4A (Expenses $ 332606134 including grants of $ 0) (Revenue $ 327236920)
EXPENSES INCURRED IN PROVIDING INPATIENT, OUTPATIENT AND EMERGENCY MEDICALLY NECESSARY SERVICES TO ALL INDIVIDUALS IN A NON-DISCRIMINATORY MANNER REGARDLESS OF RACE, COLOR, CREED, SEX, NATIONAL ORIGIN OR ABILITY TO PAY. PLEASE REFER TO SCHEDULE O FOR THE ORGANIZATION'S COMMUNITY BENEFIT STATEMENT (STATEMENT OF PROGRAM SERVICES) WHICH INCLUDES DETAILED INFORMATION REGARDING THE VARIOUS SERVICES PROVIDED BY THIS ORGANIZATION.

PART V, SECTION B, LINE 5
"IN ASSESSING THE HEALTH NEEDS OF THE COMMUNITY, RICHMOND MEDICAL CENTER D/B/A RICHMOND UNIVERSITY MEDICAL CENTER (""RUMC"") SOLICITED AND RECEIVED INPUT FROM PERSONS WHO REPRESENT THE BROAD INTERESTS OF THE COMMUNITY. THESE INDIVIDUALS PROVIDED PERSPECTIVES ON HEALTH TRENDS, EXPERTISE ABOUT EXISTING COMMUNITY RESOURCES AVAILABLE TO MEET THOSE NEEDS, AND INSIGHTS INTO SERVICE DELIVERY GAPS THAT CONTRIBUTE TO HEALTH DISPARITIES. RUMC IS AN ACTIVE PARTNER IN THE STATEN ISLAND COMMUNITY. OUR COMMUNITY PARTNERS WERE INVITED TO PARTICIPATE IN THE CHNA AS KEY INFORMANTS AND ARE IMPORTANT STAKEHOLDERS IN OUR INITIATIVES TO ADDRESS PRIORITY HEALTH NEEDS. THE COMMUNITY HEALTH IMPROVEMENT PLAN DETAILS WAYS IN WHICH WE WILL WORK WITH LOCAL PARTNERS TO ADDRESS IDENTIFIED HEALTH NEEDS. OUR COMMUNITY PARTNERSHIPS INCLUDE, BUT ARE NOT LIMITED TO, THE FOLLOWING: - RUMC IS A MEMBER OF STATEN ISLAND PARTNERSHIP FOR COMMUNITY WELLNESS (SIPCW) WHICH BRINGS TOGETHER PARTNERS, STAKEHOLDERS, AND COMMUNITY MEMBERS TO FOCUS ON STATEN ISLANDERS IN NEED, ESPECIALLY THOSE FACING HEALTH BURDENS OR INEQUITIES. - RUMC CO-LEADS THE STATEN ISLAND PERFORMING PROVIDER SYSTEM (SI PPS) WITH STATEN ISLAND UNIVERSITY HOSPITAL, WHICH FOSTERS COLLABORATION AMONG MORE THAN 70 COMMUNITY BASED STATEN ISLAND PARTNERS. KEY INFORMANT INTERVIEWS ------------------------ A KEY INFORMANT SURVEY WAS CONDUCTED WITH COMMUNITY REPRESENTATIVES WITHIN STATEN ISLAND TO SOLICIT INFORMATION ABOUT HEALTH NEEDS AMONG RESIDENTS. A TOTAL OF 22 INDIVIDUALS RESPONDED TO THE SURVEY, INCLUDING HEALTH AND SOCIAL SERVICE PROVIDERS; COMMUNITY AND PUBLIC HEALTH EXPERTS; CIVIC, RELIGIOUS, AND SOCIAL LEADERS; POLICY MAKERS AND ELECTED OFFICIALS; AND OTHERS REPRESENTING DIVERSE POPULATIONS INCLUDING MINORITY, LOW-INCOME, AND OTHER UNDERSERVED OR VULNERABLE POPULATIONS. A LIST OF THE REPRESENTED COMMUNITY ORGANIZATIONS INCLUDED THE FOLLOWING: - CAMELOT OF STATEN ISLAND - CARMEL RICHMOND HEALTHCARE AND REHABILITATION CENTER - CLOVE LAKES HEALTH CARE AND REHABILITATION CENTER - COMMUNITY HEALTH ACTION OF STATEN ISLAND - COOLEY'S ANEMIA FOUNDATION, INC. - EGER HEALTH CARE - JCC STATEN ISLAND - NEW YORK STATE ASSEMBLY - OFFICE OF STATEN ISLAND BOROUGH PRESIDENT - PROJECT HOSPITALITY - RICHMOND CENTER FOR REHABILITATION AND HEALTHCARE - RICHMOND COUNTY DISTRICT ATTORNEY - RICHMOND COUNTY SAVINGS FOUNDATION - SILVER LAKE SPECIALIZED REHAB & CARE CENTER - ST. EDWARDS FOOD PANTRY, INC. - ST. PHILIPS BAPTIST CHURCH - STATEN ISLAND HEART SOCIETY - STATEN ISLAND PARTNERSHIP FOR COMMUNITY WELLNESS - THE STATEN ISLAND FOUNDATION - VISITING NURSE ASSOCIATION OF STATEN ISLAND - WAGNER COLLEGE - YMCA GREATER NEW YORK STATEN ISLAND - NORTH SHORE"

SCHEDULE H, PART V, SECTION B, QUESTION 7A
"THE ORGANIZATION IS AN AFFILIATE WITHIN RICHMOND MEDICAL CENTER D/B/A RICHMOND UNIVERSITY MEDICAL CENTER (""RICHMOND UNIVERSITY MEDICAL CENTER"") AND AFFILIATES; A TAX-EXEMPT INTEGRATED HEALTHCARE DELIVERY SYSTEM (""SYSTEM""). DUE TO CHARACTER LIMITATIONS, THE WEBSITE LISTED IN SCHEDULE H, PART V, SECTION B, QUESTION 7A, IS THE HOME PAGE FOR THE SYSTEM. THE CHNA CAN BE ACCESSED AT THE FOLLOWING PAGE INCLUDED IN THE SYSTEM'S WEBSITE: HTTPS://WWW.RUMCSI.ORG/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT/"

SCHEDULE H, PART V, SECTION B, QUESTION 10A
"THE ORGANIZATION IS AN AFFILIATE WITHIN RICHMOND MEDICAL CENTER D/B/A RICHMOND UNIVERSITY MEDICAL CENTER (""RICHMOND UNIVERSITY MEDICAL CENTER"") AND AFFILIATES; A TAX-EXEMPT INTEGRATED HEALTHCARE DELIVERY SYSTEM (""SYSTEM"").DUE TO CHARACTER LIMITATIONS, THE WEBSITE LISTED IN SCHEDULE H, PART V, SECTION B, QUESTION 10A, IS THE HOME PAGE FOR THE SYSTEM. THE ORGANIZATION'S IMPLEMENTATION STRATEGY IS INCLUDED WITHIN ITS COMMUNITY HEALTH NEEDS ASSESSMENT. THIS IMPLEMENTATION STRATEGY CAN BE ACCESSED AT THE FOLLOWING PAGE INCLUDED IN THE SYSTEM'S WEBSITE: HTTPS://WWW.RUMCSI. ORG/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT/"

