2014-11-14T09:00:00-06:00 2013-12-31 990 2013-01-01 113340969 THE JAMAICA HOSPITAL MEDICAL CENTER DIAGNOSTIC AND TREATMENT CENTER JAMA 7182066891 8900 VAN WYCK EXPRESSWAY JAMAICA NY 11418 MOUNIR DOSS EXEC VP & CFO 7182066891 2014-11-14 1 P00851654 2122970400 2013 2015-11-30 17:44:51Z MEDISYS FAMILY CARE MOUNIR DOSS 8900 VAN WYCK EXPRESSWAY JAMAICA NY 11418 8735063 0 X N/A X 1995 NY TO PROVIDE UNDERSERVED COMMUNITIES SERVED BY JAMAICA HOSPITAL MEDICAL CENTER WITH ACCESS TO QUALITY AMBULATORY MEDICAL CARE. 11 9 105 0 0 0 148361 277599 6913625 8409980 1103 3219 18336 44265 7081425 8735063 0 0 0 0 7146864 7137908 0 0 0 4841616 4387471 11988480 11525379 -4907055 -2790316 9346785 8805361 64115115 66371892 -54768330 -57566531 TO PROVIDE UNDERSERVED COMMUNITIES SERVED BY JAMAICA HOSPITAL MEDICAL CENTER WITH ACCESS TO QUALITY AMBULATORY MEDICAL CARE. 0 0 10488093 8454245 PROVIDED 60,501 MEDICAL VISITS. PROVIDED 15,957 DENTAL VISITS. IMPLEMENTED AN ELECTRONIC MEDICAL RECORD SYSTEM. 10488093 1 0 0 0 0 0 0 0 0 0 1 0 0 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 54 0 1 105 1 0 0 0 0 0 0 0 0 0 0 X 11 9 0 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 0 0 0 NY X MANZAR SASSANI 7182066891 8900 VAN WYCK EXPRESSWAY JAMAICA NY 11418 X ANTHONY DIMARIA MD SECRETARY 1.00 40.00 X X 0 228897 24890 ANTONIETTA MORISCO DIRECTOR 1.00 2.00 X 0 0 0 ARCHIE SPIGNER ASSISTANT SECRETARY 1.00 2.00 X X 0 0 0 DOUGLAS W SINGER DIRECTOR 1.00 2.00 X 0 0 0 GEOFFREY DOUGHLIN MD SECOND VICE CHAIRMAN 1.00 41.00 X X 0 399018 26751 GERALDINE M CHAPEY PHD DIRECTOR 1.00 2.00 X 0 0 0 HON TIMOTHY J DUFFICY DIRECTOR 1.00 2.00 X 0 0 0 JOSEPH FERRARA ASSISTANT TREASURER 1.00 2.00 X X 0 0 0 JOSEPH LIANA DIRECTOR 1.00 2.00 X 0 0 0 NEIL FOSTER PHILLIPS CHAIRMAN 1.00 3.00 X X 0 0 0 ROBERT W KOOP 1ST VICE CHAIR, TREASURER 1.00 3.00 X X 0 0 0 BRUCE FLANZ PRESIDENT & CEO 2.50 62.50 X 0 1372384 25590 MOUNIR DOSS EXEC. VP & CFO 2.50 62.50 X 0 974118 25590 ERICA CARDONA DIRECTOR 40.00 X 163529 0 9157 ERLINDA CRUZ PHYSICIAN 40.00 X 121683 0 20868 FRED CLARKE PHYSICIAN 40.00 X 123924 0 20898 IRENE WONG PHYSICIAN 40.00 X 127791 0 12707 NICHOLAS PANTELO PHYSICIAN 40.00 X 168697 0 22045 705624 2974417 188496 13 0 1 0 M&S DENTAL SUPPLY CO LLC 105-30 101ST AVE OZONE PARK NY 11416 MEDICAL SUPPLIES 143229 DERIVE TECHNOLOGIES LLC 110 WILLIAM STREET 14TH FLOOR NEW YORK NY 10038 IT 117439 2 277599 277599 PATIENT SERV. REV. 621400 5206385 5206385 CAPITATION REVENUE 621400 3203595 3203595 8409980 3219 3219 RECOVERY OF BAD DEBT 900099 26151 26151 OTHER REVENUE 900099 18114 18114 44265 8735063 8454245 0 3219 5426596 4938202 488394 377469 343497 33972 855269 778295 76974 