2020-11-02T09:29:55-06:00 2019-12-31 990 2019-01-01 111639818 John T Mather Memorial Hospital % JOSEPH WISNOSKI JOHN 6314731320 75 NORTH COUNTRY ROAD PORT JEFFERSON NY 117772119 JOSEPH WISNOSKI CFO 6314731320 2020-11-02 69.27.229.128 11062320203075000000 2020-11-02 P A8E867FBD87B7B19EACF155E00BCAC716138C3E7 FE6D4BC8627C1BF7E49D7105CE5A8CB468BF2CC7 2019 2021-01-29 14:40:06Z JOSEPH WISNOSKI 75 NORTH COUNTRY ROAD PORT JEFFERSON NY 117772119 368479815 false X MATHERHOSPITAL.ORG X 1928 NY John T. Mather Memorial Hospital is an accredited 248-bed, non-profit community hospital dedicated to providing a wide spectrum of health care svcs of the highest quality 21 15 2916 226 774207 1740526 449834 349693405 363367607 1689609 -1100 18420391 4567037 371543931 368383378 3000 3000 0 0 205225795 211937584 0 0 0 159711026 161173601 364939821 373114185 6604110 -4730807 278158871 300177377 194876873 200246274 83281998 99931103 John T. Mather Memorial Hospital is an accredited 248-bed, non-profit community hospital dedicated to providing a wide spectrum of health care svcs of the highest quality, in a cost effective manner, to the residents of Suffolk County. false false 311519456 363367607 A member of Northwell Health, Inc, John T. Mather Memorial Hospital, a 248 bed community hospital, provides quality medical care regardless of race, creed, sex, national origin, handicap, age or ability to pay. Although reimbursement for services is critical to the operation of the Hospital, it is recognized not all individuals possess the ability to purchase essential medical services. In keeping with the Hospital's commitment to serve all members of the community, free and or subsidized care is provided to the indigent, care is provided to persons covered by government programs at below cost and numerous health related education and support services are offered to the community at large. 3000 To promote and encourage community service, John T. Mather Memorial Hospital Inc. provides scholarship grants to college bound junior volunteers. 311522456 true true false true false false false false false true true false false true true false false true false false false false false false false true true true false false true true false false false false false false false false true true false false false false false true false false false true 85 0 true 2916 true true true false false false false false false false false false false false X 21 15 true false false false true true true true true false false true true true true true true true true true true NY X X JOSEPH WISNOSKI 6314731320 75 NORTH COUNTRY ROAD PORT JEFFERSON NY 117772119 X KEVIN BEINER TRUSTEE/SVP NORTHWELL 0.0 50.0 X 0 1027394 42368 RALPH A NAPPI TRUSTEE/EVC 0.0 50.0 X 0 951213 53335 KENNETH D ROBERTS President & CEO 50.0 0.0 X X 860486 0 78154 JULIET NICHOLS Psychiatrist 50.0 0.0 X 610009 0 47954 JOHN YU MD TRUSTEE/PHYSICIAN NORTHWELL 0.0 50.0 X 0 610042 47883 MOHAMMAD BILAL Dir, Interventional Radiology 50.0 0.0 X 608023 0 47954 JOAN C FARO Chief Medical Officer 50.0 0.0 X 524785 0 48937 MICHELLE P PRICE Radiologist 50.0 0.0 X 521264 0 50326 JOSEPH CARRUCCIU Dir, Breast Center 50.0 0.0 X 511468 0 50754 JOSEPH WISNOSKI SVP & CFO 50.0 0.0 X 454031 0 78434 JOSEPH NG Intensivist 50.0 0.0 X 462438 0 50754 MARIE E MULLIGAN Chief Nursing Officer 50.0 0.0 X 322010 0 62597 WAYNE S SHATTES VP-Administration 50.0 0.0 X 264144 0 78154 MICHAEL BURGHARDT VP-Administration 50.0 0.0 X 181828 0 43904 KEVIN J MURRAY SVP-Administration 50.0 0.0 X 122918 0 34651 NICHOLAS CRAIG MD Pres Medical Staff/Chairman Me 0.0 2.0 X X 40000 0 0 CHRISTINE RUGGIERO VP Medical Staff/Vice Chairman 0.0 2.0 X X 20000 0 0 LEO STERNLICHT Chairman 0.0 3.0 X X 0 0 0 KONRAD J KUHN Vice Chairman 0.0 2.0 X X 0 0 0 BETSY N BRITTON Vice Chairman 0.0 2.0 X X 0 0 0 HAROLD TRANCHON JR Vice Chairman 0.0 2.0 X X 0 0 0 TIMOTHY B GLYNN ESQ Vice Chairman 0.0 2.0 X X 0 0 0 JOHN K DIVINEY ESQ Secretary 0.0 2.0 X X 0 0 0 JOHN R SINI Treasurer 0.0 2.0 X X 0 0 0 NON COMPENSATED TRUSTE SEE SCHEDULE O 0.0 2.0 X 0 0 0 5503404 2588649 816159 417 false true false ALLSCRIPTS 24630 NETWORK PLACE CHICAGO IL 606731246 INFOTECH CONSULTANTS 2462266 STONY BROOK MEDICINE 31 RESEARCH WAY STE 119 EAST SETAUKET NY 11733 MEDICAL SERVICES 1349840 NORTH SHORE HEMATOLOGY ONCOLOGY ASS 1500-4 ROUTE 112 PORT JEFFERSON STATION NY 11776 MEDICAL SERVICES 1109965 LI LAPAROSCOPIC SURGERY PLLC 625 BELLE TERRE RD PORT JEFFERSON STATION NY 11776 MEDICAL SERVICES 871338 UNITED WESTLABS INC 801 N PARKCENTER DRIVE SANTA ANA CA 92705 LABORATORY SERVICES 742268 41 53520 283546 112768 449834 PATIENT SERVICE REVENUE 621300 214789482 214789482 PHYSICIAN 621300 18153105 18153105 MEDICARE/MEDICAID PAYMENTS 621300 130161546 130161546 DSRIP 900090 263474 263474 363367607 0 0 0 247312 83642 163670 0 163670 163670 1100 -1100 -1100 -1100 0 0 0 28355 11695 16660 16660 0 0 0 MLMIC POLICY CONVERSION 900099 1694703 1694703 INVESTMENT INCOME 900099 1258000 1258000 LAB PRIVATE PATIENT 621500 668667 668667 765337 458416 88880 218041 4386707 368383378 363988593 774207 3170744 3000 3000 0 0 0 2790203 1021942 1768261 0 159015349 134403270 24612079 16892741 14278116 2614625 21775314 18404974 3370340 11463977 9689605 1774372 3027699 3027699 1493721 1493721 161875 161875 0 0 0 35599056 30089105 5509951 843704 713117 130587 78307748 66187431 12120317 0 0 4984451 4212967 771484 0 0 377962 377962 1537490 1537490 0 15627462 13208675 2418787 4040742 4040742 BAD DEBT 5740331 5740331 PURCHASED SERVICES 7621406 7621406 DUES & SUBSCRIPTIONS 439471 371451 68020 OTHER EXPENSE 1370483 1158362 212121 373114185 311522456 61591729 0 5590 0 29847836 41934900 0 0 43192483 47680537 0 0 0 0 0 0 8849405 7448714 6902397 6229033 127028083 29999584 100815185 97028499 49230713 54398215 0 0 0 0 0 0 39315262 45457479 278158871 300177377 167566873 39025277 0 0 0 0 27310000 27310000 0 0 0 0 0 0 0 0 0 133910997 194876873 200246274 X 80864482 97328640 2417516 2602463 83281998 99931103 278158871 300177377 X -4730807 2463191 18916721 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 16730 16730 false PART II-B -DESCRIPTION OF LOBBYING ACTIVITY The Hospital paid membership dues to two organizations; Healthcare Association of New York State, and the American Hospital Association. A portion of those dues have been allocated to lobbying expenditures. 