TY 2021 Form 990

(A) Name and title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W-2/1099-MISC/1099-NEC)
(1) GREGORY EVANS...................................................................... CHAIRMAN	1.00 ................. 2.50	X	X	0	0
(2) LAUREN BULL...................................................................... VICE CHAIRMAN	1.00 ................. 2.50	X	X	0	0
(3) KAREN LEACH...................................................................... SECRETARY	1.00 ................. 2.50	X	X	0	0
(4) RICHARD ZWEIFEL...................................................................... TREASURER	1.00 ................. 2.50	X	X	0	0
(5) RICHARD TANTILLO...................................................................... PHILANTHROPY CHAIR	1.00 ................. 2.50	X	X	0	0
(6) JOAN COMPSON...................................................................... CHAIR EMERITUS	1.00 ................. 2.50	X		0	0
(7) NORMAN SIEGEL...................................................................... CHAIR EMERITUS	1.00 ................. 2.50	X		0	0
(8) CATHERINE BROWNELL PHD...................................................................... DIRECTOR	1.00 ................. 2.50	X		0	0
(9) DOMENIC P AIELLO MD...................................................................... DIRECTOR	1.00 ................. 2.50	X		0	0
(10) GREGORY B MCLEAN...................................................................... DIRECTOR	1.00 ................. 2.50	X		0	0
(11) BARBARA BRODOCK...................................................................... DIRECTOR	1.00 ................. 2.50	X		0	0
(12) CATHERINE COMINSKY...................................................................... DIRECTOR	1.00 ................. 2.50	X		0	0
(13) ANDREW KOWALCZYK III...................................................................... DIRECTOR	1.00 ................. 2.50	X		0	0
(14) SYMEON TSOUPELIS...................................................................... DIRECTOR	1.00 ................. 2.50	X		0	0
(15) SUSHMA KAUL MD...................................................................... PHYSICIAN/MEDICAL STAFF PRESIDENT	51.00 ................. 2.50	X		783,453	27,233
(16) JONATHAN BLOCK MD...................................................................... DIRECTOR/MEDICAL STAFF VP	1.00 ................. 2.50	X		0	0
(17) DARLENE STROMSTAD...................................................................... PRESIDENT/CEO	30.00 ................. 25.00	X	X	917,310	19,328

(A) Name and title	(B) Average hours per week (list any hours for related organizations below dotted line)	(E) Reportable compensation from related organizations (W-2/1099-MISC/1099-NEC)	(F) Estimated amount of other compensation from the organization and related organizations
(18) LOUIS AIELLO........................................................................ SR VICE PRESIDENT/CFO	27.00 .......................23.00	X				0	558,313	35,386
(19) MANSOOR SHAHID........................................................................ SR VICE PRESIDENT/COO	30.00 .......................20.00		X			555,830	0	27,862
(20) LINDA MCCORMACK-MILLER........................................................................ SR VICE PRESIDENT/CNO	30.00 .......................20.00		X			276,789	0	13,241
(21) KENT HALL MD........................................................................ SR VICE PRESIDENT/CMO	30.00 .......................20.00		X			600,694	0	27,977
(22) ERIC PORRITT MD........................................................................ PHYSICIAN	50.00 .......................			X		658,043	0	27,416
(23) MARIO CARRILLO DO........................................................................ PHYSICIAN	50.00 .......................			X		813,715	0	27,376
(24) CHRISTOPHER MAX MD........................................................................ PHYSICIAN	50.00 .......................			X		953,665	0	27,185
(25) ANDREW PELLECCHIA MD........................................................................ PHYSICIAN	50.00 .......................			X		746,058	0	27,426
(26) GHASSAN KOUSSA MD........................................................................ PHYSICIAN	50.00 .......................			X		644,341	0	32,417
(27) WALEED ALBERT MD........................................................................ FORMER FSLH MEDICAL STAFF PRESIDE	0.00 .......................0.00				X	42,004	0	0
(28) MARIA GESUALDO MD........................................................................ FORMER DIRECTOR	0.00 .......................0.00				X	91,025	0	0
(29) SCOTT PERRA FACHE........................................................................ FORMER PRESIDENT/CEO	0.00 .......................				X	244,048	0	8,819
(30) ERIC YOSS MD........................................................................ FORMER CMO	50.00 .......................				X	392,860	0	24,327

(A) Name and business address	(B) Description of services	(C) Compensation
SUNSET ANESTHESIA ASSOCIATES 1676 SUNSET AVE UTICA,NY13502	ANESTHESIA SERVICES	4,473,413
DAVIN HEALTHCARE 18 DIVISION ST SARATOGA SPRINGS,NY12866	MEDICAL SERVICES	4,028,007
UNITED HEALTH SERVICES 10-42 MITCHELL AVE BINGHAMTON,NY13903	PHYSICIAN/MEDICAL SERVICES	1,885,000
UPSTATE UROLOGY 750 E ADAMS ST SYRACUSE,NY13210	PHYSICIAN/MEDICAL SERVICES	1,768,499
SODEXO 525 WILLIAM PENN PLACE PITTSBURGH,PA15251	NUTRITIONAL SERVICES	1,692,751
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 48

- TIN:

SCHEDULE A
(Form 990)

Department of the Treasury
Internal Revenue Service

Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section 4947(a)(1) nonexempt charitable trust.
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Attach to Form 990 or Form 990-EZ.
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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

FAXTON ST LUKE'S HEALTHCARE

Employer identification number

16-1576637

Part I

Reason for Public Charity Status (All organizations must complete this part.) See instructions.

The organization is not a private foundation because it is: (For lines 1 through 12, check only one box.)

A church, convention of churches, or association of churches described in section 170(b)(1)(A)(i).

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E (Form 990).)

A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).

A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital's name, city, and state:

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in section 170(b)(1)(A)(iv). (Complete Part II.)

A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in section 170(b)(1)(A)(vi). (Complete Part II.)

A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)

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

An organization that normally receives: (1) more than 33 1/3% of its support from contributions, membership fees, and gross receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 33 1/3% of its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)

An organization organized and operated exclusively to test for public safety. See section 509(a)(4).

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box on lines 12a through 12d that describes the type of supporting organization and complete lines 12e, 12f, and 12g.

Type I. A supporting organization operated, supervised, or controlled by its supported organization(s), typically by giving the supported organization(s) the power to regularly appoint or elect a majority of the directors or trustees of the supporting organization. You must complete Part IV, Sections A and B.

Type II. A supporting organization supervised or controlled in connection with its supported organization(s), by having control or management of the supporting organization vested in the same persons that control or manage the supported organization(s). You must complete Part IV, Sections A and C.

Type III functionally integrated. A supporting organization operated in connection with, and functionally integrated with, its supported organization(s) (see instructions). You must complete Part IV, Sections A, D, and E.

Type III non-functionally integrated. A supporting organization operated in connection with its supported organization(s) that is not functionally integrated. The organization generally must satisfy a distribution requirement and an attentiveness requirement (see instructions). You must complete Part IV, Sections A and D, and Part V.

Check this box if the organization received a written determination from the IRS that it is a Type I, Type II, Type III functionally integrated, or Type III non-functionally integrated supporting organization.

Enter the number of supported organizations ...............................

Provide the following information about the supported organization(s).

(i) Name of supported organization	(ii) EIN	(iv) Is the organization listed in your governing document?		(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)
(i) Name of supported organization	(ii) EIN	Yes	No	(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)


Total

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

Cat. No. 11285F

Schedule A (Form 990) 2021

Page 2

Part II

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

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2017	(b) 2018	(c) 2019	(d) 2020	(e) 2021	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") ..
2	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf....
3	The value of services or facilities furnished by a governmental unit to the organization without charge..
4	Total. Add lines 1 through 3
5	The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f) ..
6	Public support. Subtract line 5 from line 4.

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2017	(b) 2018	(c) 2019	(d) 2020	(e) 2021	(f) Total
7	Amounts from line 4..
8	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...
9	Net income from unrelated business activities, whether or not the business is regularly carried on..
10	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.)..
11	Total support. Add lines 7 through 10

Gross receipts from related activities, etc. (see instructions) ..................

First 5 years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here ........................................ right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2021 (line 6, column (f) divided by line 11, column (f)) .........

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

16a

33 1/3% support test—2021. If the organization did not check the box on line 13, and line 14 is 33 1/3 % or more, check this box
and stop here. The organization qualifies as a publicly supported organization ....................... right arrow

33 1/3% support test—2020. If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2021. If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain
in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization ..................................................... right arrow

10%-facts-and-circumstances test—2020. If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly
supported organization ................................................ right arrow

Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ..................................................... right arrow

Schedule A (Form 990) 2021

Page 3

Part III

Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 10 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2017	(b) 2018	(c) 2019	(d) 2020	(e) 2021	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2	Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose
3	Gross receipts from activities that are not an unrelated trade or business under section 513 .....
4	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5	The value of services or facilities furnished by a governmental unit to the organization without charge
6	Total. Add lines 1 through 5
7a	Amounts included on lines 1, 2, and 3 received from disqualified persons
b	Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c	Add lines 7a and 7b..
8	Public support. (Subtract line 7c from line 6.)

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2017	(b) 2018	(c) 2019	(d) 2020	(e) 2021	(f) Total
9	Amounts from line 6...
10a	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b	Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c	Add lines 10a and 10b.
11	Net income from unrelated business activities not included on line 10b, whether or not the business is regularly carried on.
12	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) ..
13	Total support. (Add lines 9, 10c, 11, and 12.)..

First 5 years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization,
check this box and stop here............................................. right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2021 (line 8, column (f) divided by line 13, column (f)) .........

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

Section D. Computation of Investment Income Percentage

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

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

19a

331/3% support tests—2021. If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ....... right arrow

33 1/3% support tests—2020. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .... right arrow

Private foundation. If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions .... right arrow

Schedule A (Form 990) 2021

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 12 of Part I. If you checked box 12a, of Part I, complete Sections A and B. If you checked box 12b, of Part I, complete Sections A and C. If you checked box 12c, of Part I, complete Sections A, D, and E. If you checked box12d, of Part I, complete Sections A and D, and complete Part V.)

Section A. All Supporting Organizations

Yes

Are all of the organization’s supported organizations listed by name in the organization’s governing documents?
If "No," describe in Part VI how the supported organizations are designated. If designated by class or purpose,
describe the designation. If historic and continuing relationship, explain.

Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or (2)? If "Yes," explain in Part VI how the organization determined that the supported organization was described in section 509(a)(1) or (2).

Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer lines 3b and 3c below.

Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the public support tests under section 509(a)(2)? If "Yes," describe in Part VI when and how the organization made the determination.

Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) purposes? If "Yes," explain in Part VI what controls the organization put in place to ensure such use.

Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked box 12a or 12b in Part I, answer lines 4b and 4c below.

Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? If “Yes,” describe in Part VI how the organization had such control and discretion despite being controlled or supervised by or in connection with its supported organizations.

Did the organization support any foreign supported organization that does not have an IRS determination under sections 501(c)(3) and 509(a)(1) or (2)? If “Yes,” explain in Part VI what controls the organization used to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B) purposes.

Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer lines 5b and 5c below (if applicable). Also, provide detail in Part VI, including (i) the names and EIN numbers of the supported organizations added, substituted, or removed; (ii) the reasons for each such action; (iii) the authority under the organization's organizing document authorizing such action; and (iv) how the action was accomplished (such as by amendment to the organizing document).

Type I or Type II only. Was any added or substituted supported organization part of a class already designated in the organization's organizing document?

Substitutions only. Was the substitution the result of an event beyond the organization's control?

Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (i) its supported organizations, (ii) individuals that are part of the charitable class benefited by one or more of its supported organizations, or (iii) other supporting organizations that also support or benefit one or more of the filing organization’s supported organizations? If “Yes,” provide detail in Part VI.

Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (defined in section 4958(c)(3)(C)), a family member of a substantial contributor, or a 35% controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990) .

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

Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons, as defined in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or (2))? If “Yes,” provide detail in Part VI.

Did one or more disqualified persons (as defined on line 9a) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.

Did a disqualified person (as defined on line 9a) have an ownership interest in, or derive any personal benefit from, assets in which the supporting organization also had an interest? If “Yes,” provide detail in Part VI.

10a

Was the organization subject to the excess business holdings rules of section 4943 because of section 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer line 10b below.

10a

Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to determine whether the organization had excess business holdings).

10b

Schedule A (Form 990) 2021

Page 5

Part IV

Supporting Organizations (continued)

Yes

Has the organization accepted a gift or contribution from any of the following persons?

A person who directly or indirectly controls, either alone or together with persons described on lines 11b and 11c below, the governing body of a supported organization?

11a

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

11b

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

11c

Section B. Type I Supporting Organizations

Yes

Did the officers, directors, trustees, or membership of one or more supported organizations have the power to regularly appoint or elect at least a majority of the organization’s directors or trustees at all times during the tax year? If “No,” describe in Part VI how the supported organization(s) effectively operated, supervised, or controlled the organization’s activities. If the organization had more than one supported organization, describe how the powers to appoint and/or remove directors or trustees were allocated among the supported organizations and what conditions or restrictions, if any, applied to such powers during the tax year.

Did the organization operate for the benefit of any supported organization other than the supported organization(s) that operated, supervised, or controlled the supporting organization? If “Yes,” explain in Part VI how providing such benefit carried out the purposes of the supported organization(s) that operated, supervised or controlled the supporting organization.

Section C. Type II Supporting Organizations

Yes

Were a majority of the organization’s directors or trustees during the tax year also a majority of the directors or trustees of each of the organization’s supported organization(s)? If “No,” describe in Part VI how control or management of the supporting organization was vested in the same persons that controlled or managed the supported organization(s).

Section D. All Type III Supporting Organizations

Yes

Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s tax year, (i) a written notice describing the type and amount of support provided during the prior tax year, (ii) a copy of the Form 990 that was most recently filed as of the date of notification, and (iii) copies of the organization’s governing documents in effect on the date of notification, to the extent not previously provided?

Were any of the organization’s officers, directors, or trustees either (i) appointed or elected by the supported organization(s) or (ii) serving on the governing body of a supported organization? If "No," explain in Part VI how the organization maintained a close and continuous working relationship with the supported organization(s).

By reason of the relationship described in line 2 above, did the organization’s supported organizations have a significant voice in the organization’s investment policies and in directing the use of the organization’s income or assets at all times during the tax year? If "Yes," describe in Part VI the role the organization’s supported organizations played in this regard.

Section E. Type III Functionally-Integrated Supporting Organizations

Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):

The organization satisfied the Activities Test. Complete line 2 below.

The organization is the parent of each of its supported organizations. Complete line 3 below.

The organization supported a governmental entity. Describe in Part VI how you supported a government entity (see instructions)

Activities Test. Answer lines 2a and 2b below.

Yes

Did substantially all of the organization’s activities during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was responsive? If "Yes," then in Part VI identify those supported organizations and explain how these activities directly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these activities constituted substantially all of its activities.

Did the activities described on line 2a, above constitute activities that, but for the organization’s involvement, one or more of the organization’s supported organization(s) would have been engaged in? If "Yes," explain in Part VI the reasons for the organization’s position that its supported organization(s) would have engaged in these activities but for the organization’s involvement.

Parent of Supported Organizations. Answer lines 3a and 3b below.

Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations?If "Yes" or "No", provide details in Part VI.

Did the organization exercise a substantial degree of direction over the policies, programs and activities of each of its supported organizations? If "Yes," describe in Part VI. the role played by the organization in this regard.

Schedule A (Form 990) 2021

Page 6

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations

Check here if the organization satisfied the Integral Part Test as a qualifying trust on Nov. 20, 1970 (explain in Part VI). See instructions. All other Type III non-functionally integrated supporting organizations must complete Sections A through E.

	Section A - Adjusted Net Income		(A) Prior Year	(B) Current Year (optional)
1	Net short-term capital gain	1
2	Recoveries of prior-year distributions	2
3	Other gross income (see instructions)	3
4	Add lines 1 through 3	4
5	Depreciation and depletion	5
6	Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions)	6
7	Other expenses (see instructions)	7
8	Adjusted Net Income (subtract lines 5, 6 and 7 from line 4)	8

	Section B - Minimum Asset Amount		(A) Prior Year	(B) Current Year (optional)
1	Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year):	1
a	Average monthly value of securities	1a
b	Average monthly cash balances	1b
c	Fair market value of other non-exempt-use assets	1c
d	Total (add lines 1a, 1b, and 1c)	1d
e	Discount claimed for blockage or other factors (explain in detail in Part VI):
2	Acquisition indebtedness applicable to non-exempt use assets	2
3	Subtract line 2 from line 1d	3
4	Cash deemed held for exempt use. Enter 0.015 of line 3 (for greater amount, see instructions).	4
5	Net value of non-exempt-use assets (subtract line 4 from line 3)	5
6	Multiply line 5 by 0.035	6
7	Recoveries of prior-year distributions	7
8	Minimum Asset Amount (add line 7 to line 6)	8

	Section C - Distributable Amount		Current Year
1	Adjusted net income for prior year (from Section A, line 8, Column A)	1
2	Enter 85% of line 1	2
3	Minimum asset amount for prior year (from Section B, line 8, Column A)	3
4	Enter greater of line 2 or line 3	4
5	Income tax imposed in prior year	5
6	Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions)	6

Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions)

Schedule A (Form 990) 2021

Page 7

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations(continued)

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

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

Schedule A (Form 990) (2021)

Schedule A (Form 990) 2021

Page 8

Part VI

Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; Part III, line 12; Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11a, 11b, and 11c; Part IV, Section B, lines 1 and 2; Part IV, Section C, line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 1c, 2a, 2b, 3a and 3b; Part V, line 1; Part V, Section B, line 1e; Part V Section D, lines 5, 6, and 8; and Part V, Section E, lines 2, 5, and 6. Also complete this part for any additional information. (See instructions).

