2014-11-14T08:21:18-06:00 2013-12-31 990 2013-01-01 112837244 THE LONG ISLAND HOME % MS PATRICIA PORTER CFO LONG 6316085107 400 SUNRISE HIGHWAY Suite AMITYVILLE NY 11701 Patricia A Porter CFO 2014-10-28 2013 2015-11-30 17:44:51Z ROBERT E DETOR CEO 400 SUNRISE HIGHWAY AMITYVILLE NY 11701 94361563 false X WWW.LONGISLANDHOME.ORG X 1999 NY THE LONG ISLAND HOME STRIVES TO PROVIDE innovative, effective and cost-efficient services within an integrated community health delivery system. 21 15 1329 0 522512 758414 88370935 93067782 17058 32584 427956 496020 89338461 94354800 0 0 0 0 72771888 60881826 0 0 0 27615614 25620795 100387502 86502621 -11049041 7852179 86194772 99534715 73088201 77323764 13106571 22210951 THE LONG ISLAND HOME PROVIDES INNOVATIVE, EFFECTIVE AND COST-EFFICIENT SERVICES WITHIN AN INTEGRATED COMMUNITY HEALTH DELIVERY SYSTEM, AND PROMOTES THE HIGHEST PRACTICAL LEVELS OF WELLNESS AND INDEPENDENCE FOR PATIENTS AND FAMILIES. false false 42433665 52731462 SOUTH OAKS HOSPITAL (SOH) IS A FREESTANDING PYSCHIATRIC HOSPITAL LICENSED BY THE NEW YORK STATE OFFICE OF MENTAL HEALTH (OMH) AND OFFICE OF ALCOHOLISM AND SUBSTANCE ABUSE SERVICES (OASAS). MENTAL HEALTH SERVICES ARE PROVIDED TO CHILDREN, ADOLESCENTS, ADULTS, AND GERIATRICS. SOH ALSO PROVIDES PARTIAL HOSPITALIZATION TREATMENT FOR ADULTS AND ADOLESCENTS. THIS SETTING PROVIDES INTENSIVE PSYCHIATRIC TREATMENT IN A STRUCTURED ENVIRONMENT. COMPREHENSIVE OUTPATIENT BEHAVIORAL SERVICES (COBS) PROGRAM SERVICES YOUTHS AND FAMILIES WITHIN THE COMMUNITY. 34176075 40336320 BROADLAWN MANOR NURSING AND REHABILITATION CENTER IS A COMPREHENSIVE RESIDENTIAL HEALTH CARE FACILITY, LICENSED IN NEW YORK STATE, OFFERING PROGRESSIVE AND INNOVATIVE CARE. INCLUDED IN THEIR FACILITY BEDS ARE A 40 BED SUBACUTE UNIT AND TWO 40 BED UNITS DEDICATED TO ALZHEIMER'S DISEASE AND RELATED DEMENTIAS. THE NURSING CENTER ALSO PROVIDES A NUMBER OF SPECIALTY SERVICES. ADULT DAY HEALTH SERVICES PROVIDES THERAPEAUTIC, REHABILITATIVE AND RECREATIONAL SERVICES TO THE MEDICALLY IMPAIRED OLDER ADULT AND THE DISABLED. 76609740 true true false false false false false false false false true false false true true true false true false false false false false false false false true true false false true false false false false false false false false false false false false false true false false false true 39 0 true 1329 true false false false false false false false false false false false false false X 21 15 true false false false false false false true true false false true true true true true true true true false NY X MS PATRICIA PORTER CFO 6316085107 400 SUNRISE HIGHWAY AMITYVILLE NY 11701 ROBERT E DETOR PRESIDENT & CEO 35.0 X X 772261 0 329052 ROGER A BLUMENCRANZ TRUSTEE 2.0 X 0 0 0 ROBERT W CHASANOFF TRUSTEE 2.0 X 0 0 0 ELLEN RICCIUTI VICE CHAIRPERSON 1.0 X X 0 0 0 STEPHEN SIPOLA TRUSTEE 1.0 X 0 0 0 MICHAEL STOLTZ TRUSTEE 1.0 X 0 0 0 MICHAEL E FELDMAN TRUSTEE 2.0 X 0 0 0 ROBERT F ROSE CHAIRMAN 3.0 X X 0 0 0 JOHN T O CONNELL TRUSTEE 1.0 X 0 0 0 RICHARD DUNNE TRUSTEE 1.0 X 0 0 0 RAYMOND J FUREY TRUSTEE 1.0 X 0 0 0 JACQUELINE S HARRIS TRUSTEE 1.0 X 0 0 0 MARK CLASTER TRUSTEE 2.0 X 0 0 0 LLOYD M GOLDMAN TRUSTEE 2.0 X 0 0 0 RICHARD D GOLDSTEIN TRUSTEE 2.0 X 0 0 0 MARK SHAW TRUSTEE 1.0 X 0 0 0 DONALD ZUCKER TRUSTEE 2.0 X 0 0 0 JEFFREY A KRAUT TRUSTEE/SVP PLANNING, NSLIJ 50.0 X 0 924283 213431 WINIFRED MACK TRUSTEE/REG EXEC DIR, NSLIJ 50.0 X 0 867939 383505 MARK J SOLAZZO TRUSTEE/ EVP & COO, NSLIJ 50.0 X 0 1894904 325554 DEBORAH TASCONE TRUSTEE/REG EXEC DIR, NSLIJ 50.0 X 0 462300 43150 PATRICIA A PORTER CFO 35.0 X 293699 0 95531 ROBERT S SHAPIRO TRUSTEE/EVP & CFO, NSLIJ 50.0 X 0 1199086 243156 KEITH THOMPSON TRUSTEE/GENERAL COUNSEL, NSLIJ 50.0 X 0 876784 50350 HOWARD B GOLD TRUSTEE/EVP MANAGED CARE,NSLIJ 50.0 X 0 3456217 327498 LAURENCE A KRAEMER TRUSTEE/ASST SECRETARY, NSLIJ 50.0 X 0 484790 43150 HARRY GINDI TRUSTEE/ASST SECRETARY NSLIJ 50.0 X 0 314462 43150 Laura Peabody SVP & Chief Legal Officer 50.0 X 0 261869 43150 Andrew Schulz Vp & General Counsel 50.0 X 0 522928 43150 YOGENDRA UPADHYAY MD MEDICAL DIRECTOR 35.0 X 398726 0 32087 KIRAN KAMDAR MD PHYSICIAN 35.0 X 315684 0 26991 RICHARD KRUGLEY MD PHYSICIAN 35.0 X 350483 0 24721 