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CENTRAL SUFFOLK HOSPITAL FOUNDATION: Form 990, tax year 2021

View the entire original 990 at ProPublica ↗

Organization
CENTRAL SUFFOLK HOSPITAL FOUNDATION (EIN 20-0714587)
Tax period
2021-01-01 to 2021-12-31
Filed
2022-11-15
IRS object ID
202223199349307157
Schema version
2021v4.2
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Return2022-11-15T10:05:07-06:00ReturnTs
Tax Period End2021-12-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1FORVIS LLPBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line11155 Avenue of the Americas 1200AddressLine1Txt
CityNew YorkCityNm
State AbbreviationNYStateAbbreviationCd
ZIP10036ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2021-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN200714587EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1CENTRAL SUFFOLK HOSPITAL FoundationBusinessNameLine1Txt
FieldValueIRS element (for citing)
In Care Of% MICHAEL F O'DONNELLInCareOfNm
Business Name ControlCENTBusinessNameControlTxt
Phone6315486152PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line11 Heroes WAYAddressLine1Txt
CityRIVERHEADCityNm
State AbbreviationNYStateAbbreviationCd
ZIP11901ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonAMY LEOBPersonNm
Person TitleEXECUTIVE DIRECTORPersonTitleTxt
Phone6315486064PhoneNum
Signature2022-05-22SignatureDt
Discuss With Paid PreparerYes (true)DiscussWithPaidPreparerInd

Signing Officer SigningOfficerGrp

Person Full Name PersonFullName

FieldValueIRS element (for citing)
Person FirstJackiePersonFirstNm
Person LastSmithPersonLastNm
FieldValueIRS element (for citing)
SSN999009999SSN

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonAaron ShapiroPreparerPersonNm
PTINP01333816PTIN
Phone2128674000PhoneNum

Additional Filer Information AdditionalFilerInformation

Trusted Customer TrustedCustomerGrp

FieldValueIRS element (for citing)
Trusted Customer2TrustedCustomerCd
FieldValueIRS element (for citing)
Tax2021TaxYr
Build TS2022-09-23 18:48:47ZBuildTS