949619 60045 61 -5509 1015234 936914 31984 57 19336 949619 1374421 257325 515 695347 936914 1258566 321235 32 205412 1374421 2602275 138886 8443 1491038 1258566 0.01000 0.99000 false false 8200000 8200000 56700000 7087500 49612500 11397417 2144097 9253320 46945476 19739305 27206171 3785190 1028682 2756508 97028499 INTEREST IN FOUNDATION 1612283 RIGHT OF USE ASSET 10989064 INSURANCE CLAIMS RECEIVABLE 21588109 OTHER ASSETS 268023 INTANGIBLE ASSETS 11000000 45457479 0 DUE TO/FROM AFFLIATES 9009450 INSURANCE CLAIMS LIABILITY 10880289 OTHER LIABILITY 2603929 MALPRATICE INSURANCE 28129713 ACCRUED RETIREMENT BENEFITS 66417763 OPERATING LEASE LIABILITY 10989063 CAPITAL LEASES 5880790 133910997 384538627 2463191 13751983 16215174 368323453 59925 59925 368383378 378741301 378741301 -5627116 -5627116 373114185 PART XII, LINE 2D & 4B RECONCILIATION OF REVENUE, LINE 2D PROVISION FOR BAD DEBTS (5,740,331) NON-OPERATING NET PERIODIC PENSION COST (1,225,983) DISCOUNTS & REBATES 2,231,184 NON-OPERATING GAIN 746,188 AMOUNTS REPORTED SEPARATELY 17,740,925 TOTAL 13,751,983 RECONCILIATION OF REVENUE, LINE 4B RESTRICTED CONTRIBUTIONS 59,925 TOTAL 59,925 PART XIII, LINE 2D & 4B RECONCILIATION OF EXPENSE, LINE 4B ADDITIONAL MINIMUM PENSION LIABILITY 7,378,679 NON OPERATING NET PERIODIC PENSION COSTS 1,225,983 PROVISION FOR BAD DEBTS 5,740,331 DISCOUNTS & REBATES (2,231,184) AMOUNTS REPORTED SEPARATELY (17,740,925) TOTAL (5,627,116) PART V, LINE 4 INTENTED USE OF ENDOWMENT FUNDS The endowment funds are used to improve the quality of the lives of those served by John T. Mather Memorial Hospital. 28355 5000 6695 false 0.00000 28355 5000 6695 11695 16660 NY true false true false 0.90000 0.10000 JOHN T MATHER MEMORIAL HOSPITAL 75 NORTH COUNTRY ROAD PORT JEFFERSON NY 11777 false NANCY UZO 1294 X false true true true X true X 450. true true true false true true 582449 12692 569757 0.00150 31823045 17478886 14344159 0.03700 32405494 17491578 14913916 0.03850 332942 332942 0.00090 19466381 10794606 8671775 0.02240 22164949 11781231 10383718 0.02680 38113 38113 0.00010 42002385 22575837 19426548 0.05020 74407879 40067415 34340464 0.08870 174332 174332 0.00050 1368 1368 21686 21686 0.00010 5731 5731 52723 52723 0.00010 255840 255840 0.00070 true 5615247 112126140 134507384 -22381244 X true true PORT JEFFERSON ASC MEDICAL SERVICES 0.26 1 1 JT MATHER MEMORIAL HOSPITAL 75 North Country Road PORT JEFFERSON NY 11777 http://www.matherhospital.org 5149000H X X X X Mather false false true X X X X X X X X X 19 true true true true X www.northwell.edu/education-and-resource X true 19 true www.northwell.edu/education-and-resources/com true false true X 150. 450. X X X X X true true X X X true X www.matherhospital.org/patients-v X www.matherhospital.org/patie X X X X X true X X X false X X X X X true X false false Part V Facility Information, Section C Supplemental Information Part V, Section B, line 2: N/A Part V, Section B, line 3j: N/A Part V, Section B, line 5: The CHNA was facilitated by committees established within each of the six county served by Northwell and its hospitals. External stakeholders included representatives from county health departments, area hospitals, academia, business, government agencies and community based organizations with an emphasis on those who serve communities with health disparities. Quantitative and qualitative data was collected from diverse community organizations that serve the population-at-large, as well as those communities with significant health disparities. Community partners were invited to participate via community member and community-based organization/provider surveys, facilitated focus groups and community-based organization summits. Part V, Section B, line 6a: For a detailed listing of other hospital facilities go to web link: https://www.northwell.edu/doctors-and-care/locations?type=hospitals Part V, Section B, line 6b: For a detailed listing of other organizations go to web link: https://www.northwell.edu/sites/northwell.edu/files/2019-12/Northwell-Heal th-2019-CHNA-FINAL.pdf Part V, Section B, line 7d: N/A Part V, Section B, line 11: The Northwell Health Implementation Plan for 2019-2021 includes the goals, objectives, activities, and performance measures planned to address the chosen New York State Prevention Agenda Priority Areas. The hospital identified and addressed primary needs based on an assessment of the highest ranked health priorities of the community, regulatory input and resources available. For further information go to web link: https://www.northwell.edu/sites/northwell.edu/files/2019-12/Northwell-NYSD OH-2019-chip-workplan.pdf Part V, Section B, line 13b: N/A Part V, Section B, line 13h: The hospital also uses household size. Part V, Section B, line 15e: N/A Part V, Section B, line 16j: The policy is included in the hospital's Community Service Plan and provided at health fairs and presentations open to the community at no cost, in addition to mailing financial policy summary