2011-08-08T15:10:52-07:00 2010-12-31 990 2010-01-01 132996345 NORTH GENERAL HOSPITAL NORT 5164664110 Lori L Jones Liquidation Trustee 98 Cutter Mill Road-Suite 201 N Great Neck NY 11021 Lori L Jones Liquidation Trustee 5164664110 2011-08-08 2010 2016-02-24 21:20:13Z Lori L Jones Liquidation Trustee 98 Cutter Mill Road Great Neck NY 11021 53271998 0 X www.northgeneral.org X 1979 NY North General Hospital is committed to quality in health care delivery, the provision of primary, secondary and tertiary care services, and the creation of a broader health care delivery system. 5 5 298 0 0 0 2764347 2113186 100676268 47609800 53045 5167 4573506 3543845 108067166 53271998 0 0 0 0 74961671 45251198 0 0 0 47078174 46183146 122039845 91434344 -13972679 -38162346 87868524 74127538 287315415 311736778 -199446891 -237609240 X North General Hospital is committed to quality in health care delivery, the provision of primary, secondary and tertiary care services, and the creation of a broader health care delivery system. In addition, the Hospital is committed to the economic development of the Harlem Communities we serve. 1 1 65457847 0 47609800 North General Hospital is committed to quality in health care delivery, the provision of primary, secondary and tertiary care services, and the creation of a broader health care delivery system. 0 0 0 65457847 1 1 0 0 0 0 0 1 1 0 1 0 0 1 1 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 157 0 1 298 1 0 1 BD 0 0 0 0 X 5 5 0 0 1 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 NY X Lori L Jones Liquidation Trustee 5164664110 98 Cutter Mill Road Suite 201 North Great Neck NY 11021 Calvin Butts III 2 X 0 0 0 Eugene Giscombe 2 X 0 0 0 Livingston S Francis 2 X 0 0 0 Mark Jeziorski 2 X 0 0 0 Gene A Norman 2 X 0 0 0 Samuel Daniel 35 X X 317564 0 9568 John P Maher 35 X X 359808 0 7647 Michele Prisco 35 X 165000 0 5507 Anne Goonan 35 X 228005 0 3336 Myo Maw 35 X 264655 0 2930 Stacie Pinderhughes 35 X 197789 0 3579 Samuel Kim 35 X 239958 0 5659 1772779 0 38226 27 0 1 0 Madison Avenue Emergency Medicine 1720 Hutchinson River Parkway Bronx NY 10461 Professional Emergency Services 1562518 Burns Int'l Security Services PO Box 99477 Chicago IL 60693 Security Personnel 1844906 Windels Marx Lane & Mittendorf LLC 156 West 56th St New York NY 10019 Legal Services 3150356 Alvarez and Marsal 600 Lexington Ave New York NY 10022 Professional Consulting Services 1825000 Healthcare Management Solutions LLC PO Box 56 Vails Gate NY 12584 Financial & Reimbursement Consultants 1080561 31 0 0 0 34244 2078942 0 0 2113186 Program Service Revenue 622000 47609800 47609800 0 0 0 0 0 0 47609800 18115 0 0 18115 0 0 0 0 0 0 0 0 46023 0 0 0 46023 0 46023 0 0 46023 -12948 0 0 0 -12948 0 -12948 0 0 -12948 0 Ancillary Medical Services 900099 882180 882180 0 0 Vendor Settlements 900099 1557119 0 0 1557119 Cafetaria Revenue 900099 100744 0 0 100744 957779 15150 0 942629 3497822 53271998 48507130 0 2651682 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 32140771 23009578 9131193 0 1485006 1063116 421890 0 8927475 6391180 2536295 0 2697946 1931459 766487 0 5122454 3667165 1455289 0 316567 226630 89937 0 14154368 10133112 4021256 0 162250 116155 46095 0 1861341 1332534 528807 0 48036 34389 13647 0 6662982 4770029 1892953 0 4297540 3076609 1220931 0 1458494 1044136 414358 0 Telephone 260112 186214 73898 0 Postage & Shipping 55929 40040 15889 0 Printing 24353 17434 6919 0 Prov for Bad Debt 9462752 6774384 2688368 0 Dues, Licenses & Permits 246682 176600 70082 0 2049286 1467083 582203 0 91434344 65457847 25976497 0 465503 846904 2576487 1733258 0 0 9057646 928712 0 0 0 0 0 175461 504291 0 0 0 144165741 116051737 31618709 28114004 0 0 0 0 0 0 0 43645888 42329199 87868524 74127538 61816167 64468299 0 0 0 0 135103468 134912272 0 0 0 0 43783537 66143537 0 0 46612243 46212670 287315415 311736778 X -199932792 -238073425 485901 464185 0 0 -199446891 -237609240 87868524 74127538 X -38162346 -3 X 0 0 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 X 0 1 9372676 0 253223 9119453 0 0 679211 679211 0 58034749 36931746 21103003 0 873882 365143 508739 0 83409068 78754848 4654220 0 1168831 0 1168831 28114004 Assets Limited to use-Debt Srv Reserve Fund 11827336 Misc Receivables & Prepaids 855159 Due from Related Party 398227 Other Assets 1731629 Due from DT&C 27516848 42329199 0 Third Party Settlement Payable 24993570 Accrued Benefit Liability 543085 Estimated Loss Reserve 7065000 Due to NGH Foundation 204811 Due to Related Party 203169 Pension Liability 13203035 46212670 SchD_P03_S00_L01 Schedule D, Part III, Line 1 The organization owns various pieces of art at its hospital location. These assets were appraised several years ago, but no recent appraisal has been performed. The historical artwork was has not been reported in its revenue statement or balance sheet and there is no footnote within its financial statements describing