Form 990 IRS990

Doing Business As Name DoingBusinessAsName

FieldValueIRS element (for citing)
Business Name Line1PECONIC BAY MEDICAL CENTER FOUNDATIOBusinessNameLine1Txt
FieldValueIRS element (for citing)
Principal OfficerANDREW J MITCHELLPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line11 Heroes WAYAddressLine1Txt
CityRIVERHEADCityNm
State AbbreviationNYStateAbbreviationCd
ZIP11901ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$10,747,344GrossReceiptsAmt
Group Return For AffiliatesfalseGroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressWWW.PBMCHEALTH.ORGWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation2004FormationYr
Legal Domicile StateNYLegalDomicileStateCd
Activity Or MissionTHE MISSION OF CENTRAL SUFFOLK HOSPITAL FOUNDATION IS TO SEEK PHILANTHROPIC SUPPORT ON BEHALF OF CENTRAL SUFFOLK HOSPITAL D/B/A PECONIC BAY MEDICAL CENTER.ActivityOrMissionDesc
Voting Members Governing Body12VotingMembersGoverningBodyCnt
Voting Members Independent11VotingMembersIndependentCnt
Total Employee0TotalEmployeeCnt
Total Volunteers11TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
PY Contributions Grants$6,267,036PYContributionsGrantsAmt
CY Contributions Grants$8,641,643CYContributionsGrantsAmt
PY Program Service Revenue$0PYProgramServiceRevenueAmt
CY Program Service Revenue$0CYProgramServiceRevenueAmt
PY Investment Income$60,881PYInvestmentIncomeAmt
CY Investment Income$41,574CYInvestmentIncomeAmt
PY Other Revenue-$135,459PYOtherRevenueAmt
CY Other Revenue$547,102CYOtherRevenueAmt
PY Total Revenue$6,192,458PYTotalRevenueAmt
CY Total Revenue$9,230,319CYTotalRevenueAmt
PY Grants And Similar Paid$2,410,434PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$1,250,765CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$0PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$0CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$2,061,789PYOtherExpensesAmt
CY Other Expenses$1,706,364CYOtherExpensesAmt
PY Total Expenses$4,472,223PYTotalExpensesAmt
CY Total Expenses$2,957,129CYTotalExpensesAmt
PY Revenues Less Expenses$1,720,235PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$6,273,190CYRevenuesLessExpensesAmt
Total Assets BOY$41,952,205TotalAssetsBOYAmt
Total Assets EOY$45,698,459TotalAssetsEOYAmt
Total Liabilities BOY$21,112,717TotalLiabilitiesBOYAmt
Total Liabilities EOY$18,593,625TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$20,839,488NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$27,104,834NetAssetsOrFundBalancesEOYAmt
MissionTHE FOUNDATIONS MISSION IS TO DEVELOP AND CULTIVATE PHILANTHROPIC AND COLLABORATIVE RELATIONSHIPS THAT FOSTER PROGRAMS AND SERVICES OFFERED THROUGH CENTRAL SUFFOLK HOSPITAL WHICH IMPROVE THE HEALTH OF THE COMMUNITIES IT SERVES.MissionDesc
Significant New Program SrvcfalseSignificantNewProgramSrvcInd
Significant ChangefalseSignificantChangeInd
Expense$2,950,757ExpenseAmt
Grant$1,250,765GrantAmt
DescTO SUPPORT THE SERVICES PROVIDED AT PECONIC BAY MEDICAL CENTER.Desc
Total Program Service Expenses$2,950,757TotalProgramServiceExpensesAmt
Described In Section501c3Yes (true)DescribedInSection501c3Ind
Schedule B RequiredYes (true)ScheduleBRequiredInd
Political Campaign ActyfalsePoliticalCampaignActyInd
Lobbying ActivitiesfalseLobbyingActivitiesInd
Subject To Proxy TaxfalseSubjectToProxyTaxInd
Donor Advised FundfalseDonorAdvisedFundInd
Conservation EasementsfalseConservationEasementsInd
Collections Of ArtfalseCollectionsOfArtInd
Credit CounselingfalseCreditCounselingInd
Donor Rstr Or Quasi EndowmentsfalseDonorRstrOrQuasiEndowmentsInd
Report Land Building EquipmentYes (true)ReportLandBuildingEquipmentInd
Report Investments Other SecfalseReportInvestmentsOtherSecInd
Report Program Related InvstfalseReportProgramRelatedInvstInd
Report Other AssetsfalseReportOtherAssetsInd
Report Other LiabilitiesYes (true)ReportOtherLiabilitiesInd
Include FIN48 FootnotefalseIncludeFIN48FootnoteInd
Independent Audit Fincl StmtYes (true)IndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (true)ConsolidatedAuditFinclStmtInd
School OperatingfalseSchoolOperatingInd
Foreign OfficefalseForeignOfficeInd
Foreign ActivitiesfalseForeignActivitiesInd
More Than5000 K To OrgfalseMoreThan5000KToOrgInd
More Than5000 K To IndividualsfalseMoreThan5000KToIndividualsInd
Professional FundraisingfalseProfessionalFundraisingInd
Fundraising ActivitiesYes (true)FundraisingActivitiesInd
Gaming ActivitiesfalseGamingActivitiesInd
Operate HospitalfalseOperateHospitalInd
Grants To OrganizationsYes (true)GrantsToOrganizationsInd
Grants To IndividualsfalseGrantsToIndividualsInd
Schedule J RequiredYes (true)ScheduleJRequiredInd
Tax Exempt BondsfalseTaxExemptBondsInd
Engaged In Excess Benefit TransfalseEngagedInExcessBenefitTransInd
PY Excess Benefit TransfalsePYExcessBenefitTransInd
Loan OutstandingfalseLoanOutstandingInd
Grant To Related PersonfalseGrantToRelatedPersonInd
Business Rln With Org MemfalseBusinessRlnWithOrgMemInd
Business Rln With Fam MemfalseBusinessRlnWithFamMemInd
Business Rln With35 Ctrl EntfalseBusinessRlnWith35CtrlEntInd
Deductible Non Cash ContrifalseDeductibleNonCashContriInd
Deductible Art ContributionfalseDeductibleArtContributionInd
Terminate OperationsfalseTerminateOperationsInd
Partial LiquidationfalsePartialLiquidationInd
Disregarded EntityfalseDisregardedEntityInd
Related EntityYes (true)RelatedEntityInd
Related Organization Ctrl EntfalseRelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd OrgfalseTrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted PrtshpfalseActivitiesConductedPrtshpInd
Schedule O RequiredYes (true)ScheduleORequiredInd
IRP Document1IRPDocumentCnt
IRP Document W2 G1IRPDocumentW2GCnt
Backup Wthld ComplianceYes (true)BackupWthldComplianceInd
Employee0EmployeeCnt
Unrelated Bus Incm Over LimitfalseUnrelatedBusIncmOverLimitInd
Foreign Financial AccountfalseForeignFinancialAccountInd
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTransInd
Taxable Party NotificationfalseTaxablePartyNotificationInd
Nondeductible ContributionsfalseNondeductibleContributionsInd
Quid Pro Quo ContributionsYes (true)QuidProQuoContributionsInd
Quid Pro Quo Contri DisclYes (true)QuidProQuoContriDisclInd
Form8282 Property Disposed OffalseForm8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft CntrctfalseRcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft CntrctfalsePayPremiumsPrsnlBnftCntrctInd
Indoor Tanning ServicesfalseIndoorTanningServicesInd
Subj To Tax Rmnrtn Ex Prcht PymtfalseSubjToTaxRmnrtnExPrchtPymtInd
Subject To Excs Tax Net Invst IncfalseSubjectToExcsTaxNetInvstIncInd
Governing Body Voting Members12GoverningBodyVotingMembersCnt
Independent Voting Member11IndependentVotingMemberCnt
Family Or Business RlnfalseFamilyOrBusinessRlnInd
Delegation Of Mgmt DutiesfalseDelegationOfMgmtDutiesInd
Change To Org DocumentsfalseChangeToOrgDocumentsInd
Material Diversion Or MisusefalseMaterialDiversionOrMisuseInd
Members Or StockholdersfalseMembersOrStockholdersInd
Election Of Board MembersfalseElectionOfBoardMembersInd
Decisions Subject To ApprovafalseDecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (true)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (true)MinutesOfCommitteesInd
Officer Mailing AddressfalseOfficerMailingAddressInd
Local ChaptersfalseLocalChaptersInd
Form990 Provided To Gvrn BodyYes (true)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyfalseConflictOfInterestPolicyInd
Whistleblower PolicyYes (true)WhistleblowerPolicyInd
Document Retention PolicyYes (true)DocumentRetentionPolicyInd
Compensation Process CEOfalseCompensationProcessCEOInd
Compensation Process OtherfalseCompensationProcessOtherInd
Investment In Joint VenturefalseInvestmentInJointVentureInd
States Where Copy Of Return Is FldNYStatesWhereCopyOfReturnIsFldCd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

