2018-11-15T16:08:26-06:00 2017-12-31 131517563 LOEB & TROPER LLP 655 THIRD AVENUE 12TH FLOOR NEW YORK NY 10017 990 2017-01-01 200714587 CENTRAL SUFFOLK HOSPITAL FOUNDATION CENT 6315486064 1300 ROANOKE AVENUE RIVERHEAD NY 11901 MICHAEL O'DONNELL PRESIDENT/CEO 6315486064 2018-11-15 1 AARON SHAPIRO P01333816 2128674000 64.22.227.161 2018-11-15 16:37:17 ES P 4275C7E7C8129915C35F764424C97B97C01C68F2 988419C5643A1C0877F6823E03E3852E0B43B763 2017 2019-02-21 02:37:17Z PECONIC BAY MEDICAL CENTER FOUNDATION ANDREW J MITCHELL 1300 ROANOKE AVENUE RIVERHEAD NY 11901 7712367 0 X WWW.PBMCHEALTH.ORG X 2004 NY THE MISSION OF THE CENTRAL SUFFOLK HOSPITAL FOUNDATION (THE FOUNDATION) IS TO SEEK PHILANTHROPIC SUPPORT ON BEHALF OF CENTRAL SUFFOLK HOSPITAL D/B/A PECONIC BAY MEDICAL CENTER (CSH). 11 10 0 10 0 0 3688063 7383258 0 0 20566 23761 -172248 186704 3536381 7593723 0 0 0 0 0 0 204930 430899 1543488 1074988 1118480 1279918 1549379 2256463 6044344 6374289 21558722 454626 9590458 5919663 11968264 THE FOUNDATION'S MISSION IS TO DEVELOP AND CULTIVATE PHILANTHROPIC AND COLLABORATIVE RELATIONSHIPS THAT FOSTER PROGRAMS AND SERVICES OFFERED THROUGH CSH WHICH IMPROVE THE HEALTH OF THE COMMUNITIES IT SERVES. 0 0 THE SUPPORT OF HOSPITAL SERVICES OF CSH. 1 1 0 0 0 0 0 0 1 0 1 0 0 0 1 1 1 0 0 0 0 0 0 1 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 7 0 1 0 0 0 0 0 0 1 1 0 0 0 0 X 11 10 0 0 0 0 0 0 0 1 1 0 0 1 0 1 1 0 0 0 NY X MICHAEL F O'DONNELL 6315486074 1300 ROANOKE AVENUE RIVERHEAD NY 11901 EMILIE ROY COREY MSW BOARD CHAIR 10.00 X X 0 0 0 J GORDON HUSZAGH VICE CHAIR 10.00 15.00 X X 0 0 0 RICHARD ISRAEL VICE CHAIR 1.00 1.00 X X 0 0 0 JOAN S LEVAN SECRETARY/TREASURER 1.00 1.00 X X 0 0 0 ANDREW J MITCHELL FACHE PRESIDENT/CEO 15.00 22.50 X X 0 1051786 34966 BRUCE BARNET BOARD MEMBER 1.00 X 0 0 0 MARY ANN ALEXANDER BOARD MEMBER 1.00 X 0 0 0 JUDITH JEDLICKA BOARD MEMBER 1.00 X 0 0 0 RICHARD L WINSLOW PHD BOARD MEMBER 1.00 1.00 X 0 0 0 MICHAEL SCHWENK BOARD MEMBER 1.00 1.00 X 0 0 0 STANLEY ZINBERG BOARD MEMBER 1.00 1.00 X 0 0 0 0 1051786 34966 0 0 1 0 CENTRAL SUFFOLK HOSPITAL 1300 ROANOKE AVENUE RIVERHEAD NY 11901 ADMINISTRATIVE SERVICES 629756 COMMUNITY COUNSELING CO LLC 461 FIFTH AVENUE NEW YORK NY 10017 FUNDRAISING COUNSEL 422500 2 503511 6879747 7383258 23312 23312 33290 0 33290 33290 33290 6579 6130 449 449 449 265928 503511 112514 153414 153414 7593723 0 0 210465 629756 629756 430899 430899 5891 5891 14769 14769 2865 2865 285840 285840 30883 30883 17788 17788 COMMUNITY OUTREACH 4600 4600 126088 126088 1549379 0 5891 1543488 119051 110405 3201995 1624871 1986303 6442449 9375 194703 12123786 0 0 12123786 1057565 1062508 6374289 21558722 70269 5283 121568 110479 8600000 