TY 2018 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) KATHRYN KRAUSE ROONEY ESQ...................................................................... CHAIRPERSON	1.00 .................	X	X	0	0
(2) RONALD PURPORA...................................................................... VICE CHAIR	1.00 .................	X	X	0	0
(3) CATHERINE M PAULO ESQ...................................................................... SECRETARY	1.00 .................	X	X	0	0
(4) GINA GUTZEIT...................................................................... TREASURER & FINANCE CHAIR	1.00 .................	X	X	0	0
(5) DANIEL MESSINA...................................................................... PRESIDENT & CEO	37.50 ................. 2.00	X	X	834,610	185,096
(6) PIETRO CARPENITO MD...................................................................... TRUSTEE	37.50 .................	X		482,796	77,288
(7) REV DR TONY BAKER SR...................................................................... TRUSTEE	1.00 .................	X		0	0
(8) KATHERINE ANNE CONNORS...................................................................... TRUSTEE	1.00 .................	X		0	0
(9) THOMAS DELMASTRO...................................................................... TRUSTEE	1.00 .................	X		0	0
(10) SARA WARREN GARDNER MPH...................................................................... TRUSTEE	1.00 .................	X		0	0
(11) JAMES P MOLINARO...................................................................... TRUSTEE	1.00 .................	X		0	0
(12) JILL O'DONNELL-TORMEY PHD...................................................................... TRUSTEE	1.00 .................	X		0	0
(13) DENNIS W QUIRK...................................................................... TRUSTEE	1.00 .................	X		0	0
(14) JOHN C SANTORA...................................................................... TRUSTEE	1.00 ................. 1.00	X		0	0
(15) JOHN VINCENT SCALIA SR...................................................................... TRUSTEE	1.00 .................	X		0	0
(16) PANKAJ R PATEL...................................................................... TRUSTEE/CHAIR OF PSYCHIATRY	40.00 ................. 1.00	X		81,150	0
(17) SAMALA SWAMY MD...................................................................... TRUSTEE	40.00 .................	X		189,995	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) ALAN BERNIKOW........................................................................ TRUSTEE	1.00 .......................	X				0	0
(19) STEVEN KLEIN........................................................................ TRUSTEE	1.00 .......................	X				0	0
(20) ALLAN WEISSGLASS........................................................................ TRUSTEE	1.00 .......................	X				0	0
(21) MARIANNE LABARBERA MD........................................................................ TRUSTEE/PRES MED STAFF	40.00 .......................	X				138,928	398
(22) FRANK SCAFURI MD........................................................................ TRUSTEE (UNTIL 06/18)	1.00 .......................	X				0	0
(23) MITCHELL FOGEL MD........................................................................ SENIOR VP/CHAIR OF MEDICIN	40.00 .......................		X			470,054	69,737
(24) JOSEPH SAPORITO........................................................................ SENIOR VP & CFO	37.50 .......................2.00		X			528,066	73,907
(25) ROSEMARIE STAZZONE........................................................................ SENIOR VP NURSING & CNO	37.50 .......................			X		570,084	58,486
(26) RICHARD SALHANY........................................................................ SENIOR VP PROFESSIONAL SER	37.50 .......................1.00			X		416,209	65,361
(27) MICHAEL L MORRETTI........................................................................ CHAIRMAN OF OB/GYN	37.50 .......................			X		832,740	43,337
(28) LOREN HARRIS MD........................................................................ MEDICAL CHAIRMAN	40.00 .......................			X		755,465	25,825
(29) ELI SERUR........................................................................ PHYSICIAN	40.00 .......................				X	982,471	43,228
(30) DOUGLAS COHEN MD........................................................................ PHYSICIAN	40.00 .......................				X	741,222	43,228
(31) VLADIMIR RUBINSHTEY........................................................................ PHYSICIAN	37.50 .......................				X	619,822	37,837
(32) XIN Y LI........................................................................ PHYSICIAN	40.00 .......................				X	509,689	37,837
(33) PHILLIP OTTERBECK........................................................................ PHYSICIAN	40.00 .......................1.00				X	519,999	20,325

(A) Name and business address	(B) Description of services	(C) Compensation
RICHMOND EMERGENCY ASSOCIATES 3 CENTURY DRIVE PARSIPPANY,NJ07054	EMERGENCY ROOM DOCTOR STAFFING	1,862,430
RESTORIX HEALTH 445 HAMILTON AVE 800 WHITE PLAINS,NY10601	WOUND CARE SERVICES	876,868
DIALYSIS CLINICAL INC (DCI) 800 CASTLETON AVE STATEN ISLAND,NY10310	ACUTE SERVICES FEES	840,415
NEXERA CONSULTING 555 WEST 57TH ST 15TH FLOOR NEW YORK,NY10019	PURCHASING SERVICES	531,215
RN STAFFING SOLUTIONS LLC 1672 VICTORY BLVD STATEN ISLAND,NY10314	STAFFING	516,425
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.
right arrow

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2018

Open to Public
Inspection

Name of the organization

RICHMOND MEDICAL CENTER

Employer identification number

74-3177454

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 12, 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 agricultural research organization described in 170(b)(1)(A)(ix) operated in conjunction with a land-grant college or university or a non-land grant college of agriculture. See instructions. Enter the name, city, and state of the college or university:

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 12a through 12d that describes the type of supporting organization and complete lines 12e, 12f, and 12g.

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) 2018

Page 2

Part II

Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv), 170(b)(1)(A)(vi), and 170(b)(1)(A)(ix)
(Complete only if you checked the box on line 5, 7, 8, or 9 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) 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.

Section B. Total Support

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

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 2018 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2017 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2018. 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—2017. 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—2018. 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—2017. 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) 2018

Page 3

Part III

Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 10 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) 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.)

Section B. Total Support

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.)..

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 2018 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2017 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2018 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2017 Schedule A, Part III, line 17 .............

19a

331/3% support tests—2018. 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—2017. 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) 2018

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 12 of Part I. If you checked 12a of Part I, complete Sections A and B. If you checked 12b of Part I, complete Sections A and C. If you checked 12c of Part I, complete Sections A, D, and E. If you checked 12d 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 12a or 12b 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) 2018

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) 2018

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 (explain in Part VI). 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) 2018

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 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.....

Schedule A (Form 990 or 990-EZ) (2018)

Schedule A (Form 990 or 990-EZ) 2018

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) 2018

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.

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2018

Name of the organization

RICHMOND MEDICAL CENTER

Employer identification number

74-3177454

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. Don't 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 isn't covered by the General Rule and/or the Special Rules doesn't 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 doesn't 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) (2018)

Schedule B (Form 990, 990-EZ, or 990-PF) (2018) Page 2

Name of organization RICHMOND MEDICAL CENTER

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) (2018)

Schedule B (Form 990, 990-EZ, or 990-PF) (2018)

Page 3

Name of organization RICHMOND MEDICAL CENTER		Employer identification number 74-3177454

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) (2018)

Schedule B (Form 990, 990-EZ, or 990-PF) (2018)

Page 4


Name of organization RICHMOND MEDICAL CENTER			Employer identification number 74-3177454
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) (2018)

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

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2018

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

RICHMOND MEDICAL CENTER

Employer identification number

74-3177454

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 (see instructions for definition of “political campaign activities")

Political campaign activity expenditures (see instructions) .................................................................... SchCMd Bullet

Volunteer hours for political campaign activities (see instructions) ..................................................................

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) 2018

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) 2015	(b) 2016	(c) 2017	(d) 2018	(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) 2018

Page 3

Part II-B

Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).

For each "Yes" response on lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.

(a)

Yes

(b)

Amount

During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:

Volunteers? ...........................................................................................................

Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ........

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

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

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

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

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

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

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

Yes

29,290

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

29,290

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 1:	THE HOSPITAL PAID THE FOLLOWING DUES TO NATIONAL AND STATE HOSPITAL ASSOCIATIONS, OF WHICH A PERCENTAGE WAS ALLOCABLE TO LOBBYING COSTS: HANYS - $81,039 (DUES) X 17.51% (APPROX. LOBBYING PERCENTAGE) = $14,190 GNYHA - $15,100 (DUES) X 100% (APPROX. LOBBYING PERCENTAGE) = $15,100

Schedule C (Form 990 or 990EZ) 2018

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.
SchDMd Bullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2018

Open to Public Inspection

Name of the organization

RICHMOND MEDICAL CENTER

Employer identification number

74-3177454

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 7/25/06, 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) 2018

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 ....	344,647	344,647	344,647	344,647	344,647
b	Contributions ...
c	Net investment earnings, gains, and losses
d	Grants or scholarships ...
e	Other expenditures for facilities and programs ...
f	Administrative expenses ....
g	End of year balance ......	344,647	344,647	344,647	344,647	344,647

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

Board designated or quasi-endowment SchDMd Bullet

0 %

Permanent endowment SchDMd Bullet

100.000 %

Temporarily restricted endowment SchDMd Bullet

0 %

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 .....	4,471,164		4,471,164
b	Buildings ....	47,842,635	10,996,919	36,845,716
c	Leasehold improvements	4,481,165	774,190	3,706,975
d	Equipment ....	49,842,842	33,234,980	16,607,862
e	Other .....	23,194,627	7,808,105	15,386,522
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				77,018,239

Schedule D (Form 990) 2018

Page 3

Part VII

InvestmentsOther Securities. Complete if the organization answered "Yes" on Form 990, Part IV, line 11b. See Form 990, Part X, line 12.

(a) Description of security or category (including name of security)	(b) Book value	(c) Method of valuation: Cost or end-of-year market value
(1) Financial derivatives.........
(2) Closely-held equity interests........
(3)Other
(A)
(B)
(C)
(D)
(E)
(F)
(G)
(H)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

Part VIII

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

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

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

Part IX

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

(a) Description				(b) Book value
(1) SECURITY DEPOSITS				323,777
(2) INSURANCE RECOVERIES RECEIVABLE				15,136,334
(3) SERP PENSION ASSET				837,221
(4) DUE FROM AFFILIATES				39,412,750
(5) BENEFICIAL INTEREST IN NET ASSETS OF FOUNDATION				2,687,103
(6) BOND RESERVE FUNDS				16,488,811
(7) CAPITALIZED INTEREST				4,569,389
(8) DEFERRED BOND ISSUANCE COSTS				5,030,472
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........				84,485,857

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
ESTIMATED 3RD PARTY PAYOR SETTLEMENTS	12,653,249
ESTIMATED MEDICAL MALPRACTICE CLAIMS	25,158,093
SERP LIABILITY	881,579
ACCRUED NYSNA PENSION LIABILITY	19,310,652
CAPITAL LEASES	521,532
DUE TO AFFILIATES	811,367
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	59,336,472
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) 2018

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	334,716,677
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains (losses) on investments ....	2a	-92,674
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIII.) ............	2d	-23,372,116
e	Add lines 2a through 2d .....................			2e	-23,464,790
3	Subtract line 2e from line 1..................			3	358,181,467
4	Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b .	4a
b	Other (Describe in Part XIII.) ...........	4b	-1,257,074
c	Add lines 4a and 4b....................			4c	-1,257,074
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......			5	356,924,393

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	322,030,877
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	1,257,074
e	Add lines 2a through 2d....................			2e	1,257,074
3	Subtract line 2e from line 1...................			3	320,773,803
4	Amounts included on Form 990, Part IX, line 25, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b ..	4a
b	Other (Describe in Part XIII.) ............	4b	22,088,239
c	Add lines 4a and 4b.....................			4c	22,088,239
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......			5	342,862,042

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:	THE ENDOWMENT FUND, ALSO KNOWN AS THE BELL SOCIETY ENDOWMENT FUND, IS INTENDED TO BENEFIT THE WORK OF THE MEDICAL CENTER. NO OTHER RESTRICTIONS HAVE BEEN PLACED ON THE USE OF THE INTEREST THAT IS EARNED ON THE PRINCIPAL BALANCE.
PART XI, LINE 2D - OTHER ADJUSTMENTS:	BAD DEBT EXPENSE NETTED AGAINST REVENUES ON FINANCIALS -22,088,239. PENSION LIABILITY ADJUSTMENT 43,143. CHANGE IN BENEFICIAL INTEREST IN THE FOUNDATION -1,138,514. GAIN ON TERMINATION OF LEASE 238,255. LOSS ON EXTINGUISHMENT OF DEBT -426,761.
PART XI, LINE 4B - OTHER ADJUSTMENTS:	RENTAL EXPENSES -1,257,074.
PART XII, LINE 2D - OTHER ADJUSTMENTS:	RENTAL EXPENSES 1,257,074.
PART XII, LINE 4B - OTHER ADJUSTMENTS:	BAD DEBT EXPENSE NETTED AGAINST REVENUES ON FINANCIALS 22,088,239.