FieldValueIRS element (for citing)
PersonMICHAEL F O'DONNELLPersonNm
Phone6315486074PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line11300 ROANOKE AVENUEAddressLine1Txt
CityRIVERHEADCityNm
State AbbreviationNYStateAbbreviationCd
ZIP11901ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (13 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmt
ANDREW J MITCHELL
PRESIDENT/CEO15.022.0Yes (X)Yes (X)$0$1,279,225$49,086
EMILIE ROY COREY MSW
BOARD CHAIR10.00.0Yes (X)Yes (X)$0$0$0
J GORDON HUSZAGH
VICE CHAIR15.01.0Yes (X)Yes (X)$0$0$0
RICHARD ISREAL
VICE CHAIR1.01.0Yes (X)Yes (X)$0$0$0
JOAN S LEVAN
SECRETARY/TREASURER1.01.0Yes (X)Yes (X)$0$0$0
KAREEN MASSOUD
BOARD MEMBER0.01.0Yes (X)$0$0$0
MARY ANN ALEXANDER
BOARD MEMBER0.01.0Yes (X)$0$0$0
JUDITH JEDLICKA
BOARD MEMBER0.01.0Yes (X)$0$0$0
RICHARD WINSLOW
board member1.01.0Yes (X)$0$0$0
MICHAEL SCHWENK
BOARD MEMBER1.00.0Yes (X)$0$0$0
STANLEY ZINBERG
board member1.01.0Yes (X)$0$0$0
SHERRY PATTERSON
BOARD MEMBER1.01.0Yes (X)$0$0$0
Amy Loeb
Executive Director10.00.0Yes (X)$0$0$0
FieldValueIRS element (for citing)
Total Reportable Comp From Org$0TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$1,279,225TotReportableCompRltdOrgAmt
Total Other Compensation$49,086TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K0IndivRcvdGreaterThan100KCnt
Former Ofcr Employees ListedfalseFormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (true)TotalCompGreaterThan150KInd
Compensation From Other SrcsfalseCompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp

