TY 2015 Form 990

(A) Name and Title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)
(1) ROBERT S CHALONER...................................................................... PRESIDENT & CEO	38.5 ................. 0.5	X	X	679,836	40,186
(2) KENNETH B WRIGHT...................................................................... CHAIRMAN	1.25 ................. 0.0	X	X	0	0
(3) RICHARD J HIEGEL ESQ...................................................................... VICE CHAIR	1.25 ................. 0.0	X	X	0	0
(4) STANLEY D FRIEDMAN THRU 715...................................................................... VICE PRESIDENT	1.25 ................. 0.0	X	X	0	0
(5) LAWRENCE A WILLIS...................................................................... TREASURER	1.25 ................. 0.0	X	X	0	0
(6) PATRICIA STEWART...................................................................... SECRETARY	1.25 ................. 0.0	X	X	0	0
(7) GEORGE F BIONDO ESQ...................................................................... TRUSTEE	1.25 ................. 0.0	X		0	0
(8) BARBARA BORSACK...................................................................... TRUSTEE	1.25 ................. 0.0	X		0	0
(9) RICHARD BRUCE...................................................................... TRUSTEE	1.25 ................. 0.0	X		0	0
(10) JEAN FITZSIMMONS THRU 1215...................................................................... TRUSTEE	1.25 ................. 0.0	X		0	0
(11) JAMES FORBES...................................................................... TRUSTEE	1.25 ................. 0.0	X		0	0
(12) RALPH M GIBSON MD THRU 515...................................................................... TRUSTEE	1.25 ................. 0.0	X		0	0
(13) DAVID GILLESPIE...................................................................... TRUSTEE	1.25 ................. 0.0	X		0	0
(14) GILBERT W HARRISON...................................................................... TRUSTEE	1.25 ................. 0.0	X		0	0
(15) GEORGE P KAZDIN...................................................................... TRUSTEE	1.25 ................. 0.0	X		0	0
(16) LISA CLARE KOMBRINK ESQ...................................................................... TRUSTEE	1.25 ................. 0.0	X		0	0
(17) JAY K LEVINE...................................................................... TRUSTEE	1.25 ................. 0.0	X		0	0

(A) Name and Title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(18) DOROTHY LEWIS THRU 1215........................................................................ TRUSTEE	1.25 .......................0.0	X				0	0
(19) HOWARD M LORBER........................................................................ TRUSTEE	1.25 .......................0.0	X				0	0
(20) R TIMOTHY MARAN........................................................................ TRUSTEE	1.25 .......................0.0	X				0	0
(21) JOHN MCGOWAN........................................................................ TRUSTEE	1.5 .......................0.0	X				0	0
(22) FLORENCE ROLSTON MD........................................................................ TRUSTEE	1.25 .......................0.0	X				0	0
(23) STEPHEN H SHAPOFF........................................................................ TRUSTEE	1.25 .......................0.0	X				0	0
(24) MICHAEL F SMITH........................................................................ TRUSTEE	1.25 .......................0.0	X				0	0
(25) JOHN WAMBOLD........................................................................ TRUSTEE	1.25 .......................0.0	X				0	0
(26) DARIN G WIGGINS MD........................................................................ TRUSTEE	1.25 .......................0.0	X				0	0
(27) CHIRSTOPHER J SCHULTHEIS........................................................................ CHIEF FINANCIAL OFFICER	37.5 .......................0.5		X			308,833	40,331
(28) FREDERIC I WEINBAUM........................................................................ CHIEF MEDICAL OFFICER & COO	37.5 .......................0.0		X			495,145	43,614
(29) PATRICIA A DARCEY........................................................................ CHIEF NURSING OFFICER	37.5 .......................0.0			X		231,013	41,596
(30) STEVEN GEORGOPOULOS........................................................................ PHYSICIAN	37.5 .......................0.0				X	766,622	43,372
(31) KRISTIN P NASO........................................................................ PHYSICIAN	37.5 .......................0.0				X	499,465	43,372
(32) NEEMA POURTAHERI........................................................................ PHYSICIAN	37.5 .......................0.0				X	458,045	43,372
(33) MICHAEL ELLIS........................................................................ PHYSICIAN	37.5 .......................0.0				X	428,325	38,399
(34) EDNA KAPENHAS........................................................................ DIRECTOR/BREAST SURGEON	37.5 .......................0.0				X	399,396	40,967

(A) Name and business address	(B) Description of services	(C) Compensation
E4 SERVICES LLC, 60 NORTH CAROLINA AVENUE SINKING SPRINGS,PA19608	HEALTHCARE SERVICES	1,193,958
EW HOWELL CO LLC, 245 NEWTOWN ROAD SUITE 600 PLAINVIEW,NY11803	CONSTRUCTION	1,052,130
MORRISON HEALTHCARE, PO BOX 102289 ATLANTA,GA30368	FOOD SERVICES	606,441
HAMPTONS GYNECOLOGY OB, 595 HAMPTON ROAD SOUTHAMPTON,NY11968	MEDICAL	507,500
HIM ON CALL, 1033 HAMILTON ROAD ALLENTOWN,PA18101	CONSULTING	308,930
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 28

- 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

SOUTHAMPTON HOSPITAL ASSOCIATION

Employer identification number

11-1667765

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

SOUTHAMPTON HOSPITAL ASSOCIATION

Employer identification number

11-1667765

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 SOUTHAMPTON HOSPITAL ASSOCIATION

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 SOUTHAMPTON HOSPITAL ASSOCIATION		Employer identification number 11-1667765

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 SOUTHAMPTON HOSPITAL ASSOCIATION			Employer identification number 11-1667765
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

SOUTHAMPTON HOSPITAL ASSOCIATION

Employer identification number

11-1667765

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

Yes

27,711

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

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

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

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

27,711

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

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

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

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

Part III-A

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

Yes

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

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

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

Part III-B

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

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

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

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

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

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

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

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

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

Part IV

Supplemental Information

Provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; Part II-A (affiliated group list); Part II-A, lines 1 and 2 (see instructions), and Part ll-B, line 1. Also, complete this part for any additional information.

Return Reference	Explanation
PART II-B, LINE 1F:	SOUTHAMPTON HOSPITAL ASSOCIATION PAYS MEMBERSHIP DUES TO THE BELOW MENTIONED ORGANIZATIONS. A PERCENTAGE OF THESE DUES ARE THEN USED TO REIMBURSE THE ORGANIZATION FOR THE COST OF LOBBYING ACTIVITIES PERFORMED ON BEHALF OF THE HOSPITAL. THE FUNDS ARE USED FOR LOBBYING PURPOSES IN CONNECTION WITH NEW YORK STATE AND FEDERAL POLICY ISSUES. MEMBERSHIP DUES PAID TO OTHER ORGANIZATIONS AND USED FOR LOBBYING PURPOSES: Healthcare Association of New York State........$ 9,757. American Hospital Association...................$ 6,616. Nassau Suffolk Hospital Council.................$ 1,897. Greater NY Hospital Association.................$ 8,494. 1199 HEP FUND...................................$ 947. Total...........................................$27,711.

Return Reference

Explanation

PART II-B, LINE 1F:

SOUTHAMPTON HOSPITAL ASSOCIATION PAYS MEMBERSHIP DUES TO THE BELOW MENTIONED ORGANIZATIONS. A PERCENTAGE OF THESE DUES ARE THEN USED TO REIMBURSE THE ORGANIZATION FOR THE COST OF LOBBYING ACTIVITIES PERFORMED ON BEHALF OF THE HOSPITAL. THE FUNDS ARE USED FOR LOBBYING PURPOSES IN CONNECTION WITH NEW YORK STATE AND FEDERAL POLICY ISSUES. MEMBERSHIP DUES PAID TO OTHER ORGANIZATIONS AND USED FOR LOBBYING PURPOSES: Healthcare Association of New York State........$ 9,757. American Hospital Association...................$ 6,616. Nassau Suffolk Hospital Council.................$ 1,897. Greater NY Hospital Association.................$ 8,494. 1199 HEP FUND...................................$ 947. Total...........................................$27,711.

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

SOUTHAMPTON HOSPITAL ASSOCIATION

Employer identification number

11-1667765

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 ....	11,858,782	10,808,731	4,527,461	4,115,379	4,213,766
b	Contributions ...		698,598	5,500,000
c	Net investment earnings, gains, and losses	-20,898	351,153	781,270	412,082	-98,387
d	Grants or scholarships ...
e	Other expenditures for facilities and programs ...	407,500
f	Administrative expenses ....
g	End of year balance ......	11,430,384	11,858,482	10,808,731	4,527,461	4,115,379

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

Board designated or quasi-endowment SchDMd Bullet

75.210 %

Permanent endowment SchDMd Bullet

24.790 %

Temporarily restricted endowment SchDMd Bullet

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

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

Yes

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

3a(i)

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

3a(ii)

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

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

Part VI

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

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

1a	Land ...	1,683,775		1,683,775
b	Buildings	44,563,894	39,245,620	5,318,274
c	Leasehold improvements
d	Equipment ...	115,447,847	79,322,382	36,125,465
e	Other ...	16,602,692	935,784	15,666,908
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				58,794,422

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) SHORT TERM INVESTMENTS	9,040,008	F
(B) RESTRICTIONS	3,637,476	F
(C) INVESTMENTS IN SHA PROPERTIES	6,300,000	C
(D) MALPRACTICE SELF INSURANCE-FD	7,141,000	F
(D)
(E)
(F)
(G)
(H)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)	26,118,484

Part VIII

InvestmentsProgram Related. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11c. See Form 990, Part X, line 13.

(a) Description of investment	(b) Book value	(c) Method of valuation: Cost or end-of-year market value

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

Part IX

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

(a) Description				(b) Book value
(1) DUE FROM AFFILIATE				3,127,067
(2) DUE TO THIRD-PARTY PAYORS				3,033,025
(3) BOND ISSUANCE COSTS, NET				807,617
(4) OTHER ASSETS				12,478
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........				6,980,187

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
ACCRUED PENSION LIABILITY	8,757,894
DUE TO THIRD-PARTY PAYORS, NET	7,046,783
MALPRACTICE SELF-INSURANCE LIABILITY	7,141,000
DUE TO AFFILIATE	3,000,000
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	25,945,677
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	142,770,986
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains (losses) on investments ....	2a	-745,749
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIII.) ............	2d	-2,249,402
e	Add lines 2a through 2d .....................			2e	-2,995,151
3	Subtract line 2e from line 1..................			3	145,766,137
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	104,955
b	Other (Describe in Part XIII.) ...........	4b
c	Add lines 4a and 4b....................			4c	104,955
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......			5	145,871,092

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	144,773,423
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	144,773,423
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	104,955
b	Other (Describe in Part XIII.) ............	4b
c	Add lines 4a and 4b.....................			4c	104,955
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......			5	144,878,378

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:	SOUTHAMPTON HOSPITAL ASSOCIATION CURRENTLY REPORTS ENDOWMENT FUNDS WITHIN ITS DECEMBER 31, 2015 FINANCIAL STATEMENTS. THE GOVERNING BODY INTENDS TO USE THESE FUNDS TO OFFSET THE COST OF INDIGENT CARE, EMERGENCY SERVICES AND NURSING EDUCATION.
PART X, LINE 2:	SOUTHAMPTON HOSPITAL ASSOCIATION (THE "REPORTING ORGANIZATION") HAS NOT TAKEN AN UNSUBSTANTIATED TAX POSITION THAT WOULD REQUIRE PROVISION OF A LIABILITY UNDER ASC 740. UNDER ASC 740, AN ORGANIZATION MUST RECOGNIZE THE TAX BENEFIT ASSOCIATED WITH TAX POSITIONS TAKEN FOR TAX RETURN PURPOSES WHEN IT IS MORE-LIKELY-THAN-NOT THAT THE POSITION WILL NOT BE SUSTAINED UPON EXAMINATION. THE REPORTING ORGANIZATION DOES NOT BELIEVE THERE ARE ANY MATERIAL UNCERTAIN TAX POSITIONS AND, ACCORDINGLY, HAS NOT RECOGNIZED ANY LIABILITY FOR UNRECOGNIZED TAX BENEFITS. THE REPORTING ORGANIZATION HAS FILED IRS FORM 990 TAX RETURNS, AS REQUIRED, AND ALL OTHER APPLICABLE RETURNS IN JURISDICTIONS WHEN IT IS REQUIRED. FOR THE YEAR ENDED DECEMBER 31, 2015, THERE WAS NO INTEREST OR PENALTIES RECORDED OR INCLUDED IN THE CONSOLIDATED FINANCIAL STATEMENTS. THE REPORTING ORGANIZATION BELIEVES IT IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR THE YEARS PRIOR TO 2012, WHICH IS THE STATUTE OF LIMITATION LOOK BACK PERIOD.
PART XI, LINE 2D:	CHANGE IN UNFUNDED PENSION OBLIGATION

Schedule D (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

SOUTHAMPTON HOSPITAL ASSOCIATION

Employer identification number

11-1667765

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 400 %

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"? . . . . . . . . . . . . .

