2017-11-14T13:25:03-06:00 2016-12-31 861065772 DELOITTE TAX LLP 201 N FRANKLIN ST STE 3600 TAMPA FL 33602 990 2016-01-01 590624424 MOUNT SINAI MEDICAL CENTER OF FLORIDA INC MOUN 3056742032 4300 ALTON ROAD MIAMI BEACH FL 33140 ALEXANDER MENDEZ CFO/EVPO 3056742032 2017-11-07 1 STEVEN E ROVNER P00648526 8132738355 167.219.88.140 2017-11-14 06:36:51 ES P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 4737601D873D72C3179D8C319AF5B12A06CA2997 2016 2017-02-10 21:41:12Z STEVEN D SONENREICH 4300 ALTON ROAD MIAMI BEACH FL 33140 680973624 0 X WWW.MSMC.COM X 1946 FL TO PROVIDE HIGH QUALITY HEALTH CARE TO OUR DIVERSE COMMUNITY ENHANCED THROUGH TEACHING, RESEARCH, CHARITY CARE AND FINANCIAL RESPONSIBILITY. 25 22 4798 405 289357 0 641375 735859 600826892 630769662 2381970 2853115 16390237 20199723 620240474 654558359 0 0 0 0 268201450 296293666 0 0 0 300501058 329620099 568702508 625913765 51537966 28644594 816100098 853927876 469291846 455649251 346808252 398278625 X TO PROVIDE HIGH QUALITY HEALTH CARE TO OUR DIVERSE COMMUNITY ENHANCED THROUGH TEACHING, RESEARCH, CHARITY CARE AND FINANCIAL RESPONSIBILITY. 0 0 478053732 592887332 Safety Net Hospital OperationsIn 2016, Mount Sinai served 23,312 Inpatient admissions, 201,871 Outpatient admissions, 55,126 emergency care visits in its primary service area and 19,914 in its senior health target area of Aventura. Mount Sinai performed 13,520 surgeries meeting surgical care standards and welcomed 2,678 infants with healthy birth weights.Program Expenses RevenueSafety Net Hospital Operations 478,053,732 592,887,332Short Term Goals: Address the leading causes of death through tertiary patient service.Long Term Goals:Offer Diagnostic and outpatient care to prevent or treat the top leading causes of death. 53266169 23826330 Teaching & ResearchIn 2016, to meet the nation's physician provider crisis, Mount Sinai retained its own teaching faculty and 18 accredited graduate medical education programs, teaching 160 residents or fellows. Mount Sinai provided a teaching clinical environment necessary for physicians to become board certified. Additionally, to meet the demands of the workforce, Mount Sinai taught 346 nursing students, 340 medical students and 136 Allied Health students for health care careers. To supplement the academic environment in 2016, Mount Sinai had 237 research studies approved by a national review board or by a Mount Sinai institution peer review board. Mount Sinai had 153 cancer studies, 19 cardiac and 65 other studies.Short Term Goals: Enhanced patient care through innovative clinical care, teaching and research.Long Term Goals:Expand teaching into the most needed areas in the community as decided by the State of Florida and leading health experts.Program: Academic Medical Center Expenses RevenueTeaching 35,120,182 14,056,000 Expenses RevenueResearch 18,145,987 9,770,330 21523000 14056000 Physician Network and Access to CareIn general in the United States, the demand for physicians "continues to grow faster than [the] supply" (IHS Inc., 2016). The State of Florida, Agency for Healthcare and the Statewide Medicaid Residency Program supported the teaching of specialty clinical providers. Mount Sinai provided both access to care and support for the teaching of 340 medical students, 160 residents, and fellows in 10 locations in 2 counties. By providing nearly 160,000 primary or specialty care visits, Mount Sinai has widened access to specialty care in Florida and the state Medicaid program.Program: Physician Specialty & Service Expenses RevenuePhysician Shortage Specialty Services &Wide Access Medicaid Network 21,523,000 14,056,000Short Term Goals: Address the physician shortage through teaching activities in a preventative setting, providing access to a wide specialty network that accepts most Medicaid plans.Long Term Goals:Expansion of the GME program to include shortage areas such OB/GYN and specialty physician access. 552842901 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 1 0 1 0 0 1 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 1 1 0 0 0 0 1 1 1 1 0 0 1 1011 0 1 4798 1 1 1 1 CJ 0 0 0 0 0 0 0 0 X 25 22 1 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 0 CA NC X LOURDES DIAZ 3056742032 4300 ALTON ROAD MIAMI BEACH FL 33140 MICHAEL ADLER TRUSTEE 2.00 0.00 X 0 0 0 PAUL BLOCH TRUSTEE BEG 01/16 2.00 0.00 X 0 0 0 DAVID BLOOM TRUSTEE 2.00 0.00 X 0 0 0 NORMAN BRAMAN TRUSTEE 2.00 0.00 X 0 0 0 PAUL CHAPLIN MD TRUSTEE 2.00 0.50 X 0 0 0 WAYNE CHAPLIN TRUSTEE 2.00 0.50 X 0 0 0 DENIS COLE TRUSTEE 2.00 0.50 X 0 0 0 MARC CSETE MD PHYSICIAN/PRES MED STAFF END 06/16 30.00 0.00 X 0 0 0 MIKE CUSNIR MD PHYSICIAN/PRES MED STAFF BEG 07/16 30.00 0.00 X 766947 0 56594 EDWARD DAUER MD TRUSTEE 2.00 0.00 X 0 0 0 PHILLIP FROST MD TRUSTEE 2.00 0.00 X 0 0 0 MARK HILDEBRANDT TRUSTEE 2.00 0.50 X 0 0 0 SAMUEL JACOBSON TRUSTEE 2.00 0.00 X 0 0 0 IRA LAMPERT TRUSTEE 2.00 0.50 X 0 0 0 PETRA LEVIN TRUSTEE BEG 01/16 2.00 0.00 X 0 0 0 LAURANS MENDELSON TRUSTEE 2.00 0.50 X 0 0 0 JAY PARKER TRUSTEE BEG 01/16 2.00 0.50 X 0 0 0 BONNIE SCHAEFER TRUSTEE 2.00 1.00 X 0 0 0 BARRY SIADAT TRUSTEE 2.00 0.00 X 0 0 0 BARRY SILVERMAN MD TRUSTEE 2.00 0.00 X 0 0 0 SYDNEY SILVERMAN TRUSTEE 2.00 0.00 X 0 0 0 PAUL SINGERMAN TRUSTEE 2.00 0.00 X 0 0 0 STEVEN D SONENREICH PRESIDENT/CEO 60.00 1.50 X X 1507409 0 394655 STANLEY TATE TRUSTEE 2.00 0.00 X 0 0 0 LEONARD A WIEN JR TRUSTEE 2.00 0.50 X 0 0 0 DR S HOWARD WITTELS MD PHYSICIAN/TRUSTEE 2.00 0.00 X 5000 0 0 ALEXANDER A MENDEZ EXEC VP OF OPERATIONS/CFO 60.00 1.00 X 1197988 0 70765 WAYNE CHUTKAN SENIOR VP OF FINANCE 60.00 0.00 X 442216 0 71709 BENJAMIN DAVIS VP FACILITIES/RESOURCE MGT 60.00 0.00 X 323195 0 34228 STEVEN FINE VP ADMINISTRATION 60.00 0.00 X 255198 0 68396 THOMAS GILLETTE SENIOR VP/ CIO 60.00 0.00 X 524521 0 72363 ROBERT GOLDSZER MD SENIOR VP/ CMO 60.00 0.00 X 673797 0 63642 ARNOLD JAFFEE SENIOR VP/ GEN COUNSEL 60.00 2.00 X 506414 0 51567 CATHY MCCLELLAN VP RISK MANAGEMENT 60.00 0.00 X 238231 0 58421 MERVYN MILLS VP OF FINANCE 60.00 0.00 X 317427 0 64162 KAREN MOYER SENIOR VP/ CNO 60.00 0.00 X 493064 0 59798 ANGEL PALLIN SENIOR VP OF OPERATIONS 60.00 0.00 X 445590 0 44702 DIANA SALINAS VP OF COMPLIANCE 60.00 0.00 X 184882 0 46614 CHARLENE J WELKER SENIOR VP OF SUB-ACUTE SVCS 60.00 0.00 X 333815 0 57939 DENISE TAPAK WONG VP OF SURGICAL/WOMEN'S SVCS 60.00 0.00 X 282556 0 58911 ROBERT BEASLEY EMPLOYED MD DIRECTOR OF VASCULAR 60.00 0.00 X 848347 0 74363 BRUCE BOROS EMPLOYED MD