2014-11-14T14:17:04-06:00 2013-12-31 861065772 DELOITTE TAX LLP TWO JERICHO PLAZA JERICHO NY 11753 990 2013-01-01 112665457 SHORE ROAD RADIOLOGY ASSOCIATES PC SHOR 7186307611 150 55TH STREET NO 2-36 BROOKLYN NY 11220 JAYANTH RAO PRESIDENT 7186307611 2014-11-12 1 CHRISTINE KAWECKI P00743140 5169187000 2014-11-12 2013 2015-11-30 17:44:51Z JAYANTH RAO MD 150 55TH STREET NO 2-36 BROOKLYN NY 11220 3998421 0 X N/A X 1984 NY HEALTHCARE PROVIDER OF RADIOLOGY IN CONJUNCTION WITH, AND IN SUPPORT OF, LUTHERAN MEDICAL CENTER. 1 0 9 0 0 0 0 0 4789117 3990113 504 299 0 8009 4789621 3998421 0 0 0 0 3406233 3584960 0 0 0 3514541 2811903 6920774 6396863 -2131153 -2398442 411210 481120 1524253 1479800 -1113043 -998680 X SEE SCHEDULE O. 0 0 5788446 3998122 SHORE ROAD RADIOLOGY ASSOCIATES, PC IS A PROFESSIONAL CORPORATIONTHAT PROVIDES RADIOLOGICAL SERVICES TO LUTHERAN MEDICAL CENTER ANDTHE SURROUNDING SOUTHWEST BROOKLYN COMMUNITIES. PROCEDURESINCLUDE BOTH DIAGNOSTIC AND THERAPEUTIC SERVICES, RANGING FROMX-RAY, CT, MRI, NUCLEAR MEDICINE, ULTRASOUND, MAMMOGRAPHY ANDVASCULAR AND OTHER SPECIAL PROCEDURES. IN 2013, SRR RADIOLOGISTSREAD APPROXIMATELY 112,744 TESTS PERFORMED ON LUTHERAN MEDICALCENTER PATIENTS, WITHOUT REGARD FOR THE PATIENT'S ABILITY TO PAY. 5788446 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 1 6 0 1 9 0 0 0 0 0 0 0 0 0 0 0 X 1 0 0 0 0 0 1 1 1 1 0 0 0 1 1 1 1 1 1 1 1 0 NY X ALAN SICKLES 7186307611 150 55TH STREET BROOKLYN NY 11220 JAYANTH RAO MD PRESIDENT 40.00 X X 656749 0 26455 JEN-FONG SHEN MD RADIOLOGIST 40.00 X 351191 0 55696 RON MAIMON MD RADIOLOGIST 40.00 X 390737 0 19985 ALEXANDER VIDERSHAYN MD RADIOLOGIST 40.00 X 342647 0 36715 YEVGENIY MARGULIS MD RADIOLOGIST 40.00 X 377904 0 19985 KOPRESH A GUDI MD RADIOLOGIST 40.00 X 377324 0 47127 2496552 0 205963 9 0 1 0 BARTON & ASSOCIATES 10 DEARBORN ROAD PEABODY MA 01960 LOCUM TENENS 839237 TELERADIOLOGY LLC 3520 PIEDMONT ROAD NE SUITE 250 ATLANTA GA 30305 LOCUM TENENS 456257 CADACEUS INC 30 MONTGOMERY STREET SUITE 7 JERSEY CITY NJ 07302 BILLING SERVICES 306994 TOTAL VASCULAR CARE PLLC 960 50TH STREET BROOKLYN NY 11219 LOCUM TENENS 170050 4 PATIENT SERVICE REVENU 622110 3990113 3990113 3990113 299 299 WRITE OFFS OF FSA ACNT 900099 5653 5653 PAYROLL TAX REFUND 900099 2356 2356 8009 3998421 3998122 0 299 X 683204 683204 2562842 2562842 80139 80139 126183 126183 132592 132592 107252 107252 10554 10554 1677002 1677002 15996 15996 510488 510488 BILLING EXPENSES 306994 306994 STAFF CHARGE BACK 178438 178438 FILING FEES 275 275 PAYROLL FEES 84 84 4820 4820 6396863 5788446 608417 0 67291 283688 298418 127522 115411 411210 481120 833308 675297 690945 804503 1524253 1479800 X -1113043 -998680 -1113043 -998680 411210 481120 X -2398442 2512805 X 0 1 X 1 