TY 2015 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) THOMAS T LEE MD...................................................................... CHAIRMAN	1.0 ................. 0.25	X	X	0	0	0
(2) RICHARD F KOMOSINSKI...................................................................... FIRST VICE CHAIRMAN	1.0 ................. 0.55	X	X	0	0	0
(3) GERALD T MALONE...................................................................... SECOND VICE CHAIRMAN	1.0 ................. 0.26	X	X	0	0	0
(4) PETER J MEOLA...................................................................... ASSISTANT SECRETARY(THRU 3/15)	1.0 ................. 0.25	X	X	0	0	0
(5) LENORE A MINERVA...................................................................... SECRETARY	1.0 ................. 0.0	X	X	0	0	0
(6) ROBERT C MURRAY...................................................................... TREASURER	1.0 ................. 0.25	X	X	0	0	0
(7) CHARLES J AITCHESON...................................................................... BOARD MEMBER (THRU 3/15)	1.0 ................. 0.0	X		0	0	0
(8) IYAD ANNABI MD...................................................................... BOARD MEMBER	1.0 ................. 20.0	X		57,492	49,735	18,938
(9) DOMINICK P ARTUSO MD...................................................................... CHAIR DOBBS FERRY MED EXEC COM	1.0 ................. 0.0	X		0	0	0
(10) ROY ASHIKARI MD...................................................................... BOARD MEMBER	1.0 ................. 0.0	X		0	0	0
(11) ABDUL AZEEZ MD...................................................................... FORMER CHIEF OF STAFF	1.0 ................. 0.0	X		0	0	0
(12) JIM BOSTIC...................................................................... BOARD MEMBER	1.0 ................. 0.0	X		0	0	0
(13) MELVINA M CARTER...................................................................... BOARD MEMBER	1.0 ................. 0.0	X		0	0	0
(14) JIM CASTRO-BLANCO ESQ...................................................................... BOARD MEMBER	1.0 ................. 0.0	X		0	0	0
(15) STEVE CENTRILLO...................................................................... BOARD MEMBER	1.0 ................. 0.0	X		0	0	0
(16) JOSEPH A DISALVO ESQ...................................................................... BOARD MEMBER (THRU 3/15)	1.0 ................. 0.0	X		0	0	0
(17) ANNA T DOLAN MD...................................................................... BOARD MEMBER	1.0 ................. 0.25	X		0	0	0

(A) Name and Title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(18) HON LAWRENCE H ECKER........................................................................ BOARD MEMBER	1.0 .......................0.0	X					0	0	0
(19) KEVIN FAY........................................................................ BOARD MEMBER	1.0 .......................0.31	X					0	0	0
(20) GREGORY M FISK........................................................................ BOARD MEMBER	1.0 .......................0.25	X					0	0	0
(21) PHILIP FLORIO MD........................................................................ BOARD MEMBER	1.0 .......................0.0	X					0	0	0
(22) RICHARD G FONTANA ESQ........................................................................ BOARD MEMBER (THRU 3/15)	1.0 .......................0.26	X					0	0	0
(23) MARK HERRMANN........................................................................ BOARD MEMBER	1.0 .......................0.0	X					0	0	0
(24) GREGORY F HOLCOMBE........................................................................ BOARD MEMBER (THRU 3/15)	1.0 .......................0.25	X					0	0	0
(25) ANN KACHMAR........................................................................ BOARD MEMBER	1.0 .......................0.0	X					0	0	0
(26) WM LEE KINNALLY JR........................................................................ BOARD MEMBER	1.0 .......................0.0	X					0	0	0
(27) JAMES R LETSEN........................................................................ BOARD MEMBER	1.0 .......................0.0	X					0	0	0
(28) JEANNE MARTINELLI........................................................................ BOARD MEMBER	1.0 .......................0.0	X					0	0	0
(29) MICHAEL SCHREIBER MD........................................................................ CHIEF OF STAFF	1.0 .......................0.25	X					140,830	0	240
(30) CECILE D SINGER........................................................................ BOARD MEMBER	1.0 .......................0.25	X					0	0	0
(31) RONALD CORTI........................................................................ PRESIDENT/CEO	37.5 .......................1.26		X				668,012	0	132,813
(32) LYNN NELSON........................................................................ Exec VP/COO	37.5 .......................0.25		X				567,700	0	38,346
(33) DENNIS KEANE........................................................................ VP FINANCE/CFO	37.5 .......................0.26		X				559,135	0	49,076
(34) PAUL ANTONECCHIA MD........................................................................ VP MEDICAL AFFAIRS/CMO	37.5 .......................0.26			X			449,516	0	35,056
(35) GLADYS ATTANASIO........................................................................ ASSISTANT VP REVENUE CYCLE	37.5 .......................0.0			X			218,997	0	32,903
(36) PHYLLIS BAZERMAN........................................................................ COMPLIANCE OFFICER	37.5 .......................0.0			X			175,142	0	18,210
(37) BRIAN BEHR........................................................................ DIRECTOR OF FINANCE	37.5 .......................0.0			X			178,154	0	18,537
(38) CASSANDRA BOGLE........................................................................ ASSISTANT VP NURSING	37.5 .......................0.0			X			160,362	0	24,244
(39) CHERAY BURNETT........................................................................ VP ADMINISTRATION	37.5 .......................0.0			X			194,490	0	13,008
(40) FRAN DAVIS........................................................................ VP NURSING	37.5 .......................0.0			X			241,372	0	34,871
(41) DON GASPARINI........................................................................ ASSISTANT VP BEHAVIORAL HEALTH	37.5 .......................0.0			X			167,293	0	31,474
(42) NANCY GOMEZ........................................................................ NURSING DIRECTOR	37.5 .......................0.0			X			184,040	0	31,038
(43) BRIAN KALEY........................................................................ VP BEHAVIORAL HEALTH SERVICES	37.5 .......................0.0			X			288,466	0	18,979
(44) MARC LEFF........................................................................ VP HUMAN RESOURCES	37.5 .......................0.0			X			268,233	0	17,277
(45) JANET MCCARTHY........................................................................ ASSISTANT VP NURSING	37.5 .......................0.0			X			186,012	0	17,388
(46) JOSEPH PRIVITERA........................................................................ DIR OF PHYSICIAN PRACTICE MGMT	37.5 .......................0.0			X			222,088	0	21,947
(47) PETER WEIDNER........................................................................ DIRECTOR OF INFO SVCS	37.5 .......................0.0			X			169,477	0	29,567
(48) LAURA FANNING........................................................................ DIRECTOR OF SURGICAL SERVICES	37.5 .......................0.0			X			159,250	0	17,046
(49) TARA CURTIN........................................................................ ASSISTANT VICE PRESIDENT	37.5 .......................0.0			X			158,329	0	24,082
(50) DANIELLE STANZIONE........................................................................ CHIEF OF STAFF	37.5 .......................0.0			X			157,085	0	15,747
(51) ANDREW FADER MD........................................................................ PHYSICIAN - INTERNAL MEDICINE	37.5 .......................0.0				X		263,640	0	26,367
(52) PRASERT ITHARAT MD........................................................................ PHYSICIAN	37.5 .......................0.0				X		317,760	0	48,610
(53) ANDRE OUTON MD........................................................................ PHYSICIAN - INTERNAL MEDICINE	37.5 .......................0.0				X		279,895	0	34,317
(54) EDNER PIERRE-LOUIS MD........................................................................ PHYSICIAN-INTERNAL MEDICINE	37.5 .......................0.0				X		321,320	0	49,009
(55) MICHAEL DIGIORNO MD........................................................................ PHYSICIAN - NEPHROLOGY	37.5 .......................0.0				X		308,017	0	33,554
(56) MARK POHAR........................................................................ MALOTZ NURSING HOME ADMIN	0.0 .......................37.5					X	89,642	162,855	181,153

(A) Name and business address	(B) Description of services	(C) Compensation
DOBBS FERRY EMERGENCY MEDICINE, 33 RANDOM FARMS DRIVE CHAPPAQUA,NY10514	ER SERVICES	3,967,238
HEALTHCARE RADIOLOGY DIAG SYSTEMS, PO BOX 5113 WHITE PLAINS,NY10602	RADIOLOGY SERVICES	960,000
ORANGE PATHOLOGY ASSOCIATES, PO BOX 911 RAMSEY,NY07446	LABORATORY SERVICES	521,178
ASHIKARI KELEMEN MD PC, 128 ASHFORD AVENUE DOBBS FERRY,NY10522	BREAST CANCER SVCS	460,270
SYMPHONY MEDICAL PC, 27 S WASHINGTON AVENUE DOBBS FERRY,NY10522	INTENSIVISTS	2,027,973
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 26

- 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.
right arrow

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

2015

Open to Public
Inspection

Name of the organization

ST JOHNS RIVERSIDE HOSPITAL
ANDRUS PARKCARE & DOBBS FERRY

Employer identification number

13-1740126

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 (Form 990 or 990-EZ))

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 990-EZ.

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2015

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) 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.

Section B. Total Support

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.

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 2015 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2014 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2015. 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—2014. 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—2015. 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—2014. 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) 2015

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) 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.)

Section B. Total Support

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.)..

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 2015 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2014 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2015 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2014 Schedule A, Part III, line 17 .............

19a

331/3% support tests—2015. 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—2014. 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) 2015

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 (i) its supported organizations, (ii) individuals that are part of the charitable class benefited by one or more of its supported organizations, or (iii) 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 section 4958(c)(3)(C)), a family member of a substantial contributor, or a 35% controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ) .

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

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 9a) 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 9a) 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 section 4943 because of section 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer line 10b 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

Schedule A (Form 990 or 990-EZ) 2015

Page 5

Part IV

Supporting Organizations (continued)

Yes

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

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, (i) a written notice describing the type and amount of support provided during the prior tax year, (ii) a copy of the Form 990 that was most recently filed as of the date of notification, and (iii) 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) 2015

Page 6

Part V

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

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

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) 2015

Page 7

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations (continued)

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
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)
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.
8 Breakdown of line 7:
a
b
c Excess from 2013.......
d From 2014.......
e From 2015.......

Schedule A (Form 990 or 990-EZ) (2015)

Schedule A (Form 990 or 990-EZ) 2015

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) 2015

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

2015

Name of the organization

ST JOHNS RIVERSIDE HOSPITAL
ANDRUS PARKCARE & DOBBS FERRY

Employer identification number

13-1740126

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 other 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) (2015)

Schedule B (Form 990, 990-EZ, or 990-PF) (2015) Page 2

Name of organization ST JOHNS RIVERSIDE HOSPITAL ANDRUS PARKCARE & DOBBS FERRY

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) (2015)

Schedule B (Form 990, 990-EZ, or 990-PF) (2015)

Page 3

Name of organization ST JOHNS RIVERSIDE HOSPITAL ANDRUS PARKCARE & DOBBS FERRY		Employer identification number 13-1740126

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) (2015)

Schedule B (Form 990, 990-EZ, or 990-PF) (2015)

Page 4


Name of organization ST JOHNS RIVERSIDE HOSPITAL ANDRUS PARKCARE & DOBBS FERRY			Employer identification number 13-1740126
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.) $ 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) (2015)

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

2015

Open to Public
Inspection

If the organization answered "Yes" on 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" on 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" on 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

ST JOHNS RIVERSIDE HOSPITAL
ANDRUS PARKCARE & DOBBS FERRY

Employer identification number

13-1740126

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-.
1
2
3
4
5
6

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

Cat. No. 50084S

Schedule C (Form 990 or 990-EZ) 2015

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) 2012	(b) 2013	(c) 2014	(d) 2015	(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) 2015

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 on 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)? ........

Yes

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

Yes

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

Yes

129,500

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

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

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

129,500

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	LOBBYING EXPENSES CONTACT WITH MEMBERS OF THE NYS LEGISLATURE ON SALE OF NURSING HOME AND GRANT FUNDING AND INCREASE THE HOSPITAL'S PRESENCE AND PROFILE WITH LOCAL GOVERNMENT LEADERS AND STATE LEGISLATORS.

Schedule C (Form 990 or 990EZ) 2015

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," on 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

2015

Open to Public Inspection

Name of the organization

ST JOHNS RIVERSIDE HOSPITAL
ANDRUS PARKCARE & DOBBS FERRY

Employer identification number

13-1740126

Part I

Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" on 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" on 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, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, handling of violations, 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" on 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 on 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 on 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) 2015

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" on 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


b	If "Yes," explain the arrangement in Part XIII and complete the following table:		Amount
c	Beginning balance .............................	1c
d	Additions during the year ............................	1d
e	Distributions during the year ..........................	1e
f	Ending balance ................................	1f

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" on Form 990, Part IV, line 10.

