2013-11-15T12:53:24-06:00 2012-12-31 WithumSmithBrown PC 465 South St Ste 200 Morristown NJ 079606497 990 2012-01-01 061074604 SIUH SYSTEMS INC % THOMAS RECA SIUH 7182261148 475 SEAVIEW AVENUE Suite STATEN ISLAND NY 10305 TOM RECA 9738989494 2013-11-15 true Anthony J Panico 9738989494 2012 2016-03-07 17:11:31Z ANTHONY C FERRERI 475 SEAVIEW AVENUE STATEN ISLAND NY 10305 8374 false X WWWW.SIUH.EDU X 1982 NY THE ORGANIZATION PROVIDES ASSISTANCE IN THE PLANNING FOR AND COORDINATION OF HEALTHCARE SERVICES IN THE STATEN ISLAND COMMUNITY. 136 128 0 0 0 0 0 0 0 0 10605 8374 0 0 10605 8374 0 0 0 0 0 0 0 0 0 0 0 0 0 10605 8374 6542614 4264000 4173988 1887000 2368626 2377000 X THE ORGANIZATION PROVIDES ASSISTANCE IN THE PLANNING FOR AND COORDINATION OF HEALTHCARE SERVICES IN THE STATEN ISLAND COMMUNITY AND IS PART OF THE NORTH SHORE-LONG ISLAND JEWISH HEALTH SYSTEM ("THE SYSTEM"), WHICH STRIVES TO IMPROVE THE HEALTH OF THE COMMUNITIES IT SERVES AND IS COMMITTED TO PROVIDING THE HIGHEST QUALITY CLINICAL CARE; EDUCATING THE CURRENT AND FUTURE GENERATIONS OF HEALTHCARE PROFESSIONALS; SEARCHING FOR NEW ADVANCES IN MEDICINE THROUGH THE CONDUCT OF BIOMEDICAL RESEARCH; PROMOTING HEALTH EDUCATION; AND CARING FOR THE ENTIRE COMMUNITY REGARDLESS OF THE ABILITY TO PAY. false false 0 0 0 EXPENSES AND GRANTS INCURRED IN SUPPORTING THE CHARITABLE PURPOSES OF STATEN ISLAND UNIVERSITY HOSPITAL; A RELATED INTERNAL REVENUE CODE SECTION 501(C)(3) TAX-EXEMPT ORGANIZATION AND AFFILIATES WHOSE HEALTHCARE SYSTEM PROVIDES MEDICALLY NECESSARY HEALTHCARE SERVICES TO ALL INDIVIDUALS IN A NON-DISCRIMINATORY MANNER REGARDLESS OF RACE, COLOR, CREED, SEX, NATIONAL ORIGIN, RELIGION OR ABILITY PAY. 0 true false false false false false false false false false false false false false true true false false false false false false false false false false false false false true false false false false false false false false false false false false false true false false false true 0 0 0 false false false false false false false false false false false X 136 128 true false false false false true true true true false false false true true true true true true true false NY X THOMAS RECA 7182261148 475 SEAVIEW AVENUE STATEN ISLAND NY 10305 X RICHARD D GOLDSTEIN 0.0 3.0 X X 0 0 0 JOHN W ALEXANDER 2.0 X X 0 0 0 RICHARD S ABRAMSON 2.0 X X 0 0 0 WILLIAM ACHENBAUM 2.0 X 0 0 0 PHILIP S ALTHEIM 2.0 X 0 0 0 STANLEY A APPLEBAUM 2.0 X 0 0 0 MICHAEL L ASHNER 2.0 X 0 0 0 BEVERLY BANKER 2.0 X 0 0 0 RALPH M BARUCH 2.0 X 0 0 0 FRANK J BESIGNANO 2.0 X 0 0 0 ELISE M BLOOM 2.0 X 0 0 0 ERIC S BLUMENCRANZ 2.0 X 0 0 0 ROGER A BLUMENCRANZ 2.0 X 0 0 0 DAVID BLUMENFELD 2.0 X 0 0 0 EDWARD BLUMENFELD 2.0 X 0 0 0 E STEVE BRAUN 2.0 X 0 0 0 DAYTON T BROWN JR 2.0 X 0 0 0 ALLEN E BUSCHING 2.0 X 0 0 0 JONATHAN S CANNO 2.0 X 0 0 0 MICHAEL CARIDI 2.0 X 0 0 0 REV DEMETRIUS CAROLINA SR EDD 2.0 X 0 0 0 RUDOLPH C CARRYL 2.0 X 0 0 0 ROBERT W CHASANOFF 2.0 X 0 0 0 ALAN CHOPP 2.0 X 0 0 0 MARK CLASTER 2.0 X 0 0 0 DIANA F COLGATE 2.0 X 0 0 0 DANIEL M CROWN 2.0 X 0 0 0 PHILIPPE P DAUMAN 2.0 X 0 0 0 DANIEL C DE ROULET 2.0 X 0 0 0 LORINDA DE ROULET 2.0 X 0 0 0 THOMAS E DEWEY JR 2.0 X 0 0 0 THOMAS E DOOLEY 2.0 X 0 0 0 MICHAEL J DOWLING 50.0 X 0 2823350 1128235 ROBERT N DOWNEY 2.0 X 0 0 0 MELVIN DUBIN 2.0 X 0 0 0 PATRICK R EDWARDS 2.0 X 0 0 0 MICHAEL A EPSTEIN 2.0 X 0 0 0 LEONARD FEINSTEIN 2.0 X 0 0 0 MICHAEL E FELDMAN 2.0 X 0 0 0 ANTHONY C FERRERI 50.0 X X 0 1049046 387210 ARLENE LANE FISHER 2.0 X 0 0 0 CATHERINE C FOSTER 2.0 X 0 0 0 WILLIAM H FRAZIER 2.0 X 0 0 0 EUGENE B FRIEDMAN MD 2.0 X 0 0 0 WILLIAM J FRITZ PHD 2.0 X 0 0 0 SY GARFINKEL 2.0 X 0 0 0 LLOYD MICHAEL GOLDMAN 2.0 X 0 0 0 J JOAQUIN GONZALEZ 2.0 X 0 0 0 MICHAEL GOULD 2.0 X 0 0 0 ALBERT L GRANGER DDS 2.0 X 0 0 0 ALAN I GREENE 2.0 X 0 0 0 JAMES R GREENE 2.0 X 0 0 0 STANLEY GREY 2.0 X 0 0 0 RICHARD GUARASCI PHD 2.0 X 0 0 0 PAUL B GUENTHER 2.0 X 0 0 0 AMY M HAGEDORN 2.0 X 0 0 0 IRA HAZAN 2.0 X 0 0 0 LINDA W HEANEY 2.0 X 0 0 0 MARLENE HESS 2.0 X 0 0 0 WILLIAM O HILTZ 2.0 X 0 0 0 GEDALE B HOROWITZ 2.0 X 0 0 0 RICHARD A HOROWITZ 2.0 X 0 0 0 M ALLAN HYMAN 2.0 X 0 0 0 MARK JACOBSON 2.0 X 0 0 0 JEFFREY JURICK 2.0 X 0 0 0 DAVID M KATZ 2.0 X 0 0 0 MICHAEL KATZ 2.0 X 0 0 0 SAUL B KATZ 2.0 X 0 0 0 LISA A KAUFMAN 2.0 X 0 0 0 ROBERT KAUFMAN 2.0 X 0 0 0 CARY KRAVET 2.0 X 0 0 0 STANLEY KREITMAN 2.0 X 0 