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Schedule K
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Information on Tax-Exempt Bonds
SchKMediumBullet Complete if the organization answered "Yes" to Form 990, Part Ⅵ, line 24a. Provide descriptions,
explanations, and any additional information in Part Ⅵ.
SchKMediumBullet Attach to Form 990.
SchKMediumBulletGo to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2020
Open to Public
Inspection
Name of the organization
MONTEFIORE MEDICAL CENTER
 
Employer identification number
13-1740114
Part Ⅰ
Bond Issues
(a) Issuer name (b) Issuer EIN (c) CUSIP # (d) Date issued (e) Issue price (f) Description of purpose (g) Defeased (h) On
behalf of
issuer		 (i) Pool
financing
Yes No Yes No Yes No
A DORMITORY AUTHORITY OF THE STATE OF NEW YORK
  		14-6000293 649902V83 10-14-2010 19,400,000 CONSTRUCTION PROJECT   X   X X  
B DORMITORY AUTHORITY OF THE STATE OF NEW YORK
  		14-6000293 64990E2Y2 09-16-2016 13,002,448 FACILITY IMPROVEMENTS   X   X   X
C DORMITORY AUTHORITY OF THE STATE OF NEW YORK
  		14-6000293 64990GGH9 08-01-2018 341,889,620 REFINANCE/REFUND OF PRIOR ISSUES   X   X   X
D DORMITORY AUTHORITY OF THE STATE OF NEW YORK
  		14-6000293 64990GZS4 02-02-2020 397,922,270 Facility Improv/Refund Prior issue   X   X   X
Dormitory Authority of the State of New York
  		14-6000293 000000000 01-30-2017 33,685,553 IT SYSTEM IMPLEMENTATION   X   X   X
DORMITORY AUTHORITY OF THE STATE OF NEW YORK
  		14-6000293 000000000 06-29-2017 17,827,755 EQUIPMENT LEASING   X   X   X
DORMITORY AUTHORITY OF THE STATE OF NEW YORK
  		14-6000293 000000000 12-12-2017 9,990,258 EQUIPMENT LEASING   X   X   X
Part Ⅱ
Proceeds
A B C D
1 Amount of bonds retired .................. 6,940,600 1,385,590 0 0
2 Amount of bonds legally defeased .............. 0 0 0 0
3 Total proceeds of issue .................. 19,400,000 13,343,651 351,842,551 399,639,732
4 Gross proceeds in reserve funds ............. 0 0 0 0
5 Capitalized interest from proceeds ............. 0 0 0 0
6 Proceeds in refunding escrows ............... 0 0 0 0
7 Issuance costs from proceeds ............... 97,877 22,614 3,521,580 3,006,021
8 Credit enhancement from proceeds ............. 0 0 0 2,459,248
9 Working capital expenditures from proceeds ............. 0 0 0 0
10 Capital expenditures from proceeds ............. 18,987,378 0 0 156,249,835
11 Other spent proceeds ............. 314,745 13,321,037 348,320,971 121,082,069
12 Other unspent proceeds ............. 0 0 0 116,842,559
13 Year of substantial completion ............. 2010 2018 1998 2021
Yes No Yes No Yes No Yes No
14 Were the bonds issued as part of a current refunding issue of tax-exempt
bonds (or, if issued prior to 2019, a current refunding issue)? ........ 		  X   X X   X  
15 Were the bonds issued as part of an advance refunding issue of taxable
bonds (or, if issued prior to 2019, an advance refunding issue)? ........ 		  X   X X     X
16 Has the final allocation of proceeds been made? .......... X   X   X     X
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? .................. X   X   X   X  
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50193E
Schedule K (Form 990) 2020

