2013-01-31T12:01:28-06:00 2011-12-31 131517563 LOEB & TROPER LLP 655 THIRD AVENUE 12TH FLOOR NEW YORK NY 10017 990 2011-01-01 200714587 CENTRAL SUFFOLK HOSPITAL FOUNDATION CENT 6315486064 1300 ROANOKE AVENUE RIVERHEAD NY 11901 ANDREW MITCHELL 6315486064 2013-01-30 1 FREDERICK H ROTHMAN P01275277 2128674000 2011 2016-02-25 16:41:14Z SEE SCHEDULE O FOR DBA ANDREW MITCHELL 1300 ROANOKE AVENUE RIVERHEAD NY 11901 3031232 0 X WWW.PBMEDICALCENTER.ORG X 2004 NY THE FOUNDATION'S MISSION IS TO DEVELOP AND CULTIVATE PHILANTHROPIC AND COLLABRATIVE RELATIONSHIPS THAT FOSTER PROGRAMS AND SERVICES OFFERED THROUGH THE HOSPITAL WHICH IMPROVE THE HEALTH OF THE COMMUNITIES IT SERVES. 17 16 5 16 0 0 1419214 2988253 0 0 2791 749 -35429 -26483 1386576 2962519 499587 545417 0 0 0 0 241500 375000 1184069 680081 809069 1421168 1729486 -34592 1233033 3820545 3589451 2084960 620833 1735585 2968618 X SEE SCHEDULE OTHE FOUNDATION'S MISSION IS TO DEVELOP AND CULTIVATE PHILANTHROPIC AND COLLABRATIVE RELATIONSHIPS THAT FOSTER PROGRAMS AND SERVICES OFFERED THROUGH THE HOSPITAL WHICH IMPROVE THE HEALTH OF THE COMMUNITIES IT SERVES. 0 0 545417 545417 THE SUPPORT OF HOSPITAL SERVICES OF CENTRAL SUFFOLK HOSPITAL. 545417 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0 0 0 1 1 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 0 5 1 0 0 0 0 0 1 1 0 0 0 0 X 17 16 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 J GORDON HUSZAGH 10.00 X X 0 0 0 IRWIN L GARSTEN 10.00 X X 0 0 0 EMILY ROY COREY 1.00 X X 0 0 0 RICHARD ISRAEL 1.00 X X 0 0 0 JOAN LEVAN 1.00 X X 0 0 0 ANDREW MITCHELL 10.00 X X 138340 379787 33651 JESSE R GOODALE III 1.00 X X 0 0 0 KENNEY BARRA 1.00 X 0 0 0 BRUCE BARNET 1.00 X 0 0 0 BABU EASOW MD 1.00 X 0 0 0 JACQUELINE M ENTENMANN 1.00 X 0 0 0 ELIZABETH F FAILING 1.00 X 0 0 0 RICHARD RUBENSTEIN 1.00 X 0 0 0 JOSEPH VAN DE WETERING 1.00 X 0 0 0 CAROLE HANKIN PHD 1.00 X 0 0 0 DAVID J MCCANN 1.00 X 0 0 0 RICHARD L WINSLOW PHD 1.00 X 0 0 0 138340 379787 33651 1 0 1 0 0 309822 200000 2478431 2988253 749 749 42230 309822 68713 -26483 -26483 2962519 0 0 -25734 545417 545417 5700 5700 375000 375000 471129 471129 32755 32755 179683 179683 7500 7500 9666 9666 PLAQUES 32841 32841 69795 69795 1729486 545417 0 1184069 2740127 1072950 1080418 2516501 3820545 3589451 77102 2084960 543731 2084960 620833 X 1075458 721492 660127 2247126 1735585 2968618 3820545 3589451 1233033 0 X X 0 1 1 X 0 X 2022946 1240829 967777 1419214 2988253 8639019 2022946 1240829 967777 1419214 2988253 8639019 2253036 6385983 3355 3300 1634 2791 749 11829 5319 17936 23255 8674103 102949 0.73620 0.65550 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 DUE TO CENTRAL SUFFOLK HOSPITAL D/B/A PECONIC BAY MEDICAL CENTER 492492 CONTRIBUTIONS HELD ON BEHALF OF WOMEN'S HEALTH PARTNERSHIP 51239 543731 2962519 1729486 1233033 1233033 2962519 0 2962519 0 2962519 1729486 0 1729486 0 1729486 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: UNCERTAINTY IN INCOME TAXES - 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, 2008 AND SUBSEQUENT REMAIN SUBJECT TO EXAMINATION BY APPLICABLE TAXING AUTHORITIES. X X X X 1 COMMUNITY COUNSELING SERVICES LLC 461 FIFTH AVENUE NEW YORK NY 10017 CONSULTING FOR CAPITAL CAMPAIGN 0 0 375000 0 375000 NY BLACK AND WHITE 284506 247326 37180 7500 38549 1040 3890 4401 GARDEN FESTIVAL 67546 62496 5050 6310 2143 4880 352052 309822 42230 7500 44859 3183 3890 9281 68713 -26483 1 CENTRAL SUFFOLK HOSPITAL 1300 ROANOKE AVENUE RIVERHEAD NY 11901 111661359 501(C)(3) 545417 GENERAL OPERATIONS 1 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: REQUESTS ARE RECEIVED AND REVIEWED BY THE BOARD. THE FOUNDATION REVIEWS FINANCIAL REPORTS RECEIVED FROM THE GRANT RECIPIENT WHICH VERIFY THAT THE GRANT HAS BEEN APPLIED ACCORDINGLY. 0 0 0 0 0 0 0 0 0 ANDREW MITCHELL 138340 377425 0 0 0 2362 0 28750 0 4901 138340 413438 0 0 FORM 990, PART VI, SECTION B, LINE 11 THE CEO/PRESIDENT, CHIEF OPERATING OFFICER AND CHIEF FINANCIAL OFFICER REVIEW THE 990. A COPY OF THE 990 IS PROVIDED TO THE BOARD OF DIRECTORS FOR REVIEW. FORM 990, PART VI, SECTION B, LINE 12 THE FOUNDATION FOLLOWS THE HOSPITAL'S CONFLICT OF INTEREST POLICY. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XII, LINE 2C: THIS PROCESS DID NOT CHANGE FROM THE PRIOR YEAR. NUMBER OF HOURS DEVOTED TO RELATED ORGANIZATION FORM 990, PART VII, SECTION A, LINE 1A THE FOLLOWING OFFICER IS COMPENSATED BY A RELATED ORGANIZATION: ANDREW MITCHELL 27.5 HOURS PER WEEK PRESIDENT/CEO CENTRAL SUFFOLK HOSPITAL DBA PECONIC BAY MEDICAL CENTER 1300 ROANOKE RIVERHEAD NY 11901 111661359 HOSPITAL CARE NY 501(C)(3) 3 N/A 0 0 1 0 1 1 0 0 0 0 1 1 0 1 1 0 0 0 0