Schedule D (Form 990) 2018

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

Go to www.irs.gov/Form990EZ for instructions and the latest information.

OMB No. 1545-0047

2018

Open to Public Inspection

Name of the organization

RICHMOND MEDICAL CENTER

Employer identification number

74-3177454

Part I

Financial Assistance and Certain Other Community Benefits at Cost

Yes

Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a . . . .

Yes

If "Yes," was it a written policy? ......................

Yes

If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.

Applied uniformly to all hospital facilities Applied uniformly to most hospital facilities Generally tailored to individual hospital facilities

Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.

Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?

If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:

Yes

100% 150% 200% Other %

Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate

which of the following was the family income limit for eligibility for discounted care: . . . . . . . .

Yes

200% 250% 300% 350% 400% Other %

If the organization used factors other than FPG in determining eligibility, describe in Part VI the criteria used for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.

Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? . . . . . . . . . . . . .

Yes

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

Yes

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

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

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

Yes

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

Yes

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

Financial Assistance and Certain Other Community Benefits at Cost

Financial Assistance and Means-Tested Government Programs		(c) Total community benefit expense	(d) Direct offsetting revenue	(e) Net community benefit expense	(f) Percent of total expense
a	Financial Assistance at cost (from Worksheet 1) . . .	7,964,250	2,911,423	5,052,827	1.580 %
b	Medicaid (from Worksheet 3, column a) . . . . .	91,455,683	77,666,444	13,789,239	4.300 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .
d	Total Financial Assistance and Means-Tested Government Programs . . . . .	99,419,933	80,577,867	18,842,066	5.880 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).
f	Health professions education (from Worksheet 5) . . .	36,189,708	12,148,088	24,041,620	7.490 %
g	Subsidized health services (from Worksheet 6) . . . .	26,204,716	16,619,865	9,584,851	2.990 %
h	Research (from Worksheet 7) .
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .
j	Total. Other Benefits . .	62,394,424	28,767,953	33,626,471	10.480 %
k	Total. Add lines 7d and 7j .	161,814,357	109,345,820	52,468,537	16.360 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2018

Schedule H (Form 990) 2018

Page

Part II

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

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

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................

Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......

5,940,501

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. ......

1,782,150

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).....

64,630,426

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

52,362,300

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

12,268,126

Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

Did the organization have a written debt collection policy during the tax year? ..........

Yes

If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year
contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI .........................

Yes

Part IV

Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)

(a) Name of entity	(b) Description of primary activity of entity	(c) Organization's profit % or stock ownership %	(d) Officers, directors, trustees, or key employees' profit % or stock ownership %	(e) Physicians' profit % or stock ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13

Schedule H (Form 990) 2018

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?1Name, address, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility)
1	RICHMOND MEDICAL CENTER 355 BARD AVENUE STATEN ISLAND,NY10310 7004010H	X	X	X	X

Schedule H (Form 990) 2018

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)

	RICHMOND MEDICAL CENTER
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

The impact of any actions taken to address the significant health needs identified in the hospital facility's prior CHNA(s)

Other (describe in Section C)

Indicate the tax year the hospital facility last conducted a CHNA: 20 16

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.RUMCSI.ORG/COMMUNITYHEALTHNEEDSASSESSMENT

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 16

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

Yes

If "Yes" (list url): WWW.RUMCSI.ORG/COMMUNITYHEALTHNEEDSASSESSMENT

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) 2018

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	RICHMOND MEDICAL CENTER
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility have in place during the tax year a written financial assistance policy that:

Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care?

Yes

If “Yes,” indicate the eligibility criteria explained in the FAP:

Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of 100.000000000000% and FPG family income limit for eligibility for discounted care of 300.000000000000%

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)

Was widely publicized 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):

RUMCSI.ORG/UPLOADS/PUBLIC/DOCUMENTS/FINANCIAL%20ASSISTANCE%20POLICY%20WEBSI

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

RUMCSI.ORG/UPLOADS/PUBLIC/DOCUMENTS/INITIAL%20APPLICATION.PDF

A plain language summary of the FAP was widely available on a website (list url):
RUMCSI.ORG/FINANCIALASSISTANCESUMMARY

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)

Individuals were notified about the FAP by being offered a paper copy of the plain language summary of the FAP, by
receiving a conspicuous written notice about the FAP on their billing statements, and via conspicuous public displays or
other measures reasonably calculated to attract patients' attention

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

The FAP, FAP application form, and plain language summary of the FAP were translated into the primary language(s)
spoken by LEP populations

Other (describe in Section C)

Schedule H (Form 990) 2018

Page 6

Part VFacility Information (continued)

Billing and Collections

	RICHMOND MEDICAL CENTER
Name of hospital facility or letter of facility reporting group

Yes

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 nonpayment?..................................

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

Deferring, denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

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

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

Deferring , denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

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):

Provided a written notice about upcoming ECAs (Extraordinary Collection Action) and a plain language summary of the
FAP at least 30 days before initiating those ECAs

Made a reasonable effort to orally notify individuals about the FAP and FAP application process

Processed incomplete and complete FAP applications

Made presumptive eligibility determinations

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)

Schedule H (Form 990) 2018

Page 7

Part VFacility Information (continued)

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

	RICHMOND MEDICAL CENTER
Name of hospital facility or letter of facility reporting group

Yes

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 a look-back method based on claims allowed by Medicare fee-for-service during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicaid, either alone or in combination with
Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month
period

The hospital facility used a prospective Medicare or Medicaid method

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) 2018

Page 8

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, 16j, 18e, 19e, 20e, 21c, 21d, 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
RICHMOND MEDICAL CENTER	PART V, SECTION B, LINE 5: COMMUNITY INPUT WAS A SIGNIFICANT ASPECT OF THE COMMUNITY HEALTH NEEDS ASSESSMENT. RUMC COLLABORATED WITH THE NEW YORK CITY DEPARTMENT OF HEALTH AND MENTAL HYGIENE TO OBTAIN COMMUNITY MEMBER INPUT. THE HEALTH DEPARTMENT HELD COMMUNITY CONSULTATIONS IN NEIGHBORHOODS ACROSS THE CITY, INCLUDING STATEN ISLAND, BETWEEN OCTOBER 2015 AND MARCH 2016. THEY SPOKE WITH MORE THAN 800 NEW YORKERS ABOUT TAKE CARE NEW YORK 2020 (TCNY 2020) GOALS AND LOCAL PRIORITIES FOR CHANGE. TAKE CARE NEW YORK 2020 IS THE CITY'S PLAN TO IMPROVE RESIDENT HEALTH AND ADDRESS HEALTH DISPARITY. THE INPUT RECEIVED AT THE COMMUNITY CONSULTATIONS WILL HELP RUMC COLLABORATE WITH THE HEALTH DEPARTMENT AND THE COMMUNITY TO PLAN FOR ACTION.TO AUGMENT THE COMMUNITY CONSULTATIONS, AN ONLINE KEY INFORMANT SURVEY WAS CONDUCTED IN AUGUST 2016 TO SOLICIT INPUT FROM COMMUNITY LEADERS REPRESENTING THE BROAD INTERESTS OF THE COMMUNITY, INCLUDING EXPERTS IN PUBLIC HEALTH AND INDIVIDUALS REPRESENTING MEDICALLY UNDERSERVED, LOW-INCOME, AND MINORITY POPULATIONS. KEY INFORMANTS WERE ASKED A SERIES OF QUESTIONS ABOUT THEIR PERCEPTIONS OF HEALTH NEEDS IN THE COMMUNITY, HEALTH DRIVERS, BARRIERS TO CARE, QUALITY AND RESPONSIVENESS OF HEALTH PROVIDERS, AND RECOMMENDATIONS FOR COMMUNITY HEALTH IMPROVEMENT.AT EACH COMMUNITY CONSULTATION HOSTED BY THE HEALTH DEPARTMENT, PARTICIPANTS WERE ASKED TO RANK THE INDICATORS OUTLINED IN THE TCNY 2020 PLAN ACCORDING TO ORDER OF IMPORTANCE FOR THE LOCAL COMMUNITY, WHERE THE #1 RANK REPRESENTS THE MOST IMPORTANT INDICATOR. ADDITIONALLY, PARTICIPANTS WERE ENGAGED IN DISCUSSIONS ABOUT THE HEALTH GOALS OF THE LOCAL COMMUNITY AND LOCAL ASSETS THAT CAN HELP ACHIEVE THOSE GOALS.
RICHMOND MEDICAL CENTER	PART V, SECTION B, LINE 11: RUMC COMPLETED A COMMUNITY HEALTH NEEDS ASSESSMENT WHICH HAS IDENTIFIED THE PREVENTION AND MANAGEMENT OF CHRONIC DISEASE AND ITS UNDERLYING CAUSES AS THE SINGLE MOST IMPORTANT HEALTH NEED FACING THE BOROUGH OF STATEN ISLAND WHERE SIGNIFICANT DISPARITIES EXIST ACROSS ETHNICITIES DUE TO SOCIOECONOMIC FACTORS. THE DECISION WAS SUPPORTED BY SURVEY RESPONDENTS WHO WERE QUERIED AS TO THEIR PREFERENCE FOR ADDRESSING THE 5 PRIORITY AREAS OUTLINED IN THE STATE'S PREVENTION AGENDA. RUMC HAS DECIDED TO ALIGN ITS INTERVENTIONS WITH THOSE RECOMMENDED BY THE NYS PREVENTION AGENDA 2013 - 2017 AND NYC TAKE CARE NEW YORK IN DEVELOPING ITS IMPLEMENTATION STRATEGY. TOWARD THAT END WE FEEL WE HAVE ADDRESSED THE HIGH PRIORITY AREAS NEEDS AREAS AND THE PLAN AND OUR INTERVENTIONS ARE DISCUSSED MORE FULLY IN PART VI. RUMC LEADERSHIP RECOGNIZES THAT THE HOSPITAL CAN HAVE THE GREATEST IMPACT ON THE COMMUNITY BY FOCUSING HEALTH IMPROVEMENT EFFORTS ON THE MOST PRESSING NEEDS IDENTIFIED FROM THE CHNA RESEARCH. RUMC WILL CONTINUE EXISTING EFFORTS AND WILL LEND SUPPORT TO OTHER LEAD ORGANIZATIONS, BUT WILL NOT DEVELOP A SPECIFIC FOCUS FOR THE FOLLOWING NEW YORK STATE PREVENTION AGENDA PRIORITIES:- PROMOTE A HEALTHY AND SAFE ENVIRONMENT- PROMOTE HEALTHY WOMEN, INFANTS, AND CHILDREN- PREVENT SEXUALLY TRANSMITTED DISEASES, VACCINE-PREVENTABLE DISEASES AND HEALTHCARE-ASSOCIATED INFECTIONS

