2013-11-14T17:27:26-06:00 2012-12-31 131517563 LOEB & TROPER LLP 655 THIRD AVENUE 12TH FLOOR NEW YORK NY 10017 990 2012-01-01 200714587 CENTRAL SUFFOLK HOSPITAL FOUNDATION 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 SEE SCHEDULE O FOR DBA ANDREW MITCHELL 1300 ROANOKE AVENUE RIVERHEAD NY 11901 2290440 0 X WWW.PBMEDICALCENTER.ORG X 2004 NY THE FOUNDATION'S MISSION IS TO DEVELOP AND CULTIVATE PHILANTHROPIC AND COLLABRATIVE RELATIONSHIPS THAT FOSTER PROGRAMS AND SERVICES OFFERED THROUGH THE HOSPITAL WHICH IMPROVE THE HEALTH OF THE COMMUNITIES IT SERVES. 17 16 9 16 0 0 2988253 2247758 0 0 749 408 -26483 -70127 2962519 2178039 545417 0 0 0 0 0 375000 393159 1738410 809069 1365154 1729486 1758313 1233033 419726 3589451 3910802 620833 522458 2968618 3388344 X SEE SCHEDULE OTHE FOUNDATION'S MISSION IS TO DEVELOP AND CULTIVATE PHILANTHROPIC AND COLLABRATIVE RELATIONSHIPS THAT FOSTER PROGRAMS AND SERVICES OFFERED THROUGH THE HOSPITAL WHICH IMPROVE THE HEALTH OF THE COMMUNITIES IT SERVES. 0 0 THE SUPPORT OF HOSPITAL SERVICES OF CENTRAL SUFFOLK HOSPITAL 1 1 0 0 0 0 0 0 0 0 0 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 1 0 0 0 0 1 0 0 0 1 2 0 9 1 0 0 0 0 0 1 1 0 0 0 0 X 17 16 0 0 0 0 0 0 0 1 1 0 0 1 0 1 1 1 1 0 NY X MICHAEL F O'DONNELL 6315486074 1300 ROANOKE AVENUE RIVERHEAD NY 11901 J GORDON HUSZAGH 10.00 X X 0 0 0 IRWIN L GARSTEN 10.00 X X 0 0 0 EMILY ROY COREY 1.00 X X 0 0 0 RICHARD ISRAEL 1.00 X X 0 0 0 JOAN LEVAN 1.00 X X 0 0 0 ANDREW MITCHELL 10.00 27.50 X X 191636 526998 53708 JESSE R GOODALE III 1.00 X X 0 0 0 KENNEY BARRA 1.00 X 0 0 0 BRUCE BARNET 1.00 X 0 0 0 BABU EASOW MD 1.00 X 0 0 0 RICHARD RUBENSTEIN MD 1.00 X 0 0 0 JOSEPH VAN DE WETERING 1.00 X 0 0 0 CAROLE G HANKIN PHD 1.00 X 0 0 0 DAVID J MCCANN 1.00 X 0 0 0 RICHARD L WINSLOW PHD 1.00 X 0 0 0 STANLEY ZINBERG MD 1.00 X 0 0 0 BARRY BRANDEIS 1.00 X 0 0 0 191636 526998 53708 1 0 1 0 CENTRAL SUFFOLK HOSPITAL 1300 ROANOKE AVENUE RIVERHEAD NY 11901 ADMINISTRATIVE SERVICES 963799 1 348932 300000 1598826 254807 2247758 408 408 42274 348932 112401 -70127 -70127 2178039 0 0 -69719 X 5900 5900 393159 393159 965299 965299 10190 10190 195905 195905 7500 7500 10900 10900 BAD DEBT EXPENSE 19903 19903 PLAQUES 10168 10168 139389 139389 1758313 0 19903 1738410 67299 1072950 1806050 2516501 2037453 3589451 3910802 77102 2351 543731 520107 620833 522458 X 721492 1484331 2247126 1904013 2968618 3388344 3589451 3910802 419726 0 X X 0 1 X 1 0 X 1240829 967777 1419214 2988253 2247758 8863831 1240829 967777 1419214 2988253 2247758 8863831 2332580 6531251 3300 1634 2791 749 408 