2013-11-13T09:26:23-06:00 2012-12-31 990 2012-01-01 111633487 GLEN COVE HOSPITAL C/O NORTH SHORE-LIJ HEALTH SYSTEM % NORTH SHORE-LIJ HEALTH SYSTE GLEN 5168766061 972 BRUSH HOLLOW ROAD 5TH FL Suite WESTBURY NY 11590 ROBERT S SHARPIRO 2013-11-08 2012 2016-02-25 16:41:14Z MICHAEL J DOWLING 145 COMMUNITY DRIVE GREAT NECK NY 11021 221616209 false X WWW.NSLIJ.COM X 1956 NY Glen Cove strives to improve the health of the communities it serves and is committed to providing the highest quality clinical care and caring for the entire community regardless of the ability to pay. 136 128 1482 150 0 456534 520096 188414490 189233985 2100043 1801628 6591976 5862396 197563043 197418105 0 0 0 0 124705836 133305666 0 0 21174 70108490 66920251 194814326 200225917 2748717 -2807812 184893946 188990204 93962822 94303427 90931124 94686777 GLEN COVE HOSPITAL IS PART OF THE NORTH SHORE-LIJ HEALTH SYSTEM ("THE SYSTEM"), 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 158568118 166548802 Glen Cove Hospital (GCH) is a 265-bed community hospital that offers inpatient medical/surgical, intensive and cardiac care, orthopedics, gynecology, pediatrics, and psychiatry. GCH offers state of the art inpatient and outpatient orthopedic rehabilitation services, including total join replacement, spinal procedures and sports medicine. GCH has established itself as a national and international center for orthopedic surgery and joint replacement. GCH is also a NYS DOH - designated Stroke Center. In 2012, the hospital had 8,975 inpatient discharges, provided 21,627 emergency department visits and performed 3,782 ambulatory surgeries, including endoscopies. 23122838 19661291 The Physician and Ambulatory Network Services strive to make a measurable difference in the health status of communities it serves by providing a complete and comprehensive practice management infrastructure that enable enterprise to achieve the financial status necessary to meet patient, physician and Health System needs. 1989617 3023891 North Shore-LIJ Imaging at Glen Cove provides a full range of diagnostic radiology services. Extensive imaging capabilities support multiple diagnostic goals, including primary diagnosis, the tracking of treatment process, pre-surgical testing and post-operative analysis. Exams are performed by certified technologist that use state of the art equipment coupled with the very latest advances in imaging techniques to ensure consistent high quality images, expert analysis and uncompromised quality. 183680573 true true false true false false false false false true true false false true true true false true false false true 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 X 25 0 true 1482 true true false true CJ false false false false false false false false false false false false false X 136 128 true false false false false true true true true false false true true true true true true true true false NY X X NORTH SHORE-LIJ HEALTH SYSTE 5168766061 972 BRUSH HOLLOW ROAD 5TH FL WESTBURY NY 11590 MICHAEL J DOWLING 50.0 X X 0 2823350 1128235 RICHARD D GOLDSTEIN 3.0 X X 0 0 0 WILLIAM L MACK 2.0 X X 0 0 0 BARRY RUBENSTEIN 2.0 X X 0 0 0 ALAN I GREENE 2.0 X X 0 0 0 DONALD ZUCKER 2.0 X X 0 0 0 MARK CLASTER 2.0 X X 0 0 0 RALPH NAPPI 50.0 X 0 2276547 60770 NON-COMPENSATED TRUSTEES 2.0 X 0 0 0 ANTHONY C FERRERI 50.0 X 0 1049046 387210 KEVIN F LAWLOR 50.0 X 0 799176 280574 HOWARD GOLD 50.0 X 0 1299856 298209 MARK J SOLAZZO 50.0 X 0 1698389 216113 ROBERT S SHAPIRO 50.0 X 0 1139452 231819 LAWRENCE G SMITH MD 50.0 X 0 848130 683709 KEITH THOMPSON 50.0 X 0 2868822 533031 JEFFREY KRAUT 50.0 X 0 826861 201661 KATHLEEN GALLO RN PHD 50.0 X 0 747445 271298 EUGENE TANGNEY 50.0 X 0 888508 134286 HARRY GINDI 50.0 X 0 284559 42600 DONNA DRUMMOND 50.0 X 0 571767 42600 SUSAN KWIATEK 50.0 X 286345 0 42600 EUGENE KRAUSS 50.0 X 1023909 0 42600 AYAL SEGAL 50.0 X 805025 0 42600 VINCENT LEONE 50.0 X 758516 0 42600 BRIAN PINARD 50.0 X 504509 0 42600 JAY SIMONCIC 50.0 X 642845 0 42600 4021149 18121908 4767715 205 false true false MICHAEL ANTHONY CONTRACTING CORP 161 RAILROAD AVENUE GARDEN CITY NY 11040 GENERAL CONTRACTOR 4713105 PW GROSSER CONSULTING 630 JOHNSON AVENUE SUITE 7 BOHEMIA NY 11716 ENGINEER 598233 GE HEALTHCARE 80 E SEAVIEW BLVD PORT WASHINGTON NY 11050 EQUIP SVC CONTRACTOR 417506 CANON DESIGN 360 MADISON AVENUE FLOOR 11 NEW YORK NY 10017 ARCHITECT 313660 UNITEX TEXTILE RENTAL 155 SOUTH TERRACE AVENUE MOUNT VERNON NJ 10550 LAUNDRY SERVICE 271624 15 22714 497382 520096 NET PATIENT SERVICE REVENUE 621300 109156370 109156370 PHYSICIAN PRACTICE REVENUE 621300 19760687 19760687 MEDICARE/MEDICAID PAYMENTS 621300 60316928 60316928 189233985 1513878 