PART V, SECTION B, LINE 11
UPON COMPETITION OF ITS COMMUNITY HEALTH NEEDS ASSESSMENT, RUMC LEADERSHIP REVIEWED FINDINGS FROM THE CHNA RESEARCH, INCLUDING PUBLIC HEALTH AND SOCIOECONOMIC MEASURES AND INPUT RECEIVED FROM KEY INFORMANTS, TO DETERMINE PRIORITY HEALTH NEEDS FOR STATEN ISLAND AND TO FOCUS COMMUNITY HEALTH IMPROVEMENT EFFORTS. LEADERSHIP REPRESENTATIVES CONSIDERED THE 2019 CHNA RESEARCH FINDINGS, AS WELL AS EXISTING COMMUNITY AND HOSPITAL SERVICES, PROGRAMS, AND AREAS OF EXPERTISE. DISCUSSION CULMINATED IN THE IDENTIFICATION OF THE FOLLOWING PRIORITIES TO BE ADDRESSED DURING THE NEXT THREE YEAR CYCLE. THE PRIORITIES ARE ALIGNED WITH THE NEW YORK STATE PREVENTION AGENDA AND STATEN ISLAND PERFORMING PROVIDER SYSTEM AND STATEN ISLAND PARTNERSHIP FOR COMMUNITY WELLNESS INITIATIVES. TO WORK TOWARD HEALTH EQUITY, IT IS IMPERATIVE TO PRIORITIZE RESOURCES AND ACTIVITIES TO ADDRESS THE MOST PRESSING HEALTH NEEDS WITHIN STATEN ISLAND. USING FEEDBACK FROM COMMUNITY STAKEHOLDERS AND TAKING INTO ACCOUNT THE MEDICAL CENTER'S EXPERTISE AND RESOURCES, RUMC WILL FOCUS EFFORTS ON THE FOLLOWING PRIORITIES: 1) PREVENT CHRONIC DISEASES 2) PROMOTE WELL-BEING AND PREVENT MENTAL AND SUBSTANCE USE DISORDERS SPECIFICALLY, THROUGH ITS COMMUNITY BENEFIT AND HEALTH IMPROVEMENT ACTIVITIES, RUMC WILL EMPHASIZE TOBACCO PREVENTION, PREVENTIVE CARE AND DISEASE MANAGEMENT, AND INCREASING ACCESS TO PREVENTION AND TREATMENT SERVICES FOR MENTAL AND SUBSTANCE USE DISORDERS. RUMC WILL EMPLOY EVIDENCE-BASED INITIATIVES TO ADDRESS THE IDENTIFIED PRIORITY AREAS, AND LEVERAGE RESOURCES AND PARTNERSHIPS ACROSS THE COMMUNITY TO IMPROVE OUTCOMES FOR RESIDENTS. THE FOLLOWING SECTION HIGHLIGHTS SELECT PROGRAMS FROM RUMC'S APPROACH TO ADDRESS CHRONIC DISEASE, MENTAL HEALTH, AND SUBSTANCE USE DISORDER. TO MEASURE PROGRAM SUCCESS, RUMC WILL TRACK PARTICIPATION AND OUTCOMES. 1) TOBACCO PREVENTION STRATEGIES AND INITIATIVES: - TOBACCO CESSATION PROGRAM: RUMC OFFERS A COMMUNITY TOBACCO CESSATION PROGRAM TWO TIMES PER YEAR, AS WELL AS A CERTIFIED TOBACCO TREATMENT SPECIALIST PROVIDING CESSATION COUNSELING AND HEALTH EDUCATION SPECIFICALLY TARGETING YOUTH VAPING. - TOBACCO USE DISORDER TREATMENT: RUMC PROVIDES TREATMENT FOR TOBACCO USE DISORDERS WITHIN OUR CENTER FOR INTEGRATIVE BEHAVIORAL MEDICINE. THE PROGRAM WAS IMPLEMENTED WITH SUPPORT FROM THE NYC TOBACCO CESSATION TRAINING & TECHNICAL ASSISTANCE CENTER. 2) PREVENTIVE CARE AND MANAGEMENT STRATEGIES AND INITIATIVES - NEW YORK STATE DEPARTMENT OF HEALTH CANCER SERVICES PROGRAM (CSP): AS A PARTNER AGENCY IN THE CSP, RUMC PROVIDES FREE BREAST, CERVICAL, AND COLORECTAL SCREENINGS AND DIAGNOSTIC SERVICES TO ELIGIBLE WOMEN AND MEN WHO LIVE IN NEW YORK. - BREAST HEALTH PATIENT NAVIGATION INITIATIVE: SUPPORTED BY A GRANT FROM THE NYC AFFILIATE OF SUSAN G. KOMEN FOR THE CURE, RUMC PROVIDES NAVIGATION SERVICES TO INCREASE ACCESS TO MAMMOGRAPHY AND BREAST HEALTHCARE, TARGETING UNDERSERVED WOMEN. - CARE TRANSITIONS PROGRAM: RUMC SUPPORTS THIS PROGRAM IN COLLABORATION WITH THE VISITING NURSE ASSOCIATION TO REDUCE 30-DAY READMISSION RATES WITHIN THE MEDICAID POPULATION. - MEDICAID ACCELERATED EXCHANGE (MAX): RUMC SUPPORTS THIS PROGRAM AS PART OF THE SI PPS TO IMPROVE OUTCOMES AND REDUCE UNNECESSARY CARE FOR EMERGENCY DEPARTMENT (ED) SUPER-UTILIZERS. - DIABETES MANAGEMENT PROGRAM: RUMC SUPPORTS THIS PROGRAM AS PART OF THE SI PPS TO ENSURE USE OF EVIDENCE-BASED PROTOCOLS FOR DIABETES MANAGEMENT IN THE CLINICAL SETTING AND IMPROVE PATIENT OUTCOMES THROUGH CARE MANAGEMENT INCENTIVES AND SERVICES. - BARIATRIC AND METABOLIC INSTITUTE: RUMC OPENED THE INSTITUTE IN AUGUST 2018 TO OFFER DIVERSE SURGICAL AND NON-SURGICAL CARE TO ASSIST RESIDENTS STRUGGLING WITH OBESITY. 3) PREVENT MENTAL AND SUBSTANCE USE DISORDERS STRATEGIES AND INITIATIVES - BEHAVIORAL HEALTH INFRASTRUCTURE PROJECT: RUMC SERVES ON THE STEERING COMMITTEE FOR THIS SI PPS-BASED PROJECT, WHICH FOCUSES ON REDUCING UNNECESSARY HOSPITALIZATIONS AND INCREASING ACCESS TO QUALITY BEHAVIORAL HEALTH SERVICES ON STATEN ISLAND. - PEER COUNSELOR WARM HANDOFF PROGRAM: RUMC PROVIDES THIS PROGRAM IN PARTNERSHIP WITH COMMUNITY PROVIDERS TO CONNECT PATIENTS SEEN IN THE ED FOR A SUBSTANCE USE DISORDER WITH TIMELY AND APPROPRIATE WITHDRAWAL MANAGEMENT AND TREATMENT SERVICES. - RELAY: RUMC PROVIDES RELAY PEERS TO PROVIDE FOLLOW-UP CONSULTATION FOR PATIENTS SEEN IN THE ED FOR A NONFATAL OVERDOSE. THE PROGRAM WAS IMPLEMENTED IN PARTNERSHIP WITH THE NYC DOHMH AND COMMUNITY HEALTH ACTION OF STATEN ISLAND (CHASI). - OPIOID OVERDOSE PREVENTION PROGRAM: AS A REGISTERED OPIOID OVERDOSE PREVENTION PROGRAM, THE RUMC SILBERSTEIN CLINIC PROVIDES TRAINING TO COMMUNITY MEMBERS, PATIENTS, AND PROFESSIONALS ON HOW TO RECOGNIZE, RESPOND, AND GIVE NALOXONE. - TACKLING YOUTH SUBSTANCE ABUSE: RUMC IS A PARTNER IN THE SIPCW TACKLING YOUTH SUBSTANCE ABUSE PROGRAM TO EDUCATE THE COMMUNITY, REDUCE STIGMA, SHARE DATA, AND PROVIDE OPPORTUNITIES FOR YOUTH AND COMMUNITY ENGAGEMENT, AMONG OTHER SERVICES.

SCHEDULE H, PART V, SECTION B, QUESTION 16
"THE ORGANIZATION IS AN AFFILIATE WITHIN RICHMOND MEDICAL CENTER D/B/A RICHMOND UNIVERSITY MEDICAL CENTER (""RICHMOND UNIVERSITY MEDICAL CENTER"") AND AFFILIATES; A TAX-EXEMPT INTEGRATED HEALTHCARE DELIVERY SYSTEM (""SYSTEM""). DUE TO CHARACTER LIMITATIONS, THE WEBSITE LISTED IN SCHEDULE H, PART V, SECTION B, QUESTION 16, IS THE HOME PAGE FOR THE SYSTEM. THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY, FINANCIAL ASSISTANCE APPLICATION AND PLAIN LANGUAGE SUMMARY ARE MADE WIDELY AVAILABLE ON THE ORGANIZATION'S WEBSITE. THESE DOCUMENTS CAN BE ACCESSED AT THE FOLLOWING PAGE INCLUDED IN THE SYSTEM'S WEBSITE: HTTPS://WWW.RUMCSI.ORG/PATIENTS -VISITORS/BILLING-AND INSURANCE/ FINANCIAL-ASSISTANCE-SUMMARY/"

SCHEDULE H, PART I; LINE 3C
IN ADDITION TO THE FEDERAL POVERTY GUIDELINES, THE ORGANIZATION USES OTHER FACTORS IN DETERMINING ELIGIBILITY CRITERIA FOR FREE AND DISCOUNTED CARE. AS OUTLINED IN PART V, SECTION B, QUESTION 13, OTHER FACTORS TO DETERMINE ELIGIBILITY INCLUDE: - ASSET LEVEL; - MEDICAL INDIGENCY; - INSURANCE STATUS; - UNDERINSURANCE STATUS; AND - RESIDENCY.

SCHEDULE H, PART I; QUESTION 6A
THE ORGANIZATION ANNUALLY PUBLISHES A REPORT WHICH HIGHLIGHTS ITS ACHIEVEMENTS AS WELL AS ITS PROGRAMS AND SERVICES THAT PROMOTE THE HEALTH OF THE COMMUNITIES SERVED. THIS REPORT IS MADE WIDELY AVAILABLE AND CAN BE FOUND ON THE ORGANIZATION'S WEBSITE.

SCHEDULE H, PART I; QUESTION 7
THE ORGANIZATION'S COST TO CHARGE RATIO REFLECTS TOTAL OPERATING COSTS, EXCLUDING BAD DEBT AND OTHER OPERATING REVENUE, TO GROSS CHARGES. THE HOSPITAL UTILIZED WORKSHEET 2 OF THE SCHEDULE H INSTRUCTIONS TO DERIVE ITS COST-TO-CHARGE RATIO.

SCHEDULE H, PART II
NOT APPLICABLE.

SCHEDULE H, PART III; QUESTIONS 2 & 3
BAD DEBT EXPENSE WAS CALCULATED USING THE PROVIDERS' BAD DEBT EXPENSE FROM ITS FINANCIAL STATEMENT, WHICH IS BASED UPON MANAGEMENT'S ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS, BUSINESS AND ECONOMIC CONDITIONS, TRENDS IN MEDICARE AND MEDICAID HEALTH COVERAGE AND OTHER COLLECTION INDICATORS. ADDITIONS TO THE PROVISION FOR DOUBTFUL ACCOUNTS RESULT FROM THE PROVISION FOR BAD DEBTS; DEDUCTIONS FROM THE ALLOWANCE FOR DOUBTFUL ACCOUNTS RESULT FROM ACCOUNTS WRITTEN OFF AS UNCOLLECTIBLE. THE COSTING METHODOLOGY USED TO ESTIMATE THE AMOUNT OF BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE FINANCIAL ASSISTANCE POLICY WAS THE RATIO OF APPROVED CHARITY CARE APPLICATIONS TO TOTAL APPLICATIONS APPLIED TO SELF-PAY BAD DEBTS ASSOCIATED WITH PATIENTS WHO DID NOT ADEQUATELY COMPLETE THE FINANCIAL ASSISTANCE PAPERWORK. WE BELIEVE THAT A PORTION OF OUR BAD DEBT RESULTS FROM SERVICES PROVIDED TO PATIENTS WHO MEET THE FINANCIAL ASSISTANCE GUIDELINES BUT WERE UNWILLING OR UNABLE TO PROVIDE THE APPROPRIATE DOCUMENTATION TO ALLOW THAT CLASSIFICATION. THESE SHOULD BE CONSIDERED COMMUNITY BENEFIT AS WE ARE STILL PROVIDING SERVICES TO THESE PATIENTS REGARDLESS OF THEIR ABILITY TO PAY.

