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)	(F) Estimated amount of other compensation from the organization and related organizations
(1) REV LAWRENCE C PROVENZANO...................................................................... PRESIDENT & CHAIRMAN	10.0 ................. 1.0	X	X		90,000	0
(2) MARGARET O CARPENTER...................................................................... SECOND VP	1.0 ................. 1.0	X	X		0	0
(3) RONALD O COLE...................................................................... TREASURER/SECRETARY	5.5 ................. 0.0	X	X		35,839	0
(4) REVEREND DARRYL F JAMES...................................................................... BOARD MEMBER	1.0 ................. 0.0	X			0	0
(5) REVEREND SARAH KOOPERKAMP...................................................................... BOARD MEMBER - EFFECTIVE 9/15	1.0 ................. 0.0	X			0	0
(6) GERARD WALSH...................................................................... CEO - EFFECTIVE 7/15	34.5 ................. 3.0	X	X		198,885	10,490
(7) DANIEL A KASLE...................................................................... BOARD MEMBER	1.0 ................. 0.0	X			0	0
(8) REV DR NORMAN WHITMIRE JR...................................................................... BOARD MEMBER	1.0 ................. 0.0	X			0	0
(9) REV T DIANE BRITT...................................................................... BOARD MEMBER	1.0 ................. 0.0	X			0	0
(10) PATRICK GUY...................................................................... BOARD MEMBER	1.0 ................. 0.0	X			0	0
(11) ALBERT STROGEN MD...................................................................... BOARD MEMBER	40.0 ................. 0.0	X			340,051	0
(12) STEVEN GUIDO...................................................................... CFO - EFFECTIVE 7/15	34.5 ................. 3.0		X		293,285	51,408
(13) RICHARD BROWN...................................................................... CEO - TERM 7/15	34.5 ................. 3.0		X		454,235	0
(14) WILLIAM MOORE...................................................................... CFO - TERM 7/15	34.5 ................. 3.0		X		390,463	0
(15) RAJIV PRASAD MD...................................................................... CHAIR-EMS - TERM 5/15	32.0 ................. 8.0			X	179,707	19,923
(16) SHELDON MARKOWITZ MD...................................................................... CHAIR - DEPT OF MEDICINE	40.0 ................. 0.0			X	266,536	69,278
(17) RAYMOND PASTORE MD...................................................................... CHIEF MEDICAL OFFICER	30.0 ................. 10.0			X	428,801	0

(A) Name and Title	(B) Average hours per week (list any hours for related organizations below dotted line)	(F) Estimated amount of other compensation from the organization and related organizations
(18) LOKESH REDDY MD........................................................................ CHIEF OF PSYCHIATRY	40.0 .......................0.0	X		175,335	41,001
(19) James Henry MD........................................................................ CHIEF OF ORTHOPEDICS	40.0 .......................0.0	X		359,866	32,558
(20) Kelly Barland........................................................................ Chief Information Officer	37.5 .......................0.0	X		219,319	11,846
(21) Natalie Schwartz........................................................................ VP REGULATORY AFFAIRS	37.5 .......................0.0	X		274,471	54,501
(22) SHAKIRA GORDON........................................................................ VP HUMAN RESOURCES	37.5 .......................0.0	X		156,008	32,707
(23) GWENDOLYN SEYMORE-PINCKNEY........................................................................ CHIEF NURSING OFFICER	37.5 .......................0.0	X		186,083	55,298
(24) IBIS YARDE MD........................................................................ MD EDUCATION - TERM 12/15	40.0 .......................0.0	X		330,230	43,185
(25) FRANCINE NIGRELLO........................................................................ CHIEF COMPLIANACE OFFICER	37.5 .......................0.0	X		200,872	7,000
(26) JAVIER ANDRADE MD........................................................................ PHYSICIAN	40.0 .......................0.0		X	513,053	26,864
(27) ALEX VIDAL-GUERVARA MD........................................................................ PHYSICIAN	40.0 .......................0.0		X	421,798	35,371
(28) JACKIE BATTISTA MD........................................................................ PHYSICIAN	40.0 .......................0.0		X	388,639	21,692
(29) DONALD MORRISH MD........................................................................ PHYSICIAN	40.0 .......................0.0		X	363,865	65,960
(30) JAIME TE MD........................................................................ PHYSICIAN	40.0 .......................0.0		X	287,682	31,000

(A) Name and business address	(B) Description of services	(C) Compensation
MODERN CONTRACTING INC, 157 22 POWELS COVE BLVD BEECHHURST,NY11357	CONSTRUCTION CONTRAC	1,451,584
NSLIJHS Laboratory, PO BOX 417855 BOSTON,MA11042	Laboratory Services	1,670,353
Queens County Medical Serivces LLC, 5665 New Northside Drive STE 320 ATLANTA,GA30328	Anesthesia Services	1,672,000
PRECYSE SOLUTIONS LLC, 545 BROADWAY 3RD FLOOR BROOKLYN,NY11206	HEALTH INFORMATION	1,337,791
HEALTHCARE MANAGEMENT SOLUTIONS, PO BOX 56 VAILS GATE,NY12584	CONSULTING SERVICES	1,438,295
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 62

- 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

Episcopal Health Services Inc

Employer identification number

11-1665825

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

Episcopal Health Services Inc

Employer identification number

11-1665825

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 Episcopal Health Services Inc

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 Episcopal Health Services Inc		Employer identification number 11-1665825

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 Episcopal Health Services Inc			Employer identification number 11-1665825
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

Episcopal Health Services Inc

Employer identification number

11-1665825

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)? ........

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

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

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

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

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

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

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

Yes

7,379

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

7,379

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
SCHEDULE C SUPPLEMENTAL INFO	Episcopal Health Services Inc. pays dues to The Healthcare Association of New York State (HANYS) and The Greater New York Hospital Association (GNYHA). In accordance with section 6033 (e) of the Internal Revenue Code, and as reported by HANYS and GNYHA a portion of these dues payments are attributable to lobbying activities. The lobbying activity costs attributable in 2015 to HANYS and GNYHA annual dues payments was $3,450 and $3,929 respectively.

Return Reference

Explanation

SCHEDULE C SUPPLEMENTAL INFO

Episcopal Health Services Inc. pays dues to The Healthcare Association of New York State (HANYS) and The Greater New York Hospital Association (GNYHA). In accordance with section 6033 (e) of the Internal Revenue Code, and as reported by HANYS and GNYHA a portion of these dues payments are attributable to lobbying activities. The lobbying activity costs attributable in 2015 to HANYS and GNYHA annual dues payments was $3,450 and $3,929 respectively.

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

Episcopal Health Services Inc

Employer identification number

11-1665825

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 ....	1,408,181	1,408,181	1,408,181	1,408,181	1,408,181
b	Contributions ...
c	Net investment earnings, gains, and losses	34,265	26,583	91	5	8
d	Grants or scholarships ...	446,105
e	Other expenditures for facilities and programs ...		26,583	91	5	8
f	Administrative expenses ....
g	End of year balance ......	996,341	1,408,181	1,408,181	1,408,181	1,408,181

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

Board designated or quasi-endowment SchDMd Bullet

Permanent endowment SchDMd Bullet

100.000 %

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 ...	929,366		929,366
b	Buildings	52,701,239	36,541,553	16,159,686
c	Leasehold improvements	83,827	74,071	-2,475,400
d	Equipment ...	107,091,439	94,080,883	13,010,556
e	Other ...	13,423,193	2,485,156	13,423,193
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				41,047,401

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) ASSETS WHOSE USE IS LIMITED				17,790,324
(2) DUE FROM THIRD-PARTY PAYORS				3,542,265
(3) HEALTHFIRST INVESTMENT				11,574,658
(4) INV IN & HLD BY CAPTIVE INS CO				26,253,483
(5) OTHER ASSETS				1,348,248
(6) PHSP INVESTMENT - COST				6,804,978
(7) INSURANCE RECOVERABLE				5,536,097
(8) DUE FROM RELATED ORGANIZATIONS				2,096,613
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........				74,946,666

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 THIRD PARTY PAYORS	35,368,405
OTHER LIABILITIES	7,193,108
PROFESSIONAL & SELF INSURED LI	36,113,544
ACCRUED PENSION LIABILITY	2,453,578
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	81,128,635
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

PART V, LINE 4 - INTENDED USES OF ENDOWMENT FUND

Income from endowment funds are to be used to further support the mission of the Organization. During 2015, the Organization determined that a portion of the funds are available for use based on a review of the endowment fund restrictions by the Organizations legal counsel and permission from the Attorney General of the State of New York. Therefore, the Organization released approximately $412,000 from restriction for use to support the mission of the Organization. The remaining endowment fund assets are required to be held in perpetuity by donor restriction.