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

Yes

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

Yes

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

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

Yes

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

Yes

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

Financial Assistance and Certain Other Community Benefits at Cost

Financial Assistance and Means-Tested Government Programs		(a) Number of activities or programs (optional)	(b) Persons served (optional)	(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) . . .		277	2,395,332	-2,175,885	219,447	0.150 %
b	Medicaid (from Worksheet 3, column a) . . . . .			22,714,149	11,283,622	11,430,527	7.890 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .
d	Total Financial Assistance and Means-Tested Government Programs . . . . .		277	25,109,481	9,107,737	11,649,974	8.040 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).
f	Health professions education (from Worksheet 5) . . .			8,808,652	4,094,856	4,713,796	3.250 %
g	Subsidized health services (from Worksheet 6) . . . .	4		46,041,659	35,628,461	10,413,199	8.110 %
h	Research (from Worksheet 7) .
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .
j	Total. Other Benefits . .	4		54,850,311	39,723,317	15,126,995	11.360 %
k	Total. Add lines 7d and 7j .	4	277	79,959,792	48,831,054	26,776,969	19.400 %

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
1	Physical improvements and housing
2	Economic development
3	Community support
4	Environmental improvements
5	Leadership development and training for community members
6	Coalition building
7	Community health improvement advocacy
8	Workforce development	64,129	64,129
9	Other
10	Total	64,129	64,129

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. ......

6,400,000

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. ......

2,624,314

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).....

38,092,076

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

43,044,006

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

-4,951,930

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 %
1MEETINGHOUSE LN PRAC	PRIMARY/SPECIALTY	100 %
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?14 Name, address, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility)				Other (Describe)	Facility reporting group
1	SOUTHAMPTON HOSPITAL ASSOCIATION 240 MEETINGHOUSE LANE SOUTHAMPTON,NY11968	X			A
2	DIALYSIS CENTER 184 W MONTAUK HIGHWAY HAMTPON BAYS,NY11946		X	DIALYSIS TREATMENT FACILITY	B
3	GREENPORT PRENATAL 300 ATLANTIC AVENUE GREENPORT,NY11944		X	PRENATAL/WOMEN'S SERVICES	B
4	LAB EAST 200 PANTIGO PLACE EAST HAMPTON,NY11944		X	LABORATORY SERVICES	B
5	IMAGING - EH 200 PANTIGO PLACE EAST HAMPTON,NY11937		X	RADIOLOGY SERVICES	B
6	WESTHAMPTON PRIMARY CARE 72 OLD RIVERHEAD ROAD WESTHAMPTON BEACH,NY11978		X	PRIMARY CARE PRACTICE	B
7	WESTHAMPTON SPORTS REHAB 74 OLD RIVERHEAD ROAD WESTHAMPTON BEACH,NY11978		X	SPORTS REHAB/ PHYSICAL THERAPY SERVICES	B
8	LAB SOUTH 325 MEETINGHOUSE LANE SOUTHAMPTON,NY11968		X	LABORATORY SERVICES	B
9	ATRIUM LAB 182 W MONTAUK HIGHWAY HAMPTON BAYS,NY11946		X	LABORATORY SERVICES	B
10	DAVID ROGERS CENTER 335 D MEETINGHOUSE LANE SOUTHAMPTON,NY11968		X	HIV/AIDS CARE	B
11	SHINNECOCK HEALTH CHURCH STREET SOUTHAMPTON,NY11968		X	PRIMARY CARE/DENTAL SERVICES	B
12	SOUTHAMPTON CARE CENTER 240 MEETINGHOUSE LANE SOUTHAMPTON,NY11968		X	NURSING HOME (FACILITY CLOSED)	B
13	IMAGING - HAMPTON BAYS 182 W MONTAUK HIGHWAY HAMPTON BAYS,NY11946		X	RADIOLOGY SERVICES	B
14	MEETINGHOUSE LANE PRACTICE PO BOX 2340 SOUTHAMPTON,NY11968		X	PRIMARY/SPECIALTY PHYSICIAN PATIENT CARE	B

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)

	A
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 15

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.SOUTHAMPTONHOSPITAL.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 14

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

Yes

If "Yes" (list url): WWW.SOUTHAMPTONHOSPITAL.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)

	A
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 400.% 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.SOUTHAMPTONHOSPITAL.ORG

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

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

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

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

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

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

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

Other (describe in Section C)

Billing and Collections

Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained all of the actions the hospital facility or other authorized party may take upon non-payment?..................................

Yes

Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

None of these actions or other similar actions were permitted

Schedule H (Form 990) 2015

Page 6

Part VFacility Information (continued)

	A
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility or other authorized party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?............

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

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

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

Notified individuals of the financial assistance policy on admission

Notified individuals of the financial assistance policy prior to discharge

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

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

Other (describe in Section C)

None of these efforts were made

Policy Relating to Emergency Medical Care

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

Yes

If "No," indicate why:

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

The hospital facility’s policy was not in writing

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

Other (describe in Section C)

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

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

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

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

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

Other (describe in Section C)

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

If "Yes," explain in Section C.

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

If "Yes," explain in Section C.

Schedule H (Form 990) 2015

Page 4

Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)

	B
Name of hospital facility or letter of facility reporting group

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

Yes

Community Health Needs Assessment

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

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

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

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

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

Hospital facility’s website (list url):

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

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

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

If "Yes" (list url):

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

10b

12a

Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)?...............................

12a

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

12b

If "Yes" on line 12b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $

Schedule H (Form 990) 2015

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	B
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 400.% 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

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.SOUTHAMPTONHOSPITAL.ORG

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

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

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

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

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

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

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

Other (describe in Section C)

Billing and Collections

Yes

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

None of these actions or other similar actions were permitted

Schedule H (Form 990) 2015

Page 6

Part VFacility Information (continued)

	B
Name of hospital facility or letter of facility reporting group

Yes

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

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

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

Notified individuals of the financial assistance policy on admission

Notified individuals of the financial assistance policy prior to discharge

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

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

Other (describe in Section C)

None of these efforts were made

Policy Relating to Emergency Medical Care

Yes

If "No," indicate why:

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

The hospital facility’s policy was not in writing

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

Other (describe in Section C)

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

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

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

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

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

Other (describe in Section C)

If "Yes," explain in Section C.

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

If "Yes," explain in Section C.

Schedule H (Form 990) 2015

Page 7

Part V

Facility Information (continued)

Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16i, 18d, 19d, 20e, 21c, 21d, 22d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference	Explanation
PART V, SECTION B, LINE 4:	THE HOSPITAL CONDUCTED A COMMUNITY HEALTH NEEDS ASSESSMENT ("CHNA") FOR THE PERIOD 2015 - 2017. THE CHNA WAS DEEMED CONDUCTED IN 2015 WHEN IT WAS MADE "WIDELY AVAILABLE" TO THE PUBLIC AND THE WRITTEN REPORT AND IMPLEMENTATION STRATEGY WERE FINALIZED, APPROVED, AND ACCEPTED BY THE HOSPITAL'S GOVERNING BODY, IN ACCORDANCE WITH IRS NOTICE 2011-52.
PART V, SECTION B, LINE 5:	SEE SCHEDULE H, PART VI, LINE 2 NEEDS ASSESSMENT LANGUAGE.

Schedule H (Form 990) 2015

Page 8

Part VFacility Information (continued)

Section D. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility (list in order of size, from largest to smallest) How many non-hospital health care facilities did the organization operate during the tax year?
Name and address		Type of Facility (describe)
1
2
3
4
5
6
7
8
9
10

Schedule H (Form 990) 2015

Page 9

Part VI

Supplemental Information

Provide the following information.

1	Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2	Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs reported in Part V, Section B.
3	Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4	Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5	Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6	Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7	State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.

