Ezras Cholim 2008

8/9/2019 Ezras Cholim 2008

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l efile GRAPHIC print - DO NOT PROCESS As Filed Data - DLN: 93493320038859

Form990 Return o f Organization Exempt F r om Income Tax OMB No 1545-0047Under section 501(c), 527, o r 4947(a)(1) o f the I n t e r n a l Revenue Code ( except b la c k l u ng 200enefit t rus t o r private foundation)

Department of theTreasuryI n t e r n a l RevenueService

Open to ,-The organization may have t o us e a copy o f t h i s return t o satisfy s t at e r e po r ti n g requirements Inspectior

A Fo r the 2008 calendar year, o r tax year beginning 01-01-2008 and ending 12-31-2008B Check i f a p p l i c a b l e C Name o f organization D Employer identification numberPl e a se EZRAS CHOILIM HEALTH CENTER IN CFd d r e s s cha n g e use IR S 13-3595755( - Name cha n g e

label o rprint o r D o in g B us i ne s s As E Telephone number

In i t i a l r e t u r n type . SeeSpecific (845) 782-3242I n st r u c - Number a nd s t re et ( o r P 0 bo x i f mail i s n o t d el i ve r ed t o s t r e e t address) Room/suite G Gross receipts $ 9 816 588F_ Termination tions. 49 FOREST ROAD

, ,

1mended r e t u r n C i t y or town, s t a t e or country, a nd ZIP + 41 A p p l i c a t i o n pending MONROE,

NY 10950

F Name a nd a ddr e s s o f Principal Officernuchem freedman49 FOREST ROADMONROE,NY 10950

I Ta x - exempt s t a t u s F501( c) ( 3 ) - 4 ( i n s e r t no ) 1947(a)(1) o r F_ 5273 Web site: - n/a

H(a) Is this a group r e t u r n fo raffiliates? f l Yes FNo

H(b) Ar e a ll a f f i l i a t e s included ? f l Ye s F_ No( I f "No," a t t a c h a l i s t See i n s t r u c t i o n s

H(c) Group Exemption Number 0 -

K Type o f organization Forporation1r u s t (- association1ther 1 L Ye ar o f Formation 1996 I M State o f l e g a l domicile NY

Summary1 B r i e f l y describe th e organization's mi s s i o n o r most significant activities

a f r e e s t an d i ng d i ag n o s ti c a n d treatment ce nte r licensed under a r t i c l e 28 o f the new york s t at e pu bl ic he al t h l a w th e ce nte rprovides a br o ad r a ng e o f health services t o a largely medically u nde r s e r v e d population

2 Check t h i s bo x F- i f th e organization discontinued i t s operations o r disposed o f more than 25% o f i t s a s s e t s3 Number of v o t i n g members of the governing body ( Pa r t VI , l i n e 1a ) . 3 124 Number of independent v o t i n g members of the governing body (Part VI , l i n e 1b ) 4 125 To t a l number of employees ( Pa rt V, l i n e 2a) 5 1416 Total number o f v o lu n te e r s ( e s ti ma t e i f n e c e s s a ry) 6 07a T o t a l gross u n r e l a t e d business revenue from Pa r t VIII, l i n e 12 , column ( C) 7a 0b Net u n r e l a t e d business taxable income from Form 990-T, l i n e 34 . 7b 0


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Form 990 (2008) Page 2MUMV-tatement of Program Service Accomplishments (See th e Instructions.)1 B r i e f l y describe the o r g a n i z a t i o n ' s mission

provide healthcare s e r v i c e s f o r a medically underserved population f o r approximately 82,147 v i s i t s i n y/ e 12/31/08

2 Did the organization undertake an y significant program services d u ri ng the year which were not l i s t e d onthe prior Form 990 or 990 -EZ'' . . . . . . . . . . . . . . . . . . . . fl Yes FNoI f "Yes, " describe these new services on Schedule 0

3 D id the organization cease conducting or make significant changes i n how i t conducts any programservices? FYes FNoI f "Yes, " describe these changes on Schedule 0

4 Describe the exempt purpose achievements fo r each of th e organization ' s three largest program services b y expensesSection 501 ( c)(3) and ( 4 ) o r ga n i z at i o ns and 4947 (a)(1) t ru st s a re required to r ep o rt t he amount of grants and allocations too t he r s, t he total expenses , and revenue , i f any, fo r each program s er v i ce r ep o rt ed

4a (Code ) (Expenses $ 7,990,274 i n c l u d i n g grants o f $ ) ( Revenue $ 9 ,717,436provide healthcare s e r v i c e s f o r a medically underserved population f o r approximately 82,147 v i s i t s i n y/ e 12/31/08

4b (Code ) (Expenses $ i n c l u d i n g grants o f $ ) (Revenue $


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Form 990 (2008) Page 3Li hecklist of Required Schedules

Yes No1 Is the organization described i n section 501(c)(3) or4947(a)(1) (other than a private foundation)? If "Yes," Yes

complete ScheduleAs . . . . . . . . . . . . . . . . . . . . . 12 I s the organization required t o complete Schedule B , Schedule o f Contributors? . 2 No3 D id the organization engage i n direct o r indirect p o l i t i c a l campaign a c t i v i t i e s on behalf o f o r i n opposition t o No

candidates f o r public o f f i c e ? I f "Yes,"complete Schedule C , P a r t I . . . . . . . . . . 34 Section 501(c)(3) organizations D id the organization engage i n lobbying activities? If "Yes,"complete Schedule C , NoP art I I . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 Section 501(c)(4), 501(c)(5), and 501(c)(6) organizations Is the organization subject to the section 6033(e)

notice and reporting requirement and proxy tax's If "Yes,"complete Schedule C , Part II I . . . 56 Did the organization maintain any donor advised funds o r any accounts where donors have the r i g ht t o provide

advice on the distribution o r investment o f amounts i n such funds o r accounts? I f "Yes,"completeSchedule D , P artIs . . . . . . . . . . . . . . . . . . . . . . 6 N o

7 Did the organization receive o r hold a conservation easement, including easements t o preserve open space,the environment, h i s t o r i c land areas o r h i s t o ri c structures? I f "Yes,"complete Schedule D , P a r t I I . 7 No

8 Did the organization maintain collections o f works o f a r t , historical treasures, o r other similar assets? I f "Yes,"complete Schedule D, P art I I I. . . . . . . . . . . . . . . . . . . 8 N o

9 D id the organization report an amount i n Part X, l i n e 21, serve as a custodian for amounts not listed i n Part X, orprovide credit counseling, debt management, credit r e p a i r , o r debt negotiation services? I f "Yes,"complete Schedule D, Part I V ' . 9 N o

10 D id the organization hold assets i n term, permanent,or quasi-endowments? If "Yes,"complete Schedule D, Part 1 / ' 10 No11 D id the organization report an amount i n Part X, lines 1 0, 12 , 13, 15, or 257 If "Yes,"complete Schedule D,

Parts VI , V II , V II I, IX , orXas applicable . . . . . . . . . . . . . . . . . 11 Yes12 Did the organization receive an audited f i n a n c i a l statement f o r the year f o r which i t i s completing t h i s return

that was prepared i n accordance with GAAP7 If "Yes," complete Schedule D, Parts XI , X I I, and X I I I 19 Yes1213 Is the organization a school as described i n section 170(b)(1)(A)(ii)'' If "Yes,"completeScheduleE 13 No14a D id the organization maintain an office, employees, or agents outside of the U S 7 . 14a No

b D id the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising,business, and program service activities outside the U S 7 If "Yes,"complete Schedule F , Part I . 14b No