8882 17936 17936 8890649 0.73460 0.73620 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 DUE TO CENTRAL SUFFOLK HOSPITAL D/B/A PECONIC BAY MEDICAL CENTER 452666 CONTRIBUTIONS HELD ON BEHALF OF WOMEN'S HEALTH PARTNERSHIP 67441 520107 X 2178039 0 2178039 0 2178039 1758313 0 1758313 0 1758313 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: UNCERTAINTY IN INCOME TAXES - 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, 2009 AND SUBSEQUENT REMAIN SUBJECT TO EXAMINATION BY APPLICABLE TAXING AUTHORITIES. X X X X 1 COMMUNITY COUNSELING SERVICES LLC 461 FIFTH AVENUE NEW YORK NY 10017 CONSULTING FOR CAPITAL CAMPAIGN 0 0 359087 0 HARRIS CONNECT LLC 1511 ROUTE 22 SUITE 25 BREWSTER NY 10509 CONSULTING FOR CAPITAL CAMPAIGN 0 0 34072 0 393159 NY BLACK AND WHITE 287396 250172 37224 10000 21589 26824 2125 14948 GARDEN FESTIVAL 103810 98760 5050 9979 2137 24799 391206 348932 42274 10000 31568 28961 2125 39747 112401 -70127 0 0 0 0 0 0 0 1 0 ANDREW MITCHELL 141290 388548 45600 125400 4746 13050 6533 17967 7789 21419 205958 566384 0 0 PART I, LINE 3 CENTRAL SUFFOLK HOSPITAL D/B/A PECONIC BAY MEDICAL CENTER, A RELATED ORGANIZATION, UTILIZES SALARY SURVEYS AND REVIEWS THEM WITH THE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS. THE PROCESS WAS PERFORMED IN 2012. PART I, LINE 7 PERFORMANCE BASED ON BOARD DISCRETION. AN EMPLOYMENT AGREEMENT IS IN PLACE WITH THE HOSPITAL WITH THE CEO. X 3 254807 SELLING PRICE 0 0 0 0 METHOD FOR DETERMINING NUMBER OF CONTRIBUTORS: PART I, COLUMN (B): NUMBER OF CONTRIBUTORS FORM 990, PART VI, SECTION B, LINE 11 THE CEO/PRESIDENT, AND CHIEF FINANCIAL OFFICER OF THE HOSPITAL REVIEW THE 990. A COPY OF THE 990 IS PROVIDED TO THE BOARD OF DIRECTORS FOR REVIEW. FORM 990, PART VI, SECTION B, LINE 12 THE FOUNDATION FOLLOWS THE HOSPITAL'S CONFLICT OF INTEREST POLICY. FORM 990, PART VI, SECTION B, LINE 15 CENTRAL SUFFOLK HOSPITAL D/B/A PECONIC BAY MEDICAL CENTER, A RELATED ORGANIZATION, 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 MAKES ITS GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. OTHER FEES FORM 990, PART IX, LINE 11G SPECIAL EVENT PHOTOGRAPHY: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 1,500. TOTAL EXPENSES 1,500. ADMINISTRATIVE SERVICE FEE: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 963,799. TOTAL EXPENSES 963,799. FORM 990, PART XII, LINE 2C: THIS PROCESS DID NOT CHANGE FROM THE PRIOR YEAR. CENTRAL SUFFOLK HOSPITAL DBA PECONIC BAY MEDICAL CENTER 1300 ROANOKE RIVERHEAD NY 11901 111661359 HOSPITAL CARE NY 501(C)(3) 3 N/A 0 0 0 0 1 1 0 0 0 0 0 1 1 0 1 1 0 0 0 0