Form and Line Reference	Explanation
PART I, LINE 3C:	THERE ARE TWO LEVELS OF CHARITY CARE COVERAGE: PRIMARY SERVICE AREA AND NON-PRIMARY SERVICE AREA. A PRIMARY SERVICE AREA PATIENT IS A PATIENT WHO RESIDED IN NEW YORK STATE WITHIN THE COUNTIES OF SUFFOLK OR NASSAU AT THE TIME OF SERVICE. A NON-PRIMARY SERVICE AREA PATIENT IS A PATIENT WHO RESIDED IN NEW YORK STATE BUT NOT WITHIN THE COUNTIES OF SUFFOLK OR NASSAU AT THE TIME OF SERVICE. ELIGIBLE SERVICES FOR A PRIMARY SERVICE AREA PATIENT: A PRIMARY SERVICE AREA PATIENT WHO MEETS THE FINANCIAL REQUIREMENTS IS ELIGIBLE FOR THE FOLLOWING MEDICALLY NECESSARY SERVICES: INPATIENT, AMBULATORY, EMERGENCY ROOM, EMERGENCY TRANSFERS UNDER THE EMERGENCY MEDICAL TREATMENT AND LABOR ACT (EMTALA), OUTPATIENT, AND DIAGNOSTIC CARE. UNDERINSURED PRIMARY SERVICE AREA PATIENTS ARE ELIGIBLE FOR FINANCIAL ASSISTANCE ON MEDICARE AND COMMERCIAL INSURANCE CARRIER CO-INSURANCES FOR ALL ABOVE LISTED SERVICES. ELIGIBLE SERVICES FOR A NON-PRIMARY SERVICE AREA PATIENT: A NON-PRIMARY SERVICE AREA PATIENT WHO MEETS THE FINANCIAL REQUIREMENTS IS ELIGIBLE FOR THE FOLLOWING MEDICALLY NECESSARY SERVICES: EMERGENCY ROOM, EMERGENT ADMISSIONS, AND EMERGENCY TRANSFERS UNDER THE EMERGENCY MEDICAL TREATMENT AND LABOR ACT (EMTALA). UNDERINSURED NON-PRIMARY SERVICE AREA PATIENTS ARE ELIGIBLE FOR FINANCIAL ASSISTANCE ON MEDICARE AND COMMERCIAL INSURANCE CARRIER CO-INSURANCES FOR ALL ABOVE LISTED SERVICES. INELIGIBLE SERVICES: THE FOLLOWING SERVICES AND/OR ITEMS ARE NOT COVERED BY CHARITY CARE FOR ANY PATIENT: NOT MEDICALLY NECESSARY SERVICES AS DETERMINED BY MEDICARE(E.G. COSMETIC SURGERY, BARIATRIC SURGERY), INSURANCE CO-PAYMENTS/CO-INSURANCES/DEDUCTIBLES, MEDICAID SPEND-DOWN AMOUNTS, NON-COVERED SERVICES AS DETERMINED BY THE PATIENT'S INSURANCE CARRIER, PRIVATE ROOM RATES, AND PRIVATE PHYSICIAN FEES WHICH ARE NOT BILLED BY SOUTHAMPTON HOSPITAL (E.G. RADIOLOGY, PATHOLOGY, ANESTHESIOLOGY, EMERGENCY). FAMILY INFORMATION REQUIREMENTS: A PATIENT MUST PROVIDE ON THEIR CHARITY CARE APPLICATION A LIST OF THE FAMILY/HOUSEHOLD MEMBERS AND OR DEPENDENTS WITH WHOM THE PATIENT RESIDES. IF THE PATIENT IS AN ADULT, THE PATIENT MUST LIST THEIR SPOUSE OR DOMESTIC PARTNER, CHILDREN UNDER THE AGE OF 21, AND ANY CLAIMED DEPENDENTS OR OTHER HOUSEHOLD MEMBERS THAT LIVE WITH THE PATIENT. IF THE PATIENT IS A CHILD UNDER THE AGE OF 21, THE APPLICANT MAY LIST THE PATIENT'S PARENTS, SIBLINGS UNDER THE AGE OF 21, AND ANY CLAIMED DEPENDENTS OR OTHER HOUSEHOLD MEMBERS THAT LIVE WITH THE PATIENT. A CLAIMED DEPENDENT IS DEFINED AS A PERSON WHO IS LISTED OR WOULD BE LISTED AS A DEPENDENT FOR THE PURPOSES OF AN INCOME TAX SUBMISSION TO THE IRS. FINANCIAL REQUIREMENTS: TO BE FINANCIALLY ELIGIBLE TO RECEIVE CHARITY CARE, A PATIENT MUST HAVE A GROSS FAMILY/HOUSEHOLD INCOME LESS THAN OR EQUAL TO 400% OF THE FEDERAL POVERTY LEVEL GUIDELINE (FPG). ELIGIBLE INCOME: THE FOLLOWING INCOME ITEMS WILL BE USED TO DETERMINE A PATIENT'S INCOME: EARNINGS FROM EMPLOYMENT, UNEMPLOYMENT COMPENSATION, WORKERS COMPENSATION, DISABILITY, SOCIAL SECURITY, ANNUITIZED PENSION PLAN, CHILD SUPPORT, ALIMONY, DIVIDENDS, INTEREST, RENTALS, ESTATES, TRUSTS, SALE OF ASSETS, AND OTHER MISCELLANEOUS INCOME. SOLE PROPRIETORSHIP, PARTNERSHIP, AND S CORPORATION INCOME WILL BE CALCULATED BY ITS GROSS PROFIT OR TOTAL INCOME PRIOR TO EXPENSES AND DEDUCTIONS; HOWEVER, COST OF GOODS SOLD MAY BE DEDUCTED FROM GROSS SALES. SALE OF ASSETS, SUCH AS REPORTED ON A SCHEDULE D OR ITS EQUIVALENT, WILL BE CALCULATED BY THEIR SALE PRICE AND NOT BY THEIR GAIN OR LOSS. FINANCIAL DOCUMENTATION REQUIREMENTS: A PATIENT MUST PROVIDE FINANCIAL DOCUMENTATION TO SUPPORT THEIR CURRENT STATED INCOME. THE FOLLOWING DOCUMENTS ARE ACCEPTABLE AS PROOF: COPIES OF RECENT PAY STUBS (SEVERAL CONSECUTIVE ARE PREFERRED WHEN AVAILABLE), A RECENT UNEMPLOYMENT OR DISABILITY STATEMENT, A LETTER FROM AN EMPLOYER, OR A SELF-ATTESTATION LETTER. A PATIENT MAY BE REQUIRED TO SUBMIT ADDITIONAL DOCUMENTATION AT SOUTHAMPTON HOSPITAL'S REQUEST IN ORDER TO SUBSTANTIATE THEIR STATED INCOME. IF A PATIENT IS CLAIMING ZERO INCOME, THE PATIENT WILL BE REQUIRED TO SUBMIT A VERIFICATION OF NON-FILING LETTER FROM THE IRS. THIS LETTER IS OBTAINED THROUGH IRS FORM 4506-T WHICH WILL BE MADE AVAILABLE TO THE PATIENT UPON REQUEST. THE PATIENT MUST ALSO SUBMIT A LETTER DESCRIBING THE MEANS BY WHICH THEY ARE SUPPORTED. IF THE PATIENT IS UNABLE TO FILE IRS FORM 4506-T DUE TO NOT HAVING A SOCIAL SECURITY NUMBER, THE PATIENT MUST SUBMIT THE ABOVE-MENTIONED LETTER. APPLICABLE RATES: THE APPLICABLE RATE FOR AN INPATIENT VISIT IS THE MEDICARE DIAGNOSIS RELATED GROUP (DRG) RATE FOR THAT VISIT. THE APPLICABLE RATE FOR AN AMBULATORY, EMERGENCY ROOM, OUTPATIENT, OR DIAGNOSTIC CARE VISIT IS THE MEDICARE HCPCS/CPT PAYMENT PLUS MINIMUM UNADJUSTED CO-PAYMENT FOR THAT VISIT. THE APPLICABLE RATE FOR LAB TESTS ON OUTPATIENT AND EMERGENCY ROOM VISITS WILL BE 10% OF THE CHARGE PER TEST. SELF-PAY DISCOUNT: SOUTHAMPTON HOSPITAL OFFERS A SELF-PAY DISCOUNT TO UNINSURED PATIENTS FOR SERVICES AND PROCEDURES PROVIDED AND BILLED BY SOUTHAMPTON HOSPITAL. A) ELIGIBLE SERVICES - THE FOLLOWING SERVICES PERFORMED BY SOUTHAMPTON HOSPITAL ARE ELIGIBLE FOR A SELF-PAY DISCOUNT: INPATIENT, AMBULATORY, EMERGENCY ROOM, EMERGENCY TRANSFERS UNDER THE EMERGENCY MEDICAL TREATMENT AND LABOR ACT (EMTALA), OUTPATIENT, AND DIAGNOSTIC CARE. B) INELIGIBLE SERVICES - THE FOLLOWING SERVICES AND ITEMS ARE NOT ELIGIBLE FOR A SELF-PAY DISCOUNT: OUTPATIENT CARDIAC REHABILITATION, OUTPATIENT NUTRITIONAL COUNSELING, WELLNESS CENTER SERVICES/PROGRAMS, OUTPATIENT PHYSICAL THERAPY, PRIVATE PHYSICIAN FEES NOT BILLED BY SOUTHAMPTON HOSPITAL (E.G. RADIOLOGY, PATHOLOGY, ANESTHESIOLOGY, EMERGENCY). C) DISCOUNT - SELF-PAY ACCOUNTS ARE DISCOUNTED AT A RATE OF 75% OFF TOTAL CHARGES. A. AUTOMATIC DISCOUNTING - THE SELF-PAY DISCOUNT WILL BE CALCULATED AND APPLIED TO THE PATIENTS' ACCOUNT AUTOMATICALLY BY THE HOSPITAL INFORMATION SYSTEM (HIS). B. MANUAL DISCOUNTING - THE SELF-PAY DISCOUNT MAY NEED TO BE MANUALLY CALCULATED AND APPLIED IN CERTAIN CIRCUMSTANCES (E.G. LATE CHARGES) AND WILL BE HANDLED BY PATIENT FINANCIAL SERVICES. D) ADDITIONAL FINANCIAL ASSISTANCE - PATIENTS WHO ARE UNABLE TO PAY FOR A SELF-PAY DISCOUNTED BILL MAY STILL APPLY FOR OTHER TYPES OF FINANCIAL ASSISTANCE SUCH AS CHARITY CARE. APPLYING FOR ANOTHER TYPE OF FINANCIAL ASSISTANCE WILL NOT RESULT IN THE LOSS OF THE OFFERED SELF-PAY DISCOUNT, HOWEVER, IF ACCEPTED INTO ANOTHER FINANCIAL ASSISTANCE PROGRAM, THAT PROGRAMS CALCULATION METHODOLOGY WILL BE DONE INDEPENDENTLY OF THE SELF-PAY DISCOUNTED AMOUNT (I.E. FINANCIAL ASSISTANCE PROGRAMS ARE MUTUALLY EXCLUSIVE).
PART III, LINE 3:	SOUTHAMPTON HOSPITAL UTILIZED THE AUDITED FINANCIAL STATEMENT AMOUNT REPORTED FOR BAD DEBT OF $6,400,000 AS ITS STARTING POINT. THIS AMOUNT WAS MULTIPLIED BY A COST TO CHARGE RATIO OF 100% (DETERMINED ON SCHEDULE H WORKSHEET 2) RESULTING IN A COST OF BAD DEBT OF $6,400,000. THIS COST WAS THEN MULTIPLIED BY 41.0049% - THE SELF PAY PERCENTAGE AS DETERMINED BY THE 2015 INSTITUTIONAL COST REPORT. THIS RESULTED IN A COST OF BAD DEBT FOR PATIENTS ELIGIBLE UNDER THE HOSPITAL'S CHARITY CARE POLICY OF $2,624,314.
PART III, LINE 4:	THE ORGANIZATION DETERMINE EXPECTED BAD DEBT WRITE-OFFS BASED ON ACTUAL ACCOUNTS, NET OF AN EXPECTED RATE OF RECOVERY. IT'S NOT BASED ON A PERCENTAGE OF REVENUE.
PART III, LINE 8:	SOUTHAMPTON HOSPITAL UTILIZED THE 2552 COST REPORT PREPARED ANNUALLY FOR MEDICARE TO DETERMINE THE TOTAL REVENUE RECEIVED FROM MEDICARE, AS WELL AS THE MEDICARE ALLOWABLE COSTS RELATING TO THE REVENUE REPORTED. MEDICARE ALLOWABLE COSTS OF $43,044,006 ARE GREATER THAN THE TOTAL MEDICARE REVENUE OF $38,092,076 FOR 2015; THEREFORE THE SHORTFALL OF $4,951,930 MAY BE DEEMED A COMMUNITY BENEFIT.
PART III, LINE 9B:	ACCOUNTS WITH UNCOLLECTABLE BALANCES ARE ACCOUNTS FOR A PATIENT (GUARANTOR) WHO HAS NOT RESPONDED TO REQUESTS FOR PAYMENT OR WHO HAS DEMONSTRATED AN EXEMPTION FROM PAYMENT. THE REQUEST FOR PAYMENT &/OR THE EXEMPTION MUST MEET THE FOLLOWING CRITERIA: 1. AT LEAST FOUR (4) CONSECUTIVE 120-DAY BILLS MUST HAVE BEEN GENERATED (OR NO LESS THAN 120 DAYS FROM FIRST BILL) AND SENT WITHOUT RESPONSE FROM THE PATIENT (GUARANTOR) BEFORE BEING SENT TO A COLLECTION AGENCY; OR 2. THE PATIENT (GUARANTOR) HAS DECLARED BANKRUPTCY (DISCHARGE OF DEBT OR MUST HAVE BEEN RECEIVED); OR 3. THE ESTATE OF THE PATIENT (GUARANTOR) HAS BEEN SETTLED AND THERE WERE NO FUNDS FOR PAYMENT LEFT IN THE ESTATE; OR 4. MAIL HAS BEEN RETURNED AND OTHER METHODS OF CONTACTING THE PATIENT (GUARANTOR) HAVE FAILED. THE ACCOUNT IS THEN CONSIDERED AND HANDLED AS A BAD DEBT ACCOUNT. PATIENT FINANCIAL SERVICES MAY ELECT TO SEND THE ACCOUNT TO AN OUTSIDE AGENCY, UP TO AND INCLUDING LEGAL ACTION. BAD DEBT ACCOUNTS ARE PURE SELF PAY ACCOUNTS FOR A PATIENT (GUARANTOR) WHO HAS NOT RESPONDED TO REQUESTS FOR PAYMENT. THE REQUEST FOR PAYMENT MUST MEET THE FOLLOWING CRITERIA: AT LEAST FOUR (4) CONSECUTIVE 30-DAY BILLS MUST HAVE BEEN GENERATED AND SENT WITHOUT RESPONSE FROM THE PATIENT (GUARANTOR); OR MAIL HAS BEEN RETURNED AND ALL OTHER METHODS OF CONTACTING THE PATIENT(GUARANTOR) HAVE FAILED. ONCE IT IS DETERMINED AN ACCOUNT BALANCE CANNOT BE COLLECTED BY PATIENT FINANCIAL SERVICES, THE ACCOUNT MAY BE TURNED OVER FOR COLLECTION BY AN OUTSIDE AGENCY, UP TO AND INCLUDING LEGAL ACTION. THE OUTSIDE COLLECTION AGENCY, AFTER DUE DILIGENCE, MAY DETERMINE THE BALANCE ON AN ACCOUNT CANNOT BE COLLECTED, THE ACCOUNT BALANCE MAY BE WRITTEN OFF USING THE APPROPRIATE CODE FOR THE ACCOUNT.