15 D id the organization report on Part I X, column (A), l i n e 3, more than $5,000 of grants or assistance to anyorganization or entity located outside the United States? If "Yes,"complete Schedule F Part II 15 N o

16 D id the organization report o n P art I X, column (A), l i n e 3, more than $5,000 of aggregate grants or assistanceto individuals located outside the United States? If "Yes,"complete Schedule F , P art I I I . . 16 No

17 D id the organization report more than $15,000 on Part IX , column (A), l i n e lle'' If "Yes,"complete Schedule G, 17 NoPart I

18 D id the organization report more than $15,000 total on Part V I I I , lines 1c and 8a'' If "Yes, "complete Schedule G,P art I I . . . . . . . . . . . . . . . . . . . . . . . . . 18 N o

19 D id the organization report more than $15,000 on Part V I I I , l i n e 9a'' If "Yes," complete Schedule G, P art I I I 19 No


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Form 990 (2008) Page 4Li hecklist of Required Schedules (Continued)Yes No

28 During the ta x y ea r, did any person who i s a current or former officer, director, trustee, or key employeea Have a direct business relationship with the organization (other than as an o f f i c e r , director, trustee, o r employee),

o r an indirect business relationship through ownership o f more than 35% i n another entity (individually o rcollectively with other person(s) listed i n Part VII, Section A)? If "Yes,"complete Schedule L , PartIV . . . . . . . . . . . . . . . . . . . . . . . . 28a No

b Have a family member w ho had a direct o r indirect business relationship with the organization? I f "Yes,"complete Schedule L , Part IV . . . . . . . . . . . . . . . . . . 2 8b N oc Serve as an o f f i c e r , director, trustee, key employee, partner, o r member o f an e n t i t y ( o r a shareholder o f a

p r o fessio nal co rp o r atio n) do in g business w i th t he organization? If "Yes,"complete Schedule L , Part IV . 28c No29 Did the o r g ani z atio n r ecei ve more than $25,000 i n non-cash contributions? If "Yes,"complete Schedule M 29 No30 Did the organization receive contributions o f a r t , historical treasures, o r other similar assets, o r q ua l i f i e d

conservation contributions? If "Yes,"complete Schedule M . . . . . . . . . . . 30 No31 Did the organization l i q u i d a t e , terminate, o r dissolve an d cease operations? I f "Yes,"complete Schedule N ,

Part 1 . 31 N o32 Did the organization s e l l , exchange, dispose o f , o r transfer more than 25% o f i t s net assets? I f "Yes,"complete

Schedule N, Part II . 32 N o33 Did the organization own 100% of an entity disregarded as separate from the organization under Regulations

section 301 7701-2 and 301 7701-3? If "Yes,"complete Schedule R , Part I . 33 No34 Was the organization related to any tax-exempt or taxable entity? If "Yes,"complete Schedule R , Parts I I , III, IV,

and V , line l . . . . . . . . . . . . . . . . . . . . . . . 34 N o35 Is any related organization a controlled entity within the meaning of section 512(b)(13)? If "Yes,"complete

Schedule R , Part V , line 2 . . . . . . . . . . . . . . . . . . 35 N o36 501(c)(3) organizations Did the organization make any transfers to an exempt non-charitable related

organization? If "Yes,"complete Schedule R , Part V , line 2 . . . . . . . . . . 36 No37 Did the organization conduct more than 5 percent o f i t s a c t i v i t i e s through an e n t i t y that i s not a related

organization an d that i s treated as a partnership f o r federal income tax purposes? I f "Y es,"complete Schedule R , 37 NoP art V I . .

Form 990 (2008)


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Form 990 (2008) Page 5Statements Regarding Other IRS Filings and Tax Compliance

Yes Nola Enter th e number reported i n Box 3 of Form 1096, Annual Summary and Transmittal

of U .S . In f ormat io n R et ur ns . E n te r -0 - i f no t applicable . .la 27

b Enter th e number of Forms W-2G included i n l i n e la Enter -0 - i f not applicablelb 0

c Di d th e organization comply with backup withholding rules for reportable payments to vendors and reportablegaming (gambling) winnings to prize winners?2a Enter th e number of employees reporte d on Form W-3, Transmittal of Wage and Ta x

Statements f i l e d for th e calendar year ending with or w it hi n t he year covered by thisreturn 2a 141

b I f at least one i s reported i n 2a , did th e organization f i le a ll required federal employment tax returns'Note : I f the sum o f l i n e s la an d 2a i s greater than 250, you may be required t o e - f i l e t h i s r e t u r n .

3 a Did the organization have unrelated business gross income o f $1,000 o r more during the year covered by t h i sreturn?

b I f "Yes," has i t f i l e d a Form 990-T f o r t h i s year? I f "No,"provide an explanation i n Schedule 0 . . . . .4a At any time during the calendar year, d i d the organization have an interest i n , o r a signature o r other authorityover, a financial account i n a foreign country (such as a bank account, securities account, o r other financial

account)? .b I f " Yes," e nter the name o f the foreign country

See th e instructions for exceptions and f i l i n g requirements for Form TD F 90-22 . 1 , Report of Foreign Bank andFinancial Accounts.

5a Was th e organization a party to a prohi bi t ed tax shelter transaction at any time during t he t ax year?b Did any taxable party n o t i f y the organization that i t was o r i s a party t o a prohibited tax shelter transaction?c I f "Yes," to 5a or 5b, did th e organization f i l e Form 8886-T, Disclosure by Tax-Exempt Entity Regarding Prohibited

Ta x Shelter Transaction? .6a Di d th e organization solicit any contributions that were n ot t ax deductible? . .

b I f "Yes," d i d the organization include with every solicitation an express statement that such contributions o r g i f t swere not tax deductible? .

7 Organizations t h a t may receive deductible contributions under section 170(c).a Did th e organization provide goods or services i n exchange for any quid pro quo contribution of $75 or

more? . .b I f "Yes," d i d the organization n o t i f y the donor o f the value o f the goods o r services provided?c Di d th e organization s e l l , exchange, or otherwise dispose of tangible personal property for which i t was required to

f i l e Form 82827 .d I f "Yes," indicate the number o f Forms 8282 f i l e d during the year I 7d

e D id the organization, during the year, receive any funds, directly o r i n d i re ct l y , t o pay premiums on a personalbenefit contract?

1 c

2b Yes

3a N o3 b

4a N o

5a N o5b N o

5 c6a N o

6b

7a No

7b

7 c N o

7e N o


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Form 990 (2008) Page 6L&ILM Governance , Management and Disclosure (Sections A, B, and Crequest information

about policies not required by th e Internal Revenue Code.)Section A . Governing Bodv and Management

Fo r each "Yes "response to lines 2-7 below, and fo r a "No"response to lines 8 or 9b below, describe the circumstances,processes, or changes i n Schedule 0. See instructions.

la Enter the number of voting members of the governing body . la 12b Enter the number of voting members t hat are independent . lb 12

2 Di d any officer, director, trustee, or key employee have a family relationship or a business relationship with anyother officer, director, trustee, or key employee?

3 Did the organization delegate control over management duties customarily performed by or under t he dir ectsupervision of officers, directors or trustees, or key employees to a management company or other person?

4 Di d the organization make any significant changes to i t s organizational documents since the prior Form 990 wasf i l e d ' .

