2016-11-14T11:00:49-06:00 2015-12-31 990 2015-01-01 113241243 PLAINVIEW HOSPITAL C/O NORTHWELL HEALTH INC % NORTHWELL HEALTH INC PLAI 5163216025 972 BRUSH HOLLOW ROAD 5TH FL WESTBURY NY 11590 ROBERT S SHAPIRO EVP & CFO 5163216025 2016-11-02 2015 2017-02-10 21:41:12Z MICHAEL J DOWLING 2000 MARCUS AVENUE NEW HYDE PARK NY 11042 203591593 false X WWW.NORTHWELL.EDU X 1959 NY Plainview hospital strives to improve the health of the communities it health of the communities it serves and is committed to providing the highest quality of care for the community regardless of ability to pay 123 113 1484 105 0 0 0 183759107 200322623 78056 6265 4252312 3248892 188089475 203577780 0 0 0 0 134375305 130406158 0 0 0 67058688 71280889 201433993 201687047 -13344518 1890733 79868816 81843965 108156688 108237164 -28287872 -26393199 PLAINVIEW HOSPITAL IS PART OF NORTHWELL HEALTH, INC ("NORTHWELL"), 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 157035371 179946485 Plainview Hospital is a 204-bed community hospital that provides an array of medical services, with emphases on cardiac, neurosciences and pulmonary disease. The Hospital's cardiac services include state of the art cardiac diagnostic services and an innovative program of Early Heart Attach Care. In 2015, the Hospital had 8,531 inpatient discharges, provided 32,827 emergency department visits and performed 5,990 ambulatory surgeries, including endoscopies. 20633832 20376138 Plainview Hospital is an affiliated member of Northwell Health, Inc. ("Northwell") and part of Northwell's medical group and ambulatory lines of service. It strives to make a measurable difference in the health status of the communities it serves by providing comprehensive health care regardless of ability to pay. 177669203 true false false true false false false false false false true false false true true true false true false false false false false false false false true true false false true true false false false false false false false false false false false false false false false true false false false true 31 0 true 1484 true false false false false false false false false false false false false false false false X 123 113 true false false false false true true true true false false true true true true true true true true false NY X X NORTHWELL HEALTH INC 5168766061 972 BRUSH HOLLOW ROAD WESTBURY NY 11590 MICHAEL J DOWLING PRESIDENT & CEO 0.0 50.0 X X 0 3221785 52572 RALPH NAPPI trustee and evc 0.0 50.0 X X 0 705982 46697 RICHARD D GOLDSTEIN immediate past chairman 0.0 2.0 X X 0 0 0 MARK CLASTER chairman of board of trustees 0.0 3.0 X X 0 0 0 BARRY RUBENSTEIN VICE CHAIRMAN 0.0 2.0 X X 0 0 0 WILLIAM L MACK VICE CHAIRMAN 0.0 2.0 X X 0 0 0 ALAN I GREENE TREASURER 0.0 2.0 X X 0 0 0 DONALD ZUCKER SECRETARY 0.0 2.0 X X 0 0 0 NON-COMPENSATED TRUSTEES SEE SCHEDULE O 0.0 2.0 X 0 0 0 HOWARD B GOLD EVP & CHF MGD CARE BS DVLP OFF 0.0 50.0 X 0 1638945 38059 MARK J SOLAZZO EVP, CHIEF OPERATING OFFICER 0.0 50.0 X 0 2196565 556379 ROBERT S SHAPIRO EVP, CHIEF FINANCIAL OFFICER 0.0 50.0 X 0 1269909 399624 LAWRENCE G SMITH MD EVP & PHYSICIAN IN CHIEF 0.0 50.0 X 0 1394499 47522 JEFFREY KRAUT SVP, STRATEGIC PLANNING & BUS 0.0 50.0 X 0 1077844 373819 KATHLEEN GALLO RN PHD SR VP & CHF LEARNING OFFICER 0.0 50.0 X 0 819908 46697 DONNA DRUMMOND SVP, CONSOLIDATED SERVICES 0.0 50.0 X 0 775040 55176 HARRY GINDI ASSISTANT SECRETARY 0.0 50.0 X 0 319536 46368 Laura Peabody SVP & Chief Legal Officer 0.0 50.0 X 0 1002534 210021 Andrew Schulz GEN COUNSEL & ASST SECRETARY 0.0 50.0 X 0 877620 55176 EUGENE S TANGNEY SR. VICE PRES. & CAO 0.0 50.0 X 0 1051407 229332 ANTHONY FERRERI EVP/CHF AFFILIATION OFF 0.0 50.0 X 0 1163134 396846 Michael Fener Executive Director 50.0 0.0 X 725354 0 261687 WINIFRED MACK REGIONAL EXECUTIVE DIRECTOR 0.0 50.0 X 0 969931 38059 JAN DAUER ASSOC MEDICAL DIRECTOR (ED) 50.0 0.0 X 557652 0 55104 WILLIAM FORMAN RADIOLOGIST 50.0 0.0 X 472727 0 38059 Chanchal Saha CHF, THORACIC SURGERY 50.0 0.0 X 506540 0 41495 Lawrence Katz Physician 50.0 0.0 X 761956 0 54676 MELISSA CUSUMANO PHYSICIAN - ED 50.0 0.0 X 465316 0 38229 3489545 18484639 3081597 317 false true false HYPERBARIC AND WOUND MGMT SVCS INC 626 REXCORP PLAZA 6TH FLR UNIONDALE NY 11556 Physician Services 1795435 AXIS CONSTRUCTION CO 125 LASER COURT HAUPPAUGE NY 11788 CONSTRUCTION mgmt 857496 CROSS COUNTRY STAFFING PO BOX 404674 ATLANTA GA 303844674 staffing svcs 715370 GE HEALTHCARE 80 E SEAVIEW BLVD PORT WASHINGTON NY 11050 GENERAL CONTRACTOR 682241 UNITEX TEXTILE RENTAL 155 SOUTH TERRACE AVE MOUNT VERNON NY 10550 Cleaning 613966 15 0 PATIENT SERVICE REVENUE 621300 111982783 111982783 PHYSICIANS PRACTICE REVENUE 621300 26580624 26580624 MEDICARE/MEDICAID PAYMENTS 621300 61759216 61759216 200322623 -332 -332 6597 6597 0 19462 13813 5649 0 5649 0 0 0 0 RESIDENCY ROTATION 900099 1583106 1583106 CAFETERIA SHOP 900099 698814 698814 