4A (Expenses $ 1537254698 including grants of $ 30035966) (Revenue $ 1773887617)
The Mount Sinai Hospital provides quality medical healthcare regardless of race, creed, sex, national origin, handicap, age, or ability to pay. Although reimbursement for services rendered is critical to the operation and stability of the Mount Sinai Hospital, it is recognized that not all individuals possess the ability to purchase essential medical services and healthcare education. As a matter of policy, the Hospital provides significant amounts of partially or totally uncompensated patient care. For accounting purposes, such uncompensated care is treated either as charity care or bad debt expense. The Hospital's charity care policy ensures the provision of quality health care to the community served while carefully considering the ability of the patient to pay. The policy has sliding fee schedules for inpatient, ambulatory and emergency services provided to the uninsured and under-insured patients who qualify. Patients are eligible for the charity care fee schedule if they meet certain income tests. Furthermore, as part of its charity care and financial aid policy, the Hospital obtains and uses additional financial information for uninsured or under-insured patients who have not supplied the requisite information to qualify for charity care. The additional information obtained is used by the Hospital to determine whether to qualify patients for charity care and/or financial aid in accordance with the Hospital's policies. For accounting and disclosure purposes, charity care is considered to be the difference between the Hospital's customary charges and the sliding charity care fee schedule rates. Since payment of this difference is not sought, charity care allowances are not reported as revenue. The Hospital's estimated costs for charity care were $38.8 million for 2012 and $31.8 million for 2011. The cost of charity includes the direct and indirect cost of providing charity care services. The cost is estimated by utilizing a ratio of cost to gross charges applied to the gross uncompensated charges associated with providing charity care. Funds received from the New York State Indigent Care Pool to offset charity services provided totaled approximately $17.5 million and $14.9 million for the years ended December 31, 2012 and 2011, respectively. The charity care component of the indigent care pool payments is estimated utilizing a ratio of charity care charges to total charity care and bad debt charges applied to the indigent care pool reimbursement and excludes amounts designated for teaching programs. Additionally, patients who do not qualify for sliding scale fees and all uninsured inpatients who do not qualify for Medicaid assistance are billed at the Hospital's rates. Uncollected balances for these patients are categorized as bad debts. Total uncompensated care as a result of bad debts for all patient services approximated $23.7 million in 2012 and $10.8 million in 2011. The Mount Sinai Hospital is the primary healthcare provider for the East Harlem Area of New York City. East Harlem is one of the poorest communities in the New York City region, and has been designated as a medically underserved area. A wide variety of programs and services are currently provided for the community which includes: -Primary care -AIDS -Cardiovascular health -Cancer treatment -Maternal and infant health -Geriatrics -Ambulatory sensitive conditions (Astma and Diabetes) -Adolescent health -Youth education -Volunteer services

SCHEDULE H SUPPLEMENTAL INFORMATION
Part I, Line 7 The Mount Sinai Hospital used the ratio of cost-to-charges methodology for costing purposes. The cost-to-charge ratio was derived utilizing Worksheet 2, Ratio of Patient Care Costs-to-Charges. PART I, LINE 7F BAD DEBT EXPENSES OF $22,163,986 FOR 2012 WERE INCLUDED IN TOTAL EXPENSES IN PART IX, LINE 25 AND EXCLUDED IN WORKSHEET 8, LINE 14 OF SCHEDULE H FOR PURPOSE OF COMPARISON YEAR OVER YEAR. Part I, Line 7G The Hospital reported its support for the Mount Sinai Diagnostic and Treatment Center (MSDTC) under Part I, Line 7g Subsidized Health Services. MSDTC is a separately licensed entity that operates a variety of diagnostic and treatment clinics in the Hospital's East Harlem service area. The Hospital provides sufficient funding for MSDTC so that it can meet its annual operating requirements. In 2012, the Hospital funded the MSDTC's operating loss of $13.5 million.