Facts And Circumstances Test

Return Reference	Explanation

Schedule A (Form 990) 2021

Additional Data

Software ID:
Software Version:

- TIN:

Schedule B
(Form 990)

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

Attach to Form 990, 990-EZ, or 990-PF.

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

OMB No. 1545-0047

2021

Name of the organization

FAXTON ST LUKE'S HEALTHCARE

Employer identification number

16-1576637

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

4947(a)(1) nonexempt charitable trust not treated as a private foundation

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

4947(a)(1) nonexempt charitable trust treated as a private foundation

501(c)(3) taxable private foundation

Check if your organization is covered by the General Rule or a Special Rule.
Note: Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.

General Rule

For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, contributions totaling $5,000 or more (in money or other property) from any one contributor. Complete Parts I and II. See instructions for determining a contributor's total contributions.

Special Rules

For an organization described in section 501(c)(3) filing Form 990 or 990-EZ that met the 33¹/3% support test of the regulations
under sections 509(a)(1) and 170(b)(1)(A)(vi), that checked Schedule A (Form 990 or 990-EZ), Part II, line 13, 16a, or 16b, and that received from any one contributor, during the year, total contributions of the greater of (1) $5,000 or (2) 2% of the amount on (i) Form 990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts I and II.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, total contributions of more than $1,000 exclusively for religious, charitable, scientific, literary, or educational purposes, or for the prevention of cruelty to children or animals. Complete Parts I, II, and III.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, contributions exclusively for religious, charitable, etc., purposes, but no such contributions totaled more than $1,000. If this box is checked, enter here the total contributions that were received during the year for an exclusively religious, charitable, etc., purpose. Don't complete any of the parts unless the General Rule applies to this organization because it received nonexclusively religious, charitable, etc., contributions totaling $5,000 or more during the year ......... Arrow Bullet

Caution: An organization that isn't covered by the General Rule and/or the Special Rules doesn't file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its Form 990-EZ
or on its Form 990PF, Part I, line 2, to certify that it doesn't meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).

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

Cat. No. 30613XSchedule B (Form 990) (2021)

Schedule B (Form 990) (2021) Page 2

Name of organization FAXTON ST LUKE'S HEALTHCARE

Part I Contributors	Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
RESTRICTED	,	$ RESTRICTED	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
Schedule B (Form 990) (2021)

Schedule B (Form 990) (2021)

Page 3

Name of organization FAXTON ST LUKE'S HEALTHCARE		Employer identification number 16-1576637

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 FAXTON ST LUKE'S HEALTHCARE			Employer identification number 16-1576637
Part III Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year from any one contributor. Complete columns (a) through (e) and the following line entry. For organizations completing Part III, enter the total of exclusively religious, charitable, etc., contributions of $1,000 or less for the year. (Enter this information once. See instructions.) $ Use duplicate copies of Part III if additional space is needed.

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

Schedule B (Form 990) (2021)

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE C
(Form 990)

Department of the Treasury
Internal Revenue Service

Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527

SchCMd Bullet

Complete if the organization is described below. SchCMd Bullet

Attach to Form 990 or Form 990-EZ.
SchCMd Bullet

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

OMB No. 1545-0047

2021

Open to Public
Inspection

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

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

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

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

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

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

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

Name of the organization

FAXTON ST LUKE'S HEALTHCARE

Employer identification number

16-1576637

Part I-A

Complete if the organization is exempt under section 501(c) or is a section 527 organization.

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

Political campaign activity expenditures. See instructions .................................................................... SchCMd Bullet

Volunteer hours for political campaign activities. See instructions ..................................................................

Part I-B

Complete if the organization is exempt under section 501(c)(3).

Enter the amount of any excise tax incurred by the organization under section 4955 ................................ SchCMd Bullet

Enter the amount of any excise tax incurred by organization managers under section 4955 ....................... SchCMd Bullet

If the organization incurred a section 4955 tax, did it file Form 4720 for this year? .........................................

Yes No

Was a correction made? ......................................................................................................................

Yes No

If "Yes," describe in Part IV.

Part I-C

Complete if the organization is exempt under section 501(c), except section 501(c)(3).

Enter the amount directly expended by the filing organization for section 527 exempt function activities ..... SchCMd Bullet

Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ............................................................................................................................ SchCMd Bullet

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

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

Yes No

Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.

(a) Name	(b) Address	(c) EIN	(d) Amount paid from filing organization's funds. If none, enter -0-.	(e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.
1
2
3
4
5
6

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

Cat. No. 50084S

Schedule C (Form 990) 2021

Page 2

Part II-A

Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).

A Check SchCMd Bullet

if the filing organization belongs to an affiliated group (and list in Part IV each affiliated group member's name, address, EIN, expenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet

if the filing organization checked box A and "limited control" provisions apply.

Limits on Lobbying Expenditures (The term "expenditures" means amounts paid or incurred.)		(b) Affiliated group totals
1a	Total lobbying expenditures to influence public opinion (grass roots lobbying) ......................
b	Total lobbying expenditures to influence a legislative body (direct lobbying) ........................
c	Total lobbying expenditures (add lines 1a and 1b) ............................................................
d	Other exempt purpose expenditures ...............................................................................
e	Total exempt purpose expenditures (add lines 1c and 1d) ..................................................
f	Lobbying nontaxable amount. Enter the amount from the following table in both columns.
	If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:
	Not over $500,00020% of the amount on line 1e.
	Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.
	Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.
	Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.
	Over $17,000,000$1,000,000.

g	Grassroots nontaxable amount (enter 25% of line 1f) .................................................
h	Subtract line 1g from line 1a. If zero or less, enter -0-. ................................................
i	Subtract line 1f from line 1c. If zero or less, enter -0-. ................................................
j	If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting section 4911 tax for this year? ...................................................................................................................	Yes No

4-Year Averaging Period Under Section 501(h) (Some organizations that made a section 501(h) election do not have to complete all of the five columns below. See the separate instructions for lines 2a through 2f.)
Lobbying Expenditures During 4-Year Averaging Period
	Calendar year (or fiscal year beginning in)	(a) 2018	(b) 2019	(c) 2020	(d) 2021	(e) Total

2a	Lobbying nontaxable amount

b	Lobbying ceiling amount (150% of line 2a, column(e))

c	Total lobbying expenditures

d	Grassroots nontaxable amount

e	Grassroots ceiling amount (150% of line 2d, column (e))

f	Grassroots lobbying expenditures

Schedule C (Form 990) 2021

Page 3

Part II-B

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

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

(a)

Yes|No

(b)

Amount

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

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

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

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

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

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

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

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

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

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

Yes

63,130

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

63,130

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

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

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

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

Part III-A

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

Yes

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

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

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

Part III-B

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

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

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

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

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

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

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

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

Taxable amount of lobbying and political expenditures. See Instructions .........................................

Part IV

Supplemental Information

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

Return Reference	Explanation
PART II-B, LINE 1:	PARTICIPATION IS BASED ON THE MEMBERSHIP DUES PAID TO HANYS AND IROQUOIS HEALTHCARE ASSOCIATION AS INDICATED ON LINE 2. THE FOLLOWING NARRATIVES, WERE TAKEN DIRECTLY FROM THEIR RESPECTIVE WEBSITES: 1. HANYS IS PROUD TO BE THE ONLY STATEWIDE ASSOCIATION THAT REPRESENTS AND ADVOCATES ON BEHALF OF NEW YORK'S HOSPITALS AND HEALTH SYSTEMS AT ALL LEVELS OF THE FEDERAL AND STATE GOVERNMENT. HANYS HAS ACCESS TO POLICY LEADERS, REGARDLESS OF THEIR POLITICAL AFFILIATION AND IS AN INTEGRAL PLAYER IN HEALTH POLICY DISCUSSIONS. HANYS ALSO COMMUNICATES MEMBERS CONCERNS AND POSITIONS TO NEW YORK AND NATIONAL MEDIA IN SUPPORT OF THE ASSOCIATIONS LEGISLATIVE AND REGULATORY INTITIATIVES. 2. IROQUOIS IS THE REGIONAL VOICE IN ALBANY AND WASHINGTON FOR UPSATE HOSPITALS AND HEALTH CARE SYSTEM MEMBERS. IROQUOIS PROMOTES A BROADER UNDERSTANDING OF, AND BUILDS SUPPORT FOR, THE HEALTH CARE SYSTEMS SERVING UPSTATE NEW YORK. IROQUOIS PROVIDES REPRESENTATION AND ADVOCACY AT THE STATE LEVEL BY EFFECTIVELY LOBBYING THE STATE LEGISLATURE, AND ESTABLISHING CLOSE WORKING RELATIONSHIPS WITH THE GOVERNORS OFFICE, STATE AGENCY OFFICIALS, AND REGULATORY REPRESENTATIVES. IROQUOIS INFLUENCES PUBLIC POLICY DEVELOPMENT THROUGH BOTH LEGISLATIVE AND REGULATORY ADVOCACY EFFORTS. REGIONAL ACTIVITIES, SUCH AS HOSTING LEGISLATORS AND MEETING WITH LOCAL OFFICIALS, ARE CRITICAL TO MAINTAINING A UNIFIED VOICE FOR LEGISLATIVE AND REGULATORY ACTION. IROQUOIS CONTINUES TO WORK WITH THE NY STATE ADMINISTRATION TO ADDRESS ISSUES AFFECTING UPSTATE HOSPITALS, REVIEW THE EXECUTIVE BUDGET PROPOSAL AND ALSO WORK WITH THE STATE LEGISLATURE. ALL ADVOCACY EFFORTS FOCUS ON THE SIMPLE TRUTH THAT HOSPITALS EXIST TO SERVE. THEIR ABILITY TO SERVE WELL, REQUIRES A RELATIONSHIP WITH THEIR COMMUNITIES BUILT ON TRUST AND COMPASSION. TO SERVE COMMUNITES WELL, HOSPITALS MUST ALSO MANAGE RESOURCES IN A CHALLENGING ENVIRONMENT.

Return Reference

Explanation

PART II-B, LINE 1:

PARTICIPATION IS BASED ON THE MEMBERSHIP DUES PAID TO HANYS AND IROQUOIS HEALTHCARE ASSOCIATION AS INDICATED ON LINE 2. THE FOLLOWING NARRATIVES, WERE TAKEN DIRECTLY FROM THEIR RESPECTIVE WEBSITES: 1. HANYS IS PROUD TO BE THE ONLY STATEWIDE ASSOCIATION THAT REPRESENTS AND ADVOCATES ON BEHALF OF NEW YORK'S HOSPITALS AND HEALTH SYSTEMS AT ALL LEVELS OF THE FEDERAL AND STATE GOVERNMENT. HANYS HAS ACCESS TO POLICY LEADERS, REGARDLESS OF THEIR POLITICAL AFFILIATION AND IS AN INTEGRAL PLAYER IN HEALTH POLICY DISCUSSIONS. HANYS ALSO COMMUNICATES MEMBERS CONCERNS AND POSITIONS TO NEW YORK AND NATIONAL MEDIA IN SUPPORT OF THE ASSOCIATIONS LEGISLATIVE AND REGULATORY INTITIATIVES. 2. IROQUOIS IS THE REGIONAL VOICE IN ALBANY AND WASHINGTON FOR UPSATE HOSPITALS AND HEALTH CARE SYSTEM MEMBERS. IROQUOIS PROMOTES A BROADER UNDERSTANDING OF, AND BUILDS SUPPORT FOR, THE HEALTH CARE SYSTEMS SERVING UPSTATE NEW YORK. IROQUOIS PROVIDES REPRESENTATION AND ADVOCACY AT THE STATE LEVEL BY EFFECTIVELY LOBBYING THE STATE LEGISLATURE, AND ESTABLISHING CLOSE WORKING RELATIONSHIPS WITH THE GOVERNORS OFFICE, STATE AGENCY OFFICIALS, AND REGULATORY REPRESENTATIVES. IROQUOIS INFLUENCES PUBLIC POLICY DEVELOPMENT THROUGH BOTH LEGISLATIVE AND REGULATORY ADVOCACY EFFORTS. REGIONAL ACTIVITIES, SUCH AS HOSTING LEGISLATORS AND MEETING WITH LOCAL OFFICIALS, ARE CRITICAL TO MAINTAINING A UNIFIED VOICE FOR LEGISLATIVE AND REGULATORY ACTION. IROQUOIS CONTINUES TO WORK WITH THE NY STATE ADMINISTRATION TO ADDRESS ISSUES AFFECTING UPSTATE HOSPITALS, REVIEW THE EXECUTIVE BUDGET PROPOSAL AND ALSO WORK WITH THE STATE LEGISLATURE. ALL ADVOCACY EFFORTS FOCUS ON THE SIMPLE TRUTH THAT HOSPITALS EXIST TO SERVE. THEIR ABILITY TO SERVE WELL, REQUIRES A RELATIONSHIP WITH THEIR COMMUNITIES BUILT ON TRUST AND COMPASSION. TO SERVE COMMUNITES WELL, HOSPITALS MUST ALSO MANAGE RESOURCES IN A CHALLENGING ENVIRONMENT.

Schedule C (Form 990) 2021

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," on Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b.
SchDMd Bullet

Attach to Form 990.
SchDMd Bullet

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

OMB No. 1545-0047

2021

Open to Public Inspection

Name of the organization

FAXTON ST LUKE'S HEALTHCARE

Employer identification number

16-1576637

Part I

Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" on Form 990, Part IV, line 6.

		(a) Donor advised funds	(b) Funds and other accounts
1	Total number at end of year .........
2	Aggregate value of contributions to (during year)
3	Aggregate value of grants from (during year)
4	Aggregate value at end of year ........

Did the organization inform all donors and donor advisors in writing that the assets held in donor advised funds are the organization’s property, subject to the organization’s exclusive legal control? ............

Yes No

Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................

Yes No

Part II

Conservation Easements.
Complete if the organization answered "Yes" on Form 990, Part IV, line 7.

Purpose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e.g., recreation or education) Preservation of an historically important land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.


a	Total number of conservation easements ......................	2a
b	Total acreage restricted by conservation easements ....................	2b
c	Number of conservation easements on a certified historic structure included in (a) .....	2c
d	Number of conservation easements included in (c) acquired after 7/25/06, and not on a historic structure listed in the National Register ...	2d

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the
tax year SchDMd Bullet

Number of states where property subject to conservation easement is located SchDMd Bullet

Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and enforcement of the conservation easements it holds? ............

Yes No

Staff and volunteer hours devoted to monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .............................

Yes No

In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" on Form 990, Part IV, line 8.

If the organization elected, as permitted under FASB ASC 958, not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII, the text of the footnote to its financial statements that describes these items.

If the organization elected, as permitted under FASB ASC 958, to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items:

(i)

Revenue included on Form 990, Part VIII, line 1 ......................... SchDMd Bullet

(ii)

Assets included in Form 990, Part X ............................... SchDMd Bullet

If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under FASB ASC 958 relating to these items:

Revenue included on Form 990, Part VIII, line 1 .......................... SchDMd Bullet

Assets included in Form 990, Part X ............................... SchDMd Bullet

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

Cat. No. 52283D

Schedule D (Form 990) 2021

Page 2

Part III

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

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

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

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

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

Yes No

Part IV

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

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

Yes No


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

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

Yes No

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

Part V

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

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

1a	Beginning of year balance ....	10,413,508	9,848,704	8,919,101	9,256,788	8,535,658
b	Contributions ...					1,647,171
c	Net investment earnings, gains, and losses	568,973	564,804	929,603	-337,687	490,359
d	Grants or scholarships ...
e	Other expenditures for facilities and programs ...					1,416,400
f	Administrative expenses ....
g	End of year balance ......	10,982,481	10,413,508	8,919,101	8,919,101	9,256,788

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

Board designated or quasi-endowment SchDMd Bullet

5.180 %

Permanent endowment SchDMd Bullet

41.230 %

Term endowment SchDMd Bullet

53.590 %

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

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

Yes

(i) Unrelated organizations .................

3a(i)

(ii) Related organizations .................

3a(ii)

Yes

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

Yes

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

Part VI

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

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

1a	Land .....	2,396,536		2,396,536
b	Buildings ....	113,625,104	92,370,838	21,254,266
c	Leasehold improvements	2,629,582	2,629,582	0
d	Equipment ....	158,003,059	118,994,235	39,008,824
e	Other .....	4,919,507	4,079,288	840,219
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				63,499,845

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) CORPORATE OBLIGATIONS	17,490,822	F
(B) MUTUAL FUNDS INVESTMENTS	142,248,745	F
(C) ASSETS LIMITED AS TO USE	5,128,112	C
(C)
(D)
(E)
(F)
(G)
(H)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)	164,867,679

Part VIII

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

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

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

Part IX

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

(a) Description				(b) Book value
(1)DUE FROM AFFILIATES				9,002,818
(2)G&P INSURANCE RECEIVABLE LT, NET				14,249,704
(3)OTHER ASSETS				9,852,972
(4)WC INSURANCE RECEIVABLE LT, NET				6,851,660
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........				39,957,154

Part X

Other Liabilities.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.