5 D id the organization become aware during the year o f a material diversion o f the organization's assets?6 Does the organization have members o r stockholders?7a Does the organization have members, stockholders, or other persons who may elect one or more members of the

governing body? .b Ar e an y decisions o f the gover n ing body subject t o approval by members, stockholders, o r other persons?

8 D id the organization contemporaneously document the meetings held o r written actions undertaken during theyear by the following

a the governing body? .b each committee with authority to act on behalf of the governing body?

9a Does the organization have l o c a l chapters, branches, o r a f f i l i a t e s ?b I f "Yes," does the organization have written policies and procedures governing the activities o f such chapters,

a f f i l i a t e s , an d branches t o ensure their operations are consistent with those o f the organization? .10 Was a copy of the Form 990 provided to the organization's governing body before i t was f iled? A ll organizationsmust describe i n Schedule 0 the process, i f any, the organization uses to review the Form 99011 Is there any officer, director or trustee, or key employee listed i n Part VII, Section A, who cannot be reached at

the organization's mailing address? If"Yes," provide the names and addresses i n Schedule 0

Yes No

2 No

3 No

4 No5 No6 No

7a N o7b N o

8a Yes8b Yes9a N o

9b

10 Yes

11 No

Section B . PoliciesYes No

12a Does the organization have a written conflict o f interest policy? If "No", go to line 13 . 12a Yesb Ar e o f f i c e r s , directors o r trustees, an d key employees required t o disclose annually interests that could give r i s et o conflicts? . . . . . . . . . . . . . . . . . . . . . . . . . . 12b Yesc Does the organization regularly an d consistently mon itor and enforce compliance with the policy? I f "Yes,"

describe i n Schedule 0 how t h i s i s done 12c Yes


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Form 990 (2008) Page 71 : M.lkvh$ Compensation of Officers , Directors , Trustees , Key Employees, Highest Compensated

Employees , and Independent Contractors

Section A Officers, Directors, Trustees, Key Employees, and Highest Compensated Employeesla Complete t h i s table f o r a l l persons required t o be l i s t e d Use Schedule J- 2 i f additional space i s needed* List a ll of the organization' s current officers, directors, trustees (whether individuals or organizations) and key employees regardlessof amount of compensation, and current key employees Enter -0 - i n columns (D), (E), and (F) i f no compensation was paid* List th e organization's five current highest compensated employees (other than an officer, director, trustee or key employee)who received reportable compensation (Box 5 of Form W-2 and/or Box 7 of Form 1099-MISC) of more than $100,000 from theorganization and any related organizations* L i s t a l l o f the organization's former o f f i c e r s , ke y employees, o r highest compensated employees who received more than $100,000o f reportable compensation from the organization and any related organizations* List a ll of the organization' s former directors or trustees that received, i n the capacity as a former director or trustee of th eorganization, more than $10,000 of reportable compensation from the organization and any related organizationsL i s t persons i n the following order individual trustees o r directors, i n s t i t u t i o n a l trustees, o f f i c e r s , ke y employees, highestcompensated employees, and f or mer such persons1Check t h i s b ox i f the organization d i d not compensate an y o f f i c e r , d i r e c t o r , trustee o r key employee

(C)Position (check a l l

that apply) (F )

A)Name an d T i t l e

(B )gvera g e

hourspe rweek

C , -ZS

1 ^ C .

-E0c a

&

M

Q

EL c r y

m- D

m

Ta1

(D )Reportablecompensationfrom theo r g anization ( W-2/1099MISC)

Reportablecompensationfrom relatedorganizations(W - 2/1099-MISC)

Estimatedamount o f othercompensationfrom theo r anization an dgrelatedorganizations

MARTIN SCHLESINGER , TREASURER 1 00 X 0 0 0PINCHAS KISH , BOARD MEMBER 1 00 X 0 0 0ISRAEL SOFER , BOARD MEMBER 1 00 X 0 0 0RONALD J COHEN , BOARD MEMBER 1 00 X 0 0 0NUSEN WEINSTOCK , BOARD MEMBER 1 00 X 0 0 0ABRAHAM WIEDER , BOARD MEMBER 1 00 X 0 0 0CHAIM NUCHEM WERTZBERGER , BOARDMEMBER 1 00 X 0 0 0MOSES GOLDSTEIN , BOARD MEMBER 1 00 X 0 0 0JOE L MITTELMAN , BOARD MEMBER 1 00 X 0 0 0ESTHER SRUGO , BOARD MEMBER 1 00 X 0 0 0NOEMI RUTH WEISS, BOARD MEMBER 1 00 X 0 0 0ESTHER RUBINSTEIN , BOARD MEMBER 1 00 X 0 0 0NUCHEM FRIEDMAN , EXECUTIVE DIRECTOR 40 00 X X 266,835 0 21,486


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Form 990 (2008) Page 8Continued

(c)Position (check a l l

that apply) (F)

(A)Name an d T i t l e

(B )Average

hpersweek

c - -

D

' DI D- 0QQ

3a- 0Jm

+ a

a

(D )Reportablecompensation

from theo r g anization ( W-2/1099MISC)

Reportablecompensationfrom relatedorganizations(W- 2/1099-

MISC)

Estimatedamount of o thercompensation

from theo r g anization an drelatedorgani zat i o n s

lb Total 1,191,048 1 0 76,858Total number of i n d iv i du al s ( in c l u di n g those i n 1 a) who received more than $100,000 in reportablecompensation from the organization-8

NoD id the organization l i s t an y former o f f i c e r , director o r trustee, key employee, o r highest compensated employeeon n e l a ' s I f "Yes,"complete ScheduleI forsu ch individual . . . . . . . . . . . . 3 NoFor any individual listed o nl in e 1 a, i s the sum of reportable compensation and o ther compensation from theorgani zat i o n and related o r g an i za t i o n s g r ea t er than $150,000? If "Yes," complete ScheduleI fo r suchindividual . . . . . . . . . . . . . . . . . . . . . . . . . .

Did an y p er so n l i s t e d on l i n e la receive o r accrue compensation from an y unrelated organization f o r servicesrendered t o the organization ? I f " Y e s , "complete ScheduleI f o r su ch person . . . . . . . . . 5 No


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Form 990 (2008) Page 9Statement of Revenue

(A) (B) (C) (D )Total Revenue Related o r Unrelated Revenue

Exempt Business Excl uded fromFunction Revenue Tax under IRCRevenue 512, 513, or 514

l a Federated campaigns . l ab Membership dues

lbc Fundraising events .

+ 1 { G 1cd Related organizations . .1 de Government grants ( c o n t r i b u t i o n s ) lef A l l other c o n t r i b u t i o n s , g i f t s , g r a n t s , an d

s i m i l a r amounts not i n c l u d e d above`^C} i fg Noncash contributions included i n0 M l i n e s la-1f $h Total ( Add l i n e s la-1f ) . . . . . 0 -

Business Code2a medicaid/medicare 900,099 6,317,667 6,317,667b OTHER THIRD PARTY 900,099 2,785,175 2,785,175C SELF-PAY 900,099 471,828 471,828

U5 d NYS UNCOMP CARE 900,099 142,766 142,766

ef A l l other program service revenue

Og Total . Add l i n e s 2a-2f . . . . . . . .

