TY 2021 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/1099-NEC)
(1) NORMAN SIEGEL...................................................................... EMERITUS	1.00 ................. 2.50	X		0	0
(2) JOAN COMPSON...................................................................... EMERITUS	1.00 ................. 2.50	X		0	0
(3) ROBERT DICKS...................................................................... DIRECTOR	1.00 ................. 0.00	X		0	0
(4) SYMEON TSOUPELIS...................................................................... DIRECTOR	1.00 ................. 2.50	X		0	0
(5) ANDREW KOWALCZYK III...................................................................... DIRECTOR	1.00 ................. 2.50	X		0	0
(6) LAUREN BULL...................................................................... VICE CHAIRMAN	1.00 ................. 2.50	X	X	0	0
(7) BARBARA BRODOCK...................................................................... DIRECTOR	1.00 ................. 2.50	X		0	0
(8) CATHERINE BROWNELL PHD...................................................................... DIRECTOR	1.00 ................. 2.50	X		0	0
(9) DOMENIC P AIELLO MD...................................................................... DIRECTOR	1.00 ................. 2.50	X		0	0
(10) GREGORY MCLEAN...................................................................... DIRECTOR	1.00 ................. 2.50	X		0	0
(11) CATHERINE COMINSKY...................................................................... DIRECTOR	1.00 ................. 2.50	X		0	0
(12) RICHARD TANTILLO...................................................................... PHILANTHROPY CHAIR	1.00 ................. 2.50	X	X	0	0
(13) KAREN LEACH...................................................................... SECRETARY	1.00 ................. 2.50	X	X	0	0
(14) SUSHMA KAUL MD...................................................................... MVHS MEDICAL DIRECTOR PRESIDENT/FSLH PHYSICIAN	1.00 ................. 52.50	X		783,453	27,233
(15) RICHARD ZWEIFEL...................................................................... TREASURER	1.00 ................. 2.50	X	X	0	0
(16) GREGORY EVANS...................................................................... CHAIRMAN	1.00 ................. 2.50	X	X	0	0
(17) JONATHON BLOCK MD...................................................................... MVHS MEDICAL STAFF VICE PRESIDENT	1.00 ................. 2.50	X		0	0

(A) Name and title	(B) Average hours per week (list any hours for related organizations below dotted line)	(E) Reportable compensation from related organizations (W-2/1099-MISC/1099-NEC)	(F) Estimated amount of other compensation from the organization and related organizations
(18) LOUIS AIELLO........................................................................ CFO	18.00 .......................32.00	X				558,313	0	35,386
(19) DARLENE STROMSTAD........................................................................ PRESIDENT/CEO	20.00 .......................35.00	X				0	917,310	19,328
(20) LINDA MCCORMACK-MILLER........................................................................ CNO	18.00 .......................32.00		X			0	276,789	13,241
(21) MANSOOR SHAHID........................................................................ COO	18.00 .......................32.00		X			0	555,830	27,862
(22) KENT HALL MD........................................................................ CMO (START 2/2020)	18.00 .......................32.00		X			0	600,694	27,977
(23) NABEEL EL-AMIR MD........................................................................ PHYSICIAN	50.00 .......................0.00			X		1,083,482	0	34,897
(24) ALEXANDROS KARAVAS MD........................................................................ PHYSICIAN	50.00 .......................0.00			X		830,407	0	31,748
(25) GOUTHAN MALEMPATI MD........................................................................ PHYSICIAN	50.00 .......................0.00			X		511,614	0	30,759
(26) SHWE WIN MD........................................................................ PHYSICIAN	50.00 .......................0.00			X		489,429	0	29,970
(27) DEVAYANI MANASSIVAYA MD........................................................................ PHYSICIAN	50.00 .......................0.00			X		429,405	0	26,251
(28) WALEED ALBERT MD........................................................................ FORMER DIRECTOR	0.00 .......................0.00				X	0	42,004	0
(29) MARIA GESUALDO MD........................................................................ FORMER DIRECTOR	0.00 .......................0.00				X	0	91,025	0
(30) SCOTT PERRA........................................................................ FORMER ADMINISTRATOR	0.00 .......................0.00				X	0	244,048	8,819
(31) ERIC YOSS MD........................................................................ FORMER CMO	0.00 .......................50.00				X	0	392,860	24,327

(A) Name and business address	(B) Description of services	(C) Compensation
DAVIN HEALTHCARE SOFTWARE SOLUTIONS 18 DIVISION STREET 312 SARATOGA SPRINGS,NY12866	MEDICAL STAFFING SERVICES	4,997,491
UPTOWN ANESTHESIA ASSOCIATION 2405 GENESEE STREET UTICA,NY13501	ANESTHESIA SERVICES	3,788,276
MAYO COLLABORATIVE SERVICES PO BOX 9146 MINNEAPOLIS,MN55480	LABRATORY SERVICES	2,433,793
BAXTER HEALTHCARE CORPORATION 1 BAXTER PARKWAY DEERFIELD,IL60015	HEALTHCARE PRODUCTS	1,233,645
CNY BRAIN AND SPINE NEUROSURGERY 83 GENESEE STREET NEW HARTFORD,NY13413	COMPREHENSIVE SPINE CENTER	963,802
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 45

- TIN:

SCHEDULE A
(Form 990)

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 instructions and the latest information.

OMB No. 1545-0047

2021

Open to Public
Inspection

Name of the organization

ST ELIZABETH MEDICAL CENTER

Employer identification number

15-0532245

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).)

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 33 1/3% 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 33 1/3% 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 on 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) 2021

Page 2

Part II

Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization failed to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2017	(b) 2018	(c) 2019	(d) 2020	(e) 2021	(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) 2017	(b) 2018	(c) 2019	(d) 2020	(e) 2021	(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 5 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 2021 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2020 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2021. 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—2020. 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—2021. 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—2020. 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) 2021

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) 2017	(b) 2018	(c) 2019	(d) 2020	(e) 2021	(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) 2017	(b) 2018	(c) 2019	(d) 2020	(e) 2021	(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 on 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 5 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 2021 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2020 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2021 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2020 Schedule A, Part III, line 17 .............

19a

331/3% support tests—2021. 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—2020. 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) 2021

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 12 of Part I. If you checked box 12a, of Part I, complete Sections A and B. If you checked box 12b, of Part I, complete Sections A and C. If you checked box 12c, of Part I, complete Sections A, D, and E. If you checked box12d, 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 lines 3b and 3c 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 box 12a or 12b in Part I, answer lines 4b and 4c 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 lines 5b and 5c 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) .

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

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 on 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 on 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) 2021

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 on lines 11b and 11c below, the governing body of a supported organization?

11a

A family member of a person described on 11a above?

11b

A 35% controlled entity of a person described on line 11a or 11b above? If “Yes” to 11a, 11b, or 11c, provide detail in Part VI.

11c

Section B. Type I Supporting Organizations

Yes

Did the officers, 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 line 2 above, 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 lines 2a and 2b 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 on line 2a, above 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 lines 3a and 3b 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?If "Yes" or "No", 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) 2021

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 0.015 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 0.035	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) 2021

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	1
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity	2
3 Administrative expenses paid to accomplish exempt purposes of supported organizations	3
4 Amounts paid to acquire exempt-use assets	4
5 Qualified set-aside amounts (prior IRS approval required - provide details in Part VI)	5
6 Other distributions (describe in Part VI). See instructions	6
7Total annual distributions. Add lines 1 through 6.	7
8 Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions	8
9 Distributable amount for 2021 from Section C, line 6	9
10 Line 8 amount divided by Line 9 amount	10

Section E - Distribution Allocations (see instructions)		(i) Excess Distributions	(ii) Underdistributions Pre-2021	(iii) Distributable Amount for 2021
1 Distributable amount for 2021 from Section C, line 6
2 Underdistributions, if any, for years prior to 2021 (reasonable cause required-- explain in Part VI). See instructions.
3 Excess distributions carryover, if any, to 2021:
a From 2016.......
b From 2017.......
c From 2018.......
d From 2019.......
e From 2020.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2021 distributable amount
i Carryover from 2016 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from line 3f.
4Distributions for 2021 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2021 distributable amount
c Remainder. Subtract lines 4a and 4b from line 4.
5 Remaining underdistributions for years prior to 2021, 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 2021. 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 2022. Add lines 3j and 4c.
8 Breakdown of line 7:
a Excess from 2017.....
b Excess from 2018.....
c Excess from 2019.....
d Excess from 2020.....
e Excess from 2021.....

Schedule A (Form 990) (2021)

Schedule A (Form 990) 2021

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) 2021

Additional Data

Software ID:
Software Version:

- TIN:

Schedule B
(Form 990)

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

2021

Name of the organization

ST ELIZABETH MEDICAL CENTER

Employer identification number

15-0532245

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) (2021)

Schedule B (Form 990) (2021) Page 2

Name of organization ST ELIZABETH MEDICAL CENTER

Part I Contributors	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) (2021)

Schedule B (Form 990) (2021)

Page 3

Name of organization ST ELIZABETH MEDICAL CENTER		Employer identification number 15-0532245

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) (2021)

Schedule B (Form 990) (2021)

Page 4


Name of organization ST ELIZABETH MEDICAL CENTER			Employer identification number 15-0532245
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) (2021)

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE C
(Form 990)

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

2021

Open to Public
Inspection

If the organization answered "Yes" on Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet

Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet

Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet

Section 527 organizations: Complete Part I-A only.
If the organization answered "Yes" on Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet

Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)): Complete Part II-A. Do not complete Part II-B.
Round Bullet

Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered "Yes" on Form 990, Part IV, Line 5 (Proxy Tax) (see separate instructions) or Form 990-EZ, Part V, line 35c (Proxy Tax) (see separate instructions), then
Round Bullet

Section 501(c)(4), (5), or (6) organizations: Complete Part III.

Name of the organization

ST ELIZABETH MEDICAL CENTER

Employer identification number

15-0532245

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.

Cat. No. 50084S

Schedule C (Form 990) 2021

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) 2018	(b) 2019	(c) 2020	(d) 2021	(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) 2021

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|No

(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

66,035

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

66,035

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:	ACTIVITIES INCLUDE THE PORTION OF DUES PAID TO THE HEALTH CARE ASSOCIATION OF NEW YORK STATE.

Schedule C (Form 990) 2021

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 instructions and the latest information.

OMB No. 1545-0047

2021

Open to Public Inspection

Name of the organization

ST ELIZABETH MEDICAL CENTER

Employer identification number

15-0532245

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.

			Held at the End of the Year
a	Total number of conservation easements ......................	2a	1
b	Total acreage restricted by conservation easements ....................	2b	20.00
c	Number of conservation easements on a certified historic structure included in (a) .....	2c	0
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	0

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 FASB 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 FASB 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 FASB 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) 2021

Page 2

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)

Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.

During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?...

Yes No

Part IV

Escrow and Custodial Arrangements. Complete if the organization answered "Yes" on Form 990, Part IV, line 9, or reported an amount on Form 990, Part X, line 21.

Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................

Yes No


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

Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability? ...

Yes No

If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ....

Part V

Endowment Funds.
Complete if the organization answered "Yes" on Form 990, Part IV, line 10.

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

1a	Beginning of year balance ....	1,592,390	1,557,698	1,447,744	1,638,165	1,415,847
b	Contributions ...			175,990	126,871	233,401
c	Net investment earnings, gains, and losses	548,864	57,617	250,468	-59,273	169,133
d	Grants or scholarships ...	178,690	22,925	177,564	119,411	13,100
e	Other expenditures for facilities and programs ...			138,940	138,608	167,116
f	Administrative expenses ....
g	End of year balance ......	1,962,564	1,592,390	1,557,698	1,447,744	1,638,165

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

Board designated or quasi-endowment SchDMd Bullet

Permanent endowment SchDMd Bullet

54.430 %

Term endowment SchDMd Bullet

45.570 %

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)

Yes

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

Yes

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 .....	6,159,199		6,159,199
b	Buildings ....	63,644,651	46,709,782	16,934,869
c	Leasehold improvements
d	Equipment ....	111,452,998	77,338,424	34,114,574
e	Other .....
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				57,208,642

Schedule D (Form 990) 2021

Page 3

Part VII

Investments - Other 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

Investments - Program 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)GRANT AND TUITION RECEIVABLES				5,627,731
(2)ASSETS WHOSE USE IS LIMITED- BOND FUNDS				6,476,673
(3)INTEREST IN NET ASSETS OF SEMC FOUNDATION				6,056,372
(4)INVESTMENTS RESTRICTED BY DONORS				2,348,126
(5)OPERATING LEASE RIGHT-OF-USE ASSETS				1,502,840
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........				22,011,742

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
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	65,684,979
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) 2021

Page 4

Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total revenue, gains, and other support per audited financial statements .......		1
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains (losses) on investments ....	2a
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d .....................		2e
3	Subtract line 2e from line 1..................		3
4	Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b .	4a
b	Other (Describe in Part XIII.) ...........	4b
c	Add lines 4a and 4b....................		4c
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......		5

Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total expenses and losses per audited financial statements ...........		1
2	Amounts included on line 1 but not on Form 990, Part IX, line 25:
a	Donated services and use of facilities .........	2a
b	Prior year adjustments ............	2b
c	Other losses ................	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d....................		2e
3	Subtract line 2e from line 1...................		3
4	Amounts included on Form 990, Part IX, line 25, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b ..	4a
b	Other (Describe in Part XIII.) ............	4b
c	Add lines 4a and 4b.....................		4c
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......		5

Part XIII

Supplemental Information

Provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b; Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.

Return Reference	Explanation
PART II, LINE 9:	THE AMOUNT OF CONSERVATION EASEMENT IS IMMATERIAL TO FINANCIAL STATEMENTS AND THEREFORE, IS NOT RECORDED AS PART OF TOTAL ASSETS.
PART V, LINE 4:	ENDOWMENT FUNDS - THE INTENDED PURPOSE OF THE MEDICAL CENTER'S ENDOWMENT FUNDS IS TO PROVIDE FUTURE SCHOLARSHIP AWARDS FOR STUDENTS IN THE COLLEGE OF NURSING PROGRAM.
PART X, LINE 2:	THE MEDICAL CENTER AND THE FOUNDATION HAVE BEEN RECOGNIZED AS TAX-EXEMPT PURSUANT TO SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. AS OF DECEMBER 31, 2021 AND 2020, THE MEDICAL CENTER AND THE FOUNDATION DID NOT HAVE ANY UNRECOGNIZED TAX BENEFITS OR ANY RELATED ACCRUED INTEREST OR PENALTIES. THE TAX YEARS OPEN TO EXAMINATION BY FEDERAL AND STATE TAXING AUTHORITIES ARE 2018 THROUGH 2021. THE MEDICAL CENTER AND THE FOUNDATION DOES NOT ANTICIPATE THE TOTAL UNRECOGNIZED TAX BENEFITS WILL CHANGE IN THE NEXT TWELVE MONTHS.