brochures. Part V, Section B, line 18e: Income executions/Bank restraining orders. Part V, Section B, line 19e: N/A Part V, Section B, line 20d: Financial assistance and the amounts charged are determined by the individual's score as it relates to the Federal Poverty Guidelines (FPG). Part V, Section B, line 20e: Using credit data, the hospital makes a charity care determination, referred to as "presumptive eligibility decision," for patients who were non-compliant with the charity care application process. Part V, Section B, line 21c: N/A Part V, Section B, line 21d: N/A Part V, Section B, line 23: N/A Part V, Section B, line 24: N/A 8 Outpatient Behavioral Health Services 100 Highlands Boulevard Port Jefferson NY 11777 Outpatient Physician Clinic John T Mather Memorial Hospital Outpatie 125 Oakland Avenue Port Jefferson NY 11777 Outpatient Physician Clinic Northwell Health Physician Partners 170 North Country Road Port Jefferson NY 11777 Outpatient Physician Clinic Primary Med Care Outpatient 5225 Rt 347 Port Jefferson Station NY 11776 Outpatient Physician Clinic J T Mather Wound Care Clinic 1895 Walt Whitman Road Melville NY 11747 Outpatient Physician Clinic Precision CyberKnife of New York 181 Belle Meade Road East Setauket NY 11733 Outpatient Physician Clinic Stony Brook Blood Drawing Center 2500 Nesconset Hwy Bldg 21 Stony Brook NY 11790 Laboratory Northwell Health Physician Partners 70 North Country Road Port Jefferson NY 11777 Outpatient Physician Clinic Part VI Supplemental Information Part I, Line 3c - The Hospital uses the Federal Poverty Guidelines (FPG) to determine eligibility for providing free/discounted care. Certain assets are also considered to determine eligibility. The following assets are excluded from consideration: patient's primary residence, tax-deferred or comparable retirement savings accounts, college savings accounts, and cars used by the patient or the patient's immediate family. The Hospital also uses Transunion credit scores to determine presumptive eligibility. Part I, Line 6a -The Community Benefit report is prepared by the hospital, in conjunction with an affiliated entity (Northwell) of the hospital. The Community Benefit Report is accessible to the public and can be accessed on the Northwell website https://www.northwell.edu/sites/northwell.edu/files/2020-10/nwh_community2 019-FINAL.pdf Part I, 7: Row (a) The cost of charity care was determined by utilizing the ratio of cost to charges (RCC) calculated on Worksheet 2 applied to gross charges written off for patients qualifying for charity under the hospital's financial assistance policy. Bad Debt was not reported in any row of Part I, Line 7. Row (b) The Ratio of Cost to Charges method (or RCC) is used to determine the cost of ancillary services. A RCC is developed from these costs, and that RCC is applied to total Medicaid gross ancillary services charges to determine the cost of services provided to Medicaid patients. Row (e) Costs associated with Community Health Improvement Services were determined by adding indirect or overhead costs to the direct costs of the activity. Indirect costs were calculated as a percentage of direct costs. Direct costs for staff expenses were calculated using average system hourly rates, and were adjusted to account for fringe benefits, using a blended rate based on the ratio of total employee benefit expenses to total salary and wages. Row (f) The Bad Debt Expense that appears on Form 990, Part IX, Line 25 column (A), but not included for purposes of calculating the percentage in this column is equal to the amount reported on Form 990, Part X. The costs related to health professions education were determined by utilizing the step down method of cost finding. Row (h) Costs associated with research activities were determined by adding indirect, or overhead, costs to the direct costs of the activity. Indirect costs were calculated as a percentage of costs. Row (i) The cost of in-kind contributions to community groups is comprised of the direct costs of personnel whose compensated time was donated to various charities and community groups. The salaries and wages were adjusted to include benefits using a rate based on the ratio of total employee benefit expenses to total salary and wages. Indirect costs were calculated as a percentage of direct costs. Column (f) for Rows (c)-(k) The percentage of Net Community Benefit Expense divided by Total Expense for the hospital (to calculate the percent of total expense). Note: For the entire Northwell Health Inc. and affiliates, Part I, Line 7 (Row K, Column F) is approximately 12.7 as a percentage of expenses. Part II: All community building activities improve access to health services and address federal, state, or local public health priorities, as well as leverage public health department activities, and in doing so, they provide relief of government burden. These activities broadly serve low-income, underserved patients, and include: collaboration with various community coalitions, system-wide recycling initiative, organizational response to worldly disasters, and bioterrorism efforts. Northwell has taken the lead in increasing awareness of gun violence as a public health issue. The Gun Violence Prevention Forum brought together physicians, researchers, policy experts, health care executives, NYPD counterterrorism and victims' advocates to share their thoughts on how leaders in health care can address this national public health crisis. Northwell's bioterrorism & disaster preparedness includes Center for Emergency Medical Services, has a designated Bioterrorism Resource Center, and has conducted staff training