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)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)
(1) NORMAN SIEGEL........................................................................ CHAIR	1.50 .......................3.50	X	X	0
(2) GREGORY B MCLEAN........................................................................ VICE CHAIR	1.00 .......................2.50	X	X	0
(3) GREGORY EVANS........................................................................ SECRETARY	1.00 .......................2.50	X	X	0
(4) JOAN COMPSON........................................................................ TREASURER	1.00 .......................2.50	X	X	0
(5) RICHARD TANTILLO........................................................................ BOARD MEMBER	1.00 .......................2.50	X		0
(6) TODD HUTTON PHD........................................................................ BOARD MEMBER	1.00 .......................2.50	X		0
(7) STEPHEN SWEET........................................................................ BOARD MEMBER	1.00 .......................2.50	X		0
(8) DOMENIC P AIELLO MD........................................................................ BOARD MEMBER	1.00 .......................2.50	X		0
(9) MARIA GESUALDO DO........................................................................ BOARD MEMBER	1.00 .......................2.50	X		0
(10) BONNIE WOODS........................................................................ BOARD MEMBER	1.00 .......................2.50	X		0
(11) BARBARA BRODOCK........................................................................ BOARD MEMBER	1.00 .......................5.00	X		0
(12) CATHERINE COMINSKY........................................................................ BOARD MEMBER	1.00 .......................2.50	X		0
(13) THOMAS DENNISON PHD........................................................................ BOARD MEMBER	1.00 .......................2.50	X		0
(14) ANDREW KOWALCZYK III........................................................................ BOARD MEMBER	1.00 .......................2.50	X		0
(15) SYMEON TSOUPELIS........................................................................ BOARD MEMBER	1.00 .......................2.50	X		0
(16) ERIC YOSS MD........................................................................ BOARD MEMBER	1.00 .......................2.50	X		24,514
(17) RICHARD ZWEIFEL........................................................................ BOARD MEMBER	1.00 .......................2.50	X		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)
(18) MARK WARFEL DO........................................................................ BOARD MEMBER/SEMC MEDICAL STAFF PRES	1.00 .......................52.50	X			0	340,507	23,775
(19) JOHN SPERLING MD........................................................................ BOARD MEMBER/FSLH MEDICAL STAFF PRES	51.00 .......................2.50	X			423,380	0	12,396
(20) KAREN LEACH........................................................................ BOARD MEMBER	1.00 .......................1.50	X			0	0	0
(21) ESTHER BANKERT PHD RN........................................................................ BOARD MEMBER	1.00 .......................1.50	X			0	0	0
(22) ROGER MCREYNOLDS........................................................................ BOARD MEMBER	51.00 .......................1.50	X			223,386	0	25,387
(23) SCOTT PERRA FACHE........................................................................ PRESIDENT/CEO	30.00 .......................25.00		X		756,116	0	38,391
(24) LOUIS AIELLO........................................................................ SR VICE PRESIDENT/CFO	27.00 .......................23.00		X		0	344,108	25,490
(25) ROBERT SCHOLEFIELD RN MS........................................................................ SR VICE PRESIDENT OPERATIONS	30.00 .......................20.00		X		0	251,075	25,157
(26) MICHAEL F TREVISANI MD........................................................................ SR VICE PRESIDENT/CMO	50.00 .......................0.00		X		329,673	0	24,556
(27) PATRICIA ROACH MS RN NEA-BC........................................................................ SR VICE PRESIDENT/CNO	30.00 .......................20.00		X		316,044	0	43,662
(28) ANTHONY SCIBELLI........................................................................ SR VICE PRESIDENT/COO	50.00 .......................0.00		X		254,150	0	26,107
(29) MICHAEL HAILE FHFMA........................................................................ SR VP/CFO	45.00 .......................5.00		X		391,136	0	21,076
(30) YANNICK GRENIER MD........................................................................ PHYSICIAN	50.00 .......................0.00			X	541,990	0	17,734
(31) MADANA MOHANA VALLEM MD........................................................................ PHYSICIAN	50.00 .......................0.00			X	507,231	0	34,411
(32) KENNETH ORTEGA MD........................................................................ PHYSICIAN	50.00 .......................0.00			X	478,226	0	28,495
(33) JORGE FERREIRO MD........................................................................ PHYSICIAN	50.00 .......................0.00			X	381,318	0	25,616
(34) MARK WILLIAMS MD........................................................................ PHYSICIAN	50.00 .......................0.00			X	356,146	0	18,506

(A) Name and business address	(B) Description of services	(C) Compensation
NEW YORK RADIATION THERAPY MGT 2234 COLONIAL BLVD FORT MEYERS,FL33907	RADIATION THERAPY MNGMT SERVICES	1,630,800
TEAMHEALTH EAST PO BOX 634850 CINCINNATI,OH45263	ER PHYSICIAN SERVICES	1,606,508
DHP MANAGEMENT SERVICES INC 265 BROOKVIEW CENTRE WAY KNOXVILLE,TN37919	PHYSICIAN/MEDICAL SERVICES	1,454,793
YONKERS RADIATION MEDICAL PRACTICE PC 2234 COLONIAL BLVD FORT MEYERS,FL33907	RADIATION THERAPY MNGMT SERVICES	1,321,463
XEROX CONSULTING CO INC 45 GLOVER AVENUE NORWALK,CT06856	IT CONSULTING SERVICES	1,308,306
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 154

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 ....
2	Grants and other assistance to domestic individuals. See Part IV, line 22 ....
3	Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16 ............
4	Benefits paid to or for members ....
5	Compensation of current officers, directors, trustees, and key employees ....	3,588,151	1,250,998	2,337,153
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....
7	Other salaries and wages ....	122,702,270	106,812,882	15,889,388
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	6,164,195	5,275,441	888,754
9	Other employee benefits .......	11,486,073	9,847,999	1,638,074
10	Payroll taxes ...........	8,992,136	7,695,650	1,296,486
11	Fees for services (non-employees):
a	Management ......	412,183	329,098	83,085
b	Legal .........	288,423		288,423
c	Accounting ...........	157,099		157,099
d	Lobbying ...........	99,806		99,806
e	Professional fundraising services. See Part IV, line 17
f	Investment management fees ......
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) ....	29,502,447	23,555,558	5,946,889
12	Advertising and promotion ....	265,572	212,040	53,532
13	Office expenses .......	971,788	775,902	195,886
14	Information technology ......	5,187,372	4,141,739	1,045,633
15	Royalties ..
16	Occupancy ...........	7,009,742	5,596,769	1,412,973
17	Travel ............
18	Payments of travel or entertainment expenses for any federal, state, or local public officials ......
19	Conferences, conventions, and meetings ....	587,461	469,045	118,416
20	Interest ...........	2,415,988	1,928,991	486,997
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization .....	17,814,988	12,443,645	5,371,343
23	Insurance ..............	3,707,752	2,960,370	747,382
24	Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a	MEDICAL SUPPLIES	39,553,542	39,553,542
b	BAD DEBT	7,570,419	7,570,419
c	ALL OTHER	5,017,377	4,006,031	1,011,346
d	SERVICE CONTRACTS	3,392,464	2,708,636	683,828
e	All other expenses	2,946,300	2,352,406	593,894
25	Total functional expenses. Add lines 1 through 24e	279,833,548	239,487,161	40,346,387	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 .............	-1,761,475	1	325,840
2	Savings and temporary cash investments .........	1,850,793	2	450,859
3	Pledges and grants receivable, net ...........		3
4	Accounts receivable, net .............	39,306,028	4	41,742,977
5	Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of Schedule L ..................
			5
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L
			6
7	Notes and loans receivable, net .............		7
8	Inventories for sale or use ..............	5,258,877	8	5,902,730
9	Prepaid expenses and deferred charges ..........	3,525,990	9	3,780,971
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	306,925,862
b	Less: accumulated depreciation .....	10b	220,589,392	96,402,345	10c	86,336,470
11	Investments—publicly traded securities ..........		11
12	Investments—other securities. See Part IV, line 11 .....	78,778,046	12	82,986,614
13	Investments—program-related. See Part IV, line 11 .....	11,555,669	13	11,488,752
14	Intangible assets ...............	1,698,467	14	1,425,600
15	Other assets. See Part IV, line 11 ...........	31,949,239	15	28,151,318
16	Total assets. Add lines 1 through 15 (must equal line 34)......	268,563,979	16	262,592,131
	17	Accounts payable and accrued expenses .........	32,805,396	17	34,832,144
18	Grants payable .................		18
19	Deferred revenue ................		19
20	Tax-exempt bond liabilities .............	6,370,000	20	6,145,000
21	Escrow or custodial account liability. Complete Part IV of Schedule D..		21
22	Loans and other payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
	persons. Complete Part II of Schedule L..........		22
23	Secured mortgages and notes payable to unrelated third parties ..	27,940,334	23	25,985,730
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....................	60,639,306	25	55,278,204
26	Total liabilities. Add lines 17 through 25.........	127,755,036	26	122,241,078
		Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets ..............	132,570,667	27	131,869,235
28	Temporarily restricted net assets ...........	3,710,112	28	3,953,654
29	Permanently restricted net assets ...........	4,528,164	29	4,528,164
	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 ...........	140,808,943	33	140,351,053
34	Total liabilities and net assets/fund balances ........	268,563,979	34	262,592,131

- 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

FAXTON ST LUKE'S HEALTHCARE

Employer identification number

16-1576637

Part I

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

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

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:
Software Version:

- TIN:

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

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

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

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

FAXTON ST LUKE'S HEALTHCARE

Employer identification number

16-1576637

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 FAXTON ST LUKE'S HEALTHCARE

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 FAXTON ST LUKE'S HEALTHCARE

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
FAXTON ST LUKE'S HEALTHCARE

Employer identification number

16-1576637

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:
Software Version:

- TIN:

SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Political Campaign and Lobbying Activities

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

Complete if the organization is described below. SchCMd Bullet

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

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

FAXTON ST LUKE'S HEALTHCARE

Employer identification number

16-1576637

Part I-A

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

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

76,863

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

76,863

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 1:	PARTICIPATION IS BASED ON THE MEMBERSHIP DUES PAID TO HANYS, AMERICAN HOSPITAL ASSOCIATION AND IROQUOIS HEALTHCARE ASSOCIATION AS INDICATED ON LINE 2. THE FOLLOWING NARRATIVES, DESCRIBING THESE ACTIVITIES, WERE TAKEN DIRECTLY FROM THEIR RESPECTIVE WEBSITES: 1. HANYS IS PROUD TO BE THE ONLY ASSOCIATION THAT REPRESENTS AND ADVOCATES ON BEHALF OF ALL NEW YORK'S HOSPITALS AND HEALTH SYSTEMS AT ALL LEVELS OF THE FEDERAL AND STATE GOVERNMENT. HANYS HAS ACCESS TO POLICY LEADERS, REGARDLESS OF THEIR POLITICAL AFFILIATION AND IS AN INTEGRAL PLAYER IN HEALTH POLICY DISCUSSIONS. HANYS ALSO COMMUNICATES MEMBERS CONCERNS AND POSITIONS TO NEW YORK AND NATIONAL MEDIA IN SUPPORT OF THE ASSOCIATIONS LEGISLATIVE AND REGULATORY INTITIATIVES. 2. THE AMERICAN HOSPITAL ASSOCIATION (AHA) IS THE NATIONAL ORGANIZATION THAT REPRESENTS AND SERVES ALL TYPES OF HOSPITALS, HEALTH CARE NETWORKS AND THEIR PATIENTS AND COMMUNITIES. NEARLY 5,000 HOSPITALS, HEALTH CARE SYSTEMS, NETWORKS AND OTHER PROVIDERS OF CARE AND 43,000 INDIVIDUAL MEMBERS COME TOGETHER TO FORM THE AHA. THROUGH OUR REPRESENTATION AND ADVOCACY ACTIVITIES, AHA ENSURES THAT MEMBERS PERSPECTIVES AND NEEDS ARE HEARD AND ADDRESSED IN NATIONAL HEALTH POLICY DEVELOPMENT, LEGISLATIVE AND REGULATORY DEBATES AND JUDICIAL MATTERS. OUR ADVOCACY EFFORTS INCLUDE THE LEGISLATIVE AND EXECUTIVE BRANCHES AND INCLUDE THE LEGISLATIVE AND REGULATORY ARENAS. FOUNDED IN 1898, THE AHA PROVIDES EDUCATION FOR HEALTH CARE LEADERS AND IS A SOURCE OF INFORMATION ON HEALTH CARE ISSUES AND TRENDS. 3.IROQUOIS IS THE REGIONAL VOICE IN ALBANY AND WASHINGTON FOR UPSATE HOSPITALS AND HEALTH CARE SYSTEM MEMBERS. IROQUOIS PROMOTES A BROADER UNDERSTANDING OF, AND BUILDS SUPPORT FOR, THE HEALTH CARE SYSTEMS SERVING UPSTATE NEW YORK. IROQUOIS PROVIDES REPRESENTATION AND ADVOCACY AT THE STATE LEVEL BY EFFECTIVELY LOBBYING THE STATE LEGISLATURE, AND ESTABLISHING CLOSE WORKING RELATIONSHIPS WITH THE GOVERNORS OFFICE, STATE AGENCY OFFICIALS, AND REGULATORY REPRESENTATIVES. IROQUOIS INFLUENCES PUBLIC POLICY DEVELOPMENT THROUGH BOTH LEGISLATIVE AND REGULATORY ADVOCACY EFFORTS. REGIONAL ACTIVITIES, SUCH AS HOSTING LEGISLATORS AND MEETING WITH LOCAL OFFICIALS, ARE CRITICAL TO MAINTAINING A UNIFIED VOICE FOR LEGISLATIVE AND REGULATORY ACTION. IROQUOIS CONTINUES TO WORK WITH THE CUOMO ADMINISTRATION TO ADDRESS ISSUES AFFECTING UPSTATE HOSPITALS, REVIEW THE EXECUTIVE BUDGET PROPOSAL AND ALSO WORK WITH THE STATE LEGISLATURE. ALL OF OUR ADVOCACY EFFORTS FOCUS ON THE SIMPLE TRUTH THAT HOSPTIALS EXIST TO SERVE. THEIR ABILITY TO SERVE WELL REQUIRES A RELATIONSHIP WITH THEIR COMMUNITIES BUILT ON TRUST AND COMPASSION. TO SERVE COMMUNITIES WELL, HOSPTIALS MUST ALSO MANAGE RESOURCES IN CHALLENGING ENVIRONMENT. THE HOSPITAL INDUSTRY FACES MANY CHALLENGES.

