2013-11-15T15:05:43-07:00 2012-12-31 990 2012-01-01 116037195 PENINSULA HOSPITAL CENTER PENI 5164664110 98 CUTTER MILL ROAD SUITE 201N GREAT NECK NY 11021 Lori Lapin Jones 5164664110 2013-11-14 2012 2016-03-07 17:11:31Z X Lori Lapin Jones Chapter 11 Trustee 98 Cutter Mill Road Suite 201N Great Neck NY 11021 15919244 0 X X 1957 NY THE HOSPITAL MISSION WAS TO PROVIDE THE HIGHEST QUALITY CARE TO PATIENTS OF ALL AGES, BACKGROUNDS, AND BELIEFS. WE WERE DEDICATED TO DELIVERING COMPETENT, COLLABORATIVE AND PROFESSIONAL SERVICES TO ALL OF OUR PATIENTS AND RESIDENTS OF THE ROCKAWAYS AND NEIGHBORING COMMUNITIES. THE HOSPITAL CEASED OPERATIONS ON APRIL 6, 2012. X 1 1 743 2 59247 -145000 244537 82288 73246467 11468762 0 -5586899 6916663 3054127 80407667 9018278 0 0 0 0 55613181 14987201 0 0 0 31065581 9786224 86678762 24773425 -6271095 -15755147 26226692 13076963 60009144 62658693 -33782452 -49581730 X THE HOSPITAL MISSION WAS TO PROVIDE THE HIGHEST QUALITY CARE TO PATIENTS OF ALL AGES, BACKGROUNDS, AND BELIEFS. WE WERE DEDICATED TO DELIVERING COMPETENT, COLLABORATIVE & PROFESSIONAL SERVICES TO ALL OF OUR PATIENTS AND RESIDENTS OF THE ROCKAWAYS AND NEIGHBORING COMMUNITIES. THE HOSPITAL CEASED OPERATIONS ON APRIL 6, 2012 0 1 16646604 12848788 PROVISION OF ACUTE HOSPITAL CARE SERVICES UP UNTIL THE HOSPITAL CLOSURE DATE OF APRIL 6, 2012. 0 0 0 16646604 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 1 169 0 1 743 1 1 1 0 0 0 0 0 X 1 1 1 1 1 0 0 0 0 1 1 1 0 1 1 1 1 1 1 1 1 0 NY X Lori Lapin Jones Chapter 11 Trustee 5164664110 98 Cutter Mill Road Suite 201 North Great Neck NY 11021 X David Ribet 1 0 X X 0 0 0 Louis Caucig 1 0 X X 0 0 0 Marvin Eisenstadt 1 0 X X 0 0 0 Lori Lapin Jones 0.00 0 X 216431 0 0 Monica Terrano 38 0 X 161997 0 535 Justin Baum 38 0 X 134715 0 25710 Darryl Greene 1 0 X 0 0 0 Elliot Shapiro 1 0 X 0 0 0 Francis Rudolph 1 0 X 0 0 0 Frank Russo 1 0 X 0 0 0 George Greco 1 0 X 0 0 0 George Murphy 1 0 X 0 0 0 Joel Miele Sr 1 0 X 0 0 0 Leonard Tanzer 1 0 X 0 0 0 Lucy Salpeter 1 0 X 0 0 0 Martin Oliner 1 0 X 0 0 0 Steven Greenberg 1 0 X 0 0 0 Morton Schwartz 1 0 X 0 0 0 Nancy Vardakis 1 0 X 0 0 0 Noel Schwartz 1 0 X 0 0 0 Patte Bogen Roberts 1 0 X 0 0 0 Reverend Evan D Gray 1 0 X 0 0 0 Richard Hoffman 1 0 X 0 0 0 Steven Eisentadt 1 0 X 0 0 0 Robert Levine 38 0 X 0 0 0 Mark Skulnick 38 0 X 0 0 0 Robert Aglialoro 38 0 X 0 0 0 Todd Miller 38 0 X 129514 0 21264 Thomas Egan 38 0 X 54519 0 180 David Masini 38 0 X 98673 0 326 Robin Blackwell 38 0 X 20588 0 6014 Allen Corby 38 0 X 6469 0 21 Peter Galvin 38 0 X 55812 0 0 Martin Grossman 38 0 X 18000 0 14923 Howard Sussman 38 0 X 41758 0 20974 Joel Miele Jr 1 0 X 0 0 0 David Gruber 1 0 X 0 0 0 938476 0 89947 3 1 1 0 Garfunkel Wild PC 111 Great Neck Road 6th Floor Great Neck NY 11021 Legal services 644715 Sodexo 500 Ross Street Pittsburgh PA 15262 Dietary Services 358056 Abrams Fensterman et al 630 Third Avenue 5th Floor New York NY 10017 Legal services 248172 Citistorage LLC 5 North 11th Street Brooklyn NY 11249 Record Storage 247817 The Garden City Group 1985 Marcus Avenue Suite 200 Lake Success NY 11042 Claims Processing 246222 11 0 0 0 0 0 82288 0 82288 Patient Service Revenue 622000 11409515 11409515 0 0 Medical Laboratory 621511 59247 0 59247 0 0 0 0 0 11468762 0 0 0 1314067 0 6900966 0 -5586899 -5586899 -5586899 0 0 0 Intern Resident Program 900099 358500 358500 0 0 Skilled Nursing Home 623000 1021527 1021527 0 0 1674100 1674100 0 0 3054127 9018278 8876743 59247 0 0 0 0 0 0 0 0 0 811990 178068 633922 0 0 0 8288803 6846551 1442252 0 0 0 5121202 4457120 664082 765206 631690 133516 28327 28327 7000 7000 2869152 556347 2312805 22098 22098 361473 361473 102566 102566 656460 656460 5581 5581 14486 14486 159315 159315 904409 904409 622121 622121 Bankruptcy Expenses 2375402 0 2375402 0 Supplies 1388620 1148386 240234 0 269214 269214 24773425 16646604 8126821 0 484662 2258683 0 0 308629 0 9739200 2798823 0 0 0 0 0 0 463517 0 724235 375673 14802487 12172055 9531400 2630432 4975049 5013352 26226692 13076963 30979181 32526848 525000 174805 621000 2521000 27883963 27436040 60009144 