for more than 100 hospitals and area first responders and invested heavily in the infrastructure needed for large-scale emergencies. During catastrophes (both natural and terrorism), Northwell provides a safe haven for thousands of patients, outside nursing home residents, and community members seeking shelter. Northwell assists with the transport of patients and stand ready to contribute food, medicine, and blankets for both affiliated and non-affiliated hospital patients. Investment in a field hospital has furthered the public health infrastructure needed for mass casualties that could result from a terrorist attack, natural attack, or large-scale emergency. Part III, Line 2: For patients who were determined by Northwell to have the ability to pay but did not, the uncollected amounts are recorded as bad debt expense. The amount of gross charges written off is reduced by any charity care or other discounts provided to the patient, as well as any payments received. Bad debt expense reported on this line is reported net of governmental or private offsetting funds. Part III, Line 3: N/A Part III, Line 4: For patients who were determined by Northwell to have the ability to pay but did not, the uncollected amounts are recorded as bad debt expense. Part III, Line 8: Medicare costs are determined utilizing a combination of the step down method of cost findings and a cost per unit of service. Cost per unit of service is used to calculate the routine cost of services provided to Medicare patients. The Ratio of Cost to Charges method (or RCC) is used to determine the cost of ancillary services. An RCC is developed from these costs, and that RCC is applied to total Medicare gross ancillary services charges to determine the cost of services provided to Medicare patients. Part III, Line 9b: The organization's collection policy is standard to all accounts regardless of insurance status (e.g. insured, underinsured, and uninsured). The hospital's collection policy states that they will not send patient accounts to collection if a decision on a financial assistance application is pending, or if a patient is determined to be eligible for Medicaid at the time services were rendered and for which services Medicaid payment is available. Question 2: NEEDS ASSESSMENT: The Community Health Needs Assessment (CHNA) is performed on an ongoing basis. Northwell conducts and participates in population, demographic, and health status evaluations of our respective hospitals' service areas based on county regions and the communities we serve. There is a special effort to include individuals with health disparities and organizations who serve these communities in the CHNA process. The CHNA includes the analysis of primary and secondary data. Multi-year analyses, trends and projections are developed, which identify areas of need for the continuum of health care services. Primary data is obtained through a combination of qualitative analysis of community-based organization (CBO), informant interviews and surveys, individual community member surveys, and participation in collaborative partner meetings. These meetings include representatives from the Departments of Health, CBOs, academic institutions, government agencies, and hospitals. Ongoing input concerning our communities' needs is also obtained through: our Board of Trustees/Directors who are all area residents and leaders in their respective communities; facility based advisory boards and councils, and; the feedback received by our facility administrators and clinicians that serve on local community agency boards. Secondary data analysis includes: internal hospital data, including Prevention Quality Indicators (PQI); Department of Health Community Health Assessments; local regional NYS Prevention Agenda data sources; and Statewide Planning and Research System (SPARCS) data. The Committee on Community Health, a committee of the Board of Trustees, provides recommendations that concern Northwell's community health priorities and interventions based on the CHNA. Committee discussions focus on New York State (NYS) Prevention Agenda Priority Areas, including strategies and intervention outcomes related to chronic disease prevention especially in at risk and diverse communities (Cancer, Diabetes, CVD, Obesity), healthy safe environments, health access, changes in the built environment - housing and access to affordable food, mental health and substance abuse and need for better health literacy. Regional departments of health (I.E. Nassau County Department of Health, Suffolk County Department of Health Services, and NYC Department of Health and Mental Hygiene) perform additional community health assessments (CHA) with the input of hospital and community stakeholders. These regional partners use strategies such as community member surveys, C X true true X X X X X false true false false false false false false false KENNETH D ROBERTS President & CEO 759180 0 0 0 101306 0 47000 0 31154 0 938640 0 0 0 JOSEPH WISNOSKI SVP & CFO 448304 0 0 0 5727 0 47280 0 31154 0 532465 0 0 0 JOAN C FARO Chief Medical Officer 517927 0 0 0 6858 0 36748 0 12189 0 573722 0 0 0 MARIE E MULLIGAN Chief Nursing Officer 318446 0 0 0 3564 0 31443 0 31154 0 384607 0 0 0 WAYNE S SHATTES VP-Administration 260580 0 0 0 3564 0 47000 0 31154 0 342298 0 0 0 MICHAEL BURGHARDT VP-Administration 181600 0 0 0 228 0 12750 0 31154 0 225732 0 0 0 KEVIN J MURRAY SVP-Administration 119753 0 0 0 3165 0 19000 0 15651 0 157569 0 0 0 MOHAMMAD BILAL Dir, Interventional Radiology 597213 0 0 0 10810 0 16800 0 31154 0 655977 0 0 0 JULIET NICHOLS Psychiatrist 606445 0 0 0 3564 0 16800 0 31154 0 657963 0 0 0 