ELECTRONIC HEALTH RECORD INCOME 900099 300000 300000 661323 650214 11109 3243243 203577780 202855943 716188 0 0 0 0 725354 725354 0 97681080 89875928 7805152 0 9055437 8331867 723570 16369329 15061347 1307982 6574958 6049590 525368 144828 144828 50175 50175 0 0 0 0 4057413 3733208 324205 28941 26628 2313 30765791 28307468 2458323 0 0 2035342 1872709 162633 109281 109281 0 174808 174808 567902 567902 0 4159779 3827394 332385 2883648 2883648 BAD DEBT 1979954 1979954 MEDICAL & OTHER PURCHASED SVCS 12972387 12972387 DUES & SUBSCRIPTIONS 259099 238396 20703 CENTRALIZED ADMIN EXP 9564474 9564474 1527067 1499236 27831 201687047 177669203 24017844 0 1000 45268 0 0 0 0 19857931 18975908 0 0 0 0 0 0 2680641 2265736 66092 57863 63051628 29035378 32813731 34016250 634167 638747 0 0 0 0 0 0 23815254 25844193 79868816 81843965 22014655 19718594 0 0 0 0 14075563 12614838 0 0 0 0 0 0 0 0 72066470 75903732 108156688 108237164 X -28742958 -26852225 455086 459026 0 0 -28287872 -26393199 79868816 81843965 X 1890733 3940 X false true X true true true X false false false false false false false true 15008 false 15008 false false LOBBYING ACTIVITY PLAINVIEW HOSPITAL IS A MEMBER OF THE AMERICAN HOSPITAL ASSOCIATION AND OTHER HEALTH CARE ORGANIZATIONS WHICH ENGAGE IN LOBBYING EFFORTS ON BEHALF OF THEIR MEMBER HOSPITALS. 7865080 7865080 23176009 12564884 10611125 38150 9538 28613 30489859 16359123 14130736 1482530 101833 1380696 34016250 INTEREST IN FOUNDATION 567261 INSURANCE CLAIMS RECEIVABLE 14286321 DUE FROM AFFILIATES 10357156 SECURITY DEPOSITS 16086 OTHER ASSETS 617369 25844193 0 BOND PREM/DISC 547293 DUE TO THIRD PARTY PAYORS 25446230 MALPRACTICE INSURANCE 16403000 OTHER LIABILITIES 217391 PENSION 19176387 INSURANCE CLAIMS LIABILITY 14286321 BOND FINANCING -172890 75903732 X 201611639 201611639 1966141 1966141 203577780 198525380 13813 13813 198511567 3175480 3175480 201687047 PART X, LINE 2 Certain entities included in Northwells 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, 2015 and 2014, Northwell 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 $219,000,000, which expire in varying amounts through 2035, and are available to offset future taxable income. PART XII, LINE 2D RECONCILIATION OF REVENUE PROVISION FOR BAD DEBTS (1,979,954) RENTAL ADJUSTMENT 13,813 TOTAL (1,966,141) PART XIII, LINE 2D & 4B RECONCILIATION OF EXPENSE, LINE 2D RENTAL ADJUSTMENT 13,813 RECONCILIATION OF EXPENSE, LINE 4B ADDITIONAL MINIMUM PENSION LIABILITY 1,195,526 PROVISION FOR BAD DEBTS 1,979,954 TOTAL 3,175,480 true true X true X true X 500. true true true false true true 2704645 206679 2497966 0.01260 16990208 9510535 7479673 0.03770 19694853 9717214 9977639 0.05030 387216 387216 0.00200 9680213 4587435 5092778 0.02570 499 499 102101 102101 0.00050 10170029 4587435 5582594 0.02820 29864882 14304649 15560233 0.07850 2571 2571 25684 25684 824 824 5396 5396 34475 34475 false 1940888 61134939 75425699 -14290760 X true true 1 1 PLAINVIEW HOSPTIAL 888 OLD COUNTRY ROAD PLAINVIEW NY 11803 WWW.NORTHWELL.EDU X X X X PLAINVIEW HOSPITAL 1 false false true X X X X X X X X X 13 true true true true X WWW.NORTHWELL.EDU X true 13 true WWW.NORTHWELL.EDU/ABOUT/OUR-ORGANIZATION/OFFI false false true X 100 500. X X X X true true X X X true X WWW.NORTHWELL.EDU X WWW.NORTHWELL.EDU X WWW.NORTHWELL.EDU X X X X X X true X false X X X X X true X false false Part V, Section C, Supplemental Information Part V, Section B, line 2: N/A Part V, Section B, line 3j: N/A Part V, Section B, line 5: The CHNA was facilitated by committees established within each county served by Northwell and its hospitals. These were comprised of participants such as Departments of Health; community based organizations (CBOs); Northwell; local businesses; and faith-based organizations; and a "voice of the community" (i.e. the community's perception of need). Qualitative data was collected from diverse community organizations that serve the population-at-large, as well as those communities with significant health disparities. Community partners were invited to participate via surveys and key informant interviews. Emphasis was placed on the following populations: minorities/underserved communities, seniors, women and children, special populations, and individuals with disease-specific conditions. Primary data was obtained through qualitative analysis of CBO informant interviews, CBO surveys, individual community member surveys, and participation in the collaborative partner listening sessions. For further detail go to web link: https://www.northwell.edu/about/our-organization/office-community-and-publ ic-health/reports Part V, Section B, line 6a: For a detailed listing of other hospital facilities go to web link: https://www.northwell.edu/about/our-organization/office-community-and-publ ic-health/reports Part V, Section B, line 6b: For a detailed listing of other than