62658693 X -34121029 -49876176 338577 294446 0 0 -33782452 -49581730 26226692 13076963 X -15755147 0 0 0 0 -44131 X 0 0 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 268383 268383 0 13799513 11475356 2324157 0 734591 696699 37892 0 0 0 0 0 0 0 0 2630432 Due from Affiliates 1080285 Due from third party payors 3886163 Deposit for Sale of Hospital and Clinic -725000 Deferred financing fees 57901 Other Assets 713332 Assets with restricted use 671 5013352 0 Due to Affiliates 6836983 Due to Third Party Payors 11027505 Estimated Malpractice Liability 7901109 Capitalized Lease Obligations 189329 Other Liabilities 1481114 27436040 1 1 X 1 X 1 X 1 0 0 343462 180761 162701 0.0066 6792870 3542183 3250687 0.1312 0 0 0 0 0 0 7136332 3722944 3413388 0.1378 0 0 0 0 2114322 1934875 179447 0.0072 1415271 468973 946298 0.0382 0 0 0 0 0 0 0 0 0 0 3529593 2403848 1125745 0.0454 0 0 10665925 6126792 4539133 0.1832 1 452756 95572 4558582 4408365 150217 X 1 1 1 1 Peninsula Hospital Center

51-15 Beach Channel Drive Far Rockaway NY 11691

www.peninsulahospital.org X X X X Rehabilitation, pediatric and hospice units Peninsula Hospital Center 1 1 1 100 1 300 1 X X X X X X 1 1 X X X X X 1 X X X 1 X X X X X X 1 X 1 1 1 Peninsula Center for Extended Care and Rehabilitation

50-15 Beach Channel Drive Far Rockaway NY 11691

Skilled Nursing Facility SchH_P01_S00_L03c Schedule H, Part I, Line 3c Peninsula Hospital Center uses Federal poverty guideline to determine financial assistance eligibility. SchH_P01_S00_L07 Schedule H, Part I, Line 7 Cost-to-charge ratio calculated using Worksheet 2 of the instruction was used in the calculation of costs. SchH_P03_S0A_L04 Schedule H, Part III, Section A, Line 4 The process for estimating the ultimate collection of receivables involves significant assumptions and judgments. Accounts balances are written off against the allowance when management determines it is probable the receivable will not be recovered. The use of historical collection and payor reimbursement experience is an integral part of the estimation of reserves for uncollectible accounts. Revisions in reserves for uncollectible accounts estimates are recorded as an adjustment to the provision for bad debts. SchH_P03_S0B_L08 Schedule H, Part III, Section B, Line 8 There is no Medicare shortfall. The Medicare cost was obtained from Worksheets D and D-1 of the Medicare Cost Report. Medicare cost report calculates ancillary and outpatient costs using cost to charge methodology. The inpatient routine cost was calculated using average cost per diem methodology. SchH_P03_S0C_L09b Schedule H, Part III, Section C, Line 9b The Hospital's bad debt collection policy applies uniformly. It specifically requires that collection agencies follow the financial assistance policies of the Hospital. SchH_P05_S0B_L20 Schedule H, Part V, Section B, Line 20 Peninsula Hospital Center uses the greater of Medicare or Medicaid rates when calculating the maximum amount that can be charged. SchH_P05_S0B_L21 Schedule H, Part V, Section B, Line 21 Peninsula Hospital Center uses the greater of Medicare or Medicaid rates when calculating the maximum amount that can be charged. It is possible that in some situations, the Medicare or Medicaid rate could be higher than the rate under a commercial insurance plan. SchH_P05_S0B_L22 Schedule H, Part V, Section B, Line 22 Peninsula Hospital Center set the maximum amount that can be charged to the lower of gross charge or Medicare/Medicaid rate. If Medicare or Medicaid rate is higher than gross charge, then gross charge is used. SchH_P06_S00_L02 Schedule H, Part VI, Line 2 New York State requires an annual Community Service Plan and needs assessment. The diversity in the Rockaway population is a factor in determining its health care needs. The Hospital Center utilizes the series of publications entitled, "Community Health Profiles" published by the New York City Department of Health and Mental Hygiene in addition to other data available through City, State and Federal agencies and both public and private agencies. Many members of the