SCHEDULE H, PART III, SECTION B; QUESTION 8
"MEDICARE COSTS WERE DERIVED FROM THE 2021 MEDICARE COST REPORT. THE ORGANIZATION FEELS THAT MEDICARE UNDERPAYMENTS (SHORTFALL), BAD DEBT AND ASSOCIATED COSTS ARE COMMUNITY BENEFIT AND ARE INCLUDABLE ON THE FORM 990, SCHEDULE H, PART I. AS OUTLINED MORE FULLY BELOW, THE ORGANIZATION BELIEVES THAT THESE SERVICES AND RELATED COSTS PROMOTE THE HEALTH OF THE COMMUNITY AS A WHOLE AND ARE RENDERED IN CONJUNCTION WITH THE ORGANIZATION'S CHARITABLE TAX-EXEMPT PURPOSES AND MISSION IN PROVIDING MEDICALLY NECESSARY HEALTHCARE SERVICES TO ALL INDIVIDUALS IN A NON-DISCRIMINATORY MANNER WITHOUT REGARD TO RACE, COLOR, CREED, SEX, NATIONAL ORIGIN OR ABILITY TO PAY AND CONSISTENT WITH THE COMMUNITY BENEFIT STANDARD PROMULGATED BY THE IRS. THE COMMUNITY BENEFIT STANDARD IS THE CURRENT STANDARD FOR A HOSPITAL FOR RECOGNITION AS A TAX-EXEMPT AND CHARITABLE ORGANIZATION UNDER INTERNAL REVENUE CODE (""IRC"") 501(C)(3). THE ORGANIZATION IS RECOGNIZED AS A TAX-EXEMPT ENTITY AND CHARITABLE ORGANIZATION UNDER 501(C)(3) OF THE IRC. ALTHOUGH THERE IS NO DEFINITION IN THE TAX CODE FOR THE TERM ""CHARITABLE"" A REGULATION PROMULGATED BY THE DEPARTMENT OF THE TREASURY PROVIDES SOME GUIDANCE AND STATES THAT ""THE TERM CHARITABLE IS USED IN SECTION 501(C)(3) IN ITS GENERALLY ACCEPTED LEGAL SENSE,PROVIDES EXAMPLES OF CHARITABLE PURPOSES, INCLUDING THE RELIEF OF THE POOR OR UNPRIVILEGED; THE PROMOTION OF SOCIAL WELFARE; AND THE ADVANCEMENT OF EDUCATION, RELIGION, AND SCIENCE. NOTE IT DOES NOT EXPLICITLY ADDRESS THE ACTIVITIES OF HOSPITALS. IN THE ABSENCE OF EXPLICIT STATUTORY OR REGULATORY REQUIREMENTS APPLYING THE TERM ""CHARITABLE"" TO HOSPITALS, IT HAS BEEN LEFT TO THE IRS TO DETERMINE THE CRITERIA HOSPITALS MUST MEET TO QUALIFY AS IRC 501(C)(3) CHARITABLE ORGANIZATIONS. THE ORIGINAL STANDARD WAS KNOWN AS THE CHARITY CARE STANDARD. THIS STANDARD WAS REPLACED BY THE IRS WITH THE COMMUNITY BENEFIT STANDARD WHICH IS THE CURRENT STANDARD. CHARITY CARE STANDARD IN 1956, THE IRS ISSUED REVENUE RULING 56-185, WHICH ADDRESSED THE REQUIREMENTS HOSPITALS NEEDED TO MEET IN ORDER TO QUALIFY FOR IRC 501(C)(3) STATUS. ONE OF THESE REQUIREMENTS IS KNOWN AS THE ""CHARITY CARE STANDARD."" UNDER THE STANDARD, A HOSPITAL MUST PROVIDE, TO THE EXTENT OF ITS FINANCIAL ABILITY, FREE OR REDUCED-COST CARE TO PATIENTS WHO CANNOT PAY FOR SUCH SERVICES. A HOSPITAL THAT EXPECTED FULL PAYMENT DID NOT, ACCORDING TO THE RULING, PROVIDE CHARITY CARE BASED ON THE FACT THAT SOME PATIENTS ULTIMATELY FAILED TO PAY. THE RULING EMPHASIZED THAT A LOW LEVEL OF CHARITY CARE DID NOT NECESSARILY MEAN THAT A HOSPITAL HAD FAILED TO MEET THE REQUIREMENT SINCE THAT LEVEL COULD REFLECT ITS FINANCIAL ABILITY TO PROVIDE SUCH CARE. THE RULING ALSO NOTED THAT PUBLICLY SUPPORTED COMMUNITY HOSPITALS WOULD NORMALLY QUALIFY AS CHARITABLE ORGANIZATIONS BECAUSE THEY SERVE THE ENTIRE COMMUNITY AND A LOW LEVEL OF CHARITY CARE WOULD NOT AFFECT A HOSPITAL'S EXEMPT STATUS IF IT WAS DUE TO THE SURROUNDING COMMUNITY'S LACK OF CHARITABLE DEMANDS. COMMUNITY BENEFIT STANDARD IN 1969, THE IRS ISSUED REVENUE RULING 69-545, WHICH ""REMOVED"" FROM REVENUE RULING 56-185 ""THE REQUIREMENTS RELATING TO CARING FOR PATIENTS WITHOUT CHARGE OR AT RATES BELOW COST."" UNDER THE STANDARD DEVELOPED IN REVENUE RULING 69-545, WHICH IS KNOWN AS THE ""COMMUNITY BENEFIT STANDARD,"" HOSPITALS ARE JUDGED ON WHETHER THEY PROMOTE THE HEALTH OF A BROAD CLASS OF INDIVIDUALS IN THE COMMUNITY. THE RULING INVOLVED A HOSPITAL THAT ONLY ADMITTED INDIVIDUALS WHO COULD PAY FOR THE SERVICES (BY THEMSELVES, PRIVATE INSURANCE, OR PUBLIC PROGRAMS SUCH AS MEDICARE), BUT OPERATED A FULL-TIME EMERGENCY ROOM THAT WAS OPEN TO EVERYONE. THE IRS RULED THAT THE HOSPITAL QUALIFIED AS A CHARITABLE ORGANIZATION BECAUSE IT PROMOTED THE HEALTH OF PEOPLE IN ITS COMMUNITY. THE IRS REASONED THAT BECAUSE THE PROMOTION OF HEALTH WAS A CHARITABLE PURPOSE ACCORDING TO THE GENERAL LAW OF CHARITY, IT FELL WITHIN THE ""GENERALLY ACCEPTED LEGAL SENSE"" OF THE TERM ""CHARITABLE,"" AS REQUIRED BY THE DEPARTMENT OF TREASURY REG. 1.501(C)(3)-1(D)(2). THE IRS RULING STATED THAT THE PROMOTION OF HEALTH, LIKE THE RELIEF OF POVERTY AND THE ADVANCEMENT OF EDUCATION AND RELIGION, IS ONE OF THE PURPOSES IN THE GENERAL LAW OF CHARITY THAT IS DEEMED BENEFICIAL TO THE COMMUNITY AS A WHOLE EVEN THOUGH THE CLASS OF BENEFICIARIES ELIGIBLE TO RECEIVE A DIRECT BENEFIT FROM ITS ACTIVITIES DOES NOT INCLUDE ALL MEMBERS OF THE COMMUNITY, SUCH AS INDIGENT MEMBERS OF THE COMMUNITY, PROVIDED THAT THE CLASS IS NOT SO SMALL THAT ITS RELIEF IS NOT OF BENEFIT TO THE COMMUNITY. THE IRS CONCLUDED THAT THE HOSPITAL WAS ""PROMOTING THE HEALTH OF A CLASS OF PERSONS THAT IS BROAD ENOUGH TO BENEFIT THE COMMUNITY"" BECAUSE ITS EMERGENCY ROOM WAS OPEN TO ALL AND IT PROVIDED CARE TO EVERYONE WHO COULD PAY, WHETHER DIRECTLY OR THROUGH THIRD-PARTY REIMBURSEMENT. OTHER CHARACTERISTICS OF THE HOSPITAL THAT THE IRS HIGHLIGHTED INCLUDED THE FOLLOWING: ITS SURPLUS FUNDS WERE USED TO IMPROVE PATIENT CARE, EXPAND HOSPITAL FACILITIES, AND ADVANCE MEDICAL TRAINING, EDUCATION AND RESEARCH; IT WAS CONTROLLED BY A BOARD OF TRUSTEES THAT CONSISTED OF INDEPENDENT CIVIC LEADERS; AND HOSPITAL MEDICAL STAFF PRIVILEGES WERE AVAILABLE TO ALL QUALIFIED PHYSICIANS. THE AMERICAN HOSPITAL ASSOCIATION (""AHA"") FEELS THAT MEDICARE UNDERPAYMENTS (SHORTFALL) AND BAD DEBT ARE COMMUNITY BENEFIT AND THUS INCLUDABLE ON THE FORM 990, SCHEDULE H, PART I. THIS ORGANIZATION AGREES WITH THE AHA'S POSITION. AS OUTLINED IN THE AHA'S LETTER TO THE IRS DATED AUGUST 21, 2007 WITH RESPECT TO THE FIRST PUBLISHED DRAFT OF THE NEW FORM 990 AND SCHEDULE H, THE AHA FELT THAT THE IRS SHOULD INCORPORATE THE FULL VALUE OF THE COMMUNITY BENEFIT THAT HOSPITALS PROVIDE BY COUNTING MEDICARE UNDERPAYMENTS (SHORTFALL) AS QUANTIFIABLE COMMUNITY BENEFIT FOR THE FOLLOWING REASONS: - PROVIDING CARE FOR THE ELDERLY AND SERVING MEDICARE PATIENTS IS AN ESSENTIAL PART OF THE COMMUNITY BENEFIT STANDARD. - MEDICARE, LIKE MEDICAID, DOES NOT PAY THE FULL COST OF CARE. FROM THE LATEST DATA PROVIDED BY THE AHA, MEDICARE REIMBURSES HOSPITALS ONLY 87 CENTS FOR EVERY DOLLAR THEY SPEND TO TAKE CARE OF MEDICARE PATIENTS. - MANY MEDICARE BENEFICIARIES, LIKE THEIR MEDICAID COUNTERPARTS, ARE POOR. MORE THAN 42 PERCENT OF MEDICARE SPENDING IS FOR BENEFICIARIES WHOSE INCOME IS BELOW 200 PERCENT OF THE FEDERAL POVERTY LEVEL. MANY OF THOSE MEDICARE BENEFICIARIES ARE ALSO ELIGIBLE FOR MEDICAID -- SO CALLED ELIGIBLE."" THERE IS EVERY COMPELLING PUBLIC POLICY REASON TO TREAT MEDICARE AND MEDICAID UNDERPAYMENTS SIMILARLY FOR PURPOSES OF A HOSPITAL'S COMMUNITY BENEFIT AND INCLUDE THESE COSTS ON FORM 990, SCHEDULE H, PART I. MEDICARE UNDERPAYMENT MUST BE SHOULDERED BY THE HOSPITAL IN ORDER TO CONTINUE TREATING THE COMMUNITY'S ELDERLY AND POOR. THESE UNDERPAYMENTS REPRESENT A REAL COST OF SERVING THE COMMUNITY AND SHOULD COUNT AS A QUANTIFIABLE COMMUNITY BENEFIT. BOTH THE AHA AND THIS ORGANIZATION ALSO FEEL THAT PATIENT BAD DEBT IS A COMMUNITY BENEFIT AND THUS INCLUDABLE ON THE FORM 990, SCHEDULE H, PART I. LIKE MEDICARE UNDERPAYMENT (SHORTFALLS), THERE ALSO ARE COMPELLING REASONS THAT PATIENT BAD DEBT SHOULD BE COUNTED AS QUANTIFIABLE COMMUNITY BENEFIT AS FOLLOWS: - A SIGNIFICANT MAJORITY OF BAD DEBT IS ATTRIBUTABLE TO LOW-INCOME PATIENTS, WHO, FOR MANY REASONS, DECLINE TO COMPLETE THE FORMS REQUIRED TO ESTABLISH ELIGIBILITY FOR HOSPITALS' CHARITY CARE OR THOSE WHO DO NOT PAY ALL, OR A PORTION OF THE ALREADY DISCOUNTED BILLED AMOUNTS UNDER OUR FINANCIAL ASSISTANCE POLICY. A 2006 CONGRESSIONAL BUDGET OFFICE (""CBO"") REPORT, NONPROFIT HOSPITALS AND THE PROVISION OF COMMUNITY BENEFITS, CITED TWO STUDIES INDICATING THAT ""THE GREAT MAJORITY OF BAD DEBT WAS ATTRIBUTABLE TO PATIENTS WITH INCOMES BELOW 200% OF THE FEDERAL POVERTY LINE."" - THE REPORT ALSO NOTED THAT A SUBSTANTIAL PORTION OF BAD DEBT IS PENDING CHARITY CARE. UNLIKE BAD DEBT IN OTHER INDUSTRIES, HOSPITAL BAD DEBT IS COMPLICATED BY THE FACT THAT HOSPITALS FOLLOW THEIR MISSION TO THE COMMUNITY AND TREAT EVERY PATIENT THAT COMES THROUGH THEIR EMERGENCY DEPARTMENT, REGARDLESS OF ABILITY TO PAY. PATIENTS WHO HAVE OUTSTANDING BILLS ARE NOT TURNED AWAY, UNLIKE OTHER INDUSTRIES. BAD DEBT IS FURTHER COMPLICATED BY THE AUDITING INDUSTRY'S STANDARDS ON REPORTING CHARITY CARE. MANY PATIENTS CANNOT OR DO NOT PROVIDE THE NECESSARY, EXTENSIVE DOCUMENTATION REQUIRED TO BE DEEMED CHARITY CARE BY AUDITORS. AS A RESULT, ROUGHLY 40% OF BAD DEBT IS PENDING CHARITY CARE. THE CBO CONCLUDED THAT ITS FINDINGS ""SUPPORT THE VALIDITY OF THE USE OF UNCOMPENSATED CARE [BAD DEBT AND CHARITY CARE] AS A MEASURE OF COMMUNITY BENEFIT"" ASSUMING THE FINDINGS ARE GENERALIZABLE NATIONWIDE; THE EXPERIENCE OF HOSPITALS AROUND THE NATION REINFORCES THAT THEY ARE GENERALIZABLE. AS OUTLINED BY THE AHA, DESPITE THE HOSPITAL'S BEST EFFORTS AND DUE DILIGENCE, PATIENT BAD DEBT IS A PART OF THE HOSPITAL'S MISSION AND CHARITABLE PURPOSES. BAD DEBT REPRESENTS PART OF THE BURDEN HOSPITALS SHOULDER IN SERVING ALL PATIENTS R"