Contractor Name ContractorName

FieldValueIRS element (for citing)
Personcentral suffolk hospitalPersonNm

Contractor Address ContractorAddress

US Address USAddress

FieldValueIRS element (for citing)
Address Line11300 Roanoke AvenueAddressLine1Txt
CityRIVERHEADCityNm
State AbbreviationNYStateAbbreviationCd
ZIP11901ZIPCd
FieldValueIRS element (for citing)
ServicesAdministrativeServicesDesc
Compensation$819,279CompensationAmt
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K1CntrctRcvdGreaterThan100KCnt
Fundraising$1,393,377FundraisingAmt
Government Grants$271,320GovernmentGrantsAmt
All Other Contributions$6,976,946AllOtherContributionsAmt
Total Contributions$8,641,643TotalContributionsAmt
Total Program Service Revenue$0TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$38,776TotalRevenueColumnAmt
Exclusion$38,776ExclusionAmt

Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Royalties Revenue RoyaltiesRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Gross Rents GrossRentsGrp

FieldValueIRS element (for citing)
Real$1,996,983RealAmt

Less Rental Expenses LessRentalExpensesGrp

FieldValueIRS element (for citing)
Real$1,414,582RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Real$582,401RealAmt
Personal$0PersonalAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$582,401TotalRevenueColumnAmt
Exclusion$582,401ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

FieldValueIRS element (for citing)
Securities$17,442SecuritiesAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

FieldValueIRS element (for citing)
Securities$14,644SecuritiesAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Securities$2,798SecuritiesAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column$2,798TotalRevenueColumnAmt
Exclusion$2,798ExclusionAmt
FieldValueIRS element (for citing)
Fundraising Gross Income$52,500FundraisingGrossIncomeAmt
Contri Rpt Fundraising Event$1,393,377ContriRptFundraisingEventAmt
Fundraising Direct Expenses$87,799FundraisingDirectExpensesAmt

Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp

FieldValueIRS element (for citing)
Total Revenue Column-$35,299TotalRevenueColumnAmt
Exclusion-$35,299ExclusionAmt
FieldValueIRS element (for citing)
Gaming Gross Income$0GamingGrossIncomeAmt
Gaming Direct Expenses$0GamingDirectExpensesAmt

Net Income From Gaming NetIncomeFromGamingGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt
FieldValueIRS element (for citing)
Gross Sales Of Inventory$0GrossSalesOfInventoryAmt
Cost Of Goods Sold$0CostOfGoodsSoldAmt

Net Income Or Loss NetIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt
FieldValueIRS element (for citing)
Other Revenue Total$0OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$9,230,319TotalRevenueColumnAmt
Exclusion$588,676ExclusionAmt