0 0 SETH KUPFERBERG 2.0 X 0 0 0 JEFFREY B LANE 2.0 X 0 0 0 CURT N LAUNER 2.0 X 0 0 0 LAURA LAURIA 2.0 X 0 0 0 KEVIN F LAWLOR 50.0 X 0 799176 280574 DAVID W LEHR 2.0 X 0 0 0 JONATHAN W LEIGH 2.0 X 0 0 0 SYLVIA LESTER 2.0 X 0 0 0 ARTHUR S LEVINE 2.0 X 0 0 0 STUART R LEVINE 2.0 X 0 0 0 SETH LIPSAY 2.0 X 0 0 0 DAVID S MACK 2.0 X 0 0 0 WILLIAM L MACK 2.0 X 0 0 0 LINDA MANFREDI 2.0 X 0 0 0 JAMES S MARCUS 2.0 X 0 0 0 BRADLEY MARSH DPM 2.0 X 0 0 0 JEFFREY S MAURER 2.0 X 0 0 0 RONALD J MAZZUCCO 2.0 X 0 0 0 F J MCCARTHY 2.0 X 0 0 0 PATRICK F MCDERMOTT 2.0 X 0 0 0 JAMES MCMULLEN 2.0 X 0 0 0 CHARLES MERINOFF 2.0 X 0 0 0 RICHARD D MONTI 2.0 X 0 0 0 RICHARD MURCOTT 2.0 X 0 0 0 RALPH A NAPPI 50.0 X 0 2276546 60770 RICHARD B NYE 2.0 X 0 0 0 CLYDE I PAYNE ED D 2.0 X 0 0 0 ARNOLD S PENNER 2.0 X 0 0 0 JOHN J RAGGIO 2.0 X 0 0 0 LEWIS S RANIERI 2.0 X 0 0 0 JAY R RAUBVOGEL 2.0 X 0 0 0 DENNIS RIESE 2.0 X 0 0 0 TERRY P RIFKIN MD 2.0 X 0 0 0 ROBERT F ROSE 2.0 X 0 0 0 ROBERT A ROSEN 2.0 X 0 0 0 MARCIE ROSENBERG 2.0 X 0 0 0 ROBERT D ROSENTHAL 2.0 X 0 0 0 BERNARD M ROSOF MD 2.0 X 0 0 0 JACK J ROSS 2.0 X 0 0 0 BARRY RUBENSTEIN 2.0 X 0 0 0 HERBERT RUBIN 2.0 X 0 0 0 SCOTT RUDOLPH 2.0 X 0 0 0 MICHAEL H SAHN 2.0 X 0 0 0 FRANK W SCARANGELLO SR 2.0 X 0 0 0 LOIS C SCHLISSEL 2.0 X 0 0 0 JOHN M SHALL 2.0 X 0 0 0 MARC V SHAW 2.0 X 0 0 0 SEAN G SIMON 2.0 X 0 0 0 RICHARD SIMS 2.0 X 0 0 0 MICHAEL C SLADE 2.0 X 0 0 0 PHYLLIS HILL SLATER 2.0 X 0 0 0 HOWARD D STAVE 2.0 X 0 0 0 RUSSELL STERN 2.0 X 0 0 0 JOHN B THOMSON JR 2.0 X 0 0 0 PETER TILLES 2.0 X 0 0 0 SANDRA TYTEL 2.0 X 0 0 0 FREDERICK A VOLK 2.0 X 0 0 0 NANCY WALDBAUM 2.0 X 0 0 0 EMMETT F WALKER JR 2.0 X 0 0 0 GARY WALTER 2.0 X 0 0 0 LEWIS M WESTON 2.0 X 0 0 0 BARBARA HRBEK ZUCKER 2.0 X 0 0 0 DONALD ZUCKER 2.0 X 0 0 0 ROY J ZUCKERBERG 2.0 X 0 0 0 0 6948118 1856789 0 false true false 0 X 0 0 8374 8374 0 0 0 0 0 0 0 0 0 0 8374 0 8374 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4255847 4264000 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2286767 0 6542614 4264000 5190 5000 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4168798 1882000 4173988 1887000 X 2368626 2377000 0 0 0 0 2368626 2377000 6542614 4264000 8374 X X false true X true false X X X X false false false STATEN ISLAND UNIVERSITY HOSPITAL 112868878 03 true true true 0 1 0 0 DUE TO RELATED PARTIES 1882000 1882000 X TEXT OF FIN 48 AUDITED FINANCIAL STATEMENT FOOTNOTE SCHEDULE D, PART X Certain entities included in the System's consolidated financial statements are taxable entities under Federal or state laws. U.S. generally accepted accounting principles require that the asset and liability method of accounting for income taxes be utilized by these organizations. Under the asset and liability method, deferred income taxes are recognized for the tax consequences of temporary differences by applying enacted statutory tax rates applicable to future years to differences between the financial statement carrying amounts and the tax basis of existing assets and liabilities. The effect on deferred taxes of a change in tax rates is recognized in income in the period of enactment. At December 31, 2012 and 2011, the System has a deferred income tax asset which has been fully offset by a related valuation allowance. A valuation allowance is provided when it is more likely than not that some portion, or all of the deferred tax asset will not be realized. Significant components of the deferred tax asset relate to the allowance for doubtful accounts receivable and net operating loss carry forwards. Certain entities have net operating loss carry forwards aggregating approximately $149,000,000, which expire in varying amounts through 2032, and are available to offset future taxable income. X X X X false true false false false false false true false MICHAEL J DOWLING 0 1172902 0 1628000 0 22448 0 0 0 0 0 2823350 0 0 ANTHONY C FERRERI 0 873896 0 155000 0 20150 0 372110 0 15100 0 1436256 0 0 KEVIN F LAWLOR 0 665596 0 104400 0 29180 0 0 0 0 0 799176 0 0 RALPH A NAPPI 0 672087 0 150000 0 1454459 0 0 0 0 0 2276546 0 1389266 COMPENSATION INFORMATION CORE FORM, PART VII and SCHEDULE J, PART II; QUESTION 4B one individual participates in a Supplemental Executive Retirement Plan ("SERP") which is subject to substantial risk of complete forfeiture. THE AMOUNT REFLECTED IN COLUMN B(III) FOR