Schedule D (Form 990) 2021

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

2021

Open to Public Inspection

Name of the organization

ST ELIZABETH MEDICAL CENTER

Employer identification number

15-0532245

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 25000.0000000000 %

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 32500.0000000000 %

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

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

Yes

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

Yes

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

Yes

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

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

Yes

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

Yes

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

Financial Assistance and Certain Other Community Benefits at Cost

Financial Assistance and Means-Tested Government Programs		(c) Total community benefit expense	(d) Direct offsetting revenue	(e) Net community benefit expense	(f) Percent of total expense
a	Financial Assistance at cost (from Worksheet 1) . . .	2,932,331	1,423,218	1,509,113	0.710 %
b	Medicaid (from Worksheet 3, column a) . . . . .	37,191,120	30,770,350	6,420,770	3.020 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .	3,426,182	2,208,790	1,217,392	0.570 %
d	Total Financial Assistance and Means-Tested Government Programs . . . . .	43,549,633	34,402,358	9,147,275	4.300 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).	283,382	0	283,382	0.130 %
f	Health professions education (from Worksheet 5) . . .	8,593,847	4,961,639	3,632,208	1.710 %
g	Subsidized health services (from Worksheet 6) . . . .
h	Research (from Worksheet 7) .	114,400	0	114,400	0.050 %
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .
j	Total. Other Benefits . .	8,991,629	4,961,639	4,029,990	1.890 %
k	Total. Add lines 7d and 7j .	52,541,262	39,363,997	13,177,265	6.190 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2021

Schedule H (Form 990) 2021

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 Healthcare Financial Management Association Statement No. 15? ..........................

Yes

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

8,000,648

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. ......

257,809

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).....

53,063,154

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

55,879,913

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

-2,816,759

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 %
11 MVEC	GASTROENTEROLOGY SERVICES	20.000 %	0 %	0 %
2
3
4
5
6
7
8
9
10
11
12
13

Schedule H (Form 990) 2021

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)						Other (describe)
1	ST ELIZABETH MEDICAL CENTER 2209 GENESEE STREET UTICA,NY13501	X	X	X	X	TEACHING HOSPITAL AND 24 HOUR ER

Schedule H (Form 990) 2021

Page 4

Part VFacility Information (continued)

Section B. Facility Policies and Practices

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

	ST ELIZABETH 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 19

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

Yes

6 a

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C..................................

Yes

Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................

Yes

Did the hospital facility make its CHNA report widely available to the public?..............

Yes

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

Hospital facility’s website (list url): HTTP://MVHEALTHSYSTEM.ORG

Other website (list url): HTTP://OCGOV.NET

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 19

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

Yes

If "Yes" (list url): HTTP://MVHEALTHSYSTEM.ORG

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

10b

Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.

12a

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

12a

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

12b

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

Schedule H (Form 990) 2021

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	ST ELIZABETH 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 250.000000000000%
and FPG family income limit for eligibility for discounted care of 325.000000000000%

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):

HTTP://MVHEALTHSYSTEM.ORG

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

HTTP://MVHEALTHSYSTEM.ORG

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

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

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

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

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) 2021

Page 6

Part VFacility Information (continued)

Billing and Collections

	ST ELIZABETH 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 (if not, describe in Section C)

Made a reasonable effort to orally notify individuals about the FAP and FAP application process (if not, describe in
Section C)

Processed incomplete and complete FAP applications (if not, describe in Section C)

Made presumptive eligibility determinations (if not, describe in Section C)

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) 2021

Page 7

Part VFacility Information (continued)

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

	ST ELIZABETH 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) 2021

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, 20a, 20b, 20c, 20d, 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
ST ELIZABETH MEDICAL CENTER	PART V, SECTION B, LINE 5: DISEASE PREVENTION: PLANNING WITH COMMUNITY BASED ORGANIZATIONS TO DEVELOP/DISTRIBUTE CURRICULUM FOR CANCER RELATED EDUCATIONAL ACTIVITIES IN RURAL AREAS, OFFER SCREENING EVENTS; MARKETING DEVELOPMENT AND IMPLEMENTATION PROMOTING CANCER PREVENTION; PLANNING WITH PARTNERS TO DEVELOP CURRICULUM FOR CHRONIC DISEASE PREVENTION, OUTREACH EFFORTS AND IDENTIFY VENUES TO DISTRIBUTE EDUCATIONAL INFORMATION; INCLUDING PHYSICIAN PRACTICES, FQHC'S AND OTHER PROVIDER OFFICES. MENTAL HEALTH/SUBSTANCE ABUSE: CONDUCTED PLANNING ACTIVITES WITH COMMUNITY REPRESENTATIVES RELATED TO MENTAL HEALTH TRAININGS. CONTINUED RELATIONSHIPS WITH TRAINING PROVIDERS. UPDATED LISTING OF DROP BOX LOCATIONS. CONTINUED USE OF ODMAP. PARTICPATED IN THE IHA OPIOD ALTERNATIVE PROJECT TO ESTABLISH ALTERNATIVES TO PRESCRIBING OPIODS, DEVELOPED AND IMPLEMENTED WITH TRAINING TO PROVIDERS AND STAFF IN OUR ED. CONTINUED TO WORK WITH THE COUNTY OPIOD TASK FORCE PREVENTION WORKGROUP. DEVELOPMENT OF THESE EFFORTS WAS DONE IN CONJUNCTION WITH COUNTY LOCAL HEALTH DEPARTMENT PUBLIC HEALTH EDUCATOR, A LOCAL MARKETING COMPANY, UPSTATE UNIVERSITY MOBILE MAMMOGRAPHY PROGRAM MANAGER, CANCER SERVICES PROGRAM, FIDELIS, HOSPITAL AFFILIATED PRIMARY CARE PROVIDERS, CBO'S, AMERICAN HEART ASSOCIATION, HOSPITAL NDPP, ROME MEMORIAL HOSPITAL, COUNTY HEALTH AND MENTAL HEALTH PROGRAM ANALYSTS, NYS DOH, COMMUNITY RECOVER CENTER ROME, RESCUE MISSION, CENTER FAMILY LIFE RECOVERY, INSIGHT HOUSE, IROQUOIS HEALTHCARE ALLIANCE, US ATTORNEY'S OFFICE, BOCES, SCHOOL DISTRICT.
ST ELIZABETH MEDICAL CENTER	PART V, SECTION B, LINE 6A: OTHER REPRESENTATIVES INCLUDED FAXTON ST.-LUKE'S HEALTHCARE, ST ELIZABETH MEDICAL CENTER, AND ROME MEMORIAL HOSPITAL.
ST ELIZABETH MEDICAL CENTER	PART V, SECTION B, LINE 6B: IN ADDITION TO ONEIDA COUNTY HEALTH DEPARTMENT, CENTRAL NEW YORK HOME HEALTH CARE, HERKIMER-ONEIDA COMPREHENSIVE PLANNING PROGRAM, UTICA COMMUNITY HEALTH CENTER, MOHAWK VALLEY PERINATAL NETWORK, ONEIDA COUNTY DEPARTMENT OF SOCIAL SERVICES, THE COMMUNITY FOUNDATION OF HERKIMER AND ONEIDA COUNTIES, CORNELL COOPERATIVE EXTENSION, THE PARKWAY CENTER, AMERICAN CANCER SOCIETY, UPSTATE CEREBRAL PALSY, UNITED WAY, ONEIDA COUNTY DEPARTMENT OF MENTAL HEALTH, CENTER FOR FAMILY LIFE & RECOVERY, AND THE HOUSE OF THE GOOD SHEPHERD.
ST ELIZABETH MEDICAL CENTER	PART V, SECTION B, LINE 11: THE ONGOING GOALS TO PREVENT CHRONIC DISEASE HAVE BEEN ADDRESSED WITH SUCESSFUL OUTREACH PROGRAMS SUCH AS PARTICIPATION IN MULTIPLE HEALTH FAIRS, DIABETES EDUCTATION THROUGH OUR HOSPITAL PHYSICIAN PRACTICES TO INTRODUCE EDUCATIONAL PROGRAMS. THOUGH INCLUDED IN OUR PLAN, THERE HAS BEEN LITTILE PARTNER INVOLVEMENT BY THE AMERICAN HEART ASSOCIATION AT THIS POINT IN TIME. MUCH TIME HAS BEEN DEDICATED TO PLANNING FOR THE REDUCTION OF OPIOID OVERDOSES/ABUSE. OUR PHYSICIAN PRACTICES HAVE BEEN TRAINED, AS WELL AS OUR ED STAFF HAVING WAIVER TRAINING. LOCK BOXES HAVE BEEN SET UP AT MULTIPLE LOCATIONS AND SHARED WITH OUR PARTNERS. WE ARE MAKING LITTLE PROGRESS OVERALL ON MENTAL HEALTH AND DEPENDENCY ISSUES DUE TO A NATIONAL SHORTAGE OF THE APPROPRIATE PHYSICIANS. OUR ORGANIZATION IS ACTIVELY RECRUITING FOR SAID PHYSICIANS.

Schedule H (Form 990) 2021

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?17
Name and address		Type of Facility (describe)
1	1 - SEMC AT FAMILY PRACTICE CENTER 120 HOBART STREET UTICA,NY13501	OUTPATIENT PHYSICIAN CLINIC/OUTPATIENT LAB/X-RAY
2	2 - WOUND CARE SERVICES 4401 MIDDLE SETTLEMENT ROAD NEW HARTFORD,NY13413	OUTPATIENT PHYSICIAN CLINIC
3	3 - WOMEN & CHILDREN'S FAMILY HEALTH CENTER 2212 GENESEE STREET UTICA,NY13501	OUTPATIENT PHYSICIAN CLINIC
4	4 - COMMUNITY MEDICINE AT EAST UTICA 1256 CULVER AVENUE UTICA,NY13501	OUTPATIENT PHYSICIAN CLINIC/OUTPATIENT LAB
5	5 - FAMILY PRACTICE NEW HARTFORD 4401 MIDDLE SETTLEMENT ROAD NEW HARTFORD,NY13413	OUTPATIENT PHYSICIAN CLINIC
6	6 - MARIAN MEDICAL 2211 GENESEE STREET UTICA,NY13501	OUTPATIENT LAB/PHYSICIAN CLINIC/CT SURGERY GROUP
7	7 - LITTLE FALLS FAMILY PRACTICE 500 EAST MAIN STREET LITTLE FALLS,NY13365	OUTPATIENT PHYSICIAN CLINIC/OUTPATIENT LAB
8	8 - TOWN OF WEBB HEALTH CENTER 114 SOUTH SHORE ROAD OLD FORGE,NY13420	OUTPATIENT PHYSICIAN CLINIC/OUTPATIENT LAB
9	9 - MEDICAL ARTS 4401 MIDDLE SETTLEMENT ROAD NEW HARTFORD,NY13413	OUTPATIENT LAB
10	10 - SLEEP DISORDERS CENTER 2215 GENESEE STREET UTICA,NY13501	OUTPATIENT PHYSICIAN CLINIC
11	11 - ST ELIZABETH LAB 86 GENESEE STREET NEW HARTFORD,NY13413	OUTPATIENT LAB
12	12 - ST ELIZABETH LAB - ONEIDA 131 MAIN STREET ONEIDA,NY13421	OUTPATIENT LAB
13	13 - ST ELIZABETH LAB - RIDGE MILLS 7845 ROME WESTERNVILLE ROAD ROME,NY13440	OUTPATIENT LAB
14	14 - ST ELIZABETH LAB UPSTATE CEREBRAL PALSY 1427 GENESEE STREET UTICA,NY13501	OUTPATIENT LAB
15	15 - ST ELIZABETH LAB AT UTICA BUSINESS PARK 125 BUSINESS PARK DRIVE SUITE 135 UTICA,NY13502	OUTPATIENT LAB
16	16 - ST ELIZABETH LAB - WASHINGTON MILLS 3946 ONEIDA STREET NEW HARTFORD,NY13413	OUTPATIENT LAB
17	17 - ST ELIZABETH LAB - WHITESBORO 37 MAIN STREET WHITESBORO,NY13492	OUTPATIENT LAB