Return Reference

Explanation

PART II-B, LINE 1:

PARTICIPATION IS BASED ON THE MEMBERSHIP DUES PAID TO HANYS, AMERICAN HOSPITAL ASSOCIATION AND IROQUOIS HEALTHCARE ASSOCIATION AS INDICATED ON LINE 2. THE FOLLOWING NARRATIVES, DESCRIBING THESE ACTIVITIES, WERE TAKEN DIRECTLY FROM THEIR RESPECTIVE WEBSITES: 1. HANYS IS PROUD TO BE THE ONLY ASSOCIATION THAT REPRESENTS AND ADVOCATES ON BEHALF OF ALL NEW YORK'S HOSPITALS AND HEALTH SYSTEMS AT ALL LEVELS OF THE FEDERAL AND STATE GOVERNMENT. HANYS HAS ACCESS TO POLICY LEADERS, REGARDLESS OF THEIR POLITICAL AFFILIATION AND IS AN INTEGRAL PLAYER IN HEALTH POLICY DISCUSSIONS. HANYS ALSO COMMUNICATES MEMBERS CONCERNS AND POSITIONS TO NEW YORK AND NATIONAL MEDIA IN SUPPORT OF THE ASSOCIATIONS LEGISLATIVE AND REGULATORY INTITIATIVES. 2. THE AMERICAN HOSPITAL ASSOCIATION (AHA) IS THE NATIONAL ORGANIZATION THAT REPRESENTS AND SERVES ALL TYPES OF HOSPITALS, HEALTH CARE NETWORKS AND THEIR PATIENTS AND COMMUNITIES. NEARLY 5,000 HOSPITALS, HEALTH CARE SYSTEMS, NETWORKS AND OTHER PROVIDERS OF CARE AND 43,000 INDIVIDUAL MEMBERS COME TOGETHER TO FORM THE AHA. THROUGH OUR REPRESENTATION AND ADVOCACY ACTIVITIES, AHA ENSURES THAT MEMBERS PERSPECTIVES AND NEEDS ARE HEARD AND ADDRESSED IN NATIONAL HEALTH POLICY DEVELOPMENT, LEGISLATIVE AND REGULATORY DEBATES AND JUDICIAL MATTERS. OUR ADVOCACY EFFORTS INCLUDE THE LEGISLATIVE AND EXECUTIVE BRANCHES AND INCLUDE THE LEGISLATIVE AND REGULATORY ARENAS. FOUNDED IN 1898, THE AHA PROVIDES EDUCATION FOR HEALTH CARE LEADERS AND IS A SOURCE OF INFORMATION ON HEALTH CARE ISSUES AND TRENDS. 3.IROQUOIS IS THE REGIONAL VOICE IN ALBANY AND WASHINGTON FOR UPSATE HOSPITALS AND HEALTH CARE SYSTEM MEMBERS. IROQUOIS PROMOTES A BROADER UNDERSTANDING OF, AND BUILDS SUPPORT FOR, THE HEALTH CARE SYSTEMS SERVING UPSTATE NEW YORK. IROQUOIS PROVIDES REPRESENTATION AND ADVOCACY AT THE STATE LEVEL BY EFFECTIVELY LOBBYING THE STATE LEGISLATURE, AND ESTABLISHING CLOSE WORKING RELATIONSHIPS WITH THE GOVERNORS OFFICE, STATE AGENCY OFFICIALS, AND REGULATORY REPRESENTATIVES. IROQUOIS INFLUENCES PUBLIC POLICY DEVELOPMENT THROUGH BOTH LEGISLATIVE AND REGULATORY ADVOCACY EFFORTS. REGIONAL ACTIVITIES, SUCH AS HOSTING LEGISLATORS AND MEETING WITH LOCAL OFFICIALS, ARE CRITICAL TO MAINTAINING A UNIFIED VOICE FOR LEGISLATIVE AND REGULATORY ACTION. IROQUOIS CONTINUES TO WORK WITH THE CUOMO ADMINISTRATION TO ADDRESS ISSUES AFFECTING UPSTATE HOSPITALS, REVIEW THE EXECUTIVE BUDGET PROPOSAL AND ALSO WORK WITH THE STATE LEGISLATURE. ALL OF OUR ADVOCACY EFFORTS FOCUS ON THE SIMPLE TRUTH THAT HOSPTIALS EXIST TO SERVE. THEIR ABILITY TO SERVE WELL REQUIRES A RELATIONSHIP WITH THEIR COMMUNITIES BUILT ON TRUST AND COMPASSION. TO SERVE COMMUNITIES WELL, HOSPTIALS MUST ALSO MANAGE RESOURCES IN CHALLENGING ENVIRONMENT. THE HOSPITAL INDUSTRY FACES MANY CHALLENGES.

Schedule C (Form 990 or 990EZ) 2014

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

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

Attach to Form 990.
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

FAXTON ST LUKE'S HEALTHCARE

Employer identification number

16-1576637

Part I

Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" to Form 990, Part IV, line 6.

		(a) Donor advised funds	(b) Funds and other accounts
1	Total number at end of year .........
2	Aggregate 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 ....	8,468,974	7,959,531	7,919,823	8,991,005	6,468,275
b	Contributions ........
c	Net investment earnings, gains, and losses	341,500	509,443	41,047	-1,070,843	2,522,730
d	Grants or scholarships .....
e	Other expenditures for facilities and programs ........	0		-1,339	-339
f	Administrative expenses ....
g	End of year balance ......	8,810,474	8,468,974	7,959,531	7,919,823	8,991,005

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

Board designated or quasi-endowment SchDMd Bullet

3.730 %

Permanent endowment SchDMd Bullet

51.400 %

Temporarily restricted endowment SchDMd Bullet

44.870 %

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

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

Yes

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

3a(i)

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

3a(ii)

Yes

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

Yes

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

Part VI

Land, Buildings, and Equipment. 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 .................	2,200,047		2,200,047
b	Buildings ................	113,888,106	79,114,552	34,773,554
c	Leasehold improvements ............	4,684,619	1,801,795	2,882,824
d	Equipment ................	180,901,975	136,146,091	44,755,884
e	Other .................	5,251,115	3,526,954	1,724,161
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......				86,336,470

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
(3)Other (A) MUTUAL FUNDS INVESTMENT	40,514,818	F
(B) COMMON STOCK INVESTMENT	5,425,877	F
(C) CORPORATE OBLIGATIONS	36,953,067	F
(D) CASH AND CASH EQUIVALENTS	92,852	F





Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)	82,986,614

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) OTHER ASSETS				6,343,720
(2) DUE FROM AFFILIATES				2,416,662
(3) UNAMORTIZED DEBT ISSUANCE COSTS				421,588
(4) WC INSURANCE RECEIVABLE LT, NET				7,456,664
(5) G&P INSURANCE RECEIVABLE LT, NET				8,355,047
(6) ESTIMATED THIRD PARTY PAYOR SETTLEMENTS, NET				3,157,637



Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........				28,151,318

Part X

Other Liabilities. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.

1.(a) Description of liability		(b) Book value
Federal income taxes
2006 SERIES TAXABLE BONDS		10,155,000
CAPITAL LEASE OBLIGATIONS		13,920,196
UNREALIZED LOSS ON INTEREST RATE SWAPS		4,842,008
WC INSTURANCE RECEIVABLE ST/LT		2,598,750
G&P INSURANCE RECEIVABLE ST/LT		17,127,961
ESTIMATED SELF INSURED LIABILITIES		6,488,989
DUE TO AFFILIATES		145,300


Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)		55,278,204
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	282,097,351
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains (losses) on investments ....	2a
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIII.) ............	2d	272,868
e	Add lines 2a through 2d .....................			2e	272,868
3	Subtract line 2e from line 1.....................			3	281,824,483
4	Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b .	4a
b	Other (Describe in Part XIII.) ...........	4b
c	Add lines 4a and 4b.......................			4c	0
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......			5	281,824,483

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	279,833,548
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
e	Add lines 2a through 2d......................		2e	0
3	Subtract line 2e from line 1.....................		3	279,833,548
4	Amounts included on Form 990, Part IX, line 25, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b ..	4a
b	Other (Describe in Part XIII.) ............	4b
c	Add lines 4a and 4b.......................		4c	0
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......		5	279,833,548

Part XIII

Supplemental Information

Provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b;
Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.

Return Reference	Explanation
PART V, LINE 4:	PERMANENT ENDOWMENT FUNDS ARE TO BE HELD IN PERPETUITY, THE INCOME FROM WHICH IS TO BE USED TO SUPPORT CHARITY CARE, HEALTH CARE SERVICES, SCHOLARSHIPS AND FACILITY MAINTENANCE. TEMPORARY ENDOWMENT FUNDS ARE DONOR CONTRIBUTIONS RESTRICTED BY THE DONORS FOR SPECIFIC PURPOSES.
PART X, LINE 2:	HEALTHCARE IS A NOT-FOR-PROFIT CORPORATION AND HAS BEEN RECOGNIZED AS TAX-EXEMPT PURSUANT TO SECTION 501C(3) OF THE INTERNAL REVENUE CODE. AS OF DECEMBER 31, 2014 AND 2013, HEALTHCARE DID NOT HAVE ANY UNRECOGNIZED TAX BENEFITS OR ANY RELATED ACCRUED INTEREST OR PENALTIES. THE TAX YEARS OPEN TO EXAMINATION BY FEDERAL AND STATE TAXING AUTHORITIES ARE 2011-2014. HEALTHCARE DOES NOT ANTICIPATE THE TOTAL UNRECOGNIZED TAX BENEFITS WILL CHANGE IN THE NEXT TWELVE MONTHS.
PART XI, LINE 2D - OTHER ADJUSTMENTS:	GOODWILL IMPAIRMENT 272,868.
SCHEDULE D PART V	AMOUNTS REPORTED IN 2013 WERE INCORRECT AND HAVE BEEN CORRECTED AS FOLLOWS: NET INVESTMENT INCOME $509,442 OTHER EXPENDITURES $159,077 ENDING BALANCE $8,238,277

Schedule D (Form 990) 2014

Additional Data

Software ID:
Software Version:

- 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

FAXTON ST LUKE'S HEALTHCARE

Employer identification number

16-1576637

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 30000.0000000000 %

Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate

which of the following was the family income limit for eligibility for discounted care: .........

Yes

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

If the organization used factors other than FPG in determining eligibility, describe in Part VI the 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? ......