1.(a) Description of liability	(b) Book value
(1) Federal income taxes
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	69,896,209
2. Liability for uncertain tax positions. In Part XIII, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC 740). Check here if the text of the footnote has been provided in Part XIII

Schedule D (Form 990) 2021

Page 4

Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total revenue, gains, and other support per audited financial statements .......			1	356,843,106
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	1,165,160
e	Add lines 2a through 2d .....................			2e	1,165,160
3	Subtract line 2e from line 1..................			3	355,677,946
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	8,812,952
c	Add lines 4a and 4b....................			4c	8,812,952
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......			5	364,490,898

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	344,994,333
2	Amounts included on line 1 but not on Form 990, Part IX, line 25:
a	Donated services and use of facilities .........	2a
b	Prior year adjustments ............	2b
c	Other losses ................	2c
d	Other (Describe in Part XIII.) ............	2d	1,165,160
e	Add lines 2a through 2d....................			2e	1,165,160
3	Subtract line 2e from line 1...................			3	343,829,173
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	8,812,952
c	Add lines 4a and 4b.....................			4c	8,812,952
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......			5	352,642,125

Part XIII

Supplemental Information

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

Return Reference	Explanation
PART V, LINE 4:	PERMANENT ENDOWMENT FUNDS ARE TO BE HELD IN PERPETUITY, THE INCOME FROM WHICH IS TO BE USED TO SUPPORT CHARITY CARE, HEALTH CARE SERVICES, SCHOLARSHIPS AND FACILITY MAINTENANCE. TEMPORARY ENDOWMENT FUNDS ARE DONOR CONTRIBUTIONS RESTRICTED BY THE DONORS FOR SPECIFIC PURPOSES.
PART X, LINE 2:	HEALTHCARE IS A NOT-FOR-PROFIT CORPORATION AND HAS BEEN RECOGNIZED AS TAX-EXEMPT PURSUANT TO SECTION 501C(3) OF THE INTERNAL REVENUE CODE. AS OF DECEMBER 31, 2021 AND 2020, HEALTHCARE DID NOT HAVE ANY UNRECOGNIZED TAX BENEFITS OR ANY RELATED ACCRUED INTEREST OR PENALTIES. THE TAX YEARS OPEN TO EXAMINATION BY FEDERAL AND STATE TAXING AUTHORITIES ARE 2018-2021. HEALTHCARE DOES NOT ANTICIPATE THE TOTAL UNRECOGNIZED TAX BENEFITS WILL CHANGE IN THE NEXT TWELVE MONTHS.
PART XI, LINE 2D - OTHER ADJUSTMENTS:	RENTAL EXPENSES 1,165,160.
PART XI, LINE 4B - OTHER ADJUSTMENTS:	BAD DEBT 8,812,952.
PART XII, LINE 2D - OTHER ADJUSTMENTS:	RENTAL EXPENSES 1,165,160.
PART XII, LINE 4B - OTHER ADJUSTMENTS:	BAD DEBT 8,812,952.

Schedule D (Form 990) 2021

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE H
(Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

Complete if the organization answered "Yes" on Form 990, Part IV, question 20.
MediumBullet

Attach to Form 990.
MediumBullet

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

OMB No. 1545-0047

2021

Open to Public Inspection

Name of the organization

FAXTON ST LUKE'S HEALTHCARE

Employer identification number

16-1576637

Part I

Financial Assistance and Certain Other Community Benefits at Cost

Yes

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

Yes

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

Yes

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

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

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

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

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

Yes

100% 150% 200% Other 25000.0000000000 %

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

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

Yes

200% 250% 300% 350% 400% Other 32500.0000000000 %

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

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

Yes

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

Yes

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

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

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

Yes

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

Yes

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

Financial Assistance and Certain Other Community Benefits at Cost

Financial Assistance and Means-Tested Government Programs		(c) Total community benefit expense	(d) Direct offsetting revenue	(e) Net community benefit expense	(f) Percent of total expense
a	Financial Assistance at cost (from Worksheet 1) . . .	2,731,455	806,919	1,924,536	0.560 %
b	Medicaid (from Worksheet 3, column a) . . . . .	72,890,129	55,572,805	17,317,324	5.040 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .	0	0		0 %
d	Total Financial Assistance and Means-Tested Government Programs . . . . .	75,621,584	56,379,724	19,241,860	5.600 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).	1,085,858	0	1,085,858	0.320 %
f	Health professions education (from Worksheet 5) . . .	1,059,543	917,109	142,434	0.040 %
g	Subsidized health services (from Worksheet 6) . . . .	3,670,038	2,570,265	1,099,773	0.320 %
h	Research (from Worksheet 7) .	3,635	1,210	2,425	0 %
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .	0	0		0 %
j	Total. Other Benefits . .	5,819,074	3,488,584	2,330,490	0.680 %
k	Total. Add lines 7d and 7j .	81,440,658	59,868,308	21,572,350	6.280 %

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

Schedule H (Form 990) 2021

Page

Part II

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

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

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

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

Yes

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

2,589,247

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. ......

952,115

Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.

Section B. Medicare

Enter total revenue received from Medicare (including DSH and IME).....

141,563,852

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

192,819,320

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

-51,255,468

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

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

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

Yes

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

Yes

Part IV

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

(a) Name of entity	(b) Description of primary activity of entity	(c) Organization's profit % or stock ownership %	(d) Officers, directors, trustees, or key employees' profit % or stock ownership %	(e) Physicians' profit % or stock ownership %
11 MOHAWK VALLEY ENDOSCOPY CENTER	ENDOSCOPY SERVICES	20.000 %	0 %	60.000 %
2
3
4
5
6
7
8
9
10
11
12
13

Schedule H (Form 990) 2021

Page

Part VFacility Information

Section A. Hospital Facilities (list in order of size from largest to smallest—see instructions)How many hospital facilities did the organization operate during the tax year?1Name, address, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility)					Other (describe)
1	FAXTON ST LUKES HEALTHCARE INC PO BOX 479 UTICA,NY13503 FAXTONSTLUKES.COM 17-30-91	X	X	X	DENTAL CLINIC;DIAGNOSTICS;MEDICAL IMAGING;DIALYSIS; L&D; URGENT CARE

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)

	FAXTON ST LUKES HEALTHCARE INC
Name of hospital facility or letter of facility reporting group

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

Yes

Community Health Needs Assessment

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

Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C...............

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

Yes

If "Yes," indicate what the CHNA report describes (check all that apply):

A definition of the community served by the hospital facility

Demographics of the community

Existing health care facilities and resources within the community that are available to respond to the health needs of the community

How data was obtained

The significant health needs of the community

Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups

The process for identifying and prioritizing community health needs and services to meet the community health needs

The process for consulting with persons representing the community’s interests

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

Other (describe in Section C)

Indicate the tax year the hospital facility last conducted a CHNA: 20 19

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

Yes

6 a

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

Yes

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

Yes

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

Yes

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

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

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

Made a paper copy available for public inspection without charge at the hospital facility

Other (describe in Section C)

Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. ..............

Yes

Indicate the tax year the hospital facility last adopted an implementation strategy: 20 19

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

Yes

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

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

10b

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

12a

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

12a

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

12b

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

Schedule H (Form 990) 2021

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	FAXTON ST LUKES HEALTHCARE INC
Name of hospital facility or letter of facility reporting group

Yes

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

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

Yes

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

Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of 250.000000000000%
and FPG family income limit for eligibility for discounted care of 325.000000000000%

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

Explained the basis for calculating amounts charged to patients?.................

Yes

Explained the method for applying for financial assistance?...................

Yes

If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):

Described the information the hospital facility may require an individual to provide as part of his or her application

Described the supporting documentation the hospital facility may require an individual to submit as part of his or
her application

Provided the contact information of hospital facility staff who can provide an individual with information about the
FAP and FAP application process

Provided the contact information of nonprofit organizations or government agencies that may be sources of
assistance with FAP applications

Other (describe in Section C)

Was widely publicized within the community served by the hospital facility?........

Yes

If "Yes," indicate how the hospital facility publicized the policy (check all that apply):

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

WWW.MVHEALTHSYSTEM.ORG/FINANCIAL-ASSISTANCE-PROGRAM

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

WWW.MVHEALTHSYSTEM.ORG/FINANCIAL-ASSISTANCE-PROGRAM

A plain language summary of the FAP was widely available on a website (list url):
WWW.MVHEALTHSYSTEM.ORG/FINANCIAL-ASSISTANCE-PROGRAM

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

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

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

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

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

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

Other (describe in Section C)

Schedule H (Form 990) 2021

Page 6

Part VFacility Information (continued)

Billing and Collections

	FAXTON ST LUKES HEALTHCARE INC
Name of hospital facility or letter of facility reporting group

Yes

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

Yes

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

Reporting to credit agency(ies)

Selling an individual’s debt to another party

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

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

None of these actions or other similar actions were permitted

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

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

Reporting to credit agency(ies)

Selling an individual’s debt to another party

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

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

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

Provided a written notice about upcoming ECAs (Extraordinary Collection Action) and a plain language summary of the
FAP at least 30 days before initiating those ECAs (if not, describe in Section C)

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

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

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

Other (describe in Section C)

None of these efforts were made

Policy Relating to Emergency Medical Care

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

Yes

If "No," indicate why:

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

The hospital facility’s policy was not in writing

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

Other (describe in Section C)

Schedule H (Form 990) 2021

Page 7

Part VFacility Information (continued)

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

	FAXTON ST LUKES HEALTHCARE INC
Name of hospital facility or letter of facility reporting group

Yes

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

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

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

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

The hospital facility used a prospective Medicare or Medicaid method

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

If "Yes," explain in Section C.

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

If "Yes," explain in Section C.

Schedule H (Form 990) 2021

Page 8

Part V

Facility Information (continued)

Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16j, 18e, 19e, 20a, 20b, 20c, 20d, 20e, 21c, 21d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference	Explanation
FAXTON ST LUKES HEALTHCARE, INC.	PART V, SECTION B, LINE 5: DISEASE PREVENTION: PLANNING WITH COMMUNITY BASED ORGANIZATIONS TO DEVELOP/DISTRIBUTE CURRICULUM FOR CANCER RELATED EDUCATIONAL ACTIVITIES IN RURAL AREAS, OFFER SCREENING EVENTS; MARKETING DEVELOPMENT AND IMPLEMENTATION PROMOTING CANCER PREVENTION; PLANNING WITH PARTNERS TO DEVELOP CURRICULUM FOR CHRONIC DISEASE PREVENTION, OUTREACH EFFORTS AND IDENTIFY VENUES TO DISTRIBUTE EDUCATIONAL INFORMATION; INCLUDING PHYSICIAN PRACTICES, FQHC'S AND OTHER PROVIDER OFFICES. MENTAL HEALTH/SUBSTANCE ABUSE: CONDUCTED PLANNING ACTIVITES WITH COMMUNITY REPRESENTATIVES RELATED TO MENTAL HEALTH TRAININGS. CONTINUED RELATIONSHIPS WITH TRAINING PROVIDERS. UPDATED LISTING OF DROP BOX LOCATIONS. CONTINUED ODMAP. PARTICIPATED IN THE IHA OPIOD ALTERNATIVE PROJECT TO ESTABLISH ALTERNATIVES TO PRESCRIBING OPIODS, DEVELOPED AND IMPLEMENTED WITH TRAINING TO PROVIDERS AND STAFF IN OUR ED. CONTINUED WORK WITH THE COUNTY OPIOD TASK FORCE PREVENTION WORKGROUP. DEVELOPMENT OF THESE EFFORTS WAS DONE IN CONJUNCTION WITH COUNTY LOCAL HEALTH DEPARTMENT PUBLIC HEALTH EDUCATOR, A LOCAL MARKETING COMPANY, UPSTATE UNIVERSITY MOBILE MAMMOGRAPHY PROGRAM MANAGER, CANCER SERVICES PROGRAM, FIDELIS, HOSPITAL AFFILIATED PRIMARY CARE PROVIDERS, CBO'S, AMERICAN HEART ASSOCIATION, HOSPITAL NDPP, ROME MEMORIAL HOSPITAL, COUNTY HEALTH AND MENTAL HEALTH PROGRAM ANALYSTS, NYS DOH, COMMUNITY RECOVER CENTER ROME, RESCUE MISSION, CENTER FAMILY LIFE RECOVERY, INSIGHT HOUSE, IROQUOIS HEALTHCARE ALLIANCE, US ATTORNEY'S OFFICE, BOCES, SCHOOL DISTRICT.
FAXTON ST LUKES HEALTHCARE, INC.	PART V, SECTION B, LINE 6A: OTHER REPRESENTATIVES INCLUDED FSLH, SEMC, ROME MEMORIAL HOSPITAL.
FAXTON ST LUKES HEALTHCARE, INC.	PART V, SECTION B, LINE 6B: PARTNERS INCLUDE THE ONEIDA COUNTY HEALTH COALITION STEERING COMMITTEE AND THE TWO PREVENTION AGENDA PRIORITY AREA WORK GROUPS THAT FOCUS ON TOBACCO USE CESSATION AND BREASTFEEDING. THE COALITION CONSISTS OF COMMUNITY PARTNERS INCLUDING HOSPITALS, OCHD AND COMMUNITY ORGANIZATIONS. THE STEERING COMMITTEE ASSISTED BY REAFFIRMING OUR PRIORITY AREAS AND WILL SERVE AS AN ONGOING RESOURCE FOR IMPLEMENTATION EFFORTS. OUR PRIORITY AREA WORK GROUPS INCLUDE MEMBERS FROM ONEIDA COUNTY HOSPITALS, OCHD AND COMMUNITY ORGANIZATION STAFF MEMBERS WHO HAVE A FOCUS ON THE PRIORITY AREA.IN ADDITION TO ONEIDA COUNTY HEALTH DEPARTMENT, CENTRAL NEW YORK HOME HEALTH CARE, HERKIMER-ONEIDA COMPREHENSIVE PLANNING PROGRAM, UTICA COMMUNITY HEALTH CENTER, MOHAWK VALLEY PERINATAL NETWORK, ONEIDA COUNTY DEPARTMENT OF SOCIAL SERVICES, THE COMMUNITY FOUNDATION OF HERKIMER AND ONEIDA COUNTIES, CORNELL COOPERATIVE EXTENSION, THE PARKWAY CENTER, AMERICAN CANCER SOCIETY, UPSTATE CEREBRAL PALSY, UNITED WAY, ONEIDA COUNTY DEPARTMENT OF MENTAL HEALTH, CENTER FOR FAMILY LIFE & RECOVERY, AND THE HOUSE OF THE GOOD SHEPHERD.
FAXTON ST LUKES HEALTHCARE, INC.	PART V, SECTION B, LINE 11: THE ONGOING GOALS TO PREVENT CHRONIC DISEASE HAVE BEEN ADDRESSED WITH SUCESSFUL OUTREACH PROGRAMS SUCH AS PARTICIPATION IN MULTIPLE HEALTH FAIRS, DIABETES EDUCTATION THROUGH OUR HOSPITAL PHYSICIAN PRACTICES TO INTRODUCE EDUCATIONAL PROGRAMS. THOUGH INCLUDED IN OUR PLAN, THERE HAS BEEN LITTILE PARTNER INVOLVEMENT BY THE AMERICAN HEART ASSOCIATION AT THIS POINT IN TIME. MUCH TIME HAS BEEN DEDICATED TO PLANNING FOR THE REDUCTION OF OPIOID OVERDOSES/ABUSE. OUR PHYSICIAN PRACTICES HAVE BEEN TRAINED, AS WELL AS OUR ED STAFF HAVING WAIVER TRAINING. LOCK BOXES HAVE BEEN SET UP AT MULTIPLE LOCATIONS AND SHARED WITH OUR PARTNERS. WE ARE MAKING LITTLE PROGRESS OVERALL ON MENTAL HEALTH AND DEPENDENCY ISSUES DUE TO A NATIONAL SHORTAGE OF THE APPROPRIATE PHYSICIANS. OUR ORGANIZATION IS ACTIVELY RECRUITING FOR SAID PHYSICIANS.