THE FOLLOWING INDIVIDUAL INCLUDES PARTICIPATION IN A SERP FOR WHICH AMOUNTS ARE NO LONGER SUBJECT TO A SUBSTANTIAL RISK OF COMPLETE FORFEITURE. THE AMOUNT OUTLINED HEREIN WAS INCLUDED IN the INDIVIDUAL'S 2012 FORM W-2, BOX 5, AS TAXABLE MEDICARE WAGES: RALPH A. NAPPI, $1,389,266. four individuals' participate in a Supplemental Executive Retirement Plan ("SERP") which is subject to substantial risk of complete forfeiture. Accordingly, the individualS 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, AS TAXABLE MEDICARE WAGES. These amounts are included in Schedule J-II, Column C for Michael J. DowlinG, $1,079,610; ANTHONY C. FERRERI, $344,610; KEVIN F. LAWLOR, $233,853 and Ralph A. Nappi, $14,495. COMPENSATION INFORMATION SCHEDULE J, PART I; QUESTION 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-1, PART I, B (II). COMPENSATION INFORMATION SCHEDULE J, PART II, COLUMN F THE AMOUNT REPORTED IN SCHEDULE J, PART II, COLUMN F FOR THE FOLLOWING INDIVIDUAL INCLUDEs VESTED BENEFITS IN A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN ("SERP") WHICH AMOUNT is NO LONGER SUBJECT TO A SUBSTANTIAL RISK OF COMPLETE FORFEITURE. THis AMOUNT Was REPORTED IN SCHEDULE J, PART II, COLUMN C AS RETIREMENT AND OTHER DEFERRED COMPENSATION ON PRIOR YEAR'S FORMS 990. THE AMOUNT Was TREATED AS TAXABLE INCOME AND REPORTED ON the INDIVIDUAL'S 2012 FORM W-2, BOX 5, AS TAXABLE MEDICARE WAGES: RALPH A. NAPPI, $1,389,266. BUSINESS AND FAMILY RELATIONSHIPS CORE FORM, PART VI, SECTION A; QUESTION 2 FORM 990 SCHEDULE A, PART III STATEMENT ABOUT ACTIVITY ====================================================== 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. William Achenbaum ----------------- has a business relationship with Eric Blumencranz and Roger Blumencranz. John Alexander -------------- has a business relationship with John Shall. Philip Altheim -------------- has a business relationship with Eric Blumencranz. Stanley Applebaum ----------------- has a business relationship with John Shall. Michael Ashner -------------- has a business relationship with William Mack and Scott Rudolph. Eric Blumencranz ---------------- has as a family relationship with Roger Blumencranz. He has a business relationship with Roger Blumencranz, William Achenbaum, Philip Altheim, Arlene Lane Fisher, Richard Goldstein, Lloyd Goldman, Alan Greene, James Greene, Stanley Grey, Richard Guarasci, Richard Horowitz, M. Allen Hyman, Jeffrey Jurick, Arthur Levine, Stuart Levine, David Mack, Bradley Marsh, Charles Merinoff, Ralph Nappi, Dennis Riese and Michael Slade. Roger Blumencranz ----------------- has a family relationship with Eric Blumencranz. He has a business relationship with Eric Blumencranz, William Achenbaum, mark claster, Alan Greene, James Greene, Stanley Grey, Richard Goldstein, Richard Horowitz, Jeffrey Jurick, Stuart Levine, David Mack, Ralph Nappi, Donald Zucker, Barbara Zucker. David Blumenfeld ---------------- has a family relationship with Edward Blumenfeld. Edward Blumenfeld ----------------- has a family relationship with David Blumenfeld. He has a business relationship with William Mack. Steve Braun ----------- has a family relationship with Richard Sims. he has a business relationship with cary kravet. Robert w. Chasanoff ------------------- has a business relationship with Michael h. Sahn. Alan Chopp ---------- has a business relationship with Patrick Mc Dermott. Mark Claster ------------ has a business relationship with Roger A. Blumencranz, Richard Goldstein, Saul Katz, robert d. rosenthal and Barry Rubenstein. Philippe Dauman --------------- has a business relationship with thomas dooley. Daniel de Roulet ---------------- has a family relationship with Lorinda de Roulet. Lorinda de Roulet ---------------- has a family relationship with Daniel de Roulet. thomas dooley ------------- has a business relationship with philippe dauman. Leonard Feinstein ----------------- has a business relationship with William Mack. Anthony Ferreri --------------- has a family and business relationship with John Shall. Arlene Lane Fisher ------------------ has a business relationship with eric blumencranz. Lloyd Goldman ---------------- has a business relationship with Eric Blumencranz, Richard Goldstein and William Mack. RICHARD GOLDSTEIN ----------------- has a business relationship