Schedule D (Form 990) 2015

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE F(Form 990)

Department of the Treasury
Internal Revenue Service

Statement of Activities Outside the United States

Complete if the organization answered "Yes" to Form 990,Part IV, line 14b, 15, or 16. Right pointing arrow large image

Attach to Form 990. Right pointing arrow large image

See separate instructions. Right pointing arrow large image

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

OMB No. 1545-0047

2015

Open to Public Inspection

Name of the organization
Episcopal Health Services Inc

Employer identification number

11-1665825

Part I

General Information on Activities Outside the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 14b.

For grantmakers.Does the organization maintain records to substantiate the amount of its grants and

other assistance, the grantees’ eligibility for the grants or assistance, and the selection criteria used

to award the grants or assistance? . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

For grantmakers. Describe in Part V the organization’s procedures for monitoring the use of its grants and other assistance outside the United States.

Activites per Region. (The following Part I, line 3 table can be duplicated if additional space is needed.)

(a) Region		(d) Activities conducted in region (by type) (e.g., fundraising, program services, investments, grants to recipients located in the region)	(e) If activity listed in (d) is a program service, describe specific type of service(s) in region	(f) Total expenditures for and investments in region
	Central America and the Caribbean	Investments	CAPTIVE INSURANCE CO.	31,789,580
















3a	Sub-total .....			31,789,580
b	Total from continuation sheets to Part I ...
c	Totals (add lines 3a and 3b)			31,789,580

For Paperwork Reduction Act Notice, see the Instructions for Form 990.Cat. No. 50082W Schedule F (Form 990) 2015

Schedule F (Form 990) 2015

Page 2

Part II

Grants and Other Assistance to Organizations or Entities Outside the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 15, for any recipient who received more than $5,000. Part II can be duplicated if additional space is needed.

1 (a) Name of organization		(b) IRS code section and EIN (if applicable)	(a)(c) Region	(b)(d) Purpose of grant	(e) Amount of cash grant	(f) Manner of cash disbursement	(g) Amount of non-cash assistance	(h) Description of non-cash assistance	(i) Method of valuation (book, FMV, appraisal, other)

2	Enter total number of recipient organizations listed above that are recognized as charities by the foreign country, recognized as tax-exempt by the IRS, or for which the grantee or counsel has provided a section 501(c)(3) equivalency letter .......
3	Enter total number of other organizations or entities .......................

Schedule F (Form 990) 2015

Schedule F (Form 990) 2015Page 3

Part III

Grants and Other Assistance to Individuals Outside the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 16.

Part III can be duplicated if additional space is needed.

(a) Type of grant or assistance		(b) Region	(c) Number of recipients	(d) Amount of cash grant	(e) Manner of cash disbursement	(f) Amount of non-cash assistance	(g) Description of non-cash assistance	(h) Method of valuation (book, FMV, appraisal, other)

Schedule F (Form 990) 2015

Page 4

Part IV

Foreign Forms

Schedule F (Form 990) 2015

Page 5

Part V

Supplemental Information
Provide the information required by Part I, line 2 (monitoring of funds); Part I, line 3, column (f) (accounting method; amounts of investments vs. expenditures per region); Part II, line 1 (accounting method); Part III (accounting method); and Part III, column (c) (estimated number of recipients), as applicable. Also complete this part to provide any additional information (see instructions).

ReturnReference	Explanation
SCHEDULE F, PART I, LINE 3, COLUMN F	THE HOSPITAL IS A PARTIAL OWNER OF CAPTIVE FOREIGN INSURANCE COMPANIES. THE HOSPITAL'S INVESTMENTS IN THE FOREIGN INSURANCE COMPANIES ARE REPORTED AT FAIR MARKET VALUE OR COST.

Schedule F (Form 990) 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

Episcopal Health Services Inc

Employer identification number

11-1665825

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? . . . . . .

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

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

Yes

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

Yes

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

Financial Assistance and Certain Other Community Benefits at Cost

Financial Assistance and Means-Tested Government Programs		(c) Total community benefit expense	(d) Direct offsetting revenue	(e) Net community benefit expense	(f) Percent of total expense
a	Financial Assistance at cost (from Worksheet 1) . . .	2,341,386	2,151,792	189,594	0.100 %
b	Medicaid (from Worksheet 3, column a) . . . . .	97,476,311	63,594,474	33,881,837	17.580 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .
d	Total Financial Assistance and Means-Tested Government Programs . . . . .	99,817,697	65,746,266	34,071,431	17.680 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).	702,538		702,538	0.360 %
f	Health professions education (from Worksheet 5) . . .	29,969,173	21,960,753	8,008,420	4.150 %
g	Subsidized health services (from Worksheet 6) . . . .	35,458,323	16,720,732	18,737,591	9.720 %
h	Research (from Worksheet 7) .
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .
j	Total. Other Benefits . .	66,130,034	38,681,485	27,448,549	14.230 %
k	Total. Add lines 7d and 7j .	165,947,731	104,427,751	61,519,980	31.910 %

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.

		(c) Total community building expense	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing
2	Economic development
3	Community support	302,271	302,271	0.160 %
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	302,271	302,271	0.160 %

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. ......

3,305,515

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. ......

563,837

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).....

51,338,652

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

39,515,188

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

11,823,464

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?1 Name, address, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility)
1	St John's Episcopal Hospital 327 Beach 19th Street Far Rockaway,NY11691	X	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)

	St Johns Episcopal Hospital
Name of hospital facility or letter of facility reporting group

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

Yes

Community Health Needs Assessment

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

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

During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 12......................

Yes

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

A definition of the community served by the hospital facility

Demographics of the community

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

How data was obtained

The significant health needs of the community

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

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

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

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

Other (describe in Section C)

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

In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted .................

Yes

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..................................

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. ............................

