Attach to Form 990 or Form 990-EZ.
Go to
www.irs.gov/Form990 for the latest information.
| (i) Name of supported organization | (ii) EIN | (iii) Type of organization (described on lines 1- 10 above (see instructions)) | (iv) Is the organization listed in your governing document? | (v) Amount of monetary support (see instructions) | (vi) Amount of other support (see instructions) | |
|---|---|---|---|---|---|---|
| Yes | No | |||||
| (A)
MONTEFIORE MEDICAL CENTER |
131740114 | 3 | Yes | 0 | 0 | |
| (B)
MONTEFIORE NEW ROCHELLE HOSPITAL |
462931956 | 3 | Yes | 0 | 0 | |
| (C)
MONTEFIORE MOUNT VERNON HOSPITAL |
462916938 | 3 | Yes | 0 | 0 | |
| (D)
SCHAFFER EXTENDED CARE CENTER |
462929888 | 3 | Yes | 0 | 0 | |
| (E)
MONTEFIORE NYACK HOSPITAL |
131740119 | 3 | Yes | 0 | 0 | |
| (F)
WHITE PLAINS HOSPITAL MEDICAL CENTER |
131740130 | 3 | Yes | 0 | 0 | |
| (G)
THE WINIFRED MASTERSON BURKE REHABILITATION HOSPITAL |
131739937 | 3 | Yes | 0 | 0 | |
| (H)
ST LUKE'S CORNWALL HOSPITAL |
141340054 | 3 | Yes | 0 | 0 | |
| (I)
ALBERT EINSTEIN COLLEGE OF MEDICINE |
472209056 | 2 | Yes | 0 | 0 | |
|
Total 9
|
0 | 0 | ||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2014 | (b) 2015 | (c) 2016 | (d) 2017 | (e) 2018 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") .. | ||||||
| 2 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.... | ||||||
| 3 | The value of services or facilities furnished by a governmental unit to the organization without charge.. | ||||||
| 4 | Total. Add lines 1 through 3 | ||||||
| 5 | The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f).. | ||||||
| 6 | Public support. Subtract line 5 from line 4. | ||||||
Calendar year
(or fiscal year beginning in) ![]() |
(a) 2014 | (b) 2015 | (c) 2016 | (d) 2017 | (e) 2018 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | ||||||
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources... | ||||||
| 9 | Net income from unrelated business activities, whether or not the business is regularly carried on.. | ||||||
| 10 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.).. | ||||||
| 11 | Total support. Add lines 7 through 10 | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2014 | (b) 2015 | (c) 2016 | (d) 2017 | (e) 2018 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") . | ||||||
| 2 | Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose | ||||||
| 3 | Gross receipts from activities that are not an unrelated trade or business under section 513 ..... | ||||||
| 4 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf... | ||||||
| 5 | The value of services or facilities furnished by a governmental unit to the organization without charge | ||||||
| 6 | Total. Add lines 1 through 5 | ||||||
| 7a | Amounts included on lines 1, 2, and 3 received from disqualified persons | ||||||
| b | Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year. | ||||||
| c | Add lines 7a and 7b.. | ||||||
| 8 | Public support. (Subtract line 7c from line 6.) | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2014 | (b) 2015 | (c) 2016 | (d) 2017 | (e) 2018 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | ||||||
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | ||||||
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | ||||||
| c | Add lines 10a and 10b. | ||||||
| 11 | Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on. | ||||||
| 12 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) .. | ||||||
| 13 | Total support. (Add lines 9, 10c, 11, and 12.).. | ||||||
| Section A - Adjusted Net Income | (A) Prior Year |
(B) Current Year (optional) |
||||
| 1 | Net short-term capital gain | 1 | ||||
| 2 | Recoveries of prior-year distributions | 2 | ||||
| 3 | Other gross income (see instructions) | 3 | ||||
| 4 | Add lines 1 through 3 | 4 | ||||
| 5 | Depreciation and depletion | 5 | ||||
| 6 | Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) | 6 | ||||
| 7 | Other expenses (see instructions) | 7 | ||||
| 8 | Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) | 8 | ||||
| Section B - Minimum Asset Amount | (A) Prior Year |
(B) Current Year (optional) |
||||
| 1 | Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year): | 1 | ||||
| a | Average monthly value of securities | 1a | ||||
| b | Average monthly cash balances | 1b | ||||
| c | Fair market value of other non-exempt-use assets | 1c | ||||
| d | Total (add lines 1a, 1b, and 1c) | 1d | ||||
| e |
Discount claimed for blockage or other factors (explain in detail in Part VI): |
|||||
| 2 | Acquisition indebtedness applicable to non-exempt use assets | 2 | ||||
| 3 | Subtract line 2 from line 1d | 3 | ||||
| 4 | Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions). | 4 | ||||
| 5 | Net value of non-exempt-use assets (subtract line 4 from line 3) | 5 | ||||
| 6 | Multiply line 5 by .035 | 6 | ||||
| 7 | Recoveries of prior-year distributions | 7 | ||||
| 8 | Minimum Asset Amount (add line 7 to line 6) | 8 | ||||
| Section C - Distributable Amount | Current Year | |||||