SCHEDULE H, PART III, SECTION B; QUESTION 9B
ALL PATIENTS WITH SELF PAY BALANCES RELATED TO SERVICES RENDERED AT RICHMOND UNIVERSITY MEDICAL CENTER ARE GIVEN THE OPPORTUNITY TO ADDRESS THEIR RESPONSIBILITY THROUGH A PAYMENT ARRANGEMENT OR A REDUCED FEE, BASED ON THE CRITERIA OF OUR FINANCIAL ASSISTANCE PROGRAM. A SLIDING FEE SCALE IS UTILIZED AND IS BASED UPON FAMILY INCOME AND NUMBER OF FAMILY MEMBERS. ALL PATIENTS WILL RECEIVE STATEMENTS AND/OR LETTERS AND ARE GIVEN THE OPPORTUNITY TO SATISFY THEIR OBLIGATION TO THE FACILITY PRIOR TO TRANSFER TO A COLLECTION AGENCY AND WRITE-OFF TO A BAD DEBT. PATIENTS WHO CANNOT AFFORD TO PAY ARE OFFERED INSTALLMENT PAYMENTS OR A REDUCTION IN BALANCE THROUGH THE FINANCIAL ASSISTANCE PROGRAM.

SCHEDULE H, PART VI; QUESTION 2
RICHMOND UNIVERSITY MEDICAL CENTER'S (RUMC) BOARD, ADMINISTRATION AND STAFF FUNCTION FROM AN UNDERSTANDING THAT HEALTH IS THE CORNERSTONE OF A PRODUCTIVE AND POSITIVE QUALITY-OF-LIFE FOR EVERY STATEN ISLANDER. AS SUCH, OUR FOCUS IS NOT ONLY ON HEALING THE SICK, BUT ALSO UNDERSTANDING THE ROOT CAUSE OF CONDITIONS AFFECTING STATEN ISLANDERS AND WHAT WE CAN DO TO PREVENT THE DISEASE PROCESSES PREVALENT IN OUR COMMUNITY. RUMC UTILIZES A VARIETY OF SOURCES AND APPROACHES TO IDENTIFY THE HEALTH NEEDS OF THE COMMUNITY WE SERVE. COMMUNITY BENEFIT PLANNING IS FORMULATED AROUND INFORMATION GATHERED FROM CONSOLIDATING DATA FROM NEW YORK STATE AND NEW YORK CITY DEPARTMENTS OF HEALTH AND OBTAINING PERSPECTIVES FROM KEY COMMUNITY ORGANIZATIONS AND STAKEHOLDERS ON THE CRITICAL HEALTHCARE ISSUES FACING STATEN ISLAND. THROUGH DATA OBTAINED FROM THE NEW YORK STATE DEPARTMENT OF HEALTH AND NEW YORK CITY DEPARTMENT OF HEALTH, AS WELL AS COLLABORATIONS WITH HEALTHCARE AND OTHER KEY COMMUNITY STAKEHOLDERS, RUMC COORDINATES A UNIFIED EFFORT TO PROVIDE PROGRAMS THAT IMPACT THE HEALTH AND WELL-BEING OF OUR COMMUNITY. TO ENSURE OUR SERVICES ARE ALIGNED WITH THE HEALTHCARE NEEDS OF OUR COMMUNITY, WE CONDUCT A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) EVERY THREE YEARS. THIS STUDY HELPS US TO DETERMINE AND PORTRAY HEALTH STATUS, GATHER STAKEHOLDER PERSPECTIVES, DEFINE EXISTING COMMUNITY ASSETS, AND ULTIMATELY BETTER SERVE OUR COMMUNITY. RUMC REPRESENTATIVES LEAD THE CHNA AND OVERSAW RESEARCH AND STAKEHOLDER ENGAGEMENT. STEERING COMMITTEE MEMBERS ARE LISTED BELOW, ALONG WITH THE CONSULTANT TEAM MEMBERS. COMMUNITY HEALTH CONSULTANTS ASSISTED IN ALL PHASES OF THE CHNA, INCLUDING PROJECT MANAGEMENT, DATA COLLECTION AND ANALYSIS, AND REPORT WRITING. THE CHNA INCLUDED QUANTITATIVE AND QUALITATIVE RESEARCH METHODS TO DETERMINE HEALTH TRENDS AND DISPARITIES WITHIN STATEN ISLAND. PRIMARY STUDY METHODS WERE USED TO SOLICIT INPUT FROM KEY COMMUNITY STAKEHOLDERS REPRESENTING THE BROAD INTERESTS OF THE COMMUNITY. SECONDARY STUDY METHODS WERE USED TO IDENTIFY AND ANALYZE STATISTICAL DEMOGRAPHIC AND HEALTH TRENDS. SPECIFIC CHNA STUDY METHODS INCLUDED: - AN ANALYSIS OF SECONDARY DATA SOURCES, INCLUDING PUBLIC HEALTH, DEMOGRAPHIC, AND SOCIAL MEASURES; AND - A KEY INFORMANT SURVEY WITH 22 COMMUNITY REPRESENTATIVES TO SOLICIT FEEDBACK ON COMMUNITY HEALTH PRIORITIES, UNDERSERVED POPULATIONS, AND PARTNERSHIP OPPORTUNITIES.