Schedule H (Form 990) 2021

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 PATIENTS COST-TO-CHARGE RATIO WAS COMPUTED USING ALL CHARGES AND EXPENSES LESS NON-ALLOWABLE. THE COST TO CHARGE RATIO WAS USED TO COMPUTE COST. COST-TO-CHARGE WAS DERIVED BY DIVIDING TOTAL CHARGES FROM THE FINANCIAL STATEMENTS INTO TOTAL COST FROM THE FINANCIAL STATEMENTS, LESS NON-PATIENT COSTS.
PART I, LN 7 COL(F):	THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 24(B), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $8,000,648.
PART II, COMMUNITY BUILDING ACTIVITIES:	IN RESPONSE TO THE PANDEMIC, MVHS HELD COVID-19 VACCINATION PODS FOR THE COMMUNITY AND STAFF DAILY STARTING ON DECEMBER 16 THROUGH THE END OF THE YEAR, 2020. MVHS STOOD UP A COMMUNITY COVID-19 TESTING SITE AT OUR BURRSTONE ROAD LOCATION. MVHS PROVIDED COMMUNITY TESTING TENTS/TRAILERS AT BOTH ST. LUKE'S AND ST. ELIZABETH CAMPUSES. MVHS PROVIDED A COVID-19 TESTING SITE FOR THE HEALTH EQUITY POPULATION AT SISTER ROSE VINCENT FAMILY MEDICINE CENTER IN UTICA.
PART III, LINE 4:	990 PART III LINE 4: (FOOTNOTE)THE MEDICAL CENTER PROVIDES CARE TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS CHARITY CARE POLICY WITHOUT CHARGE OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATES. THE MEDICAL CENTER'S POLICY IS NOT TO PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE; THEREFORE, THESE AMOUNTS ARE NOT REPORTED IN NET PATIENT SERVICE REVENUE. DURING 2021 AND 2020, COSTS INCURRED BY THE MEDICAL CENTER IN THE PROVISION OF CHARITY CARE WERE BASED ON THE RATIO OF THE MEDICAL CENTER'S COSTS TO GROSS CHARGES AND APPROXIMATED $258,000 AND $231,000 FOR THE YEARS ENDED DECEMBER 31, 2021 AND 2020, RESPECTIVELY. 990 PART III, LINE 3:THE MEDICAL CENTER GRANTS CREDIT WITHOUT COLLATERAL TO PATIENTS, MOST OF WHOM ARE LOCAL RESIDENTS AND ARE INSURED UNDER THIRD-PARTY AGREEMENTS. ADDITIONS TO THE ALLOWANCE FOR DOUBTFUL ACCOUNTS ARE MADE BY MEANS OF THE PROVISION FOR DOUBTFUL ACCOUNTS. ACCOUNTS WRITTEN OFF AS UNCOLLECTIBLE ARE DEDUCTED FROM THE ALLOWANCE AND SUBSEQUENT RECOVERIES ARE ADDED. THE AMOUNT OF THE PROVISION FOR DOUBTFUL ACCOUNTS IS BASED UPON MANAGEMENT'S ASSESSMENT OF HISTORICAL EXPECTED NET COLLECTIONS, BUSINESS AND ECONOMIC CONDITIONS, TRENDS IN FEDERAL AND STATE GOVERNMENT HEALTH CARE COVERAGE AND OTHER COLLECTION INDICATORS. SERVICES RENDERED TO INDIVIDUALS WHEN PAYMENT IS EXPECTED AND ULTIMATELY NOT RECEIVED ARE WRITTEN OFF TO THE ALLOWANCE FOR DOUBTFUL ACCOUNTS.
PART III, LINE 8:	THE COSTING METHODOLOGY USED TO DETERMINE THE AMOUNT REPORTED ON LINE 6 IS COST TO CHARGE RATIO. THE SHORTFALL REPORTED IS COMMUNITY BENEFIT EXPENSE BECAUSE THIS AMOUNT REPRESENTS THE UNREIMBURSED COSTS TO THE MEDICAL CENTER FOR PROVIDING CARE FOR THE COMMUNITY'S ELDERLY AND DISABLED.
PART III, LINE 9B:	COLLECTION POLICY PROVISIONS PATIENTS THAT QUALIFY FOR THE MEDICAL CENTER'S CHARITY CARE PROGRAM HAVE THE CHARGES ON THEIR ACCOUNTS FORGIVEN AS THEY ARE PLACED IN CHARITY CARE AND THE BALANCES ARE WRITTEN OFF. THE MEDICAL CENTER'S CHARITY CARE PROGRAM USED THE FEDERAL POVERTY GUIDELINES (FPG) AS A GUIDE WITH HIGH-END LIMITS AT 300% OF THE FPG. IN THOSE SITUATIONS WHERE THE PATIENT'S INCOME IS BETWEEN 200% - 300% OF THE FPG, A SMALL COST SHARE WOULD BE THE ONLY AMOUNT NOT INCLUDED IN CHARITY CARE. ADDITIONALLY THIS SMALL COST SHARE WOULD BE THE ONLY AMOUNT TURNED OVER TO COLLECTION WITH THE OPPORTUNITY OF EVENTUALLY BEING WRITTEN OF TO BAD DEBT IF NOT PAID.
PART VI, LINE 2:	ONEIDA COUNTY HEALTH DEPARTMENT (OCHD), ROME MEMORIAL HOSPITAL (RMH) AND MOHAWK VALLEY HEALTH SYSTEM(MVHS) COLLABORATED WITH KEY COMMUNITY STAKEHOLDERS TO DEVELOP A THREE-YEAR COMMUNITY HEALTH ASSESSMENT, COMMUNITY SERVICE PLAN, AND COMMUNITY HEALTH IMPROVEMENT PLAN (CHA/CSP/CHIP). THE DEVELOPMENT OF THE CHA, CSP AND CHIP FOR THE PERIOD OF 2019-2021 INVOLVED A SYSTEMATIC APPROACH OF DATA RETRIEVAL AND ANALYSIS, COMMUNITY ENGAGEMENT WITH A UNIFIED MISSION TO IDENTIFY AND RANK HEALTH PRIORITIES THAT AIM TO IMPROVE HEALTH OUTCOMES AND REDUCE DISPARITIES AMONG ONEIDA COUNTY RESIDENTS. THE 2019-2024 NEW YORK STATE PREVENTION AGENDA PROVIDES A BLUEPRINT TO IMPROVE THE HEALTH AND WELLBEING, AS WELL AS TO PROMOTE HEALTH EQUITY ACROSS POPULATIONS WHO EXPERIENCE DISPARITIES AND GUIDE THE DEVELOPMENT OF THE PLAN. THE FIVE PRIORITY AREAS ARE AS FOLLOWS: PREVENT CHRONIC DISEASES, PROMOTE A HEALTHY AND SAFE ENVIRONMENT, PROMOTE HEALTHY WOMEN, INFANTS, AND CHILDREN, PROMOTE WELL-BEING AND PREVENT MENTAL HEALTH AND SUBSTANCE USE DISORDERS, AND PREVENT COMMUNICABLE DISEASES. THOROUGH EVALUATION INCLUDED SYNTHESIS AND ANALYSIS OF THE 2016-2018 CHA/CSP/CHIP, RECOGNIZING ACHIEVEMENTS AS WELL AS AREAS OF CONTINUED OPPORTUNITY. THE SELECTION OF THE HEALTH PRIORITIES WAS DERIVED FROM A COLLABORATIVE COMMITTEE OF STAKEHOLDERS.THE CHA PROCESS AND THE IDENTIFICATION OF PRIORITIES AND INTERVENTIONS IN THE IMPROVEMENT PLAN WAS GUIDED BY THE ONEIDA COUNTY HEALTH COALITION (OCHC) AND STEERING COMMITTEE, WHICH IS A PARTNERSHIP OF COMMUNITY AGENCIES, ORGANIZATIONS AND GROUPS THAT CONVENE TO IDENTIFY AND ASSESS PUBLIC HEALTH PROBLEMS AND ENCOURAGE ACTION TO ADDRESS ISSUES. STRATEGIC COMMUNITY PARTNERS WERE ALSO SOLICITED TO PARTICIPATE IN A COMMUNITY STAKEHOLDER CONFERENCE. THE GOAL OF OBTAINING COMMUNITY STAKEHOLDER INPUT WAS TO GAIN GLOBAL INSIGHT FROM COMMUNITY PARTNERS ON PERCEPTIONS OF HEALTH ISSUES WITHIN THE COMMUNITY, CONSIDERING SOCIAL DETERMINANTS OF HEALTH AND PROVIDING INSIGHT ON SPECIFIC ASPECTS OF PRIORITIZING HEALTH NEEDS TO FACILITATE A THOROUGH AND THOUGHTFUL ASSESSMENT AND PLANNING PROCESS FOR DEVELOPMENT OF THE CHA, CSP AND CHIP. THE CHA PROVIDES A COMPREHENSIVE OVERVIEW OF HEALTH STATUS INDICATOR DATA FOR RESIDENTS OF ONEIDA COUNTY USING THENYS PREVENTION AGENDA FRAMEWORK AND OTHER REPUTABLE DATA SOURCES. THE ASSESSMENT WAS CREATED FOLLOWING AFORMAL DATA COLLECTION AND ANALYSIS PROCESS WHICH INCLUDED REVIEW OF HEALTH DATA FINDINGS WITH THE STEERING COMMITTEE. ASSESSMENT ACTIVITIES INCLUDED COMPARISON OF ONEIDA COUNTY STATISTICS TO NYS PREVENTION AGENDA DASHBOARD RATES OF NEW YORK STATE (NYS) (EXCLUDING NEW YORK CITY (NYC),4 WHERE APPROPRIATE, AS WELL AS TORHE NYS COMMUNITY HEALTH INDICATOR REPORTS (CHIRS)5. CENTERS FOR DISEASE CONTROL (CDC) BEHAVIORAL RISK FACT SURVEILLANCE SYSTEM (BRFSS) DATA WAS ALSO REVIEWED TO FURTHER IDENTIFY HEALTH TRENDS. IN ADDITION, THE STEERING COMMITTEE SOLICITED INPUT FROM THE COMMUNITY DEFINED WITHIN THE PRIMARY SERVICE AREA. THE QUALITATIVE WORK INCLUDED INPUT FROM COMMUNITY STAKEHOLDERS THROUGH A STRATEGIC PLANNING CONFERENCE, AS WELL AS ON-LINE/IN-PERSON SURVEYS, REACHING 898 RESIDENTS. THIS COMBINATION OF PRIMARY AND SECONDARYRESEARCH FINDINGS WAS USED AS KEY REFERENCES FOR THE DEVELOPMENT OF THE OCHD, RMH AND MVHS' 2019-2021 CHA/CSP AND CHIP.
PART VI, LINE 3:	PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCETHIS IS COMMUNICATED THROUGH ST ELIZABETH MEDICAL CENTER'S FACILITATED ENROLLMENT PROGRAM AND THE FINANCIAL ASSISTANCE PROGRAM. INFORMATION IS INCLUDED IN THE PATIENT INFORMATION GUIDES PRESENTED TO INPATIENTS AND OUTPATIENTS AND IS AVAILABLE ON THE HOSPITAL'S WEBSITE.ST ELIZABETH MEDICAL CENTER'S FINANCIAL ASSISTANCE PROGRAMTO SUPPORT OUR MISSION, THE ST ELIZABETH MEDICAL CENTER HAS DEVELOPED THE FINANCIAL ASSISTANCE PROGRAM. THE MEDICAL CENTER WILL MAKE AVAILABLE A RESONABLE AMOUNT OF UNCOMPENSATED SERVICES TO ELIGIBLE PERSONS.ST. ELIZABETH MEDICAL CENTER'S FACILITATED ENROLLMENT PROGRAMIN 2000, ST ELIZABETH MEDICAL CENTER DEVELOPED AND IMPLEMENTED THE FACILITATED ENROLLMENT PROGRAM AS A RESULT OF THE UNIQUE COLLABORATION THAT WAS FORGED BETWEEN ST ELIZABETH MEDICAL CENTER AND ONEIDA COUNTY SOCIAL SERVICES DEPARTMENT. THIS PROGAM ALLOWS ST ELIZABETH MEDICAL CENTER STAFF, PATIENT ACCOUNT REPRESENTATIVES, TO ACT AS AN AUTHORIZED REPRESENTATIVE OF THE PATIENT AT THE ONEIDA COUNTY DEPARTMENT OF SOCIAL SERVICES AND SUBMIT THE APPLICATION FOR BENEFITS. THIS SUCCESSFUL PROGRAM HAS EXPANDED THROUGHOUT THE PAST SEVERAL YEARS TO INCLUDE OUTPATIENTS AND EMERGENCY DEPARTMENT PATIENTS.
PART VI, LINE 4:	THE MAJORITY OF PATIENTS RESIDE IN ONEIDA, HERKIMER AND MADISON COUNTIES, WITH APPROXIMATELY 78% OF MVHS PATIENTS RESIDING IN ONEIDA COUNTY ZIP CODES. ONEIDA COUNTY BORDERS FIVE OTHER COUNTIES: OSWEGO, MADISON, HERKIMER, OTSEGO, AND LEWIS. THE COUNTY IS THE 550TH LARGEST COUNTY IN THE UNITED STATES AND COVERS 3,257.25 SQUARE MILES OF LAND WATER AREA, IN COMPARISON TO A TOTAL OF 3,141 COUNTIES IN THE UNITED STATES AND DISTRICT OF COLUMBIA. THE COUNTY IS EXPECTED TO SEE A SLIGHT INCREASE IN POPULATION THROUGH 2023 (560+ INDIVIDUALS), WHILE THE GENDER DISTRIBUTION IS PROJECTED TO REMAIN CONSISTENT DURING THIS TIMEFRAME. RESIDENTS BETWEEN THE AGES OF 55-64 YEARS OLD MAKE UP THE LARGEST PERCENTAGE OF THE POPULATION. SIMILARLY, POPULATION DISTRIBUTION BY RACE IS FORECASTED TO REMAIN CONSISTENT, BUT HAS BECOME MORE DIVERSE SINCE 2000. MOST RESIDENTS IN THE COUNTY HAVE HEALTH INSURANCE, WITH PRIVATE INSURANCE BEING THE MOST COMMON. THE INSURED RATE FOR ONEIDA COUNTY IS SLIGHTLY HIGHER THAN THE OVERALL NYS RATE FOR THOSE WITH PRIVATE HEALTH INSURANCE. THE MEDIAN HOUSEHOLD INCOME HAS STEADILY INCREASED SINCE 2000 AND IS EXPECTED TO INCREASE THROUGH 2023. HOWEVER, THE PER CAPITA INCOME FOR ONEIDA COUNTY HAS BEEN STEADILY LOWER THAN THAT OF NYS SINCE 2000 AND IS EXPECTED TO REMAIN ON TREND THROUGH 2023. FAMILIES WITH RELATED CHILDREN UNDER 5 YEARS OLD ARE THE MOST IMPOVERISHED IN THE COUNTY, WHILE 29% OF ONEIDA COUNTY ADULTS HAVE EXPERIENCED HOUSING INSECURITY IN THE PAST 12 MONTHS AND 15% HAVE SEVERE HOUSING PROBLEMS. THE EDUCATIONAL ATTAINMENT FOR THOSE IN THE COUNTY WHO COMPLETE A HIGH SCHOOL DEGREE OR HIGHER IS EXPECTED TO INCREASE THROUGH 2023, WHILE THOSE WHO COMPLETE AN EIGHTH-GRADE EDUCATION OR LOWER IS EXPECTED TO DECREASE. ALMOST HALF OF ONEIDA COUNTY'S POPULATION IS EMPLOYED, WITH ONLY 3.5% OF THE EMPLOYABLE POPULATION UNEMPLOYED. THE MOST COMMON INDUSTRY OF EMPLOYMENT FOR ONEIDA COUNTY IS "EDUCATIONAL SERVICES, AND HEALTHCARE AND SOCIAL ASSISTANCE," FOLLOWED BY "RETAIL TRADE, AND "MANUFACTURING." IN ONEIDA COUNTY, MORE THAN HALF OF RESIDENTS HAVE ACCESS TO TWO OR MORE VEHICLES, AND MOST PEOPLE COMMUTE TO WORK ALONE. FOR THE PAST 40 YEARS, UTICA HAS HOUSED THE CENTER (FORMERLY KNOWN AS THE MOHAWK VALLEY RESOURCE CENTER FOR REFUGEES), RESETTLING OVER 16,500 REFUGEES. THIS INFLUX OF REFUGEES HAS CONTRIBUTED SIGNIFICANTLY TO THE POPULATION PROFILE OF ONEIDA COUNTY. OVERALL, THE CENTER HAS HELPED INDIVIDUALS FROM OVER 35 COUNTRIES RESETTLE IN UTICA WHICH CONTINUES TO HELP STABILIZE THE COUNTY'S POPULATION AND ECONOMY.