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

FieldValueIRS element (for citing)
Total$1,250,765TotalAmt
Program Services$1,250,765ProgramServicesAmt

Grants To Domestic Individuals GrantsToDomesticIndividualsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Foreign Grants ForeignGrantsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Benefits To Members BenefitsToMembersGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Comp Disqual Persons CompDisqualPersonsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Services Management FeesForServicesManagementGrp

FieldValueIRS element (for citing)
Total$819,279TotalAmt
Program Services$819,279ProgramServicesAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$113,894TotalAmt
Program Services$113,894ProgramServicesAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Services Lobbying FeesForServicesLobbyingGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

FieldValueIRS element (for citing)
Total$6,372TotalAmt
Management And General$6,372ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$39,172TotalAmt
Program Services$39,172ProgramServicesAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$272,923TotalAmt
Program Services$272,923ProgramServicesAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Royalties RoyaltiesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$160,352TotalAmt
Program Services$160,352ProgramServicesAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Pymt Travel Entrtnmnt Pub Ofcl PymtTravelEntrtnmntPubOfclGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$3,446TotalAmt
Program Services$3,446ProgramServicesAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Payments To Affiliates PaymentsToAffiliatesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmt
STEWARDSHIP$49,163$49,163
BAD DEBT$143,197$143,197
COMMUNITY OUTREACH$28,115$28,115
MISCELLANEOUS$70,451$70,451

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$2,957,129TotalAmt
Program Services$2,950,757ProgramServicesAmt
Management And General$6,372ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$12,091,890BOYAmt
EOY$14,503,918EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Pledges And Grants Receivable PledgesAndGrantsReceivableGrp

FieldValueIRS element (for citing)
BOY$2,852,317BOYAmt
EOY$4,829,873EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$734,156BOYAmt
EOY$690,107EOYAmt

Receivables From Officers Etc ReceivablesFromOfficersEtcGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$25,894,427LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$1,611,198LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$24,891,190BOYAmt
EOY$24,283,229EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$1,207,504BOYAmt
EOY$1,210,466EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Investments Program Related InvestmentsProgramRelatedGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Intangible Assets IntangibleAssetsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$175,148BOYAmt
EOY$180,866EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$41,952,205BOYAmt
EOY$45,698,459EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$68,001BOYAmt
EOY$69,025EOYAmt

Grants Payable GrantsPayableGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Deferred Revenue DeferredRevenueGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Escrow Account Liability EscrowAccountLiabilityGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Loans From Officers Directors LoansFromOfficersDirectorsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

FieldValueIRS element (for citing)
BOY$18,268,337BOYAmt
EOY$17,734,861EOYAmt

Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$2,776,379BOYAmt
EOY$789,739EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$21,112,717BOYAmt
EOY$18,593,625EOYAmt
FieldValueIRS element (for citing)
Organization Follows FASB117Yes (X)OrganizationFollowsFASB117Ind

No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$18,175,295BOYAmt
EOY$21,501,766EOYAmt

Donor Restriction Net Assets DonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$2,664,193BOYAmt
EOY$5,603,068EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$20,839,488BOYAmt
EOY$27,104,834EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$41,952,205BOYAmt
EOY$45,698,459EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss$6,273,190ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst-$7,844NetUnrlzdGainsLossesInvstAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or ReviewfalseAccountantCompileOrReviewInd
FS AuditedYes (true)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Consol And Sep Basis Fincl StmtYes (X)ConsolAndSepBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (true)AuditCommitteeInd
Federal Grant Audit RequiredfalseFederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Public Organization170Yes (X)PublicOrganization170Ind

Gifts Grants Contri Rcvd170 GiftsGrantsContriRcvd170Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$7,383,258CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$2,832,846CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$6,285,524CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$6,267,036CurrentTaxYearMinus1YearAmt
Current Tax Year$8,641,643CurrentTaxYearAmt
Total$31,410,307TotalAmt

