Form990


Department of the TreasuryInternal Revenue Service
Return of Organization Exempt From Income Tax
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except private foundations)
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OMB No. 1545-0047
2021
Open to Public Inspection
A For the 2021 calendar year, or tax year beginning 01-01-2021 , and ending 12-31-2021
BCheck if applicable:
CName of organization
THE NEW YORK GRACIE SQUARE HOSPITAL INC
 
 
Doing business as
 
 
Number and street (or P.O. box if mail is not delivered to street address)
420 EAST 76 STREET
 
Room/suite
City or town, state or province, country, and ZIP or foreign postal code
NEW YORK, NY10021
D Employer identification number

13-3746997
E Telephone number

G Gross receipts $ 72,320,328
F Name and address of principal officer:
PHILIP J WILNER MD
420 EAST 76 STREET
NEW YORK,NY10021
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
WWW.NYGSH.ORG
H(a)
Is this a group return for
subordinates?
H(b)
Are all subordinates
included?
If "No," attach a list. See instructions.
H(c)
Group exemption number MediumBullet  
K Form of organization:  
L Year of formation: 1958
M State of legal domicile: NY
Part I
Summary
Activities & Governance 1 Briefly describe the organization’s mission or most significant activities: OUR MISSION IS TO PROVIDE THE HIGHEST QUALITY, STATE-OF-THE ART MENTAL HEALTH AND CHEMICAL DEPENDENCY TREATMENT IN A WARM, HEALING ENVIRONMENT.
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a) ........ 3 9
4 Number of independent voting members of the governing body (Part VI, line 1b) ..... 4 5
5 Total number of individuals employed in calendar year 2021 (Part V, line 2a) ...... 5 522
6 Total number of volunteers (estimate if necessary) ............. 6 0
7a Total unrelated business revenue from Part VIII, column (C), line 12 ........ 7a 0
b Net unrelated business taxable income from Form 990-T, Part I, line 11 ......... 7b 0
Revenues Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 19,398,061 10,623,835
9 Program service revenue (Part VIII, line 2g) ......... 46,947,580 61,549,736
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 29,046 52,821
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 98,642 93,936
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12) 66,473,329 72,320,328
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 27,455 94,850
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) 47,161,404 49,628,056
16a Professional fundraising fees (Part IX, column (A), line 11e) ..... 90,000 66,000
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet66,000    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e).... 15,635,853 16,157,491
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 62,914,712 65,946,397
19 Revenue less expenses. Subtract line 18 from line 12....... 3,558,617 6,373,931
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 56,066,655 62,924,626
21 Total liabilities (Part X, line 26)............. 48,040,944 48,475,552
22 Net assets or fund balances. Subtract line 21 from line 20..... 8,025,711 14,449,074
Part II
Signature Block
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.
Sign Here
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Signature of officer Date
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Type or print name and title
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Print/Type preparer's name
Preparer's signature
Date
PTIN
Firm's name MediumBullet

Firm's EIN MediumBullet
Firm's address MediumBullet



Phone no.
May the IRS discuss this return with the preparer shown above? (see instructions) ..........
For Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y Form 990 (2021)
Form 990 (2021)
Page 2
Part III
Statement of Program Service Accomplishments
Check if Schedule O contains a response or note to any line in this Part III..............
1
Briefly describe the organization’s mission: OUR MISSION IS TO PROVIDE THE HIGHEST-QUALITY, STATE-OF THE-ART MENTAL HEALTH AND CHEMICAL DEPENDENCY TREATMENT IN A WARM, HEALING ENVIRONMENT. OUR CARING, COMPASSIONATE TEAM PREPARES OUR PATIENTS TO RETURN TO THEIR FAMILIES AND COMMUNITIES AND ENGAGE IN PRODUCTIVE AND FULFILLING LIVES. WE SERVE THE DIVERSE RESIDENTS OF THE GREATER NEW YORK METROPOLITAN AREA THROUGH TREATMENT, EDUCATION AND HEALTH PROMOTION.
2
Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? .....................
If "Yes," describe these new services on Schedule O.
3
Did the organization cease conducting, or make significant changes in how it conducts, any program
services? ...........................
If "Yes," describe these changes on Schedule O.
4
Describe the organization’s program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.
4a (Code:   ) (Expenses $ 56,311,734 including grants of $ 94,850 ) (Revenue $ 61,549,736 )
As described in the needs assessment above during 2015 the hospital embarked upon a revitalization program to improve the quality of patient care and the way we provide it; with the goal of providing the highest quality, state-of-the-art mental health and chemical dependency treatment in a warm and healing environment. This program included improving staffing ratios, quality and safety monitoring, plant renovations, its infrastructure, and the implementation of an electronic health record. The following describes some of the changes to our mission, culture and values, programs, and healthcare team that began in 2015 and have continued since that time. Gracie Square Hospital has provided advanced, patient-centered inpatient behavioral health services since 1959. We are committed to providing patients with compassionate and comprehensive care in a warm and welcoming environment in order to facilitate their recovery and return to their families and communities. Gracie Square Hospital, a psychiatric inpatient facility located on a quiet side street on the upper east side of Manhattan, is now experiencing a period of extraordinary transformation and revitalization. Through our affiliation with NewYork-Presbyterian, one of the nation's premier academic healthcare delivery systems. Gracie Square Hospital is undergoing renovations, growing its staff, and enhancing services and programs. Under new leadership, the hospital is focused on providing the highest quality of care, evidence-based treatments, education, and training. Patient Care Programs Gracie Square Hospital has dedicated and specialized inpatient care programs tailored to meet the needs of patients from different cultural and religious backgrounds and age groups and those suffering from specific diagnoses. Based on a comprehensive and personalized assessment upon arrival at our hospital, we match patients with exceptional care providers equipped with the expertise, tools, and resources to provide compassionate short-term, individualized treatment in a caring and safe environment. During each patient's hospital stay, our expert social workers plan for the transition to outpatient care and facilitate connections with community resources to promote recovery. Gracie Square Hospital's multifaceted interdisciplinary and targeted approach incorporates medications; individual, milieu, and group therapy; and/or therapeutic activities into treatment plans. We work together to promote wellness while providing patients with skills to reduce the risk of relapse and enhance function and independence. Specialized patient care programs include: Crisis Stabilization Program for patients with mood and anxiety disorders, post-traumatic stress disorders, and other psychiatric syndromes and who are in distress. Affective (Mood) Disorders Program for patients with mood disorders such as depression and bipolar disorder. Psychotic Disorders Program for individuals with acute symptoms of schizophrenia and schizoaffective disorders, as well as those with bipolar disorder with psychotic features. Dual Focus Program for people with significant emotional or psychiatric problems plus abuse challenges. Many of these patients suffer from two co-existing illnesses. They may be treated either in mental health or addiction systems, or shuttled back and forth between them - an often unsuccessful approach. The Dual Focus Program addresses both psychiatric and addiction components through customized treatment plans. The team includes addiction-trained social workers. Asian Psychiatry Program provides culturally appropriate services to members of Chinese, Korean, Japanese, and other Asian communities in need of inpatient mental health care. The program is directed by a culturally diverse clinical team and support staff who speak Mandarin, Cantonese, Chinese ethnic dialects, Korean, Japanese, and other Asian languages. Activities incorporate Asian influences and the unit is decorated with Asian art. Patients are served Chinese food and tea, and educational materials and newspapers are available in both English and Asian languages. Young Adult Program for young adults ages 18-25 with emerging psychiatric disorders. Symptoms of major psychiatric disorders, including affective and psychotic disorders, often begin in the late teens or early 20s. The sooner treatment begins, the better outcomes will be. Older Adult Program (Geriatric Service) for people age 65 and older with psychiatric disorders that require inpatient treatment. Team members have training in the care of older adults. Psychiatrists and internists on this unit are also knowledgeable about co-existing medical conditions that may cause psychiatric symptoms. They manage patients' psychiatric and non-psychiatric medications and pay careful attention to drug interactions. Healthcare Team Patients at Gracie Square Hospital benefit from a multidisciplinary care team specially trained to meet their personal needs. We call upon specialists from other areas of medicine as needed, ensuring that our patients benefit from the comprehensive range of healthcare services available through the NewYork-Presbyterian network. Our treatment team includes: Certified occupational therapists. Our certified occupational therapists focus on enabling individuals to re-engage in meaningful occupations through a variety of skill sets such as skills development, establishing positive habits and routines, setting therapy goals, using cognitive-behavioral techniques (CBT), and understanding underlying physiological influences. They help our patients develop, recover, improve, and maintain the skills needed for daily living and working. Certified alcoholism and substance abuse counselor. These professionals provide care and support for patients dealing with co-occurring disorders, such as alcohol and/or drug use and a mental health condition. Internist or family nurse practitioner. After conducting thorough physical and neurological examinations, the primary care provider orders any needed diagnostic testing, identifies medical conditions present, and designs medical treatment plans. Nursing aides. Our aides help provide for the comfort and safety of our patients through assistance with activities of daily living and education. They support our patients, family members, and other caregivers. Nutritionist. A nutritionist with experience in behavioral health care evaluates each patient and creates an individualized dietary plan. In addition, patients and their families receive nutritional guidance, education on food and drug interactions, and information about dietary supplements. Registered professional psychiatric nurse. Our nurses work at the top of their professional licensure via the utilization of a professional governance structure. Through collaboration, our nurses ensure optimal patient care delivery while driving highly reliable quality outcomes. Psychiatrist or psychiatric nurse practitioner. The psychiatrist or psychiatric nurse practitioner has expertise in the patient's diagnosis. This professional serves as a patient's team leader and coordinates and implements the patient's comprehensive treatment plan. Psychologist. Licensed clinical psychologists provide individual and group therapy using approaches such as CBT, acceptance and commitment therapy (ACT), dialectical behavioral therapy (DBT) skills training, and short-term psychodynamic therapy. Social workers. Our clinicians conduct psychosocial assessments which incorporate all resources available to inform an individualized treatment plan that will lead to a timely and successful discharge to community resources. Physical therapist. For patients who may need assistive devices for mobility (walkers, wheelchairs, etc.), and for those recovering from a recent injury who are in need of a rehabilitation assessment.
4b (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4c (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4d Other program services (Describe in Schedule O.)
(Expenses $   including grants of $   ) (Revenue $   )
4e Total program service expensesMediumBullet56,311,734
Form 990 (2021)
Form 990 (2021)
Page 3
Part IV
Checklist of Required Schedules
Yes
No
1
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If "Yes," complete Schedule AClick to see attachment.....................
1
Yes
 
2
Is the organization required to complete Schedule B, Schedule of Contributors? See instructions. Click to see attachment...
2
Yes
 
3
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If "Yes," complete Schedule C, Part I.............
3
 
No
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities, or have a section 501(h) election in effect during the tax year? If "Yes," complete Schedule C, Part IIClick to see attachment.........
4
Yes
 
5
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Rev. Proc. 98-19? If "Yes," complete Schedule C, Part III..
5
 
 
6
Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If "Yes," complete Schedule D, Part I.........................
6
 
No
7
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas, or historic structures? If "Yes," complete Schedule D, Part II....
7
 
No
8
Did the organization maintain collections of works of art, historical treasures, or other similar assets? If "Yes,"
complete Schedule D, Part III..............
8
 
No
9
Did the organization report an amount in Part X, line 21 for escrow or custodial account liability; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If "Yes," complete Schedule D, Part IV..............
9
 
No
10
Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments, permanent endowments, or quasi endowments? If "Yes," complete Schedule D, Part V......
10
 
No
11
If the organization’s answer to any of the following questions is "Yes," then complete Schedule D, Parts VI, VII, VIII, IX, or X, as applicable.
a
Did the organization report an amount for land, buildings, and equipment in Part X, line 10? If "Yes," complete
Schedule D, Part VI. Click to see attachment...................
11a
Yes
 
b
Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VII.......
11b
 
No
c
Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VIII.......
11c
 
No
d
Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part IX............
11d
 
No
e
Did the organization report an amount for other liabilities in Part X, line 25? If "Yes," complete Schedule D, Part XClick to see attachment
11e
Yes
 
f
Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If "Yes," complete Schedule D, Part X
11f
 
No
12a
Did the organization obtain separate, independent audited financial statements for the tax year? If "Yes," complete
Schedule D, Parts XI and XIIClick to see attachment......................
12a
Yes
 
b
Was the organization included in consolidated, independent audited financial statements for the tax year? If "Yes," and if the organization answered "No" to line 12a, then completing Schedule D, Parts XI and XII is optional
12b
 
No
13
Is the organization a school described in section 170(b)(1)(A)(ii)? If "Yes," complete Schedule E
13
 
No
14a
Did the organization maintain an office, employees, or agents outside of the United States? .....
14a
 
No
b
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, investment, and program service activities outside the United States, or aggregate foreign investments valued at $100,000 or more? If "Yes," complete Schedule F, Parts I and IV.........
14b
 
No
15
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or other assistance to or for any foreign organization? If “Yes,” complete Schedule F, Parts II and IV.....
15
 
No
16
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or other assistance to or for foreign individuals? If “Yes,” complete Schedule F, Parts III and IV...
16
 
No
17
Did the organization report a total of more than $15,000 of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11e? If "Yes," complete Schedule G, Part I. See instructions. ....Click to see attachment
17
Yes
 
18
Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If "Yes," complete Schedule G, Part II............
18
 
No
19
Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If "Yes," complete Schedule G, Part III...................
19
 
No
20a
Did the organization operate one or more hospital facilities? If "Yes," complete Schedule H....Click to see attachment
20a
Yes
 
b
If "Yes" to line 20a, did the organization attach a copy of its audited financial statements to this return? Click to see attachment
20b
Yes
 
21
Did the organization report more than $5,000 of grants or other assistance to any domestic organization or domestic government on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II.....Click to see attachment
21
Yes
 
Form 990 (2021)
Form 990 (2021)
Page 4
Part IV
Checklist of Required Schedules (continued)
Yes
No
22
Did the organization report more than $5,000 of grants or other assistance to or for domestic individuals on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III........Click to see attachment
22
Yes
 
23
Did the organization answer "Yes" to Part VII, Section A, line 3, 4, or 5, about compensation of the organization’s current and former officers, directors, trustees, key employees, and highest compensated employees? If "Yes," complete Schedule J....................... Click to see attachment
23
Yes
 
24a
Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If “Yes,” answer lines 24b through 24d and complete Schedule K. If “No,” go to line 25a...............
24a
 
No
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
 
c
Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds? ...............
24c
 
 
d
Did the organization act as an "on behalf of" issuer for bonds outstanding at any time during the year?...
24d
 
 
25a
Section 501(c)(3), 501(c)(4), and 501(c)(29) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If "Yes," complete Schedule L, Part I ....
25a
 
No
b
Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If "Yes," complete Schedule L, Part I.......................
25b
 
No
26
Did the organization report any amount on Part X, line 5 or 22 for receivables from or 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? If "Yes," complete Schedule L, Part II...........
26
 
No
27
Did the organization provide a grant or other assistance to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or employee thereof, a grant selection committee member, or to a 35% controlled entity (including an employee thereof) or family member of any of these persons?
If "Yes," complete
Schedule L, Part III.........................
27
 
No
28
Was the organization a party to a business transaction with one of the following parties (see the Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):
a
A current or former officer, director, trustee, key employee, creator or founder, or substantial contributor? If "Yes," complete Schedule L, Part IV......................
28a
 
No
b
A family member of any individual described in line 28a? If "Yes," complete Schedule L, Part IV.....
28b
 
No
c
A 35% controlled entity of one or more individuals and/or organizations described in line 28a or 28b? If "Yes," complete Schedule L, Part IV.....................
28c
 
No
29
Did the organization receive more than $25,000 in non-cash contributions? If "Yes," complete Schedule M..
29
 
No
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If "Yes," complete Schedule M .................
30
 
No
31
Did the organization liquidate, terminate, or dissolve and cease operations? If "Yes," complete Schedule N, Part I
31
 
No
32
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If "Yes," complete Schedule N, Part II........................
32
 
No
33
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If "Yes," complete Schedule R, Part I............
33
 
No
34
Was the organization related to any tax-exempt or taxable entity? If "Yes," complete Schedule R, Part II, III, or IV, and Part V, line 1.........................Click to see attachment
34
Yes
 
35a
Did the organization have a controlled entity within the meaning of section 512(b)(13)?
35a
 
No
b
If ‘Yes’ to line 35a, did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If "Yes," complete Schedule R, Part V, line 2 ...
35b
 
 
36
Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If "Yes," complete Schedule R, Part V, line 2.............
36
 
No
37
Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If "Yes," complete Schedule R, Part VI
37
 