SCHEDULE H, PART III; QUESTION 4
"RICHMOND MEDICAL CENTER D/B/A RICHMOND UNIVERSITY MEDICAL CENTER (""RICHMOND UNIVERSITY MEDICAL CENTER"") AND AFFILIATES PREPARE AND ISSUE AUDITED CONSOLIDATED FINANCIAL STATEMENTS. THE TEXT BELOW WAS OBTAINED FROM THE RICHMOND UNIVERSITY MEDICAL CENTER AUDITED CONSOLIDATED FINANCIAL STATEMENTS FOOTNOTES: PATIENT ACCOUNTS RECEIVABLE --------------------------- PATIENT ACCOUNTS RECEIVABLE ARE RECORDED AT NET REALIZABLE VALUE AT THE TRANSACTION PRICE BASED ON STANDARD CHARGES FOR SERVICES PROVIDED, REDUCED BY CONTRACTUAL ADJUSTMENTS PROVIDED TO THIRD-PARTY PAYORS, DISCOUNTS PROVIDED TO UNINSURED OR UNDERINSURED PATIENTS IN ACCORDANCE WITH THE MEDICAL CENTER'S POLICIES, AND/OR IMPLICIT PRICE CONCESSIONS PROVIDED TO UNINSURED OR UNDERINSURED PATIENTS, AND DO NOT BEAR INTEREST. SUBSEQUENT CHANGES TO THE ESTIMATE OF THE TRANSACTION PRICE (DETERMINED ON A PORTFOLIO BASIS WHEN APPLICABLE) ARE GENERALLY RECORDED AS ADJUSTMENTS TO PATIENT REVENUE IN THE PERIOD OF THE CHANGE. ACCOUNTS ARE WRITTEN OFF THROUGH THE PROVISION FOR BAD DEBTS WHEN THE MEDICAL CENTER HAS EXHAUSTED ALL COLLECTION EFFORTS AND DETERMINES ACCOUNTS ARE IMPAIRED BASED ON CHANGES IN PATIENT CREDIT WORTHINESS. NET PATIENT SERVICE REVENUES ---------------------------- NET PATIENT SERVICE REVENUES ARE RECOGNIZED AT THE AMOUNT THAT REFLECTS THE CONSIDERATION TO WHICH THE MEDICAL CENTER EXPECTS TO BE ENTITLED IN EXCHANGE FOR PROVIDING PATIENT CARE. THESE AMOUNTS ARE DUE FROM PATIENTS, THIRD PARTY PAYORS (INCLUDING COMMERCIAL AND GOVERNMENTAL PROGRAMS) AND OTHERS AND INCLUDES VARIABLE CONSIDERATION FOR RETROACTIVE REVENUE ADJUSTMENTS DUE TO SETTLEMENT OF AUDITS, REVIEWS AND INVESTIGATIONS. GENERALLY, THE MEDICAL CENTER BILLS THE PATIENTS AND THIRD PARTY PAYORS SEVERAL DAYS AFTER THE SERVICES ARE PERFORMED AND/OR THE PATIENT IS DISCHARGED FROM THE FACILITY. REVENUES ARE RECOGNIZED AS PERFORMANCE OBLIGATIONS ARE SATISFIED. PERFORMANCE OBLIGATIONS ARE DETERMINED BASED ON THE NATURE OF THE SERVICES PROVIDED BY THE MEDICAL CENTER. REVENUES FOR PERFORMANCE OBLIGATIONS SATISFIED OVER TIME ARE RECOGNIZED BASED ON ACTUAL CHARGES INCURRED IN RELATION TO TOTAL EXPECTED (OR ACTUAL) CHARGES. THE MEDICAL CENTER BELIEVES THAT THIS METHOD PROVIDES A FAITHFUL DEPICTION OF THE TRANSFER OF SERVICES OVER THE TERM OF THE PERFORMANCE OBLIGATION BASED ON THE INPUTS NEEDED TO SATISFY THE OBLIGATION. GENERALLY, PERFORMANCE OBLIGATIONS SATISFIED OVER TIME RELATE TO PATIENTS RECEIVING INPATIENT ACUTE CARE SERVICES. THE MEDICAL CENTER MEASURES THE PERFORMANCE OBLIGATION FROM ADMISSION INTO THE HOSPITAL, OR THE COMMENCEMENT OF AN OUTPATIENT SERVICE, TO THE POINT WHEN IT IS NO LONGER REQUIRED TO PROVIDE SERVICES TO THAT PATIENT, WHICH IS GENERALLY AT THE TIME OF DISCHARGE OR COMPLETION OF THE OUTPATIENT SERVICES. REVENUES FOR PERFORMANCE OBLIGATIONS SATISFIED AT A POINT-IN-TIME ARE GENERALLY RECOGNIZED WHEN GOODS OR SERVICES ARE PROVIDED, AND THE MEDICAL CENTER DOES NOT BELIEVE IT IS REQUIRED TO PROVIDE ADDITIONAL SERVICES TO THE PATIENT. ALL OF THE MEDICAL CENTER'S PERFORMANCE OBLIGATIONS RELATE TO CONTRACTS WITH A DURATION OF LESS THAN ONE YEAR, THEREFORE THE MEDICAL CENTER HAS ELECTED TO APPLY THE OPTIONAL EXEMPTIONS PROVIDED IN FASB ASC 606-10-50-14(A) AND AS A RESULT IS NOT REQUIRED TO DISCLOSE THE AGGREGATE AMOUNT OF THE TRANSACTION PRICE ALLOCATED TO PERFORMANCE OBLIGATIONS THAT ARE UNSATISFIED OR PARTIALLY UNSATISFIED AT THE END OF THE REPORTING PERIOD. THE UNSATISFIED OR PARTIALLY UNSATISFIED PERFORMANCE OBLIGATIONS REFERRED TO ABOVE ARE PRIMARILY RELATED TO INPATIENT ACUTE CARE SERVICES AT THE END OF THE REPORTING PERIOD. THE PERFORMANCE OBLIGATIONS FOR THESE CONTRACTS ARE GENERALLY COMPLETED WHEN THE PATIENTS ARE DISCHARGED, WHICH GENERALLY OCCURS WITHIN DAYS OR WEEKS OF THE END OF THE REPORTING PERIOD. THE MEDICAL CENTER DETERMINES THE TRANSACTION PRICE BASED ON STANDARD CHARGES FOR SERVICES PROVIDED, REDUCED BY CONTRACTUAL ADJUSTMENTS PROVIDED TO THIRD PARTY PAYORS, DISCOUNTS PROVIDED TO UNINSURED OR UNDERINSURED PATIENTS IN ACCORDANCE WITH THE MEDICAL CENTER'S POLICIES AND/OR IMPLICIT PRICE CONCESSIONS PROVIDED TO UNINSURED OR UNDERINSURED PATIENTS. THE MEDICAL CENTER DETERMINES ITS ESTIMATES OF CONTRACTUAL ADJUSTMENTS AND DISCOUNTS BASED ON CONTRACTUAL AGREEMENTS, ITS DISCOUNT POLICIES AND HISTORICAL EXPERIENCE. THE MEDICAL CENTER DETERMINES ITS ESTIMATES OF IMPLICIT PRICE CONCESSIONS BASED ON ITS HISTORICAL COLLECTION EXPERIENCE WITH A RESPECTIVE CLASS OF PATIENT. THE MEDICAL CENTER HAS ELECTED THE PRACTICAL EXPEDIENT ALLOWED UNDER FASB ASC 606-10-32-18 AND DOES NOT ADJUST THE PROMISED AMOUNT OF CONSIDERATION FROM PATIENTS AND THIRD PARTY PAYORS FOR THE EFFECTS OF A SIGNIFICANT FINANCING COMPONENT DUE TO THE MEDICAL CENTER'S EXPECTATION THAT THE PERIOD BETWEEN THE TIME THE SERVICE IS PROVIDED TO A PATIENT AND THE TIME THAT THE PATIENT OR A THIRD PARTY PAYOR PAYS FOR THAT SERVICE WILL BE ONE YEAR OR LESS. THE MEDICAL CENTER DOES, IN CERTAIN INSTANCES, ENTER INTO PAYMENT AGREEMENTS WITH PATIENTS THAT ALLOW PAYMENTS IN EXCESS OF ONE YEAR, HOWEVER, IN THESE CASES THE FINANCING COMPONENT IS NOT DEEMED TO BE SIGNIFICANT TO THE CONTRACT. CHARITY CARE ------------ THE MEDICAL CENTER PROVIDES CHARITY CARE TO PATIENTS WHO MEET CERTAIN CRITERIA WITHOUT CHARGE OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATES. THE MEDICAL CENTER PROVIDES FREE CARE OR SLIDING FEE SCALES BASED ON FEDERAL POVERTY INCOME GUIDELINES OR WHEN IT IS DETERMINED THAT THE PATIENTS ARE UNABLE TO FULFILL THEIR OBLIGATIONS TO THE MEDICAL CENTER. BECAUSE THE MEDICAL CENTER DOES NOT PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE, THEY ARE NOT REPORTED AS REVENUES."

