2017-11-15T13:30:20-06:00 2016-12-31 131517563 LOEB & TROPER LLP 655 THIRD AVENUE 12TH FLOOR NEW YORK NY 10017 990 2016-01-01 200714587 CENTRAL SUFFOLK HOSPITAL FOUNDATION CENT 6315486064 1300 ROANOKE AVENUE RIVERHEAD NY 11901 MICHAEL O'DONNELL CFO 6315486064 2017-11-15 1 AARON SHAPIRO P01333816 2128674000 38.98.118.70 2017-11-15 12:18:57 ES P D7076C0EC39B17C3336BFEA465ABF20A32036F2A 73A2BDB4DEE3E1301F7FB9DCBA9193E2BC5F7900 2016 2021-01-29 14:40:06Z PECONIC BAY MEDICAL CENTER FOUNDATION MICHAEL O'DONNELL 1300 ROANOKE AVENUE RIVERHEAD NY 11901 3903765 0 X WWW.PBMEDICALCENTER.ORG X 2004 NY THE MISSION OF THE CENTRAL SUFFOLK HOSPITAL FOUNDATION (THE FOUNDATION) IS TO SEEK PHILANTHROPIC SUPPORT ON BEHALF OF CENTRAL SUFFOLK HOSPITAL D/B/A PECONIC BAY MEDICAL CENTER (CSH). 11 9 0 9 0 0 1408832 3688063 0 0 1361 20566 -149962 -172248 1260231 3536381 0 0 0 0 0 0 260310 204930 1274159 1323671 1074988 1583981 1279918 -323750 2256463 4091319 6374289 442197 454626 3649122 5919663 THE FOUNDATION'S MISSION IS TO DEVELOP AND CULTIVATE PHILANTHROPIC AND COLLABORATIVE RELATIONSHIPS THAT FOSTER PROGRAMS AND SERVICES OFFERED THROUGH CSH WHICH IMPROVE THE HEALTH OF THE COMMUNITIES IT SERVES. 0 0 THE SUPPORT OF HOSPITAL SERVICES OF CSH. 1 1 0 0 0 0 0 0 1 0 0 0 0 0 1 1 1 0 0 0 0 0 0 1 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 1 1 1 0 0 0 0 0 0 1 1 0 0 0 0 X 11 9 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 EMILIE ROY COREY MSW BOARD CHAIR 10.00 X X 0 0 0 J GORDON HUSZAGH VICE CHAIR 10.00 15.00 X X 0 0 0 RICHARD ISRAEL VICE CHAIR 1.00 1.00 X X 0 0 0 JOAN S LEVAN SECRETARY/TREASURER 1.00 1.00 X X 0 0 0 ANDREW J MITCHELL FACHE PRESIDENT/CEO 15.00 22.50 X X 0 1098832 54872 BRUCE BARNET BOARD MEMBER 1.00 X 0 0 0 ALISON GROSSMAN BOARD MEMBER 1.00 X 0 0 0 CAROLE G HANKIN PHD BOARD MEMBER 1.00 X 0 0 0 RICHARD L WINSLOW PHD BOARD MEMBER 1.00 1.00 X 0 0 0 SHERRY PATTERSON BOARD MEMBER 1.00 1.00 X 0 0 0 STANLEY ZINBERG BOARD MEMBER 1.00 1.00 X 0 0 0 0 1098832 54872 0 0 1 0 CENTRAL SUFFOLK HOSPITAL 1300 ROANOKE AVENUE RIVERHEAD NY 11901 ADMINISTRATIVE SERVICES 673498 THE GOBEL GROUP 16 WEST MARKET STREET 2ND FLOOR WEST CHESTER PA 19382 FUNDRAISING COUNSEL 107430 2 612007 3076056 3688063 19995 19995 192157 191586 571 571 571 3550 612007 175798 -172248 -172248 3536381 0 0 -151682 673498 673498 204930 204930 5759 5759 15120 15120 4045 4045 231268 231268 7500 7500 25095 25095 COMMUNITY OUTREACH 7003 7003 105700 105700 1279918 0 5759 1274159 106621 119051 1398693 3201995 1719693 1986303 9375 9375 856937 1057565 4091319 6374289 3231 70269 106927 121568 