Part II Community Building Expense
"The Mount Sinai Hospital expended funds on advocacy and community support during 2012. These activities represented efforts by the Hospital to improve the health of the community by advocating for enhanced services and public policies that would expand access to important medical and social services for its surrounding community. Additionally, the Hospital invested in emergency preparedness so as to ensure the provision of necessary medical services in the event of any situation that required emergency medical services for the members of the community. Part III Line 2 In evaluating the collectability of accounts receivable, the Hospital analyzes its past history and identifies trends for each of its major payor sources of revenue to estimate the appropriate allowance for doubtful accounts and provision for bad debts. Additionally, patients who do not qualify for sliding scale fees and all uninsured inpatients who do not qualify for Medicaid assistance are billed at the Hospital's rates. Uncollected balances for these patients are categorized as bad debts. Part III, Line 4 The Mount Sinai Hospital reported bad debt as an expense in Part IX. However, in its audited financial statements, the Hospital reports bad debts as a reduction to revenue in accordance with Accounting Standards Update No. 2011-07, Presentation and Disclosure of Patient Service Revenue, Provision for Bad Debts, and the Allowance for Doubtful Accounts for Certain Health Care Entities. The Hospital's Accounts Receivable and Net Patient Service Revenue footnote includes the following disclosures in relation to bad debts: ""Deductibles and copayments under third-party payment programs within the third-party payor amount above are the patient's responsibility and the Hospital considers these amounts in its determination of the provision for bad debts based on collection experience."" ""In evaluating the collectability of accounts receivable, the Hospital analyzes its past history and identifies trends for each of its major payor sources of revenue to estimate the appropriate allowance for doubtful accounts and provision for bad debts."" ""Patients who do not qualify for sliding scale fees and all uninsured inpatients who do not qualify for Medicaid assistance are billed at the Hospital's rates. Uncollected balances for these patients are categorized as bad debts."" Part III, Line 8 Schedule H, Part III, Section B. Medicare Line 6 (Medicare Allowable Cost) were obtained from the Medicare cost report. The cost report utilizes a step-down methodology to allocate an institution's allowable costs by service and program. In addition, the Hospital included the Medicare share of the loss for Health Professions Education (Schedule H, Part I, Line 7f), which amounted to $23.4 million in order to provide a more accurate reflection of the Hospital's Medicare financial results. Part III, Line 9 The Hospital's collection practices do not apply to charity care balances. Once an account or a portion thereof is deemed to be charity care, it is written off as such. As a result, there is no further collection effort on the account balance. Part V, Section A. Hospital Facilities Mount Sinai Hospital and Mount Sinai Hospital of Queens both operate under the same Certificate Number 7002024H issued by the State of New York's Department of Health. We thereby consider them to be one hospital facility subject to Section 501(r) including its Community Health Needs Assessment requirement. Part V, Line 18E The Hospital would follow up with phone calls and emails as part of the outreach effort to determine the patients eligibility under the facilitys FAP. Part V, Line 20D In compliance with New York State Law, Mount Sinai uses the set contract rates of it highest volume commercial payer."

2. Needs Assessment
A continuous community needs assessment process occurs in Manhattan and Western Queens through active membership/participation of administrative leaders, staff and faculty in over 20 community committees, coalitions and board; and through service and educational partnerships with community health, social service, civic organization and schools. The Department of Community and Government Affairs acts as a liaison for the Medical Center to health, social service and civic organizations, schools, coalition and community leaders in East and Central Harlem, the Upper West Side and in boroughs outside of Manhattan and Western Queens. Community and Government Affairs work closely with the Mount Sinai School of Medicine, Mount Sinai's Center for Multicultural and Community Affairs and the Department of Community and Preventive Medicine to assist other Medical Center departments that seek to implement community programs and research projects. The Mount Sinai Medical Center actively seeks the views of community residents, hospital consumers, health care providers, religious groups, community boards, elected officials, supports groups, and community health and human service professionals in identifying the need for services and public health priorities. The Mount Sinai Medical Center's public participation includes the following: * Mount Sinai's Board of Trustees has established a Community Affairs committee whose members include senior management, health providers, and Trustees. A Trustee serves as a Community Advisory Board