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Schedule K
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Information on Tax-Exempt Bonds
Complete if the organization answered "Yes" to Form 990, Part Ⅵ, line 24a. Provide descriptions,
explanations, and any additional information in Part Ⅵ.
Attach to Form 990.
Go to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2023
Open to Public
Inspection
Name of the organization
PLAINVIEW HOSPITAL
C/O NORTHWELL HEALTH INC
Employer identification number
11-3241243
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 64990BNL3 06-23-2015 2,500,439 2015 A BONDS - REFUND 05   X   X   X
B DORMITORY AUTHORITY OF THE STATE OF NEW YORK
  		14-6000293 64990GTD4 09-26-2019 2,484,973 2019 A&B BONDS - REFUND 2009   X   X   X
Part Ⅱ
Proceeds
A B C D
1 Amount of bonds retired .................. 403,658 376,262    
2 Amount of bonds legally defeased .............. 0 0    
3 Total proceeds of issue .................. 2,768,645 2,805,667    
4 Gross proceeds in reserve funds ............. 0 0    
5 Capitalized interest from proceeds ............. 15,761 0    
6 Proceeds in refunding escrows ............... 0 0    
7 Issuance costs from proceeds ............... 25,016 26,085    
8 Credit enhancement from proceeds ............. 0 0    
9 Working capital expenditures from proceeds ............. 0 0    
10 Capital expenditures from proceeds ............. 356,250 2,227,326    
11 Other spent proceeds ............. 2,371,617 552,257    
12 Other unspent proceeds ............. 0 0    
13 Year of substantial completion ............. 2019
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 2020, a current refunding issue)? ........ 		X   X          
15 Were the bonds issued as part of an advance refunding issue of taxable
bonds (or, if issued prior to 2020, an advance refunding issue)? ........ 		X     X        
16 Has the final allocation of proceeds been made? .......... X     X        
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? .................. X   X          
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50193E
Schedule K (Form 990) 2023
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Schedule K (Form 990) 2023
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        
2 Are there any lease arrangements that may result in private business use of bond-financed property? ...............   X   X        
3a Are there any management or service contracts that may result in private business use of bond-financed property? .............   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?                
c Are there any research agreements that may result in private business use of bond-financed property? .............   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 .... 0 % 0 %    
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 .........        
6 Total of lines 4 and 5 .............        
7 Does the bond issue meet the private security or payment test? ...   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        
b If "Yes" to line 8a, enter the percentage of bond-financed property sold or disposed of. ..        
c If "Yes" to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? .............   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          
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        
2 If "No" to line 1, did the following apply? ....
a Rebate not due yet? .......   X X          
b Exception to rebate? ........ X   X          
c No rebate due? ......... 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          
Schedule K (Form 990) 2023
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Schedule K (Form 990) 2023
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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        
b Name of provider .......... 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        
b Name of provider .......... 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          
7 Has the organization established written procedures to monitor the requirements of section 148? ... 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          
Part Ⅵ
Supplemental Information. Provide additional information for responses to questions on Schedule K. (See instructions).
Return Reference Explanation
PART II, LINE 3 - PROCEEDS, THE TOTAL PROCEEDS DO NOT AGREE TO THE ISSUE PRICE IN PART I, COLUMN (E) DUE TO INVEST EARNINGS & TRANSFERRED PROCEEDS.
PART IV, LINE 2C - REBATE CALCULATION PERFORMED 5/31/2020 FOR 2015 BONDS SINCE BOND PROCEEDS HAVE BEEN SPENT A SPEDNING EXCEPTION HAS BEEN MET.
Schedule K (Form 990) 2023

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