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): www.EHS.org

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): www.EHS.org

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)

	St Johns Episcopal Hospital
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 400.%

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.EHS.org

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

www.EHS.org

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

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)

	St Johns Episcopal Hospital
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 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
Schedule H, Part V SEC B, Line 5	PUBLIC PARTICIPATION To advance the goals of the New York State Prevention Agenda 2013-2017 and Healthy People 2020 in its Service Area, St. John's Episcopal Hospital reached out and partnered with numerous community-based organizations and other stakeholders to identify community health needs and develop plans to address these needs. The participating organizations included: -St. John's Episcopal Hospital Community Advisory Board -Joseph P. Addabbo Family Health Center -NAACP of Rockaway -Rockaway Beach Channel Long Term Recovery -Rockaway United -Community Board 14 -Deerfield Area Civic Association -Rockaway Development and Revitalization Corp. -Visiting Nurse Service of New York -Rockaway Manor Home Care -Queens County Perinatal Council -Doctors of the World -SCO Family of Services -Met Council -Queens Public Library -Lucille Rose Day Care -Safe Space -Rockaway Beach Civic Association -New YOrk State Assemblyman Phillip Goldfeder Community Meetings: Sampling Public Opinion Two initial community meetings were held to gather input from the public on the health concerns of the community, the application of the New York State Department of Health Prevention Agenda 2013-2017 to their community and their views of health data gathered by the Hospital. At those meetings participants were then asked to give their opinion on the two highest priorities in the Rockaways. In this manner a sampling of the community opinion was conducted. The meetings were held on: -July 9, 2013 at 6 pm at the Peninsula Preparatory Charter School - 34 attendees -July 16, 2013 at 6 pm at the Knights of Columbus Rockaway Council #2672- 55 attendees The meetings were publicized through a variety of ways including four full-page color advertisements in the local newspapers, the "Wave", the "Rockaway Pointer", and the "Five Towns Jewish Press a community email blast; social media; and St. John's website. Coalition Meetings: Ongoing Community Health Task Force Following the public Community Meetings, two subsequent meetings were held. Representatives of Community-Based Organizations who had attended the public meetings were contacted by email and telephone. At this meeting the health priorities public opinion sampling, combined action on these priorities and the need for continued meetings on a quarterly basis were discussed. Discussion at these meetings also included: the need for additional mental health services with more of a personal touch; the Hospital's crowded Emergency Room; coordination of services; education and the need for more teen services; dialysis services on the Rockaways; need for diabetes services; need for participation of elected officials; need for trauma services on the Rockaways; more primary care; need for urgent care on the west end of the peninsula; concern with closure of mental health services; requests for copies of the data presented. Selection of Public Health Priorities The Hospital convened the aforementioned open meetings to present the draft Community Health Needs Assessment and, based on the data; gather public input on the selection of health priorities for the community. The sampling showed that the community was most concerned about Chronic Disease, especially diabetes and high blood pressure, and Mental Health and Substance Abuse.
Schedule H, Part V SEC B, Line 11	THE HOSPITAL RECOGNIZES THERE IS A NEED TO ADDRESS ALL IDENTIFIED HEALTH CONCERNS. DUE TO LIMITATIONS IN STAFFING AND RESOURCES, THE HOSPITAL FOCUSED ITS EFFORTS ON THOSE PRIORITIES THAT APPEARED TO BE OF THE MOST NEED AND HAD THE STAFFING AND RESOURCES TO COMMIT TO A THREE-YEAR PLAN OF IMPLEMENTATION. HIV AND AIDS SERVICES ARE CURRENTLY OFFERED AT THE JOSEPH P ADDABO FAMILY HEALTH CENTER THE COMMUNITY HEALTH PRIORITIES THAT THE HOSPTAL IDENTIFIED IN ITS HEALTH NEEDS ASSESSMENT BUT DOES NOT INTEND TO MEET ARE: CANCER; RESPIRATORY DISEASE; HIV AND AIDS; MATERNAL CHILD HEALTH.
Schedule H, Part V SEC B, Line 22D	During 2015, the Hospital determined that the maximum amount that can be charged to FAP-eligible individuals was a flat fee plus the following, based on the federal poverty level the individual qualified for: - Percentage of the APR-DRG Rate - Percentage of the APG Rate - Percentage of the Ancillary Charges