PART VI, LINE 5:	THE NEW YORK STATE PREVENTION AGENDA SERVES AS A GUIDE TO HEALTH DEPARTMENTS AND HOSPITALS AS THEY DEVELOP THE CHNA AND PROMOTE COMMUNITY HEALTH. RESULTS OF PRIORITY AREAS, PRESENTED AND REVISED IN PREVIOUS CHNA YEARS:IMPROVEMENT AREAS: PREVENTION AGENDA AREAS WHERE ONEIDA COUNTY STATISTICS IMPROVED:1. IMPROVE HEALTH STATUS AND REDUCE HEALTH DISPARITIESA. PREMATURE DEATHS: RATIO OF BLACK NON-HISPANICS TO WHITE NON-HISPANICSB. AGE-ADJUSTED PREVENTABLE HOSPITALIZATION RATE PER 10,000 - AGED 18+ YEARS2. PROMOTE A HEALTHY AND SAFE ENVIRONMENTA. ASSAULT-RELATED HOSPITALIZATION RATE PER 10,000 POPULATIONB. ASSAULT-RELATED HOSPITALIZATION: RATIO OF BLACK NON-HISPANICS TO WHITE NON-HISPANICSC. PERCENTAGE OF EMPLOYED CIVILIAN WORKERS AGE 16 AND OVER WHO USE ALTERNATE MODES OF TRANSPORTATION TOWORK OR WORK FROM HOMED. PERCENTAGE OF POPULATION WITH LOW-INCOME AND LOW ACCESS TO A SUPERMARKET OR LARGE GROCERY STORE3. PREVENT CHRONIC DISEASESA. RATE OF HOSPITALIZATIONS FOR SHORT-TERM COMPLICATIONS OF DIABETES PER 10,000 - AGED 6-17 YEARS4. PREVENT HIV/STDS, VACCINE PREVENTABLE DISEASES AND HEALTHCARE-ASSOCIATED INFECTIONSA. PERCENTAGE OF ADOLESCENT FEMALES THAT RECEIVED 3 OR MORE DOSES OF HPV VACCINE - AGED 13-17 YEARS5. PROMOTING HEALTHY WOMEN, INFANTS, AND CHILDRENA. PREMATURE BIRTHS: RATIO OF BLACK NON-HISPANICS TO WHITE NON-HISPANICSB. PREMATURE BIRTHS: RATIO OF HISPANICS TO WHITE NON-HISPANICSC. PREMATURE BIRTHS: RATIO OF MEDICAID BIRTHS TO NON-MEDICAID BIRTHSD. EXCLUSIVELY BREASTFED: RATIO OF BLACK NON-HISPANICS TO WHITE NON-HISPANICSE. EXCLUSIVELY BREASTFED: RATIO OF HISPANICS TO WHITE NON-HISPANICSF. EXCLUSIVELY BREASTFED: RATIO OF MEDICAID BIRTHS TO NON-MEDICAID BIRTHSG. ADOLESCENT PREGNANCY: RATIO OF BLACK NON-HISPANICS TO WHITE NON-HISPANICS6. PROMOTE MENTAL HEALTH AND PREVENTING SUBSTANCE USEA. AGE-ADJUSTED SUICIDE DEATH RATE PER 100,000 POPULATIONSTATIC OR WORSENING AREAS: PREVENTION AGENDA AREAS WHERE ONEIDA COUNTY STATISTICS REMAINEDUNCHANGED/WORSENED. (THOSE MEASURES THAT HAVE WORSENED WILL BE INDICATED IN BOLD BELOW.)1. IMPROVE HEALTH STATUS AND REDUCE HEALTH DISPARITIESA. PERCENTAGE OF PREMATURE DEATHS (BEFORE AGE 65 YEARS)B. PREMATURE DEATHS: RATIO OF HISPANICS TO WHITE NON-HISPANICSC. PREVENTABLE HOSPITALIZATIONS: RATIO OF BLACK NON-HISPANIC TO WHITE NON-HISPANICSD. PERCENTAGE OF ADULTS (AGED 18-64) WITH HEALTH INSURANCEE. AGE-ADJUSTED PERCENTAGE OF ADULTS WHO HAVE A REGULAR HEALTHCARE PROVIDER AGED 18+ YEARS2. PROMOTE A HEALTHY AND SAFE ENVIRONMENTA. RATE OF HOSPITALIZATIONS DUE TO FALLS PER 10,000 AGED 65+ YEARSB. RATE OF EMERGENCY DEPARTMENT VISITS DUE TO FALLS PER 10,000 AGED 1-4 YEARSC. ASSAULT-RELATED HOSPITALIZATION: RATIO OF LOW-INCOME ZIP CODESD. PERCENTAGE OF HOMES IN HEALTHY NEIGHBORHOODS PROGRAM THAT HAVE FEWER ASTHMA TRIGGERS DURINGTHE HOME REVISIT26 ONEIDA COUNTY HEALTH DEPARTMENT CHA/CSP 2019-2021E. PERCENTAGE OF RESIDENTS SERVED BY COMMUNITY WATER SYSTEMS WITH OPTIMALLY FLUORIDATED WATERF. ASSAULT-RELATED HOSPITALIZATION: RATIO OF HISPANICS TO WHITE NON-HISPANICSG. RATE OF OCCUPATIONAL INJURIES TREATED IN ED PER 10,000 ADOLESCENTS - AGED 15-19 YEARSH. PERCENTAGE OF POPULATION THAT LIVES IN A JURISDICTION THAT ADOPTED THE CLIMATE SMART COMMUNITIES PLEDGE3. PREVENT CHRONIC DISEASESA. PERCENTAGE OF ADULTS WHO ARE OBESEB. PERCENTAGE OF CHILDREN AND ADOLESCENTS WHO ARE OBESEC. PERCENTAGE OF CIGARETTE SMOKING ADULTSD. PERCENTAGE OF ADULTS WHO RECEIVED A COLORECTAL CANCER SCREENING BASED ON THE MOST RECENT GUIDELINES AGED 50-75 YEARSE. AGE-ADJUSTED HEART ATTACK HOSPITALIZATION RATE PER 10,000 POPULATIONF. RATE OF HOSPITALIZATIONS FOR SHORT-TERM COMPLICATIONS OF DIABETES PER 10,000 18+ YEARSG. ASTHMA EMERGENCY DEPARTMENT VISIT RATE PER 10,000 POPULATIONH. ASTHMA EMERGENCY DEPARTMENT VISIT RATE PER 10,000 - AGED 0-4 YEARS4. PREVENT HIV/STDS, VACCINE PREVENTABLE DISEASES AND HEALTHCARE-ASSOCIATED INFECTIONSA. PERCENTAGE OF CHILDREN WITH 4:3:1:3:3:1:4 IMMUNIZATION SERIES AGED 19-35 MONTHSB. PERCENTAGE OF ADULTS WITH FLU IMMUNIZATION - AGED 65+ YEARSC. NEWLY DIAGNOSED HIV CASE RATE PER 100,000 POPULATIOND. DIFFERENCE IN RATES (BLACK AND WHITE) OF NEWLY DIAGNOSED HIV CASESE. GONORRHEA CASE RATE PER 100,000 WOMEN - AGED 15-44 YEARSF. GONORRHEA CASE RATE PER 100,000 MEN - AGED 15-44 YEARSG. CHLAMYDIA CASE RATE PER 100,000 WOMEN - AGED 15-44 YEARSH. PRIMARY AND SECONDARY SYPHILIS CASE RATE PER 100,000 MENI. PRIMARY AND SECONDARY SYPHILIS CASE RATE PER 100,000 WOMEN5. PROMOTING HEALTHY WOMEN, INFANTS, AND CHILDRENA. PERCENTAGE OF PRETERM BIRTHSB. MATERNAL MORTALITY RATE PER 100,000 LIVE BIRTHSC. PERCENTAGE OF CHILDREN WHO HAVE HAD THE RECOMMENDED NUMBER OF WELL CHILD VISITS IN GOVERNMENTSPONSORED INSURANCE PROGRAMSD. PERCENTAGE OF CHILDREN AGED 0-15 MONTHS WHO HAVE HAD THE RECOMMENDED NUMBER OF WELL CHILD VISITS INGOVERNMENT SPONSORED INSURANCE PROGRAMSE. PERCENTAGE OF CHILDREN AGED 3-6 YEARS WHO HAVE HAD THE RECOMMENDED NUMBER OF WELL CHILD VISITS INGOVERNMENT SPONSORED INSURANCE PROGRAMSF. PERCENTAGE OF CHILDREN AGED12-21 YEARS WHO HAVE HAD THE RECOMMENDED NUMBER OF WELL CHILD VISITS INGOVERNMENT SPONSORED INSURANCE PROGRAMSG. PERCENTAGE OF CHILDREN (AGED UNDER 19 YEARS) WITH HEALTH INSURANCEH. ADOLESCENT PREGNANCY: RATIO OF HISPANICS TO WHITE NON-HISPANICSI. PERCENTAGE OF UNINTENDED PREGNANCY AMONG LIVE BIRTHSJ. UNINTENDED PREGNANCY: RATIO OF HISPANICS TO WHITE NON-HISPANICSK. UNINTENDED PREGNANCY: RATIO OF MEDICAID BIRTHS TO NON-MEDICAID BIRTHSL. PERCENTAGE OF WOMEN (AGED 18-64) WITH HEALTH INSURANCE27 ONEIDA COUNTY HEALTH DEPARTMENT CHA/CSP 2019-2021M. PERCENTAGE OF LIVE BIRTHS THAT OCCUR WITHIN 24 MONTHS OF A PREVIOUS PREGNANCYN. ADOLESCENT PREGNANCY RATE PER 1,000 FEMALES - AGED 15-17 YEARSO. UNINTENDED PREGNANCY: RATIO OF BLACK NON-HISPANIC TO WHITE NON-HISPANICP. PERCENTAGE OF INFANTS EXCLUSIVELY BREASTFED IN THE HOSPITAL6. PROMOTE MENTAL HEALTH AND PREVENTING SUBSTANCE USEA. AGE-ADJUSTED PERCENTAGE OF ADULTS WITH POOR MENTAL HEALTH FOR 14 OR MORE DAYS IN THE LAST MONTHB. AGE-ADJUSTED PERCENTAGE OF ADULTS BINGE DRINKING DURING THE PAST MONTHTHE CHARTS PROVIDED ON THE ATTACHED CHNA, BEGINNING ON PAGE 31, GIVE MORE DETAILED TREND INFORMATION ON SELECTED MEASURES.
PART VI, LINE 6:	ST. ELIZABETH MEDICAL CENTER (SEMC) AND FAXTON ST. LUKE'S HEALTHCARE (FSLH) AFFILIATED UNDER THE MOHAWK VALLEY HEALTH SYSTEM (MVHS) ON MARCH 6, 2014. MVHS MAIN CAMPUSES: ST. ELIZABETH CAMPUS 2209 GENESEE STREET, UTICA, NY ST. LUKE'S CAMPUS 1656 CHAMPLIN AVENUE, NEW HARTFORD, NY FAXTON CAMPUS 1676 SUNSET AVENUE, UTICA, NY THE MVHS MEDICAL GROUP OFFERS 17 PRIMARY CARE OFFICES LOCATED THROUGHOUT ONEIDA AND HERKIMER COUNTIES, A CHILDREN'S HEALTH CENTER, WOMEN'S HEALTH CENTER AND MULTI-SPECIALTY PROVIDERS INCLUDING GENERAL, ORTHOPEDIC, VASCULAR AND CARDIAC AND THORACIC SURGERY, GASTROENTEROLOGY AND ADVANCED ENDOSCOPY, AND NEURO SCIENCES. THE SISTER ROSE VINCENT FAMILY MEDICINE CENTER PROVIDES PATIENT CARE SERVICES AND IS ALSO A TEACHING FACILITY FOR NEW PHYSICIANS.FAXTON ST. LUKE'S HEALTHCAREA NOT-FOR-PROFIT HEALTHCARE ORGANIZATION, FSLH INCLUDES ST. LUKE'S HOME, SENIOR NETWORK HEALTH, AND THE VISITING NURSE ASSOCIATION OF UTICA AND ONEIDA COUNTY. ST. LUKE'S CAMPUS: BARIATRIC SURGERY PROGRAM MATERNAL CHILD SERVICES MOHAWK VALLEY VASCULAR CENTER STROKE CENTER SURGICAL AND AMBULATORY SERVICES TOTAL JOINT ORTHOPEDIC PROGRAMFAXTON CAMPUS CANCER CENTER DIALYSIS CENTER OUTPATIENT REHABILITATION SERVICES WELLNESS CENTERCENTER FOR REHABILITATION AND CONTINUING CARE SERVICES ACUTE INPATIENT REHABILITATION UNIT ADULT DAY HEALTH CARE SERVICE OUTPATIENT DIALYSIS CENTER ST. LUKE'S HOME SENIOR NETWORK HEALTH VISITING NURSE ASSOCIATION OF UTICA AND ONEIDA COUNTYST. ELIZABETH MEDICAL CENTERA NOT-FOR-PROFIT HEALTHCARE ORGANIZATION, SEMC ALSO INCLUDES ST. ELIZABETH HOME CARE, WHICH SERVES PATIENTS IN THEIR HOMES AND ST. ELIZABETH HEALTH SUPPORT SERVICES OFFERING RESPIRATORY SERVICES AND DURABLE MEDICAL EQUIPMENT TO PATIENTS IN THEIR HOMES. SEMC HAS 202 ACUTE CARE BEDS.SEMC MAIN CAMPUS: CARDIAC SERVICES MOHAWK VALLEY SLEEP DISORDERS CENTER ORTHOPEDIC SERVICES ST. ELIZABETH COLLEGE OF NURSING ST. ELIZABETH FAMILY MEDICINE RESIDENCY PROGRAM SURGICAL AND AMBULATORY SERVICES TRAUMA CENTER FELLOWSHIP IN HOSPITAL MEDICINE FELLOWSHIP IN GYNECOLOGIC ENDOSCOPYMEDICAL ARTS CAMPUS: ADVANCED WOUND CARE CENTER OUTPATIENT LABORATORY DRAW SITE BOTH HOSPITALS ACCEPT ALL MAJOR INSURANCES AND HAVE DESIGNATED CHARITY CARE PROGRAMS TO HELP PROVIDE FOR INDIVIDUALS WITHOUT INSURANCE. OUR AFFILIATION ENHANCES SERVICES FOR THE RESIDENTS OF THE MOHAWK VALLEY THROUGH GREATER COLLABORATION AND IMPROVED CLINICAL QUALITY FOR PATIENT AND RESIDENT CARE. AS A LARGE SYSTEM, MVHS HAS MUCH TO OFFER WHEN RECRUITING NEW PHYSICIANS. SEMC IS A CATHOLIC HOSPITAL, SPONSORED BY THE SISTERS OF ST. FRANCIS OF THE NEUMANN COMMUNITIES. SPECIALTIES THE BARIATRIC SURGERY PROGRAM IS AN AMERICAN SOCIETY FOR METABOLIC & BARIATRIC SURGERY BARIATRIC SURGERY CENTER OF EXCELLENCE. AS AN ACCREDITED PROGRAM, MVHS DEMONSTRATES THAT OUR CENTER MEETS THE NEEDS OF BARIATRIC SURGERY PATIENTS BY PROVIDING MULTIDISCIPLINARY, HIGH-QUALITY, PATIENT-CENTERED CARE. THE CANCER CENTER PROVIDES CARE TO PATIENTS IN OUR COMMUNITY FROM THE TIME OF DIAGNOSIS THROUGH TREATMENT AND RECOVERY. SERVICES INCLUDE OUTPATIENT INFUSION, RADIATION ONCOLOGY, CLINICAL TRIALS, INPATIENT ONCOLOGY, INTEGRATIVE MEDICINE, A BREAST CARE CENTER, A NURSE NAVIGATOR PROGRAM, CANCER EDUCATION AND SUPPORT SERVICES. THE CENTRAL YORK DIABETES EDUCATION PROGRAM (CNY DIABETES) IS RECOGNIZED BY THE AMERICAN DIABETES ASSOCIATION. CNY DIABETES OFFERS THE NATIONAL DIABETES PREVENTION PROGRAM WHICH IS ENDORSED BY THE CENTERS FOR DISEASE CONTROL AND PREVENTION. THE DIALYSIS CENTER IS THE SOLE PROVIDER OF DIALYSIS TREATMENT WITHIN A 25 MILE SERVICE AREA. EACH YEAR, MORE THAN 400 PATIENTS RECEIVE MORE THAN 69,000 DIALYSIS TREATMENTS AT ONE OF SIX FACILITIES LOCATED THROUGHOUT THE MOHAWK VALLEY. DIALYSIS CENTERS ARE LOCATED IN UTICA, ROME, HAMILTON AND HERKIMER. FSLH IS THE ONLY DESIGNATED PRIMARY STROKE CENTER IN THE MOHAWK VALLEY AND ONE OF 115 DESIGNATED STROKE CENTERS IN NEW YORK STATE. THE ORGANIZATION IS A RECIPIENT OF THE AMERICAN HEART ASSOCIATION/AMERICAN STROKE ASSOCIATION'S GET WITH THE GUIDELINES STROKE GOLD PLUS ACHIEVEMENT AWARD. THE AWARD RECOGNIZES FSLH'S COMMITMENT AND SUCCESS IN IMPLEMENTING EXCELLENT CARE FOR STROKE PATIENTS, ACCORDING TO EVIDENCE-BASED GUIDELINES. MVHS'S ACUTE INPATIENT REHABILITATION PROGRAM IS ACCREDITED BY THE COMMISSION ON ACCREDITATION OF REHABILITATION FACILITIES. THE REHABILITATION CENTER PROVIDES BOTH INPATIENT AND OUTPATIENT SERVICES WITH LOCATIONS AT THE FAXTON CAMPUS, ST. LUKE'S CAMPUS, ST. LUKE'S HOME, ST. ELIZABETH CAMPUS AND ST. ELIZABETH MEDICAL ARTS. ST. LUKE'S HOME IS A 202-BED LONG TERM CARE FACILITY WITH A 40-BED SUBACUTE REHABILITATION UNIT. ST. LUKE'S HOME OPENED IN 1996 ON THE ST. LUKE'S CAMPUS AND RECENTLY UNDERWENT A $31.3 MILLION RENOVATION AND EXPANSION. THE VISITING NURSE ASSOCIATION (VNA) OF UTICA AND ONEIDA COUNTY IS ACCREDITED BY THE COMMUNITY HEALTH ACCREDITATION PROGRAM, INC. THE VNA OF UTICA AND ONEIDA COUNTY CELEBRATED ITS 100TH ANNIVERSARY IN 2015 AND SERVES NEARLY 2,200 PATIENTS ANNUALLY.
PART VI, LINE 7, REPORTS FILED WITH STATES	NY