hospital facilities go to web link: https://www.northwell.edu/about/our-organization/office-community-and-publ ic-health/reports Part V, Section B, line 7d: N/A Part V, Section B, line 11: The hospital identified and addressed primary needs based on an assessment of the highest ranked health priorities of the community, regulatory input (i.e. the NYC Department of Health prevention priority agenda), and resources available. For further information go to web link: https://www.northwell.edu/about/our-organization/office-community-and-publ ic-health/reports Part V, Section B, line 13b: N/A Part V, Section B, line 13h: The hospital also uses household size. Part V, Section B, line 15e: N/A Part V, Section B, line 16i: The policy is included in the hospital's Community Service Plan and provided at health fairs and presentations open to the community at no cost, in addition to mailing financial policy summary brochures. Part V, Section B, line 18d: N/A Part V, Section B, line 19d: N/A Part V, Section B, line 20e: Before initiating any of the actions, the hospital facility sends letters, makes telephone calls and utilizes presumptive eligibility. Part V, Section B, line 21c: N/A Part V, Section B, line 21d: N/A Part V, Section B, line 22d: The hospital used a blended Medicaid rate as a criterion during the tax year to determine the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care. Under NYS Health Law Section 2807-k (9a) indigent care pool requires a sliding fee scale from qualifying patients. A reduction from gross charges must result in an expected payment that does not exceed the amount paid for the same services by the hospital's highest volume payer (i.e. Medicare or Medicaid). Part V, Section B, line 23: N/A Part V, Section B, line 24: N/A 3 NORTHWELL HEALTH PHYSICIAN PARTNERS 25 central park road plainview NY 11803 OUTPATIENT PHYSICIAN CLINIC PREMIER INTERNAL MEDICINE 85O FULTON STREET FARMINGDALE NY 11735 OUTPATIENT PHYSICIAN CLINIC WOODBURY PRIMARY CARE 321 CROSSWAYS PARK DRIVE WOODBURY NY 11797 OUTPATIENT PHYSICIAN CLINIC PART VI - SUPPLEMENTAL INFORMATION Question 1: Part I, Line 3c: This hospital is an affiliated entity of Northwell Health Inc.("Northwell"). Northwell uses FPG to determine eligibility and utilizes the New York State Department of Health (NYSDOH) guidelines regarding the consideration of assets. Asset tests cannot be used to deny financial assistance, but only to "upgrade" a patient's level of obligation, up to the legal maximum permitted under the financial assistance law. Part I, Line 6a: The Community Benefit report is prepared by the hospital, in conjunction with an affiliated entity (Northwell) of the hospital. The Community Benefit Report is accessible to the public and can be accessed on the Northwell website: http://www.northwell.edu/about/our-organization/office-community-and-publi c-health/reports Part I, 7: Row (a) The cost of charity care was determined by utilizing the ratio of cost to charges (RCC) calculated on Worksheet 2 applied to gross charges written off for patients qualifying for charity under the hospitals financial assistance policy. Bad Debt was not reported in any row of Part I, Line 7. Row (b) The Ratio of Cost to Charges method (or RCC) is used to determine the cost of ancillary services. An RCC is developed from these costs, and that RCC is applied to total Medicaid gross ancillary services charges to determine the cost of services provided to Medicaid patients. Row (e) Costs associated with Community Health Improvement Services were determined by adding indirect or overhead costs to the direct costs of the activity. Indirect costs were calculated as a percentage of direct costs. Direct costs for staff expenses were calculated using average hospital facility hourly rates, and were adjusted to account for fringe benefits, using a blended rate based on the ratio of total employee benefit expenses to total salary and wages. Row (f) The costs related to health professions education were determined by utilizing the step down method of cost finding. Row (h) Costs associated with research activities were determined by adding indirect, or overhead, costs to the direct costs of the activity. Indirect costs were calculated as a percentage of costs. Row (i) The cost of in-kind contributions to community groups is comprised of the direct costs of personnel whose compensated time was donated to various charities and community groups. The salaries and wages were adjusted to include benefits using a rate based on the ratio of total employee benefit expenses to total salary and wages. Indirect costs were calculated as a percentage of direct costs. Column (f) for Rows (a)-(k) The percentage of Net Community Benefit Expense divided by Total Expense for the hospital that appears on Form 990, Part IX Line 25 column (A), less bad debt expense (to calculate