No
38
Did the organization complete Schedule O and provide explanations on Schedule O for Part VI, lines 11b and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Part V
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response or note to any line in this Part V...........
Yes
No
1a
Enter the number reported in box 3 of Form 1096. Enter -0- if not applicable ..
1a
48
b
Enter the number of Forms W-2G included on line 1a. Enter -0- if not applicable .
1b
0
c
Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................
1c
Yes
 
Form 990 (2021)
Form 990 (2021)
Page 5
Part V
Statements Regarding Other IRS Filings and Tax Compliance (continued)
2a
Enter the number of employees reported on Form W-3, Transmittal of Wage and
Tax Statements, filed for the calendar year ending with or within the year covered by this return ..................
2a
522
b
If at least one is reported on line 2a, did the organization file all required federal employment tax returns?
Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file. See instructions.
2b
Yes
 
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?...
3a
 
No
b
If “Yes,” has it filed a Form 990-T for this year? If “No” to line 3b, provide an explanation in Schedule O...
3b
 
 
4a
At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account, securities account, or other financial account)? ..
4a
 
No
b
If "Yes," enter the name of the foreign country: MediumBullet
See instructions for filing requirements for FinCEN Form 114, Report of Foreign Bank and Financial Accounts (FBAR).
5a
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year? ..
5a
 
No
b
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
5b
 
No
c
If "Yes," to line 5a or 5b, did the organization file Form 8886-T? ............
5c
 
 
6a
Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible as charitable contributions? ...
6a
 
No
b
If "Yes," did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible? ......................
6b
 
 
7
Organizations that may receive deductible contributions under section 170(c).
a
Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor? ....................
7a
 
No
b
If "Yes," did the organization notify the donor of the value of the goods or services provided? .....
7b
 
 
c
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282? .........................
7c
 
No
d
If "Yes," indicate the number of Forms 8282 filed during the year ....
7d
 
e
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?
7e
 
No
f
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract? ..
7f
 
No
g
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required? ......................
7g
 
 
h
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C? ..........................
7h
 
 
8
Sponsoring organizations maintaining donor advised funds. Did a donor advised fund maintained by the sponsoring organization have excess business holdings at any time during the year? ........
8
 
 
9
Sponsoring organizations maintaining donor advised funds.
a
Did the sponsoring organization make any taxable distributions under section 4966?........
9a
 
 
b
Did the sponsoring organization make a distribution to a donor, donor advisor, or related person?...
9b
 
 
10
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on Part VIII, line 12 ...
10a
 
b
Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
10b
 
11
Section 501(c)(12) organizations. Enter:
a
Gross income from members or shareholders .........
11a
 
b
Gross income from other sources. (Do not net amounts due or paid to other sources against amounts due or received from them.) ..........
11b
 
12a
Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?
12a
 
 
b
If "Yes," enter the amount of tax-exempt interest received or accrued during the year.
12b
 
13
Section 501(c)(29) qualified nonprofit health insurance issuers.
a
Is the organization licensed to issue qualified health plans in more than one state? .........
Note. See the instructions for additional information the organization must report on Schedule O.
13a
 
 
b
Enter the amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans ....
13b
 
c
Enter the amount of reserves on hand ............
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
No
b
If "Yes," has it filed a Form 720 to report these payments? If "No," provide an explanation in Schedule O..
14b
 
 
15
Is the organization subject to the section 4960 tax on payment(s) of more than $1,000,000 in remuneration or excess parachute payment(s) during the year? ....................
If "Yes," see the instructions and file Form 4720, Schedule N.
15
 
No
16
Is the organization an educational institution subject to the section 4968 excise tax on net investment income? ..
If "Yes," complete Form 4720, Schedule O.
16
 
No
17
Section 501(c)(21) organizations. Did the trust, any disqualified person, or mine operator engage in any activities that would result in the imposition of an excise tax under section 4951, 4952, or 4953? ..
If "Yes," complete Form 6069.
17
 
 
Form 990 (2021)
Form 990 (2021)
Page 6
Part VI
Governance, Management, and Disclosure. For each "Yes" response to lines 2 through 7b below, and for a "No" response to lines 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.
Check if Schedule O contains a response or note to any line in this Part VI..............
Section A. Governing Body and Management
Yes
No
1a
Enter the number of voting members of the governing body at the end of the tax year
1a
9
If there are material differences in voting rights among members of the governing body, or if the governing body delegated broad authority to an executive committee or similar committee, explain in Schedule O.
b
Enter the number of voting members included in line 1a, above, who are independent
1b
5
2
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................
2
 
No
3
Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? .
3
 
No
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed? .
4
 
No
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
 
No
6
Did the organization have members or stockholders? ................
6
Yes
 
7a
Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or more members of the governing body? ....................
7a
Yes
 
b
Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body? ...................
7b
Yes
 
8
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a
The governing body? .......................
8a
Yes
 
b
Each committee with authority to act on behalf of the governing body? ............
8b
Yes
 
9
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If "Yes," provide the names and addresses in Schedule O.......
9
 
No
Section B. Policies (This Section B requests information about policies not required by the Internal Revenue Code.)
Yes
No
10a
Did the organization have local chapters, branches, or affiliates? ............
10a
 
No
b
If "Yes," did the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes?
10b
 
 
11a
Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form? ............................
11a
Yes
 
b
Describe on Schedule O the process, if any, used by the organization to review this Form 990. .....
12a
Did the organization have a written conflict of interest policy? If "No," go to line 13.......
12a
Yes
 
b
Were officers, directors, or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ..........................
12b
Yes
 
c
Did the organization regularly and consistently monitor and enforce compliance with the policy? If "Yes," describe on Schedule O how this was done...................
12c
Yes
 
13
Did the organization have a written whistleblower policy? ...............
13
Yes
 
14
Did the organization have a written document retention and destruction policy? .........
14
Yes
 
15
Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
a
The organization’s CEO, Executive Director, or top management official ...........
15a
Yes
 
b
Other officers or key employees of the organization ................
15b
Yes
 
If "Yes" to line 15a or 15b, describe the process on Schedule O. See instructions.
16a
Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? ......................
16a
 
No
b
If "Yes," did the organization follow a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and take steps to safeguard the organization’s exempt status with respect to such arrangements? ............
16b
 
 
Section C. Disclosure
17
List the states with which a copy of this Form 990 is required to be filedMediumBullet
NY
18
Section 6104 requires an organization to make its Form 1023 (1024 or 1024-A, if applicable), 990, and 990-T (section 501(c)(3)s only) available for public inspection. Indicate how you made these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how) the organization made its governing documents, conflict of interest policy, and financial statements available to the public during the tax year.
20
State the name, address, and telephone number of the person who possesses the organization's books and records:
MediumBulletSANDY KWONG420 EAST 76 STREET   NEW YORK,NY10021 (212) 434-5300
Form 990 (2021)
Form 990 (2021)
Page 7
Part VII
Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
Check if Schedule O contains a response or note to any line in this Part VII..............
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization’s tax year.
RoundBullet List all of the organization’s current officers, directors, trustees (whether individuals or organizations), regardless of amount
of compensation. Enter -0- in columns (D), (E), and (F) if no compensation was paid.

RoundBullet List all of the organization’s current key employees, if any. See the instructions for definition of "key employee."
RoundBullet List the organization’s five current highest compensated employees (other than an officer, director, trustee or key employee)
who received reportable compensation (box 5 of Form W-2, Form 1099-MISC, and/or box 1 of Form 1099-NEC) of more than $100,000 from the
organization and any related organizations.

RoundBullet List all of the organization’s former officers, key employees, or highest compensated employees who received more than $100,000
of reportable compensation from the organization and any related organizations.

RoundBullet List all of the organization’s former directors or trustees that received, in the capacity as a former director or trustee of the
organization, more than $10,000 of reportable compensation from the organization and any related organizations.

See the instructions for the order in which to list the persons above.
Check this box if neither the organization nor any related organization compensated any current officer, director, or trustee.
(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) 		(D)
Reportable compensation from the organization (W-2/1099-MISC/1099-NEC) 		(E)
Reportable compensation from related organizations (W-2/1099-MISC/1099-NEC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; OfficerInd; Key Employee; Highest compensated employee; FormerOfcrDirectorTrusteeInd;
(1) DAVID WYMAN
 
BOARD MEMBER/PRESIDENT (THRU 5/2021)
 60.0
.................
0.0 		X   X       437,930 344,575 53,740
(2) GARY J ZUAR
 
BOARD MEMBER/ASS'T TREASURER
 2.0
.................
58.0 		X   X       0 1,349,002 170,828
(3) PHILIP J WILNER
 
CHAIRMAN (THRU 5/2021)/ PRESIDENT (FROM 6/2021)
 15.0
.................
45.0 		X   X       0 0 0
(4) ADAM OWETT SR
 
BOARD MEMBER
 2.0
.................
0 		X           0 0 0
(5) BRIAN K REGAN
 
BOARD MEMBER
 2.0
.................
58.0 		X           0 458,401 64,167
(6) JOHN ZIRINSKY
 
BOARD MEMBER
 2.0
.................
0 		X           0 0 0
(7) JOSEPH PEYRONNIN
 
BOARD MEMBER
 2.0
.................
0 		X           0 0 0
(8) KAREN WESTERVELT
 
BOARD MEMBER/ CHAIRMAN (FROM 6/2021)
 2.0
.................
58.0 		X           0 1,372,771 57,958
(9) LORINDA DE ROULET
 
BOARD MEMBER
 2.0
.................
0 		X           0 0 0
(10) NAZIM B MALATYALI
 
BOARD MEMBER
 2.0
.................
58.0 		X           0 722,625 61,725
(11) JOHN V CAMPANO
 
SECRETARY
 2.0
.................
58.0 		    X       0 628,480 78,685
(12) KATHLEEN M BURKE
 
ASS'T SECRETARY
 1.0
.................
59.0 		    X       0 434,266 67,606
(13) MELISSA E WELCH
 
ASS'T SECRETARY
 1.0
.................
34.0 		    X       0 180,133 32,096
(14) MICHAEL P BRESLIN
 
TREASURER
 1.0
.................
59.0 		    X       0 2,192,989 73,403
(15) DONNA T ANTHONY
 
CHIEF MEDICAL OFFICER
 60.0
.................
0 		      X     409,878 0 41,796
(16) MARGARET MANCUSO
 
CHIEF ADMINISTRATIVE OFFICER
 60.0
.................
0 		      X     289,472 0 29,965
(17) MICHAEL RADOSTA
 
CHIEF NURSING & QUAL. OFFICER
 34.0
.................
26.0 		      X     191,365 233,716 44,811
Form 990 (2021)
Form 990 (2021)
Page 8
Part VII
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)
(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) 		(D)
Reportable compensation from the organization (W-2/1099-MISC/1099-NEC) 		(E)
Reportable compensation from related organizations (W-2/1099-MISC/1099-NEC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; OfficerInd; Key Employee; Highest compensated employee; FormerOfcrDirectorTrusteeInd;
(18) NATASHA BOWMAN
 
CHIEF HR OFFICER
 60.0
.......................0 		      X     268,842 0 49,572
(19) AMY PARIKH
 
PER DIEM PSYCH
 37.5
.......................0 		        X   221,603 0 11,080
(20) BORIS AVEZBAKIYEV
 
PER DIEM MD
 37.5
.......................0 		        X   176,813 0 10,609
(21) DOUGLAS SAPHIER
 
PER DIEM PSYCH
 37.5
.......................0 		        X   215,408 0 12,924
(22) FRANCINE FAKIH
 
DIRECTOR OF NURSING
 37.5
.......................0 		        X   191,315 0 45,422
(23) NIESHA WESTMORELAND
 
PER DIEM PSYCH
 37.5
.......................0 		        X   257,460 0 12,873
(24) PHYLLIS R LANTOS
 
FORMER OFFICER
 0.0
.......................0.0 		          X 0 1,227,272 21,053












1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)...........MediumBullet 2,660,086 9,144,230 940,313
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organization MediumBullet83
Yes
No
3
Did the organization list any former officer, director or trustee, key employee, or highest compensated employee on line 1a? If "Yes," complete Schedule J for such individual ..............
3
Yes
 
4
For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If "Yes," complete Schedule J for such
individual...........................
4
Yes
 
5
Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If "Yes," complete Schedule J for such person ........
5
 
No
Section B. Independent Contractors
1
Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization. Report compensation for the calendar year ending with or within the organization’s tax year.
(A)
Name and business address 		(B)
Description of services 		(C)
Compensation
G-NET CONSTRUCTION

360 TARGEE STREET
STATEN ISLAND,NY10304 		CONSTRUCTION 1,689,062
BATSKA CONSULTING GROUP LLC

54 WEST 40TH STREET
NEW YORK,NY10018 		CONSULTING 1,348,995
ARAMARK

600 EAST LUZERNE STREET
PHILADELPHIA,PA19124 		FOOD SERVICE 1,100,142
DOOLEY ELECTRIC CO INC

4014 3RD AVENUE
BROOKLYN,NY12232 		ELECTRICAN 1,064,236
HM HUGHES

323 EAST 65TH STREET
NEW YORK,NY10065 		CONSTRUCTION 775,347
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet21
Form 990 (2021)
Form 990 (2021)
Page 9
Part VIII
Statement of Revenue
Check if Schedule O contains a response or note to any line in this Part VIII.............
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512 - 514
Contributions, Gifts, Grants, and OtherAmt Similar Amounts 1a Federated campaigns..1a  
b Membership dues..1b  
c Fundraising events..1c  
d Related organizations1d 8,943,803
e Government grants (contributions)1e 1,536,021
f All other contributions, gifts, grants, and similar amounts not included above1f 144,011
g Noncash contributions included in lines 1a - 1f:$ 1g 1,293
h Total. Add lines 1a-1f.......MediumBullet 10,623,835
Program Service RevenueAmt Business Code
2a PATIENT REVENUE 621110 61,549,736 61,549,736    
b
c
d
e
f All other program service revenue. 0 0 0 0
g Total. Add lines 2a–2f .....MediumBullet 61,549,736
OtherAmtRevenueAmt 3 Investment income (including dividends, interest, and othersimilar amounts) ......MediumBullet 52,821     52,821
4 Income from investment of tax-exempt bond proceedsMediumBullet        
5 Royalties...........MediumBullet        
(ii) Personal (i) Real
6a Gross rents   59,550 6a
b Less: rental expenses     6b
c Rental income or (loss) 0 59,550 6c
d Net rental income or (loss).......MediumBullet 59,550     59,550
(ii) Other (i) Securities
7a Gross amount from sales of assets other than inventory     7a
b Less: cost or other basis and sales expenses     7b
c Gain or (loss) 0 0 7c
d Net gain or (loss).........MediumBullet        
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..MediumBullet      
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..MediumBullet        
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..MediumBullet        
Business Code Miscellaneous Revenue
11a OTHER MISCELLANEOUS 900099 34,386     34,386
b            
c            
d All other revenue .... 0 0 0 0
e Total. Add lines 11a–11d ...... MediumBullet 34,386
12 Total revenue. See instructions.....MediumBullet 72,320,328 61,549,736 0 146,757
Form 990 (2021)
Form 990 (2021)
Page 10
Part IX
Statement of Functional Expenses
Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A).Check if Schedule O contains a response or note to any line in this Part IX..............
Do not include amounts reported on lines 6b,
7b, 8b, 9b, and 10b of Part VIII. 		(A)
Total expenses 		(B)
Program service expenses 		(C)
Management and general expenses 		(D)
Fundraising
expenses
1 Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 .... 10,000 10,000
2 Grants and other assistance to domestic individuals. See Part IV, line 22 ........... 84,850 84,850
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 ....... 0 0
5 Compensation of current officers, directors, trustees, and key employees ........... 1,927,544   1,927,544  
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........ 34,310,777 30,072,137 4,238,640  
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) .... 2,360,909 2,069,250 291,659  
9 Other employee benefits ....... 8,585,288 7,524,690 1,060,598  
10 Payroll taxes ........... 2,443,538 2,141,671 301,867  
11 Fees for services (non-employees):        
a Management ......        
b Legal ......... 89,558   89,558  
c Accounting ........... 286,000   286,000  
d Lobbying ........... 1,319   1,319  
e Professional fundraising services. See Part IV, line 17 66,000 66,000
f Investment management fees ......        
g Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) 4,836,174 4,407,991 428,183 0
12 Advertising and promotion .... 243,756 213,643 30,113  
13 Office expenses ....... 3,865,209 3,387,714 477,495  
14 Information technology ...... 978,955 858,018 120,937  
15 Royalties ..        
16 Occupancy ........... 1,193,545 1,121,608 71,937  
17 Travel ............ 13,553   13,553  
18 Payments of travel or entertainment expenses for any federal, state, or local public officials .        
19 Conferences, conventions, and meetings .... 22,315   22,315  
20 Interest ........... 81,955 77,017 4,938  
21 Payments to affiliates .......        
22 Depreciation, depletion, and amortization .. 3,066,201 2,881,395 184,806  
23 Insurance ... 603,939 595,228 8,711  
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 & PHARMACY SUPPLIES 806,290 806,290    
b DUES & MEMBERSHIP 64,829 56,820 8,009  
c Permits/License 3,893 3,412 481  
d
e All other expenses 0 0 0 0
25 Total functional expenses. Add lines 1 through 24e 65,946,397 56,311,734 9,568,663 66,000
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 MediumBullet if following SOP 98-2 (ASC 958-720).        
Form 990 (2021)
Form 990 (2021)
Page 11
Part X
Balance Sheet
Check if Schedule O contains a response or note to any line in this Part IX..............
(A)
Beginning of year 		(B)
End of year
Assets 1 Cash–non-interest-bearing ........ 41,883 1 9,500
2 Savings and temporary cash investments ......... 4,338,198 2 6,507,721
3 Pledges and grants receivable, net ...... 254,651 3 133,583
4 Accounts receivable, net ............. 7,003,227 4 8,561,622
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 .......
0 5 0
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) ...
0 6 0
7 Notes and loans receivable, net ...........   7  
8 Inventories for sale or use ............ 52,991 8 52,943
9 Prepaid expenses and deferred charges ...... 1,473,508 9 591,114
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 61,076,559
b Less: accumulated depreciation 10b 15,474,589 42,121,473 10c 45,601,970
11 Investments—publicly traded securities .   11  
12 Investments—other securities. See Part IV, line 11 ..... 0 12  
13 Investments—program-related. See Part IV, line 11 .. 0 13  
14 Intangible assets ...............   14  
15 Other assets. See Part IV, line 11 ........... 780,724 15 1,466,173
16 Total assets. Add lines 1 through 15 (must equal line 33)... 56,066,655 16 62,924,626
Liabilities 17 Accounts payable and accrued expenses ..... 13,139,783 17 9,955,115
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 .........
0 22 0
23 Secured mortgages and notes payable to unrelated third parties .. 13,113,710 23 4,868,779
24 Unsecured notes and loans payable to unrelated third parties ..   24  
25 Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17 - 24). Complete Part X of Schedule D 21,787,451 25 33,651,658
26 Total liabilities. Add lines 17 through 25.. 48,040,944 26 48,475,552
Net Assets or Fund Balance Organizations that follow FASB ASC 958, check here MediumBullet and complete lines 27, 28, 32, and 33.
27 Net assets without donor restrictions .......... 7,772,060 27 14,145,991
28 Net assets with donor restrictions ........... 253,651 28 303,083
Organizations that do not follow FASB ASC 958, check here MediumBullet 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 ........... 8,025,711 32 14,449,074
33 Total liabilities and net assets/fund balances ........ 56,066,655 33 62,924,626
Form 990 (2021)
Form 990 (2021)
Page 12
Part XI
Reconcilliation of Net Assets
Check if Schedule O contains a response or note to any line in this Part XI..............
1
Total revenue (must equal Part VIII, column (A), line 12) ............
1
72,320,328
2
Total expenses (must equal Part IX, column (A), line 25) ............
2
65,946,397
3
Revenue less expenses. Subtract line 2 from line 1 ..............
3
6,373,931
4
Net assets or fund balances at beginning of year (must equal Part X, line 32, column (A)) ..
4
8,025,711
5
Net unrealized gains (losses) on investments ...............
5
 