JOSEPH CARRUCCIU Dir, Breast Center 507904 0 0 0 3564 0 19600 0 31154 0 562222 0 0 0 MICHELLE P PRICE Radiologist 520454 0 0 0 810 0 19600 0 30726 0 571590 0 0 0 JOSEPH NG Intensivist 462147 0 0 0 291 0 19600 0 31154 0 513192 0 0 0 KEVIN BEINER TRUSTEE/SVP NORTHWELL 0 836564 0 153344 0 37486 0 30800 0 11568 0 1069762 0 0 RALPH A NAPPI TRUSTEE/EVC 0 754221 0 164063 0 32929 0 30800 0 22535 0 1004548 0 0 JOHN YU MD TRUSTEE/PHYSICIAN NORTHWELL 0 583752 0 25000 0 1290 0 30800 0 17083 0 657925 0 0 Part 1, Line 1a - Relevant Information Regarding Compensation Benefits Travel for companions Administrative approval Board member's spouse, relative or significant other, may be reimbursed subject to the following; the nature of the conference, workshop or seminar contains a critical social element in the judgement of the President or the Chairman of the Board and warrants their attendance. The reimbursement is a non-taxable transaction and considered de minimis in the opinion of legal counsel. Part ii, Line 2(i), column (iii) Kenneth D. Roberts other reportable compensation, $101,306, includes the proceeds of a Supplemental Executive Retirement Plan ("SERP") in the amount of $86,075 which was paid out of a legacy KEYSOP plan set up to fund the SERP. A TOWN OF BROOKHAVEN LDC 272768182 2012-11-30 20105000 REFINANCE 1996 DASNY BONDS false false false B TOWN OF BROOKHAVEN LDC 272768182 2013-08-15 23000000 CONSTRUCTION FACILITY ADDITION false false false A 0 0 20105000 0 0 0 323740 0 0 0 19781260 0 2015 true false true true B 0 0 23000000 0 1070827 0 351394 0 0 21577779 0 0 2015 false false true true A false false false false 0 false false false true B false false false false 0.00000 0.00000 0.00000 false false false true A false true false false true true PEOPLE'S UNITED BANK 10. false false false 0 false true B false true false false true true PEOPLE'S UNITED BANK 10. false false false 0 false true A true B true North Shore Professional LLC Business Relation: Kathryn Frey 1987287 Business false ANNE MARIE GOLDBERG Family Relation: KENNETH ROBERTS 64103 Employees false KIMBERLY JARETT Family Relation: HAROLD TRANCHON 44547 Employees false PART VI, SECTION A - GOVERNING BODY, LINE 2 All transactions with John T. Mater Memorial Hospital are as follows: (1) negotiated at arm's length; (2) all purchases are at fair market value; and (3) all products or services are rendered on an "as needed" basis. Timothy Glynn has a business relationship with Harold Tranchon and John Sini. Craig Nicholas has a business relationship with John Yu. Harold Tranchon has a business relationship with Timothy Glynn and John Sini. John Sini has a business relationship with Timothy Glynn and Harold Tranchon. John Yu has a business relationship with Craig Nicholas. PART VI, SECTION B - POLICIES, LINE 11 The annual Return of Organization Exempt From Income Tax (Form 990) for Northwell Health, Inc. and Affiliated entities are prepared with input from various departments including Corporate Compliance, Finance, Human Resources, and Legal. Before filing the returns, the documents are electronically made available to all trustees through a secure online portal. Members of the Executive Committee are then informed the returns are ready for review. The Executive Committee, which is a committee made up of members from the Board of Trustees, may exercise all of the authority of the Board of Trustees except as such authority is limited by applicable law and except to the extent, if any, that such authority would be inconsistent with any provision of these By-laws or is limited by any resolution to such effect adopted by the Board of Trustees. PART VI, SECTION B - POLICIES, LINE 12C CONFLICT OF INTEREST DICLOSURE STATEMENT FOR DIRECTORS and OFFICERS Each year all members of the board, officers and key employees must reaffirm that the conflict of interest form on file with the Hospital is accurate and complete.The sixteen question document is intended to identify business dealings that involve improper conflicts of interest and is prefaced with detailed definitions with regard to; immediate family, vendors, competitors, doing business or a business relationship and disclosable interests. The compliance and audit committee is charged with oversight of adherence to the conflict of interest policy. At the instruction of the compliance and audit committee, legal counsel conducts a review of each disclosure statement and submits findings to the audit committee. The audit committee notifies the board of directors of any potential or perceived conflicts of interest. Individuals that have disclosed a potential conflict of interest are asked to excuse themselves from deliberation or actions that may be construed as a conflict of interest. Employees are governed by the same principles and tenets by a written Code of Conduct and Conflict of Interest Policy. PART VI, SECTION B - POLICIES, LINE 15 The following compensation policy applies to the Hospital's President & CEO and the Hospital's CFO hereafter referred to as a "Covered Individual". The Compensation Committee shall determine and/or approve the amount of Compensation to be paid to any Covered Individual. In making such determination or approval, which shall be performed at least annually, the Compensation Committee shall consider all components of the Covered Individual's Compensation. In determining the appropriate Compensation to be paid to a Covered Individual, the Compensation Committee may, in its discretion, consider and rely upon the following data, as well as other information or data that it deems relevant; (i) compensation paid for comparable positions by similarly situated