Tax Rev Levied Orgnztnl Bnft170 TaxRevLeviedOrgnztnlBnft170Grp

FieldValueIRS element (for citing)
Total$0TotalAmt

Govt Furn Srvc Fclts Vl170 GovtFurnSrvcFcltsVl170Grp

FieldValueIRS element (for citing)
Total$0TotalAmt

Total Calendar Year170 TotalCalendarYear170Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$7,383,258CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$2,832,846CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$6,285,524CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$6,267,036CurrentTaxYearMinus1YearAmt
Current Tax Year$8,641,643CurrentTaxYearAmt
Total$31,410,307TotalAmt
FieldValueIRS element (for citing)
Substantial Contributors Tot$8,917,246SubstantialContributorsTotAmt
Public Support Total170$22,493,061PublicSupportTotal170Amt

Gross Investment Income170 GrossInvestmentIncome170Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$56,602CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$1,084,375CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$1,028,094CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$1,060,235CurrentTaxYearMinus1YearAmt
Current Tax Year$2,035,759CurrentTaxYearAmt
Total$5,265,065TotalAmt

Unrelated Business Net Incm170 UnrelatedBusinessNetIncm170Grp

FieldValueIRS element (for citing)
Total$0TotalAmt

Other Income170 OtherIncome170Grp

FieldValueIRS element (for citing)
Total$0TotalAmt
FieldValueIRS element (for citing)
Total Support$36,675,372TotalSupportAmt
Public Support CY1700.61330PublicSupportCY170Pct
Public Support PY1700.59050PublicSupportPY170Pct
Thirty Thr Pct Suprt Tests CY170Yes (X)ThirtyThrPctSuprtTestsCY170Ind

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Total ContributionsRESTRICTEDTotalContributionsAmt

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Art Public Exhibition AmountsArtPublicExhibitionAmountsGrp
Held Works ArtHeldWorksArtGrp
CY Minus3 Yr Endwmt FundCYMinus3YrEndwmtFundGrp
CY Minus4 Yr Endwmt FundCYMinus4YrEndwmtFundGrp

Land LandGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$1,740,500OtherCostOrOtherBasisAmt
Book Value$1,740,500BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$24,153,927OtherCostOrOtherBasisAmt
Depreciation$1,611,198DepreciationAmt
Book Value$22,542,729BookValueAmt
FieldValueIRS element (for citing)
Leasehold ImprovementsLeaseholdImprovementsGrp
EquipmentEquipmentGrp
Other Land BuildingsOtherLandBuildingsGrp
Total Book Value Land Buildings$24,283,229TotalBookValueLandBuildingsAmt
Federal Income Tax Liability$0FederalIncomeTaxLiabilityAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)

DescDescAmtAmt
DUE TO PECONIC BAY MEDICAL CENTER$736,121
OTHER$53,618
FieldValueIRS element (for citing)
Total Liability$789,739TotalLiabilityAmt
Total Rev Etc Audited Fincl Stmt$10,630,685TotalRevEtcAuditedFinclStmtAmt
Net Unrealized Gains Invst-$7,844NetUnrealizedGainsInvstAmt
Other Revenue$1,414,582OtherRevenueAmt
Revenue Not Reported$1,406,738RevenueNotReportedAmt
Revenue Subtotal$9,223,947RevenueSubtotalAmt
Investment Expenses Not Incld$6,372InvestmentExpensesNotIncldAmt
Revenue Not Reported Fincl Stmt$6,372RevenueNotReportedFinclStmtAmt
Total Revenue Per Form990$9,230,319TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt$4,365,339TotExpnsEtcAuditedFinclStmtAmt
Other Expenses Included$1,414,582OtherExpensesIncludedAmt
Expenses Not Reported$1,414,582ExpensesNotReportedAmt
Expenses Subtotal$2,950,757ExpensesSubtotalAmt
Investment Expenses Not Incld2$6,372InvestmentExpensesNotIncld2Amt
Expenses Not Rpt Fincl Stmt$6,372ExpensesNotRptFinclStmtAmt
Total Expenses Per Form990$2,957,129TotalExpensesPerForm990Amt