6
Donated services and use of facilities .................
6
 
7
Investment expenses .....................
7
 
8
Prior period adjustments .....................
8
 
9
Other changes in net assets or fund balances (explain in Schedule O) ........
9
49,432
10
Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line 32, column (B))
10
14,449,074
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response or note to any line in this Part XII.............
Yes
No
1
Accounting method used to prepare the Form 990:  
If the organization changed its method of accounting from a prior year or checked "Other," explain on
Schedule O.
2a
Were the organization’s financial statements compiled or reviewed by an independent accountant?
2a
 
No
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were compiled or reviewed on a separate basis, consolidated basis, or both:
b
Were the organization’s financial statements audited by an independent accountant?
2b
Yes
 
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were audited on a separate basis, consolidated basis, or both:
c
If "Yes," to line 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant?
2c
Yes
 
If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O.
3a
As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A-133?
3a
Yes
 
b
If "Yes," did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits.
3b
Yes
 
Form 990 (2021)
Form 990 (2021)
Additional Data


Software ID: 21014044
Software Version: 2021v4.2
Form 990, Special Condition Description:
Special Condition Description
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
THE NEW YORK GRACIE SQUARE HOSPITAL INC
 
Employer identification number

13-3746997
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.)
1
2
3
4
5
6
7
8
9
10
11
12
a
b
c
d
e
f
Enter the number of supported organizations ...............................  
g
Provide the following information about the supported organization(s).
(i) Name of supported organization (ii) EIN (iii) Type of organization (described on lines 1- 10 above (see instructions)) (iv) Is the organization listed in your governing document? (v) Amount of monetary support (see instructions) (vi) Amount of other support (see instructions)
Yes No
Total
 
   
For Paperwork Reduction Act Notice, see the Instructions for
Form 990 or 990-EZ.
Cat. No. 11285F
Schedule A (Form 990) 2021

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) right arrow (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) right arrow (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  
12
12
 
13
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
14
14
 
15
15
 
16a
b
17a
b
18
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

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) right arrow (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) right arrow (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.)..            
14
Section C. Computation of Public Support Percentage
15
15
 
16
16
 
Section D. Computation of Investment Income Percentage
17
17
 
18
18
 
19a
b
20
Schedule A (Form 990) 2021

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
No
1
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.
1
 
 
2
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).
2
 
 
3a
Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer lines 3b and 3c below.
3a
 
 
b
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.
3b
 
 
c
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.
3c
 
 
4a
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.
4a
 
 
b
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.
4b
 
 
c
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.
4c
 
 
5a
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).
5a
 
 
b
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?
5b
 
 
c
Substitutions only. Was the substitution the result of an event beyond the organization's control?
5c
 
 
6
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.
6
 
 
7
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) .
7
 
 
8
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).
8
 
 
9a
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.
9a
 
 
b
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.
9b
 
 
c
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.
9c
 
 
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
 
 
b
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

Schedule A (Form 990) 2021
Page 5
Part IV
Supporting Organizations (continued)
Yes
No
11
Has the organization accepted a gift or contribution from any of the following persons?
a
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
 
 
b
A family member of a person described on 11a above?
11b
 
 
c
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
No
1
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.
1
 
 
2
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.
2
 
 
Section C. Type II Supporting Organizations
Yes
No
1
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).
1
 
 
Section D. All Type III Supporting Organizations
Yes
No
1
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?
1
 
 
2
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).
2
 
 
3
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.
3
 
 
Section E. Type III Functionally-Integrated Supporting Organizations
1
Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):
a
b
c
2
Activities Test. Answer lines 2a and 2b below.
Yes
No
a
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.
2a
 
 
b
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.
2b
 
 
3
Parent of Supported Organizations. Answer lines 3a and 3b below.
a
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.
3a
 
 
b
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.
3b
 
 
Schedule A (Form 990) 2021

Schedule A (Form 990) 2021
Page 6
Part V
Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations
1
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  
7
Schedule A (Form 990) 2021

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: 21014044
Software Version: 2021v4.2
Schedule B
(Form 990)
Department of the Treasury
Internal Revenue Service
Schedule of Contributors

Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
Arrow Bullet Go to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2021
Name of the organization
THE NEW YORK GRACIE SQUARE HOSPITAL INC
 
Employer identification number

13-3746997
Organization type (check one):
Filers of:
Section:
Form 990 or 990-EZ






Form 990-PF




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
Special Rules
......... 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
THE NEW YORK GRACIE SQUARE HOSPITAL INC
  		Employer identification number
13-3746997
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


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 
 

$  


(Complete Part II for noncash contributions.)
Schedule B (Form 990) (2021)
Schedule B (Form 990) (2021)
Page 3
Name of organization
THE NEW YORK GRACIE SQUARE HOSPITAL INC
  		Employer identification number

13-3746997
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
THE NEW YORK GRACIE SQUARE HOSPITAL INC
  		Employer identification number

13-3746997
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 $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet$  
Use duplicate copies of Part III if additional space is needed.
(a)
No. from Part I		 (b) Purpose of gift (c) Use 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 (c) Use 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 (c) Use 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 (c) Use 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: 21014044
Software Version: 2021v4.2
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 BulletGo 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
THE NEW YORK GRACIE SQUARE HOSPITAL INC
 
Employer identification number

13-3746997
Part I-A
Complete if the organization is exempt under section 501(c) or is a section 527 organization.

1
Provide a description of the organization’s direct and indirect political campaign activities in Part IV. See instructions for definition of “political campaign activities."

2
Political campaign activity expenditures. See instructions ....................................................................SchCMd Bullet
$  
3
Volunteer hours for political campaign activities. See instructions ..................................................................
 

Part I-B
Complete if the organization is exempt under section 501(c)(3).
1
Enter the amount of any excise tax incurred by the organization under section 4955 ................................SchCMd Bullet
$  
2
Enter the amount of any excise tax incurred by organization managers under section 4955 .......................SchCMd Bullet
$  
3
If the organization incurred a section 4955 tax, did it file Form 4720 for this year? .........................................
4a
Was a correction made? ......................................................................................................................
b
If "Yes," describe in Part IV.
Part I-C
Complete if the organization is exempt under section 501(c), except section 501(c)(3).
1
Enter the amount directly expended by the filing organization for section 527 exempt function activities ..... SchCMd Bullet
$  
2
Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ............................................................................................................................SchCMd Bullet

$  
3
Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b...........SchCMd Bullet

$  
4
Did the filing organization file Form 1120-POL for this year? ...................................................................
5
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

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 Bulletexpenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet
Limits on Lobbying Expenditures
(The term "expenditures" means amounts paid or incurred.) 		(a) Filing
organization's
totals 		(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? ...................................................................................................................

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


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
1
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:
a
Volunteers? ...........................................................................................................
 
No
b
Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ........
 
No
c
Media advertisements? ...................................................................................................
 
No
 
d
Mailings to members, legislators, or the public? .............................................................................
 
No
 
e
Publications, or published or broadcast statements? ...........................................................
 
No
 
f
Grants to other organizations for lobbying purposes? ..........................................................
 
No
 
g
Direct contact with legislators, their staffs, government officials, or a legislative body? .......................
 
No
 
h
Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ..................
 
No
 
i
Other activities? ...................................................................................................................
Yes
 
1,319
j
Total. Add lines 1c through 1i ....................................................................................................
1,319
2a
Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....
 
No
b
If "Yes," enter the amount of any tax incurred under section 4912 ...........................................
 
c
If "Yes," enter the amount of any tax incurred by organization managers under section 4912 ...................
 
d
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
No
1
Were substantially all (90% or more) dues received nondeductible by members? ...............................................
1
 
 
2
Did the organization make only in-house lobbying expenditures of $2,000 or less? ............................................
2
 
 
3
Did the organization agree to carry over lobbying and political expenditures from the prior year? .................................
3
 
 
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."
1
Dues, assessments and similar amounts from members ......................................................................
1
 
2
Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political expenses for which the section 527(f) tax was paid).
a
Current year .............................................................................................................................
2a
 
b
Carryover from last year ............................................................................................................
2b
 
c
Total ...........................................................................................................................................
2c
 
3
Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .
3
 
4
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? ......................................................................................................................
4
 
5
Taxable amount of lobbying and political expenditures. See Instructions .........................................
5
 
Part IV
Supplemental Information
Provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; Part II-A (affiliated group list); Part II-A, lines 1 and 2 (see instructions), and Part ll-B, line 1. Also, complete this part for any additional information.
Return Reference Explanation
Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY MEMBERSHIP DUES PAID TO INDEPENDENT THIRD PARTY ASSOCIATIONS AND 1199 EMPLOYER CONTRIBUTIONS THAT ARE ALLOCATED FOR LOBBYING PURPOSES TO EDUCATE POLICYMAKERS AND STATE AND FEDERAL LEGISLATORS ON THE COMPLEXITIES AND CONSTRAINTS HOSPITALS FACE IN DELIVERING CARE. GRACIE SQUARE HOSPITAL'S PRO-RATED SHARE OF MEMBERSHIP DUES FOR 2021 IS 1,045 AND HEP-1199 LOBBYING EXPENSES FOR 2021 IS 274.
Schedule C (Form 990) 2021


Additional Data


Software ID: 21014044
Software Version: 2021v4.2

SCHEDULE D
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Financial Statements
SchDMd Bullet 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
THE NEW YORK GRACIE SQUARE HOSPITAL INC
 
Employer identification number

13-3746997
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 ........    
5
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? ............
6
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? ...................................
Part II
Conservation Easements.
Complete if the organization answered "Yes" on Form 990, Part IV, line 7.
1
Purpose(s) of conservation easements held by the organization (check all that apply).
2
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  
b Total acreage restricted by conservation easements .................... 2b  
c Number of conservation easements on a certified historic structure included in (a) ..... 2c  
d Number of conservation easements included in (c) acquired after 7/25/06, and not on a historic structure listed in the National Register ... 2d  
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the
tax year SchDMd Bullet  
4
Number of states where property subject to conservation easement is located SchDMd Bullet  
5
Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and enforcement of the conservation easements it holds? ............
6
Staff and volunteer hours devoted to monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet  
7
Amount of expenses incurred in monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet $  
8
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)? .............................
9
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.
1a
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.
b
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 $  
2
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:
a
Revenue included on Form 990, Part VIII, line 1 ..........................SchDMd Bullet $  
b
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

Schedule D (Form 990) 2021
Page 2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3
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):
a
d
b
e
 
c
4
Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.
5
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?...
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.
1a
Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................
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  
2a
Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability? ...
b
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 ....          
b Contributions ...          
c Net investment earnings, gains, and losses          
d Grants or scholarships ...          
e Other expenditures for facilities
and programs ... 		         
f Administrative expenses ....          
g End of year balance ......          
2
Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:
a
Board designated or quasi-endowment SchDMd Bullet  
b
Permanent endowment SchDMd Bullet  
c
Term endowment SchDMd Bullet  
The percentages on lines 2a, 2b, and 2c should equal 100%.
3a
Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes
No
(i) Unrelated organizations .................
3a(i)
 
 
(ii) Related organizations .................
3a(ii)
 
 
b
If "Yes" on 3a(ii), are the related organizations listed as required on Schedule R? .........
3b
 
 
4
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 .....      
b Buildings ....        
c Leasehold improvements   34,253,261 11,529,816 22,723,445
d Equipment ....   9,812,795 3,944,773 5,868,022
e Other .....   17,010,503   17,010,503
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..SchDMdBullet 45,601,970
Schedule D (Form 990) 2021

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.)Small Bullet  
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.)Small Bullet  
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)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........Small Bullet  
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  
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)Small Bullet 33,651,658
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

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 63,376,525
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 0
e Add lines 2a through 2d ..................... 2e 0
3 Subtract line 2e from line 1.................. 3 63,376,525
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 8,943,803
c Add lines 4a and 4b.................... 4c 8,943,803
5 Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ...... 5 72,320,328
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 65,946,397
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 0
e Add lines 2a through 2d.................... 2e 0
3 Subtract line 2e from line 1................... 3 65,946,397
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 0
c Add lines 4a and 4b..................... 4c 0
5 Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ...... 5 65,946,397
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
Schedule D, Part XI, Line 4(b) Other revenues in form 990 not in audited financial statements NET ASSET TRANSFER FROM NEW YORK PRESBYTERIAN HOSPITAL - 8943803
Schedule D (Form 990) 2021


Additional Data


Software ID: 21014044
Software Version: 2021v4.2




SCHEDULE G (Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Information Regarding
Fundraising or Gaming Activities
Complete if the organization answered "Yes" on Form 990, Part IV, lines 17, 18, or 19, or if the organization entered more than $15,000 on Form 990-EZ, line 6a. right arrowAttach to Form 990 or Form 990-EZ.
right arrowGo to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2021
Open to Public Inspection
Name of the organization
THE NEW YORK GRACIE SQUARE HOSPITAL INC
 
Employer identification number

13-3746997
Part I
Fundraising Activities.Complete if the organization answered "Yes" on Form 990, Part IV, line 17.
Form 990-EZ filers are not required to complete this part.
1
Indicate whether the organization raised funds through any of the following activities. Check all that apply.
a e
b f
c g
d
2a
Did the organization have a written or oral agreement with any individual (including officers, directors, trustees
or key employees listed in Form 990, Part VII) or entity in connection with professional fundraising services?
b
If "Yes," list the 10 highest paid individuals or entities (fundraisers) pursuant to agreements under which the fundraiser is
to be compensated at least $5,000 by the organization.