Schedule H (Form 990) 2021

Additional Data

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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

2021

Open to Public Inspection

Name of the organization

ST ELIZABETH MEDICAL CENTER

Employer identification number

15-0532245

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

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

Yes

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

Yes

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

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) 2021

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, 1099-MISC compensation, and/or 1099-NEC			(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)
1NABEEL EL-AMIR MD PHYSICIAN	(i) (ii)	979,333 ------------- 0	99,158 ------------- 0	4,991 ------------- 0	17,350 ------------- 0	17,547 ------------- 0	1,118,379 ------------- 0	0 ------------- 0
2DARLENE STROMSTAD PRESIDENT/CEO	(i) (ii)	0 ------------- 725,000	0 ------------- 183,750	0 ------------- 8,560	0 ------------- 11,600	0 ------------- 7,728	0 ------------- 936,638	0 ------------- 0
3ALEXANDROS KARAVAS MD PHYSICIAN	(i) (ii)	799,600 ------------- 0	30,703 ------------- 0	104 ------------- 0	14,416 ------------- 0	17,332 ------------- 0	862,155 ------------- 0	0 ------------- 0
4SUSHMA KAUL MD MVHS MEDICAL DIRECTOR PRESIDENT/FSLH	(i) (ii)	0 ------------- 486,868	0 ------------- 296,391	0 ------------- 194	0 ------------- 11,600	0 ------------- 15,633	0 ------------- 810,686	0 ------------- 0
5KENT HALL MD CMO (START 2/2020)	(i) (ii)	0 ------------- 477,405	0 ------------- 82,350	0 ------------- 40,939	0 ------------- 11,600	0 ------------- 16,377	0 ------------- 628,671	0 ------------- 0
6LOUIS AIELLO CFO	(i) (ii)	458,942 ------------- 0	80,649 ------------- 0	18,722 ------------- 0	25,816 ------------- 0	9,570 ------------- 0	593,699 ------------- 0	0 ------------- 0
7MANSOOR SHAHID COO	(i) (ii)	0 ------------- 465,222	0 ------------- 80,200	0 ------------- 10,408	0 ------------- 11,600	0 ------------- 16,262	0 ------------- 583,692	0 ------------- 0
8GOUTHAN MALEMPATI MD PHYSICIAN	(i) (ii)	496,065 ------------- 0	15,481 ------------- 0	68 ------------- 0	14,500 ------------- 0	16,259 ------------- 0	542,373 ------------- 0	0 ------------- 0
9SHWE WIN MD PHYSICIAN	(i) (ii)	481,188 ------------- 0	8,173 ------------- 0	68 ------------- 0	12,921 ------------- 0	17,049 ------------- 0	519,399 ------------- 0	0 ------------- 0
10DEVAYANI MANASSIVAYA MD PHYSICIAN	(i) (ii)	378,037 ------------- 0	51,174 ------------- 0	194 ------------- 0	17,025 ------------- 0	9,226 ------------- 0	455,656 ------------- 0	0 ------------- 0
11ERIC YOSS MD FORMER CMO	(i) (ii)	0 ------------- 323,880	0 ------------- 46,041	0 ------------- 22,939	0 ------------- 11,600	0 ------------- 12,727	0 ------------- 417,187	0 ------------- 0
12LINDA MCCORMACK-MILLER CNO	(i) (ii)	0 ------------- 274,978	0 ------------- 0	0 ------------- 1,811	0 ------------- 5,437	0 ------------- 7,804	0 ------------- 290,030	0 ------------- 0
13SCOTT PERRA FORMER ADMINISTRATOR	(i) (ii)	0 ------------- 231,827	0 ------------- 0	0 ------------- 12,221	0 ------------- 409	0 ------------- 8,410	0 ------------- 252,867	0 ------------- 0
14MARIA GESUALDO MD FORMER DIRECTOR	(i) (ii)	0 ------------- 91,025	0 ------------- 0	0 ------------- 0	0 ------------- 0	0 ------------- 0	0 ------------- 91,025	0 ------------- 0
15WALEED ALBERT MD FORMER DIRECTOR	(i) (ii)	0 ------------- 42,004	0 ------------- 0	0 ------------- 0	0 ------------- 0	0 ------------- 0	0 ------------- 42,004	0 ------------- 0

Schedule J (Form 990) 2021

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 6	AN INCENTIVE COMPENSATION PLAN EXISTS FOR THE EXECUTIVE STAFF. COMPENSATION IS BASED ON PERFORMANCE RELATIVE, IN PART, TO THE ORGANIZATION NET EARNINGS TARGETS, AS WELL AS, VARIOUS OTHER QUALITY RELATED PERFORMANCE TARGETS. THE INCENTIVES ARE ONLY PAID OUT UPON ACHIEVEMENT OF THESE SET TARGETS.

Schedule J (Form 990) 2021

Additional Data

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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 instructions and the latest information.

OMB No. 1545-0047

2021

Open to Public
Inspection

Name of the organization
ST ELIZABETH MEDICAL CENTER

Employer identification number
15-0532245

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	ONEIDA COUNTY LOCAL DEVELOPMENT CORP	27-3190422	NONEAVAIL	11-21-2019	19,515,000	REFINANCING OLD DEBT		X		X	X
B	ONEIDA COUNTY LOCAL DEVELOPMENT CORP	27-3190422	NONEAVAIL	11-21-2019	6,395,000	EPIC EMR SYSTEM IMPLEMENTATION		X		X	X
C	ONEIDA COUNTY LOCAL DEVELOPMENT CORP	27-3190422	NONEAVAIL	11-21-2019	2,020,000	CAPITAL EQUIPMENT		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 ..................	22,023,739		7,762,993		2,598,879
4 Gross proceeds in reserve funds .............
5 Capitalized interest from proceeds .............
6 Proceeds in refunding escrows ...............	21,215,525
7 Issuance costs from proceeds ...............	299,774		98,229		37,330
8 Credit enhancement from proceeds .............	497,062		162,876		61,898
9 Working capital expenditures from proceeds .............
10 Capital expenditures from proceeds .............			7,516,589		2,105,263
11 Other spent proceeds .............	11,378		14,701		349
12 Other unspent proceeds .............					394,737
13 Year of substantial completion .............	2019		2019		2022
	Yes	No	Yes	No	Yes	No	Yes	No
14 Were the bonds issued as part of a current refunding issue of tax-exempt bonds (or, if issued prior to 2020, a current refunding issue)? ........		X		X		X
15 Were the bonds issued as part of an advance refunding issue of taxable bonds (or, if issued prior to 2020, an advance refunding issue)? ........		X		X		X
16 Has the final allocation of proceeds been made? ..........	X		X			X
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? ..................	X		X		X

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

Cat. No. 50193E

Schedule K (Form 990) 2021

Page 2

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		X		X
2 Are there any lease arrangements that may result in private business use of bond-financed property? ...............		X		X		X
3a Are there any management or service contracts that may result in private business use of bond-financed property? .............		X		X		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		X		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 ....
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 .........
6 Total of lines 4 and 5 .............
7 Does the bond issue meet the private security or payment test? ...	X		X			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		X		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		X		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		X		X
2 If "No" to line 1, did the following apply? ....
a Rebate not due yet? .......	X		X		X
b Exception to rebate? ........		X		X		X
c No rebate due? .........		X		X		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		X		X

Schedule K (Form 990) 2021

Page 3

Part Ⅳ

Arbitrage (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?		X		X		X
b Name of provider ..........
c Term of hedge .........
d Was the hedge superintegrated? ......
e Was the hedge terminated? ........
5a Were gross proceeds invested in a guaranteed investment contract (GIC)?		X		X		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		X		X
7 Has the organization established written procedures to monitor the requirements of section 148? ...		X		X		X

Part Ⅴ

Procedures To Undertake Corrective Action

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

Part Ⅵ

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

Return Reference

Explanation

SCHEDULE K, PART II

THE PROCEEDS OF THE SERIES 2019 A&B BONDS WERE ISSUED BY MVHS AND USED TO 1) FINANCE THE COST OF THE NEW REGIONAL MEDICAL CENTER, INCLUDING CAPITALIZED INTEREST ON THE NEW HOSPITAL THROUGH AUGUST 2023 2) FINANCE CAPITAL EXPENDITURES AND EQUIPMENT AT THE EXISTING FACILITIES OF FSLH AND SEMC, 3) REFINANCE THE COST OF THE EPIC EMR IMPLEMENTATION THAT WAS COMPLETED IN 2019, AND 4) REFINANCE EXISTING DEBT OF OF SEMC AND FSLH. THE AMOUNTS PROVIDED IN THIS SCHEDULE RELATE SOLELY TO SEMC. ALL OTHER DEBT THAT WAS ISSUED AS PART OF THIS POOLED FINANCING WAS REPORTED ON THE RESPECTIVE SUBSIDIARY TO WHICH THE FUNDS WERE ALLOCATED.

Schedule K (Form 990) 2021

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Schedule L
(Form 990)

Department of the Treasury
Internal Revenue Service

Transactions with Interested Persons

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

Attach to Form 990 or Form 990-EZ.
MediumBullet

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

OMB No. 1545-0047

2021

Open to Public Inspection

Name of the organization

ST ELIZABETH MEDICAL CENTER

Employer identification number

15-0532245

Part I

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

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

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

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

Part II

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

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






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

Part III

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

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

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

Cat. No. 50056A

Schedule L (Form 990) 2021

Page 2

Part IV

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

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of transaction	(d) Description of transaction	(e) Sharing of organization's revenues?
(a) Name of interested person		(c) Amount of transaction	(d) Description of transaction	Yes	No
(1) MARIA GESUALDO	FORMER BOARD DIRECTOR	91,025	QUALITY CARE CONSULTANT		No

Part V

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

Return Reference	Explanation

Schedule L (Form 990) 2021

Additional Data

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SCHEDULE O
(Form 990)