the percent of total expense). Note: For the entire Northwell Health Inc. and affiliates, Part I, Line 7 (Row K, Column F) is approximately 12.65 as a percentage of expenses. Part II: All community building activities improve access to health services and address federal, state, or local public health priorities, as well as leverage public health department activities, and in doing so, they provide relief of government burden. These activities broadly serve low-income, underserved patients, and include: collaboration with various community coalitions, system-wide recycling initiative, organizational response to worldly disasters, and bioterrorism efforts. Northwells bioterrorism & disaster preparedness includes Center for Emergency Medical Services, has a designated Bioterrorism Resource Center, and has conducted staff training for more than 100 hospitals and area first responders and invested heavily in the infrastructure needed for large-scale emergencies. During catastrophes (both natural and terrorism), Northwell provides a safe haven for thousands of patients, outside nursing home residents, and community members seeking shelter. Northwell assists with the transport of patients and stand ready to contribute food, medicine, and blankets for both affiliated and non-affiliated hospital patients. Investment in a field hospital has furthered the public health infrastructure needed for mass casualties that could result from a terrorist attack, natural attack, or large-scale emergency. Part III, Line 2: For patients who were determined by Northwell to have the ability to pay but did not, the uncollected amounts are recorded as bad debt expense. The amount of gross charges written off is reduced by any charity care or other discounts provided to the patient, as well as any payments received. Bad debt expense reported on this line is reported net of governmental or private offsetting funds. Part III, Line 3: N/A Part III, Line 4: For patients who were determined by Northwell to have the ability to pay but did not, the uncollected amounts are recorded as bad debt expense. Part III, Line 8: Medicare costs are determined utilizing a combination of the step down method of cost findings and a cost per unit of service. Cost per unit of service is used to calculate the routine cost of services provided to Medicare patients. The Ratio of Cost to Charges method (or RCC) is used to determine the cost of ancillary services. An RCC is developed from these costs, and that RCC is applied to total Medicare gross ancillary services charges to determine the cost of services provided to Medicare patients. Part III, Line 9b: The organizations collection policy is standard to all accounts regardless of insurance status (e.g. insured, underinsured, and uninsured). The hospitals collection policy states that they will not send patient accounts to collection if a decision on a financial assistance application is pending, or if a patient is determined to be eligible for Medicaid at the time services were rendered and for which services Medicaid payment is available. Question 2: NEEDS ASSESSMENT: The Community Health Needs Assessment (CHNA) is performed on an ongoing basis. Northwell conducts and participates in population, demographic, and health status evaluations of our respective hospitals service areas based on county regions and the communities we serve. There is a special effort to include individuals with health disparities and organizations who serve these communities in the CHNA process. The CHNA includes the analysis of primary and secondary data. Multi-year analyses, trends and projections are developed, which identify areas of need for the continuum of health care services. Primary data is obtained through a combination of qualitative analysis of community-based organization (CBO), informant interviews and surveys, individual community member surveys, and participation in collaborative partner meetings. These meetings include representatives from the Departments of Health, CBOs, academic institutions, government agencies, and hospitals. Ongoing input concerning our communities needs is also obtained through: our Board of Trustees/Directors who are all area residents and leaders in their respective communities; facility based advisory boards and councils, and; the feedback received by our facility administrators and clinicians that serve on local community agency boards. Secondary data analysis includes: internal hospital data, including Prevention Quality Indicators (PQI); Department of Health Community Health Assessments; local regional NYS Prevention Agenda data sources; and Statewide Planning and Research System (SPARCS) data. The Committee on Community Health, a committee of the Board of Trustees, provides recommendations that concern Northwells community health priorities and interventions based on