478574 435502 43072 48762 48762 209317 190477 18840 243566 221646 21920 445906 405774 40132 778769 708680 70089 CHARGE BACK 1759616 1759616 MEDICAL SUPPLIES 373779 340139 33640 CONTRA REVENUE 240753 219085 21668 LAB SERVICE 232168 211273 20895 54835 -64093 118928 11525379 10488093 1037286 0 1656 1658 281488 270285 32812 684693 707274 16253764 10083185 6260856 6170579 656990 545949 1428290 1109616 9346785 8805361 1095127 1120191 10344840 9413473 52675148 55838228 64115115 66371892 X -54768330 -57566531 -54768330 -57566531 9346785 8805361 -2790316 -7885 0 X X 0 1 X 1 0 X 700150 700150 10798166 6492586 4305580 215179 215179 0 4512706 3375420 1137286 27563 27563 6170579 PCDC DEBT SERVICE FUND 1012533 DUE FROM RELATED PARTY 15458 HEALTHFIRST 81625 1109616 DUE TO AFFILIATED ENTITIES 55507196 ESTIMATED INSURANCE LIABILITY 316127 MEDICAL REIMBURSEMENT SETTLEMENT 14905 55838228 X 8727177 -7886 -7886 8735063 0 8735063 11525379 0 11525379 0 11525379 PART X, LINE 2: THE D&TC QUALIFIES AS A TAX-EXEMPT, NON PROFIT ORGANIZATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND ITS INCOME IS GENERALLY NOT SUBJECT TO FEDERAL, STATE, OR LOCAL INCOME TAXES. 0 1 0 0 0 0 0 0 0 ANTHONY DIMARIA MD SECRETARY 0 216193 0 0 0 12704 0 5550 0 19340 0 253787 0 0 GEOFFREY DOUGHLIN MD SECOND VICE CHAIRMAN 0 399018 0 0 0 0 0 6250 0 20501 0 425769 0 0 BRUCE FLANZ PRESIDENT & CEO 0 1247508 0 0 0 124876 0 6250 0 19340 0 1397974 0 0 MOUNIR DOSS EXEC. VP & CFO 0 896259 0 0 0 77859 0 6250 0 19340 0 999708 0 0 ERICA CARDONA DIRECTOR 163525 0 0 0 4 0 4133 0 6867 0 174529 0 0 0 NICHOLAS PANTELO PHYSICIAN 168616 0 0 0 81 0 4316 0 21792 0 194805 0 0 0 PART I, LINE 4B THE FOLLOWING INDIVIDUAL RECEIVED SERP PAYMENTS DURING 2013: BRUCE FLANZ - 24,898 FORM 990, PART IV, LINE 20: THE ORGANIZATION IS LICENSED UNDER ARTICLE 28 OF NEW YORK STATE PUBLIC HEALTH LAW. HOWEVER, SUBSECTION 10 OF ARTICLE 28 EXCLUDES CERTAIN HEALTHCARE FACILITIES FROM THE DEFINITION OF GENERAL HOSPITAL. THEREFORE, THE ORGANIZATION IS NOT INCLUDING SCHEDULE H IN THE CURRENT YEAR FORM 990 AS THEY DO NOT MEET THIS DEFINITION. FORM 990, PART VI, SECTION A, LINE 6 MEDISYS HEALTH NETWORK IS THE SOLE MEMBER. FORM 990, PART VI, SECTION A, LINE 7A MEDISYS HEALTH NETWORK, AS SOLE MEMBER CAN APPOINT THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 AND APPROPRIATE SCHEDULES, AS REQUIRED (FORM 990), IS PREPARED BY OUTSIDE ACCOUNTANT AND REVIEWED INTERNALLY BY MANAGEMENT, AT WHICH TIME IT IS CONSIDERED THE FINAL DRAFT. THE FINAL DRAFT OF THE FORM 990 IS PRESENTED TO THE TRUSTEES VIA EMAIL AND OR A BOARD MEETING. ONCE THE REVIEW OF THE FORM 990 HAS BEEN COMPLETED TO THE BOARD'S SATISFACTION, IT IS FINALIZED AND SUBSEQUENTLY FILED WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C DISCLOSURE IN ACCORDANCE WITH THE CONFLICT OF INTEREST POLICY BY EMPLOYEES THAT SATISFY THE CRITERIA TO BE CONSIDERED AN "INTERESTED PERSON" IS SUBMITTED UPON HIRING AND ANNUALLY THEREAFTER. THE COMPLIANCE OFFICERS REVIEW THE SUBMISSIONS FOR CONFLICTS AND REPORTS THEM TO THE BOARD. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS - CERTIFICATE OF INCORPORATION FILED WITH THE NYS DEPARTMENT OF STATE; CONFLICT OF INTEREST POLICY IS NOT PUBLICLY AVAILABLE. FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. FORM 990, PART VII, SECTION A, LINE 1B: FOR BRUCE FLANZ, PRESIDENT & CEO, MOUNIR DOSS, EXECUTIVE VICE PRESIDENT & CFO, THE HOURS REPORTED BELOW REFLECT THE TOTAL TIME WORKED AS OFFICERS FOR ALL OF THE RELATED ORGANIZATIONS SHOWN ON SCHEDULE R. TOTAL COMPENSATION IS REPORTED ON EACH ENTITY'S FORM 990. COST ALLOCATION AMONG THE ENTITIES IS PERFORMED CONSISTENTLY WITH ACCOUNTING RULES AND APPLICABLE COST ALLOCATION METHODOLOGIES. ESTIMATED NUMBER OF HOURS WORKED PER WEEK FOR RELATED ORGANIZATIONS IS AS FOLLOWS: MEDISYS HEALTH NETWORK - 10 HOURS PER WEEK FLUSHING HOSPITAL MEDICAL CENTER - 15 HOURS PER WEEK JAMAICA HOSPITAL MEDICAL CENTER - 30 HOURS PER WEEK OTHER RELATED ENTITIES LISTED ON SCHEDULE R - 10.0 HOURS PER WEEK FORM 990, PART VII, SECTION A, LINE 1B: MANAGEMENT HAS IN THE PREPARATION OF ITS FORM 990 REVIEWED PERSONNEL IN THE INSTITUTION TO SEE IF ANYONE MEETS THE CRITERIA ESTABLISHED TO BE CONSIDERED A "KEY EMPLOYEE" FOR IRS PURPOSES. IT IS THE CONTENTION OF MANAGEMENT THAT NO EMPLOYEE FULFILLS ANY OF THE SITUATIONS UNDER THE RESPONSIBILITY TEST ESTABLISHED BY THE IRS TO MEET TITLE OF KEY EMPLOYEE. THEREFORE, PART VII OF FORM 990 DOES NOT HAVE ANY INDIVIDUALS WHO WOULD BE CONSIDERED A "KEY EMPLOYEE". ANTHONY DIMARIA, M.D., RECEIVED COMPENSATION FOR THE PERFORMANCE OF SERVICES AS A PHYSICIAN FOR JAMAICA HOSPITAL NURSING HOME WORKING ABOUT 40 HOURS PER WEEK. ANTHONY DIMARIA, M.D. RECEIVED NO COMPENSATION AS A TRUSTEE FOR JAMAICA HOSPITAL DIAGNOSTIC AND TREATMENT CENTER CORP, MEDISYS HEALTH NETWORK, AND JAMAICA HOSPITAL MEDICAL CENTER, FOR EACH OF WHICH HE WORKED ABOUT 1 HOUR PER WEEK. GEOFFREY DOUGHLIN M.D., RECEIVED COMPENSATION FOR THE PERFORMANCE OF SERVICES AS A PHYSICIAN FOR JAMAICA HOSPITAL MEDICAL CENTER, FOR WHICH HE WORKED ON AVERAGE 40 HOURS PER WEEK. GEOFFREY DOUGHLIN M.D. RECEIVED NO COMPENSATION AS A TRUSTEE FOR JAMAICA HOSPITAL DIAGNOSTIC AND TREATMENT CENTER CORP. THE JAMAICA MEDICAL CENTER AND DIAGNOSTIC AND TREATMENT CENTER CORP, AND MEDISYS HEALTH NETWORK, FOR EACH OF WHICH HE WORKED