Schedule H (Form 990) 2021

Page 9

Part VFacility Information (continued)

Section D. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility (list in order of size, from largest to smallest) How many non-hospital health care facilities did the organization operate during the tax year?27
Name and address		Type of Facility (describe)
1	1 - MVHS ORTHOPEDIC GROUP 1903 SUNSET AVE UTICA,NY13502	PHYSICIAN OFFICE
2	2 - MVHS SURGICAL GROUP 1656 CHAMPLIN AVE PROF OFFICE BLDNG UTICA,NY13502	PHYSICIAN OFFICE
3	3 - WOMEN'S MEDICAL IMAGING CENTER 106 BUSINESS PARK DRIVE UTICA,NY13502	RADIOLOGY SERVICES
4	4 - MVHS MOHAWK VALLEY MEDICAL GROUP 201 EAST STATE STREET HERKIMER,NY13350	PHYSICIAN OFFICE
5	5 - HERKIMER DIALYSIS CENTER 201 EAST STATE STREET HERKIMER,NY13350	DIALYSIS SITE
6	6 - ONEIDA DIALYSIS CENTER 221 BROAD STREET ONEIDA,NY13421	DIALYSIS SITE
7	7 - DENTAL HEALTH CENTER 1714 BURRSTONE ROAD NEW HARTFORD,NY13413	DENTAL CLINIC
8	8 - MVHS NEW HARTFORD MEDICAL GROUP 8411 SENECA TURNPIKE NEW HARTFORD,NY13413	PHYSICIAN OFFICE
9	9 - MVHS WASHINGTON MILLS MEDICAL GROUP 3946 ONEIDA STREET NEW HARTFORD,NY13413	PHYSICIAN OFFICE
10	10 - MASONIC CARE COMMUNITY DIALYSIS 2150 BLEEKER STREET UTICA,NY13501	DIALYSIS SITE
11	11 - ROME DIALYSIS CENTER 91 PERIMETER ROAD SUITE 140 ROME,NY13440	DIALYSIS SITE
12	12 - MVHS BARNEVELD MEDICAL GROUP 7980 STATE RT 12 BARNEVELD,NY13304	PHYSICIAN OFFICE
13	13 - MVHS WHITESBORO MEDICAL GROUP 37 MAIN STREET WHITESBORO,NY13492	PHYSICIAN OFFICE
14	14 - MVHS BOONVILLE MEDICAL GROUP 13460 STATE ROUTE 12 BOONVILLE,NY13304	PHYSICIAN OFFICE
15	15 - MVHS NORTH UTICA MEDICAL GROUP 35 RIVERSIDE DRIVE UTICA,NY13502	PHYSICIAN OFFICE
16	16 - HAMILTON DIALYSIS CENTER 10 EATON STREET HAMILTON,NY13346	DIALYSIS SITE
17	18 - MVHS NEUROSURGERY GROUP 1656 CHAMPLIN AVE PROF OFFICE BLDNG UTICA,NY13502	PHYSICIAN OFFICE
18	19 - CENTER FOR REHABCONTINUING CARE SRVCS 1650 CHAMPLIN AVE UTICA,NY13502	INTENSIVE REHAB UNIT/CONTINUING CARE SERVC CTR
19	20 - MVHS CLINTON MEDICAL GROUP 101 COLLEGE STREET CLINTON,NY13323	PHYSICIAN OFFICE
20	22 - MVHS GI OFFICE 1656 CHAMPLIN AVE PROF OFFICE BLDNG UTICA,NY13502	PHYSICIAN OFFICE
21	23 - MVHS VASCULAR SURGERY GROUP 1675 BENNETT STREET UTICA,NY13502	PHYSICIAN OFFICE
22	24 - NEUROPSYCHOLOGYNEURO SCIENCE GROUP 8411 SENECA TURNPIKE NEW HARTFORD,NY13413	PHYSICIAN OFFICE
23	25 - WATERVILLE COMMUNITY MEDICINE 117 W MAIN STREET WATERVILLE,NY13480	PHYSICIAN OFFICE
24	26 - MVHS PULMONARY MEDICINECRITICAL CARE 35 RIVERSIDE DRIVE UTICA,NY13502	PHYSICIAN OFFICE
25	27 - MVHS UROLOGY GROUP 1676 SUNSET AVENUE UTICA,NY13502	PHYSICIAN OFFICE
26	28 - ONEIDA MEDICAL GROUP 131 MAIN STREET ONEIDA,NY13421	PHYSICIAN OFFICE
27	29 - ROME MEDICAL GROUP 1617 NORTH JAMES STREET ROME,NY13440	PHYSICIAN OFFICE

Schedule H (Form 990) 2021

Page 10

Part VI

Supplemental Information

Provide the following information.