PART VI, LINE 2:	Online Key Informant Survey: To solicit input from key informants, those individuals who have a broad interest in the health of the community, an Online Key Informant Survey was also implemented as part of this process. A list of recommended participants was provided by Southampton Hospital; this list included names and contact information for physicians, public health representatives, other health professionals, social service providers, and a variety of other community leaders. Potential participants were chosen because of their ability to identify primary concerns of the populations with whom they work, as well as of the community overall. Key informants were contacted by email, introducing the purpose of the survey and providing a link to take the survey online; reminder emails were sent as needed to increase participation. In all, 133 community stakeholders took part in the Online Key Informant Survey, as outlined below: Online Key Informant Survey Participation Key Informant Type Number Invited Number Participating Physician 24 11 Public Health Representative 2 2 Other Health Provider 63 28 Social Services Provider 61 18 Community/Business Leader 144 74 Final Participation included representatives of the organizations outlined below: 91 Hill LLC; Adele Macmillan, LCSW-R, Private Practitioner; Amaden Gay Agencies; Barth Counseling; Bartky HealthCare Center; Bellringer Communications, Inc.; Blumenfield & Fleming, LLC; Bridgehampton Citizens Advisory Committee; Bridgehampton UFSD; Brookhaven Memorial Hospital Outpatient Behavioral Health; Coalition for Women's Cancers at Southampton Hospital; David E. Rogers Center; Development Officer; East End Clinical Connections; East End Counseling; East End DBT; East End Pediatrics; East End Regional Intervention Court; East Hampton Family Medicine; East Hampton Healthcare Foundation; East Hampton Lions Club Foundation; East Hampton Town Police Department; East Hampton Union Free School District; East Hampton Village Ambulance Association; East Quogue Fire Department; Eastern Suffolk BOCES Employee Assistance Program; ELIHO; Family Service League; Fighting Chance; First Presbyterian Church; Hampton Bays Public Library; Hampton Counseling; Hamptons Gynecology and Obstetrics; Indian Health/ACS; I-TRI Inspirational Triathlon Racing International; Maggie Bloomfield, LCSW, CASAC, MFA; Montauk Fire Department; Montauk Library; OLA of Eastern Long Island; Our Lady of the Hamptons School; Peer Recovery Services; Private Provider; Public Library; Remsenburg-Speonk UFSD; Retired Educator; Rogers Memorial Library; School District; Seafield Center; Shelter Island School; Shinnecock Indian Health Service; Southampton Business Alliance; Southampton Hospital; Southampton Pediatric Associates; Southampton Town Police Department; Southampton Volunteer Ambulance; Suffolk County Department of Health Services; The Retreat; Town of East Hampton Department of Human Services; Town of Southampton Youth Bureau; Tuckahoe Common School District; Village of Southampton; Westhampton Beach Police Department; Westhampton Primary Care. Through this process, input was gathered from several individuals whose organizations work with low-income, minority populations (including abused families, African-Americans, Asians, Caribbean Islanders, Central Americans, children with learning disabilities, Columbians, the disabled, Eastern Europeans, Ecuadorians, Hispanics, immigrants, LGBT community, low income residents, Medicaid/Medicare beneficiaries, Native Americans, non-English speaking individuals, Portuguese people, South Americans, undocumented persons, the uninsured/underinsured, and veterans), or other medically underserved populations (including African-Americans, cancer patients, children, children and young adults, the disabled, the elderly, Hispanics, HIV positive individuals, The homeless, immigrants, LGBT community, those living alone, low income residents, Medicaid/Medicare beneficiaries, the mentally ill, Native Americans, non-English speaking individuals, pregnant teens, substance abusers, undocumented persons, unemployed residents, the uninsured/underinsured, veterans, women, and young adults). In the online survey, key informants were asked to rate the degree to which various health issues are a problem in their own community. Follow-up questions asked them to describe why they identify problem areas as such, and how these might be better addressed. Results of their ratings, as well as their verbatim comments, are included throughout this report as they relate to the various other data presented. NOTE: These findings represent qualitative rather than quantitative data. The Online Key Informant Survey was designed to gather input from participants regarding their opinions and perceptions of the health of the residents in the area. Thus, these findings are based on perceptions, not facts. Benchmark Data: New York Risk Factor Data - Statewide risk factor data are provided where available as an additional benchmark against which to compare local survey findings; these data are reported in the most recent BRFSS (Behavioral Risk Factor Surveillance System) Prevalence and Trend Data published by the Centers for Disease Control and Prevention and the US Department of Health & Human Services. Nationwide Risk Factor Data - Nationwide risk factor data, which are also provided in comparison charts, are taken from the 2013 PRC National Health Survey; the methodological approach for the national study is identical to that employed in this assessment, and these data may be generalized to the US population with a high degree of confidence. Healthy People 2020 - Healthy People provides science-based, 10-year national objectives for improving the health of all Americans. The Healthy People initiative is grounded in the principle that setting national objectives and monitoring progress can motivate action. For three decades, Healthy People has established benchmarks and monitored progress over time in order to: - Encourage collaborations across sectors. - Guide individuals toward making informed health decisions. - Measure the impact of prevention activities. Healthy People 2020 is the product of an extensive stakeholder feedback process that is unparalleled in government and health. It integrates input from public health and prevention experts, a wide range of federal, state and local government officials, a consortium of more than 2,000 organizations, and perhaps most importantly, the public. More than 8,000 comments were considered in drafting a comprehensive set of Healthy People 2020 objectives. Determining Significance - Differences noted in this report represent those determined to be significant. For survey-derived indicators (which are subject to sampling error), statistical significance is determined based on confidence intervals (at the 95 percent confidence level) using question-specific samples and response rates. Information Gaps - While this assessment is quite comprehensive, it cannot measure all possible aspects of health in the community, nor can it adequately represent all possible populations of interest. It must be recognized that these information gaps might in some ways limit the ability to assess all of the communitys health needs. For example, certain population groups - such as homeless, instutionalized persons, or those who only speack a language other than English or Spanish - are not represented in the survey data. Other population groups - for example, pregnant women, lesbian/gay/bisexual/transgender residents, undocumented residents, and members or certain racial/ethnic or immigrant groups - might not be identifiable or might not be represented in numbers sufficient for independent analyses. In addition, this assessment does not include secondary data from existing sources which can provide relevant data collected through death certificates, birth certificates, or notifications or infectious disease cases in the community. In terms of content, this assessment was designed to provide a comprehensive and broad picture of the health of the overall community. However, there are certainly a great number of medical conditions that are not specifically addressed. Prioritization of Health Needs - On December 11, 2015, more than 30 individuals (representing local health providers, social service providers, and community leaders, as well as Southampton Hospital senior leaders and other internal stakeholders) met to evaluate, discuss and prioritize health issues for the community, based on findings of the 2015 PRC Community Health Needs Assessment (CHNA). Professional Research Consultants, Inc. (PRC) began the meetings with a presentation of key findings from the CHNA, highlighting the significant health issues identified from the research (see Areas of Opportunity above). Following the data review, PRC answered any questions and facilitated a group dialogue, allowing participants to advocate for any of the h
PART VI, LINE 3:	FINANCIAL AID PROGRAM: SOUTHAMPTON HOSPITAL'S COMMITMENT AND DETERMINATION TO PROVIDE QUALITY HEALTHCARE AT AFFORDABLE RATES HAS LEAD US TO DESIGN A CHARITY CARE PROGRAM THAT GOES "ABOVE AND BEYOND" THE EXPECTATIONS AND MINIMUM REQUIREMENTS SET FORTH BY NEW YORK STATE LAW. IT IS THE HOSPITAL'S "ABOVE AND BEYOND" ATTITUDE THAT IS OUR PROGRAMS GREATEST STRENGTH AND CAN BEST BE SEEN IN OUR POLICY TO PROVIDE CHARITY CARE DISCOUNTED RATES TO PATIENTS MAKING UP TO 400% OF THE FEDERAL POVERTY LEVEL GUIDELINE (FPG) RATHER THAN THE MINIMUM REQUIREMENT OF 300% FPG. IN ADDITION, THE HOSPITAL INCLUDES A FORM TO APPLY FOR CHARITY CARE IN EVERY SELF-PAY BILL TO BE RETURNED TO PATIENT FINANCIAL SERVICES. SELF-PAY PATIENTS ARE GIVEN A 75% DISCOUNT OF CHARGES, AS WELL. SOUTHAMPTON HOSPITAL CONTINUES TO FACE FINANCIAL CHALLENGES INCLUDING CONTINUED REDUCTIONS IN NEW YORK STATE AND FEDERAL REIMBURSEMENT RATES AT THE SAME TIME THAT HOSPITAL FACES THE INCREASING COST OF PROVIDING CARE, INCLUDING DOUBLE DIGIT EXPENSES INCREASES IN SOME CATEGORIES. WHILE THE HOSPITAL WAITS TO UNDERSTAND THE IMPACT ON ITS CHARITY POLICIES THAT MAY RESULT FROM EXPANDING RESIDENT ACCESS TO HEALTH CARE INSURANCE THAT IS PART OF HEALTH CARE REFORM, THE HOSPITAL REMAINS CONCERNED THAT A SIGNIFICANT PART OF THE INDIGENT CARE THE HOSPITAL PROVIDES TO UNDOCUMENTED WORKERS WILL NOT BE COVERED.