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
EXPLANATION OF COSTING METHODOLOGY	ST. JOHN'S EPISCOPAL HOSPITAL COSTING METHODOLOGY WAS BASED UPON THE 2015 NEW YORK STATE INSTITUTIONAL COST REPORT AND THE 2015 MEDICARE (FORM 2552) COST REPORT. THESE COST REPORTS ARE FILED WITH THE NEW YORK STATE DEPARTMENT OF HEALTH AND THE APPLICABLE CMS INTERMEDIARY, RESPECTIVELY. THE COST-TO-CHARGE RATIO DERIVED FROM WORKSHEET 2, RATIO OF PATIENT CARE COST-TO-CHARGE, WAS USED FOR THE VARIOUS SUB-LINE ITEMS OF LINE #7.
BAD DEBT EXPENSE	St. John's Hospital utilizes the estimated percentage of patients living at or below the federal poverty level 20.4% and the self pay percentage 83.615% to arrive at the amount of bad debt that is potentially attributable to patients eligible under the organization's financial assistance policy.
BAD DEBT EXPENSE	THE AMOUNT REPORTED ON LINE 2 IS EQUAL TO THE PROVISION FOR BAD DEBTS SHOWN IN THE AUDITED FINANCIAL STATEMENTS ("AFS"). THE EXPLANATION OF THE METHODOLOGY USED TO ESTIMATE IS EXCERPTED BELOW: Accounts receivable are also reduced by an allowance for doubtful accounts. In evaluating the collectability of accounts receivable, the Corporation analyzes its past history and identifies trends for each of its major payer sources of revenue to estimate the appropriate allowance for doubtful accounts and provision for bad debts. Management regularly reviews data about these major payer sources of revenue in evaluating the sufficiency of the allowance for doubtful accounts. For receivables associated with services provided to patients who have third-party coverage, the Corporation analyzes contractually due amounts and provides an allowance for doubtful accounts and a provision for bad debts, if necessary (for example, for payers who are known to be having financial difficulties that make the realization of amounts due unlikely). For receivables associated with self-pay patients, which includes both patients without insurance and patients with deductible and copayment balances due for which third-party coverage exists for part of the bill, the Corporation records a significant provision for bad debts in the period of service on the basis of its past experience, which indicates that many patients are unable or unwilling to pay the portion of their bill for which they are financially responsible. The difference between discounted rates and the amounts actually collected after all reasonable collection efforts have been exhausted is charged to the allowance for doubtful accounts.
MEDICARE REVENUE	Included in the calculation of the Medicare revenue of $51,338,652 is $9,223,843 of Disproportionate Share (DSH) payments and $9,714,530 of Indirect Medical Education (IME) payments which total $18,938,373 Resulting in true patient service revenue of $32,400,279.
MEDICARE REVENUE	Pursuant to the instructions included in Medicare Revenue Received on Part III Section B Line 5 is Reimbursement for Indirect Medical Education (IME) of $9.7 million. There are $0 cost included in Part III Line 6 Medicare Allowable Cost related to IME.
MEDICARE SURPLUS/SHORTFALL	The Medicare surplus shown of $11,823,464 includes the additional items of Medicare revenue detailed in the explanation for Line 5 above without inclusion of additional costs related to them. Had these amounts not been received the operating Medicare shortfall would have been $7,114,909. Losses on treating Medicare beneficiaries should be included as a community benefit in their entirety. St. John's Episcopal Hospital incurred this operating Medicare loss of $7.1 million to deliver care to Medicare patients. This represents the amount by which costs to deliver care to Medicare recipients exceeds the level of payment. St. John's Episcopal Hospital bears the burden of not only providing the best and most advanced medical care possible to the community, but also doing so with no recourse to obtain payment for the cost of providing care in excess of the Medicare payment. As Medicare revenue declines and the cost to provide cutting edge care to the community increases, the Hospital will carry the burden as a participating provider and a charitable organization. Like all patients those on Medicare, the majority of whom are elderly OR disabled, are not turned away, so St. John's Episcopal Hospital will continue to bear the loss in providing the best care possible to the local community.
COSTING METHODOLOGY	the Medicare revenue and allowable costs shown in Part III Section B Lines 5 and 6, respectively, were derived from the as-filed 2015 CMS-2552 (Medicare Cost Report). Medicare revenue is based on the Medicare Provider Statistical and Reimbursement Report and Medicare costs were developed utilizing a ratio of Medicare allowable costs to charges methodology.
COLLECTION PRACTICES TO BE FOLLOWED RELATIVE TO PATIENTS THAT QUALIFY FOR	The charity care and financial assistance policies of St. John's Episcopal Hospital (which are further summarized in Schedule H Part VI Line 3) ensure that every effort is made to identify patients that are eligible for financial assistance and/or charity care. Included below is a summary of the billing and collection procedures followed by St. John's Episcopal Hospital: - The forced sale of or foreclosure on the patient's primary residence is prohibited - Sending an account to collection if the patient has submitted a completed application for financial assistance, including any required documentation, while the application is pending is prohibited - Provide written notification to a patient at least 30 days before an account is sent to collection (written notice can be included on a bill). - Require the collection agency to have the hospital's written consent prior to starting a legal action for collection. - Require all hospital staff that interacts with patients or have responsibility for billing and collection to be trained in the hospital's policies. - Have a way of measuring the hospital's compliance with its policies. - Require any collection agency under contract with the hospital to follow the hospital's financial assistance policy and provide information to patients on how to apply, where appropriate. - Prohibit collection activity if the patient is determined eligible for Medicaid for the services that were rendered and the hospital is able to collect Medicaid payment.
NEEDS ASSESSMENT	St. John's Episcopal Hospital (the "Hospital"St. John's") is a 257 licensed bed acute care hospital located in Far Rockaway, New York. St. Johns Medical, P.C. (formerly St. John's Emergency Services PC); St. John's Medical Services PC, form the patient care services of Episcopal Health Services, Inc., fall under the auspices of the Episcopal Diocese of Long Island. This discussion relates to the Hospital only as required in Form 990 Schedule H. As the result of several meetings with community groups, a comprehensive Community Health Needs Assessment (CHNA) for the Hospital community was developed. The report fulfills the requirements of the new Federal statute established within the Patient Protection and Affordable Care Act (PPACA) requiring non-profit hospitals to conduct CHNAs every three years. The CHNA process undertaken by the Hospital utilized extensive input from persons who represent the broad interests of the community. In addition, this document satisfies the requirements set forth by the New York State Department of Health (DOH) relative to the preparation of a three year Community Service Plan (CSP). The overlapping nature of these requirements enabled the Hospital to complete one comprehensive document. New York's relevant statute, Section 2803-1 of the Public Health Law, requires voluntary non-profit hospitals to submit a comprehensive CSP to the State Department of Health (DOH) every three years that includes a solicitation of the views of the communities served by the Hospital on service priorities; demonstrates the Hospital's operational and financial commitment to meet community health needs; provision of charity care; and improving access by the underserved, among other elements. In submitting their CSPs, hospitals are required to take steps that include: - Reaffirming organizational mission statements; - Defining the service area used for community and local health planning and describing the methods used to determine such service area; - Identifying all participants involved in assessing community health needs and describing and summarizing the hospital's public input sessions; - Discussing the identified public health priorities, including the criteria used to select priorities and the status of priorities; - Establishing an evolving plan of action; and - Disseminating a written summary of the CSP to the public through various channels. The statutory CSP requirements were recently enhanced by DOH's Prevention Agenda initiative, a process that asks hospitals to work with local public health departments and community partners to assess community health needs, jointly develop plans to address two or three of the identified needs, and include this collaborative work in the hospital's CSP update submitted to DOH. St. John's has incorporated the Prevention Agenda into its three year plan. To advance the goals of the New York State Prevention Agenda 2013-2017 and Healthy People 2020 in its Service Area, St. John's reached out and partnered with numerous community-based organizations and other stakeholders to identify community health needs and develop plans to address these needs. The participating organizations included: -St. John's Episcopal Hospital Community Advisory Board -Joseph P. Addabbo Family Health Center -NAACP of Rockaway -Rockaway Beach Channel Long Term Recovery -Rockaway United -Community Board 14 -Deerfield Area Civic Association -Rockaway Development and Revitalization Corp. -Visiting Nurse Service of New York -Rockaway Manor Home Care -Queens County Perinatal Council -Doctors of the World -SCO Family of Services -Met Council -Queens Public Library -Lucille Rose Day Care -Safe Space -Rockaway Beach Civic Association -New York State Assemblyman Phillip Goldfeder Two initial community meetings were held to gather input from the public on the health concerns of the community, the application of the New York State Department of Health Prevention Agenda 2013-2017 to their community and their views of health data gathered by the Hospital. At those meetings participants were then asked to give their opinion on the two highest priorities in the Rockaways. In this manner a sampling of the community opinion was conducted. The meetings were held on July 9, 2013 at 6 pm at the Peninsula Preparatory Charter School (34 attendees); and July 16, 2013 at 6 pm at the Knights of Columbus Rockaway Council #2672 (55 attendees). The meetings were publicized through a variety of ways including four full-page color advertisements in the local newspapers, the "Wave", the "Rockaway Pointer", and the "Five Towns Jewish Press a community email blast; social media; and the St. John's website.
PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE	St. John's Hospital is committed to providing access to quality health care services with compassion, dignity and respect for all patients, particularly the poor and the underserved in our community. Accordingly, St. John's Hospital has implemented a Charity Care and Financial Assistance Process to help facilitate the provision of much needed care. This process includes: - Providing patient care regardless of the ability to pay for services; - Assisting patients who cannot pay for part or all of the care they receive; - Financial counselors will confidentially review the situation to see if patients quality for some form of government or other financial assistance; - Balancing needed financial assistance for some patients with the broader fiscal responsibilities in order to sustain viability and provide the quality and quantity of services residents in the community need; and - Offer installment plans to allow patients to pay over time without the imposition of interest charges.