hospital administration staff are actively involved in community-based organizations. In 2007, The Hospital Center commissioned Charney Research to assist it in determining the needs of the community and continues to solicit feedback from its Community Advisory Council, Board of Directors and Support Groups. SchH_P06_S00_L03 Schedule H, Part VI, Line 3 The Hospital Center implemented its Financial Aid Program entitled "PHC Choices" to ensure that all uninsured patients who are interested in financial aid can obtain the same, with minimal eligibility barriers. The Hospital Center has posted information on "PHC Choices" throughout the hospital and on its website, made brochures available in all patient registration areas, intake areas and in its Hospital Patient Guide. The Hospital Center continually attempts to integrate the full range of financial options for uninsured patients into a process whereby patients are evaluated for eligibility into Medicaid, Family Health Plus/Child Health Plus and all financial assistance plans. SchH_P06_S00_L04 Schedule H, Part VI, Line 4 The Hospital Center is located in Far Rockaway, Queens. Our primary service area was the Rockaway Peninsula, including zip codes 11691 through 11697. It also served parts of mainland Queens and Brooklyn as well as the Five Towns area of Nassau County. It had a diverse population of 106,000, and the population is rapidly growing. Approximately 28% of the population is living at and below the Federal poverty level. Due to its isolated geographic location and the limited public transportation available. SchH_P06_S00_L05 Schedule H, Part VI, Line 5 The Hospital Center participated in various community health fairs and support groups. The Hospital Center participated in a community outreach program which brought a mobile health van weekly to various locations in the Rockaway community. Basic health screenings were provided. This forum provides opportunities for members of the community to talk about their health and for Hospital Center staff to solicit comments and opinions about how they would like health care delivered. The Hospital Center provided free angio-screenings weekly to the community. This is a screening tool to help determine risk for heart attack and stroke. Statistics have shown that this screening has saved lives and many who didn't realize they had some significant health issues are now being treated successfully. The Hospital Center was actively involved in various emergency preparedness activities. It was the goal of the Hospital Center, in collaboration with other local, City and State agencies and organizations, to ensure that the community was knowledgeable, prepared and aware of all means of personal protection including evacuation and last resort shelters. SchH_P06_S00_L06 Schedule H, Part VI, Line 6 The Hospital Center is affiliated with the Joseph P. Addabbo Family Health Center, providing emergency, ancillary, specialist and inpatient services as needed. The Joseph P. Addabbo Family Health Center is a Federally Qualified Health Center (FQHC) serving a medically under served population. The Hospital Center has affiliations and collaborations with various hospital and medical facilities to assist in the training of interns and residents as well as a growing Family Practice Residency Program the focus of which is to "train and retain" physicians in this under served area. SchH_P06_S00_L07 Schedule H, Part VI, Line 7 New York X 0 0 0 0 0 0 0 0 0 Monica Terrano 161997 0 0 0 0 0 0 0 535 0 162532 0 0 0 Justin Baum 134715 0 0 0 0 0 0 0 25710 0 160425 0 0 0 Todd Miller 129514 0 0 0 0 0 0 0 21264 0 150778 0 0 0 Lori Lapin Jones 216431 0 0 0 0 0 0 0 0 0 216431 0 0 0 On June 27, 2012 Peninsula Hospital Center conducted an auction sale of substantially all of the facility's equipment, furniture and supplies. The auction was conducted by The Great American Group. On May 2, 2013 a sale of the Peninsula Hospital Center real estate was completed. 