(i) Name and address of individual
or entity (fundraiser) 		(ii) Activity (iii) Did fundraiser have custody or control of contributions? (iv) Gross receipts
from activity 		(v) Amount paid to
(or retained by)
fundraiser listed in
col. (i) 		(vi) Amount paid to
(or retained by)
organization
Yes No
 
COMMUNITY COUNSELING FUNDRAISING SERVICES CO LLC
527 MADISON AVE 5TH FLOOR
 
NEW YORK, NY10022 		FUNDRAISING COUNSEL   No   66,000 -66,000
             
             
             
             
             
             
             
             
             
Total . . . . . . . . . . . . . . . . . . . . right arrow 0 66,000 -66,000
3
List all states in which the organization is registered or licensed to solicit contributions or has been notified it is exempt from registration or licensing.
NY
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 50083H
Schedule G (Form 990) 2021
Schedule G (Form 990) 2021
Page 2
Part II
Fundraising Events. Complete if the organization answered "Yes" on Form 990, Part IV, line 18, or reported more than $15,000 of fundraising event contributions and gross income on Form 990-EZ, lines 1 and 6b. List events with gross receipts greater than $5,000.









VerticalRevenue
(a) Event #1

 
(event type) 		(b) Event #2

 
(event type) 		(c) Other events

 
(total number) 		(d) Total events
(add col. (a) through col. (c))

1
Gross receipts . . . . .
 
 
 
 

2
Less: Contributions . . . .
 
 
 
 
3 Gross income (line 1 minus
line 2) . . . . . .
 
 
 
 



VerticalDirectExpenses
4 Cash prizes . . . . .        
5 Noncash prizes . . . .        
6 Rent/facility costs . . . .        
7 Food and beverages . . .        
8 Entertainment . . . .        
9 Other direct expenses . . .        
10 Direct expense summary. Add lines 4 through 9 in column (d) . . . . . . . . . . right arrow  
11 Net income summary. Subtract line 10 from line 3, column (d). . . . . . . . . . right arrow  
Part III
Gaming. Complete if the organization answered "Yes" on Form 990, Part IV, line 19, or reported more than $15,000 on Form 990-EZ, line 6a.
VerticalRevenue
(a) Bingo (b) Pull tabs/Instant
bingo/progressive bingo 		(c) Other gaming (d) Total gaming (add col.(a) through col.(c))

1
Gross revenue . . . . .
 
 
 
 
VerticalDirectExpenses

2
Cash prizes . . . . .
 
 
 
 

3
Noncash prizes . . . .
 
 
 
 

4
Rent/facility costs . . . .
 
 
 
 

5
Other direct expenses . . .
 
 
 
 


6

Volunteer labor . . . .
%
%
%


7
Direct expense summary. Add lines 2 through 5 in column (d) . . . . . . . . . . right arrow
 

8
Net gaming income summary. Subtract line 7 from line 1, column (d). . . . . . . . . right arrow
 

9
Enter the state(s) in which the organization conducts gaming activities:
a
Is the organization licensed to conduct gaming activities in each of these states? . . . . . . . .
b
If "No," explain:
 
10a
Were any of the organization's gaming licenses revoked, suspended or terminated during the tax year? . . .
b
If "Yes," explain:
 
Schedule G (Form 990) 2021
Schedule G (Form 990) 2021
Page 3
11
Does the organization conduct gaming activities with nonmembers? . . . . . . . . . . .
12
Is the organization a grantor, beneficiary or trustee of a trust or a member of a partnership or other entity
formed to administer charitable gaming? . . . . . . . . . . . . . . . . .
13
Indicate the percentage of gaming activity conducted in:
a
The organization's facility . . . . . . . . . . . . . . . . . .
13a
%
b
An outside facility . . . . . . . . . . . . . . . . . . . .
13b
%
14
Enter the name and address of the person who prepares the organization's gaming/special events books and records:
Name right arrow
Address right arrow
15a
Does the organization have a contract with a third party from whom the organization receives gaming
revenue? . . . . . . . . . . . . . . . . . . . . . . . .
b
If "Yes," enter the amount of gaming revenue received by the organization right arrow $   and the
amount of gaming revenue retained by the third party right arrow $   .
c
If "Yes," enter name and address of the third party:
Name right arrow
Address right arrow
16
Gaming manager information:
Name right arrow
Gaming manager compensation right arrow $  
Description of services provided right arrow
 
17
Mandatory distributions:
a
Is the organization required under state law to make charitable distributions from the gaming proceeds to
retain the state gaming license? . . . . . . . . . . . . . . . . . . .
b
Enter the amount of distributions required under state law distributed to other exempt organizations or spent
in the organization's own exempt activities during the tax year right arrow$  
Part IV
Supplemental Information. Provide the explanations required by Part I, line 2b, columns (iii) and (v); and Part III, lines 9, 9b, 10b, 15b, 15c, 16, and 17b, as applicable. Also provide any additional information. See instructions.
Return Reference Explanation
Schedule G, Part I, Line 2b(v) payment of fees or payment of expenses COMMUNITY COUNSELING FUNDRAISING SERVICES CO., LLC-COMMUNITY COUNSELLING SERVICES CO, LLC (CCS) HAS A TWELVE MONTH AGREEMENT(JAN 1 - DEC 31, 2021) FOR A FEE OF $66,000.;
Schedule G (Form 990) 2021
Additional Data


Software ID: 21014044
Software Version: 2021v4.2
SCHEDULE H
(Form 990)
Department of the Treasury
Internal Revenue Service
Hospitals
MediumBullet 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
THE NEW YORK GRACIE SQUARE HOSPITAL INC
 
Employer identification number

13-3746997
Part I
Financial Assistance and Certain Other Community Benefits at Cost
Yes
No
1a
Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a . . . .
1a
Yes
 
b
If "Yes," was it a written policy? ......................
1b
Yes
 
2
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.
3
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.
a
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:
3a
Yes
 
%
b
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: . . . . . . . .
3b
Yes
 
%
c
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.
4
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"? . . . . . . . . . . . . .

4

Yes

 
5a
Did the organization budget amounts for free or discounted care provided under its financial assistance policy during
the tax year? . . . . . . . . . . . . . . . . . . . . . . .

5a

Yes

 
b
If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? . . . . . .
5b
Yes
 
c
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? . . . . . . . . . . . . .
5c
 
No
6a
Did the organization prepare a community benefit report during the tax year? . . . . . . . . .
6a
Yes
 
b
If "Yes," did the organization make it available to the public? . . . . . . . . . . . . .
6b
Yes
 
Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.
7
Financial Assistance and Certain Other Community Benefits at Cost
Financial Assistance and
Means-Tested
Government Programs
 (a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community benefit expense (d) Direct offsetting revenue (e) Net community benefit expense (f) Percent of total expense
a Financial Assistance at cost
(from Worksheet 1) . . . 		    1,453,231 0 1,453,231 2.20 %
b Medicaid (from Worksheet 3, column a) . . . . .     0 0 0 0 %
c Costs of other means-tested government programs (from Worksheet 3, column b) . .     0 0 0 0 %
d Total Financial Assistance and Means-Tested Government Programs . . . . . 0 0 1,453,231 0 1,453,231 2.20 %
Other Benefits
e Community health improvement services and community benefit operations (from Worksheet 4).   1,855 87,120 0 87,120 0.13 %
f Health professions education (from Worksheet 5) . . .     0 0 0 0 %
g Subsidized health services (from Worksheet 6) . . . .     0 0 0 0 %
h Research (from Worksheet 7) .     0 0 0 0 %
i Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .     0 0 0 0 %
j Total. Other Benefits . . 0 1,855 87,120 0 87,120 0.13 %
k Total. Add lines 7d and 7j . 0 1,855 1,540,351 0 1,540,351 2.34 %
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         0 0 %
2 Economic development         0 0 %
3 Community support         0 0 %
4 Environmental improvements         0 0 %
5 Leadership development and
training for community members		         0 0 %
6 Coalition building         0 0 %
7 Community health improvement advocacy         0 0 %
8 Workforce development         0 0 %
9 Other         0 0 %
10 Total 0 0 0 0 0 0 %
Part III
Bad Debt, Medicare, & Collection Practices
Section A. Bad Debt Expense
Yes
No
1
Did the organization report bad debt expense in accordance with Healthcare Financial Management Association Statement No. 15? ..........................
1
Yes
 
2
Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......
2
998,134
3
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. ......
3
59,629
4
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
5
Enter total revenue received from Medicare (including DSH and IME).....
5
6,538,245
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
6,999,565
7
Subtract line 6 from line 5. This is the surplus (or shortfall)........
7
-461,320
8
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:
Section C. Collection Practices
9a
Did the organization have a written debt collection policy during the tax year? ..........
9a
Yes
 
b
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 .........................

9b

Yes

 
Part IV
Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)
(a) Name of entity (b) Description of primary
activity of entity 		(c) Organization's
profit % or stock
ownership % 		(d) Officers, directors,
trustees, or key
employees' profit %
or stock ownership % 		(e) Physicians'
profit % or stock
ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13
Schedule H (Form 990) 2021
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) 		Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital ResearchGrp Facility ER-24Hours ER-Other Other (describe) Facility reporting group
1 THE NEW YORK GRACIE SQUARE HOSPITAL
420 EAST 76TH STREET
NEW YORK,NY10021
WWW.NYGSH.ORG
8713070 		X               PSYCHIATRIC HOSPITAL  
Schedule H (Form 990) 2021
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)
THE NEW YORK GRACIE SQUARE HOSPITAL
Name of hospital facility or letter of facility reporting group  
Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A): 		1
Yes No
Community Health Needs Assessment
1 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?........................ 1   No
2 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............... 2   No
3 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...................... 3 Yes  
If "Yes," indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
4 Indicate the tax year the hospital facility last conducted a CHNA: 20 19
5 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 ................. 5 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.................................. 6a   No
b 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. ............................ 6b   No
7 Did the hospital facility make its CHNA report widely available to the public?.............. 7 Yes  
If "Yes," indicate how the CHNA report was made widely available (check all that apply):
a
b
c
d
8 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. .............. 		8 Yes  
9 Indicate the tax year the hospital facility last adopted an implementation strategy: 20 19
10 Is the hospital facility's most recently adopted implementation strategy posted on a website?......... 10 Yes  
a If "Yes" (list url): https://www.nygsh.org/community-health-needs.html
b If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ...... 10b    
11 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   No
b If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........ 12b    
c 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
Schedule H (Form 990) 2021
Page 5
Part VFacility Information (continued)

Financial Assistance Policy (FAP)
THE NEW YORK GRACIE SQUARE HOSPITAL
Name of hospital facility or letter of facility reporting group  
Yes No
Did the hospital facility have in place during the tax year a written financial assistance policy that:
13 Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care? 13 Yes  
If “Yes,” indicate the eligibility criteria explained in the FAP:
a
b
c
d
e
f
g
h
14 Explained the basis for calculating amounts charged to patients?................. 14 Yes  
15 Explained the method for applying for financial assistance?................... 15 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):
a
b
c
d
e
16 Was widely publicized within the community served by the hospital facility?........ 16 Yes  
If "Yes," indicate how the hospital facility publicized the policy (check all that apply):
a
https://www.nygsh.org/admissions-and-insurance.html
b
https://www.nygsh.org/admissions-and-insurance.html
c
d
e
f
g
h
i
j
Schedule H (Form 990) 2021
Schedule H (Form 990) 2021
Page 6
Part VFacility Information (continued)

