2013-11-14T17:35:20-06:00 2012-12-31 131517563 LOEB & TROPER LLP 655 THIRD AVENUE 12TH FLOOR NEW YORK NY 10017 990 2012-01-01 111661359 CENTRAL SUFFOLK HOSPITAL CENT 6315486064 1300 ROANOKE AVENUE RIVERHEAD NY 11901 ANDREW MITCHELL 6315486064 2013-11-13 1 FREDERICK H ROTHMAN P01275277 2128674000 2012 2016-02-24 21:20:13Z PECONIC BAY MEDICAL CENTER ANDREW MITCHELL 1300 ROANOKE AVENUE RIVERHEAD NY 11901 144680100 0 X WWW.PBMEDICALCENTER.ORG X 1951 NY CENTRAL SUFFOLK HOSPITAL (CSH) IS A NOT-FOR-PROFIT HOSPITAL CONSISTING OF 122 ACUTE CARE BEDS, A 60-BED SKILLED NURSING FACILITY AND A CERTIFIED HOME CARE AGENCY. CSH PROVIDES A FULL RANGE OF HEALTH CARE SERVICES TO THE LOCAL COMMUNITY. 24 22 1309 170 0 0 2165400 8915623 145939986 133860699 80244 47893 1394754 798951 149580384 143623166 0 0 0 0 70972866 77138387 0 0 77640 75956724 61178596 146929590 138316983 2650794 5306183 106938694 119049801 100323749 104485885 6614945 14563916 CENTRAL SUFFOLK HOSPITAL (CSH) IS A NOT-FOR-PROFIT HOSPITAL CONSISTING OF 122 ACUTE CARE BEDS, A 60-BED SKILLED NURSING FACILITY AND A CERTIFIED HOME CARE AGENCY. CSH PROVIDES A FULL RANGE OF HEALTH CARE SERVICES TO THE LOCAL COMMUNITY. 0 0 106504076 133860699 COMPREHENSIVE HEALTHCARE SERVICES INCLUDING EMERGENCY, SURGICAL, MEDICAL, ICU AND OBSTETRICS/GYNECOLOGICAL. TOTAL PATIENT DAYS FOR ALL INPATIENT SERVICES WERE 50,885. TOTAL OUTPATIENT VISITS WERE 101,758. 106504076 1 1 0 1 0 0 0 1 0 1 1 0 0 1 1 1 1 0 0 0 0 0 0 0 1 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 1 0 1 82 2 1 1309 1 0 0 0 0 0 1 1 0 0 0 0 X 24 22 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 NY X MICHAEL F O'DONNELL 6315486074 1300 ROANOKE AVENUE RIVERHEAD NY 11901 ANDREW MITCHELL 27.50 10.00 X X 526998 191636 53708 GERARD ZUNNO 37.50 X X 204964 0 23891 JESSE R GOODALE 1.00 X X 0 0 0 SHERRY PATTERSON 15.00 X X 0 0 0 J GORDON HUSZAGH 15.00 X X 0 0 0 CHARLES MASSOUD 15.00 X X 0 0 0 ANDREW MENDELSON 15.00 X X 0 0 0 MARC ALESSI 1.00 X 0 0 0 KENN BARRA 1.00 X 0 0 0 JAMES R FARRELL 1.00 X 0 0 0 ROBERT GAFFNEY 1.00 X 0 0 0 JOSEPH GERGELA 10.00 X 0 0 0 EDWARD HARBES 1.00 X 0 0 0 RICHARD ISRAEL 1.00 X 0 0 0 JOAN LEVAN 1.00 X 0 0 0 MARILYN A MCLAUGHLIN 1.00 X 0 0 0 RICHARD V MUSTO 1.00 X 0 0 0 RICHARD RUBENSTIEN 1.00 X 0 0 0 SCOTT B SHEREN 10.00 X 0 0 0 WILLIAM SIEMERS 1.00 X 0 0 0 GEORGE SUMMERS 1.00 X 0 0 0 MAUREEN TOBIN 1.00 X 0 0 0 RICHARD L WINSLOW 1.00 X 0 0 0 JOSEPH VAN DE WETERING 1.00 X 0 0 0 ALAN SCHECHTER 37.50 X 291367 0 26972 MICHAEL O'DONNELL 37.50 X 257591 0 33909 DEMETRIOS KADENAS 37.50 X 155062 0 8162 JAY ZUCKERMAN 37.50 X 142897 0 4245 RONALD MCMANUS 37.50 X 202861 0 32710 RICHARD KUBIAK 37.50 X 318862 0 34213 CHERYL MAKOSKE 37.50 X 171093 0 21077 PETER SULTAN MD 37.50 X 829603 0 34213 DAVID PRENTISS 37.50 X 261883 0 6484 MAHMOOD AFGHANI 37.50 X 212217 0 28898 RICHARD MALESKI 37.50 X 186936 0 14970 FAISAL HAMID 37.50 X 182426 0 27325 3944760 191636 350777 97 0 1 0 SIEMENS PO BOX 7777W3580 PHILADELPHIA PA 19175 INFORMATION TECHNOLOGY 