with Roger Blumencranz, Eric Blumencranz, Mark Claster, Lloyd Goldman, William Mack, and Barry Rubenstein. Joaquin Gonzalez ---------------- has a business relationship with John Shall. Alan I. Greene -------------- has a family relationship with James R. Greene. He has a business relationship with Eric blumencranz and Roger Blumencranz. James R. Greene --------------- has a family relationship with Alan I. Green. He has a business relationship with Eric blumencranz and Roger Blumencranz. Stanley Grey ------------ has a business relationship with eric blumencranz and Roger Blumencranz. Richard Guarasci ---------------- has a business relationship with Eric Blumencranz. William Hiltz ------------- has a business relationship with jeff maurer. Richard Horowitz ---------------- has a business relationship with Eric blumencranz, Roger Blumencranz and m. allen hyman. m. allen hyman -------------- has a business relationship with eric blumencranz, richard horowitz, saul katz and donald zucker. Jeffrey Jurick -------------- has a business relationship with Eric blumencranz and Roger Blumencranz. David Katz ---------- has a family relationship with Saul Katz and Michael Katz. He has a business relationship with saul katz and seth lipsay. Michael Katz ------------ has a family relationship with Saul Katz and David Katz. He has a business relationship with Saul Katz, Curt Launer and Michael Slade. Saul Katz --------- has a family relationship with Michael Katz and David Katz. He has a business relationship with Mark Claster, Michael Katz, Curt Launer, Michael Slade, m. allen hyman and david katz. cary kravet ----------- has a business relationship with steve braun. Jeffrey Lane ------------ has a business relationship with William Mack. Curt Launer ----------- has a business relationship with Michael Katz and Saul Katz. David Lehr ---------- has a business relationship with Ronald Mazzucco. Arthur Levine ------------- has a business relationship with Eric Blumencranz. Stuart Levine ------------- has a business relationship with Eric blumencranz and Roger blumencranz. David MACK ---------- has a family relationship with William Mack. He has a business relationship with William Mack, Eric Blumencranz, and Roger Blumencranz. William Mack ------------ has a family relationship with David Mack. He has business relationships with David Mack, Michael Ashner, Edward Blumenfeld, Leonard Feinstein, Lloyd Goldman, Jeffrey Lane, Barry Rubenstein, Richard Goldstein and Roy Zuckerberg. Bradley Marsh ------------- has a family relationship with Jack Ross. He has a business relationship with Eric Blumencranz. jeffrey maurer -------------- has a business relationship with william hiltz. Ronald Mazzucco --------------- has a business relationship with David Lehr. F.J. McCarthy ------------- has a business relationship with Robert Rosenthal. Patrick McDermott ----------------- has a business relationship with Alan Chopp and John Shall. Charles Merinoff ---------------- has a business relationship with Eric Blumencranz. richard murcott --------------- has a business relationship with barry rubenstein. Ralph Nappi ----------- has a business relationship with Eric Blumencranz and roger blumencranz. Dennis Riese ------------ has a business relationship with Eric Blumencranz. Robert Rosenthal ---------------- has a business relationship with Mark Claster, F.J. McCarthy and nancy waldenbaum. Jack Ross --------- has a family relationship with Bradley Marsh. Barry Rubenstein ---------------- has a business relationship with mark claster, richard goldstein, william mack and Saul Katz. Scott Rudolph ------------- has a business relationship with michael ashner. John Shall ---------- has a family relationship with Anthony Ferreri. He has a business relationship with Anthony Ferreri, Patrick McDermott, John Alexander, Stanley Applebaum, and Joaquin Gonzalez. Richard Sims ------------ has a family relationship with Steve Braun. Michael Slade ------------- has a business relationship with Eric Blumencranz, Saul Katz and Michael Katz. nancy waldenbaum ---------------- has a business relationship with robert rosenthal. Barbara Hrbek Zucker -------------------- has a family relationship with Donald Zucker. She has a business relationship with Roger Blumencranz. Donald Zucker ------------- has