Billing and Collections
THE NEW YORK GRACIE SQUARE HOSPITAL
Name of hospital facility or letter of facility reporting group  
Yes No
17 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?.................................. 17 Yes  
18 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:
a
b
c
d
e
f
19 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?............ 19   No
If "Yes," check all actions in which the hospital facility or a third party engaged:
a
b
c
d
e
20 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):
a
b
c
d
e
f
Policy Relating to Emergency Medical Care
21 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?.................. 21 Yes  
If "No," indicate why:
a
b
c
d
Schedule H (Form 990) 2021
Schedule H (Form 990) 2021
Page 7
Part VFacility Information (continued)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)
THE NEW YORK GRACIE SQUARE HOSPITAL
Name of hospital facility or letter of facility reporting group  
Yes No
22 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.
a
b
c
d
23 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? ............................... 23   No
If "Yes," explain in Section C.
24 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? ........................... 24   No
If "Yes," explain in Section C.
Schedule H (Form 990) 2021
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
Schedule H, Part V, Section B, Line 5 Facility , 1 Facility , 1 - THE NEW YORK GRACIE SQUARE HOSPITAL, INC.. AS PART OF OUR COMMUNITY BENEFIT STRATEGY, GRACIE SQUARE HOSPITAL CONTINUOUSLY STRIVES TO MAINTAIN AND IMPROVE THE QUALITY OF OUR SERVICES PROVIDED TO OUR PATIENTS THROUGH QUALITY IMPROVEMENT STUDIES AND PATIENT SATISFACTION SURVEYS. WE VIEW THESE TOOLS AS A WAY OF TRULY HEARING OUR PATIENTS' VOICES AND THEIR OPINIONS ABOUT OUR SERVICES. GRACIE SQUARE HOSPITAL HAS CONTRIBUTED TO A VARIETY OF KEY STAKEHOLDERS, NETWORKS AND COALITIONS IN THE CITY, INCLUDING THE NY COALITION FOR QUALITY ASSISTED LIVING (WE ARE A GOLD MEMBER), THE CHINESE AMERICAN FUND, THE BROOKLYN CHINESE AMERICAN FUND, AND CHINATOWN HEALTH. OUR CONNECTIONS WITH THESE GROUPS HELP TO ENSURE THAT OUR INPATIENT BEHAVIORAL HEALTH SERVICES ARE TAILORED TO MEET THE NEEDS OF THESE SPECIALIZED COMMUNITIES, MOST NOTABLY THOSE IN OUR ASIAN AND GERIATRIC PSYCHIATRY PROGRAMS. FURTHER, BY COLLABORATING WITH AND CONTRIBUTING TO THESE GROUPS YEAR AFTER YEAR THE COMMUNITY'S AWARENESS OF GRACIE SQUARE HOSPITAL AND OUR SERVICES HAS INCREASED, HELPING TO FACILITATE THE TRANSITION INTO OUR CARE DURING A CRISIS REQUIRING ACUTE PSYCHIATRIC CARE AND TO REGAIN A SENSE OF EMPOWERMENT AND TO REGAIN A SENSE OF EMPOWERMENT AND COMPETENCY THAT IS OFTEN COMPROMISED BY THE INDIVIDUAL'S STRUGGLE WITH HIS/HER BEHAVIORAL HEALTH ISSUES. DATA GATHERED AS PART OF THE MOST RECENT CHNA WAS FROM SURVEYS AND MORE IN DEPTH STUDIES CONDUCTED OVER THE COURSE OF 2019. THIS INFORMATION IS USED TO IDENTIFY ANY AREAS OF UNMET NEED OR WAYS TO IMPROVE OUR SERVICES. WE OFTEN ALSO DISCOVER OPPORTUNITIES THAT WE CAN IMPROVE THE CULTURAL COMPETENCE OF OUR SERVICES THROUGH THESE METHODS. FURTHER, BY ENSURING THAT EACH OF OUR CONSUMERS HAS THE CHANCE TO SHARE THEIR THOUGHTS AND FEELINGS ABOUT THEIR EXPERIENCE WITH US, WE HELP THEM TO REGAIN A SENSE OF EMPOWERMENT AND COMPETENCY THAT IS OFTEN COMPROMISED BY THE INDIVIDUAL'S STRUGGLE WITH HIS/HER BEHAVIORAL HEALTH ISSUES.
Schedule H, Part V, Section B, Line 11 Facility , 1 Facility , 1 - THE NEW YORK GRACIE SQUARE HOSPITAL, INC.. THE HOSPITAL IS LICENSED BY THE NEW YORK STATE OFFICE OF MENTAL HEALTH AS AN ARTICLE 31 FREE STANDING PSYCHIATRIC HOSPITAL AND AS SUCH IS LIMITED IN REGARDS TO PROVIDING ADDITIONAL MEDICAL SERVICES. OUR MOST RECENT COMMUNITY HEALTH NEEDS ASSESSMENT INDICATED THE HOSPITAL WAS MEETING THE BEHAVIORAL HEALTH NEEDS OF THE COMMUNITY. FOR NEARLY SIX DECADES, GRACIE SQUARE HOSPITAL HAS BEEN A MAINSTAY OF THE UPPER EAST SIDE, PROVIDING THE HIGHEST QUALITY AND MOST COMPASSIONATE CARE TO ADULTS 18 YEARS AND OLDER WITH BEHAVIORAL HEALTH NEEDS WHO CAN BENEFIT FROM INPATIENT HOSPITALIZATION. THE HOSPITAL OFFERS INDIVIDUALS A WARM AND WELCOMING ENVIRONMENT IN WHICH TO RECEIVE STATE-OF-THE-ART TREATMENT TO FACILITATE A HEALTHY RECOVERY. THROUGH GRACIE SQUARE HOSPITAL'S AFFILIATION WITH NEWYORK- PRESBYTERIAN, ONE OF THE NATION'S PREMIER ACADEMIC HEALTHCARE DELIVERY SYSTEMS, WE ARE COMMITTED TO PROVIDING HIGH-QUALITY, PATIENT-CENTERED MENTAL HEALTH AND CHEMICAL DEPENDENCY TREATMENT SERVICES TO INDIVIDUALS LIVING IN THE GREATER NEW YORK CITY METROPOLITAN AREA. ONE OF THE NATION'S PREMIER ACADEMIC HEALTHCARE DELIVERY SYSTEMS, WE ARE COMMITTED TO PROVIDING HIGH-QUALITY, PATIENT-CENTERED MENTAL HEALTH AND CHEMICAL DEPENDENCY TREATMENT SERVICES TO INDIVIDUALS LIVING IN THE GREATER NEW YORK CITY METROPOLITAN AREA.
Schedule H, Part V, Section B, Line 15 Facility , 1 Facility , 1 - THE NEW YORK GRACIE SQUARE HOSPITAL, INC.. THE HOSPITAL HAS A FINANCIAL ADVOCACY PROGRAM STAFFED BY REPRESENTATIVES WHO REACH OUT TO PATIENTS TO PROVIDE INFORMATION REGARDING MEDICAID, EXCHANGE PLANS, FINANCIAL AID AND TO ASSIST THOSE PATIENTS WHO NEED HELP TO APPLY TO SUCH PROGRAMS.
Schedule H, Part V, Section B, Line 16 Facility , 1 Facility , 1 - THE NEW YORK GRACIE SQUARE HOSPITAL, INC.. PLEASE REFER TO THE DISCLOSURES IN PART VI REGARDING GRACIE SQUARE HOSPITAL'S EFFORTS TO REVITALIZE THE WAY IT INFORMS PATIENTS OF THE AVAILABILITY OF FINANCIAL ASSISTANCE. PLEASE REFER TO THE DISCLOSURES IN PART VI REGARDING GRACIE SQUARE HOSPITAL'S EFFORTS TO REVITALIZE THE WAY IT INFORMS PATIENTS OF THE AVAILABILITY OF FINANCIAL ASSISTANCE.
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
Schedule H (Form 990) 2021
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?0
Name and address Type of Facility (describe)
1
2
3
4
5
6
7
8
9
10
Schedule H (Form 990) 2021
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
Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance Description: BAD DEBT PRICE CONCESSIONS ARE OFFSET AGAINST REVENUE AND NOT INCLUDED IN EXPENSES. THE FOLLOWING IS A DETAIL OF THE SOURCES USED FOR DETERMINING THE AMOUNTS REPORTED ON SCHEDULE H: LINE 7A - COST TO CHARGE RATIO LINE 7E - ACTUAL EXPENSES
Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount Description: THE COSTS TO PROVIDE CARE WHICH HAS BECOME UNCOLLECTIBLE OR BAD DEBT, HAS BEEN CALCULATED UTILIZING A COST TO CHARGE RATIO. PAYMENTS, DISCOUNTS AND FINANCIAL ASSISTANCE EXCLUDE FROM AMOUNTS CONSIDERED TO BE BAD DEBT.
Schedule H, Part III, Line 3 Bad Debt Expense Methodology Description: THE AMOUNT AT COST INCLUDED REPRESENTS PATIENTS WHO QUALIFY FOR CHARITY CARE/FINANCIAL ASSISTANCE AND HAVE A BAD DEBT WRITE-OFF. BAD DEBT PRICE CONCESSIONS ASSOCIATED WITH PATIENTS THAT RECEIVED CHARITY CARE/FINANCIAL ASSISTANCE IS REPRESENTED IN THIS $59,629. THESE PATIENTS WENT THROUGH OUR CHARITY CARE/FINANCIAL ASSISTANCE PROCESS AND WERE DETERMINED TO HAVE FINANCIAL NEED. AS A RESULT, WE PROVIDED THEM WITH A DISCOUNT BASED ON OUR SLIDING SCALE CHARITY CARE POLICY. IF THEY WERE UNABLE TO PAY THE REDUCED BALANCES, THEY WERE WRITTEN OFF AS BAD DEBT PRICE CONCESSIONS AND INCLUDED AS A COMMUNITY BENEFIT.
Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote Description: AUDITED FINANCIAL STATEMENTS SEE PAGE 12.
Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs MEDICARE ALLOWABLE COSTS ARE DETERMINED PURSUANT TO THE LAWS AND REGULATIONS APPLICABLE TO ALLOWABLE COSTS AND MEDICARE'S STEP DOWN METHODOLOGY.
Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance Description: THE PURPOSE OF THE COLLECTION POLICY (POLICY) IS TO PROMOTE PATIENT ACCESS TO QUALITY HEALTH CARE WHILE MINIMIZING BAD DEBT AT GRACIE SQUARE HOSPITAL (HOSPITAL). THIS POLICY PLACES REQUIREMENTS UPON HOSPITAL AND THOSE AGENCIES AND ATTORNEYS UNDERTAKING DEBT COLLECTION ACTIVITIES THAT ARE CONSISTENT WITH THE CORE MISSION, VALUES, AND PRINCIPLES OF HOSPITAL INCLUDING, BUT NOT LIMITED TO, CHARITY CARE POLICY. PROCEDURES: GENERAL GUIDELINES 1. HOSPITAL, COLLECTION AGENCIES (AGENCY), AND LAWYERS AND LAW FIRMS (OUTSIDE COUNSEL) WILL COMPLY WITH ALL APPLICABLE FEDERAL AND STATE LAWS AND ACCREDITING AGENCY REQUIREMENTS GOVERNING THE COLLECTION OF DEBTS INCLUDING, BUT NOT LIMITED TO, THE FAIR DEBT COLLECTION PRACTICES ACT (FDCPA), THE FAIR CREDIT BILLING ACT, THE CONSUMER CREDIT PROTECTION ACTS, PUBLIC HEALTH LAW SECTION 2807-K-9-A, INTERNAL REVENUE SERVICE CODE 501(R), ARTICLE 52 OF THE NEW YORK CIVIL PRACTICE LAW AND RULES, AND THE HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT (HIPAA). HOSPITAL, AGENCY AND OUTSIDE COUNSEL WILL ALSO COMPLY WITH HOSPITAL'S CHARITY CARE POLICY. TO THE EXTENT THAT THERE ARE ANY INCONSISTENCIES BETWEEN HOSPITAL'S COLLECTION POLICY AND CHARITY CARE POLICY, THE CHARITY CARE POLICY SHALL SUPERSEDE AND CONTROL. 2. HOSPITAL SHALL ENTER LEGALLY BINDING WRITTEN AGREEMENTS WITH ANY PARTIES (INCLUDING AGENCY OR OUTSIDE COUNSEL) TO WHICH IT REFERS AN INDIVIDUAL'S DEBT RELATED TO CARE THAT ARE REASONABLY DESIGNED TO PREVENT EXTRAORDINARY COLLECTION ACTIONS (ECAS) FROM BEING TAKEN TO OBTAIN PAYMENT FOR THE CARE, UNTIL REASONABLE EFFORTS HAVE BEEN MADE TO DETERMINE WHETHER THE INDIVIDUAL IS ELIGIBLE FOR CHARITY CARE.
Schedule H, Part V, Section B, Line 16a FAP website - THE NEW YORK GRACIE SQUARE HOSPITAL: Line 16a URL: https://www.nygsh.org/admissions-and-insurance.html;
Schedule H, Part V, Section B, Line 16b FAP Application website - THE NEW YORK GRACIE SQUARE HOSPITAL: Line 16b URL: https://www.nygsh.org/admissions-and-insurance.html;
Schedule H, Part V, Section B, Line 16c FAP plain language summary website - THE NEW YORK GRACIE SQUARE HOSPITAL: Line 16c URL: https://www.nygsh.org/admissions-and-insurance.html;
Schedule H, Part VI, Line 2 Needs assessment GRACIE SQUARE IS DEEPLY COMMITTED TO THE COMMUNITY MEMBERS RESIDING IN NYC AND THE SURROUNDING AREAS BY DELIVERING A RANGE OF HIGH QUALITY INPATIENT PSYCHIATRIC SERVICES. THE COMMUNITY HEALTH NEEDS ASSESSMENT CHNA) PROCESS IS UNDERTAKEN EVERY THREE YEARS TO DETERMINE THE HIGH DISPARITY COMMUNITIES AND HEALTH NEEDS THAT CAN BE MOST POSITIVELY IMPACTED BY FOCUSED INTERVENTIONS AND INITIATIVES. THE CHNA ALIGNS WITH THE NEW YORK STATE 2019-2024 PREVENTION AGENDA (NYS PA) PRIORITIES TO IMPROVE HEALTH EQUITY FOR ALL NEW YORKERS THROUGH PARTNERSHIPS WITH COMMUNITY ORGANIZATIONS TO ADDRESS SOCIAL DETERMINANTS OF HEALTH (SDOH) AND INTERVENTIONS TO REDUCE INEQUALITIES IN HEALTH INDICATORS. THROUGH THE NYS PA ALIGNMENT WITH THE CHNA PROCESS, NYS HAS IMPROVED ITS OVERALL NATIONAL RANKING FROM 28TH TO 10TH HEALTHIEST STATE SINCE 2008. OUR COMMITMENT AS AN INPATIENT PSYCHIATRIC FACILITY WITHIN NEW YORK STATE IS TO ALIGN OUR EFFORTS WITH THAT OF THE STATE AND TO STRATEGICALLY INVEST IN OPPORTUNITIES TO IMPROVE THE HEALTH OF THE PATIENTS WITHIN OUR COMMUNITY. GRACIE SQUARE HOSPITAL (GRACIE SQUARE) COMPLETED A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) TO IDENTIFY THE NEEDS OF THE COMMUNITY AND DEVELOP A COMMUNITY SERVICE PLAN (CSP) AND DETAILED IMPLEMENTATION PLAN TO ADDRESS THE AREAS OF HIGHEST NEED. THE COMMUNITY, SPANNING 168 NEW YORK CITY NEIGHBORHOOD TABULATION AREAS (NTAS) IN KINGS, QUEENS, BRONX, AND NEW YORK COUNTIES REPRESENT A BROAD DIVERSITY OF DEMOGRAPHICS, SOCIOECONOMICS AND HEALTH SERVICE UTILIZATION NEED, AND REQUIRES A CUSTOM APPROACH TO COMMUNITY SERVICE PLANNING TO ENSURE ALIGNMENT WITH THE NEEDS OF SUCH A DIVERSE POPULATION. THERE WERE ALSO FIVE ZIP CODES ORIGINATING IN THE SOUTHERN PORTION OF WESTCHESTER COUNTY THAT WERE PART OF THE DEFINED COMMUNITY. DUE TO THE LACK OF PUBLICLY AVAILABLE DATA AT THE ZIP CODE LEVEL FOR WESTCHESTER, THIS CHNA FOCUSED SOLELY UPON THE NEW YORK CITY COMMUNITY. THE LEADERS OF GRACIE SQUARE ARE DEDICATED TO OUR COMMUNITY WITH A MISSION TO BE THE PREMIER HEALTHCARE INSTITUTION SERVING OUR GREATER COMMUNITY BY PROVIDING EXCELLENCE IN INPATIENT PSYCHIATRIC CARE. A PRIORITIZATION PROCESS WAS CREATED TO ANALYZE THE QUANTITATIVE AND QUALITATIVE DATA INPUTS COLLECTED THROUGH THE CHNA PROCESS. THE PROCESS HAD SEVERAL LAYERS IN WHICH THE DATA WAS INPUT AND PRIORITIZED TO ARRIVE AT THE FINAL PRIORITY INDICATORS. THE DATA IDENTIFICATION AND PRIORITIZATION PROCESS FOR GRACIE SQUARE RESULTED IN NUMEROUS INDICATORS. AT A HIGH LEVEL, THESE INDICATORS CAN GENERALLY BE GROUPED INTO: 1 MENTAL HEALTH & SUBSTANCE ABUSE 2 HIV 3 CHRONIC DISEASE & OBESITY 4 WOMEN'S HEALTH / MATERNAL HEALTH THE TOP PRIORITIES ALLOWED THE GRACIE SQUARE LEADERSHIP TO DEVELOP FOCUSED EFFORTS TO ENSURE IT CAN CONTRIBUTE TO A DIRECT IMPACT OF IMPROVEMENT FOR THE COMMUNITY. THE CSP FOCUS WILL ALLOW GRACIE SQUARE TO INVEST IN NEW OPPORTUNITIES.
Schedule H, Part VI, Line 3 Patient education of eligibility for assistance Description: WRITTEN MATERIALS, INCLUDING THE APPLICATION, FULL POLICY, AND PLAIN LANGUAGE SUMMARY (SUMMARY), SHALL BE AVAILABLE TO PATIENTS IN THE HOSPITAL'S PRIMARY LANGUAGES, UPON REQUEST AND WITHOUT CHARGE, FROM THE ADMITTING DEPARTMENT AT THE HOSPITAL DURING THE INTAKE AND REGISTRATION PROCESS, AT DISCHARGE AND/OR BYMAIL. ADDITIONALLY, THOSE MATERIALS SHALL BE AVAILABLE ON THE HOSPITAL'S WEBSITE(WWW.NYGSH.ORG) AND BY CALLING (212) 434-5315. ALSO, NOTIFICATION TO PATIENTS REGARDING THIS POLICY SHALL BE MADE THROUGH CONSPICUOUS POSTING OF LANGUAGE-APPROPRIATE INFORMATION IN THE ADMITTING DEPARTMENT OF THE HOSPITAL, AND INCLUSION OF INFORMATION ON BILLS AND STATEMENTS SENT TO PATIENTS EXPLAINING THAT FINANCIAL AID MAY BE AVAILABLE TO QUALIFIED PATIENTS AND HOW TO OBTAIN FURTHER INFORMATION.
Schedule H, Part VI, Line 4 Community information Description: THE COMMUNITY DEFINITION FOR GRACIE SQUARE HOSPITAL WAS DERIVED USING 80% OF ZIP CODES FROM WHICH GRACIE SQUARE'S PATIENTS ORIGINATE AND ADDING ZIP CODES NOT AMONG THE ORIGINAL PATIENT ORIGIN TO CREATE CONTINUITY IN GEOGRAPHICAL BOUNDARIES, RESULTING IN A TOTAL OF 148 COMMUNITY ZIP CODES MAINLY WITHIN NYC. 7.8+M PEOPLE - THE DEFINED COMMUNITY COVERS A GEOGRAPHY OF APPROXIMATELY 7.8+M PEOPLE 2.6% GROWTH POPULATION FORECASTED TO GROW FASTER, 2.6%, THAN THE STATE AVERAGE,1.5%, BETWEEN 2019-2024. 14.0% 65+ POPULATION IS SLIGHTLY YOUNGER WITH ONLY 14.0% OF THE POPULATION AGED 65+ COMPARED TO 16.3%. $99,251 HOUSEHOLD INCOME THE AVERAGE HOUSEHOLD INCOME, $99,251, IS LOWER THAN THE AVERAGE OF NEW YORK STATE, $101,507. 18.0% UNEMPLOYMENT RATE THE UNEMPLOYMENT RATE, 18.0%, IS HIGHER THAN THE NEW YORK STATE BENCHMARK, AND THERE ARE 2% FEWER WHITE-COLLAR WORKERS THAN THE STATE AVERAGE. HIGHER MINORITY POPULATION HIGHER NON-WHITE POPULATION, 70.2%, THAN THE STATE 45.6%, DRIVEN BY HISPANICS, 31.6%, AND AFRICAN AMERICANS, 21.1%. TO ENSURE THAT WE ARE IMPLEMENTING INITIATIVES THAT WILL IMPACT THE COMMUNITIES WITH THE HIGHEST DISPARITIES WITH THIS COMMUNITY SERVICE PLAN, GRACIE SQUARE UNDERTOOK ADDITIONAL ANALYSIS OF COMMUNITY HEALTH NEED AND RISK OF HIGH RESOURCE UTILIZATION AT THE NEIGHBORHOOD TABULATION AREA (NTA) GEOGRAPHY BASED UPON A COMPOSITE OF 29 DIFFERENT INDICATORS. INDICATORS WERE CAREFULLY SELECTED, ACROSS FIVE DOMAINS: DEMOGRAPHICS, INCOME, INSURANCE, ACCESS TO CARE AND NEW YORK STATE DEPARTMENT OF HEALTH PREVENTION AGENDA PRIORITIES. THE OBJECTIVE WAS TO IDENTIFY THE SPECIFIC NYC NTAS WHERE THERE IS A HIGHER HEALTH NEED AND/OR A HIGHER EXPECTATION OF REQUIRED RESOURCES. THE DEFINED COMMUNITY'S 148 ZIP CODES WERE CROSS WALKED TO 168 NEW YORK CITY NTAS (MOSTLY IN KINGS, QUEENS, BRONX, AND NEW YORK COUNTIES) AND CATEGORIZED INTO FOUR QUARTILES. ADDITIONAL ANALYSIS WAS UNDERTAKEN FOR THE 84 NTAS OF HIGHER DISPARITY THAT FELL INTO QUARTILES 3 AND 4. GRACIE SQUARE HOSPITAL FOCUSED HIGH DISPARITY COMMUNITY: 4.1+M PEOPLE THE DEFINED COMMUNITY COVERS A GEOGRAPHY OF APPROXIMATELY 4.1+M PEOPLE. 15.9% UNINSURED HIGHER PERCENTAGE OF UNINSURED POPULATION AT 15.9% COMPARED TO NYC AVERAGE OF 13.5%. 27.7% LIVING IN POVERTY THERE ARE MORE LIVING IN POVERTY, ALL AGES 27.7%, THAN THE NYC AVERAGE, 20.6%. 43.3% MEDICAID ENROLLMENT NUMEROUS NEIGHBORHOODS ALSO HAVE A HIGHER THAN AVERAGE MEDICAID ENROLLMENT, OVERALL 43.3%, NYC 37.0%. 32.1% RECEIVING SNAP BENEFITS AN ESTIMATED 32.1% RECEIVE SNAP BENEFITS, IN COMPARISON TO THE NYC AVERAGE OF 7.9%. 87.7% MINORITY POPULATION HIGHER NON-WHITE POPULATION, 87.7% AS COMPARED TO NYC AVERAGE OF 67.3%. ACKNOWLEDGING THAT THERE WAS VARIATION ACROSS THE NTAS AND COUNTIES AMONG SPECIFIC MEASURABLE INDICATORS FOR DEMOGRAPHICS, SOCIOECONOMICS, SOCIAL DETERMINANTS OF HEALTH (SDOH), HEALTH STATUS AND UTILIZATION THAT EACH REQUIRE A CUSTOM APPROACH TO COMMUNITY SERVICE PLANNING, THERE WERE SPECIFIC COMMUNITIES THAT FREQUENTLY SHOWED MORE NEED THAN THE OTHERS. WITH SUCH A LARGE COMMUNITY, COVERING ALL FIVE BOROUGHS OF NEW YORK CITY, THERE ARE MANY NEIGHBORHOODS THAT FELL INTO THE HIGH DISPARITY (3RD AND 4TH QUARTILES) COMMUNITIES BASED ON THE ANALYSIS AND PRIORITIZATION OR THE QUANTITATIVE AND QUALITATIVE DATA COLLECTED FOR THE CHNA. THE GRACIE SQUARE COMMUNITY IS DIVERSE IN ITS GEOGRAPHY WITH THE NYC NTAS HAVING A YOUNGER, MORE MINORITY, AND ECONOMICALLY CHALLENGED POPULATION. THE SDOH CONCERNS ARE CONCENTRATED UPON LANGUAGE, SAFETY, FOOD INSECURITY, HIGH COST OF HOUSING, AND PUBLIC TRANSPORTATION. BEHAVIORAL RISK FACTORS SUCH AS SMOKING, DRINKING, AND CONSUMING FRUITS AND VEGETABLES VARY AMONG THE NTAS BUT ARE PROBLEMATIC FOR THOSE IN HIGH-DISPARITY NEIGHBORHOODS.
Schedule H, Part VI, Line 5 Promotion of community health Description: THE DATA OUTLINED ALLOWED US TO IDENTIFY A COMMUNITY OF FOCUS AS WELL AS PRIORITY AREAS TO IMPACT THE HEALTHCARE OF THE MOST VULNERABLE POPULATIONS. BACKGROUND SUMMARY: MENTAL HEALTH FIRST AID (MHFA) IS AN INTERNATIONAL TRAINING PROGRAM PROVEN TO BE AN EFFECTIVE INTERVENTION FOR MENTAL HEALTH EDUCATION, PREVENTION AND ADDRESSING STIGMA. PEER-REVIEWED STUDIES SHOW THAT INDIVIDUALS TRAINED IN THE PROGRAM ACHIEVE THE FOLLOWING OUTCOMES: 1 GROW THEIR KNOWLEDGE OF SIGNS, SYMPTOMS, AND RISK FACTORS OF MENTAL ILLNESSES AND ADDICTIONS. 2 CAN IDENTIFY MULTIPLE TYPES OF PROFESSIONAL AND SELF-HELP RESOURCES FOR INDIVIDUALS WITH A MENTAL ILLNESS OR ADDICTION. 3 INCREASE THEIR CONFIDENCE IN AND LIKELIHOOD TO HELP AN INDIVIDUAL IN DISTRESS. 4 SHOW INCREASE MENTAL WELLNESS THEMSELVES. MENTAL HEALTH FIRST AID USA IS LISTED IN THE SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMINISTRATION'S NATIONAL REGISTRY OF EVIDENCE-BASED PROGRAMS AND PRACTICES . BACKGROUND SUMMARY: BASED ON THE EXPERTISE THAT GRACIE SQUARE HOSPITAL (GSH) CAN BRING TO THE BEHAVIORAL HEALTH PRIORITY AREA, WE WILL PARTNER WITH NEWYORK-PRESBYTERIAN HOSPITAL (NYPH) TO INVEST AND CONCENTRATE EFFORTS TO DIRECTLY IMPACT THE NYPH TARGETED COMMUNITIES WITH A SPECIAL FOCUS BY GSH IN WASHINGTON HEIGHTS AND LOWER EAST SIDE NEIGHBORHOODS. GRACIE SQUARE HOSPITAL CONTINUES TO WORK AND COORDINATE WITH NYPH AND PROVIDE SERVICES AS A REFERRAL SOURCE. PROGRESS TRACKING WILL BE MAINTAINED QUARTERLY BY THE GRACIE SQUARE LEADERSHIP TEAM. QUARTERLY FINDINGS WILL BE USED AS A QUALITY PERFORMANCE IMPROVEMENT PROCESS TO REFINE PROCESSES AND PROGRAM DEVELOPMENTAL EFFORTS TO ENSURE NEEDS OF THE POPULATION ARE MET. THE QUARTERLY UPDATES WILL THEN TO BE USED TO COMPILE AN ANNUAL REPORT TO MEET BOTH THE STATE AND FEDERAL EXPECTATIONS OF REPORTING.
Schedule H, Part VI, Line 6 Affiliated health care system Description: GRACIE SQUARE HOSPITAL IS A MEMBER OF THE NEW YORK-PRESBYTERIAN HEALTHCARE SYSTEM. THE NEW YORK-PRESBYTERIAN HEALTHCARE SYSTEM IS A FEDERATION OF TOP-QUALITY HOSPITALS, SPECIALTY INSTITUTES, AND CONTINUING CARE CENTERS. IT WAS FOUNDED TO BRING ABOUT A POSITIVE CHANGE IN THE WAY HEALTHCARE IS DELIVERED TO THE COMMUNITY. THE NEW YORK-PRESBYTERIAN HEALTHCARE SYSTEM IS DEDICATED TO IMPROVING PATIENT CARE, MEDICAL EDUCATION AND RESEARCH THROUGHOUT THIS REGION OF THE UNITED STATES.
Schedule H, Part VI, Line 7 State filing of community benefit report NY
Schedule H (Form 990) 2021
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Software Version: 2021v4.2

