2011-11-15T13:22:15-06:00 2010-12-31 LOEB & TROPER LLP 655 THIRD AVENUE 12TH FLOOR NEW YORK NY 10017 990 2010-01-01 200714587 CENTRAL SUFFOLK HOSPITAL FOUNDATION CENT 6315486064 1300 ROANOKE AVENUE RIVERHEAD NY 11901 ANDREW MITCHELL 6315486064 2011-11-14 1 FREDERICK H ROTHMAN 2128674000 2010 2016-02-24 21:20:13Z SEE SCHEDULE O FOR DBA ANDREW MITCHELL 1300 ROANOKE AVENUE RIVERHEAD NY 11901 1459905 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. 15 14 6 0 0 0 967777 1419214 0 0 1634 2791 17936 -35429 987347 1386576 937133 499587 0 0 0 0 0 241500 921581 704754 680081 1641887 1421168 -654540 -34592 3095330 3820545 1325153 2084960 1770177 1735585 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 499587 499587 THE SUPPORT OF HOSPITAL SERVICES OF CENTRAL SUFFOLK HOSPITAL. 499587 1 1 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0 0 0 1 1 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 1 1 6 1 0 0 0 0 0 1 1 0 0 0 0 X 15 14 0 0 0 0 0 0 0 1 1 0 0 1 0 1 1 0 0 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 RICHARD L WINSLOW 1.00 X X 0 0 0 BABU EASOW MD 1.00 X X 0 0 0 ANDREW MITCHELL 1.00 X X 0 612901 33052 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 RICHARD ISRAEL 1.00 X 0 0 0 JACQUELINE M ENTENMANN 1.00 X 0 0 0 ELIZABETH F FAILING 1.00 X 0 0 0 JOAN LEVAN 10.00 X 0 0 0 RICHARD RUBENSTEIN 1.00 X 0 0 0 JOSEPH VAN DE WETERING 1.00 X 0 0 0 CAROLE HANKIN PHD 1.00 X 0 0 0 0 612901 33052 0 0 1 0 0 351269 300000 767945 1419214 2791 2791 37900 351269 73329 -35429 -35429 1386576 0 0 -32638 499587 499587 75461 75461 9736 9736 241500 241500 427265 427265 3578 3578 84577 84577 7500 7500 3967 3967 BAD DEBT 36000 36000 MISCELLANEOUS 27897 27897 PLAQUES 4100 4100 1421168 499587 0 921581 2216279 2740127 879051 1080418 3095330 3820545 1325153 2084960 1325153 2084960 X 1342944 1075458 427233 660127 1770177 1735585 3095330 3820545 -34592 0 X X 0 1 1 X 0 X 1108369 2022946 1240829 967777 1419214 6759135 1108369 2022946 1240829 967777 1419214 6759135 2047478 4711657 5044 3355 3300 1634 2791 16124 130626 102949 52290 89011 37900 412776 7188035 233575 0.65550 0.71400 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: SPECIAL EVENTS RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 DUE TO CENTRAL SUFFOLK HOSPITAL D/B/A PECONIC BAY MEDICAL CENTER 2035466 CONTRIBUTIONS HELD ON BEHALF OF WOMEN'S HEALTH PARTNERSHIP 49494 2084960 1386576 1421168 -34592 0 -34592 1386576 0 1386576 0 1386576 1421168 0 1421168 0 1421168 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE FOUNDATION 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, 2007 AND SUBSEQUENT REMAIN SUBJECT TO EXAMINATION BY APPLICABLE TAXING AUTHORITIES. THE ASSETS OF THE FOUNDATION ARE PLEDGED AS A COLLATERAL FOR A BOND ISSUANCE OF CENTRAL SUFFOLK HOSPITAL D/B/A PECONIC BAY MEDICAL CENTER A RELATED PARTY. X X X X 1 COMMUNITY COUNSELING SERVICES LLC 461 FIFTH AVENUE NEW YORK NY 10017 CONSULTING FOR CAPITAL CAMPAIGN 0 0 241500 0 241500 BLACK AND WHITE 257779 224179 33600 19500 41713 1475 3631 GARDEN FESTIVAL 131390 127090 4300 4710 2300 1 389169 351269 37900 19500 46423 2300 1475 3631 73329 -35429 1 CENTRAL SUFFOLK HOSPITAL 1300 ROANOKE AVENUE RIVERHEAD NY 11901 111661359 501(C)(3) 499587 GENERAL OPERATIONS 1 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: REQUESTS ARE RECEIVED AND REVIEWED BY THE BOARD. THE FOUNDATION REVIEWS FINANCIAL REPORTS RECEIVED FROM THE GRANT RECEIPIENT WHICH VERIFY THAT THE GRANT HAS BEEN APPLIED ACCORDINGLY. 0 0 0 0 0 0 0 0 0 ANDREW MITCHELL 0 489130 0 106351 0 17420 0 31200 0 1852 0 645953 0 0 FORM 990, PART VI, SECTION B, LINE 11 THE CEO/PRESIDENT, CHIEF OPERATING OFFICER AND CHIEF FINANCIAL OFFICER REVIEW THE 990 AND MEET WITH THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS TO DISCUSS AND REVIEW THE 990. FORM 990, PART VI, SECTION B, LINE 12 THE FOUNDATION FOLLOWS THE HOSPITAL'S CONFLICT OF INTEREST POLICY. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XII, LINE 2C THE PROCESS DIDN'T CHANGE FROM THE PRIOR YEAR. OFFICERS COMPENSATED FROM RELATED ORGANIZATIONS FORM 990, PART VII, SECTION A, LINE 1A THE FOLLOWING OFFICER IS COMPENSATED BY RELATED ORGANIZATIONS: ANDREW MITCHELL 36.5 HOURS PER WEEK PRESIDENT/CEO 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 1 0 1 1 0 0 0 0 1 1 0 1 1 0 0 0 0