the CHNA. Committee discussions focus on New York State (NYS) Prevention Agenda Priority Areas, including strategies and intervention outcomes related to chronic disease prevention, women and childrens health, healthy safe environments, health access, mental health and substance abuse, HIV/AIDS/STDs and community immunizations. Regional departments of health (i.e. Nassau County Department of Health, Suffolk County Department of Health Services, and NYC Department of Health and Mental Hygiene) perform additional community health assessments (CHA) with the input of hospital and community stakeholders. These regional partners use strategies such as community member surveys, CBO surveys, and public listening sessions to solicit information on community needs. Together with other healthcare organizations and CBOs, Northwell participates in meetings organized by these regional departments of health academic organizations to discuss the shared responsibility of public health planning within the NYS Prevention Agenda. These meetings provide an opportunity for general discussion regarding the public health goals of the NYS Prevention Agenda and the selection of shared priorities for collaborative regional planning. The partnership among local health departments, hospitals and CBOs, enables region wide leveraging of resources, co X X X X X false true false true false false false true false MICHAEL J DOWLING PRESIDENT & CEO 0 1468126 0 1728000 0 25659 0 29150 0 23422 0 3274357 0 0 HOWARD B GOLD EVP & CHF MGD CARE BS DVLP OFF 0 1079181 0 528000 0 31764 0 29150 0 8909 0 1677004 0 0 MARK J SOLAZZO EVP, CHIEF OPERATING OFFICER 0 1267281 0 900000 0 29284 0 538262 0 18117 0 2752944 0 0 ROBERT S SHAPIRO EVP, CHIEF FINANCIAL OFFICER 0 1066127 0 171000 0 32782 0 382085 0 17539 0 1669533 0 0 LAWRENCE G SMITH MD EVP & PHYSICIAN IN CHIEF 0 925804 0 337000 0 131695 0 29150 0 18372 0 1442021 0 0 JEFFREY KRAUT SVP, STRATEGIC PLANNING & BUS 0 910565 0 135000 0 32279 0 347793 0 26026 0 1451663 0 0 KATHLEEN GALLO RN PHD SR VP & CHF LEARNING OFFICER 0 670104 0 117000 0 32804 0 29150 0 17547 0 866605 0 0 DONNA DRUMMOND SVP, CONSOLIDATED SERVICES 0 587951 0 97000 0 90089 0 29150 0 26026 0 830216 0 0 HARRY GINDI ASSISTANT SECRETARY 0 288163 0 27171 0 4202 0 29150 0 17218 0 365904 0 0 RALPH NAPPI trustee and evc 0 672187 0 0 0 33795 0 29150 0 17547 0 752679 0 0 Michael Fener Executive Director 619358 0 76000 0 29996 0 238358 0 23329 0 987041 0 0 0 JAN DAUER ASSOC MEDICAL DIRECTOR (ED) 311823 0 13000 0 232829 0 29150 0 25954 0 612756 0 0 0 WILLIAM FORMAN RADIOLOGIST 399647 0 0 0 73080 0 29150 0 8909 0 510786 0 0 0 Chanchal Saha CHF, THORACIC SURGERY 190022 0 2301 0 314217 0 29150 0 12345 0 548035 0 0 0 Lawrence Katz Physician 709734 0 0 0 52222 0 29150 0 25526 0 816632 0 0 0 Laura Peabody SVP & Chief Legal Officer 0 819005 0 140000 0 43529 0 183995 0 26026 0 1212555 0 0 Andrew Schulz GEN COUNSEL & ASST SECRETARY 0 737078 0 108000 0 32542 0 29150 0 26026 0 932796 0 0 WINIFRED MACK REGIONAL EXECUTIVE DIRECTOR 0 799411 0 135000 0 35520 0 29150 0 8909 0 1007990 0 0 EUGENE S TANGNEY SR. VICE PRES. & CAO 0 887365 0 153000 0 11042 0 203306 0 26026 0 1280739 0 0 ANTHONY FERRERI EVP/CHF AFFILIATION OFF 0 854187 0 237000 0 71947 0 379299 0 17547 0 1559980 0 0 MELISSA CUSUMANO PHYSICIAN - ED 332684 0 12000 0 120632 0 29150 0 9079 0 503545 0 0 0 PART I, LINE 4B Certain individuals participate in a Supplemental Executive Retirement Plan ("SERP") which is subject to substantial risk of complete forfeiture. Accordingly, the individual 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. These amounts are included in Schedule J, Column C for Mark J Solazzo ($509,112), Robert S Shapiro ($352,935), Jeffery Kraut ($318,643), Michael Fener ($209,208), Laura Peabody ($154,845), Eugene S. Tangney ($174,156), and Anthony Ferreri ($350,149). PART 1, LINE 5A Pursuant to the persons listed in Form 990, Part VII, section A, line 1A, there is no contractual obligation to pay or accrue any compensation to officers of the Northwell Health, Inc. based on the revenue of the organization. A listed person(s) that may qualify under this condition could be one or more of the physicians listed as a highly compensated employee. PART I, LINE 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, Part II, B (ii). Part II, Column (F) The amount reported in Schedule J, Part II, Column (F) includes SERP amounts which were previously reported on Form 990, Schedule J, Part II, Column (C) in prior years. In accordance with the IRS instructions, these amounts were originally reported when contributions were made to the SERP plan and are now being reported for a second time upon receipt of distribution from the SERP plan. A DORMITORY AUTHORITY OF NEW YORK STATE 146000293 649903LC3 2007-05-31 6570025 2007 A&B BONDS-CAP IMPROV & REFUND true false false B DORMITORY AUTHORITY