these items. NGH is the custodian of pension plan assets. These assets are not reported on the balance sheet or income statement but the 2010 internal financial statements. SchD_P03_S00_L04 Schedule D, Part III, Line 4 The organization owns various pieces of art at its location. These assets were appraised several years ago but no recent appraisal has been performed. The historical art work has not been reported in its revenue statement or balance sheet and there is no footnote within its financial statements. SchD_P04_S00_L01b Schedule D, Part IV, Line 1b North General Hospital is the custodian of the pension plan assets. These assets are not reported on the balance sheet or income statement of the hospital internal financial statements. Central America and the Caribbean 0 0 Program Services Captive Insurance 0 0 0 0 0 0 1 0 0 0 SchF_P04_S00_L00 Schedule F, Part IV North General Hospital formed a wholly-owned captive insurance company, North General Insurance, LTD, (Captive) which was incorporated and licensed in Bermuda to write general and professional insurance. The captive insured the professional liability exposures of the hospital on a claims made basis. The captive insured the general liability exposures of the hospital on an occurrence basis. The captive was dissolved in the year 2010. The remaining assets of approximately $223,000 was transferred back to North General Hospital upon dissolution. 1 1 X 1 X 1 X 1 0 0 2419552 589470 1830082 0.02 55457084 27711047 27746037 0.3035 0 0 57876636 28300517 29576119 0.3235 22356349 9572827 12783522 0.1398 0 0 22356349 9572827 12783522 0.1398 0 0 80232985 37873344 42359641 0.4633 1 11320169 0 11102426 10897710 204716 X 1 0 1 1 North General Hospital

1879 Madison Ave New York NY 10035

X North General Hospital 1 SchH_P01_S00_L07 Schedule H, Part I, Line 7 Hospital used a ratio of cost to charges to develop cost by payer SchH_P01_S00_L072f Schedule H, Part I, Line 7, Column f Provision of bad debt for hospital was $9,462,752 SchH_P01_S00_L07g Schedule H, Part I, Line 7g No physician services were included on line 7g SchH_P03_S0A_L04 Schedule H, Part III, Section A, Line 4 No audit was done for 2010 since hospital closed. SchH_P03_S0B_L08 Schedule H, Part III, Section B, Line 8 No Medicare shortfall was included in line 7 SchH_P03_S0C_L09b Schedule H, Part III, Section C, Line 9b Hospital had a collection/write off policy. If patient qualified for financial assistance, their account was not considered bad debt SchH_P06_S00_L02 Schedule H, Part VI, Line 2 The communities of East and Central Harlem are economically underprivileged-working class communities populated primarily by Latinos and African-Americans. Relative to the rest of New York City, East and Central Harlem are inhabited by traditionally under-served populations, living at the higher levels of povery and who suffer disproportionately from increased rates of mortality due to common illnesses and treatable diseases. Residents in these communities rank among the bottom of New York City neighborhoods and have below average scores in areas such as general health, maternal and child health, infectious disease (including pneumonia, influenza and HIV/AIDS) and chronic disease (including heart disease, diabetes and lung diseases). The Hospital's existence has been essential to providing the residents of East and Central Harlem with the health services they critically require. SchH_P06_S00_L03 Schedule H, Part VI, Line 3 Hospital had financial counselors meet with patients and discuss Medicaid and financial assistance opportunities. In addition, signage explaining financial assistance was provided in patient access areas. SchH_P06_S00_L04 Schedule H, Part VI, Line 4 The patients served by North General are largely made up of traditionally under-served, undocumented populations. The population surrounding North General consists primarily of groups with lower levels of education living at higher levels of poverty compared to the greater New York City population. As a result, the standard of living in Harlem is relatively low, death rates are relatively high for both adults and infants, and the unemployment rates are significantly higher in Harlem than in surrounding areas. X X X X 1 0 0 0 0 0 0 0 0 Samuel Daniel 317564 0 0 0 0 0 3049 0 6519 0 327132 0 523712 0 John P Maher 359808 0 0 0 0 0 5500 0 2147 0 367455 0 295330 0 Michele Prisco 165000 0 0 0 0 0 3875 0 1632 0 170507 0 180209 0 Stacie Pinderhughes 197789 0 0 0 0 0 1300 0 2279 0 201368 0 317800 0 Anne Goonan 228005 0 0 0 0 0 0 0 3336 0 231341 0 224873 0 Myo Maw 264655 0 0 0 0 0 0 0 2930 0 267585 0 331385 0 Samuel Kim 239958 0 0 0 0 0 0 0 5659 0 245617 0 0 0 SchJ_P01_S00_L04 Schedule J, Part I, Line 4 The facility paid severance to S. Pinderhughes, M. Maw and S. Kim. Dormitory Authority of New York State 2003-01-23 138135000 Refinancing of 1998 Bond 0 0 0 0 0 