a family relationship with Barbara Hrbek Zucker. He has a business relationship with Roger Blumencranz and m. allen hyman. Roy Zuckerberg -------------- has a business relationship with William Mack. DISCLOSURE INFORMATION CORE FORM, PART VI, SECTION A; QUESTION 7 North Shore-Long Island Jewish Health Care, Inc. ("HealthCare") is the sole corporate member of the organization. HealthCare has the right to elect or appoint members of the organization's governing body and has the right to approve or ratify certain corporate decisions. This organization and HealthCare are part of the North Shore-Long Island Jewish Health System, an integrated healthcare delivery system. DISCLOSURE INFORMATION CORE FORM, PART VI, SECTION B; QUESTION 11B All North Shore-LIJ Health System Inc. and affiliated entities prepare the annual Return of Organization Exempt Form Income Tax (Form 990) with input from various departments including Corporate Compliance, Finance, Human Resources, and Legal). Before filing the returns, the documents are electronically made available for review to members of the Executive Committee. 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. DISCLOSURE INFORMATION CORE FORM, PART VI, SECTION B; QUESTION 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 filed 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. DISCLOSURE INFORMATION CORE FORM, PART VI, SECTION b; QUESTION 15 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. DISCLOSURE INFORMATION CORE FORM, PART VI, SECTION C; QUESTION 19 CURRENTLY THE ORGANIZATION PROVIDES GOVERNANCE DOCUMENTS, CONFLICT OF INTEREST POLICIES AND FINANCIAL STATEMENTS TO THE PUBLIC UPON REQUEST. RELATED HOURS INFORMATION CORE FORM, PART VII, SECTION A This organization is affiliated with the North Shore Long Island Jewish Health System (the "Health System"). The Officers, Directors and Trustees listed on Schedule J hold similar positions with both this organization and other affiliates of the Health System, and they do not separately allocate their time to this organization and such other affiliates. The hours shown for all such persons reflect time devoted to the entire Health System and its affiliates, including this organization. For Directors and Trustees, the hours shown reflect the estimated average weekly time. For officers, Key Employees and Highest Compensated Employees, the hours shown reflect the weekly hours used when determining compensation payments for services rendered and are, generally, less than the actual weekly hours devoted to the Health System and its affiliates. COMPENSATION INFORMATION DISCLOSURE CORE FORM, PART VII AND SCHEDULE J PART VII AND SCHEDULE J REFLECT CERTAIN BOARD MEMBERS AND OFFICERS RECEIVING COMPENSATION AND BENEFITS from RELATED ORGANIZATIONs. PLEASE NOTE THIS REMUNERATION WAS FOR SERVICES RENDERED AS FULL-TIME EMPLOYEES OF THose RELATED ORGANIZATIONs AND NOT FOR SERVICES RENDERED AS A VOTING MEMBER OR OFFICER OF THIS ORGANIZATION'S BOARD OF TRUSTEES. AUDITED FINANCIAL STATEMENTS CORE FORM, PART XII; QUESTION 2 THE ORGANIZATION IS AN AFFILIATE WITHIN THE NORTH SHORE - LONG ISLAND JEWISH HEALTH SYSTEM, INC. ("SYSTEM"), A TAX-EXEMPT INTEGRATED HEALTHCARE DELIVERY SYSTEM WHICH INCLUDES STATEN ISLAND UNIVERSITY HOSPITAL. THE SYSTEM'S PARENT ENTITY IS NORTH SHORE - LONG ISLAND JEWISH HEALTH SYSTEM, INC. AN INDEPENDENT CPA FIRM AUDITED THE CONSOLIDATED FINANCIAL STATEMENTS OF NORTH SHORE - LONG ISLAND JEWISH HEALTH SYSTEM, INC. AND ITS AFFILIATES FOR THE YEARS ENDED DECEMBER 31, 2012 AND DECEMBER 31, 2011; RESPECTIVELY. THESE CONSOLIDATED AUDITED FINANCIAL STATEMENTS INCLUDE CONSOLIDATING SCHEDULES ON AN ENTITY BY ENTITY BASIS. THE INDEPENDENT CPA FIRM ISSUED AN UNQUALIFIED OPINION WITH RESPECT TO THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS. THE NORTH SHORE - LONG ISLAND JEWISH HEALTHCARE SYSTEM, INC. EXECUTIVE COMMITTEE HAS ASSUMED RESPONSIBILITY FOR THE OVERSIGHT OF THE AUDIT OF THE CONSOLIDATED FINANCIAL STATEMENTS, WHICH INCLUDES THIS ORGANIZATION, AND THE SELECTION OF AN INDEPENDENT AUDITOR. CHAPS Community Health Center Inc 1 Edgewater Plaza 6th Floor Staten Island NY 10305 113345477 Inactive NY 501(C)(3) 9 SIUH false Feinstein Institute for Medical Research 972 Brush Hollow Rd Westbury NY 11590 112673595 Research NY 501(C)(3) 4 NS-LIJ HS false Forest