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

2021

Open to Public
Inspection

Name of the organization

ST ELIZABETH MEDICAL CENTER

Employer identification number

15-0532245

Return Reference	Explanation
FORM 990, PART VI, SECTION A, LINE 6	MOHAWK VALLEY HEALTH SYSTEM AND PARTNERS IN FRANCISCAN MINISTRIES, INC.
FORM 990, PART VI, SECTION A, LINE 7A	RESERVED POWERS TO MOHAWK VALLEY HEALTH SYSTEM ("MVHS"): IN ADDITION TO ALL OTHER RIGHTS AND POWERS OF MEMBERSHIP PRESCRIBED BY NEW YORK LAW, THE CERTIFICATE OF INCORPORATION AND/OR THE BYLAWS OF THE CORPORATION, THE FOLLOWING GOVERNANCE AND MANAGEMENT POWERS SHALL BE DELEGATED TO MVHS TO THE EXTENT PERMITTED BY THE NEW YORK NOT-FOR-PROFIT CORPORATION LAW: (1) EXCEPT AS OTHERWISE SET FORTH HEREIN, TO APPROVE AND INTERPRET THE STATEMENT OF MISSION AND PHILOSOPHY ADOPTED BY THE CORPORATION, TO REQUIRE THAT THE CORPORATION OPERATE IN CONFORMANCE WITH ITS MISSION AND PHILOSOPHY AND TO COORDINATE THE MISSIONS, VISIONS, ACTIVITIES AND RESOURCES OF THE CORPORATION IN ORDER TO PROMOTE HIGH QUALITY, EFFICIENT AND EFFECTIVE HEALTH CARE SERVICES IN ONEIDA COUNTY, NEW YORK, AND SURROUNDING AREAS. NOTWITHSTANDING THE FOREGOING, MVHS SHALL NOT HAVE THE POWER TO APPROVE OR INTERPRET THOSE ELEMENTS OF THE CORPORATION'S MISSION AND PHILOSOPHY THAT RELATE SPECIFICALLY TO ITS STATUS AS A CATHOLIC ORGANIZATION OR THE PURSUIT OF THE CORPORATION'S CATHOLIC MISSION AND PHILOSOPHY; (2) TO ELECT OR APPOINT, FIX THE NUMBER OF, AND REMOVE, WITH OR WITHOUT CAUSE, THE DIRECTORS OF THE CORPORATION, AND TO APPOINT AND REMOVE, WITH OR WITHOUT CAUSE, THE PRESIDENT/CHIEF EXECUTIVE OFFICER OF THE CORPORATION. NOTWITHSTANDING THE FOREGOING, PFM SHALL BE ENTITLED TO APPOINT AND REMOVE, WITH OR WITHOUT CAUSE, THE ONE ADDITIONAL DIRECTOR DESIGNATED BY PFM TO THE CORPORATION'S BOARD OF DIRECTORS; (3) TO AMEND OR REPEAL THE CERTIFICATE AND BYLAWS, AND TO ADOPT ANY NEW OR RESTATED CERTIFICATE OF INCORPORATION OR BYLAWS, OF THE CORPORATION; (4) TO APPROVE ANY PLAN OF MERGER, CONSOLIDATION, DISSOLUTION OR LIQUIDATION OF THE CORPORATION; (5) TO APPROVE THE DEBT OF THE CORPORATION IN EXCESS OF AN AMOUNT TO BE FIXED FROM TIME TO TIME BY MVHS; (6) TO APPROVE THE SALE, ACQUISITION, LEASE, TRANSFER, MORTGAGE, GUARANTEE OR PLEDGE OF REAL OR PERSONAL PROPERTY OF THE CORPORATION IN EXCESS OF AN AMOUNT TO BE FIXED FROM TIME TO TIME BY MVHS. NOTWITHSTANDING THE FOREGOING, THE APPROVAL OF PFM SHALL BE REQUIRED FOR THE SALE, TRANSFER, MORTGAGE, GUARANTEE, PLEDGE OR OTHER ALIENATION OF REAL OR PERSONAL PROPERTY OF THE CORPORATION IN EXCESS OF AN AMOUNT TO BE FIXED FROM TIME TO TIME BY PFM, TO MEET THE REQUIREMENTS OF THE UNITED STATES CONFERENCE OF CATHOLIC BISHOPS; (7) TO APPROVE THE CAPITAL AND OPERATING BUDGETS OF THE CORPORATION; (8) TO APPROVE SETTLEMENTS OF LITIGATION WHEN SUCH SETTLEMENTS EXCEED APPLICABLE INSURANCE COVERAGE OR THE AMOUNT OF ANY APPLICABLE SELF-INSURANCE FUND AVAILABLE TO SUCH CORPORATION; (9) TO APPROVE ANY CORPORATE REORGANIZATION OF THE CORPORATION AND THE ESTABLISHMENT, MERGER, CONSOLIDATION, REORGANIZATION OR DISSOLUTION OF ANY ORGANIZATIONAL RELATIONSHIP OF THE CORPORATION, INCLUDING BUT NOT LIMITED TO SUBSIDIARY CORPORATIONS, PARTNERSHIPS, OR JOINT VENTURES OF THE CORPORATION; (10) TO APPROVE AND COORDINATE THE STRATEGIC PLANS OF THE CORPORATION; (11) TO THE EXTENT APPLICABLE, TO APPROVE ALL CONTRACTS OF REIMBURSEMENT FOR THE CORPORATION FROM GOVERNMENTAL OR PRIVATE THIRD PARTY INSURERS; (12) TO THE EXTENT APPLICABLE, TO APPROVE ALL APPLICATIONS OF THE CORPORATION TO FEDERAL OR STATE GOVERNMENTAL AGENCIES FOR ESTABLISHMENT OR OPERATING LICENSURE, INCLUDING BUT NOT LIMITED TO CERTIFICATE OF NEED APPLICATIONS TO THE NEW YORK STATE DEPARTMENT OF HEALTH AS REQUIRED; (13) TO THE EXTENT APPLICABLE, TO APPROVE MANAGEMENT CONTRACTS FOR THE CORPORATION SUBJECT TO APPROVAL AND/OR REGULATION UNDER THE LAWS AND REGULATIONS OF THE STATE OF NEW YORK; (14) TO APPROVE ANY MATERIAL CHANGE IN THE SERVICES OFFERED BY THE CORPORATION; (15) TO REQUIRE THE CORPORATION TO PARTICIPATE IN ANY AND ALL PROGRAMS AND SERVICES, AS DETERMINED BY MVHS IN ITS DISCRETION, PROVIDED, HOWEVER, THAT MVHS MAY NOT REQUIRE CORPORATION TO PARTICIPATE IN ANY PROGRAM OR SERVICE OR TAKE ANY ACTION THAT WOULD CONSTITUTE A DEFAULT OR EVENT OF DEFAULT UNDER ANY MORTGAGE, INDENTURE OR OTHER MATERIAL AGREEMENT OR INSTRUMENT TO WHICH THE CORPORATION IS A PARTY AND BY WHICH IT IS BOUND, AND MAY NOT REQUIRE THE CORPORATION'S PARTICIPATION IN ANY PROGRAM OR SERVICE WHICH WOULD BE CONTRARY TO ITS STATUS AS A CATHOLIC ORGANIZATION OR THE PURSUIT OF ITS CATHOLIC MISSION OR PHILOSOPHY; AND (16) TO ACCEPT DELEGATIONS OF AUTHORITY ON BEHALF OF THE CORPORATION PURSUANT TO SECTION 701 OF THE NOT-FOR PROFIT CORPORATION LAW AND EXERCISE ON BEHALF OF THE CORPORATION, THE AUTHORITY TO ACCEPT, UTILIZE, TRANSFER AND SHARE IN THE ASSETS, REVENUES AND INCOME OF THE CORPORATION AND TO MAINTAIN A SINGLE CONSOLIDATED SET OF BOOKS AND FINANCIAL RECORDS, AS MAY BE NECESSARY OR DESIRABLE TO CARRY OUT THE OBLIGATIONS OF THE CORPORATION PURSUANT TO ANY MASTER TRUST INDENTURE OR SIMILAR INSTRUMENT AND, PROVIDED, HOWEVER, THAT NO SUCH AUTHORITY SHALL BE ACCEPTED OR EXERCISED EXCEPT PURSUANT TO THE NOT-FOR-PROFIT CORPORATION LAW AND UNTIL ALL APPROVALS REQUIRED BY LAW HAVE FIRST BEEN OBTAINED, INCLUDING, WITHOUT LIMITATION, THE PRIOR APPROVAL OF THE DEPARTMENT OF HEALTH AS MAY BE REQUIRED FOR OBLIGATED GROUP FINANCINGS. FOR THE PURPOSES OF THE FOREGOING, MVHS SHALL HAVE: (I) THE POWER TO INITIATE AND DIRECT ACTION BY THE CORPORATION WITHOUT A PRIOR RECOMMENDATION OF THE CORPORATION'S BOARD OF DIRECTORS; AND (II) THE POWER TO ACCEPT, REJECT OR MODIFY THE RECOMMENDATION OF THE CORPORATION'S BOARD OF DIRECTORS AND TO DIRECT ACTION BY THE CORPORATION OR TO RETURN THE MATTER TO THE BOARD OF DIRECTORS OF THE CORPORATION FOR RECONSIDERATION, WITH REASONS FOR REJECTION AND/OR SUGGESTED CHANGE. NOTWITHSTANDING THE FOREGOING, IN THE CASE OF THE CORPORATION, MVHS SHALL NOT DIRECT ANY ACTION WITH RESPECT TO THE CORPORATION THAT REQUIRES THE APPROVAL OF PFM WITHOUT PRIOR APPROVAL OF SUCH ACTION BY PFM. THE BOARD OF DIRECTORS AND OFFICERS OF THE CORPORATION SHALL NOT IMPLEMENT ANY ACTION REQUIRING THE APPROVAL OF MVHS UNTIL MVHS SHALL HAVE EXERCISED ITS RESERVE POWERS AND COMMUNICATED ITS DETERMINATIONS IN WRITING TO THE CORPORATION'S BOARD OF DIRECTORS AND, IN THE CASE OF ANY POWERS OVER THE CORPORATION THAT ARE ALSO RESERVED TO PFM, TO PFM. RESERVED POWERS TO PARTNERS IN FRANCISCAN MINISTRIES, INC. ("PFM") THE FOLLOWING POWERS SHALL BE RESERVED EXCLUSIVELY TO PFM: (1) TO APPROVE AND INTERPRET THOSE ELEMENTS OF THE CORPORATION'S STATEMENT OF MISSION AND PHILOSOPHY ADOPTED BY THE CORPORATION THAT RELATE TO THE CORPORATION'S STATUS AS A CATHOLIC ORGANIZATION OR THE PURSUIT OF THE CORPORATION'S CATHOLIC MISSION AND PHILOSOPHY, AND ANY AMENDMENTS THEREOF, AND TO REQUIRE THE CORPORATION TO OPERATE IN CONFORMANCE WITH ITS CATHOLIC MISSION AND PHILOSOPHY; THIS POWER SHALL INCLUDE APPROVAL OF THE INDIVIDUAL WHO WILL SERVE IN A POSITION TO OVERSEE MISSION, WHICH POSITION WILL REPORT DIRECTLY TO THE PRESIDENT/CEO AND SHALL NOT BE ELIMINATED WITHOUT THE PRIOR APPROVAL OF PFM. (2) TO APPROVE ANY AMENDMENT OF THE CORPORATION'S PURPOSES OR POWERS IN ITS CERTIFICATE OF INCORPORATION THAT WOULD TERMINATE THE CORPORATION'S STATUS AS A CATHOLIC ORGANIZATION OR DIMINISH ITS COMMITMENT OR ABILITY TO OPERATE IN A MANNER CONSISTENT WITH THE ETHICAL AND RELIGIOUS DIRECTIVES FOR CATHOLIC HEALTHCARE SERVICES; AND (3) TO APPROVE THE SALE, TRANSFER, MORTGAGE, GUARANTY, PLEDGE OR OTHER ALIENATION OF REAL OR PERSONAL PROPERTY OF THE CORPORATION IN EXCESS OF AN AMOUNT TO BE FIXED FROM TIME TO TIME BY THE PFM TO MEET THE REQUIREMENTS OF THE UNITED STATES CONFERENCE OF CATHOLIC BISHOPS. (4) TO APPROVE AND REJECT APPOINTMENTS TO THE PENSION COMMITTEE FOR THE SEMC CHURCH PLAN. (5) TO APPROVE ANY AMENDMENTS OR MODIFICATIONS TO, OR THE TERMINATION OF, THE SEMC CHURCH PLAN; AND (6) TO ELECT OR APPOINT AND REMOVE, WITH OR WITHOUT CAUSE, ONE DIRECTOR OF THE CORPORATION WHO DOES NOT CURRENTLY SERVE ON THE BOARD OF MVHS.
FORM 990, PART VI, SECTION A, LINE 7B	RESERVED POWERS TO MOHAWK VALLEY HEALTH SYSTEM ("MVHS"): IN ADDITION TO ALL OTHER RIGHTS AND POWERS OF MEMBERSHIP PRESCRIBED BY NEW YORK LAW, THE CERTIFICATE OF INCORPORATION AND/OR THE BYLAWS OF THE CORPORATION, THE FOLLOWING GOVERNANCE AND MANAGEMENT POWERS SHALL BE DELEGATED TO MVHS TO THE EXTENT PERMITTED BY THE NEW YORK NOT-FOR-PROFIT CORPORATION LAW: (1) EXCEPT AS OTHERWISE SET FORTH HEREIN, TO APPROVE AND INTERPRET THE STATEMENT OF MISSION AND PHILOSOPHY ADOPTED BY THE CORPORATION, TO REQUIRE THAT THE CORPORATION OPERATE IN CONFORMANCE WITH ITS MISSION AND PHILOSOPHY AND TO COORDINATE THE MISSIONS, VISIONS, ACTIVITIES AND RESOURCES OF THE CORPORATION IN ORDER TO PROMOTE HIGH QUALITY, EFFICIENT AND EFFECTIVE HEALTH CARE SERVICES IN ONEIDA COUNTY, NEW YORK, AND SURROUNDING AREAS. NOTWITHSTANDING THE FOREGOING, MVHS SHALL NOT HAVE THE POWER TO APPROVE OR INTERPRET THOSE ELEMENTS OF THE CORPORATION'S MISSION AND PHILOSOPHY THAT RELATE SPECIFICALLY TO ITS STATUS AS A CATHOLIC ORGANIZATION OR THE PURSUIT OF THE CORPORATION'S CATHOLIC MISSION AND PHILOSOPHY; (2) TO ELECT OR APPOINT, FIX THE NUMBER OF, AND REMOVE, WITH OR WITHOUT CAUSE, THE DIRECTORS OF THE CORPORATION, AND TO APPOINT AND REMOVE, WITH OR WITHOUT CAUSE, THE PRESIDENT/CHIEF EXECUTIVE OFFICER OF THE CORPORATION. NOTWITHSTANDING THE FOREGOING, PFM SHALL BE ENTITLED TO APPOINT AND REMOVE, WITH OR WITHOUT CAUSE, THE ONE ADDITIONAL DIRECTOR DESIGNATED BY PFM TO THE CORPORATION'S BOARD OF DIRECTORS; (3) TO AMEND OR REPEAL THE CERTIFICATE AND BYLAWS, AND TO ADOPT ANY NEW OR RESTATED CERTIFICATE OF INCORPORATION OR BYLAWS, OF THE CORPORATION; (4) TO APPROVE ANY PLAN OF MERGER, CONSOLIDATION, DISSOLUTION OR LIQUIDATION OF THE CORPORATION; (5) TO APPROVE THE DEBT OF THE CORPORATION IN EXCESS OF AN AMOUNT TO BE FIXED FROM TIME TO TIME BY MVHS; (6) TO APPROVE THE SALE, ACQUISITION, LEASE, TRANSFER, MORTGAGE, GUARANTEE OR PLEDGE OF REAL OR PERSONAL PROPERTY OF THE CORPORATION IN EXCESS OF AN AMOUNT TO BE FIXED FROM TIME TO TIME BY MVHS. NOTWITHSTANDING THE FOREGOING, THE APPROVAL OF PFM SHALL BE REQUIRED FOR THE SALE, TRANSFER, MORTGAGE, GUARANTEE, PLEDGE OR OTHER ALIENATION OF REAL OR PERSONAL PROPERTY OF THE CORPORATION IN EXCESS OF AN AMOUNT TO BE FIXED FROM TIME TO TIME BY PFM, TO MEET THE REQUIREMENTS OF THE UNITED STATES CONFERENCE OF CATHOLIC BISHOPS; (7) TO APPROVE THE CAPITAL AND OPERATING BUDGETS OF THE CORPORATION; (8) TO APPROVE SETTLEMENTS OF LITIGATION WHEN SUCH SETTLEMENTS EXCEED APPLICABLE INSURANCE COVERAGE OR THE AMOUNT OF ANY APPLICABLE SELF-INSURANCE FUND AVAILABLE TO SUCH CORPORATION; (9) TO APPROVE ANY CORPORATE REORGANIZATION OF THE CORPORATION AND THE ESTABLISHMENT, MERGER, CONSOLIDATION, REORGANIZATION OR DISSOLUTION OF ANY ORGANIZATIONAL RELATIONSHIP OF THE CORPORATION, INCLUDING BUT NOT LIMITED