KARAN KUMAR MD PHYSICAN 35.0 X 357984 0 24480 Patrice Reives-Bright Physician 35.0 X 293501 0 32669 2782338 11265562 2324775 45 false true false AFFINITY REHABILITATION 10600 YORK ROAD SUITE 105 COCKEYSVILLE MD 21030 PT/OT/ST THERAPY 1754999 Transcare Ambulance Corp 1 Metrtech Center 20th Floor BROOKLYN NY 11201 Transportation SVCS 876382 North Shore-LIJ Core Laboratory 10 Nevada Drive LAKE SUCCESS NY 11201 LABORARTORY SERVICES 549870 ERNST YOUNG LLP 395 NORTH SERVICE ROAD MELVILLE NY 11747 AUDITING SERVICES 165000 PHOENIX MEDICAL BILLING CONSULTAN PO BOX 1203 BELLMORE NY 11710 PHYSICIAN BILLING SV 137249 57 3921 533610 220883 758414 BEHAVIORAL HEALTH PSYCHIATRIC 900099 52731462 52731462 SENIOR HEALTH SERVICES 623000 40336320 40336320 93067782 32584 32584 0 0 39468 39468 0 39468 0 10375 3921 6763 3612 0 0 EXCESS UTILITIES 221000 22451 22451 CAFETERIA 722210 100286 100286 CHALLENGE ACCTIVITIES ROPES 900099 72392 72392 257811 164857 92954 452940 94354800 93305031 248275 0 0 0 0 1065960 1065960 0 51234367 47922745 3311622 0 -8548423 -7713806 -834617 12992394 11865930 1126464 4137528 3778797 358731 155391 155391 210150 210150 0 0 0 0 0 146746 2017 144729 329447 271840 57607 840727 840727 0 1747877 1264117 483760 52704 41920 10784 0 24881 19765 5116 1601501 1601501 0 2337463 2114447 223016 1392185 1250879 141306 BAD DEBT 1428034 1428034 PURCHASED SERVICES 5663218 4978837 684381 COST OF DRUGS 2340206 2338462 1744 STATE CASH ASSESSMENT 1957021 1957021 5393244 5088735 304509 86502621 76609740 9892881 0 1620546 1814692 2580510 2247074 0 0 11806244 14194307 0 0 0 0 0 0 481362 475230 604145 760122 58471907 3473958 55009314 54997949 74146 7073433 0 0 0 0 0 0 14018505 17971908 86194772 99534715 7990661 8000013 0 0 0 0 0 0 0 0 0 0 31824920 30012984 0 0 33272620 39310767 73088201 77323764 X 13106571 22210951 0 0 0 0 13106571 22210951 86194772 99534715 X 7852179 -713 1252914 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 20669023 20669023 32042903 1824589 30218314 5415960 1649369 3766591 344021 344021 54997949 INSURANCE CLAIMS RECIEVABLE 8439748 457B PLAN ASSETS 438300 INTANGIBLE ASSETS 8700000 OTHER ASSETS 393860 17971908 0 PENSION & POST-RET. BENEFITS 2289065 ACCRUED PENSION LIAB 3827575 DUE TO THIRD PARTY PAYORS 1472471 INTEREST RATE SWAP LIABILITY 1433997 INSURANCE CLAIMS LIABILITY 8439748 NOTE PAYABLE TO AFFILIATE 16989106 MALPRACTICE & OTHER INSURANCE LIABILITY 3643391 DUE TO AFFILIATE 1215414 39310767 X 92926053 -713 -1428034 -1428747 94354800 94354800 96280352 96280352 -9777731 -9777731 86502621 PART X, LINE 2 The Long Island Home and the Foundation are exempt from federal income taxes under the provisions of Section 501(a) of the Internal Revenue Code (the Code) as organizations described in Section 501(C)(3) and are also exempt from New York State and local income taxes. LIH has determined that there are no material uncertain tax positions that require recognition or disclosure in the consolidated financial statements. LIH's Wholly Owned, For-Profit entities (SOMBHA, Inc. and LIPA-1, Inc., both of which are currently dormant) are taxable entities under federal and state laws. PART XI, LINE 2D PROVISION FOR BAD DEBT (1,428,034) TOTAL (1,428,034) PART XII, LINE 4B ADDITIONAL MINIMUM PENSION Adjustment (11,205,765) PROVISION FOR BAD DEBTS 1,428,034 TOTAL (9,777,731) true true X true X true X 500. true true true false true true 1 422249 422249 0.00780 1 1288560 1288560 0.02390 2 1710809 1710809 0.03170 1 29 10616 10616 0.00020 1 619526 619526 0.01150 2 29 630142 630142 0.01170 4 29 2340951 2340951 0.04340 false 960999 96100 13411037 11734807 1676230 X true true 1 1 SOUTH OAKS HOSPITAL 400 SURNISE HIGHWAY AMITYVILLE NY 11701 WWW.LONGISLANDHOME.ORG 5199001N X SOUTH OAKS HOSPITAL 1 true X X X X X X X X X 13 true true true X www.northshorelij.com X X X X X X X X X false false true true 100 true 500. true X X X X X X X true true X X X X X X X true false X X X X X true X false false PART V, SECTION C - SUPPLEMENTAL INFORMATION Part V, Section B, line 1j: N/A Part V, Section B, line 3: The CHNA was facilitated by committees established within each county served by NSLIJ and its hospitals. These were comprised of participants such as Departments of Health; community based organizations (CBOs); the NSLIJ Health System; local businesses; and faith-based organizations; and a "voice of the community" (i.e. the community's perception of need). 