1959937 SODEXO PO BOX 81049 WOBURN MA 01813 CAFETERIA 1382725 STONY BROOK UNIVERSITY HOSPITAL 31 RESEARCH WAY EAST SETAUKET NY 11733 EMERGENCY ROOM 1343454 CROTHALL FACILITIES 955 CHESTERBROOK BLVD WAYNE PA 19087 HOUSEKEEPING 494314 EUGENE KRAUSS 833 NORTHERN BLVD GREAT NECK NY 11021 PROFESSIONAL MEDICAL SERVICES 414583 27 259204 3743669 4912750 8915623 PATIENT CARE 621400 133703419 133703419 PROVISION OF MEDICAL SERVICES BY 621110 157280 157280 133860699 71956 71956 931823 955886 -24063 -24063 -24063 41500 259204 101048 -59548 -59548 MISCELLANEOUS REVENUE 900000 463879 463879 X-RAY SCHOOL TUITION 611430 202519 202519 CAFETERIA 624210 192101 192101 858499 143623166 133860699 0 846844 2430663 2430663 55258326 42548910 12709416 6962787 5361346 1601441 8444933 6502598 1942335 4041678 3112092 929586 765658 765658 189996 189996 11924 11924 13063755 10059091 3004664 294942 217302 77640 27389199 20556683 6832516 408941 408941 1615368 1615368 115267 88756 26511 3588437 3588437 5396402 5396402 3756216 3756216 NEW YORK STATE ASSESSME 706282 706282 3876209 2982669 893540 138316983 106504076 31735267 77640 11098521 13350611 6723958 6102830 3815070 15220717 14969476 3119724 4201170 2008956 3277580 652678 653411 132045769 72263216 57524691 59782553 3824746 4845519 6764703 8051581 106938694 119049801 18849528 19892668 40180000 38260000 4004118 3493626 37290103 42839591 100323749 104485885 X 3580911 8057925 2247126 5719083 786908 786908 6614945 14563916 106938694 119049801 X 5306183 322330 2320458 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 11924 11924 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: PORTION OF MEMBERSHIP DUES ASSOCIATED WITH LOBBYING ACTIVITIES X 0 786908 36084 36084 786908 786908 1368 1368 786908 786908 61625 61625 786908 786908 90497 90497 786908 786908 786908 1.00000 0 0 380654 380654 42545034 31933572 10611462 82238672 39468885 42769787 6881409 860759 6020650 59782553 EQUITY INTEREST IN THE CENTRAL SUFFOLK HOSPITAL FOUNDATION/ DBA PECONIC BAY 3388344 DEFERRED EXPENSES 2454160 ESTIMATED DUE FROM THIRD PARTY PAYORS 2209077 8051581 ESTIMATED MALPRACTICE COSTS 9295000 ESTIMATED DUE TO THIRD-PARTY PAYORS 5692805 CAPITAL LEASES PAYABLE 4057177 DUE TO AFFILIATE 9000000 SWAP LIABILTY 9500718 ACCRUED PENSION COSTS 5293891 42839591 X 146265954 322330 2320458 2642788 143623166 0 143623166 138316983 0 138316983 0 138316983 PART III, LINE 4: THE DONATED ARTWORK PROVIDES A SOOTHING AND CALMING ENVIRONMENT TO THE PATIENTS AND THEIR FAMILIES WHEN THEY ATTEND THE HOSPITAL FOR MEDICAL SERVICES. THE HOSPITAL HOPES THAT WITH A GOOD EXPERIENCE, THEIR PATIENTS CONTINUE TO UTILIZE THE HOSPITAL TO PROVIDE MEDICAL SERVICES. DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: ENDOWMENT FUNDS HAVE BEEN RESTRICED BY DONORS TO BE MAINTAINED BY CSH IN PERPETUITY, THE INCOME FROM WHICH IS AVAILABLE FOR GENERAL PURPOSES. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: CSH ADOPTED THE PROVISION PERTAINING TO UNCERTAIN TAX POSITIONS, ASC TOPIC 740, AND HAS DETERMINED THAT THERE ARE NO MATERIAL UNCERTAIN TAX POSITIONS THAT REQUIRE RECOGNITION OR DISCLOSURE IN THE FINANCIAL STATEMENTS. TAX RETURNS FOR THE YEARS DECEMBER 31, 2009 AND SUBSEQUENT REMAIN SUBJECT TO EXAMINATION BY APPLICABLE TAXING AUTHORITIES. PART XI, LINE 2D - OTHER ADJUSTMENTS: LOSS ON SWAP AGREEMENT -75,054. PENSION ADJUSTMENTS 1,975,786. CHANGE IN EQUITY INTEREST IN CENTRAL SUFFOLK HOSPITAL FOUNDATION 419,726. ANNUAL BALL 300704 259204 41500 20000 5449 39823 11250 24526 300704 259204 41500 20000 5449 39823 11250 24526 101048 -59548 1 1 1 X 300.000000000000 1 X 1 1 1 0 1 1 241381 273728 -32347 0.00000 17132978 12385954 4747024 0.03430 17374359 12659682 4714677 0.03430 4025670 1530574 2495096 0.01800 9182678 3263463 5919215 0.04280 13208348 4794037 8414311 0.06080 30582707 17453719 13128988 0.09510 1 4422402 17275006 42214934 50628054 -8413120 X 1 1 1 1 PECONIC BAY MEDICAL CENTER

1300 ROANOKE AVENUE RIVERHEAD NY 11901

X X X X PECONIC BAY MEDICAL CENTER 1 1 0 1 300.000000000000 0 1 1 X X X X X X 1 X X X 1 X X X X X X X 1 X 0 0 1 RIVERHEAD MANAGEMENT CORPORATION

1300 ROANOKE AVENUE REVERHEAD NY 11901

MANAGEMENT SERVICE ORGANIZATION PART III, LINE 4: BAD DEBT EXPENSES ON ACCOUNTS RECEIVABLE AND CONTRIBUTIONS RECEIVABLE ARE CHARGED IF THE RECEIVABLE IS DETERMINED TO BE UNCOLLECTIBLE BASED ON PERIODIC REVIEW BY MANAGEMENT. FACTORS USED TO DETERMINE WHETHER AN ALLOWANCE SHOULD BE RECORDED INCLUDE THE AGE OF THE RECEIVABLE AND A REVIEW OF PAYMENTS SUBSEQUENT TO YEAR END. PART III, LINE 9B: PECONIC BAY MEDICAL CENTER TAKES THE DISCOUNTED AMOUNT AFTER CHARITY (SELF PAY BALANCE) AND FOLLOWS THE SAME GUIDELINES AS SELF PAY. PECONIC BAY MEDICAL CENTER PART V, SECTION B, LINE 20D: RATES OF THE HIGHEST VOLUME PAYOR. PART VI, LINE 2: PECONIC BAY MEDICAL CENTER WAS AN ACTIVE PARTICIPANT IN THE COLLABORATIVE PLANNING PROCESS WITH THE SUFFOLK COUNTY DEPARTMENT OF HEALTH AND COMMUNITY PARTNERS TO ASSESS COMMUNITY HEALTH NEEDS IDENTIFY HEALTH PRIORITIES AND DEVELOP PUBLIC HEALTH PROGRAMS TO MEET THE IDENTIFIED NEEDS. THIS COLLABORATIVE GROUP MET FROM THE FALL OF 2008 THROUGH AUGUST OF 2009, AND SELECTED TOBACCO USE AND UNINTENTIONAL INJURY AS THE TWO HEALTH PRIORITIES IDENTIFIED IN THE NEW YORK STATE PREVENTION AGENDA TOWARD THE HEALTHIEST STATE.SMOKING CESSATION WAS SELECTED BECAUSE THE USE OF TOBACCO IS THE NUMBER ONE UNDERLYING RISK FACTOR FOR MULTIPLE DISEASES. MOREOVER, NASSAU AND SUFFOLK COUNTIES SUFFER FROM SOME OF THE HIGHEST MORTALITY RATES FROM HEART DISEASE IN NEW YORK STATE. UNINTENTIONAL INJURIES WAS SELECTED AS A PRIORITY GIVEN THE FACT THAT SUFFOLK COUNTY HAS A RELATIVELY HIGH MORTALITY RATE FOR UNINTENTIONAL INJURIES WHEN COMPARED TO NEW YORK STATE AND NATIONALLY. THE GROUP ALSO AGREED THAT GIVEN THE SHORTAGE OF RESOURCES AVAILABLE TO ADVANCE PUBLIC HEALTH AGENDAS, IT WAS IMPORTANT TO SELECT PRIORITIES THAT COULD BUILD ON PROGRAMS THAT ARE ALREADY IN PLACE.BOTH SMOKING CESSATION AND PROGRAMS TO REDUCE UNINTENTIONAL