0 X X X X 0 0 0 LUTHERAN MEDICAL CENTER 111839567 HOSPITAL 1 1 1 6396863 1 6396863 0 DUE TO AFFILIATES 804503 804503 X X X X 0 0 0 0 0 0 0 1 0 JAYANTH RAO MD PRESIDENT 646749 0 10000 0 0 0 10200 0 16255 0 683204 0 0 0 JEN-FONG SHEN MD RADIOLOGIST 349802 0 0 0 1389 0 10200 0 45496 0 406887 0 0 0 RON MAIMON MD RADIOLOGIST 390414 0 0 0 323 0 10200 0 9785 0 410722 0 0 0 ALEXANDER VIDERSHAYN MD RADIOLOGIST 342324 0 0 0 323 0 10200 0 26515 0 379362 0 0 0 YEVGENIY MARGULIS MD RADIOLOGIST 377613 0 0 0 291 0 10200 0 9785 0 397889 0 0 0 KOPRESH A GUDI MD RADIOLOGIST 375192 0 0 0 2132 0 10200 0 36927 0 424451 0 0 0 PART I, LINE 7 DR. RAO IS ELIGIBLE FOR A BONUS EACH YEAR IF HE ACHIEVES CERTAIN HOSPITAL GOALS. IN 2013 HE WAS PAID $10,000 FOR ACHIEVING HOSPITAL TARGETS FOR HIS DEPARTMENT. HEMALATHA RAO BOARD DIRECTOR & OFFICER 84125 THE ORGANIZATIONS PRESIDENT AND SOLE DIRECTOR DR. JAYANTH RAO IS MARRIED TO HEMALATHA RAO AN INDEPENDENT CONTRACTOR THAT PROVIDES PHYSICIAN SERVICES TO THE ORGANIZATION PURSUANT TO A WRITTEN CONTRACT AGREEMENT. THE AMOUNT PAID FOR THE PHYSICIAN SERVICES FOR THE YEAR ENDED DEC 31, 2013 IS 84,125. 0 FORM 990, PART III, LINE 1 ORGANIZATION'S MISSION SHORE ROAD RADIOLOGY ASSOCIATES, PC ("PC") IS FORMED FOR THE SOLE PURPOSE OF PROMOTING HEALTH FOR THE BENEFIT OF THE COMMUNITY BY SERVING A LARGE AND INDEFINITE CLASS. THE ORGANIZATION PROMOTES HEALTH BY ENGAGING IN THE PROFESSION OF MEDICINE AND PROVIDING MEDICAL SERVICES, IN A MANNER THAT IS EXCLUSIVELY CHARITABLE WITHIN THE MEANING OF SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THE PROVISION OF MEDICAL SERVICES HAS BEEN CARRIED ON SINCE THE INCEPTION OF THE ORGANIZATION IN 1983. THE PC OPERATES IN SUPPORT OF LUTHERAN MEDICAL CENTER. LUTHERAN MEDICAL CENTER IS A NOT-FOR-PROFIT CORPORATION ORGANIZED UNDER THE LAWS OF THE STATE OF NEW YORK, AND A CHARITABLE, TAX-EXEMPT ORGANIZATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. LUTHERAN MEDICAL CENTER IS AN ACUTE CARE HOSPITAL THAT CONDUCTS CHARITABLE AND HOSPITAL ACTIVITIES. THE PC PROVIDES PROFESSIONAL MEDICAL SERVICES TO PATIENTS, WITHOUT REGARD FOR THE PATIENT'S ABILITY TO PAY. THE ORGANIZATION HAS ADOPTED THE CHARITY CARE POLICY OF LUTHERAN MEDICAL CENTER. FORM 990, PART IV, LINE 12B SHORE ROAD RADIOLOGY ASSOCIATES, P.C. IS INCLUDED IN A COMBINED AUDITED FINANCIAL STATEMENT FOR THE YEAR ENDING DECEMBER 31ST, 2013. THE COMBINED FINANCIAL STATEMENTS ARE PREPARED IN ACCORDANCE WITH GENERALLY ACCEPTED ACCOUNTING PRINCIPLES IN THE UNITED STATES OF AMERICA ("GAAP"). THE COMBINED FINANCIAL STATEMENTS INCLUDE THE ACCOUNTS OF LUTHERAN MEDICAL CENTER AND ALL OF ITS AFFILIATED ORGANIZATIONS. PER THE INSTRUCTIONS TO THE FORM 990, THE ORGANIZATION IS REQUIRED TO RESPOND "YES" TO