Hills Hospital 972 Brush Hollow Rd Westbury NY 11590 112163522 HealthCare NY 501(C)(3) 3 NS-LIJ HC false Franklin Hospital 972 Brush Hollow Rd Westbury NY 11590 112296824 HealthCare NY 501(C)(3) 3 NS-LIJ HC false Glen Cove Hospital 972 Brush Hollow Rd Westbury NY 11590 111633487 HealthCare NY 501(C)(3) 3 NS-LIJ HC false Hillside Hospital Houses Inc 972 Brush Hollow Rd Westbury NY 11590 112113949 Housing Comp NY 501(C)(2) N/A NS-LIJ HS false Hospice Care Network 99 Sunnyside Blvd Woodbury NY 11797 112925757 Hospice NY 501(C)(3) 9 NS-LIJ HS false Huntington Hospital 270 Park Avenue Huntington NY 11743 111630914 HealthCare NY 501(C)(3) 3 NS-LIJ HC false Huntington Hosp Dolan Family Health Ctr 284 Pulaski Rd Greenlawn NY 11740 113368503 HealthCare NY 501(C)(3) 3 Huntington false LIJ Foundation 972 Brush Hollow Rd Westbury NY 11590 112661239 support org NY 501(C)(3) 11, TYPE I NS-LIJ HS false Long Island Jewish Medical Center 972 Brush Hollow Rd Westbury NY 11590 112241326 HealthCare NY 501(C)(3) 3 NS-LIJ HC false LIJ Medical Center at Home Pharmacy 972 Brush Hollow Rd Westbury NY 11590 113251128 support org NY 501(C)(3) 11, TYPE I NS-LIJ HS false North Shore Community Services Inc 972 Brush Hollow Rd Westbury NY 11590 237273200 Housing Comp NY 501(C)(2) N/A NS-LIJ HS false North Shore University Hospital 972 Brush Hollow Rd Westbury NY 11590 111562701 HealthCare NY 501(C)(3) 3 NS-LIJ HC false NS Univ Hospital at Glen Cove Housing 972 Brush Hollow Rd Westbury NY 11590 237010468 Housing Comp NY 501(C)(2) N/A NS-LIJ HS false North Shore University Hospital Housing 972 Brush Hollow Rd Westbury NY 11590 112171903 Housing Comp NY 501(C)(2) N/A NS-LIJ HS false NSLIJ STERN FAMILY CENTER FOR REHAB 972 Brush Hollow Rd Westbury NY 11590 237007485 Nursing Home NY 501(C)(3) 9 NS-LIJ HC false North Shore-LIJ Health Care Inc 972 Brush Hollow Rd Westbury NY 11590 112965586 support org NY 501(C)(3) 11, TYPE I NS-LIJ HS false North Shore-LIJ Health System 972 Brush Hollow Rd Westbury NY 11590 113418133 support org NY 501(C)(3) 11, TYPE I NA false North Shore-LIJ Health System Foundation 972 Brush Hollow Rd Westbury NY 11590 112965575 Fundraising NY 501(C)(3) 7 NS-LIJ HS false North Shore-LIJ Health Sys Laboratories 972 Brush Hollow Rd Westbury NY 11590 113412370 Support Org NY 501(C)(3) 11, TYPE I NS-LIJ HS false North Shore-LIJ Medical Care Centers 972 Brush Hollow Rd Westbury NY 11590 113473923 support org NY 501(C)(3) 11, TYPE I NS-LIJ HS false Plainview Hospital 972 Brush Hollow Rd Westbury NY 11590 113241243 HealthCare NY 501(C)(3) 3 NS-LIJ HC false Southside Hospital 972 Brush Hollow Rd Westbury NY 11590 111667761 HealthCare NY 501(C)(3) 3 NS-LIJ HC false SSH Inc 972 Brush Hollow Rd Westbury NY 11590 112774102 support org NY 501(C)(3) 11, TYPE I SOUTHSIDE false Staten Island University Hospital 475 Seaview Avenue Staten Island NY 10305 112868878 HEALTH CARE NY 501(C)(3) 3 NS-LIJ HC false STATEN ISLAND UNIV HOSPITAL FOUNDATION 360 SEAVIEW AVENUE STATEN ISLAND NY 10305 870765787 FUNDRAISING NY 501(C)(3) 7 SIUH false THE HEART INSTITUTE 475 SEAVIEW AVENUE STATEN ISLAND NY 10305 311757254 SUPPORT ORG NY 501(C)(3) 11, TYPE I NA false PHYSICIANS OF UNIVERSITY HOSPITAL PC 1 EDGEWATER PLAZA 6th floor STATEN ISLAND NY 10305 200096809 HEALTHCARE NY N/A 11, TYPE I SIUH false LENOX HILL HOSPITAL 100 EAST 77 STREET NEW YORK NY 10021 131624070 HEALTHCARE NY 501(C)(3) 3 NS-LIJ HC false LHH CORPORATION 100 EAST 77TH STREET NEW YORK NY 10021 133272016 SUPPORT ORG NY 501(C)(3) 11, TYPE I NS-LIJ HS false THE ELMEZZI GRAD SCHOOL OF MOLECULAR MED 972 BRUSH HOLLOW RD WESTBURY NY 11590 113284934 GRADUATE SCH NY 501(C)(3) 2 NS-LIJ HS false SPORTS PHYSICAL THERAPY AND REHAB SVCS 972 BRUSH HOLLOW RD WESTBURY NY 11590 061655704 HEALTHCARE NY 501(C)(3) 9 LIJ false NORTH SHORE - LIJ ALLIANCE 972 BRUSH HOLLOW RD WESTBURY NY 11590 263727582 HEALTHCARE NY 501(C)(3) 3 NA false THE LONG ISLAND HOME 400 SUNRISE HIGHWAY AMITYVILLE NY 11701 112837244 HEALTHCARE NY 501(c)(3) 3 LHH CORP false THE LONG ISLAND HOME FOUNDATION 400 SUNRISE HIGHWAY AMITYVILLE NY 11701 112049038 HEALTHCARE NY 501(C)(3) 11, TYPE 1 LHH CORP false KRASNOFF CONS SVCS 972 Brush Hollow ROAD WESTBURY NY 11590 262838027 CONSULTING NY CARE MGT GROUP N/A LONG ISL BEHAV HLTH 972 BRUSH HOLLOW RD WESTBURY NY 11590 453572263 STATISTICS NY