Attach to Form 990 or Form 990-EZ.
Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
| (i)Name of supported organization | (ii) EIN | (iii) Type of organization (described on lines 1- 9 above (see instructions)) | (iv) Is the organization listed in your governing document? | (v) Amount of monetary support (see instructions) | (vi) Amount of other support (see instructions) | |
|---|---|---|---|---|---|---|
| Yes | No | |||||
| (A)
WHITE PLAINS HOSPITAL MEDICAL CENTER |
131740130 | 3 | Yes | 6,315,079 | 0 | |
| (B)
LAWRENCE HOSPITAL CENTER |
131740110 | 3 | Yes | 6,186,061 | 0 | |
| (C)
NORTHERN WESTCHESTER HOSPITAL |
131740118 | 3 | Yes | 6,242,679 | 0 | |
| (D)
PHELPS MEMORIAL HOSPITAL ASSOC |
131725076 | 3 | Yes | 6,175,032 | 0 | |
| Total 4 | 24,918,851 | 0 | ||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2011 | (b) 2012 | (c) 2013 | (d) 2014 | (e) 2015 | (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. | ||||||
Calendar year
(or fiscal year beginning in) ![]() |
(a) 2011 | (b) 2012 | (c) 2013 | (d) 2014 | (e) 2015 | (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. | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2011 | (b) 2012 | (c) 2013 | (d) 2014 | (e) 2015 | (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.) | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2011 | (b) 2012 | (c) 2013 | (d) 2014 | (e) 2015 | (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.).. | ||||||
| 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 | ||||
| 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 2015 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-2015 |
(iii) Distributable Amount for 2015 |
|
|---|---|---|---|---|
|
1
Distributable amount for 2015 from Section C, line 6 |
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|
2
Underdistributions, if any, for years prior to 2015 (reasonable cause required--see instructions) |
||||
| 3 Excess distributions carryover, if any, to 2015: | ||||
| a | ||||
| b | ||||
| c | ||||
| d From 2013....... | ||||
| e From 2014....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2015 distributable amount | ||||
|
i
Carryover from 2010 not applied (see instructions) |
||||
| j Remainder. Subtract lines 3g, 3h, and 3i from 3f. | ||||
| 4Distributions for 2015 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2015 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from 4. | ||||
|
5
Remaining underdistributions for years prior to 2015, if any. Subtract lines 3g and 4a from line 2 (if amount greater than zero, see instructions) |
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|
6
Remaining underdistributions for 2015. Subtract lines 3h and 4b from line 1 (if amount greater than zero, see instructions) |
||||
|
7 Excess distributions carryover to 2016. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a | ||||
| b | ||||
| c Excess from 2013....... | ||||
| d From 2014....... | ||||
| e From 2015....... | ||||
| Facts And Circumstances Test |
|---|
| Return Reference | Explanation |
|---|---|