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

Form and Line Reference	Explanation
PART I, LINE 7:	THE PATIENTS COST-TO-CHARGE RATIO WAS COMPUTED USING ALL CHARGES AND EXPENSES LESS NON-ALLOWABLE. THE COST TO CHARGE RATIO WAS USED TO COMPUTE COST. COST-TO-CHARGE WAS DERIVED BY DIVIDING TOTAL CHARGES FROM THE FINANCIAL STATEMENTS INTO TOTAL COST FROM THE FINANCIAL STATEMENTS, LESS NON-PATIENT COSTS.
PART I, LINE 7, COLUMN (F):	THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 8,812,952.
PART II, COMMUNITY BUILDING ACTIVITIES:	THE 2020 PANDEMIC SIGNIFICANTLY AFFECTED COMMUNITY BUILDING ACTIVITIES. THOSE ACTIVITIES NORMALLY HELD ON AN ANNUAL BASIS HAD TO BE CANCELED. ADDITIONALLY, EFFORTS IN 2020 WERE MADE TO ASSIST THE COMMUNITY AND ACCOMMODATE ACTIVITIES, EITHER REMOTELY OR VIA SAFE SOCIAL DISTANCING #3 COMMUNITY SUPPORT : A) REMOTE: DIABETES SUPPORT GROUP IS A FREE SUPPORT GROUP FOR ANY PERSON WITH DIABETES OR PRE-DIABETES WHO IS INTERESTED IN SPEAKING WITH OTHERS WHO ARE LIVING SIMILAR LIFESTYLES AND DEALING WITH THE DAILY IMPACT OF DIABETES MANAGEMENT. C) REMOTE AND FACEBOOK-MONTHLY STROKE SUPPORT GROUP FOR PATIENTS AND FAMILIES. D) PAUSED IN MARCH: THE ABC SUPPORT GROUP WAS CREATED BY WOMEN WHO HAVE HAD BREAST CANCER. THE GROUP IS DEDICATED TO PROVIDING EDUCATION, INFORMATION AND EMOTIONAL SUPPORT TO WOMEN AND MEN WHO ARE FACING BIOPSY, SURGERY OR RECOVERY FROM BREAST CANCER. PEOPLE FROM THE COMMUNITY ATTENDED NONE MEETINGS HELD THROUGHOUT THE YEAR, ON THE FSLH CAMPUS. F) PAUSED IN MARCH WITH VIRTUAL SUPPORT AS NEEDED: THE CANCER SUPPORT GROUP FORUM, LED BY THE CANCER CENTER'S SOCIAL WORKER, OFFERS SUPPORT TO ANYONE WHO HAS RECEIVED A CANCER DIAGNOSIS. MEETINGS COVER A WIDE VARIETY OF ISSUES INCLUDING: HOW TO TALK WITH CHILDREN ABOUT MOM OR DAD HAVING CANCER, FINANCIAL CONCERNS, PHYSICAL ISSUES, INTIMACY ISSUES AND NUTRITION DURING TREATMENTS, PLUS MANY MORE. THE FORUM PROVIDES A COMFORTABLE ATMOSPHERE FOR PATIENTS AND CANCER SURVIVORS TO COME TOGETHER AND SHARE USEFUL INFORMATION. G) PAUSED IN MARCH: CAREGIVER BURNOUT GROUP IS A SUPPORT GROUP TO HELP COPE WITH THE DIFFICULTIES IN TAKING CARE OF OTHERS. #5 LEADERSHIP DEVELOPMENT AND TRAINING FOR COMMUNITY: A) MEDICAMP- MVHS HOSTED A TWO-DAY MEDICAL CAMP AT EACH ORGANIZATION FOR TEENS AGES 15 THROUGH 18 TO DEMONSTRATE HOW A HOSPITAL OPERATES AND PROVIDES THEM WITH THE OPPORTUNITY TO EXPLORE DIFFERENT DEPARTMENTS FOR POTENTIAL CAREER ENDEAVORS. B)ONEIDA COUNTY WORKFORCE DEVELOPMENT INTERNSHIP PROGRAM: FUNDING OF COLLEGE INTERNSHIP PROGRAM IN COOPERATION WITH ONEIDA COUNTY . #6 COALITION BUILDING: FSLH WORKS WITH MULTIPLE AGENCIES, TO SUPPORT COMMUNITY HEALTH EXPOS IN THE FORM OF FINANCIAL/EDUCATIONAL/FREE HEALTH SCREENINGS: A) AMERICA'S GREATEST HEART RUN & WALK FOR THE AMERICAN HEART ASSOCIATION WITH HEART WEEKEND, WHICH INCLUDES THE HEALTH & FITNESS EXPO. B) HEALTH FRIENDS IS A PROGRAM SPONSORSHIP TO PROVIDE FINANCIAL RESOURCES FOR RX ASSISTANCE TO UN- OR UNDER-INSURED PEOPLE. #7 COMMUNITY HEALTH IMPROVEMENT ADVOCACY: A) THE CHRONIC KIDNEY DISEASE EDUCATION PROGRAM ALLOWS FOR PATIENTS TO LEARN MORE ABOUT KIDNEY DISEASE, WAYS TO SLOW THE LOSS OF KIDNEY FUNCTION, AND HOW MEDICATIONS, DIET AND LIFESTYLE CAN AFFECT THE PROGRESSION OF THE DISEASE. PATIENTS HAVE THE OPPORTUNITY TO MEET WITH DIETICIANS, SOCIAL WORKERS AND NURSES WHO SPECIALIZE IN RENAL (KIDNEY) CARE. FAMILY MEMBERS, FRIENDS AND CAREGIVERS ARE INVITED TO ATTEND THE PROGRAM AS WELL. B) THE BALANCE CENTER AT MVHS OFFERS FREE BALANCE SCREENINGS TO HELP COMMUNITY MEMBERS WITH QUESTIONS OR SYMPTOMS RELATED TO BALANCE, VERTIGO AND INNER EAR DISORDERS. THE SCREENING EVALUATES PATIENTS FOR SPECIFIC BALANCE CONCERNS, RISK FOR FALLS AND SYMPTOMS OF VERTIGO TO DETERMINE IF THEY WILL BENEFIT FROM FORMAL TESTING AND THERAPY. C) CANCELED AFTER MARCH 2020: MVHS IS A PRESENCE AT ALL LOCAL HEALTH FAIRS PERFORMING SCREENINGS (DIABETES, HEART, STROKE, BALANCE, ETC) AND PROVIDING EDUCATION AND INFORMATION ; IE. SENIOR CENTER, LOCAL EMPLOYERS, COMMUNITY EVENTS, ETC. D) MOHAWK VALLEY HEALTH SYSTEM (MVHS) OFFERS THE HOUSEHOLD SHARPS DISPOSAL PROGRAM FOR COMMUNITY MEMBERS TO PROPERLY DISPOSE OF THEIR MEDICAL WASTE. ITEMS SUCH AS SYRINGES AND LANCETS MAY BE DROPPED OFF ANY DAY OF THE WEEK FROM 7AM TO 3PM AT THE FSLH ENERGY CENTER LOCATED ON THE ST. LUKE'S CAMPUS OR AT THE CENTER FOR REHABILITATION AND CONTINUING CARE SERVICES (CRCCS) ALSO ON THE ST. LUKE'S CAMPUS. ONLY ITEMS FROM PRIVATE RESIDENCES IN CLEARLY MARKED "SHARPS" PUNCTURE-PROOF CONTAINERS WILL BE ACCEPTED. CANCELED AFTER MARCH 2020: E) PODIATRY PROGRAM HELD 4 TIMES A YEAR, FOR PEOPLE WITH DIABETES WHO ARE AT HIGH RISK FOR CIRCULATION PROBLEMS THAT COULD LEAD TO LOSS OF SENSATION AND POOR HEALING IN THEIR FEET. PROPER SKIN AND FOOT CARE IS ESSENTIAL. THIS IS AN INFORMATIONAL SESSION AND FREE FOOT EXAM PROVIDED BY AREA PODIATRISTS. F) CHILDBIRTH CLASSES - FREE 5-WEEK SERIES OF CLASSES IN CHILDBIRTH AND INFANT CARE TAUGHT BY AN EXPERIENCED LABOR AND DELIVERY REGISTERED NURSE. G) FSLH OFFERS FREE MONTHLY BREASTFEEDING CLASSES FOR EXPECTANT PARENTS WHO HAVE CHOSEN OR ARE CONSIDERING BREASTFEEDING. H) DIABETES EDUCATION CLASSES ARE HELD THROUGHOUT THE YEAR TO PROVIDE INFORMATION TO THOSE WITH DIABETES ABOUT HOW TO SUCCESSFULLY MANAGE THEIR DISEASE. I) THE FSLH DIABETES EDUCATION DEPARTMENT OFFERS A GROCERY TOUR ON A QUARTERLY BASIS FOR EVERY DAY PEOPLE WITH DIABETES TO LEARN HOW TO MAKE NUTRITIONAL CHOICES THAT IMPACT OVERALL HEALTH AND BLOOD SUGAR. THIS FREE CLASS TEACHES PARTICIPANTS HOW TO IMPROVE THEIR DAILY CHOICES WITH BETTER NUTRITION BY GROCERY SHOPPING WITH A CERTIFIED DIABETES EDUCATOR AND NUTRITIONALIST. J) NATIONAL DIABETES MONTH OFFERED EDUCATION AND RECIPE TASTING TO ANYONE IN THE COMMUNITY WHO IS INTERESTED IN ATTENDING. K)NATIONAL DIABETES PREVENTION PROGRAM FOCUSES ON TREATING THOSE WITH PRE-DIABETES TO PREVENT TYPE 2 DIABETES. L) BLOOD DRIVES ARE HOSTED TO COLLECT BLOOD FROM THOSE WHO ARE ELIGIBLE AND WILLING TO DONATE. THE FLSH BLOOD BANK WORKS IN ASSOCIATION WITH THE AMERICAN RED CROSS TO HOST THE BLOOD DRIVES. FOR EVERY UNIT OF BLOOD COLLECTED, UP TO THREE PEOPLE BENEFIT FROM THE DONATION. CANCELED AFTER MARCH 2020: M)IN AN EFFORT TO PROMOTE THE EARLY DETECTION OR POTENTIAL FOR HEARING LOSS, THE AUDIOLOGY DEPARTMENT PROVIDES FREE HEARING AND SPEECH SCREENINGS TO THE COMMUNITY AS REQUESTED. P) LIMITED AFTER MARCH 2020: OUR EMS EDUCATION DEPARTMENT OFFERS FREE PROGRAMS FOR COMMUNITY TRAINING IN AHA CPR, EMS CRITICAL STRESS TEAMS AND OPIATE OVERDOSE, WHILE ALSO PARTICIPATING IN REGIONAL EMS COUNCIL MEETINGS ON A REGULAR BASIS. IN RESPONSE TO THE PANDEMIC, MVHS HELD COVID-19 VACCINATION PODS FOR THE COMMUNITY AND STAFF DAILY STARTING ON DECEMBER 16 THROUGH THE END OF THE YEAR, 2020.MVHS STOOD UP A COMMUNITY COVID-19 TESTING SITE AT OUR BURRSTONE ROAD LOCATION. MVHS PROVIDED COMMUNITY TESTING TENTS/TRAILERS AT BOTH ST. LUKE'S AND ST. ELIZABETH CAMPUSESMVHS PROVIDED A COVID-19 TESTING SITE FOR THE HEALTH EQUITY POPULATION AT SISTER ROSE VINCENT FAMILY MEDICINE CENTER IN UTICA.
PART III, LINE 2:	BAD DEBT FOR SCHEDULE H REPORTING IS DETERMINED BY TAKING THE ACTUAL BAD DEBT EXPENSE REPORTED FOR THE YEAR ON THE HOSPITAL AUDITED FINANCIAL STATMENTS, LESS ANY BAD DEBT RECOVERIES RECEIVED DURING THE YEAR FROM THE AUDITED FINANCIAL STATEMENTS. THEN, ADJUSTING THAT AMOUNT TO COST BASED ON THE HOSPITAL'S CURRENT YEAR MEDICARE COST REPORT DERIVED COST TO CHARGE RATIO. THIS AMOUNT UNDERSTATES BAD DEBT SOMEWHAT BECAUSE A LARGE PORTION OF BAD DEBT IS THE RESULT OF UNPAID DEDUCTIBLE AND CONINSURANCE BALANCES. THOSE BALANCES ARE NO LONGER RECORDED AT FULL CHARGES BECAUSE CONTRACTUAL ADJUSTMENTS HAVE ALREADY REDUCED CHARGES TO AN EXPECTED REIMBURSEMENT AMOUNT; HENCE, REDUCING BY A COST-TO-CHARGE RATIO, REDUCES AN ALREADY DISCOUNTED CHARGE. WE REPORT THIS WAY BECAUSE BAD DEBT IS REPORTED IN MUTLIPLE STATE AND FEDERAL REQUIRED REPORTS, RETURNS AND DISCLOSURE STATEMENTS. IN ORDER TO BE CONSISTENT WE ARE REPORTING USING THE COSERVATIVE METHOD WHICH IS REQUIRED FOR HOSPTIAL MEDICARE COST REPORT REPORTING.
PART III, LINE 3:	MANY PATIENTS WHO WOULD QUALIFY FOR CHARITY CARE ASSISTANCE ARE UNWILLING TO APPLY FOR IT. THE HOSPITAL BUSINESS OFFICE OFFERS OUR CHARITY CARE PACKAGE TO ALL PATIENTS. IN 2015, THE CHARITY CARE PROGRAM WAS EXPANDED DUE TO THE IMPLEMENTATION OF THE 340B PROGRAM. MANY PATIENTS WILL AGREE TO HAVE THE CHARITY CARE REQUEST FORMS SENT TO THEM BUT NEVER RETURN THEM. MANY PATIENTS SAY THEY CANNOT PAY BUT ARE UNWILLING TO COMPLETE ANY FORMS. THE HOSPITAL BUSINESS OFFICE, COLLECTIONS STAFF, HAVE FORMED A PERCENTAGE ESTIMATE BASED ON THE NUMBER OF CASES OF PATIENTS WHO RECEIVE CHARITY CARE FORMS AND DON'T COMPLETE THEM PLUS THE NUMBER OF PATIENTS WHO STATE THEY CANNOT PAY BUT ARE UNWILLING TO REQUEST ASSISTANCE. THIS RECORDED BAD DEBT EXPENSE WOULD BE RECORDED AS CHARITY CARE IF PATIENT'S WERE WILLING TO COMPLY WITH MINIMAL APPLICATION REQUIREMENTS. THE NATURE OF THE PRESENTATION ON HOSPITAL FIANANCIAL STATEMENTS DOES NOT DETERMINE THE COMMUNITY BENEFIT BUT RATHER THE NATURE OF THE REASON FOR THE EXPENSE. THIS IS CHARITY CARE.
PART III, LINE 4:	FOR UNINSURED PATIENTS THAT DO NOT QUALIFY FOR CHARITY CARE, HEALTHCARE RECOGNIZES REVENUE ON THE BASIS OF ITS STANDARD RATES FOR SERVICES PROVIDED. ON THE BASIS OF HISTORICAL EXPERIENCE, A SIGNIFICANT PORTION OF HEALTHCARES UNINSURED PATIENTS WILL BE UNABLE OR UNWILLING TO PAY FOR THE SERVICES PROVIDED. THUS, HEALTHCARE RECORDS A PROVISION FOR BAD DEBTS RELATED TO UNINSURED PATIENTS IN THE PERIOD THE SERVICES ARE PROVIDED. PATIENT ACCOUNTS RECEIVABLE ARE REDUCED BY A RESERVE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTABILITY OF PATIENT ACCOUNTS RECEIVABLE, HEALTHCARE ANALYZES PAST PAYMENT HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE RESERVE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. FOR RECEIVABLES ASSOCIATED WITH PATIENTS WHO HAVE THIRD PARTY COVERAGE, HEALTHCARE ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES A RESERVE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS, IF NECESSARY (FOR EXAMPLE, FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS, OR FOR PAYORS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY). FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), HEALTHCARE RECORDS A RESERVE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICES BASED ON ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE, OR UNWILLING, TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED)AND THE AMOUNT ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS.
PART III, LINE 8:	ALL OF THIS IS COMMUNITY BENEFIT; THE HOSPTIAL IS RECEIVING LESS THAN COST ON COMMUNITY MEDICARE RECIPIENTS, THUS A COMMUNITY BENEFIT TO THESE PATIENTS. THE PATIENTS COST-TO-CHARGE RATIO WAS COMPUTED USING ALL CHARGES AND EXPENSES LESS NON-ALLOWABLE. THE COST-TO-CHARGE RATIO WAS USED TO COMPUTE COST. COST-TO-CHARGE WAS DERIVED, USING THE FINANCIAL STATEMENTS, BY DIVIDING TOTAL CHARGES INTO TOTAL COSTS LESS NON-PATIENT COSTS.
PART III, LINE 9B:	THE HOSPITAL FAP POLICY PLACES ALL ACCOUNTS, FOR COLLECTION EFFORTS, ON HOLD FROM THE DATE OF APPLICATION UNTIL A DETERMINATION HAS BEEN MADE FOR FINANCIAL ASSISTANCE ELIGIBILITY. THE APPLICATION IS REVIEWED BY THE HOSPTIAL WITHIN THIRTY DAYS OF RECEIPT OF THE COMPLETED APPLICATION AND SUPPORTING DOCUMENTAION. THE PATIENT OR GUARANTOR WILL BE NOTIFIFED OF THE DETERMINATION. IF DENIED, THE APPLICANT IS PROVIDED DIRECTIONS FOR AN APPEAL WITHIN THIRTY DAYS OF THE DENTIAL. IF THE APPEAL IS THEN DENIED, THE PATIENT WILL BE NOTIFIED OF THE REASON AND THE STATEMENT CYCLE WILL BEGIN. FIVE STATEMENTS ARE SENT, WITHIN THE 120 DAY BILLING CYCLE. IF NOT PAID, A FINAL PRE-COLLECTION LETTER IS ISSUED ADVISING THE ACCOUNT WILL BE SENT TO COLLECTIONS WITHIN THIRTY DAYS. IF THE PATIENT IS ACCEPTED IN THE FAP PROGRAM, THIS STATUS WILL BE EFFECTIVE FOR ONE YEAR FROM ACCEPTANCE.
PART VI, LINE 2:	ONEIDA COUNTY HEALTH DEPARTMENT (OCHD), ROME MEMORIAL HOSPITAL (RMH) AND MOHAWK VALLEY HEALTH SYSTEM (MVHS) COLLABORATED WITH KEY COMMUNITY STAKEHOLDERS TO DEVELOP A THREE-YEAR COMMUNITY HEALTH ASSESSMENT,COMMUNITY SERVICE PLAN, AND COMMUNITY HEALTH IMPROVEMENT PLAN (CHA/CSP/CHIP). THE DEVELOPMENT OF THE CHA, CSP AND CHIP FOR THE PERIOD OF 2019-2021 INVOLVED A SYSTEMATIC APPROACH OF DATA RETRIEVAL AND ANALYSIS, COMMUNITY ENGAGEMENT WITH A UNIFIED MISSION TO IDENTIFY AND RANK HEALTH PRIORITIES THAT AIM TO IMPROVE HEALTH OUTCOMES AND REDUCE DISPARITIES AMONG ONEIDA COUNTY RESIDENTS. THE 2019-2024 NEW YORK STATE PREVENTION AGENDA PROVIDES A BLUEPRINT TO IMPROVE THE HEALTH AND WELLBEING, AS WELL AS TO PROMOTE HEALTH EQUITY ACROSS POPULATIONS WHO EXPERIENCE DISPARITIES AND GUIDE THE DEVELOPMENT OF THE PLAN. THE FIVE PRIORITY AREAS ARE AS FOLLOWS: PREVENT CHRONIC DISEASES, PROMOTE A HEALTHY AND SAFE ENVIRONMENT, PROMOTE HEALTHY WOMEN, INFANTS, AND CHILDREN, PROMOTE WELL-BEING AND PREVENT MENTAL HEALTH AND SUBSTANCE USE DISORDERS, AND PREVENT COMMUNICABLE DISEASES. THOROUGH EVALUATION INCLUDED SYNTHESIS AND ANALYSIS OF THE 2016-2018 CHA/CSP/CHIP, RECOGNIZING ACHIEVEMENTS AS WELL AS AREAS OF CONTINUED OPPORTUNITY. THE SELECTION OF THE HEALTH PRIORITIES WAS DERIVED FROM A COLLABORATIVE COMMITTEE OF STAKEHOLDERS.THE CHA PROCESS AND THE IDENTIFICATION OF PRIORITIES AND INTERVENTIONS IN THE IMPROVEMENT PLAN WAS GUIDED BY THE ONEIDA COUNTY HEALTH COALITION (OCHC) AND STEERING COMMITTEE, WHICH IS A PARTNERSHIP OF COMMUNITY AGENCIES, ORGANIZATIONS AND GROUPS THAT CONVENE TO IDENTIFY AND ASSESS PUBLIC HEALTH PROBLEMS AND ENCOURAGE ACTION TO ADDRESS ISSUES. STRATEGIC COMMUNITY PARTNERS WERE ALSO SOLICITED TO PARTICIPATE IN A COMMUNITY STAKEHOLDER CONFERENCE. THE GOAL OF OBTAINING COMMUNITY STAKEHOLDER INPUT WAS TO GAIN GLOBAL INSIGHT FROM COMMUNITY PARTNERS ON PERCEPTIONS OF HEALTH ISSUES WITHIN THE COMMUNITY, CONSIDERING SOCIAL DETERMINANTS OF HEALTH AND PROVIDING INSIGHT ON SPECIFIC ASPECTS OF PRIORITIZING HEALTH NEEDS TO FACILITATE A THOROUGH AND THOUGHTFUL ASSESSMENT AND PLANNING PROCESS FOR DEVELOPMENT OF THE CHA, CSP AND CHIP. THE CHA PROVIDES A COMPREHENSIVE OVERVIEW OF HEALTH STATUS INDICATOR DATA FOR RESIDENTS OF ONEIDA COUNTY USING THENYS PREVENTION AGENDA FRAMEWORK AND OTHER REPUTABLE DATA SOURCES. THE ASSESSMENT WAS CREATED FOLLOWING AFORMAL DATA COLLECTION AND ANALYSIS PROCESS WHICH INCLUDED REVIEW OF HEALTH DATA FINDINGS WITH THE STEERING COMMITTEE. ASSESSMENT ACTIVITIES INCLUDED COMPARISON OF ONEIDA COUNTY STATISTICS TO NYS PREVENTION AGENDA DASHBOARD RATES OF NEW YORK STATE (NYS) (EXCLUDING NEW YORK CITY (NYC),4 WHERE APPROPRIATE, AS WELL AS TORHE NYS COMMUNITY HEALTH INDICATOR REPORTS (CHIRS)5. CENTERS FOR DISEASE CONTROL (CDC) BEHAVIORAL RISK FACT SURVEILLANCE SYSTEM (BRFSS) DATA WAS ALSO REVIEWED TO FURTHER IDENTIFY HEALTH TRENDS6. IN ADDITION, THE STEERING COMMITTEE SOLICITED INPUT FROM THE COMMUNITY DEFINED WITHIN THE PRIMARY SERVICE AREA. THE QUALITATIVE WORK INCLUDED INPUT FROM COMMUNITY STAKEHOLDERS THROUGH A STRATEGIC PLANNING CONFERENCE, AS WELL AS ON-LINE/IN-PERSON SURVEYS, REACHING 898 RESIDENTS. THIS COMBINATION OF PRIMARY AND SECONDARYRESEARCH FINDINGS WAS USED AS KEY REFERENCES FOR THE DEVELOPMENT OF THE OCHD, RMH AND MVHS' 2019-2021 CHA/CSP AND CHIP.