1513878 7275 7275 0 195282 195282 0 195282 24478579 24198104 280475 280475 0 0 0 CAFETERIA SALES 900099 671671 671671 ELECTRONIC HEALTH RECORD MEANINGFUL USE 900099 177775 177775 RESIDENT ROTATION PROGRAM 900099 106800 106800 4710868 4584486 126382 5667114 197418105 194103046 2319206 0 0 0 0 286345 286345 0 96904855 92273716 4618938 12201 12669040 12063579 603866 1595 17218276 16395405 820703 2168 6227150 5929551 296815 784 0 26375 26375 0 0 0 0 1213389 1155400 57836 153 19698 18757 939 2 30417334 28963672 1449832 3830 0 0 2867026 2730009 136656 361 160124 160124 0 212141 212141 279227 279227 0 5835597 5556710 278887 5628079 5628079 MEDICAL & OTHER PURCHASED SERV 7590556 7590556 BAD DEBT 2854234 2854234 CENTRALIZED ADMIN EXP 7923478 7923478 DUES & SUBSCRIPTIONS 241493 229952 11511 30 1651500 1632343 19107 50 200225917 183680573 16524170 21174 66009 15863 56842831 64262617 50002 79642 13778569 13560281 0 0 0 0 0 0 2522088 2391200 54451 52820 99908417 43424746 50998530 56483671 3427397 3129238 0 0 0 0 0 0 57154069 49014872 184893946 188990204 24903753 24660899 0 0 0 0 10106872 8891451 0 0 0 0 0 0 0 0 58952197 60751077 93962822 94303427 X 82629477 85969821 5603236 5998092 2698411 2718864 90931124 94686777 184893946 188990204 X -2807812 5481536 1081929 X false true X true true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false true 30763 false 30763 false false LOBBYING ACTIVITY EXPLANATION SCHEDULE C, PART 11-B, line 1 h GLEN COVE HOSPITAL IS A MEMEBER OF THE AMERICAN HOSPITAL ASSOCIATION AND OTHER HEALTH CARE ASSOCIATIONS WHICH ENGAGE IN LOBBYING EFFORTS ON BEHALF OF THEIR MEMBER HOSPITALS. 2713081 20454 392564 20454 3105645 2562388 238613 -49307 38613 2713081 2282024 27451 278282 25369 2562388 1816559 40965 464366 39866 2282024 2300116 563641 -986465 60733 1816559 1.00000 false false 174043 174043 73780938 32528886 41252052 23596770 10725526 12871243 2356666 170333 2186333 56483671 DUE FROM AFFILIATE 28433502 INTEREST IN FOUNDATION,UNREST. 2373488 BOND FINANCING 196740 DEPOSITS ON EQUIPMENT 13792 OTHER ASSETS 172261 AUXILIARY 56519 INSURANCE CLAIMS RECEIVABLE 17768570 MALPRACTICE SELF INSURANCE 0 49014872 0 ESTIMATED PAYABLE TO 3RD PARTY 14497370 OTHER LIABILITIES 899219 MALPRACTICE INSURANCE 14575000 PENSION 12512672 BOND PREM/DISC 498246 INSURANCE CLAIMS LIABILITY 17768570 60751077 X 199443962 5149894 -188429 4961465 194482497 2935608 2935608 197418105 191001715 191001715 9224202 9224202 200225917 FIN 48 PART X, LINE 2 Certain entities included in the System's 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, 2012 and 2011, the System 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 $149,000,000, which expire in varying amounts through 2032, and are available to offset future taxable income. INTENDED USE OF ENDOWMENTS PART V, LINE 4 There are various components that encompass the Endowment Fund. In general, their intended use is for teaching, research and training, major modernization, and purchases of equipment. REVENUE ON BOOKS NOT ON RETURN PART XI, LINE 2D GAIN/LOSS ON REFINANCING OF LONG TERM DEBT (188,429) REVENUE ON RETURN BUT NOT ON BOOKS PART XI, LINE 4B RESTRICTED CONTRIBUTIONS 20,454 RESTRICTED INVESTMENT INCOME 60,921 PROVISION FOR BAD DEBT 2,854,234 TOTAL 2,935,608 EXPENSE ON RETURN BUT NOT ON BOOKS PART XII, LINE 4B ADDITIONAL MINIMUM LIABILITY ON PENSION 6,369,968 PROVISION FOR BAD DEBT 2,854,234 TOTAL 9,224,202 Central America and the Caribbean Investments 3917748 Europe (Including Iceland and Greenland) Investments 1261352 5179100 5179100 false false false false false false true true X true X true X 500. true true true false true true 1 5804 5991000 2286000 3705000 0.01940 1 15253 17169645 11030032 6139613 0.03210 2 21057 23160645 13316032 9844613 0.05150 47 29460 611190 1487 609703 0.00320 23 244 3907665 1744581 2163084 0.01130 1 43500 43500 0.00020 4 2 119259 119259 0.00060 75 29706 4681614 1746068 2935546 0.01530 77 50763 27842259 15062100 12780159 0.06680 2 12 17318 17318 0.00010 1 141 141 1 35 35 5 212 17494 17494 0.00010 false 2500000 66263926 71157324 -4893398 X true true 1 1 GLEN COVE HOSPITAL

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FAMILY HEALTH CENTER NORTH COAST INTERNAL MEDICINE PC

207 GLEN COVE AVENUE SEA CLIFF NY 11579

