Total support Add lines 7 through 10.

Gross receipts from related activities, etc. (see instructions) ..................

First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here........................................ right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2014 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2013 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2014. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization ....................... right arrow

33 1/3% support test—2013. If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2014. If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain
in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization ..................................................... right arrow

10%-facts-and-circumstances test—2013. If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly
supported organization ................................................ right arrow

Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ..................................................... right arrow

Schedule A (Form 990 or 990-EZ) 2014

Page 3

Part III

Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 9 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2010	(b) 2011	(c) 2012	(d) 2013	(e) 2014	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2	Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......
3	Gross receipts from activities that are not an unrelated trade or business under section 513..
4	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5	The value of services or facilities furnished by a governmental unit to the organization without charge..
6	Total. Add lines 1 through 5.
7a	Amounts included on lines 1, 2, and 3 received from disqualified persons...
b	Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c	Add lines 7a and 7b..
8	Public support (Subtract line 7c from line 6.)

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2010	(b) 2011	(c) 2012	(d) 2013	(e) 2014	(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 VI.) ..
13	Total support. (Add lines 9, 10c, 11, and 12.)..

First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization,
check this box and stop here............................................. right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2014 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2013 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2014 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2013 Schedule A, Part III, line 17 .............

19a

33 1/3% support tests—2014. If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ....... right arrow

33 1/3% support tests—2013. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .... right arrow

Private foundation. If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions .... right arrow

Schedule A (Form 990 or 990-EZ) 2014

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 11 of Part I. If you checked 11a of Part I, complete Sections A and B. If you checked 11b of Part I, complete Sections A and C. If you checked 11c of Part I, complete Sections A, D, and E. If you checked 11d of Part I, complete Sections A and D, and complete Part V.)

Section A. All Supporting Organizations

Yes

Are all of the organization’s supported organizations listed by name in the organization’s governing documents?
If "No," describe in Part VI how the supported organizations are designated. If designated by class or purpose,
describe the designation. If historic and continuing relationship, explain.

Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or (2)? If "Yes," explain in Part VI how the organization determined that the supported organization was described in section 509(a)(1) or (2).

Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer (b) and (c) below.

Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the public support tests under section 509(a)(2)? If "Yes," describe in Part VI when and how the organization made the determination.

Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) purposes? If "Yes," explain in Part VI what controls the organization put in place to ensure such use.

Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked 11a or 11b in Part I, answer (b) and (c) below.

Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? If “Yes,” describe in Part VI how the organization had such control and discretion despite being controlled or supervised by or in connection with its supported organizations....

Did the organization support any foreign supported organization that does not have an IRS determination under sections 501(c)(3) and 509(a)(1) or (2)? If “Yes,” explain in Part VI what controls the organization used to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B) purposes.

Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer (b) and (c) below (if applicable). Also, provide detail in Part VI, including (i) the names and EIN numbers of the supported organizations added, substituted, or removed, (ii) the reasons for each such action, (iii) the authority under the organization's organizing document authorizing such action, and (iv) how the action was accomplished (such as by amendment to the organizing document).

Type I or Type II only. Was any added or substituted supported organization part of a class already designated in the organization's organizing document?

Substitutions only. Was the substitution the result of an event beyond the organization's control?

Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (a) its supported organizations; (b) individuals that are part of the charitable class benefited by one or more of its supported organizations; or (c) other supporting organizations that also support or benefit one or more of the filing organization’s supported organizations? If “Yes,” provide detail in Part VI.

Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (defined in IRC 4958(c)(3)(C)), a family member of a substantial contributor, or a 35-percent controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990) .

Did the organization make a loan to a disqualified person (as defined in section 4958) not described in line 7? If “Yes,” complete Part II of Schedule L (Form 990).

Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons as defined in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or (2))? If “Yes,” provide detail in Part VI.

Did one or more disqualified persons (as defined in line 9(a)) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.

Did a disqualified person (as defined in line 9(a)) have an ownership interest in, or derive any personal benefit from, assets in which the supporting organization also had an interest? If “Yes,” provide detail in Part VI.

10a

Was the organization subject to the excess business holdings rules of IRC 4943 because of IRC 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer b below.

10a

Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to determine whether the organization had excess business holdings).

10b

Has the organization accepted a gift or contribution from any of the following persons?

A person who directly or indirectly controls, either alone or together with persons described in (b) and (c) below, the governing body of a supported organization?

11a

A family member of a person described in (a) above?

11b

A 35% controlled entity of a person described in (a) or (b) above? If “Yes” to a, b, or c, provide detail in Part VI.

11c

Schedule A (Form 990 or 990-EZ) 2014

Page 5

Part IV

Supporting Organizations (continued)

Section B. Type I Supporting Organizations

Yes

Did the directors, trustees, or membership of one or more supported organizations have the power to regularly appoint or elect at least a majority of the organization’s directors or trustees at all times during the tax year? If “No,” describe in Part VI how the supported organization(s) effectively operated, supervised, or controlled the organization’s activities. If the organization had more than one supported organization, describe how the powers to appoint and/or remove directors or trustees were allocated among the supported organizations and what conditions or restrictions, if any, applied to such powers during the tax year.

Did the organization operate for the benefit of any supported organization other than the supported organization(s) that operated, supervised, or controlled the supporting organization? If “Yes,” explain in Part VI how providing such benefit carried out the purposes of the supported organization(s) that operated, supervised or controlled the supporting organization.

Section C. Type II Supporting Organizations

Yes

Were a majority of the organization’s directors or trustees during the tax year also a majority of the directors or trustees of each of the organization’s supported organization(s)? If “No,” describe in Part VI how control or management of the supporting organization was vested in the same persons that controlled or managed the supported organization(s).

Section D. All Type III Supporting Organizations

Yes

Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s tax year, (1) a written notice describing the type and amount of support provided during the prior tax year, (2) a copy of the Form 990 that was most recently filed as of the date of notification, and (3) copies of the organization’s governing documents in effect on the date of notification, to the extent not previously provided?

Were any of the organization’s officers, directors, or trustees either (i) appointed or elected by the supported organization(s) or (ii) serving on the governing body of a supported organization? If "No," explain in Part VI how the organization maintained a close and continuous working relationship with the supported organization(s).

By reason of the relationship described in (2), did the organization’s supported organizations have a significant voice in the organization’s investment policies and in directing the use of the organization’s income or assets at all times during the tax year? If "Yes," describe in Part VI the role the organization’s supported organizations played in this regard.

Section E. Type III Functionally-Integrated Supporting Organizations

Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):

The organization satisfied the Activities Test. Complete line 2 below.

The organization is the parent of each of its supported organizations. Complete line 3 below.

The organization supported a governmental entity. Describe in Part VI how you supported a government entity (see instructions)

Activities Test. Answer (a) and (b) below.

Yes

Did substantially all of the organization’s activities during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was responsive? If "Yes," then in Part VI identify those supported organizations and explain how these activities directly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these activities constituted substantially all of its activities.

Did the activities described in (a) constitute activities that, but for the organization’s involvement, one or more of the organization’s supported organization(s) would have been engaged in? If "Yes," explain in Part VI the reasons for the organization’s position that its supported organization(s) would have engaged in these activities but for the organization’s involvement.

Parent of Supported Organizations. Answer (a) and (b) below.

Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations? Provide details in Part VI.

Did the organization exercise a substantial degree of direction over the policies, programs and activities of each of its supported organizations? If "Yes," describe in Part VI the role played by the organization in this regard.

Schedule A (Form 990 or 990-EZ) 2014

Page 6

Part V – Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations

1. Check here if the organization satisfied the Integral Part Test as a qualifying trust on Nov. 20, 1970. See instructions. All other Type III non-functionally integrated supporting organizations must complete Sections A through E.

	Section A - Adjusted Net Income		(A) Prior Year	(B) Current Year (optional)
1	Net short-term capital gain	1
2	Recoveries of prior-year distributions	2
3	Other gross income (see instructions)	3
4	Add lines 1 through 3	4
5	Depreciation and depletion	5
6	Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions)	6
7	Other expenses (see instructions)	7
8	Adjusted Net Income (subtract lines 5, 6 and 7 from line 4)	8

	Section B - Minimum Asset Amount		(A) Prior Year	(B) Current Year (optional)
1	Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year):	1
a	Average monthly value of securities	1a
b	Average monthly cash balances	1b
c	Fair market value of other non-exempt-use assets	1c
d	Total (add lines 1a, 1b, and 1c)	1d
e	Discount claimed for blockage or other factors (explain in detail in Part VI):
2	Acquisition indebtedness applicable to non-exempt use assets	2
3	Subtract line 2 from line 1d	3
4	Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions).	4
5	Net value of non-exempt-use assets (subtract line 4 from line 3)	5
6	Multiply line 5 by .035	6
7	Recoveries of prior-year distributions	7
8	Minimum Asset Amount (add line 7 to line 6)	8

	Section C - Distributable Amount		Current Year
1	Adjusted net income for prior year (from Section A, line 8, Column A)	1
2	Enter 85% of line 1	2
3	Minimum asset amount for prior year (from Section B, line 8, Column A)	3
4	Enter greater of line 2 or line 3	4
5	Income tax imposed in prior year	5
6	Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions)	6
7	Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions)

Schedule A (Form 990 or 990-EZ) 2014

Page 7

Section D - Distributions		Current Year
1 Amounts paid to supported organizations to accomplish exempt purposes
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity
3 Administrative expenses paid to accomplish exempt purposes of supported organizations
4 Amounts paid to acquire exempt-use assets
5 Qualified set-aside amounts (prior IRS approval required)
6 Other distributions (describe in Part VI). See instructions
7Total annual distributions. Add lines 1 through 6.
8 Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions
9 Distributable amount for 2014 from Section C, line 6
10 Line 8 amount divided by Line 9 amount

Section E - Distribution Allocations (see instructions)		(i) Excess Distributions	(ii) Underdistributions Pre-2014	(iii) Distributable Amount for 2014
1 Distributable amount for 2014 from Section C, line 6
2 Underdistributions, if any, for years prior to 2014 (reasonable cause required--see instructions)
3 Excess distributions carryover, if any, to 2014:
a From 2009.......X
b From 2010.......X
c From 2011.......X
d From 2012.......X
e From 2013.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2014 distributable amount
i Carryover from 2009 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from 3f.
4Distributions for 2014 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2014 distributable amount
c Remainder. Subtract lines 4a and 4b from 4.
5 Remaining underdistributions for years prior to 2014, if any. Subtract lines 3g and 4a from line 2 (if amount greater than zero, see instructions)
6 Remaining underdistributions for 2014. Subtract lines 3h and 4b from line 1 (if amount greater than zero, see instructions)
7 Excess distributions carryover to 2015. Add lines 3j and 4c.
8 Breakdown of line 7:
a From 2010.......X
b From 2011.......X
c From 2012.......X
d From 2013.......
e From 2014.......

Schedule A (Form 990 or 990-EZ) (2014)

Schedule A (Form 990 or 990-EZ) 2014

Page 8

Part VI

Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; Part III, line 12; Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11a, 11b, and 11c; Part IV, Section B, lines 1 and 2; Part IV, Section C, line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 1c, 2a, 2b, 3a and 3b; Part V, line 1; Part V, Section B, line 1e; Part V Section D, lines 5, 6, and 8; and Part V, Section E, lines 2, 5, and 6. Also complete this part for any additional information. (See instructions).

Facts And Circumstances Test

Return Reference	Explanation

Schedule A (Form 990 or 990-EZ) 2014

Additional Data

Software ID:	14000265
Software Version:	2014v5.0

- TIN:

Schedule B
(Form 990, 990-EZ,
or 990-PF)

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

Attach to Form 990, 990-EZ, or 990-PF.

Information about Schedule B (Form 990, 990-EZ, or 990-PF) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2014

Name of the organization

Ellis Hospital

Employer identification number

14-1338428

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

4947(a)(1) nonexempt charitable trust not treated as a private foundation

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

4947(a)(1) nonexempt charitable trust treated as a private foundation

501(c)(3) taxable private foundation

Check if your organization is covered by the General Rule or a Special Rule.
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.

General Rule

For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, contributions totaling $5,000 or more (in money or
property) from any one contributor. Complete Parts I and II. See instructions for determining a contributor's total contributions.