PART VI, LINE 4:	Southampton's Service area extends from Montauk to the East to Westhampton Beach to the West and the Southern area of Riverhead in the center of the East End of Long Island. The service area accounts for approximately eight-five (85) percent of total admissions to the Hospital and includes the following zip codes: Amagansett (11930); East Hampton (11937); Bridgehampton (11932); Southampton (11968); Hampton Bays (11946); Sag Harbor (11963); Sagaponack (11962); Montauk (11954); Riverhead (11901); East Quogue (11942); Quogue (11959); Remsenburg (11960); Water Mill (11976); Westhampton Beach (11978); and Westhampton (11977). In addition, the Hospital's service area is home to the Shinnecock Nation. Since April of 1995, Southampton Hospital has worked with the Nation to provide services at the Shinnecock Indian Health Clinic through a contract with the NYS Department of Health. On an annual basis, the Clinic provides approximately 2,100 medical and 1,000 dental visits for eligible members of the Shinnecock Nation. Southampton Hospital's service area has a year-round population of approximately 102,689 residents. The population in the Hospital's service area, a resort destination, more than doubles during the summer season when tourists and seasonal residents from all over the world come to the South Fork of Long Island. AS THE TABLE BELOW INDICATES, THIS SERVICE AREA HAS A YEAR ROUND POPULATION OF APPROXIMATELY 70,000 RESIDENTS. THE AREA IS PROJECTED TO SEE A SIGNIFICANT INCREASE IN POPULATION, MORE THAN 4 PERCENT OVER THE NEXT FIVE YEARS. DEMOGRAPHIC CHARACTERISTICS SELECTED AREA USA 2010 TOTAL POPULATION............65,013............308,745,538 2015 TOTAL POPULATION............66,786............319,459,991 2020 TOTAL POPULATION............68,584............330,689,365 % CHANGE 2015 - 2020...............2.7%...................3.5% AVERAGE HOUSEHOLD INCOME.......$115,280................$74,165 THE POPULATION ON THE HOSPITAL'S SERVICE AREA, A RESORT DESTINATION, MORE THAN DOUBLES DURING THE SUMMER SEASON WHEN TOURISTS FROM ALL OVER THE WORLD VISIT THE SOUTH FORK OF LONG ISLAND. AS A RESULT, DEMAND FOR SOUTHAMPTON HOSPITAL SERVICES INCREASES SIGNIFICANTLY DURING THE SUMMER, IN PARTICULAR DEMAND FOR THE HOSPITAL'S EMERGENCY SERVICES. THE HOSPITAL HAS RESPONDED TO THIS NEED BY MAKING A CAPITAL INVESTMENT IN EXPANDING AND RENOVATING THE EMERGENCY DEPARTMENT AND IMPLEMENTING A STATE-OF-THE-ART EMERGENCY DEPARTMENT INFORMATION SYSTEMS THAT PERMITS THE HOSPITAL TO TRACK PATIENTS, AND READ AND INTERPRET LABORATORY AND RADIOLOGICAL RESULTS. AS THE TABLE BELOW INDICATES, THE SERVICE AREA HAS A SIGNIFICANT PERCENTAGE OF THEIR POPULATION AGED FIFTY-FIVE (55) AND OVER, A POPULATION THAT HAS GREATER NEED FOR HEALTH CARE SERVICES. AGE DISTRIBUTION: USA 2015 AGE GROUP 2015 % OF TOTAL 2020 % OF TOTAL % OF TOTAL 0-14 10,755 16.1% 10,655 15.5% 19.1% 15-17 2,349 3.5% 2,456 3.6% 4.0% 18-24 5,159 7.7% 5,506 8.0% 9.9% 25-34 7,278 10.9% 7,254 10.6% 13.3% 35-54 18,112 27.1% 17,130 25.0% 26.3% 55-64 9,903 14.8% 10,584 15.4% 12.7% 65+ 13,230 19.8% 14,999 21.9% 14.7% TOTAL 66,786 100.0% 68,584 100.0% 100.0% THERE ARE NO FIRM ESTIMATES OF THE NUMBER OF MIGRANT AGRICULTURAL WORKERS THAT COME INTO THIS AREA. AGRICULTURE IS ONE OF SUFFOLK COUNTY'S LEADING INDUSTRIES. ITS SUCCESS RELIES ON WORKERS WHO MOVE THROUGH THE EASTERN UNITED STATES IN RESPONSE TO THE AVAILABILITY OF SEASONAL WORK. SOUTHAMPTON HOSPITAL RECOGNIZES THAT THIS POPULATION PRESENTS SERIOUS HEALTH PROBLEMS AND IS COMMITTED TO PROVIDING CARE FOR ITS CULTURALLY DIVERSE PATIENT POPULATION. MANY OF THESE INDIVIDUALS ARE UNINSURED AND UNABLE TO SPEAK ENGLISH. THEY RELY ON THE HOSPITAL'S EMERGENCY DEPARTMENT, AS WELL AS THE SUFFOLK COUNTY HEALTH CLINIC, LOCATED ON THE HOSPITAL'S CAMPUS, FOR HEALTH CARE. AS ARESULT, THE HOSPITAL'S OFFICE OF CULTURAL DIVERSITY PROVIDES TRANSLATION AND INTERPRETATION SERVICES, AS WELL AS COUNSELING ON MEDICAL INSURANCE AND BILLING FOR THOSE INDIVIDUALS WHO DO NOT SPEAK ENGLISH. THE HOSPITAL PROVIDES BI-LINGUAL PUBLICATIONS AND SIGNAGE AND ACTIVELY ASSISTS THE CULTURALLY DIVERSE COMMUNITIES IT CARES FOR. RACE/ETHNICITY: RACE/ETHNICITY DISTRIBUTION RACE/ETHNICITY 2015 POP % OF TOTAL USA % OF TOTAL WHITE NON-HISPANIC 45,479 68.1% 61.8% BLACK NON-HISPANIC 1,917 2.9% 12.3% HISPANIC 16,945 25.4% 17.6% ASIAN & PACIFIC IS. 899 1.3% 5.3% ALL OTHERS 1,546 2.3% 3.1% TOTAL 66,786 100.0% 100.0%
PART VI, LINE 5:	SOUTHAMPTON HOSPITAL SPONSORS "FOCUS ON SOUTHAMPTON HOSPITAL" ON SEA-TV, A MONTHLY PUBLIC ACCESS INTERVIEW PROGRAM FOR THE TOWNS OF EAST HAMPTON AND SOUTHAMPTON THAT COVERS HEALTH-RELATED INFORMATION OF INTEREST TO THE COMMUNITY AND PROVIDES INFORMATION ON HEALTHCARE SERVICES AVAILABLE AT SOUTHAMPTON HOSPITAL. THE HOSPITAL HAS DEVELOPED NUMEROUS SERVICES AND OUTREACH TO RESPOND TO THE NEEDS OF THESE PATIENTS, INCLUDING RECRUITING ADDITIONAL PRIMARY CARE PHYSICIANS AND IMPLEMENTING A GRADUATE MEDICAL EDUCATION PROGRAM THAT WILL HOPEFULLY ATTRACT THESE YOUNG PHYSICIANS TO STAY AND PRACTICE IN THE COMMUNITY. THE HOSPITAL'S WEBSITE, WWW.SOUTHAMPTONHOSPITAL.ORG, PROVIDES INFORMATION ON HOSPITAL SERVICES, SPECIAL PROGRAMS AND EVENTS. THE SITE ENABLES PATIENTS TO FIND PHYSICIANS IN DIFFERENT SPECIALTIES, ALLOWS ON-LINE INQUIRIES THAT ARE ANSWERED DAILY, AND PROVIDES ACCESS TO AVAILABLE EMPLOYMENT OPPORTUNITY AND JOB APPLICATIONS. SERVICES FOR SHORT-TERM AND LONG-TERM CARE FOR CHRONIC AND ACUTE ILLNESS ARE CONTINUALLY EVALUATED THROUGH STATISTICAL DATA THAT INCLUDE QUALITY INDICATORS AND PATIENT OUTCOMES. THIS DATA IS COMPARED NATIONALLY WITH OTHER HEALTH FACILITIES AND INFORMS THE HOSPITAL'S STRATEGIC PLAN AND COMMUNITY SERVICE PLAN. THE HOSPITAL'S STRATEGIC PLANNING COMMITTEE INCLUDES COMMUNITY MEMBERS, HOSPITAL STAFF AND HOSPITAL AND FOUNDATION BOARD MEMBERS WHO WORK COLLABORATIVELY TO ASSESS COMMUNITY NEEDS AND DEVELOP STRATEGIES TO MEET THESE NEEDS. THE HOSPITAL'S PUBLIC AFFAIRS COMMITTEE IS RESPONSIVE TO COMMUNITY INTERESTS AND CONCERNS. MEMBERSHIP IS A CROSS-SECTION OF PHYSICIANS, HOSPITAL MANAGEMENT, BOARD MEMBERS AND HOSPITAL EMPLOYEES. BASED ON THE HOSPITAL'S ASSESSMENT OF INTEREST IN THE COMMUNITY, A NUMBER OF HEALTH LECTURES AND PROGRAMS ARE PROVIDED THROUGHOUT THE YEAR. THESE PROGRAMS ARE SOMETIMES SPONSORED THROUGH OUR PARTNERSHIPS WITH LOCAL ORGANIZATIONS INCLUDING FIGHTING CHANCE, NEW YORK ORGAN DONOR NETWORK, COMMUNITY LIBRARIES, AND SERVICE CLUBS (LIONS, KIWANIS, ELKS). THE 2015 OUTREACH SCHEDULE INCLUDED THE FOLLOWING PROGRAMS AT: A) SOUTHAMPTON'S ROGERS MEMORIAL LIBRARY - Heart Health-Know Your Numbers; Heart Health Exercise is Medicine; Natural Sleep Solutions B) WESTHAMPTON FREE LIBRARY - Key to a Healthy Heart; Shingles- What Vaccines Do Adults Need; Help with Shoulder Injuries and Arthritis; Back Pain; Healthy Kidneys-Healthy You; Lyme and Tick-Borne Disease; Baby Fair; Acupuncture Can Reveal Your True Self; Spa Days; Healthy At Any Age; Relax and Heal Using Therapeutic Massage; Breast Cancer Awareness; Living with Osteoporosis. C) HAMPTON BAYS LIBRARY - LIVING WITH OSTEOPOROSIS; HEALTHY KIDNEYS-HEALTHY YOU. D) QUOGUE LIBRARY - TREATMENTS FOR VARICOSE VEINS; LIVING WITH ARTHRITIS; KEY TO A HEALTHY HEART. E) HAMPTON LIBRARY IN BRIDGEHAMPTON - OH MY ACHING BACK! F) SHELTER ISLAND LIBRARY - TICK-BORNE DISEASE G) SAG HARBOR'S JOHN JERMAIN LIBRARY - HEART HEALTH - EXERCISE IS MEDICINE; DEFINING REFLEXOLOGY. H) CUTCHOGUE/NEW SUFFOLK LIBRARY - HEALTHY EYES, HEALTHY VISION; HEELAND FOOT PAIN; HYPNOSIS FOR PEAK PERFORMANCE, BEHAVIOR MODIFICATION, AND BETTER NIGHT'S SLEEP; HAND THERAPY FOR ARTHRITIS; LYME AND TICK-BORNE DISEASE. I) MATTITUCK/LAUREL LIBRARY - PREVENTING LYME AND TICK-BORNE DISEASE; LIVING WITH ARTHRITIS. J) SHINNECOCK INDIAN RESERVATION - STROKE AWARENESS K) CHILDREN'S MUSEUM OF THE EAST END IN BRIDGEHAMPTON - TRAIN YOUR EYES TO BE TICKWISE; PECONIC FAMILY FUND DAY TICK EDUCATION L) D.A.R. SOUTHAMPTON CHAPTER - HEALTHY AT ANY AGE M) ROTARY CLUB SOUTHAMPTON - TICK-BORNE DISEASE EDUCATION AND PREVENTION N) SOUTHAMPTON HOSPITAL - CAR SEAT SAFETY INSPECTON DAY IN CONJUNCTION WITH SOUTHAMPTON POLICE DEPARTMENT O) TICK-BORNE DISEASE PUBLIC EDUCATION - BAY STREET THEATER, SOUTHAMPTON HOSPITAL'S PARRISH HALL, EAST HAMPTON HEALTH FAIR P) EASTPORT ATLANTIC SHORES SENIOR COMMUNITY - RELAX AND HEAL USING THERAPEUTIC MASSAGE. PUBLIC INFORMATION: Southampton Hospital understands the importance of educating the community about its available services. Brochures detailing these services are distributed and displayed on every floor of the hospital, at community and school health fairs, and at hospital satellite facilities and physician offices across the North and South Forks. In addition, this information, along with the Hospitals 2015-17 Community Service Plan, is available on the Hospitals website, www.southamptonhospital.org.
GENERAL INFORMATION:	PATIENT SATISFACTION SURVEYS: IN ADDITION, SOUTHAMPTON HOSPITAL CONTINUALLY SOLICITS PATIENT INPUT THROUGH ITS PATIENT SATISFACTION SURVEY PROCESS, WHICH INCLUDES EVERY INPATIENT, AMBULATORY SURGERY PATIENT AND EMERGENCY ROOM PATIENT. THE DATA COLLECTED FROM THESE COMPREHENSIVE SURVEYS PROVIDES VALUABLE INFORMATION ON A WIDE RANGE OF QUALITY INDICATORS AND AREAS OF INTEREST TO THE HOSPITAL'S PATIENTS. RESULTS FROM THESE SURVEYS ARE REGULARLY DISTRIBUTED TO HOSPITAL AND MEDICAL STAFFS AND THE BOARD OF DIRECTORS. THE QUALITY MANAGEMENT AND PUBLIC AFFAIRS DEPARTMENTS, AS WELL AS THE OFFICE OF THE PRESIDENT, CAREFULLY REVIEW CORRESPONDENCE FROM PATIENTS AND THE COMMUNITY AT LARGE. A MEMBER OF THE HOSPITAL STAFF PERSONALLY ANSWERS ALL CORRESPONDENCE.