0 - $ 9,717,4363 I nves t men t i nc o me (including dividends, interest

o t he r similar amounts) . 6,201 6,201

4 Income from investment o f tax-exempt b o n d p ro ceeds

5 Royalt ies .( i ) Real ( i i ) Personal

6a Gross Rents


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Form 990 (2008) Page 101:Me Statement of Functional Expenses

Section 501(c)(3) and 501(c)(4) organizations must complete a l l columns.A l l otner or anizations must corn i e t e column w Dui are not r e uirea t o c orn i e t e coiumns i s , 04, an a u .

Do not include amounts reported on lines 6b, 7b,8b , 9b , and 10b of Part VIII .i i

( A )T o t a l expenses

(B)Program s e r v i c eexpenses

(C)Management andgeneral expenses

(D)Fundraisingexpenses

1 Grants and other assistance to governments and organizationsin the U S See P ar t I V, l i n e 21

2 Grants and other assistance to individuals in th eU S See P ar t I V, l i n e 22

3 Grants and other assistance to governments,organizations and individuals outside the U S SeeP ar t I V, lines 15 and 16

4 Benefits paid t o o r f o r members5 Compensation of current officers, directors , trustees, and

key employees 266,835 213,468 53,3676 Compensation no t inc luded above, to disqualified persons

(as defined under section 4958(f)(1)) and personsdescribed in section 4958 ( c)(3)(B) .7 Other salaries and wages 4,346,748 3,523,5348 Pension plan contributions ( include section 401(k) and section

40 3(b) employer contributions ) 3,285 2,661 6249 Other employee benefits 437,412 354,304 83,10810 Payroll taxes 306,825 248,528 58,29711 Fees for services ( non-employees)

a Management . .b Legal 9,172 9,172c Accounting 47,175 47,175d Lobbying . .e Professional fundraising See Part I V, l ine 17f Investment management feesg Other 1,483 ,419 1,435,919 47,500

12 Advertising and promotion .13 Office expenses 537,020 496,963 40,05714 Information technology15 Royalties16 Occupancy 1,048,601 838,881 209,720


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Form 990 (2008) Page 11Balance Sheet

(A) (B)Beginning of year End of year

1 Cash-non-interest-bearing 660,103 1 668,2702 Savings and temporary cash investments 23 P le dg es a nd grants receivable, net 34 Accounts receivable, ne t 1,188,147 4 1,419,2465 Receivables from current a nd f or me r o f f i c e r s , directors, trustees, ke y employees o r

other related parties Complete P a r t I I o f Schedule L 56 Receivables f ro m o th er disqualified persons ( a s defined under section 4958(f)(1)) an d

persons described i n section 4958(c)(3)(B) Complete Part II of Schedule L . 67 Notes an d loans receivable, net 78 Inventories fo r sale or use 89 Prepaid expenses and deferred charges 143,980 9 172,33310a

+ 6 Land, buildings, an d e qu ipment cost basis 10a 2,636,330b Less accumulated depreciati on Complete Part VI of

Schedule D . 10b 1,662,729 911,933 10c 973,60111 Investments-publicly traded securities 1112 Investments-other securities See Pa rt I V, l i n e 11 Complete Part VI I of

Schedule D . . 1213 Investments-program-related See Pa rt I V, l i n e 11 Complete Part VIII

o f Schedule D . 1314 Intangi ble assets 1415 Other assets See Part IV, l i n e 11 Complete Part IX of Schedule

D . 1516 Total assets . Add lines 1 through 15 (must e qual line 34) 2,904,163 16 3,233,45017 Accounts payable and accrued expenses 687,384 17 626,07918 Grants payable 1819 Deferred revenue 1920 Tax-exempt bond liabilities 20

} 21 Escrow account l i a b i l i t y Complete Part IVof ScheduleD . 2122 Payable t o current a nd f or me r o f f i c e r s , directors, trustees, ke y

employees, highest compensated employees, an d disqualifiedpersons Complete Part II of Schedule L . 22

23 Secured mortgages and notes payable to unrelated third parties 2324 Unsecured notes and loans payable 24


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l efile GRAPHIC p rint - DO NOT PROCESS As Filed Data - DLN: 93493320038859SCHEDULE A P u b l i c Charity Status a nd P u b l i c Support OMB No 1545-0047(Form 990 or 200890EZ) To be completed by a l l section 501(c)( 3) organizations and section 4947(a)(1)nonexempt charitable trusts.Department of t h e Attach to Form 990 or Form 990- EZ . See separate i n s t r u c t i o n s . Open to PublicTreasury InspectionI nt e r n a l RevenueServiceName of the organization Employer identification numberEZRAS CHOILIM HEALTH CENTER IN C

13-3595755MMOK-eason for Public Charity Status ( to be com p l et ed b y a l l or g a n i z a t i o n s ) ( See Ins tru c ti o ns )Th e organization i s no t a private foundation b e c a u s e i t i s (Please c h e c k only on e organization )

1 1 A church, convention of churches, or association of churches described in Section 170(b)(1)(A)(i).2 1 A school described in Section 170(b)(1)(A)(ii). (Attach Schedule E )3 1 A h o s p i t a l or a cooperative h os pi t a l s e r v i ce o r ga n i za t i on described i n Section 170(b)(1)(A)(iii). (Attach Schedule H4 1 A medical research o r g a n i z a t i o n operated in conjunction with a h os pi t a l described in Section 170(b)(1)(A)(iii). Enter t h e

h os pi t a l 's name, city, and s t a t e5 1 A n o r g a n i z a t i o n operated fo r t h e b en ef it of a college or u n i v e r s i t y owned or operated b y a governmental unit described in

Section 170 ( b)(1)(A)(iv ) . (Complete P a r t I I )6 1 A f e d e r a l , state, o r l oc al government o r go ve rnme nt a l u n i t d escr ibed i n Section 170 ( b)(1)(A)(v).7 1 An o r g a n i z a t i o n t h a t normally r e c e i v e s a s u b s t a n t i a l pa rt of it s support from a governmental u ni t or from t h e g e n e r a l public

described in Section 170 ( b)(1)(A)(vi ) (Complete P art I I )8 1 A community t r u s t described in Section 170 ( b)(1)(A)(vi ) (Complete P a r t I I )9 F An organization that n or ma l l y r e ce i v es ( 1 ) more t h a n 331/3% o f i t s s u pp or t f ro m contributions, membership fees, a n d gross

receipts from activities related t o i t s exempt f u n ct ion s-subject t o certain e x ce p ti o ns , a n d ( 2 ) no more t h a n 331/3% o fit s support from gross investment income and u n r e l a t e d business t a x a b l e income ( l e s s section 511 t ax) from businessesacquired by t h e o r g a n i z a t i o n af te r June 30, 1975 See Section 509(a)(2). (Complete Pa r t III )

10 1 An o r g a n i z a t i o n organized and operated e x c l u s i v e l y to t e s t for public s a f e t y See Section 509(a )(4). (See instructions11 1 An o r g a n i z a t i o n organized and operated e x c l u s i v e l y for t h e b en ef it of , to perform t h e f u n c t i o n s of , or to c a r r y ou t t h e purposes of

one or more publicly supported o r g a n i z a t i o n s described i n section 509(a)(1) or section 509(a)(2) See Section 509(a)(3). Checkt h e box t h a t describes t h e type of supporting o r g a n i z a t i o n and complete lines 11e through 11h

a 1Type I b 1Type I I c 1Type III - F u n c t i o n a l l y Integrated d 1Type III - Othere (- By checking this b ox, I certify t h a t t h e o r g a n i z a t i o n is n ot controlled d ir ec tl y or i nd ir ec tl y by one or more disqualified persons

o t h e r than foundation managers and o t h e r than one or more publicly supported o r g a n i z a t i o n s described in section 509(a)(1) ors e c t i o n 509(a)(2)

f I f t h e o r g a n i z a t i o n received a wr i t t e n determination from t h e IRS t h a t i t is a Type I , Type I I or Type III supporting organization,check this box (-

g Since August 17, 2006, has t h e o r g a n i z a t i o n accepted any g i f t or c o n t r i b u t i o n from any of t h efollowing pe r s o ns?( i ) a p er son who directly o r indirectly cont rol s , e i th e r alone o r together with p e rs o ns d es c ri b ed i n ( i i ) Ye s Noa nd ( i i i ) below, th e governing body o f th e th e s up p or t ed organization? 11g(i)