2013-06-30 1040953 Great American Group conducted a public auction in which the assets were sold to highest bidder. Public Auction 0 0 0 0 SchN_P01_S00_L01 Schedule N, Part I, Line 1 On May 2, 2013 the Chapter 11 Trustee consummated a sale of the Peninsula Hospital Center real estate. F990_P00_S00_L0A Form 990, Header, Line A This tax return is for the calendar year ending December 31, 2012. It includes the period January 1, 2012 to March 8, 2012, which was the period prior to the appointment of the Chapter 11 Trustee. The financial information for the period prior to the appointment of the Chapter 11 Trustee is based on the books and records of Peninsula Hospital Center which were inherited by the Trustee. While the Trustee believes the books and records are accurate, she does not assume responsibility for such information. F990_P03_S00_L03 Form 990, Part III, Line 3 Under the direction of the court appointed Chapter 11 Trustee, Lori Lapin Jones, Peninsula Hospital Center ceased operating as a Hospital on April 6, 2012. F990_P04_S00_L20a Form 990, Part IV, Line 20a The Hospital ceased operations on April 6, 2012. Inpatient and Outpatient services were closed F990_P06_S0A_L02 Form 990, Part VI, Section A, Line 2 The following family members are board members: Joel A. Miele Sr. (Chairman) and Joel Miele Jr. (Director); Marvin E. Eisenstadt (Sr. Vice Chairman) and Steven Eisenstadt (Director). F990_P06_S0A_L03 Form 990, Part VI, Section A, Line 3 By Order dated March 9, 2012, the Court approved the appointment of Lori Lapin Jones as the Chapter 11 Trustee of the Debtors' estates. F990_P06_S0A_L04 Form 990, Part VI, Section A, Line 4 On August 16, 2011, an involuntary petition for relief under chapter 11 of the Bankruptcy Code was filed against PHC. On September 19, 2011, PHC consented to entry of the order for relief under chapter 11 of the Bankruptcy Code. On September 21, 2011, the Court entered an order for relief under chapter 11 of the Bankruptcy Code. In February 2012, the NYS DOH issued summary orders closing the laboratory and directing suspension of hospital services dependent on the laboratory. By Order dated March 9, 2012, the Court approved the appointment of Lori Lapin Jones as the Chapter 11 Trustee of the Debtors' estates, for the chapter 11 cases. In April, 2012 the NYS DOH approved a plan of closure for Peninsula Hospital Center. F990_P06_S0A_L09 Form 990, Part VI, Section A, Line 9 Lori Lapin Jones, the court appointed Chapter 11 Trustee, can be reached at her office located at: Lori Lapin Jones PLLC 98 Cutter Mill Road - Suite 201N Great Neck, New York 11021 F990_P06_S0B_L11b Form 990, Part VI, Section B, Line 11b The document was prepared by Monica Terrano and Justin Baum and reviewed by Lori Lapin Jones, Chapter 11 Trustee. F990_P06_S0B_L12c Form 990, Part VI, Section B, Line 12c Upon information and belief, prior to the Trustee's appointment, disclosure in accordance with the Conflict of Interest Policy by employees that satisfy the criteria to be considered an "interested person" was submitted upon hiring and annually thereafter. The Audit and Compliance committee reviewed the submissions for conflicts and the Department of Internal Audit monitors compliance. F990_P06_S0B_L15 Form 990, Part VI, Section B, Line 15 The Chapter 11 Trustee was appointed and reviewed executive compensation. F990_P06_S0C_L19 Form 990, Part VI, Section C, Line 19 Governing documents: Certificate of Inc. filed with the NYS Department of State; Conflict of Interest Policy is not publicly available. Monthly Operating Reports are filed with the Bankruptcy Court and are available upon request. F990_P07_S0A_L01a Form 990, Part VII, Section A, Line 1a Compensation for Lori Lapin Jones, Chapter 11 Trustee, consists of commissions and expenses approved by order of the Bankruptcy Court. F990_P11_S00_L09 Form 990, Part XI, Line 9 Change in unrestricted and temporarily restricted net assets Peninsula General Nursing Home Corp 50-51 Beach Channel Drive Far Rockaway NY 11691 237086890 Nursing Home and Rehabilitation Center NY 501 (c) 3 3 N/A 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 Peninsula General Nursing Home Corp q 2196856