COMMUNITY INFORMATION	The Rockaway Peninsula is a narrow strip of land bordered by the Atlantic Ocean and Jamaica Bay and is a part of Queens County, New York City and also borders Nassau County on Long Island. Superstorm Sandy had a devastating impact on the Rockaway Peninsula. Much of the community was without gas and electric for weeks following the storm. Homes and businesses were in ruin, some claimed by the sea, others by fire, entire blocks in Belle Harbor and Rockaway Park were engulfed in flames, a considerable portion of Breezy Point literally burned to the ground. Debris and sand were everywhere, including the inside of homes. Cars that had been flooded were scattered throughout the streets of the community. The rebuilding has been extremely slow, and is an ongoing process, with many displaced residents having still not returned to their homes. Many nursing homes and adult homes - sources of admissions to the Hospital, as well as other local businesses never reopened. Transportation between the peninsula and the mainland is a long time commitment for residents as the peninsula is connected to New York City by two toll bridges, the Marine Park Bridge and the Cross Bay Bridge, and by the "A" subway line of the New York City Metropolitan Transit Authority, which was out of commission until late Summer 2013. Throughout the two weeks after the storm St. John's was like a beacon in the darkness for Far Rockaway and the surrounding communities. Running on generator power for 12 days, the Hospital was a place where shelter, warmth, light and food could be found. People stopped in to charge cell phones, and found electricity to power much needed medical devices. Many residents lost everything they had, carrying what they could of their prized possessions. Ongoing recovery assistance was also provided by the Hospital. Collections were made to help employees defray some of the costs of recovery, and clothing drives put much needed clothes on the backs of local residents. ST. JOHN'S HAS SERVED THE COMMUNITY FOR MORE THAN 100 YEARS. AS A NOT-FOR-PROFIT FAITH-BASED INSTITUTION THAT IS DEEPLY AWARE OF THE COMMUNITY'S GEOGRAPHIC ISOLATION AND VULNERABILITIES, IT IS DEEPLY COMMITTED TO CONTINUING TO SERVE THE COMMUNITY WELL INTO THE FUTURE. IT IS ALSO COMMITTED TO IMPROVING THE HEALTH OF THE COMMUNITY AND CONTINUING TO OFFER A WIDE RANGE OF SERVICES, AS WELL AS COMMUNITY OUTREACH AND HEALTH EDUCATION. While "community" can be defined in many ways, the Hospital defined its Service Area as the 6 zip codes from which approximately 70% discharges came, namely Far Rockaway; Inwood; Arverne; Rockaway Beach; Belle Harbor; and Breezy Point. In 2013 the Rockaways had a population totaling over 123,000 with almost 30% of the Service Area's population under the age of 20, and almost 13% over the age of 65. More than 20% live under the federal poverty level, while the overall Queens county rate is just below 14%. The percentage of the Service Area population who are deemed to be minorities is 65.4%, with African Americans comprising 38% of the population. A large population of Hispanics resides in Inwood, which is the most northeast boundary of the Service Area. population. A large population of Hispanics resides in Inwood, which is the most northeast boundary of the Service Area.
PROMOTION OF COMMUNITY HEALTH	Community Health Fairs and Events St. John's medical staff and residents held blood pressure screenings and health education sessions at 10 health fairs and community events throughout 2015 in schools, community based non-profits, clubs and houses of faith, interacting with a minimum of 100 participants per event. Brochures were handed out on a variety of topics, including diabetes care, hypertension and heart health, obesity, health pregnancy, breastfeeding and smoking prevention. St. John's Health Fairs St. John's Episcopal Hospital hosted two community-wide health fairs in June and September of 2015. At both, St. John's medical staff and residents provided blood pressure screenings, and attendees were involved in a variety of educational sessions focused on services provided by the Hospital. Mammography and breast health, health pregnancy and childbirth, breastfeeding, heart health and hypertension, emergency services, living well with diabetes, wound care, St. John's behavioral health services and the importance of mental health. Residents received informational brochures to support their learning. St. John's Clinical Nutrition Staff provided Nutritional Information on various topics including: My Plate, How to Eat Healthy, Reducing Sodium in the Diet, Low Cholesterol Tips and How to Make Meals More Healthy. At the September Fair, Nutrition program information also covered healthy eating for children through the teen years in addition to the general nutrition information provided. At both events healthy snacks such as granola bars and samples of Truvia were distributed. St. John's Executive Chef conducted cooking demonstrations at the September Health Fair, and the hospital received news coverage on these healthy cooking demos. Members of the Hospital's Community Advisory Board were present to talk about how community residents can become involved with learning about the Hospital's services and representing the Hospital within their neighborhoods as well as across the Hospital's primary service area. In addition, community based organizations from across the Rockaway Peninsula had tables and presented information about their services, including New Horizons Community Support Services, Peninsula Nursing & Rehabilitation Center, Rockaway Walks, Ready Rockaway, St. John's Sandy Connect and Family Resource Center offices. Both Fairs had community attendance of 700 plus residents. Preventative Services Dr. Natalie Schwartz, Senior Vice President of Quality and PI at St. John's, wrote a research proposal entitled "Reducing the Risk of Developing Diabetes in Obese High School Students." The New York City Department of Education Institutional Review Board (NYCDOE IRB) approved this proposal, which focuses on going into the schools to develop an obesity program. Ongoing discussions with area high school[s] focus on putting in place processes and procedures to support this study. For several years now, St. John's has partnered with the Queens Quits smoking cessation program established through the NYCDOH. Patients are asked about smoking habits and their desire to quit. With their consent, smokers' contact information is forwarded to Queens Quits and a smoking cessation counselor then reaches out to them to provide tips for quitting and support services to do so. Representatives from the program come to St. John's throughout the year to meet with physicians, residents and staff to review the program. Mental Health and Substance Abuse Screenings: -St John's Community Mental Health Center - 440 patients screened; 50 patients identified as having substance abuse issues and treated within the CMHC; 6 patients having substance abuse issues were referred to a local appropriate substance abuse treatment program. -St. John's Continuing Day Treatment Program - 45 patients screened; 2 referred to 21 day inpatient substance abuse treatment; 27 having substance abuse and mental illness dual diagnosis treated within the CDTP. -St. John's Family Resource Center - 391 patients screened; 1 needing substance abuse treatment, refused referral to local treatment program. -St. John's Home Based Crisis Intervention Program - 59 patients screened; 6 needing substance abuse treatment referred to local outpatient treatment; 3 refused treatment, one did not make appointment, one seen at residential program, one in process of referral. -St. John's Blended Case Management Program - 60 patients screened; 7 identified as needing substance abuse treatment, four refused treatment, three made appointments with outpatient treatment programs. -Surfside Manor Adult Home On-Site Mental Health Clinic - 180 patients screened at the on-site adult home outpatient mental health clinic at Surfside Manor adult home. None identified as having substance abuse issues that required referral or even treatment within the clinic setting at the home. In addiiton, the Office of the Mission participated in the following 2015 charitable programs: Baby Bags endeavors: Description: Each mother who delivers a baby at the hospital receives a baby bag. The bags are filled with handmade baby items (hats, booties, sweaters or blankets), toiletries, diapers, wipes, linens and clothing. The Hospital Auxiliary members and the congregations they are affiliated with donate the items that go inside the bags. The Office for the VP of Mission sends letters, fliers and visits donors and the organizations they are affiliated with to solicit donations. The VP of Mission's office sometimes collects donations and always sends thank you letters to donors. The Patient Advocates sort the donations, pack and label the baby bags and keep the Postpartum Nursing Unit stocked with bags. The Postpartum Nursing Unit purchases the baby bags. Purchases: Baby bags - $876.82 Staff time: Postpartum nurse - 104 hours a year Patient Advocate - 200 hours a year VP for Mission - 50 hours a year Coordinator for VP of Mission's departments - 110 hours a year First Baby of the New Year Description: The hospital recognizes and celebrates the mother who gives birth to the first baby of the new year. With the mother's consent, the hospital features her, her baby and family in the hospital's news vehicles. She receives an assortment of gifts: baby monitor, pack-n-play, baby clothing, diaper pail, handmade items and more. A member of the executive staff congratulates her, presents her with gifts and, along with key staff from the unit and her baby, pose for pictures. The Hospital Auxiliary members and the congregations they are affiliated with donate the gifts, nursing staff on the Postpartum unit wrap the gifts, a member of the communications office takes pictures and crafts news articles and press releases and the Postpartum Unit Manager along with a member of the executive staff congratulates the mother and presents the gifts. Purchases: Wrap, decorations, baskets $35 Staff Time: Postpartum nurses - 2 hours a year Nurse Manager - 1 hour a year CEO, COO or other - 30 minutes a year Director of Communication - 4 hours a year School Back-Packs Description: The Pediatric Office and the Family and Children's Services Program (offices at 102nd Street) distributed 80 back-packs filled with school supplies to their patients/clients in the fall. The Hospital Auxiliary members and the congregations they are affiliated with donated composition notebooks, three ring binders, pens, pencils, crayons, markers, rulers, protractors, post-it notes, tape, glue, memory sticks and more. The Auxilians, hospital volunteers and staff from the office of the VP of Mission sorted the supplies, filled the back-packs and delivered 40 back-packs to the Pediatric Office. Family and Children's Services sent staff to collect the balance of bags. Purchases: back-packs - $783.96 Staff Time: Coordinate for VP of Mission's departments - 50 hours a year VP for Mission - 30 hours a year Director, Family & Chidlren's Services (Catrina Gordon) - 4 hours a year Venus Terry-Smith - 4 hours a year Cynthia Criss - Chair of Pediatric Service - 2 hours a year Books Description: Children who are patients of the Pediatric Office or clients of Family and Children's Services or the Community Mental Health programs are given books to encourage parents to read to their children and children to read on their own. In 2015 a large donation of 2000 new books was received from Scholastic Books. These books were combined with new and used books donated by Auxillians. Hospital volunteers and staff sorted the books into age groups, packed them into boxes and delivered to the books to Pediatric Office and Community Mental Health Center. Staff from the Family and Children's Services Program came to the hospital to collect their share of books. The VP for Mission and her coordinator solicited and received the donations and wrote the thank you notes. Purchases: Breakfast & Lunch in SJEH cafeteria for 8 volunteers - $86 Snack - $25 Staff: Materials Management staff (in Warehouse) - 1 hour a year
EXPLANATION OF HOW ORGANIZATION FURTHERS ITS EXEMPT PURPOSE	St. John's Episcopal Hospital plays an important role in the local community as a provider of needed medical services. St. John's is the only hospital on the peninsula and is also the largest non-governmental employer in the local community. In addition to providing high quality medical services, St. John's is also an active member of the local community, participating in various health fairs, screenings, and educational sessions and events to local residents at no cost. Many of the various programs and initiatives that St. John's Hospital has identified to demonstrate our commitment to further its exempt purpose and promote the health care of the local community have been highlighted previously in this form. St. John's Hospital has an active Community Advisory Board comprised of local residents and business people who meet with Hospital leadership quarterly to discuss at a high level the overall operations of the Hospital, demographics and health needs of the Rockaway community. St. John's extends medical staff privileges to all qualified physicians in its community for the various services provided by the Hospital. The Hospital's medical staff is a large diverse group of highly trained professionals numbering approximately 450 members. In addition, St. John's overall responsiveness to the needs of our community is evidenced by our willingness to participate in a range of coalitions, panels, advisory groups, commissions and boards, including Ready Rockaway, which is a coalition of community based organizations that recognize the need for planning for emergencies such as Superstorm Sandy which severely impacted the Rockaway peninsula in October. In addition, St. John's has internal emergency and disaster drills throughout the year to ensure the Hospital is prepared to meet the needs of its local community and the surrounding areas.
AFFILIATED HEALTH CARE SYSTEM ROLES AND PROMOTION	NOT APPLICABLE
STATES WHERE COMMUNITY BENEFIT REPORT IS FILED	NEW YORK.