Special Rules

For an organization described in section 501(c)(3) filing Form 990 or 990-EZ that met the 33¹/3% support test of the regulations
under sections 509(a)(1) and 170(b)(1)(A)(vi), that checked Schedule A (Form 990 or 990-EZ), Part II, line 13, 16a, or 16b, and that received from any one contributor, during the year, total contributions of the greater of (1) $5,000 or (2) 2% of the amount on (i) Form 990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts I and II.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, total contributions of more than $1,000 exclusively for religious, charitable, scientific, literary, or educational purposes, or for the prevention of cruelty to children or animals. Complete Parts I, II, and III.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, contributions exclusively for religious, charitable, etc., purposes, but no such contributions totaled more than $1,000. If this box is checked, enter here the total contributions that were received during the year for an exclusively religious, charitable, etc., purpose. Do not complete any of the parts unless the General Rule applies to this organization because it received nonexclusively religious, charitable, etc., contributions totaling $5,000 or more during the year ......... Arrow Bullet

Caution. An organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its
Form 990-EZ or on 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) (2014)

Schedule B (Form 990, 990-EZ, or 990-PF) (2014)

Page 2

Name of organization Ellis Hospital

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	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2014)

Schedule B (Form 990, 990-EZ, or 990-PF) (2014)

Page 3

Name of organization Ellis Hospital

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) (2014)

Schedule B (Form 990, 990-EZ, or 990-PF) (2014)

Page 4

Name of organization
Ellis Hospital

Employer identification number

14-1338428

Part III

Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10)
that total more than $1,000 for the year from any one contributor. Complete columns (a) through (e) and the following line entry. For organizations completing Part III, enter the total of exclusively religious, charitable, etc., contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet

$
Use duplicate copies of Part III if additional space is needed.

(a) No.
from
Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a) No.
from
Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a) No.
from
Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a) No.
from
Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

Schedule B (Form 990, 990-EZ, or 990-PF) (2014)

Additional Data

Software ID:	14000265
Software Version:	2014v5.0

- TIN:

SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527
SchCMd Bullet

Complete if the organization is described below. SchCMd Bullet

Attach to Form 990 or Form 990-EZ.
SchCMd Bullet

Information about Schedule C (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2014

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) (see separate instructions) or Form 990-EZ, Part V, line 35c (Proxy Tax) (see separate instructions), then
Round Bullet

Section 501(c)(4), (5), or (6) organizations: Complete Part III.

Name of the organization

Ellis Hospital

Employer identification number

14-1338428

Part I-A

Complete if the organization is exempt under section 501(c) or is a section 527 organization.

Provide a description of the organization’s direct and indirect political campaign activities in Part IV.

Political expenditures .................................... SchCMd Bullet

Volunteer hours ........................................

Part I-B

Complete if the organization is exempt under section 501(c)(3).

Enter the amount of any excise tax incurred by the organization under section 4955 ......... SchCMd Bullet

Enter the amount of any excise tax incurred by organization managers under section 4955 ...... SchCMd Bullet

If the organization incurred a section 4955 tax, did it file Form 4720 for this year? ..............

Yes No

Was a correction made? .........................................

Yes No

If "Yes," describe in Part IV.

Part I-C

Complete if the organization is exempt under section 501(c), except section 501(c)(3).

Enter the amount directly expended by the filing organization for section 527 exempt function activities SchCMd Bullet

Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ................................... SchCMd Bullet

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

Did the filing organization file Form 1120-POL for this year? ..........................

Yes No

Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.

(a) Name	(b) Address	(c) EIN	(d) Amount paid from filing organization's funds. If none, enter -0-.	(e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.

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

Cat. No. 50084S

Schedule C (Form 990 or 990-EZ) 2014

Page 2

Part II-A

Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).

A Check SchCMd Bullet

if the filing organization belongs to an affiliated group (and list in Part IV each affiliated group member's name, address, EIN, expenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet

if the filing organization checked box A and "limited control" provisions apply.

Limits on Lobbying Expenditures (The term "expenditures" means amounts paid or incurred.)		(b) Affiliated group totals
1a	Total lobbying expenditures to influence public opinion (grass roots lobbying) ......
b	Total lobbying expenditures to influence a legislative body (direct lobbying) .......
c	Total lobbying expenditures (add lines 1a and 1b) ...................
d	Other exempt purpose expenditures ........................
e	Total exempt purpose expenditures (add lines 1c and 1d) ...............
f	Lobbying nontaxable amount. Enter the amount from the following table in both columns.
	If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:
	Not over $500,00020% of the amount on line 1e.
	Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.
	Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.
	Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.
	Over $17,000,000$1,000,000.

g	Grassroots nontaxable amount (enter 25% of line 1f) .................
h	Subtract line 1g from line 1a. If zero or less, enter -0-. ................
i	Subtract line 1f from line 1c. If zero or less, enter -0-. ................
j	If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting section 4911 tax for this year? ......................................	Yes No

4-Year Averaging Period Under section 501(h) (Some organizations that made a section 501(h) election do not have to complete all of the five columns below. See the separate instructions for lines 2a through 2f.)
Lobbying Expenditures During 4-Year Averaging Period
	Calendar year (or fiscal year beginning in)	(a) 2011	(b) 2012	(c) 2013	(d) 2014	(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) 2014

Page 3

Part II-B

Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).

For each "Yes" response to lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.

(a)

Yes

(b)

Amount

During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:

Volunteers? .........................................

Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ....

Media advertisements? ....................................

Mailings to members, legislators, or the public? .........................

Publications, or published or broadcast statements? .......................

Grants to other organizations for lobbying purposes? .......................

Direct contact with legislators, their staffs, government officials, or a legislative body? ........

Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ......

Other activities? ..........................

Yes

47,962

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

47,962

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

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

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

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

Part III-A

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

Yes

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

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

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

Part III-B

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

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

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

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

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

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

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

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

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

Part IV

Supplemental Information

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, lines 1 and 2 (see instructions), and Part ll-B, line 1. Also, complete this part for any additional information.

Return Reference	Explanation
Part II-B, Line 1i - Other Activities Description	Ellis Hospital pays dues to the Healthcare Association of New York State, Iroquois Healthcare Alliance, and American Hospital Association. The portion of the dues that were attributable to lobbying activities are shown on form 990, Part IX, Line 11 D and above in Schedule C, Part II-B, Line 1i.

Schedule C (Form 990 or 990EZ) 2014

Additional Data

Software ID:	14000265
Software Version:	2014v5.0

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," to Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b.
SchDMd Bullet

Attach to Form 990.
Information about Schedule D (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2014

Open to Public Inspection

Name of the organization

Ellis Hospital

Employer identification number

14-1338428

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 value of contributions to (during year)
3	Aggregate value of grants from (during year)
4	Aggregate value at end of year ........

Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ............

Yes No

Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................

Yes No

Part II

Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.

Purpose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e.g., recreation or education) Preservation of an historically important land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.


a	Total number of conservation easements .......................	2a
b	Total acreage restricted by conservation easements ..................	2b
c	Number of conservation easements on a certified historic structure included in (a) .....	2c
d	Number of conservation easements included in (c) acquired after 8/17/06, and not on a historic structure listed in the National Register ....................	2d

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the tax year SchDMd Bullet

Number of states where property subject to conservation easement is located SchDMd Bullet

Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................

Yes No

Staff and volunteer hours devoted to monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet

Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .......................................

Yes No

In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" to Form 990, Part IV, line 8.

If the organization elected, as permitted under SFAS 116 (ASC 958), not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII, the text of the footnote to its financial statements that describes these items.

If the organization elected, as permitted under SFAS 116 (ASC 958), to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items:

(i)

Revenue included in Form 990, Part VIII, line 1 ........................ SchDMd Bullet

(ii)

Assets included in Form 990, Part X .............................. SchDMd Bullet

If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 (ASC 958) relating to these items:

Revenue included in Form 990, Part VIII, line 1 .......................... SchDMd Bullet

Assets included in Form 990, Part X ............................... SchDMd Bullet

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

Cat. No. 52283D

Schedule D (Form 990) 2014

Page 2

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)

Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.

During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?........

Yes No

Part IV

Escrow and Custodial Arrangements. Complete if the organization answered "Yes" to Form 990,
Part IV, line 9, or reported an amount on Form 990, Part X, line 21.

Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................

Yes No

If "Yes," explain the arrangement in Part XIII and complete the following table:


c	Beginning balance .................................	1c
d	Additions during the year ..............................	1d
e	Distributions during the year .............................	1e
f	Ending balance ...................................	1f

Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability?

Yes No

If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII .......

Part V

Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.

		(a)Current year	(b)Prior year	b (c)Two years back	(d)Three years back	(e)Four years back
1a	Beginning of year balance ....	5,610,421	5,449,599	5,208,275	3,969,599	3,919,510
b	Contributions ........
c	Net investment earnings, gains, and losses	143,101	160,822	241,324	1,238,676	50,089
d	Grants or scholarships .....
e	Other expenditures for facilities and programs ........
f	Administrative expenses ....
g	End of year balance ......	5,753,522	5,610,421	5,449,599	5,208,275	3,969,599

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

Board designated or quasi-endowment SchDMd Bullet

Permanent endowment SchDMd Bullet

Temporarily restricted endowment SchDMd Bullet

The percentages in lines 2a, 2b, and 2c should equal 100%.

Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes

(i) unrelated organizations ........................

3a(i)

Yes

(ii) related organizations ........................

3a(ii)

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

Describe in Part XIII the intended uses of the organization's endowment funds.

Part VI

Land, Buildings, and Equipment. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11a. See Form 990, Part X, line 10.

Description of property		(b)Cost or other basis (other)	(c) Accumulated depreciation	(d) Book value
1a	Land .................	6,474,443		6,474,443
b	Buildings ................	183,558,835	76,828,649	106,730,186
c	Leasehold improvements ............	1,316,425	1,101,308	215,117
d	Equipment ................	240,434,226	179,795,107	60,639,119
e	Other .................	6,644,088		6,644,088
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......				180,702,953

Schedule D (Form 990) 2014

Page 3

Part VII

InvestmentsOther 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
Other








Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

Part VIII

InvestmentsProgram 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.)

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) Accrued interest receivable				-196,513
(2) Allowance Uncollectable				-538,975
(3) Deferred financing costs				1,528,034
(4) DSH for OP Mental Health				826,481
(5) Due from Foundation				78,792
(6) Grant receivable				584,576
(7) IHANY				55,540
(8) Interest in Net Assets of Foundation				17,575,660
(9) Meaningful Use Receivable				478,205
(10) MIsc				12,801
(11) Miscellaneous receivables				1,095,508
(12) Pension Assets
(13) Rent receivable				133,925
(14) Security Deposits				146,658
(15) Yankee Alliance investment				591,318
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........				22,372,010

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
Accrued interest payable		176,580
Accrued pension		11,094,737
Accrued post retirement benefits		215,572
Accrued sick payable		6,997,711
Accrued vacation payable		9,518,895
Asset retirement obligation		894,986
Claims payable		1,920,301
DEF Con payable - employer		211,161
Employee withholdings		602,863
Estimated payables to 3rd Party Payers		5,619,513
Estimated self-insurance		14,575,816
Retainage payable		2,081,266
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)		53,909,401
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) 2014

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	360,766,502
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains (losses) on investments ....	2a	-2,057,167
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIII.) ............	2d	-25,627,046
e	Add lines 2a through 2d .....................			2e	-27,684,213
3	Subtract line 2e from line 1.....................			3	388,450,715
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	-320,148
b	Other (Describe in Part XIII.) ...........	4b
c	Add lines 4a and 4b.......................			4c	-320,148
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......			5	388,130,567

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	366,511,814
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	-8,164,980
e	Add lines 2a through 2d......................			2e	-8,164,980
3	Subtract line 2e from line 1.....................			3	374,676,794
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	-320,148
b	Other (Describe in Part XIII.) ............	4b
c	Add lines 4a and 4b.......................			4c	-320,148
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......			5	374,356,646

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 IV, Line 2b: Explanation of escrow account liability	The Ellis Residential and Rehabilitation Center residents spending account is included in line 2 and line 21 on Schedule X. The total is $6,578. These funds belong to the residents and are deposited and disbursed by the Ellis Residential and Rehabilitation Director's designee. The Ellis Hospital Accounting Department is responsible for tracking the funds.Medical/Dental Staff Dues Account is included in line 2 and line 21 on Schedule X. The total is $102353. This fund contains deposits and disbursements as directed by the Medical/Dental Staff appointed officers. The Ellis Hospital Accounting department is responsible for depositing and disbursing the funds on the Medical/Dental officer's behalf. The accounting department also issues IRS form 1099 based on the disbursements.
Part V, Line 4: Intended uses of the endowment fund.	Permanently Restricted Net Assets (Endowment Funds) are investments to be held in perpetuity, the income from which is expendable to support health care services (reported as Other Operating Revenue). These Net Assets amounted to $477,514 at 12/31/2014. The remaining amount of $5,276,008 are Net Assets held by the Foundation (including $1,341,054 for beneficial interest in perpetual trusts). Grand total was $5,753,522.
Part X : FIN48 Footnote	The Hospital recognizes the effect of income tax positions only if those positions are more likely than not of being sustained. Recognized income tax positions are measured at the largest amounts that is greater than fifty percent likely of being realized upon settlement. Changes in recognition in measurement are reflected in the period in which the change in judgment occurs. The Hospital did not recognize the effect of any uncertain income tax positions in either 2014 or 2013.