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 surveys and key informant interviews. Emphasis was placed on the following populations: minorities/underserved communities, seniors, women and children, special populations, and individuals with disease-specific conditions. Primary data was obtained through qualitative analysis of CBO informant interviews, CBO surveys, individual community member surveys, and participation in the collaborative partner listening sessions. For further detail go to web link: http://www.northshorelij.com/hospitals/about-us/about-us-community-service -plans-benefit-report Part V, Section B, line 4: For a detailed listing of other hospital facilities go to web link: http://www.northshorelij.com/hospitals/about-us/about-us-community-service -plans-benefit-report Part V, Section B, line 5d: N/A Part V, Section B, line 6i: N/A Part V, Section B, line 7: The hospital identified and addressed primary needs based on an assessment of the highest ranked health priorities of the community, regulatory input (I.E. the NYC Department of Health prevention priority agenda), and resources available. For further information go to web link: http://www.northshorelij.com/hospitals/about-us/about-us-community-service -plans-benefit-report Part V, Section B, line 10: N/A Part V, Section B, line 11: N/A Part V, Section B, line 12i: The hospital also uses household size. Part V, Section B, line 14g: 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 16e: N/A Part V, Section B, line 17e: N/A Part V, Section B, line 18e: Before initiating any of the actions, the hospital facility sends letters, makes telephone calls and utilizes presumptive eligibility. Part V, Section B, line 19c: N/A Part V, Section B, line 19d: N/A Part V, Section B, line 20d: The hospital used a blended Medicaid rate as a criterion during the tax year to determine the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care. Under NYS Health Law Section 2807-k (9a) indigent care pool requires a sliding fee scale from qualifying patients. A reduction from gross charges must result in an expected payment that does not exceed the amount paid for the same services by the hospital's highest volume payer (i.e. Medicare or Medicaid) Part V, Section B, line 21: N/A 1 BROADLAWN MANOR NURSING & REHABILITATION 399 COUNTY LINE ROAD AMITYVILLE NY 11701 SKILLED NURSING FACILITY PART VI - SUPPLEMENTAL INFORMATION Question 1: Part I, Line 3c: This hospital is an affiliated entity of the North Shore-LIJ Health System ("North Shore-LIJ" or "the System"). North Shore-LIJ uses FPG to determine eligibility and utilizes the New York State Department of Health (NYSDOH) guidelines regarding the consideration of assets. Asset tests cannot be used to deny financial assistance, but only to "upgrade" a patient's level of obligation, up to the legal maximum permitted under the financial assistance law. Part I, Line 6a: The Community Benefit report is prepared by the hospital, in conjunction with an affiliated entity (North Shore-Long Island Jewish Health System) of the hospital. The Community Benefit Report is accessible to the public and can be accessed on the North Shore-LIJ website: http://www.northshorelij.com. 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 hospital facility 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 (a) The number of activities or programs was determined by counting unique community benefit activities or programs conducted throughout the year. Each activity or program may include multiple occurrences. In Part I line 7a-k, column (a) represents the total number of unique community benefit activities and programs; not the number of occurrences for each activity and program. Column (b) Persons served were determined by the unique number of community members that encountered a specific community benefit activity or program. Persons were reported multiple times when engaged in services in different categories of activity or program. Column (f) for Rows (a)-(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 North Shore-LIJ Health System, Part I, Line 7 (Row K, Column F) is approximately 11.5% 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. The System's bioterrorism & disaster preparedness includes Center for Emergency Medical Services, which is a state and federal planning resource on weapons of mass destruction, and a designated a Bioterrorism Resource Center. The System 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, (i.e. Super storm Sandy), North Shore-LIJ provides a safe haven for thousands of patients, outside nursing home residents, and community members seeking shelter. North Shore-LIJ ambulances assists with the transport of patients throughout the metropolitan area and stand ready to contribute food, medicine and blankets to numerous individuals who may lose power in their homes, and assist 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 the System 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 the System 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. North Shore-LIJ 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; E-BRFSS; 2010 US Census data and Statewide Planning and Research System (SPARCS) data. The Committee on Community Health, a committee of the Board of Trustees, provides recommendations that concern North Shore-LIJ'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, women and children's health, healthy safe environments, health access, mental health and substance abuse, HIV/AIDS X X X X X false true false false false false false true false ROBERT E DETOR PRESIDENT & CEO 457924 0 142000 0 172337 0 304500 0 24552 0 1101313 0 0 0 PATRICIA A PORTER CFO 243699 0 50000 0 0 0 87152 0 8379 0 389230 0 0 0 YOGENDRA UPADHYAY MD MEDICAL DIRECTOR 394427 0 4299 0 0 0 23990 0 8097 0 430813 0 0 0 KIRAN KAMDAR MD PHYSICIAN 315684 0 0 0 0 0 18612 0 8379 0 342675 0 0 0 RICHARD KRUGLEY MD PHYSICIAN 350483 0 0 0 0 0 8880 0 15841 0 375204 0 0 0 KARAN KUMAR MD PHYSICAN 357984 0 0 0 0 0 8640 0 15840 0 382464 0 0 0 ROBERT S SHAPIRO TRUSTEE/EVP & CFO, NSLIJ 0 926327 0 242000 0 30759 0 220856 0 22300 0 1442242 0 0 KEITH THOMPSON TRUSTEE/GENERAL COUNSEL, NSLIJ 0 726199 0 112000 0 38585 0 28050 0 22300 0 927134 0 0 HOWARD B GOLD TRUSTEE/EVP MANAGED CARE,NSLIJ 0 1032469 0 392000 0 2031748 0 312398 0 15100 0 3783715 0 562264 LAURENCE A KRAEMER TRUSTEE/ASST SECRETARY, NSLIJ 0 431036 0 33152 0 20602 0 28050 0 15100 0 527940 0 0 HARRY GINDI TRUSTEE/ASST SECRETARY NSLIJ 0 288687 0 21382 0 4393 0 28050 0 15100 0 357612 0 0 JEFFREY A KRAUT TRUSTEE/SVP PLANNING, NSLIJ 0 720655 0 158000 0 45628 0 198331 0 15100 0 1137714 0 0 WINIFRED MACK TRUSTEE/REG EXEC DIR, NSLIJ 0 726486 0 107000 0 34453 0 368405 0 15100 0 1251444 0 0 MARK J SOLAZZO TRUSTEE/ EVP & COO, NSLIJ 0 1166663 0 700000 0 28241 0 310664 0 14890 0 2220458 0 0 DEBORAH TASCONE TRUSTEE/REG EXEC DIR, NSLIJ 0 430542 0 0 0 31758 0 28050 0 15100 0 505450 0 0 Patrice Reives-Bright Physician 293501 0 0 0 0 0 8116 0 24553 0 326170 0 0 0 Laura Peabody SVP & Chief Legal Officer 0 161148 0 100000 0 721 0 28050 0 15100 0 305019 0 0 Andrew Schulz Vp & General Counsel 0 468164 0 33897 0 20867 0 28050 0 15100 0 566078 0 0 PART I, LINE 4B Certain individuals participate in a Supplemental Executive Retirement Plan ("SERP") which is subject to substantial risk of complete forfeiture. Accordingly, the individual may never actually receive the unvested benefit amount and the amounts outlined herein were properly not reported in each individual's Form W-2, Box 5. These amounts are included in Schedule J, Column C for Mark J Solazzo ($282,614), Robert S Shapiro ($192,806), Jefferey Kraut ($170,281), Howard B Gold ($284,348), Winfred Mack ($340,355), Robert E Detor ($270,634), and Patricia A Porter ($67,451). PART I, LINE 7 On Form 990, Part VII, Section A, line 1A, the organization may provide non-fixed payments, not described on lines 5 and 6, to certain listed persons. The organization bases such payments on many performance based factors. Payments of this type appear on Schedule J, Part II, B (ii). Schedule J, Part II, Column (F) The amount reported in Schedule J, Part II, Column (F) includes SERP amounts which were