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Schedule I
(Form 990)
Department of the Treasury
Internal Revenue Service
Grants and Other Assistance to Organizations,
Governments and Individuals in the United States
Complete if the organization answered "Yes," on Form 990, Part IV, line 21 or 22.
lBullet Attach to Form 990.
lBullet Go to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2021
Open to Public
Inspection
Name of the organization
THE NEW YORK GRACIE SQUARE HOSPITAL INC
 
Employer identification number
13-3746997
Part I
General Information on Grants and Assistance
1
Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ........................
2
Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.
Part II
Grants and Other Assistance to Domestic Organizations and Domestic Governments. Complete if the organization answered "Yes" on Form 990, Part IV, line 21, for any recipient
that received more than $5,000. Part II can be duplicated if additional space is needed.
(a) Name and address of organization
or government		 (b) EIN (c) IRC section
(if applicable)		 (d) Amount of cash grant (e) Amount of non-cash
assistance		 (f) Method of valuation
(book, FMV, appraisal,
other)		 (g) Description of
noncash assistance		 (h) Purpose of grant
or assistance
(1) LIFEFORCE IN LATER YEARS INC
PO BOX 250402
NEW YORK,NY10025 		80-0401075 501(C)(3) 6,500       SUPPORT
2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image
1
3
Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image
0
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2021

Schedule I (Form 990) 2021
Page 2
Part III
Grants and Other Assistance to Domestic Individuals. Complete if the organization answered "Yes" on Form 990, Part IV, line 22.
Part III can be duplicated if additional space is needed.
(a) Type of grant or assistance (b) Number of
recipients		 (c) Amount of
cash grant		 (d) Amount of
noncash assistance		 (e) Method of valuation (book,
FMV, appraisal, other)		 (f) Description of noncash assistance
(1) DIRECT ASSISTANCE 1833   84,850 COST Medication, Transportation & Clothing
(1)
(2)
(3)
(4)
(5)
(6)
(7)
Part IV
Supplemental Information. Provide the information required in Part I, line 2; Part III, column (b); and any other additional information.
Return Reference Explanation
Schedule I, Part I, Line 2 Procedures for monitoring use of grant funds. PRIOR TO AWARDING ASSISTANCE TO ORGANIZATIONS, AN ASSESSMENT IS MADE ON THE USE OF THE FUNDS. FINAL DETERMINATION IS BASED ON WHETHER FUNDS WILL BE USED TO FURTHER OUR MISSION.
Schedule I (Form 990) 2021



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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
THE NEW YORK GRACIE SQUARE HOSPITAL INC
 
Employer identification number

13-3746997
Part I
Questions Regarding Compensation
Yes
No
1a
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.
b
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 .....
1b
 
 
2
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? ....
2
 
 
3
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.
4
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:
a
Receive a severance payment or change-of-control payment? .............
4a
 
No
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........
4b
Yes
 
c
Participate in, or receive payment from, an equity-based compensation arrangement? .........
4c
 
No
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.
5
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:
a
The organization? ....................
5a
 
No
b
Any related organization? .......................
5b
 
No
If "Yes," on line 5a or 5b, describe in Part III.
6
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:
a
The organization? ..................
6a
 
No
b
Any related organization? ......................
6b
 
No
If "Yes," on line 6a or 6b, describe in Part III.
7
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 ............
7
Yes
 
8
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 ..........................
8
 
No
9
If "Yes" on line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................
9
 
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50053T
Schedule J (Form 990) 2021

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
(i) Base
compensation 		(ii) Bonus & incentive
compensation 		(iii) Other reportable compensation
1DAVID WYMAN
 
BOARD MEMBER/PRESIDENT (THRU 5/2021) 		(i)

(ii)		 240,865
-------------
316,798 		188,940
-------------
0 		8,125
-------------
27,777 		8,700
-------------
17,400 		5,029
-------------
22,611 		451,659
-------------
384,586 		0
-------------
0
2GARY J ZUAR
 
BOARD MEMBER/ASS'T TREASURER 		(i)

(ii)		 0
-------------
718,491 		0
-------------
473,153 		0
-------------
157,358 		0
-------------
132,290 		0
-------------
38,538 		0
-------------
1,519,830 		0
-------------
12,259
3NAZIM B MALATYALI
 
BOARD MEMBER 		(i)

(ii)		 0
-------------
444,091 		0
-------------
228,762 		0
-------------
49,772 		0
-------------
19,877 		0
-------------
41,848 		0
-------------
784,350 		0
-------------
0
4BRIAN K REGAN
 
BOARD MEMBER 		(i)

(ii)		 0
-------------
306,365 		0
-------------
119,130 		0
-------------
32,906 		0
-------------
33,275 		0
-------------
30,892 		0
-------------
522,568 		0
-------------
0
5KAREN WESTERVELT
 
BOARD MEMBER/ CHAIRMAN (FROM 6/2021) 		(i)

(ii)		 0
-------------
727,605 		0
-------------
555,655 		0
-------------
89,511 		0
-------------
20,679 		0
-------------
37,279 		0
-------------
1,430,729 		0
-------------
0
6PHYLLIS R LANTOS
 
FORMER OFFICER 		(i)

(ii)		 0
-------------
27,184 		0
-------------
0 		0
-------------
1,200,088 		0
-------------
17,253 		0
-------------
3,800 		0
-------------
1,248,325 		0
-------------
0
7MICHAEL P BRESLIN
 
TREASURER 		(i)

(ii)		 0
-------------
1,170,753 		0
-------------
888,010 		0
-------------
134,226 		0
-------------
21,250 		0
-------------
52,153 		0
-------------
2,266,392 		0
-------------
0
8KATHLEEN M BURKE
 
ASS'T SECRETARY 		(i)

(ii)		 0
-------------
299,170 		0
-------------
102,232 		0
-------------
32,864 		0
-------------
44,620 		0
-------------
22,986 		0
-------------
501,872 		0
-------------
0
9JOHN V CAMPANO
 
SECRETARY 		(i)

(ii)		 0
-------------
371,763 		0
-------------
152,498 		0
-------------
104,219 		0
-------------
38,701 		0
-------------
39,984 		0
-------------
707,165 		0
-------------
0
10MELISSA E WELCH
 
ASS'T SECRETARY 		(i)

(ii)		 0
-------------
171,362 		0
-------------
8,625 		0
-------------
146 		0
-------------
17,052 		0
-------------
15,044 		0
-------------
212,229 		0
-------------
0
11DONNA T ANTHONY
 
CHIEF MEDICAL OFFICER 		(i)

(ii)		 336,419
-------------
0 		73,459
-------------
0 		0
-------------
0 		29,000
-------------
0 		12,796
-------------
0 		451,674
-------------
0 		0
-------------
0
12NATASHA BOWMAN
 
CHIEF HR OFFICER 		(i)

(ii)		 216,493
-------------
0 		52,349
-------------
0 		0
-------------
0 		13,764
-------------
0 		35,808
-------------
0 		318,414
-------------
0 		0
-------------
0
13MARGARET MANCUSO
 
CHIEF ADMINISTRATIVE OFFICER 		(i)

(ii)		 231,419
-------------
0 		58,053
-------------
0 		0
-------------
0 		17,400
-------------
0 		12,565
-------------
0 		319,437
-------------
0 		0
-------------
0
14MICHAEL RADOSTA
 
CHIEF NURSING & QUAL. OFFICER 		(i)

(ii)		 128,795
-------------
199,455 		62,570
-------------
30,000 		0
-------------
4,261 		5,801
-------------
16,172 		2,018
-------------
20,820 		199,184
-------------
270,708 		0
-------------
0
15BORIS AVEZBAKIYEV
 
PER DIEM MD 		(i)

(ii)		 176,813
-------------
0 		0
-------------
0 		0
-------------
0 		10,609
-------------
0 		0
-------------
0 		187,422
-------------
0 		0
-------------
0
16FRANCINE FAKIH
 
DIRECTOR OF NURSING 		(i)

(ii)		 189,315
-------------
0 		2,000
-------------
0 		0
-------------
0 		9,836
-------------
0 		35,586
-------------
0 		236,737
-------------
0 		0
-------------
0
17AMY PARIKH
 
PER DIEM PSYCH 		(i)

(ii)		 221,603
-------------
0 		0
-------------
0 		0
-------------
0 		11,080
-------------
0 		0
-------------
0 		232,683
-------------
0 		0
-------------
0
18DOUGLAS SAPHIER
 
PER DIEM PSYCH 		(i)