		(a)Current year	(b)Prior year	(c)Two years back	(d)Three years back	(e)Four years back

1a	Beginning of year balance ....	29,107,717	37,262,626	31,741,170	28,178,518	24,246,543
b	Contributions ...			2,500,000	1,750,000	3,000,000
c	Net investment earnings, gains, and losses	151,048	1,537,571	3,059,821	1,909,624	969,309
d	Grants or scholarships ...
e	Other expenditures for facilities and programs ...	1,692,047	9,654,046
f	Administrative expenses ....	129,886	38,434	38,365	96,972	37,334
g	End of year balance ......	27,436,832	29,107,717	37,262,626	31,741,170	28,178,518

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

Board designated or quasi-endowment SchDMd Bullet

92.200 %

Permanent endowment SchDMd Bullet

7.800 %

Temporarily restricted endowment SchDMd Bullet

The percentages on 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)

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

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

Part VI

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

Description of property		(a) Cost or other basis (investment)	(b)Cost or other basis (other)	(c) Accumulated depreciation	(d) Book value

1a	Land ...	1,185,005		1,185,005
b	Buildings	113,277,449	88,741,435	24,536,014
c	Leasehold improvements	7,245,715	4,208,681	3,037,034
d	Equipment ...	139,170,741	117,422,963	21,747,778
e	Other ...	683,808		683,808
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				51,189,639

Schedule D (Form 990) 2015

Page 3

Part VII

InvestmentsOther Securities. Complete if the organization answered 'Yes' on 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)
(B)
(C)
(D)
(E)
(F)
(G)
(H)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

Part VIII

InvestmentsProgram Related. Complete if the organization answered 'Yes' on 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

(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)

Part IX

Other Assets. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11d. See Form 990, Part X, line 15.

(a) Description				(b) Book value
(1) DUE FROM THIRD PARTY PAYORS				10,086,270
(2) OTHER NON-CURRENT ASSETS				3,669,040
(3) OTHER RECEIVABLES				3,096,848
(4) PROFESSIONAL INSURANCE - RCVBL				6,011,334
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........				22,863,492

Part X

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

1.(a) Description of liability	(b) Book value
(1) Federal income taxes	0
DUE TO AFFILIATE-CAPTIVE INSURANCE	631,180
DUE TO THIRD PARTY PAYORS	507,618
ACCRUED POSTRETIREMENT BENEFIT	79,245,259
OTHER LT LIAB-DEF ASBESTOS	17,973,881
MALPRACTICE LIABILITY	6,585,080
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	104,943,018
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) 2015

Page 4

Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total revenue, gains, and other support per audited financial statements .......		1
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
e	Add lines 2a through 2d .....................		2e
3	Subtract line 2e from line 1..................		3
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
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......		5

Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total expenses and losses per audited financial statements ...........		1
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
3	Subtract line 2e from line 1...................		3
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
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......		5

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

INTENDED USE OF ENDOWMENT FUNDS

FORM 990, SCHEDULE D, PART V, LINE 4 THE ENDOWMENT FUND OF THE HOSPITAL HAS BEEN ESTABLISHED TO PROVIDE FUNDING FOR PROGRAMS SUPPORTED BY ITS ENDOWMENT OR TO PROVIDE EMERGENCY FUNDS FOR USAGE TO BE APPROVED BY THE FINANCE COMMITTEE ON AN EMERGENCY BASIS.

ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES

FORM 990, SCHEDULE D, PART X, LINE 2 THE HOSPITAL IS A NOT-FOR-PROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE CODE, AND IS EXEMPT FROM FEDERAL AND STATE INCOME TAXES PURSUANT TO SECTION 501(A) OF THE CODE. THERE ARE CERTAIN TRANSACTIONS THAT COULD BE DEEMED "UNRELATED BUSINESS INCOMEWOULD RESULT IN A TAX LIABILITY. MANAGEMENT REVIEWS TRANSACTIONS TO ESTIMATE POTENTIAL TAX LIABILITIES USING A THRESHOLD OF MORE LIKELY THAN NOT OF BEING SUSTAINED. IT IS MANAGEMENT'S ESTIMATION THAT THERE ARE NO MATERIAL TAX LIABILITIES THAT NEED TO BE RECORDED.

Schedule D (Form 990) 2015

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE G (Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information Regarding
Fundraising or Gaming Activities

Complete if the organization answered "Yes" on Form 990, Part IV, lines 17, 18, or 19, or if the organization entered more than $15,000 on Form 990-EZ, line 6a. right arrow

Attach to Form 990 or Form 990-EZ.
right arrow

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

OMB No. 1545-0047

2015

Open to Public Inspection

Name of the organization
ST JOHNS RIVERSIDE HOSPITAL
ANDRUS PARKCARE & DOBBS FERRY

Employer identification number

13-1740126

Part I

Fundraising Activities. Complete if the organization answered "Yes" on Form 990, Part IV, line 17.

Form 990-EZ filers are not required to complete this part.

Indicate whether the organization raised funds through any of the following activities. Check all that apply.

a	Mail solicitations	e	Solicitation of non-government grants
b	Internet and email solicitations	f	Solicitation of government grants
c	Phone solicitations	g	Special fundraising events
d	In-person solicitations

Did the organization have a written or oral agreement with any individual (including officers, directors, trustees

or key employees listed in Form 990, Part VII) or entity in connection with professional fundraising services?

YesNo

If "Yes," list the ten highest paid individuals or entities (fundraisers) pursuant to agreements under which the fundraiser is
to be compensated at least $5,000 by the organization.

(i) Name and address of individual or entity (fundraiser)		(ii) Activity	(iii) Did fundraiser have custody or control of contributions?
			Yes	No
	CHANGING OUR WORLD	PLANNING		No









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

List all states in which the organization is registered or licensed to solicit contributions or has been notified it is exempt from registration or licensing.

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

Cat. No. 50083H

Schedule G (Form 990 or 990-EZ) 2015

Page 2

Part II

Fundraising Events. Complete if the organization answered "Yes" on Form 990, Part IV, line 18, or reported more than $15,000 of fundraising event contributions and gross income on Form 990-EZ, lines 1 and 6b. List events with gross receipts greater than $5,000.

		(a) Event #1 GOLF OUTING (event type)	(b) Event #2 GOLF OUTING (event type)	(d) Total events (add col. (a) through col. (c))
1	Gross receipts . . . . .	226,288	206,059	432,347
2	Less: Contributions . . . .	145,175	142,843	288,018
3	Gross income (line 1 minus line 2) . . . . . .	81,113	63,216	144,329

4	Cash prizes . . . . .
5	Noncash prizes . . . .	9,014	17,771	26,785
6	Rent/facility costs . . . .	69,431	33,401	102,832
7	Food and beverages . . .
8	Entertainment . . . .
9	Other direct expenses . . .	4,648	11,671	16,319
10	Direct expense summary. Add lines 4 through 9 in column (d) . . . . . . . . . .			145,936
11	Net income summary. Subtract line 10 from line 3, column (d). . . . . . . . . .			-1,607

Part III

Gaming. Complete if the organization answered "Yes" on Form 990, Part IV, line 19, or reported more than $15,000 on Form 990-EZ, line 6a.

		(a) Bingo	(b) Pull tabs/Instant bingo/progressive bingo	(c) Other gaming	(d) Total gaming (add col.(a) through col.(c))
1	Gross revenue . . . . .

2	Cash prizes . . . . .
3	Noncash prizes . . . .
4	Rent/facility costs . . . .
5	Other direct expenses . . .	4,648	11,671	16,319

Volunteer labor . . . .

	Yes %
	No

	Yes %
	No

	Yes %
	No

Direct expense summary. Add lines 2 through 5 in column (d) . . . . . . . . . . right arrow

Net gaming income summary. Subtract line 7 from line 1, column (d). . . . . . . . . right arrow

Enter the state(s) in which the organization conducts gaming activities:

Is the organization licensed to conduct gaming activities in each of these states? . . . . . . . .

YesNo

If "No," explain:

10a

Were any of the organization's gaming licenses revoked, suspended or terminated during the tax year? . . .

YesNo

If "Yes," explain:

Schedule G (Form 990 or 990-EZ) 2015

Page 3

Does the organization conduct gaming activities with nonmembers? . . . . . . . . . . .

YesNo

Is the organization a grantor, beneficiary or trustee of a trust or a member of a partnership or other entity

formed to administer charitable gaming? . . . . . . . . . . . . . . . . .

YesNo

Indicate the percentage of gaming activity conducted in:

The organization's facility . . . . . . . . . . . . . . . . . .

13a

An outside facility . . . . . . . . . . . . . . . . . . . .

13b

Enter the name and address of the person who prepares the organization's gaming/special events books and records:

Name

Address

15a

Does the organization have a contract with a third party from whom the organization receives gaming

revenue? . . . . . . . . . . . . . . . . . . . . . . . .

YesNo

If "Yes," enter the amount of gaming revenue received by the organization right arrow

$ and the

amount of gaming revenue retained by the third party right arrow

$ .

If "Yes," enter name and address of the third party:

Name

Address

Gaming manager information:

Name

Gaming manager compensation right arrow

Description of services provided right arrow

Director/officer Employee Independent contractor

Mandatory distributions:

Is the organization required under state law to make charitable distributions from the gaming proceeds to

retain the state gaming license? . . . . . . . . . . . . . . . . . . .

YesNo

Enter the amount of distributions required under state law distributed to other exempt organizations or spent

in the organization's own exempt activities during the tax year right arrow

Part IV

Supplemental Information. Provide the explanations required by Part I, line 2b, columns (iii) and (v); and Part III, lines 9, 9b, 10b, 15b, 15c, 16, and 17b, as applicable. Also complete this part to provide any additional information (see instructions).

Return Reference	Explanation

Schedule G (Form 990 or 990-EZ) 2015

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE H
(Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

Complete if the organization answered "Yes" on 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

2015

Open to Public Inspection

Name of the organization

ST JOHNS RIVERSIDE HOSPITAL
ANDRUS PARKCARE & DOBBS FERRY

Employer identification number

13-1740126

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 %

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? . . . . . .

Yes

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

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

Yes

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

Yes

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

Financial Assistance and Certain Other Community Benefits at Cost

Financial Assistance and Means-Tested Government Programs		(c) Total community benefit expense	(d) Direct offsetting revenue	(e) Net community benefit expense	(f) Percent of total expense
a	Financial Assistance at cost (from Worksheet 1) . . .	1,024,000	105,754	918,246	0.370 %
b	Medicaid (from Worksheet 3, column a) . . . . .	75,033,930	66,297,403	8,736,527	3.490 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .
d	Total Financial Assistance and Means-Tested Government Programs . . . . .	76,057,930	66,403,157	9,654,773	3.860 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).	756,879		756,879	0.300 %
f	Health professions education (from Worksheet 5) . . .	4,220,569	3,243,938	976,631	0.390 %
g	Subsidized health services (from Worksheet 6) . . . .
h	Research (from Worksheet 7) .
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .
j	Total. Other Benefits . .	4,977,448	3,243,938	1,733,510	0.690 %
k	Total. Add lines 7d and 7j .	81,035,378	69,647,095	11,388,283	4.550 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2015

Schedule H (Form 990) 2015

Page

Part II

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

		(a) Number of activities or programs (optional)	(b) Persons served (optional)	(c) Total community building expense	(d) Direct offsetting revenue	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing
2	Economic development
3	Community support
4	Environmental improvements
5	Leadership development and training for community members
6	Coalition building
7	Community health improvement advocacy
8	Workforce development
9	Other
10	Total

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. ......

15,576,556

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. ......

4,229,185

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).....