member to ensure board to board communications. The Board of Trustees meets quarterly to evaluate services and community needs. * Mount Sinai's Community Advisory Board (CAB) members represent diverse socioeconomic and ethnic constituencies and representatives from the Medical Center leadership and departments. The CAB's goal is to ensure that the medical center is responsive to health care needs of consumers, with particular emphasis on the needs of East Harlem. The CAB meets monthly to evaluate services and community needs. * The Tisch Cancer Institute has established a CAB to work in partnership with East and Central Harlem community residents and organizations to reduce the excess burden of cancer among its majority African-American and Hispanic residents to find ways to overcome cancer disparities. The CAB meets monthly to discuss community resources, strengths and interventions to improve the quality of cancer prevention, treatment and care. * Mount Sinai has established and hosts a monthly Community Roundtable to keep its pulse on the needs of East Harlem and Central Harlem communities. Approximately 80 community leaders, educators, elected officials, and CAB members are in attendance at the monthly meetings. * The Mount Sinai Medical Center representatives participate actively in monthly/quarterly meetings with the following organizations in its continuing efforts to discuss health care needs of the community. * Abyssinian Development Corporation. * Boriken Neighborhood Health Center. * Bronx Aids Services. * Children's Aids Society. * Community Board No.11 - Manhattan, Health & Human Services Committee. * East Harlem Chamber of Commerce. * East Harlem HIV Care Network. * East Harlem Partnership for Cancer. * Greater Harlem Chamber of Commerce. * Little Sisters of the Assumption Family Health Services. * New York Academy of Medicine. * New York City Housing Authority - Carver Houses Tenants Association & Johnson Tenants Association. * Jewish Home and Hospital * Settlement Health Association. * Union Settlement Association. * Yorkville Common Pantry The Mount Sinai Hospital of Queens' public participation includes the following: * Mount Sinai Hospital of Queens recently formed a CAB and serves the needs of a culturally diverse population with representatives from social and human service organizations, civic associations, public housing authority, and health care providers. The CAB meets quarterly to evaluate services and community needs. * Mount Sinai Hospital of Queens conducts an annual Community Roundtable to inform and update participants on new programs and projects and facility improvements at the Hospital. The focus is also on engaging participants in a discussion of ways in which the Hospital can improve and better serve the needs of the community. * The annual Pastoral Care Forum for clergy and other religious leaders in the community featured an educational session as well as an information-sharing component of services available in the community. * Mount Sinai representatives participate actively in monthly/quarterly meetings with the following organizations in its continuing efforts to discuss health care needs of the community. * American Cancer Society. * Astoria Civic Association. * Catholic Charities of Brooklyn and Queens. * Community Boards No.1 & 2 - Queens. * Gateway to Health Sciences Secondary School. * Greek Orthodox Archdiocesan of America Hellenic Cultural Center. * HANAC. * Jacob Riis Neighborhood Settlement House. * Queens Chamber of Commerce. * New York City Housing Authority - Ravenswood Tenants Association. * SHAREing and CAREing. * United Community Civic Association. * Visiting Nurse of New York. The Mount Sinai Medical Center discusses and analyzes the following demographic and socio-economic data with community partners as part of the community needs assessment process. 1. Utilization - Identify which services/programs have met or exceeded projected utilization 2. Patient satisfaction surveys - Analyze the hospitals' patient surveys to determine areas of needs identified by patients and their families 3. Local demand for services - Identify the services/programs with waiting lists, which demonstrate that the local demand for services exceeds capacity 4. Community need data - Determine the health of the community by examining the health statistics on the NYCDOHMH and NYSDOH websites; and determine the areas in which the target goals of Take Care New York are not met. Additionally, in assessing the communities' needs in conjunction with community partners, consumers, community boards, community leaders, and community health and human service professionals, the following questions are considered: 1. Is the cause of the illness, disease or health behavior preventable? 2. Does the hospital have existing resources, capacity, and processes to conduct outreach, provide screenings and treatment, measure, and evaluate set goals? 3. Was the health focus also identified by, discussed with, and determined as a priority in the health of the community by community partners, consumers, community health and human service professionals, NYCDOHMH, and the hospital's Community Advisory Board? Based on the information gathering process described above, the Hospital develops a community service plan that focuses on the health priorities for the surrounding community.