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

SOUTHAMPTON HOSPITAL ASSOCIATION

Employer identification number

11-1667765

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 .........

Yes

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

Yes

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

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

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

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

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

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

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)
1ROBERT S CHALONERPRESIDENT & CEO	(i) (ii)	510,000 ------------- 0	127,500 ------------- 0	42,336 ------------- 0	15,900 ------------- 0	24,286 ------------- 0	720,022 ------------- 0	0 ------------- 0
2CHIRSTOPHER J SCHULTHEISCHIEF FINANCIAL OFFICER	(i) (ii)	254,392 ------------- 0	47,636 ------------- 0	6,805 ------------- 0	15,264 ------------- 0	25,067 ------------- 0	349,164 ------------- 0	0 ------------- 0
3FREDERIC I WEINBAUMCHIEF MEDICAL OFFICER & COO	(i) (ii)	399,389 ------------- 0	59,908 ------------- 0	35,848 ------------- 0	15,900 ------------- 0	27,714 ------------- 0	538,759 ------------- 0	0 ------------- 0
4PATRICIA A DARCEYCHIEF NURSING OFFICER	(i) (ii)	231,364 ------------- 0	0 ------------- 0	-351 ------------- 0	13,882 ------------- 0	27,714 ------------- 0	272,609 ------------- 0	0 ------------- 0
5STEVEN GEORGOPOULOSPHYSICIAN	(i) (ii)	707,308 ------------- 0	0 ------------- 0	59,314 ------------- 0	15,900 ------------- 0	27,472 ------------- 0	809,994 ------------- 0	0 ------------- 0
6KRISTIN P NASOPHYSICIAN	(i) (ii)	500,000 ------------- 0	0 ------------- 0	-535 ------------- 0	15,900 ------------- 0	27,472 ------------- 0	542,837 ------------- 0	0 ------------- 0
7NEEMA POURTAHERIPHYSICIAN	(i) (ii)	434,423 ------------- 0	0 ------------- 0	23,622 ------------- 0	15,900 ------------- 0	27,472 ------------- 0	501,417 ------------- 0	0 ------------- 0
8MICHAEL ELLISPHYSICIAN	(i) (ii)	393,923 ------------- 0	0 ------------- 0	34,402 ------------- 0	15,900 ------------- 0	22,499 ------------- 0	466,724 ------------- 0	0 ------------- 0
9EDNA KAPENHASDIRECTOR/BREAST SURGEON	(i) (ii)	400,000 ------------- 0	0 ------------- 0	-604 ------------- 0	15,900 ------------- 0	25,067 ------------- 0	440,363 ------------- 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 I, LINE 1A:

Southampton Hospital Association provides the following special allowances/perquisites to the President & CEO, as well as to certain key executives. These allowances for housing and automobile are stipulated in the executives Employment Agreement/terms at time of hire. All payments of these perquisites are made on a bi-weekly basis with the employees regular paycheck and they are made in accordance with the guidelines of a non-accountable expense plan. Annual allowances are as listed below: 1) ROBERT CHALONER, PRESIDENT & CEO - Housing Allowance: $38,000. 2) FREDRIC WEINBAUM, MD, EVP, COO & CMO - Housing Allowance: $30,000. Auto Allowance: $7,000. 3) CHRISTOPHER J. SCHULTHEIS, CFO & VP of Finance - AUTO ALLOWANCE: $8,400. 4) NEEMA POURTAHERI, PHYSICIAN - HOUSING ALLOWANCE: $22,157. 5) MICHAEL ELLIS, PHYSICIAN - HOUSING ALLOWANCE: $36,000.

PART II, COLUMN (B)(II):

THE PRESIDENT & CEO, EXECUTIVE VICE PRESIDENT/CHIEF MEDICAL OFFICER, AND CFO OF SOUTHAMPTON HOSPITAL WERE ELIGIBLE FOR A PERFORMANCE BONUS IN 2015 WHICH WAS BASED UPON CRITERIA THAT THE EXECUTIVE COMMITTEE OF THE BOARD ESTABLISHED. THE PRESIDENT & CEO'S BONUS IS AN ANNUAL BONUS SET FORTH IN HIS EMPLOYMENT AGREEMENT AND IS DETERMINED AFTER A REVIEW OF HOW WELL HE PERFORMED IN THE PRIOR YEAR AGAINST GOALS AND OBJECTIVES ESTABLISHED BY THE EXECUTIVE COMMITTEE. THE EXECUTIVE VICE PRESIDENT/CHIEF MEDICAL OFFICER AND CFO WERE AWARDED A PERFORMANCE BONUS BASED UPON THE RECOMMENDATION OF THE PRESIDENT & CEO AS WELL AS A REVIEW OF THEIR PERFORMANCE AGAINST GOALS AND OBJECTIVES ESTABLISHED BY THE PRESIDENT AND THE EXECUTIVE COMMITTEE.

Schedule J (Form 990) 2015

Additional Data

Software ID:
Software Version:

- TIN:

Schedule K
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Information on Tax Exempt Bonds

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

Attach to Form 990.
SchKMediumBullet

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

OMB No. 1545-0047

2015

Open to Public
Inspection

Name of the organization
SOUTHAMPTON HOSPITAL ASSOCIATION

Employer identification number
11-1667765

Part I

Bond Issues

(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	(g) Defeased		(h) On behalf of issuer		(i) Pool financing
(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	Yes	No	Yes	No	Yes	No
A	SUFFOLK COUNTY ECONOMIC DEVELOPMENT CORPORATION	27-3722095		10-02-2014	33,500,000	refinance series 1999a and 1999b		X		X		X

Part II

Proceeds

	A		B		C		D
	1 Amount of bonds retired ..................	0
2 Amount of bonds legally defeased ..............	0
3 Total proceeds of issue ..................	33,500,000
4 Gross proceeds in reserve funds .............	0
5 Capitalized interest from proceeds .............	0
6 Proceeds in refunding escrows ...............	28,644,501
7 Issuance costs from proceeds ...............	607,619
8 Credit enhancement from proceeds .............	0
9 Working capital expenditures from proceeds .............	0
10 Capital expenditures from proceeds .............	3,931,601
11 Other spent proceeds .............	823,269
12 Other unspent proceeds .............	0
13 Year of substantial completion .............
	Yes	No	Yes	No	Yes	No	Yes	No
14 Were the bonds issued as part of a current refunding issue? ....	X
15 Were the bonds issued as part of an advance refunding issue? .....		X
16 Has the final allocation of proceeds been made? ..........		X
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? ..................	X

Part III

Private Business Use

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

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

Cat. No. 50193E

Schedule K (Form 990) 2015

Page 2

Part III

Private Business Use (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
3a Are there any management or service contracts that may result in private business use of bond-financed property? .............		X
b If "Yes" to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property?
c Are there any research agreements that may result in private business use of bond-financed property? .............		X
d If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property?
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government ....	0 %
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government .........	1.400 %
6 Total of lines 4 and 5 .............	1.400 %
7 Does the bond issue meet the private security or payment test? ...		X
8a Has there been a sale or disposition of any of the bond-financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were issued?.............		X
b If "Yes" to line 8a, enter the percentage of bond-financed property sold or disposed of. ..
c If "Yes" to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? .............		X
9 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under Regulations sections 1.141-12 and 1.145-2? ........		X

Part IV

Arbitrage

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Has the issuer filed Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate? ...		X
2 If "No" to line 1, did the following apply? ....
a Rebate not due yet? .......	X
b Exception to rebate? ........		X
c No rebate due? .........		X
If "Yes" to line 2c, provide in Part VI the date the rebate computation was performed ......
3 Is the bond issue a variable rate issue? .....		X
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?		X
b Name of provider ..........	0
c Term of hedge .........
d Was the hedge superintegrated? ......
e Was the hedge terminated? ........

Schedule K (Form 990) 2015

Page 3

Part IV

Arbitrage (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
5a Were gross proceeds invested in a guaranteed investment contract (GIC)?		X
b Name of provider ..........	0
c Term of GIC .........
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? ........
6 Were any gross proceeds invested beyond an available temporary period?		X
7 Has the organization established written procedures to monitor the requirements of section 148? ...		X