previously reported on Form 990, Schedule J, Part II, Column (C) in prior years. In accordance with the IRS instructions, these amounts were originally reported when contributions were made to the SERP plan and are now being reported for a second time upon receipt of distribution from the SERP plan. PART VI, SECTION A, LINE 2 All transactions with North Shore-LIJ Health System entities 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. Roger Blumencranz has a business relationship with Richard Goldstein. Mark Claster has a business relationship with Richard Goldstein. Robert Detor has a business relationship with Michael Stoltz. Richard Goldstein has a business relationship with Roger Blumencranz, Mark Claster and Lloyd Goldman Lloyd Goldman has a business relationship with Richard Goldstein. Michael Stoltz has a business relationship with Robert Detor. PART VI, SECTION B, LINE 11 The annual Return of Organization Exempt From Income Tax (Form 990) for North Shore-LIJ Health System 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, LINE 12 The North Shore-Long Island Jewish Health System ("Health System") has several control mechanisms to mitigate conflicts of interest. The Health System's Code of Ethical Conduct contains a detailed section educating individuals about how to avoid potential conflicts of interest. Specifically, our Code of Ethical Conduct requires individuals to conduct Health System business in a manner that places the interests of the Health System ahead of their personal interests. In addition, the Health System has a Conflicts of Interest Policy Statement further elaborating upon individuals' disclosure and recusal obligations. Individuals that are in a position to influence the business or other decisions of the Health System are required to fill out a conflicts of interest disclosure form on a regular basis. The Corporate Compliance Office reviews all disclosures of possible conflicts, including matters disclosed in any conflicts of interest disclosure report and takes any actions deemed required or appropriate to manage or resolve any actual or potential conflicts of interest. In appropriate cases these disclosures and responsive actions will be reported to the Health System's Audit and Corporate Compliance Committee and other applicable committees. In addition, the Health System provides training to individuals on an annual basis regarding conflicts of interest and other compliance related topics. If an individual violates the Code of Ethical Conduct or any related policy such as the Conflicts of Interest Policy Statement, appropriate disciplinary action is taken based upon the facts and circumstances of the situation. PART VI, SECTION B, LINE 15b The by-laws of the Health System create a committee of the Board with full powers of the Board to review and approve the compensation of officers and other key employees. The committee consists of approximately 6 trustees who have no connection to the System except as trustees and they have no conflicts as to matters they consider. The committee meets several times a year as needed but always meets in November/December to review and determine officer and key employee compensation for the following year. For purposes of their review the committee considers the recommendations of the CEO for all persons other than the CEO. For purposes of the review each year the committee receives information from an outside independent compensation consultant as to compensation for comparable positions in comparable organizations and makes its decisions on this basis, with the overall objective of paying base salary at the 50th percentile. Any contracts or other compensation for officers or key employees are separately considered and normally only approved after receipt of a "fairness opinion" from the independent consultant. .All the work and process of the committee is structured to fall within the applicable safe harbor regulations. PART VI, SECTION C, LINE 19 CURRENTLY THE ORGANIZATION PROVIDES GOVERNANCE DOCUMENTS, CONFLICT OF INTEREST POLICIES AND FINANCIAL STATEMENTS TO THE PUBLIC UPON REQUEST. PART XI, LINE 9 CHANGE IN INTEREST RATE SWAP 1,252,914 TOTAL OTHER CHANGES IN NET