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) ..	1,384,563	349,402	1,035,161	0.370 %
b	Medicaid (from Worksheet 3, column a) ....	51,343,696	35,725,181	15,618,515	5.580 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) .
d	Total Financial Assistance and Means-Tested Government Programs .	52,728,259	36,074,583	16,653,676	5.950 %
Other Benefits		1,022,041		1,022,041	0.370 %
e	Community health improvement services and community benefit operations (from Worksheet 4) ..	1,022,041		1,022,041	0.370 %
f	Health professions education (from Worksheet 5) ..	971,905	775,040	196,865	0.070 %
g	Subsidized health services (from Worksheet 6) ..	16,221,147	12,971,466	3,249,681	1.160 %
h	Research (from Worksheet 7)	59,530	14,650	44,880	0.050 %
i	Cash and in-kind contributions for community benefit (from Worksheet 8)
j	Total. Other Benefits ..	18,274,623	13,761,156	4,513,467	1.650 %
k	Total. Add lines 7d and 7j .	71,002,882	49,835,739	21,167,143	7.600 %

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	(d) Direct offsetting revenue	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing
2	Economic development
3	Community support	26,510	3,709	22,801	0.010 %
4	Environmental improvements
5	Leadership development and training for community members
6	Coalition building	5,152	0	5,152	0 %
7	Community health improvement advocacy	188,942	60,162	128,780	0.050 %
8	Workforce development	18,041	10,530	7,511	0 %
9	Other
10	Total	238,645	74,401	164,244	0.060 %

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

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

Yes

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

2,566,279

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. ......

943,669

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).....

110,252,225

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

135,433,083

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

-25,180,858

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

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

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

Yes

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

Yes

Part IV

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

(a) Name of entity	(b) Description of primary activity of entity	(c) Organization's profit % or stock ownership %	(d) Officers, directors, trustees, or key employees' profit % or stock ownership %	(e) Physicians' profit % or stock ownership %
11 NEW HARTFORD SCANNER	MEDICAL IMAGING SERVICES	60.000 %	0 %	40.000 %
22 MOHAWK VALLEY HEART INSTITUTE (MVHI)	CARDIAC SURGICAL SERVICES	30.000 %	0 %	0 %
33 MOHAWK VALLEY ENDOSCOPY CENTER	ENDOSCOPY SERVICES	20.000 %	0 %	60.000 %
4
5
6
7
8
9
10
11
12
13

Schedule H (Form 990) 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	FAXTON ST LUKES HEALTHCARE INC PO BOX 479 UTICA,NY13503 FAXTONSTLUKES.COM 17-30-91	X	X	X	X	DENTAL CLINIC;DIAGNOSTICS;MEDICAL IMAGING;DIALYSIS; L&D; URGENT CARE

Schedule H (Form 990) 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)

	FAXTON ST LUKES HEALTHCARE INC
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://FAXTONSTLUKES.COM

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:/FAXTONSTLUKES.COM

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)

	FAXTON ST LUKES HEALTHCARE INC
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 300.000000000000%
and FPG family income limit for eligibility for discounted care of 300.000000000000%

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)

	FAXTON ST LUKES HEALTHCARE INC
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?.........

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

Yes

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
FAXTON ST LUKES HEALTHCARE, INC.	PART V, SECTION B, LINE 5: ON MONDAY, MAY 20, 2013 MEMBERS OF THE FSLH HEALTH CARE TEAM, ALONG WITH AREA HOSPITALS, HEALTHCARE ORGANIZATIONS AND AGENCIES PARTICIPATED IN A HEALTH ASSESSMENT INITIATIVE. THE PROGRAM, LED BY THE ONEIDA COUNTY HEALTH DEPARTMENT, USED THE MOBILIZING FOR ACTION THROUGH PLANNING AND PARTNERSHIPS FRAMEWORK (MAPP) TO CONDUCT THE CHNA ACTIVITIES. THE ASSESSMENT RESULTS WERE COMBINED WITH POPULATION TO IDENTIFY THE TOP TWO PRIORITY* AGENDA INITIATIVES FOR 2014 THROUGH 2017. THE TOP TWO PRIORITIES* FOR ONEIDA COUNTY AND PARTICIPATING HEALTH CARE ORGANIZATIONS ARE SMOKING CESSATION AND INCREASED BREAST FEEDING. THE NEW YORK STATE PREVENTION AGENDA (THE PREVENTION AGENDA) SERVES AS A GUIDE TO HEALTH DEPARTMENTS AND HOSPITALS AS THEY DEVELOP THE CHNA REQUIRED BY THE PATIENT PROTECTION AND AFFORDABLE CARE ACT (PPACA). THE COMMUNITY SERVICE PLANS, REQUIRED ANNUALLY BY NEW YORK STATE DEPARTMENT OF HEALTH (DOH), ALSO REFLECT THE COLLABORATIVE WORK OF THE COUNTY AND HOSPITALS AS PART OF THEIR COMMUNITY HEALTH IMPROVEMENT PLAN (CHIP). FSLH PARTICIPATED IN THE NEEDS ASSESSMENT FOR HERKIMER COUNTY WHICH WAS HELD ON THURSDAY, MARCH 28, 2013. NEARLY 15 PERCENT OF THE PATIENTS SERVED BY FSLH LIVE IN HERKIMER COUNTY. THE HERKIMER COUNTY CNA THAT WAS DEVELOPED IS A COLLABORATIVE EFFORT OF HERKIMER COUNTY PUBLIC HEALTH, HERKIMER COUNTY7 HEALTHNET, MEMBERS OF THE CNY MPH, AREA HOSPITALS AND AGENCIES.
FAXTON ST LUKES HEALTHCARE, INC.	PART V, SECTION B, LINE 6A: OTHER REPRESENTATIVES INCLUDED FSLH, SEMC, ROME MEMORIAL HOSPITAL, ONEIDA COUNTY HEALTH DEPARTMENT AND A NUMBER OF COMMUNITY AGENCIES.
FAXTON ST LUKES HEALTHCARE, INC.	PART V, SECTION B, LINE 11: THE PREVENTION AGENDA IDENTIFIES FIVE PRIORITY AREAS, FOCUS AREAS WITHIN EACH PRIORITY AREA, AND ESTABLISHES GOALS FOR EACH PRIORITY AREA. INDICATORS ARE USED TO MEASURE PROGRESS TOWARD ACHIEVING THE GOALS, INCLUDING REDUCTIONS IN HEALTH DISPARITIES AMONG RACIAL, ETHNIC, AND SOCIOECONOMIC GROUPS AND PERSONS WITH DISABILITIES. THE FIVE PRIORITY AREAS ARE:1. PREVENT CHRONIC DISEASES- REDUCE OBESITY IN CHILDREN AND ADULTS- REDUCE ILLNESS, DISABILITY AND DEATH RELATED TO TOBACCO USE AND SECONDHAND SMOKE EXPOSURE - INCREASE ACCESS TO HIGH-QUALITY CHRONIC DISEASE PREVENTIVE CARE AND MANAGEMENT IN CLINICAL AND COMMUNITY SETTINGS.2. PROMOTE A HEALTHY AND SAFE ENVIRONMENT- OUTDOOR AIR QUALITY- WATER QUALITY- BUILT ENVIRONMENT- INJURIES, VIOLENCE AND OCCUPATIONAL HEALTH3. PROMOTE HEALTHY WOMEN, INFANTS AND CHILDREN* - MATERNAL AND INFANT HEALTH- CHILD HEALTH- REPRODUCTIVE, PRECONCEPTION AND INTER-CONCEPTION HEALTH.4. PROMOTE MENTAL HEALTH AND PREVENT SUBSTANCE ABUSE- PROMOTE MENTAL, EMOTIONAL AND BEHAVIORAL WELL-BEING IN COMMUNITIES- PREVENT SUBSTANCE ABUSE AND OTHER MENTAL EMOTIONAL BEHAVIORAL DISORDERS- STRENGTHEN INFRASTRUCTURE ACROSS SYSTEMS.5. PREVENT HIV, SEXUALLY TRANSMITTED DISEASES, VACCINE-PREVENTABLE DISEASES AND HEALTHCARE-ASSOCIATED INFECTIONS- PREVENT HIV AND STDS- PREVENT VACCINE-PREVENTABLE DISEASES- PREVENT HEALTH CARE-ASSOCIATED INFECTIONS.INDICATES THE TWO PRIORITY/FOCUS AREAS SELECTED BY ONEIDA COUNTY HEALTH DEPARTMENT, FSLH AND PARTICIPATING HOSPITALS AND HEALTH AGENCIES.
FAXTON ST LUKES HEALTHCARE, INC.	PART V, SECTION B, LINE 22D: FOR PATIENTS WITH NO INSURANCE, FSLH SCREENS FOR FINANCIAL ASSISTANCE ELIGIBILITY AND HELPS WITH ANY OF THE APPLICATIONS. IF PATIENT DOES NOT QUALIFY OR COOPERATE WITH THE PROCESS, THE ORGANIZATION BILLS BASED ON GROSS CHARGES AND 20% PROMPT PAY DISCOUNT.
FAXTON ST LUKES HEALTHCARE, INC.	PART V, SECTION B, LINE 24: FOR PATIENTS WITH NO INSURANCE, FSLH SCREENS FOR FINANCIAL ASSISTANCE ELIGIBILITY AND HELPS WITH ANY OF THE APPLICATIONS. IF PATIENT DOES NOT QUALIFY OR COOPERATE WITH THE PROCESS, THE ORGANIZATION BILLS BASED ON GROSS CHARGES AND 20% PROMPT PAY DISCOUNT.

Schedule H (Form 990) 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?20
Name and address		Type of Facility (describe)
1	ACP ORTHOPEDIC GROUP 1903 SUNSET AVE UTICA,NY13502	PHYSICIAN OFFICE
2	ACP SURGICAL GROUP 1656 CHAMPLIN AVE PROF OFFICE BLDNG UTICA,NY13502	PHYSICIAN OFFICE
3	WOMEN'S MEDICAL IMAGING CENTER 106 BUSINESS PARK DRIVE UTICA,NY13502	RADIOLOGY SERVICES
4	ACP MOHAWK VALLEY MEDICAL (HERKIMER) 201 EAST STATE STREET HERKIMER,NY13350	PHYSICIAN OFFICE
5	HERKIMER DIALYSIS CENTER 201 EAST STATE STREET HERKIMER,NY13350	DIALYSIS SITE
6	ONEIDA DIALYSIS CENTER 221 BROAD STREET ONEIDA,NY13421	DIALYSIS SITE
7	DENTAL HEALTH CENTER 1714 BURRSTONE ROAD NEW HARTFORD,NY13413	DENTAL CLINIC
8	ACP NEW HARTFORD MEDICAL OFFICE 8411 SENECA TURNPIKE NEW HARTFORD,NY13413	PHYSICIAN OFFICE
9	ACP WASHINGTON MILLS MEDICAL OFFICE 3946 ONEIDA STREET NEW HARTFORD,NY13413	PHYSICIAN OFFICE
10	MASONIC CARE COMMUNITY DIALYSIS 2150 BLEEKER STREET UTICA,NY13501	DIALYSIS SITE
11	ROME DIALYSIS CENTER 91 PERIMETER ROAD SUITE 140 ROME,NY13440	DIALYSIS SITE
12	ACP BARNEVELD MEDICAL OFFICE 7980 STATE RT 12 BARNEVELD,NY13304	PHYSICIAN OFFICE
13	ACP WHITESBORO MEDICAL OFFICE 37 MAIN STREET WHITESBORO,NY13492	PHYSICIAN OFFICE
14	ACP BOONVILLE MEDICAL OFFICE 13460 STATE ROUTE 12 BOONVILLE,NY13309	PHYSICIAN OFFICE
15	ACP NORTH UTICA PRIMARY CARE OFFICE 35 RIVERSIDE DRIVE UTICA,NY13502	PHYSICIAN OFFICE
16	HAMILTON DIALYSIS CENTER 10 EATON STREET HAMILTON,NY13346	DIALYSIS SITE
17	ACP WATERVILLE MEDICAL OFFICE MADISON ST BUS PARK 358 MADISON AVE WATERVILLE,NY13480	PHYSICIAN OFFICE
18	ACP NEUROSURGERY 1656 CHAMPLIN AVE PROF OFFICE BLDNG UTICA,NY13502	PHYSICIAN OFFICE
19	ROME RADIATION SATELLITE 91 PERIMETER ROAD SUITE 130 ROME,NY13440	RADIATION SITE
20	CENTER FOR REHABCONTINUING CARE SRVCS 1650 CHAMPLIN AVE UTICA,NY13502	INTENSIVE REHAB UNIT/CONTINUING CARE SERVC CTR