CARDIOLOGY 60.00 0.00 X 879287 0 68139 JOSEPH LAMELAS EMPLOYED MD CHIEF,CARDIOTHORACIC SURGERY 60.00 0.00 X 2465720 0 68043 TODD M LASNER EMPLOYED MD NEUROSURGERY 60.00 0.00 X 793636 0 25654 ROY WILLIAMS EMPLOYED MD CHIEF,THORACIC SURGERY 60.00 0.00 X 824719 0 74579 14309959 0 1585244 343 0 1 0 MCKESSON PO BOX 409521 ATLANTA GA 303849521 MEDICATION SUPPLIER 34717476 ROBINS & MORTON 423 SOUTH KELLER ROAD SUITE 200 ORLANDO FL 32810 GENERAL CONTRACTOR 13877388 MEDTRONIC USA Inc 710 MEDTRONIC PARKWAY NE MINNEAPOLIS MN 554325604 MEDICAL SUPPLIER 12079530 FLORIDA LEMARK CORPORATION 9627 SOUTH DIXIE HIGHWAY MIAMI FL 33156 GENERAL CONTRACTOR 10279188 ARAMARK CTS Inc 12483 collections center drive CHICAGO IL 60693 MANAGEMENT SERVICES 5509033 206 735859 735859 PATIENT SERVICE REVENU 621300 445181107 445181107 MEDICARE/MEDICAID REVE 621300 155371521 155371521 GRANT REVENUE 900099 28378586 28378586 PARTNERSHIP INCOME 900099 1514607 1498018 16589 OTHER PATIENT REVENUE 621300 323841 323841 630769662 3176184 3176184 8949170 17820 4215254 0 4733916 17820 4751736 272768 4478968 21840930 36012 22200011 0 -359081 36012 -323069 -323069 EMERGENCY DEPARTMENT 621990 3999996 3999996 CAFETERIA 722210 2426774 2426774 PARKING 812930 1492255 1492255 7528962 7528962 15447987 654558359 630753073 289357 22780070 14309959 14309959 239164646 217947872 21216774 26924547 23150857 3773690 15894514 13666771 2227743 543872 76228 467644 727121 727121 591500 591500 5876927 5876927 1750471 1750471 131029499 129947155 1082344 12787433 10994920 1792513 1153386 991730 161656 1839508 1581686 257822 10744025 9238164 1505861 28804305 24767152 4037153 13942459 11988312 1954147 PROVISION FOR BAD DEBT 79106512 68019104 11087408 SERVICE CONTRACTS/MAINT 18826161 15180190 3645971 CONSULTANT FEES 6624297 5695849 928448 STATE INDIG. TAX ASSESS 5944029 5944029 9328594 7775955 1552639 625913765 552842901 73070864 0 266174659 262739073 5174250 4254566 62019480 62801478 10368686 9602175 10643810 12202742 469506800 289962149 138557131 179544651 105249863 74557374 217912219 248225817 816100098 853927876 52229516 54551871 298598538 287016671 11205898 9525939 107257894 104554770 469291846 455649251 X 200417292 228339665 138622000 161773000 7768960 8165960 346808252 398278625 816100098 853927876 X 28644594 -14300 22840079 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 308790 0 1 153042 0 461832 0 38888000 8706000 452000 2295000 676000 45075000 36723000 4545000 434000 2258000 556000 38888000 32690000 5659000 402000 1244000 784000 36723000 32882000 1779000 413000 1755000 629000 32690000 31392000 4731000 449000 3041000 649000 32882000 0.00000 0.12630 0.87370 0 1 1 8357216 8357216 278881918 176110442 102771476 179902472 113851707 66050765 2365194 2365194 179544651 INVESTMENTS IN AFFILIATES 2124178 DEPOSITS 159713 BENEFICIAL INTEREST IN NET ASSETS OF MOUNT SINAI MEDICAL CENTER FOUNDATION 172316546 CONSTRUCTION IN PROGRESS 73625380 248225817 INDIGENT CARE ASSESSMENT 8136122 OTHER CURRENT LIABILITIES 36394515 SELF-INSURED CLAIMS RESERVE 33889000 CAPITAL LEASE 10724173 DUE TO THIRD PARTIES 14972438 OTHER LONG-TERM LIABILITIES 324780 DUE TO AFFILIATES 113742 104554770 X 566992000 -78991918 -78991918 645983918 8574441 8574441 654558359 548207000 1399747 1399747 546807253 79106512 79106512 625913765 Part V, Line 4: The Foundation's endowment consists of approximately 46 individual funds established for a variety of purposes. The endowment consists of donor-restricted funds that have been limited by donors to a specific time period or purpose. As required by GAAP, net assets associated with endowment funds are classified and reported based on the existence or absence of donor-imposed restrictions. The endowment net asset composition by fund type as of December 31, 2016, is composed of the following: TEMPORARILY RESTRICTED PERMANENTLY RESTRICTED ALZHEIMER'S PROGRAM 6,604,000 0 MSMC 50 YEARS (PATIENT TOWER) 12,710,000 0 MELANOMA RESEARCH 2,606,000 0 CANCER LIFELINE 929,000 0 CANCER RESEARCH 1,937,000 0 OTHER PROGRAMS 14,598,000 5,691,000 __________ _________ TOTAL FUNDS 39,384,000 5,691,000 Part X, Line 2: THE FOOTNOTE TO THE AUDITED FINANCIAL STATEMENTS FOR MOUNT SINAI MEDICAL CENTER OF FLORIDA, INC. AND SUBSIDIARIES REGARDING FIN48 READS AS FOLLOWS: THE MEDICAL CENTER FOLLOWS THE PROVISIONS OF ASC 740-15-2, INCOME TAXES, AND HAS DETERMINED THAT AS OF DECEMBER 31, 2016 AND 2015, THE MEDICAL CENTER HAD NO MATERIAL UNRECOGNIZED TAX BENEFITS. THE MEDICAL CENTER DOES NOT EXPECT THAT UNRECOGNIZED TAX BENEFITS WILL MATERIALLY INCREASE WITHIN THE NEXT TWELVE MONTHS. IN THE EVENT THE MEDICAL CENTER WERE TO RECOGNIZE INTEREST AND PENALTIES RELATED TO UNCERTAIN TAX POSITIONS, IT WOULD BE RECOGNIZED IN THE CONSOLIDATED FINANCIAL STATEMENTS AS INCOME TAX EXPENSE. TAX YEARS FROM 2010 THROUGH 2015 ARE SUBJECT TO EXAMINATION BY THE FEDERAL AND STATE TAXING AUTHORITIES. THERE ARE NO INCOME TAX EXAMINATIONS CURRENTLY IN PROCESS. Part XI, Line 2d - Other Adjustments: PROVISION FOR BAD DEBT -79,106,512. INCOME FROM MT SINAI MEDICAL OFFICE BLDG II, INC 128,894. UNREALIZED GAINS ON INVESTMENTS -14,300. Part XI, Line 4b - Other Adjustments: INCOME FROM PREMIER HEALTHCARE ALLIANCE, L.P. 1,547,914. EXPENSES NETTED AGAINST REVENUES -2,233,473. CONTRIBUTIONS RELEASED FROM RESTRICTIONS FOR CAPITAL PURPOSES 9,260,000. Part XII, Line 2d - Other Adjustments: EXPENSES NETTED AGAINST REVENUE 2,233,473. DISTRIBUTIONS FROM PREMIER HEALTHCARE ALLIANCE, L.P. -833,726. Part XII, Line 4b - Other Adjustments: PROVISION FOR BAD DEBT 79,106,512. CENTRAL AMERICA & THE CARIBBEAN 0 0 PROGRAM SERVICES INSURANCE PREMIUM 448000 0 0 0 0 0 0 448000 0 448000 0 0 1 0 0 0 PART IV, LINE 3: MOUNT SINAI MEDICAL CENTER OF FLORIDA, INC.'S INTEREST IN A FOREIGN CORPORATION IS A WHOLLY OWNED INTEREST IN MOUNT SINAI MEDICAL CENTER OF FLORIDA GUARANTEE CORPORATION, A CORPORATION INCORPORATED IN THE CAYMAN ISLANDS. 