ASSETS OR FUND BALANCES 9,104,089 NORTH SHORE-LIJ HEALTH SYSTEM 972 BRUSH HOLLOW RD WESTBURY NY 11590 113418133 SUPPORT NY 501(C)(3) 11, TYPE 1 NA false NORTH SHORE-LIJ HEALTH CARE INC 972 BRUSH HOLLOW RD WESTBURY NY 11590 112965586 SUPPORT NY 501(C)(3) 11, TYPE 1 NSLIJ HS false NORTH SHORE UNIVERSITY HOSPITAL 972 BRUSH HOLLOW RD WESTBURY NY 11590 111562701 HEALTH CARE NY 501(C)(3) 3 NSLIJ HCI false LONG ISLAND JEWISH MEDICAL CENTER 972 BRUSH HOLLOW RD WESTBURY NY 11590 112241326 HEALTH CARE NY 501(C)(3) 3 NSLIJ HCI false GLEN COVE HOSPITAL 972 BRUSH HOLLOW RD WESTBURY NY 11590 111633487 HEALTH CARE NY 501(C)(3) 3 NSLIJ HCI false FOREST HILLS HOSPITAL 972 BRUSH HOLLOW RD WESTBURY NY 11590 112163522 HEALTH CARE NY 501(C)(3) 3 NSLIJ HCI false PLAINVIEW HOSPITAL 972 BRUSH HOLLOW RD WESTBURY NY 11590 113241243 HEALTH CARE NY 501(C)(3) 3 NSLIJ HCI false FRANKLIN HOSPITAL 972 BRUSH HOLLOW RD WESTBURY NY 11590 112296824 HEALTH CARE NY 501(C)(3) 3 NSLIJ HCI false SOUTHSIDE HOSPITAL 972 BRUSH HOLLOW RD WESTBURY NY 11590 111667761 HEALTH CARE NY 501(C)(3) 3 NSLIJ HCI false NORTH SHORE-LIJ HEALTH SYSTEM LABS 972 BRUSH HOLLOW RD WESTBURY NY 11590 113412370 SUPPORT NY 501(C)(3) 11, TYPE 1 NSLIJ HS false FEINSTEIN INSTITUTE FOR MEDICAL RESEARCH 972 BRUSH HOLLOW RD WESTBURY NY 11590 112673595 RESEARCH NY 501(C)(3) 4 NSLIJ HS false NORTH SHORE-LIJ HEALTH SYSTEM FOUNDATION 972 BRUSH HOLLOW RD WESTBURY NY 11590 112965586 FUNDRAISING NY 501(C)(3) 7 NSLIJ HS false NS-LIJ STERN FAMILY CENTER FOR REHAB 972 BRUSH HOLLOW RD WESTBURY NY 11590 237007485 NURSING HOME NY 501(C)(3) 9 NSLIJ HCI false LIJ AT HOME PHARMACY 972 BRUSH HOLLOW RD WESTBURY NY 11590 113251128 SUPPORT NY 501(C)(3) 11, TYPE 1 NSLIJ HS false LIJ FOUNDATION 972 BRUSH HOLLOW RD WESTBURY NY 11590 112661239 SUPPORT NY 501(C)(3) 11, TYPE 1 NSLIJ HS false NORTH SHORE-LIJ MEDICAL CARE CENTERS INC 972 BRUSH HOLLOW RD WESTBURY NY 11590 113473923 SUPPORT NY 501(C)(3) 11, TYPE 1 NSLIJ HS false SSH INC 972 BRUSH HOLLOW RD WESTBURY NY 11590 112774102 SUPPORT NY 501(C)(3) 11, TYPE 1 SOUTHSIDE false NORTH SHORE COMMUNITY SERVICES INC 972 BRUSH HOLLOW RD WESTBURY NY 11590 237273200 HOUSING NY 501(C)(2) N/A NSLIJ HS false NORTH SHORE UNIVERSITY HOSPITAL HOUSING 972 BRUSH HOLLOW RD WESTBURY NY 11590 112171903 HOUSING NY 501(C)(2) N/A NSLIJ HS false NSUH AT GLEN COVE HOUSING 972 BRUSH HOLLOW RD WESTBURY NY 11590 237010468 HOUSING NY 501(C)(2) N/A NSLIJ HS false HILLSIDE HOUSING HOUSES INC 972 BRUSH HOLLOW RD WESTBURY NY 11590 112113949 HOUSING NY 501(C)(2) N/A NSLIJ HS false SIUH SYSTEMS INC 475 SEAVIEW AVE STATEN ISLAND NY 10305 061074604 FUNDRAISING NY 501(C)(3) 7 NSLIJ HCI false STATEN ISLAND UNIVERSITY HOSPITAL 475 SEAVIEW AVE STATEN ISLAND NY 10305 112868878 HEALTH CARE NY 501(C)(3) 3 NSLIJ HCI false STATEN ISLAND UNIVERSITY HOSPITAL FDN 360 SEAVIEW AVE STATEN ISLAND NY 10305 870765787 FUNDRAISING NY 501(C)(3) 7 SIUH false THE HEART INSTITUTE 475 SEAVIEW AVE STATEN ISLAND NY 10305 311757254 INACTIVE NY 501(C)(3) 11, TYPE 1 NA false CHAPS COMMUNITY HEALTH CENTER INC 1 EDGEWATER PLAZA 6TH FL STATEN ISLAND NY 10305 113345477 INACTIVE NY 501(C)(3) 9 SIUH false PHYSICIANS OF UNIVERSITY HOSPITAL PC 1 EDGEWATER PLAZA 6TH FL STATEN ISLAND NY 10305 200096809 HEALTH CARE NY 501(C)(3) 11, TYPE 1 SIUH false HOSPICE CARE NETWORK 99 SUNNYSIDE BVLD WOODBURY NY 11797 112925757 HOSPICE NY 501(C)(3) 9 NSLIJ HS false HUNTINGTON HOSPITAL 270 PARK AVENUE HUNTINGTON NY 11743 111630914 HEALTH CARE NY 501(C)(3) 3 NSLIJ HCI false HUNTINGTON HOSPITAL DOLAN FAMILY HEALTH 284 PULASKI RD GREENLAWN NY 11740 113368503 HEALTH CARE NY 501(C)(3) 3 HUNTINGTON false LENOX HILL HOSPITAL 972 BRUSH HOLLOW RD WESTBURY NY 11590 131624070 HEALTH CARE NY 501(C)(3) 3 NSLIJ HCI false LHH CORPORATION 100 EAST 77TH ST NEW YORK NY 10021 133272016 SUPPORT NY 501(C)(3) 11, TYPE 1 NSLIJ HS false THE ELMEZZI GRADUATE SCHOOL OF MOLECULAR 972 BRUSH HOLLOW RD WESTBURY NY 11590 113284934 GRAD SCHOOL NY 501(C)(3) 2 RESEARCH false SPORTS PHYSICAL THERAPY AND REHAB SVCS 972 BRUSH HOLLOW RD WESTBURY NY 11590 061655704 HEALTH CARE NY 501(C)(3) 9 LIJ false NORTH SHORE-LIJ ALLIANCE 972 BRUSH HOLLOW RD WESTBURY NY 11590 263727582 HEALTH CARE NY 501(C)(3) 3 NA false