non-profit and for-profit entities; (ii) availability of individuals possessing similar expertise or specialized training in the geographic area; (iii) independent compensation surveys compiled by independent firms; and (iv) written offers that the Covered Individual has received from other similar institutions competing for his or her services. In determining the appropriate Compensation to be paid to a Covered Individual, the Compensation Committee will evaluate, or review an evaluation of, the Covered Individual's job performance (if currently employed) and/or a description of the Covered Individual's qualifications (if being recruited by the Organization). Such evaluations and descriptions may include and/or consider a description of the duties and responsibilities of the Covered Individual's position and the results achieved by such individual; other executive's assessments of the importance of the Covered Individual to the Organization and the role of Compensation in retaining and incentivizing the performance of the Covered Individual; whether and to what extent the Covered Individual possesses unique talents and abilities that increase his or her value to the Organization; increases in the nature, scope, or extent of the Covered Individual's duties; and any other subjective factors or other information concerning the Covered Individual's contributions to the Organization that the Compensation Committee deems relevant in setting the Covered Individual's Compensation concerning the Covered Individual's contributions to the Organization that the Compensation that the Compensation Committee deems relevant in setting the covered individual's compensation. PART VI, SECTION C - DISCLOSURES, LINE 19 CURRENTLY THE ORGANIZATION PROVIDES GOVERNANCE DOCUMENTS, CONFLICT OF INTEREST POLICIES AND FINANCIAL STATEMENTS TO THE PUBLIC UPON REQUEST. PART VII, SECTION A - LINE 1A Kevin S. Beiner Donald E. Lippencott Roger Blumencranze Richard Lusack Betsy N. Britton Ralph Nappi Nicholas Craig Kenneth D. Roberts James Danowski Christine Ruggiero, MD Sylvia Diaz John Sini John Diviney Leo Sternlicht Debra Engelhardt Harold Tranchon Kathryn B. Frey Edward Weiss Timothy Glynn John Yu, MD Konard Kuhn PART VI, SECTION A - GOVERNING BODY, LINE 7 Northwell Healthcare, Inc. ("Northwell Healthcare") is the sole corporate member of the organization. Northwell Healthcare has the right to elect or appoint member of the organization's governing body and has the right to approve or ratify certain corporate decisions. This organization and Northwell Healthcare are part of Northwell Health, Inc., an integrated health care delivery system. PART XI, LINE 9 - RECONCILIATION OF NET ASSETS CHANGE IN FV SWAP AGREEMENT - CASH FLOW (111,609) TRANSFER TO AFFILIATE 18,000,000 NET ASSETS RELEASED FROM RESTRICTION (26,924) NON-OPERATING GAINS 746,189 OTHER CHANGE IN NET ASSETS 309,065 TOTAL 18,916,721 Brightwaters Gynecology PC 972 Brush Hollow Rd Westbury NY 11590 821883445 Medical Servi NY 501(C)(3) 10 NSUH false Brooklyn Ambulatory Care PC 972 Brush Hollow Rd Westbury NY 11590 474447289 Medical Servi NY 501(C)(3) 12, Type I NSUH false Carnegie Cardiovascular PC 972 Brush Hollow Rd Westbury NY 11590 474377825 Medical Servi NY 501(C)(3) 12, Type I Lenox Hill false Central Suffolk Hospital 1300 Roanoke Ave Riverhead NY 11901 111661359 Health Care NY 501(C)(3) 3 NW Healthcar false CLNY Alliance Inc 972 Brush Hollow Rd Westbury NY 11590 463146870 Laboratory NY 501(C)(3) 3 NW Labs false Community Drive Surgery PC 972 Brush Hollow Rd Westbury NY 11590 821672429 Medical Servi NY 501(C)(3) 12, Type I NSUH false Glen Cove Hospital 972 Brush Hollow Rd Westbury NY 11590 111633487 Health Care NY 501(C)(3) 3 Northwell He false Harbor View Medical Services PC 75 North Country Rd Port Jefferson NY 11777 264517010 Supporting Or NY 501(C)(3) 12, Type I Mather true Hillside Hospital Houses Inc 972 Brush Hollow Rd Westbury NY 11590 112113949 Housing Comp NY 501(C)(2) N/A Northwell He false Hospice Care in Westchester and Putnam 540 White Plains Rd Tarrytown NY 10591 133882602 Hospice Care NY 501(C)(3) 10 VNA Hudson false Hospice Care Network 99 Sunnyside Blvd Woodbury NY 11797 112925757 Hospice NY 501(C)(3) 9 Northwell He false Huntington Hospital Association 270 Park Avenue Huntington NY 11743 111630914 Health Care NY 501(C)(3) 3 Northwell He false Huntington Hospital Dolan Family Health 284 Pulaski Rd Greenlawn NY 11740 113368503 Health Care NY 501(C)(3) 3 Huntington false John T Mather Health Facilities Foundat 75 North Country Rd Port Jefferson NY 11777 112714670 FUNDRAISING NY 501(C)(3) 7 MATHER HEALT false Lakeville Surgery PC 972 Brush Hollow Rd Westbury NY 11590 474377760 Medical Servi NY 501(C)(3) 10 Lenox Hill false Lenox Hill Hospital 972 Brush Hollow Rd Westbury NY 11590 131624070 Health Care NY 501(C)(3) 3 Northwell He false Lenox Hill Hospital Medical PC 972 Brush Hollow Rd Westbury NY 11590 452661543 Medical Servi NY 501(C)(3) 10 Lenox Hill false Lenox Hill Pathology PC 972 Brush Hollow Rd Westbury NY 11590 133644370 Medical Servi NY 501(C)(3) 12, Type I Lenox Hill false Lenox Otolaryngology Head & Neck Surgery 972 Brush Hollow Rd Westbury NY 11590 208784395 Medical Servi NY 501(C)(3) 12, Type I Lenox Hill false LHH Corporation 972 Brush Hollow Rd Westbury NY 11590 133272016 Supporting Or NY 501(C)(3) 12, Type I Northwell He false LIJ Foundation 972 Brush Hollow Rd Westbury NY 11590 112661239 Supporting Or NY 501(C)(3) 12, Type I Northwell He false Long Island Jewish Medical Center 972 Brush Hollow Rd Westbury NY 11590 112241326 Health Care NY 501(C)(3) 3 Northwell He false Long Island Jewish Medical Center