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

Episcopal Health Services Inc

Employer identification number

11-1665825

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

Yes

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

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

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

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

For persons listed 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)
1GERARD WALSHCEO - EFFECTIVE 7/15	(i) (ii)	198,111 ------------- 0	0 ------------- 0	774 ------------- 0	0 ------------- 0	10,490 ------------- 0	209,375 ------------- 0	0 ------------- 0
2STEVEN GUIDOCFO - EFFECTIVE 7/15	(i) (ii)	293,150 ------------- 0	------------- 0	135 ------------- 0	17,480 ------------- 0	33,928 ------------- 0	344,693 ------------- 0	0 ------------- 0
3RICHARD BROWNCEO - TERM 7/15	(i) (ii)	443,841 ------------- 0	0 ------------- 0	10,394 ------------- 0	0 ------------- 0	0 ------------- 0	454,235 ------------- 0	0 ------------- 0
4WILLIAM MOORECFO - TERM 7/15	(i) (ii)	380,421 ------------- 0	0 ------------- 0	10,042 ------------- 0	0 ------------- 0	0 ------------- 0	390,463 ------------- 0	0 ------------- 0
5RAJIV PRASAD MDCHAIR-EMS - TERM 5/15	(i) (ii)	144,527 ------------- 0	0 ------------- 0	35,180 ------------- 0	19,923 ------------- 0	0 ------------- 0	199,630 ------------- 0	0 ------------- 0
6SHELDON MARKOWITZ MDCHAIR - DEPT OF MEDICINE	(i) (ii)	262,726 ------------- 0	0 ------------- 0	3,810 ------------- 0	28,288 ------------- 0	40,990 ------------- 0	335,814 ------------- 0	0 ------------- 0
7RAYMOND PASTORE MDCHIEF MEDICAL OFFICER	(i) (ii)	423,857 ------------- 0	0 ------------- 0	4,944 ------------- 0	0 ------------- 0	0 ------------- 0	428,801 ------------- 0	0 ------------- 0
8LOKESH REDDY MDCHIEF OF PSYCHIATRY	(i) (ii)	111,153 ------------- 0	0 ------------- 0	64,182 ------------- 0	17,507 ------------- 0	23,494 ------------- 0	216,336 ------------- 0	0 ------------- 0
9James Henry MDCHIEF OF ORTHOPEDICS	(i) (ii)	359,234 ------------- 0	0 ------------- 0	632 ------------- 0	31,000 ------------- 0	1,558 ------------- 0	392,424 ------------- 0	0 ------------- 0
10Kelly BarlandChief Information Officer	(i) (ii)	218,077 ------------- 0	0 ------------- 0	1,242 ------------- 0	11,846 ------------- 0	0 ------------- 0	231,165 ------------- 0	0 ------------- 0
11Natalie SchwartzVP REGULATORY AFFAIRS	(i) (ii)	272,149 ------------- 0	0 ------------- 0	2,322 ------------- 0	13,511 ------------- 0	40,990 ------------- 0	328,972 ------------- 0	0 ------------- 0
12SHAKIRA GORDONVP HUMAN RESOURCES	(i) (ii)	155,468 ------------- 0	0 ------------- 0	540 ------------- 0	9,883 ------------- 0	22,824 ------------- 0	188,715 ------------- 0	0 ------------- 0
13GWENDOLYN SEYMORE-PINCKNEYCHIEF NURSING OFFICER	(i) (ii)	184,841 ------------- 0	0 ------------- 0	1,242 ------------- 0	14,308 ------------- 0	40,990 ------------- 0	241,381 ------------- 0	0 ------------- 0
14ALBERT STROGEN MDBOARD MEMBER	(i) (ii)	340,051 ------------- 0	0 ------------- 0	0 ------------- 0	0 ------------- 0	0 ------------- 0	340,051 ------------- 0	0 ------------- 0
15IBIS YARDE MDMD EDUCATION - TERM 12/15	(i) (ii)	291,445 ------------- 0	0 ------------- 0	38,785 ------------- 0	0 ------------- 0	43,185 ------------- 0	373,415 ------------- 0	0 ------------- 0
16FRANCINE NIGRELLOCHIEF COMPLIANACE OFFICER	(i) (ii)	197,308 ------------- 0	0 ------------- 0	3,564 ------------- 0	7,000 ------------- 0	0 ------------- 0	207,872 ------------- 0	0 ------------- 0
17JAVIER ANDRADE MDPHYSICIAN	(i) (ii)	512,783 ------------- 0	0 ------------- 0	270 ------------- 0	6,154 ------------- 0	20,710 ------------- 0	539,917 ------------- 0	0 ------------- 0
18ALEX VIDAL-GUERVARA MDPHYSICIAN	(i) (ii)	421,398 ------------- 0	0 ------------- 0	400 ------------- 0	18,000 ------------- 0	17,371 ------------- 0	457,169 ------------- 0	0 ------------- 0
19JACKIE BATTISTA MDPHYSICIAN	(i) (ii)	311,539 ------------- 0	0 ------------- 0	77,100 ------------- 0	21,692 ------------- 0	0 ------------- 0	410,331 ------------- 0	0 ------------- 0
20DONALD MORRISH MDPHYSICIAN	(i) (ii)	322,738 ------------- 0	35,676 ------------- 0	5,451 ------------- 0	24,970 ------------- 0	40,990 ------------- 0	429,825 ------------- 0	0 ------------- 0
21JAIME TE MDPHYSICIAN	(i) (ii)	286,019 ------------- 0	0 ------------- 0	1,663 ------------- 0	31,000 ------------- 0	0 ------------- 0	318,682 ------------- 0	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 II	Dr. Strogan was paid as an administrator at the Hospital and not as a member of the board. Dr. Strogen devotes 2.5 hours per week on average to the board and 32 hours per week as a physician at the hospital