| 1 | Adjusted net income for prior year (from Section A, line 8, Column A) | 1 | ||||
| 2 | Enter 85% of line 1 | 2 | ||||
| 3 | Minimum asset amount for prior year (from Section B, line 8, Column A) | 3 | ||||
| 4 | Enter greater of line 2 or line 3 | 4 | ||||
| 5 | Income tax imposed in prior year | 5 | ||||
| 6 | Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions) | 6 | ||||
| Section D - Distributions | Current Year | |
|---|---|---|
| 1 Amounts paid to supported organizations to accomplish exempt purposes | ||
|
2
Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity |
||
| 3 Administrative expenses paid to accomplish exempt purposes of supported organizations | ||
| 4 Amounts paid to acquire exempt-use assets | ||
| 5 Qualified set-aside amounts (prior IRS approval required) | ||
| 6 Other distributions (describe in Part VI). See instructions | ||
| 7Total annual distributions. Add lines 1 through 6. | ||
|
8
Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions |
||
| 9 Distributable amount for 2018 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-2018 |
(iii) Distributable Amount for 2018 |
|
|---|---|---|---|---|
|
1
Distributable amount for 2018 from Section C, line 6 |
||||
|
2
Underdistributions, if any, for years prior to 2018 (reasonable cause required-- explain in Part VI). See instructions. |
||||
| 3 Excess distributions carryover, if any, to 2018: | ||||
| a From 2013....... | ||||
| b From 2014....... | ||||
| c From 2015....... | ||||
| d From 2016....... | ||||
| e From 2017....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2018 distributable amount | ||||
|
i
Carryover from 2013 not applied (see instructions) |
||||
| j Remainder. Subtract lines 3g, 3h, and 3i from 3f. | ||||
| 4Distributions for 2018 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2018 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from 4. | ||||
|
5
Remaining underdistributions for years prior to 2018, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions. |
||||
|
6
Remaining underdistributions for 2018. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions. |
||||
|
7 Excess distributions carryover to 2019. Add lines 3j and 4c. |
||||
| 8 Breakdown of line 7: | ||||
| a Excess from 2014...... | ||||
| b Excess from 2015..... | ||||
| c Excess from 2016..... | ||||
| d Excess from 2017..... | ||||
| e Excess from 2018..... | ||||
| Facts And Circumstances Test |
|---|
| Return Reference | Explanation |
|---|---|
| Part IV, Section A, Line 1 | The organization's supported organizations are designated by class. The Certificate of Incorporation reads "The corporation shall carry out such charitable purposes and operate for the benefit of (1) the integrated group of affiliated health care providers and related legal entities of which Montefiore Health System, Inc. is the direct or indirect parent corporation, (2) one or more medical schools chartered by the Board of Regents of the State of New York". |
| Part IV, Section A, Line 5a | During the tax year, the organization removed Montefiore North Ambulatory Care Center, Inc., EIN 01-0796859, as a supported organization. The entity was dissolved in 2017 and its activities merged into Montefiore Medical Center, another supported entity of the Health System. |
| Part IV, Section C, Line 1 | Montefiore Medicine Academic Health System, Inc.(System Parent) qualifies as a Type II supporting organization under Section 509(a)(3), consistent with the foregoing IRS guidelines, in a number of ways. First, there is generally expected to be significant overlap among the Officers, Trustees and other leadership of the System Parent with the Officers, Trustees and other leadership of the Supported Organizations. Currently, each of the Trustees and Officers serve as Directors, Trustees and/or Officers of one or more of the Supported Organizations. Given the overlap among the individuals responsible for the governance of both the System Parent and the Supported Organizations, and the regular coordination and interaction among the boards, officers, and other leadership of all of the entities within the Montefiore system, the System Parent will inherently have the information necessary to ensure that the System Parent will be aware of and responsive to the needs of the Supported Organizations. The nature of the System Parent's purposes and activities also demonstrate that it can and will be responsive to the needs or demands of each of its Supported Organizations and that it can and will be an integral part of, or maintain a significant involvement in, the operations of each Supported Organization. In addition, The System Parent was formed to function as the parent entity of the entire Montefiore system, in such capacity, to oversee, supervise and coordinate the missions, governance, policy making, resource allocation and strategic planning for, and provide other forms of support for the benefit of the Supported Organizations and for the Montefiore System as a whole. |
| Software ID: | |
| Software Version: |
Attach to Form 990 or 990-EZ.