262789 874696 454626 9590458 X 4194082 7128133 1725581 4840131 5919663 11968264 6374289 21558722 6044344 4257 0 X X 0 1 X 1 0 X 1318620 3071944 1408832 3688063 7383258 16870717 1318620 3071944 1408832 3688063 7383258 16870717 3525574 13345143 2091 4311 8575 19995 56602 91574 153414 153414 17115705 0.77970 0.67300 X 0 1 X 240500 240500 11883286 11883286 12123786 DUE TO CENTRAL SUFFOLK HOSPITAL D/B/A PECONIC BAY MEDICAL CENTER 874696 874696 X 7597980 4257 4257 7593723 0 7593723 1549379 0 1549379 0 1549379 PART IV, LINE 2B: IN ACCORDANCE WITH GENERALLY ACCEPTED ACCOUNTING PRINCIPLES, THE FOUNDATION HAS REFLECTED AS A LIABILITY FOR THOSE CONTRIBUTIONS BEING HELD ON BEHALF OF WOMEN'S HEALTH PARTNERSHIP. PART X, LINE 2: THE FOUNDATION HAS DETERMINED THAT THERE ARE NO MATERIAL UNCERTAIN TAX POSITIONS THAT REQUIRE RECOGNITION OR DISCLOSURE IN THE FINANCIAL STATEMENTS. PERIODS ENDING DECEMBER 31, 2014 AND SUBSEQUENT REMAIN SUBJECT TO EXAMINATION BY APPLICABLE TAXING AUTHORITIES. X X X X X 1 THE GOBEL GROUP 16 WEST MARKET STREET 2ND FLOOR WEST CHESTER PA 19382 FUNDRAISING COUNSEL 0 0 8399 0 COMMUNITY COUNSELING CO LLC 461 FIFTH AVENUE NEW YORK NY 10017 FUNDRAISING COUNSEL 0 0 422500 0 430899 NY BLACK AND WHITE 480778 346475 134303 13141 25168 2000 5964 GOLF EVENT 179725 48100 131625 15000 32983 5367 1 108936 108936 8440 3438 1013 769439 503511 265928 36581 61589 2000 12344 112514 153414 0 0 0 0 0 0 0 0 0 ANDREW J MITCHELL FACHE PRESIDENT/CEO 0 807795 0 243991 0 0 0 18500 0 16466 0 1086752 0 0 PART I, LINE 3 CSH UTILIZES SALARY SURVEYS AND REVIEWS THEM WITH THE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS. THE PROCESS WAS LAST PERFORMED IN 2017. FORM 990, PART VI, SECTION B, LINE 11B THE CEO/PRESIDENT, AND CHIEF FINANCIAL OFFICER OF CSH, A RELATED ORGANIZATION, REVIEW THE FORM 990. A COPY OF THE FORM 990 IS ALSO PROVIDED TO THE BOARD OF DIRECTORS FOR REVIEW. THE BOARD REVIEWS THE DOCUMENT AND REACHES OUT TO CSH SHOULD THEY HAVE ANY QUESTIONS. IF NO QUESTIONS ARE RAISED, THE FORM 990 IS SUBMITTED FOR FILING. FORM 990, PART VI, SECTION B, LINE 12 THE FOUNDATION FOLLOWS CSH'S CONFLICT OF INTEREST POLICY. FORM 990, PART VI, SECTION B, LINE 15 CSH UTILIZES SALARY SURVEYS AND REVIEWS THEM WITH THE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS. THE PROCESS WAS LAST PERFORMED IN 2017. FORM 990, PART VI, SECTION C, LINE 19 THESE DOCUMENTS ARE AVAILABLE UPON REQUEST. FORM 990, PART XII, LINE 2C: THIS PROCESS DID NOT CHANGE FROM THAT OF THE PRIOR YEAR. CENTRAL SUFFOLK HOSPITAL DBA PECONIC BAY MEDICAL CENTER 1300 ROANOKE AVE RIVERHEAD NY 11901 111661359 HOSPITAL CARE NY 501(C)(3) 3 PECONIC HEALTH CORPORATION 0 0 0 0 0 1 0 0 0 0 0 1 1 0 0 1 1 0 0 0