TO SUBSIDIARY CORPORATIONS, PARTNERSHIPS, OR JOINT VENTURES OF THE CORPORATION; (10) TO APPROVE AND COORDINATE THE STRATEGIC PLANS OF THE CORPORATION; (11) TO THE EXTENT APPLICABLE, TO APPROVE ALL CONTRACTS OF REIMBURSEMENT FOR THE CORPORATION FROM GOVERNMENTAL OR PRIVATE THIRD PARTY INSURERS; (12) TO THE EXTENT APPLICABLE, TO APPROVE ALL APPLICATIONS OF THE CORPORATION TO FEDERAL OR STATE GOVERNMENTAL AGENCIES FOR ESTABLISHMENT OR OPERATING LICENSURE, INCLUDING BUT NOT LIMITED TO CERTIFICATE OF NEED APPLICATIONS TO THE NEW YORK STATE DEPARTMENT OF HEALTH AS REQUIRED; (13) TO THE EXTENT APPLICABLE, TO APPROVE MANAGEMENT CONTRACTS FOR THE CORPORATION SUBJECT TO APPROVAL AND/OR REGULATION UNDER THE LAWS AND REGULATIONS OF THE STATE OF NEW YORK; (14) TO APPROVE ANY MATERIAL CHANGE IN THE SERVICES OFFERED BY THE CORPORATION; (15) TO REQUIRE THE CORPORATION TO PARTICIPATE IN ANY AND ALL PROGRAMS AND SERVICES, AS DETERMINED BY MVHS IN ITS DISCRETION, PROVIDED, HOWEVER, THAT MVHS MAY NOT REQUIRE CORPORATION TO PARTICIPATE IN ANY PROGRAM OR SERVICE OR TAKE ANY ACTION THAT WOULD CONSTITUTE A DEFAULT OR EVENT OF DEFAULT UNDER ANY MORTGAGE, INDENTURE OR OTHER MATERIAL AGREEMENT OR INSTRUMENT TO WHICH THE CORPORATION IS A PARTY AND BY WHICH IT IS BOUND, AND MAY NOT REQUIRE THE CORPORATION'S PARTICIPATION IN ANY PROGRAM OR SERVICE WHICH WOULD BE CONTRARY TO ITS STATUS AS A CATHOLIC ORGANIZATION OR THE PURSUIT OF ITS CATHOLIC MISSION OR PHILOSOPHY; AND (16) TO ACCEPT DELEGATIONS OF AUTHORITY ON BEHALF OF THE CORPORATION PURSUANT TO SECTION 701 OF THE NOT-FOR PROFIT CORPORATION LAW AND EXERCISE ON BEHALF OF THE CORPORATION, THE AUTHORITY TO ACCEPT, UTILIZE, TRANSFER AND SHARE IN THE ASSETS, REVENUES AND INCOME OF THE CORPORATION AND TO MAINTAIN A SINGLE CONSOLIDATED SET OF BOOKS AND FINANCIAL RECORDS, AS MAY BE NECESSARY OR DESIRABLE TO CARRY OUT THE OBLIGATIONS OF THE CORPORATION PURSUANT TO ANY MASTER TRUST INDENTURE OR SIMILAR INSTRUMENT AND, PROVIDED, HOWEVER, THAT NO SUCH AUTHORITY SHALL BE ACCEPTED OR EXERCISED EXCEPT PURSUANT TO THE NOT-FOR-PROFIT CORPORATION LAW AND UNTIL ALL APPROVALS REQUIRED BY LAW HAVE FIRST BEEN OBTAINED, INCLUDING, WITHOUT LIMITATION, THE PRIOR APPROVAL OF THE DEPARTMENT OF HEALTH AS MAY BE REQUIRED FOR OBLIGATED GROUP FINANCINGS. FOR THE PURPOSES OF THE FOREGOING, MVHS SHALL HAVE: (I) THE POWER TO INITIATE AND DIRECT ACTION BY THE CORPORATION WITHOUT A PRIOR RECOMMENDATION OF THE CORPORATION'S BOARD OF DIRECTORS; AND (II) THE POWER TO ACCEPT, REJECT OR MODIFY THE RECOMMENDATION OF THE CORPORATION'S BOARD OF DIRECTORS AND TO DIRECT ACTION BY THE CORPORATION OR TO RETURN THE MATTER TO THE BOARD OF DIRECTORS OF THE CORPORATION FOR RECONSIDERATION, WITH REASONS FOR REJECTION AND/OR SUGGESTED CHANGE. NOTWITHSTANDING THE FOREGOING, IN THE CASE OF THE CORPORATION, MVHS SHALL NOT DIRECT ANY ACTION WITH RESPECT TO THE CORPORATION THAT REQUIRES THE APPROVAL OF PFM WITHOUT PRIOR APPROVAL OF SUCH ACTION BY PFM. THE BOARD OF DIRECTORS AND OFFICERS OF THE CORPORATION SHALL NOT IMPLEMENT ANY ACTION REQUIRING THE APPROVAL OF MVHS UNTIL MVHS SHALL HAVE EXERCISED ITS RESERVE POWERS AND COMMUNICATED ITS DETERMINATIONS IN WRITING TO THE CORPORATION'S BOARD OF DIRECTORS AND, IN THE CASE OF ANY POWERS OVER THE CORPORATION THAT ARE ALSO RESERVED TO PFM, TO PFM. RESERVED POWERS TO PARTNERS IN FRANCISCAN MINISTRIES, INC. ("PFM") THE FOLLOWING POWERS SHALL BE RESERVED EXCLUSIVELY TO PFM: (1) TO APPROVE AND INTERPRET THOSE ELEMENTS OF THE CORPORATION'S STATEMENT OF MISSION AND PHILOSOPHY ADOPTED BY THE CORPORATION THAT RELATE TO THE CORPORATION'S STATUS AS A CATHOLIC ORGANIZATION OR THE PURSUIT OF THE CORPORATION'S CATHOLIC MISSION AND PHILOSOPHY, AND ANY AMENDMENTS THEREOF, AND TO REQUIRE THE CORPORATION TO OPERATE IN CONFORMANCE WITH ITS CATHOLIC MISSION AND PHILOSOPHY; THIS POWER SHALL INCLUDE APPROVAL OF THE INDIVIDUAL WHO WILL SERVE IN A POSITION TO OVERSEE MISSION, WHICH POSITION WILL REPORT DIRECTLY TO THE PRESIDENT/CEO AND SHALL NOT BE ELIMINATED WITHOUT THE PRIOR APPROVAL OF PFM. (2) TO APPROVE ANY AMENDMENT OF THE CORPORATION'S PURPOSES OR POWERS IN ITS CERTIFICATE OF INCORPORATION THAT WOULD TERMINATE THE CORPORATION'S STATUS AS A CATHOLIC ORGANIZATION OR DIMINISH ITS COMMITMENT OR ABILITY TO OPERATE IN A MANNER CONSISTENT WITH THE ETHICAL AND RELIGIOUS DIRECTIVES FOR CATHOLIC HEALTHCARE SERVICES; AND (3) TO APPROVE THE SALE, TRANSFER, MORTGAGE, GUARANTY, PLEDGE OR OTHER ALIENATION OF REAL OR PERSONAL PROPERTY OF THE CORPORATION IN EXCESS OF AN AMOUNT TO BE FIXED FROM TIME TO TIME BY THE PFM TO MEET THE REQUIREMENTS OF THE UNITED STATES CONFERENCE OF CATHOLIC BISHOPS. (4) TO APPROVE AND REJECT APPOINTMENTS TO THE PENSION COMMITTEE FOR THE SEMC CHURCH PLAN. (5) TO APPROVE ANY AMENDMENTS OR MODIFICATIONS TO, OR THE TERMINATION OF, THE SEMC CHURCH PLAN; AND (6) TO ELECT OR APPOINT AND REMOVE, WITH OR WITHOUT CAUSE, ONE DIRECTOR OF THE CORPORATION WHO DOES NOT CURRENTLY SERVE ON THE BOARD OF MVHS.
FORM 990, PART VI, SECTION B, LINE 11B	INFORMATION IS GATHERED FROM THE ACCOUNTING AND PAYROLL DEPARTMENTS, WHICH IS USED BY THE SENIOR ACCOUNTANT TO PREPARE WORKSHEETS USED TO POPULATE THE FORM 990. MEMBERS OF AN EXTERNAL AUDIT AND TAX FIRM (CURRENTLY FUST CHARLES CHAMBERS LLP) INITIALLY DISCUSS, PREPARE AND REVIEW THE RETURN WITH THE SENIOR ACCOUNTANT. THE SEMC MANAGEMENT TEAM REVIEWS THE DRAFT AND HAS THE OPPORTUNITY TO ASK QUESTIONS AND DISCUSS THE RETURN WITH THE TAX STAFF. AFTER THE MANAGEMENT TEAM'S APPROVAL, THE FORM 990 IS DISTRIBUTED TO THE GOVERNING BODY FOR THEIR REVIEW AND COMMENT PRIOR TO THE FILING OF THE FORM 990.
FORM 990, PART VI, SECTION B, LINE 12C	CONFLICT OF INTEREST POLICY FIRST, EACH BOARD OF TRUSTEE MEMBER, THE PRESIDENT/CEO, CHIEF OPERATING OFFICER, AND EACH VICE PRESIDENT COMPLETE AN ANNUAL CONFLICT OF INTEREST QUESTIONNAIRE. THE RESULTS OF THE QUESTIONNAIRE ARE REVIEWED BY THE AUDIT COMMITTEE OF THE BOARD OF TRUSTEES WHICH IDENTIFIES ANY POTENTIAL CONFLICTS. AS PART OF THE POLICY, BOARD MEMBERS THAT HAVE A CONFLICT ARE UNABLE TO VOTE WHEN A SUBJECT THAT THEY HAVE A CONFLICT OF INTEREST IN COMES UP FOR A VOTE AT A BOARD MEETING. BOARD MEMBERS ARE NOT ALLOWED TO BE INVOLVED IN THE DISCUSSIONS RELATED TO THE ISSUE OTHER THAN TO MAKE A BRIEF COMMENT. STINCE 2010, THE MEDICAL CENTER BEGAN TO REQUIRE ALL DEPARTMENT MANAGERS TO COMPLETE A CONFLICT OF INTEREST QUESTIONNAIRE ON AN ANNUAL BASIS. SINCE 2010, ALL MEMBERS OF THE MEDICAL STAFF ARE REQUIRED TO COMPLETE A CONFLICT OF INTEREST QUESTIONNAIRE ONCE EVERY TWO YEARS, AS PART OF THE CREDENTIALING PROCESS. FOR ALL OTHER EMPLOYEES, A POLICY IS IN PLACE AS PART OF THE COMPLIANCE PLAN THAT REQUIRES EMPLOYEES TO DISCLOSE ANY CONFLICT OF INTEREST TO THEIR SUPERVISOR. THE SUPERVISOR IS THEN REQUIRED TO DISCLOSE THE INFORMATION TO THE COMPLIANCE OFFICER. BOARD MEMBERS OF SUBSIDIARIES ARE ALSO REQUIRED TO COMPLETE CONFLICT OF INTEREST QUESTIONNAIRES.
FORM 990, PART VI, SECTION B, LINE 15	COMPENSATION POLICY THE BOARD OF DIRECTORS HAS ESTABLISHED AN EXECUTIVE COMPENSATION COMMITTEE THAT IS COMPOSED OF THE CHAIRPERSON AND AT LEAST FOUR (4) ADDITIONAL DIRECTORS RECOMMENDED BY THE CHAIRPERSON AND APPROVED BY THE BOARD. ALL MEMBERS OF THE EXECUTIVE COMPENSATION COMMITTEE SHALL BE "INDEPENDENT DIRECTORS" AS THAT TERM IS DEFINED IN SECTION 4958 OF THE INTERNAL REVENUE CODE AND SUPPORTING REGULATIONS. IN THE EVENT THAT THE CHAIRPERSON IS NOT AN "INDEPENDENT DIRECTOR", THE BOARD SHALL APPOINT ANOTHER INDEPENDENT DIRECTOR TO SERVE IN THE PLACE OF THE CHAIRPERSON. THE PRESIDENT/CEO MAY SERVE AS AN ADVISOR TO THE COMMITTEE AS LONG AS HE OR SHE IS EXCUSED WHEN THE COMMITTEE IS REVIEWING THE CEO'S COMPENSATION PACKAGE. THE EXECUTIVE COMPENSATION COMMITTEE IS APPOINTED TO DISCHARGE THE DUTY OF THE BOARD TO FULFILL ITS OVERSIGHT RESPONSIBILITY IN DETERMINING THE ADEQUACY AND REASONABLENESS OF THE COMPENSATION PAID TO THE PRESIDENT/CEO AND OTHER EMPLOYEES OR INDIVIDUALS THAT THE COMMITTEE BELIEVES ARE IN A POSITION TO EXERCISE SUBSTANTIAL INFLUENCE OVER THE AFFAIRS OF THE CORPORATION, OR ITS AFFILIATES OR SUBSIDIARIES, ALL AS OUTLINED IN SECTION 4958 OF THE INTERNAL REVENUE CODE AND SUPPORTING REGULATIONS ("DISQUALIFIED PERSONS"). THE COMMITTEE: (1). ESTABLISHES, MONITORS, REVIEWS AND REVISES, AT LEAST ANNUALLY, PERFORMANCE GUIDELINES FOR THE CEO; (2). ASSISTS THE BOARD IN ASSESSING AND EVALUATING THE CEO'S PERFORMANCE; (3). REVIEWS AND RECOMMENDS TO THE FULL BOARD THE CEO'S COMPENSATION, INCLUDING SALARY, INCENTIVES, BENEFITS AND OTHER PREREQUISITES; (4). REGULARLY ESTABLISHES, REVIEWS AND MONITORS SUCCESSION PLANS (INCLUDING EMERGENCY SUCCESSION PLANS) FOR ALL KEY MANAGEMENT PERSONNEL; (5). AT LEAST ANNUALLY, REVIEWS EXECUTIVE COMPENSATION TO ENSURE THAT IT IS APPROPRIATE IN VIEW OF CORPORATION'S TAX-EXEMPT STATUS AND TAKES THE REQUIRED STEPS TO ESTABLISH A "REBUTTABLE PRESUMPTION OF REASONABLENESS" [UNDER I.R.C. SECTION 4958] OF THE EXECUTIVE COMPENSATION, WHICH MAY INCLUDE EVALUATING: A. THE COMPENSATION PAID BY SIMILAR ORGANIZATIONS, BOTH EXEMPT AND TAXABLE, FOR EQUIVALENT POSITIONS IN THE SAME OR SIMILAR COMMUNITY OR GEOGRAPHIC AREA; B. THE UNIQUENESS OF THE PERSON'S BACKGROUND, EDUCATION, TRAINING, EXPERIENCE, AND RESPONSIBILITIES; C. THE SIZE AND COMPLEXITY OF THE CORPORATION'S INCOME AND ASSETS AND THE NUMBER OF CORPORATIONS EMPLOYEES; D. CEO'S JOB PERFORMANCE; E. RELATIONSHIP OF THE CEO'S COMPENSATION TO THE COMPENSATION PAID TO CORPORATION'S OTHER EMPLOYEES; AND F. THE NUMBER OF HOURS THE CEO SPENDS PERFORMING HIS OR HER JOB. (6). REVIEW AND APPROVE THE COMPENSATION PACKAGE OF THE CHIEF OPERATING, MEDICAL, NURSING AND FINANCIAL OFFICERS, AS RECOMMENDED BY THE CEO. THE COMMITTEE IS PROVIDED SUCH RESOURCES AND AUTHORITY AS IT DEEMS APPROPRIATE TO DISCHARGE ITS DUTIES AND RESPONSIBILITIES, INCLUDING THE AUTHORITY TO DIRECTLY SELECT, ENGAGE AND SUPERVISE ANY CONSULTANT, ACCOUNTANT, LEGAL COUNSEL OR OTHER ADVISOR HIRED BY THE CORPORATION TO ADVISE THE COMMITTEE ON EXECUTIVE COMPENSATION AND RELATED MATTERS. IN CARRYING OUT ITS RESPONSIBILITIES, THE COMMITTEE MAY RELY UPON REASONED, WRITTEN OPINIONS OF CONSULTANTS AND/OR LEGAL COUNSEL.
FORM 990, PART VI, SECTION C, LINE 19	PUBLIC DISCLOSURE THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. THE ORGANIZATION'S FORM 990 IS POSTED ON WWW.GUIDESTAR.ORG.
FORM 990, PART IX, LINE 11G	PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 24,419,142. MANAGEMENT AND GENERAL EXPENSES 865,781. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 25,284,923.
FORM 990, PART XI, LINE 9:	SEMC CHANGE IN FOUNDATION'S NET ASSETS 487,704. PENSION RELATED CHANGES OTHER OTHER THAN NET PERIODIC PENSION COST 20,137,523. OTHER COMPONENTS OF PERIODIC BENEFIT COST -3,878,129. OTHER CHANGES TO NET ASSETS -465,599. CONTRIBUTIONS FOR PROPERTY AND EQUIPMENT 250,231.
FORM 990, PART XII, LINE 2C:	THERE HAS BEEN NO CHANGE IN THE PROCESS BY WHICH THE ORGANIZATION OVERSEES ITS AUDIT OR THE PROCESS BY WHICH THE ORGANIZATION SELECTS ITS INDEPENDENT ACCOUNTANT.