Schedule H (Form 990) 2018

Page 9

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) 2018

Page 10

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 7:	THE COSTS ASSOCIATED WITH CHARITY CARE AND MEANS TESTED GOVERNMENT PROGRAMS WERE DETERMINED USING THE RATIO OF PATIENT CARE COSTS TO PATIENT CHARGES UTILIZING WORKSHEET 2 OF THE INSTRUCTIONS FOR SCHEDULE H (FORM 990). THE COSTS ASSOCIATED WITH "OTHER BENEFITS" WERE DETERMINED USING THE ACTUAL COSTS INCURRED BY THE PROGRAM USING AN INDIRECT OVERHEAD ALLOCATION, ADJUSTED FOR THE ACTUAL LOCATION OF THE PROGRAM.
PART I, LINE 7G:	THE ORGANIZATION DID NOT INCLUDE ANY COSTS ATTRIBUTABLE TO A PHYSICIAN CLINIC IN THE AMOUNT REPORTED FOR SUBSIDIZED HEALTH SERVICES ON PART I, LINE 7G.
PART I, LN 7 COL(F):	THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 24, BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $22,088,239.
PART III, LINE 2:	THE COSTS ASSOCIATED WITH BAD DEBT EXPENSE WERE DETERMINED USING THE RATIO OF PATIENT CARE COSTS TO PATIENT CHARGES UTILIZING WORKSHEET 2 OF THE INSTRUCTIONS FOR SCHEDULE H (FORM 990).
PART III, LINE 3:	THE COSTING METHODOLOGY USED TO ESTIMATE THE AMOUNT OF BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE CHARITY CARE POLICY WAS THE RATIO OF APPROVED CHARITY CARE APPLICATIONS TO TOTAL APPLICATIONS APPLIED TO SELF PAY BAD DEBTS ASSOCIATED WITH PATIENTS WHO DID NOT ADEQUATELY COMPLETE THE CHARITY CARE PAPERWORK. WE BELIEVE THAT A PORTION OF OUR BAD DEBT RESULTS FROM SERVICES PROVIDED TO PATIENTS WHO MEET THE CHARITY CARE GUIDELINES BUT WERE UNWILLING OR UNABLE TO PROVIDE THE APPROPRIATE DOCUMENTATION TO ALLOW THAT CLASSIFICATION. THESE SHOULD BE CONSIDERED COMMUNITY BENEFIT AS WE ARE STILL PROVIDING SERVICES TO THESE PATIENTS REGARDLESS OF THEIR ABILITY TO PAY.
PART III, LINE 4:	ACCOUNTS RECEIVABLE, PATIENTS, ARE REPORTED AT NET REALIZABLE VALUE. ACCOUNTS ARE WRITTEN OFF WHEN THEY ARE DETERMINED TO BE UNCOLLECTIBLE BASED UPON MANAGEMENT'S ASSESSMENT OF INDIVIDUAL ACCOUNTS. IN EVALUATING THE COLLECTABILITY OF PATIENT ACCOUNTS RECEIVABLE, THE MEDICAL CENTER ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE (WHICH INCLUDES PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE MEDICAL CENTER ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS, IF NECESSARY. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS, THE MEDICAL CENTER RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE BILLED RATES AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS.
PART III, LINE 8:	MEDICARE COSTS WERE DETERMINED USING THE RATIO OF PATIENT CARE COSTS TO PATIENT CHARGES UTILIZING WORKSHEET 2 OF THE INSTRUCTIONS FOR SCHEDULE H (FORM 990).
PART III, LINE 9B:	ALL PATIENTS WITH SELF PAY BALANCES RELATED TO SERVICES RENDERED AT RICHMOND UNIVERSITY MEDICAL CENTER ARE GIVEN THE OPPORTUNITY TO ADDRESS THEIR RESPONSIBILITY THROUGH A PAYMENT ARRANGEMENT OR A REDUCED FEE, BASED ON THE CRITERIA OF OUR FINANCIAL ASSISTANCE PROGRAM. A SLIDING FEE SCALE IS UTILIZED AND IS BASED UPON FAMILY INCOME AND NUMBER OF FAMILY MEMBERS. ALL PATIENTS WILL RECEIVE STATEMENTS AND/OR LETTERS AND ARE GIVEN THE OPPORTUNITY TO SATISFY THEIR OBLIGATION TO THE FACILITY PRIOR TO TRANSFER TO A COLLECTION AGENCY AND WRITE-OFF TO A BAD DEBT. PATIENTS WHO CANNOT AFFORD TO PAY ARE OFFERED INSTALLMENT PAYMENTS OR A REDUCTION IN BALANCE THROUGH THE FINANCIAL ASSISTANCE PROGRAM (FAP).
PART VI, LINE 2:	RICHMOND UNIVERSITY MEDICAL CENTER'S (RUMC) BOARD, ADMINISTRATION AND STAFF FUNCTION FROM AN UNDERSTANDING THAT HEALTH IS THE CORNERSTONE OF A PRODUCTIVE AND POSITIVE QUALITY-OF-LIFE FOR EVERY STATEN ISLANDER. AS SUCH, OUR FOCUS IS NOT ONLY ON HEALING THE SICK, BUT ALSO UNDERSTANDING THE ROOT CAUSE OF CONDITIONS AFFECTING STATEN ISLANDERS AND WHAT WE CAN DO TO PREVENT THE DISEASE PROCESSES PREVALENT IN OUR COMMUNITY. RUMC UTILIZES A VARIETY OF SOURCES AND APPROACHES TO IDENTIFY THE HEALTH NEEDS OF THE COMMUNITY WE SERVE.COMMUNITY BENEFIT PLANNING IS FORMULATED AROUND INFORMATION GATHERED FROM CONSOLIDATING DATA FROM NEW YORK STATE AND NEW YORK CITY DEPARTMENTS OF HEALTH AND OBTAINING PERSPECTIVES FROM KEY COMMUNITY ORGANIZATIONS AND STAKEHOLDERS ON THE CRITICAL HEALTHCARE ISSUES FACING STATEN ISLAND. THROUGH DATA OBTAINED FROM THE NEW YORK STATE DEPARTMENT OF HEALTH AND NEW YORK CITY DEPARTMENT OF HEALTH, AS WELL AS COLLABORATIONS WITH HEALTHCARE AND OTHER KEY COMMUNITY STAKEHOLDERS, RUMC COORDINATES A UNIFIED EFFORT TO PROVIDE PROGRAMS THAT IMPACT THE HEALTH AND WELL-BEING OF OUR COMMUNITY. RUMC CONDUCTED A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) IN 2016 TO GUIDE COMMUNITY HEALTH IMPROVEMENT EFFORTS ACROSS OUR PRIMARY SERVICE AREA, STATEN ISLAND. THE 2016 CHNA BUILDS UPON OUR 2013 CHNA AND WAS CONDUCTED IN A TIMELINE CONSISTENT WITH THE REQUIREMENTS SET FORTH BY THE AFFORDABLE CARE ACT FOR NON-PROFIT HOSPITALS AND THE NEW YORK STATE DEPARTMENT OF HEALTH COMMUNITY SERVICE PLAN INITIATIVE. THE PURPOSE OF THE ASSESSMENT WAS TO GATHER INFORMATION ABOUT LOCAL HEALTH NEEDS AND HEALTH BEHAVIORS. WE EXAMINED A VARIETY OF HOUSEHOLD AND HEALTH STATISTICS TO CREATE A FULL PICTURE OF THE HEALTH AND SOCIAL DETERMINANTS ACROSS STATEN ISLAND. THE FINDINGS HELP ENSURE THAT OUR INITIATIVES, ACTIVITIES AND PARTNERSHIPS MEET THE NEEDS OF OUR COMMUNITIES. QUANTITATIVE AND QUALITATIVE METHODS, REPRESENTING BOTH PRIMARY AND SECONDARY RESEARCH, WERE USED TO ILLUSTRATE AND COMPARE HEALTH TRENDS AND DISPARITIES ACROSS STATEN ISLAND. PRIMARY RESEARCH METHODS SOUGHT TO SOLICIT INPUT FROM KEY COMMUNITY STAKEHOLDERS REPRESENTING THE BROAD INTERESTS OF THE COMMUNITY, INCLUDING EXPERTS IN PUBLIC HEALTH AND INDIVIDUALS REPRESENTING MEDICALLY UNDERSERVED, LOW-INCOME, AND MINORITY POPULATIONS. SECONDARY RESEARCH METHODS SOUGHT TO IDENTIFY COMMUNITY HEALTH NEEDS AND TRENDS ACROSS GEOGRAPHIC AREAS AND POPULATIONS. THE FOLLOWING RESEARCH WAS CONDUCTED TO DETERMINE COMMUNITY HEALTH NEEDS: 1) A REVIEW OF PUBLIC HEALTH AND DEMOGRAPHIC DATA PORTRAYING THE HEALTH AND SOCIOECONOMIC STATUS OF THE COMMUNITY; AND 2) A KEY INFORMANT SURVEY WITH 30 COMMUNITY REPRESENTATIVES WAS USED TO SOLICIT FEEDBACK ON COMMUNITY HEALTH PRIORITIES, UNDERSERVED POPULATIONS, AND PARTNERSHIP OPPORTUNITIES. THE 2016 CHNA WAS OVERSEEN BY A STEERING COMMITTEE OF REPRESENTATIVES FROM RUMC AND THE NEW YORK CITY DEPARTMENT OF HEALTH AND MENTAL HYGIENE, WITH INPUT FROM COMMUNITY REPRESENTATIVES AND PARTNERS.RUMC LEADERSHIP REVIEWED FINDINGS FROM THE CHNA RESEARCH, INCLUDING PUBLIC HEALTH AND SOCIOECONOMIC MEASURES AND INPUT RECEIVED FROM KEY INFORMANTS, TO DETERMINE THE HIGHEST PRIORITIES ACROSS STATEN ISLAND AND TO FOCUS COMMUNITY HEALTH IMPROVEMENT EFFORTS. BASED ON THE 2016 CHNA RESEARCH FINDINGS AND EXISTING SERVICES, RESOURCES, AND AREAS OF EXPERTISE, RUMC SELECTED PRIORITIES TO ADDRESS DURING THE NEXT THREE YEAR CYCLE. THE PRIORITIES ARE ALIGNED WITH THE NEW YORK STATE PREVENTION AGENDA AND TAKE CARE NEW YORK 2020. THE RATIONALE AND CRITERIA USED TO SELECT THESE PRIORITIES INCLUDED: A) PREVALENCE OF DISEASE AND NUMBER OF COMMUNITY MEMBERS IMPACTED; B) RATE OF DISEASE IN COMPARISON TO LOCAL AND NATIONAL BENCHMARKS; C) HEALTH DISPARITIES AMONG RACIAL AND ETHNIC MINORITIES; D) EXISTING PROGRAMS, RESOURCES, AND EXPERTISE TO ADDRESS THE ISSUE; E) INPUT FROM REPRESENTATIVES OF UNDERSERVED POPULATIONS; AND F) ALIGNMENT WITH CONCURRENT PUBLIC HEALTH AND SOCIAL SERVICE ORGANIZATION INITIATIVES.PRIORITY I: PREVENT CHRONIC DISEASESCHRONIC DISEASE RATES ARE INCREASING ACROSS THE NATION AND ARE THE LEADING CAUSES OF DEATH AND DISABILITY. THE STATEN ISLAND HEART DISEASE DEATH RATE IS THE HIGHEST OF THE NYC BOROUGHS, AND EXCEEDS THE NATIONAL RATE. HEART DISEASE IS OFTEN A RESULT OF HIGH BLOOD PRESSURE AND HIGH CHOLESTEROL. MORE THAN 25% OF STATEN ISLAND ADULTS REPORT HAVING HIGH BLOOD PRESSURE AND/OR HIGH CHOLESTEROL, A SIMILAR PERCENTAGE TO NYC OVERALL. STATEN ISLAND HAS HIGHER CANCER INCIDENCE AND DEATH RATES COMPARED TO ALL OF NYC. AMONG THE FOUR MOST COMMONLY DIAGNOSED CANCERS (FEMALE BREAST, COLORECTAL, LUNG, AND PROSTATE), STATEN ISLAND INCIDENCE RATES EXCEED NYC FOR ALL CANCER TYPES, EXCEPT PROSTATE. STATEN ISLAND DEATH RATES EXCEED NYC FOR ALL CANCER TYPES, EXCEPT FEMALE BREAST. STATEN ISLAND LUNG CANCER INCIDENCE AND DEATH RATES ARE THE HIGHEST IN COMPARISON TO NYC. CHRONIC LOWER RESPIRATORY DISEASE (CLRD) ENCOMPASSES DISEASES LIKE CHRONIC OBSTRUCTIVE