SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or 990-EZ or to provide any additional information.
MediumBullet Attach to Form 990 or 990-EZ.
MediumBullet Go to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2020
Open to Public
Inspection
Name of the organization
THE MEDICAL-DENTAL STAFF OF
NYACK HOSPITAL INC
Employer identification number

13-3093634
Return Reference Explanation
Form 990, Part VI, Section A., Line 6 The organization members consist of the active medical staff of Montefiore Nyack Hospital.
Form 990, Part VI, Section A., Line 7a The members of the medical staff of Montefiore Nyack Hospital have the power to elect or appoint the officers of the organization.
Form 990, Part VI, Section A., Line 7b The active medical staff members of Montefiore Nyack Hospital have the right to vote on certain Medical Staff, departmental and assigned committees issues.
Form 990, Part VI, Section B., line 11B The Form 990 was prepared by the Finance Department of Montefiore Medical Center and reviewed internally by the Montefiore Nyack Hospital Finance team. An independent Public Accounting firm was engaged to review the Form 990. Upon completion of the various reviews, the final 990 was presented to the Board for approval prior to filing.
Form 990, Part VI, Section C., Line 19 The organization's governing documents and financial statements are made available to the public upon request.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2020


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