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 7:	THE PATIENTS COST-TO-CHARGE RATIO WAS COMPUTED USING ALL CHARGES AND EXPENSES LESS NON-ALLOWABLE. THE COST TO CHARGE RATIO WAS USED TO COMPUTE COST. COST-TO-CHARGE WAS DERIVED BY DIVIDING TOTAL CHARGES FROM THE FINANCIAL STATEMENTS INTO TOTAL COST FROM THE FINANCIAL STATEMENTS, LESS NON-PATIENT COSTS.
PART II, COMMUNITY BUILDING ACTIVITIES:	#3 COMMUNITY SUPPORT: CANCER SURVIVORS' BREAKFAST - EVENT SPONSORED BY THE MVHS CANCER CENTER HONORING CANCER SURVIVORS AND FAMILIES. KODSY SPENT PAID TIME RESEARCHING/COLLECTING DONATION MATERIALS FOR EVENT RAFFLE.CAR SEAT INSPECTION - THE FSLH SECURITY TEAM WORKED IN CONJUNCTION WITH THE NEW HARTFORD, WHITESTOWN AND UTICA POLICE DEPARTMENTS, AS WELL AS THE NEW YORK STATE POLICE, TO INSPECT CAR SEATS FREE OF CHARGE TO MAKE SURE THEY WERE PROPERLY INSTALLED IN VEHICLES. IF A CAR SEAT WAS FOUND TO BE UNSAFE, A NEW CAR SEAT WAS PROVIDED AND PROPERLY INSTALLED FREE OF CHARGE. BOILERMAKER EXPO - PROVIIDE HEALTHCARE STATIONS AND SPONSORSHIP FOR COMMUNITY ROAD RACE. HEALTH QUESTION PHONE BANK WITH WKTV AND ONEIDA COUNTY DEPARTMENT OF HEALTH - THE MOHAWK VALLEY HEALTH SYSTEM MVHS, IN PARTNERSHIP WITH WKTV AND THE ONEIDA COUNTY DOH, HELD A PHONE BANK TO ANSWER THE COMMUNITY MEMBER'S QUESTIONS ABOUT CURRENT HEALTH ISSUES. DURING THE NOON NEWS HOUR, AS WELL AS FROM 5PM TO 6:30PM, PEOPLE CALLED IN AND A HEALTH PROVIDER ANSWERED THEIR QUESTIONS ABOUT TOPICS SUCH AS ENTEROVIRUS, FLU, EBOLA, IMMUNIZATIONS AND A VARIETY OF OTHER TOPICS. WKTV AIRED THE PHONE BANK LIVE DURING THEIR NEWSCASTS. CANCER SUPPORT GROUPS - THE FORUM, LED BY THE CANCER CENTER'S SOCIAL WORKER, OFFERS SUPPORT TO ANYONE WHO HAS RECEIVED A CANCER DIAGNOSIS. MEETINGS COVER A WIDE VARIETY OF ISSUES INCLUDING: HOW TO TALK WITH CHILDREN ABOUT MOM OR DAD HAVING CANCER, FINANCIAL CONCERNS, PHYSICAL ISSUES, INTIMACY ISSUES AND NUTRITION DURING TREATMENTS, PLUS MANY MORE. THE FORUM PROVIDES A COMFORTABLE ATMOSPHERE FOR PATIENTS AND CANCER SURVIVORS TO COME TOGETHER AND SHARE USEFUL INFORMATION. AFTER BREAST CANCER SUPPORT GROUP - THE ABC SUPPORT GROUP WAS CREATED BY WOMEN WHO HAVE HAD BREAST CANCER. THE GROUP IS DEDICATED TO PROVIDING EDUCATION, INFORMATION AND EMOTIONAL SUPPORT TO WOMEN AND MEN WHO ARE FACING BIOPSY, SURGERY OR RECOVERY FROM BREAST CANCER. RELAY FOR LIFE - EVENTS CONSISTED OF NUMEROUS FUNDRAISERS FOR THE SEMC RELAY SPONSORSHIP: BOWLING 3/9/14, SAVE ON SWEATS VENDOR SALE 2/24- 25/14, EASTER BASKET SALE 4/10-4/11/14, MAY BASKET RAFFLE 5/1-5/2/14, MAIN RELAY FOR LIFE WALK ADVANCED DIRECTIVES TALK/MOLST - EVELYN KROPP, RN, BPS, CPHQ, PALLIATIVE CARE NAVIGATOR FOR THE MOHAWK VALLEY HEALTH SYSTEM, PRESENTED "HOW TO GET THE BEST CARE POSSIBLE WHEN SERIOUS ILLNESS STRIKES." THERE WERE QUESTIONS AND ANSWERS AFTER HER TALK AND POWERPOINT PRESENTATION. #6 COALITION BUILDING: WORLD BREASTFEEDING WEEK EXPO - COMMUNITY AGENCIES COME TOGETHER IN HONOR OF WORLD BREASTFEEDING WEEK IN ORDER TO PROMOTE THE IMPORTANCE OF BREASTFEEDING. HEALTH FRIENDS - PROGRAM SPONSORSHIP TO PROVIDE FINANCIAL RESOURCES TO PORIVED RX ASSISTANCE TO UN OR UNDERINSURED PEOPLE.GREATER UTICA CHAMBER'S COMMUNITY BUSINESS EXPO - COMPANIES FROM THE GREATER UTICA AREA PROVIDE INFORMATION ABOUT THEIR BUSINESS AS WELL AS JOB OPPORTUNITIES TO THE COMMUNITY. #7 COMMUNITY HEALTH IMPROVEMENT ADVOCACY: WEIGHT LOSS SEMINAR - FREE INFORMATIONAL SESSION ABOUT WEIGHT LOSS SURGERY PRESENTED BY THE BARIATRIC SURGERY TEAM AND GREGORY DALENCOURT, MD. BLOOD DRIVES - BLOOD DRIVES ARE HOSTED TO COLLECT BLOOD FROM THOSE WHO ARE ELIGIBLE AND WILLING TO DONATE. THE FLSH BLOOD BANK WORKS IN ASSOCIATION WITH THE AMERICAN RED CROSS TO HOST THE BLOOD DRIVES. FOR EVERY UNIT OF BLOOD COLLECTED, UP TOP THREE PEOPLE BENEFIT FROM THE DONATION. 281 UNITS OF BLOOD WERE COLLECTED IN 2014, HELPING AS MANY AT 843 INDIVIDUALS. HEARING SCREENINGS - IN AN EFFORT TO PROMOTE THE EARLY DETECTION OR POTENTIAL FOR HEARING LOSS, THE AUDIOLOGY DEPARTMENT PROVIDES FREE HEARING AND SPEECH SCREENINGS TO THE COMMUNITY AS REQUESTED. GO RED CHALLENGE - AN EIGHT-WEEK CHALLENGE FOR EMPLOYEES OF MVHS TO WALK 5,000 STEPS AND EAT FIVE SERVINGS OF FRUITS AND VEGETABLES A DAY. GROCERY STORE TOURS - EVERY DAY PEOPLE WITH DIABETES MAKE NUTRITIONAL CHOICES THAT IMPACT OVERALL HEALTH AND BLOOD SUGAR. THIS FREE CLASS TEACHES PARTICIPANTS HOW TO IMPROVE THEIR DAILY CHOICES WITH BETTER NUTRITION BY GROCERY SHOPPING WITH A CERTIFIED DIABETES EDUCATOR TO LEARN ABOUT FOOD CHOICES.PODIATRY PROGRAM - PEOPLE WITH DIABETES ARE AT HIGH RISK FOR CIRCULATION PROBLEMS THAT COULD LEAD TO LOSS OF SENSATION AND POOR HEALING IN THEIR FEET. PROPER SKIN AND FOOT CARE IS ESSENTIAL. THIS IS AN INFORMATIONAL SESSION AND FREE FOOT EXAM LEAD BY AREA PODIATRISTS. DIABETES SUPPORT GROUP - A FREE SUPPORT GROUP FOR ANY PERSON WITH DIABETES OR PRE-DIABETES WHO IS INTERESTED IN SPEAKING WITH OTHERS WHO ARE LIVING SIMILAR LIFESTYLES AND DEALING WITH THE DAILY IMPACT OF DIABETES MANAGEMENT. EDUCATION CLASSES - PROVIDES INFORMATION TO THOSE WITH DIABETES ABOUT HOW TO SUCCESSFULLY MANAGE THEIR DISEASE. NATIONAL DIABETES PREVENTION PROGRAM - PROGRAM FOCUSES ON TREATING THOSE WITH PREDIABETES TO PREVENT TYPE 2 DIABETES. NATIONAL DIABETES MONTH SPEAKER - DR. MARGARITA P. PEREZ-CHERON PRESENTED "BLOOD SUGAR, OBESITY AND STRATEGIES FOR WEIGHT REDUCTION" IN A FREE COMMUNITY PRESENTATION. STROKE GRAND ROUNDS - EDUCATIONAL SESSIONS PERTAINING TO STROKE. IDENTIFICATION OF STROKE IN THE FIELD - EDUCATIONAL FORUM FOR EMS PROVIDERS AND THOSE CARING FOR ACUTE STROKE PATIENTS. COMPLIMENTARY DINNER PROVIDED. WORLD STROKE DAY DINNER - A DINNER AND PRESENTATION IN HONOR OF WORLD STROKE DAY. STROKE TEACHING DAY - A DAY-LONG EVENT WITH PRESENTATION COVER A NUMBER OF STROKE-RELATED TOPICS. CCUS WERE AVAILABLE. STROKE SCREENINGS - STROKE SCREENING TO INCLUDE BP CHECK, FAMILY HISTORY, CHOLESTEROL SCREENING AND EDUCATION BREASTFEEDING CLASSES - FSLH OFFERS FREE MONTHLY BREASTFEEDING CLASSES FOR EXPECTANT PARENTS WHO HAVE CHOSEN OR ARE CONSIDERING BREASTFEEDING. BIRTHING CLASSES - FREE 5-WEEK SERIES OF CLASSES IN CHILDBIRTH AND INFANT CARE TAUGHT BY AN EXPERIENCED LABOR AND DELIVERY REGISTERED NURSE. SENIOR SUNDAYS - SENIOR SUNDAY LEARN AND LEARNS ARE HELD IN THE SPRING AND FALL TO EDUCATE ELDERLY MEMBERS OF THE COMMUNITY ON IMPORTANT HEALTH AND SAFETY TOPICS INCLUDING MANAGING MEDICATIONS, CULTURAL DIVERSITY, COPING WITH SERIOUS ILLNESS AND CARDIAC CARE. A HOT LUNCH IS SERVED AND A VOLUNTARY $5 DONATION IS ASKED FOR. WELLNESS CENTER - THE WELLNESS CENTER OFFERS MANY PROGRAMS AIMED AT KEEPING THE COMMUNITY HEALTHY. FROM WATER EXERCISE CLASSES TO FITNESS ASSESSMENTS WITH PERSONALIZED HEALTH PLANS TO KEEP INDIVIDUALS FIT, THE WELLNESS CENTER IS MUCH MORE THAN JUST A "GYM." THE WELLNESS CENTER IS HOME TO AN AQUA THERAPY POOL, STRENGTH TRAINING EQUIPMENT, CARDIOVASCULAR TRAINING EQUIPMENT AND CERTIFIED AND SPECIALLY TRAINED STAFF. IN 2014, 1,267 CLASSES AND 145 OPEN POOL SESSION WERE HELD. CHRONIC KIDNEY DISEASE EDUCATION PROGRAM - IN THIS PROGRAM, PATIENTS LEARN MORE ABOUT KIDNEY DISEASE, WAYS TO SLOW THE LOSS OF KIDNEY FUNCTION, AND HOW MEDICATIONS, DIET AND LIFESTYLE CAN AFFECT THE PROGRESSION OF THE DISEASE. PATIENTS HAVE THE OPPORTUNITY TO MEET WITH DIETITIANS, SOCIAL WORKERS AND NURSES WHO SPECIALIZE IN RENAL (KIDNEY) CARE. FAMILY MEMBERS, FRIENDS AND CAREGIVERS ARE INVITED TO ATTEND THE PROGRAM AS WELL. WRVO MENTAL HEALTH FORUM - WRVO OFFERED A FORUM TO BE RECORDED LIVE AND PLAYED LATER ON RADIO