OF NEW YORK STATE 146000293 649905QL3 2009-09-17 3245437 2009 A&E BONDS-CAP IMPROV & REFINA true false false C DORMITORY AUTHORITY OF NEW YORK STATE 146000293 649906UY8 2012-05-03 5941675 2012 A BONDS-REFUND PRIOR BONDS false false false D DORMITORY AUTHORITY OF NEW YORK STATE 146000293 64990BNL3 2015-06-23 2500439 2015 A BONDS - REFUND 05 false false false A 3394226 4117411 9232955 108206 139114 527024 93298 0 0 2213737 6259781 0 2009 true true false true B 382062 2826854 4138641 65096 322534 0 67614 0 151912 2913244 683338 0 2012 true false true true C 880383 0 6806931 0 0 0 128279 0 0 0 6678652 0 2012 true false true true D 0 0 2712623 0 5916 2165647 24995 0 0 56797 151445 0 true true false true A false false false false 0 false false false true B false false false false 0 false false false true C false false false false 0 false false false true D false false false false 0 false false false true A false false true true false true CITIBANK NA 25.9 true false true MBIA 18.1 true true true B false false true true false false 0 false 0 true true C false false true true false false 0 false 0 false true D false true true false false false 0 false 0 false true A true B true C true D true PART II, LINE 3 - PROCEEDS, THE TOTAL PROCEEDS DO NOT AGREE TO THE ISSUE PRICE IN PART I, COLUMN (E) DUE TO INVEST EARNINGS & TRANSFERRED PROCEEDS PART IV, LINE 2C - REBATE CALCUATION PERFORMED 5/31/2012 FOR 2007 BONDS PART IV, LINE 2C - REBATE CALCUATION PERFORMED 8/31/2014 FOR 2009 BONDS PART IV, LINE 2C - REBATE CALCUATION PERFORMED 11/3/2012 FOR 2012 BONDS, SINCE BOND PROCEEDS HAVE BEEN SPENT A SPENDING EXCEPTION HAS BEEN MET. PART VI, SECTION A-GOVERNING BODY, LINE 2 All transactions with Northwell Health entities are as follows: (1) negotiated at arms 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 Elise Bloom and Eric and Roger Blumencranz. John Alexander has a business relationship with Laura Lauria, Frank Patafio and John Shall. Philip Altheim has a business relationship with Eric Blumencranz and Saul Katz. Michael Ashner has a business relationship with William Mack. Frank Besignano has a business relationship with Laura Lauria. Elise Bloom has a business relationship with William Achenbaum, Leonard Feinstein and Lewis Ranieri. Eric Blumencranz has as a family relationship with Roger Blumencranz. He has a business relationship with Roger Blumencranz, William Achenbaum, Philip Altheim, Patrick Edwards, Richard D. Goldstein, Alan Greene, Stanley Grey, Richard Horowitz, M. Allan Hyman, Jeffrey Jurick, Lisa Kaufman, Stuart Levine, David Mack, William Mack, Bradley Marsh, Charles Merinoff, Ralph Nappi, Dennis Riese, Michael Slade, Mark Solazzo, Barbara Hrbek Zucker and Donald Zucker. Roger Blumencranz has a family relationship with Eric Blumencranz. He has a business relationship with Eric Blumencranz, William Achenbaum, Richard D. Goldstein, Alan Greene, Stanley Grey, Richard Horowitz, M. Allan Hyman, Jeffrey Jurick, Stuart Levine, David Mack, Ralph Nappi, Dennis Riese, Michael Slade, Mark Solazzo, Barbara Hrbek Zucker and Donald Zucker. David Blumenfeld has a family relationship with Edward Blumenfeld. He has a business relationship with M. Allan Hyman and William Mack. Edward Blumenfeld has a family relationship with David Blumenfeld. He has a business relationship with M. Allan Hyman and William Mack. Steve Braun has a family relationship with Richard Sims. He has a business relationship with Cary Kravet. Alan Chopp has a business relationship with Patrick McDermott. Mark Claster has a business relationship with Richard Goldstein and Robert Rosenthal. Philippe Dauman has a business relationship with Thomas Dooley. Thomas Dooley has a business relationship with Philippe Dauman. Patrick Edwards has a business relationship with Eric Blumencranz. Leonard Feinstein has a business relationship with Elise Bloom and William Mack. Lloyd Goldman has a business relationship with Richard Goldstein and William Mack. Richard D. 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 business relationship with Eric Blumencranz and Roger Blumencranz. Stanley Grey has a business relationship with Eric Blumencranz and Roger Blumencranz. William Hiltz has a business relationship with Jeff Maurer. Richard Horowitz has a business relationship with Eric Blumencranz and Roger Blumencranz. M. Allan Hyman has a business relationship with Eric Blumencranz, Roger Blumencranz, David Blumenfeld, Edward Blumenfeld, David Katz, Michael Katz, Saul Katz, Stanely Kreitman and Donald Zucker. Jeffrey Jurick has a business relationship with Eric and Roger Blumencranz. David Katz has a family relationship with Saul Katz and Michael Katz. He has a business relationship with M. Allan Hyman, Michael Katz, Saul Katz, Seth Lipsay and Robert Rosenthal. Michael Katz has a family relationship with Saul Katz and David Katz. He has a business