Part V

Procedures To Undertake Corrective Action

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations?		X

Part VI

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

Return Reference	Explanation

Schedule K (Form 990) 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

SOUTHAMPTON HOSPITAL ASSOCIATION

Employer identification number

11-1667765

Return Reference	Explanation
FORM 990, PART VI, SECTION A, LINES 6, 7A AND 7B:	THE ORGANIZATION'S SOLE MEMBER IS EAST END HEALTH ALLIANCE, A NOT-FOR-PROFIT CORPORATION THAT CAN ELECT ONE OR MORE MEMBERS OF THE HOSPITAL'S GOVERNING BODY. THE EAST END HEALTH ALLIANCE, THE ARTICLE 28 PARENT OF EASTERN LONG ISLAND HOSPITAL, PECONIC BAY MEDICAL CENTER AND SOUTHAMPTON HOSPITAL, WAS CREATED IN RESPONSE TO THE RECOMMENDATIONS OF THE COMMISSION ON HEALTH CARE IN THE 21ST CENTURY. CONSISTENT WITH THE MISSION OF SOUTHAMPTON HOSPITAL, THE GOALS OF THE ALLIANCE ARE AS FOLLOWS: A) TO COLLABORATIVELY DEVELOP HIGH QUALITY, COMPREHENSIVE AND ACCESSIBLE HEALTH CARE SERVICES TO MEET THE NEEDS OF THE COMMUNITY SERVED; B) TO RATIONALIZE HEALTH CARE SERVICES ACROSS THE SYSTEM; AND C) TO REALIZE MANAGEMENT EFFICIENCIES. THE FOLLOWING DECISIONS MADE BY THE GOVERNING BODY OF SOUTHAMPTON HOSPITAL REQUIRE EAST END HEALTH ALLIANCE APPROVAL: ADOPTION OF OPERATING AND CAPITAL BUDGETS, APPLICATION FOR NEW CERTIFICATES OF NEED, AND CERTAIN BORROWING TRANSACTIONS.
FORM 990, PART VI, SECTION B, LINE 11B:	SOUTHAMPTON HOSPITAL ASSOCIATION HAS ITS FORM 990 PREPARED BY AN OUTSIDE ACCOUNTING FIRM AND HAS ESTABLISHED THE FOLLOWING REVIEW PROCESS TO ENSURE THAT THE INFORMATION REPORTED IS COMPLETE AND ACCURATE. UPON COMPLETION, THE FORM 990 IS REVIEWED BY MANAGEMENT AND IS THEN FORWARDED ELECTRONICALLY TO THE MEMBERS OF THE BOARD OF TRUSTEES FOR THEIR REVIEW. ANY QUESTIONS OR ISSUES ARE THEN ADDRESSED BY THE APPROPRIATE PARTIES PRIOR TO THE FILING OF THE RETURN.
FORM 990, PART VI, SECTION B, LINE 12C:	SOUTHAMPTON HOSPITAL CURRENTLY HAS A CONFLICT OF INTEREST POLICY AND A PROCEDURE FOR ANNUAL DISCLOSURE BY KEY EMPLOYEES, PHYSICIAN LEADERS, AND SENIOR MANAGEMENT. WHEN NEW/POTENTIAL CONFLICTS/RELATIONSHIPS ARE IDENTIFIED, THEY ARE INVESTIGATED BY THE CORPORATE COMPLIANCE OFFICER AND ANY RECOMMENDATIONS AND/OR CORRECTIVE ACTIONS ARE PRESENTED TO THE PRESIDENT AND CEO. AS APPROPRIATE, THESE POTENTIAL CONFLICTS/DISCLOSURES ARE ALSO REVIEWED WITH THE CFO AND MEDICAL DIRECTOR/COO. WHEN A POTENTIAL CONFLICT IS IDENTIFIED, THE STAFF MEMBER IS PROHIBITED FROM TAKING PART IN ANY HOSPITAL DECISIONS THAT MAY RELATE TO THE INTEREST OR RELATIONSHIP, UNTIL THE REVIEW IS COMPLETED AND A DETERMINATION IS MADE THAT THERE IS NO CONFLICT. SIMILARLY, ON AN ANNUAL BASIS, ALL MEMBERS OF THE BOARD OF DIRECTORS ARE REQUIRED TO COMPLETE A CONFLICT OF INTEREST FORM. ALL POTENTIAL CONFLICTS OF INTEREST THAT MAY EXIST MUST BE DISCLOSED. IF A POTENTIAL OR ACTUAL CONFLICT OF INTEREST EXISTS, THE AFFECTED MEMBER WILL BE NOTIFIED AND THE EXECUTIVE COMMITTEE OF THE BOARD WILL INVESTIGATE AND MAKE THE DETERMINATION AS TO WHAT, IF ANY RECUSAL OR OTHER CORRECTIVE ACTION MAY BE REQUIRED TO AVOID ANY POTENTIAL CONFLICT. THE RESULTS OF THE INVESTIGATION WILL THEN BE REPORTED TO THE GOVERNING BODY. IF AN ACTUAL CONFLICT OF INTEREST EXISTS, THE AFFECTED MEMBER WILL BE NOTIFIED OF THIS DETERMINATION AND THEIR PARTICIPATION IN RELATED MATTERS AND/OR VOTING RIGHTS, PERTAINING TO THE AREA OF CONFLICT, WILL BE RELINQUISHED.
FORM 990, PART VI, SECTION B, LINES 15A AND 15B:	Southampton Hospital has established an Executive Compensation Policy which sets forth the terms and criteria for the review of the compensation of the President & CEO, the Chief Medical Officer/COO and the Vice President of Finance/CFO as well as other executive leaders. The policy outlines the procedures and criteria the Executive Committee will follow in evaluating the CEO's, the CMO/COO's, and the CFOs performance against established goals. It also outlines the Executive Committees' role and responsibility in determining all aspects of the CEO's, Chief Medical Officer/COO's, and CFOs compensation including any incentive or bonus compensation. The Committee reviews contract terms which cover compensation and benefits including, but not limited to, housing allowances, automobile allowances, severance or change of control payments. On a periodic basis, the Executive Committee meets to review the terms of compensation and reviews external compensation data and studies to ensure that compensation decisions are reasonable and consistent with fair market value. The Committee documents the full terms of compensation approved and includes date of the decision, details of the comparability data obtained and relied upon, and how the data was obtained. Members of the Executive Committee must be free from any conflict of interest that may relate to the arrangement. All members of the Committee who were present during the discussion of the arrangement will be documented in the Meeting minutes along with their votes. The compensation review process for the President & CEO, Chief Medical Officer and CFO was last undertaken September 17, 2015.
FORM 990, PART VI, SECTION C, LINE 19:	SOUTHAMPTON HOSPITAL'S FORM 990, AS WELL AS ITS FINANCIAL STATEMENTS AND CONFLICT OF INTEREST POLICY, ARE AVAILABLE FOR PUBLIC INSPECTION UPON REQUEST, AS REQUIRED UNDER SECTION 6104 OF THE INTERNAL REVENUE CODE. INTERESTED PARTIES MAY REQUEST THE DOCUMENTS AT 240 MEETINGHOUSE LANE, SOUTHAMPTON, NY 11968 OR BY CALLING THE ORGANIZATION DIRECTLY AT (631)726-8200.
FORM 990, PART XI, LINE 9:	PENSION OBLIGATION..................................$(2,249,402) CHARITABLE REALIZED GAINS/LOSSES & DISTRIBUTIONS....$ (64,377) TOTAL...............................................$(2,313,779)

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

SOUTHAMPTON HOSPITAL ASSOCIATION

Employer identification number

11-1667765

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)SOUTHAMPTON CARE CENTER 240 MEETING HOUSE LANE SOUTHAMPTON,NY11968 11-2658403	NURSING HOME	NY	501(c)(3)	9			No
(2)THE SOUTHAMPTON HOSPITAL FOUNDATION 240 MEETING HOUSE LANE SOUTHAMPTON,NY11968 11-3466516	SRVC PROVIDER	NY	501(C)(3)	7			No
(3)MEETINGHOUSE LANE MEDICAL PRACTICE PO BOX 2340 SOUTHAMPTON,NY11968 20-8853938	PATIENT CARE	NY	501(C)(3)	11			No

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

Cat. No. 50135Y

Schedule R (Form 990) 2015

Page 2

Part III

Identification of Related Organizations Taxable as a Partnership Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.

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

Part IV

Identification of Related Organizations Taxable as a Corporation or Trust Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(h) Percentage ownership	(i) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets		Yes	No
(1) SHA PROPERTIES 240 MEETING HOUSE LANE SOUTHAMPTON,NY11968 11-2563612	REAL ESTATE	NY	NA	C	0	13,162	100.000 %	Yes
(2) OLD TOWN MEDICAL PRACTICE PC 240 MEETING HOUSE LANE SOUTHAMPTON,NY11968 45-2430883	MEDICAL PRACTICE	NY	NA	C	0	0	100.000 %	Yes

Schedule R (Form 990) 2015

Page 3

Part V

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

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

Yes

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

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

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

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

Yes

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

Yes

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

Yes

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

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

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

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

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

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

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

Yes

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

Yes

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

Yes

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

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

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

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

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

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

Schedule R (Form 990) 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 AND ENSURE THE HIGHEST QUALITY OF HEALTHCARE SERVICES FOR ITS ENTIRE COMMUNITY.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	22
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	21
5	Total number of individuals employed in calendar year 2015 (Part V, line 2a) ......	5	1,227
6	Total number of volunteers (estimate if necessary) .............	6	25
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	3,263,661
b	Net unrelated business taxable income from Form 990-T, line 34 .........	7b

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	11,272,875	5,486,201
9	Program service revenue (Part VIII, line 2g) .........	130,907,809	138,558,938
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	1,094,544	813,291
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	941,126	1,012,662
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	144,216,354	145,871,092
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)	83,145,144	89,750,094
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)....	51,888,924	55,128,284
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	135,034,068	144,878,378
19	Revenue less expenses. Subtract line 18 from line 12.......	9,182,286	992,714
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	112,332,163	120,793,141
21	Total liabilities (Part X, line 26).............	82,418,298	92,946,090
22	Net assets or fund balances. Subtract line 21 from line 20.....	29,913,865	27,847,051