AND POST ONLINE ABOUT MENTAL HEALTH ISSUES AND THE CHANGING NATURE OF THEIR DELIVERY IN NYS. WRVO MODERATED 3 PANELISTS, ONE OF WHOM WAS A SEMC SOCIAL WORKER WHO WORKS WITH MANY PATIENTS WITH MENTAL HEALTH DELIVERY IN NYS. COCVAC HEALTH AND WELLNESS FAIR - THE CENTRAL ONEIDA COUNTY VOLUNTEER AMBULANCE CORPS ANNUAL COMMUNITY HEALTH & SAFETY EXPO PROVIDES INFORMATION ON MULTIPLE AREAS OF HEALTH AND SAFETY FOR COMMUNITY MEMBERS. ONEIDA NATION EMPLOYEE HEALTH AND WELLNESS FAIR - TURNING STONE HOLDS AN ANNUAL HEALTH EXPO FOR THEIR EMPLOYEES WHERE LOCAL COMMUNITY AGENCIES PROVIDE HEALTH AND WELLNESS INFORMATION. #8 WORKFORCE DEVELOPMENT: SABA - IN THE SUMMER OF 2014, 24 STUDENTS FROM ONEIDA, HERKIMER AND MADISON COUNTIES HAD THE OPPORTUNITY TO WORK IN VARIOUS DEPARTMENTS AT FSLH THROUGH THE SCHOOL AND BUSINESS ALLIANCE (SABA) SUMMER YOUTH EMPLOYMENT PROGRAM (SYEP). FROM AMBULATORY SURGERY AND THE EMERGENCY DEPARTMENT TO CASE MANAGEMENT AND HEALTH INFORMATION MANAGEMENT, STUDENTS WERE ASSIGNED TO WORK THROUGHOUT THE ORGANIZATION FOR FIVE WEEKS. STUDENTS WERE MENTORED BY ON-SITE SABA CAREER SPECIALISTS AND FSLH PROFESSIONALS IN THE ASSIGNED FIELD. MEDICAMP - FSLH HOSTED A TWO-DAY MEDICAL CAMP FOR TEENS AGES 15 THROUGH 18 IN JULY 2014. MEDICAMP DEMONSTRATES TO TEENS HOW A HOSPITAL OPERATES AND PROVIDES THEM WITH THE OPPORTUNITY TO EXPLORE DIFFERENT DEPARTMENTS FOR POTENTIAL CAREER ENDEAVORS. REGISTRATION IS $20 PER STUDENT WHICH INCLUDED SCRUB TOPS, A STETHOSCOPE AND BREAKFAST AND LUNCH FOR BOTH DAYS. THERE WERE 14 PARTICIPANTS.
PART III, LINE 2:	BAD DEBT FOR SCHEDULE H REPORTING IS DETERMINED BY TAKING THE ACTUAL BAD DEBT EXPENSE REPORTED FOR THE YEAR ON THE HOSPITAL AUDITED FINANCIAL STATEMENTS, LESS ANY BAD DEBT RECOVERIES RECEIVED DURING THE YEAR FROM THE AUDITED FINANCIAL STATEMENTS. THEN,ADJUSTING THAT AMOUNT TO COST BASED ON THE HOSPITAL'S CURRENT YEAR MEDICARE COST REPORT DERIVED COST TO CHARGE RATIO. THIS AMOUNT UNDERSTATES BAD DEBT SOMEWHAT BECAUSE A LARGE PORTION OF BAD DEBT IS THE RESULT OF UNPAID DEDUCTIBLE AND COINSURANCE BALANCES. THOSE BALANCES ARE NO LONGER RECORDED AT FULL CHARGES BECAUSE CONTRACTUAL ADJUSTMENTS HAVE ALREADY REDUCED CHARGES TO AN EXPECTED REIMBURSEMENT AMOUNT. HENCE REDUCING BY A COST TO CHARGE RATIO REDUCES AN ALREADY DISCOUNTED CHARGE. WE REPORT THIS WAY BECAUSE BAD DEBT IS REPORTED IN MULTIPLE STATE AND FEDERAL REQUIRED REPORTS, RETURNS AND DISCLOSURE STATEMENTS. IN ORDER TO BE CONSISTANT WE ARE REPORTING USING THIS CONSERVATIVE METHOD WHICH IS REQUIRED FOR HOSPITAL MEDICARE COST REPORT REPORTING.
PART III, LINE 3:	MANY PATIENTS WHO WOULD QUALIFY FOR CHARITY CARE ASSISTANCE ARE UNWILLING TO APPLY FOR IT. THE HOSPITAL BUSINESS OFFICE OFFERS OUR CHARITY CARE PACKAGE TO ALL PATIENTS. MANY PATIENTS WILL AGREE TO HAVE THE CHARITY CARE REQUEST FORMS SENT TO THEM BUT NEVER RETURN THEM. MANY PATIENTS SAY THEY CANNOT PAY AND ARE UNWILLING TO COMPLETE ANY FORMS. THE HOSPITAL BUSINESS OFFICE, COLLECTIONS STAFF, HAVE FORMED A PERCENTAGE ESTIMATE BASED ON THE NUMBER OF CASES OF PATIENTS WHO RECEIVE CHARITY CARE FORMS AND DON'T COMPLETE THEM PLUS THE NUMBER OF PATIENTS WHO STATE THEY CANNOT PAY BUT ARE UNWILLING TO REQUEST ASSISTANCE. THIS RECORDED BAD DEBT EXPENSE WOULD BE RECORDED AS CHARITY CARE IF PATIENT'S WERE WILLING TO COMPLY WITH MINIMAL APPLICATION REQUIREMENTS. THE NATURE OF THE PRESENTATION ON HOSPITAL FINANCIAL STATEMENTS DOES NOT DETERMINE THE COMMUNITY BENEFIT BUT RATHER THE NATURE OF THE REASON FOR THE EXPENSE. THIS IS CHARITY CARE.
PART III, LINE 4:	FOR UNINSURED PATIENTS THAT DO NOT QUALIFY FOR CHARITY CARE, HEALTHCARE RECOGNIZES REVENUE ON THE BASIS OF ITS STANDARD RATES FOR SERVICES PROVIDED. ON THE BASIS OF HISTORICAL EXPERIENCE, A SIGNIFICANT PORTION OF HEALTHCARES UNINSURED PATIENTS WILL BE UNABLE OR UNWILLING TO PAY FOR THE SERVICES PROVIDED. THUS, HEALTHCARE RECORDS A PROVISION FOR BAD DEBTS RELATED TO UNINSURED PATIENTS IN THE PERIOD THE SERVICES ARE PROVIDED. PATIENT ACCOUNTS RECEIVABLE ARE REDUCED BY A RESERVE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTABILITY OF PATIENT ACCOUNTS RECEIVABLE, HEALTHCARE ANALYZES PAST PAYMENT HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE RESERVE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. FOR RECEIVABLES ASSOCIATED WITH PATIENTS WHO HAVE THIRD PARTY COVERAGE, HEALTHCARE ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES A RESERVE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS, IF NECESSARY (FOR EXAMPLE, FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS, OR FOR PAYORS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY). FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), HEALTHCARE RECORDS A RESERVE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICES BASED ON ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE, OR UNWILLING, TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED)AND THE AMOUNT ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS.
PART III, LINE 8:	ALL OF THIS IS COMMUNITY BENEFIT; THE HOSPTIAL IS RECEIVING LESS THAN COST ON COMMUNITY MEDICARE RECIPIENTS, THUS A COMMUNITY BENEFIT TO THESE PATIENTS. THE PATIENTS COST-TO-CHARGE RATIO WAS COMPUTED USING ALL CHARGES AND EXPENSES LESS NON-ALLOWABLE. THE COST-TO-CHARGE RATIO WAS USED TO COMPUTE COST. COST-TO-CHARGE WAS DERIVED, USING THE FINANCIAL STATEMENTS, BY DIVIDING TOTAL CHARGES INTO TOTAL COSTS LESS NON-PATIENT COSTS.
PART III, LINE 9B:	FOR PATIENTS WITH NO INSURANCE, FSLH SCREENS FOR FINANCIAL ASSISTANCE ELIGIBILITY AND HELPS WITH ANY OF THE APPLICATIONS. IF PATIENT DOES NOT QUALIFY OR COOPERATE WITH THE PROCESS, THEY ARE BILLED BASED ON GROSS CHARGES AND 20% PROMPT PAY DISCOUNT.THE UNCOMPENSATED CARE POLICY IS AS FOLLOWS:1.0 PURPOSE-TO PROVIDE SERVICES TO PATIENTS WHO ARE UNINSURED OR UNABLE TO COMMIT TO A FINANCIAL AGREEMENT. THIS POLICY DOES NOT APPLY TO THOSE PATIENTS WHO SEEK ELECTIVE SERVICES OR PROCEDURES SUCH AS ELECTIVE COSMETIC SURGERY, ELECTIVE DENTAL SURGERY, MEALS ON WHEELS,LIFELINE SERVICES, HEARING AIDS, OR THERAPIES OUTSIDE THE SCOPE OF PHYSICIANS ORDERS. FAXTON ST. LUKES HEALTHCARE COMPLIES WITH REGULATION 312-D OF THE HCFA MANUAL AND PROVIDES AN UNCOMPENSATED CARE PROGRAM FOR THOSE INDIVIDUALS WHO CANNOT PAY FOR NEEDED HEALTHCARE SERVICES, ON AN ORGANIZATION-WIDE BASIS. ACCORDING TO REGULATION 312-D OF THE HCFA MANUAL, THE HOSPITALS/CLINICS MUST INVESTIGATE THE FINANCIAL SITUATION OF PATIENTS WHO REQUEST THE UNCOMPENSATED CARE PROGRAM.PROCEDURE:1. A PATIENT OR GUARANTOR REQUESTING UNCOMPENSATED CARE MAY BE ASKED TO APPLY FOR MEDICAID. PATIENT/GUARANTOR WILL HAVE UP TO 90 DAYS FROM SERVICE DATE TO APPLY FOR FINANCIAL ASSISTANCE. THE FOLLOWING INFORMATION MUST BE PROVIDED WITH THE APPLICATION TO AID IN THE DECISION BY THE HOSPITAL TO PROVIDE FREE CARE. A COPY OF THE LATEST YEAR OF TAX FILING. A COMPLETED UNCOMPENSATED CARE APPLICATION, WHICH IS PROVIDED BY THE HOSPITAL MUST BE COMPLETED IN ITS ENTIRETY WITHIN THIRTY DAYS OF RECEIPT OF THE APPLICATION. PROOF OF INCOME INFORMATION, WE MUST CONSIDER BANK ACCOUNTS, PENSION CHECKS AND INSURANCE POLICIES. AS THE LAW STATES ONLY THOSE ASSETS CONVERTIBLE TO CASH AND UNNECESSARY FOR THEPATIENTS DAILY LIVING. THE CALCULATION OF ELIGIBILITY MAY INCLUDE SOME OR ALL OF THE FOLLOWING SOURCES:ALL ASSETSEXCESS AMOUNTSPEND DOWN AMOUNTBANK ACCOUNTSPENSION ACCOUNTSINSURANCE POLICIESPLUS INCOMEEQUALS GUIDELINE AMOUNTTHE GUIDELINE AMOUNT IS COMPARED TO (3X) THE FEDERAL POVERTY GUIDELINE.3. THE PATIENT IS NOTIFIED WITH A DECISION WHETHER APPROVED OR DENIED BY THE DIRECTOR OF PATIENT ACCOUNTING WITHIN FOURTEEN BUSINESS DAYS OF RECEIPT OF A COMPLETED APPLICATION INCLUDING ALL NECESSARY FINANCIAL SUPPORTING DOCUMENTATION. 