138135000 11827336 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 F990_P03_S00_L02 Form 990, Part III, Line 2 Hospital filed for bankruptcy on July 2, 2010 and closed on July 9, 2010 F990_P03_S00_L03 Form 990, Part III, Line 3 Hospital filed for bankruptcy on July 2, 2010 and closed on July 9, 2010 F990_P06_S0A_L04 Form 990, Part VI, Section A, Line 4 Hospital filed bankruptcy on July 2, 2010 and closed on July 9, 2010. Effective June 30, 2011, the United States Bankruptcy Court Southern District of New York approved a Chapter 11 Plan of liquidation for North General Hospital and its Affiliated Debtors. Pursuant to the Plan, a Liquidation Trustee was appointed and the assets of North General Hospital were sold, and/or transferred back to the Dormitory Authority of the State of New York. F990_P06_S0A_L06 Form 990, Part VI, Section A, Line 6 North General Service Corporation (NGSC) is the sole corporate member (and parent entity) of North General Hospital F990_P06_S0A_L07a Form 990, Part VI, Section A, Line 7a North General Service Corporation (NGSC) is the sole corporate member (and parent entity) of North General Hospital (NGH). NGSC has the sole authority to appoint and remove trustees to the North General Hospital Board of Trustees. This power has been specifically enumerated in both the NGSC and NGH Bylaws. F990_P06_S0A_L07b Form 990, Part VI, Section A, Line 7b North General Service Corporation (NGSC) is the sole corporate member (and parent entity) of North General Hospital (NGH). NGSC does not have the authority to approve every-day decisions of the North General Hospital Board of Trustees regarding the hospital's operations, however, NGSC must approve the Board of Director's decisions with regard to certain corporate transactions (such as dissolution, creation of new entities, etc.) F990_P06_S0B_L11a Form 990, Part VI, Section B, Line 11a The books and records were maintained by hospital staff. Hospital financial statements were prepared internally for 2010 and not audited by an independent accounting firm due to the bankruptcy. The Form 990 was reviewed in detail by North General Hospital's President & CRO, as well as the Liquidation Trustee prior to filing. Lori Lapin Jones executed this Form 990 solely in her capacity as Liquidation Trustee of North General Hospital. The information contained in this Form 990 is based on transactions and events that precede the appointment of the Liquidation Trustee on June 30, 2011. The Liquidation Trustee does not have complete knowledge of the information in this Form 990, but has no reason to believe the information contained in this return is not fairly presented. F990_P06_S0B_L12c Form 990, Part VI, Section B, Line 12c Each Officer, Director, Trustee and key employee of North General Hospital (NGH) is required to annually disclose any conflicts of interest that arise by virtue of their employment and position with NGH. The Hospital monitors compliance with its conflict of interest policy through an annual questionnaire submitted to these individuals. Potential conflicts are investigated immediately. F990_P06_S0B_L15 Form 990, Part VI, Section B, Line 15 Pursuant to hospital by-laws, the compensation committee of the hospital Board of Trustees evaluates executive compensation and makes recommendations to the Board based on comparative studies and industry practice specific to tax-exempt, not-for-profit, charitable organizations F990_P06_S0C_L19 Form 990, Part VI, Section C, Line 19 The organization's Form 990 is available for public inspection on WWW.Guidestar.org F990_P11_S00_L05 Form 990, Part XI, Line 5 Rounding adjustment North General Hospital Home Attendent Corp 205 East 122nd St New York NY 10035 133047556 Home Care NY 501 C 3 11A N/A 0 North General Housing Develop Fund Co 1879 Madison Ave New York NY 10035 133552466 Inactive NY 501 C 3 11A N/A 0 North General Service Corp 1879 Madison Ave New York NY 10035 133696783 Sole Member/Parent NY 501 C 3 11A N/A 0 North Gen Aids Housing Develop Fund Corp 1879 Madison Ave New York NY 10035 133737001 Housing NY 501 C 3 11A N/A 0 North General Hospital Foundation 1879 Madison Ave New York NY 10035 133700925 Fundraising NY 501 C 3 11A N/A 0 North General Diagnostic & Treatment Ctr 1879 Madison Ave New York NY 10035 200561166 Healthcare NY 501 C 3 3 N/A 0 NGSC Insurance Limited Craig Appin House 8 Wesely Street Hamilton BD Captive Insurance NY N/A C 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 1 1 0 North General Diagnostic & Treatment Ctr a-i 793488 North General Diagnostic & Treatment Ctr n 3099848 North General Diagnostic & Treatment Ctr b 7063927 North General Diagnostic & Treatment Ctr p 27516849 Pursuant to Announcement 2011-20, the IRS has granted an automatic three-month extension of time to file the Form 990 to hospital organizations with original tax year filing due dates before August 15, 2011.