relationship with M. Allan Hyman, David Katz, Saul Katz, Seth Lipsay, Robert Rosenthal and Michael Slade. Saul Katz has a family relationship with Michael Katz and David Katz. He has a business relationship with M. Allan Hyman, David Katz, Michael Katz, Seth Lipsay, F.J. McCarthy, Robert Rosenthal and Michael Slade. Lisa Kaufman has a business relationship with Eric Blumencranz. Cary Kravet has a business relationship with Steve Braun. Stanley Kreitman has a business relationship with Allan Hyman. Jeffrey Lane has a business relationship with William Mack. Laura Lauria has a business relationship with John Alexander and Frank Besignano. Stuart Levine has a business relationship with Eric Blumencranz and Roger Blumencranz. Seth Lipsay has a business relationship with David Katz, Michael Katz, Saul Katz and Robert Rosenthal. David Mack has a family relationship with William Mack. He has a business relationship with William Mack and Eric Blumencranz. William Mack has a family relationship with David Mack. He has business relationships with David Mack, Michael Ashner, Eric Blumencranz, Edward and David Blumenfeld, Leonard Feinstein, Lloyd Goldman, Richard Goldstein, Jeffrey Lane, Barry Rubenstein and Roy Zuckerberg. Bradley Marsh has a family relationship with Jack Ross. He has a business relationship with Eric Blumencranz. Jeff Maurer has a business relationship with William Hiltz. F.J. McCarthy has a business relationship with Saul Katz, Robert Rosenthal and Emmett Walker. Patrick McDermott has a business relationship with Alan Chopp and John Shall. Charles Merinoff has a business relationship with Eric Blumencranz. Ralph Nappi has a business relationship with Eric Blumencranz and Roger Blumencranz. Frank Patafio has a business relationship with John Alexander. John J. Raggio has a family relationship with John V. Raggio. John V. Raggio has a family relationship with John J. Raggio. Lewis Ranieri has a business relationship with Elise Bloom. Dennis Riese has a business relationship with Eric Blumencranz and Roger Blumencranz. Robert Rosenthal has a business relationship with Mark Claster, David Katz, Michael Katz, Saul Katz, Seth Lipsay, F.J. McCarthy and Nancy Waldbaum. Jack Ross has a family relationship with Bradley Marsh. Barry Rubenstein has a business relationship with Richard Goldstein and William Mack. John Shall has a business relationship with Patrick McDermott, John Alexander, and Joaquin Gonzalez. Richard Sims has a family relationship with Steve Braun. Michael Slade has a business relationship with Eric Blumencranz and Roger Blumencranz, Saul Katz and Michael Katz. Mark Solazzo has a business relationship with Eric Blumencranz and Roger Blumencranz. Nancy Waldbaum has a business relationship with Robert Rosenthal. Emmett Walker has a business relationship with F.J. McCarthy. Barbara Hrbek Zucker has a family relationship with Donald Zucker. She has a business relationship with Eric Blumencranz and Roger Blumencranz. Donald Zucker has a family relationship with Barbara Hrbek Zucker. He has a business relationship with Eric Blumencranz, Roger Blumencranz and M. Allan Hyman. Roy Zuckerberg has a business relationship with William Mack. PART VI, SECTION B-POLICIES, LINE 11 The annual Return of Organization Exempt From Income Tax (Form 990) for Northwell Health, Inc. and Affiliated entities are prepared with input from various departments including Corporate Compliance, Finance, Human Resources, and Legal. Before filing the returns, the documents are electronically made available to all trustees through a secure online portal. Members of the Executive Committee are then informed the returns are ready for review. 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. PART VI, SECTION B-POLICIES, LINE 12C Northwell Health, Inc. ("Northwell") has several control mechanisms to mitigate conflicts of interest. Northwells 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 Northwell business in a manner that places the interests of Northwell ahead of their personal interests. In addition, Northwell 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 Northwell are required to fill 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 Northwells Audit and Corporate Compliance Committee and other applicable committees. In addition, Northwell 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. PART VI, SECTION B-POLICIES, LINE 15 The by-laws of Northwell Health, Inc. ("Northwell") 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 Northwell 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. PART VI, SECTION C-DISCLOSURES, LINE 19 CURRENTLY THE ORGANIZATION PROVIDES GOVERNANCE DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS TO THE PUBLIC UPON REQUEST. PART VII, SECTION A - LINE 1A Richard S. Abramson Albert L. Granger, DDS Kenneth J. Miller William Achenbaum Alan I. Greene