59,206,878

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

61,338,851

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

-2,131,973

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 %
1
2
3
4
5
6
7
8
9
10
11
12
13

Schedule H (Form 990) 2015

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?3 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)
1	SJR HOSPITAL ANDRUS PAVILION 967 NORTH BROADWAY YONKERS,NY10701 WWW.RIVERSIDEHEALTH.ORG	X	X	X
2	SJR PARK CARE PAVILION 2 PARK AVENUE YONKERS,NY10703 WWW.RIVERSIDEHEALTH.ORG	X	X
3	SJR DOBBS FERRY PAVILION 128 ASHFORD AVE DOBBS FERRY,NY10522 WWW.RIVERSIDEHEALTH.ORG	X	X	X

Schedule H (Form 990) 2015

Page 4

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)

	SJR HOSPITAL ANDRUS PAVILION
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

6 a

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): SEE SECTION C

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): SEE SECTION C

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

12b

If "Yes" on 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) 2015

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	SJR HOSPITAL ANDRUS PAVILION
Name of hospital facility or letter of facility reporting group

Yes

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 100% and FPG family income limit for eligibility for discounted care of 300.%

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):

www.riversidehealth.org

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

SEE SECTION C

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

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) 2015

Page 6

Part VFacility Information (continued)

	SJR HOSPITAL ANDRUS PAVILION
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility or other authorized 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 19. (check all that apply):

Notified individuals of the financial assistance policy on admission

Notified individuals of the financial assistance policy prior to discharge

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

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

Other (describe in Section C)

None of these efforts were made

Policy Relating to Emergency Medical Care

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

Yes

If "No," indicate why:

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

The hospital facility’s policy was not in writing

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

Other (describe in Section C)

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

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

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

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

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

Other (describe in Section C)

During the tax year, did the hospital facility charge any FAP-eligible individual to whom the hospital facility provided emergency or other medically necessary services more than the amounts generally billed to individuals who had insurance covering such care? ...............................

If "Yes," explain in Section C.

During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ...........................

If "Yes," explain in Section C.

Schedule H (Form 990) 2015

Page 4

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)

	SJR PARK CARE PAVILION
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?........................

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

Yes

6 a

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): SEE SECTION C

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): SEE SECTION C

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

10b

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

12b

If "Yes" on 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) 2015

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	SJR PARK CARE PAVILION
Name of hospital facility or letter of facility reporting group

Yes

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 100% and FPG family income limit for eligibility for discounted care of 300.%

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

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):

www.riversidehealth.org

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

SEE SECTION C

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

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

Yes

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) 2015

Page 6

Part VFacility Information (continued)

	SJR PARK CARE PAVILION
Name of hospital facility or letter of facility reporting group

Yes

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

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 19. (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

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)

If "Yes," explain in Section C.

During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ...........................

If "Yes," explain in Section C.

Schedule H (Form 990) 2015

Page 4

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)

	SJR DOBBS FERRY PAVILION
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?........................

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

Yes

6 a

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): SEE SECTION C

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): SEE SECTION C

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

10b

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

12b

If "Yes" on 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) 2015

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	SJR DOBBS FERRY PAVILION
Name of hospital facility or letter of facility reporting group

Yes

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 100% and FPG family income limit for eligibility for discounted care of 300.%

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

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):

www.riversidehealth.org

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

SEE SECTION C

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

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

Yes

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) 2015

Page 6

Part VFacility Information (continued)

	SJR DOBBS FERRY PAVILION
Name of hospital facility or letter of facility reporting group

Yes

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

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 19. (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

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)

If "Yes," explain in Section C.

During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ...........................

If "Yes," explain in Section C.

Schedule H (Form 990) 2015

Page 7

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
ALL PART V DESCRIPTIONS RELATE TO EACH HOSPITAL FACILITY.	PART V, LINES 5 & 6 THE SJRH's community needs were identified and prioritization of those needs was established as part of a county-wide planning process facilitated by the Westchester County Department of Health's Health Planning Team. SJRH is an active participant in the Health Planning Team. Participating hospitals and health centers helped guide the Community Health Needs Assessment (CHNA) process by providing community input into the design of its framework and implementation plan. The public input process encompassed the following primary collaborations: WCDOH's Healthy Hospital's collaborative, Health Planning Team, and Health Summit; City of Yonkers and SJRH's Healthy Yonkers Initiative; SJRH Community Advisory Committee, and collaboration with local and regional maternity and HIV partnerships. WHILE SJRH COLLABORATED WITH THESE ORGANIZATIONS and community partners THROUGH THE CHNA PROCESS, IT DOCUMENTED ITS COMMUNITY HEALTH NEEDS ASSESSMENT IN A SEPARATE WRITTEN REPORT. SJRH has experienced significant public involvement and enthusiasm, as community relationships were fortified and new ones were established with numerous health-related associations. To ensure a broad assessment of our community health needs we engaged a variety of participants including, but not limited to, the community at large through local residents participating in SJRH Speakers Bureau health education programs. We shared health data and sought feedback through the following SJRH groups: Community Advisory Committee, Employee Wellness Committee, Pastoral Care Committee, Radiology Advisory Committee, Physician Alignment Committee, Board of Trustees and our employees. SJRH also gathered information from external sources by conducting public forums at the Cross County Shopping Center in Yonkers, New York and other health sessions held at select locations to address the community that represented the diverse population that we serve. The hospital receives input from the community and patients through periodic focus groups, patient satisfaction surveys, sent by a third party provider and on-line surveys. Patient experience feedback is also captured through traditional compliment and complaint letters received through administration. SJRH'S 2013 COMMUNITY HEALTH NEEDS ASSESSMENT WAS CONDUCTED TO INCLUDE ITS THREE HOSPITAL SITES (SJR HOSPITAL ANDRUS PAVILION, SJR PARK CARE PAVILION, AND SJR DOBBS FERRY PAVILION), AND A JOINT REPORT WAS ISSUED. THE FACILITIES SERVE A DIVERSE POPULATION IN WESTCHESTER COUNTY AND SHARE AN AUTHORIZED BODY WHICH ADOPTED THE JOINT REPORT. PART V, LINE 7A AND 10A THE HOSPITAL'S 2013 CHNA AND IMPLEMENTATION STRATEGY CAN BE FOUND AT THE FOLLOWING WEBSITE: www.riversidehealth.org/About/CommunityServicePlan PART V, LINE 11 ADDRESSING COMMUNITY NEEDS The SJRH community health priorities were selected as part of a countywide planning process facilitated by the Westchester County Department of Health's (WCDOH) Health Planning Team, of which SJRH is an active participant. We formally collaborated with the WCDOH assessing needs, determining priorities, developing interventions and implementation of our CHNA. The service area assessed was Westchester County. The NYS Prevention Agenda 2013-2017 assisted in guiding our collaboration in development of our plan around community health improvement priorities that are consistent with the population health principles embodied in federal and state health care reform. Following review of this data and results from the myriad of community health assessments conducted by SJRH, we prioritized needs and developed a plan. The following is a summary of priority areas and goals identified in our most recently conducted CHNA are being addressed and are updated as follows: Priority 1: Prevent Chronic Diseases Focus Area: Increase access to high-quality chronic disease preventive care and management in both clinical and community settings Goal # 1: Promote culturally relevant chronic disease self-management education. Priority Area 2: Promote Healthy Women, Infants, and Children Focus Area: Maternal and Infant Health Goal # 2: Increase the proportion of babies who are breastfed. Priority Area 3: Prevent HIV, STDs, Vaccine-Preventable Diseases, and Health Care-Associated Infections Focus Area: Human Immunodeficiency Virus (HIV) Goal # 3: Increase early access to and retention in HIV care. Focus Area: Hepatitis C Virus (HCV) Goal # 4: Increase and coordinate HCV prevention and treatment capacity. In addition to a thorough review of the data, the priorities selected included consideration of priorities that were attainable and that aligned with each agency's mission and service area. With the diversity and the number of hospitals in the County, it was quite challenging for the team to select its priorities especially when for a number of indicators the data revealed only certain parts of the County being impacted. Priority Areas, Goals and Interventions - details ----------------------------------------------------------------- PRIORITY 1: PREVENT CHRONIC DISEASES ----------------------------------------------------------------- FOCUS: Increase access to high-quality chronic disease preventive care and management in both clinical and community settings GOAL #1: Promote culturally relevant chronic disease self-management education. Objective 1: SJRH Care Transition Coach to assess an additional 75 patients, discharged from the inpatient setting to home, to provide culturally relevant chronic disease self-management patient education sessions (An additional 20 in 2014, 25 in 2015, and 30 in 2016) - Baseline 2012: 144 patients educated. OUTCOME: 2013 - 170 PATIENT ENCOUNTERS. 2014 - 241 PATIENT ENCOUNTERS - AN ADDITIONAL 17 PATIENTS PER QUARTER FROM 2013. 2015- THE SJRH CARE TRANSITION COACH PROGRAM ADDRESSED BARRIERS TO THE SUCCESS OF SELF-CARE MANAGEMENT AS WELL AS AVOIDANCE OF RETURNS TO THE ED THAT ARE UNNECESSARY. A TOTAL OF 194 PATIENT ASSESSMENTS WERE MADE "IN HOSPITAL" BY THE TRANSITION COACH IN 2015 WITH ONE-THIRD OF PATIENTS (65) RECEIVING COACHING VISITS "IN HOME." 109 PATIENTS WERE 65 YEARS AND OLDER AND 85 WERE LESS THAN 65 YEARS OF AGE. THE PROJECTS' FOCUS AREAS ACCOUNTED FOR MORE THAN HALF OF THE 194 PATIENT ASSESSMENTS (aSTHMA, CANCER, DEHYDRATION, DIABETES, HYPERTENSION, PNEUMONIA INCLUDING COPD AND HEART FAILURE). THE MINORITY POPULATION SERVED DURING 2015 EXCEEDED TWO-THIRDS OF THE PATIENTS ASSESSED. BARRIERS TO SELF-CARE-MANAGEMENT WERE ADDRESSED, I.E. COMPLIANCE WITH MEDICATIONS, HEALTH LITERACY, ACCESS TO HEALTH MAINTENANCE EQUIPMENT, AND REFERRALS WERE MADE TO PRIMARY CARE PROVIDERS, REHABILITATION SERVICES, TRANSPORTATION, HOUSING, FINANCIAL SUPPORT, SOCIAL SERVICES AND SUPPORT GROUPS. THE TRANSITION COACH PROGRAM ENDED 12/4/2015. PRIORITY 2: PROMOTE HEALTHY WOMEN, INFANTS, AND CHILDREN ------------------------------------------------------------------ FOCUS: Maternal and Infant Health GOAL #2: Increase the proportion of NYS babies who are breastfed. Objective 1: Increase the percentage of SJRH-born infants breastfed in the hospital by 10% to 64% (By 2% in 2014, 4% in 2015, 4% in 2016) - Baseline 2012: 54%. Outcome: January - December 2014 = 60% (An additional 6% from 2012). January December 2015 = Breastfeeding increased to 65% in the 1st Quarter, 72.6% in the 2nd Quarter and 75% in the 3rd and 4th Quarters of 2015 (for patients breastfeeding exclusively or with supplementation.) Objective 2: Reduce disparity by 3% by 2016: Ratio of Black and Ratio of Hispanic to White percentage of infants exclusively breastfed in the hospital (By 1% in 2014, 1% in 2015, 1% in 2016) - Baseline 2012: Black 14%, Hispanic 10%, White 20%. Disparity gap: Black 6%, Hispanic 10%. Outcome: The Feed type by race for SJRH, as reported by NYS in June 2015, is as follows: (Exclusive Breast Milk) White 15%, Black 10%, Hispanic 9%, Other 14%. The disparity gap for infants exclusively breastfed in the hospital was decreased by 1% for Blacks and by 4% for Hispanics from the 2012 disparity gap measure. Improvements/Action Plan: Distributed Breastfeeding Bill of Rights upon Admission - Promoted Skin to Skin & Breastfeeding in Labor & Delivery - Encouraged Rooming-In - Continued practice of NOT placing pacifiers & bottles in Cribs of Breastfed Babies - Removal of magazines that contain formula coupons or advertisements - Enhanced Follow-up Phone Call Protocol - Developed internal report to track exclusive Breastfeeding by Race - Partnered with NYS "Great Beginnings NY" Campaign - Participated in NYC & WCDOH Initiatives. Challenges: WIC restriction of formula and other supplies if mother states that she is breastfeeding. Data measure for exclusive breast feeding is not acceptable if the mother uses formula ONE or more times while in the hospital. PRIORITY 3: PREVENT HIV, STDs, VACCINE-PREVENTABLE DISEASES, AND HEALTH CARE-ASSOCIATED INFECTIONS ------------------------------------------------------------------- FOCUS: Human
PART V, LINE 13H	AMOUNTS CHARGED TO PATIENTS THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY PROVIDES ASSISTANCE TO INDIVIDUALS IN THE FOLLOWING GEOGRAPHIC AREAS: 1. FOR EMERGENCY CARE SERVICES: ALL NEW YORK STATE RESIDENTS. 2. FOR MEDICALLY NECESSARY NON-EMERGENT INPATIENT, AMBULATORY SURGERY, AND OUTPATIENT SERVICES (INCLUDING CLINICS), THE HOSPITAL'S PRIMARY SERVICE AREA (PSA) INCLUDES ALL PATIENTS RESIDING IN THE FOLLOWING COUNTIES: WESTCHESTER, ORANGE, PUTNAM, ROCKLAND, BRONX, MANHATTAN (NEW YORK), BROOKLYN (KINGS) AND QUEENS. PART V, LINE 16B THE FINANCIAL ASSISTANCE POLICY APPLICATION CAN BE FOUND AT THE FOLLOWING WEBSITE: http://riversidehealth.org/Portals/0/2016/2016%20Health%20Solutions%20Appl ication%20(Merged).pdf PART V, LINE 16C A PLAIN LANGUAGE SUMMARY OF THE SJRH FAP CAN BE FOUND AT THE FOLLOWING WEBSITE: HTTP://WWW.RIVERSIDEHEALTH.ORG/PATIENTSVISITORS/PATIENTFINANCIALSERVICES.A SPX PART V, LINE 16I PUBLICATION OF FINANCIAL ASSISTANCE POLICY SEE SUPPLEMENTAL INFORMATION, PART VI, LINE 3 FOR MORE INFORMATION.
Part V, Line 22D	MAXIMUM AMOUNTS CHARGED IN 2015, THE FACILITY USED BLUE CROSS INSURANCE RATES WHEN CALCULATING THE MAXIMUM AMOUNTS THAT CAN BE CHARGED. IN 2016, TO COMPLY WITH THE FINAL SECTION 501(R) REGULATIONS, THE HOSPITAL HAS ADOPTED THE LOOKBACK METHOD AND LIMITS AMOUNTS CHARGED TO INDIVIDUALS ELIGIBLE UNDER ITS FINANCIAL ASSISTANCE TO AN AMOUNT CALCULATED USING MEDICARE FEE FOR SERVICE, MEDICAID AND COMMERCIAL PAYOR RATES.