Schedule D (Form 990) 2014

Additional Data

Software ID:	14000265
Software Version:	2014v5.0

- TIN:

SCHEDULE H (Form 990)

Department of the TreasuryInternal Revenue Service

Hospitals

Complete if the organization answered "Yes" to Form 990, Part IV, question 20.
MediumBullet

Attach to Form 990.
MediumBullet

Information about Schedule H (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2014

Open to Public Inspection

Name of the organization

Ellis Hospital

Employer identification number

14-1338428

Part I

Financial Assistance and Certain Other Community Benefits at Cost

Yes

Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a ...

Yes

If "Yes," was it a written policy? .......................

Yes

If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.

Applied uniformly to all hospital facilities Applied uniformly to most hospital facilities Generally tailored to individual hospital facilities

Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.

Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?

If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:

Yes

100% 150% 200% Other 30000.0000000 %

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: .........

200% 250% 300% 350% 400% Other %

If the organization used factors other than FPG in determining eligibility, describe in Part VI the criteria used for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.

Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? ..............

Yes

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

Yes

If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? ......

Yes

If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? ..............

Did the organization prepare a community benefit report during the tax year? ..........

Yes

If "Yes," did the organization make it available to the public? ..............

Yes

Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.

Financial Assistance and Certain Other Community Benefits at Cost

Financial Assistance and Means-Tested Government Programs		(c) Total community benefit expense	(d) Direct offsetting revenue	(e) Net community benefit expense	(f) Percent of total expense
a	Financial Assistance at cost (from Worksheet 1) ..	2,612,058	262,929	2,349,129	0.630 %
b	Medicaid (from Worksheet 3, column a) ....	73,437,575	60,321,580	13,115,995	3.500 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) .
d	Total Financial Assistance and Means-Tested Government Programs .	76,049,633	60,584,509	15,465,124	4.130 %
Other Benefits		292,843		292,843	0.080 %
e	Community health improvement services and community benefit operations (from Worksheet 4) ..	292,843		292,843	0.080 %
f	Health professions education (from Worksheet 5) ..	12,023,590	3,820,292	8,203,298	2.240 %
g	Subsidized health services (from Worksheet 6) ..	429,107		429,107	0.120 %
h	Research (from Worksheet 7)
i	Cash and in-kind contributions for community benefit (from Worksheet 8)
j	Total. Other Benefits ..	12,745,540	3,820,292	8,925,248	2.440 %
k	Total. Add lines 7d and 7j .	88,795,173	64,404,801	24,390,372	6.570 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2014

Schedule H (Form 990) 2014

Page

Part II

Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.

		(c) Total community building expense	(e) Net community building expense
1	Physical improvements and housing
2	Economic development
3	Community support
4	Environmental improvements
5	Leadership development and training for community members	276	276
6	Coalition building	1,355	1,355
7	Community health improvement advocacy	434	434
8	Workforce development
9	Other
10	Total	2,065	2,065

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................

Yes

Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......

8,164,980

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. ......

1,108,123

Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.

Section B. Medicare

Enter total revenue received from Medicare (including DSH and IME).....

68,287,842

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

69,332,947

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

-1,045,105

Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

Did the organization have a written debt collection policy during the tax year? ..........

Yes

If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI.......................

Yes

Part IV

Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)

(a) Name of entity	(b) Description of primary activity of entity	(c) Organization's profit % or stock ownership %
1Visiting Nurse Svc Assoc	serves home health needs	100.000 %
2
3
4
5
6
7
8
9
10
11
12
13

Schedule H (Form 990) 2014

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 (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility)						Other (describe)
1	Ellis Hospital 1101 Nott Street Schenectady,NY12308 www.ellismedicine.org 4601001H	X	X	X	X	82 Bed Skilled Nursing Facility

Schedule H (Form 990) 2014

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)

	Ellis Hospital
Name of hospital facility or letter of facility reporting group

Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A):

Yes

Community Health Needs Assessment

Was the hospital facility first licensed, registered, or similarly recognized by a State as a hospital facility in the current tax year or the immediately preceding tax year?.......................

Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C..........

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 12....................

Yes

If "Yes," indicate what the CHNA report describes (check all that apply):

A definition of the community served by the hospital facility

Demographics of the community

Existing health care facilities and resources within the community that are available to respond to the health needs of the community

How data was obtained

The significant health needs of the community

Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups

The process for identifying and prioritizing community health needs and services to meet the community health needs

The process for consulting with persons representing the community’s interests

Information gaps that limit the hospital facility’s ability to assess the community’s health needs

Other (describe in Section C)

Indicate the tax year the hospital facility last conducted a CHNA: 20 13

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 Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted .................

Yes

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C................................

Yes

Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................

Yes

Did the hospital facility make its CHNA report widely available to the public? ..............

Yes

If "Yes," indicate how the CHNA report was made widely available (check all that apply):

Hospital facility’s website (list url): http://www.ellismedicine.org/blob/Public

Other website (list url):

Made a paper copy available for public inspection without charge at the hospital facility

Other (describe in Section C)

Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. .............

Yes

Indicate the tax year the hospital facility last adopted an implementation strategy: 20 13

Is the hospital facility's most recently adopted implementation strategy posted on a website? ........

Yes

If "Yes" (list url): http://www.ellismedicine.org/pages/community-report.aspx

If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ......

10b

Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.

12a

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)? ...........................

12a

If "Yes" to line 12a, did the organization file Form 4720 to report the section 4959 excise tax? ......

12b

If "Yes" to line 12b, 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) 2014

Page

Part VFacility Information (continued)

	Ellis Hospital
Name of hospital facility or letter of facility reporting group

Yes

Financial Assistance Policy (FAP)

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 included free or discounted care?

Yes

If “Yes,” indicate the eligibility criteria explained in the FAP:

Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of 300.0000%
and FPG family income limit for eligibility for discounted care of %

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

Explained the basis for calculating amounts charged to patients?.................

Yes

Explained the method for applying for financial assistance?...................

Yes

If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):

Described the information the hospital facility may require an individual to provide as part of his or her application.

Described the supporting documentation the hospital facility may require an individual to submit as part of his or
her application.

Provided the contact information of hospital facility staff who can provide an individual with information about the
FAP and FAP application process.

Provided the contact information of nonprofit organizations or government agencies that may be sources of
assistance with FAP applications.

Other (describe in Section C)

Included measures to publicize the policy within the community served by the hospital facility?.......

Yes

If "Yes," indicate how the hospital facility publicized the policy (check all that apply):

The FAP was widely available on a website (list url):

The FAP application form was widely available on a website (list url):

A plain language summary of the FAP was widely available on a website (list url):

The FAP was available upon request and without charge (in public locations in the hospital facility and by mail)

The FAP application form was available upon request and without charge (in public locations in the hospital facility
and by mail)

A plain language summary of the FAP was available upon request and without charge (in public locations in the
hospital facility and by mail)

Notice of availability of the FAP was conspicuously displayed throughout the hospital facility

Notified members of the community who are most likely to require financial assistance about availability of the FAP

Other (describe in Section C)

Billing and Collections

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 all of the actions the hospital facility or other authorized party may take upon non-payment?..................................

Yes

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:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

None of these actions or other similar actions were permitted

Schedule H (Form 990) 2014

Page

Part VFacility Information (continued)

	Ellis Hospital
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility or other 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?.........

Yes

If "Yes," check all actions in which the hospital facility or a third party engaged:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 18. (check all that apply):

Notified individuals of the financial assistance policy on admission

Notified individuals of the financial assistance policy prior to discharge

Notified individuals of the financial assistance policy in communications with the individuals regarding the individuals’ bills

Documented its determination of whether individuals were eligible for financial assistance under the hospital facility’s financial assistance policy

Other (describe in Section C)

None of these efforts were made

Policy Relating to Emergency Medical Care

Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?................

Yes

If "No," indicate why:

The hospital facility did not provide care for any emergency medical conditions

The hospital facility’s policy was not in writing

The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Section C)

Other (describe in Section C)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)

Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.

The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged

The hospital facility used the average of its three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged

The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged

Other (describe in Section C)

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

If "Yes," explain in Section C.

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

If "Yes," explain in Section C.

Schedule H (Form 990) 2014

Page

Part V

Facility Information (continued)

Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16i, 18d, 19d, 20e, 21c, 21d, 22d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference	Explanation
Part V, Line 5 - Account Input from Persons Who Represent the Community	Yes, the hospital took into account input from persons who represent the broad interests of the community served, including those with special knowledge of or expertise in public health. Meetings in 2012, 2013, and 2014, including listings of the participating community organizations, are listed below:Schenectady Coalition for a Healthy Community (full group)November 15, 2012Topics: Overview of the community assessment project and timeline. Visioning (targets and outcomes), survey topics, and subcommittees. Organize subcommittee for survey questions and development. Establishment of a separate committee of community members (the Community Committee). Open discussion.Attendees: Ellis Medicine, Schenectady County Public Health Services, Schenectady Inner City Ministry, Visiting Nurse Service of Schenectady and Saratoga, Price Chopper Supermarkets, Union Graduate Collage, Schenectady Free Clinic, Schenectady ARC, Schenectady Community Action Program, Schenectady YMCA, Tobacco Free Coalition, League of Women Voters, University at Albany School of Public Health, Cornell Cooperative Extension, Schenectady Municipal Housing Authority, Schenectady County Probation Department, Mohawk Valley Physicians Health Plan, Union Graduate College, HCDI, United Way of the Greater Capital Region, Capital Region BOCESDecember 13, 2012Topics: Naming of the Coalition. Detailed review of the survey goals, targets, and topics. Open discussion.Attendees: Ellis Medicine, Schenectady County Public Health Services, Price Chopper Supermarkets, Schenectady YMCA, Tobacco Free Coalition, University at Albany School of Public Health, Schenectady Free Clinic, Cornell Cooperative Extension, League of Women Voters, Schenectady ARC, Catholic Charities, Northern Rivers (Parsons Center), Schenectady Inner City Ministry, Mohawk Valley Physicians Health Plan, Schenectady County Youth Bureau, Schenectady County Probation DepartmentJanuary 17, 2013Topics: UMatter survey project updates: Schenectady Foundation grant, IRB approval of survey, start date of data collection and kickoff event, Community Health Workers, Student Volunteers, iPads and survey app, spreading the word and ideas for advertisement, venue planning. Update on the HCDI profile and survey. Open discussion.Attendees: Ellis Medicine, Schenectady County Public Health Services, The Chamber of Schenectady County, Schenectady ARC, League of Women Voters, University at Albany School of Public Health, Cornell Cooperative Extension, Catholic Charities Senior Services, Schenectady Inner City Ministry, HCDI, Schenectady County Department of Social Services, Capitol Region BOCES, Schenectady Community Action ProgramMarch 21, 2013Topics: UMatter survey updates including survey progress and venue/event planning. Review of substance of preliminary survey data. Open discussion.Attendees: Ellis Medicine, Schenectady County Public Health Services, Schenectady Inner City Ministry, Schenectady ARC, Mohawk Ambulance, Schenectady Community Action Program, Rehabilitation Support Services, Cornell Cooperative Extension, Capital Region BOCES, University at Albany School of Public Health, independent consultant, The Chamber of Schenectady County, League of Women Voters, Habitat for Humanity, Schenectady Community Action Program, Schenectady County Office of Senior and Long Term Care, Catholic Charities Senior ServicesApril 18, 2013Topics: UMatter survey updates and review of preliminary data. Initial establishment of post-survey analysis and evaluation subcommittees. Report on UMatter website and Facebook page. Open discussion.Attendees: Ellis Medicine, Schenectady County Public Health Services, HCDI, Schenectady Community Action program, League of Women Voters, University at Albany School of Public Health, independent consultant, Schenectady YMCA, Capitol Region BOCES, SAFE, Inc., Schenectady Inner City Ministry, Mohawk Valley Physicians Health Plan, Habitat for Humanity, Schenectady Day Nursery, Catholic Charities Senior Services, Schenectady Municipal Housing Authority, Schenectady ARC, The Chamber of Schenectady County, The Schenectady FoundationMay 16, 2013Topics: Project updates on UMatter survey completion, HCDI data, and CMS Innovation Awards. Establish post-survey analysis and evaluation subcommittees, including meeting schedule. Seek recruitment of additional Coalition partners and attendance at June 20th meeting for presentation of survey results. Availability of Community Health Workers for employment. Open discussion.Attendees: Ellis Medicine, Schenectady County Public Health Services, HCDI, Schenectady Community Action program, League of Women Voters, University at Albany School of Public Health, independent consultant, Schenectady YMCA, Capitol Region BOCES, SAFE, Inc., Schenectady Inner City Ministry, Mohawk Valley Physicians Health Plan, Habitat for Humanity, Schenectady Day Nursery, Catholic Charities Senior Services, Schenectady Municipal Housing Authority, Schenectady ARC, The Chamber of Schenectady County, The Schenectady FoundationJune 20, 2013Topics: Presentation of the initial results of the UMatter survey.Attendees: Ellis Medicine, Schenectady County Public Health Services, CDPHP, Schenectady ARC, University at Albany School of Public Health, Schenectady Free Clinic, Schenectady Day Nursery, The Chamber of Schenectady, Schenectady Community Action Program, Mohawk Ambulance, Tobacco Free Coalition, Schenectady Inner City Ministry, The Schenectady Foundation, Schenectady YMCA, HCDI, Visiting Nurse Service of Schenectady and Saratoga.July 18, 2013Topics: Discussion of work of Strategic Issues Development subcommittee. Voting (Multi-Voting Method) to determine the highest priority community health needs. Open discussion.Attendees: Ellis Medicine, Schenectady County Public Health Services, Schenectady YMCA, Schenectady ARC, University at Albany School of Public Health, Capital Region BOCES, Schenectady Free Clinic, CDPHP, Union Graduate College, Mohawk Ambulance, Schenectady Community Action Program, HCDI, Visiting Nurse Service of Schenectady and Saratoga, Tobacco Free CoalitionAugust 15, 2013Topics: Review recommendations of the Implementation Plan Development subcommittee. Discussion of Action Plan contents for the top five significant community health needs.Attendees: Ellis Medicine, Schenectady County Public Health Services, Tobacco Free Coalition, Seton Health Center for Smoking Cessation, Mohawk Valley Physicians Health Plan, Community Fathers, Schenectady Free Clinic, Schenectady Community Action Program, Bigelow Corners Partnership, Schenectady Day Nursery, Schenectady ARC, Habitat for Humanity, Chamber of Schenectady County, The Schenectady Foundation, Union Graduate College, Schenectady Inner City Ministry, Foundation for Ellis Medicine, CDPHP, HCDI, Schenectady Community Action Program, Schenectady County Office of Community Services, Northeast Parent and Child Society, Schenectady YMCASeptember 19, 2013Topics: Review and comment on draft of CHNA document. Meet new PPACA health insurance navigators for Schenectady County.Attendees: Schenectady County Public Health Services, Ellis Medicine, Schenectady ARC, SCAP Head Start, Bigelow Corners Partnership, University at Albany School of Public Health, Schenectady Free Health Clinic, Habitat for Humanity, Schenectady County Senior and Long Term Care Services, Citizen Action Public Policy and Education Fund, Capital District Tobacco Free Coalition, The Schenectady Foundation, Schenectady League of Women Voters, Center for Smoking Cessation, University at Albany School of Social Welfare, MVP Health Care, Mohawk Ambulance, Schenectady County Department of Social Services, Chamber of Schenectady, Schenectady YMCA, Healthy Capital District Initiative, Schenectady Day Nursery, Catholic Charities Senior Services, Price Chopper SupermarketsOctober 17, 2013Topics: Final review and approval of the Community Action Plan. Particular discussion of upcoming agenda regarding Smoking and Asthma issues. Presentation by Schenectady High School students regarding planned approach to adolescent pregnancy issues.Attendees: Schenectady County Public Health Services, Ellis Medicine, Catholic Charities, League of Women Voters, University at Albany School of Public Health, Visiting Nurse Service of Schenectady and Saratoga Counties, Bigelow Corners Partnership, Union Graduate College, Schenectady Free Health Clinic, The Chamber of Schenectady, Capital District YMCA, Schenectady Inner City Ministry, Mohawk Ambulance, MVP Health Care, Schenectady Community Action Program, Schenectady County Community College, Sunnyview Rehabilitation Hospital, Healthy Capital District Initiative, Capital District Tobacco Free Coalition, The Foundation for Ellis Medicine, Schenectady Day Nursery, Capital District Physicians Health PlanMarch 27, 2014Topics: Care Central care management for Medicaid managed care, 1115 Waiver update, Workgroup updates, Partner updates.Attendees: Cornell Cooperative Exten
Part V, Line 6a - List Other Hospital Facilities that Jointly Conducted Needs Assessment	The portion of the CHNA which includes compiled public health data and information was prepared by the Healthy Capital District Initiative (HCDI), a regional health research and planning entity whose hospital system members include Ellis Medicine, St. Peters Health Partners, and Albany Medical Center
Part V, Line 11 - Explanation of Needs Not Addressed and Reasons Why	We have identified at least one action for each of the needs. In some cases the action is trivial (e.g., staff to attend meetings) but there is some response. Due to time restrictions not all have been resolved but are in process.
Part V, Line 13b - Criteria For Providing Discounted Care If Not FPG	We do not use FPG to determine qualification for our Tier 2 "self pay discount". Tier 2 patients are: (1) uninsured patients residing in Albany, Schenectady, Fulton, Montgomery, Saratoga and Schoharie Counties whose income is above 300% of the Federal Poverty Guideline; (2) uninsured patients residing outside those counties; (3) foreign nationals visiting the area; or (4) students at colleges and universities (less than 26 years old). Emergent/urgent services only. The financial obligation of Tier 2 patients will be based the reduction of charges to the reimbursement rate of our highest volume HMO
Part V, Line 22d - Other Billing Determination of Individuals Without Insurance	Facility: 1All uninsured patients are automatically eligible for a reduction of charges to thereimbusement rate from Ellis's highest volume health maintenance organization.Uninsured patients with income at or below 300% FPG are eligible to recieve charity(free) care.

Schedule H (Form 990) 2014

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?15
Name and address		Type of Facility (describe)
1	Ellis Hospital Mental Health Clinic 216 Lafayette Street Schenectady,NY12305	Mental Health Services
2	Glenville Healthcare Center 115 Saratoga Road Glenville,NY12302	Primary Care Services
3	Ellis Hospital Bariatric Center 2125 River Rd Niskayuna,NY12309	Bariatric Care Services
4	Pelvic Health Center 930 Albany Shaker Road Latham,NY12110	Pelvic Health Services
5	Ellis Hospital Primary Care 1201 Nott Street Schenectady,NY12308	Primary Care Services
6	Ellis Hospital Neurology 1101 Nott Street B6 Schenectady,NY12308	Outpatient Neurology
7	Ellis Hospital PROS Program 216 Lafayette Street Schenectady,NY12308	Mental Health Services
8	Ellis Hospital Rehabilitation Services 650 McClellan Street Schenectady,NY12304	Physical Therapy Services
9	Medical Center of Clifton Park 103 Sitterly Road Clifton Park,NY12065	24/7 emergent care, lab, medical imaging, primary care and specialty services
10	Blood Draw - Niskayuna 2123 River Rd Niskayuna,NY12309	Provide blood draw services
11	Spine and Pain Care 939 RT 146 Clifton Park,NY12065	Spine and Pain Care located in Clifton Park NY
12	Ellis Cushing Medical Arts Building 624 McClellan Street Schenectady,NY12304	Family and Primary care services
13	Ellis Medicine Primary Care - Ballston Spa 990 State Route 67 Ballston Spa,NY12020	Primary Care Medicine
14	Ellis Hospital McClellan St Health Center 600 McClellan Street Schenectady,NY12304	Medical Center
15	Ellis Medicine Primary Care - Malta 2537 Route 9 Malta,NY12020	Primary Care Medicine