3. Patient education and eligibility for assistance
All patients that do not have insurance are notified that financial assistance may be available for them. Prominently placed signs notify patients of the financial assistance policy and flyers summarizing the process are available in registration areas. The Hospital provides assistance with enrollment in Federal and State insurance programs including Medicare, Medicaid, Child Health Plus and Family Health Plus. If patients do not qualify for these programs they may qualify for financial assistance through the Hospital's Charity Care and Self Pay Discount Policy. Patient bills also provide information as to where a patient or the person responsible for the Hospital bill can call to receive financial assistance if they are not able to pay the Hospital's bill. Patients are provided with assistance through the Hospital's Financial Counseling Department (Mount Sinai patients only) or through its Resource Entitlement and Advocacy Program (REAP) Office. The REAP Office assists both Hospital patients and community members to obtain financial assistance for their medical expenses.

4. Community Information
"The Mount Sinai Medical Center serves patients in all five boroughs of New York City, Long Island, Westchester and Rockland counties, New Jersey and Connecticut. Mount Sinai is a regional and national referral center. The hospital defines New York County as the area used for community/local health planning for the purposes of the Community Service Plan. Census data were used to determine the service area of The Mount Sinai Medical Center. The total population of New York County in 2010 was 1,585,873 (increase of 3.2 percent from the 2000 Census). Approximately 52% of the New York County population in 2010 was of a minority population (18.5% African-American, 11.8% Asian and 21.7% ""other"" minority group members including individuals of 2+ races). There were 405,983 (25.6%) Hispanics, who can be of any race. New York County has eight federally-designated medically underserved areas. There are 20 hospitals, including specialty hospitals, serving this area. The U.S. Census identified that 282,285 members (17.8%) of the population were living at or below the Federal Poverty Level in 2010. It has been documented that individuals of minority and/or low-income status experience difficulties in accessing healthcare in some places. Mount Sinai serves residents of its service area without regard to any personal characteristics, including race/ethnicity or payer source. It is important to note the large minority population that Mount Sinai serves as most minority groups have been documented to suffer from cardiovascular disease at rates in excess of those of the White population. The Mount Sinai Medical Center has a strong history of serving traditionally underserved individuals throughout its service area, including Harlem and East Harlem communities surrounding the hospital. Mount Sinai provides the following health services to its community: * 67% of clinic visits are minority patients. * 53% of inpatient discharges are minority patients. * 85% of Emergency Department visits are minority patients. * More than 30% of inpatients reside in upper Manhattan. * Nearly 50% of outpatients reside in upper Manhattan. * More than 50% of Emergency Department patients reside in upper Manhattan. Reflective of the Hospitals location in the East Harlem neighborhood of New York County, approximately 45.5% and 53.5% of the hospital's inpatient discharges and outpatient visits, respectively, were from Medicaid patients. In many of the hospital's programs, over 60% of the patients have historically belonged to a minority group. The total number and percentage of individuals in the 45 and older age group in New York County is projected to grow dramatically from 2000 to 2015. The total number of individuals in this group is projected to increase from 534,263 individuals in 2000 to 694,295 individuals in 2015, representing a growth of 30.0% over this time period. This age group is projected to grow at a rate over seven times that of New York County from 2000 to 2015, and is at greater risk for cardiac problems than the general population. There were 217,265 individuals older than age 65 (comprising 13.7% of the population) residing within the service area in 2010. This population is projected to continue to grow to 242,281 individuals (comprising 15.1% of the population) by 2015, per the New York Statistical Information System from Cornell University. This age group is at greater risk for cancer than the general population. According to data from the New York State Department of Health (NYSDOH), infectious diseases, such as HIV, are more prevalent in the hospital's service area of New York County than in New York City and New York State overall. The HIV case rate from 2005 to 2007 in New York County was 72.9 individuals per 100,000, which was significantly higher than that of New York City (46.0 persons per 100,000) and the State (24.3 persons per 100,000). The Mount Sinai Hospital of Queens defines its primary service area as the following zip codes that comprise Northwestern Queens: 11101, 11102, 11103, 11104, 11105 and 11106 known as Long Island City/Astoria. The secondary service area consists of zip codes that comprise Western Queens: 11368, 11369, 11370, 11372, 11373, 11377 and 11378. Those zip codes define the areas used for community/local health planning for the purposes of