PART IV, QUESTION 12B IF THE ORGANIZATION IS PART OF A CONSOLIDATED FINANCIAL STATEMENT. SINCE SELECTING "YES" TO THIS QUESTION MAY BE MISCONSTRUED, THE TAXPAYER IS ATTACHING THIS EXPLANATION TO ITS FORM 990. FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION IS A PROFESSIONAL SERVICE CORPORATION ("PC") WITH ONE SHAREHOLDER. UNDER APPLICABLE NYS LAW, ONLY A LICENSED PHYSICIAN MAY HOLD SHARES IN THE PC. DR. JAYANTH RAO, CHAIR OF RADIOLOGY OF LUTHERAN MEDICAL CENTER IS THE SOLE SHAREHOLDER OF THE PC, AND PURSUANT TO A SHAREHOLDER AGREEMENT AMONG DR. RAO, THE PC AND THE MEDICAL CENTER, THE SHAREHOLDER HAS VERY LIMITED AUTHORITY. IN PARTICULAR, THE SHAREHOLDER MAY NOT TRANSFER OR ENCUMBER THE SHARES OR DECLARE DISTRIBUTIONS WITHOUT THE EXPRESS CONSENT OF THE MEDICAL CENTER. FORM 990, PART VI, SECTION A, LINE 7A THE SOLE SHAREHOLDER HAS THE AUTHORITY TO APPOINT THE DIRECTORS AND OFFICERS OF THE PC. FORM 990, PART VI, SECTION A, LINE 7B PURSUANT TO THE SHAREHOLDER AGREEMENT, DR. JAYANTH RAO HAS LIMITED AUTHORITY AND ALL DECISIONS ARE CONTROLLED BY LUTHERAN MEDICAL CENTER. FORM 990, PART VI, SECTION A, LINE 8B THE ORGANIZATION HAS ANSWERED THIS QUESTION "NO" AS THERE ARE NO COMMITTEES WITH AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 IS REVIEWED BY THE VICE PRESIDENT OF FINANCE OF THE ORGANIZATION'S PARENT ORGANIZATION, LUTHERAN MEDICAL CENTER. A COPY OF THE FORM 990 IS PROVIDED TO THE SOLE DIRECTOR, DR. JAYANTH RAO, FOR HIS COMMENT AND REVIEW. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION OPERATES UNDER THE CONFLICT OF INTEREST POLICY OF ITS PARENT ORGANIZATION, LUTHERN MEDICAL CENTER. THE PRESIDENT AND SOLE DIRECTOR, DR. JAYANTH RAO, IS REQUIRED TO DISCLOSE POTENTIAL CONFLICTS OF INTEREST ON AN ANNUAL SURVEY/QUESTIONNAIRE SUBMITTED BY THE MEDICAL CENTER'S GENERAL COUNSEL. THE SUBMITTED QUESTIONNAIRE IS REVIEWED BY THE MEDICAL CENTER'S GENERAL COUNSEL TO ENSURE COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY. FORM 990, PART VI, SECTION B, LINE 15 SENIOR MANAGEMENT AT THE PARENT ORGANIZATION, LUTHERAN MEDICAL CENTER, REGULARLY REVIEWS VARIOUS OBJECTIVE DATA SOURCES THAT FACTOR INTO COMPENSATION FOR EMPLOYED AND CONTRACTED PHYSICIANS AND GROUPS PROVIDING SERVICES TO THE ORGANIZATION. THESE SOURCES INCLUDE NATIONAL AND REGIONAL SURVEY SAMPLES BY PHYSICIAN CLINICAL SPECIALTY, AS PUBLISHED BY SULLIVAN COTTER AND AS PURCHASED FROM OTHER CONSULTANTS, WHICH GUIDE THE ESTABLISHMENT OF FAIR MARKET VALUE FOR EACH PHYSICIAN'S/GROUP'S COMPENSATION LEVEL IN THE ORGANIZATION. WITH RESPECT TO CERTAIN PHYSICIANS WHO MIGHT BE CONSIDERED "LUMINARIES" OR WHOSE COMPENSATION FALLS INTO AN OUTLIER CATEGORY IN THE CLINICAL SPECIALTY, LMC SEEKS ADVICE AND OPINIONS FROM OUTSIDE CONSULTANTS