INJURIES ACCOMPLISH THIS GOAL. ONE OF THE PRIORITY INITIATIVES FOR THE SUFFOLK COUNTY OFFICE OF HEALTH EDUCATION IS TO DEVELOP AND IMPLEMENT EFFECTIVE ANTI-SMOKING PROGRAMS THAT WILL REDUCE THE RATE OF TOBACCO USE IN SCHOOL-AGED CHILDREN. IN ADDITION, MANY OF THE HOSPITALS IN SUFFOLK COUNTY, INCLUDING PECONIC BAY MEDICAL CENTER HAVE PROGRAMS AND SUPPORT GROUPS IN PLACE TO WORK WITH THEIR EMPLOYEES AND COMMUNITY BASED ORGANIZATIONS TO REDUCE SMOKING. COMMUNITY BASED PROGRAMS AUGMENT COUNTY AND HOSPITAL EFFORTS IN REDUCING TOBACCO USE. THE TOBACCO ACTION COALITION AND HEALTHY MOTHERS/HEALTHY BABY COALITION WILL BE SOUGHT OUT TO ENGAGE IN COLLABORATIVE EFFORTS AS WELL.THERE ARE ALSO A NUMBER OF EXISTING PROGRAMS IN SUFFOLK COUNTY THAT HAVE DEVELOPED STRATEGIES FOR REDUCING THE INCIDENCE OF UNINTENTIONAL INJURIES. THE COUNTY'S BUREAU OF PUBLIC HEALTH NURSING PROVIDES HOME HEALTH CARE SERVICES FOR PATIENTS SUFFERING THE SEQUELAE OF UNINTENTIONAL INJURIES. THE COUNTY ALSO PROVIDES EDUCATION AND SUPPORT TO MOTHERS AND CHILDREN AIMED AT PREVENTING INJURIES FROM BURNS. A PARTNERSHIP BETWEEN ST. JOSEPHS COLLEGE AND THE SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES HAS HELP IDENTIFY THE APPROPRIATE TARGET POPULATION FOR EDUCATION AND INTERVENTIONS TO REDUCE THESE INJURIES. FINALLY, ARTICLE 6 FUNDS CAN BE USED BY THE SUFFOLK COUNTY HEALTH DEPARTMENT CONSISTENT WITH NEW YORK STATE'S HEALTH AGENDA TO REDUCE THESE INJURIES.THESE TWO PRIORITIES WILL BE A MAJOR OPERATIONAL COMMITMENT OF PECONIC BAY MEDICAL CENTER OVER THE NEXT THREE YEARS. THE MEDICAL CENTER WILL CONTINUE TO COLLABORATE WITH THE SUFFOLK COUNTY DEPARTMENT OF HEALTH AND COMMUNITY PARTNERS IN ENSURING THAT WE REACH THE GOALS SET FOR THESE TWO PRIORITY AREAS, MEASURE PROGRESS IN ACHIEVING THESE GOALS AND ELIMINATING RACIAL, ETHNIC AND SOCIOECONOMIC HEALTH DISPARITIES WHERE THEY EXIST.ONCE THE PLANNING GROUP ADOPTED THESE PRIORITIES, REPRESENTATIVES FROM THE SUFFOLK COUNTY DEPARTMENT OF HEALTH, SUFFOLK COUNTY HOSPITALS, INCLUDING PECONIC BAY MEDICAL CENTER AND COMMUNITY REPRESENTATIVES DIVIDED INTO TWO WORK GROUPS. EACH WORK GROUP WAS CHARGED WITH DEVELOPING A SET OF RECOMMENDATIONS TO IMPLEMENT EFFECTIVE STRATEGIES TO ADDRESS BOTH HEALTH CARE PRIORITIES. PART VI, LINE 4: THE MEDICAL CENTER'S PRIMARY SERVICE AREA INCLUDES THE FOLLOWING ZIP CODES: RIVERHEAD (11901); CALVERTON (11933): MANORVILLE (11949). THESE ZIP CODES ACCOUNT FOR FIFTY PERCENT OF THE MEDICAL CENTER'S TOTAL DISCHARGES.THE MEDICAL CENTER'S SECONDARY SERVICE AREA INCLUDES THE FOLLOWING ZIP CODES: HAMPTON BAYS (1946); EAST QUOGUE (11942); MATTITUCK (11952); WESTHAMPTON BEACH (11978); EASTPORT (11941); CENTER MORICHES (11934); EAST MORICHES (11940); WESTHAMPTON (11977); CUTCHOGUE (11935); SHIRLEY (11967); WADING RIVER (11792): SOUTHOLD (11971); RIDGE (11961); MASTIC (11950); GREENPORT (11944); AND LAUREL (11948). THESE ZIP CODES ACCOUNT FOR THIRTY-FIVE PERCENT OF THE MEDICAL CENTER'S TOTAL DISCHARGES.THE SERVICE HAS