PULMONARY DISORDER, EMPHYSEMA, AND ASTHMA. STATEN ISLAND HAS THE HIGHEST RATE OF CLRD DEATH AMONG NYC BOROUGHS; THE RATE INCREASED 6 POINTS FROM 2008 TO 2014. STATEN ISLAND ALSO HAS THE HIGHEST PERCENTAGE OF ADULTS WITH A CURRENT ASTHMA DIAGNOSIS.CHRONIC DISEASES ARE OFTEN PREVENTABLE THROUGH REDUCED HEALTH RISK BEHAVIORS LIKE SMOKING, INCREASED PHYSICAL ACTIVITY AND GOOD NUTRITION, AND EARLY DETECTION. STATEN ISLAND CONTINUES TO HAVE THE HIGHEST ADULT SMOKING RATE AMONG NYC BOROUGHS, AND EXCEEDS THE HEALTHY PEOPLE 2020 GOAL FOR SMOKING (12%) BY NEARLY 5 POINTS. THE PERCENTAGE OF STATEN ISLAND HIGH SCHOOL STUDENTS WHO REPORT SMOKING CIGARETTES ON ONE OR MORE OF THE PAST 30 DAYS IS THE HIGHEST OF THE FIVE BOROUGHS AND EXCEEDS THE NYC AVERAGE BY NEARLY 4 POINTS. IN STATEN ISLAND, THE PERCENTAGE OF OBESE ADULTS IS ALSO NEARLY 5 POINTS HIGHER THAN THE CITY AVERAGE. TO ADDRESS THESE IDENTIFIED HEALTH RISKS, RUMC IS UNDERTAKING A MULTI-FACETED APPROACH WITH THE GOAL TO INCREASE SCREENING RATES FOR CARDIOVASCULAR DISEASE, DIABETES AND BREAST, CERVICAL AND COLORECTAL CANCERS, ESPECIALLY AMONG DISPARATE POPULATIONS. THIS APPROACH INCLUDES, BUT IS NOT LIMITED TO: A) CONTINUING AS A PARTNER IN THE NEW YORK STATE DEPARTMENT OF HEALTH CANCER SERVICES PROGRAM, OFFERING FREE BREAST, CERVICAL, AND COLORECTAL SCREENINGS TO INDIVIDUALS WHO ARE UNINSURED OR UNDERINSURED; B) CONTINUING TO OFFER THE BREAST HEALTH PATIENT NAVIGATION INITIATIVE, PROVIDING FREE MAMMOGRAPHY EDUCATION AND SCREENINGS AND SUPPORTING WOMEN WHO HAVE ABNORMAL MAMMOGRAPHY FINDINGS AND BARRIERS TO ACCESSING APPROPRIATE CARE (TRANSPORTATION, CHILDCARE, INABILITY TO PAY, ETC.); C) FOSTERING COLLABORATION AMONG COMMUNITY-BASED ORGANIZATIONS AND CLINICIANS TO IDENTIFY UNDERSERVED POPULATIONS AND IMPLEMENT PROGRAMS TO IMPROVE EDUCATION AND ACCESS FOR PREVENTATIVE SERVICES; D) USING MEDIA AND HEALTH COMMUNICATIONS TO BUILD PUBLIC AWARENESS AND DEMAND FOR PREVENTATIVE SERVICES; E) CONTINUE UTILIZING ELECTRONIC HEALTH RECORDS AND THE PATIENT PORTAL TO REMIND PATIENTS OF PREVENTIVE AND FOLLOW-UP CARE SERVICES; F) PARTICIPATING IN COMMUNITY HEALTH AND OUTREACH EVENTS HOSTED BY STATEN ISLAND PARTNER ORGANIZATIONS AND BUSINESSES TO PROMOTE FREE SCREENINGS AND EDUCATION; AND G) PARTNERING WITH THE STATEN ISLAND PERFORMING PROVIDER SYSTEM (SI PPS) TO DEVELOP A PUBLIC CAMPAIGN TO PROMOTE UTILIZATION OF PREVENTIVE CARE SERVICES. IN ADDITION, RICHMOND UNIVERSITY MEDICAL CENTER IS A PARTNER IN THE SI PPS DIABETES MANAGEMENT PROJECT. THE GOAL OF THE PROJECT IS TO ENSURE THAT CLINICAL PRACTICES IN THE COMMUNITY AND AMBULATORY CARE SETTINGS USE EVIDENCE-BASED STRATEGIES TO IMPROVE MANAGEMENT OF DIABETES AND LINK PATIENTS TO SELF-MANAGEMENT PROGRAMS. IN ADDITION TO THE ROBUST ENDOCRINE SERVICES ALREADY OFFERED BY RUMC, RUMC HAS IMPLEMENTED A BARIATRIC PROGRAM THAT INCLUDES BOARD CERTIFIED BARIATRIC SURGEONS AND BARIATRIC SURGERY INTERVENTIONS. BARIATRIC SURGERY IS AN EVIDENCE-BASED PROCEDURE THAT HAS BEEN PROVEN EFFECTIVE IN IMPROVING POPULATION HEALTH WITH REGARD TO OBESITY AND DIABETES.TO REDUCE ILLNESS, DISABILITY, AND DEATH RELATED TO TOBACCO USE AND SECONDHAND SMOKE, RUMC CONTINUES TO OFFER A TOBACCO CESSATION PROGRAM FOR ADULTS AGES 18 YEARS OR OLDER. THE 6-WEEK PROGRAM IS LED BY A LUNG NURSE NAVIGATOR. PARTICIPANTS ARE PROVIDED INFORMATION, INDIVIDUAL COUNSELING, AND COPING MECHANISMS IN ORDER TO BETTER FIGHT THEIR ADDICTION. THE LUNG NURSE NAVIGATOR MAINTAINS CONSTANT CONTACT WITH PARTICIPANTS, OFFERING THEM SUPPORT AND ASSISTANCE WHENEVER THE NEED ARISES. RUMC ALSO CONTINUES TO PROMOTE AND PUBLICIZE THE NYS SMOKERS' QUITLINE, ESPECIALLY AMONG DISPARATE POPULATIONS.
PART VI, LINE 3:	IN KEEPING WITH ITS CHARITABLE PURPOSES, RUMC PROVIDES HEALTHCARE SERVICES TO ALL INDIVIDUALS IN A NON-DISCRIMINATORY WAY, REGARDLESS OF RACE, COLOR, CREED OR ETHNICITY. RUMC CONTINUES TO PROVIDE REDUCED-FEE OR FREE CARE IN ACCORDANCE TO PUBLIC LAW 2807(K)(9-A). ALTHOUGH NOT REQUIRED BY THIS LAW, WE DO EXTEND THIS POLICY TO INDIVIDUALS WHO MAY NOT BE QUALIFIED BASED ON THE GUIDELINES OF OUR FINANCIAL ASSISTANCE POLICY, BUT DO DEMONSTRATE AN INABILITY TO PAY ALL OF THEIR MEDICAL EXPENSES. AS PART OF BEST-PRACTICE CARE, RUMC IS IN COMMUNICATION WITH LOCAL COMMUNITY-BASED CONSUMER ADVOCATE ORGANIZATIONS TO BE CERTAIN THAT THEY ARE AWARE OF THE PROVISIONS OF OUR FINANCIAL AID POLICY. THE PATIENT ACCESS DEPARTMENT HAS RECEIVED SUMMARY DATA OF THE LAW AND OUR REQUIREMENTS. ASSISTANCE CONTINUES TO BE OFFERED BY OUR FINANCIAL SCREENING STAFF AND MEDICAL APPLICATION OFFICE TO THOSE INDIVIDUALS NOT ELIGIBLE FOR MEDICAID, AS WELL AS FINANCIAL SCREENING STAFF LOCATED IN OUR EMERGENCY DEPARTMENT. RUMC POSTS THE HOSPITAL'S CHARITY CARE POLICY SUMMARY AND FINANCIAL ASSISTANCE CONTACT INFORMATION IN MANY DIFFERENT LANGUAGES (AS DETERMINED BY RUMC'S ANNUAL LANGUAGE NEEDS ASSESSMENT) IN LOCATIONS SUCH AS THE EMERGENCY DEPARTMENT, INTAKE, REGISTRATION AND ADMISSION AREAS. PATIENTS ARE PROVIDED A SUMMARY OF THE POLICY AND FINANCIAL ASSISTANCE CONTACT INFORMATION AS PART OF THE INTAKE PROCESS AND FINANCIAL SCREENING PROCESS. PATIENT BILLS INCLUDE A STATEMENT ON FINANCIAL ASSISTANCE. EVERY PATIENT SEEN IN THE FINANCIAL OFFICE HAS A DISCUSSION ON THE AVAILABILITY OF GOVERNMENT BENEFITS SUCH AS MEDICAID AND AT THE SAME TIME QUALIFICATIONS ON THE HOSPITAL'S FINANCIAL ASSISTANCE PROGRAM. RUMC HAS AN INTERDISCIPLINARY TEAM THAT INTERACTS WITH FINANCIAL ASSISTANCE COUNSELORS SUCH AS SOCIAL WORKERS AND CASE MANAGERS TO IDENTIFY AND ASSIST ELIGIBLE PATIENTS. STAFF TRAINING ON FINANCIAL ASSISTANCE IS DONE ANNUALLY THROUGH AN IN-SERVICE PROGRAM THAT INCLUDES A REVIEW OF HOW TO QUALIFY PATIENTS FOR MEDICAID AND OTHER GOVERNMENT PROGRAMS. ALL THIRD PARTIES THAT WORK FOR RUMC IN THE COLLECTION OF FEES ARE REQUIRED TO FOLLOW THE HOSPITAL'S POLICIES REGARDING PATIENT NOTIFICATION ABOUT THE AVAILABILITY OF FINANCIAL ASSISTANCE. RUMC'S FINANCIAL ASSISTANCE POLICY CLEARLY STATES THAT MEDICAL CARE IS PROVIDED TO INDIVIDUALS IN NEED, REGARDLESS OF THEIR ABILITY TO PAY AND MAKES CERTAIN THAT ALL REQUESTS FOR FINANCIAL ASSISTANCE ARE EVALUATED AND PROCESSED FAIRLY AND CONSISTENTLY WITH DIGNITY, COMPASSION AND IN A RESPECTFUL MANNER, CONSISTENT WITH RUMC MISSION AND VALUES.
PART VI, LINE 4:	RICHMOND UNIVERSITY MEDICAL CENTER PRIMARILY SERVES STATEN ISLAND, ONE OF FIVE BOROUGHS COMPRISING NEW YORK CITY. STATEN ISLAND'S 2017 POPULATION OF 479,458 REPRESENTS AN INCREASE OF 2.3% FROM THE 2010 CENSUS. OUR POPULATION IS A CROSS MIX OF THE OVERALL POPULATION, HOWEVER WE ARE LOCATED ON THE NORTH SHORE. AS A RESULT, RUMC TREATS A SIGNIFICANTLY HIGHER NUMBER OF THE UNDERSERVED AND UNDER INSURED THAN HEALTHCARE PROVIDERS IN OTHER AREAS OF STATEN ISLAND.THE PRIMARY SERVICE AREA FOR RUMC INCLUDES THE ZIP CODE COMMUNITIES IN ST. GEORGE (10301), PORT RICHMOND (10302); MARINER'S HARBOR (10303); STAPLETON (10304); ROSEBANK (10305), WEST BRIGHTON (10310), AND WILLOWBROOK (10314). COMPARISON OF EACH ZIP CODE SHOWS THAT FIVE OF THE ZIP CODES IN RUMC'S PRIMARY SERVICE AREA HAVE THE HIGHEST NUMBER OF FAMILIES LIVING IN POVERTY (10310, 10303, 10304, 10302, 10301). IN FACT THERE ARE TWICE AS MANY FAMILIES LIVING IN POVERTY IN THE 10310 ZIP CODE THAN COMPARED TO THE BOROUGH OVERALL.STATEN ISLAND RESIDENTS ARE LESS LIKELY TO SPEAK ENGLISH AS THEIR PRIMARY LANGUAGE WHEN COMPARED TO THE NATION, BUT MORE LIKELY WHEN COMPARED TO NEW YORK CITY. THE BOROUGH'S MOST COMMON LANGUAGES, OTHER THAN ENGLISH, ARE INDO-EUROPEAN (12.3%) AND SPANISH (10.5%). RESIDENTS IN ZIP CODES 10305 AND 10303 ARE THE LEAST LIKELY TO SPEAK ENGLISH AS THEIR PRIMARY LANGUAGE (51.9% AND 58.2% RESPECTIVELY). INDO-EUROPEAN LANGUAGES ARE THE SECOND MOST COMMON LANGUAGES IN ZIP CODE 10305, WHILE SPANISH IS THE SECOND MOST COMMON LANGUAGE IN ZIP CODE 10303.STATEN ISLAND HAS A COMPARABLE RACIAL AND ETHNIC MAKEUP TO THE NATION WITH 39.9% OF RESIDENTS IDENTIFYING WITH A RACE OTHER THAN WHITE AND 18.6% OF RESIDENTS IDENTIFYING AS HISPANIC OR LATINO. STATEN ISLAND IS LESS RACIALLY AND ETHNICALLY DIVERSE COMPARED TO NEW YORK CITY OVERALL. THE BOROUGH'S MEDIAN AGE IS OLDER THAN CITY AND NATIONAL MEDIANS.CURRENTLY 15.8% OF STATEN ISLAND'S POPULATION IS 65 YEARS OF AGE AND OLDER. WITH THIS STEADY INCREASE IN POPULATION AND THE RISING TREND IN THE AGING OF STATEN ISLAND'S POPULATION OVERALL, THE COMMUNITY IS EXPERIENCING A RISE IN HEALTHCARE NEEDS AND HEALTHCARE COSTS. AS MORE BABY BOOMERS DEVELOP CHRONIC ILLNESSES, THE DEMAND ON THE HEALTHCARE SYSTEM WILL RISE. WITH THIS IN MIND, RICHMOND UNIVERSITY MEDICAL CENTER RECOGNIZES THAT ITS FOCUS MUST SHIFT TO PREVENTION ISSUES AND KEEPING PEOPLE HEALTHY.