Richard D. Monti John W. Alexander Stanley Grey Richard Murcott Philip S. Altheim Paul B. Guenther Ralph A. Nappi Patricia Armstrong Amy M. Hagedorn Raffiq A. Nathoo Michael L. Ashner Aubrey Hawes Richard B. Nye Frank J. Besignano Ira Hazan Daun Paris Elise M. Bloom Linda W. Heaney Frank P. Patafio Eric S. Blumencranz Lisa Heffernan Arnold S. Penner Roger A. Blumencranz William O. Hiltz John J. Raggio David Blumenfeld Richard A. Horowitz John V. Raggio Edward Blumenfeld Seth R. Horowitz Lewis S. Ranieri E. Steve Braun M. Allan Hyman Dennis Riese Dayton T. Brown, Jr Mark Jacobson Terry Rifkin, MD Michael Caridi Jeffrey Jurick Robert A. Rosen Robert W. Chasanoff Nancy Karch Marcie Rosenberg Alan Chopp David M. Katz Robert Rosenthal Mark L. Claster Michael Katz Bernard Rosof, MD Gary A. Cohen Saul B. Katz Jack J. Ross Diana F. Colgate Lisa A. Kaufman Barry Rubenstein Margaret M. Crotty Cary Kravet Herbert Rubin Daniel M. Crown Stanley Kreitman Michael H. Sahn Philippe P. Dauman Seth Kupferberg Lois C. Schlissel Thomas E. Dooley Jeffrey B. Lane John M. Shall Michael J. Dowling Curt N. Launer Marc V. Shaw Robert N. Downey Laura Lauria Richard Sims Patrick R. Edwards David W. Lehr Richard J. Sinni Michael A. Epstein Jonathan W. Leigh Michael C. Slade Leonard Feinstein Arthur S. Levine Phyllis H. Slater Michael E. Feldman Stuart R. Levine Hon. Robert Spolzino Arlene Lane Fisher Seth Lipsay Howard D. Stave Catherine C. Foster David S. Mack Kenneth Taber William H. Frazier William L. Mack Peter Tilles Eugene B. Friedman MD Linda Manfredi Paula D Tropello, Ed William J. Fritz, PHD Bradley Marsh, DPM Sandra Tytel Sy Garfinkel Jeffrey S. Maurer Louis Wachtel Peter Gaslow Ronald J. Mazzucco Nancy Waldbaum Lloyd M. Goldman F.J. McCarthy Emmett F. Walker, Jr Richard D. Goldstein Patrick F. McDermott Barbara Hrbek Zucker J. Joaquin Gonzalez Charles Merinoff Donald Zucker Michael Gould David Miller, MD Roy J. Zuckerberg PART VII, SECTION A - LINE 1A, COLUMN (B) This organization is affiliated with Northwell Health, Inc. ("Northwell"). The Officers, Directors and Trustees listed on Schedule J hold similar positions with both this organization and other affiliates of Northwell, 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 Northwell 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 Northwell and its affiliates. PART VI, SECTION A-GOVERNING BODY, LINE 7 Northwell Healthcare, Inc. ("Northwell Healthcare") is the sole corporate member of the organization. Northwell Healthcare has the right to elect or appoint member of the organization's governing body and has the right to approve or ratify certain corporate decisions. This organization and Northwell Healthcare are part of Northwell Health, Inc., an integrated health care delivery system. PART XI, LINE 9 RECONCILIATION OF NET ASSETS CHANGE IN EQUITY UNDER FAS 136 3,940 TOTAL 3,940 NORTHWELL HEALTH INC 972 BRUSH HOLLOW RD WESTBURY NY 11590 113418133 SUPPORT NY 501(C)(3) 11, TYPE I NA false NORTHWELL HEALTHCARE INC 972 BRUSH HOLLOW RD WESTBURY NY 11590 112965586 SUPPORT NY 501(C)(3) 11, TYPE I NW HEALTH false NORTH SHORE UNIVERSITY HOSPITAL 972 BRUSH HOLLOW RD WESTBURY NY 11590 111562701 HEALTH CARE NY 501(C)(3) 3 NW HEALTHCAR false LONG ISLAND JEWISH MEDICAL CENTER 972 BRUSH HOLLOW RD WESTBURY NY 11590 112241326 HEALTH CARE NY 501(C)(3) 3 NW HEALTHCAR false GLEN COVE HOSPITAL 972 BRUSH HOLLOW RD WESTBURY NY 11590 111633487 HEALTH CARE NY 501(C)(3) 3 NW HEALTHCAR false FOREST HILLS HOSPITAL 972 BRUSH HOLLOW RD WESTBURY NY 11590 112163522 HEALTH CARE NY 501(C)(3) 3 NW HEALTHCAR false FRANKLIN HOSPITAL 972 BRUSH HOLLOW RD WESTBURY NY 11590 112296824 HEALTH CARE NY 501(C)(3) 3 NW HEALTHCAR false SOUTHSIDE HOSPITAL 972 BRUSH HOLLOW RD WESTBURY NY 11590 111667761 HEALTH CARE 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HOLDING C false NORTH SHORE MEDICAL ACCELERATOR PC 972 BRUSH HOLLOW ROAD WESTBURY NY 11590 112945979 MEDICAL SERVI NY NSUH S false TRUE NORTH HEALTH PHARMACY INC 972 BRUSH HOLLOW ROAD WESTBURY NY 11590 471020508 PHARMACY NY NSUH C false NORTH SHORE-LIJ CARECONNECT INSURANCE AG 972 BRUSH HOLLOW ROAD WESTBURY NY 11590 471994548 INSURANCE AGE NY GROUP HOLDING C false CARECONNECT GROUP HOLDING COMPANY INC 972 BRUSH HOLLOW ROAD WESTBURY NY 11590 472478692 HOLDING CO NY HPLAN HOLDING C false NORTH SHORE-LIJ PEDIATRICS OF SUFFOLK CO 972 BRUSH HOLLOW ROAD WESTBURY NY 11590 465746956 MEDICAL SERVI NY NSUH C false NORTH SHORE-LIJ URGENT CARE PC 972 BRUSH HOLLOW ROAD WESTBURY NY 11590 471758444 MEDICAL SERVI NY NSUH C false NORTH SHORE-LIJ MATERNAL FETAL MEDICINE 972 BRUSH HOLLOW ROAD WESTBURY NY 11590 465495054 MEDICAL SERVI NY NSUH C false North Shore-LIJ Ophthalmology Institute 972 Brush Hollow Rd Westbury NY 11590 300930851 Inactive NY NSUH C false Phelps Realty Corp 701 North Broadway Sleepy 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