NS-LIJ HC RELATED Adv Heart Phys & Surgeons Network PC 130 East 77th St 4th Floor New York NY 10021 133853125 Medical Services NY LENOX HILL c corporation false Adv Imag & Rad of Lenox Hill Hosp PC 100 East 77th St New York NY 10021 200719612 Medical Services NY LENOX HILL C CORPORATION false Aletta Corporation 972 Brush Hollow Rd Westbury NY 11590 112622371 Physician svcs. NY SOUTHSIDE C CORPORATION false Autoimmune Research Therapeutics 972 Brush Hollow Rd Westbury NY 11590 270701489 Inactive NY RESEARCH C CORPORATION false Care Management Group of Greater NY 972 Brush Hollow Rd Westbury NY 11590 113336381 Business Services NY NSH ENTERPRISES C CORPORATION false Emergency Med Svcs of Staten Island PC 1 Edgewater Plaza 6th floor Staten Island NY 10305 134200899 Medical ServiCES NY SIUH C CORPORATION false Goethals Radiology PC 500 Seaview Ave Staten Island NY 10305 200010287 Radiology SVCs. NY SIUH C CORPORATION false Lenox Hill Cardiology Associates PC 100 East 77th St New York NY 10021 133385163 Medical ServiCES NY LENOX HILL C CORPORATION false Lenox Hill Int Card & Vasc Svcs PC 130 East 77th St 9th floor New York NY 10021 201435770 Medical ServiCES NY LENOX HILL C CORPORATION false Lenox Hill Pathology PC 100 East 77th St New York NY 10021 133644370 Medical ServiCES NY LENOX HILL C CORPORATION false Lenox Hill Phy Hospital Org Inc 122 East 76th St suite 3-a New York NY 100212834 133775996 Managed Care NY LENOX HILL C CORPORATION false Lenox otolaryngology head & neck surgery 186 East 76th St 2nd floor New York NY 10021 208784395 Medical Services NY LENOX HILL C CORPORATION false Manhattan Min Inv and Bar Surgery PC 186 East 76th St 1st Floor New York NY 10021 200250107 Medical Services NY LENOX HILL C CORPORATION false North Shore Health Enterprises 972 Brush Hollow Rd Westbury NY 11590 061605319 Holding Comp NY NSHS ENTERPRISE C CORPORATION false NS Health System Enterprises 972 Brush Hollow Rd Westbury NY 11590 113316922 Holding Comp NY NS-LIJ HS C CORPORATION false North Shore IPA 5 Inc 972 Brush Hollow Rd Westbury NY 11590 113383468 Business Services NY NS-LIJ HC C CORPORATION false NS Radiology at Glen Cove PC 972 Brush Hollow Rd Westbury NY 11590 113301179 Medical Services NY NSUH C CORPORATION false NS-LIJ Health System IPA #1 972 Brush Hollow Rd Westbury NY 11590 113533659 Health Care NY LIJ C CORPORATION false NS-LIJ Health System IPA #2 972 Brush Hollow Rd Westbury NY 11590 113533670 Health Care NY LIJ C CORPORATION false NS-LIJ Health System IPA #3 972 Brush Hollow Rd Westbury NY 11590 113533678 Health Care NY LIJ C CORPORATION false NS-LIJ Health System IPA #4 972 Brush Hollow Rd Westbury NY 11590 113533677 Health Care NY LIJ C CORPORATION false NS-LIJ Health System IPA #5 972 Brush Hollow Rd Westbury NY 11590 113533675 Health Care NY LIJ C CORPORATION false NS-LIJ Medical Gr at Huntington PC 972 Brush Hollow Rd Westbury NY 11590 274384049 Medical Services NY NSUH C CORPORATION false NS-LIJ Medical Gr at North Nassau PC 972 Brush Hollow Rd Westbury NY 11590 274384146 Medical Services NY NSUH C CORPORATION false NS-LIJ Medical Gr at Syosset PC 972 Brush Hollow Rd Westbury NY 11590 273957752 Medical Services NY NSUH C CORPORATION false NS-LIJ Medical Group PC 972 Brush Hollow Rd Westbury NY 11590 274384249 Medical Services NY NSUH C CORPORATION false NS-LIJ Network Inc 972 Brush Hollow Rd Westbury NY 11590 320257193 Support Services NY NS-LIJ HS C CORPORATION false NS-LIJ Phys Insurance Co Risk Ret Group 100 Bank St Burlington VT 05401 261487515 INSURANCE VT NS-LIJ HC C CORPORATION false North Shore-LIJ Physicians Group PC 972 Brush Hollow Rd Westbury NY 11590 274384326 Medical Services NY NSUH C CORPORATION false North Shore-LIJ Radiology Services PC 972 Brush Hollow Rd Westbury NY 11590 223970667 Medical Services NY NSUH C CORPORATION false North Shore-LIJ Service Alliance Inc 972 Brush Hollow Rd Westbury NY 11590 263651575 Support Services NY NA C CORPORATION false Ocean Breeze Home Care Agency 1 Edgewater Plaza 6th Floor Staten Island NY 10305 133773601 Inactive NY OVM C CORPORATION false Ocean View Management INC 1 Edgewater Plaza 6th Floor Staten Island NY 10305 133138888 Management Svcs. NY SIUH C CORPORATION false Palliative Care Medical Services PC 99 Sunnyside Blvd Woodbury NY 11797 273957835 Medical Services NY HOSPICE C