PART VI, LINE 5:	RICHMOND UNIVERSITY MEDICAL CENTER IS A LICENSED 400-PLUS BED HOSPITAL, ONE OF ONLY TWO PRIVATE HOSPITALS SERVING THE ENTIRE POPULATION OF THE BOROUGH. OUR COMMUNITY OUTREACH INITIATIVES, INCLUDING EDUCATION AND SCREENING, REACH THOUSANDS EACH YEAR. THE HOSPITAL IS THE MAIN SPONSOR AND/OR ACTIVE PARTICIPANT IN SEVERAL ANNUAL HEALTH RELATED EVENTS ON STATEN ISLAND, INCLUDING THE STATEN ISLAND ECONOMIC DEVELOPMENT CORPORATION'S HEALTH AND WELLNESS CONFERENCE HELD EACH FALL. THE CONFERENCE OFFERS THOUSANDS OF RESIDENTS A FORUM TO HAVE ACCESS TO EDUCATIONAL MATERIALS, SPEAK WITH PHYSICIANS AND HEALTHCARE PROFESSIONALS, AND HAVE HEALTH SCREENINGS CONDUCTED ON THE PREMISES. OUR COMMUNITY OUTREACH TEAM, KNOWN AS TRAUMA, ATTENDS OVER 100 COMMUNITY EVENTS EACH YEAR, PROVIDING BROCHURES, EDUCATIONAL MATERIALS, AND HANDS ON TRAINING TO THOUSANDS OF ADULTS AND CHILDREN ANNUALLY. PROGRAMS THEY PROVIDE INCLUDE "STOP THE BLEED", WHICH DISCUSSES HOW TO HANDLE BLEEDING EMERGENCIES, AND HANDS ON CPR WHICH SHOWS PEOPLE THE BASICS OF CARDIOPULMONARY RESUSCITATION. FOR MORE THAN 30 YEARS RUMC'S WIC PROGRAM HAS SUCCESSFULLY SERVED THE POOR WOMEN, INFANTS AND CHILDREN OF STATEN ISLAND. THE MISSION IS TO IMPROVE THE NUTRITION AND HEALTH STATUS OF ELIGIBLE WOMEN, INFANTS AND CHILDREN THROUGH THE PROVISION OF NUTRITIOUS FOODS, NUTRITION EDUCATION, COUNSELING AND LINKING PARTICIPANTS TO HEALTH AND HUMAN SERVICES. WIC SERVICES ASSIST WOMEN AND CHILDREN WHO HAVE LOW INCOME, ARE UNDOCUMENTED CITIZENS, ARE UNINSURED, TEENAGERS, UNWED MOTHERS, VICTIMS OF DOMESTIC VIOLENCE, AND FOSTER CHILDREN. OVER 50% OF THE PEOPLE ACCESSING SERVICES AT THE WIC SITE ARE HISPANIC.RUMC HAS A WELL-ESTABLISHED HISTORY OF WORKING WITH OTHER COMMUNITY MENTAL HEALTH ORGANIZATIONS TO WORK COLLABORATIVELY TO ASSIST THOSE IN THE BOROUGH WITH MENTAL HEALTH ISSUES. AMONG ITS PARTNERS ARE THE STATEN ISLAND MENTAL HEALTH SOCIETY, AND JEWISH BOARD OF FAMILY AND CHILDREN SERVICES. RUMC ALSO MAINTAINS RELATIONSHIPS WITH THE LOCAL COMMUNITY ORGANIZATIONS IN ITS VICINITY AND WITH STATEN ISLAND COMMUNITY BOARD #1. THE COMMUNITY HEALTH ACTION CENTER, STATEN ISLAND CHAMBER OF COMMERCE, PROJECT HOSPITALITY, AND THE PORT RICHMOND COMMUNITY HEALTH CENTER ARE JUST A FEW OF THE LOCAL ORGANIZATIONS RUMC MAINTAINS PARTNERSHIPS WITH. HOSPITAL ADMINISTRATION AND MEMBERS OF THE BOARD OF TRUSTEES VISIT ALBANY ANNUALLY TO LOBBY FOR HEALTHCARE ISSUES AND TO SPEAK WITH STATE HEALTH OFFICIALS.IN ADDITION TO THE COMMUNITY, RUMC MAINTAINS REGULAR COMMUNICATIONS WITH ALL OF STATEN ISLAND'S ELECTED OFFICIALS INCLUDING THE BOROUGH PRESIDENT. THESE PARTNERS ARE MET WITH ON A REGULAR BASIS ALLOWING ADMINISTRATION TO PROVIDE UPDATES ON SERVICE AND SEEK SUPPORT FROM THEM FOR ISSUES IMPORTANT TO THE HOSPITAL.
PART VI, LINE 7, REPORTS FILED WITH STATES	NY
PART VI, LINE 2 CONTINUATION:	IN RECENT MONTHS' RUMC HAS ALSO OPENED A STAND-ALONE CENTER FOR CANCER CARE, BRING ALL OF ITS CANCER RESOURCES FOR THE EDUCATION, DIAGNOSIS AND TREATMENT OF CANCER UNDER ONE ROOF. IN A SEPARATE LOCATION ON THE GROUNDS OF THE HOSPITAL, RUMC HAS OPENED A CARDIOPULMONARY REHABILITATION CENTER GIVING PATIENTS ACCESS TO STATE OF THE ART EQUIPMENT AND PROGRAMS SO THEY CAN LEAD HEALTHIER AND MORE PRODUCTIVE LIVES. IN THE COMING MONTHS, RUMC WILL ALSO OPEN A BREAST AND WOMAN'S CARE CENTER AS WELL AS A SEPARATE INSTITUTE FOR WEIGHT LOSS AND METABOLIC SURGERY.PRIORITY II: PROMOTE MENTAL HEALTH AND PREVENT SUBSTANCE ABUSE STATEN ISLAND RESIDENTS ARE PRIMARILY AFFECTED BY SUBSTANCE ABUSE ISSUES RATHER THAN MENTAL HEALTH ISSUES; HOWEVER, THERE IS A STRONG CONNECTION BETWEEN THE TWO CONDITIONS. BOTH ADULTS AND YOUTH IN STATEN ISLAND ARE MORE LIKELY TO ABUSE ALCOHOL. STATEN ISLAND HAS THE HIGHEST PERCENTAGE OF DRIVING DEATHS DUE TO ALCOHOL IMPAIRMENT AMONG ALL NYC BOROUGHS, AND HIGH SCHOOL STUDENTS ARE THE MOST LIKELY TO REPORT CONSUMING ALCOHOL AND BINGE DRINKING. APPROXIMATELY 29% OF STATEN ISLAND HIGH SCHOOL STUDENTS REPORT DRINKING WITHIN THE PAST 30 DAYS. THE DRUG-INDUCED DEATH RATE IN STATEN ISLAND IS THE HIGHEST OF ALL NYC BOROUGHS AND EXCEEDS THE NATIONAL RATE. THE RATE HAS BEEN ON THE RISE SINCE 2007, INCREASING 7 POINTS. AMONG HIGH SCHOOL STUDENTS, STATEN ISLAND HAS THE HIGHEST RATES OF SUBSTANCE ABUSE FOR ALL REPORTED DRUGS (MARIJUANA, COCAINE, HEROIN, ECSTASY, AND PAIN MEDICATION).STATEN ISLAND ADULTS REPORT A LOWER 30-DAY AVERAGE OF POOR MENTAL HEALTH DAYS WHEN COMPARED TO OTHER NYC BOROUGHS AND THE NATION AND ARE LESS LIKELY TO HAVE BEEN DIAGNOSED WITH DEPRESSION. THE STATEN ISLAND SUICIDE AND MENTAL AND BEHAVIORAL DISORDERS DEATH RATES ARE ALSO LOWER THAN BOTH NYC AND NATIONAL RATES AND MEET HEALTHY PEOPLE 2020 GOALS (AS APPLICABLE). HOWEVER, IN A 2013 SURVEY AMONG HIGH SCHOOL STUDENTS, MORE THAN 25% OF STATEN ISLAND STUDENTS REPORTED FEELING SO SAD OR HOPELESS ALMOST EVERY DAY FOR TWO WEEKS OR MORE, THAT THEY STOPPED DOING THEIR USUAL ACTIVITIES; APPROXIMATELY 9% OF STUDENTS ATTEMPTED SUICIDE ONE OR MORE TIMES DURING THE PAST YEAR. THE PERCENTAGES ARE ON PAR WITH NYC OVERALL, BUT NOTEWORTHY. LACK OF BEHAVIORAL HEALTH SERVICES WITHIN STATEN ISLAND WAS IDENTIFIED BY KEY INFORMANTS AS A KEY BARRIER TO RECEIVING TIMELY AND APPROPRIATE CARE.TO HELP PREVENT SUBSTANCE ABUSE AND OTHER MENTAL EMOTIONAL BEHAVIORAL (MEB) DISORDERS, RUMC IS ADDRESSING UNDERAGE DRINKING, AND NON-MEDICAL USE OF PRESCRIPTION DRUGS BY YOUTH. RUMC WILL CONTINUE TO SERVE ON THE BOARD OF ADVISORS FOR THE STATEN ISLAND PARTNERSHIP FOR COMMUNITY WELLNESS AND SUPPORT THEIR INITIATIVE, TACKLING YOUTH SUBSTANCE ABUSE (TYSA). THE TYSA INITIATIVE IS A CROSS-SECTOR COALITION AIMED AT DRIVING MAJOR IMPROVEMENTS IN YOUTH SUBSTANCE ABUSE ON STATEN ISLAND. COMMON GOALS SHARED BY THE INITIATIVE ARE TO REDUCE THE PERCENTAGE OF YOUTH REPORTING ALCOHOL USE IN THE PAST 30 DAYS AND OPIATES EVER BY 2020. AS A PARTNER IN THE INITIATIVE, RUMC WILL SUPPORT ACTIVITIES TO: A) ADVOCATE FOR SYSTEMS-LEVEL CHANGE AT THE LOCAL, STATE, AND FEDERAL LEVEL; B) COLLECT AND SHARE DATA THAT DRIVES INITIATIVES; C) CONNECT THE COMMUNITY WITH NEEDED RESOURCES USING THE STATEN ISLAND DRUG AND ALCOHOL TREATMENT RESOURCE GUIDE AND RUMC BEHAVIORAL HEALTH RESOURCES; D) EDUCATE THE COMMUNITY ON SUBSTANCE ABUSE; AND E) STRENGTHEN PROVIDER AND PATIENT EDUCATION TO ADDRESS PRESCRIPTION DRUG MISUSE AND REDUCE ACCIDENTAL OVERDOSERUMC IS ALSO HELPING TO IDENTIFY AND STRENGTHEN OPPORTUNITIES FOR IMPLEMENTING MEB HEALTH PROMOTION AND MEB DISORDER PREVENTION WITH INDIVIDUALS. RICHMOND UNIVERSITY MEDICAL CENTER CONTINUES TO SERVE ON THE STEERING COMMITTEE OF THE STATEN ISLAND PPS BEHAVIORAL HEALTH INFRASTRUCTURE PROJECT (BHIP). THE GOAL OF BHIP IS TO HELP STRENGTHEN MENTAL HEALTH AND SUBSTANCE ABUSE INFRASTRUCTURE ACROSS SYSTEMS. THE PEER COUNSELOR WARM HANDOFF PROGRAM AT RUMC LAUNCHED IN 2016. THE PROGRAM CONNECTS SUBSTANCE USE DISORDER PATIENTS THAT VISIT THE EMERGENCY DEPARTMENT WITH TIMELY AND APPROPRIATE WITHDRAWAL MANAGEMENT, CARE COORDINATION, AND OTHER TREATMENT SERVICES. RUMC'S SILBERSTEIN OUTPATIENT CHEMICAL DEPENDENCE PROGRAM EXISTS TO REHABILITATE INDIVIDUALS SUFFERING FROM CO-OCCURRING SUBSTANCE USE AND MENTAL HEALTH DISORDERS. SILBERSTEIN PROVIDES IN-HOUSE SERVICES OFFERING SUPPORT TO CLIENTS AND THE COMMUNITY. UP TO 35 WEEKLY GROUP THERAPY SESSIONS ARE HELD AT THE CLINIC, WHILE ALCOHOLICS ANONYMOUS (AA) MEETINGS ARE HOSTED DAILY AND ARE OPEN TO THE PUBLIC. SILBERSTEIN ALSO COLLABORATES WITH OTHER AGENCIES SERVING INDIVIDUALS IN NEED OF SUBSTANCE ABUSE TREATMENT TO IMPROVE SERVICES. PARTNER AGENCIES INCLUDE TREATMENT ALTERNATIVES TO STREET CRIME (TSAC), DRUG TREATMENT COURT, ADMINISTRATION FOR CHILDREN SERVICES (ACS), AND LOCAL AND STATE REHAB, DETOX AND RESIDENTIAL FACILITIES. CLIENTS OF THE SILBERSTEIN CLINIC ARE ALSO TRAINED TO DETECT AND PREVENT AN OPIOID OVERDOSE THROUGH THE USE OF NALOXONE (NARCAN). THE NASAL SPRAY MEDICATION CAN BE ADMINISTERED TO AN OVERDOSING USER DURING AN OVERDOSE EVENT TO BLOCK THE EFFECTS OF OPIOIDS AND RESUSCITATE THE PATIENT. KITS ARE DISTRIBUTED AT SILBERSTEIN AND CLIENTELE ARE EDUCATED ON ADMINISTRATION OF THE ANTIDOTE.