332039 262789 442197 454626 X 2150840 4194082 1498282 1725581 3649122 5919663 4091319 6374289 2256463 14078 0 X X 0 1 X 1 0 X 2247758 1318620 3071944 1408832 3688063 11735217 2247758 1318620 3071944 1408832 3688063 11735217 3813446 7921771 408 2091 4311 8575 19995 35380 11770597 0.67300 0.73260 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 X 0 DUE TO CENTRAL SUFFOLK HOSPITAL D/B/A PECONIC BAY MEDICAL CENTER 262789 262789 X 3550459 14078 14078 3536381 0 3536381 1279918 0 1279918 0 1279918 PART IV, LINE 2B: IN ACCORDANCE WITH GENERALLY ACCEPTED ACCOUNTING PRINCIPLES, THE FOUNDATION HAS REFLECTED AS A LIABILITY FOR THOSE CONTRIBUTIONS BEING HELD ON BEHALF OF WOMEN'S HEALTH PARTNERSHIP. PART X, LINE 2: THE FOUNDATION HAS DETERMINED THAT THERE ARE NO MATERIAL UNCERTAIN TAX POSITIONS THAT REQUIRE RECOGNITION OR DISCLOSURE IN THE FINANCIAL STATEMENTS. PERIODS ENDING DECEMBER 31, 2013 AND SUBSEQUENT REMAIN SUBJECT TO EXAMINATION BY APPLICABLE TAXING AUTHORITIES. X X X X X 1 THE GOBEL GROUP 16 WEST MARKET STREET 2ND FLOOR WEST CHESTER PA 19382 FUNDRAISING COUNSEL 0 0 107430 0 COMMUNITY COUNSELING CO LLC 461 FIFTH AVENUE NEW YORK NY 10017 FUNDRAISING COUNSEL 0 0 97500 0 204930 NY BLACK AND WHITE 383049 382749 300 21875 10000 30749 2725 917 GOLF EVENT 159940 156690 3250 1810 39200 42152 3162 667 1 72568 72568 11606 2141 8794 615557 612007 3550 21875 1810 60806 75042 5887 10378 175798 -172248 0 0 0 0 0 0 0 0 0 ANDREW J MITCHELL FACHE PRESIDENT/CEO 0 774771 0 323287 0 774 0 33900 0 20972 0 1153704 0 0 PART I, LINE 3 CSH UTILIZES SALARY SURVEYS AND REVIEWS THEM WITH THE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS. THE PROCESS WAS LAST PERFORMED IN 2016. FORM 990, PART VI, SECTION B, LINE 11B THE CEO/PRESIDENT, AND CHIEF FINANCIAL OFFICER OF CSH, A RELATED ORGANIZATION, REVIEW THE FORM 990. A COPY OF THE FORM 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 FORM 990 IS SUBMITTED FOR FILING. FORM 990, PART VI, SECTION B, LINE 12 THE FOUNDATION FOLLOWS CSH'S CONFLICT OF INTEREST POLICY. FORM 990, PART VI, SECTION B, LINE 15 CSH UTILIZES SALARY SURVEYS AND REVIEWS THEM WITH THE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS. THE PROCESS WAS LAST PERFORMED IN 2016. FORM 990, PART VI, SECTION C, LINE 19 THESE DOCUMENTS ARE AVAILABLE UPON REQUEST. FORM 990, PART XII, LINE 2C: THIS PROCESS DID NOT CHANGE FROM THAT OF THE PRIOR YEAR. CENTRAL SUFFOLK HOSPITAL DBA PECONIC BAY MEDICAL CENTER 1300 ROANOKE AVE RIVERHEAD NY 11901 111661359 HOSPITAL CARE NY 501(C)(3) 3 PECONIC HEALTH CORPORATION 0 0 0 0 0 1 0 0 0 0 0 1 1 0 0 1 1 0 0 0