1 1 X 1 X 1 X 1 1 1 0 1 1 16665828 16665828 0.03050 14898371 13053011 1845360 0.00340 32458683 17458492 15000191 0.02740 64022882 30511503 33511379 0.06130 2677075 15000 2662075 0.00490 25616533 12588706 13027827 0.02380 52105749 36467376 15638373 0.02860 8872079 7355082 1516997 0.00280 332559 332559 0.00060 89603995 56426164 33177831 0.06070 153626877 86937667 66689210 0.12200 20723763 5081700 15642063 0.02860 326280 326280 0.00060 3391354 3391354 0.00620 24441397 5081700 19359697 0.03540 0 16433758 250167079 273042398 -22875319 X 1 0 1 1 MOUNT SINAI MEDICAL CENTER OF FL INC 4300 ALTON ROAD MIAMI BEACH FL 33140 X X X X X MOUNT SINAI MEDICAL CENTER OF FL INC 1 0 0 1 X X X X X X X X X 15 1 0 0 1 X www.msmc.com/about-us/community-health-needs-assessment-2017/ X X 1 16 1 www.msmc.com/about-us/community-health-needs-assessment-2017/ 0 1 X 200.000000000000 200.000000000000 X X X X X 1 1 X X X 1 X www.msmc.com/patient-info/financial-assistance-information X www.msmc.com/patient-info/financial-assistance-information X X X X X X 1 X 0 1 X 0 0 MOUNT SINAI MEDICAL CENTER OF FL, INC. Part V, Section B, Line 5: Persons Representing the Broad Interests of The Community The Patient Protection and Affordable Care Act requires, in IRC Section 501(r)(3), that when assessing community health needs, Mount Sinai consult with and receive input from persons representing the broad interests of the community. This includes, but is not limited to, those with special knowledge of or expertise in public health and at a minimum: (1) At least one state, local, tribal, or regional governmental public health department (or equivalent department or agency) with knowledge, information, or expertise relevant to the health needs of the community; (2) members of medically underserved, low-income, and minority populations in the community, or individuals or organizations serving or representing the interests of such populations; and (3) written comments received on the hospital facility's most recently conducted CHNA and most recently adopted implementation strategy.To receive this input and data, Mount Sinai sought information from the State regional healthcare planning agency, the Health Council of South Florida, and the local City of Miami Beach Healthcare Advisory Committee. Additionally, the hospital met with focus groups that represent each geographic service area of the city, representing a variety of incomes and demographics. Mount Sinai sought individual input from noted and leading members of the healthcare industry in its primary service area including medical providers, small and large ancillary businesses owners, nursing home staff and residents and other special senior health related professions or patients representing the uninsured and new or undocumented residents. Focus meetings were also held in English and Spanish to accommodate the broad need of a multilingual community.Public Health Expert Input and Guidance Community Health AnalysisThe community health priorities are based on an analysis of demographic, environmental, statistical, and behavioral public health data about Miami-Dade County, and when possible about Miami Beach. The data is reviewed by numerous staff members at Mount Sinai including clinical, research and community health workers. Members of the community, nurses and physicians and businesses owners provide input.City of Miami Beach Health Advisory Committee. Mount Sinai maintains a seat and lead role on the Health Advisory Committee of the City of Miami Beach, along with the Miami Beach Community Health Center and the Health Council of South Florida. The Miami Beach Health Advisory Committee is a City Commission appointed body of local representatives that meet to address Miami Beach health issues in a publicly advertised meeting forum. This organization serves the medically underserved, low-income, and minority populations amongst others in the city.The Health Council of South Florida. Mount Sinai contracts with the Health Council of South Florida to obtain federal Prevention Quality Indicator data, which tracks local hospital admissions by chronic diseases and conditions. Mount Sinai also receives Leading Causes of Death data for the Miami Beach service area. This organization also has members of medically underserved, low-income, and minority populations in the community and serves the same populations. Public Health Agencies from which Data or Input was sought:- U.S. Agency for Healthcare Quality & Research- Centers for Disease Control & Prevention- National Committee On Vital And Health Statistics- U.S. Census Bureau- Trust for America's Health- Kaiser Family Foundation- Agency for Healthcare Administration- Florida Department of Health- Health Council of South Florida- Miami-Dade County Health Department- Florida Hospital Association- Miami Beach Health Advisory Committee MOUNT SINAI MEDICAL CENTER OF FL, INC. Part V, Section B, Line 7d: THE CHNA REPORT IS AVAILABLE VIA E-MAIL. MOUNT SINAI MEDICAL CENTER OF FL, INC. Part V, Section B, Line 11: In its CHNA, Mount Sinai identified Two Tiers of Community Health Needs to be addressed within its purview as an acute care academic medical center and accessible teaching physician network that provides primary and specialty on par with almost all Medicaid plans in its region. Tier One - Provide a wide range of Safety Net services- Training to address Florida's physician and healthcare worker shortage - Charity care for the uninsured and underinsured- Disaster first response health services and regional leadership- Emergency medical services- Adult psychiatric and behavioral care- Intensive geriatric / senior care- Maternity services and neonatal emergent care- Health and disease prevention education- Interventional and community health screeningsTier Two - Mission Driven Community Health PrioritiesMount Sinai focuses resources on providing access to care while treating and preventing the leading disease related conditions for all incomes in the community by subsidizing a nonprofit teaching and community physician network.Tier One - Provide a wide range of Safety Net servicesTo address Florida's physician and healthcare worker shortage, Mount Sinai retained its own teaching faculty and 18 accredited graduate medical education programs, teaching more than 160 residents or fellows. Mount Sinai also provided a teaching clinical environment for both its acute care and specialty care physician teaching network for physicians to become board certified and to educate the other crucial components of the healthcare workforce not within a traditional CMS residency program. In 2016, Mount Sinai taught 346 nursing students, 340 medical students and 136 Allied Health students for health care careers. In 2016, Mount Sinai served 23,312 Inpatient admissions and 201,871 Outpatient admissions. To address charity care for the uninsured and underinsured, Mount Sinai provided $131,886,265 in charity and uncompensated care in 2016. Additionally, in its primary service Mount Sinai is the