| SCHEDULE A, SECTION D, LINE 2: | THE BOARD OF DIRECTORS SHALL INCLUDE THE PRESIDENT/CEO OF THE ORGANIZATION, THE CEO OF EACH HOSPITAL (SUPPORTED ORGANIZATIONS) OR THE DESIGNEE OF EACH CEO AND THE CHAIRPERSON OF THE BOARD OF EACH HOSPITAL OR THE DESIGNEE OF EACH CHAIRPERSON OF EACH HOSPITAL. A HOSPITAL'S DESIGNEE REPRESENTATIVE TO THE BOARD SHALL BE A MEMBER OF SUCH HOSPITAL'S BOARD AND SHALL NOT BE AN EMPLOYEE OF THE HOSPITALS. PER THE BYLAWS OF THE ORGANIZATION, THE CHIEF EXECUTIVE OFFICERS ("CEOS") OF THE SUPPORTED ORGANIZATIONS LISTED IN PART I, LINE 11G, SHALL MAINTAIN AN ACTIVE ROLE IN THE AFFAIRS OF THE CORPORATION AND THE PRESIDENT/CEO OF THE ORGANIZATION SHALL SEEK THE ADVICE AND COUNSEL OF THE CEOS OF LAWRENCE HOSPITAL CENTER, NORTHERN WESTCHESTER HOSPITAL ASSOCIATION, PHELPS MEMORIAL HOSPITAL ASSOCIATION, AND WHITE PLAINS HOSPITAL MEDICAL CENTER (EACH INDIVIDUALLY, A "HOSPITAL AND COLLECTIVELY, THE "HOSPITALS") IN ORDER TO ASSESS THE DEGREE TO WHICH THE CORPORATION IS MEETING THE NEEDS OF THE HOSPITALS. THE CEOS OF THE HOSPITALS SHALL MAKE RECOMMENDATIONS TO THE PRESIDENT/CEO OF THE ORGANIZATION AND TO THE BOARD OF DIRECTORS AS TO HOW THESE NEEDS CAN BEST BE MET. |
| PART I, LINE 11, COLUMN (VI): | HEALTHSTAR NETWORK INC. PROVIDES THE FOLLOWING SERVICES TO EACH OF ITS SUPPORTED ORGANIZATIONS: 1. SUPPLY CHAIN RELATIONSHIP MANAGEMENT, OVERSIGHT AND REPORTING UNDER THE GPO AGREEMENTS; CLINICAL VALUE ANALYSIS AND PHYSICIAN PREFERENCE ITEM SERVICES. 2. INSURANCE FUNCTION MANAGEMENT, OVERSIGHT AND CONSULTING; MONITOR AND COORDINATE BENEFITS AND SUBROGATION OF CLAIMS; RISK MANAGEMENT FUNCTION, ACCIDENT PREVENTION AND LOSS CONTROL PROGRAMS; AND PROVIDE ACCESS TO AND COORDINATE THE MEDICAL MALPRACTICE INSURANCE PROGRAM AND THE NWLP CAPTIVE INSURANCE PROGRAM. 3. CLINICAL INFORMATICS AND ANALYSIS AND INFORMATION TECHNOLOGY MANAGEMENT, INCLUDING PHARMACY SUPPLY CHAIN, IT, PHARMACY, ORDER SET RE-WRITE (ONLY), ICD-10 AND MEANINGFUL USE REPORTING AND DEMONSTRATION. 4. DATA MARTS AND DATA REPORTING SERVICES, TO INCLUDE UPGRADE WORK, JOINT MEANINGFUL USE REPORTING, JOINT SUPPLY CHAIN WORK AND MAINTENANCE. 5. WESTCHESTER EMERGENCY MEDICAL SERVICES, INCLUDING AMBULANCE TRANSPORTS, EMERGENCY PREPAREDNESS, FLY CAR SYSTEM, CALL CENTER AND TOWN EMERGENCY MEDICAL TECHNICIAN LEASING. 6. ICD-10 REMEDIATION MANAGEMENT AND COORDINATION SERVICES. 7. ACCESS TO INFORMATION TECHNOLOGY UNDER EXISTING CAPITAL LEASE ARRANGEMENT. 8. ACCESS TO INFORMATION TECHNOLOGY SUPPORT AND RELATED SERVICES FROM IT SERVICE PROVIDERS CURRENTLY CONTRACTING WITH SERVICE PROVIDER. |
| SCHEDULE A, SECTION D, LINE 3: | THE CEO AND CHAIRPERSON OF EACH SUPPORTED ORGANIZATION SERVES ON THE BOARD OF HEALTHSTAR NETWORK INC. AS BOARD MEMBERS OF THE ORGANIZATION THEY HAVE THE POWER TO CREATE THE ORGANIZATION'S INVESTMENT POLICIES AS WELL AS DIRECT THE USE OF THE ORGANIZATION'S INCOME AND ASSETS AT ANY POINT DURING THE YEAR. |
| SCHEDULE A, SECTION E, LINE 2A: | THE SUPPORTED ORGANIZATIONS MISSIONS IS TO PROVIDE QUALITY, PATIENT CENTERED CARE THROUGH A UNIQUE COMBINATION OF MEDICAL EXPERTISE, LEADING-EDGE TECHNOLOGY, AND A COMMITMENT TO HUMANITY. HEALTHSTAR NETWORK INC. WORKS TO HELP THE SUPPORTED ORGANIZATIONS ACHIEVE THEIR MISSIONS BY PROVIDING NETWORK LEVEL SERVICES SUCH AS INFORMATION TECHNOLOGY SERVICES, JOINT INSURANCE PROGRAMS, SUPPLY CHAIN SERVICES, AND AMBULANCE SERVICES TO THE SUPPORTED ORGANIZATIONS. |
| SCHEDULE A, SECTION E, LINE 3: | THE ORGANIZATION'S ACTIVITIES WOULD HAVE BEEN PERFORMED BY THE SUPPORTED ORGANIZATIONS HAD THE ORGANIZATION NOT HAD PERFORMED THEM. THE SUPPORTED ORGANIZATIONS NEED ALL OF THE SERVICES PROVIDED BY THE ORGANIZATION IN ORDER TO OPERATE THE HOSPITAL AND TO PROVIDE OPTIMAL SERVICE TO THEIR PATIENTS. |
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Attach to Form 990 or 990-EZ.