CORPORATION false Park Lenox Emergency Medicine PC 100 East 77th St New York NY 10021 262661082 Medical Services NY LENOX HILL C CORPORATION false Park Lenox Medical PC 100 East 77th St New York NY 10021 133575380 Medical Services NY LENOX HILL C CORPORATION false Park Lenox OBGYN PC 130 East 77th St 2nd Floor New York NY 10021 133596988 Medical Services NY LENOX HILL C CORPORATION false Park Lenox Orthopedics PC 100 East 77th St New York NY 10021 264634966 Medical Services NY LENOX HILL C CORPORATION false Park Lenox Pediatrics PC 100 East 77th St New York NY 10021 133755683 Medical Services NY LENOX HILL C CORPORATION false Park Lenox Surgical PC 130 East 77th St 13th Floor New York NY 10021 133397814 Medical Services NY LENOX HILL C CORPORATION false Regency Alliance Services Inc 1 Edgewater Plaza 6th Floor Staten Island NY 10305 133277698 inactive NY OVM C CORPORATION false Regional Insurance Company LTD 41 Cedar Ave Hamilton BERMUDA BD HM 12 insurance BD NS-LIJ HC C CORPORATION false Regioncare Inc 972 Brush Hollow Rd Westbury NY 11590 113052191 Homecare NY NSHS ENTERPRISE C CORPORATION false Staten Island Hospitalists PC 475 Seaview Ave Staten Island NY 10305 331010283 Medical Services NY SIUH C CORPORATION false Staten Island Imaging Corp 1 Edgewater Plaza 6th Floor Staten Island NY 10305 133615474 Inactive NY OVM C CORPORATION false Staten Island Medical Intensivist PC 501 Seaview Ave Suite 102 Staten Island NY 10305 043716494 Medical Services NY SIUH C CORPORATION false Staten Island Neonatology PC 500 Seaview Ave Staten Island NY 10305 133375474 Medical Services NY SIUH C CORPORATION false SIUH Perinatology PC 475 Seaview Ave Staten Island NY 10305 134107082 Medical Services NY SIUH C CORPORATION false United Medical Surgical PC 256 Mason Ave BLDG B 2nd FL Staten Island NY 10305 134038780 Surgical Services NY SIUH C CORPORATION false Univ Ph OncHematology Gp PC 500 Seaview Ave Staten Island NY 10305 133642729 Medical Services NY SIUH s CORPORATION false Verrazano Radiology Assoc PC 500 Seaview Ave Suite 200 Staten Island NY 10305 200011201 Radiology Svcs. NY SIUH C CORPORATION false Vivohealth Inc 972 Brush Hollow Rd Westbury NY 11590 264118016 Inactive NY NSH ENTERPRISE C CORPORATION false PARK LENOX PSYCHIATRY PC 130 EAST 77TH STREET NEW YORK NY 10021 133424466 Medical Services NY LENOX HILL c corporation false NS-LIJ CARDIOVASCULAR MEDICINE PC 972 BRUSH HOLLOW RD WESTBURY NY 11590 275078717 Medical Services NY NSUH C CORPORATION false NS-LIJ CARDIOLOGY PC 972 BRUSH HOLLOW RD WESTBURY NY 11590 275078531 Medical Services NY NSUH C CORPORATION false NS-LIJ HEART SURGERY PC 972 BRUSH HOLLOW RD WESTBURY NY 11590 275078838 Medical Services NY NSUH C CORPORATION false NS-LIJ INTERNAL MEDICINE PC 972 BRUSH HOLLOW RD WESTBURY NY 11590 275078361 Medical Services NY NSUH C CORPORATION false NS-LIJ MEDICAL GROUP URGENT MED CARE PC 972 BRUSH HOLLOW RD WESTBURY NY 11590 275078426 Medical Services NY NSUH C CORPORATION false LENOX HILL HOSPITAL MEDICAL PC 972 BRUSH HOLLOW RD WESTBURY NY 11590 452661543 Medical Services NY NSUH C CORPORATION false NS-LIJ MEDICAL PC 972 BRUSH HOLLOW RD WESTBURY NY 11590 453023019 Medical Services NY NSUH C CORPORATION false NS-LIJ OCCUPATIONAL MEDICINE PC 972 BRUSH HOLLOW RD WESTBURY NY 11590 451004103 Medical Services NY NSUH C CORPORATION false NS-LIJ OB-GYN PC 972 Brush Hollow Rd Westbury NY 11590 461382916 Medical Services NY nsuh c corporation false NS-LIJ ANESTHESIOLOGY PC 972 BRUSH HOLLOW RD WESTBURY NY 11590 461382916 Medical Services NY NSUH C CORPORATION false NS-LIJ HEALTH PLANS INC 972 Brush Hollow Rd Westbury NY 11590 461382916 Medical Services NY nsuh c corporation false false false false false false false false false false false false false false false true false false false false TRANSACTIONS WITH RELATED ORGANIZATIONS SCHEDULE R, PART V THIS ORGANIZATION IS AN AFFILIATE OF North Shore - long Island Jewish Health System ("sYSTEM"). ORGANIZATIONS WITHIN THE SYSTEM ROUTINELY PAY EXPENSES FOR VARIOUS AFFILIATES IN THE ORDINARY COURSE OF BUSINESS. THESE RELATED PARTY TRANSACTIONS ARE RECORDED ON THE REVENUE/EXPENSE AND BALANCE SHEET STATEMENTS OF THIS ORGANIZATION AND ITS AFFILIATES. THESE ENTITIES WORK TOGETHER TO DELIVER HIGH QUALITY HEALTHCARE AND WELLNESS SERVICES TO THE COMMUNITIES IN WHICH THEY ARE SITUATED.