SCHEDULE H, PART VI; QUESTION 3
IN FURTHERANCE OF ITS CHARITABLE PURPOSES, RUMC PROVIDES HEALTHCARE SERVICES TO ALL INDIVIDUALS IN A NON-DISCRIMINATORY WAY, REGARDLESS OF RACE, COLOR, CREED OR ETHNICITY. RUMC CONTINUES TO PROVIDE REDUCED-FEE OR FREE CARE IN ACCORDANCE WITH PUBLIC LAW 2807(K)(9-A). ALTHOUGH NOT REQUIRED BY THIS LAW, WE DO EXTEND THIS POLICY TO INDIVIDUALS WHO MAY NOT BE QUALIFIED BASED ON THE GUIDELINES OF OUR FINANCIAL ASSISTANCE POLICY BUT DO DEMONSTRATE AN INABILITY TO PAY ALL OF THEIR MEDICAL EXPENSES. AS PART OF BEST-PRACTICE CARE, RUMC IS IN COMMUNICATION WITH LOCAL COMMUNITY-BASED CONSUMER ADVOCATE ORGANIZATIONS TO BE CERTAIN THAT THEY ARE AWARE OF THE PROVISIONS OF OUR FINANCIAL AID POLICY. THE PATIENT ACCESS DEPARTMENT HAS RECEIVED SUMMARY DATA OF THE LAW AND OUR REQUIREMENTS. ASSISTANCE CONTINUES TO BE OFFERED BY OUR FINANCIAL SCREENING STAFF AND MEDICAL APPLICATION OFFICE TO THOSE INDIVIDUALS NOT ELIGIBLE FOR MEDICAID, AS WELL AS FINANCIAL SCREENING STAFF LOCATED IN OUR EMERGENCY DEPARTMENT. RUMC POSTS THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY SUMMARY AND FINANCIAL ASSISTANCE CONTACT INFORMATION IN MANY DIFFERENT LANGUAGES (AS DETERMINED BY RUMC'S ANNUAL LANGUAGE NEEDS ASSESSMENT) IN LOCATIONS SUCH AS THE EMERGENCY DEPARTMENT, INTAKE, REGISTRATION AND ADMISSION AREAS. PATIENTS ARE PROVIDED A SUMMARY OF THE POLICY AND FINANCIAL ASSISTANCE CONTACT INFORMATION AS PART OF THE INTAKE PROCESS AND FINANCIAL SCREENING PROCESS. PATIENT BILLS INCLUDE A STATEMENT ON FINANCIAL ASSISTANCE. EVERY PATIENT SEEN IN THE FINANCIAL OFFICE HAS A DISCUSSION ON THE AVAILABILITY OF GOVERNMENT BENEFITS SUCH AS MEDICAID AND AT THE SAME TIME QUALIFICATIONS ON THE HOSPITAL'S FINANCIAL ASSISTANCE PROGRAM. RUMC HAS AN INTERDISCIPLINARY TEAM THAT INTERACTS WITH FINANCIAL ASSISTANCE COUNSELORS SUCH AS SOCIAL WORKERS AND CASE MANAGERS TO IDENTIFY AND ASSIST ELIGIBLE PATIENTS. STAFF TRAINING ON FINANCIAL ASSISTANCE IS DONE ANNUALLY THROUGH AN IN-SERVICE PROGRAM THAT INCLUDES A REVIEW OF HOW TO QUALIFY PATIENTS FOR MEDICAID AND OTHER GOVERNMENT PROGRAMS. ALL THIRD PARTIES THAT WORK FOR RUMC IN THE COLLECTION OF FEES ARE REQUIRED TO FOLLOW THE HOSPITAL'S POLICIES REGARDING PATIENT NOTIFICATION ABOUT THE AVAILABILITY OF FINANCIAL ASSISTANCE. RUMC'S FINANCIAL ASSISTANCE POLICY CLEARLY STATES THAT MEDICAL CARE IS PROVIDED TO INDIVIDUALS IN NEED, REGARDLESS OF THEIR ABILITY TO PAY AND MAKES CERTAIN THAT ALL REQUESTS FOR FINANCIAL ASSISTANCE ARE EVALUATED AND PROCESSED FAIRLY AND CONSISTENTLY WITH DIGNITY, COMPASSION AND IN A RESPECTFUL MANNER, CONSISTENT WITH ITS MISSION AND VALUES.

SCHEDULE H, PART VI; QUESTION 7
THIS ORGANIZATION IS LOCATED IN THE STATE OF NEW YORK. NEW YORK REQUIRES HOSPITALS TO REPORT THEIR COSTS OF PROVIDING UNREIMBURSED CARE AND REQUIRES NONPROFIT HOSPITALS TO DEMONSTRATE THEIR COMMITMENT TO MEETING COMMUNITY HEALTH NEEDS. NEW YORK LAW REQUIRES THAT NONPROFIT AND FOR-PROFIT HOSPITALS FILE FINANCIAL REPORTS DETAILING, AMONG OTHER THINGS, THEIR COSTS OF PROVIDING FREE OR REDUCED COST SERVICES. N.Y. PUB. HEALTH LAW 2805-A(2)(A); 2803-L(2)(IV). IN ADDITION, AT LEAST EVERY THREE YEARS THE GOVERNING BODY OF A NONPROFIT HOSPITAL MUST DEMONSTRATE THE HOSPITAL'S COMMITMENT TO MEETING COMMUNITY HEALTH CARE NEEDS, PROVIDING CHARITY CARE, AND IMPROVING UNDERSERVED INDIVIDUALS' ACCESS TO HEALTH CARE SERVICES. THE GOVERNING BODY MUST ALSO MAKE AVAILABLE TO THE PUBLIC A SUMMARY STATEMENT OF THE HOSPITAL'S FINANCIAL RESOURCES AND ALLOCATION TO HOSPITAL PURPOSES, INCLUDING ITS PROVISION OF FREE AND DISCOUNTED CARE. AT LEAST ANNUALLY, THE GOVERNING BODY MUST MAKE AVAILABLE TO THE PUBLIC AN IMPLEMENTATION REPORT AS TO THE HOSPITAL'S EFFORTS TO MEET COMMUNITY HEALTH CARE NEEDS, PROVIDE CHARITY CARE, AND IMPROVE ACCESS TO CARE. AT LEAST EVERY THREE YEARS, A NONPROFIT HOSPITAL MUST FILE WITH THE COMMISSIONER OF HEALTH A REPORT DETAILING CHANGES TO ITS MISSION STATEMENT AND ITS OPERATIONAL AND FINANCIAL COMMITMENT TO MEETING COMMUNITY HEALTH CARE NEEDS, TO ITS PROVISION OF CHARITY CARE, AND TO IMPROVING UNDERSERVED INDIVIDUALS' ACCESS TO CARE. N.Y. PUB. HEALTH LAW 2803-L.