Schedule A (Form 990 o r 990-EZ) 2008 Page 2


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Support Schedule for Organizations Described in IRC 170(b )( 1)(A)(iv) and 170(b)(1)(A)(vi)(Complete only i f you checked the box on l i n e 5 , 7 , or 8 of Part I . )

Public SupportCalendar year (or fiscal year beginning i n ) (a) 2004 (b) 2005 (c) 2006 (d) 2007 (e) 2008 (f) Total1 G i f t s , grants, contributions, an d

membership fees received (Do notinclude a ny "un us ual grants " )

2 Tax revenues levied f o r the organization'sbenefit an d either paid t o o r expended oni t s behalf3 The value o f services o r f a c i l i t i e sfurnished by a governmental u ni t t o theorganization without charge

4 Total .Add l i n e 1-35 The portion o f t o t a l contribution by each

person (other than a government u n i t o rpublicly supported organization) includedon l i n e 1 that exceed 2% o f the amountshown on l i n e 11 , column( f )

6 Public Support subtract l i n e 5 from l i n e4

Total SupportCalendar year ( or f i s c al year beginning i n )

10

111213

Amounts from l i n e 4Gross income from i n t e r e s t , dividends,payments received on securities loans,rents, royalties an d income from similarsourcesNe t income from unrelated businessa c t i v i t i e s , whether o r n ot the business i sregularly carried onOther income Do not i n clude g ai n or los sfrom the sale of capital assets (Explain inPart IV )Total Support (Add lines 7 through 10)Gross receipts from related acti vi ties, etc

a) 2004

(See instructions )

b) 2005 1 (c) 2006 (d) 2007 1 (e) 2008

12First Five Years . I f the Form 990 i s for the organization ' s f i r s t , second, third, f ou rth, o r f i f t h tax year as a 501(c)(3)organization , check this box and stop here

f ) Total

I l k - FComp utation o f P ubli c Support Percentag e

14 Public Support Percentage for 2008 ( l i n e 6 column ( f ) divided by l i n e 11 column ( f ) ) 1415 Public Support Percentage for 2007 Schedule A, Part IV-A, l i n e 26f 1516a 33 1 / 3% Test - 2008 . I f the organization did not check th e box on l i n e 1 3, and l i n e 14 is 33 1/3% or more, check this box

and stop here . The organization qualifies as a publicly supportedorganizationFb 33 1 / 3% Test -2007 . I f th e organization did not check the box on l i n e 13 or 16a, and l i n e 15 is 33 1/3% or more, check this



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IMMOTMSupport Schedule for Organizations Described in IRC 509(a)(2)(Complete only i f y ou checked the bo x on l i n e 9 of Part I . )

Section A . Public SupportCalendar year ( or fiscal year beginning i n ) ( a) 2004 ( b) 2005 ( c) 2006 (d) 2007 (e) 2008 ( f) Total

1 G i f t s , grants , contributions, an dmembership fees received (D o notinclude an y " unusual grants " )

2 Gross receipts from admissions,merchandise sold o r services performed,o r f a c i l i t i e s furnished i n an y activity that 6,685 ,713 7,652,754 9,005,375 8,9 9 5,09 0 9 ,717,436 42,056,368i s related t o the organization's tax-exempt purpose

3 Gross receipts from activities t hat arenot an unrelated trade o r business undersection 513

4 Tax revenues levied f o r theorganization s benefit an d either paid t oo r expended on i t s behalf

5 The value o f services o r f a c i l i t i e sfurnished by a governmental u n i t t o theorganization without charge

6 Total Add lines 1-5 6,685 ,713 7,652,754 9,005,375 8,9 9 5,09 0 9 ,717,436 42,056,3687a Amounts i ncluded o n l i n e s 1 , 2 , an d 3

received from disqualified personsb Amounts included on l i n e s 2 an d 3

received from other than disqualifiedpersons that exceed the greater o f 1% o fthe total of lines 9 , 10c, 1 1 , and 12 forthe year or $5,000

c Total o f l i n e s 7a an d 7b8 Public Support ( Substract l i n e 7c from 42,056,368l i n e 6)Total SuuuortCalendar year (or f i s cal year beginning i n )9 Amounts from l i n e 6

10a Gross income from i n t e r e s t , dividends,payments received on securities loans,rents, royalties an d income from similarsources

b Unrelated business taxable income (lesssection 511 taxes) from businessesacquired after 30 June, 1975

c Add l i n e s 10a an d 10b11 Net income from unrelated businessa c t i v i t i e s not included i n l i n e 10b,

whether o r n ot the business i s regularlycarried on

(a) 2004 ( b) 2005 ( c) 2006 ( d) 2007 ( e) 2008 ( f) Total6,685,713 7,652,754 9,005,375 8,9 9 5,09 0 9 ,717,436 42,056,368

3,867 37,185 49 ,185 13,970 6,201 110,408

3,867 37,185 49 ,185 13,970 6,201 110,408



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MOWupplemental Information . Complete this part to provide t he information required by Part I I , l i n e 10;Part I I , l i n e 17a or 17b, or Part I I I , l i n e 1 2 . Provide an d any other additional information. (see instructions)

Schedule A (Form 990 or 990-EZ) 2008

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SCHEDULE D OMB No 1545-0047(Form 990) Supplemental F i n a n c i a l Statements 2008Department of the 1 - Attach to Form 990 . To be completed by organizations that Ope n to PublicTreasury answered " Yes," to Form 9 9 0, P ar t IV , line 6 , 7 , 8 , 9 , 10 , 1 1, or 12. InspectionInternal RevenueServiceName of the organization Employer identi f ication numberEZRAS CHOILIM HEALTH CENTER IN C

13-3595755Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts . Complete i f t heor g anization answered "Yes" to Form 990 Part IV , l i n e 6 .

(a) Donor advised funds (b ) Fu nds a nd other accounts1 Total number a t end o f year2 Aggregate Contributions to (during y e a r )3 Aggregate Grants from (during y e a r )4 Aggregate valu e at end of year5 Did th e o r ga n iza t ion i n for m a l l don or s a nd d on or advisors i n w r i t i n g t ha t t he assets held i n donor advised

funds ar e the organization's property, subject t o th e organization's exclusive l e g a l control? 1Ye s 1No6 Di d th e o r ga n iza t ion i n for m a l l g rant e e s , donors, a nd d on or advisors i n w r i t i n g that g ra nt f un ds may b e

us ed only f o r charitable purposes an d not f o r t he b en ef it o f th e donor o r donor advisor o r otherimpermissible private b e n e f i t ? 1Yes 1NoWWWW-onservation Easements . Complete i f the organization answered "Yes" t o Form 990, Part IV, l i n e 7 .