Schedule J (Form 990) 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

Episcopal Health Services Inc

Employer identification number

11-1665825

Return Reference	Explanation
FORM 990, PART VI, LINE 8B	THERE ARE NO SEPARATE COMMITTEES WITH AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY.
FORM 990, PART VI, LINE 11B	THE FORM 990 AND APPROPRIATE SCHEDULES, AS REQUIRED (FORM 990), IS COMPLETED BY THE ACCOUNTING AND FINANCE STAFF OF THE ORGANIZATION AND REVIEWED INTERNALLY BY MANAGEMENT. IT IS THEN REVIEWED BY OUTSIDE TAX ADVISORS AND ANY NECESSARY ADJUSTMENTS ARE MADE, AFTER WHICH TIME IT IS CONSIDERED AN initial DRAFT. THE DRAFT OF THE FORM 990 IS THEN PRESENTED TO THE EPISCOPAL HEALTH SERVICES AUDIT COMMITTEE (THE COMMITTEE) OF THE BOARD OF TRUSTEES(THE BOARD), WHICH HAS BEEN DELEGATED THE DETAILED REVIEW FUNCTION BY THE BOARD. ONCE THE Committee'S REVIEW IS COMPLETE THE FORM 990 IS THEN PROVIDED TO ALL VOTING MEMBERS OF THE BOARD.
FORM 990, PART VI, LINE 12C	The Corporate Compliance and Privacy Office distributes, gathers and reviews all annual conflict of interest questionnaires. Where positive responses are indicated additional information is gathered to determine if a conflict actually exists. If a conflict exists, appropriate action is taken to eliminate the conflict, including such steps as notifying the board, reassignment of responsibilities or establishment of protective agreements. If a matter involves a board member or officer, appropriate action, including recusal and additional disclosures, will be determined by the board.
FORM 990, PART VI, LINE 15A	THE COMPENSATION REVIEW & APPROVAL PROCESS INCLUDES A COMPARISON OF COMPENSATION RATES PAID for Executive level positions that are compared to COMPARABLE POSITIONS IN THE Northeast and Greater New York Region. The Human Resources Department reviews each position and uses published external salary surveys to recommend fair and equitable salaries. Positions are evaluated against Hospitals with similar Bed Size, Full-time equivalents and revenue size. COMPENSATION WAS REVIEWED AND APPROVED BY THE ORGANIZATION'S BOARD OF DIRECTORS. BOARD DECISIONS ARE CONTEMPORANEOUSLY DOCUMENTED IN BOARD MINUTES
FORM 990, PART VI, LINE 15B	THE COMPENSATION OF KEY EMPLOYEES IS DETERMINED AND/OR APPROVED AFTER COMPARISON TO CURRENT COMPENSATION RATES PAID FOR COMPARABLE POSITIONS IN THE ORGANIZATION'S REGION. BOARD DECISIONS ARE CONTEMPORANEOUSLY DOCUMENTED IN BOARD MINUTES.
FORM 990, PART VI, LINE 19	UPON REQUEST, THE ORGANIZATION WILL MAKE AVAILABLE THOSE DOCUMENTS REQUIRED TO BE DISCLOSED UNDER THE PUBLIC INSPECTION LAWS.
FORM 990, PART VII, SECTION A	DR. ALBERT STROGEN IS COMPENSATED FOR SERVICES RENDERED AS A PHYSICIAN OF THE HOSPITAL AND NOT AS A MEMBER OF THE BOARD. DR. STROGEN DEVOTES 2.5 HOURS PER WEEK ON AVERAGE TO THE BOARD AND 32 HOURS PER WEEK AS A PHYSICIAN AT THE HOSPITAL.
FORM 990, PART XI, LINE 9 - OTHER CHANGES IN NET ASSETS	CHANGE IN PENSION LIABILITY. . . . . . . . . . . . .($167,804)

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

Episcopal Health Services Inc

Employer identification number

11-1665825

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)BISHOP HENRY B HUCLES NURSING HOME 700 HICKSVILLE ROAD SUITE 210 Bethpage,NY11714 11-3277961	Nursing/Rehab	NY	501(C)(3)	LINE 9	NA	Yes
(2)CHURCH CHARITY CORPORATION AND SUB 700 HICKSVILLE ROAD SUITE 210 BETHPAGE,NY11714 11-2797706	CHARITY	NY	501(C)(3)		NA	Yes
(3)ST JOHN'S EMERGENCY MEDICAL SERVICE 700 HICKSVILLE ROAD SUITE 210 BETHPAGE,NY11714 26-2884115	ER SERVICES	NY	501(C)(3)	LINE 11A	NA	Yes
(4)ST JOHN'S MEDICAL SERVICE PC 700 HICKSVILLE ROAD SUITE 210 BETHPAGE,NY11714 54-2164621	MEDICAL SVCS	NY	501(C)(3)	LINE 11A	NA	Yes

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	(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) BEACH REINSURANCE CORP PO BOX 1109 GRAND CAYMAN CJ	INSURANCE	CJ	CCC	C CORP			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) ............................

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

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

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

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

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

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

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

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

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

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

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

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

Yes

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

Yes

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) Bishop Henry B Hucles Bursing Home Inc	S	41,019	Cost
(2) BISHOP HENRY B HUCLES NURSING HOME INC	P	348,293	COST
(3) BISHOP HENRY B HUCLES NURSING HOME INC	Q	28,626	COST
(4) BISHOP HENRY B HUCLES NURSING HOME INC	R	10,000	COST
(5) ST JOHN'S MEDICAL PC	P	50,971	COST
(6) ST JOHN'S MEDICAL PC	Q	311,947	COST
(7) ST JOHN'S MEDICAL PC	S	300,754	COST
(8) ST JOHN'S MEDICAL SERVICES	P	39,813	COST
(9) ST JOHN'S MEDICAL SERVICES	R	949,592	COST
(10) ST JOHN'S MEDICAL SERVICES	S	921,037	COST

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: TO PROVIDE QUALITY HEALTH CARE THROUGH ITS HOSPITAL, AMBULATORY CARE HOSPITAL, AMBULATORY CARE FACILITIES, NURSING HOMES AND EDUCATION, RECOGNIZING THE EMERGING LIFE-CARE NEEDS OF THE COMMUNITIES SERVED.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	11
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	7
5	Total number of individuals employed in calendar year 2015 (Part V, line 2a) ......	5	1,637
6	Total number of volunteers (estimate if necessary) .............	6	50
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	0
b	Net unrelated business taxable income from Form 990-T, line 34 .........	7b	0

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	2,155,478	2,967,430
9	Program service revenue (Part VIII, line 2g) .........	165,755,881	163,661,227
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	846,279	1,675,423
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	9,133,119	24,393,953
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	177,890,757	192,698,033
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)	123,898,366	128,146,784
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	58,323,995	63,103,194
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	182,222,361	191,249,978
19	Revenue less expenses. Subtract line 18 from line 12.......	-4,331,604	1,448,055
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	143,765,723	136,987,828
21	Total liabilities (Part X, line 26).............	135,419,813	127,394,192
22	Net assets or fund balances. Subtract line 21 from line 20.....	8,345,910	9,593,636

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 169,053,225 including grants of $ ) (Revenue $ 187,985,125 )
	ST.JOHN'S EPISCOPAL HOSPITAL PROVIDED THE FOLLOWING SERVICES TO RESIDENTS OF ITS LOCAL COMMUNITY IN 2015: 8,879 DISCHARGES 44,987 ADULT AND PEDIATRIC MEDICAL AND SURGICAL DAYS OF CARE TO 7,393 PATIENTS. 12,821 DAYS OF BEHAVIORAL HEALTHCARE TO 803 PATIENTS. 683 BABIES WERE DELIVERED. 34,045 PATIENTS WERE TREATED AND RELEASED FROM THE 24 HR EMERGENCY ROOM. 14,987 VISITS TO THE CHRONIC DIALYSIS SERVICE. 59,256 VISITS TO THE AMBULATORY AND BEHAVIORAL HEALTH CLINICS.