functional public health system area though it does not receive the tax revenue meant to provide these services. In its service area, Mount Sinai provides the overwhelming majority, as high as 65-75%, of the charity care, indigent care, and Medicaid hospital services.To provide disaster first response health services and regional leadership, in conjunction with the City of Miami Beach and the State of Florida, Mount Sinai has embarked on its $275 million regional Emergency Services and Tower Project. This project will provide a joint Emergency Operations Center for the city staff, police, fire, and medical staff during declared community crisis. It will relocate operating rooms above the flood plain in a Special Hazard Flood Zone, provide emergency care services for the state's second largest tourism area in High Velocity Hurricane Zone, provide a medical management disaster shelter for oxygen and electric dependent residents including those in intensive care that cannot evacuate, ensure that all patient care for regional facility meets a modern level of care, provide safe helipad service and boat access to the island when bridges are locked down and serve as a national stockpile drop location for counter terrorism measures.To address the need for Emergency medical services as the sole hospital on the barrier islands of Miami Dade County, in 2016, Mount Sinai provided emergency services for 55,126 visits in the primary service area of Miami Beach and for an additional 19,914 in its senior and geriatric target area of Aventura.To address intensive geriatric / senior care, Mount Sinai maintains the Wein Center for Alzheimer Care, the State of Florida's leading Memory Disorder Clinic with over 2,000 visits annually and 3,000 memory disorder screenings. It also serves as the Miami Dade County coordinator for the State authorized Caregiver Support and Silver Alert Programs, and provides inbound senior visits through its State authorized Geriatric House Call Program.To address maternity services and neonatal emergent care, Mount Sinai partners with the Miami Beach Community Health Center to provide preventative and acute OB/GYN care for all incomes, races, and ethnicities regardless of national origin or documentation. In 2016, Mount Sinai welcomed 2,678 infants to the community.To address health education and community health screenings and education, Mount Sinai provided over 54 health events, 40 health lectures, and 115 screenings. To address access to care and mission driven community health, Mount Sinai provided access to care by providing nearly 160,000 primary care visits in one of the widest Medicaid networks in Miami Dade County. Mount Sinai seeks to include all possible plans and promote teaching and specialty physician network in partnership with the State of Florida and the State of Florida Medical Schools. Additionally, Mount Sinai's academic medical component of its physician teaching network provided access to 237 research trials to help community members receive the latest cancer, cardiac and other treatments near their home.Community Health FacilitiesMount Sinai Medical Center is the only acute care hospital located in the city of Miami Beach. There are four public health centers, including three Federally Qualified Health Centers: the Miami Beach Community Health Center (two locations) and the Borinquen Health Care Center. For substance and mental health issues, there are two residential treatment centers. For geriatric residential services, there are five nursing homes and five assisted living facilities.Community Health Needs Not within the Implementation StrategySpecialized AIDS/HIV services are not within the implementation strategy of Mount Sinai. Primary care health services for the uninsured or undocumented are available at Mount Sinai but also are provided in the service area by the Miami Beach Community Health Centers, the Borinquen Health Care Center and Jackson Memorial Health Center and the Miami-Dade County Health Department/Office of HIV/AIDS. PART V, LINE 16B: Mount Sinai's Community Health Needs Assessment identifies increasing access to care and removing cultural barriers to care as important goals.Mount Sinai's Financial Assistance Policy / Application Process is one way they have addressed this need. Mount Sinai has pioneered an efficient and culturally sensitive Financial Assistance Policy / Application Process that addresses the key obstacles of financial anxiety and lack of familiarity of the American healthcare system. This application process is unique in that it does not require an upfront paper document submission. Instead the Mount Sinai FAP, as explained in the Financial Assistance Policy / Application Process document posted online, is a people process that begins with a verbal counseling session. This session is relationship oriented and it also serves to identify linguistic, cultural, and educational issues that may inhibit the patient's ability to provide proper information using a paper based intake form. See further discussion regarding the FAP application process in Schedule H, Part VI, Line 3. Part I, Line 7: A ratio of patient care cost to patient care charges was applied to gross write-offs to arrive at an estimated program cost. Any applicable program revenues received were offset against gross cost to arrive at the net cost or shortfall of the program. Part I, Line 7g: Mount Sinai's Teaching Physician Network is a not for profit clinical physician and provider network that operates at a loss. The network provides a wide range of Medicaid eligible treatment for underserved patients. It also trains providers in advanced specialties that are documented by the State of the Florida to be in supply-demand deficit. The goal is to alleviate the healthcare crisis for all residents but especially for the uninsured, underinsured and Medicaid patients. Because of the lack of capacity, the State of Florida has shared the responsibility of remedying the physician shortage with teaching hospitals in Florida. Mount Sinai is one of two Miami-Dade County hospitals that is an AHCA Medicaid Essential Provider for adult care because of its role in teaching and training Florida's healthcare workforce under the Statewide Medicaid Residency Program (SMRP).The community benefit method for subsidized health services is taken from the Profit and Loss Detail for the Mount Sinai Teaching Physician Network. The expenses represent direct clinical expenses which generate primary care and specialty care patient revenue in Miami-Dade County and Monroe County. These costs include, but are not limited to patient care services, utilities, departmental supplies and other expenses associated with a medical office. The methodology used is a more accurate cost accounting than the charge to cost ratio based primarily on Inpatient and Outpatient Hospital Care. 