Schedule H (Form 990) 2018

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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

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2018

Open to Public Inspection

Name of the organization

RICHMOND MEDICAL CENTER

Employer identification number

74-3177454

Part I

Questions Regarding Compensation

Yes

Check the appropiate box(es) if the organization provided any of the following to or for a person listed on Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.

First-class or charter travel Housing allowance or residence for personal use

Travel for companions Payments for business use of personal residence

Tax idemnification and gross-up payments Health or social club dues or initiation fees

Discretionary spending account Personal services (e.g., maid, chauffeur, chef)

If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain .........

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

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

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

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

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

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

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

Yes

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

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

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

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

The organization? ....................

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

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

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

The organization? ..................

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

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

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization provide any nonfixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............

Yes

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) 2018

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)
1DANIEL MESSINA PRESIDENT & CEO	(i) (ii)	834,473 ------------- 0	0 ------------- 0	137 ------------- 0	166,351 ------------- 0	18,745 ------------- 0	1,019,706 ------------- 0	0 ------------- 0
2PIETRO CARPENITO MD TRUSTEE	(i) (ii)	469,204 ------------- 0	0 ------------- 0	13,592 ------------- 0	52,422 ------------- 0	24,866 ------------- 0	560,084 ------------- 0	13,184 ------------- 0
3SAMALA SWAMY MD TRUSTEE	(i) (ii)	189,995 ------------- 0	0 ------------- 0	0 ------------- 0	0 ------------- 0	0 ------------- 0	189,995 ------------- 0	0 ------------- 0
4MITCHELL FOGEL MD SENIOR VP/CHAIR OF MEDICIN	(i) (ii)	469,978 ------------- 0	0 ------------- 0	76 ------------- 0	51,150 ------------- 0	18,587 ------------- 0	539,791 ------------- 0	0 ------------- 0
5JOSEPH SAPORITO SENIOR VP & CFO	(i) (ii)	448,184 ------------- 0	79,745 ------------- 0	137 ------------- 0	50,180 ------------- 0	23,727 ------------- 0	601,973 ------------- 0	0 ------------- 0
6ROSEMARIE STAZZONE SENIOR VP NURSING & CNO	(i) (ii)	513,581 ------------- 0	0 ------------- 0	56,503 ------------- 0	56,494 ------------- 0	1,992 ------------- 0	628,570 ------------- 0	56,239 ------------- 0
7RICHARD SALHANY SENIOR VP PROFESSIONAL SER	(i) (ii)	416,072 ------------- 0	0 ------------- 0	137 ------------- 0	40,466 ------------- 0	24,895 ------------- 0	481,570 ------------- 0	0 ------------- 0
8MICHAEL L MORRETTI CHAIRMAN OF OB/GYN	(i) (ii)	561,703 ------------- 0	270,890 ------------- 0	147 ------------- 0	24,750 ------------- 0	18,587 ------------- 0	876,077 ------------- 0	0 ------------- 0
9LOREN HARRIS MD MEDICAL CHAIRMAN	(i) (ii)	755,415 ------------- 0	0 ------------- 0	50 ------------- 0	24,750 ------------- 0	1,075 ------------- 0	781,290 ------------- 0	0 ------------- 0
10ELI SERUR PHYSICIAN	(i) (ii)	982,395 ------------- 0	0 ------------- 0	76 ------------- 0	19,250 ------------- 0	23,978 ------------- 0	1,025,699 ------------- 0	0 ------------- 0
11DOUGLAS COHEN MD PHYSICIAN	(i) (ii)	616,172 ------------- 0	125,000 ------------- 0	50 ------------- 0	19,250 ------------- 0	23,978 ------------- 0	784,450 ------------- 0	0 ------------- 0
12VLADIMIR RUBINSHTEY PHYSICIAN	(i) (ii)	251,364 ------------- 0	368,446 ------------- 0	12 ------------- 0	19,250 ------------- 0	18,587 ------------- 0	657,659 ------------- 0	0 ------------- 0
13XIN Y LI PHYSICIAN	(i) (ii)	272,553 ------------- 0	237,124 ------------- 0	12 ------------- 0	19,250 ------------- 0	18,587 ------------- 0	547,526 ------------- 0	0 ------------- 0
14PHILLIP OTTERBECK PHYSICIAN	(i) (ii)	200,000 ------------- 0	319,989 ------------- 0	10 ------------- 0	19,250 ------------- 0	1,075 ------------- 0	540,324 ------------- 0	0 ------------- 0

Schedule J (Form 990) 2018

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 4B

THE FOLLOWING INDIVIDUALS ACCRUED CONTRIBUTIONS TO A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN DURING 2018: DANIEL MESSINA, PRESIDENT & CEO - $136,101 ROSEMARIE STAZZONE, SENIOR VP NURSING & CNO - $26,244 PIETRO CARPENITO, TRUSTEE - $22,172 RICHARD SALHANEY, SENIOR VP PROFESSIONAL SERVICES - $10,216 JOSEPH SAPORITO, SENIOR VP & CFO - $19,930 THE FOLLOWING INDIVIDUALS RECEIVED DISTRIBUTIONS FROM THE SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN DURING 2018: PIETRO CARPENITO, TRUSTEE - $13,184 ROSEMARIE STAZZONE, SENIOR VP NURSING & CNO - $56,239

PART I, LINE 7

AN ANNUAL INCENTIVE PROGRAM (AIP) HAS BEEN ESTABLISHED AND APPROVED BY THE FACILITY OUTLINING THE COMPONENTS OF THE BONUS PROGRAM. ORGANIZATIONAL GOALS ARE ESTABLISHED ANNUALLY. ADDITIONALLY, ANNUAL GOALS FOR EACH INDIVIDUAL ELIGIBLE FOR THE AIP PROGRAM ARE SET. THE AIP BONUS FOR EACH ELIGIBLE INDIVIDUAL IS BASED ON HOW WELL THE ORGANIZATION MET THE ESTABLISHED ORGANIZATIONAL GOALS, AND HOW WELL THAT INDIVIDUAL MET HIS/HER INDIVIDUALLY ESTABLISHED GOALS. THERE IS ALSO A SMALL PERCENTAGE THAT IS AWARDED AT THE DISCRETION OF THE CEO (OR BOARD COMMITTEE WITH RESPECT TO THE CEO'S BONUS DETERMINATION). THE APPROVAL OF ALL BONUSES ARE DOCUMENTED.