Schedule H (Form 990) 2015

Page 8

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?
Name and address		Type of Facility (describe)
1
2
3
4
5
6
7
8
9
10

Schedule H (Form 990) 2015

Page 9

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 3A AND PART V, LINE 13	FREE CARE AS OUTLINED IN THE NEW YORK STATE HOSPITAL FINANCIAL ASSISTANCE LAW, UNINSURED INDIVIDUALS WITH DOCUMENTED INCOME AND FAMILY SIZE LEVELS THAT FALL AT OR BELOW 100% FPL WILL BE ENTITLED TO PAY THE AMOUNTS SPECIFIED UNDER THE STATE'S NOMINAL PAYMENT GUIDELINES (AS SHOWN BELOW AND INCLUDED IN THE HOSPITAL'S FINANCIAL AND CHARITY CARE PROGRAM POLICY): I. INPATIENT SERVICES - $150/DISCHARGE II. AMBULATORY SURGERY - $150/PROCEDURE III. ALL ANCILLARY SERVICES - $150/PROCEDURE IV. ADULT ER/CLINIC SERVICES - $15/VISIT V. PRENATAL AND PEDIATRIC ER/CLINIC SERVICES - NO CHARGE PART I, LINE 6A THE HOSPITAL SUBMITTED A COMMUNITY SERVICE PLAN (CSP) TO NEW YORK STATE IN 2015 AND PREPARED A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) REPORT IN 2013, BOTH OF WHICH ARE MADE AVAILABLE TO THE PUBLIC THROUGH POSTING ON THE HOSPITAL'S WEBSITE AND UPON REQUEST. THE HOSPITAL'S MISSION STATEMENT HAS NOT CHANGED SINCE THE SUBMISSION OF THE 2015 CSP. THE HOSPITAL IS CURRENTLY INVOLVED IN A STRATEGIC PLANNING PROCESS WHICH HAS LED TO A FOCUSED EFFORT ON ADDRESSING QUALITY OF CARE, CUSTOMER SATISFACTION, ACCESS TO CARE, MARKET SHARE AND PHYSICIAN ALIGNMENT. PLEASE NOTE, THE HOSPITAL'S PRIMARY SERVICE AREA UTILIZED IN COMMUNITY SERVICE PLANNING IS THE SAME AS REPORTED IN THE 2015 CSP. PART I, LINE 7 THE COST-TO-CHARGE RATIO METHODOLOGY WAS UTILIZED TO CALCULATE THE AMOUNTS INCLUDED IN THE TABLE. THE CALCULATION OF THIS RATIO WAS DERIVED FROM THE MEDICARE COST REPORT. PART III, LINES 2 & 4 THE HOSPITAL REGULARLY REVIEWS ITS PAST COLLECTION HISTORY AND PAYMENT TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF PATIENT SERVICE REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. FOR PATIENT ACCOUNTS RECEIVABLE ASSOCIATED WITH SELF-PAY PATIENTS, WHICH INCLUDES THOSE PATIENTS WITHOUT INSURANCE COVERAGE AND PATIENTS WITH DEDUCTIBLES AND COPAYMENT BALANCES FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PORTION OF THE BILL, THE HOSPITAL RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS FOR PATIENTS THAT ARE UNABLE OR UNWILLING TO PAY FOR THE PORTION OF THE BILL REPRESENTING THEIR FINANCIAL RESPONSIBILITY. ACCOUNT BALANCES ARE CHARGED OFF AGAINST THE ALLOWANCES FOR DOUBTFUL ACCOUNTS AFTER ALL MEANS OF COLLECTION HAVE BEEN EXHAUSTED. The 2015 consolidated audited financial statements contain a patient accounts receivable footnote on Page 9 and a charity care and uncompensated care footnote on Page 10. PART III, LINE 3 The hospital is dedicated to providing comprehensive medical and nursing care in a compassionate, professional, respectful and ethical manner to every patient regardless of ability to pay. The amount of $4,229,185 represents the hospital's bad debt expense attributable to patients eligible under the Hospital Financial Assistance policy and is comprised of the dollar value of the discounts made available to patients under the Hospital Financial Assistance policy as well as the uncompensated care provided to the members of our community that we serve who are in need of emergency and medically necessary care and do not have the ability to pay. PART III, LINE 8 TO DETERMINE THE MEDICARE ALLOWABLE COSTS OF CARE ON PART III, LINE 6, MEDICARE CHARGES WERE MULTIPLIED BY THE COST TO CHARGE RATIO, AS DERIVED FROM THE MEDICARE COST REPORT. THE HOSPITAL BELIEVES 100% OF THE MEDICARE SHORTFALL SHOULD BE TREATED AS A COMMUNITY BENEFIT.
PART III, LINE 9B	1. PATIENTS ELIGIBLE FOR FINANCIAL ASSISTANCE UNDER THE HEALTH SOLUTION PROGRAM WILL HAVE THEIR OPEN ACCOUNTS ADJUSTED TO THE AMOUNT DUE BASED ON THE LEVEL OF ASSISTANCE THEY RECEIVE, SO THAT BILLS AND STATEMENTS WILL REFLECT THE DISCOUNTED AMOUNT DUE. PATIENTS WILL THEN BE EXPECTED TO PAY THE ADJUSTED AMOUNT DUE. 2. PATIENTS WHO ARE UNABLE TO PAY THE ADJUSTED AMOUNT DUE WILL BE OFFERED PAYMENT PLANS. 3. PAYMENT PLANS WILL NOT REQUIRE A PATIENT TO PAY MORE THAN 10% OF THEIR MONTHLY GROSS INCOME TOWARDS MONTHLY INSTALLMENT PAYMENTS. IF THE HOSPITAL ELECTS TO CONSIDER OTHER NON-EXCLUDED ASSETS IN DETERMINING FINANCIAL ASSISTANCE ELIGIBILITY, THEN MONTHLY PAYMENTS MAY EXCEED 10%. 4. THE HOSPITAL WILL NOT COLLECT FROM A PATIENT WHO IS DETERMINED TO BE ELIGIBLE FOR MEDICAID, OR WHO IS ELIGIBLE FOR MEDICAID AT THE TIME SERVICES WERE RENDERED. 5. IF A PATIENT OR RESPONSIBLE PARTY DEFAULTS ON ITS PAYMENT OBLIGATIONS, OR FAILS TO MEET THE TERMS OF ANY FINANCIAL AGREEMENT, THE ACCOUNT IN QUESTION WILL BE CONSIDERED DELINQUENT, AND MAY BE REFERRED TO A COLLECTION AGENCY BASED ON THE HOSPITAL'S COLLECTION POLICY. 6. THE HOSPITAL WILL NOT SEND AN ACCOUNT TO COLLECTION IF THE PATIENT HAS SUBMITTED A COMPLETED APPLICATION FOR FINANCIAL AID, INCLUDING REQUIRED SUPPORTING DOCUMENTATION, WHILE THE HOSPITAL DETERMINES THE PATIENT'S ELIGIBILITY FOR SUCH AID, OR DURING THE PROCESS WHERE THE PATIENT HAS APPEALED AN ELIGIBILITY DETERMINATION. 7. THE HOSPITAL WILL REVIEW ALL ACCOUNTS DETERMINED TO BE REFERRED TO OUTSIDE COLLECTION TO ENSURE THAT ITS FINANCIAL POLICY AND PROCEDURES WERE FOLLOWED. 8. THE HOSPITAL WILL PROVIDE WRITTEN NOTIFICATION AND A NOTICE ON THE PATIENT'S BILL LESS THAN 30 DAYS PRIOR TO REFERRING THE ACCOUNT TO OUTSIDE COLLECTION. 9. THE HOSPITAL WILL SEND EACH OF ITS COLLECTION AGENCIES A COPY OF ITS FINANCIAL ASSISTANCE POLICY AND PROCEDURES, AND WILL INSTRUCT THE AGENCY TO FOLLOW THESE PROCEDURES WHEN INSTRUCTING THE PATIENT HOW TO APPLY FOR SUCH AID. 10. COLLECTION AGENCIES MUST OBTAIN THE HOSPITAL'S WRITTEN CONSENT PRIOR TO COMMENCING A LEGAL ACTION ON A PATIENT'S ACCOUNT. 11. LEGAL ACTION MAY INCLUDE GARNISHMENT OF WAGES WHERE THERE IS EVIDENCE THAT THE PATIENT OR RESPONSIBLE PARTY HAS INCOME AND/OR ASSETS TO MEET HIS/HER FINANCIAL OBLIGATION UNDER THIS POLICY. 12. THE HOSPITAL WILL NOT PERMIT THE FORCED SALE OR FORECLOSURE OF A PATIENT'S PRIMARY RESIDENCE IN ORDER TO COLLECT AN OUTSTANDING MEDICAL BILL.
2. NEEDS ASSESSMENT	ST. JOHN'S RIVERSIDE HOSPITAL (SJRH) LOCATED IN THE HUDSON VALLEY REGION WITHIN WESTCHESTER COUNTY, SERVES THE CITY OF YONKERS AND THE RIVERTOWN AREAS AND ACTIVELY WORKS WITH THE FOLLOWING PARTNERS TO ASSESS THE COMMUNITIES' HEALTH CARE NEEDS: LOCAL COMMUNITY-BASED ORGANIZATIONS, BUSINESSES, CITY PLANNING COUNCILS, SCHOOLS, THE WESTCHESTER COUNTY HEALTH DEPARTMENT, OTHER HEALTH CARE ORGANIZATIONS AND THE HOSPITALS' COMMUNITY ADVISORY COMMITTEE. WE ALSO PARTNER WITH THE AMERICAN CANCER SOCIETY, DIABETES AND HEART ASSOCIATIONS, FEMA, MARCH OF DIMES, CABRINI IMMIGRANT SERVICES AND OTHERS TO ASSESS THE HEALTH CARE NEEDS OF THE COMMUNITY THAT WE SERVE. THIS IS ACCOMPLISHED THROUGH SHARED DATA FOR PLANNING PURPOSES, AWARENESS OF SERVICES OFFERED BY OUR PARTNERS, COLLABORATIVE PROGRAM PLANNING, IMPLEMENTATION AND EVALUATION, AND COORDINATED HEALTH OUTREACH AND PROMOTION. THESE EFFORTS HAVE RESULTED IN ST. JOHN'S PROVIDING ON-GOING EDUCATION AND GUIDANCE TO THE YONKERS PTA COORDINATING COUNCIL AND THE LOCAL YMCA'S HEALTH INITIATIVE RELATIVE TO HEALTH CARE ISSUES. THE COMMUNITY SERVICE PLAN AGENDA WAS ESTABLISHED BASED ON A COMPREHENSIVE HEALTH NEEDS ASSESSMENT, FINDINGS, AND FOCUSED ON SEVERAL AREAS: PREVENTION OF CHRONIC DISEASES, MATERNAL AND INFANT HEALTH, and HIV and HIV Prevention. SEVERAL SURVEYS AND COMMUNITY FOCUS GROUPS WERE ALSO CONDUCTED TO GATHER DATA. THE RESPONSES OF THE PARTICIPANTS AS TO WHAT HEALTH CARE EDUCATION IS NEEDED WAS ONE OF THE KEY COMMUNITY INPUTS TO SETTING THE FRAMEWORK FOR PLANNING EDUCATIONAL PROGRAMS FOR THE COMMUNITY. A JOINT WELLNESS PROGRAM WITH THE AMERICAN DIABETES ASSOCIATION WAS PROVIDED FOR HOSPITAL EMPLOYEES AND THE LOCAL COMMUNITY AT THE ST. JOHN'S HOSPITAL SITE. THE SJRH ONSITE WELLNESS PROGRAM HELD SEVERAL HEALTH EVENTS FOR EMPLOYEES DURING 2015.
3. PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE	THE ST. JOHN'S FINANCIAL ASSISTANCE UNIT EDUCATES PATIENTS AND THE PUBLIC ABOUT THEIR RIGHTS, RESPONSIBILITIES AND OPTIONS TO ATTAIN SOME COVERAGE OF COSTS FOR THEIR HEALTH CARE. ST. JOHN'S RIVERSIDE HOSPITAL EDUCATES OUR PATIENTS ABOUT OUR CHARITY CARE PROGRAM CALLED HEALTH SOLUTION* IN THE FOLLOWING MANNER: A. THE HOSPITAL WEB SITE HAS THE COMPLETE HEALTH SOLUTION SUMMARY. THE SUMMARY DESCRIBES THE RESIDENTIAL AREAS WE COVER, THE TYPE OF SERVICES THAT ARE NOT COVERED, WHERE TO APPLY, THE PHONE NUMBER TO OBTAIN INFORMATION, THE FEDERAL POVERTY GUIDELINES INCOME LEVEL AND HOW TO APPEAL THE APPLICATION DECISION. B. THERE ARE POSTED NOTICES IN ALL REGISTRATION AND CASHIER AREAS WITHIN THE HOSPITAL. C. THE HEALTH SOLUTION SUMMARY IS INCLUDED IN THE REGISTRATION PACKET THAT IS GIVEN TO ALL PATIENTS. D. THE FINANCIAL ASSISTANT UNIT STAFF WHEN VISITING PATIENT ROOMS WILL DISCUSS THE HEALTH SOLUTION PROGRAM. * HEALTH SOLUTION, OFFERED SINCE 2000, IS AN OPTION FOR PATIENTS WITH A FINANCIAL NEED. PATIENTS WHO APPLY ARE ASSESSED TO DETERMINE ELIGIBILITY TO PAY DOWN HEALTHCARE BILLS WITHIN THEIR BUDGET. HEALTH SOLUTION IS A CHARITY CARE PROGRAM WHERE PAYMENTS BY PATIENTS CAN BE MADE OVER TIME. ELIGIBILITY FOR MEDICAID IS DETERMINED FIRST. WHEN ELIGIBLE, HEALTH SOLUTION PAYMENTS CAN ALSO BE USED TO PAY INSURANCE DEDUCTIBLES.
4. COMMUNITY INFORMATION	ST. JOHN'S RIVERSIDE HOSPITAL (SJRH) IS LOCATED IN YONKERS, NEW YORK A FEDERALLY DESIGNATED MEDICALLY UNDERSERVED AREA. AS SUCH, IT IS A KEY EMERGENCY MEDICAL SERVICE (EMS) PARTICIPANT OPERATING IN ITS TWO HOSPITALS WITH 52,546 VISITS IN 2015. OVER 250,000 INDIVIDUALS ARE SERVED ANNUALLY WITHIN OUR NETWORK. THE RESIDENT POPULATION OF THE CITY OF YONKERS COMPRISES ONE-THIRD OF THE HOSPITAL'S SERVICE AREA AND DEPENDING ON THE ZIP CODE ACCOUNTS FOR BETWEEN 30 TO 50 PERCENT OF ITS ADMISSIONS. YONKERS IS THE LARGEST CITY IN WESTCHESTER COUNTY AND THE FOURTH LARGEST CITY IN THE STATE AND SIGNIFICANT INEQUITIES IN HEALTH STATUS ACCOMPANY ITS DIVERSITY. THE SERVICE AREAS OF THIS HEALTH CARE SYSTEM ARE WIDESPREAD. THE ZIP CODES THAT WE MOST COMMONLY PROVIDE SERVICES FOR ARE: 10701, 10703, 10704, 10705, 10706, 10710, 10502, 10522, 10523, 10530, 10533 AND 10591. THE ANDRUS PAVILION (225 BEDS) GENERAL MEDICINE, SURGERY AND OBSTETRICS AND THE PARK CARE PAVILION (141 BEDS) BEHAVIORAL HEALTH, ARE LOCATED IN YONKERS. THE DOBBS FERRY PAVILION (12 BEDS) GENERAL MEDICINE AND SURGERY IS LOCATED IN DOBBS FERRY. THE ST. JOHN'S SERVICE AREA IS ETHNICALLY DIVERSE, ENCOMPASSING NEIGHBORHOODS WITH LARGE NUMBERS OF HISPANIC AND AFRICAN AMERICAN RESIDENTS. YONKERS HAS THE HIGHEST PROPORTION OF HISPANIC RESIDENTS IN WESTCHESTER COUNTY. SPANISH IS THE DOMINANT LANGUAGE, ALTHOUGH THERE ARE SIGNIFICANT NUMBER OF RESIDENTS WHO SPEAK ITALIAN, PORTUGUESE AND ARABIC. YONKERS (ZIP CODES 10701, 10703, 10704, 10705, AND 10710) HAS BEEN FEDERALLY DEFINED AS A MEDICALLY UNDERSERVED AREA. THE 2013 YONKERS' POPULATION ESTIMATE IS 199,766 AS PER THE US CENSUS BUREAU. ONE IN FIVE FAMILIES LIVES IN POVERTY AND OVER ONE THIRD OF THESE FAMILIES ARE HEADED BY FEMALES. THE PROFILE OF THIS AREA INCLUDES HIGH UNEMPLOYMENT, LARGE NUMBERS OF HIGH SCHOOL DROPOUTS, OVERCROWDED HOUSING, AND FAMILIES AND CHILDREN IN POVERTY. YONKERS IS FEDERALLY DESIGNATED AS A HIGH INTENSITY DRUG TRAFFICKING AREA. THERE IS A HIGH RATE OF POVERTY, TEEN PREGNANCY, LACK OF PRENATAL CARE, VACCINE PREVENTABLE DISEASE, TUBERCULOSIS, AND HIV/AIDS. THE CITY HAS THE HIGHEST CONCENTRATION OF HIV/AIDS IN THE COUNTRY. OUR SUBSTANCE ABUSE TREATMENT AND TRAINING CENTER IS NEW YORK'S LARGEST PROVIDER OF SUBSTANCE ABUSE SERVICES WITH NINE OUT OF TEN INPATIENTS PAID FOR BY MEDICAID AND WHERE REIMBURSEMENT RATES HAVE BEEN SIGNIFICANTLY REDUCED OVER THE LAST SEVERAL NYS BUDGET CYCLES. THE DOBBS FERRY PAVILION IS THE ONLY HOSPITAL LOCATED IN THE TOWN OF DOBBS FERRY. THE PRIMARY SERVICE AREAS INCLUDE DOBBS FERRY, HASTINGS-ON-HUDSON, ARDSLEY, IRVINGTON, TARRYTOWN, ELMSFORD, HARTSDALE, GREENBURG, WHITE PLAINS AND SCARSDALE. THE TOTAL POPULATION OF THIS SERVICE AREA IS APPROXIMATELY 83,000. THIS AREA IS DEFINED BY A POPULATION THAT IS LARGELY WHITE AND AFFLUENT.
5. PROMOTION OF COMMUNITY HEALTH	ST. JOHN'S CONTINUES TO ADDRESS THE HEALTH CARE NEEDS OF OUR POPULATION THROUGH A VARIETY OF SOURCES. OUR COMMUNITY ADVISORY COMMITTEE IS A KEY FORUM FOR ACCESS TO INFORMATION ON COMMUNITY HEALTH CARE NEEDS AND RESIDENT SATISFACTION WITH THE HEALTH CARE THAT THEY RECEIVE. ADVISORY MEMBERS ALSO PROVIDE ACCESS TO LOCAL COMMUNITY BASED ORGANIZATIONS AND BUSINESSES FOR HEALTH PROMOTION. THE HEALTH YONKERS INITIATIVE (HYI) IS A COLLABORATION OF OVER THIRTY COMMUNITY/HEALTH/FAITH-BASED ORGANIZATIONS, BUSINESSES, SCHOOLS AND RESIDENTS, LED BY ST. JOHN'S AND THE CITY OF YONKERS. IT IS AN INTEGRAL COMPONENT OF OUR OUTREACH EFFORTS. THE HYI PARTNERS MEET QUARTERLY, PLAN HEALTH OUTREACH ACTIVITIES, SHARE INFORMATION AND PROVIDE ACCESS TO RESIDENTS AND PLANNED ORGANIZATION COMMUNITY EVENTS. A SPEAKER'S FORUM PROVIDES PHYSICIANS TO EDUCATE ON KEY HEALTH TOPICS IN THE COMMUNITY. FUNDS AVAILABLE THROUGH GRANTS ALSO PROVIDE THE ABILITY TO PROVIDE A HOST OF PREVENTION AND WELLNESS ACTIVITIES. SOME OF OUR KEY ACTIVITIES HAVE ENHANCED HEALTH CARE ACCESS, PROVIDED PATIENT NAVIGATION AND A HOST OF SUPPORT SERVICES FOR OUR PATENTS. OUR COMMUNITY, OUTPATIENT, INPATIENT AND CLINICAL PATIENT NAVIGATION SERVICES PROVIDE COMMUNITY HEALTH EDUCATION, COORDINATE SCREENINGS, DEMYSTIFY TREATMENT OPTIONS, UN-COMPLICATE THE PROCESS FROM DIAGNOSIS TO TREATMENT, FACILITATE SCREENING AND DIAGNOSTIC TEST AND HEALTH AND PSYCHOSOCIAL SUPPORT SERVICES. BARRIERS TO CARE AND ACCESS TO TECHNOLOGICAL ADVANCEMENTS IN TREATING DISEASE ARE CONTINUALLY ADDRESSED FOR THE UNDERINSURED/UNDERSERVED POPULATION. OUR BREAST HEALTH PROGRAM IS DESIGNED TO REDUCE THE RATE OF LATE DIAGNOSIS AMONG MINORITY POPULATIONS, PARTICULARLY AFRICAN AMERICAN, WHO ARE MORE LIKELY TO BE DIAGNOSED AT LATER STAGES. WE COORDINATE CLINICAL BREAST EXAMS THAT LEAD TO MAMMOGRAMS, DIAGNOSTIC SERVICES, DIAGNOSIS AND TREATMENT. FOLLOW-UP SERVICES AND CLINICAL PATIENT NAVIGATION PROVIDED FREE OF CHARGE TO PATIENTS, IS AN EXTENSION OF THE HOSPITAL STAY FOR DISCHARGED PATIENTS WHO ARE FREQUENTLY AT RISK FOR READMISSION. TYPICALLY, THESE ARE CHRONICALLY ILL PATIENTS THAT ARE READMITTED BECAUSE OF THEIR UNIQUE FRAILTIES AND LACK OF SUPPORT FOR FOLLOW UP CARE REGIMENTS. THEY HAVE LONGER PATIENT STAYS AND SIGNIFICANT AFTERCARE NEEDS. AS A RESULT, PATIENTS WELCOME THE ADDITIONAL CARE AND SUPPORT PROVIDED. GRANT FUNDS ACQUIRED DURING 2015 WERE UTILIZED TO SUPPORT PREVENTION AND HEALTH PROMOTION PROGRAMS AND SUPPORT SERVICES FOR THE COMMUNITY.
6. AFFILIATED HEALTH CARE SYSTEM	After several years of affiliation with Mount Sinai Medical Center in Manhattan, New York, St. John's changed affiliation to Montefiore Medical Center in Bronx, New York to strengthen its mission to provide a comprehensive program of clinical access and health education for the St. John's community. The geographical proximity to Montefiore, similar demographics and collaboration with their tertiary care professionals, is an asset to health promotion activities and quality care for our growing communities. The official affiliation occurred in November of 2014 and both organizations formally announced through press release in May 2015.
7. STATE FILING OF COMMUNITY BENEFIT REPORT	ST. JOHN'S RIVERSIDE HOSPITAL FILES A COMMUNITY BENEFIT REPORT WITH THE STATE OF NEW YORK ONLY.