Schedule H (Form 990) 2014

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
Part I, Line 3c - Charity Care Eligibility Criteria (FPG Is Not Used)	All uninsured patients are automatically eligible for a reduction of charges to the reimbursement rate from Ellis' highest volume health maintenance organization. Uninsured patients with incomes at or below 300% FPG are eligible to receive charity (free) care.
Part I, Line 7 - Explanation of Costing Methodology	Ellis Hospital used a cost - to - charge ratio derived from our worksheet 2- Ratio of Patient Care Cost to Charges. The adjusted patient care cost is divided by adjusted patient care charges resulting in the ratio.
Part I, Line 7, Column F - Explanation of Bad Debt Expense	In calculating our community benefit percent in column (f), Ellis used total expense reduced by bad debt. In calculating the percent of total expense for line 7 column f, total expense was reduced by bad debt expense of $8,164,980
Part III, Line 2 - Methodology Used To Estimate Bad Debt Expense	The costing methodology used in determining the amounts on Part III, cost to charge ration was applied at 100%. Bad debts already represented as expense on financials therefore no need to apply RCC here.
Part III, Line 9b - Provisions On Collection Practices For Qualified Patients	Ellis Hospital does not use presumptive eligibility for charity care. All patients eligible for charity care must submit an application which is then reviewed by Ellis to verify charity care eligibility. Without a submitted application, charity care is not approved and patients are subject to routine collection efforts as outlined in Ellis' collection policies. However, once approved for charity care, patients balances are eliminated and no collection efforts take place.
Part VI - Needs Assessment	On November 5, 2013, the Board of Trustees of Ellis Hospital adopted by Resolution a Community Health Needs Assessment and associated Implementation Strategy, the latter in the form of a grid. The document is being made widely available on the Ellis Medicine website http://www.ellismedicine.org/pages/community-report.aspx and as a paper copy for public inspection at the administrative office of Ellis Hospital (1101 Nott Street, Schenectady, New York 12308) as of November 15, 2013.Development of this assessment and plan has been a unique undertaking for the Schenectady healthcare and human services community. The document, a consolidated, multi-year, multi-agency, community-wide plan for action to improve the health of people in Schenectady, New York is the result of the combined efforts of 62 organizations. The Schenectady Coalition for a Healthy Community, informed by multiple credible data sources including a door-to-door survey of community residents, developed this assessment and plan to serve the people of the City and County of Schenectady.Three of the top priorities identified in Schenectady are consistent with the three Prevention Agenda priorities of the other Capital Region counties; Albany and Rensselaer. This consistency will enable consideration of a Region-wide approach to implementation strategies.Central to this assessment and plan, the UMatter Schenectady survey consisted of more than 280 questions and was administered to over 2,000 residents of the City of Schenectady between February and May 2013 by Community Health Workers and volunteer college students. In addition to the survey results, this plan was informed by secondary data from such sources as the U.S. Census and the New York State Department of Health, and from specialized data sources including a recent federally-funded study of diabetes in Schenectadys West Indian population.All told, between November 2012 and October 2013 the Coalition held 28 meetings of healthcare experts, representatives of community interests, and community residents; utilizing government-recommended group-voting techniques to compile a list of 20 significant community health needs, and to prioritize five of these as most requiring community-wide corrective action over the next three years.
Part VI - Patient Education of Eligibility for Assistance	Ellis Medicine provides financial assistance information about programs available to assist patients in paying for their bills, including discount programs and charity care, on its external website (www.ellismedicine.org) (specifically at http://www.ellismedicine.org/financial-assistance/faqs.aspx), in readily available and publicly distributed brochures, and through flyers and posters visible throughout the organization. Applications for financial assistance are available online at the Ellis website. Additionally, Ellis employs Financial Advocates who assist patients in determining the availability of and their eligibility for free or low-cost care, and then assist them with completing the necessary paperwork. Since 2009, Ellis Medicine has included affirmative financial assistance outreach as part of the innovative Medical Home through which it aims to increase access to care and provide healthcare navigation services to patients (especially the underserved and uninsured / underinsured), including education about and assistance with charity care and financial assistance services. Prior to creation of the health insurance enrollment programs by the Patient Protection and Affordable Care Act of 2010 (PPACA), Ellis offered Medicaid enrollment through employees deputized by the Schenectady County Department of Social Services, through Facilitated Enrollers employed by the not-for-profit Health Capital District Initiative (HCDI), and through Fidelis, one of New Yorks not-for-profit Medicaid Managed Care Organizations. Starting in 2013, Ellis arranged for on-site services of Health Insurance Navigators engaged by all four not-for-profit organizations designated pursuant to the PPACA. Navigators saw uninsured residents at both the Nott Street and Ellis Health Center Campuses. Ellis employees also completed training as Certified Application Counselors (CACs) and are qualified to help people enroll both in Medicaid as well as in Exchange insurance products.Additionally, Ellis publicizes its Financial Call Center & Information Line (sharing with our 3,300 employees; our local, state and federal lawmakers offices in case they receive constituent inquiries related to hospital costs and/or financial services at Ellis; and the general public), highlighting a number to call (518-243-1695) through which patients can receive information about how much their care will cost at Ellis Medicine as a way to be transparent and helpful in providing this information, as more and more patients are paying higher deductibles and are concerned about the cost to them out-of-pocket. This is particularly significant in Ellis Primary Service Area, as the largest local employer has converted to a high-deductible health insurance plan for most of its employees.Ellis has also participated in health fairs and employer information functions to advise small businesses and their employees of Ellis Financial Call Center & Information Line. Ellis Call Center has trained specialists who can help enroll qualifying patients in Financial Assistance programs, estimate a patients out-of-pocket expenses based on their medical plan, provide pricing for procedures and tests at Ellis Medicine and assist patients in completing Medicaid applications when applicable. Ellis Information Line helps with physician referrals, scheduling outpatient testing and providing general information about programs and services at Ellis Medicine.
Part VI - Community Information	In accordance with industry standards, Ellis Hospitals community is defined as the hospitals Primary and Secondary Service Areas, accounting for 80% of the hospitals discharge volume. These include all or portions of Schenectady, Saratoga, Albany, Fulton, and Montgomery counties and are comprised of 22 zip codes. Since the State-mandated consolidation of Schenectadys hospitals, Ellis has become the sole provider of acute hospital care in Schenectady County, and it is the largest hospital within its Service Areas.The Primary Service Area is focused on the City of Schenectady, an older industrial city with a population of about 60,000, a substantial decline from the 1940 high of over 90,000. According to the City of Schenectadys 2010-2014 Consolidated Plan, 67% of households in the city are considered low or moderate income, while the poverty rate in the Hamilton Hill neighborhood, adjacent to Ellis Hospital, is over 28%. Nearly all (95%) of the Citys housing stock was built before 1978, and Schenectady neighborhoods have been identified as having among the highest concentration of elevated blood levels for lead in New York State.An impact of the level of poverty in the City of Schenectady has been the extent to which Ellis patients are either covered by government health programs or are uninsured. During 2013, Medicare patients accounted for 40.8% of inpatient discharges, 30.1% of outpatient visits, and 35.5% of net patient revenues before bad debts. Medicaid covered 21.0% of inpatient discharges, 27.4% of outpatient visits, and 16.3% of net patient revenues before bad debts. Uninsured patients accounted for 3.8% of inpatient discharges and 5.6% of outpatient visits, and 1.7% of net patient revenues before bad debts. Overall, uninsured or government insured patients made up 65.6% of inpatient discharges and 63.1% of outpatient visits, while generating 53.5% of net patient revenues before bad debts.There is one Medically Underserved Population (MUP) within Ellis Primary Service Area. The homebound population of Schenectady County is designated MUP 06211. In response, physicians on the staff of the Ellis Family Health Center make house calls, and residents in the hospitals Family Medicine Residency may include house calls in their training. During 2013, two Health Professions Shortage Areas (HPSA) were re-designated in the City of Schenectady: the entire City is now identified as an HPSA for Dental and Mental Health services. The Primary Care HPSAs remain limited to a small number of Census Tracts in the Hamilton Hill/Mont Pleasant neighborhoods.The Secondary Service Area is a much wider geographic area, including rural and farming communities, as well as affluent suburbs. Overall, the combined Service Areas represent a study in contrasts. A nearly equal number of people have incomes below $25,000 as above $100,000. Health status variations are similarly dramatic. For example, according to the New York State Department of Health the rates of asthma-related hospital admissions per 10,000 people vary from 458 in the 12307 ZIP code to 49 in the 12309 ZIP code, a distance of about five miles.Census data for the combined Primary and Secondary Service Areas for 2013 estimate a total population of 377,974. This is projected to increase to 380,182 by 2018. The 2013 median income was $62,648 while the mean income was $73,485, demonstrating the impact of outliers. The gender distribution is 49% male and 51% female. Twenty-one percent of the population has a bachelors degree or higher. There will, however, likely be increased need for healthcare services as the community ages. The greatest increase in population from 2013 to 2018 is expected to be in the 65 and over age range (2.08%), while the greatest decrease is expected in the 35-54 age range (2.43%).
Part VI - Community Building Activities	Ellis Medicine (the trade name for Ellis Hospital) successfully restructured healthcare services following the New York State-mandated hospital consolidation in Schenectady in 2007-2008, and has since been working to improve the efficiency and effectiveness of services to its community by aligning its innovative approaches to community health with the services provided by other local community-based public and not-for-profit organizations. Ellis is now the sole acute care hospital in Schenectady County, and is one of the largest primary care providers, having assumed responsibility for the services of two former hospitals which closed during the States rightsizing process. In this important role, Ellis has engaged the community and developed coalitions with community partners in order to ensure access to a full range of healthcare services, with special attention paid to disadvantaged members of our community. Ellis has undertaken and is planning a number of significant capital projects to consolidate care, enhance access to care, and improve the overall quality, efficiency, and cost-effectiveness of our local healthcare system. One of Ellis Medicines key community building activities is Care Central, a community-focused, multi-partner, care management program derived from Ellis original Medical Home initiative, which is a central location for primary care and outpatient services on a single campus aimed at improving access to healthcare, especially among the uninsured and underinsured. The Ellis Medical Home offers primary care (adult and pediatric), dental care, outpatient child/adolescent mental health services, and diabetes education,along with a number of outpatient services such as medical imaging, laboratory, a sleep disorders center, wound care, and day surgery. The Medical Home features specially trained Health Services Navigators, one an Ellis employee and the other contracted from Schenectady County Public Health Services, and a Community Services Navigator, a counselor employed by the local community action agency, who help patients connect to the healthcare and social services programs they need, including Medicaid facilitated enrollment services, and a free Community Shuttle which provides transportation from a number of community sites including homeless shelters and soup kitchens to the healthcare campus. The Medical Home is an effective partnership among Ellis Medicine and numerous community groups, including the Schenectady Community Action Program, the Salvation Army, the City Mission, YWCA, YMCA, Schenectady City School District, and Schenectady County Public Health Services, among other social service and community agencies.The success of the Medical Home in building community coalitions helped lead to a successful application by a community partnership for designation by the New York State Department of Health as one of the first three upstate Medicaid Health Homes. The Health Home program, which was established by the Patient Protection and Affordable Care Act (PPACA) of 2010 and conforming State law, is intended to provide a comprehensive array of healthcare and community support services to Medicaid patients with designated high-cost conditions. New York State has chosen to initially focus on patients with multiple chronic conditions, behavioral health issues, and/or HIV/AIDS. A coalition of over 40 healthcare and community agencies led by Ellis, the Visiting Nurse Service of Schenectady and Saratoga Counties, Inc., and Hometown Health (the Schenectady FQHC) now provides comprehensive care management services to high risk Medicaid patients in Schenectady County.A third component of Care Central is a Medicare Community-based Care Transitions Program (CCTP) which serves patients discharged from ten different hospitals in a ten-county region. Ellis is the largest participating hospital.Another example of Ellis coalition building activities is its participation in the Schenectady County Public Health Services federally funded Strategic Alliance for Health (SAH), which brings together a host of healthcare and community organizations to address chronic disease and to promote disease prevention and wellness. An Ellis representative participates in regular meetings of the SAH board. Ellis also works closely with the Schenectady County Public Health Services and the Healthy Capital District Initiative (HCDI) to assess community needs and to develop both the federally-required Community Health Needs Assessment and the State-required Community Service Plan (CSP) to identify health priorities (see Part V).Additionally, Ellis partners with a number of community partners, such as the American Cancer Society and the YWCA, to provide health screenings to uninsured and underinsured populations in our service area. Ellis provides office space and other in-kind support for the State-sponsored Schenectady County Cancer Services Program. In collaboration with community partners, Ellis offers outpatient smoking cessation courses and sponsors peer-driven mental health and cancer patient support groups. And, Ellis cooperates with community groups to facilitate access to healthy foods for people through the community. In past years, acting in collaboration with the Schenectady County Planning Department and the Cooperative Extension, Ellis hosted a weekly Farmers Market in the parking lot of the Ellis Health Center during the summer months. Starting in 2013, physicians at the Family Health Center began prescribing fresh vegetables to at-risk patients as part of a foundation-funded grant program. The prescription constitutes a voucher for no-charge locally-grown vegetables which are distributed at a farm stand located at the Ellis Health Center.Medical residents from the Ellis Family Medicine Residency donate their time and expertise to staff two free community-based medical clinics. A weekly clinic at the Schenectady City Mission serves uninsured, homeless individuals in the City of Schenectady. And a rural seasonal clinic provides care to uninsured migrant workers in collaboration with the Columbia County Department of Health.Ellis staffs a Green Team that works to promote recycling and other eco-friendly practices throughout the organization. Ellis staff members also sit on numerous community boards and healthcare coalitions to target improvements in such areas as diabetes, long term care, cancer, hospital readmission rates, and healthy living.
Part VI - Explanation Of How Organization Furthers Its Exempt Purpose	Ellis Medicine furthers its exempt purpose by promoting the health of the community through:A volunteer Board of Trustees that is comprised of community members, medical staff members and hospital administrators who serve three year terms, up to a three term maximum. Currently, the Ellis Board is comprised of 23 trustees 18 non-physician citizens of the community, four physicians, and one senior hospital administrator (the hospitals President and CEO). Ellis does not have a parent corporation.An open medical staff consisting of approximately 595 affiliated physicians and other providers. Medical privileges at Ellis Hospital are available to all qualified physicians in the area. Approximately 230 physicians and other providers are employed by Ellis, including 30 residents participating in the Family Medicine Residency and three in the General Dental Residency. Ellis medical staff is led by a Medical-Dental Executive Committee (MDEC). The MDEC plays an integral part in the hospitals corporate structure and daily operations. The MDEC and the department chairs, who oversee specific clinical services, work collaboratively with the hospitals volunteer Board of Trustees, administrators, and staff to ensure the highest quality of care is delivered to patients and that the community's healthcare needs are met with excellence. Physicians also serve as members of the hospitals Board of Trustees, and they are directly involved in the hospitals annual budget process: they rank and prioritize all capital items in the hospitals capital budget and they sign off on volume projections for the hospitals annual operating budget.Operation of two, full service, fully staffed emergency rooms on two separate Schenectady campuses, both of which are open 24 hours-a-day, seven days-a-week, 365 days-a-year, along with 24/7 emergent care services now available for the first time in Southern Saratoga County. Ellis emergency rooms care for all those in need of emergency care regardless of their ability to pay. Similarly, Ellis Hospitals admission policy is not restrictive. Ellis does not deny admission to any patient based on his/her ability to pay. The work of The Foundation for Ellis Medicine, a 501 (c) (3) tax-exempt charitable organization whose sole purpose is to encourage philanthropic support for Ellis Hospital. The Ellis Hospital Foundation was established in 1982 and is governed by a separate board of trustees. Funds raised through the Foundations activities are used to assist the hospital in acquiring state-of-the-art medical equipment and support a wide range of health care programs and services. Reinvesting its surplus funds to expand/replace/modernize its facilities and medical equipment; support programs/activities aimed at improving quality of care and patient safety; train and educate its medical and nursing staffs; and to improve the overall delivery of and accessibility to health care services in the community.Ellis Medicine demonstrates leadership as a charitable institution by organizing and participating in communitywide efforts for the needy; reaching out to the underserved to provide needed primary and preventative healthcare services and health education, especially through its Medical Home; attracting and using funds to serve the needy; participating in Medicaid and other federal, state, and local healthcare reimbursement programs for the needy such as Child Health Plus; and formally planning for and providing charity care and maintaining a policy of administering care to all persons in need.Ellis Medicine is accountable to the community by having a volunteer governing board comprised of members of the Schenectady community; inviting and responding to community input and involvement in planning and review of hospital activities; voluntarily disclosing information to the public on hospital services, financial status, community benefit activities and charity care; and advocating for healthcare cost containment and promoting the efficient use of healthcare resources within the community.
Part VI - Affilated Health Care System Roles and Promotion	Not Applicable
Part VI - States Where Community Benefit Report Filed	NY