1 Purpose ( s ) o f conservation easements held by th e organization ( check a l l that apply)1 Preservation o f land f o r public use ( e g , recreation o r pleasure ) 1 Preservation o f an h i s t o r i c a l l y importantly land area1 Protection o f natural habitat 1 Preservation o f c e rt i fi e d h i s t o r i c structure1 Preservation of open space

2 Complete l i n e s 2a-2d i f th e organization held a q u a l i f i e d conservation contribution i n the form o f a conservation easementon th e l a s t da y o f t he t ax year

Held at t he En d of the Yeara Total number o f conservation easements 2ab Total acr eage restricted by conservation easements 2 bc N umber o f conservation easements on a c e r t i f i e d h i s t o r i c s t ru ct u re i n clu ded i n ( a ) 2cd N umber o f conservation easements included i n ( c ) acquired a f t e r 8/17/06 2d

3 N umber o f conservation easements modified, transferred, released, extinguished, o r terminated by th e organization duringth e taxable year 0 -

4 Number o f states where property subject t o conservation easement i s located 0 -


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Schedule D (Form 990) 2008 Page 2Organizations Maintaining Collections of Art, Historical Treasures , or Other Similar Assets (continued)

3 Using t h e o rgan i z at i o n 's access ion and o t he r r e co r ds , c h e c k a ny o f th e following t ha t a re a significant use o f i t s collectionitems ( c h e c k a l l that apply)

a F_ P u bl i c e x hi bi t io n d 1 Loan o r exchange prog ramsb 1 Scholarly research e F Oth erc F Preservation f o r future generations

4 Provide a d e s c r i p t i o n of t h e o r g a n i z a t i o n ' s c o l l e c t i o n s and e x p l a i n how they f ur th er t h e o r g a n i z a t i o n ' s exempt purpose i nP a r t XIV5 Duri ng t he ye ar , d i d th e organization s o l i c i t o r receive donations o f a r t , historical treasures o r other similar

assets t o b e sol d t o r a i s e funds rather than t o be maintained as part o f th e o rgan i z at i o n 's co l l e ct i o n ? 1Ye s 1NoTrust, Escrow and Custodial Arrangements . Complete i f t h e o r g a n i z a t i o n answered "Yes" to Form 990,P a r t IV , l i n e 9 , or reported an amount on Form 990, P art X, l i n e 21 .

l a I s th e o r ga n iz a ti o n a n a ge n t, trustee, custodian o r o t he r i n te r me d ia r y f o r contributions o r other assets no ti n c l u d e d on Form 990, P a r t X ' ' 1Yes f l No

b I f "Yes," e x p l ai n why i n Part XIV a nd c o m p l e t e t he f ol l ow in g t ab le

c Beginning balanced Additions during th e yeare D istr i b ut i o ns du r i ng th e yearf E nd i ng b a l an ce

2a Di d t h e o r ga n i za t i o n i n cl u d e an amount on Form 990, P a r t X, l i n e 21''b I f "Yes, " e x p l a i n t h e arrangement i n P a r t XIV

Endowment Funds . Complete i f th e organization answered "Yes" t o Form 990, Part IV, l i n e 1 0 .(a)Current Year ( b ) P r i o r Year ( c )T w o Years Ba ck ( d) Th re e Years Ba ck (e)Four Years Ba ck

l a Beginning of year balanceb Contributionsc Investment earnings or l o s s e sd Grants or scholarships .e Other expenditures fo r facilities

and programsf Administrative e x p e n s e sg En d o f y ea r b a la n ce

2 Provide th e estimated p e r c e n t a g e o f th e ye ar e nd b al an ce hel d asa B o ar d d e si gn a te d o r quasi-endowment 0 -b Permanent endowment 0 -

f l Yes lNo


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Schedule D (Form 990) 2008 Page 3Investments-Other Securities . See Form 990 , Part X , line 12 .

(a) Description o f security o r cateory (b)Book value ( c ) Method o f valuation(including name o f security) Cost o r end-of-year market valueFinancial derivatives an d other financial productsClosely-held equity interestsOther

Total . (Column ( b ) should equal Form 990, Part X , c o l ( B ) l i n e 12) 0 1

investments-Pro g ram Related . See Form 9 9 0 , Part X , l i n e 1 3 .I(b) Book value

( c ) Method o f valuation(a) Description o f investment type Cost o r end-of-vear market value

T o t a l . (Column ( b) s h o u ld e q u a l Form 9 9 0 , P ar t X , c ol ( B) l i n e 13 ) 0 1MOWther Assets . See Form 990 , Part X line 15 .(a) DescriDtion ( b ) Book value


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Schedule D (Form 990) 2008 Page 4Reconciliation of Chang e i n Net Assets from Form 990 to Financial Statements

1 Total revenue (Form 990, Part VIII, column (A), l i n e 12) 1 9,816,5882 Total expenses (Form 990, Part IX, column (A), l i n e 25) 2 9,461,7213 Excess or (deficit) for the year Subtract l i n e 2 from l i n e 1 3 354,8674 Net unrealize d g ains ( losses) on investments 45 Donated services and use o f f a c i l i t i e s 56 Investment expenses 67 Prior period adjustments 78 Other (Describe in Part XIV) 89 Total adjustments (net) Add lines 4 - 8 9 010 Excess or (deficit) for the year pe r financial statements Combine lines 3 and 9 10 354,867

Reconciliation of Revenue p er Audited Financial Statements With Revenue p er Return1 Total revenue, gains, and other support per audite d financial

statements 19,816,588

2 Amounts i nc lu d ed o n l i n e 1 b ut not on Form 990, Part VIII, l i n e 12a Net unrealized gains on investments . 2ab Donated services and use o f f a c i l i t i e s . 2bc Recoveries of prior year grants 2cd Other (Describe in Part XIV) 2de Add l i n e s 2 a th roug h 2 d . . . . . . . . . . . . . . . . . . . . 2e 0

3 Subtract l i n e 2e from l i n e 1 . . . . . . . . . . . . . . . . . . . . 3 9,816,5884 Amounts included on Form 990, Part VIII, l i n e 12, b ut not on l i n e 1a Investment expenses not included on Form 990, Part VIII, l i n e 7b 4ab Other (Describe in Part XIV) 4bc Add lines 4a and 4b . . . . . . . . . . . . . . . . . . . . . . c 0

5 Total Revenue Add lines 3 and 4c. (This should equal Form 990, Part I , l i n e 12 . 5 9,816,588Reconciliation of Exp enses p er Audited Financial Statements With Exp ense s p er Return

1 Total expenses and losses per audite d financial statements 1 9,461,7212 Amounts included on l i n e 1 b ut n ot on Form 990, Part IX, l i n e 25a Donated services and use of facilities . 2ab Prior year adjustments 2bc Losses reported on Form 990, Part IX, l i n e 25 . 2cd Other (Describe i n Part XIV) 2de Add lines 2a through 2d . . . . . . . . . . . . . . . . . . . . . e 0

Schedule D (Form 990) 2008


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Page 5Supplemental Information continued