(ii)		 215,408
-------------
0 		0
-------------
0 		0
-------------
0 		12,924
-------------
0 		0
-------------
0 		228,332
-------------
0 		0
-------------
0
19NIESHA WESTMORELAND
 
PER DIEM PSYCH 		(i)

(ii)		 257,460
-------------
0 		0
-------------
0 		0
-------------
0 		12,873
-------------
0 		0
-------------
0 		270,333
-------------
0 		0
-------------
0
Schedule J (Form 990) 2021

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
Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan PARTICIPATED IN A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN: GARY ZUAR: $98,632 SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN AS REPORTED ON THE W-2: GARY ZUAR: $73,937 PHYLLIS R. LANTOS: $1,183,467 PART I LINE 4B: LEGACY NONQUALIFIED RETIREMENT PLAN REPORTED ON THE W2: JOHN CAMPANO: $64,158
Schedule J, Part I, Line 7 Non-fixed payments ALL BONUSES ARE GRANTED AT THE DISCRETION OF AND APPROVED BY THE COMPENSATION COMMITTEE OF THE BOARD OF TRUSTEES; THEY ARE BASED ON THE ACHIEVEMENT OF PREDETERMINED GOALS AND OBJECTIVES.
Schedule J, Part I PART VII AND SCHEDULE J SUPPLEMENTAL INFORMATION CERTAIN EMPLOYEES OF THE NEW YORK PRESBYTERIAN HOSPITAL THAT ARE IDENTIFIED IN PART VII AS OFFICERS OR TRUSTEES OF THE NEW YORK GRACIE SQUARE HOSPITAL INC. ARE RESPONSIBLE FOR EXECUTING THE MISSION AND MANAGEMENT OF THE NEW YORK PRESBYTERIAN HOSPITAL (NYP) AND ITS AFFILIATED ENTITIES. COMPENSATION FOR 2021 OF THESE UPPER LEVEL EXECUTIVES INCLUDES THE PAYOUT OF AN ANNUAL INCENTIVE PLAN AND A LONG-TERM INCENTIVE PLAN. THIS PERFORMANCE-ORIENTED PROGRAM CONDITIONS PAYMENTS UPON THE ACHIEVEMENT OF MULTIPLE INDIVIDUAL AND GROUP PERFORMANCE MEASURES. MEASURES TO MONITOR PERFORMANCE INCLUDE OPERATIONAL AND FINANCIAL STRENGTH, PATIENT QUALITY AND SAFETY, PATIENT SATISFACTION, ADVANCEMENT OF PATIENT CARE, AND PEOPLE DEVELOPMENT AND PARTNERSHIP. INCENTIVE AWARDS MAY ONLY BE GRANTED IF THE ORGANIZATION ACHIEVES A FINANCIAL SURPLUS. EVEN IF ALL RELEVANT PERFORMANCE MEASUREMENTS ARE ACHIEVED, THE NYP BOARD OF TRUSTEES RETAINS FULL DISCRETION TO MAKE OR NOT MAKE ANY INCENTIVE AWARDS, OR TO REDUCE THE AMOUNT OF ANY INCENTIVE AWARD. THIS INITIATIVE IS CRITICAL TO ASSURING THAT NYP HAS THE REQUISITE LEADERSHIP TO CREATE AND MANAGE A HIGHLY MOTIVATED AND ENGAGED WORKFORCE, DRIVE SUPERIOR PERFORMANCE THROUGHOUT THE ORGANIZATION, AND ACHIEVE TOP TIER MEDICAL CENTER STATUS. AS A SEPARATE MATTER, DUE TO RESTRICTIONS IMPOSED BY THE INTERNAL REVENUE CODE, UPPER LEVEL EXECUTIVES ARE LIMITED IN THE AMOUNT OF BENEFITS RECEIVED UNDER A TAX-QUALIFIED RETIREMENT PLAN. LIKE MANY EMPLOYERS, NYP SUPPLEMENTS THESE EXECUTIVES' PENSION BENEFITS THROUGH A SUPPLEMENTAL ("NONQUALIFIED") RETIREMENT PLAN. THE SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP) IS SUBJECT TO A MULTI-YEAR VESTING REQUIREMENT (COMMENCING AFTER FIVE YEARS OF PARTICIPATION IN THE SERP, IN PRORATED AMOUNTS THROUGH AGE 65) WHICH PLACES AN EXECUTIVE'S SUPPLEMENTAL RETIREMENT BENEFIT AT RISK OF FORFEITURE IF THE VESTING REQUIREMENTS ARE NOT SATISFIED. ONCE VESTED, HOWEVER, PROVISIONS OF THE INTERNAL REVENUE CODE REQUIRE THAT THE VESTED EXECUTIVE INCLUDE IN CURRENT INCOME THE VALUE OF HIS OR HER VESTED SUPPLEMENTAL RETIREMENT BENEFIT. NOTWITHSTANDING THE LEGAL REQUIREMENT TO RECOGNIZE THE VESTED VALUE OF THE SUPPLEMENTAL RETIREMENT BENEFIT AS CURRENT INCOME, THE SUPPLEMENTAL RETIREMENT BENEFIT WILL NOT BE DISTRIBUTED TO THE EXECUTIVE UNTIL THE EXECUTIVE ACTUALLY RETIRES FROM NYP (ALTHOUGH, AS PERMITTED BY THE INTERNAL REVENUE CODE, THE SUPPLEMENTAL RETIREMENT PLAN WILL EFFECT A DISTRIBUTION OF AN AMOUNT NECESSARY TO SATISFY THE EXECUTIVE'S TAX LIABILITY RESULTING FROM THE INCOME RECOGNITION UPON VESTING). AS NOTED, THIS SUPPLEMENTAL RETIREMENT BENEFIT WILL NOT BE DISTRIBUTED TO THE EXECUTIVE UNTIL THE EXECUTIVE ACTUALLY RETIRES FROM NYP. THERE ARE CONSTANTLY CHANGING LEGAL, TAX, ACCOUNTING, AND PUBLIC DISCLOSURE RULES FOR A SERP (SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN) IN NOT-FOR-PROFIT ORGANIZATIONS. THE EXECUTIVE COMPENSATION COMMITTEE CONTINUOUSLY MONITORS THESE CHANGES AND INCORPORATES ANY CHANGES INTO THE OVERALL SERP PLAN DESIGN. AS IN PAST YEARS, THE EXECUTIVE COMPENSATION COMMITTEE OF NYP REQUIRES A THIRD PARTY TO COMPLETE A REVIEW OF THE ORGANIZATION'S COMPENSATION PROGRAM TO ENSURE ITS EFFECTIVENESS IN TERMS OF GOVERNMENT REGULATIONS, MARKET CONDITIONS, AND THE NEED TO CONTINUALLY ELEVATE ORGANIZATIONAL PERFORMANCE. THE REPORT ALSO SERVES TO MEET THE REGULATORY OBLIGATIONS TO ENSURE THAT ALL ELEMENTS OF THE EXECUTIVE COMPENSATION PROGRAMS ARE REASONABLE. THE INDIVIDUALS LISTED IN PART VII THAT ARE COMPENSATED BY NEW YORK PRESBYTERIAN HOSPITAL DEVOTE AN AVERAGE OF SIXTY HOURS PER WEEK TO PERFORM THEIR RESPONSIBILITIES FOR THE NEW YORK PRESBYTERIAN HOSPITAL AND OTHER RELATED ORGANIZATIONS IN THE AGGREGATE. THE INDIVIDUALS LISTED IN PART VII THAT ARE COMPENSATED BY THE NEW YORK GRACIE SQUARE HOSPITAL, UNLESS OTHERWISE INDICATED, DEVOTE AN AVERAGE OF SIXTY HOURS PER WEEK TO PERFORM THEIR RESPONSIBILITIES FOR THE NEW YORK GRACIE SQUARE HOSPITAL.
Schedule J (Form 990) 2021

Additional Data


Software ID: 21014044
Software Version: 2021v4.2
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
THE NEW YORK GRACIE SQUARE HOSPITAL INC
 
Employer identification number

13-3746997
Return Reference Explanation
Form 990, Part VI, Line 6 Classes of members or stockholders THE NEW YORK GRACIE SQUARE HOSPITAL (GSH), INC. IS A MEMBERSHIP CORPORATION, WHOSE MEMBERS ARE APPOINTED BY NEW YORK-PRESBYTERIAN HEALTHCARE SYSTEM, INC. ("SYSTEM INC."). SYSTEM INC. IS A TAX-EXEMPT ORGANIZATION WHOSE MEMBERS ARE APPOINTED BY NEW YORK-PRESBYTERIAN FOUNDATION, INC., WHICH IS ALSO A TAX-EXEMPT ORGANIZATION.
Form 990, Part VI, Line 7a Members or stockholders electing members of governing body The Members shall have the sole authority to establish from time to time the number of Trustees to be elected at large, to elect Trustees to be elected at large and Honorary Trustees, and to elect the Chairman of the Board (the "Chairman").
Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders The approval of the Members shall be required for: (1) the removal by the Board of the President the "President"), Chief Financial Officer, Chief Medical Officer and Chief Information Officer, if any, or any other corporate officer whose powers and duties include those which usually appertain to such offices. (2) the amendment of the Certificate of Incorporation or By-Laws of the Corporation, (3) the disposition of all or substantially all of the assets of the Corporation, (4) the merger or consolidation of the Corporation with another entity or (5) the dissolution of the Corporation. Except as may be limited by applicable law governing health care institutions, the Members shall have such other powers and authority as are afforded to the Members under the Corporation's Certificate of Incorporation or generally to members of not-for-profit corporations under the laws of the State of New York.
Form 990, Part VI, Line 11b Review of form 990 by governing body MEMBERS OF THE NEWYORK-PRESBYTERIAN HOSPITAL (NYPH) FINANCE DEPARTMENT (FINANCE) COORDINATED AND COMPLETED ALL OF THE INFORMATION REQUIRED FOR FORM 990, ACCESSING VARIOUS RESOURCES INCLUDING, LEGAL, HUMAN RESOURCES, CORPORATE COMPLIANCE, DEVELOPMENT, AND OTHER DEPARTMENTS AS NEEDED. THE COMPLETED FORM 990 IS FORWARDED TO ERNST & YOUNG U.S. LLP (EY) FOR REVIEW. EY PERFORMS REVIEW PROCEDURES DESIGNED TO EVALUATE THE CORRECTNESS AND MECHANICAL ACCURACY OF THE RETURN. UPON COMPLETION OF THEIR REVIEW PROCEDURES, A DRAFT OF THE FORM 990 WILL BE PROVIDED TO SENIOR MANAGEMENT FOR REVIEW. A DRAFT 990 IS THEN PROVIDED TO ALL MEMBERS OF THE BOARD OF DIRECTORS. THE CORPORATION FILES THE FORM 990 WITH THE IRS UPON FINAL REVIEW BY THE BOARD.
Form 990, Part VI, Line 12c Conflict of interest policy THE HOSPITAL ADHERES TO A CONFLICT OF INTEREST (COI) POLICY THAT WAS APPROVED BY THE AUDIT AND CORPORATE COMPLIANCE COMMITTEE OF THE BOARD OF TRUSTEES. THE POLICY STATES IN PART: "EACH BOARD MEMBER, OFFICER OR KEY PERSON OF A NEW YORK-PRESBYTERIAN ORGANIZATION SHALL COMPLETE A CONFLICT OF INTEREST QUESTIONNAIRE PRIOR TO BECOMING A BOARD MEMBER, OFFICER OR KEY PERSON OF THE NEW YORK-PRESBYTERIAN ORGANIZATION AND ANNUALLY THEREAFTER." THE POLICY ALSO STATES THAT "EACH BOARD MEMBER, OFFICER, OR KEY PERSON SHALL PROMPTLY ADVISE THE CHIEF EXECUTIVE OFFICER OF THE NEWYORK-PRESBYTERIAN ORGANIZATION, OR HIS OR HER DESIGNEE, OF ANY CHANGES TO THE INFORMATION PROVIDED IN THAT INDIVIDUAL'S LAST COMPLETED CONFLICT OF INTEREST QUESTIONNAIRE." THE CHIEF EXECUTIVE OFFICER OF NEW YORK-PRESBYTERIAN HOSPITAL, OR HIS OR HER DESIGNEE, SHALL REVIEW ALL COMPLETED QUESTIONNAIRES AND ALL SUBSEQUENT ADVICE OF CHANGES AND SHALL TAKE SUCH ACTION AS IS DEEMED APPROPRIATE TO ELIMINATE POTENTIALS FOR CONFLICTS OF INTEREST, INCLUDING SUCH STEPS AS REASSIGNMENT OF RESPONSIBILITIES OR ESTABLISHMENT OF PROTECTIVE ARRANGEMENTS. ALL DISCLOSURES OF INTERESTS IN COMPLETED QUESTIONNAIRES OR SUBSEQUENT ADVICE, UNLESS CLEARLY IRRELEVANT OR IMMATERIAL, SHALL BE COMPILED AND REPORTED BY MANAGEMENT TO THE AUDIT AND CORPORATE COMPLIANCE COMMITTEE OF THE BOARD OF NEW YORK- PRESBYTERIAN HOSPITAL, TOGETHER, IN EACH CASE, WITH RESPONSE OR RECOMMENDATION OF MANAGEMENT. THE AUDIT AND CORPORATE COMPLIANCE COMMITTEE SHALL DETERMINE WHETHER THE REPORTED RESOLUTION OF ISSUES RAISED BY THE DISCLOSURES IS SATISFACTORY AND, IF NOT, SHALL REQUIRE SUCH FURTHER ACTION AS IT DEEMS APPROPRIATE.
Form 990, Part VI, Line 15a Process to establish compensation of top management official THE HOSPITAL'S EXECUTIVE COMPENSATION COMMITTEE OF THE BOARD OF TRUSTEES (THE "COMMITTEE") OVERSEES MATTERS CONCERNING COMPENSATION AND BENEFITS FOR OFFICERS AND OTHER EXECUTIVES. THE MEMBERS OF THE COMMITTEE INCLUDE INDEPENDENT TRUSTEES. PART OF THE COMMITTEES DELIBERATION AND DECISION PROCESS INCLUDES REVIEW OF COMPARABLE AND CONTEMPORANEOUS DATA.
Form 990, Part VI, Line 15b Process to establish compensation of other employees SEE DESCRIPTION FOR FORM 990, PART VI, LINE 15A.
Form 990, Part VI, Line 19 Required documents available to the public INSPECTION OF THE HOSPITAL'S FORM 990, GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS WILL BE ARRANGED UPON REQUEST.
Form 990, Part XI, Line 9 Other changes in net assets or fund balances RESTRICTED CONTRIBUTION AND NET ASSETS RELEASED FROM RESTRICTION, NET - 49432;
COVID 19 DISCLOSURE AT GRACIE SQUARE HOSPITAL, GUIDANCE FROM THE CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC) WAS FOLLOWED AND SAFETY MEASURES WERE STANDARDIZED ON ALL UNITS. THESE INCLUDED: MONITORING THE CDC WEBSITE FOR UPDATED INFORMATION, PREPARING A MULTIDISCIPLINARY TEAM OF MEDICINE AND PSYCHIATRY, ATTENDING TO THE EXISTING INFECTION CONTROL GUIDELINES FOR ENHANCING HAND HYGIENE AND DISINFECTION, APPLYING SOCIAL DISTANCING STRATEGIES TO INCREASE SPACE AMONG PATIENTS AND AMONG STAFF, SCREENING PATIENTS FOR COVID-19 AT TIME OF ADMISSION, RESTRICTING VISITATION TO LIMIT THE POTENTIAL TRANSMISSION FROM VISITORS, USING PERSONAL PROTECTIVE EQUIPMENT (PPE), CREATING A TEMPERATURE MONITORING PROTOCOL FOR ALL PATIENTS, IDENTIFYING PATIENTS WHO ARE AT INCREASED RISK FOR SEVERE SYMPTOMS FROM COVID-19 SECONDARY TO MEDICAL COMORBIDITIES, ISOLATING PATIENTS WITH SUSPECTED OR CONFIRMED COVID-19, AND QUARANTINING THE CLOSE CONTACTS. WHILE IMPLEMENTING THE CDC RECOMMENDATIONS, WE FACED CHALLENGES CONCERNING PSYCHIATRIC PATIENTS. ACCORDINGLY, GRACIE SQUARE HOSPITAL CONVERTED ONE OF ITS GENERAL PSYCHIATRIC UNITS INTO A PSYCHIATRIC COVID UNIT. THE UNIT WAS DEDICATED ENTIRELY TO TREATING COVID-19 PATIENTS WHO NEED PSYCHIATRIC CARE WITH THE GOAL OF MINIMIZING THE RISK OF EXPOSURE TO PATIENTS AND STAFF. THIS CONVERSION PROCESS WAS EXECUTED IN A TIMELY MANNER CONSIDERING THE RAPIDLY EVOLVING OUTBREAK. THE HOSPITAL DESIGNATED A MULTIDISCIPLINARY TEAM TO MEETING THE COMPLEX NEEDS OF THIS UNIQUE PATIENT POPULATION. MOREOVER, THE DEPARTMENT OF INFECTION PREVENTION AND CONTROL (IPC) AT NYP WAS PROVIDING ONGOING CLINICAL ADVICE INCLUDING CLINICAL PROTOCOLS AND CONSULTATION ON INDIVIDUAL PATIENT CASES. THE COVID-19 PANDEMIC HAS DRAMATICALLY CHANGED PSYCHIATRIC PRACTICE OVER A SHORT PERIOD OF TIME GIVEN THE LEVEL OF CLINICAL UNCERTAINTY AND UNIQUE CIRCUMSTANCES.
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: 21014044
Software Version: 2021v4.2
SCHEDULE R
(Form 990)
Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
MediumBulletComplete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBulletAttach 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
THE NEW YORK GRACIE SQUARE HOSPITAL INC
 