the Community Service Plan. The population of the primary service area of Northwestern Queens in 2008 was 231,440 while the population of the secondary service area of Western Queens was 464,497 for a total of 695,937 residents. Over half (51%) of the population (representing more than 100 cultural and ethnic groups) is foreign-born compared to only 36% for New York City as a whole. In Northwestern Queens, roughly one in five persons lives in poverty; one in five adults smoke and is less likely to quit than smokers in New York City overall; women are less likely to get a regular Pap test for cervical cancer than women in New York City as a whole; and the service area has the second highest proportion of uninsured adults among all New York City neighborhoods, with foreign-born residents more likely to be without health insurance than those born in the United States. The heart disease hospitalization rate in the primary service area has increased by more than 10% in the past 10 years. The poverty and language barriers in Western Queens inhibit access to inpatient care. Per the New York City Department of City Planning, Mount Sinai Hospital of Queens is located in Queens Community Board No.1 - Queens. In 2007, 24.2% of the residents lived below the poverty level. This percentage is much greater than the percentage of residents below the poverty level (12.2%) for the entire county. Overall, greater than 50% of the residents in Community Board No.1 - Queens do not speak English ""very well"", according to the US Census Bureau. Staff members at Mount Sinai Hospital of Queens speak approximately 50 languages, a statistic that is growing each year. This is reflective of the cultural diversity of the service area, which includes residents comprising greater than 100 cultural and ethnic groups."

5. Promotion of Community Health
As mentioned in the description of the Needs Assessment in Part VI.2, the Hospital has formed a Community Board to ensure that the Medical Center is able to work closely with the surrounding community to identify and respond to the healthcare needs of the community. The Mount Sinai Medical Center Community Advisory Board was formed as a committee of the Board of Trustees to review and comment on the Medical Center's service, educational and research programs. The Board's goal is to ensure that the medical center is responsive to the health care needs of consumers, with particular emphasis on the needs of East Harlem. The Community Advisory Board is a forum for articulating patient care and community health concerns and for evaluating the effectiveness of services on the community's health status, patients' rights, and the quality of services provided to consumers. Community Advisory Board members represent diverse socioeconomic and ethnic constituencies and representatives of Medical Center leadership and departments. A majority are consumers. A Trustee serves as a Community Advisory Board member to ensure board-to-board communications. Based on the needs assessment and feedback the Hospital receives from groups like the Community Advisory Board, the Mount Sinai Hospital conducts a number of services and activities that are designed to promote and improve the health of individuals residing in the surrounding community. These services and activities help to inform people of healthy living habits and provide access to valuable health care services, including diagnostic screening services for at risk people. A brief description of each of these services and activities is provided below. * HouseCall is a newsletter developed and designed to introduce the Harlem community to the doctors, nurses, social workers, and other health professionals who serve the community. The publication includes extensive outpatient service information * Prescriptions for Healthy Living is a campaign launched in 2007 in which banners that stress the importance of taking control of health care and adopting a healthy lifestyle are placed throughout the community. * Good Health Is Precious brings health education and screening to community organizations, responding to a need for early detection. Mini health talks about asthma, cancer, cardiovascular health, chronic kidney disease, diabetes, mental health, nutrition and fitness, orthopedic care, palliative care, and women's health are available in English and Spanish. * The Greenmarket is a partnership between the Medical Center and the Council on the Environment of New York City that sells fresh fruit and vegetables in East Harlem each week. It also offers free medical screenings as well as demonstrations of healthy cooking. * Free Community Health Screenings. In the past year Mount Sinai faculty and staff sponsored and/or participated in thirty-six community health fairs and health screening programs, street festivals, children's festivals, health expos and information fairs, reaching over 25,000 people. Screening have been conducted to test blood pressure, glucose, cholesterol, vision, bone density, body mass index, kidney disease, and Hepatitis C at health fairs year-round. There are nearly 7,000 screenings annually. * Support Groups are offered to patients and their families so that they can share their stories with others who have had similar experiences. * Workshops and seminars are important components of Mount Sinai's commitment to the community. Topics covered have included areas such as Power of Attorney, Living Wills and Advanced Directives: What You