SCHEDULE H, PART VI; QUESTION 4
"RUMC SERVES RESIDENTS OF STATEN ISLAND, ONE OF THE FIVE BOROUGHS COMPRISING NYC. STATEN ISLAND IS DIVIDED GEOGRAPHICALLY INTO THREE AREAS: NORTH SHORE, MID-ISLAND, AND SOUTH SHORE. RUMC IS LOCATED WITHIN THE NORTH SHORE AND PRIMARILY SERVES RESIDENTS OF THIS AREA. THE POPULATION OF THE NORTH SHORE IS UNIQUELY DIVERSE. A RECENT REPORT BY THE CITIZEN'S COMMITTEE FOR CHILDREN OF NEW YORK STATED, ""THE NORTH SHORE IS ONE OF ONLY 10 COMMUNITY DISTRICTS IN THE CITY WHERE NO RACIAL/ETHNIC GROUP REPRESENTS MORE THAN 40% OF THE POPULATION. HOWEVER, ACROSS THE SEVEN NEIGHBORHOODS THAT MAKE UP THE NORTH SHORE, THE DEMOGRAPHIC CHARACTERISTICS OF THE POPULATION AND OUTCOMES VARY GREATLY. FOR EXAMPLE, CAUCASIAN RESIDENTS MAKE UP MORE THAN 70% OF THE POPULATION IN WESTERLEIGH, WHILE AFRICAN AMERICAN AND LATINO RESIDENTS MAKE UP MORE THAN 70% OF THE POPULATION IN GRYMES HILL-PARK HILL."" ECONOMIC INDICATORS FOR THE NORTH SHORE ARE ALSO UNIQUE WITH NOTABLE DIFFERENCES IN INCOME ACROSS NEIGHBORHOODS, AND A HIGH PROPORTION OF RESIDENTS BOTH LIVING IN POVERTY AND AFFLUENCE. THE POPULATION OF STATEN ISLAND IS MORE SIMILAR TO THE NATION THAN THE OTHER NYC BOROUGHS IN TERMS OF RACIAL COMPOSITION, WITH CAUCASIANS REPRESENTING THE MAJORITY, BUT CURRENT POPULATION PROJECTIONS ANTICIPATE INCREASING DIVERSITY IN YEARS TO COME. LATINX RESIDENTS ARE AMONG THE FASTEST GROWING DEMOGRAPHIC IN STATEN ISLAND. RELATED TO AGE, STATEN ISLAND RESIDENTS ARE SLIGHTLY OLDER THAN OTHER NEW YORKERS, AS EVIDENCED BY A MEDIAN AGE OF 39.5 VERSUS 36.8. STRONG FINANCIAL INDICATORS ARE ASSOCIATED WITH A HIGH QUALITY OF LIFE AND SUPPORT POSITIVE HEALTH OUTCOMES. STATEN ISLANDERS ARE GENERALLY MORE FINANCIALLY COMFORTABLE THAN MOST OTHER NEW YORKERS. THIS FINDING IS EVIDENCED BY A HIGH MEDIAN INCOME ($82,540), LOW POVERTY (13%), LOW UNEMPLOYMENT (3.6%), AND HIGH PERCENTAGE OF HOMEOWNERS (64.9%). HOWEVER, WHEN STRATIFIED BY RACE, AFRICAN AMERICANS AND LATINXS ARE MORE LIKELY TO LIVE IN POVERTY THAN OTHER DEMOGRAPHIC GROUPS IN STATEN ISLAND. WHEN REVIEWED AT THE ZIP CODE LEVEL, STATEN ISLAND ZIP CODES THAT ARE MORE RACIALLY DIVERSE AND HAVE A YOUNGER POPULATION TEND TO EXPERIENCE GREATER SOCIOECONOMIC NEED. EDUCATION IS A STRONG INDICATOR OF COMMUNITY ECONOMIC STABILITY, QUALITY OF LIFE, AND HEALTH OUTCOMES. STATEN ISLANDERS ARE MORE LIKELY TO COMPLETE HIGH SCHOOL THAN THEIR PEERS ACROSS NYC AND THE NATION, AND ROUGHLY 1 IN 3 ADULTS HAVE COMPLETED A BACHELOR'S DEGREE OR HIGHER. WHEN STRATIFIED BY RACE, AFRICAN AMERICANS AND LATINXS IN STATEN ISLAND ARE MORE LIKELY TO HAVE COMPLETED A BACHELOR'S DEGREE OR HIGHER THAN THEIR PEERS IN NYC, BUT LESS LIKELY WHEN COMPARED TO OTHER DEMOGRAPHIC GROUPS WITHIN STATEN ISLAND. THE 2018 POPULATION OF STATEN ISLAND IS 485,143; APPROXIMATELY 42% OF RESIDENTS LIVE IN THE NORTH SHORE. THE NORTH SHORE EXPERIENCED THE GREATEST POPULATION GROWTH OF THE THREE STATEN ISLAND REGIONS FROM 2010 TO 2018 (2.7%) AND IS PROJECTED TO EXPERIENCE THE GREATEST GROWTH THROUGH 2023 (2.7%). STATEN ISLAND OVERALL IS PROJECTED TO EXPERIENCE 2.4% POPULATION GROWTH BY 2023 COMPARED TO 3.3% ACROSS NYC. ALTHOUGH STATEN ISLAND IS ONE OF NYC'S FIVE BOROUGHS, ITS RACIAL COMPOSITION MORE CLOSELY MIRRORS THE US. IN STATEN ISLAND, THE MAJORITY OF RESIDENTS ARE CAUCASIAN (70.1%), WITH ROUGHLY 1 IN 5 RESIDENTS LATINX OF ANY RACE. POPULATION PROJECTIONS PREDICT THAT BY 2023, STATEN ISLAND WILL BE MORE DIVERSE THAN TODAY, CONSISTENT WITH TRENDS ANTICIPATED IN THE NATION IN GENERAL. THE POPULATION IN STATEN ISLAND IS SLIGHTLY OLDER THAN NYC AND THE NATION IN GENERAL. NEARLY 1 IN 3 HOUSEHOLDS IN STATEN ISLAND REPORT SPEAKING A LANGUAGE OTHER THAN ENGLISH AT HOME, MORE THAN THE NATION, BUT LOWER THAN NYC OVERALL. AMONG INDIVIDUALS SPEAKING A LANGUAGE OTHER THAN ENGLISH, 40.5% SPEAK AN INDO-EUROPEAN LANGUAGE (E.G. ITALIAN, GERMAN) AND 34.5% SPEAK SPANISH. THIS FINDING IS CONSISTENT WITH THE ETHNIC AND ANCESTRAL MAKEUP OF STATEN ISLAND. RESIDENTS OF STATEN ISLAND HAVE HIGHER INCOMES AND ARE LESS LIKELY TO LIVE IN POVERTY THAN OTHER RESIDENTS OF NYC. WHILE THE MEDIAN INCOME IN STATEN ISLAND IS NOTICEABLY GREATER THAN THE NATION IN GENERAL, THE PROPORTION OF ADULTS AND CHILDREN EXPERIENCING POVERTY IS SIMILAR, SUGGESTING INCOME DISPARITY WITHIN STATEN ISLAND. WHEN STRATIFIED BY RACE, THE PERCENT OF AFRICAN AMERICAN AND LATINX PEOPLE LIVING IN POVERTY IN STATEN ISLAND IS SIMILAR TO NYC OR THE NATION IN GENERAL. CAUCASIAN PEOPLE AND ASIAN PEOPLE IN STATE ISLAND ARE LESS LIKELY TO EXPERIENCE POVERTY THAN THEIR PEERS IN NYC. THIS FINDING SUGGESTS THAT RACE AND ETHNICITY HAS AN EFFECT ON THE ECONOMIC DISPARITY SEEN IN STATEN ISLAND. UNEMPLOYMENT IN STATEN ISLAND IS LOW. RESIDENTS OF ALL RACES AND ETHNICITIES ARE LESS LIKELY TO BE UNEMPLOYED THAN THEIR PEERS IN NYC AND THROUGHOUT THE NATION. WORKERS LIVING IN STATEN ISLAND ARE MORE LIKELY TO HAVE WHITE COLLAR JOBS THAN BLUE COLLAR JOBS, BUT IN PROPORTIONS CONSISTENT WITH NYC AND THE NATION AS A WHOLE. RESIDENTS OF STATEN ISLAND ARE MORE THAN TWICE AS LIKELY AS OTHER NEW YORKERS TO OWN THEIR HOMES. WHILE THE MEDIAN HOME VALUE IN STATEN ISLAND IS NEARLY $100,000 LESS THAN NYC IN GENERAL, IT IS STILL MORE THAN TWO TIMES GREATER THAN THE NATIONAL MEDIAN. THE PROPORTION OF RENTERS AND HOMEOWNERS IN STATEN ISLAND IS SIMILAR TO THE NATION, BUT HOMEOWNERS IN STATEN ISLAND ARE MORE LIKELY TO BE COST BURDENED BY THEIR HOME THAN HOMEOWNERS ACROSS THE NATION. EDUCATION IS A STRONG INDICATOR OF COMMUNITY ECONOMIC STABILITY. STATEN ISLAND RESIDENTS HAVE MORE YEARS OF EDUCATION THAN OTHER NEW YORKERS AND MOST AMERICANS. WHEN VIEWED AS A WHOLE, 1 IN 3 STATEN ISLAND RESIDENTS HAS COMPLETED A BACHELOR'S DEGREE OR HIGHER, WHILE ROUGHLY 1 IN 10 DID NOT COMPLETE HIGH SCHOOL. BOTH OF THESE INDICATORS REPRESENT BETTER OUTCOMES THAN NYC OR THE NATION."

SCHEDULE H, PART VI; QUESTION 5
"RICHMOND UNIVERSITY MEDICAL CENTER IS A LICENSED 400-PLUS BED HOSPITAL, ONE OF ONLY TWO PRIVATE HOSPITALS SERVING THE ENTIRE POPULATION OF THE BOROUGH. PURSUANT TO ITS CHARITABLE PURPOSES, RUMC PROVIDES HEALTHCARE SERVICES TO ALL INDIVIDUALS IN A NON-DISCRIMINATORY MANNER REGARDLESS OF RACE, COLOR, CREED, SEX, NATIONAL ORIGIN OR ABILITY TO PAY. MOREOVER, IT OPERATES CONSISTENTLY WITH THE FOLLOWING CRITERIA OUTLINED IN IRS REVENUE RULING 69-545: 1. PROVIDES HEALTHCARE SERVICES TO ALL INDIVIDUALS REGARDLESS OF ABILITY TO PAY, INCLUDING CHARITY CARE, SELF-PAY, MEDICARE AND MEDICAID PATIENTS; 2. OPERATES AN EMERGENCY DEPARTMENT FOR ALL PERSONS; WHICH IS OPEN 24 HOURS A DAY, 7 DAYS A WEEK, 365 DAYS PER YEAR; 3. MAINTAINS AN OPEN MEDICAL STAFF, WITH PRIVILEGES AVAILABLE TO ALL QUALIFIED PHYSICIANS; 4. CONTROL RESTS WITH ITS BOARD OF TRUSTEES WHICH IS COMPRISED OF INDEPENDENT CIVIC LEADERS AND OTHER PROMINENT MEMBERS OF THE COMMUNITY; AND 5. SURPLUS FUNDS ARE USED TO IMPROVE THE QUALITY OF PATIENT CARE, EXPAND AND RENOVATE FACILITIES AND ADVANCE MEDICAL CARE, PROGRAMS AND ACTIVITIES. SURPLUS FUNDS ARE REINVESTED IN THE ORGANIZATION, PRINCIPALLY THROUGH CAPITAL INVESTMENT, AND ALSO TO MEET FUTURE PROGRAMMATIC NEEDS, WHICH MEETS THE ORGANIZATION'S COMMITMENT TO MEET THE EXPECTATIONS OF ITS PATIENTS BY PROVIDING QUALITY HEALTHCARE AND THEREFORE, MAKES THESE INVESTMENTS TO SECURE ITS FUTURE OF SERVICE DELIVERY TO THE COMMUNITY. THE OPERATIONS OF THE HOSPITAL AS SHOWN THROUGH THE FACTORS OUTLINED ABOVE AND OTHER INFORMATION CONTAINED HEREIN, CLEARLY DEMONSTRATE THAT THE USE AND CONTROL IS FOR THE BENEFIT OF THE PUBLIC AND THAT NO PART OF THE INCOME OR NET EARNINGS OF THE ORGANIZATION INURES TO THE BENEFIT OF ANY PRIVATE INDIVIDUAL NOR IS ANY PRIVATE INTEREST BEING SERVED OTHER THAN INCIDENTALLY. IN ADDITION, RUMC COMMUNITY OUTREACH INITIATIVES, INCLUDING EDUCATION AND SCREENING, REACH THOUSANDS EACH YEAR. THE HOSPITAL IS THE MAIN SPONSOR AND/OR ACTIVE PARTICIPANT IN SEVERAL ANNUAL HEALTH RELATED EVENTS ON STATEN ISLAND, INCLUDING THE STATEN ISLAND ECONOMIC DEVELOPMENT CORPORATION'S HEALTH AND WELLNESS CONFERENCE HELD EACH FALL. THE CONFERENCE OFFERS THOUSANDS OF RESIDENTS A FORUM TO HAVE ACCESS TO EDUCATIONAL MATERIALS, SPEAK WITH PHYSICIANS AND HEALTHCARE PROFESSIONALS, AND HAVE HEALTH SCREENINGS CONDUCTED ON THE PREMISES. OUR COMMUNITY OUTREACH TEAM, KNOWN AS TRAUMA, ATTENDS OVER 100 COMMUNITY EVENTS EACH YEAR, PROVIDING BROCHURES, EDUCATIONAL MATERIALS, AND HANDS ON TRAINING TO THOUSANDS OF ADULTS AND CHILDREN ANNUALLY. PROGRAMS THEY PROVIDE INCLUDE ""STOP THE BLEED"", WHICH DISCUSSES HOW TO HANDLE BLEEDING EMERGENCIES, AND HANDS ON CPR WHICH SHOWS PEOPLE THE BASICS OF CARDIOPULMONARY RESUSCITATION. FOR MORE THAN 30 YEARS RUMC'S WIC PROGRAM HAS SUCCESSFULLY SERVED THE POOR WOMEN, INFANTS AND CHILDREN OF STATEN ISLAND. THE MISSION IS TO IMPROVE THE NUTRITION AND HEALTH STATUS OF ELIGIBLE WOMEN, INFANTS AND CHILDREN THROUGH THE PROVISION OF NUTRITIOUS FOODS, NUTRITION EDUCATION, COUNSELING AND LINKING PARTICIPANTS TO HEALTH AND HUMAN SERVICES. WIC SERVICES ASSIST WOMEN AND CHILDREN WHO HAVE LOW INCOME, ARE UNDOCUMENTED CITIZENS, ARE UNINSURED, TEENAGERS, UNWED MOTHERS, VICTIMS OF DOMESTIC VIOLENCE, AND FOSTER CHILDREN. OVER 50% OF THE PEOPLE ACCESSING SERVICES AT THE WIC SITE ARE HISPANIC. RUMC HAS A WELL-ESTABLISHED HISTORY OF WORKING WITH OTHER COMMUNITY MENTAL HEALTH ORGANIZATIONS TO WORK COLLABORATIVELY TO ASSIST THOSE IN THE BOROUGH WITH MENTAL HEALTH ISSUES. AMONG ITS PARTNERS ARE THE STATEN ISLAND MENTAL HEALTH SOCIETY, AND JEWISH BOARD OF FAMILY AND CHILDREN SERVICES. RUMC ALSO MAINTAINS RELATIONSHIPS WITH THE LOCAL COMMUNITY ORGANIZATIONS IN ITS VICINITY AND WITH STATEN ISLAND COMMUNITY BOARD. THE COMMUNITY HEALTH ACTION CENTER, STATEN ISLAND CHAMBER OF COMMERCE, PROJECT HOSPITALITY, AND THE PORT RICHMOND COMMUNITY HEALTH CENTER ARE JUST A FEW OF THE LOCAL ORGANIZATIONS RUMC MAINTAINS PARTNERSHIPS WITH. HOSPITAL ADMINISTRATION AND MEMBERS OF THE BOARD OF TRUSTEES VISIT ALBANY ANNUALLY TO LOBBY FOR HEALTHCARE ISSUES AND TO SPEAK WITH STATE HEALTH OFFICIALS. IN ADDITION TO THE COMMUNITY, RUMC MAINTAINS REGULAR COMMUNICATIONS WITH ALL OF STATEN ISLAND'S ELECTED OFFICIALS INCLUDING THE BOROUGH PRESIDENT. THESE PARTNERS ARE MET WITH ON A REGULAR BASIS ALLOWING ADMINISTRATION TO PROVIDE UPDATES ON SERVICE AND SEEK SUPPORT FROM THEM FOR ISSUES IMPORTANT TO THE HOSPITAL."