MORE THAN 191,000 RESIDENTS AND THE POPULATION IS EXPECTED TO GROW BY FIVE PERCENT FROM 2008 TO 2013. AS THE POPULATION OF THIS REGION CONTINUES TO GROW AND IS DRIVING INCREASED DEMAND FOR HEALTH CARE SERVICES, THE MEDICAL CENTER HAS RESPONDED BY MAKING CAPITAL INVESTMENTS IN EMERGENCY ROOM AND SURGICAL SERVICES, AND THE RECRUITMENT OF PHYSICIANS TO BE ABLE TO MEET THESE NEEDS.THE SERVICE AREA HAS A SIGNIFICANTLY HIGHER PERCENTAGE OF ELDERLY THAN SUFFOLK COUNTY, NASSAU COUNTY AND NEW YORK STATE. APPROXIMATELY ONE IN FIVE RESIDENTS OF THE MEDICAL CENTER'S SERVICE AREA ARE OVER THE AGE OF FIFTY-FIVE,THE POPULATION THAT DRIVES HIGHER DEMAND FOR HEALTH CARE SERVICES. MOREOVER, THIS AGE COHORT IS EXPECTED TO INCREASE AS A PERCENTAGE OF THE TOTAL POPULATION OVER THE NEXT FIVE YEARS.THE HOSPITAL HAS DEVELOPED PROGRAMS, ENHANCED ORTHOPEDICS AND NEUROSURGICAL SERVICES, ENHANCED HOME HEALTH CARE AND SKILLED NURSING SERVICES THAT ARE SPECIFICALLY GEARED TOWARDS MEETING THE UNIQUE HEALTH CARE NEEDS OF THIS POPULATION.TO THE EXTENT THAT THERE ARE HEALTH CARE DISPARITIES BASED ON RACE AND ETHNICITY, THE EAST END OF SUFFOLK COUNTY FACES A CHALLENGE WITH A HIGH PROPORTION OF MINORITY RESIDENTS -- AN AVERAGE OF TWENTY PERCENT -- BUT AS HIGH AS THIRTY-THREE PERCENT IN SOME OF THE PRIMARY AND SECONDARY SERVICE AREAS.THERE ARE NO FIRM ESTIMATES OF THE NUMBER OF MIGRANT AGRICULTURAL WORKERS THAT COME INTO THIS AREA. AGRICULTURE IS ONE OF SUFFOLK COUNTY'S LEADING INDUSTRIES. ITS SUCCESS RELIES ON WORKERS WHO MOVE THROUGH THE EASTERN UNITED STATES IN RESPONSE TO THE AVAILABILITY OF SEASONAL WORK. PECONIC BAY MEDICAL CENTER RECOGNIZES THAT THIS POPULATION PRESENTS SERIOUS HEALTH PROBLEMS AND IS COMMITTED TO PROVIDING CARE FOR ITS CULTURALLY DIVERSE PATIENT POPULATION. MANY OF THESE INDIVIDUALS ARE UNINSURED AND UNABLE TO SPEAK ENGLISH. THEY RELY ON THE MEDICAL CENTERS EMERGENCY DEPARTMENT, AS WELL AS THE SUFFOLK COUNTY HEALTH CLINIC, LOCATED IN RIVERHEAD, FOR HEALTH CARE. THE HOSPITAL PROVIDES BI-LINGUAL PUBLICATIONS AND SIGNAGE AND ACTIVELY ASSISTS THE CULTURALLY DIVERSE COMMUNITIES THAT ARE CARED FOR AT THE MEDICAL CENTER.PUBLIC PARTICIPATION:PECONIC BAY MEDICAL CENTER HAS AN EXTENSIVE PROGRAM OF COMMUNITY OUTREACH THAT IS COMPLEMENTED BY THE EFFORTS OF THE EAST END HEALTH ALLIANCE, THE MEDICAL CENTER'S ACTIVE PARENT. INPUT ON THE COMMUNITY SERVICE PLAN IS RECEIVED FROM BOTH INTERNAL AND EXTERNAL SOURCES. NEEDS ARE ASSESSED ON AN ANNUAL BASIS BY THE BOARD OF TRUSTEES, MEDICAL CENTER MANAGEMENT AND STAFF, VOLUNTEERS, AND LEADERS OF LOCAL NOT-FOR-PROFIT ORGANIZATIONS AND GOVERNMENTAL AGENCIES.COMMUNITY PROGRAMS ARE PUBLICIZED IN A VARIETY OF WAYS: DIRECT MAIL, FLYERS, CALENDAR LISTINGS, E-MAIL COMMUNICATIONS, TELEPHONE INFORMATION LINES, NEWSPRINT ADVERTISING, AND LOCAL CABLE TELEVISION. COMMUNITY MEMBERS ARE ENCOURAGED TO OFFER INPUT ON PECONIC BAY MEDICAL CENTER'S COMMUNITY PROGRAMS BY E-MAIL AND VIA SURVEYS COLLECTED AT PUBLIC EVENTS. THE MEDICAL CENTER'S PRESIDENT