Need to Know, Men's Health Seminars, Women's Cardiovascular Health * Exercise and Education classes are offered weekly or bi-monthly. * Resource Entitlement Advocacy Program (REAP ) serves uninsured and underinsured community members and hospital patients who need assistance with entitlement issues. REAP enables them to get health insurance and gain access to health care. In addition, it helps them obtain income, home care, and nutrition support by working with community agencies. REAP also provides technical assistance regarding changes to entitlement programs such as welfare, Medicaid, Medicare, Family Health Plus, child health insurance, and other programs. * East Harlem Free Clinic, created and operated by the students of the Mount Sinai School of Medicine, provides free medical care to East Harlem residents. * The Medical Center provides HEART (Heart Failure Education and Rehabilitation Training), a congestive heart failure nurse-management program to improve patient self management and physician-initiated services for patients with heart failure in East and Central Harlem. Additionally, Mount Sinai offers a wide variety of community outreach programs that provide screening, educational and patient care. These programs are funded through operating revenues of the Hospital. Some of the programs provided by the Medical Center include: * The Jack Martin Fund Clinic is a New York State Department of Health Designated AIDS Center that provides primary and specialty care, urgent care, social services, and counseling to those who are infected; and preventive services to those at risk. * Mount Sinai Adolescent Health Center was the first primary care facility in New York City specifically designed to meet the health care needs of adolescents. Today, it is the largest, most comprehensive adolescent center in the United States, with a mission to help adolescents grow up happy, healthy, and well educated by preventing disease and promoting health. The Adolescent Health Center offers comprehensive medical, nutritional, exercise, and mental health services to teenagers concerned with eating disorders, becoming overweight or obese, and high cholesterol. * The Mount Sinai Diabetes Center provides inpatient and outpatient treatment and education to adults with type I or type II diabetes. The Diabetes Center works closely with Mount Sinai Internal Medicine Associates, whose patient population includes many patients from East and Central Harlem. The Diabetes Center sponsors community diabetes screenings in English and Spanish. * The Mount Sinai Emergency Department provides state-of-the-art emergency care for the residents of East Harlem and Northern Manhattan 24 hours/day 7 days/week and is a receiving hospital for the 911 ambulance system. It is organized into five treatment areas: Emergency Psychiatric Care, Adult Urgent Care, Chest Pain Unit, Adult Emergency Services, and Pediatric Emergency Services. On-site bilingual staff and social work services are available around the clock. Many initiatives have been introduced in response to community needs and concerns. * Martha Stewart Center for Living at Mount Sinai was established in 2007 as a state-of-the-art medical practice for the outpatient care of seniors, and will surely become a benchmark in geriatric patient care. The Center provides care for patients and training for physicians, and coordinates healthy-aging research and practices. * The Dubin Breast Center opened at the The Tisch Cancer Institute, providing patients with a multidisciplinary, comprehensive approach to breast cancer screening, treatment and survivorship in a serene setting. Dubin Breast Center offers state-of-the-art diagnostics, including 3-D mammography, and minimally invasive diagnostic procedures. Our highly skilled physicians are some of the most sought-after breast cancer experts in the country. Patients at the Dubin Breast Center have access to the latest approaches and techniques, such as seed localization. A team of breast cancer experts are specialized in the diagnosis and treatment of breast cancer patients and offer the most advanced services in breast cancer prevention, diagnosis, and treatment. * The Breast Health Resource Program (BHRP) is dedicated to meeting the emotional and practical needs of women and men with breast cancer. The program offers information, guidance, and critical support to patients from diagnosis through survivorship. Our clinical social workers offer highly individualized counseling to help manage the complex demands of a breast cancer diagnosis. The Breast Health Resource Program offers counseling, seminars, support groups, and a library of information about the latest breast cancer treatments * The Visiting Doctors Program at Mount Sinai provides hands-on, high quality medical care and social support to men and women with complex and serious illnesses who have difficulty leaving their homes. The program aims to help patients maximize their health and independence. The homebound population has traditionally been underserved by the medical community, but the Visiting Doctors Program works to fill that gap by providing ongoing primary medical care. Today, Visiting Doctors serves over 1,000 patients throughout Manhattan and is a national model for the care of this most vulnerable group. * The Mount Sina

6. Part of an Affiliated Health Care System
NOT APPLICABLE

7. Community Benefit Report
Mount Sinai files a community service plan in New York State.