SCHEDULE H, PART VI; QUESTION 6
"OUTLINED BELOW IS A SUMMARY OF THE ENTITIES WHICH COMPRISES RICHMOND MEDICAL CENTER D/B/A RICHMOND UNIVERSITY MEDICAL CENTER (""RICHMOND UNIVERSITY MEDICAL CENTER"") AND ITS AFFILIATES: BRIDGE REGIONAL HEALTH SYSTEM ----------------------------- BRIDGE REGIONAL HEALTH SYSTEM IS THE PARENT ENTITY OF THE SYSTEM. THIS INTEGRATED HEALTHCARE DELIVERY SYSTEM CONSISTS OF A GROUP OF AFFILIATED HEALTHCARE ORGANIZATIONS. THE SOLE MEMBER OF EACH AFFILIATE IS EITHER BRIDGE REGIONAL HEALTH SYSTEM OR RICHMOND UNIVERSITY MEDICAL CENTER. RICHMOND UNIVERSITY MEDICAL CENTER ---------------------------------- RICHMOND UNIVERSITY MEDICAL CENTER (""RUMC"") WAS FOUNDED IN 2007 AND IS CURRENTLY A 448-LICENSED BED, MAJOR TEACHING, ACUTE CARE HOSPITAL LOCATED IN STATEN ISLAND, NEW YORK. RUMC IS I A NOT-FOR-PROFIT HEALTH CARE PROVIDER SERVING THE ETHNICALLY DIVERSE COMMUNITY OF STATEN ISLAND AND ITS NEIGHBORS. WE PROVIDE PREMIER QUALITY PATIENT CARE THROUGH A FULL SPECTRUM OF EMERGENT, ACUTE, PRIMARY, BEHAVIORAL HEALTH AND EDUCATIONAL SERVICES. WE DO THIS IN AN ENVIRONMENT THAT PROMOTES THE HIGHEST SATISFACTION AMONG PATIENTS, FAMILIES, PHYSICIANS AND STAFF. ON JANUARY 1, 2019, THE RICHMOND ACQUIRED CERTAIN ASSETS AND ASSUMED CERTAIN LIABILITIES OF STATEN ISLAND MENTAL HEALTH SOCIETY, INC., A NOT-FOR-PROFIT ORGANIZATION THAT PROVIDES COMPREHENSIVE MENTAL HEALTH, EARLY CHILDHOOD AND RELATED SERVICES TO STATEN ISLAND CHILDREN AND THEIR FAMILIES. RUMC IS RECOGNIZED BY THE INTERNAL REVENUE SERVICE AS AN INTERNAL REVENUE CODE 501(C)(3) TAX-EXEMPT ORGANIZATION. PURSUANT TO ITS CHARITABLE PURPOSES, THE ORGANIZATION PROVIDES MEDICALLY NECESSARY HEALTHCARE SERVICES TO ALL INDIVIDUALS IN A NON-DISCRIMINATORY MANNER REGARDLESS OF RACE, COLOR, CREED, SEX, NATIONAL ORIGIN OR ABILITY TO PAY. MOREOVER, IT OPERATES CONSISTENTLY WITH THE CRITERIA OUTLINED IN IRS REVENUE RULING 69-545. AMBOY MEDICAL PRACTICE, P.C. ---------------------------- AMBOY MEDICAL PRACTICE, P.C. IS A NOT-FOR-PROFIT ORGANIZATION FOUNDED IN 2008. THE ORGANIZATION IS RECOGNIZED BY THE INTERNAL REVENUE SERVICE AS TAX-EXEMPT PURSUANT TO INTERNAL REVENUE CODE 501(C)(3) AND IS A SUPPORTING ORGANIZATION PURSUANT TO INTERNAL REVENUE CODE 509(A)(3). THE ORGANIZATION IS STRUCTURED AS A PROFESSIONAL CORPORATION PURSUANT TO THE PROVISIONS OF THE CORPORATE PRACTICE OF MEDICINE ACT. THE ORGANIZATION'S PURPOSE IS TO PROVIDE PHYSICIAN SERVICES TO FURTHER THE CHARITABLE AND HEALTHCARE PURPOSES OF THE SYSTEM. THE ORGANIZATION'S BOARD-CERTIFIED TEAM OF EXPERIENCED PHYSICIANS AND MEDICAL PROVIDERS ARE COMMITTED TO IMPROVING THE HEALTH OF OUR PATIENTS SUFFERING FROM ILLNESS, ACUTE OR CHRONIC CONDITIONS, OR IN NEED OF ADDITIONAL MEDICAL ASSISTANCE. RICHMOND MEDICAL CENTER FOUNDATION, INC. ---------------------------------------- RICHMOND MEDICAL CENTER FOUNDATION, INC. IS NOT-FOR-PROFIT ORGANIZATION FOUNDED IN 2009. THE ORGANIZATION IS RECOGNIZED BY THE INTERNAL REVENUE SERVICE AS TAX-EXEMPT PURSUANT TO INTERNAL REVENUE CODE 501(C)(3) AND AS A NON-PRIVATE FOUNDATION PURSUANT TO INTERNAL REVENUE CODE 509(A)(3). THROUGH FUNDRAISING AND DEVELOPMENT ACTIVITIES THE ORGANIZATION SUPPORTS THE CHARITABLE PURPOSES, PROGRAMS AND SERVICES OF RICHMOND UNIVERSITY MEDICAL CENTER; A RELATED INTERNAL REVENUE CODE 501(C)(3) TAX-EXEMPT HOSPITAL ORGANIZATION, THAT PROVIDES MEDICALLY NECESSARY HEALTHCARE SERVICES TO ALL INDIVIDUALS IN A NON-DISCRIMINATORY MANNER REGARDLESS OF RACE, COLOR, CREED, SEX, NATIONAL ORIGIN OR ABILITY TO PAY. RICHMOND QUALITY, LLC --------------------- RICHMOND QUALITY, LLC IS A LIMITED LIABILITY COMPANY FORMED IN THE STATE OF NEW YORK WHOSE SOLE MEMBER IS RICHMOND UNIVERSITY MEDICAL CENTER. THE MISSION OF THIS ORGANIZATION IS TO ESTABLISH A GROUP OF COORDINATED HEALTHCARE PROVIDERS WHICH AGREE TO BE ACCOUNTABLE FOR THE QUALITY, COST AND OVERALL CARE FOR AN ASSIGNED GROUP OF MEDICARE BENEFICIARIES."