Go to www.irs.gov/Form990 for the latest information.
| Return Reference | Explanation |
|---|---|
| Form 990, Part VI, Section A, Line 4 | Montefiore Medicine Academic Health System, Inc's (MMAHS) Bylaws was amended in May 2018 to: (i) clarify that the CEO of Montefiore Health System, Inc. shall be an ex officio member of MMAHS Board of Trustees; (ii) list Montefiore Health System, Inc. as one of the entities over which the Compensation Committee shall have authority; (iii) modify the name and duties of the Real Estate and Facilities Committee among other clarifying changes. Part VI, Section B, Line 11B The form 990 was prepared by Montefiore's Finance Department with the assistance of various departments. The form 990 was reviewed and approved by the Vice-president-Finance and Montefiore's senior leadership team including the chief financial officer. In addition, an independent accounting firm was engaged to review the form 990. Upon completion of the various reviews, the form 990 was presented to the board of trustees for review and approval prior to filing. |
| Form 990, Part VI, Section B, Line 12C | The organization regularly and consistently monitors and enforces compliance with the disclosure policy by means of a survey form developed by counsel and approved by the Legal and Compliance Committees of the Board of Trustees. The survey is sent to all trustees, officers and key employees for completion. All survey responses are reviewed by the compliance officer. Any potential conflicts identified in the responses are discussed with senior management and/or the Legal and Compliance Committees of the Board of Trustees. Potential actions to be taken in response to a conflict would be one or more of the following: 1)Disclosure of conflict; 2)Individual recusal from decisions for transactions where that individual may have a conflict; 3) Request the individual to alleviate the conflict; or 4)Removal of the individual from the Board of Trustees. |
| Form 990, Part VI, Section B, Line 15A & Line 15B | Montefiore Medicine Academic Health System, Inc. is committed to ensuring that its executive compensation program adheres to the highest standards of regulatory compliance and best corporate governance. The Board of Trustees has charged the Compensation Committee of the Board (which is comprised of independent Board members with no conflicts of interest in regards to executive compensation) with making all decisions related to compensation for officers and key employees. All decisions made by the Compensation Committee are appropriately and timely documented in meeting minutes. The compensation committee's review process follows the Intermediate Sanctions guidelines for qualifying for the rebuttable presumption of reasonableness. The Committee retains an independent compensation consultant to assist it with this process. Compensation levels are established considering data for comparable organizations, an assessment of management performance (including the services provided to the community), and other business judgment factors, consistent with Montefiore's executive compensation philosophy. The Committee's decisions are made in the best interest of Montefiore, and are intended to ensure the recruitment and retention of key executive talent, consistent with the market practices of other not-for-profit healthcare organizations of comparable scope, mission and complexity. On an annual basis, the Committee provides the full Board of Trustees with a description of the committee's review and approval process and its decisions. |
| Form 990, Part VI, Section C, Line 19 | The conflicts of interest policy and governing documents are made available upon request. |
| Form 990, Part IX, Lines 8, 9 & 10 | Concerning Employee Benefits Allocation: All employees benefit costs, including pension and payroll taxes, for the system's parent organizations are charged to Montefiore Medical Center. The Medical Center, in turn, assesses the Parent organizations for a composite rate based on salaries for all benefit costs. The organization's assessment for employee benefits is reflected on line 9, other employee benefits, of Part IX that includes cost for both pension and payroll taxes. |
| Form 990, Part XI, Line 9 | The Other changes in net assets increase of $76,243 was due to a reclassification of intercompany donations. |
| Software ID: | |
| Software Version: |