CLNY Alliance Inc 972 Brush Hollow Road Westbury NY 11590 463146870 Laboratory NY Applied For NS-LIJ Labs false North Shore-LIJ Cardiovascular Medicine 972 Brush Hollow Road Westbury NY 11590 275078717 Medical Servi NY 501(C)(3) 11, Type 1 NSUH false North Shore-LIJ Cardiology At Deer Park 972 Brush Hollow Road Westbury NY 11590 275078531 Medical Servi NY 501(C)(3) 11, Type 1 NSUH false North Shore-LIJ Heart Surgery PC 972 Brush Hollow Road Westbury NY 11590 275078838 Medical Servi NY 501(C)(3) 11, Type 1 NSUH false North Shore-LIJ Internal Medicine PC 972 Brush Hollow Road Westbury NY 11590 275078631 Medical Servi NY 501(C)(3) 11, type 1 NSUH false North Shore-LIJ Medical Group Urgent Med 972 Brush Hollow Road Westbury NY 11590 275078426 Medical Servi NY 501(C)(3) 11, Type 1 NSUH false North Shore-LIJ Medical PC 972 Brush Hollow Road Westbury NY 11590 453023019 Medical Servi NY 501(C)(3) 11, type 1 NSUH false North Shore-LIJ Health Plan Inc 972 Brush Hollow Road Westbury NY 11590 461617516 Insurance NY Applied For NS-LIJ HC false KRASNOFF CONSULTATIVE SERVICES LLC 972 BRUSH HOLLOW RD WESTBURY NY 11590 262838027 CONSULTING NY CMG LONG ISLAND BEHAVIORAL HEALTH LLC 972 BRUSH HOLLOW RD WESTBURY NY 11590 453572263 STATISTICS NY NSLIJ HCI Endoscopy Center of Long Island 972 Brush Hollow Road Westbury NY 11590 260000980 Medical Services NY NS-LIJ Ventures True North Urgent Care LLC 972 Brush Hollow Road Westbury NY 11590 464113494 Medical Services NY NSLIJ Urgent Ca True North DC LLC 972 Brush Hollow Road Westbury NY 11590 464601950 Medical Services NY Renal Ventures Synergy Health True North LLC 972 Brush Hollow Road Westbury NY 11590 464106483 Medical Services NY Central Sterile North Shore-LIJ Medical Air Transport L 972 Brush Hollow Road Westbury NY 11590 464858222 Air Transport NY NSUH NORTH SHORE HEALTH SYSTEM ENTERPRISES 972 BRUSH HOLLOW RD WESTBURY NY 11590 113316922 HOLDING COMPA NY NSLIJ HS C false REGIONCARE INC 972 BRUSH HOLLOW RD WESTBURY NY 11590 113052191 HOMECARE NY NSHS ENT C false NORTH SHORE HEALTH ENTERPRISES 972 BRUSH HOLLOW RD WESTBURY NY 11590 061605319 HOLDING COMPA NY NSHS ENT C false CARE MANAGEMENT GROUP OF GREATER NY 972 BRUSH HOLLOW RD WESTBURY NY 11590 113336381 BUSINESS SERV NY NSH ENT C false VIVOHEALTH INC 972 BRUSH HOLLOW RD WESTBURY NY 11590 264118016 HEALTH CARE NY NSH ENT C false REGIONAL INSURANCE COMPANY LTD C/O CEDAR HOUSE 41 CEDAR AVE HAMILTON BERMUDA BD HM 12 000000000 INSURANCE BD NSLIJ HCI C false ALETTA CORPORATION 972 BRUSH HOLLOW RD WESTBURY NY 11590 112622371 HEALTH CARE NY SOUTHSIDE C false NS-LIJ PHYSICIAN INSURANCE COMPANY RRG 100 BANK ST BURLINGTON VT 05401 261487515 INSURANCE VT NSLIJ HCI C false NORTH SHORE-LIJ SERVICE ALLIANCE INC 972 BRUSH HOLLOW RD WESTBURY NY 11590 263651575 SUPPORT NY NA C false NORTH SHORE-LIJ HEALTH SYSTEM IPA #1 972 BRUSH HOLLOW RD WESTBURY NY 11590 113533659 HEALTH CARE NY LIJ C false NORTH SHORE-LIJ HEALTH SYSTEM IPA #2 972 BRUSH HOLLOW RD WESTBURY NY 11590 113533670 HEALTH CARE NY LIJ C false NORTH SHORE-LIJ HEALTH SYSTEM IPA #3 972 BRUSH HOLLOW RD WESTBURY NY 11590 113533678 HEALTH CARE NY LIJ C false NORTH SHORE-LIJ HEALTH SYSTEM IPA #4 972 BRUSH HOLLOW RD WESTBURY NY 11590 113533677 HEALTH CARE NY LIJ C false NORTH SHORE-LIJ HEALTH SYSTEM IPA #5 972 BRUSH HOLLOW RD WESTBURY NY 11590 113533675 HEALTH CARE NY LIJ C false NORTH SHORE IPA 5 INC 972 BRUSH HOLLOW RD WESTBURY NY 11590 113383468 BUSINESS SERV NY NSLIJ HCI C false NORTH SHORE-LIJ NETWORK INC 972 BRUSH HOLLOW RD WESTBURY NY 11590 320257193 SUPPORT NY NSLIJ HS C false AUTOIMMUNE RESEARCH THERAPEUTICS 972 BRUSH HOLLOW RD WESTBURY NY 11590 270701489 INACTIVE NY RESEARCH C false NORTH SHORE RADIOLOGY AT GLEN COVE PC 972 BRUSH HOLLOW RD WESTBURY NY 11590 113301179 MEDICAL SERVI NY NSUH C false NORTH SHORE-LIJ RADIOLOGY SERVICES PC 972 BRUSH HOLLOW RD WESTBURY NY 11590 223970667 MEDICAL SERVI NY NSUH C false NORTH SHORE-LIJ MEDICAL GROUP AT SYOSSET 972 BRUSH HOLLOW RD WESTBURY NY 11590 273957752 MEDICAL SERVI NY NSUH C false PALLIATIVE CARE MEDICAL SERVICES PC 99 SUNNYSIDE BLVD WOODBURY NY 11797 273957835 MEDICAL SERVI NY HOSPICE C false NORTH SHORE-LIJ MEDICAL GROUP PC 972 BRUSH HOLLOW RD WESTBURY NY 11590 