Schedule H (Form 990) 2014

Additional Data

Software ID:	14000265
Software Version:	2014v5.0

- TIN:

Schedule I
(Form 990)

Department of the Treasury
Internal Revenue Service

Grants and Other Assistance to Organizations,
Governments and Individuals in the United States

Complete if the organization answered "Yes," to Form 990, Part IV, line 21 or 22.
lBullet

Attach to Form 990.
lBullet

Information about Schedule I (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2014

Open to Public
Inspection

Name of the organization
Ellis Hospital

Employer identification number
14-1338428

Part I

General Information on Grants and Assistance

Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ....................................

Yes No

Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.

Part II

Grants and Other Assistance to Domestic Organizations and Domestic Governments. Complete if the organization answered "Yes" to
Form 990, Part IV, line 21, for any recipient that received more than $5,000. Part II can be duplicated if additional space is needed.

(a) Name and address of organization or government	(b) EIN	(c) IRC section if applicable	(d) Amount of cash grant	(e) Amount of non-cash assistance	(f) Method of valuation (book, FMV, appraisal, other)	(g) Description of non-cash assistance	(h) Purpose of grant or assistance

Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................ Bullet Image

Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image

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

Cat. No. 50055P

Schedule I (Form 990) 2014

Page 2

Part III

Grants and Other Assistance to Domestic Individuals. Complete if the organization answered "Yes" to Form 990, Part IV, line 22.
Part III can be duplicated if additional space is needed.

(a)Type of grant or assistance	(b)Number of recipients	(d)Amount of non-cash assistance	(e)Method of valuation (book, FMV, appraisal, other)	(f)Description of non-cash assistance
(1) School of Nursing Scholarship	103	55,697	FMV	Tuition Reduction

Part IV

Supplemental Information. Provide the information required in Part I, line 2, Part III, column (b), and any other additional information.

Return Reference

Explanation

Grantmaker's Description of How Grants are Used

The School of Nursing (SON) works with the office of the Vice President for Nursing and the Ellis Hospital Foundation to track awards and to assure that the grants and monies are used for the intended purpose. It is the responsibility of the Ellis Finance Department to release the funds and account for the remaining balance. In the case of the Auer Scholarship, the faculty interviews the potential recipients and makes a recommendation (in rank order) of who should receive the scholarship. The Director of the SON meets with the VP for Nursing and they make a decision on how many scholarships to award to the top candidates. The Finance Department then credits the student tuition receivable account and draws the money from the Scholarship fund. There are scholarship monies that community organizations give. The organizations either send a check or hand it to the student at commencement.

Schedule I (Form 990) 2014

Additional Data

Software ID:	14000265
Software Version:	2014v5.0

- TIN:

Schedule J
(Form 990)

Department of the Treasury
Internal Revenue Service

Compensation Information

For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet

Complete if the organization answered "Yes" to Form 990, Part IV, line 23.
SchJMediumBullet

Attach to Form 990.
SchJMediumBullet

Information about Schedule J (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2014

Open to Public Inspection

Name of the organization

Ellis Hospital

Employer identification number

14-1338428

Part I

Questions Regarding Compensation

Yes

Check the appropiate box(es) if the organization provided any of the following to or for a person listed in Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.

First-class or charter travel Housing allowance or residence for personal use

Travel for companions Payments for business use of personal residence

Tax idemnification and gross-up payments Health or social club dues or initiation fees

Discretionary spending account Personal services (e.g., maid, chauffeur, chef)

If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain....

Yes

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? ..

Yes

Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

Form 990 of other organizations Approval by the board or compensation committee

During the year, did any person listed in Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:

Receive a severance payment or change-of-control payment? ................

Yes

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

Participate in, or receive payment from, an equity-based compensation arrangement? .........

If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.

Only 501(c)(3), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.

For persons listed in Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:

The organization? ...........................

Any related organization? .........................

If "Yes," to line 5a or 5b, describe in Part III.

For persons listed in Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:

The organization? ...........................

Yes

Any related organization? .........................

If "Yes," to line 6a or 6b, describe in Part III.

For persons listed in Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............

Were any amounts reported in Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................

If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................

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

Cat. No. 50053T

Schedule J (Form 990) 2014

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 in column(B) reported as deferred in prior Form 990
(A) Name and Title		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)
1Anoush Koroghlian - ScottVP Legal Affairs & General Counsel	(i) (ii)	211,740 ...............................	20,777 ...............................	445 ...............................	2,679 ...............................	12,251 ...............................	247,892 ...............................	...............................
2Chanderdeep Singh MDCardiothoracic Sur	(i) (ii)	530,554 ...............................	...............................	17,801 ...............................	64,188 ...............................	15,708 ...............................	628,251 ...............................	90,600 ...............................
3Daniel J RinaldiCFO	(i) (ii)	190,258 ...............................	39,216 ...............................	20,607 ...............................	4,175 ...............................	6,700 ...............................	260,956 ...............................	...............................
4David M Liebers MDCMO/VP Quality Services/Med Affairs	(i) (ii)	315,212 ...............................	25,440 ...............................	805 ...............................	12,068 ...............................	26,511 ...............................	380,036 ...............................	...............................
5David SnyderVice President Information Services	(i) (ii)	99,884 ...............................	21,322 ...............................	114,431 ...............................	122,704 ...............................	22,994 ...............................	381,335 ...............................	...............................
6Donald J McLaughlinVice President Facility and Support	(i) (ii)	151,227 ...............................	16,654 ...............................	21,986 ...............................	7,508 ...............................	23,598 ...............................	220,973 ...............................	...............................
7Ernest Lee MDTrustee	(i) (ii)	217,223 ...............................	...............................	68,985 ...............................	4,000 ...............................	981 ...............................	291,189 ...............................	...............................
8Frank Genovese MDNeurosurgeon	(i) (ii)	697,931 ...............................	...............................	17,531 ...............................	34,725 ...............................	13,208 ...............................	763,395 ...............................	27,800 ...............................
9Herbert Reich MDSurgeon-Cardiothor	(i) (ii)	528,843 ...............................	90,600 ...............................	17,945 ...............................	63,315 ...............................	11,858 ...............................	712,561 ...............................	90,600 ...............................
10James W ConnollyPresident & CEO	(i) (ii)	521,246 ...............................	96,414 ...............................	29,104 ...............................	10,400 ...............................	31,708 ...............................	688,872 ...............................	...............................
11Joseph GiansanteVice President, Human Resources	(i) (ii)	205,504 ...............................	23,303 ...............................	23,008 ...............................	10,093 ...............................	24,545 ...............................	286,453 ...............................	...............................
12Kathleen HaleCNO	(i) (ii)	214,476 ...............................	...............................	...............................	31 ...............................	...............................	214,507 ...............................	...............................
13Kelli ValentiVP Strategic Planning/Progam Dev	(i) (ii)	174,558 ...............................	17,114 ...............................	175 ...............................	8,093 ...............................	25,157 ...............................	225,097 ...............................	...............................
14Marc MesickCFO	(i) (ii)	185,852 ...............................	...............................	2,971 ...............................	7,514 ...............................	4,850 ...............................	201,187 ...............................	...............................
15Paul A MiltonEVP/COO	(i) (ii)	308,229 ...............................	44,118 ...............................	18,305 ...............................	10,400 ...............................	27,933 ...............................	408,985 ...............................	...............................
16Paul Spurgas MDNeurosurgeon	(i) (ii)	810,059 ...............................	27,617 ...............................	1,219 ...............................	29,883 ...............................	10,525 ...............................	879,303 ...............................	27,617 ...............................
17Roger BarrowmanVP/CEO- Ellis Med Group	(i) (ii)	409,703 ...............................	...............................	23,771 ...............................	11,034 ...............................	27,183 ...............................	471,691 ...............................	...............................
18Terence Clarke MDSurgeon	(i) (ii)	566,498 ...............................	83,702 ...............................	28,096 ...............................	64,400 ...............................	13,208 ...............................	755,904 ...............................	83,702 ...............................
19Wendy RosherVice President Clinical Services	(i) (ii)	206,431 ...............................	21,800 ...............................	18,305 ...............................	14,961 ...............................	20,273 ...............................	281,770 ...............................	...............................

Schedule J (Form 990) 2014

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 1a: Relevant information in regards to selections on 1a.

Ellis Hospital has a corporate membership at the Mohawk Golf Club that is in the CEO's name, however, the club is used for business purposes and functions only.

Part III, Additional Information

Dr. Terence Clarke is a Surgeon employed by Ellis Hospital. In addition to his base salary, he participates in an incentive compensation plan. In Schedule J Column F, the $83,702 represents the incentive compensation he earned in 2013. This amount was included in his 2014 W-2 and is included in column B (ii). This amount was reported as Deferred Compensation in the 2013 990 Schedule J Part II in Column C.Dr. Herbert Reich is a Surgeon employed by Ellis Hospital. In addition to his base salary, he participates in an incentive compensation plan. In Schedule J Column F, the $90,600 represents the incentive compensation he earned in 2013. This amount was included in his 2014 W-2 and is included in column B (ii). This amount was reported as Deferred Compensation in the 2013 990 Schedule J Part II in Column C.Dr. Frank Genovese is a Neuro-surgeon employed by Ellis Hospital. In addition to his base salary, he participates in an incentive compensation plan. In Schedule J Column F, the $27,800 represents the incentive compensation he earned in 2013. This amount was included in his 2014 W-2 and is included in column B (ii). Dr. Chanderdeep Singh is a Cardiothoracic-surgeon employed by Ellis Hospital. In addition to his base salary, he participates in an incentive compensation plan. In Schedule J Column F, the $90,600 represents the incentive compensation he earned in 2013. This amount was included in his 2014 W-2 and is included in column B (ii). Dr. Paul Spurgas is a Neuro-Surgeon employed by Ellis Hospital. In addition to his base salary, he participates in an incentive compensation plan. In Schedule J Column F, the $27,617 represents the incentive compensation he earned in 2013. This amount was included in his 2014 W-2 and is included in column B (ii). This amount was reported as Deferred Compensation in the 2013 990 Schedule J Part II in Column C.