4. IF THE PATIENT IS APPROVED THE ACCOUNT IS WRITTEN OFF TO CHARITY/BAD DEBT. IF THE PATIENT HAS MEDICARE FOR INSURANCE, THE HOSPITAL WILL PROCESS AS A MEDICARE CHARITY/BAD DEBT WRITE OFF. 5. FURTHER INTERNAL REQUIREMENTS FOR MEDICARE WRITE OFF MUST INCLUDE A CODR (CREATE ON DEMAND BILL) AND MEDICARE EOB (EXPLANATION OF BENEFITS), WHICH ACCOMPANIES EACH MEDICARE ACCOUNT THAT IS BEING CONSIDERED FOR A WRITE OFF. 6. AN AGENCY ACTIVITY REPORT IS UTILIZED TO REPORT ANY MEDICARE RECOVERIES. GENERAL GUIDELINES FOR EMERGENCY DENTAL TREATMENT ON UNINSURED PATIENTS: THE DENTAL SERVICE WILL SCREEN ALL UNINSURED PATIENTS AND EVALUATE THE PATIENTS NEED FOR EMERGENCY DENTAL TREATMENT. WALK-IN DENTAL EMERGENCY PATIENTS WHO INDICATE THEY ARE UNABLE TO PAY FOR SERVICES ARE EXPECTED TO COMPLY WITH HOSPITAL POLICY REQUIRING THEM TO FILL OUT A MEDICAIDAPPLICATION. IN THE MEANTIME, DENTAL PAIN IS MANAGED ON AN INDIVIDUAL BASIS AND MAY BE EITHER TREATED OR SCRIPTED AT THE DISCRETION OF THE EXAMINING DOCTOR. PALLIATIVE TREATMENT MAY BE ALL THAT IS OFFERED UNTIL PAYMENT FOR DEFINITIVE TREATMENT IS SECURED OR UNTIL IT IS DETERMINED THAT THE PATIENT IS ELIGIBLE FOR CHARITY CARE. DEFINITIVE TREATMENT IS LIMITED TO THE APPROPRIATE PROCEDURE(S) TO ELIMINATE THE SOURCE OF THE PAIN AND DOES NOT NECESSARILY INVOLVE ADDITIONAL PROCEDURES TO RESTORE MISSING TOOTH STRUCTURE OR REPLACE ANY SUBSEQUENT MISSING TEETH.
PART VI, LINE 2:	COMMUNITY HEALTH PLANNING PROCESSON MONDAY, MAY 20, 2013 MEMBERS OF THE FSLH HEALTH CARE TEAM, ALONG WITH AREA HOSPITALS, HEALTHCARE ORGANIZATIONS AND AGENCIES PARTICIPATED IN A HEALTH ASSESSMENT INITIATIVE. THE PROGRAM, LED BY THE ONEIDA COUNTY HEALTH DEPARTMENT, USED THE MOBILIZING FOR ACTION THROUGH PLANNING AND PARTNERSHIPS FRAMEWORK (MAPP) TO CONDUCT THE CHNA ACTIVITIES. THE ASSESSMENT RESULTS WERE COMBINED WITH POPULATION TO IDENTIFY THE TOP TWO PRIORITY AGENDA INITIATIVES FOR 2014 THROUGH 2017. FSLH WILL CONTINUE TO WORK WITH HERKIMER COUNTY TO MORE FULLY DEVELOP AND ADOPT STRATEGIES AND MEASURES TO SUPPORT THE PRIORITIES. THE CHNA FOR FSLH WILL BE UPDATED QUARTERLY AND REVIEWED ANNUALLY FOR PROGRESS AND UPDATES BY MEMBERS OF THE FSLH HEALTH IMPROVEMENT TEAM AND IN COOPERATION WITH OUR COMMUNITY PARTNERS.
PART VI, LINE 3:	THE PATIENT IS EDUCATED ABOUT ELIGIBILITY FOR ASSISTANCE UNDER FEDERAL, STATE OR LOCAL GOVERNMENT PROGRAMS AND FSLH INTERNAL FAP BY MULTIPLE METHODS. WE HAVE DEVELOPED A USER FRIENDLY TRI-FOLD PAMPHLET DESCRIBING THE VARIOUS PAYMENT OPTIONS OFFERED AT FSLH. THESE PAMPHLETS ARE AVAILABLE IN THE EMERGENCY ROOM, ADMISSIONS, URGENT CARE, ACP PHYSICIAN'S OFFICES AND OUTREACH CLINICS. ON SITE FINANCIAL COUNSELORS ARE AVAILABLE TO ASSIST THE PATIENTS AT BOTH CAMPUSES TO EXPLAIN OUR PAYMENT OPTIONS, INCLUDING THE FAP. FSLH HAS TRAINED CERTIFIED APPLICATION COUNSELORS TO ASSIST THE PATIENT WITH THE NYS EXCHANGE. AN HMO MEDICAID REPRESENTATIVE IS AVAILABLE TO ASSIST PATIENTS WITH ELIGIBILITY AND APPLICATIONS FOR NY STATE MEDICAID. THE PATIENT IS CONTACTED BY TELEPHONE PRIOR TO SERVICE/POST DISCHARGE AND ADVISED OF PAYMENT OPTIONS AND HOW TO RECEIVE ASSISTANCE; IF NECESSARY, WITH THE FAP APPLICATION. FSLH BILLING STATEMENTS INCLUDE DIRECTIONS TO OUR WEBSITE, WHICH INCLUDES OPTIONS, FAP APPLICATION AND CONTACT INFORMATION; INCLUDING AVAILABLE STAFF TIMES.
PART VI, LINE 4:	COMMUNITY CHARACTERISTICS -MOST ZIP CODES IN THE PRIMARY AND SECONDARY SERVICE AREAS ARE LOCATED IN ONEIDA AND HERKIMER COUNTIES. THE COMMUNITIES OF THESE COUNTIES ARE DESCRIBED BY THEIR GEOGRAPHIC, DEMOGRAPHIC AND SOCIO-ECONOMIC CHARACTERISTICS.*1 THE CITY OF UTICA, POPULATION 62,000, IS THE LARGEST URBAN CENTER LOCATED IN ONEIDA COUNTY, WHILE THE SURROUNDING COMMUNITIES ARE MOSTLY RURAL. IN THE RECENT DECADES, UTICA BECAME HOME TO OVER 6,500 REFUGEES FROM DIFFERENT PARTS OF THE WORLD.SOURCE: UNITED STATES CENSUS BUREAU
PART VI, LINE 5:	THE NEW YORK STATE PREVENTION AGENDA (THE PREVENTION AGENDA) SERVES AS A GUIDE TO HEALTH DEPARTMENTS AND HOSPITALS AS THEY DEVELOP THE CHNA REQUIRED BY THE PATIENT PROTECTION AND AFFORDABLE CARE ACT (PPACA). THE COMMUNITY SERVICE PLANS, REQUIRED ANNUALLY BY NEW YORK STATE DEPARTMENT OF HEALTH (DOH), ALSO REFLECT THE COLLABORATIVE WORK OF THE COUNTY AND HOSPITALS AS PART OF THEIR COMMUNITY HEALTH IMPROVEMENT PLAN (CHIP). THE PREVENTION AGENDA IDENTIFIES FIVE PRIORITY AREAS, FOCUS AREAS WITHIN EACH PRIORITY AREA, AND ESTABLISHES GOALS FOR EACH PRIORITY AREA. INDICATORS ARE USED TO MEASURE PROGRESS TOWARD ACHIEVING THE GOALS, INCLUDING REDUCTIONS IN HEALTH DISPARITIES AMONG RACIAL, ETHNIC, AND SOCIOECONOMIC GROUPS AND PERSONS WITH DISABILITIES. THE FIVE PRIORITY AREAS ARE: 1.PREVENT CHRONIC DISEASES- REDUCE OBESITY IN CHILDREN AND ADULTS- REDUCE ILLNESS, DISABILITY AND DEATH RELATED TO TOBACCO USE AND SECONDHAND SMOKE EXPOSURE- INCREASE ACCESS TO HIGH-QUALITY CHRONIC DISEASE PREVENTIVE CARE AND MANAGEMENT IN CLINICAL AND COMMUNITY SETTINGS.2.PROMOTE A HEALTHY AND SAFE ENVIRONMENT- OUTDOOR AIR QUALITY- WATER QUALITY- BUILT ENVIRONMENT- INJURIES, VIOLENCE AND OCCUPATIONAL HEALTH3.PROMOTE HEALTHY WOMEN, INFANTS AND CHILDREN- MATERNAL AND INFANT HEALTH- CHILD HEALTH- REPRODUCTIVE, PRECONCEPTION AND INTER-CONCEPTION HEALTH.4. PROMOTE MENTAL HEALTH AND PREVENT SUBSTANCE ABUSE- PROMOTE MENTAL, EMOTIONAL AND BEHAVIORAL WELL-BEING IN COMMUNITIES- PREVENT SUBSTANCE ABUSE AND OTHER MENTAL EMOTIONAL BEHAVIORAL DISORDERS- STRENGTHEN INFRASTRUCTURE ACROSS SYSTEMS.5.PREVENT HIV, SEXUALLY TRANSMITTED DISEASES, VACCINE-PREVENTABLE DISEASES AND HEALTHCARE-ASSOCIATED INFECTIONS- PREVENT HIV AND STDS- PREVENT VACCINE-PREVENTABLE DISEASES- PREVENT HEALTH CARE-ASSOCIATED INFECTIONS.*INDICATES THE TWO PRIORITY/FOCUS AREAS SELECTED BY ONEIDA COUNTY HEALTH DEPARTMENT, FSLH AND PARTICIPATING HOSPITALS AND HEALTH AGENCIES.
PART VI, LINE 6:	ST. ELIZABETH MEDICAL CENTER (SEMC) AND FAXTON ST. LUKE'S HEALTHCARE (FSLH) AFFILIATED UNDER THE MOHAWK VALLEY HEALTH SYSTEM (MVHS) ON MARCH 6, 2014. THE TWO ORGANIZATIONS ARE NOW GOVERNED BY A SINGLE, 18-MEMBER MVHS BOARD OF DIRECTORS AND A SINGLE MANAGEMENT TEAM. AS THE ORGANIZATIONS MOVE FORWARD, THEY WILL CONTINUE TO WORK COLLABORATIVELY TO MEET THEIR RESPECTIVE 2013 COMMUNITY SERVICE PLAN GOALS. IN MAY 2014, FSLH WAS RECOGNIZED BY THE NYSDOH AS AN EMERGING PERFORMING PROVIDER SYSTEM (PPS). IN DECEMBER 2014, FSLH JOINED WITH AUBURN COMMUNITY HOSPITAL, ST. JOSEPH'S HOSPITAL HEALTH CENTER AND SUNY UPSTATE UNIVERSITY HOSPITAL AS A SINGLE PPS UNDER THE NAME CENTRAL NEW YORK CARE COLLABORATIVE (CNYCC). THE CNYCC WILL COLLABORATE TO MEET THE HEALTHCARE NEEDS OF PEOPLE LIVING IN CAYUGA, LEWIS, MADISON, ONEIDA, ONONDAGA AND OSWEGO COUNTIES. THE COMBINED DSRIP APPLICATION INCLUDES TWO PROJECTS THAT ARE TIED TO THE FLSH AND SEMC COMMUNITY SERVICE PLANS. ONE IS TO ADDRESS TOBACCO USE IN PREGNANT WOMEN TO HELP PREVENT PREMATURE BIRTHS. THE SECOND IS IMPLEMENTING EVIDENCE-BASED STRATEGIES FOR DISEASE MANAGEMENT IN HIGH RISK/AFFECTED POPULATIONS, SPECIFICALLY CARDIOVASCULAR, BY ADOPTING STRATEGIES FROM THE MILLION HEARTS CAMPAIGN THAT FOCUSES ON ABCS (ASPIRIN, BLOOD PRESSURE, CHOLESTEROL AND SMOKING). THE ELECTRONIC MEDICAL RECORD (EMR) AT BOTH HOSPITALS WILL PROMPT PROVIDERS TO COMPLETE THE 5 AS: ASK, ASSESS, ADVISE, ASSIST, ARRANGE (FOLLOW-UP) OF TOBACCO CONTROL.
PART VI, LINE 7, REPORTS FILED WITH STATES	NY