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 122,966,280 including grants of $ 0 ) (Revenue $ 135,295,277 )
	SOUTHAMPTON HOSPITAL ASSOCIATION OFFERS A FULL CONTINUUM OF AMBULATORY AND INPATIENT SERVICES RANGING FROM PRIMARY MEDICAL CARE TO SPECIALIZED SURGICAL PROCEDURES, AND IS STAFFED BY MORE THAN 280 PHYSICIANS, DENTISTS AND ALLIED HEALTH PROFESSIONALS REPRESENTING 44 MEDICAL SPECIALTIES. THE ORGANIZATION has developed numerous services and outreach, detailed below, to respond to the needs of its patients, including recruiting additional primary care and specialty physicians, RNs, NPs, and PAs. The graduate medical education program is training physicians for primary and family practice, as well as surgery, and a gratifying number of these doctors are staying within the Hospital's service area. It is anticipated that the Affordable Care Act and the insurance exchanges will result in many more people accessing primary care and the Hospital continues to prepare for this inevitability through its medical education program. SINCE THE ORGANIZATION'S SERVICE AREA EXTENDS FROM WESTHAMPTON BEACH TO MONTAUK, THE HOSPITAL HAS A NUMBER OF SATELLITE OFFICES TO PROVIDE CONVENIENT, SPECIALIZED CARE TO THESE COMMUNITIES. THESE INCLUDE: A) MEETING HOUSE LANE MEDICAL PRACTICE - the practice continues to add new offices in primary, internal medicine, and specialty care on the South Fork. Specialty care services include rheumatology, nephrology, neurology, allergy/asthma, pulmonology, psychiatry, infectious disease, gastroenterology, as well as nutritional and diabetes education. In Southampton, an office was added to the four existing sites, bringing the total to five and a surgical specialty office was also opened in 2015, offering general, orthopedic and bariatric surgery. Other offices include locations in Amagansett, East Hampton (two offices), Hampton Bays (three offices), Montauk, Riverhead, Sag Harbor, Wainscott, and Water Mill. B) WESTHAMPTON PRIMARY CARE CENTER - PROVIDING CARE FOR THE WESTHAMPTON, WESTHAMPTON BEACH, QUOGUE, AND REMSENBURG COMMUNITIES. C) LABORATORY AND IMAGING SERVICES - PROVIDING SERVICES IN EAST HAMPTON, HAMPTON BAYS AND SOUTHAMPTON. D) REGIONAL DIALYSIS CENTER - SERVICE TO DIALYSIS PATIENTS IS PROVIDED BY A DEDICATED INTERDISCIPLINARY TEAM OF BOARD-CERTIFIED NEPHROLOGISTS, CERTIFIED DIALYSIS RNS, LPNS AND DIALYSIS TECHNICIANS, CERTIFIED SOCIAL WORKERS, AND A NYS REGISTERED DIETITIAN. 24-HOUR EMERGENCY SERVICE IS ALSO AVAILABLE. E) CENTER FOR PHYSICAL THERAPY AND SPORTS REHABILITATION - PROVIDING CARE FOR THE WESTHAMPTON, WESTHAMPTON BEACH, EAST QUOGUE, QUOGUE, AND REMSENBURG COMMUNITIES. F) THE SHINNECOCK INDIAN HEALTH CLINIC - SINCE APRIL OF 1995, SOUTHAMPTON HOSPITAL HAS WORKED WITH THE SHINNECOCK NATION TO PROVIDE SERVICES AT THE SHINNECOCK INDIAN HEALTH CLINIC THROUGH A CONTRACT WITH THE NEW YORK STATE DEPARTMENT OF HEALTH. ON AN ANNUAL BASIS, THE CLINIC PROVIDES APPROXIMATELY 2,100 MEDICAL AND 1,000 DENTAL VISITS FOR ELIGIBLE MEMBERS OF THE SHINNECOCK NATION. DENTAL SERVICES, INCLUDING COMMUNITY EDUCATION, SCREENING, RADIOLOGICAL EXAMS, DENTAL HYGIENE AND RESTORATIVE CARE ARE PROVIDED THROUGH A SUBCONTRACT WITH STONY BROOK UNIVERSITY SCHOOL OF DENTAL MEDICINE. CURRENTLY, DENTAL SERVICES ARE AVAILABLE EIGHT DAYS PER MONTH FOR ADULTS AND TWO DAYS FOR CHILDREN. IN ADDITION TO PRIMARY CARE, DENTAL SERVICES, NUTRITIONAL COUNSELING, PRENATAL CARE AND ENDOCRINE SERVICES, THE CLINIC PROVIDES MENTAL HEALTH AND SUBSTANCE ABUSE COUNSELING. HEALTH SCREENING DAY IS ALSO HELD ANNUALLY IN COLLABORATION WITH LOCAL HEALTHCARE PROVIDERS AND INSTITUTIONS. G) THE DAVID E. ROGERS CENTER FOR HIV/AIDS CARE (DRC) provides comprehensive HIV medical care, with 24/7 on call service; mental health counseling; psychiatry care; medical case management with treatment adherence; nutritional counseling; Hepatitis C treatment; Pre-Exposure Prophylaxis (PrEP) care; Post-Exposure Prophylaxis (PEP) care; free HIV testing; help with advocacy, case management, entitlements, and legal service; Wellness Fund, financial support for patient's special needs; and other support services to people living with HIV/AIDS. The Center also provides education and outreach to affected friends and families. From initial diagnosis of HIV through all stages of illness, our medical team of credentialed HIV specialists provides state-of-the-art care. SINCE 1994 THE DRC HAS PROVIDED HIV CARE TO RESIDENTS OF THE EAST END OF LONG ISLAND, A GEOGRAPHIC AREA PREVIOUSLY UNDERSERVED DESPITE A HIGH HIV PREVALENCE RATE. FROM ITS INCEPTION, THE DRC HAS ENJOYED THE COOPERATIVE EFFORTS OF ITS PARTNER ORGANIZATIONS SOUTHAMPTON HOSPITAL AND THE STONY BROOK UNIVERSITY MEDICAL CENTER AS WELL AS THE SUPPORT OF THE COMMUNITIES OF THE EAST END. THE CENTER HAS MET ITS OBJECTIVES BY PROVIDING CONTINUITY AND ACCESSIBILITY OF CARE BY ESTABLISHING LINKAGES BETWEEN THE HOSPITALS AND WITH COMMUNITY BASED ORGANIZATIONS AND THE COMMUNITY AT LARGE. THE DRC DEPENDS ON THE COOPERATIVE EFFORTS OF ALL HEALTH & HUMAN SERVICE AGENCIES FOR OUTREACH, TO ENSURE A CONTINUITY OF CARE FOR OUR PATIENTS, AND TO PROVIDE SERVICES FOR THE EAST END COMMUNITY. Annually the DRC provides approximately: 844 Medical visits; 56 Hepatitis C visits; 561 Mental Health/Social Work visits; 229 Psychiatry visits; 32 Nutritional Counseling visits; 21 HIV Testing visits; 14 Pre-Exposure Prophylaxis (PrEP) visits; 4 Occupational Exposure visits; 10 Post Exposure Prophylaxis (PEP) visits; for a total of 1,771 visits provided for 219 active patients. H) CENTER FOR PRENATAL CARE - THE CENTER FOR PRENATAL CARE AT GREENPORT PROVIDES COMPREHENSIVE PRENATAL, GYNECOLOGIC AND FAMILY PLANNING SERVICES FOR WOMEN AND IS AN IMPORTANT OUTREACH ACTIVITY THAT PERMITS THE HOSPITAL TO TAILOR ITS PROGRAMS TO COMMUNITY NEEDS. THE CENTER'S STAFF PROVIDES EXTENSIVE EDUCATION AND COUNSEL TO THEIR PATIENTS IN THE AREAS OF NUTRITION, CHILDBIRTH EDUCATION, DOMESTIC VIOLENCE, AS WELL AS DRUG AND ALCOHOL ABUSE, WHILE ALSO PROVIDING IMMEDIATE ACCESS TO MEDICAID ASSISTANCE, FOR MOTHERS MEETING THE ELIGIBILITY REQUIREMENTS, THROUGH THE PRENATAL CARE ASSISTANCE PROGRAM (PCAP). THE CENTER HAS SUCCESSFULLY WORKED WITH THE LOCAL TOWN GOVERNMENT TO OBTAIN THE AGREEMENT OF LOCAL GROCERS TO ACCEPT WIC VOUCHERS. STAFF ALSO UTILIZES FLYERS, BROCHURES, AND POSTERS TO INCREASE AWARENESS OF HOSPITAL SERVICES AND OFFERS TRANSLATION SERVICES TO THE SIGNIFICANT NUMBER OF HISPANIC WOMEN SEEKING CARE AT THE CENTER. THE CENTER RECENTLY STARTED IMPLEMENTING GENETIC SCREEING, WHICH IS AVAILABLE TO ALL ITS PATIENTS AND CAN BE PERFORMED AT 10 WEEKS GESTATION. THE SCREENING INCLUDES TESTING FOR DOWN SYNDROME CF, AS WELL AS PROVIDING THE SEX OF THE CHILD. THE CENTER PROVIDES PRENATAL CARE TO APPROXIMATELY 50 MOTHERS ANNUALLY IN AN UNDERSERVED AND GEOGRAPHICALLY REMOTE AREA. ALL OF THESE BABIES ARE BORN AT SOUTHAMPTON HOSPITAL. IN ADDITION, THE ORGANIZATION IS PROUD OF THE EXCEPTIONAL SPECIALTY SERVICES IT PROVIDES TO THE COMMUNITY. THESE INCLUDE: 1) Audrey and Martin Gruss Heart & Stroke Center - opened in April 2015, providing vascular surgery and diagnostics in a state-of-the-art operating suite. This is particularly critical to the Hospital's service area since the nearest tertiary medical center is 46 miles away in Stony Brook, NY. 2) Tick-Borne Disease Resource Center - established in 2014, was created in response to a growing concern for diseases that are prevalent in the East End population due to several varieties of ticks found in the area. The Resource Center educates the public, promotes collaboration in the medical community, and facilitates access to diagnosis and treatment of tick-borne diseases. We maintain a dedicated phone "help" line for advice, include information about the complex set of tick-borne diseases on the Hospital website, and raise public awareness by presenting educational programs throughout the East End community. 3) THE ELLEN HERMANSON BREAST CENTER - OFFERS A WIDE SPECTRUM OF BREAST HEALTH SERVICES, INCLUDING EDUCATION, EARLY DETECTION SCREENINGS, SURGERY, BREAST CANCER TREATMENT AND SUPPORT. ACCREDITED BY THE AMERICAN COLLEGE OF RADIOLOGY, THE CENTER UTILIZES STATE-OF-THE-ART DIAGNOSTIC TECHNIQUES, INCLUDING COMPUTER-ASSISTED MAMMOGRAPHY, TOMOSYNTHESIS, ULTRASOUND AND BREAST BIOPSY. 4) THE ED & PHYLLIS DAVIS WELLNESS INSTITUTE - OFFERS THE ONLY HOSPITAL-BASED INTEGRATIVE MEDICINE ON LONG ISLAND'S EAST END. INTEGRATIVE MEDICINE COMBINES MODERN SCIENCE, PSYCHOLOGY, NUTRITION, AND EXERCISE TO ENHANCE THE NATURAL HEALING CAPACITY OF THE BODY. SPECIAL PROGRAMS ARE AVAILABLE FOR PATIENTS SUFFERING FROM CHRONIC ILLNESS. CLASSES IN YOGA, TAI CHI, PILATES, ZUMBA, ARE AVAILABLE. PROGRAMS IN STRESS MANAGEMENT, NUTRITIONAL AND WEIGHT LOSS COUNSELING, SMOKING CESSATION, MASSAGE THERAPY, AND ACUPUNCTURE ARE ALSO AVAILABLE. 5) THE JENNY AND JOHN PAULSON DEPARTMENT OF EMERGENCY MEDICINE - SERVES MORE THAN 25,000 EMERGENCY PATIENTS ANNUALLY AND IS THE ONLY HOSPITAL-BASED EMERGENCY CARE ON THE SOUTH FORK OF LONG ISLAND. STAFFED 24/7 BY BOARD-CERTIFIED EMERGENCY PHYSICIANS

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 expenses122,966,280

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	4,266,680	0	375,209

1a	Federated campaigns..		1a	154,999
b	Membership dues..		1b
c	Fundraising events..		1c
d	Related organizations		1d	3,836,837
e	Government grants (contributions)		1e	1,337,758

f	All other contributions, gifts, grants, and similar amounts not included above		1f	156,607

g	Noncash contributions included in lines 1a-1f:$
h Total.Add lines 1a-1f.......		5,486,201

		Business Code
2a	INPATIENT SERVICES	624200	71,097,679	71,097,679
b	OUTPATIENT SERVICES	624200	69,793,025	69,793,025
c	LABORATORY EXTENDED SERVICES	621500	2,825,351		2,825,351
d	LESS: PROVISION FOR UNCOLLECTIBLES, NET	624200	-6,400,000	-6,400,000
e	LABORATORY REVENUE	621500	675,848	675,848
f	All other program service revenue.			567,035	128,725	438,310
g Total.Add lines 2a–2f.....			138,558,938

3 Investment income (including dividends, interest, and othersimilar amounts) ..........			262,256			262,256
4 Income from investment of tax-exempt bond proceeds			0
5 Royalties...........			0
		(ii) Personal	(i) Real
6a	Gross rents		851,116
b	Less: rental expenses
c	Rental income or (loss)	0	851,116
d	Net rental income or (loss)......			851,116			851,116
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory		5,133,649
b	Less: cost or other basis and sales expenses		4,582,614
c	Gain or (loss)		551,035
d	Net gain or (loss).....			551,035			551,035
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	SHINNECOCK 3RD PARTY		900099	34,388			34,388
b	VENDOR REBATES		900099	6,940			6,940
c	FILM COPIES		900099	5,816			5,816
d	All other revenue ....			114,402			114,402
e	Total. Add lines 11a–11d ......			161,546
12	Total revenue. See Instructions......			145,871,092	135,295,277	3,263,661	1,825,953

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 ....	1,880,554		1,880,554
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	65,418,405	56,914,012	8,504,393
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	4,875,532	4,241,713	633,819
9	Other employee benefits .......	12,869,163	11,196,172	1,672,991
10	Payroll taxes ...........	4,706,440	4,094,603	611,837
11	Fees for services (non-employees):
a	Management ......	841,623	732,212	109,411
b	Legal .........	620,724		620,724
c	Accounting ...........	310,362		310,362
d	Lobbying ...........	27,711	24,108	3,603
e	Professional fundraising services. See Part IV, line 17	0
f	Investment management fees ......	104,955		104,955
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	5,884,315	5,119,354	764,961
12	Advertising and promotion ....	6,979	6,072	907
13	Office expenses .......	17,731,744	15,426,617	2,305,127
14	Information technology ......	2,105,230	1,831,550	273,680
15	Royalties ..	0
16	Occupancy ...........	1,832,595	1,594,358	238,237
17	Travel ............	323,800		323,800
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .	0
19	Conferences, conventions, and meetings ....	6,258		6,258
20	Interest ...........	1,501,747	1,306,520	195,227
21	Payments to affiliates .......	0
22	Depreciation, depletion, and amortization ..	6,954,633	6,050,531	904,102
23	Insurance ...	2,443,424	2,125,779	317,645
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	OTHER PURCHASE SERVICES	10,113,736	8,798,950	1,314,786
b	UTILITIES	1,981,661	1,724,045	257,616
c	OTHER DIRECT EXPENSES	1,652,136	1,437,358	214,778
d	MISCELLANEOUS	684,651	342,326	342,325
e	All other expenses
25	Total functional expenses. Add lines 1 through 24e	144,878,378	122,966,280	21,912,098	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 ........			3,966,458	1	1,032,639
2	Savings and temporary cash investments .........			1,979,735	2	5,682,148
3	Pledges and grants receivable, net ......			0	3	0
4	Accounts receivable, net .............			18,825,248	4	18,258,115
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 ........			2,178,899	8	3,088,612
9	Prepaid expenses and deferred charges ......			553,011	9	838,534
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	178,298,208
b	Less: accumulated depreciation	10b	119,503,786	57,061,494	10c	58,794,422
11	Investments—publicly traded securities .			0	11	0
12	Investments—other securities. See Part IV, line 11 .....			26,787,892	12	26,118,484
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 ...........			979,426	15	6,980,187
16	Total assets. Add lines 1 through 15 (must equal line 34)...			112,332,163	16	120,793,141

17	Accounts payable and accrued expenses .....	21,142,884	17	25,155,912
18	Grants payable ...	0	18	0
19	Deferred revenue .........	0	19	0
20	Tax-exempt bond liabilities .........	33,500,000	20	33,500,000
21	Escrow or custodial account liability. Complete Part IV of Schedule D	0	21	0
22	Loans and other payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
	persons. Complete Part II of Schedule L..	0	22	0
23	Secured mortgages and notes payable to unrelated third parties ..	6,794,600	23	8,344,501
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	20,980,814	25	25,945,677
26	Total liabilities. Add lines 17 through 25..	82,418,298	26	92,946,090

	Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets	26,211,281	27	24,209,575
28	Temporarily restricted net assets ...........	868,566	28	803,459
29	Permanently restricted net assets	2,834,018	29	2,834,017
	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 ...........	29,913,865	33	27,847,051
34	Total liabilities and net assets/fund balances ........	112,332,163	34	120,793,141