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 $ 79,106,512. Part II, Community Building Activities: COMMUNITY BUILDING ACTIVITIES:1. Workforce development projects to recruit healthcare workers, including physicians, nurses and allied health professionals;2. Workforce housing approved by the city's state housing initiative program (SHIP) and the florida housing finance corporation (FHFC);3. Tower/Emergency Department Building Improvements to fulfill its existing State and City verified role as an essential Community Emergency Services Healthcare Provider, Regional EOC, Sole MMF and functional Public Health Provider on the barrier islands. Improvements include elevating operating rooms and other critical services above the flood plain in the state's second largest tourist area and high velocity hurricane zone and special hazard flood zone. Part III, Line 2: A ratio of patient care cost to patient care charges was applied to bad debt gross write-offs to arrive at an estimated bad debt expense at cost. Part III, Line 4: THE FOOTNOTE TO THE AUDITED FINANCIAL STATEMENTS FOR MOUNT SINAI MEDICAL CENTER OF FLORIDA, INC. AND SUBSIDIARIES REGARDING BAD DEBT EXPENSE READS AS FOLLOWS:THE MEDICAL CENTER RECOGNIZES REVENUE ON THE BASIS OF ITS STANDARD RATES FOR SERVICES PROVIDED (OR ON THE BASIS OF DISCOUNTED RATES, IF NEGOTIATED OR PROVIDED BY POLICY). HISTORICALLY, A SIGNIFICANT PORTION OF THE MEDICAL CENTER'S UNINSURED PATIENTS WILL BE UNABLE TO PAY FOR THE SERVICES PROVIDED. AS SUCH, THE MEDICAL CENTER RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS RELATED TO UNINSURED PATIENTS IN THE PERIOD THE SERVICES ARE PROVIDED.PATIENT ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTIBILIY OF PATIENT ACCOUNTS RECEIVABLE THE MEDICAL CENTER ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR UNCOLLECTABLE ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR UNCOLLECTABLE ACCOUNTS. FOR ALL PAYOR TYPES, WHEN THE MEDICAL CENTER CAN NO LONGER REASONABLY ESTIMATE COLLECTIBILITY OF AN ACCOUNT BASED ON THE AGING OF THE BALANCE DUE AND THE VOLATILITY AND UNPREDICTABLE NATURE OF THE AMOUNT, THE MEDICAL CENTER RESERVES SUBSTANTIALLY ALL AMOUNTS DUE. Part III, Line 8: A ratio of patient care cost to patient care charges was applied to medicare revenues and allowable costs to arrive at an estimated medicare expense at cost. The hospital does not treat any Medicare shortfall amounts as community benefit. Part III, Line 9b: Patients are first screened to see if they are eligible for Medicaid or charity when they come in through the ER. The hospital determines which patients qualify for charity based on a verifiable process required by the Agency Health Care Administration using the following criteria:o Patient is eligible if the patient's family aggregate income during the 12 months preceding the determination date is at or below 200% of the then current Federal Poverty Guidelines.o If patient is eligible for charity the amount of eligible charges are reduced on a sliding scale based on where they fall in relation to the Federal Poverty Guidelines.o Medicaid patients with benefits exhausted may apply for charity.o Patients with documentation that a third party benefit has been denied or exhausted may apply for charity.All opportunities for payment of hospital debt will be investigated prior to approval including a complete review of the financial information provided in the Uncompensated Care Application.The Business Office's role in Charity Care deals with the final review and approval of eligible patients. Business Office is responsible for adjusting account charges/balances after reviewing Search America's results, and/or any red flags on the account that would suggest the possibility of alternate methods of payment. These practices set forth in the policy would only apply to patients who may qualify for charity care. Part VI, Line 2: NEEDS ASSESSMENT:COMMUNITY HEALTH NEEDS WERE IDENTIFIED THROUGH A RECOGNIZED HEALTH PLANNING ASSESSMENT PROCESS. THE ASSESSMENT INCLUDED, BUT WAS NOT LIMITED TO, AN ANALYSIS OF DEMOGRAPHIC, ENVIRONMENTAL, STATISTICAL AND BEHAVIORAL PUBLIC HEALTH DATA, ORGANIZING PUBLIC DISCUSSIONS ON HEALTH TOPICS, AND CONDUCTING A SURVEY OF CURRENT HEALTH TOPICS TO EXPLORE THE HEALTH NEEDS OF THE PRIMARY, NEIGHBORING AND COUNTYWIDE SERVICE AREAS OF MOUNT SINAI MEDICAL CENTER. Part VI, Line 3: PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE:Mount Sinai's Community Health Needs Assessment identifies increasing access to care and removing cultural barriers to care as an important goals. The Financial Assistance Policy / Application Process is one way that Mount Sinai has addressed this need. Mount Sinai has pioneered an efficient and culturally sensitive Financial Assistance Policy / Application Process that addresses the key obstacles of financial anxiety and lack of familiarity of the American healthcare system.Mount Sinai's financial assistance policy and application process and plain-language summary are available on Mount Sinai's website at https://www.msmc.com/patient-info/financial-assistance-information as well as in person at the Mount Sinai Business Office, in the registration and admitting departments, upon request in any other department or in any other public space. Mount Sinai's financial assistance policy and application are available free of charge in English and Spanish, the primary languages spoken by the local populations and, upon request, can be translated into other languages such as French, German, Yiddish, Creole, Italian and Russian as needed.This application process is unique in that it does not require an upfront paper document submission. A prospective applicant schedules an in person counseling session using the contact information available in plain language at https://www.msmc.com/patient-info/financial-assistance-information. While scheduling the meeting, the applicant receives information also posted online about helpful financial documentation to show financial status that will be