Schedule H (Form 990) 2015

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" on 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

2015

Open to Public Inspection

Name of the organization

ST JOHNS RIVERSIDE HOSPITAL
ANDRUS PARKCARE & DOBBS FERRY

Employer identification number

13-1740126

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 on 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 on 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? ................

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

Yes

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 on 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," on line 5a or 5b, describe in Part III.

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

The organization?

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

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

For persons listed on 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 on 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" on 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) 2015

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 on 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 on 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)
1PAUL ANTONECCHIA MDVP MEDICAL AFFAIRS/CMO	(i) (ii)	443,516 ------------- 0	0 ------------- 0	6,000 ------------- 0	15,900 ------------- 0	19,156 ------------- 0	484,572 ------------- 0	0 ------------- 0
2GLADYS ATTANASIOASSISTANT VP REVENUE CYCLE	(i) (ii)	218,997 ------------- 0	0 ------------- 0	0 ------------- 0	14,246 ------------- 0	18,657 ------------- 0	251,900 ------------- 0	0 ------------- 0
3PHYLLIS BAZERMANCOMPLIANCE OFFICER	(i) (ii)	175,142 ------------- 0	0 ------------- 0	0 ------------- 0	11,393 ------------- 0	6,817 ------------- 0	193,352 ------------- 0	0 ------------- 0
4BRIAN BEHRDIRECTOR OF FINANCE	(i) (ii)	178,154 ------------- 0	0 ------------- 0	0 ------------- 0	10,811 ------------- 0	7,726 ------------- 0	196,691 ------------- 0	0 ------------- 0
5CASSANDRA BOGLEASSISTANT VP NURSING	(i) (ii)	160,362 ------------- 0	0 ------------- 0	0 ------------- 0	16,887 ------------- 0	7,357 ------------- 0	184,606 ------------- 0	0 ------------- 0
6CHERAY BURNETTVP ADMINISTRATION	(i) (ii)	194,490 ------------- 0	0 ------------- 0	0 ------------- 0	12,596 ------------- 0	412 ------------- 0	207,498 ------------- 0	0 ------------- 0
7RONALD CORTIPRESIDENT/CEO	(i) (ii)	668,012 ------------- 0	0 ------------- 0	0 ------------- 0	113,522 ------------- 0	19,291 ------------- 0	800,825 ------------- 0	0 ------------- 0
8FRAN DAVISVP NURSING	(i) (ii)	235,372 ------------- 0	0 ------------- 0	6,000 ------------- 0	15,548 ------------- 0	19,323 ------------- 0	276,243 ------------- 0	0 ------------- 0
9ANDREW FADER MDPHYSICIAN - INTERNAL MEDICINE	(i) (ii)	263,640 ------------- 0	0 ------------- 0	0 ------------- 0	0 ------------- 0	26,367 ------------- 0	290,007 ------------- 0	0 ------------- 0
10DON GASPARINIASSISTANT VP BEHAVIORAL HEALTH	(i) (ii)	167,293 ------------- 0	0 ------------- 0	0 ------------- 0	12,664 ------------- 0	18,810 ------------- 0	198,767 ------------- 0	0 ------------- 0
11NANCY GOMEZNURSING DIRECTOR	(i) (ii)	184,040 ------------- 0	0 ------------- 0	0 ------------- 0	11,940 ------------- 0	19,098 ------------- 0	215,078 ------------- 0	0 ------------- 0
12PRASERT ITHARAT MDPHYSICIAN	(i) (ii)	317,760 ------------- 0	0 ------------- 0	0 ------------- 0	14,140 ------------- 0	34,470 ------------- 0	366,370 ------------- 0	0 ------------- 0
13BRIAN KALEYVP BEHAVIORAL HEALTH SERVICES	(i) (ii)	280,066 ------------- 0	0 ------------- 0	8,400 ------------- 0	18,137 ------------- 0	842 ------------- 0	307,445 ------------- 0	0 ------------- 0
14LYNN NELSONExec VP/COO	(i) (ii)	459,300 ------------- 0	100,000 ------------- 0	8,400 ------------- 0	30,563 ------------- 0	7,783 ------------- 0	606,046 ------------- 0	0 ------------- 0
15DENNIS KEANEVP FINANCE/CFO	(i) (ii)	450,735 ------------- 0	100,000 ------------- 0	8,400 ------------- 0	30,182 ------------- 0	18,894 ------------- 0	608,211 ------------- 0	0 ------------- 0
16MARC LEFFVP HUMAN RESOURCES	(i) (ii)	262,233 ------------- 0	0 ------------- 0	6,000 ------------- 0	15,900 ------------- 0	1,377 ------------- 0	285,510 ------------- 0	0 ------------- 0
17JANET MCCARTHYASSISTANT VP NURSING	(i) (ii)	186,012 ------------- 0	0 ------------- 0	0 ------------- 0	10,438 ------------- 0	6,950 ------------- 0	203,400 ------------- 0	0 ------------- 0
18ANDRE OUTON MDPHYSICIAN - INTERNAL MEDICINE	(i) (ii)	279,895 ------------- 0	0 ------------- 0	0 ------------- 0	0 ------------- 0	34,317 ------------- 0	314,212 ------------- 0	0 ------------- 0
19EDNER PIERRE-LOUIS MDPHYSICIAN-INTERNAL MEDICINE	(i) (ii)	321,320 ------------- 0	0 ------------- 0	0 ------------- 0	14,299 ------------- 0	34,710 ------------- 0	370,329 ------------- 0	0 ------------- 0
20JOSEPH PRIVITERADIR OF PHYSICIAN PRACTICE MGMT	(i) (ii)	222,088 ------------- 0	0 ------------- 0	0 ------------- 0	13,400 ------------- 0	8,547 ------------- 0	244,035 ------------- 0	0 ------------- 0
21PETER WEIDNERDIRECTOR OF INFO SVCS	(i) (ii)	169,477 ------------- 0	0 ------------- 0	0 ------------- 0	11,004 ------------- 0	18,563 ------------- 0	199,044 ------------- 0	0 ------------- 0
22LAURA FANNINGDIRECTOR OF SURGICAL SERVICES	(i) (ii)	159,250 ------------- 0	0 ------------- 0	0 ------------- 0	16,634 ------------- 0	412 ------------- 0	176,296 ------------- 0	0 ------------- 0
23TARA CURTINASSISTANT VICE PRESIDENT	(i) (ii)	158,329 ------------- 0	0 ------------- 0	0 ------------- 0	5,057 ------------- 0	19,025 ------------- 0	182,411 ------------- 0	0 ------------- 0
24DANIELLE STANZIONECHIEF OF STAFF	(i) (ii)	157,085 ------------- 0	0 ------------- 0	0 ------------- 0	8,508 ------------- 0	7,239 ------------- 0	172,832 ------------- 0	0 ------------- 0
25MICHAEL DIGIORNO MDPHYSICIAN - NEPHROLOGY	(i) (ii)	308,017 ------------- 0	0 ------------- 0	0 ------------- 0	0 ------------- 0	33,554 ------------- 0	341,571 ------------- 0	0 ------------- 0
26MARK POHARMALOTZ NURSING HOME ADMIN	(i) (ii)	89,642 ------------- 162,855	0 ------------- 0	0 ------------- 0	0 ------------- 153,519	0 ------------- 27,634	89,642 ------------- 344,008	0 ------------- 0

Schedule J (Form 990) 2015

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 III, COLUMN (B)(II)	AMOUNTS REPORTED IN COLUMN (B)(II) FOR LYNN NELSON AND DENNIS KEANE INCLUDE PAYMENTS UNDER A BOARD-APPROVED RETENTION PLAN. NONQUALIFIED DEFERRED COMPENSATION PLAN PART I, LINE 4B AND PART II, COLUMN (C) AMOUNTS REPORTED IN COLUMN (C) FOR RON CORTI INCLUDE $78,495 DEFERRED UNDER A 457(F) PLAN.

Schedule J (Form 990) 2015

Additional Data

Software ID:
Software Version:

- TIN:

Schedule L
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Transactions with Interested Persons

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

Attach to Form 990 or Form 990-EZ.
MediumBullet

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

OMB No. 1545-0047

2015

Open to Public Inspection

Name of the organization

ST JOHNS RIVERSIDE HOSPITAL
ANDRUS PARKCARE & DOBBS FERRY

Employer identification number

13-1740126

Part I

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

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

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

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

Part II

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

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










Total ............... $

Part III

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

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

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

Cat. No. 50056A

Schedule L (Form 990 or 990-EZ) 2015

Page 2

Part IV

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

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of transaction	(d) Description of transaction	(e) Sharing of organization's revenues?
(a) Name of interested person		(c) Amount of transaction	(d) Description of transaction	Yes	No
(1) ASHIKARI KELEMEN PC	SEE PART V	460,270	PAYMENT FOR SERVICES		No
(2) RIVERSIDE HEALTH CARE SYSTEMS BERMU	SEE PART V	2,511,000	INSURANCE PREMIUMS		No
(3) RICHARD ASHIKARI	SEE PART V	124,052	COMPENSATION		No
(4) EMPRESS AMBULANCE SERVICE	SEE PART V	179,722	AMBULANCE SERVICE		No
(5) NANCY ANNABI	SEE PART V	20,291	COMPENSATION		No

Part V

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

Return Reference

Explanation

BUSINESS TRANSACTIONS

SCHEDULE L, PART IV (1) MR. ROY ASHIKARI IS ON THE ST. JOHN'S RIVERSIDE HOSPITAL (SJRH) BOARD OF DIRECTORS AND IS ALSO A PARTNER AT ASHIKARI & KELEMAN PC, A BREAST CENTER WHICH DOES BUSINESS WITH THE HOSPITAL. (2) IN 2015, SJRH PAID INSURANCE PREMIUMS TO A RELATED, TAXABLE ENTITY RIVERSIDE HEALTH CARE SYSTEMS BERMUDA. RHCS BERMUDA IS A 35% CONTROLLED ENTITY OF RIVERSIDE HEALTH CARE SYSTEM, INC., WHICH IS THE SOLE MEMBER OF AND A SUPPORTING ORGANIZATION OF ST. JOHN'S RIVERSIDE HOSPITAL. (3) RICHARD ASHIKARI IS AN EMPLOYEE OF SJRH AND IS THE SON OF SJRH BOARD MEMBER, ROY ASHIKARI. (4) IN 2015, EMPRESS AMBULANCE SERVICE PROVIDED SERVICES TO SJRH. EMPRESS AMBULANCE SERVICE IS OWNED BY THE SONS OF LENORE MINERVA, SJRH BOARD MEMBER. (5) NANCY ANNABI IS AN EMPLOYEE OF SJRH AND IS THE WIFE OF SJRH BOARD MEMBER, DR. IYAD ANNABI.