Identifier Return Reference ExplanationIn June 2006, th e Financial Accounting Standards Board (theFASB) issued FASB Interpretation No 48, Accounting forUncertainty i n Income Taxes an interpretation of FASBStatement No 109 (FIN 48) FIN 48 clarifies th e accounting foruncertainty i n income taxes recognized i n an entity's financialstatements i n accordance with FASB Statement No 109,Accounting for Income Taxes FIN 48 prescribes acomprehensive model for recognizing, measuring, presentingand disclosing i n th e financial statements tax positions taken orexpected to be taken on a tax return including positions that th eCenter i s exempt from income taxes or not subject to incometaxes on unrelated business income I f there are changes i n netassets as a result of application of FIN 48, these w i l l beaccounted for as an adjustment to th e opening ne t assetsbalance Additional disclosures about th e amounts of suchliabilities w i l l be req uired also The Center presently recognizesincome tax positions based on management's estimate ofwhether i t i s reasonably possible that a l i a bi l i t y has beenincurred for unrecognized income tax benefits by applying FASBStatement No 5, Accounting for Contingencies The Center haselected to defer th e application of FIN 48 i n accordance withFASB Staff Position (FSP) FIN 48-3 This FSP defers th eeffective date of FIN 48 for nonpublic enterprises, such as theCenter, included within i ts scope to th e annual financialstatements for fiscal years beginning after December 15 , 2008The Center w i l l be required to adopt FIN 48 i n i t s 2009 annualfinancial statements Management i s currently assessing th eimpact of FIN 48 on i ts financial position and results ofoperation and has not yet determined i f th e adoption of FIN 48w i l l have a material effect on i ts financial statements

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SCHEDULE H Hospitals OMB No 1545-0047(Form 990) 20081 - Attach to Form 990. To be completed by organizations that

Department of th e answer " Yes" to Form 9 9 0, P ar t IV , line 20 . OpenTreasuryInternal Revenue Inspect i onServiceName o f the organizationEZRAS CHOILIM HEALTH CENTER INC

Employer identification number13-3595755

Charit y Care and Certain Other Communit y Bene f its at Cost (Op tional for 2008)Yes No

l a Does th e o r g a n i z a t i o n have a charity c a r e pol i cy? I f "N o," s ki p to question 6a . l ab I f "Yes," i s i t a w ri t te n p o l i c y? . . . . . . . . . . . . . . . . . . . . . lb

2 I f th e o r g a n i z a t i o n has m ul t ip le h os p it a ls , i n di c at e which of t he f o ll o wi ng best describes application of t he c ha r it ycare policy t o the various hospitalsFpplied uniformly t o a l l hospitals Fpplied uniformly t o most hospitalsrenerally tailored t o individual hospitals

3 A nswer t he f o ll o wi ng based on t he c ha ri ty care eligibility criteria that applies to t he l a rg es t number of th eo r g a n i z a t i o n s patients

a Does the organization us e Federal Poverty Guidelines (FPG) t o determine e l i gi b i li t y f o r providing f r e e care t o lowincome individuals? I f "Yes," indicate which of t he f o ll o wi ng i s t he f a mi l y income l i mi t f or e l igi bi li ty f or free care 3aF100% F150% F200% Fther %

b Does the organization us e FPG t o determine e l i gi b i li t y f o r pro vi di ng d i s co u nte d c a re t o low incom e individuals? If"Yes," indicate which of th e following i s t he f ami l y income l i mi t f or e l igib il it y f or discounted c a r e 3bF200% F250% F300% F350% F400% Ither %

c I f the organization does not us e FPG t o determine e l i g i b i l i t y , describe i n Part VI the i n co me ba se d c r i t e r i a f ordetermining e l i g i b i l i t y f o r f r ee o r discounted care Include i n the description whether the organization uses an ass ettest o r other threshold, regardless o f income, t o determine e l i g i b i l i t y f or f r e e o r discounted care

4 Does the organization's policy provide f r e e o r discounted care t o the "medically indigent"? . 45a Does the organization budget amounts f o r f r e e o r discounted c a re p ro v id e d under i t s charity care policy? 5ab I f "Yes," d i d the organization's charity care e xp e ns e s e xc e e d the budgeted amount ? . 5bc I f "Yes" t o l i n e 5b, as a result o f budget considerations, wa s the organization unable t o provide f r e e o r discounted

c a r e to a pat i e nt who was e l igi bi l e f or free or discounted care? . Sc6a Does th e o r g a n i z a t i o n prepare a n annual community b e ne f i t r e p or t ? 6a6b I f "Yes," does th e o r g a n i z a t i o n make i t avai l abl e to t he p ub li c ? 6b

Complete t he f ol lo wi ng t abl e using th e worksheets provided i n th e Schedule H instructions Do no t submit these

Schedule H (Form 990) 2008 Page 2


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ff Community Building Activities (Complete this table i f t he organization conducted any community buildingactivities) (Optional fo r 2008)

( a ) Number o f (b) Personsa c t i v i t i e s o r served ( c ) T o t a l community (d) D i r ec t o f fs e t t i n g ( e ) Net community ( f ) Percent o fprograms ( o p t i o n a l ) b u i l d i n g expense revenue b u i l d i n g expense t o t a l expense( o p t i o n a l )1 P h y s i c a l improvements and housing2 Economic development

3 Community support4 Environmental improvements5 Leadership development and t r a i n i n g

f o r community members6 C o a l i t i o n b u i l d i n g7 Community health improvement

advocacy8 Workforce development9 Other

10 TotalBad Debt , Medicare , & Collection Practices (Optional for 2008)

Section A. Bad Debt Expense Yes No1 Does t he organization report bad debt expense i n accordance w ith Heathcare Financial Management Association

Statement No 157 .2 Enter the amount o f the organization's bad debt expense ( a t cost) . 23 Enter the estimated amount o f the organization's bad debt expense ( a t cost)

attributable t o patients e l i g i b l e under the organization's charity care policy 34 Provide i n Part VI t he t ext o f the footnote t o the organization's financial statements that describes bad debt expense

I n addition, describe the costing methodology used i n determining the amounts reported on l i n e s 2 and 3 , o r rationalef o r including other bad debt amounts i n community benefit

Section B. Medicare5 Enter total revenue received from Mecicare (including DSH and IM E) . 56 Enter Medicare allowable costs of care relating to payments on l i n e 5 . 67 Enter l i n e 5 less l i n e 6-surplus or (shortfall) 78 Descri be i n Part VI the extent t o w hi c h any s h o r t f a l l reported on l i n e 7 should be treated as community benefit and

the costing methodology o r s o ur ce u s ed t o determine the amount reported on l i n e 6 and indicate which o f th efollowing methods was usedr- Cost accounting system Fost to charge ratio Fther

Section C . Collection Practices9a Does the organization have a written debt collection policy? . 9a9b I f "Yes," does the organization's collection policy conta in provi s i ons on the collection practices t o be followed f o r

S c h e d u l e H ( F o r m 990) 2008 Page 3


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Facility Information (Required fo r 2008)

Name an d a d d r e s srr n

CP

i

r n

M-

{7p

ac o

p(

P-

2 _

{a 0(

0

gm

L

mO th e r

(Describe)

e zr as c h oi li m49 forest r o a dmonroe, NY 10950

article 28 Diag & treatment ctr

Schedule H (Form 990) 2008 Page 4rMINTSupplemental Information (Optional for 2008)


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Complete t h i s part t o provide the following information1 Provide the description required for Part I , l i n e 3c , Par t I , l i n e 7, Part III, l i n e 4, Part III, l i n e 8, and Part III, l i n e 9b

2 Needs Assessment . Describe how the organization assesses the health care needs of the communities i t serves

3 Patient Education of Eligibility fo r Assistance . Describe how the organization informs and educates patients and persons who may b ebilled for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization'scharity care policy

4 Community Information . Describe the community the organization serves, taking into account the geographic area and demographicconstituents i t serves