Schedule J (Form 990) 2014

Additional Data

Software ID:	14000265
Software Version:	2014v5.0

- TIN:

Schedule K
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Information on Tax Exempt Bonds

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

Attach to Form 990.
SchKMediumBullet

Information about Schedule K (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2014

Open to Public
Inspection

Name of the organization
Ellis Hospital

Employer identification number
14-1338428

Part I

Bond Issues

(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	(g) Defeased		(h) On behalf of issuer		(i) Pool financing
(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	Yes	No	Yes	No	Yes	No
A	Schen Cnty Cap Res Corp	27-3478847	806418AU3	06-01-2012	15,320,000	Refinance of 1995 Debt		X		X		X

Part II

Proceeds

	A		B		C		D
	1 Amount of bonds retired . . . . . . . . . . . . . .	8,721,661
2 Amount of bonds legally defeased . . . . . . . . . . .
3 Total proceeds of issue . . . . . . . . . . . . . .	15,320,000
4 Gross proceeds in reserve funds . . . . . . . . . . . .	571,000
5 Capitalized interest from proceeds . . . . . . . . . . .
6 Proceeds in refunding escrows . . . . . . . . . . . .
7 Issuance costs from proceeds . . . . . . . . . . . .	306,400
8 Credit enhancement from proceeds . . . . . . . . . . .	134,554
9 Working capital expenditures from proceeds . . . . . . . . .
10 Capital expenditures from proceeds . . . . . . . . . . .
11 Other spent proceeds . . . . . . . . . . . . . .	14,308,046
12 Other unspent proceeds . . . . . . . . . . . . . .
13 Year of substantial completion . . . . . . . . . . . .
	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) 2014

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?		X
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 . .
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government . . . . . . .
6 Total of lines 4 and 5 . . . . . . . . . . . . .
7 Does the bond issue meet the private security or payment test? . . . . .		X
8a Has there been a sale or disposition of any of the bond-financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were issued?. . . . . . . . . . . . . . . . .		X
b If "Yes" to line 8a, enter the percentage of bond-financed property sold or disposed of.
c If "Yes" to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? . . . . . . . . . . . . .
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, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate? . .		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 "Yes" to line 2c, provide in Part VI the date the rebate computation was performed . . . . . .
3 Is the bond issue a variable rate issue? . . . .
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?		X
b Name of provider . . . . . . . . .
c Term of hedge . . . . . . . . . .
d Was the hedge superintegrated? . . . .
e Was the hedge terminated? . . . . . .

Schedule K (Form 990) 2014

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
Part VI	The bond issuer, Dormitory Authority of the State of New York, has completed arbitrage rebate calculations for this bond issue as required and it has been determined that no arbitrage rebate exists.

Schedule K (Form 990) 2014

Additional Data

Software ID:	14000265
Software Version:	2014v5.0

- TIN:

Schedule L
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Transactions with Interested Persons

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

Attach to Form 990 or Form 990-EZ.
MediumBullet

Information about Schedule L (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2014

Open to Public Inspection

Name of the organization

Ellis Hospital

Employer identification number

14-1338428

Part I

Excess Benefit Transactions (section 501(c)(3), section 501(c)(4), and 501(c)(29) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.

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

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

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

Part II

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

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






Total ...... $

Part III

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

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

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

Cat. No. 50056A

Schedule L (Form 990 or 990-EZ) 2014

Page 2

Part IV

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

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of transaction	(d) Description of transaction	(e) Sharing of organization's revenues?
(a) Name of interested person		(c) Amount of transaction	(d) Description of transaction	Yes	No
(1) Brian McDonald MD	Trustee	1,222,393	Medical Services		No
(2) Sarah Schermerhorn	Trustee	72,152	family member comp		No
(3) Cristine Cioffi	Trustee	40,666	son is employee		No
(4) Janet Sapio-Mayta	Trustee	108,948	Sister is Employee		No
(5) Robert Joy MD	Trustee	814,524	Medical Services		No

Part V

Supplemental Information
Provide additional information for responses to questions on Schedule L (see instructions).

Return Reference

Explanation

Schedule L, Part V Supplemental Information

Dr. Brian McDonald is a partner in physician practice-Schenectady Pulmonary & Critical Care Associates (SPCCA). SPCCA provides 24/7 coverage to Ellis and was paid $1,172,393 in 2014. Dr. McDonald also individually receives compensation as Chief of Medical Staff Elect. ($50,000)Sarah Schermerhorn's son Paul is an employee of Ellis and his annual salary was $72152. Sarah Schermerhorn did not have any impact in the hiring of Paul and does not have any influence in the determination of his annual salary.Cristine Cioffi's son Patrick Sharkey is an ER nurse. His annual salary was $40,666 in 2014. Christine Cioffi did not have any impact in the hiring of Patrick and does not have any influence in the determination of his annual salary.Janet Sapio-Mayta sister Nancy is an employee of Ellis. Her annual salary was $108,948 in 2013. Janet did not have any impact in the hiring of Jane and does not have any influence in the determination of her annual salary.Dr. Robery Joy is a partner of Cardiology Associates of Schenectady (CAS). CAS receives a stipend for the direction of the cardiology program at Ellis Medicine. Ellis Medicine also leases physicians's assistants from CAS. Total recieved from CAS was $799,524. Dr. Joy also received $15,000 from Medical Staff fund as Chief Staff Elect

Schedule L (Form 990 or 990-EZ) 2014

Additional Data

Software ID:	14000265
Software Version:	2014v5.0

- TIN:

SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or 990-EZ 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

2014

Open to Public
Inspection

Name of the organization

Ellis Hospital

Employer identification number

14-1338428

Return Reference	Explanation
Form 990, Part VI, Line 11b: Form 990 Review Process	A copy of the Ellis Hospital's 990 was prepared and submitted for review to the Senior Management team comprised of the Chief Executive Officer, the Chief Operating Officer, Chief Financial Officer, and Vice Presidents. After their review was completed, the Form 990 was sent to each member of the Audit Committee for review. After review by the Audit committee, a copy of the Form 990, including all required schedules, as ultimately filed with the IRS, was given to each voting member of Ellis' Board of Trustees, prior to its filing with the IRS. After review by the Board of Trustees, and upon the recommendation of the Audit Committee, approval is given for filing the return with the IRS.
Form 990, Part VI, Line 12c: Explanation of Monitoring and Enforcement of Conflicts	Ellis Hospital's Conflict of Interest Policy applies to all Hospital Trustees, Officers, employees, Medical/Dental staff members, Directors, Managers, appointees with administrative and/or decision-making responsibilities, Volunteers or any of these parties' immediate families (collectively called Hospital Agents). The Ellis Hospital Corporate Bylaws require Hospital Agents and other selected individuals as identified by the Vice President, Human Resources and the Corporate Compliance Officer/Director of Internal Audit (CCO), to file a conflict of interest disclosure statement with the Hospital on a annual basis. When the statements are completed they are returned to the CCO. Upon receipt, the CCO will review the disclosure and, if a potential conflict is disclosed, will meet with the Hospital Agent and/or his/her appropriate supervisor to discuss the disclosure and need for action if any. All statements for Trustees are also reviewed by the CCO, and if a potential conflict has been disclosed, he/she will meet with the Board Chairperson to discuss the disclosure and need for action, if any. All potential conflicts involving the Board of Trustees will be summarized by the CCO and reported to the Audit Committee of the Board. This Committee will then share this information with the Board Chairperson. When a potential or actual conflict exists, An interested person may make a presentation to the Board or at a Committee meeting, but after such presentation, he/she shall leave the meeting during the discussion of, and the vote upon, the transaction or arrangement that could constitute the conflict of interest. The Board or Committee members shall determine by a majority vote whether the transaction or arrangement is in the Hospital's best interest.
Form 990, Part VI, Line 15a: Compensation Review & Approval Process - CEO, Top Management	The current Executive Compensation Plan is in full compliance with all existing rules and regulations applicable to a 501(c) corporation. The following is a summary of each plan:Executive Compensation Plan-The President, and all other senior executivies are governed by our Executive Compensation Program established by the Board of Trustees. The Executive Compensation Plan is administered also by the Executive Compensation Committee under the direction of the Board of Trustees.All payments from this program are based on audited results and reviewed by the Board of Trustees prior to any payments being made. The review of the compensation agreemtents and gathering of compoarability data in determining the reasonableness of compensation follow the procedures described in treasury regulation section 53.4958-6.
Form 990, Part VI, Line 19: Other Organization Documents Publicly Available	Corporate Compliance Policies (including Conflicts of Interest Policy) and audited Financial Statements are available to the general public via posting on the Ellis Hospital website: www.ellismedicine.org. In addition, these documents and governing documents are available to the public upon request.
Other Changes In Net Assets Or Fund Balances - Other Increases	Additional Min. Postretire Liability = $0
Other Changes In Net Assets Or Fund Balances - Other Increases	Change in Interest in Foundation = $256475
Other Changes In Net Assets Or Fund Balances - Other Increases	misc = $2
Other Changes In Net Assets Or Fund Balances - Other Decreases	Post Retire Liabiity = -$17718543

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

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2014

Additional Data

Software ID:	14000265
Software Version:	2014v5.0

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

Complete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBullet

Attach to Form 990.
MediumBullet

Information about Schedule R (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2014

Open to Public Inspection

Name of the organization

Ellis Hospital

Employer identification number

14-1338428

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

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?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No
(1) Visiting Nurse Service Assoc of Schen 108 Erie Boulevard Schenectady,NY12305 14-1338478	Home Health Care	NY	501(c)(3)	3	Ellis Hospital	Yes

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

Cat. No. 50135Y

Schedule R (Form 990) 2014

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	(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?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

Part IV

Identification of Related Organizations Taxable as a Corporation or Trust Complete if the organization answered "Yes" 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	(i) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	Yes	No

Schedule R (Form 990) 2014

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

1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?

a Receipt of (i) interest, (ii) annuities, (iii) royalties, or (iv) rent from a controlled entity . . . . . . . . . . . . . . . . . . . . . . .

b Gift, grant, or capital contribution to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

c Gift, grant, or capital contribution from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

d Loans or loan guarantees to or for related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

e Loans or loan guarantees by related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

f Dividends from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

g Sale of assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

h Purchase of assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

i Exchange of assets with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

j Lease of facilities, equipment, or other assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .

k Lease of facilities, equipment, or other assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .

l Performance of services or membership or fundraising solicitations for related organization(s) . . . . . . . . . . . . . . . . . . . .

m Performance of services or membership or fundraising solicitations by related organization(s) . . . . . . . . . . . . . . . . . . . .

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

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

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

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

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

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

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

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

Schedule R (Form 990) 2014

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)	(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?
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

Schedule R (Form 990) 2014

Page 5

Part VII

Supplemental Information

Provide additional information for responses to questions on Schedule R (see instructions).

Return Reference	Explanation

Schedule R (Form 990) 2014

Additional Data

Software ID:	14000265
Software Version:	2014v5.0

1	Briefly describe the organization’s mission or most significant activities: The Mission of Ellis Hospital (d/b/a Ellis Medicine) is to meet the health and wellness needs of our community with excellence. Our vision is to be an world class healthcare system by providing patient-centered care and collaborating with our physicians.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	22
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	16
5	Total number of individuals employed in calendar year 2014 (Part V, line 2a) ......	5	4,098
6	Total number of volunteers (estimate if necessary) .............	6	281
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	5,936,312
b	Net unrelated business taxable income from Form 990-T, line 34 .........	7b	-402,877

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	6,590,373	5,780,731
9	Program service revenue (Part VIII, line 2g) .........	367,549,089	372,632,922
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	5,125,209	4,763,588
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	6,244,044	4,953,326
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)...................	385,508,715	388,130,567
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	20,795	55,697
14	Benefits paid to or for members (Part IX, column (A), line 4).....		0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	223,085,372	218,389,486
16a	Professional fundraising fees (Part IX, column (A), line 11e).....		0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	153,792,169	155,911,463
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	376,898,336	374,356,646
19	Revenue less expenses. Subtract line 18 from line 12.......	8,610,379	13,773,921
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	304,324,675	328,714,441
21	Total liabilities (Part X, line 26).............	152,380,088	182,515,166
22	Net assets or fund balances. Subtract line 21 from line 20.....	151,944,587	146,199,275