WHO SPECIALIZE IN HIS WORK. IN ADDITION, ALL EMPLOYED AND CONTRACTED PHYSICIANS IN THE PC ARE REQUIRED TO HAVE WRITTEN CONTRACTS, SIGNED BY THE PHYSICIAN AND THE DIRECTOR OF THE ORGANIZATION, DELINEATING THE DUTIES FOR WHICH THEY ARE BEING COMPENSATED. ON A MONTHLY BASIS, THE PHYSICIANS ARE REQUIRED TO SUBMIT TIME REPORTS WHICH DOCUMENT THE TIME SPENT ON VARIOUS ADMINISTRATIVE, SUPERVISORY, TEACHING AND CLINICAL ACTIVITIES. FORM 990, PART VI, SECTION C, LINE 19 THE TAXPAYER MAKES ITS FORM 990 AND FORM 1023 AVAILABLE TO THE PUBLIC BY RETAINING A COPY OF EACH AT ITS HEAD OFFICES. ANY INDIVIDUAL REQUESTING A COPY OF THESE DOCUMENTS IS PROVIDED THAT COPY ON THE SAME BUSINESS DAY. THE ORGANIZATION'S GOVERNING DOCUMENTS AND CONFICT OF INTEREST POLICY ARE AVAILABLE TO THE PUBLIC UPON REQUEST. THE ORGANIZATION DOES NOT OBTAIN AUDITED FINANCIAL STATEMENTS SO THESE ARE NOT MADE AVAILABLE TO THE PUBLIC. PART VI, SECTION B, LINE 13 & 14 THE ORGANIZATION OPERATES UNDER THE WHISTLEBLOWER AND DOCUMENT RETENTION POLICY OF ITS PARENT ORGANIZATION, LUTHERAN MEDICAL CENTER. FORM 990, PART IX, LINE 11G OUTSIDE PHYSICIAN SERVICES: PROGRAM SERVICE EXPENSES 259,300. TOTAL EXPENSES 259,300. OUTSIDE MEDICAL SERVICES: PROGRAM SERVICE EXPENSES 1,417,702. TOTAL EXPENSES 1,417,702. FORM 990, PART XI, LINE 9: TRANSFERS OF NET ASSETS FROM RELATED ENTITIES 2,512,805. LUTHERAN MEDICAL CENTER 150 55TH STREET BROOKLYN NY 11220 111839567 HEALTHCARE NY 501(C)(3) 3 N/A 0 LUTHERAN AUGUSTANA CECR INC 5434 2ND AVE BROOKLYN NY 11220 112150953 EXTENDED CARE NY 501(C)(3) 9 N/A 0 OHP PHSP INC 5800 3RD AVENUE BROOKLYN NY 11220 113245559 INSURANCE NY 501(C)(4) N/A N/A 0 SHORE HILL HOUSING COMPANY INC 9000 SHORE ROAD BROOKLYN NY 11209 237405105 HOUSING NY 501(C)(3) 7 N/A 0 HARBOR HILL HOUSING 150 55TH STREET BROOKLYN NY 11220 113152691 HOUSING NY 501(C)(3) 9 N/A 0 SUNSET BAY COMMUNITY SERVICES 150 55TH STREET BROOKLYN NY 11220 112439925 DAY CARE & SENIOR SERVICES NY 501(C)(3) 7 N/A 0 LMC COMMUNITY FOUNDATION 150 55TH STREET BROOKLYN NY 11220 237439784 SUPPORT ORG. NY 501(C)(3) 11B N/A 0 COMMUNITY CARE ORGANLZATLON 246 55TH STREET APT AA4 BROOKLYN NY 11220 113001682 HOME HEALTH NY 501(C)(3) 9 N/A 0 SUNSET GARDENS HOUSING CORP 150 55TH STREET BROOKLYN NY 11220 203461755 HOUSING NY 501(C)(3) 7 N/A 0 LMC HEALTH SYSTEM INC 150 55TH STREET BROOKLYN NY 11220 113589771 SUPPORT ORG. NY 501(C)(3) 11A N/A 0 LMC PHYSICIAN SERVICES PC 150 55TH STREET BROOKLYN NY 11220 113192423 PHYS. SERVICE NY 501(C)(3) 11C N/A 0 SHORE ROAD COMMUNITY SERVICES 150 55TH STREET BROOKLYN NY 11220 NURSING & HOUSING NY LMC COMMUNITY FOUNDATION C 0 SHORE HILL HOUSING ASSOCIATES GP INC 150 55TH STREET BROOKLYN NY 11220 HOUSING NY N/A C 0 0 0 1 0 0 0 0 0 0 1 1 0 1 1 1 1 0 0 0