reviewed and input into a Mount Sinai Medical Center Financial Assistance Form by a Mount Sinai financial assistant together with the applicant at the financial counseling session. For patients without health insurance, Mount Sinai will determine eligibility using public information about the patient's available assets, and all other financial resources that the patient supplies as well as a review of the patient's account history. Mount Sinai will first screen for applicant eligibility for means tested programs and locally available grants. If ineligible for these programs, Mount Sinai provides an automatic reduction to gross charges based upon the "look back" method. All prospective and retrospective medically necessary patient care will be considered, though charity care is first focused on patients whose income for the 12 months preceding the determination is less than or equal to 200 percent of the federal poverty level for the patient's family size, unless the amount of hospital charges from the patient will or do exceed 25 percent of the annual family income. Individuals may obtain free, written information on the Determination of Amount of Financial Assistance by contacting the Business Office at (305) 674-2130, Monday-Friday 9:00am-4:00pm. Mount Sinai provides a right to appeal and receive assistance in all parts of the application. The patient must write a letter which can be post mailed or emailed to the Business Office Director to explain why the decision made by Mount Sinai Medical Center was inappropriate. The appeal letter will be reviewed by Mount Sinai Medical Center and a final decision will be sent to the patient within 30 days of the receipt of the request for appeal. Part VI, Line 4: COMMUNITY INFORMATION:Mount Sinai is the only acute care hospital and emergency care provider on the northeastern barrier islands of Miami-Dade County. Mount Sinai primarily services a densely populated diverse urban area encompassing the barrier island cities of Miami Beach, Surfside, North Bay Village, Bal Harbour, and Bay Harbor Islands. The neighboring mainland or secondary service area includes sections of the cities of Miami, North Miami, and North Miami Beach. Mount Sinai's Health Needs target areas include sections of the upper barrier island city of Sunny Isles Beach and the mainland cities of Aventura, Hialeah, and coral gables. The northeastern barrier islands have 130,309 year round residents that are 51% male and 49% female. The population is 88% White, 4% Black with 8% all other races. 51% of residents report their ethnicity as Hispanic. The median age is 41.1 years old. The median household income is $42,265. There are three designated medically underserved areas in the primary service area represented by MUAs Federal ID# 5031, 511 and 7474. Part VI, Line 5: As South Florida's largest independent teaching hospital, Mount Sinai's not-for-profit mission is to provide high quality health care to our diverse community enhanced through teaching, research, charity care, and financial responsibility. We maintain our not for profit mission using a two-tier strategy, focusing, first, on safety net services and, second, on addressing health risks related to heart disease, cancer, neurological, pulmonary and other diseases that pose serious community health risks.This not for profit community driven mission is detailed further in Schedule O. We have briefly discussed it below.Tier One - Provide a wide range of Safety Net services- Training to address Florida's physician and healthcare worker shortage - Charity care for the uninsured and underinsured- Disaster first response health services and regional leadership- Emergency medical services- Adult psychiatric and behavioral care- Intensive geriatric / senior care- Maternity services and neonatal emergent care- Health and disease prevention education- Interventional and community health screeningsTier Two - Mission Driven Community Health PrioritiesMount Sinai focuses resources on providing access to care while treating and preventing the leading disease related conditions for all incomes in the community by subsidizing a nonprofit teaching and community physician network.Tier One - Provide a wide range of Safety Net servicesTo address Florida's physician and healthcare worker shortage, Mount Sinai retained its own teaching faculty and 18 accredited graduate medical education programs, teaching more than 160 residents or fellows. Mount Sinai also provided a teaching clinical environment for both its acute care and specialty care physician teaching network for physicians to become board certified and to educate the other crucial components of the healthcare workforce not within a traditional CMS residency program. In 2016, Mount Sinai taught 346 nursing students, 340 medical students and 136 Allied Health students for health care careers. In 2016, Mount Sinai served 23,312 Inpatient admissions and 201,871 Outpatient admissions. To address charity care for the uninsured and underinsured, Mount Sinai provided $131,886,265 in charity and uncompensated care in 2016. Additionally, in its primary service Mount Sinai is the functional public health system area though it does not receive the tax revenue meant to provide these services. In its service area, Mount Sinai provides the overwhelming majority, as high as 65-75%, of the charity care, indigent care, and Medicaid hospital services.To provide disaster first response health services and regional leadership, in conjunction with the City of Miami Beach and the State of Florida, Mount Sinai has embarked on its $275 million regional Emergency Services and Tower Project. This project will provide a joint Emergency Operations Center for the city staff, police, fire, and medical staff during declared community crisis. It will relocate operating rooms above the flood plain in a Special Hazard Flood Zone, provide emergency care services for the state's second largest tourism area in High Velocity Hurricane Zone, provide a medical management disaster shelter for oxygen and electric dependent residents including those in intensive care that cannot evacuate, ensure that all patient care for regional facility meets a modern level of care, provide safe helipad service and boat access to the island when bridges are locked down and serve as a national stockpile drop location for counter terrorism measures.To address the need for Emergency medical services as the sole