at Hom 972 Brush Hollow Rd Westbury NY 11590 113251128 Supporting Or NY 501(C)(3) 12, Type I Northwell He false Marcus Avenue Medical PC 972 Brush Hollow Rd Westbury NY 11590 810861452 Medical Servi NY 501(C)(3) 12, Type I NSUH false Medical Care of Queens PC 972 Brush Hollow Rd Westbury NY 11590 474377679 Medical Servi NY 501(C)(3) 12, Type I Lenox Hill false NORCORP Inc 400 East Main Street Mount Kisco NY 10549 133366748 Support Org NY 501(C)(3) 12, Type I NWHA false North Shore Community Services Inc 972 Brush Hollow Rd Westbury NY 11590 237273200 Housing Comp NY 501(C)(2) N/A Northwell He false North Shore-LIJ Medical Care Centers 972 Brush Hollow Rd Westbury NY 11590 113473923 Supporting Or NY 501(C)(3) 12, Type I Northwell He false North Shore University Hospital 972 Brush Hollow Rd Westbury NY 11590 111562701 Health Care NY 501(C)(3) 3 Northwell He false North Shore University Hospital at Glen 972 Brush Hollow Rd Westbury NY 11590 237010468 Housing Comp NY 501(C)(2) N/A Northwell He false North Shore University Hospital Housing 972 Brush Hollow Rd Westbury NY 11590 112171903 Housing Comp NY 501(C)(2) N/A Northwell He false North Shore-LIJ Anesthesiology PC 972 Brush Hollow Rd Westbury NY 11590 461617561 Medical Servi NY 501(C)(3) 12, Type I SSIDE false North Shore-LIJ Cardiology at Deer Park 972 Brush Hollow Rd Westbury NY 11590 275078531 Medical Servi NY 501(C)(3) 12, Type I NSUH false North Shore-LIJ Cardiovascular Medicine 972 Brush Hollow Rd Westbury NY 11590 275078717 Medical Servi NY 501(C)(3) 12, Type I NSUH false North Shore-LIJ Health Plan Inc 972 Brush Hollow Rd Westbury NY 11590 461617516 Insurance NY 501(C)(3) 9 Health Plan false Northwell Health Plans Holding Company 972 Brush Hollow Rd Westbury NY 11590 462478147 Holding Compa NY 501(C)(3) 12, Type II Northwell He false North Shore-LIJ Heart Surgery PC 972 Brush Hollow Rd Westbury NY 11590 275078838 Medical Servi NY 501(C)(3) 12, Type I NSUH false North Shore-LIJ Internal Medicine at Lyn 972 Brush Hollow Rd Westbury NY 11590 463475908 Medical Servi NY 501(C)(3) 12, Type I NSUH false North Shore-LIJ Internal Medicine at New 972 Brush Hollow Rd Westbury NY 11590 462822879 Medical Servi NY 501(C)(3) 10 NSUH false North Shore-LIJ Internal Medicine PC 972 Brush Hollow Rd Westbury NY 11590 275078631 Medical Servi NY 501(C)(3) 12, Type I NSUH false North Shore-LIJ Medical Group at Hunting 972 Brush Hollow Rd Westbury NY 11590 274384049 Medical Servi NY 501(C)(3) 12, Type I NSUH false North Shore-LIJ Medical Group at North N 972 Brush Hollow Rd Westbury NY 11590 274384146 Medical Servi NY 501(C)(3) 10 NSUH false North Shore-LIJ Medical Group at Syosset 972 Brush Hollow Rd Westbury NY 11590 273957752 Medical Servi NY 501(C)(3) 12, Type I NSUH false North Shore-LIJ Medical Group PC 972 Brush Hollow Rd Westbury NY 11590 274384249 Medical Servi NY 501(C)(3) 10 NSUH false North Shore-LIJ Medical Group Urgent Med 972 Brush Hollow Rd Westbury NY 11590 275078426 Medical Servi NY 501(C)(3) 12, Type I NSUH false North Shore-LIJ Medical PC 972 Brush Hollow Rd Westbury NY 11590 453023019 Medical Servi NY 501(C)(3) 12, Type I NSUH false North Shore-LIJ OB-GYN at Garden City P 972 Brush Hollow Rd Westbury NY 11590 462886776 Medical Servi NY 501(C)(3) 12, Type I NSUH false North Shore-LIJ OB-GYN at New Hyde Park 972 Brush Hollow Rd Westbury NY 11590 473722278 Medical Servi NY 501(C)(3) 12, Type I NSUH false North Shore-LIJ OB-GYN PC 972 Brush Hollow Rd Westbury NY 11590 461382916 Medical Servi NY 501(C)(3) 10 LIJMC false North Shore-LIJ Occupational Medicine PC 972 Brush Hollow Rd Westbury NY 11590 451004103 Medical Servi NY 501(C)(3) 10 NSUH false North Shore-LIJ Pediatrics of Suffolk Co 972 Brush Hollow Rd Westbury NY 11590 465746956 Medical Servi NY 501(C)(3) 12, Type I NSUH false North Shore-LIJ Radiology Services PC 972 Brush Hollow Rd Westbury NY 11590 223970667 Medical Servi NY 501(C)(3) 12, Type I NSUH false Northern Westchester Hospital Associatio 400 East Main Street Mount Kisco NY 10549 131740118 Health Care NY 501(C)(3) 3 Northwell He false Northern Westchester Hospital Center Fou 400 East Main Street Mount Kisco NY 10549 134067064 Foundation NY 501(C)(3) 9 NWHA false Northern Westchester Realty Holding Comp 400 East Main Street Mount Kisco NY 10549 912134215 Holding Compa NY 501(C)(2) N/A NWHA false Northwell Health Alliance Inc 972 Brush Hollow Rd Westbury NY 11590 263727582 Health Care NY 501(C)(3) 3 NA false Northwell Health Foundation 972 Brush Hollow Rd Westbury NY 11590 112965575 Fundraising NY 501(C)(3) 7 Northwell He false Northwell Health Laboratories 972 Brush Hollow Rd Westbury NY 11590 113412370 Supporting Or NY 501(C)(3) 12, Type I Northwell He false Northwell Health Stern Family Center for 972 Brush Hollow Rd Westbury NY 11590 237007485 Nursing Home NY 501(C)(3) 9 Northwell He false Northwell Health Inc 972 Brush Hollow Rd Westbury NY 11590 113418133 Supporting Or NY 501(C)(3) 12, Type I NA false Northwell Healthcare Inc 972 Brush Hollow Rd Westbury NY 11590 112965586 Supporting Or NY 501(C)(3) 12, Type I Northwell He false Northwell Proton Therapy PC 972 Brush Hollow Rd Westbury NY 11590 812766298 Medical Servi NY 501(C)(3) 10 NSUH false Northwell Quality and Medical Affairs I 972 Brush Hollow Rd Westbury NY 11590 824113233 Supporting Or NY 501(C)(3) 12, Type I Healthcare false Peconic Cardiology PC 972 Brush Hollow Rd Westbury NY 11590 813149464 Medical Servi NY 501(C)(3) 12, Type I NSUH false Phelps Medical Services PC 701 North Broadway Sleepy Hollow NY 10591 274416017 Medical Servi NY 501(C)(3) 12, Type I Phelps Memor false Phelps Memorial Hospital Association 701 North Broadway Sleepy