PART VI, LINE 3:	THE HOSPITAL FAP APPLICATION AND POLICY SUMMARY ARE INCLUDED IN THE ADMISSION PACKETS MAILED TO ALL PATIENTS PRIOR TO ADMISSION FOR INPATIENT SERVICES. THE HOSPITAL PROVIDES ACCESSIBLE COMMUNICATION, WITHIN THE HOSPITAL AND ALL OFF-SITE LOCATIONS, IN THE FORM OF 1)SIGNAGE IN FIVE LANGUAGES,2)A PATIENT PAMPHLET WHICH DESCRIBES PAYMENT OPTIONS INCLUDING FAP,WEBSITE INFORMATION AND STAFF CONTACT INFORMATION FOR ASSISTANCE. THE FAP SUMMARY AND WEBSITE INFORMATION ARE DISPLAYED IN PATIENT COMMON ENTRANCE AREAS IN THE HOSPITAL AND OFFSITE LOCATIONS. THE HOSPITAL HAS UP-FRONT FINANCIAL COUNSELORS AND CAC'S (CERTIFED APPLICATION COUNSELORS) TO ASSIST OUR PATIENTS WITH ONLINE APPLICATIONS FOR AFFORDABLE INSURANCE, MEDICAID AND OTHER PROGRAMS/GRANTS. OUR PRE-COLLECTIONS OUTSOURCE VENDOR HAS OUR POLICY INFORMATION AND COUNSELS THE PATIENT IN THE SAME MANNER AS HOSPITAL EMPLOYEES. THE DOCUMENTATION OF OUR FINANCIAL POLICY PATIENT EDUCATION IS PROVIDED IN OUR BILLING SYSTEM. THE COLLECTION STAFF IN THE BUSINESS OFFICE FOLLOWS UP ON ALL APPLICATIONS SENT BY THE PRE-COLLECTIONS VENDOR. DURING THE APPLICATION PROCESS, THE ACCOUNT IS PLACED ON HOLD UNTIL A FINAL DETERMINATION IS MADE. THE DETERMINATION IS MADE WITHIN THIRTY DAYS OF RECEIVING A COMPLETED APPLICATION, INCLUDING REQUESTED SUPPORTING DOCUMNETATION IN WRITING, WITH AND EXPLANATION OF DETERMINATION. WHEN DETERMINATION REQUIRES IT, THE APPLICANT IS GIVEN INSTRUCTIONS AS TO HOW TO APPEAL A DECISION.
PART VI, LINE 4:	THE MAJORITY OF PATIENTS RESIDE IN ONEIDA, HERKIMER AND MADISON COUNTIES, WITH APPROXIMATELY 78% OF MVHS PATIENTS RESIDING IN ONEIDA COUNTY ZIP CODES. ONEIDA COUNTY BORDERS FIVE OTHER COUNTIES: OSWEGO, MADISON, HERKIMER, OTSEGO, AND LEWIS. THE COUNTY IS THE 550TH LARGEST COUNTY IN THE UNITED STATES AND COVERS 3,257.25 SQUARE MILES OF LAND WATER AREA, IN COMPARISON TO A TOTAL OF 3,141 COUNTIES IN THE UNITED STATES AND DISTRICT OF COLUMBIA. THE COUNTY IS EXPECTED TO SEE A SLIGHT INCREASE IN POPULATION THROUGH 2023 (560+ INDIVIDUALS), WHILE THE GENDER DISTRIBUTION IS PROJECTED TO REMAIN CONSISTENT DURING THIS TIMEFRAME. RESIDENTS BETWEEN THE AGES OF 55-64 YEARS OLD MAKE UP THE LARGEST PERCENTAGE OF THE POPULATION. SIMILARLY, POPULATION DISTRIBUTION BY RACE IS FORECASTED TO REMAIN CONSISTENT, BUT HAS BECOME MORE DIVERSE SINCE 2000. MOST RESIDENTS IN THE COUNTY HAVE HEALTH INSURANCE, WITH PRIVATE INSURANCE BEING THE MOST COMMON. THE INSURED RATE FOR ONEIDA COUNTY IS SLIGHTLY HIGHER THAN THE OVERALL NYS RATE FOR THOSE WITH PRIVATE HEALTH INSURANCE. THE MEDIAN HOUSEHOLD INCOME HAS STEADILY INCREASED SINCE 2000 AND IS EXPECTED TO INCREASE THROUGH 2023. HOWEVER, THE PER CAPITA INCOME FOR ONEIDA COUNTY HAS BEEN STEADILY LOWER THAN THAT OF NYS SINCE 2000 AND IS EXPECTED TO REMAIN ON TREND THROUGH 2023. FAMILIES WITH RELATED CHILDREN UNDER 5 YEARS OLD ARE THE MOST IMPOVERISHED IN THE COUNTY, WHILE 29% OF ONEIDA COUNTY ADULTS HAVE EXPERIENCED HOUSING INSECURITY IN THE PAST 12 MONTHS AND 15% HAVE SEVERE HOUSING PROBLEMS. THE EDUCATIONAL ATTAINMENT FOR THOSE IN THE COUNTY WHO COMPLETE A HIGH SCHOOL DEGREE OR HIGHER IS EXPECTED TO INCREASE THROUGH 2023, WHILE THOSE WHO COMPLETE AN EIGHTH-GRADE EDUCATION OR LOWER IS EXPECTED TO DECREASE. ALMOST HALF OF ONEIDA COUNTY'S POPULATION IS EMPLOYED, WITH ONLY 3.5% OF THE EMPLOYABLE POPULATION UNEMPLOYED. THE MOST COMMON INDUSTRY OF EMPLOYMENT FOR ONEIDA COUNTY IS "EDUCATIONAL SERVICES, AND HEALTHCARE AND SOCIAL ASSISTANCE," FOLLOWED BY "RETAIL TRADE, AND "MANUFACTURING." IN ONEIDA COUNTY, MORE THAN HALF OF RESIDENTS HAVE ACCESS TO TWO OR MORE VEHICLES, AND MOST PEOPLE COMMUTE TO WORK ALONE. FOR THE PAST 40 YEARS, UTICA HAS HOUSED THE CENTER (FORMERLY KNOWN AS THE MOHAWK VALLEY RESOURCE CENTER FOR REFUGEES), RESETTLING OVER 16,500 REFUGEES. THIS INFLUX OF REFUGEES HAS CONTRIBUTED SIGNIFICANTLY TO THE POPULATION PROFILE OF ONEIDA COUNTY. OVERALL, THE CENTER HAS HELPED INDIVIDUALS FROM OVER 35 COUNTRIES RESETTLE IN UTICA WHICH CONTINUES TO HELP STABILIZE THE COUNTY'S POPULATION AND ECONOMY. THE EIGHT COUNTIES OF CNY HAVE A TOTAL OF 277,458 MEDICAID ENROLLEES; ONONDAGA AND ONEIDA COUNTY ACCOUNT FOR 171,713 OR 62% OF ALL OF THE MEDICAID ENROLLEES. (CENTRAL NY CARE COLLABORATIVE COMMUNITY HEALTH ASSESSMENT).
PART VI, LINE 5:	THE NEW YORK STATE PREVENTION AGENDA SERVES AS A GUIDE TO HEALTH DEPARTMENTS AND HOSPITALS AS THEY DEVELOP THE CHNA AND PROMOTE COMMUNITY HEALTH. RESULTS OF PRIORITY AREAS, PRESENTED AND REVISED IN PREVIOUS CHNA YEARS:IMPROVEMENT AREAS: PREVENTION AGENDA AREAS WHERE ONEIDA COUNTY STATISTICS IMPROVED:1. IMPROVE HEALTH STATUS AND REDUCE HEALTH DISPARITIESA. PREMATURE DEATHS: RATIO OF BLACK NON-HISPANICS TO WHITE NON-HISPANICSB. AGE-ADJUSTED PREVENTABLE HOSPITALIZATION RATE PER 10,000 - AGED 18+ YEARS2. PROMOTE A HEALTHY AND SAFE ENVIRONMENTA. ASSAULT-RELATED HOSPITALIZATION RATE PER 10,000 POPULATIONB. ASSAULT-RELATED HOSPITALIZATION: RATIO OF BLACK NON-HISPANICS TO WHITE NON-HISPANICSC. PERCENTAGE OF EMPLOYED CIVILIAN WORKERS AGE 16 AND OVER WHO USE ALTERNATE MODES OF TRANSPORTATION TOWORK OR WORK FROM HOMED. PERCENTAGE OF POPULATION WITH LOW-INCOME AND LOW ACCESS TO A SUPERMARKET OR LARGE GROCERY STORE3. PREVENT CHRONIC DISEASESA. RATE OF HOSPITALIZATIONS FOR SHORT-TERM COMPLICATIONS OF DIABETES PER 10,000 - AGED 6-17 YEARS4. PREVENT HIV/STDS, VACCINE PREVENTABLE DISEASES AND HEALTHCARE-ASSOCIATED INFECTIONSA. PERCENTAGE OF ADOLESCENT FEMALES THAT RECEIVED 3 OR MORE DOSES OF HPV VACCINE - AGED 13-17 YEARS5. PROMOTING HEALTHY WOMEN, INFANTS, AND CHILDRENA. PREMATURE BIRTHS: RATIO OF BLACK NON-HISPANICS TO WHITE NON-HISPANICSB. PREMATURE BIRTHS: RATIO OF HISPANICS TO WHITE NON-HISPANICSC. PREMATURE BIRTHS: RATIO OF MEDICAID BIRTHS TO NON-MEDICAID BIRTHSD. EXCLUSIVELY BREASTFED: RATIO OF BLACK NON-HISPANICS TO WHITE NON-HISPANICSE. EXCLUSIVELY BREASTFED: RATIO OF HISPANICS TO WHITE NON-HISPANICSF. EXCLUSIVELY BREASTFED: RATIO OF MEDICAID BIRTHS TO NON-MEDICAID BIRTHSG. ADOLESCENT PREGNANCY: RATIO OF BLACK NON-HISPANICS TO WHITE NON-HISPANICS6. PROMOTE MENTAL HEALTH AND PREVENTING SUBSTANCE USEA. AGE-ADJUSTED SUICIDE DEATH RATE PER 100,000 POPULATIONSTATIC OR WORSENING AREAS: PREVENTION AGENDA AREAS WHERE ONEIDA COUNTY STATISTICS REMAINEDUNCHANGED/WORSENED. (THOSE MEASURES THAT HAVE WORSENED WILL BE INDICATED IN BOLD BELOW.)1. IMPROVE HEALTH STATUS AND REDUCE HEALTH DISPARITIESA. PERCENTAGE OF PREMATURE DEATHS (BEFORE AGE 65 YEARS)B. PREMATURE DEATHS: RATIO OF HISPANICS TO WHITE NON-HISPANICSC. PREVENTABLE HOSPITALIZATIONS: RATIO OF BLACK NON-HISPANIC TO WHITE NON-HISPANICSD. PERCENTAGE OF ADULTS (AGED 18-64) WITH HEALTH INSURANCEE. AGE-ADJUSTED PERCENTAGE OF ADULTS WHO HAVE A REGULAR HEALTHCARE PROVIDER AGED 18+ YEARS2. PROMOTE A HEALTHY AND SAFE ENVIRONMENTA. RATE OF HOSPITALIZATIONS DUE TO FALLS PER 10,000 AGED 65+ YEARSB. RATE OF EMERGENCY DEPARTMENT VISITS DUE TO FALLS PER 10,000 AGED 1-4 YEARSC. ASSAULT-RELATED HOSPITALIZATION: RATIO OF LOW-INCOME ZIP CODESD. PERCENTAGE OF HOMES IN HEALTHY NEIGHBORHOODS PROGRAM THAT HAVE FEWER ASTHMA TRIGGERS DURINGTHE HOME REVISITE. PERCENTAGE OF RESIDENTS SERVED BY COMMUNITY WATER SYSTEMS WITH OPTIMALLY FLUORIDATED WATERF. ASSAULT-RELATED HOSPITALIZATION: RATIO OF HISPANICS TO WHITE NON-HISPANICSG. RATE OF OCCUPATIONAL INJURIES TREATED IN ED PER 10,000 ADOLESCENTS - AGED 15-19 YEARSH. PERCENTAGE OF POPULATION THAT LIVES IN A JURISDICTION THAT ADOPTED THE CLIMATE SMART COMMUNITIES PLEDGE3. PREVENT CHRONIC DISEASESA. PERCENTAGE OF ADULTS WHO ARE OBESEB. PERCENTAGE OF CHILDREN AND ADOLESCENTS WHO ARE OBESEC. PERCENTAGE OF CIGARETTE SMOKING ADULTSD. PERCENTAGE OF ADULTS WHO RECEIVED A COLORECTAL CANCER SCREENING BASED ON THE MOST RECENT GUIDELINES AGED 50-75 YEARSE. AGE-ADJUSTED HEART ATTACK HOSPITALIZATION RATE PER 10,000 POPULATIONF. RATE OF HOSPITALIZATIONS FOR SHORT-TERM COMPLICATIONS OF DIABETES PER 10,000 18+ YEARSG. ASTHMA EMERGENCY DEPARTMENT VISIT RATE PER 10,000 POPULATIONH. ASTHMA EMERGENCY DEPARTMENT VISIT RATE PER 10,000 - AGED 0-4 YEARS4. PREVENT HIV/STDS, VACCINE PREVENTABLE DISEASES AND HEALTHCARE-ASSOCIATED INFECTIONSA. PERCENTAGE OF CHILDREN WITH 4:3:1:3:3:1:4 IMMUNIZATION SERIES AGED 19-35 MONTHSB. PERCENTAGE OF ADULTS WITH FLU IMMUNIZATION - AGED 65+ YEARSC. NEWLY DIAGNOSED HIV CASE RATE PER 100,000 POPULATIOND. DIFFERENCE IN RATES (BLACK AND WHITE) OF NEWLY DIAGNOSED HIV CASESE. GONORRHEA CASE RATE PER 100,000 WOMEN - AGED 15-44 YEARSF. GONORRHEA CASE RATE PER 100,000 MEN - AGED 15-44 YEARSG. CHLAMYDIA CASE RATE PER 100,000 WOMEN - AGED 15-44 YEARSH. PRIMARY AND SECONDARY SYPHILIS CASE RATE PER 100,000 MENI. PRIMARY AND SECONDARY SYPHILIS CASE RATE PER 100,000 WOMEN5. PROMOTING HEALTHY WOMEN, INFANTS, AND CHILDRENA. PERCENTAGE OF PRETERM BIRTHSB. MATERNAL MORTALITY RATE PER 100,000 LIVE BIRTHSC. PERCENTAGE OF CHILDREN WHO HAVE HAD THE RECOMMENDED NUMBER OF WELL CHILD VISITS IN GOVERNMENTSPONSORED INSURANCE PROGRAMSD. PERCENTAGE OF CHILDREN AGED 0-15 MONTHS WHO HAVE HAD THE RECOMMENDED NUMBER OF WELL CHILD VISITS INGOVERNMENT SPONSORED INSURANCE PROGRAMSE. PERCENTAGE OF CHILDREN AGED 3-6 YEARS WHO HAVE HAD THE RECOMMENDED NUMBER OF WELL CHILD VISITS INGOVERNMENT SPONSORED INSURANCE PROGRAMSF. PERCENTAGE OF CHILDREN AGED12-21 YEARS WHO HAVE HAD THE RECOMMENDED NUMBER OF WELL CHILD VISITS INGOVERNMENT SPONSORED INSURANCE PROGRAMSG. PERCENTAGE OF CHILDREN (AGED UNDER 19 YEARS) WITH HEALTH INSURANCEH. ADOLESCENT PREGNANCY: RATIO OF HISPANICS TO WHITE NON-HISPANICSI. PERCENTAGE OF UNINTENDED PREGNANCY AMONG LIVE BIRTHSJ. UNINTENDED PREGNANCY: RATIO OF HISPANICS TO WHITE NON-HISPANICSK. UNINTENDED PREGNANCY: RATIO OF MEDICAID BIRTHS TO NON-MEDICAID BIRTHSL. PERCENTAGE OF WOMEN (AGED 18-64) WITH HEALTH INSURANCEM. PERCENTAGE OF LIVE BIRTHS THAT OCCUR WITHIN 24 MONTHS OF A PREVIOUS PREGNANCYN. ADOLESCENT PREGNANCY RATE PER 1,000 FEMALES - AGED 15-17 YEARSO. UNINTENDED PREGNANCY: RATIO OF BLACK NON-HISPANIC TO WHITE NON-HISPANICP. PERCENTAGE OF INFANTS EXCLUSIVELY BREASTFED IN THE HOSPITAL6. PROMOTE MENTAL HEALTH AND PREVENTING SUBSTANCE USEA. AGE-ADJUSTED PERCENTAGE OF ADULTS WITH POOR MENTAL HEALTH FOR 14 OR MORE DAYS IN THE LAST MONTHB. AGE-ADJUSTED PERCENTAGE OF ADULTS BINGE DRINKING DURING THE PAST MONTHTHE CHARTS PROVIDED ON THE ATTACHED CHNA, BEGINNING ON PAGE 31, GIVE MORE DETAILED TREND INFORMATION ON SELECTED MEASURES.
PART VI, LINE 6:	ST. ELIZABETH MEDICAL CENTER (SEMC) AND FAXTON ST. LUKE'S HEALTHCARE (FSLH) AFFILIATED UNDER THE MOHAWK VALLEY HEALTH SYSTEM (MVHS) ON MARCH 6, 2014. MVHS MAIN CAMPUSES: ST. ELIZABETH CAMPUS 2209 GENESEE STREET, UTICA, NY ST. LUKE'S CAMPUS 1656 CHAMPLIN AVENUE, NEW HARTFORD, NY FAXTON CAMPUS 1676 SUNSET AVENUE, UTICA, NY THE MVHS MEDICAL GROUP OFFERS 11 PRIMARY CARE OFFICES LOCATED THROUGHOUT ONEIDA AND HERKIMER COUNTIES, A CHILDREN'S HEALTH CENTER, WOMEN'S HEALTH CENTER AND MULTI-SPECIALTY PROVIDERS INCLUDING GENERAL, ORTHOPEDIC, VASCULAR AND CARDIAC AND THORACIC SURGERY, GASTROENTEROLOGY AND ADVANCED ENDOSCOPY, UROLOGY AND NEURO SCIENCES. THE SISTER ROSE VINCENT FAMILY MEDICINE CENTER PROVIDES PATIENT CARE SERVICES AND IS ALSO A TEACHING FACILITY FOR NEW PHYSICIANS.FAXTON ST. LUKE'S HEALTHCAREA NOT-FOR-PROFIT HEALTHCARE ORGANIZATION, FSLH INCLUDES ST. LUKE'S HOME, SENIOR NETWORK HEALTH, AND THE VISITING NURSE ASSOCIATION OF UTICA AND ONEIDA COUNTY. ST. LUKE'S CAMPUS: BARIATRIC SURGERY PROGRAM MATERNAL CHILD SERVICES MOHAWK VALLEY VASCULAR CENTER STROKE CENTER SURGICAL AND AMBULATORY SERVICES TOTAL JOINT ORTHOPEDIC PROGRAMFAXTON CAMPUS CANCER CENTER DIALYSIS CENTER OUTPATIENT REHABILITATION SERVICES WELLNESS CENTERCENTER FOR REHABILITATION AND CONTINUING CARE SERVICES ACUTE INPATIENT REHABILITATION UNIT ADULT DAY HEALTH CARE SERVICE OUTPATIENT DIALYSIS CENTER ST. LUKE'S HOME SENIOR NETWORK HEALTH VISITING NURSE ASSOCIATION OF UTICA AND ONEIDA COUNTYST. ELIZABETH MEDICAL CENTERA NOT-FOR-PROFIT HEALTHCARE ORGANIZATION, SEMC ALSO INCLUDES ST. ELIZABETH HOME CARE, WHICH SERVES PATIENTS IN THEIR HOMES AND ST. ELIZABETH HEALTH SUPPORT SERVICES OFFERING RESPIRATORY SERVICES AND DURABLE MEDICAL EQUIPMENT TO PATIENTS IN THEIR HOMES. SEMC HAS 202 ACUTE CARE BEDS.SEMC MAIN CAMPUS: CARDIAC SERVICES MOHAWK VALLEY SLEEP DISORDERS CENTER ORTHOPEDIC SERVICES ST. ELIZABETH COLLEGE OF NURSING ST. ELIZABETH FAMILY MEDICINE RESIDENCY PROGRAM SURGICAL AND AMBULATORY SERVICES TRAUMA CENTER FELLOWSHIP IN HOSPITAL MEDICINE FELLOWSHIP IN GYNECOLOGIC ENDOSCOPYMEDICAL ARTS CAMPUS: ADVANCED WOUND CARE CENTER OUTPATIENT LABORATORY DRAW SITE BOTH HOSPITALS ACCEPT ALL MAJOR INSURANCES AND HAVE DESIGNATED CHARITY CARE PROGRAMS TO HELP PROVIDE FOR INDIVIDUALS WITHOUT INSURANCE. OUR AFFILIATION ENHANCES SERVICES FOR THE RESIDENTS OF THE MOHAWK VALLEY THROUGH GREATER COLLABORATION AND IMPROVED CLINICAL QUALITY FOR PATIENT AND RESIDENT CARE. AS A LARGE SYSTEM, MVHS HAS MUCH TO OFFER WHEN RECRUITING NEW PHYSICIANS. SEMC IS A CATHOLIC HOSPITAL, SPONSORED BY THE SISTERS OF ST. FRANCIS OF THE NEUMANN COMMUNITIES. SPECIALTIES THE BARIATRIC SURGERY PROGRAM IS AN AMERICAN SOCIETY FOR METABOLIC & BARIATRIC SURGERY BARIATRIC SURGERY CENTER OF EXCELLENCE. AS AN ACCREDITED PROGRAM, MVHS DEMONSTRATES THAT OUR CENTER MEETS THE NEEDS OF BARIATRIC SURGERY PATIENTS BY PROVIDING MULTIDISCIPLINARY, HIGH-QUALITY, PATIENT-CENTERED CARE. THE CANCER CENTER PROVIDES CARE TO PATIENTS IN OUR COMMUNITY FROM THE TIME OF DIAGNOSIS THROUGH TREATMENT AND RECOVERY. SERVICES INCLUDE OUTPATIENT INFUSION, RADIATION ONCOLOGY, CLINICAL TRIALS, INPATIENT ONCOLOGY, INTEGRATIVE MEDICINE, A BREAST CARE CENTER, A NURSE NAVIGATOR PROGRAM, CANCER EDUCATION AND SUPPORT SERVICES. THE CENTRAL YORK DIABETES EDUCATION PROGRAM (CNY DIABETES) IS RECOGNIZED BY THE AMERICAN DIABETES ASSOCIATION. CNY DIABETES OFFERS THE NATIONAL DIABETES PREVENTION PROGRAM WHICH IS ENDORSED BY THE CENTERS FOR DISEASE CONTROL AND PREVENTION. THE DIALYSIS CENTER IS THE SOLE PROVIDER OF DIALYSIS TREATMENT WITHIN A 25 MILE SERVICE AREA. EACH YEAR, MORE THAN 400 PATIENTS RECEIVE MORE THAN 69,000 DIALYSIS TREATMENTS AT ONE OF SIX FACILITIES LOCATED THROUGHOUT THE MOHAWK VALLEY. DIALYSIS CENTERS ARE LOCATED IN UTICA, ROME, HAMILTON AND HERKIMER. FSLH IS THE ONLY DESIGNATED PRIMARY STROKE CENTER IN THE MOHAWK VALLEY AND ONE OF 115 DESIGNATED STROKE CENTERS IN NEW YORK STATE. THE ORGANIZATION IS A RECIPIENT OF THE AMERICAN HEART ASSOCIATION/AMERICAN STROKE ASSOCIATION'S GET WITH THE GUIDELINES STROKE GOLD PLUS ACHIEVEMENT AWARD. THE AWARD RECOGNIZES FSLH'S COMMITMENT AND SUCCESS IN IMPLEMENTING EXCELLENT CARE FOR STROKE PATIENTS, ACCORDING TO EVIDENCE-BASED GUIDELINES.MVHS'S ACUTE INPATIENT REHABILITATION PROGRAM IS ACCREDITED BY THE COMMISSION ON ACCREDITATION OF REHABILITATION FACILITIES. THE REHABILITATION CENTER PROVIDES BOTH INPATIENT AND OUTPATIENT SERVICES WITH LOCATIONS AT THE FAXTON CAMPUS, ST. LUKE'S CAMPUS, ST. LUKE'S HOME, ST. ELIZABETH CAMPUS AND ST. ELIZABETH MEDICAL ARTS. ST. LUKE'S HOME IS A 202-BED LONG TERM CARE FACILITY WITH A 40-BED SUBACUTE REHABILITATION UNIT. ST. LUKE'S HOME OPENED IN 1996 ON THE ST. LUKE'S CAMPUS AND RECENTLY UNDERWENT A $31.3 MILLION RENOVATION AND EXPANSION. THE VISITING NURSE ASSOCIATION (VNA) OF UTICA AND ONEIDA COUNTY IS ACCREDITED BY THE COMMUNITY HEALTH ACCREDITATION PROGRAM, INC. THE VNA OF UTICA AND ONEIDA COUNTY CELEBRATED ITS 100TH ANNIVERSARY IN 2015 AND SERVES NEARLY 2,200 PATIENTS ANNUALLY.
PART VI, LINE 7, REPORTS FILED WITH STATES	NY