Employer identification number

13-3746997
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?
Yes No
(1)NEW YORK-PRESBYTERIAN FOUNDATION INC
525 E 68TH ST BOX 156

NEW YORK,NY10065
13-4153668 		SUPPORT ORG. NY 501(c)(3) Type I NA
 
 
No
(2)THE NEW YORK AND PRESBYTERIAN HOSPITAL
525 E 68TH ST BOX 156

NEW YORK,NY10065
13-3957095 		HEALTH CARE NY 501(c)(3) 3 NYP FDN
 
 
No
(3)THE HOSPITAL FOR SPECIAL SURGERY
535 E 70TH ST

NEW YORK,NY10021
13-1624135 		HEALTH CARE NY 501(c)(3) 3 NYP FDN
 
 
No
(4)ROYAL CHARTER PROPERTIES INC
525 E 68TH ST BOX 156

NEW YORK,NY10065
13-3158502 		REAL ESTATE NY 501(c)(3) Type II NYP FDN
 
 
No
(5)ROYAL CHARTER PROPERTIES EAST INC
525 E 68TH ST BOX 156

NEW YORK,NY10065
13-3158496 		REAL ESTATE NY 501(c)(3) Type II NYP FDN
 
 
No
(6)ROYAL CHARTER PROPERTIES-WESTCHESTER INC
525 E 68TH ST BOX 156

NEW YORK,NY10065
13-3160354 		REAL ESTATE NY 501(c)(3) Type II NYP FDN
 
 
No
(7)NY PRESBYTERIAN HEALTHCARE SYSTEM INC
525 E 68TH ST BOX 156

NEW YORK,NY10065
13-3792361 		SPONSOR NY 501(c)(3) Type III-FI NYP FDN
 
 
No
(8)NEW YORK-PRESBYTERIAN FUND INC
525 E 68TH ST BOX 156

NEW YORK,NY10065
13-3160356 		FUNDRAISING NY 501(c)(3) 7 NYP FDN
 
 
No
(9)NYP COMMUNITY SERVICES INC
525 E 68TH ST BOX 156

NEW YORK,NY10065
46-3951535 		HEALTH CARE NY 501(c)(3) Type I NYP HOSPITAL
 
 
No
(10)THE ELIZABETH BLACKWELL FOUNDATION INC
525 E 68TH ST BOX 156

NEW YORK,NY10065
11-3344692 		HLTH INFO SVS NY 501(c)(3) Type I NYP HOSPITAL
 
 
No
(11)LAWRENCE MEDICAL ASSOCIATES PC
55 PALMER AVENUE

BRONXVILLE,NY10708
26-4076297 		HEALTH CARE NY 501(c)(3) Type I NYP HOSPITAL
 
 
No
(12)BEEKMAN STAFF RESIDENCE
525 E 68TH ST BOX 156

NEW YORK,NY10065
13-2773085 		REAL ESTATE NY 501(c)(3) Type I NYP HOSPITAL
 
 
No
(13)NYP COMMUNITY PROGRAMS INC
525 E 68TH ST BOX 156

NEW YORK,NY10065
47-2126668 		HEALTH CARE NY 501(c)(3) Type I NYP HOSPITAL
 
 
No
(14)LAWRENCE CARE INC
55 PALMER AVENUE

BRONXVILLE,NY10708
13-3415158 		HEALTH CARE NY 501(c)(3) Type I NYP HOSPITAL
 
 
No
(15)LAWRENCE COMMUNITY HEALTH SERVICES INC
670 WHITE PLAINS ROAD

SCARSDALE,NY10583
13-1740022 		HEALTH CARE NY 501(c)(3) 10 LAWRENCE CAR
 
 
No
(16)NYHB INC
506 SIXTH STREET

BROOKLYN,NY11215
46-2486539 		HEALTH CARE NY 501(c)(3) Type II NYP SYS INC
 
 
No
(17)NEW YORK DOWNTOWN HOSPITAL CCPH
525 E 68TH ST BOX 156

NEW YORK,NY10065
11-3614596 		FUND/SUPPORT NY 501(c)(3) Type II NYP FUND IN
 
 
No
(18)THE ROGOSIN INSTITUTE INC
505 E 70TH STREET

NEW YORK,NY10021
13-3184198 		HEALTH CARE NY 501(c)(3) 4 NYP SYS INC
 
 
No
(19)PREFERRED HEALTH NETWORK INC
525 E 68TH ST BOX 156

NEW YORK,NY10065
11-2964432 		INACTIVE NY 501(c)(3) Type I NYP SYS INC
 
 
No
(20)NETWORK RECOVERY SERVICES INC
525 E 68TH ST BOX 156

NEW YORK,NY10065
11-3160901 		COLLECTION NY 501(c)(3) Type III-FI NYP SYS INC
 
 
No
(21)THE SILVERCREST CTR FOR NURSING & REHAB
144-45 87TH AVENUE

JAMAICA,NY11435
11-2925535 		HEALTH CARE NY 501(c)(3) 10 NYP SYS INC
 
 
No
(22)SILVERCREST SENIOR HOUSING DEVELOPMENT
144-45 87TH AVENUE

BRIARWOOD,NY11435
26-2894911 		HOUSING NY 501(c)(3) 10 SILVERCREST
 
 
No
(23)HUDSON EAST RIVER SYSTEMS LLC
525 E 68TH ST BOX 156

NEW YORK,NY10065
82-2253311 		INVESTMENT NY 501(c)(3) 7 NYP FUND IN
 
 
No
(24)NEWYORK-PRESBYTERIANBKLYN METHODIST
506 SIXTH STREET

BROOKLYN,NY11215
11-1631796 		HEALTH CARE NY 501(c)(3) 3 NYP COMM PRO
 
 
No
(25)HUDSON VALLEY HOSPITAL CENTER
1980 CROMPOND RD

CORTLANDT MANOR,NY10567
13-1740120 		HEALTH CARE NY 501(c)(3) 3 NYP COMM PRO
 
 
No
(26)THE FDN OF NYPHUDSON VALLEY HOSPITAL
1980 CROMPOND RD

CORTLANDT MANOR,NY10567
13-3307781 		SUPPORT NY 501(c)(3) Type I NYPHVH HOS
 
 
No
(27)THE WESTCHESTER MEDICAL PRACTICE PC
2649 STRANG BLVD

YORKTOWN HEIGHTS,NY10598
56-2662502 		HEALTH CARE NY 501(c)(3) Type I NYPHVH HOS
 
 
No
(28)WESTCHESTER PUTNAM HEALTH MANAGEMENT SYS
1980 CROMPOND RD

CORTLANDT MANOR,NY10567
13-3420263 		SUPPORT NY 501(c)(3) Type I NYP COMM PRO
 
 
No
(29)GI VENTURES INC
1980 CROMPOND RD

CORTLANDT MANOR,NY10567
45-4644781 		SUPPORT NY 501(c)(3) Type II WPHMS
 
 
No
(30)NEWYORK-PRESBYTERIANQUEENS
56-45 MAIN STREET

FLUSHING,NY11355
11-1839362 		HEALTH CARE NY 501(c)(3) 3 NYP COMM PRO
 
 
No
(31)NEW YORK QUEENS CHARTER VENTURES INC
56-45 MAIN STREET

FLUSHING,NY11355
45-4795032 		REAL ESTATE NY 501(c)(3) Type I NYPQUEENS
 
 
No
(32)NY QUEENS MEDICINE AND SURGERY PC
56-45 MAIN STREET

FLUSHING,NY11355
27-4719998 		HEALTH CARE NY 501(c)(3) Type I NYPQUEENS
 
 
No
(33)BROOKLYN DENTAL SERVICES PC
506 SIXTH STREET

BROOKLYN,NY11215
43-2015903 		DENTAL SERVIC NY 501(c)(3) Type I BKLYN METHOD
 
 
No
(34)BROOKLYN FOOT AND ANKLE PC
506 SIXTH STREET

BROOKLYN,NY11215
11-3441502 		INACTIVE NY 501(c)(3) Type I BKLYN METHOD
 
 
No
(35)BROOKLYN RADIOLOGY SERVICES PC
506 SIXTH STREET

BROOKLYN,NY11215
11-3423162 		RADIOLOGY NY 501(c)(3) Type I BKLYN METHOD
 
 
No
(36)KINGS PHYSICIAN SERVICES
506 SIXTH STREET

BROOKLYN,NY11215
46-2333282 		HEALTH CARE NY 501(c)(3) Type I BKLYN METHOD
 
 
No
(37)PARK SLOPE EMERGENCY PHYSICIAN SERV PC
506 SIXTH STREET

BROOKLYN,NY11215
06-1160280 		INACTIVE NY 501(c)(3) Type I BKLYN METHOD
 
 
No
(38)PARK SLOPE HEMATOLOGY & ONCOLOGY PC
506 SIXTH STREET

BROOKLYN,NY11215
42-1591811 		INACTIVE NY 501(c)(3) Type I BKLYN METHOD
 
 
No
(39)PARK SLOPE MEDICAL HEALTH PROVIDER PC
506 SIXTH STREET

BROOKLYN,NY11215
11-3564621 		INACTIVE NY 501(c)(3) Type I BKLYN METHOD
 
 
No
(40)PARK SLOPE MEDICAL SERVICE PC
506 SIXTH STREET

BROOKLYN,NY11215
11-2843882 		HEALTH CARE NY 501(c)(3) Type I BKLYN METHOD
 
 
No
(41)PARK SLOPE MEDICINE PC
506 SIXTH STREET

BROOKLYN,NY11215
11-3362663 		INACTIVE NY 501(c)(3) Type I BKLYN METHOD
 
 
No
(42)PARK SLOPE OBSTETRICS & GYNECOLOGY PC
506 SIXTH STREET

BROOKLYN,NY11215
11-3124294 		INACTIVE NY 501(c)(3) Type I BKLYN METHOD
 
 
No
(43)PARK SLOPE PATHOLOGY SERVICES PC
506 SIXTH STREET

BROOKLYN,NY11215
11-2843879 		PATHOLOGY NY 501(c)(3) Type I BKLYN METHOD
 
 
No
(44)PARK SLOPE PEDIATRIC MEDICINE PC
506 SIXTH STREET

BROOKLYN,NY11215
11-3303499 		INACTIVE NY 501(c)(3) Type I BKLYN METHOD
 
 
No
(45)PARK SLOPE PHYSICIAN SERVICES PC
506 SIXTH STREET

BROOKLYN,NY11215
11-3231685 		INACTIVE NY 501(c)(3) Type I BKLYN METHOD
 
 
No
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2021
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



 		(e)
Predominant income(related, unrelated, excluded from tax under sections 512-514)

(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
Yes No Yes No












Part IV
Identification of Related Organizations Taxable as a Corporation or Trust. Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.
(a)
Name, address, and EIN of
related organization
 		(b)
Primary activity
 		(c)
Legal
domicile
(state or foreign
country)
 		(d)
Direct controlling
entity
 		(e)
Type of entity
(C corp, S corp,
or trust) 		(f)
Share of total income
 		(g)
Share of end-of-year
assets
 		(h)
Percentage
ownership
 		(i)
Section 512(b)(13) controlled entity?
Yes No
(1) NYP PROGRAMS INC

525 EAST 68TH STREET
NEW YORK,NY10065
47-5351503 		HEALTHCARE NY NYP FOUNDATION
  		C Corporation         No
(2) NYP SERVICES INC

525 EAST 68TH STREET
NEW YORK,NY10065
06-1830524 		HEALTHCARE NY NYP FOUNDATION
  		C Corporation         No
(3) NEW YORK-PRESBYTERIAN GLOBAL INC

525 EAST 68TH STREET
NEW YORK,NY10065
80-0336716 		INACTIVE NY NYP FOUNDATION
  		C Corporation         No
(4) HARKNESS HALL CLUB INC

525 EAST 68TH STREET
NEW YORK,NY10065
13-3170488 		INACTIVE NY NYP HOSPITAL
  		C Corporation         No
(5) VERNON HILLS MEDICAL PRACTICE PC

55 PALMER AVENUE
BRONXVILLE,NY10708
82-1988737 		INACTIVE NY NYP HOSPITAL
  		C Corporation         No
(6) NYP GLOBAL SERVICES INC

525 EAST 68TH STREET
NEW YORK,NY10065
13-3845935 		INACTIVE NY NYP FUND INC
  		C Corporation         No
(7) HUDSON VALLEY VENTURES INC

1980 CROMPOND ROAD
CORTLANDT MANOR,NY10567
11-3611982 		INACTIVE NY WESTCHESTER PUT
  		C Corporation         No
(8) AC VENTURES INC

1980 CROMPOND ROAD
CORTLANDT MANOR,NY10567
13-3758209 		REAL ESTATE NY WESTCHESTER PUT
  		C Corporation         No
(9) KNOWA VENTURES INC

1980 CROMPOND ROAD
CORTLANDT MANOR,NY10567
13-3845922 		INACTIVE NY WESTCHESTER PUT
  		C Corporation         No
(10) MSO OF KINGS COUNTY LLC

506 SIXTH STREET
BROOKLYN,NY11215
12-2387333 		EMPLOY/STAFFING NY BKLYN METHODIST
  		C Corporation         No
(11) LC SERVICES CORPORATION

55 PALMER AVENUE
BRONXVILLE,NY10708
13-3448332 		INACTIVE NY LAWRENCE CARE
  		C Corporation         No
(12) NETWORK INSURANCE COMPANY LTD

PO BOX HM
  HAMILTON1760
BD
REINSURANCE BD NYP SYSTEMS INC
  		C Corporation         No
(13) CRT SURGICAL ASSOCIATES PC

56-45 MAIN STREET
FLUSHING,NY11355
11-2226870 		INACTIVE NY NYP QUEENS
  		C Corporation         No
Schedule R (Form 990) 2021
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
No
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 .....................
1a
 
No
b Gift, grant, or capital contribution to related organization(s) ............................
1b
 
No
c Gift, grant, or capital contribution from related organization(s) ............................
1c
Yes
 
d Loans or loan guarantees to or for related organization(s) ............................
1d
 
No
e Loans or loan guarantees by related organization(s) ............................
1e
Yes
 
f Dividends from related organization(s) ............................
1f
 
No
g Sale of assets to related organization(s) ............................
1g
 
No
h Purchase of assets from related organization(s) ............................
1h
 
No
i Exchange of assets with related organization(s) ............................
1i
 
No
j Lease of facilities, equipment, or other assets to related organization(s) .......................
1j
 
No
k Lease of facilities, equipment, or other assets from related organization(s) ......................
1k
Yes
 
l Performance of services or membership or fundraising solicitations for related organization(s) .....................
1l
 
No
m Performance of services or membership or fundraising solicitations by related organization(s) .................
1m
Yes
 
n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) ...................
1n
 
No
o Sharing of paid employees with related organization(s) ............................
1o
Yes
 
p Reimbursement paid to related organization(s) for expenses ............................
1p
Yes
 
q Reimbursement paid by related organization(s) for expenses ............................
1q
 
No
r Other transfer of cash or property to related organization(s) ............................
1r
 
No
s Other transfer of cash or property from related organization(s) ............................
1s
 
No
2
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
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) 		(d)
Predominant income (related, unrelated, excluded from tax under sections 512-514)

(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
Yes No Yes No Yes No






























Schedule R (Form 990) 2021
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


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Software Version: 2021v4.2