Schedule K (Form 990) 2020
Page 2
Part Ⅲ
Private Business Use
A B C D
Yes No Yes No Yes No Yes No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? .............   X   X   X   X
2 Are there any lease arrangements that may result in private business use of bond-financed property? ...............   X   X   X   X
3a Are there any management or service contracts that may result in private business use of bond-financed property? .............   X   X X   X  
b If "Yes" to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property?           X   X
c Are there any research agreements that may result in private business use of bond-financed property? .............   X   X   X   X
d If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property?                
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government ....SchKMediumBullet 0 % 0 % 0.377 % 0.036 %
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government ......... SchKMediumBullet 0 % 0 % 0 % 0 %
6 Total of lines 4 and 5 ............. 0 % 0 % 0.377 % 0.036 %
7 Does the bond issue meet the private security or payment test? ...   X   X   X   X
8a Has there been a sale or disposition of any of the bond-financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were issued?.............   X   X   X   X
b If "Yes" to line 8a, enter the percentage of bond-financed property sold or disposed of. .. 0 % 0 % 0 % 0 %
c If "Yes" to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? .............   X   X   X   X
9 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under
Regulations sections 1.141-12 and 1.145-2? ........ 		X   X   X   X  
Part Ⅳ
Arbitrage
A B C D
Yes No Yes No Yes No Yes No
1 Has the issuer filed Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate? ...   X   X   X   X
2 If "No" to line 1, did the following apply? ....
a Rebate not due yet? .......   X X   X   X  
b Exception to rebate? ........ X   X   X   X  
c No rebate due? ......... X     X   X   X
If "Yes" to line 2c, provide in Part Ⅵ the date the rebate
computation was performed ......
3 Is the bond issue a variable rate issue? .....   X   X   X   X
Schedule K (Form 990) 2020

Schedule K (Form 990) 2020
Page 3
Part Ⅳ
Arbitrage (Continued)
A B C D
Yes No Yes No Yes No Yes No
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?   X   X   X   X
b Name of provider .......... 0
  		0
  		0
  		0
 
c Term of hedge .........        
d Was the hedge superintegrated? ......                
e Was the hedge terminated? ........                
5a Were gross proceeds invested in a guaranteed investment contract (GIC)?   X   X   X   X
b Name of provider .......... 0
  		0
  		0
  		0
 
c Term of GIC .........        
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? ........                
6 Were any gross proceeds invested beyond an available temporary period?   X   X   X   X
7 Has the organization established written procedures to monitor the requirements of section 148? ... X   X   X   X  
Part Ⅴ
Procedures To Undertake Corrective Action
--------------------------------------------------------------------------------------------------------------- A B C D
Yes No Yes No Yes No Yes No
Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations? X   X   X   X  
Part Ⅵ
Supplemental Information. Provide additional information for responses to questions on Schedule K. (See instructions).
Return Reference Explanation
Mortgages & Facility Improvements - Part I, Bond B Issue Date The bonds were issued 9/16/2016 and were floated until the organization closed on the mortgage loan with DASNY in December 2018.
Mortgages & Facility Improvements - Part I, Bond C Description of Purpose Current issue refunded prior tax exempt debt (6/17/93, 12/22/05, 2/7/08 and 10/1/14) and taxable debt (7/29/09, 5/19/11, 5/12/16 and 11/2/16).
Mortgages & Facility Improvements - Part I, Bond D Description of Purpose The bond proceeds were used for both new construction and capital improvements as well as a refund of a prior bond issue. Part of the current proceeds refunded a prior tax exempt debt (6/27/2018) that was issued to refund the original 4/19/13 tax-exempt bond. Mortgages & Facility Improvements - Bond A proceeds - Part II, line 3 DASNY's $562,510,000 State personal income tax revenue bond (general purpose), series 2010E, provided financing for several borrowers. Of this amount, $19,400,000 represented the amount of the bond proceeds originally allocated to Yeshiva University. The remaining balance of the Yeshiva debt was assumed by Montefiore Medical Center in 2015 when the Medical center took over the operations of the DOSA Program.
Mortgages & Facility Improvements - Bond B Proceeds - Part II, line 3 The total proceeds do not agree to the issue price in Part 1, column (e) due to investment earnings. Mortgages & Facility Improvement - Bond C Proceeds - Part II, Line 3 The total proceeds do not agree to the issue price in Part 1, column (e) due to investment earnings. Mortgages & Facility Improvement - Bond D Proceeds - Part II, Line 3 The total proceeds do not agree to the issue price in Part 1, column (e) due to investment earnings.
Mortgages & Facility Improvements - Part III, Bonds C & D, Line 3b Management contracts relating to the financed property are reviewed internally by in-house counsel and referred to bond counsel for further review as needed.
Mortgages & Facility Improvements - Arbitrage - Part IV, Bond A, Line 2c 1 The rebate computation was performed 12/18/18.
Schedule K (Form 990) 2020

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