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Schedule J Compensation Information OMB No 1545-0047(Form 990) 2008o r c er t ai n O ff i ce r s, Di r e ct or s , Trustees , Key Employees, and HighestCompensated Employees

Department of the 1 - Attach to Form 990. To be completed by organizations ' t o Pub li cTreasury that answered " Yes" to Form 9 9 0, Par t IV , line 23 . InspectionI n t e r nal RevenueServiceName of the organizationEZRAS CHOILIM HEALTH CENTER I NC

Employer identification number13-3595755

Ouestions Reaardina Comuensation

l a Check the appropiate box(es ) i f the organizatio n provided any of t he following to or for a person listed i n Form990, Part V I I , Section A, l i n e la Complete Part I I I to p rovide any r e l eva nt i n f or ma ti on r e ga rd i ng these items1 First class or charter travel 1 Housing allowance or residence for personal use1 Travel for companions 1 Payments for business use of personal residence1 Tax idem nificatio n and gross - up payments 1 Health or social club dues or initiation f e e s1 Discretionary sp en d in g account 1 Personal services ( e g , maid, chauffeur, chef)

b I f l i n e la i s checked, d i d th e organization follow a w ri t te n p ol icy regarding payment o r r eimbursemen t o rprovision o f a l l th e ex p e n s e s described above? I f "No," complete Part I I I t o explain l b

2 Did t he organization require substantiation p r i o r t o reimbursing o r allowing expenses i n cur r ed by a l lo f f i c e r s , directors, trustees, an d th e CEO/Executive Director, regarding th e items checked i n l i n e 1a ? 2

3 I n di cat e whi ch, i f any, of t he f ol lo wi ng t he organizatio n uses to es tablish t he compensation of theorganizatio n ' s CEO/Executive Directo r Check al l that a p p l y1 Compensation committee 1 W r i t t e n employment contract1 Independent compensation consultant 1 Compensation survey or study1 Form 990 of o th e r o rganizatio ns F Approval by the board or compensation committee

Yes I No

4 During the year, di d any person listed i n Form 990, Pa rt V II , Section A, l i n e laa Receive a severance payment or change of control payment? 4a Nob Par ti ci pat e i n , or receive payment from, a supplemental no nqualified retirement p la n? 4b Noc Participate i n , or receive payment from, an equity-based compensation arrangement? 4c No

I f "Yes" to any o f l in es 4a-c, l i s t t he persons and p rovide the app licable amounts for each i t e m i n Part II I

501(c ) ( 3) and 501( c)(4) organizations o n l y must complete lines 5-8.5 For persons listed i n form 990, Part V I I , Section A, l i n e l a, di d the organizatio n pay or accrue any

compensation contingent on the revenues of

Schedule J (Form 990) 2008 Page 2OTITFI-fficers , Directors , Trustees , Key Employees, and Highest Compensated Employees. Use Schedule 3- 1 i f additional space needed.


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Fo r each individual whose compensation must be reported i n Schedule J , report compensation from th e organization on row (i ) and from related organizations described i n th einstructions on row ( i i ) Do no t l i s t any individuals that ar e no t listed on Form 990, Part VII

Note . The sum of columns ( B ) ( i ) - ( i i i ) must equal th e applicable column (D) or column (E ) amounts on Form 990, Part VII, l i n e la

(A) Name (B ) Breakdown of W-2 and/or 1099-MISC compensation (C ) Deferred (D ) Nontaxable (E ) Total of columns (F ) Compensation(i ) Base

compensation( i i ) Bonus &

i n c e n t i v ecompensation

( i i i ) Othercompensation

compensation benefits (B)(i)-(D) reported i n p r i o r Form99 0 o r F or m 9 9 0- E Z

NUCHEM FRIEDMAN (1 )( 1 1 )

266,835 21,486 288,321

Jacob freedman ( 1 ) 166,650 21,486 188,136

SURESH M RAO ( i ) 225,638 4,650 230,288

JEFFERY KAPLAN ( i ) 154,386 12,293 166,679

VLADIMIR ZELENKO ( 1 ) 232,486 12,293 244,779

( i i )0)( i i )0)( i i )0)( i i )0)( i i )(i )( i i )

Schedule 3 (Form 990) 2008

Schedule J (Form 990) 2008 Page 3EIRISTW Supplemental Information


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Complete t h i s p a r t t o p r o v i d e t h e i n f or m a t io n , e x p l a n a t i o n , o r d e s c r i p t i o n s r e q u i r e d f o r P a r t I , l i n e s la , 1b , 4c , 5 a, 5 b, 6a , 6b , 7 , a nd 8 A ls o c o mp l e t e t h i s p a r t f o r a ny a d d i t i o n a l i n f o r m a t i o n

I II d e n t i f i e r Ret u r n ExplanationR e f e r e n c e

Schedule 3 (Form 990) 2008

Additional Data Return to Form


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Software ID:Software Version:

EIN: 13-3595755Name : EZRAS CHOILIM HEALTH CENTER INC

Supplemental InformationComplete t h i s part t o provide the information, explanation, o r descriptions required f o r Part I , l i n e s la, 1b, 4c, 5a, 5b, 6a, 6b, 7 , an d 8 A l so c o m p l et e t h i s part f o r an y additional information

IIdentifier

IReturn Reference

IExplanation

l efile GRAPHIC p rint - DO NOT PROCESS As Filed Data - DLN: 93493320038859OMB No 1545 0047


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SCHEDULE0(Form 990) Supplemental Information to Form 990 2008Department of the 1 - Attach to Form 990 . To be completed by organizations to provide additional information f orresponses to specific questions for the Form 990 or t o provide any additional information . _ 'TreasuryIn t e r nal RevenueServiceName of the organization Employer identification numberEZRAS CHOILIM HEALTH CENTER INC

13-3595755

ReturnI d e n t i f i e r ExplanationRefer en c eForm 9 9 0 , P a r t V I, S e c t i o n THE 99 0 I S REVIEWED BY MANAGEMENT PRIOR TO SUBMISSION TH E FINAL 990 I SA , l i n e 1 0 DISCUSSED ATA MEETING OF TH E BOARDOF DIRECTORS

I d e n t i f i e r Return Refer en c e ExplanationForm 9 9 0 , P a r t V I, S e c t i o n B , l i n e 12c REVIEWED ANNUALLY

I d e n t i f i e r Return Refer en c e ExplanationForm 9 9 0 , P a r t V I , S e c t i o n B , l i n e 1 5 EVALUATION & COMPARABILITY DELIBERATION

ReturnI d e n t i f i e r ExplanationRefer en c eForm 9 9 0 , P a r t V I, GOVERNING DOCUMENTSAND POLICIES AND ORGANIZATION'S FINANCIAL STATEMENTSARES e c t i o n C , l i n e 1 9 MADEAVAILABLETO TH E PUBLIC UPON REQUEST, SUPERVISED BY MANAGEMENT

ReturnI d e n t i f i e r Refer en c e Explanation

P A r t X I f i na n ci a l t h e r e has been no change s i n c e l a s t year - t h e c e n t e r has a committee t h a t accepts r e s p o n s i b l u t e sstatements an d r e p o r t i n g f o r t h e acceptance o f t h e f i n a n c i a l statements an d t h e s e l e c t i o n o f t h e independent accountingf i r m

For Paperwork Reduction Act Notice , see the Instructions f or Form 990 . Cat No 51056K Schedule 0 ( Form 990) 2008

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Ezras Cholim 2008

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