Schedule H (Form 990) 2021

Additional Data

Software ID:
Software Version:

- TIN:

Schedule J
(Form 990)

Department of the Treasury
Internal Revenue Service

Compensation Information

For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet

Complete if the organization answered "Yes" on Form 990, Part IV, line 23.
SchJMediumBullet

Attach to Form 990.
SchJMediumBullet

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

FAXTON ST LUKE'S HEALTHCARE

Employer identification number

16-1576637

Part I

Questions Regarding Compensation

Yes

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

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

Travel for companions Payments for business use of personal residence

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

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

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

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

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

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

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

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

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

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

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

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

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

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

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

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

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

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

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

Yes

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

Yes

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

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

Were any amounts reported on Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III ..........................

If "Yes" on line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................

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

Cat. No. 50053T

Schedule J (Form 990) 2021

Page 2

Part II

Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.

For each individual whose compensation must be reported on Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions, on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.
Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.

(A) Name and Title		(B) Breakdown of W-2, 1099-MISC compensation, and/or 1099-NEC			(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation in column (B) reported as deferred on prior Form 990
(A) Name and Title		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)
1CHRISTOPHER MAX MD PHYSICIAN	(i) (ii)	602,750 ------------- 0	350,343 ------------- 0	572 ------------- 0	11,600 ------------- 0	15,585 ------------- 0	980,850 ------------- 0	0 ------------- 0
2DARLENE STROMSTAD PRESIDENT/CEO	(i) (ii)	725,000 ------------- 0	183,750 ------------- 0	8,560 ------------- 0	11,600 ------------- 0	7,728 ------------- 0	936,638 ------------- 0	0 ------------- 0
3MARIO CARRILLO DO PHYSICIAN	(i) (ii)	599,166 ------------- 0	214,355 ------------- 0	194 ------------- 0	11,600 ------------- 0	15,776 ------------- 0	841,091 ------------- 0	0 ------------- 0
4SUSHMA KAUL MD PHYSICIAN/MEDICAL STAFF PRESIDENT	(i) (ii)	486,868 ------------- 0	296,391 ------------- 0	194 ------------- 0	11,600 ------------- 0	15,633 ------------- 0	810,686 ------------- 0	0 ------------- 0
5ANDREW PELLECCHIA MD PHYSICIAN	(i) (ii)	604,990 ------------- 0	141,000 ------------- 0	68 ------------- 0	11,600 ------------- 0	15,826 ------------- 0	773,484 ------------- 0	0 ------------- 0
6ERIC PORRITT MD PHYSICIAN	(i) (ii)	657,998 ------------- 0	0 ------------- 0	45 ------------- 0	11,600 ------------- 0	15,816 ------------- 0	685,459 ------------- 0	0 ------------- 0
7GHASSAN KOUSSA MD PHYSICIAN	(i) (ii)	356,819 ------------- 0	287,477 ------------- 0	45 ------------- 0	11,447 ------------- 0	20,970 ------------- 0	676,758 ------------- 0	0 ------------- 0
8KENT HALL MD SR VICE PRESIDENT/CMO	(i) (ii)	477,405 ------------- 0	82,350 ------------- 0	40,939 ------------- 0	11,600 ------------- 0	16,377 ------------- 0	628,671 ------------- 0	0 ------------- 0
9LOUIS AIELLO SR VICE PRESIDENT/CFO	(i) (ii)	0 ------------- 458,942	0 ------------- 80,649	0 ------------- 18,722	0 ------------- 25,816	0 ------------- 9,570	0 ------------- 593,699	0 ------------- 0
10MANSOOR SHAHID SR VICE PRESIDENT/COO	(i) (ii)	465,222 ------------- 0	80,200 ------------- 0	10,408 ------------- 0	11,600 ------------- 0	16,262 ------------- 0	583,692 ------------- 0	0 ------------- 0
11ERIC YOSS MD FORMER CMO	(i) (ii)	323,880 ------------- 0	46,041 ------------- 0	22,939 ------------- 0	11,600 ------------- 0	12,727 ------------- 0	417,187 ------------- 0	0 ------------- 0
12LINDA MCCORMACK-MILLER SR VICE PRESIDENT/CNO	(i) (ii)	274,978 ------------- 0	0 ------------- 0	1,811 ------------- 0	5,437 ------------- 0	7,804 ------------- 0	290,030 ------------- 0	0 ------------- 0
13SCOTT PERRA FACHE FORMER PRESIDENT/CEO	(i) (ii)	231,827 ------------- 0	0 ------------- 0	12,221 ------------- 0	409 ------------- 0	8,410 ------------- 0	252,867 ------------- 0	0 ------------- 0
14MARIA GESUALDO MD FORMER DIRECTOR	(i) (ii)	91,025 ------------- 0	0 ------------- 0	0 ------------- 0	0 ------------- 0	0 ------------- 0	91,025 ------------- 0	0 ------------- 0
15WALEED ALBERT MD FORMER FSLH MEDICAL STAFF PRESIDE	(i) (ii)	42,004 ------------- 0	0 ------------- 0	0 ------------- 0	0 ------------- 0	0 ------------- 0	42,004 ------------- 0	0 ------------- 0

Schedule J (Form 990) 2021

Page 3

Part III

Supplemental Information

Provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II. Also complete this part for any additional information.

Return Reference

Explanation

PART I, LINE 6

AN INCENTIVE COMPENSATION PLAN EXISTS FOR THE EXECUTIVE STAFF OF FSLH. COMPENSATION IS BASED ON PERFORMANCE RELATIVE, IN PART, TO THE ORGANIZATION NET EARNINGS TARGETS, AS WELL AS, VARIOUS OTHER QUALITY RELATED PERFORMANCE TARGETS. THE INCENTIVES ARE ONLY PAID OUT UPON ACHIEVEMENT OF THESE SET TARGETS. DURING 2021, $497,588 OF INCENTIVE COMPENSATION WAS PAID OUT UNDER THIS PLAN RELATING TO THE 2020 FISCAL YEAR. $610,000 WAS ACCRUED FOR THE 2021 FISCAL YEAR INCENTIVE COMPENSATION AND $461,839 WAS PAID OUT IN 2022.

Schedule J (Form 990) 2021

Additional Data

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Schedule K
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Information on Tax-Exempt Bonds

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

Attach to Form 990.
SchKMediumBullet

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

OMB No. 1545-0047

2021

Open to Public
Inspection

Name of the organization
FAXTON ST LUKE'S HEALTHCARE

Employer identification number
16-1576637

Part Ⅰ

Bond Issues

(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	(g) Defeased		(h) On behalf of issuer		(i) Pool financing
(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	Yes	No	Yes	No	Yes	No
A	ONEIDA COUNTY LOCAL DEVELOPMENT CORP	27-3190422		11-21-2019	16,220,000	REFINANCING OLD DEBT (2006 BONDS)		X		X	X
B	ONEIDA COUNTY LOCAL DEVELOPMENT CORP	27-3190422		11-21-2019	6,395,000	EPIC EMR SYSTEM IMPLEMENTATION		X		X	X
C	ONEIDA COUNTY LOCAL DEVELOPMENT CORP	27-3190422		11-21-2019	2,020,000	CAPITAL EQUIPMENT		X		X	X

Part Ⅱ

Proceeds

	A		B		C		D
	1 Amount of bonds retired ..................
2 Amount of bonds legally defeased ..............
3 Total proceeds of issue ..................	17,015,117		7,762,993		2,598,879
4 Gross proceeds in reserve funds .............
5 Capitalized interest from proceeds .............
6 Proceeds in refunding escrows ...............	13,066,526
7 Issuance costs from proceeds ...............	249,126		98,229		37,330
8 Credit enhancement from proceeds .............	413,080		162,876		61,898
9 Working capital expenditures from proceeds .............
10 Capital expenditures from proceeds .............			7,516,589
11 Other spent proceeds .............	3,286,385		14,701		349
12 Other unspent proceeds .............					2,500,000
13 Year of substantial completion .............	2019		2019		2020
	Yes	No	Yes	No	Yes	No	Yes	No
14 Were the bonds issued as part of a current refunding issue of tax-exempt bonds (or, if issued prior to 2020, a current refunding issue)? ........	X			X		X
15 Were the bonds issued as part of an advance refunding issue of taxable bonds (or, if issued prior to 2020, an advance refunding issue)? ........	X			X		X
16 Has the final allocation of proceeds been made? ..........	X		X			X
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? ..................	X		X		X

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

Cat. No. 50193E

Schedule K (Form 990) 2021

Page 2

Part Ⅲ

Private Business Use

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

Part Ⅳ

Arbitrage

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Has the issuer filed Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate? ...		X		X		X
2 If "No" to line 1, did the following apply? ....
a Rebate not due yet? .......	X		X		X
b Exception to rebate? ........		X		X		X
c No rebate due? .........		X		X		X
If "Yes" to line 2c, provide in Part Ⅵ the date the rebate computation was performed ......
3 Is the bond issue a variable rate issue? .....		X		X		X

Schedule K (Form 990) 2021

Page 3

Part Ⅳ

Arbitrage (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?		X		X		X
b Name of provider ..........
c Term of hedge .........
d Was the hedge superintegrated? ......
e Was the hedge terminated? ........
5a Were gross proceeds invested in a guaranteed investment contract (GIC)?		X		X		X
b Name of provider ..........
c Term of GIC .........
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? ........
6 Were any gross proceeds invested beyond an available temporary period?	X		X		X
7 Has the organization established written procedures to monitor the requirements of section 148? ...	X		X		X

Part Ⅴ

Procedures To Undertake Corrective Action

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

Part Ⅵ

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

Return Reference	Explanation

Schedule K (Form 990) 2021

Additional Data

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Schedule L
(Form 990)

Department of the Treasury
Internal Revenue Service

Transactions with Interested Persons

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

Attach to Form 990 or Form 990-EZ.
MediumBullet

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

OMB No. 1545-0047

2021

Open to Public Inspection

Name of the organization

FAXTON ST LUKE'S HEALTHCARE

Employer identification number

16-1576637

Part I

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

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

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

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

Part II

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

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






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

Part III

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

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

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

Cat. No. 50056A

Schedule L (Form 990) 2021

Page 2

Part IV

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

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of transaction	(d) Description of transaction	(e) Sharing of organization's revenues?
(a) Name of interested person		(c) Amount of transaction	(d) Description of transaction	Yes	No
(1) SLOCUM DICKSON MEDICAL GROUP	MARIA GESUALDO, DO	53,679	RENTAL INCOME		No

Part V

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

Return Reference	Explanation
SCH L, PART IV, BUSINESS TRANSACTIONS INVOLVING INTERESTED PERSONS	DR MARIA GESUALDO, DO IS A FORMER BOARD MEMBER AND A PARTNER AT SLOCUM DICKSON MEDICAL GROUP. THE RENTAL INCOME IS FOR IT SYSTEMS.

Schedule L (Form 990) 2021

Additional Data

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SCHEDULE O
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or 990-EZ or to provide any additional information.
MediumBullet

Attach to Form 990 or 990-EZ.
MediumBullet

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

OMB No. 1545-0047

2021

Open to Public
Inspection

Name of the organization

FAXTON ST LUKE'S HEALTHCARE

Employer identification number

16-1576637

Return Reference	Explanation
FORM 990, PART VI, SECTION A, LINE 6	MOHAWK VALLEY HEALTH SYSTEM, INC IS THE SOLE MEMBER OF THE CORPORATION.
FORM 990, PART VI, SECTION A, LINE 7A	MOHAWK VALLEY HEALTH SYSTEM, INC APPOINTS THE DIRECTORS AND GOVERNING BODY OF THE ORGANIZATION. THE BOARD OF DIRECTORS ARE LISTED IN SECTION VII.
FORM 990, PART VI, SECTION B, LINE 11B	THE FORM 990 AND FORM 990T ARE REVIEWED AT A MEETING WITH THE EXECUTIVE COMMITTEE AND THE BOARD OF DIRECTORS, PRIOR TO SUBMITTING THE REPORT.
FORM 990, PART VI, SECTION B, LINE 12C	CONFLICT OF INTEREST POLICY: THE PURPOSE OF THE POLICIES AND DIRECTIVES SET OUT IN THIS POLICY STATEMENT IS TO ASSURE THAT THE BUSINESS CONDUCTED BY THE ORGANIZATION IS CONDUCTED FREE FROM THE POSSIBLE INFLUENCE OF CONFLICTS OF INTEREST OF INTERESTED PERSONS. THIS POLICY EXISTS TO PROTECT THE ORGANIZATIONS INTEREST WHEN IT IS CONTEMPLATING ENTERING INTO A TRANSACTION OR ARRANGEMENT THAT MIGHT BENEFIT THE PRIVATE INTEREST OF AN INTERESTED PERSON IN THE ORGANIZATION. INTERESTED PERSONS MAY NOT ENTER INTO ANY EMPLOYMENT TRANSACTION OR OTHER ARRANGEMENT THAT MAY CAUSE OR BE PERCEIVED TO CAUSE A CONFLICT OF INTEREST. INTERESTED PERSONS MUST REVIEW THIS POLICY ANNUALLY AND COMPLETE THE ACKNOWLEDGEMENT AND DISCLOSURE FORM ANNUALLY. THE COMPLIANCE OFFICER AND/OR THE COMPLIANCE COMMITTEE WILL REVIEW ALL ANNUAL ACKNOWLEDGEMENT AND DISCLOSURE FORMS AND ANY CONFLICTS OR POTENTIAL CONFLICTS IDENTIFIED. WHEN A POTENTIAL CONFLICT IS IDENTIFIED, THE COMPLIANCE OFFICER WILL ENSURE APPROPRIATE ACTIONS ARE TAKEN TO RESOLVE THE CONFLICT. THIS POLICY IS INTENDED TO SUPPLEMENT BUT NOT REPLACE ANY APPLICABLE FEDERAL AND STATE LAWS GOVERNING CONFLICTS OF INTEREST APPLICABLE TO NONPROFIT AND CHARITABLE CORPORATIONS.
FORM 990, PART VI, SECTION B, LINE 15	THE BOARDS EXECUTIVE COMPENSATION COMMITTEE, HAS ADOPTED AND FOLLOWS A PROCESS FOR REVIEWING AND DETERMINING THE COMPENSATION OF THE CEO AND THE EXECUTIVE MANAGEMENT TEAM. THE EXECUTIVE MANAGEMENT TEAM CONSISTS OF THE FOLLOWING POSITIONS: SENIOR VICE PRESIDENT/CHIEF OPERATING OFFICER SENIOR VICE PRESIDENT/CHIEF FINANCIAL OFFICER SENIOR VICE PRESIDENT/CHIEF MEDICAL OFFICER SENIOR VICE PRESIDENT/CHIEF NURSING OFFICER THE COMMITTEE HAS ENGAGED AN INDEPENDENT COMPENSATION CONSULTANT TO PROVIDE INFORMATION AND ADVICE TO COMMITTEE, INCLUDING BUT NOT LIMITED, PROVIDING INDEPENDENT COMPENSATION COMPARABILITY DATA FOR FUNCTIONALLY COMPARABLE POSITIONS IN SIMILARLY SITUATED HOSPITALS. THE DATA IS PROVIDED ON AN ANNUAL BASIS AND IS REVIEWED BY THE COMMITTEE, ALONG WITH OTHER INFORMATION, PRIOR TO APPROVING ANY CHANGES TO COMPENSATION. THE INDEPENDENCE OF THE COMMITTEES MEMBERS IS REVIEWED AND VERIFIED PRIOR TO THE START OF THE ANNUAL COMPENSATION REVIEW PROCESS. SHOULD A CONFLICT PRESENT, THOSE INDIVIDUALS WITH ACTUAL OR PERCEIVED CONFLICTS ABSTAIN FROM VOTING UNTIL SUCH TIME AS THE CONFLICT CAN BE RESOLVED OR A REPLACEMENT MEMBER IS APPOINTED TO THE COMMITTEE. THE COMMITTEES DELIBERATIONS AND DECISIONS ARE GUIDED BY A WRITTEN COMPENSATION PHILOSOPHY AND DOCUMENTED THROUGH WRITTEN MINUTES TAKEN DURING EACH MEETING. THE MINUTES INCLUDE, AMONG OTHER THINGS, THE WRITTEN MATERIALS DISTRIBUTED OR PRESENTED DURING THE MEETING AND THE SPECIFIC DECISIONS TAKEN AT THE MEETING.
FORM 990, PART VI, SECTION C, LINE 19	POLICY: IT IS THE POLICY OF THIS HOSPITAL TO MAKE AVAILABLE TO ANYONE WHO ASKS, A COPY OF ITS ANNUAL REPORT TO THE INTERNAL REVENUE SERVICE (IRS) ON FORM 990, AND ITS EXEMPT STATUS FORM. IN ACCORDANCE WITH THE LAW, FORM 990 FOR A GIVEN YEAR, WILL BE MADE AVAILABLE FOR PUBLIC INSPECTION FOR A THREE-YEAR PERIOD.PURPOSE: THE PURPOSE OF THIS POLICY IS TO COMPLY WITH IRS LAW, WHICH APPLIES FOR TAX YEARS BEGINNING AFTER JUNE 8, 1999 SPECIAL INSTRUCTIONS: A. A COPY OF THE ABOVE NAMED DOCUMENTS, WILL BE MADE AVAILABLE FOR INSPECTION BY A REQUESTER, IN A DESIGNATED ROOM, IN THE FINANCE DEPARTMENT OF THE HOSPITAL. B. THE DOCUMENTS WILL BE MADE AVAILABLE, IMMEDIATELY, TO ANYONE WHO APPEARS IN PERSON DURING USUAL BUSINESS HOURS. FOR WRITTEN REQUESTS FOR COPIES OF DOCUMENTS, RESPONSE WILL BE PROVIDED WITHIN THIRTY (30) DAYS OF RECEIPT OF PAYMENT OF REASONABLE COPYING FEES. C. EITHER THE HOSPITAL SENIOR VICE PRESIDENT/CFO, THE CONTROLLER, OR THEIR DESIGNATED REPRESENTATIVE WILL BE PRESENT DURING AN INSPECTION BY A REQUESTER. D. ONLY THE HOSPITAL SENIOR VICE PRESIDENT/CFO, THE CONTROLLER, OR THEIR DESIGNATED REPRESENTATIVE WILL BE PERMITTED TO ANSWER QUESTIONS THAT A REQUESTER MAY HAVE. SHOULD A REQUESTER ASK THE HOSPITAL FOR A PHOTOCOPY OF ANY OR ALL PARTS OF DOCUMENTS, THE HOSPITAL WILL CHARGE $1.00 FOR THE FIRST PAGE, PLUS $.15 FOR EACH ADDITIONAL PAGE.
FORM 990, PART IX, LINE 11G	OTHER FEES: PROGRAM SERVICE EXPENSES 30,860,606. MANAGEMENT AND GENERAL EXPENSES 4,828,773. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 35,689,379.
FORM 990, PART XI, LINE 9:	CHANGE IN INVESTMENTS IN FOUNDATION 245,247. CONTRIBUTIONS FOR CAPITAL ACQUISITIONS 522,219.
PART XII LINE 2C	NO CHANGE FROM PRIOR YEAR