hospital on the barrier islands of Miami Dade County, in 2016, Mount Sinai provided emergency services for 55,126 visits in the primary service area of Miami Beach and for an additional 19,914 in its senior and geriatric target area of Aventura.To address intensive geriatric / senior care, Mount Sinai maintains the Wein Center for Alzheimer Care, the State of Florida's leading Memory Disorder Clinic with over 2,000 visits annually and 3,000 memory disorder screenings. It also serves as the Miami Dade County coordinator for the State authorized Caregiver Support and Silver Alert Programs, and provides inbound senior visits through its State authorized Geriatric House Call Program.To address maternity services and neonatal emergent care, Mount Sinai partners with the Miami Beach Community Health Center to provide preventative and acute OB/GYN care for all incomes, races, and ethnicities regardless of national origin or documentation. In 2016, Mount Sinai welcomed 2,678 infants to the community.To address health education and community health screenings and education, Mount Sinai provided over 54 health events, 40 health lectures, and 115 screenings. To address access to care and mission driven community health, Mount Sinai provided access to care by providing nearly 160,000 primary care visits in one of the widest Medicaid networks in Miami Dade County. Mount Sinai seeks to include all possible plans and promote teaching and specialty physician network in partnership with the State of Florida and the State of Florida Medical Schools. Additionally, Mount Sinai's academic medical component of its physician teaching network provided access to 237 research trials to help community members receive the latest cancer, cardiac and other treatments near their home. X X X X X 0 1 0 0 0 0 0 0 0 MIKE CUSNIR MD PHYSICIAN/PRES MED STAFF BEG 07/16 498893 0 267784 0 270 0 43350 0 13244 0 823541 0 0 0 STEVEN D SONENREICH PRESIDENT/CEO 867489 0 459589 0 180331 0 367240 0 27415 0 1902064 0 0 0 ALEXANDER A MENDEZ EXEC VP OF OPERATIONS/CFO 614390 0 264031 0 319567 0 43350 0 27415 0 1268753 0 0 0 WAYNE CHUTKAN SENIOR VP OF FINANCE 307792 0 67781 0 66643 0 43350 0 28359 0 513925 0 0 0 BENJAMIN DAVIS VP FACILITIES/RESOURCE MGT 231080 0 46200 0 45915 0 25350 0 8878 0 357423 0 0 0 STEVEN FINE VP ADMINISTRATION 226529 0 27481 0 1188 0 49350 0 19046 0 323594 0 0 0 THOMAS GILLETTE SENIOR VP/ CIO 366635 0 79156 0 78730 0 43350 0 29013 0 596884 0 0 0 ROBERT GOLDSZER MD SENIOR VP/ CMO 404491 0 89604 0 179702 0 40100 0 23542 0 737439 0 0 0 ARNOLD JAFFEE SENIOR VP/ GEN COUNSEL 357937 0 74419 0 74058 0 31350 0 20217 0 557981 0 0 0 CATHY MCCLELLAN VP RISK MANAGEMENT 160683 0 40000 0 37548 0 49350 0 9071 0 296652 0 0 0 MERVYN MILLS VP OF FINANCE 220899 0 48510 0 48018 0 43350 0 20812 0 381589 0 0 0 KAREN MOYER SENIOR VP/ CNO 316894 0 36284 0 139886 0 49350 0 10448 0 552862 0 0 0 ANGEL PALLIN SENIOR VP OF OPERATIONS 317353 0 63525 0 64712 0 31350 0 13352 0 490292 0 0 0 DIANA SALINAS VP OF COMPLIANCE 137546 0 0 0 47336 0 42796 0 3818 0 231496 0 0 0 CHARLENE J WELKER SENIOR VP OF SUB-ACUTE SVCS 227820 0 54394 0 51601 0 49350 0 8589 0 391754 0 0 0 DENISE TAPAK WONG VP OF SURGICAL/WOMEN'S SVCS 189068 0 51500 0 41988 0 49350 0 9561 0 341467 0 0 0 ROBERT BEASLEY EMPLOYED MD DIRECTOR OF VASCULAR 620908 0 220000 0 7439 0 49350 0 25013 0 922710 0 0 0 BRUCE BOROS EMPLOYED MD CARDIOLOGY 877001 0 0 0 2286 0 49350 0 18789 0 947426 0 0 0 JOSEPH LAMELAS EMPLOYED MD CHIEF,CARDIOTHORACIC SURGERY 2449678 0 0 0 16042 0 42000 0 26043 0 2533763 0 0 0 TODD M LASNER EMPLOYED MD NEUROSURGERY 791842 0 0 0 1794 0 0 0 25654 0 819290 0 0 0 ROY WILLIAMS EMPLOYED MD CHIEF,THORACIC SURGERY 817617 0 0 0 7102 0 48536 0 26043 0 899298 0 0 0 PART I, LINE 4B: STEVEN D. SONENREICH, PRESIDENT AND CHIEF EXECUTIVE OFFICER OF MSMC, PARTICIPATES IN AN IRC SEC 457(F) PLAN. THE PAYMENT TO THE PLAN IN 2016 WAS $317,890. A CITY OF MIAMI BEACH HEALTH FACILITIES AUTHORITY 650372870 593211DY8 2012-09-11 141194667 CURRENT REFUND BONDS ISSUED 12/22/98 & 5/24/01 0 0 0 B CITY OF MIAMI BEACH HEALTH FACILITIES AUTHORITY 650372870 593211EZ4 2014-09-04 181289212 CURRENT REFUND BOND ISSUED 4/28/04 & CAPITAL IMPROVEMENTS 0 0 0 A 24915000 141194667 12265509 141194667 1 0 1 1 B 2335000 181710982 776926 2358111 48519113 69334698 61499059 1 0 0 1 B 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 1 0 0 0 0 0 0 1 B 0 1 0 0 0 0 0 0 1 A 1 B 1 PART II, LINE 4, COL A THE AMOUNT SHOWN HERE CONSISTS OF $11,290,888 IN A DEBT SERVICE RESERVE FUND, PLUS $974,621 OF DEBT SERVICE FUNDS DEPOSITS. PART II, LINE 4, COL B THE AMOUNT SHOWN HERE CONSISTS OF $776,926 OF DEBT SERVICE FUNDS DEPOSITS. PART II, LINE 3, COL B DIFFERENCES BETWEEN THE AMOUNT SHOWN HERE AND THE ISSUE PRICE REPORTED IN PART I, COLUMN (E) ARE DUE TO ACCUMULATED INTEREST EARNINGS. MARC CSETE MDPA SEE PART V 284062 SERVICES 0 MIAMI BEACH ANESTHESIOLOGY SEE PART V 783265 SERVICES 0 MICHAEL B WITTELS MD SEE PART V 216705 SERVICES 0 PART IV, COLUMN B MARC CSETE M.D. P.A.: MARC CSETE, M.D., BOARD MEMBER OF MSMC, IS PRESIDENT OF MARC E. CSETE M.D. P.A., WHICH PROVIDES INTENSIVIST SERVICES TO THE HOSPITAL AT FAIR MARKET VALUE.MIAMI BEACH ANESTHESIOLOGY: S. HOWARD WITTELS, M.D., BOARD MEMBER, IS PRESIDENT OF MIAMI BEACH ANESTHESIOLOGY, WHICH PROVIDES ANESTHESIA SERVICES TO THE HOSPITAL AT FAIR MARKET VALUE.MICHAEL B. WITTELS M.D.: FAMILY MEMBER OF S. HOWARD WITTELS, HOSPITAL BOARD MEMBER. Form 990, Part VI, Section A, line 2 TRUSTEES WAYNE CHAPLIN AND PAUL CHAPLIN HAVE A BUSINESS AND FAMILY RELATIONSHIP. TRUSTEES MARK H. HILDEBRANDT AND LAURANS A. MENDELSON HAVE A BUSINESS RELATIONSHIP. Form 990, Part VI, Section B, line 11b THE PROCESS FOR REVIEW OF THE FORM 990 BY MEMBERS OF THE GOVERNING BODY AND MANAGEMENT IS AS FOLLOWS: THE MEMBERS OF THE GOVERNING BODY, MANAGEMENT, AND THE INDEPENDENT TAX CONSULTANTS WILL MEET AND REVIEW IN DETAIL THE COMPLETED FORM 990. A FINAL DRAFT OF FORM 990 IS PROVIDED TO ALL VOTING MEMBERS OF THE ORGANIZATION BEFORE THE FINAL FORM IS FILED WITH THE IRS. Form 990, Part VI, Section B, line 12c CONFLICT OF INTEREST POLICY: Mount Sinai Medical Center of Florida, Inc. and subsidiaries (the "Medical Center") formally implemented a written Conflict of Interest Policy (the "Policy") in March 2006 to protect the Medical Center and ensure that the deliberations and decisions made on behalf of the Medical Center are made in the best interest of the Medical Center. The term "conflict