Hollow NY 10591 131725076 Health Care NY 501(C)(3) 3 Northwell He false Physicians of Univeristy Hospital PC 1 Edgewater Plaza 6th Fl Staten Island NY 10305 200096809 Health Care NY 501(C)(3) 12, Type I SIUH false Plainview Hospital 972 Brush Hollow Rd Westbury NY 11590 113241243 Health Care NY 501(C)(3) 3 Northwell He false SIUH Systems Inc 475 Seaview Avenue Staten Island NY 10305 061074604 Fundraising NY 501(C)(3) 7 Northwell He false Southside Hospital 972 Brush Hollow Rd Westbury NY 11590 111667761 Health Care NY 501(C)(3) 3 Northwell He false Sports Physical Therapy Occupational Th 972 Brush Hollow Rd Westbury NY 11590 061655704 Health Care NY 501(C)(3) 9 LIJ false Staten Island Performing Provider System 972 Brush Hollow Rd Westbury NY 11590 472544659 DSRIP NY 501(C)(3) 10 NA false Staten Island University Hospital 475 Seaview Avenue Staten Island NY 10305 112868878 Health Care NY 501(C)(3) 3 Northwell He false Staten Island University Hospital Founda 360 Seaview Avenue Staten Island NY 10305 870765787 Fundraising NY 501(C)(3) 7 SIUH false Suite 130 Plastic Surgery PC 972 Brush Hollow Rd Westbury NY 11590 821772747 Medical Servi NY 501(C)(3) 12, Type I LIJ false The Calverton Foundation Inc 972 Brush Hollow Rd Westbury NY 11590 831118138 Medical Servi NY 501(C)(3) Applied For HCI false The Elmezzi Graduate School of Molecular 972 Brush Hollow Rd Westbury NY 11590 113284934 Graduate Scho NY 501(C)(3) 2 Research false The Feinstein Institute for Medical Rese 972 Brush Hollow Rd Westbury NY 11590 112673595 Research NY 501(C)(3) 4 Northwell He false The Heart Institute 475 Seaview Avenue Staten Island NY 10305 311757254 Inactive NY 501(C)(3) 12, Type I NA false The Long Island Home 400 Sunrise Hghwy Amityville NY 11701 112837244 Health Care NY 501(C)(3) 3 LHH Corporat false True North Flexstaff Inc 972 Brush Hollow Rd Westbury NY 11590 821446568 Medical Servi NY 501(C)(3) Applied For HCI false True North Patient Safety Organization 972 Brush Hollow Rd Westbury NY 11590 831429773 Medical Servi NY 501(C)(3) Applied For Northwell He false Virtual Health Medicine PC 972 Brush Hollow Rd Westbury NY 11590 274384326 Medical Servi NY 501(C)(3) 10 NSUH false Visiting Nurse Association of Hudson Val 540 White Plains Rd Tarrytown NY 10591 131739952 Home Health C NY 501(C)(3) 10 NW Healthcar false VNA Home Health Services Inc 540 White Plains Rd Tarrytown NY 10591 133690105 Home Health C NY 501(C)(3) 10 VNA Hudson false Westchester Health Medical PC 972 Brush Hollow Rd Westbury NY 11590 474539584 Medical Servi NY 501(C)(3) 12, Type I NSUH false True North Health Management Inc 972 Brush Hollow Rd Westbury NY 11590 813428274 Supporting Or NY 501(C)(3) 12, Type I Healthcare false Wellbridge Psychiatry PC 972 Brush Hollow Rd Westbury NY 11590 465495054 Medical Servi NY 501(C)(3) 12, Type I NSUH false Brooklyn Ambulatory Services LLC 972 Brush Hollow Rd Westbury NY 11590 812910850 Medical Svcs NY Northwell Healt DHCH LLC 972 Brush Hollow Rd Westbury NY 11590 811030907 Medical Svcs NY Endoscopy Ventu Endo Group LLC 972 Brush Hollow Rd Westbury NY 11590 200248148 Medical Svcs NY Ventures GCSC Endoscopy Center of Long Island 972 Brush Hollow Rd Westbury NY 11590 260000980 Medical Svcs NY NS-LIJ Ventures Formativ Health Intermediate LLC 972 Brush Hollow Rd Westbury NY 11590 814614788 Holding Co DE Formativ Health Formativ Health LLC 972 Brush Hollow Rd Westbury NY 11590 813121231 Holding Co DE TN Health Svcs Hospital City LLC 972 Brush Hollow Rd Westbury NY 11590 474091780 Inactive DE Northwell Healt Krasnoff Consultative Services LLC 972 Brush Hollow Rd Westbury NY 11590 262838027 Consulting NY Care Mgmt Grp Melville SC LLC 1895 Walt Whitman Rd Melville NY 11747 203487522 Medical Svcs NY Melville ASC North Shore-LIJ and Yale New Haven Medic 972 Brush Hollow Rd Westbury NY 11590 464858222 Air Transport NY NSUH North Shore-LIJ Contract Research Organi 972 Brush Hollow Rd Westbury NY 11590 464469806 Research NY Health Care Northwell Genomics Alliance LLC 972 Brush Hollow Rd Westbury NY 11590 810826710 Inactive DE NWH Labs Northwell Health Sleep Lab LLC 972 Brush Hollow Rd Westbury NY 11590 821516748 Medical Svcs NY Sleep Holdings Phelps Professional Building Corp LP 777 North Broadway Sleepy Hollow NY 10591 133645137 Real Estate NY PMHA South Shore Surgery Center LLC 972 Brush Hollow Rd Westbury NY 11590 341997077 Medical Svcs NY Multispecialty Suffolk Surgery Center 972 Brush Hollow Rd Westbury NY 11590 200080609 Medical Svcs NY Multispecialty Technopath Northwell Health North Americ 972 Brush Hollow Rd Westbury NY 11590 822869458 Lab Services NY Technopath USA True North II DC LLC 972 Brush Hollow Rd Westbury NY 11590 352568005 Medical Svcs NY DC Holding True North IV DC LLC 972 Brush Hollow Rd Westbury NY 11590 611816900 Medical Svcs NY DC Holding True North Urgent Care LLC 972 Brush Hollow Rd Westbury NY 11590 464113494 Medical Svcs NY NSLIJ Urgent Ca True North V DC LLC 972 Brush Hollow Rd Westbury NY 11590 320518811 Medical Svcs NY DC Holding True North Rad-Onc MSO LLC 972 Brush Hollow Rd Westbury NY 11590 834660846 Medical Svcs NY Northwell Rad-O PORT JEFFERSON ASC 1500 ROUTE 112 BUILDING 3 PORT JEFFERSON STATION NY 11776 371794376 AMBULATORY SURGER NY NA RELATED -407798 147798 false false 0.26000 Regional Insurance Company LTD c/o Cedar House 41 Cedar Ave Hamilton BD HM 12 000000000 Insurance BD Healthcare C false false false true false false false false false false false false false false false true true false false false JT MATHER HEALTH FACILITIES FOUNDATION C 205924 CASH JT MATHER HEALTH FACILITIES FOUNDATION O 701765 CASH JT MATHER HEALTH FACILITIES FOUNDATION P 701765 CASH