AND CHIEF EXECUTIVE OFFICER AND OTHER SENIOR STAFF REGULARLY MEET WITH COMMUNITY GROUPS FROM THE EAST END REGION OF LONG ISLAND TO KEEP AREA RESIDENTS INFORMED ABOUT MEDICAL CENTER PROGRAMS AND TO RECEIVE FEEDBACK AND FIELD QUESTIONS FROM THE COMMUNITY.THE MEDICAL CENTER'S WEB SITE WWW.PBMEDICALCENTER.ORG OFFERS A USER-FRIENDLY FORMAT AND EASY ACCESS TO INFORMATION ON MEDICAL CENTER SERVICES AND PROGRAMS. IN ADDITION, THE SITE ALLOWS FOR PHYSICIAN SEARCHES, ON-LINE INQUIRIES AND ON-LINE JOB APPLICATIONS.SERVICES FOR SHORT-TERM AND LONG-TERM CARE FOR CHRONIC AND ACUTE ILLNESS ARE CONTINUALLY EVALUATED THROUGH STATISTICAL DATA THAT INCLUDE QUALITY INDICATORS AND PATIENT OUTCOMES. THIS DATA IS COMPARED NATIONALLY WITH OTHER HEALTH FACILITIES AND INFORMS THE HOSPITAL'S STRATEGIC PLAN AND COMMUNITY SERVICE PLAN. THE MEDICAL CENTER'S STRATEGIC PLANNING COMMITTEE INCLUDES COMMUNITY MEMBERS, MEDICAL CENTER STAFF AND MEDICAL CENTER AND FOUNDATION BOARD MEMBERS WHO WORK COLLABORATIVELY TO ASSESS COMMUNITY NEEDS AND DEVELOP STRATEGIES TO MEET THESE NEEDS. THE EXTERNAL AFFAIRS COMMITTEE WAS ESTABLISHED TO ENHANCE COMMUNICATION BETWEEN THE MEDICAL CENTER AND THE COMMUNITIES IT SERVES. MEMBERS OF THE COMMITTEE INCLUDE A CROSS-SECTION OF PHYSICIANS, NURSES, MEDICAL CENTER MANAGEMENT, MEDICAL CENTER EMPLOYEES AND COMMUNITY VOLUNTEERS.THE MEDICAL CENTER HAS A LONGSTANDING COMMITMENT AND EXPERIENCE IN OUTREACH HAVING ADMINISTERED THE SUFFOLK COUNTY DEPARTMENT OF HEALTH'S WOMEN'S HEALTH PARTNERSHIP FOR THE PAST FIVE YEARS. THIS PROGRAM PROVIDES NO-COST BREAST CANCER SCREENING AND DIAGNOSTIC SERVICES TO WOMEN WHO ARE UNINSURED, AS WELL AS SCREENING FOR PROSTATE, COLORECTAL AND GYNECOLOGIC ONCOLOGY FOR BOTH MEN AND WOMEN. IT ALSO PROVIDES PATIENT NAVIGATION AND COORDINATION OF SERVICES FOR WOMEN DIAGNOSED WITH BREAST AND CERVICAL CANCER THROUGH THE SCREENING PROGRAM. THE MEDICAL CENTER PROVIDES INFORMATION AND SUPPORT SERVICES IN SPANISH TO ACCOMMODATE THOSE WOMEN WHO ARE NOT PROFICIENT IN ENGLISH. THE PARTNERSHIP MODEL WAS CONCEIVED AND IMPLEMENTED BASED ON THE PRINCIPLE THAT COMMUNITY MEMBERS ARE THE BEST PEOPLE TO IDENTIFY THE NEEDS OF THEIR COMMUNITY AND TO CARRY OUT A PLAY OF ACTION THAT ADDRESSES THOSE NEEDS.RESPONDING TO THE NEEDS OF THE COMMUNITY FOR OBSTETRICAL CARE, INCLUDING THOSE WHO ARE UNDER OR UNINSURED, PECONIC BAY MEDICAL CENTER PROVIDES OBSTETRICAL AND GYNECOLOGICAL SERVICES TO THE SUFFOLK COUNTY HEALTH CENTER. IN ADDITION, A SEPARATE GROUP OF PRIMARY CARE PHYSICIANS PROVIDE CARE TO ANY RIVERHEAD HEALTH CENTER PATIENT WHO NEEDS TO BE ADMITTED TO THE MEDICAL CENTER. IN CONJUNCTION WITH SUFFOLK COUNTY, THE MEDICAL CENTER OPERATES A SECURED FORENSIC UNIT FOR INMATES OF THE SUFFOLK COUNTY JAIL WHO REQUIRE HOSPITALIZATION. THE MEDICAL CENTER PROVIDES FREE FLU SHOTS TO RESIDENTS OF THE COMMUNITY WHO ARE AT HIGH RISK FOR INFLUENZA. THE MEDICAL CENTER ALSO HAS RESPONDED TO COMMUNITY NEEDS BY SPONSORING A NUMBER OF COMMUNITY HEALTH FAIRS OFFERING