of interest" as defined by this Policy refers to situations in which financial or other personal considerations may compromise, or have the appearance of compromising, the judgment of someone charged with the responsibility to act on behalf of the Medical Center. This Policy is reviewed periodically but not less than once a year by the Audit Committee of the Board of Trustees to better meet its objectives. It is intended to supplement but not replace any applicable laws governing conflicts of interest in nonprofit and charitable organizations. Persons covered under this policy include: (1) Any current or former Trustee, officer, or member of a committee with board delegated powers for the Medical Center; (2) Members of management and any employee of the Medical Center who: a) Receives compensation from the Medical Center in excess of $150,000 annually, whether as a full- or part-time employee, independent contractor, or otherwise, and, b) Has responsibilities, power of influence over an activity of the Medical Center similar to that of an officer or Trustee and which represents more than 10% of the activities, assets, income or expenses of the Medical Center, and c) Is one of the twenty employees with the highest compensation from the Medical Center. (3) Any person(s) who serve as a member of the Medical Center's Medical Staff as a Chairperson of a Department, Chief of a clinical service, or member of the Medical Executive Committee. Monitoring and Compliance: An important step in monitoring and enforcing compliance with a conflict of interest policy includes management's education efforts to make interested persons aware of the organization's Conflict of Interest Policy. To that end, Management has included in its Code of Conduct (the "Code") a section on conflicts of interest which has to be signed and returned by every interested person to acknowledge and attest that they read the Code including the conflict of interest section. Annually, interested persons also receive a refresher training session on ethics and conflicts of interest. In addition, the Audit Committee of the Board of Trustees has created a Subcommittee on Conflicts of Interest ("Conflicts Committee") to administer and monitor compliance with this Policy. The Conflicts Committee requires a statement from each interested person not less frequently than once a year setting forth all business and other affiliations that relate in any way to the business and other activities of the Medical Center. Internal Audit compiles and summarizes all the disclosures received from interested persons to facilitate their review by the Conflicts Committee. The Conflicts Committee individually discusses each disclosure to evaluate whether a conflict of interest exists and determines the appropriate course of action to take. Neither the Board nor any Committee of the Board shall vote upon any proposed transaction or arrangement in connection with a potential conflict of interest until such time as the Conflicts Committee has determined whether a conflict of interest exists. Where the Conflicts Committee has concluded that a conflict of interest exists, the Chairman of the Conflicts Committee shall, if appropriate, appoint a disinterested person or committee to investigate alternatives to a proposed transaction, contract, or arrangement. If the Conflicts Committee determines that the Medical Center can obtain a more advantageous transaction or arrangement with reasonable efforts from a person or entity that would not give rise to a conflict of interest, then the Medical Center shall not enter into the transaction that involves the conflict of interest. If a transaction or arrangement more advantageous is not reasonably attainable under the circumstances that would not give rise to a conflict of interest, then the Board or Committee, as applicable, shall determine by a majority vote of the disinterested Trustees whether the transaction or arrangement is in the Medical Center's best interest and whether it is fair and reasonable to the Medical Center, and shall make its decision as to whether to enter into the transaction or arrangement in conformity with such determination. Failure by an interested person to disclose an actual or possible conflict of interest under the Conflict of Interest Policy is considered a serious matter and may constitute "cause" for removal or termination of a Trustee, Officer, or the termination of any contractual or employment relationship the Medical Center may have with an interested person or other party. Form 990, Part VI, Section B, line 15 ON AN ANNUAL BASIS, THE MOUNT SINAI MEDICAL CENTER COMPENSATION COMMITTEE CONTRACTS WITH AN INDEPENDENT CONSULTANT TO PREPARE AN OPINION REGARDING THE REASONABLENESS AND COMPARABILITY OF THE TOTAL COMPENSATION PROVIDED TO ITS SENIOR OFFICERS AND KEY EMPLOYEES. THE COMPENSATION COMMITTEE INFORMS THE INDEPENDENT CONSULTANT THAT THE INDEPENDENT CONSULTANT'S OPINION WILL BE PART OF THE COMMITTEE'S PROCEDURE FOR ESTABLISHING THE REBUTTABLE PRESUMPTION OF REASONABLENESS DESCRIBED IN THE INCOME TAX REGULATIONS. THE INDEPENDENT CONSULTANT'S DETERMINATION OF REASONABLENESS IS MADE AFTER A THOROUGH REVIEW OF ALL THE ELEMENTS OF THE TOTAL COMPENSATION COMPRISED OF: CASH COMPENSATION, HEALTH AND WELFARE BENEFITS, RETIREMENT BENEFITS, EXECUTIVE BENEFITS AND PERQUISITES, AND OTHER ELEMENTS OF COMPENSATION INCLUDING SEVERANCE ARRANGEMENTS. THE OPINION EXPRESSED BY THE INDEPENDENT CONSULTANT IS THEN PRESENTED TO THE MSMC COMPENSATION COMMITTEE IN A REPORT FORM FOR THEIR REVIEW. THE OPINION REPORT IS REFERRED TO BY THE COMPENSATION COMMITTEE WHEN DETERMINING AND APPROVING THE ANNUAL COMPENSATION FOR ITS SENIOR OFFICERS AND KEY EMPLOYEES. THE EXECUTIVE BOARD OF TRUSTEES OF MSMC HAS AUTHORIZED ITS COMPENSATION COMMITTEE TO SET ANNUAL COMPENSATION FOR MSMC'S SENIOR OFFICERS AND KEY EMPLOYEES. Form 990, Part VI, Section C, line 19 DOCUMENTS THAT ARE REQUIRED TO BE OPEN FOR PUBLIC INSPECTION ARE MADE AVAILABLE UPON REQUEST. FORM 990, PART VI, SECTION B, LINE 16B: IF THE HOSPITAL JOINS A PARTNERSHIP/JOINT VENTURE ARRANGEMENT, ADMINISTRATION WILL PRESENT IT TO THE BOARD AND THE BOARD MUST APPROVE THE ACTION. Form 990, Part XI, line 9: INCOME FROM PREMIER HEALTHCARE ALLIANCE, L.P. -714,188. CHANGE IN THE BENEFICIAL INTEREST IN THE NET ASSETS OF MSMC FOUNDATION 23,548,000. AMOUNTS REPORTED SEPARATELY 6,267. 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