Schedule J (Form 990) 2018

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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 Ⅵ, line 24a. Provide descriptions,
explanations, and any additional information in Part Ⅵ.
SchKMediumBullet

Attach to Form 990.
SchKMediumBullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2018

Open to Public
Inspection

Name of the organization
RICHMOND MEDICAL CENTER

Employer identification number
74-3177454

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	BUILD NYC RESOURCE CORPORATION			12-20-2018	132,065,000	SEE PART VI		X		X		X

Part Ⅱ

Proceeds

	A		B		C		D
	1 Amount of bonds retired ..................
2 Amount of bonds legally defeased ..............
3 Total proceeds of issue ..................	47,286,413
4 Gross proceeds in reserve funds .............	3,586,063
5 Capitalized interest from proceeds .............
6 Proceeds in refunding escrows ...............
7 Issuance costs from proceeds ...............	1,084,150
8 Credit enhancement from proceeds .............
9 Working capital expenditures from proceeds .............
10 Capital expenditures from proceeds .............
11 Other spent proceeds .............	6,766,329
12 Other unspent proceeds .............	35,849,871
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) 2018

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 .........	0 %
6 Total of lines 4 and 5 .............	0 %
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? .............
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 ..........
c Term of hedge .........
d Was the hedge superintegrated? ......
e Was the hedge terminated? ........

Schedule K (Form 990) 2018

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 ..........
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?

Part Ⅵ

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

Return Reference	Explanation
SCHEDULE K, PART I BOX F	THE PROCEEDS OF THE 2018 BONDS WILL BE USED TO (I) REFINANCE THE MEDICAL CENTER'S EXISTING REVOLVING LOAN PAYABLE, TERM LOAN PAYABLE, AND FIRST MORTGAGE LOAN PAYABLE, (II) FINANCE THE COST OF VARIOUS CAPITAL IMPROVEMENTS TO THE MEDICAL CENTER'S CAMPUS, (III) FUND A DEBT SERVICE RESERVE FUND AND A CAPITALIZED INTEREST FUND, AND (IV) PAY CERTAIN COSTS RELATED TO THE ISSUANCE OF THE 2018 BONDS.
SCHEDULE K, PART II LINE 3	TOTAL PROCEEDS OF ISSUE REPORTED IN PART II LINE 3 REPRESENTS THE AMOUNT OF BOND PROCEEDS DRAWN DOWN AS OF 12/31/2018. TOTAL ISSUE PRICE OF THE 2018 BONDS IS REPORTED IN PART I.

Schedule K (Form 990) 2018

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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

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2018

Open to Public
Inspection

Name of the organization

RICHMOND MEDICAL CENTER

Employer identification number

74-3177454

Return Reference	Explanation
FORM 990, PART VI, SECTION B, LINE 11B	A COPY OF FORM 990 WAS SENT TO MEMBERS OF THE FINANCE COMMITTEE OF THE BOARD FOR REVIEW BEFORE FILING WITH THE IRS. DUE TO TIME CONSTRAINTS FOR THE 2018 TAX YEAR, THE ENTIRE BOARD DID NOT RECEIVE A COPY OF FORM 990 BEFORE IT WAS FILED WITH THE IRS. THE BOARD RECEIVED A COPY OF THE RETURN AFTER IT WAS FILED WITH THE IRS AND HAD A CHANCE TO REVIEW IT IN DETAIL AND POSE QUESTIONS.
FORM 990, PART VI, SECTION B, LINE 12C	CONFLICT OF INTEREST POLICY FORMS ARE DISTRIBUTED TO ALL TRUSTEES AND TO EMPLOYEES DOWN TO THE DEPARTMENT DIRECTOR LEVEL THROUGH THE PRESIDENT'S OFFICE AND COLLECTED THERE AS WELL. ALL FORMS ARE REVIEWED BY THE COMPLIANCE OFFICER. IF POTENTIAL CONFLICTS ARE IDENTIFIED, THE INDIVIDUAL IS CONTACTED FOR ADDITIONAL INFORMATION. ALL IDENTIFIED CONFLICTS ARE PRESENTED TO THE BOARD OF TRUSTEES' AUDIT AND COMPLIANCE COMMITTEE FOR ACTION WHERE APPLICABLE. A BOARD MEMBER WITH A CONFLICT OF INTEREST WILL ABSTAIN FROM VOTING ON THE MATTER AND WILL BE EXCUSED FROM THE PORTION OF THE MEETING WHERE THE MATTER IS DISCUSSED.
FORM 990, PART VI, SECTION B, LINE 15	IN 2009, THE ORGANIZATION'S BOARD ADOPTED A COMPENSATION POLICY (THE "POLICY") FOR COVERED INDIVIDUALS AND TO EMPLOYEES DOWN TO DEPARTMENT DIRECTORS. PURSUANT TO THE POLICY, A COMPENSATION COMMITTEE OF INDEPENDENT DIRECTORS WAS ESTABLISHED TO REVIEW THE COMPENSATION OF ALL EMPLOYEES SPECIFIED AS HAVING A SUBSTANTIAL INFLUENCE OVER THE ORGANIZATION AND WHO RECEIVE REMUNERATION FROM THE ORGANIZATION, INCLUDING, AMONG OTHERS, THE ORGANIZATION'S PRESIDENT AND CHIEF EXECUTIVE OFFICER AND THE ORGANIZATION'S CHIEF FINANCIAL OFFICER. THE COMPENSATION COMMITTEE IS ADVISED BY OUTSIDE COUNSEL AND AN INDEPENDENT COMPENSATION CONSULTANT, EACH OF WHOM OPINE TO THE COMPENSATION COMMITTEE THAT THE LEVEL OF COMPENSATION PAID AND THE PROCESS BY WHICH COMPENSATION IS ESTABLISHED MEET APPLICABLE IRS REASONABLENESS AND "SAFE HARBOR" STANDARDS. THE OUTSIDE COMPENSATION CONSULTANT PROVIDES DATA OF COMPENSATION PROVIDED AT SIMILAR ORGANIZATIONS TO ENSURE THAT THE ORGANIZATION DOES NOT COMPENSATE IN EXCESS OF MARKET NORMS. THIS CONSULTANT WAS ENGAGED EACH YEAR FROM 2009 THROUGH 2012 TO PERFORM THESE SERVICES, AND A MARKET STUDY WAS COMPLETED IN 2015. THE COMPENSATION COMMITTEE OF THE BOARD IS COMPRISED OF INDEPENDENT PERSONS. THIS COMMITTEE REVIEWS EXECUTIVE COMPENSATION ANNUALLY AND RECORDS THEIR REVIEW IN THE MEETING MINUTES.
FORM 990, PART VI, SECTION C, LINE 19	THE ORGANIZATION WILL MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST.
FORM 990, PART VI, LINE 1A	THE EXECUTIVE COMMITTEE HAS BROAD AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. THE SCOPE OF THE COMMITTEE'S AUTHORITY IS TO ACT WITH FULL POWER ON THE BEHALF OF THE BOARD OF TRUSTEES. ALL EXECUTIVE COMMITTEE MEMBERS ARE MEMBERS OF THE GOVERNING BODY. THE MEMBERS OF THE EXECUTIVE COMMITTEE ARE AS FOLLOWS: KATHRYN K. ROONEY RONALD PURPORA CATHERINE M. PAULO GINA GUTZEIT DENNIS QUIRK DANIEL J. MESSINA
FORM 990, PART XI, LINE 9:	PENSION LIABILITY ADUSTMENT 43,143. CHANGE IN BENEFICIAL INTEREST IN THE FOUNDATION -1,138,514. GAIN ON TERMINATION OF LEASE 238,255. LOSS ON EXTINGUISHMENT OF DEBT -426,761.
FORM 990 AMENDED RETURN	THE FORM 990 IS AMENDED TO REFLECT A CHANGE IN THE REVIEW PROCESS OF THE 990. FOR PART VI QUESTION 11, OUR RESPONSE WAS CHANGED TO NO. OUR PROCESS IS TO HAVE THE 990 REVIEWED IN DETAIL BY THE AUDIT COMMITTEE AND AND APPROVED FINAL COPY PASSED ON TO ALL BOARD MEMBERS BEFORE FILING WITH THE IRS. DUE TO EMPLOYEE TURNOVER AND TIME CONSTRAINTS FOR TAX YEAR 2018, A COPY WAS NOT MADE AVAILABLE TO ALL BOARD MEMBERS UNTIL AFTER IT WAS FILED WITH THE IRS.

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

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2018

Additional Data

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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

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2018

Open to Public Inspection

Name of the organization

RICHMOND MEDICAL CENTER

Employer identification number

74-3177454

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
(1) RICHMOND QUALITY LLC 335 BARD AVENUE STATEN ISLAND,NY10310 47-1464075	ACCOUNTABLE CARE ORGANIZATION	NY	4,871,914	5,437,438	RICHMOND MEDICAL CENTER

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)AMBOY MEDICAL PRACTICE PC 355 BARD AVENUE STATEN ISLAND,NY10310 26-3381883	PHYSICIAN MEDICAL PRACTICE	NY	501(C)(3)	LINE 12A, I	RICHMOND MEDICAL CENTER	Yes
(2)RICHMOND MEDICAL CENTER FOUNDATION INC 355 BARD AVENUE STATEN ISLAND,NY10310 27-1059815	SUPPORTING ORGANIZATION	NY	501(C)(3)	LINE 12A, I	RICHMOND MEDICAL CENTER	Yes

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

Cat. No. 50135Y

Schedule R (Form 990) 2018

Page 2

Part III

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

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

Part IV

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

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(i) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	Yes	No
(1) BRIDGE REGIONAL HEALTH SYSTEM 355 BARD AVENUE STATEN ISLAND,NY10310 20-5171165	HOLDING COMPANY	NY	N/A	C				No

Schedule R (Form 990) 2018

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

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

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

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

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

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

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

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

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

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

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

Yes

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

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

Yes

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
(1) RICHMOND MEDICAL CENTER FOUNDATION INC	C	2,084,608	COST
(2) RICHMOND MEDICAL CENTER FOUNDATION INC	D	299,048	COST
(3) AMBOY MEDICAL PRACTICE PC	D	39,113,702	COST

Schedule R (Form 990) 2018

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) 2018

Page 5

Part VII

Supplemental Information

Provide additional information for responses to questions on Schedule R (see instructions).

Return Reference

Explanation

FORM 990, PART IV, LINE 35

RICHMOND MEDICAL CENTER (THE "COMPANY") IS AFFILIATED WITH AMBOY MEDICAL PRACTICE, PC ("AMBOY"), A NEW YORK PROFESSIONAL SERVICES CORPORATION, WHICH WAS ESTABLISHED TO PROVIDE PRIMARY CARE SERVICES TO THE COMMUNITY AND HAS ONE SHAREHOLDER, THE CHIEF MEDICAL OFFICER OF THE COMPANY. THE COMPANY AND AMBOY ARE PARTIES TO A CERTAIN STOCK RESTRICTION AGREEMENT (THE "RESTRICTION AGREEMENT") WHICH PROVIDES, AMONG OTHER THINGS, THAT WITHOUT THE CONSENT OF THE COMPANY, THE CHIEF MEDICAL OFFICER MAY NOT TRANSFER HIS/HER STOCK IN AMBOY, OR CAUSE AMBOY TO DISSOLVE, MERGE, ISSUE STOCK, COMMENCE LITIGATION, SELL OR LEASE REAL PROPERTY, BORROW OR LEND MONEY, OR FILE FOR BANKRUPTCY. THE RESTRICTION AGREEMENT ALSO PROVIDES THAT THE CHIEF MEDICAL OFFICER MUST, UPON THE REQUEST OF THE COMPANY, TRANSFER ALL OF HIS/HER STOCK IN AMBOY TO A COMPANY DESIGNEE. DUE TO THESE RESTRICTIONS, AMBOY IS CONSIDERED A CONTROLLED ENTITY WITHIN THE MEANING OF SECTION 512(B)(13).