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

Cat. No. 51056K

Schedule O (Form 990) 2021

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

Complete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBullet

Attach to Form 990.
MediumBullet

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

OMB No. 1545-0047

2021

Open to Public Inspection

Name of the organization

ST ELIZABETH MEDICAL CENTER

Employer identification number

15-0532245

Part I

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

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

Part II

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

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No
(1)FAXTON- ST LUKE'S HEALTHCARE PO BOX 479 UTICA,NY13502 16-1576637	ACCUTE CARE HOSPITAL	NY	501 (C) (3)	3	MOHAWK VALLEY HEALTH SYSTEM INC		No
(2)SR OF ST FRANCIS OF THE NEUMANN COMMUNITY 2500 GRANT BLVD SYRACUSE,NY13208 20-4292535	RELIGIOUS ORDER	NY	501 (C) (3)	LINE 1	N/A		No
(3)PARTNERS IN FRANCISCAN MINISTRIES 2500 GRANT BLVD SYRACUSE,NY13208 45-2279986	SPONSOR MINISTRIES	NY	501 (C) (3)	LINE 12A, I	N/A		No
(4)VISITING NURSES ASSOCIATION OF UTICA AND ONEIDA COUNTY 2608 GENESEE STREET UTICA,NY13502 15-0532259	HOME HEALTH NURSING	NY	501 (C) (3)	LINE 10	MOHAWK VALLEY HEALTH SYSTEM INC		No
(5)ST ELIZABETH MEDICAL CENTER FOUNDATION 2209 GENESEE STREET UTICA,NY13501 22-2562170	FUNDRAISING	NY	501 (C) (3)	LINE 12B, II	ST ELIZABETH MEDICAL CENTER	Yes
(6)MOHAWK VALLEY HEALTH SYSTEM PO BOX 4308 UTICA,NY13504 22-3124162	PROMOTE HEALTHCARE	NY	501 (C) (3)	3	N/A		No
(7)MOHAWK VALLEY HEALTH SYSTEM FOUNDATION 1676 SUNSET AVENUE UTICA,NY13502 22-3078768	FUNDRAISING	NY	501 (C) (3)	LINE 12B, II	MVHS		No
(8)ST LUKE'S HOME RESIDENTIAL HEALTHCARE FACILITY PO BOX 6305 UTICA,NY13504 16-1476372	202 BED RHCF	NY	501 (C) (3)	LINE 10	FAXTON ST LUKE'S HEALTHCARE INC		No

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

Cat. No. 50135Y

Schedule R (Form 990) 2021

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?		(k) Percentage ownership
(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	(k) Percentage ownership

Part IV

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

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(h) Percentage ownership	(i) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(h) Percentage ownership	Yes	No
(1) HEALTHCARE UNDERWRITERS MUTUAL RISK MA NY (UNINCORPORATED) 5687 MAIN STREET WILLIAMSVILLE,NY14221 16-1484203	SELF-INSURANCE GROUP	NY	N/A	T					No

Schedule R (Form 990) 2021

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

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

Yes

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

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

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

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

Yes

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

Yes

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

Yes

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

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

Yes

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

Yes

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

Yes

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

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

Schedule R (Form 990) 2021

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?		(k) Percentage ownership
(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	(k) Percentage ownership

Schedule R (Form 990) 2021

Page 5

Part VII

Supplemental Information

Provide additional information for responses to questions on Schedule R. See instructions.

Return Reference	Explanation

Schedule R (Form 990) 2021

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: ST. ELIZABETH MEDICAL CENTER COMMUNITY, INSPIRED BY ST. FRANCIS OF ASSISI AND FAITHFUL TO THE TEACHINGS OF THE ROMAN CATHOLIC CHURCH, IS COMMITTED TO EXCELLENCE IN HEALTHCARE AND EDUCATION.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	17
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 2021 (Part V, line 2a) ......	5	1,886
6	Total number of volunteers (estimate if necessary) .............	6	6
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	426,197
b	Net unrelated business taxable income from Form 990-T, Part I, line 11 .........	7b	0

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	463,366	4,126,626
9	Program service revenue (Part VIII, line 2g) .........	201,086,132	212,222,186
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	526,875	815,760
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	10,849,693	3,550,404
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	212,926,066	220,714,976
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)	116,115,822	113,283,936
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)....	103,552,773	107,136,844
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	219,668,595	220,420,780
19	Revenue less expenses. Subtract line 18 from line 12.......	-6,742,529	294,196
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	139,020,571	133,239,350
21	Total liabilities (Part X, line 26).............	164,690,444	140,340,984
22	Net assets or fund balances. Subtract line 21 from line 20.....	-25,669,873	-7,101,634

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 112,797,130 including grants of $ ) (Revenue $ 117,171,249 )
	INPATIENT SERVICES- ST ELIZABETH MEDICAL CENTER IS A FULL SERVICE GENERAL HOSPITAL WITH 201 LICENSED BEDS. THE HOSPITAL PROVIDES A FULL RANGE OF ROUTINE AND ANCILLARY SERVICES, INCLUDING CARDIAC SURGERY AND ANGIOPLASTY. DISBURSEMENTS MADE BY THE HOSPITAL ARE EXCLUSIVELY FOR SERVICES AND MATERIALS USED IN PERFORMING THE HOSPITAL'S EXEMPT FUNCTIONS. ST ELIZABETH MEDICAL CENTER PROVIDES CARE TO EVERYONE REGARDLESS OF RACE, RELIGION OR ABILITY TO PAY.

4b	(Code: ) (Expenses $ 44,122,278 including grants of $ ) (Revenue $ 55,724,995 )
	AMBULATORY SURGERY- ST ELIZABETH MEDICAL CENTER HAS A FULL RANGE OF AMBULATORY SURGERY SERVICES ON ITS CAMPUS FOR PATIENTS THAT DO NOT REQUIRE OVERNIGHT OR LONG INPATIENT STAYS. ST ELIZABETH MEDICAL CENTER PROVIDES SERVICES TO EVERYONE REGARDLESS OF RACE, RELIGION, OR ABILITY TO PAY.

4c	(Code: ) (Expenses $ 15,077,671 including grants of $ ) (Revenue $ 5,214,079 )
	COMMUNITY MEDICINE - IN ADDITION TO HAVING OUTPATIENT VISITS ON SITE, ST. ELIZABETH MEDICAL CENTER HAS SEVERAL OFF-SITE CLINICS TO PROVIDE PATIENTS WITH CONVENIENT MEDICAL CARE AT A LOWER COST THAN IN THE HOSPITAL SETTING. THE OFF-SITE CLINICS INCLUDE FAMILY PRACTICE AND COMMUNITY MEDICINE.

	(Code: ) (Expenses $ 21,968,402 including grants of $ ) (Revenue $ 36,573,454 )
	OTHER PROGRAM SERVICES INCLUDE EMERGENCY ROOM, REFERRED AMBULATORY, CLINICS, FAMILY PRACTICE, SPORTS MEDICINE CENTER, COLLEGE OF NURSING, INTERNS AND RESIDENTS, AND HOME HEALTH AGENCY

4d	Other program services (Describe in Schedule O.)
	(Expenses $ 21,968,402 including grants of $ ) (Revenue $ 36,573,454 )
4e	Total program service expenses193,965,481

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	3,902,650	3,904,013	337,798

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c
d	Related organizations		1d	3,075
e	Government grants (contributions)		1e	4,056,508

f	All other contributions, gifts, grants, and similar amounts not included above		1f	67,043

g	Noncash contributions included in lines 1a - 1f:$		1g

h Total. Add lines 1a-1f.......		4,126,626

		Business Code
2a	ACUTE CARE	622200	117,171,249	117,171,249
b	AMBULATORY SURGERY	622200	55,724,995	55,724,995
c	EMERGENCY DEPARTMENT	622200	28,794,632	28,794,632
d	PRIMARY CARE	622200	5,214,079	5,214,079
e	LABORATORY TESTING	622200	469,429		469,429
f	All other program service revenue.		4,847,802	4,847,802
g	Total. Add lines 2a–2f .....		212,222,186

3 Investment income (including dividends, interest, and othersimilar amounts) ......			562,371			562,371
4 Income from investment of tax-exempt bond proceeds
5 Royalties...........
		(ii) Personal	(i) Real
6a	Gross rents		757,164	6a
b	Less: rental expenses		137,780	6b
c	Rental income or (loss)		619,384	6c
d	Net rental income or (loss).......			619,384		-43,232	662,616
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory		253,389	7a
b	Less: cost or other basis and sales expenses		0	7b
c	Gain or (loss)		253,389	7c
d	Net gain or (loss).........			253,389			253,389
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ....
			8a
b	Less: direct expenses ...		8b
c	Net income or (loss) from fundraising events..
9a	Gross income from gaming activities. See Part IV, line 19 ...
			9a
b	Less: direct expenses ...		9b
c	Net income or (loss) from gaming activities..
10a	Gross sales of inventory, less returns and allowances ..
			10a
b	Less: cost of goods sold ..		10b
c	Net income or (loss) from sales of inventory..
Business Code			Miscellaneous Revenue
11a	TUITION AND FEES		622200	1,641,022	1,641,022
b
c
d	All other revenue ....			1,289,998	1,289,998
e	Total. Add lines 11a–11d ......			2,931,020
12	Total revenue. See instructions.....			220,714,976	214,683,777	426,197	1,478,376

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, lines 15 and 16. .............
4	Benefits paid to or for members .......
5	Compensation of current officers, directors, trustees, and key employees ...........	593,699		593,699
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........	95,822,664	83,690,286	12,132,378
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	3,717,172	3,232,310	484,862
9	Other employee benefits .......	6,546,188	5,692,313	853,875
10	Payroll taxes ...........	6,604,213	5,742,769	861,444
11	Fees for services (non-employees):
a	Management ......	588,677	510,521	78,156
b	Legal .........	252,481	218,960	33,521
c	Accounting ...........	127,200	110,312	16,888
d	Lobbying ...........	66,035		66,035
e	Professional fundraising services. See Part IV, line 17
f	Investment management fees ......	36,681	36,681
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	25,284,923	24,419,142	865,781
12	Advertising and promotion ....	1,349	1,170	179
13	Office expenses .......	615,298	533,607	81,691
14	Information technology ......	2,806,710	2,434,075	372,635
15	Royalties ..
16	Occupancy ...........	3,082,186	2,672,977	409,209
17	Travel ............
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .
19	Conferences, conventions, and meetings ....	50,535	43,826	6,709
20	Interest ...........	1,018,041		1,018,041
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization ..	8,569,941	7,431,081	1,138,860
23	Insurance ...	2,296,466	1,991,574	304,892
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	43,873,210	38,048,347	5,824,863
b	BAD DEBTS	8,000,648	8,000,648
c	SERVICE CONTRACTS	3,827,568	3,319,398	508,170
d	NON MEDICAL SUPPLIES	3,555,767	3,083,683	472,084
e	All other expenses	3,083,128	2,751,801	331,327
25	Total functional expenses. Add lines 1 through 24e	220,420,780	193,965,481	26,455,299	0
26	Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here if following SOP 98-2 (ASC 958-720).

1	Cash–non-interest-bearing ........			5,247,222	1	875,205
2	Savings and temporary cash investments .........				2
3	Pledges and grants receivable, net ......				3
4	Accounts receivable, net .............			19,301,685	4	21,576,933
5	Loans and other receivables from any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .......
					5
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), and persons described in section 4958(c)(3)(B) ...
					6
7	Notes and loans receivable, net ...........				7
8	Inventories for sale or use ............			6,038,379	8	7,703,011
9	Prepaid expenses and deferred charges ......			1,244,919	9	1,450,659
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	181,256,848
b	Less: accumulated depreciation	10b	124,048,206	61,239,803	10c	57,208,642
11	Investments—publicly traded securities .			19,255,478	11	22,413,158
12	Investments—other securities. See Part IV, line 11 .....				12
13	Investments—program-related. See Part IV, line 11 ..				13
14	Intangible assets ...............				14
15	Other assets. See Part IV, line 11 ...........			26,693,085	15	22,011,742
16	Total assets. Add lines 1 through 15 (must equal line 33)...			139,020,571	16	133,239,350

17	Accounts payable and accrued expenses .....	25,420,068	17	23,609,068
18	Grants payable ...		18
19	Deferred revenue .........		19
20	Tax-exempt bond liabilities .........		20
21	Escrow or custodial account liability. Complete Part IV of Schedule D		21
22	Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .........
			22
23	Secured mortgages and notes payable to unrelated third parties ..	32,344,744	23	31,871,881
24	Unsecured notes and loans payable to unrelated third parties ..	15,164,872	24	19,175,056
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	91,760,760	25	65,684,979
26	Total liabilities. Add lines 17 through 25..	164,690,444	26	140,340,984

	Organizations that follow FASB ASC 958, check here and complete lines 27, 28, 32, and 33.
27	Net assets without donor restrictions ..........	-27,262,263	27	-9,064,198
28	Net assets with donor restrictions ...........	1,592,390	28	1,962,564
	Organizations that do not follow FASB ASC 958, check here and complete lines 29 through 33.
29	Capital stock or trust principal, or current funds .....		29
30	Paid-in or capital surplus, or land, building or equipment fund ...		30
31	Retained earnings, endowment, accumulated income, or other funds		31
32	Total net assets or fund balances ...........	-25,669,873	32	-7,101,634
33	Total liabilities and net assets/fund balances ........	139,020,571	33	133,239,350