274384249 MEDICAL SERVI NY NSUH C false NS-LIJ MEDICAL GROUP AT HUNTINGTON 972 BRUSH HOLLOW RD WESTBURY NY 11590 274384049 MEDICAL SERVI NY NSUH C false NS-LIJ MEDICAL GROUP AT NORTH NASSAU PC 972 BRUSH HOLLOW RD WESTBURY NY 11590 274384146 MEDICAL SERVI NY NSUH C false NORTH SHORE-LIJ PHYSICIANS GROUP PC 972 BRUSH HOLLOW RD WESTBURY NY 11590 274384326 MEDICAL SERVI NY NSUH C false LENOX HILL HOSPITAL MEDICAL PC 972 BRUSH HOLLOW RD WESTBURY NY 11590 452661543 MEDICAL SERVI NY LENOX C false NS-LIJ OCCUPATIONAL MEDICINE PC 972 BRUSH HOLLOW RD WESTBURY NY 11590 451004103 MEDICAL SERVI NY NSUH C false NORTH SHORE-LIJ OB-GYN PC 972 BRUSH HOLLOW RD WESTBURY NY 11590 461382916 MEDICAL SERVI NY LIJ C false NORTH SHORE-LIJ ANESTHESIOLOGY PC 972 BRUSH HOLLOW RD WESTBURY NY 11590 461617561 MEDICAL SERVI NY SOUTHSIDE C false STATEN ISLAND IMAGING CORP 1 EDGEWATER PLAZA 6TH FL STATEN ISLAND NY 10305 133615474 INACTIVE NY OVM C false OCEAN VIEW MANAGEMENT 1 EDGEWATER PLAZA 6TH FL STATEN ISLAND NY 10305 133138888 MANAGEMENT SV NY SIUH C false OCEAN BREEZE HOME CARE AGENCY 1 EDGEWATER PLAZA 6TH FL STATEN ISLAND NY 10305 133773601 INACTIVE NY OVM C false REGENCY ALLIANCE SERVICES INC 1 EDGEWATER PLAZA 6TH FL STATEN ISLAND NY 10305 133277698 INACTIVE NY OVM C false VERRAZANO RADIOLOGY ASSOCIATES PC 500 SEAVIEW AVE STATEN ISLAND NY 10305 200011201 MEDICAL SERVI NY SIUH C false SIUH PERINATOLOGY PC 475 SEAVIEW AVE STATEN ISLAND NY 10305 134107082 MEDICAL SERVI NY SIUH C false UNITED MEDICAL SURGICAL PC 256 MASON AVE BLDG B 2ND FL STATEN ISLAND NY 10305 134038780 MEDICAL SERVI NY SIUH C false UNIVERSITY HOSPITAL ONCOLOGYHEMATOLOGY 500 SEAVIEW AVE STATEN ISLAND NY 10305 133642729 MEDICAL SERVI NY SIUH S false EMERGENCY MEDICINE SERVICES OF SI PC 1 EDGEWATER PLAZA 6TH FL STATEN ISLAND NY 10305 134200899 MEDICAL SERVI NY SIUH C false GOETHALS RADIOLOGY PC 500 SEAVIEW AVE STATEN ISLAND NY 10305 200010287 MEDIAL SERVIC NY SIUH C false STATEN ISLAND HOSPITALISTS PC 475 SEAVIEW AVE STATEN ISLAND NY 10305 331010283 MEDICAL SERVI NY SIUH C false STATEN ISLAND NEONATOLOGY PC 500 SEAVIEW AVE STATEN ISLAND NY 10305 133375474 MEDICAL SERVI NY SIUH C false STATEN ISLAND MEDICAL INTENSIVIST PC 501 SEAVIEW AVE STE 102 STATEN ISLAND NY 10305 043716494 MEDICAL SERVI NY SIUH C false LENOX HILL PHYSICIAN HOSPITAL ORG 122 EAST 76TH ST STE 3-A NEW YORK NY 10021 133775996 MANAGED CARE NY LENOX C false LENOX OTOLARYNGOLOGY HEAD & NECK SURGERY 186 EAST 76TH ST 2ND FL NEW YORK NY 10021 208784395 MEDICAL SERVI NY LENOX C false ADVANCED IMAGING & RADIOLOGY OF LHH PC 100 EAST 77TH ST NEW YORK NY 10021 200719612 MEDICAL SERVI NY LENOX C false LENOX HILL CARDIOLOGY ASSOCIATES PC 100 EAST 77TH ST NEW YORK NY 10021 133385163 MEDICAL SERVI NY LENOX C false LENOX HILL ICVS PC 130 EAST 77TH ST 9TH FL NEW YORK NY 10021 201435770 MEDICAL SERVI NY LENOX C false LENOX HILL PATHOLOGY PC 100 EAST 77TH ST NEW YORK NY 10021 133644370 MEDICAL SERVI NY LENOX C false PARK LENOX EMERGENCY MEDICINE PC 100 EAST 77TH ST NEW YORK NY 10021 262661082 MEDICAL SERVI LENOX C false PARK LENOX MEDICAL PC 100 EAST 77TH NEW YORK NY 10021 133575380 MEDICAL SERVI NY LENOX C false PARK LENOX PEDIATRICS PC 100 EAST 77TH ST NEW YORK NY 10021 133755683 MEDICAL SERVI NY LENOX C false PARK LENOX SURGICAL PC 130 EAST 77TH ST 13TH FL NEW YORK NY 10021 133397814 MEDICAL SERVI NY LENOX C false North Shore-LIJ Internal Medicine at Lyn 972 Brush Hollow Road Westbury NY 11590 463475908 Medical Services NY NSUH C false North Shore-LIJ Internal Medicine At NHP 972 Brush Hollow Road Westbury NY 11590 462822879 Medical Services NY NSUH C false North Shore-LIJ OB-GYN at Garden City P 972 Brush Hollow Road Westbury NY 11590 462886776 Medical Services NY NSUH C false North Shore-LIJ Health Plan Holding Inc 972 Brush Hollow Road Westbury NY 11590 462478147 Insurance NY NS-LIJ HC C false North Shore-LIJ CareConnect Insurance Co 972 Brush Hollow Road Westbury NY 11590 462270382 Insurance NY NSLIJ Health Pl C false NORTH SHORE MEDICAL ACCELERATOR PC 972 BRUSH HOLLOW ROAD WESTBURY NY 11590 112945979 MEDICAL SERVICES NY NSUH S false false false false false false false false false false false false false false false false false false false false