FREE BLOOD PRESSURE, CHOLESTEROL AND GLUCOSE SCREENINGS AS WELL AS PROVIDING IMPORTANT HEALTH AND WELLNESS INFORMATION. THESE HEALTH FAIRS ALSO CREATE THE OPPORTUNITY FOR MEDICAL CENTER STAFF TO OBTAIN IMPORTANT COMMUNITY FEEDBACK, INFORMATION THAT IS SHARED WITH MEDICAL CENTER LEADERSHIP AND CONSIDERED IN FUTURE COMMUNITY OUTREACH.SUPPORTING THIS EDUCATIONAL OUTREACH AND OPPORTUNITY FOR COMMUNITY INPUT, THE MEDICAL CENTER HAS A SPEAKERS BUREAU THAT PROVIDES PROFESSIONAL INPUT RELATED TO HEALTH AND WELLNESS TOPICS, HEALTH HEART DIET, TREATING OVARIAN CANCER, ETC.BASED ON COMMUNITY INPUT, THE MEDICAL CENTER HAS ALSO LAUNCHED PROJECT CARE IN CONJUNCTION WITH STONY BROOK UNIVERSITY'S SCHOOL OF HEALTH MANAGEMENT AND TECHNOLOGY. THIS PROGRAM PROVIDES IN-HOME MONITORING FOR HIGH-RISK PATIENTS THAT WOULD OTHERWISE HAVE DIFFICULTY ACCESSING CARE. THE MEDICAL CENTER HAS ALSO RESPONDED TO COMMUNITY INPUT FROM THE REGIONS AMBULANCE CORPS AND WITH THE SUPPORT OF STONY BROOK PROVIDES THREE FIRST RESPONDER VEHICLES THAT AUGMENT THE LOCAL EMS DURING PEAK HOURS.PBMC WAS SUCCESSFUL IN OBTAINING FUNDING FOR A PATIENT TRANSPORTATION VAN THAT PROVIDES TRANSPORT ROOM OUR SKILLED NURSING FACILITY FOR MEDICAL SERVICES, AS WELL AS PATIENTS FROM OTHER COMMUNITY NURSING HOMES THAT MAY NEED RADIOLOGY OR LABORATORY TESTING.COMMUNITY ORGANIZATION PARTICIPATION: THE HOSPITAL ALSO ROUTINELY SEEKS FEEDBACK FROM COMMUNITY MEMBERS WHO PARTICIPATE IN OUR COMMUNITY OUTREACH PROGRAMS. PECONIC BAY MEDICAL CENTER HAS SIGNIFICANT REPRESENTATION ON A WIDE-RANGE OF COMMUNITY ORGANIZATIONS THAT FACILITATE INPUT FROM RESIDENTS, CORPORATE AND COMMUNITY LEADERS, PATIENTS AND ALLIED HEALTH PROFESSIONS. THIS PARTICIPATION SUPPORTS EFFECTIVE INPUT FROM THE COMMUNITY THROUGH MEDICAL CENTER STAFF AND MEDICAL CENTER TRUSTEE PARTICIPATION COMPLEMENTED BY A CONTINUAL AND OPEN DIALOGUE WITH RESPECTED COMMUNITY LEADERS. X X X X 0 1 0 1 0 0 0 1 0 ANDREW MITCHELL 388548 141290 125400 45600 13050 4746 17967 6533 21419 7789 566384 205958 0 0 GERARD ZUNNO 203218 0 0 0 1746 0 6082 0 17809 0 228855 0 0 0 ALAN SCHECHTER 283833 0 0 0 7534 0 7500 0 19472 0 318339 0 0 0 MICHAEL O'DONNELL 256799 0 0 0 792 0 7196 0 26713 0 291500 0 0 0 DEMETRIOS KADENAS 154957 0 0 0 105 0 0 0 8162 0 163224 0 0 0 RONALD MCMANUS 201931 0 0 0 930 0 5997 0 26713 0 235571 0 0 0 RICHARD KUBIAK 317548 0 0 0 1314 0 7500 0 26713 0 353075 0 0 0 CHERYL MAKOSKE 170766 0 0 0 327 0 5049 0 16028 0 192170 0 0 0 PETER SULTAN MD 417569 0 411129 0 905 0 7500 0 26713 0 863816 0 0 0 DAVID PRENTISS 261530 0 0 0 353 0 6484 0 0 0 268367 0 0 0 MAHMOOD AFGHANI 212074 0 0 0 143 0 2185 0 26713 0 241115 0 0 0 RICHARD MALESKI 186713 0 0 0 223 0 5234 0 9736 0 201906 0 0 0 FAISAL HAMID 182307 0 0 0 119 0 612 0 26713 0 209751 0 0 0 PART I, LINE 3 THE HOSPITAL UTILIZES SALARY SURVEYS AND REVIEWS THEM WITH THE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS. THE PROCESS WAS PERFORMED IN 2012 PART I, LINE 4B ANDREW MITCHELL - $17,000 PART I, LINE 5 THE