Schedule H (Form 990) 2014

Additional Data

Software ID:
Software Version:

- TIN:

Schedule J
(Form 990)

Department of the Treasury
Internal Revenue Service

Compensation Information

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

Complete if the organization answered "Yes" to Form 990, Part IV, 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

FAXTON ST LUKE'S HEALTHCARE

Employer identification number

16-1576637

Part I

Questions Regarding Compensation

Yes

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

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

Travel for companions Payments for business use of personal residence

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

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

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

Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked in line 1a? ..

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

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

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

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

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

Yes

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

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

Yes

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)
1MARK WARFEL DOBOARD MEMBER/SEMC MEDICAL STAFF PRES	(i) (ii)	0 ............................... 327,883	0 ............................... 12,624	0 ............................... 0	0 ............................... 15,300	0 ............................... 8,475	0 ............................... 364,282	0 ............................... 0
2JOHN SPERLING MDBOARD MEMBER/FSLH MEDICAL STAFF PRES	(i) (ii)	278,741 ............................... 0	125,663 ............................... 0	18,976 ............................... 0	10,400 ............................... 0	1,996 ............................... 0	435,776 ............................... 0	0 ............................... 0
3ROGER MCREYNOLDSBOARD MEMBER	(i) (ii)	194,663 ............................... 0	16,561 ............................... 0	12,162 ............................... 0	8,050 ............................... 0	17,337 ............................... 0	248,773 ............................... 0	0 ............................... 0
4SCOTT PERRA FACHEPRESIDENT/CEO	(i) (ii)	558,333 ............................... 0	85,723 ............................... 0	112,060 ............................... 0	20,800 ............................... 0	17,591 ............................... 0	794,507 ............................... 0	0 ............................... 0
5LOUIS AIELLOSR VICE PRESIDENT/CFO	(i) (ii)	0 ............................... 340,775	0 ............................... 3,333	0 ............................... 0	0 ............................... 17,850	0 ............................... 7,640	0 ............................... 369,598	0 ............................... 0
6ROBERT SCHOLEFIELD RN MSSR VICE PRESIDENT OPERATIONS	(i) (ii)	0 ............................... 247,742	0 ............................... 3,333	0 ............................... 0	0 ............................... 17,517	0 ............................... 7,640	0 ............................... 276,232	0 ............................... 0
7MICHAEL F TREVISANI MDSR VICE PRESIDENT/CMO	(i) (ii)	317,949 ............................... 0	0 ............................... 0	11,724 ............................... 0	2,197 ............................... 0	22,359 ............................... 0	354,229 ............................... 0	0 ............................... 0
8PATRICIA ROACH MS RN NEA-BCSR VICE PRESIDENT/CNO	(i) (ii)	254,167 ............................... 0	32,634 ............................... 0	29,243 ............................... 0	20,800 ............................... 0	22,862 ............................... 0	359,706 ............................... 0	0 ............................... 0
9ANTHONY SCIBELLISR VICE PRESIDENT/COO	(i) (ii)	211,667 ............................... 0	24,154 ............................... 0	18,329 ............................... 0	8,761 ............................... 0	17,346 ............................... 0	280,257 ............................... 0	0 ............................... 0
10MICHAEL HAILE FHFMASR VP/CFO	(i) (ii)	85,905 ............................... 0	42,883 ............................... 0	262,348 ............................... 0	3,559 ............................... 0	17,517 ............................... 0	412,212 ............................... 0	0 ............................... 0
11YANNICK GRENIER MDPHYSICIAN	(i) (ii)	541,990 ............................... 0	0 ............................... 0	0 ............................... 0	10,400 ............................... 0	7,334 ............................... 0	559,724 ............................... 0	0 ............................... 0
12MADANA MOHANA VALLEM MDPHYSICIAN	(i) (ii)	507,231 ............................... 0	0 ............................... 0	0 ............................... 0	10,400 ............................... 0	24,011 ............................... 0	541,642 ............................... 0	0 ............................... 0
13KENNETH ORTEGA MDPHYSICIAN	(i) (ii)	469,497 ............................... 0	5,165 ............................... 0	3,564 ............................... 0	10,400 ............................... 0	18,095 ............................... 0	506,721 ............................... 0	0 ............................... 0
14JORGE FERREIRO MDPHYSICIAN	(i) (ii)	278,742 ............................... 0	99,012 ............................... 0	3,564 ............................... 0	10,400 ............................... 0	15,215 ............................... 0	406,933 ............................... 0	0 ............................... 0
15MARK WILLIAMS MDPHYSICIAN	(i) (ii)	278,742 ............................... 0	76,270 ............................... 0	1,134 ............................... 0	10,400 ............................... 0	8,106 ............................... 0	374,652 ............................... 0	0 ............................... 0

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 4A

MICHAEL HAILE, FORMER CFO (THRU 3/5/2014) RECEIVED A SEVERANCE PAYMENT OF $240,750 IN 2014.

PART I, LINE 6

AN INCENTIVE COMPENSATION PLAN EXISTS FOR THE EXECUTIVE STAFF OF FSLH. COMPENSATION IS BASED ON PERFORMANCE RELATIVE, IN PART, TO THE ORGANIZATION NET EARNINGS TARGETS, AS WELL AS, VARIOUS OTHER QUALITY RELATED PERFORMANCE TARGETS. THE INCENTIVES ARE ONLY PAID OUT UPON ACHIEVEMENT OF THESE SET TARGETS. DURING 2014, $230,884 OF INCENTIVE COMPENSATION WAS PAID OUT UNDER THIS PLAN RELATING TO THE 2013 FISCAL YEAR. $200,000 WAS ACCRUED FOR THE 2014 FISCAL YEAR INCENTIVE COMPENSATION. HOWEVER, THIS WAS UNDER-ESTIMATED AND THE ACTUAL 2015 PAYMENTS FOR THE 2014 FISCAL YEAR, WAS $219,067.

Schedule J (Form 990) 2014

Additional Data

Software ID:
Software Version:

- TIN:

Schedule K
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Information on Tax Exempt Bonds

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

Attach to Form 990.
SchKMediumBullet

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
FAXTON ST LUKE'S HEALTHCARE

Employer identification number
16-1576637

Part I

Bond Issues

(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	(g) Defeased		(h) On behalf of issuer		(i) Pool financing
(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	ONEIDA COUNTY INDUSTRIAL DEVELOPMENT AUTHORITY	16-6158201	682465AB5	06-26-2006	7,705,000	WINDOW WALL REPLACEMENT, ED PROJECT, AC WING REHAB		X		X		X

Part II

Proceeds

	A		B		C		D
	1 Amount of bonds retired . . . . . . . . . . . . . .
2 Amount of bonds legally defeased . . . . . . . . . . .
3 Total proceeds of issue . . . . . . . . . . . . . .	7,705,000
4 Gross proceeds in reserve funds . . . . . . . . . . . .
5 Capitalized interest from proceeds . . . . . . . . . . .
6 Proceeds in refunding escrows . . . . . . . . . . . .
7 Issuance costs from proceeds . . . . . . . . . . . .	319,348
8 Credit enhancement from proceeds . . . . . . . . . . .
9 Working capital expenditures from proceeds . . . . . . . . .
10 Capital expenditures from proceeds . . . . . . . . . . .	7,385,652
11 Other spent proceeds . . . . . . . . . . . . . .
12 Other unspent proceeds . . . . . . . . . . . . . .
13 Year of substantial completion . . . . . . . . . . . .	2008
	Yes	No	Yes	No	Yes	No	Yes	No
14 Were the bonds issued as part of a current refunding issue? . . . . .		X
15 Were the bonds issued as part of an advance refunding issue? . . . . .		X
16 Has the final allocation of proceeds been made? . . . . . . . .	X
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? . . . . . . . . . . . . . .	X

Part III

Private Business Use

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

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

Cat. No. 50193E

Schedule K (Form 990) 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?
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? . . . .	X
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?	X
b Name of provider . . . . . . . . .	BANK OF AMERICA
c Term of hedge . . . . . . . . . .	24.800000000000
d Was the hedge superintegrated? . . . .		X
e Was the hedge terminated? . . . . . .		X

Schedule K (Form 990) 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

Schedule K (Form 990) 2014

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information to Form 990 or 990-EZ

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

FAXTON ST LUKE'S HEALTHCARE

Employer identification number

16-1576637

Return Reference	Explanation
FORM 990, PART VI, SECTION A, LINE 6	MOHAWK VALLEY HEALTH SYSTEM, INC IS THE SOLE MEMBER OF THE CORPORATION.
FORM 990, PART VI, SECTION A, LINE 7A	MOHAWK VALLEY HEALTH SYSTEM, INC APPOINTS THE DIRECTORS AND GOVERNING BODY OF THE ORGANIZATION. THE BOARD OF DIRECTORS ARE LISTED IN SECTION VII.
FORM 990, PART VI, SECTION B, LINE 11	THE FORM 990 AND FORM 990T ARE REVIEWED AT A MEETING WITH THE EXECUTIVE COMMITTEE AND THE BOARD OF DIRECTORS, PRIOR TO SUBMITTING THE REPORT.
FORM 990, PART VI, SECTION B, LINE 12C	CONFLICT OF INTEREST POLICY: THE PURPOSE OF THE POLICIES AND DIRECTIVES SET OUT IN THIS POLICY STATEMENT IS TO ASSURE THAT THE BUSINESS CONDUCTED BY THE ORGANIZATION IS CONDUCTED FREE FROM THE POSSIBLE INFLUENCE OF CONFLICTS OF INTEREST OF INTERESTED PERSONS. THIS POLICY EXISTS TO PROTECT THE ORGANIZATIONS INTEREST WHEN IT IS CONTEMPLATING ENTERING INTO A TRANSACTION OR ARRANGEMENT THAT MIGHT BENEFIT THE PRIVATE INTEREST OF AN INTERESTED PERSON IN THE ORGANIZATION. INTERESTED PERSONS MAY NOT ENTER INTO ANY EMPLOYMENT TRANSACTION OR OTHER ARRANGEMENT THAT MAY CAUSE OR BE PERCEIVED TO CAUSE A CONFLICT OF INTEREST. INTERESTED PERSONS MUST REVIEW THIS POLICY ANNUALLY AND COMPLETE THE ACKNOWLEDGEMENT AND DISCLOSURE FORM ANNUALLY. THE COMPLIANCE OFFICER AND/OR THE COMPLIANCE COMMITTEE WILL REVIEW ALL ANNUAL ACKNOWLEDGEMENT AND DISCLOSURE FORMS AND ANY CONFLICTS OR POTENTIAL CONFLICTS IDENTIFIED. WHEN A POTENTIAL CONFLICT IS IDENTIFIED, THE COMPLIANCE OFFICER WILL ENSURE APPROPRIATE ACTIONS ARE TAKEN TO RESOLVE THE CONFLICT. THIS POLICY IS INTENDED TO SUPPLEMENT BUT NOT REPLACE ANY APPLICABLE FEDERAL AND STATE LAWS GOVERNING CONFLICTS OF INTEREST APPLICABLE TO NONPROFIT AND CHARITABLE CORPORATIONS.
FORM 990, PART VI, SECTION B, LINE 15	THE BOARDS EXECUTIVE COMPENSATION COMMITTEE, HAS ADOPTED AND FOLLOWS A PROCESS FOR REVIEWING AND DETERMINING THE COMPENSATION OF THE CEO AND THE EXECUTIVE MANAGEMENT TEAM. THE EXECUTIVE MANAGEMENT TEAM CONSISTS OF THE FOLLOWING POSITIONS: SENIOR VICE PRESIDENT/CHIEF OPERATING OFFICER SENIOR VICE PRESIDENT/CHIEF FINANCIAL OFFICER SENIOR VICE PRESIDENT/CHIEF MEDICAL OFFICER SENIOR VICE PRESIDENT/CHIEF NURSING OFFICER THE COMMITTEE HAS ENGAGED AN INDEPENDENT COMPENSATION CONSULTANT TO PROVIDE INFORMATION AND ADVICE TO COMMITTEE, INCLUDING BUT NOT LIMITED, PROVIDING INDEPENDENT COMPENSATION COMPARABILITY DATA FOR FUNCTIONALLY COMPARABLE POSITIONS IN SIMILARLY SITUATED HOSPITALS. THE DATA IS PROVIDED ON AN ANNUAL BASIS AND IS REVIEWED BY THE COMMITTEE, ALONG WITH OTHER INFORMATION, PRIOR TO APPROVING ANY CHANGES TO COMPENSATION. THE INDEPENDENCE OF THE COMMITTEES MEMBERS IS REVIEWED AND VERIFIED PRIOR TO THE START OF THE ANNUAL COMPENSATION REVIEW PROCESS. SHOULD A CONFLICT PRESENT, THOSE INDIVIDUALS WITH ACTUAL OR PERCEIVED CONFLICTS ABSTAIN FROM VOTING UNTIL SUCH TIME AS THE CONFLICT CAN BE RESOLVED OR A REPLACEMENT MEMBER IS APPOINTED TO THE COMMITTEE. THE COMMITTEES DELIBERATIONS AND DECISIONS ARE GUIDED BY A WRITTEN COMPENSATION PHILOSOPHY AND DOCUMENTED THROUGH WRITTEN MINUTES TAKEN DURING EACH MEETING. THE MINUTES INCLUDE, AMONG OTHER THINGS, THE WRITTEN MATERIALS DISTRIBUTED OR PRESENTED DURING THE MEETING AND THE SPECIFIC DECISIONS TAKEN AT THE MEETING.
FORM 990, PART VI, SECTION C, LINE 19	POLICY: IT IS THE POLICY OF THIS HOSPITAL TO MAKE AVAILABLE TO ANYONE WHO ASKS, A COPY OF ITS ANNUAL REPORT TO THE INTERNAL REVENUE SERVICE (IRS) ON FORM 990, AND ITS EXEMPT STATUS FORM. IN ACCORDANCE WITH THE LAW, FORM 990 FOR A GIVEN YEAR, WILL BE MADE AVAILABLE FOR PUBLIC INSPECTION FOR A THREE-YEAR PERIOD.PURPOSE: THE PURPOSE OF THIS POLICY IS TO COMPLY WITH IRS LAW, WHICH APPLIES FOR TAX YEARS BEGINNING AFTER JUNE 8, 1999 SPECIAL INSTRUCTIONS: A. A COPY OF THE ABOVE NAMED DOCUMENTS, WILL BE MADE AVAILABLE FOR INSPECTION BY A REQUESTER, IN A DESIGNATED ROOM, IN THE FINANCE DEPARTMENT OF THE HOSPITAL. B. THE DOCUMENTS WILL BE MADE AVAILABLE, IMMEDIATELY, TO ANYONE WHO APPEARS IN PERSON DURING USUAL BUSINESS HOURS. FOR WRITTEN REQUESTS FOR COPIES OF DOCUMENTS, RESPONSE WILL BE PROVIDED WITHIN THIRTY (30) DAYS OF RECEIPT OF PAYMENT OF REASONABLE COPYING FEES. C. EITHER THE HOSPITAL SENIOR VICE PRESIDENT/CFO, THE CONTROLLER, OR THEIR DESIGNATED REPRESENTATIVE WILL BE PRESENT DURING AN INSPECTION BY A REQUESTER. D. ONLY THE HOSPITAL SENIOR VICE PRESIDENT/CFO, THE CONTROLLER, OR THEIR DESIGNATED REPRESENTATIVE WILL BE PERMITTED TO ANSWER QUESTIONS THAT A REQUESTER MAY HAVE. SHOULD A REQUESTER ASK THE HOSPITAL FOR A PHOTOCOPY OF ANY OR ALL PARTS OF DOCUMENTS, THE HOSPITAL WILL CHARGE $1.00 FOR THE FIRST PAGE, PLUS $.15 FOR EACH ADDITIONAL PAGE.
FORM 990, PART IX, LINE 11G	OTHER FEES: PROGRAM SERVICE EXPENSES 23,555,558. MANAGEMENT AND GENERAL EXPENSES 5,946,889. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 29,502,447.
FORM 990, PART XI, LINE 9:	CHANGE IN FV OF INTEREST RATE SWAPS -990,272. CHANGE IN INTEREST IN UNRESTRICTED NET ASSETS OF FOUNDATION -156,959. CHANGE IN INTEREST IN TEMPORARILY RESTRICTED NET ASSETS OF FOUNDATION 243,540.
PART XII LINE 2C	NO CHANGE FROM PRIOR YEAR