Schedule L (Form 990 or 990-EZ) 2015

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

2015

Open to Public
Inspection

Name of the organization

ST JOHNS RIVERSIDE HOSPITAL
ANDRUS PARKCARE & DOBBS FERRY

Employer identification number

13-1740126

Return Reference	Explanation
VOLUNTEERS	FORM 990, PART I, LINE 6 THE VOLUNTEER PROGRAM AT ST. JOHN'S RIVERSIDE HOSPITAL AND MICHAEL N. MALOTZ SKILLED NURSING PAVILION IS CURRENTLY COMPRISED OF 225 ACTIVE VOLUNTEERS, INTERNS AND STUDENTS(218 - ST. JOHN'S RIVERSIDE HOSPITAL; 7 - MICHAEL N. MALOTZ SKILLED NURSING PAVILION). VOLUNTEER RECORDS AND HOURS ARE TRACKED THROUGH A COMPUTER PROGRAM LOCATED IN THE VOLUNTEER OFFICE AT ST. JOHN'S ANDRUS PAVILION. OFFSITE VOLUNTEERS COMPLETE TIME SHEETS AT THEIR RESPECTIVE FACILITY/DEPARTMENT AND SUBMIT THOSE REPORTS TO THIS OFFICE ON A MONTHLY BASIS FOR INCLUSION IN THE VOLUNTEER WORKS COMPUTER PROGRAM. MISSION STATEMENT FORM 990, PART III, LINE 1 St. Johns Riverside Hospital is dedicated to providing comprehensive medical and nursing care in a compassionate, professional, respectful and ethical manner to every patient. By offering excellence in medical care, nursing, state-of-the-art technologies, continuing education and preventive services, we are committed to improving the care we provide within each of our institutions and the quality of life in our community. We are open to new ideas, directions and initiatives that most effectively respond to community health care needs. NEW PROGRAM SERVICES FORM 990, PART III, LINE 2 THE HOSPITAL INTRODUCED DAVINCI ROBOTIC SURGERY WITH A 3D CAMERA TO MAGNIFY UP TO TEN TIMES WHICH PROVIDES BETTER VISUALIZATION, LESS BLOOD LOSS, MINIMAL PAIN, SHORTER HOSPITAL STAYS, LESS COMPLICATIONS AND BETTER OUTCOMES.
PROGRAM SERVICE ACCOMPLISHMENTS	FORM 990, PART III, LINE 4B THE DAY PROGRAM INCLUDES INTENSIVE, MEDICALLY SUPERVISED SERVICES FOR UP TO FIVE DAYS PER WEEK, FOUR HOURS PER DAY WITH INDIVIDUAL AND GROUP THERAPY PSYCHIATRIC ASSESSMENT, 12 STEP PROGRAMMING, VOCATIONAL AND EDUCATIONAL SERVICES, AND RECREATION THERAPY. THE CLINIC PROGRAM HAS SERVICES AVAILABLE FOR UP TO FOUR TIMES PER WEEK. FLEXIBLE DAY AND EVENING HOURS FOR THOSE WHO WORK, GO TO SCHOOL OR NEED A STEP-DOWN LEVEL OF CARE. TARGETED SERVICES FOR ADOLESCENTS AND FOR FAMILY MEMBERS IMPACTED BY ALCOHOLISM AND DRUG DEPENDENCE.
PROGRAM SERVICE ACCOMPLISHMENTS	FORM 990, PART III, LINE 4C TO DATE, THERE ARE OVER 186 STUDENTS ENROLLED IN THE PROFESSIONAL NURSING PROGRAM. IN 1999 THERE WERE NO MORE THAN 50 STUDENTS ENROLLED AND NOW THE SCHOOL PROUDLY COUNTS MORE THAN 2,500 GRADUATES WHO HAVE SERVED PATIENTS AND HEALTH CARE THROUGHOUT THE UNITED STATES AND AROUND THE WORLD. DUE TO OUR GROWTH, THE SCHOOL HAS GROWN ITS WEBSITE WHICH ENABLES APPLICANTS TO QUICKLY COMPLETE ONLINE FORMS, ONLINE APPLICATIONS, AND SURVEYS. THE COCHRAN SCHOOL OF NURSING IS ACCREDITED BY THE NATIONAL LEAGUE FOR NURSING. PROGRAM SERVICE ACCOMPLISHMENTS FORM 990, PART III, LINE 4D ST. JOHN'S RIVERSIDE HOSPITAL OPERATES A METHADONE MAINTENANCE PROGRAM SEVEN DAYS A WEEK, 365 DAYS A YEAR TO ENABLE CLIENTS SUFFERING NARCOTIC ADDICTION TO CONTINUE PRODUCTIVE LIVES. IN 2015, THE CLINIC HAD 87,767 VISITS.
BUSINESS RELATIONSHIP	FORM 990, PART VI, SECTION A, LINE 2 CECILE SINGER, SJRH BOARD MEMBER, GREG HOLCOMBE, SJRH BOARD MEMBER AND RON CORTI, SJRH PRESIDENT/CEO HAVE A BUSINESS RELATIONSHIP.
MEMBERS/STOCK HOLDERS	FORM 990, PART VI, SECTION A, LINE 6 ST. JOHN'S RIVERSIDE HOSPITAL HAS A SOLE MEMBER - RIVERSIDE HEALTHCARE SYSTEM, INC., A SECTION 501(C)(3) ENTITY.
ELECTION OF MEMBERS	FORM 990, PART VI, SECTION A, LINE 7 A AND B THE FOLLOWING POWERS ARE RESERVED TO RIVERSIDE HEALTH CARE SYSTEM (RHCS): 1. APPOINTMENT AND REMOVAL OF THE CHIEF EXECUTIVE OFFICER OF ST. JOHN'S UPON CONSULTATION WITH THE BOARD OF TRUSTEES; 2. REVIEW AND APPROVAL OF THE CAPITAL AND OPERATING BUDGETS OF ST. JOHN'S PROVIDED THAT RHCS MAY ONLY APPROVE OR REJECT A CAPITAL OR OPERATING BUDGET IN ITS ENTIRETY; 3. APPROVAL OF ANY SALE OF ACQUISITION BY ST. JOHN'S OF ASSETS VALUED IN EXCESS OF ONE MILLION DOLLARS ($1,000,000), PROVIDED THAT RHCS APPROVAL SHALL NOT BE REQUIRED FOR SALES OR ACQUISITIONS OF MEDICAL EQUIPMENT (INCLUDING, WITHOUT LIMITATION, MAGNETIC RESONANCE IMAGING AND COMPUTERIZED TOMOGRAPHY EQUIPMENT, OPERATING ROOM EQUIPMENT, AND EQUIPMENT FOR ENDOSCOPY AND DELIVERY SUITES); AND 4. APPROVAL OF ANY AMENDMENTS TO THE CONSTITUTION, THE BYLAWS OR THE CERTIFICATE OF INCORPORATION OF ST. JOHN'S WHICH WOULD MODIFY, LIMIT OR IN ANY WAY RESTRICT THE RIGHT AND POWERS OF RHCS AS THE SOLE CORPORATE MEMBER.
BOARD OF TRUSTEES' REVIEW OF FORM 990	FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 IS DRAFTED BY THE FINANCE DEPARTMENT OF ST. JOHN'S RIVERSIDE HOSPITAL AND REVIEWED BY THE DIRECTOR OF FINANCE AND CHIEF FINANCIAL OFFICER OF THE HOSPITAL. THE DRAFT FORM 990, AND WORKPAPER SUPPORT, IS PROVIDED TO THE HOSPITAL'S TAX PREPARER TO PREPARE A FINAL VERSION OF THE FORM 990. THE FINAL VERSION OF THE FORM 990 IS THEN REVIEWED BY THE HOSPITAL'S FINANCE COMMITTEE MEMBERS OF THE GOVERNING BOARD OF TRUSTEES AND THEN A COPY IS PROVIDED TO THE ENTIRE BOARD OF TRUSTEES PRIOR TO SUBMISSION TO THE IRS.
CONFLICT OF INTEREST POLICY	FORM 990, PART VI, SECTION B, LINE 12C ALL MEMBERS OF THE BOARD OF TRUSTEES AND ALL PERSONNEL OF THE ORGANIZATION WHO ARE IN A POSITION TO INFLUENCE ANY PURCHASING DECISION OR BUSINESS TRANSACTION MUST COMPLETE A CONFLICT OF INTEREST STATEMENT. THIS INCLUDES ADMINISTRATIVE STAFF, DEPARTMENT HEADS AND MEMBERS OF THE MEDICAL BOARD. THE STATEMENTS ARE DISTRIBUTED BY THE COMPLIANCE OFFICER ANNUALLY IN NOVEMBER WITH THE EXPECTATION THAT THEY BE RETURNED TO THE COMPLIANCE OFFICER IN JANUARY OF THE FOLLOWING YEAR. WHEN RETURNED, THE STATEMENTS ARE REVIEWED BY THE COMPLIANCE OFFICER. ALL INFORMATION IS KEPT CONFIDENTIAL AND STATEMENTS ARE MAINTAINED IN THE COMPLIANCE OFFICE. THE COMPLIANCE OFFICER WILL CONSULT WITH OUTSIDE COUNSEL AS NECESSARY CONCERNING ANY POTENTIAL PROBLEMS OR POSSIBLE CONFLICTS OF INTEREST. THE COMPLIANCE OFFICER WILL REPORT ANY CONFLICTS OF INTEREST OR POSSIBLE CONFLICTS OF INTEREST TO THE AUDIT AND CORPORATE COMPLIANCE COMMITTEE AND TO THE FINANCE COMMITTEE OF THE BOARD OF TRUSTEES. IN CASES WHERE A CONFLICT OF INTEREST EXISTS, BOARD MEMBERS WITH A CONFLICT ARE PROHIBITED FROM PARTICIPATING IN THE GOVERNING BODY'S DELIBERATIONS AND DECISIONS IN THE TRANSACTION.
COMPENSATION REVIEW	FORM 990, PART VI, SECTION B, LINE 15A AND 15B THE ORGANIZATION CONTRACTS WITH AN INDEPENDENT THIRD PARTY TO BRING THE COMPENSATION LEVELS TO A COMPETITIVE LEVEL IN THE MARKET AREA. A REQUEST FOR PROPOSAL FOR AN EXECUTIVE COMPENSATION SURVEY IS INITIATED BY HUMAN RESOURCES TO FIND A VENDOR WHO COULD PROVIDE A COMPREHENSIVE REVIEW AND COMPARISON OF THE SALARY AND BENEFITS RIVERSIDE HEALTH CARE SYSTEMS INC. SHOULD BE PROVIDING ITS EXECUTIVES WHILE MEETING ALL LEGAL AND ANTI-TRUST REQUIREMENTS. THIS SURVEY IS TO IDENTIFY THE BASE COMPENSATION, INCENTIVE COMPENSATION AND NON-CASH COMPENSATION FOR LIKE POSITIONS IN THE COMPETING WESTCHESTER COUNTY, NEW YORK AREA. THE AREAS THAT WOULD BE EVALUATED INCLUDE: CHIEF EXECUTIVE OFFICER, CHIEF OPERATING OFFICER, CHIEF FINANCIAL OFFICER, NURSING HOME ADMINISTRATOR, VICE PRESIDENT NURSING, VICE PRESIDENT COCHRAN SCHOOL OF NURSING, VICE PRESIDENT BEHAVIORAL HEALTH, VICE PRESIDENT STRATEGIC CORPORATE DEVELOPMENT, VICE PRESIDENT PERFORMANCE IMPROVEMENT & RISK MANAGEMENT, AND VICE PRESIDENT HUMAN RESOURCES. THE REQUEST FOR PROPOSAL GETS SENT TO EIGHT COMPANIES WITH A KNOWN TRACK RECORD IN COMPENSATION CONSULTING. EACH OF THE VENDORS RESPONDS WITH THE DETAILED ANALYSIS THAT THEY WILL PROVIDE AND THE COST ASSOCIATED WITH THE PROCESS. BASED ON THE TIMEFRAME AND THE COST, A VENDOR IS CHOSEN TO PERFORM THE EXECUTIVE COMPENSATION SURVEY. A PROPOSAL IS PRESENTED TO INDEPENDENT MEMBERS OF THE BOARD OF TRUSTEES PERSONNEL AND COMPENSATION COMMITTEE FOR APPROVAL. THE PERSONNEL AND COMPENSATION COMMITTEE CONTEMPORANEOUSLY DOCUMENTS ITS FINDINGS IN ITS MINUTES. INDEPENDENT MEMBERS OF THE BOARD OF TRUSTEES MAKE THE DECISION ON APPROVING THE SALARY CHANGES. AN EXECUTIVE COMPENSATION REVIEW TOOK PLACE IN SPRING 2013 and a review is ongoing in 2016.
PUBLIC DISCLOSURE	FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST.
OTHER CHANGES IN NET ASSETS	FORM 990, PART XI, LINE 9 PENSION ADJUSTMENT 10,578,733 WRITE OFF OF PLEDGES RECEIVABLE (70,000) TRANSFER FROM RHCS 5,700,000 -------------- TOTAL 16,208,733

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

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2015

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

2015

Open to Public Inspection

Name of the organization

ST JOHNS RIVERSIDE HOSPITAL
ANDRUS PARKCARE & DOBBS FERRY

Employer identification number

13-1740126

Part I

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

(a) Name, address, and EIN (if applicable) of disregarded entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Total income	(e) End-of-year assets	(f) Direct controlling entity

Part II

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

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No
(1)RIVERSIDE HEALTH CARE SYSTEMINC (RHCS) 967 NORTH BROADWAY YONKERS,NY10701 13-3237215	MANAGEMENT	NY	501(C)(3)	11A II	NA		No
(2)MICHAEL MALOTZ SKILLED NURSING PAVILION 120 ODELL AVENUE YONKERS,NY10701 31-1587828	HEALTH CARE	NY	501(C)(3)	9	RHCS		No

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

Cat. No. 50135Y

Schedule R (Form 990) 2015

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) RIVERSIDE MANAGEMENT SERVICES ORG (RMSO) 967 NORTH BROADWAY YONKERS,NY10701 13-3846601	MANAGEMENT	NY	RMI	C CORP					No
(2) RIVER MANAGEMENT CO INC 967 N BROADWAY ANDRUS PAVIL YONKERS,NY10701 13-3474004	MANAGEMENT	NY	RHCS	C CORP					No
(3) RHCS BERMUDA LTD 967 NORTH BROADWAY YONKERS,NY10701 13-3237215	INSURANCE	BD	RHCS	C CORP					No
(4) SJR MEDICAL PC 967 NORTH BROADWAY YONKERS,NY10701 13-4185781	MED. SERVICE	NY	SJRH	C CORP	155,365		100.000 %	Yes
(5) FDN FOR COMM HOSPITAL AT DOBBS FERRY 128 ASHFORD AVE DOBBS FERRY,NY10522 13-3971735	FUNDRAISING	NY	SJRH	C CORP	-119	4,027	100.000 %	Yes

Schedule R (Form 990) 2015

Page 3

Part V

Transactions With Related Organizations Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36.

Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.

Yes

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

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

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

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

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

Yes

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

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

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

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

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

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

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

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

Yes

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

Yes

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

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

Yes

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

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

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

Yes

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

Yes

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
(1) SJR MEDICAL PC	l	155,364	FMV
(2) SJR MEDICAL PC	o	4,059,167	FMV
(3) RIVERSIDE HEALTH CARE SYSTEMINC	s	5,700,000	book

Schedule R (Form 990) 2015

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) 2015

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) 2015

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: THE HOSPITAL IS DEDICATED TO PROVIDING COMPREHENSIVE MEDICAL AND NURSING CARE IN A COMPASSIONATE, PROFESSIONAL, RESPECTFUL AND ETHICAL MANNER TO EVERY PATIENT.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	25
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	19
5	Total number of individuals employed in calendar year 2015 (Part V, line 2a) ......	5	2,126
6	Total number of volunteers (estimate if necessary) .............	6	218
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	1,325
b	Net unrelated business taxable income from Form 990-T, line 34 .........	7b

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	8,430,619	4,749,089
9	Program service revenue (Part VIII, line 2g) .........	229,627,457	231,642,061
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	751,695	975,698
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	3,482,075	5,271,746
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	242,291,846	242,638,594
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)	156,036,698	159,581,829
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 151,343
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	90,138,331	90,436,143
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	246,175,029	250,017,972
19	Revenue less expenses. Subtract line 18 from line 12.......	-3,883,183	-7,379,378
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	148,705,587	145,470,855
21	Total liabilities (Part X, line 26).............	175,161,566	163,841,338
22	Net assets or fund balances. Subtract line 21 from line 20.....	-26,455,979	-18,370,483

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 216,823,941 including grants of $ ) (Revenue $ 188,477,180 )
	IN 2015, ST. JOHN'S TREATED 10,733 INPATIENTS, THROUGH 50,867 PATIENT DAYS, WITH A LARGE PROPORTION (67%) BEING MEDICARE AND MEDICAID PATIENTS. THE HOSPITAL'S INPATIENT AND OUTPATIENT SPECIALTY SERVICES INCLUDE BARIATRIC SURGERY, BEHAVIORAL HEALTH SERVICES, BREAST CARE, CANCER CARE, CARDIOLOGY SERVICES, DIAGNOSTIC IMAGING, EMERGENCY SERVICES, HOLISTIC CARE SERVICES, HOPE CENTER, HYPERBARIC OXYGEN TREATMENT, MATERNITY, ORTHOPEDIC SURGERY CENTER, PHYSICAL THERAPY, RESPIRATORY THERAPY SERVICES, SLEEP SERVICES, SURGICAL SERVICES AND WOUND HEALING.

4b	(Code: ) (Expenses $ 11,762,945 including grants of $ ) (Revenue $ 34,796,460 )
	IN 2015, ST. JOHN'S PROVIDED 45,561 DAYS OF INPATIENT DRUG AND ALCOHOL SUBSTANCE ABUSE SERVICES TO 7,411 PATIENTS. OUTPATIENT FOLLOW-UP TREATMENT AND SUPPORT SERVICES PROVIDED FOR 72,471 CLIENT VISITS. THE INPATIENT REHABILITATION PROGRAM IS BASED UPON THE 12 STEP PHILOSOPHY AND PROVIDES A COMPREHENSIVE ARRAY OF SERVICES TO MEN AND WOMEN IN SEPARATE, GENDER-SPECIFIC UNITS. PATIENTS WITH CO-OCCURRING PSYCHIATRIC DISORDERS AND THOSE WITH A HISTORY OF RELAPSE ARE WELCOMED. OUTPATIENT TREATMENT PROGRAMS INCLUDE A DAY REHABILITATION PROGRAM AND A CLINIC PROGRAM. FOR MORE INFORMATION, SEE SCHEDULE O.

4c	(Code: ) (Expenses $ 2,354,562 including grants of $ ) (Revenue $ 1,103,614 )
	ST. JOHN'S OPERATES THE COCHRAN SCHOOL OF NURSING, AN ASSOCIATE DEGREE PROGRAM WHOSE PURPOSE IS TO TRAIN NURSES. IN 2015, 119 STUDENTS WERE ENROLLED AT THE SCHOOL. FOUNDED IN 1894 AT ST. JOHN'S RIVERSIDE HOSPITAL, THE COCHRAN SCHOOL OF NURSING IS THE OLDEST HOSPITAL-BASED SCHOOL OF NURSING IN THE METROPOLITAN REGION. THE SCHOOL OFFERS A REGISTERED NURSE (RN) CURRICULUM LEADING TO A DEGREE OF ASSOCIATE IN APPLIED SCIENCE. FOR MORE INFORMATION, SEE SCHEDULE O.

	(Code: ) (Expenses $ 1,522,879 including grants of $ ) (Revenue $ 3,102,492 )
	TOTAL OTHER PROGRAM EXPENSES

	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )
	ST. JOHN'S RIVERSIDE HOSPITAL OPERATES A

	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )
	METHADONE MAINTENANCE PROGRAM SEVEN DAYS A

	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )
	WEEK, 365 DAYS A YEAR TO ENABLE CLIENTS

	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )
	SUFFERING NARCOTIC ADDICTION TO CONTINUE

	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )
	PRODUCTIVE LIVES. IN 2015, THE CLINIC HAD

	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )
	87,767 VISITS.

4d	Other program services (Describe in Schedule O.)
	(Expenses $ 1,522,879 including grants of $ ) (Revenue $ 3,102,492 )
4e	Total program service expenses232,464,327

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	7,151,749	212,590	1,013,797

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c	288,018
d	Related organizations		1d
e	Government grants (contributions)		1e	3,892,160

f	All other contributions, gifts, grants, and similar amounts not included above		1f	568,911

g	Noncash contributions included in lines 1a-1f:$
h Total.Add lines 1a-1f.......		4,749,089

			Business Code
2a	NET PATIENT SERVICE REVENUE	623000	218,732,901	218,732,901
b	UNCOMPENSATED CARE SUBSIDIZED	623000	7,670,121	7,670,121
c	STUDENT TUITION ADMISSIONS	900099	1,090,156	1,090,156
d	PHYSICIAN BILLING	900099	4,148,883	4,148,883
e
f	All other program service revenue.
g Total.Add lines 2a–2f.....			231,642,061

3 Investment income (including dividends, interest, and othersimilar amounts) ..........			497,556		1,325	496,231
4 Income from investment of tax-exempt bond proceeds			0
5 Royalties...........			0
		(ii) Personal	(i) Real
6a	Gross rents		1,095,755
b	Less: rental expenses
c	Rental income or (loss)	0	1,095,755
d	Net rental income or (loss)......			1,095,755			1,095,755
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory		17,556,076
b	Less: cost or other basis and sales expenses		17,077,934
c	Gain or (loss)		478,142
d	Net gain or (loss).....			478,142			478,142
8a	Gross income from fundraising events (not including $ 288,018of contributions reported on line 1c). See Part IV, line 18 ....
	a		144,329
b	Less: direct expenses ...b		145,936
c	Net income or (loss) from fundraising events..			-1,607			-1,607
9a	Gross income from gaming activities. See Part IV, line 19 ...
	a
b	Less: direct expenses ...b
c	Net income or (loss) from gaming activities..			0
10a	Gross sales of inventory, less returns and allowances ..
	a		64,797
b	Less: cost of goods sold ..b		21,090
c	Net income or (loss) from sales of inventory..			43,707			43,707
Business Code			Miscellaneous Revenue
11a	MALOTZ SKILLED NURSING MEALS		900099	263,381	263,381
b	CAFETERIA		900099	388,332			388,332
c	ALL OTHER REVENUE		900099	3,482,178			3,482,178
d	All other revenue ....
e	Total. Add lines 11a–11d ......			4,133,891
12	Total revenue. See Instructions......			242,638,594	231,905,442	1,325	5,982,738

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21	0
2	Grants and other assistance to individuals in the United States. See Part IV, line 22	0
3	Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16	0
4	Benefits paid to or for members	0
5	Compensation of current officers, directors, trustees, and key employees ....	6,212,262	6,212,262
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....	604,613	604,613
7	Other salaries and wages	105,953,752	100,095,082	5,858,670
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	15,976,952	15,117,991	858,961
9	Other employee benefits .......	22,826,518	21,616,062	1,210,456
10	Payroll taxes ...........	8,007,732	7,587,612	420,120
11	Fees for services (non-employees):
a	Management ......	2,435,235	1,681,629	753,606
b	Legal .........	527,635	4,960	522,675
c	Accounting ...........	419,119		419,119
d	Lobbying ...........	129,500	129,500
e	Professional fundraising services. See Part IV, line 17	0
f	Investment management fees ......	129,886		129,886
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	24,077,072	21,531,029	2,546,043
12	Advertising and promotion ....	906,040		866,662	39,378
13	Office expenses .......	35,967,726	34,672,758	1,294,968
14	Information technology ......	1,947,798	973,899	973,899
15	Royalties ..	0
16	Occupancy ...........	5,104,974	4,888,182	216,792
17	Travel ............	36,527	28,751	7,776
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .	0
19	Conferences, conventions, and meetings ....	447,859	178,677	269,182
20	Interest ...........	2,075,197	2,075,197
21	Payments to affiliates .......	0
22	Depreciation, depletion, and amortization ..	10,719,138	10,719,138
23	Insurance ...	3,374,773	3,374,773
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	DUES, BOOKS, SUBSCRIPTIONS	361,709	258,967	102,742
b	COLLECTION FEES	867,707	510,044	357,663
c	AUXILIARY EXPENSES	111,965			111,965
d	ALL OTHER EXPENSES	796,283	203,201	593,082
e	All other expenses
25	Total functional expenses. Add lines 1 through 24e	250,017,972	232,464,327	17,402,302	151,343
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).

1	Cash–non-interest-bearing ........			1,071,486	1	8,661,106
2	Savings and temporary cash investments .........			5,795,345	2	4,897,095
3	Pledges and grants receivable, net ......			114,577	3	20,800
4	Accounts receivable, net .............			22,164,111	4	21,794,953
5	Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of Schedule L
				0	5	0
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L
				0	6	0
7	Notes and loans receivable, net ....			6,667,744	7	1,435,707
8	Inventories for sale or use ........			3,030,374	8	2,850,744
9	Prepaid expenses and deferred charges ......			1,127,874	9	1,622,463
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	261,562,718
b	Less: accumulated depreciation	10b	210,373,079	54,491,732	10c	51,189,639
11	Investments—publicly traded securities .			29,107,717	11	27,436,832
12	Investments—other securities. See Part IV, line 11 .....			0	12	0
13	Investments—program-related. See Part IV, line 11 ..			0	13	0
14	Intangible assets ...............			2,781,937	14	2,698,024
15	Other assets. See Part IV, line 11 ...........			22,352,690	15	22,863,492
16	Total assets. Add lines 1 through 15 (must equal line 34)...			148,705,587	16	145,470,855

17	Accounts payable and accrued expenses .....	32,935,417	17	33,612,640
18	Grants payable ...	0	18	0
19	Deferred revenue .........	0	19	0
20	Tax-exempt bond liabilities .........	20,655,000	20	19,990,000
21	Escrow or custodial account liability. Complete Part IV of Schedule D	0	21	0
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..	0	22	0
23	Secured mortgages and notes payable to unrelated third parties ..	6,066,303	23	5,295,680
24	Unsecured notes and loans payable to unrelated third parties ..	0	24	0
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	115,504,846	25	104,943,018
26	Total liabilities. Add lines 17 through 25..	175,161,566	26	163,841,338

	Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets	-31,211,657	27	-22,961,313
28	Temporarily restricted net assets ...........	2,626,041	28	2,461,193
29	Permanently restricted net assets	2,129,637	29	2,129,637
	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 ...........	-26,455,979	33	-18,370,483
34	Total liabilities and net assets/fund balances ........	148,705,587	34	145,470,855