MEDICAL CENTER HAS A CONTRACTUAL ARRANGEMENT FOR A PHYSICIAN ENTITLING THE PHYSICIAN TO ADDITIONAL COMPENSATION BASED UPON CASH COLLECTIONS. PART I, LINE 7 PERFORMANCE BASED ON BOARD DISCRETION. AN EMPLOYMENT AGREEMENT IS IN PLACE WITH THE HOSPITAL WITH THE CEO A TOWN OF RIVERHEAD INDUSTRIAL DEVELOPMENT AGENCY 112560077 768765AB5 2006-06-23 35000000 CONSTRUCTION OF FACILITY AND REFUNDING OF PRIOR ISSUE (8/12/1993) 0 0 0 B TOWN OF RIVERHEAD INDUSTRIAL DEVELOPMENT AGENCY 112560077 768765AE9 2007-06-27 12000000 CONSTRUCTION OF FACILITY 0 0 0 A 7945000 36622284 700000 359652 24392812 11169820 2008 1 0 1 1 B 795000 12350712 5009217 50272 240000 307959 11752481 2009 0 0 1 1 A 0 0 0 0 0 0 0 B 0 0 0 0 0 0 0 A 0 0 1 1 1 1 HSBC BANK 25.000000000000 0 0 1 MBIA INC 2.200000000000 1 0 0 B 0 0 0 1 1 1 HSBC BANK 25.000000000000 0 0 0 0 0 A 0 B 0 RICHARD ISRAEL BOARD MEMBER 450416 RENTAL OF PROPERTY 0 FORM 990, PART VI, SECTION B, LINE 11 THE CEO/PRESIDENT, CHIEF OPERATING OFFICER AND CHIEF FINANCIAL OFFICER REVIEW THE 990. A COPY OF THE 990 IS PROVIDED TO THE BOARD OF DIRECTORS FOR REVIEW. FORM 990, PART VI, SECTION B, LINE 12C THE CONFLICTS OF INTEREST POLICY APPLIES TO MEMBERS OF THE BOARD OF DIRECTORS, OFFICERS, VICE PRESIDENTS, ASSISTANT VICE PRESIDENTS, DEPARTMENT HEADS, CLINICAL DIRECTORS OF DEPARTMENTS, AND OTHER EMPLOYEES (INCLUDING PHYSICIANS) WHO ARE IN A POSITION TO INFLUENCE ANY SUBSTANTIVE BUSINESS DECISION BETWEEN THE MEDICAL CENTER AND A VENDOR. THE DIRECTOR OF CORPORATE COMPLIANCE CONTINUOUSLY MONITORS ALL TRANSACTIONS TO DETERMINE IF ANY POTENTIAL CONFLICT EXISTS. IF IT IS DETERMINED THAT A POTENTIAL CONFLICT EXISTS, THE INDIVIDUAL IS PROHIBITED FROM PARTICIPATING IN THE DECISIONS OF THE TRANSACTION. FORM 990, PART VI, SECTION B, LINE 15 THE HOSPITAL UTILIZES SALARY SURVEYS AND REVIEWS THEM WITH THE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS. THE PROCESS WAS PERFORMED IN 2012 FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE MADE AVAILABLE UPON REQUEST. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: PENSION ADJUSTMENT TO REFLECT FUNDED STATUS 1,975,786. LOSS ON SWAP AGREEMENT -75,054. CHANGE IN EQUITY INTEREST IN CENTRAL SUFFOLK HOSPITAL FOUNDATION 419,726. PENSION ADJUSTMENT TO REFLECT FUNDED STATUS LOSS ON SWAP AGREEMENT CHANGE IN EQUITY INTEREST IN CENTRAL SUFFOLK HOSPITAL FOUNDATION FORM 990, PART XI, LINE 2C: THE PROCESS HAS NOT CHANGED FROM PRIOR YEARS. CENTRAL SUFFOLK HOSPITAL DBA PECONIC BAY MEDICAL CENTER FOUNDATION 1300 ROANOKE AVENUE RIVERHEAD NY 11901 200714587 FUNDRAISING/PHILANTHROPIC NY 501(C)(3) 7 PECONIC BAY HEALTH SYSTEM 0 EAST END HEALTH ALLIANCE 201 MANOR PLACE GREENPORT NY 11944 113407476 PARENT COMPANY OF PBMC, SOUTHAMPTON HOSPITAL, EASTERN LONG ISLAND HOSPITAL NY 501(C)(3) 11, TYPE I N/A 0 RIVERHEAD MANAGEMENT CORPORATION 1300 ROANOKE AVENUE RIVERHEAD NY 11901 112800287 MANAGEMENT SERVICE ORGANIZATION NY N/A C 0 0 0 0 1 1 0 0 0 0 1 0 0 1 1 1 0 0 0 0 RIVERHEAD MANAGEMENT CORPORATION D 708701 COST