4b	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4c	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4d	Other program services (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses169,053,225

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	6,555,023	0	610,082

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c
d	Related organizations		1d
e	Government grants (contributions)		1e	2,241,939

f	All other contributions, gifts, grants, and similar amounts not included above		1f	725,491

g	Noncash contributions included in lines 1a-1f:$
h Total.Add lines 1a-1f.......		2,967,430

			Business Code
2a	NET PATIENT SERVICE REV	621300	166,148,858	166,148,858
b	PHYSICIAN BILLING REVENUE	621110	817,884	817,884
c	PROVISION FOR BAD DEBTS	621300	-3,305,515	-3,305,515
d
e
f	All other program service revenue.
g Total.Add lines 2a–2f.....			163,661,227

3 Investment income (including dividends, interest, and othersimilar amounts) ..........			1,666,486			1,666,486
4 Income from investment of tax-exempt bond proceeds			0
5 Royalties...........			0
		(ii) Personal	(i) Real
6a	Gross rents		70,055
b	Less: rental expenses
c	Rental income or (loss)	0	70,055
d	Net rental income or (loss)......			70,055			70,055
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory	38,774
b	Less: cost or other basis and sales expenses	29,837
c	Gain or (loss)	8,937
d	Net gain or (loss).....			8,937			8,937
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ....
	a
b	Less: direct expenses ...b
c	Net income or (loss) from fundraising events..			0
9a	Gross income from gaming activities. See Part IV, line 19 ...
	a
b	Less: direct expenses ...b
c	Net income or (loss) from gaming activities..			0
10a	Gross sales of inventory, less returns and allowances ..
	a
b	Less: cost of goods sold ..b
c	Net income or (loss) from sales of inventory..			0
Business Code			Miscellaneous Revenue
11a	NYS IAAF FUNDS		900099	13,163,618	13,163,618
b	I&R AND NON I&R ROTATION INCOME		900099	5,353,948	5,353,948
c	HEALTHFIRST INVESTMENT INCOME		900099	2,729,472	2,729,472
d	All other revenue ....			3,076,860	865,016		2,211,844
e	Total. Add lines 11a–11d ......			24,323,898
12	Total revenue. See Instructions......			192,698,033	185,773,281		3,957,322

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 ....	5,009,179		5,009,179
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....	0
7	Other salaries and wages	90,553,308	85,505,289	5,048,019
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	6,513,471	5,908,437	605,034
9	Other employee benefits .......	19,096,443	17,108,535	1,987,908
10	Payroll taxes ...........	6,974,383	6,164,926	809,457
11	Fees for services (non-employees):
a	Management ......	0
b	Legal .........	1,635,507	47,174	1,588,333
c	Accounting ...........	74,541		74,541
d	Lobbying ...........	7,379		7,379
e	Professional fundraising services. See Part IV, line 17	0
f	Investment management fees ......	0
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	10,047,912	10,328,283	-280,371
12	Advertising and promotion ....	120,781	10,048	110,733
13	Office expenses .......	390,056	308,377	81,679
14	Information technology ......	779,417	688,957	90,460
15	Royalties ..	0
16	Occupancy ...........	4,604,536	3,360,174	1,244,362
17	Travel ............	62,308	28,493	33,815
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .	0
19	Conferences, conventions, and meetings ....	166,537	100,410	66,127
20	Interest ...........	771,134	319,050	452,084
21	Payments to affiliates .......	0
22	Depreciation, depletion, and amortization ..	6,213,374	5,492,241	721,133
23	Insurance ...	9,382,475	8,936,834	445,641
24	Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a	MEDICAL SUPPLIES	8,382,701	8,381,247	1,454
b	OTHER MATERIALS & EXPENSES	7,923,325	6,880,284	1,043,041
c	PURCHASE SERVICE EXPENSE	7,840,911	4,784,166	3,056,745
d	DRUGS	4,700,300	4,700,300
e	All other expenses
25	Total functional expenses. Add lines 1 through 24e	191,249,978	169,053,225	22,196,753	0
26	Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here if following SOP 98-2 (ASC 958-720).

1	Cash–non-interest-bearing ........			5,930,086	1	359,152
2	Savings and temporary cash investments .........			796,173	2	90,299
3	Pledges and grants receivable, net ......			341,162	3	690,409
4	Accounts receivable, net .............			14,241,213	4	14,099,323
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 ....			0	7	0
8	Inventories for sale or use ........			731,935	8	1,544,607
9	Prepaid expenses and deferred charges ......			5,185,750	9	4,209,971
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	174,229,064
b	Less: accumulated depreciation	10b	133,181,663	42,576,138	10c	41,047,401
11	Investments—publicly traded securities .			0	11	0
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 ...............			0	14	0
15	Other assets. See Part IV, line 11 ...........			73,963,266	15	74,946,666
16	Total assets. Add lines 1 through 15 (must equal line 34)...			143,765,723	16	136,987,828

17	Accounts payable and accrued expenses .....	44,135,591	17	37,041,203
18	Grants payable ...	0	18	0
19	Deferred revenue .........	5,278,387	19	5,346,671
20	Tax-exempt bond liabilities .........	0	20	0
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 ..	7,210,103	23	3,877,683
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	78,795,732	25	81,128,635
26	Total liabilities. Add lines 17 through 25..	135,419,813	26	127,394,192

	Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets	6,563,654	27	7,881,800
28	Temporarily restricted net assets ...........	374,075	28	715,495
29	Permanently restricted net assets	1,408,181	29	996,341
	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 ...........	8,345,910	33	9,593,636
34	Total liabilities and net assets/fund balances ........	143,765,723	34	136,987,828

1	Was the organization a U.S. transferor of property to a foreign corporation during the tax year? If "Yes,"the organization may be required to file Form 926, Return by a U.S. Transferor of Property to a Foreign Corporation (see Instructions for Form 926). . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	Yes	No
2	Did the organization have an interest in a foreign trust during the tax year? If "Yes," the organization may be required to separately file Form 3520, Annual Return to Report Transactions with Foreign Trusts and Receipt of Certain Foreign Gifts, and/or Form 3520-A, Annual Information Return of Foreign Trust With a U.S. Owner (see Instructions for Forms 3520 and 3520-A). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	Yes	No
3	Did the organization have an ownership interest in a foreign corporation during the tax year? If "Yes," the organization may be required to file Form 5471, Information Return of U.S. Persons with Respect to Certain Foreign Corporations. (see Instructions for Form 5471). . . . . . . . . . . . . . . . . . . . . . . . . . . .	Yes	No
4	Was the organization a direct or indirect shareholder of a passive foreign investment company or a qualified electing fund during the tax year? If “Yes,” the organization may be required to file Form 8621, Information Return by a Shareholder of a Passive Foreign Investment Company or Qualified Electing Fund. (see Instructions for Form 8621) .	Yes	No
5	Did the organization have an ownership interest in a foreign partnership during the tax year? If "Yes," the organization may be required to file Form 8865, Return of U.S. Persons with Respect to Certain Foreign Partnerships. (see Instructions for Form 8865). . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	Yes	No
6	Did the organization have any operations in or related to any boycotting countries during the tax year? If "Yes," the organization may be required to separately file Form 5713, International Boycott Report (see Instructions for Form 5713).. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	Yes	No