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 282,967,304 including grants of $ 55,697 ) (Revenue $ 348,049,214 )
	Ellis is a community and teaching hospital with 438 licensed beds across three campuses, including 52 inpatient mental health beds (see item 4B below). The hospital is overseen by a volunteer Board of Trustees drawn from the community. Ellis is the sole provider of acute hospital care in Schenectady County, following state-mandated restructuring which resulted in consolidation of three hospitals into one in 2007-2008. With the mission to meet the health and wellness needs of our community with excellence, Ellis balances state-of-the-art technology and advanced medical procedures with a tradition of community-based caring and a firm commitment to quality.Ellis has earned numerous recognitions for clinical excellence and community service. Ellis is a New York State designated Primary Stroke Center and recipient of the Gold/Gold Plus Award from the American Stroke Association (2007-2015), recognized for using the ASAs Get with the Guidelines program for improving the quality of care and patient outcomes. The hospital is a fully accredited Center of Excellence by the American College of Surgeons and the American Society of Metabolic and Bariatric Surgery. Additionally, the Sleep Disorders Center is accredited by the American Academy of Sleep Medicine; the Belanger (Ellis) School of Nursing is accredited by the National League for Nursing Accrediting Commission; the Family Medicine Residency is accredited by both the Accreditation Council for Graduate Medical Education and the American Osteopathic Association; and four Ellis Primary Care practices in Glenville, Schenectady and Clifton Park have achieved National Commission on Quality Assurance (NCQA) Patient-Centered Medical Home (PCMH) recognition. Ellis is also a 2013 Mass Excellence Gold Baldrige Award winner, recognized for its dedication and work to create a culture and systems where innovation and performance excellence become the accepted norm. Ellis has also been honored with the Five Rings Award by IntelliCentrics, Inc. for excellence in vendor credentialing and creating a culture of vigilance to make hospitals safer for employees and patients. During recent years, Ellis has received community service awards from the Chamber of Schenectady County (Corporation of the Year in 2013), the City Mission of Schenectady (Partners Award, specifically recognizing the hospitals free community shuttle, health service navigators, and other services for the underserved), the Schenectady ARC (Employer of the Year, recognizing the hospital for providing employment, with opportunities for growth and meaningful experience, to individuals with developmental disabilities), the Sight Society of Northeastern New York (Hospital of the Year for commitment and compassion to grieving families along with outstanding accomplishments and best practices to facilitate cornea donations), the Goose Hill Neighborhood Association (Community Award for being a good neighbor and proactive communicator), and the Seventh National Learning Congress of the United States Department of Health and Human Services (Silver Medal for organ donation).Ellis operates two Emergency Departments which had 83,788 visits in 2014, the Bellevue Womans Care Center which delivered 2,634 babies in 2014 (see line 4d), five primary care practices (in Schenectady (2), Glenville, Clifton Park, and Latham) and numerous specialty medical services through the Ellis Medical Group (EMG), an 82-bed skilled nursing facility and short-stay rehabilitation facility (see line 4c), two off-site blood draw stations, a Bariatric Care location, a Sleep Disorders Center, a Wound Care Center, a Family Medicine Residency including an Osteopathic Residency, a General Dental Residency, and a School of Nursing. Residents enrolled in the Family Medicine Residency and the General Dental Residency provide primary medical and dental care to patients, the majority of whom are uninsured or are participants in government programs such as Medicaid, Family Health Plus, and Child Health Plus through three clinics located at the Ellis McClellan Street Health Center: the Family Health Center, the Pediatric Health Center, and the Dental Health Center. In late 2012, Ellis opened the Medical Center of Clifton Park (MCCP), currently the only 24/7 emergent care facility located in Southern Saratoga County, one of the fastest-growing communities in New York State. The emergent care facility saw 35,579 patient visits in 2014, an increase of 23% over the prior year. MCCP is also the location for a primary care practice and several specialty practices. Ellis is currently seeking State Health Department certification of MCCP as a free-standing Emergency Department. If granted, ambulances would be able to deliver appropriate patients directly to MCCP, eliminating the 20-minute trip to hospital Emergency Departments in Albany, Schenectady, or Troy, and enabling local first responders to achieve significantly faster turn-around times. Ellis is the corporate member of the Visiting Nurse Service of Northeastern New York (VNS), a not-for-profit home health care agency which is the largest State-certified provider of home health care services in Schenectady County, and also serves several other counties in the region. The Belanger School of Nursing at Ellis prepares students for licensure as professional Registered Nurses (RN). In 2014, 88% of the schools graduates passed the New York State nursing licensure examination. Total enrollment is about 130 students, with a typical graduating class of about 50. About three-quarters of graduates join the nursing staff at Ellis upon graduation.Ellis serves the community by addressing identified health care priorities, including access to care and prevention and treatment of chronic diseases, through a variety of programs. Identification of needs includes such mechanisms as the federally required Community Health Needs Assessment (see Schedule H, Part V) and the State-mandated three-year Community Service Plan. Ellis is a member of the Healthy Capital District Initiative (HCDI) (a six-county health data collection and planning entity which brings together county health departments, hospitals, FQHCs, and not-for-profit insurers) and the Schenectady County Strategic Alliance for Health (a federally-designated and funded collaborative focused on preventing chronic disease and promoting community health). Ellis also collaborates with the Schenectady County Public Health Services, including joint grant applications and joint development of health needs assessments. Care Central, a multi-agency provider of care management services led by Ellis and VNS, addresses community health needs through: 1) the Medical Home, an innovative community collaboration which centralizes primary care and outpatient health and community services in one location at the Ellis McClellan Street Health Center campus, featuring health services and community services navigators, a free community shuttle van, and community-focused programs such as health fairs and seminars, 2) a Medicaid Health Home which also provides both care management and direct chronic care services to uninsured patients, and 3) a Medicare Community-based Care Transitions Program (CCTP). Community needs are also addressed by such programs as: the Wright Heart Center, which offers complete cardiac care and which has partnered with local volunteer ambulance corps to improve response times through installation of advanced EKG equipment on ambulances and location of AEDs at community sites such as recreation fields, and which also participated with IPRO in a three-year project funded by CMS to evaluate the transition of patients for each level of care and make improvements to reduce hospital readmissions; the Stroke Center, which is the regions most comprehensive source for stroke education; and the Ellis Center for Diabetes, which helps children and adults with diabetes improve their quality of life through education and support, including the areas only summer day camp for children with type 1 diabetes which provides full-tuition scholarships for low-income children.Ellis counted 19,643 inpatient discharges (consisting of 17,834 acute care and 1,809 psychiatric) and 520,142 outpatient visits during 2014. In pursuing its mission, the hospital provides services to anyone who walks through its doors, regardless of their ability to pay. In 2014, Ellis provided $8,448,000 in Financial Assistance, consisting of $2,505,000 in Charity Care and $5,943,000 in Uninsured Discounts. Ellis has granted discounted rates to all uninsured patients, without requiring evidence of ability to pay, since November 2009.

4b	(Code: ) (Expenses $ 20,595,917 including grants of $ ) (Revenue $ 17,933,231 )
	Ellis operates a 52-bed (certified and staffed) inpatient mental health unit, along with expanded outpatient services. This is the only inpatient mental health facility in Schenectady County, and is one of only two inpatient units in a 16-county region providing services to adolescents. Ellis mental health services include: inpatient care for adults and adolescents; outpatient child, adolescent, and adult mental health services; crisis intervention, including a 24-hour crisis information hotline; a peer advocacy program; and a support and education group for those suffering from schizophrenia and other major disorders and their families. In response to a nationally-studied Schenectady suicide cluster of teenage African-American females, Ellis moved the outpatient child and adolescent mental health clinic to substantially expanded facilities at the Ellis Health Center, where it is co-located with the Pediatric and Family Health Centers, and with the hospitals Medical Home. In 2014, the Ellis mental health programs had 1,809 inpatient discharges

4c	(Code: ) (Expenses $ 11,208,964 including grants of $ ) (Revenue $ 8,889,139 )
	The Ellis Center, an 82-bed skilled nursing facility and short-stay rehabilitation facility specializing in medically complex cases, operates from its renovated facility on the Ellis Health Center campus. The facility provides residents with more private rooms and such amenities as a cyber-center, a larger hair salon, and a roof-top garden. Inpatient days for 2014 were 28,290. The relocation in 2010 freed up two floors at Ellis Hospital which, while now used for clinical and administrative offices, could be made available for surge capacity in the event of a community disaster or epidemic

4d	Other program services (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses314,772,185

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)............	7,754,810	815,713

				(A) Total revenue	(B) Related or exempt function revenue	(C) Unrelated business revenue	(D) Revenue excluded from tax under sections 512-514
1a	Federated campaigns..1a
b	Membership dues....1b
c	Fundraising events....1c
d	Related organizations...1d
e	Government grants (contributions)1e		3,229,962

f	All other contributions, gifts, grants, and similar amounts not included above1f		2,550,769

g	Noncash contributions included in lines 1a-1f:$
h	Total. Add lines 1a-1f.......			5,780,731
			Business Code
2a	General Hospital		621990	339,819,093	339,819,093
b	Lab-Physician Referrals		621500	2,773,259		2,773,259
c	Long Term Care		623000	8,889,139	8,889,139
d	Mental Health Services		621990	17,933,231	17,933,231
e	Sunnyview Hosp Svcs		621990	2,433,684		2,433,684
f	All other program service revenue .			784,516	784,516
g	Total. Add lines 2a–2f........			372,632,922
3	Investment income (including dividends, interest, and other similar amounts).......			1,654,702			1,654,702
4	Income from investment of tax-exempt bond proceeds..			0
5	Royalties...........			0
		(i) Real	(ii) Personal
6a	Gross rents
b	Less: rental expenses
c	Rental income or (loss)
d	Net rental income or (loss).......			0
		(i) Securities	(ii) Other
7a	Gross amount from sales of assets other than inventory	3,125,119
b	Less: cost or other basis and sales expenses	16,233
c	Gain or (loss)	3,108,886
d	Net gain or (loss)..........			3,108,886			3,108,886
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ..
	a
b	Less: direct expenses ...b
c	Net income or (loss) from fundraising events..			0
9a	Gross income from gaming activities. See Part IV, line 19 ...
	a
b	Less: direct expenses ...b
c	Net income or (loss) from gaming activities...			0
10a	Gross sales of inventory, less returns and allowances .
	a
b	Less: cost of goods sold ..b
c	Net income or (loss) from sales of inventory..			0
Miscellaneous Revenue			Business Code
11a	Eddy SeniorCare/Other		624210	547,659	547,659
b	Fd Svc, park,emp pharm,ot			1,718,418			1,718,418
c	Purch Disc / Leased Emp		900099	1,242,493	1,242,493
d	All other revenue ....			1,444,756	448,510	729,369	266,877
e	Total. Add lines 11a–11d ......			4,953,326
12	Total revenue. See Instructions......			388,130,567	369,664,641	5,936,312	6,748,883


				(A) Beginning of year		(B) End of year
1	Cash–non-interest-bearing .............			15,377	1	15,792
2	Savings and temporary cash investments .........			17,675,796	2	26,817,361
3	Pledges and grants receivable, net ...........				3	0
4	Accounts receivable, net .............			32,233,432	4	29,834,538
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	0
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L
					6	0
7	Notes and loans receivable, net .............			310,900	7	127,567
8	Inventories for sale or use ..............			5,977,039	8	6,620,973
9	Prepaid expenses and deferred charges ..........			1,583,337	9	1,978,239
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	438,428,017
b	Less: accumulated depreciation .....	10b	257,725,064	162,633,118	10c	180,702,953
11	Investments—publicly traded securities ..........			52,868,438	11	60,245,008
12	Investments—other securities. See Part IV, line 11 .....				12	0
13	Investments—program-related. See Part IV, line 11 .....				13	0
14	Intangible assets ...............				14	0
15	Other assets. See Part IV, line 11 ...........			31,027,238	15	22,372,010
16	Total assets. Add lines 1 through 15 (must equal line 34)......			304,324,675	16	328,714,441
17	Accounts payable and accrued expenses .........			29,936,205	17	26,332,191
18	Grants payable .................				18
19	Deferred revenue ................			157,619	19	157,619
20	Tax-exempt bond liabilities .............			22,501,438	20	6,598,339
21	Escrow or custodial account liability. Complete Part IV of Schedule D..			100,002	21	106,951
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 ..			58,249,657	23	95,410,665
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....................			41,435,167	25	53,909,401
26	Total liabilities. Add lines 17 through 25.........			152,380,088	26	182,515,166
	Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets ..............			136,965,014	27	130,541,705
28	Temporarily restricted net assets ...........			9,369,152	28	9,904,048
29	Permanently restricted net assets ...........			5,610,421	29	5,753,522
	Organizations that do not follow SFAS 117 (ASC 958), check here and complete lines 30 through 34.
30	Capital stock or trust principal, or current funds ........				30
31	Paid-in or capital surplus, or land, building or equipment fund .....				31
32	Retained earnings, endowment, accumulated income, or other funds				32
33	Total net assets or fund balances ...........			151,944,587	33	146,199,275
34	Total liabilities and net assets/fund balances ........			304,324,675	34	328,714,441