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

Cat. No. 51056K

Schedule O (Form 990) 2021

Additional Data

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Software Version:

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SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

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

Attach to Form 990.
MediumBullet

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

OMB No. 1545-0047

2021

Open to Public Inspection

Name of the organization

FAXTON ST LUKE'S HEALTHCARE

Employer identification number

16-1576637

Part I

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

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

Part II

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

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No
(1)MOHAWK VALLEY HEALTH SYSTEM INC PO BOX 4308 UTICA,NY13504 22-3124162	PROMOTE HEALTH CARE	NY	501(C)(3)	LINE 3	N/A		No
(2)ST LUKE'S HOME RESIDENTIAL HEALTHCARE FACILITY PO BOX 6305 UTICA,NY13504 16-1476372	202 BED RHCF	NY	501(C)(3)	LINE 10	FAXTON ST LUKE'S HEALTHCARE INC		No
(3)VISITING NURSE'S ASSOCIATION OF UTICA & ONEIDA COUNTIES 2608 GENESEE STREE UTICA,NY13502 15-0532259	HOME HEALTH NURSING	NY	501(C)(3)	LINE 10	MOHAWK VALLEY NETWORK INC		No
(4)ST ELIZABETH'S MEDICAL CENTER INC 2209 GENESEE STREET UTICA,NY13501 15-0532245	HEALTH CARE	NY	501(C)(3)	LINE 3	PARTNERS IN FRANCISCAN MINISTRIES INC		No
(5)ST ELIZABETH MEDICAL CENTER FOUNDATION 2209 GENESEE STREET UTICA,NY13501 22-2562170	FUNDRAISING	NY	501(C)(3)	LINE 12B, II	ST ELIZABETH MEDICAL CENTER	Yes
(6)MOHAWK VALLEY HEALTH SYSTEM FOUNDATION PO BOX 4309 UTICA,NY13503 22-3078768	FUND RAISING	NY	501(C)(3)	LINE 12B, II	MOHAWK VALLEY NETWORK INC		No

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

Cat. No. 50135Y

Schedule R (Form 990) 2021

Page 2

Part III

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

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

Part IV

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

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(h) Percentage ownership	(i) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(h) Percentage ownership	Yes	No

Schedule R (Form 990) 2021

Page 3

Part V

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

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

Yes

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

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

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

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

Yes

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

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

Yes

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

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

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

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

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

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

Yes

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

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

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

Yes

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

Yes

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

Yes

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

Yes

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

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

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

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

Schedule R (Form 990) 2021

Page 4

Part VI

Unrelated Organizations Taxable as a Partnership. Complete if the organization answered "Yes" on Form 990, Part IV, line 37.

Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.

(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(e) Are all partners section 501(c)(3) organizations?		(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?		(k) Percentage ownership
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No	(k) Percentage ownership

Schedule R (Form 990) 2021

Page 5

Part VII

Supplemental Information

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

Return Reference	Explanation

Schedule R (Form 990) 2021

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: TO PROVIDE FOR EXCELLENCE IN HEALTHCARE FOR OUR COMMUNITIES.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	17
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	15
5	Total number of individuals employed in calendar year 2021 (Part V, line 2a) ......	5	2,716
6	Total number of volunteers (estimate if necessary) .............	6	24
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	-112,382
b	Net unrelated business taxable income from Form 990-T, Part I, line 11 .........	7b	0

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	30,897,226	4,837,421
9	Program service revenue (Part VIII, line 2g) .........	273,207,791	324,505,280
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	1,233,811	8,950,288
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	21,630,452	26,197,909
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	326,969,280	364,490,898
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	0	0
14	Benefits paid to or for members (Part IX, column (A), line 4).....	0	0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	174,863,612	183,777,017
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	140,814,346	168,865,108
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	315,677,958	352,642,125
19	Revenue less expenses. Subtract line 18 from line 12.......	11,291,322	11,848,773
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	312,187,526	336,161,577
21	Total liabilities (Part X, line 26).............	137,849,854	136,026,134
22	Net assets or fund balances. Subtract line 21 from line 20.....	174,337,672	200,135,443

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 100,531,975 including grants of $ ) (Revenue $ 103,618,690 )
	INPATIENT/ACUTE CARE SERVICES - FSLH IS A FULL SERVICE GENERAL HOSPTIAL WITH 320 LICENSED BEDS. THE HOSPTIAL PROVIDES A FULL RANGE OF ANCILLARY SERVICES, INCLUDING MATERNITY AND NEWBORN CARE SERVICES. DISBURSEMENTS MADE BY THE HOSPTIAL ARE EXCLUSIVELY FOR SERVICES AND MATERIALS USED IN PERFORMING THE HOSPITAL'S EXEMPT FUNCTIONS. FSLH PROVIDES CARE TO EVERYONE REGARDLESS OF RACE, RELIGION OR ABILITY TO PAY.

4b	(Code: ) (Expenses $ 60,440,731 including grants of $ ) (Revenue $ 62,296,491 )
	RADIOLOGY/MEDICAL IMAGING - MVHS MEDICAL IMAGING PROVIDES DIAGNOSTIC AND INTERVENTIONAL RADIOLOGY USING RADIATION, SOUND WAVES OR MAGNETIC FIELDS IN MEDICAL DIAGNOSIS AND INCLUDES IMAGING TECHNOLOGY SUCH AS X-RAYS, COMPUTED TOMOGRAPHY (CT), MAGNETIC RESONANCE IMAGING (MRI) AND ULTRASOUND. MVHS OFFERS THE FOLLOWING MEDICAL IMAGING SERVICES AT 4 CENTRAL LOCATIONS, IN ADDITION TO THOSE OUTPATIENT X-RAY SERVICES PROVIDED AT VARIOUS PRIMARY CARE SITES: CT SCANS, ULTRASOUND, EMERGENCY RADIOLOGY, FLUOROSCOPY, INPATIENT X-RAY, OUTPATIENT X-RAY, INTERVENTIONAL RADIOLOGY, NUCLEAR MEDICINE, PET SCAN, DIGITAL MAMMOGRAPHY, 3D MAMMOGRAPHY, STEREOTACTIC AND ULTRASOUND BREAST BIOPSY AND BONE DENSITY/DEXA SCAN. MRI SERVICES ARE AVAILABLE AT THE ST LUKE'S CAMPUS, WHICH ARE PROVIDED BY COOPERATIVE MAGNETIC IMAGING.

4c	(Code: ) (Expenses $ 23,561,378 including grants of $ ) (Revenue $ 25,260,369 )
	RENAL DIALYSIS - THE DIALYSIS PROGRAM AT MOHAWK VALLEY HEALTH SYSTEM (MVHS) IS THE SOLE PROVIDER OF IP, OP AND HOME DIALYSIS TREATMENTS WITHIN 25 MILES TO THE EAST AND WEST, AND NEARLY 75 MILES TO THE NORTH AND SOUTH. IN 2021, PATIENTS FROM SEVEN COUNTIES, RECEIVED MORE THAN 58,000 DIALYSIS TREATMENTS AT ONE OF SEVEN FACILITIES LOCATED THROUGHOUT THE MOHAWK VALLEY. MVHS IS ONE OF THE LARGEST HOSPITAL-BASED DIALYSIS PROGRAMS IN THE COUNTRY AND IS GROWING TO ADDRESS THE UNMET NEEDS OF THE LOCAL POPULATION. ADDITIONALLY, MVHS PROVIDES HOME DIALYSIS TREATMENTS FOR PERITONEAL AND HOME HEMO.

	(Code: ) (Expenses $ 129,357,947 including grants of $ ) (Revenue $ 159,640,021 )


4d	Other program services (Describe in Schedule O.)
	(Expenses $ 129,357,947 including grants of $ ) (Revenue $ 159,640,021 )
4e	Total program service expenses313,892,031

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	7,719,835	558,313	325,993

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c
d	Related organizations		1d	510,763
e	Government grants (contributions)		1e	4,325,408

f	All other contributions, gifts, grants, and similar amounts not included above		1f	1,250

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

h Total. Add lines 1a-1f.......		4,837,421

		Business Code
2a	ACUTE CARE	622200	103,618,690	103,618,690
b	RADIOLOGY	622200	62,296,491	62,296,491
c	RENAL DIALYSIS	622200	25,260,369	25,260,369
d	LABORATORY	621500	20,050,037	20,050,037
e	CANCER CARE	622200	16,239,618	16,239,618
f	All other program service revenue.		97,040,075	97,040,075
g	Total. Add lines 2a–2f .....		324,505,280

3 Investment income (including dividends, interest, and othersimilar amounts) ......			5,082,568			5,082,568
4 Income from investment of tax-exempt bond proceeds
5 Royalties...........
		(ii) Personal	(i) Real
6a	Gross rents		1,052,778	6a
b	Less: rental expenses		1,165,160	6b
c	Rental income or (loss)		-112,382	6c
d	Net rental income or (loss).......			-112,382		-112,382
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory	6,398,614		7a
b	Less: cost or other basis and sales expenses	2,530,894		7b
c	Gain or (loss)	3,867,720		7c
d	Net gain or (loss).........			3,867,720			3,867,720
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ....
			8a
b	Less: direct expenses ...		8b
c	Net income or (loss) from fundraising events..
9a	Gross income from gaming activities. See Part IV, line 19 ...
			9a
b	Less: direct expenses ...		9b
c	Net income or (loss) from gaming activities..
10a	Gross sales of inventory, less returns and allowances ..
			10a
b	Less: cost of goods sold ..		10b
c	Net income or (loss) from sales of inventory..
Business Code			Miscellaneous Revenue
11a	340B CONTRACT		900099	18,812,336	18,812,336
b	RETAIL PHARMACY		900099	5,153,263	5,153,263
c
d	All other revenue ....			2,344,692	2,344,692
e	Total. Add lines 11a–11d ......			26,310,291
12	Total revenue. See instructions.....			364,490,898	350,815,571	-112,382	8,950,288

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 ....
2	Grants and other assistance to domestic individuals. See Part IV, line 22 ...........
3	Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16. .............
4	Benefits paid to or for members .......
5	Compensation of current officers, directors, trustees, and key employees ...........	3,249,717	1,495,401	1,754,316
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........	152,264,424	131,663,047	20,601,377
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	6,231,854	5,388,684	843,170
9	Other employee benefits .......	11,769,661	10,177,226	1,592,435
10	Payroll taxes ...........	10,261,361	8,872,999	1,388,362
11	Fees for services (non-employees):
a	Management ......	1,898,268	1,641,432	256,836
b	Legal .........	535,433		535,433
c	Accounting ...........	144,996		144,996
d	Lobbying ...........	63,130		63,130
e	Professional fundraising services. See Part IV, line 17
f	Investment management fees ......
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	35,689,379	30,860,606	4,828,773
12	Advertising and promotion ....	550,546	476,057	74,489
13	Office expenses .......	852,038	736,757	115,281
14	Information technology ......	5,154,388	4,456,999	697,389
15	Royalties ..
16	Occupancy ...........	7,415,985	6,383,021	1,032,964
17	Travel ............
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .
19	Conferences, conventions, and meetings ....	490,894	424,476	66,418
20	Interest ...........	688,788	595,595	93,193
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization ..	10,767,023	9,273,692	1,493,331
23	Insurance ...	3,363,032	2,908,014	455,018
24	Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a	MEDICAL SUPPLIES	73,061,526	73,061,526
b	BAD DEBT	8,812,952	8,812,952
c	SERVICE CONTRACTS	6,852,498	5,925,355	927,143
d	NON MEDICAL SUPPLIES	5,956,231	5,150,353	805,878
e	All other expenses	6,568,001	5,587,839	980,162
25	Total functional expenses. Add lines 1 through 24e	352,642,125	313,892,031	38,750,094	0
26	Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here if following SOP 98-2 (ASC 958-720).

1	Cash–non-interest-bearing ........			12,807,396	1	13,201,123
2	Savings and temporary cash investments .........			1,415,367	2	3,583,007
3	Pledges and grants receivable, net ......			128,265	3	109,860
4	Accounts receivable, net .............			28,617,661	4	33,978,717
5	Loans and other receivables from any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .......
					5
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), and persons described in section 4958(c)(3)(B) ...
					6
7	Notes and loans receivable, net ...........				7
8	Inventories for sale or use ............			8,866,791	8	9,147,694
9	Prepaid expenses and deferred charges ......			1,980,688	9	3,707,567
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	281,573,788
b	Less: accumulated depreciation	10b	218,073,943	68,994,536	10c	63,499,845
11	Investments—publicly traded securities .				11
12	Investments—other securities. See Part IV, line 11 .....			143,893,067	12	164,867,679
13	Investments—program-related. See Part IV, line 11 ..			4,235,121	13	4,108,931
14	Intangible assets ...............			250,000	14
15	Other assets. See Part IV, line 11 ...........			40,998,634	15	39,957,154
16	Total assets. Add lines 1 through 15 (must equal line 33)...			312,187,526	16	336,161,577

17	Accounts payable and accrued expenses .....	36,456,500	17	43,199,619
18	Grants payable ...		18
19	Deferred revenue .........		19
20	Tax-exempt bond liabilities .........	24,963,555	20	19,472,306
21	Escrow or custodial account liability. Complete Part IV of Schedule D		21
22	Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .........
			22
23	Secured mortgages and notes payable to unrelated third parties ..		23	3,458,000
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	76,429,799	25	69,896,209
26	Total liabilities. Add lines 17 through 25..	137,849,854	26	136,026,134

	Organizations that follow FASB ASC 958, check here and complete lines 27, 28, 32, and 33.
27	Net assets without donor restrictions ..........	166,264,999	27	191,817,523
28	Net assets with donor restrictions ...........	8,072,673	28	8,317,920
	Organizations that do not follow FASB ASC 958, check here and complete lines 29 through 33.
29	Capital stock or trust principal, or current funds .....		29
30	Paid-in or capital surplus, or land, building or equipment fund ...		30
31	Retained earnings, endowment, accumulated income, or other funds		31
32	Total net assets or fund balances ...........	174,337,672	32	200,135,443
33	Total liabilities and net assets/fund balances ........	312,187,526	33	336,161,577