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:
Software Version:

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

Complete if the organization answered "Yes" 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

FAXTON ST LUKE'S HEALTHCARE

Employer identification number

16-1576637

Part I

Identification of Disregarded Entities Complete if the organization answered "Yes" on Form 990, Part IV, line 33.

(a) Name, address, and EIN (if applicable) of disregarded entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(f) Direct controlling entity
(1) PARAFFIN LLC PO BOX 479 UTICA,NY13503 27-1341112	LABORATORY SERVICES	NY	FAXTON-ST LUKE'S HEALTHCARE INC

Part II

Identification of Related Tax-Exempt Organizations Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled entity?
(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) MOHAWK VALLEY HEALTH SYSTEM INC PO BOX 4308 UTICA,NY13504 22-3124162	PROMOTE HEALTH CARE	NY	501(C)(3)	HOSPTIAL	N/A		No
(2) ST LUKE'S HOME RESIDENTIAL HEALTHCARE FACILITY PO BOX 6305 UTICA,NY13504 16-1476372	202 BED RHCF	NY	501(C)(3)	LINE 9	FAXTON ST LUKE'S HEALTHCARE INC		No
(3) VISITING NURSE'S ASSOCIATION OF UTICA & ONEIDA COUNTIES 2608 GENESEE STREE UTICA,NY13502 15-0532259	HOME HEALTH NURSING	NY	501(C)(3)	LINE 9	MOHAWK VALLEY NETWORK INC		No
(4) FAXTON ST LUKE'S HEALTHCARE FOUNDATION PO BOX 479 UTICA,NY13503 22-3078768	FUND RAISING	NY	501(C)(3)	LINE 9	MOHAWK VALLEY NETWORK INC		No
(5) ST ELIZABETH'S MEDICAL CENTER INC 2209 GENESEE STREET UTICA,NY13501 15-0532245	HEALTH CARE	NY	501(C)(3)	HOSPTIAL	PARTNERS IN FRANCISCAN MINISTRIES INC		No
(6) ST ELIZABETH MEDICAL CENTER FOUNDATION 2209 GENESEE STREET UTICA,NY13501 22-2562170	FUNDRAISING	NY	501(C)(3)	9	ST ELIZABETH MEDICAL CENTER	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	(h) Percentage ownership	(i) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets		Yes	No
(1) SLM CORPORATION PO BOX 479 UTICA,NY13503 16-1134876	REAL ESTATE MANAGEMENT	NY		T			100.000 %		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) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

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

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

Yes

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

Yes

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

Yes

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

Yes

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

Yes

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

Yes

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

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

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

(a) Name of 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:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: TO PROVIDE THE HIGHEST QUALITY HEALTH CARE IN OUR REGION.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	20
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	2,698
6	Total number of volunteers (estimate if necessary) .............	6	402
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	753,545
b	Net unrelated business taxable income from Form 990-T, line 34 .........	7b	0

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	3,225,425	2,363,824
9	Program service revenue (Part VIII, line 2g) .........	263,667,802	267,973,594
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	6,226,214	3,752,760
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	5,473,213	7,734,305
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)...................	278,592,654	281,824,483
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	0	0
14	Benefits paid to or for members (Part IX, column (A), line 4).....	0	0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	152,675,214	152,932,825
16a	Professional fundraising fees (Part IX, column (A), line 11e).....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	130,078,958	126,900,723
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	282,754,172	279,833,548
19	Revenue less expenses. Subtract line 18 from line 12.......	-4,161,518	1,990,935
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	268,563,979	262,592,131
21	Total liabilities (Part X, line 26).............	127,755,036	122,241,078
22	Net assets or fund balances. Subtract line 21 from line 20.....	140,808,943	140,351,053

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 118,229,083 including grants of $ ) (Revenue $ 109,395,582 )
	INPATIENT/ACUTE CARE SERVICES - FSLH IS A FULL SERVICE GENERAL HOSPTIAL WITH 320 LICENSED BEDS. THE HOSPTIAL PROVIDES A FULL RANGE OF ANCILLARY SERVICES, INCLUDING MATERNITY AND NEWBORN CARE SERVICES. DISBURSEMENTS MADE BY THE HOSPTIAL ARE EXCLUSIVELY FOR SERVICES AND MATERIALS USED IN PERFORMING THE HOSPITAL'S EXEMPT FUNCTIONS. FSLH PROVIDES CARE TO EVERYONE REGARDLESS OF RACE, RELIGION OR ABILITY TO PAY.

4b	(Code: ) (Expenses $ 32,651,952 including grants of $ ) (Revenue $ 43,871,797 )
	AMBULATORY/OUTPATIENT SURGERY - FSLH HAS A FULL RANGE OF AMBULATORY SURGERY SERVICES ON ITS CAMPUS FOR PATIENTS THAT DO NOT REQUIRE OVERNIGHT OR LONG INPATIENT STAYS. FSLH PROVIDES SERVICES TO EVERYONE REGARDLESS OF RACE, RELIGION OR ABILITY TO PAY.

4c	(Code: ) (Expenses $ 16,584,094 including grants of $ ) (Revenue $ 20,133,108 )
	THE CANCER CARE PROGRAM AT FSLH INCLUDES RADIATION MEDICINE, OUTPATIENT INFUSION, BREAST CARE, PALLIATIVE CARE, AND INTEGRATIVE MEDICINES, AS WELL AS TUMOR REGISTRY AND CLINICAL TRIALS. FSLH PROVIDES SERVICES TO EVERYONE REGARDLESS OF RACE, RELIGION OR ABILITY TO PAY.

	(Code: ) (Expenses $ 72,022,032 including grants of $ ) (Revenue $ 101,553,867 )
	RENAL DIALYSIS, LABOR AND DELIVER, RADIOLOGY, PRIMARY CARE, DENTAL, PT, OT, DIAGNOSTICS, EMERGENT AND URGENT CARE, ORTHOPEDICS, PSYCHIATRIC IP, EDUCATION.

4d	Other program services (Describe in Schedule O.)
	(Expenses $ 72,022,032 including grants of $ ) (Revenue $ 101,553,867 )
4e	Total program service expenses239,487,161

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)............	4,958,796	960,204	390,759

				(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		1,088,623
e	Government grants (contributions)1e		533,978

f	All other contributions, gifts, grants, and similar amounts not included above1f		741,223

g	Noncash contributions included in lines 1a-1f:$
h	Total. Add lines 1a-1f.......			2,363,824
			Business Code
2a	ACUTE CARE		622200	109,395,582	109,395,582
b	OUTPATIENT SURGERY		622200	43,871,797	43,871,797
c	CANCER CARE PROGRAM		622200	20,133,108	20,133,108
d	RENAL DIALYSIS		622200	18,712,090	18,712,090
e	MATERNAL AND CHILDCARE		622200	9,751,487	9,751,487
f	All other program service revenue .			66,109,530	65,995,696	113,834
g	Total. Add lines 2a–2f........			267,973,594
3	Investment income (including dividends, interest, and other similar amounts).......			3,752,760			3,752,760
4	Income from investment of tax-exempt bond proceeds..
5	Royalties...........
		(i) Real	(ii) Personal
6a	Gross rents	623,283
b	Less: rental expenses	0
c	Rental income or (loss)	623,283
d	Net rental income or (loss).......			623,283		623,283
		(i) Securities	(ii) Other
7a	Gross amount from sales of assets other than inventory
b	Less: cost or other basis and sales expenses
c	Gain or (loss)
d	Net gain or (loss)..........
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..
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...
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..
Miscellaneous Revenue			Business Code
11a	340B CONTRACT		900099	2,458,859	2,458,859
b	RETAIL PHARMACY		900099	956,508	956,508
c	NH SCANNER		900099	949,726	949,726
d	All other revenue ....			2,745,929	2,729,501	16,428
e	Total. Add lines 11a–11d ......			7,111,022
12	Total revenue. See Instructions......			281,824,483	274,954,354	753,545	3,752,760


				(A) Beginning of year		(B) End of year
1	Cash–non-interest-bearing .............			-1,761,475	1	325,840
2	Savings and temporary cash investments .........			1,850,793	2	450,859
3	Pledges and grants receivable, net ...........				3
4	Accounts receivable, net .............			39,306,028	4	41,742,977
5	Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of Schedule L ..................
					5
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L
					6
7	Notes and loans receivable, net .............				7
8	Inventories for sale or use ..............			5,258,877	8	5,902,730
9	Prepaid expenses and deferred charges ..........			3,525,990	9	3,780,971
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	306,925,862
b	Less: accumulated depreciation .....	10b	220,589,392	96,402,345	10c	86,336,470
11	Investments—publicly traded securities ..........				11
12	Investments—other securities. See Part IV, line 11 .....			78,778,046	12	82,986,614
13	Investments—program-related. See Part IV, line 11 .....			11,555,669	13	11,488,752
14	Intangible assets ...............			1,698,467	14	1,425,600
15	Other assets. See Part IV, line 11 ...........			31,949,239	15	28,151,318
16	Total assets. Add lines 1 through 15 (must equal line 34)......			268,563,979	16	262,592,131
17	Accounts payable and accrued expenses .........			32,805,396	17	34,832,144
18	Grants payable .................				18
19	Deferred revenue ................				19
20	Tax-exempt bond liabilities .............			6,370,000	20	6,145,000
21	Escrow or custodial account liability. Complete Part IV of Schedule D..				21
22	Loans and other payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
	persons. Complete Part II of Schedule L..........				22
23	Secured mortgages and notes payable to unrelated third parties ..			27,940,334	23	25,985,730
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....................			60,639,306	25	55,278,204
26	Total liabilities. Add lines 17 through 25.........			127,755,036	26	122,241,078
	Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets ..............			132,570,667	27	131,869,235
28	Temporarily restricted net assets ...........			3,710,112	28	3,953,654
29	Permanently restricted net assets ...........			4,528,164	29	4,528,164
	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 ...........			140,808,943	33	140,351,053
34	Total liabilities and net assets/fund balances ........			268,563,979	34	262,592,131