Schedule R (Form 990) 2018

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: PROVISION OF HEALTH CARE SERVICES TO THE PUBLIC
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	21
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	16
5	Total number of individuals employed in calendar year 2018 (Part V, line 2a) ......	5	2,738
6	Total number of volunteers (estimate if necessary) .............	6	50
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	1,979
b	Net unrelated business taxable income from Form 990-T, line 34 .........	7b	979

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	15,836,915	25,070,118
9	Program service revenue (Part VIII, line 2g) .........	323,511,304	315,315,484
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	115,837	491,941
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	11,910,015	16,046,850
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	351,374,071	356,924,393
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)	218,061,784	219,275,642
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)....	122,650,567	123,586,400
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	340,712,351	342,862,042
19	Revenue less expenses. Subtract line 18 from line 12.......	10,661,720	14,062,351
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	207,563,449	255,798,298
21	Total liabilities (Part X, line 26).............	129,471,367	165,020,416
22	Net assets or fund balances. Subtract line 21 from line 20.....	78,092,082	90,777,882

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 293,396,270 including grants of $ 0 ) (Revenue $ 315,315,484 )
	RICHMOND UNIVERSITY MEDICAL CENTER (RUMC OR THE MEDICAL CENTER) IS A 448 LICENSED BED, ACUTE CARE HOSPITAL SERVING NEARLY 500,000 RESIDENTS OF STATEN ISLAND, NEW YORK. THE MAIN CAMPUS IS LOCATED IN THE WEST BRIGHTON SECTION OF STATEN ISLAND.RUMC PROVIDES VARIOUS INPATIENT AND OUTPATIENT SERVICES, INCLUDING: MEDICAL/SURGICAL, PEDIATRICS, OBSTETRICS/GYNECOLOGY, NICU, A DESIGNATED STROKE CENTER, A LEVEL 1 TRAUMA CENTER, BEHAVIORAL HEALTH SERVICES, EMERGENCY SERVICES AND CLINIC SERVICES. THE MEDICAL CENTER ALSO PROVIDES AN ARRAY OF COMMUNITY OUTREACH SERVICES INCLUDING HEALTH EDUCATION, FREE AND LOW COST SCREENINGS AND IMMUNIZATIONS, A WIC PROGRAM, AND VARIOUS OTHER OUTPATIENT SERVICES.THE MEDICAL CENTER PROVIDES FOR THE HEALTHCARE NEEDS OF STATEN ISLAND'S MOST INDIGENT AND MARGINALIZED RESIDENTS. BASED ON COST, IN 2018, APPROXIMATELY $5,101,000 IN CHARITY CARE WAS PROVIDED TO PATIENTS WHO MEET CERTAIN NYS DEPARTMENT OF HEALTH AND SENIOR SERVICES CRITERIA. THESE PATIENTS RECEIVED SERVICES WITHOUT CHARGE OR AT AMOUNTS LESS THAN ESTABLISHED RATES. THE MEDICAL CENTER ALSO PROVIDED COMMUNITY BENEFITS BY PROVIDING SERVICES TO MEDICAID PATIENTS AT RATES THAT WERE BELOW THE COSTS FOR PROVIDING SUCH SERVICES. IN 2018, INPATIENT VOLUME EXCEEDED 15,000 INPATIENT DISCHARGES ACCOUNTING FOR OVER 79,000 PATIENT DAYS. OUTPATIENT VOLUME EXCEEDED 58,000 EMERGENCY ROOM VISITS AND OVER 190,000 OTHER OUTPATIENT VISITS. THE LARGEST PROGRAM SERVICES BY EXPENSES ARE: MEDICAL / SURGICAL, BEHAVIORAL HEALTH AND OBSTETRICS / GYNECOLOGY.MEDICAL / SURGICALTHE MEDICAL CENTER PROVIDED COMPREHENSIVE INPATIENT AND OUTPATIENT MEDICAL/SURGICAL SERVICES TO THOUSANDS OF PATIENTS IN 2018. DURING THE YEAR, THE MEDICAL CENTER PERFORMED OVER 1,600 INPATIENT AND 6,000 OUTPATIENT SURGERIES MEDICAL/SURGICAL SERVICES INCLUDE ENDOSCOPY, PAIN MANAGEMENT, VASCULAR SURGERY, UROLOGIC SURGERY, SPORTS MEDICINE, JOINT REPLACEMENT, AND ARTHROSCOPIC SURGERY. BEHAVIORAL HEALTHBEHAVIORAL HEALTH SERVICES AT THE MEDICAL CENTER TREATED THOUSANDS OF ADULTS AND CHILDREN IN 2018. DURING THE YEAR, BEHAVIORAL HEALTH INPATIENT DISCHARGES TOTALED OVER 1,300 AND ACCOUNTED FOR MORE THAN 14,000 PATIENT DAYS. INPATIENT SERVICES INCLUDED A PSYCHIATRIC UNIT, A CHILD AND ADOLESCENT PROGRAM SERVICES. BEHAVIOR HEALTH OUTPATIENT CARE IS AVAILABLE THROUGH THE COMPREHENSIVE PSYCHIATRIC EMERGENCY PROGRAM (CPEP), WHICH PROVIDES IMMEDIATE ACUTE PSYCHIATRIC CARE WITH AN EXTENDED OBSERVATION BED UNIT AND A MOBILE OUTREACH TEAM. OTHER OUTPATIENT SERVICES INCLUDE A CONTINUING DAY TREATMENT PROGRAM, SUBSTANCE ABUSE OUTPATIENT CLINICS, A SUBSTANCE ABUSE CRISIS CENTER, A GAMBLERS TREATMENT CENTER AND AN ONGOING EVALUATION AND REFERRAL SERVICE.

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 expenses293,396,270

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	8,673,300	0	781,890

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c
d	Related organizations		1d	2,084,608
e	Government grants (contributions)		1e	22,770,685

f	All other contributions, gifts, grants, and similar amounts not included above		1f	214,825

g	Noncash contributions included in lines 1a - 1f:$
h Total. Add lines 1a-1f.......		25,070,118

		Business Code
2a	NET PATIENT SERVICE REVENUES	621990	308,016,144	308,016,144
b	NYS DOH PUBLIC POOL REV	621990	7,299,340	7,299,340
c
d
e
f	All other program service revenue.
g	Total. Add lines 2a–2f ....		315,315,484

3 Investment income (including dividends, interest, and othersimilar amounts) ......			267,705		1,979	265,726
4 Income from investment of tax-exempt bond proceeds
5 Royalties...........
		(ii) Personal	(i) Real
6a	Gross rents		1,715,311
b	Less: rental expenses		1,257,074
c	Rental income or (loss)		458,237
d	Net rental income or (loss)......			458,237			458,237
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory	10,000	214,236
b	Less: cost or other basis and sales expenses	0	0
c	Gain or (loss)	10,000	214,236
d	Net gain or (loss).....			224,236			224,236
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..
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..
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..
Business Code			Miscellaneous Revenue
11a	VENDOR REBATES AND REFUNDS		900099	6,898,462			6,898,462
b	OTHER PROGRAM INCOME		900099	3,246,022			3,246,022
c	STUDENT SERVICES INCOME		900099	2,651,182			2,651,182
d	All other revenue ....			2,792,947			2,792,947
e	Total. Add lines 11a–11d ......			15,588,613
12	Total revenue. See Instructions......			356,924,393	315,315,484	1,979	16,536,812

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21
2	Grants and other assistance to domestic individuals. See Part IV, line 22
3	Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, line 15 and 16.
4	Benefits paid to or for members
5	Compensation of current officers, directors, trustees, and key employees ....	5,900,291	5,049,469	850,822
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....
7	Other salaries and wages	158,599,544	135,729,490	22,870,054
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	13,732,273	11,752,079	1,980,194
9	Other employee benefits .......	28,784,703	24,633,949	4,150,754
10	Payroll taxes ...........	12,258,831	10,491,108	1,767,723
11	Fees for services (non-employees):
a	Management ......
b	Legal .........	421,111	360,387	60,724
c	Accounting ...........	242,394	207,441	34,953
d	Lobbying ...........	29,290		29,290
e	Professional fundraising services. See Part IV, line 17
f	Investment management fees ......
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	26,986,160	23,094,756	3,891,404
12	Advertising and promotion ....	816,983	699,174	117,809
13	Office expenses .......	2,442,741	2,090,498	352,243
14	Information technology ......	3,300	2,824	476
15	Royalties ..
16	Occupancy ...........	4,590,723	3,928,741	661,982
17	Travel ............	59,634	51,035	8,599
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .
19	Conferences, conventions, and meetings ....	289,817	248,025	41,792
20	Interest ...........	943,876	807,769	136,107
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization ..	9,170,681	7,848,269	1,322,412
23	Insurance ...	4,273,718	3,657,448	616,270
24	Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a	MEDICAL SUPPLIES	37,100,535	31,750,638	5,349,897
b	BAD DEBT EXPENSE	22,088,239	18,903,115	3,185,124
c	REPAIRS & MAINTENANCE	5,477,317	4,687,488	789,829
d	LICENSES & FEES	2,381,083	2,037,731	343,352
e	All other expenses	6,268,798	5,364,836	903,962
25	Total functional expenses. Add lines 1 through 24e	342,862,042	293,396,270	49,465,772	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 ........			7,208,327	1	9,639,555
2	Savings and temporary cash investments .........			24,821,462	2	18,783,650
3	Pledges and grants receivable, net ......				3
4	Accounts receivable, net .............			36,008,990	4	47,504,977
5	Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of Schedule L .............
					5
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 ..............
					6
7	Notes and loans receivable, net ....			6,048,655	7	10,707,496
8	Inventories for sale or use ........			6,288,940	8	6,209,659
9	Prepaid expenses and deferred charges ......			1,767,629	9	1,326,305
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	129,832,433
b	Less: accumulated depreciation	10b	52,814,194	77,117,592	10c	77,018,239
11	Investments—publicly traded securities .				11
12	Investments—other securities. See Part IV, line 11 .....			50,000	12	50,000
13	Investments—program-related. See Part IV, line 11 ..				13
14	Intangible assets ...............			616,628	14	72,560
15	Other assets. See Part IV, line 11 ...........			47,635,226	15	84,485,857
16	Total assets. Add lines 1 through 15 (must equal line 34)...			207,563,449	16	255,798,298

17	Accounts payable and accrued expenses .....	41,953,297	17	46,948,709
18	Grants payable ...		18
19	Deferred revenue .........	3,981,568	19	3,699,195
20	Tax-exempt bond liabilities .........		20	50,580,000
21	Escrow or custodial account liability. Complete Part IV of Schedule D		21
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..		22
23	Secured mortgages and notes payable to unrelated third parties ..	10,807,030	23	4,456,040
24	Unsecured notes and loans payable to unrelated third parties ..		24
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	72,729,472	25	59,336,472
26	Total liabilities. Add lines 17 through 25..	129,471,367	26	165,020,416

	Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets	73,340,992	27	87,155,525
28	Temporarily restricted net assets ...........	4,406,443	28	3,277,710
29	Permanently restricted net assets	344,647	29	344,647
	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 ...........	78,092,082	33	90,777,882
34	Total liabilities and net assets/fund balances ........	207,563,449	34	255,798,298