Information about Schedule O (Form 990 or 990-EZ) and its instructions is at| Return Reference | Explanation |
|---|---|
| FORM 990, PART V, LINE 4B: | THE BANK ACCOUNTS LISTED ON PART V, LINE 4(B) ARE RELATED TO THE BUSINESS ACTIVITIES OF THE 100% OWNED SUBSIDIARY, NWLP INSURANCE COMPANY, LTD. |
| FORM 990, PART VI, SECTION A, LINE 2 | JOEL SELIGMAN, JON SCHANDLER, EDWARD DINAN, DANIEL BLUM, MICHAEL FOSINA AND SHARON LUCIAN ARE ALSO DIRECTORS OF NWLP INSURANCE COMPANY AND, THEREFORE, HAVE A BUSINESS RELATIONSHIP AS DESCRIBED BY THE IRS FOR FORM 990 REPORTING PURPOSES. |
| FORM 990, PART VI, SECTION B, LINE 11 | HEALTHSTAR NETWORK INC. D/B/A STELLARIS HEALTH NETWORK'S FORM 990 FOR THE YEAR ENDING DECEMBER 31, 2015 WAS REVIEWED IN DETAIL BY THE ORGANIZATION'S PRESIDENT/CEO. THE BOARD WAS PROVIDED A PAPER DRAFT OF THE FORM 990 PRIOR TO FILING TO REVIEW AND PROVIDE COMMENTS TO THE ORGANIZATION'S TAX PREPARER PKF O'CONNOR DAVIES LLP AT A BOARD MEETING, WHERE THE FORM 990 WAS PRESENTED. |
| FORM 990, PART VI, SECTION B, LINE 12C | HEALTHSTAR NETWORK INC. D/B/A STELLARIS HEALTH NETWORK'S CONFLICT OF INTEREST POLICY IS DISTRIBUTED TO OFFICERS, DIRECTORS, SENIOR MANAGERS, OTHER EMPLOYEES AND VOLUNTEERS. ANNUALLY, A QUESTIONNAIRE IS COMPLETED BY ALL OFFICERS AND DIRECTORS IN WHICH THEY ARE ASKED SPECIFIC QUESTIONS AND DISCLOSE INFORMATION REGARDING ACTUAL OR POTENTIAL CONFLICTS BETWEEN STELLARIS AND THEMSELVES OR CERTAIN RELATED PARTIES (AS DEFINED IN THE INSTRUCTIONS TO THE FORM 990). THESE QUESTIONNAIRES ARE COLLECTED AND REVIEWED ANNUALLY TO ENSURE COMPLIANCE WITH STELLARIS' CONFLICT OF INTEREST POLICY. IF A CONFLICT OF INTEREST IS IDENTIFIED, THE INDIVIDUAL WILL BE RECUSED FROM VOTING ON THE SUBJECT MATTER. |
| FORM 990, PART VI, SECTION B, LINE 15A | HEALTHSTAR NETWORK INC. D/B/A STELLARIS HEALTH NETWORK ENGAGES AN EXECUTIVE COMPENSATION CONSULTANT TO DETERMINE THE COMPENSATION OF ITS PRESIDENT/CEO. THE CONSULTANT'S ANALYSIS INCLUDES DATA OF COMPENSATION PAID BY COMPARABLE ORGANIZATIONS AND TO OFFICERS SIMILARLY SITUATED (WITH SAME FUNCTIONS/JOBS RESPONSIBILITIES). COMPENSATION IS THEN REVIEWED, APPROVED AND DOCUMENTED BY A SEPARATE COMPENSATION COMMITTEE. DETERMINATION WAS DOCUMENTED IN A LETTER STATING THE SET COMPENSATION. OTHER THAN THIS INDIVIDUAL, HEALTHSTAR NETWORK INC. D/B/A STELLARIS HEALTH NETWORK DOES NOT HAVE ANY KEY EMPLOYEES AS DEFINED BY THE INTERNAL REVENUE SERVICES. |
| FORM 990, PART VI, SECTION C, LINE 19 | HEALTHSTAR NETWORK INC. D/B/A STELLARIS HEALTH NETWORK'S FINANCIAL STATEMENTS, GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE AVAILABLE TO THE PUBLIC UPON REQUEST, AND AT THE DISCRETION OF MANAGEMENT. |
| FORM 990, PART XI, LINE 9: | CAPITAL TRANSFERS WITH SUBSIDIARY -105,301. |
| FORM 990, PART XI, LINE 8: | STELLARIS' 2014 CONSOLIDATED FINANCIAL STATEMENTS HAVE BEEN RESTATED TO REFLECT A CORRECTION IN ITS ACCOUNTING FOR PROPERTY AND EQUIPMENT UNDER A CAPITAL LEASE. THE ERROR OCCURRED AS THE RESULT OF ERRONEOUSLY RECOGNIZING PROPERTY AND EQUIPMENT AND DEPRECIATION ON ASSETS WHICH WERE NOT YET ACQUIRED BUT INSTEAD REPRESENTED THE UNEXPENDED PROCEEDS OF THE CAPITAL LEASE. THIS RESULTED IN A PRIOR PERIOD ADJUSTMENT OF $11,391,298. |
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