ABOUT 1 HOUR PER WEEK. FORM 990, PART XII, 2C: THE SELECTION & OVERSIGHT PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. ADVANCED CENTER FOR PSYCHOTHERAPY 89-06 135TH STREET JAMAICA NY 11418 111864871 HEALTHCARE NY 501(C)(3) 9 MEDISYS HEALTH NETWORK 0 ALLIED HEALTH FOUNDATION OF QUEENS INC 4500 PARSONS BLVD FLUSHING NY 11355 112813535 INACTIVE NY 501(C)(3) 9 MEDISYS HEALTH NETWORK 0 FLUSHING HOSPITAL MEDICAL CENTER 4500 PARSONS BLVD FLUSHING NY 11355 111631781 HOSPITAL NY 501(C)(3) 3 MEDISYS HEALTH NETWORK 0 INTERNATIONAL ASSOCIATION OF MEDICAL BIKE UNITS INC 8900 VAN WYCK EXPY JAMAICA NY 11418 113483140 INACTIVE NY 501(C)(3) 9 MEDISYS HEALTH NETWORK 0 JAMAICA HOSPITAL MEDICAL CENTER 8900 VAN WYCK EXPY JAMAICA NY 11418 111631788 HEALTHCARE NY 501(C)(3) 3 MEDISYS HEALTH NETWORK 0 JAMAICA HOSPITAL NURSING HOME 90-28 VAN WYCK EXPY JAMAICA NY 11418 237216197 HEALTHCARE NY 501(C)(3) 3 MEDISYS HEALTH NETWORK 0 MEDISYS AMBULANCE SERVICE 8900 VAN WYCK EXPY JAMAICA NY 11418 542124788 HEALTHCARE NY 501(C)(3) 9 MEDISYS HEALTH NETWORK 0 MEDISYS HEALTH NETWORK 8900 VAN WYCK EXPY JAMAICA NY 11418 113316802 ADMIN NY 501(C)(3) 11A N/A 0 NEIGHBORHOOD HEALTH PROVIDERS INC 521 FIFTH AVE 3RD FLOOR NEW YORK NY 10175 943474115 MANAGED CARE PLAN NY 501(C)(3) 9 JAMAICA HOSPITAL MEDICAL CENTERLINROC COMMUNITY SERVICE CORP 0 VWE PROPERTIES CORPORATION 8900 VAN WYCK EXPY JAMAICA NY 11418 113485165 PARKING GARAGE NY 501(C)(3) 11A MEDISYS HEALTH NETWORK 0 NHP HOLDINGS LLC 521 FIFTH AVE 3RD FLOOR NEW YORK NY 10175 203418837 HOLDING COMPANY NY N/A ROYAL HEALTHCARE OF LONG ISLAND 521 FIFTH AVE 3RD FLOOR NEW YORK NY 10175 133887900 MANAGEMENT SERVICES ORG. NY N/A FRR RECOVERY SERVICES 80 MARCUS DRIVE MELVILLE NY 11747 113454555 COLLECTION AGENCY NY N/A C 0 HI TECH MEDICAL EQUIPMENT 103-51 101 ST OZONE PARK NY 11416 113313334 DURABLE MEDICAL EQUIPMENT COMPANY NY N/A C 0 JAMAICA RX 8900 VAN WYCK EXPRESSWAY JAMAICA NY 11418 205292781 RETAIL PHARMACY NY N/A C 0 MEDISYS HOME CARE SERVICE INC 8900 VAN WYCK EXPRESSWAY JAMAICA NY 11418 030474027 HOME CARE STAFFING/INACTIVE NY N/A C 0 MEDISYS IPA 8900 VAN WYCK EXPRESSWAY JAMAICA NY 11418 113452476 PHYSICIAN CONTRACTING/INACTIVE NY N/A C 0 MEDISYS SERVICE CORPORATION 8900 VAN WYCK EXPRESSWAY JAMAICA NY 11418 113479920 HOLDING COMPANY NY N/A C 0 MEDISYS VENTURES 111 STEWART AVE HICKSVILLE NY 11801 113431792 HOLDING COMPANY NY N/A C 0 MHN REALTY 8900 VAN WYCK EXPRESSWAY JAMAICA NY 11418 113458286 REAL ESTATE/INACTIVE NY N/A C 0 SECOND CENTURY SERVICE CORPORATION 4500 PARSONS BLVD FLUSHING NY 11355 112843101 RETAIL PHARMACY NY N/A C 0 0 0 0 0 1 0 0 0 0 0 0 0 1 1 1 1 1 0 1 FRR RECOVERY INC P 3359 COST