Supplemental Information Detail SupplementalInformationDetail (3 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART X, LINE 2ASC 740 FOOTNOTE MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTITFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE FINANCIAL STATEMENTS.
PART XI, LINE 2BRENT EXPENSE: $1,414,582
Part XII, Line 2BRENT EXPENSE: $1,414,582

Schedule G IRS990ScheduleG

Fundraising Event Information FundraisingEventInformationGrp

FieldValueIRS element (for citing)
Event1GALAEvent1Nm
Gross Receipts Event1$1,116,477GrossReceiptsEvent1Amt
Charitable Contri Event1$1,116,477CharitableContriEvent1Amt
Food And Beverage Event1$25,427FoodAndBeverageEvent1Amt
Entertainment Event1$8,175EntertainmentEvent1Amt
Other Direct Expenses Event1$28,310OtherDirectExpensesEvent1Amt
Event2GOLFEvent2Nm
Gross Receipts Event2$194,801GrossReceiptsEvent2Amt
Charitable Contri Event2$142,301CharitableContriEvent2Amt
Gross Revenue Event2$52,500GrossRevenueEvent2Amt
Food And Beverage Event2$14,337FoodAndBeverageEvent2Amt
Other Direct Expenses Event2$10,000OtherDirectExpensesEvent2Amt
Other Events Total2OtherEventsTotalCnt
Gross Receipts Other Events$134,599GrossReceiptsOtherEventsAmt
Charitable Contri Other Events$134,599CharitableContriOtherEventsAmt
Oth Direct Expnss Other Events$1,550OthDirectExpnssOtherEventsAmt
Gross Receipts Total$1,445,877GrossReceiptsTotalAmt
Charitable Contributions Tot$1,393,377CharitableContributionsTotAmt
Gross Revenue Total Events$52,500GrossRevenueTotalEventsAmt
Food And Beverage Total Events$39,764FoodAndBeverageTotalEventsAmt
Entertainment Total Events$8,175EntertainmentTotalEventsAmt
Oth Direct Expnss Total Events$39,860OthDirectExpnssTotalEventsAmt
Direct Expense Summary Events$87,799DirectExpenseSummaryEventsAmt
Net Income Summary-$35,299NetIncomeSummaryAmt

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Grant Records MaintainedYes (true)GrantRecordsMaintainedInd

Recipient Table RecipientTable

Recipient Business Name RecipientBusinessName

FieldValueIRS element (for citing)
Business Name Line1Peconic Bay Medical CenterBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line11300 Roanoke AveAddressLine1Txt
Address Line2RiverheadAddressLine2Txt
CityNew YorkCityNm
State AbbreviationNYStateAbbreviationCd
ZIP11901ZIPCd
FieldValueIRS element (for citing)
Recipient EIN111661359RecipientEIN
IRC Section501(C)(3)IRCSectionDesc
Cash Grant$1,250,765CashGrantAmt
Purpose Of GrantHospital carePurposeOfGrantTxt
FieldValueIRS element (for citing)
Total501c3 Org1Total501c3OrgCnt

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePART I DESCRIPTION OF PROCEDURE FOR MONITORING USE OF FUNDSFormAndLineReferenceDesc
ExplanationTHIS GRANT WAS BETWEEN RELATED ORGANIZATIONS AND ALL SUCH TRANSACTIONS ARE CLOSELY MONITORED BY THE BOARD OF DIRECTORS TO ENSURE COMPLIANCE WITH THE GRANT PURPOSE.ExplanationTxt

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Severance PaymentfalseSeverancePaymentInd
Supplemental Nonqual Rtr PlanfalseSupplementalNonqualRtrPlanInd
Equity Based Comp ArrngmfalseEquityBasedCompArrngmInd
Comp Based On Revenue Of Flng OrgfalseCompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related OrgsfalseCompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng OrgfalseCompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd OrgsfalseCompBsdNetEarnsRltdOrgsInd
Any Non Fixed PaymentsfalseAnyNonFixedPaymentsInd
Initial Contract ExceptionfalseInitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp

FieldValueIRS element (for citing)
PersonANDREW J MITCHELLPersonNm
TitlePRESIDENT/CEOTitleTxt
Compensation Based On Rltd Orgs$886,738CompensationBasedOnRltdOrgsAmt
Bonus Related Organizations$388,923BonusRelatedOrganizationsAmt
Other Compensation Rltd Orgs$3,564OtherCompensationRltdOrgsAmt
Deferred Comp Rltd Orgs$23,200DeferredCompRltdOrgsAmt
Nontaxable Benefits Rltd Orgs$25,886NontaxableBenefitsRltdOrgsAmt
Total Compensation Rltd Orgs$1,328,311TotalCompensationRltdOrgsAmt

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (4 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART VI, SECTION B, LINE 11BTHE CEO AND CFO OF CENTRAL SUFFOLK HOSPITAL (CSH), A RELATED ORGANIZATION, REVIEW THE 990. A COPY OF THE 990 IS ALSO PROVIDED TO THE BOARD OF DIRECTORS FOR REVIEW. THE BOARD REVIEWS THE DOCUMENT AND REACHES OUT TO CSH SHOULD THEY HAVE ANY QUESTIONS. IF NO QUESTIONS ARE RAISED THE 990 IS SUBMITTED FOR FILING.
FORM 990, PART VI, SECTION B, LINE 12THE FOUNDATION FOLLOWS CSH'S CONFLICT OF INTEREST POLICY.
FORM 990 , PART VI, SECTION B, LINE 15ACSH UTILIZES SALARY SURVEYS AND REVIEWS THEM WITH THE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS. THE PROCESS WAS LAST PERFORMED IN 2020 and subsequently in March of 2022.
FORM 990, PART VI, SECTION C, LINE 19THESE DOCUMENTS ARE AVAILABLE UPON REQUEST.

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp

Disregarded Entity Name DisregardedEntityName

FieldValueIRS element (for citing)
Business Name Line1CENTRAL SUFFOLK HOSPITAL DBA PECONIC BAYBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line11300 ROANOKE AVENUEAddressLine1Txt
CityRIVERHEADCityNm
State AbbreviationNYStateAbbreviationCd
ZIP11901ZIPCd
FieldValueIRS element (for citing)
EIN111661359EIN
Primary ActivitiesHOSPITAL CAREPrimaryActivitiesTxt
Legal Domicile StateNYLegalDomicileStateCd
Exempt Code Section501(C)(3)ExemptCodeSectionTxt
Public Charity Status3PublicCharityStatusTxt

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1NORTHWELLBusinessNameLine1Txt
FieldValueIRS element (for citing)
Controlled OrganizationfalseControlledOrganizationInd
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts RyltsYes (true)ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth OrgYes (true)GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth OrgfalseGiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth OrgYes (true)LoansOrGuaranteesFromOthOrgInd
Div Related OrganizationfalseDivRelatedOrganizationInd
Asset Sale To Other OrgfalseAssetSaleToOtherOrgInd
Asset Purchase From Other OrgfalseAssetPurchaseFromOtherOrgInd
Asset ExchangefalseAssetExchangeInd
Rental Of Facilities To Oth OrgfalseRentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth OrgYes (true)RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth OrgYes (true)PerformOfServicesForOthOrgInd
Perform Of Services By Other OrgfalsePerformOfServicesByOtherOrgInd
Sharing Of FacilitiesfalseSharingOfFacilitiesInd
Paid Employees SharingYes (true)PaidEmployeesSharingInd
Reimbursement Paid To Other OrgYes (true)ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other OrgfalseReimbursementPaidByOtherOrgInd
Transfer To Other OrgfalseTransferToOtherOrgInd
Transfer From Other OrgfalseTransferFromOtherOrgInd