OUTPATIENT PHYSICIAN CLINIC PART VI - SUPPLEMENTAL INFORMATION Question 1. Part I, Line 3c: This hospital is an affiliated entity of the North Shore-LIJ Health System ("North Shore-LIJ" or "the System"). North Shore-LIJ 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 (North Shore-Long Island Jewish Health System) of the hospital. The Community Benefit Report is accessible to the public and can be accessed on the North Shore-LIJ website: http://www.northshorelij.com. 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 hospital's 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. A 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 Bad Debt Expense that appears on Form 990, Part IX, Line 25 column (A), but not included for purposes of calculating the percentage in this column is equal to the amount reported on Form 990, Part X. 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 (a) The number of activities or programs was determined by counting unique community benefit activities or programs conducted throughout the year. Each activity or program may include multiple occurrences. In Part I line 7a-k, column (a) represents the total number of unique community benefit activities and programs; not the number of occurrences for each activity and program. Column (b) Persons served were determined by the unique number of community members that encountered a specific community benefit activity or program. Persons were reported multiple times when engaged in services in different categories of activity or program. Column (f) for Rows (a)-(k) The percentage of Net Community Benefit Expense divided by Total Expense for the hospital (to calculate the percent of total expense). Note: For the entire North Shore-LIJ Health System, Part I, Line 7 (Row K, Column F) is approximately 10.9% 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. The System's bioterrorism & disaster preparedness includes Center for Emergency Medical Services, which is a state and federal planning resource on weapons of mass destruction, and a designated a Bioterrorism Resource Center. The System 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, (i.e. Super storm Sandy), North Shore-LIJ provides a safe haven for thousands of patients, outside nursing home residents, and community members seeking shelter. North Shore-LIJ ambulances assists with the transport of patients throughout the metropolitan area and stand ready to contribute food, medicine and blankets to numerous individuals who may lose power in their homes, and assist 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 4: For patients who were determined by the System to have the ability to pay but did not, the uncollected amounts are recorded as bad debt expense. Bad debt expenses are determined by applying the ratio of cost to charges from Worksheet 2 to gross patient charges written off to bad debt. 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 organization's collection policy is standard to all accounts regardless of insurance status (e.g. insured, underinsured, and uninsured). The hospital's 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. Part V, Section B, line 8: N/A Part V, Section B, line 9b: The organization's financial assistance policy will review a patient's assets if they fall within the family size and income levels approved by the New York State to provide free or discounted care. Asset test 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 V, Section B, line 10: N/A Part V, Section B, line 11: N/A Part V, Section B, line 12h: The hospital also uses household size. Part V, Section B, line 14g: 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 16e: N/A Part V, Section B, line 17e: N/A Part V, Section B, line 18e: Before initiating any of the actions, the hospital facility sends letters, makes telephone calls and utilizes presumptive eligibility. Part V, Section B, line 19d: N/A Part V, Section B, line 20d: 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 21: N/A Part V, Section B, line 22: In general, the hospital facility does not charge its FAP-eligible patients an amount equal to the gross charge for any service provided. The hospital may charge an amount equal to the gross charge when it is less than the Medicaid rate. Question 2. NEEDS ASSESSMENT: The Community Health Needs Assessment (CHNA) is performed on an ongoing basis. North Shore-LIJ 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. M X X X X X false true false true false false false true false MICHAEL J DOWLING 0 1172902 0 1628000 0 22448 0 1107110 0 21125 0 3951585 0 0 HOWARD GOLD 0 928383 0 340000 0 31473 0 283109 0 15100 0 1598065 0 0 MARK J SOLAZZO 0 974451 0 700000 0 23938 0 198500 0 17613 0 1914502 0 0 ROBERT S SHAPIRO 0 921946 0 190000 0 27506 0 209519 0 22300 0 1371271 0 0 LAWRENCE G SMITH MD 0 720972 0 100000 0 27158 0 667034 0 16675 0 1531839 0 0 KEITH THOMPSON 0 724853 0 113000 0 2030969 0 511950 0 21081 0 3401853 0 313468 JEFFREY KRAUT 0 695349 0 101010 0 30502 0 186561 0 15100 0 1028522 0 0 KATHLEEN GALLO RN PHD 0 622472 0 93240 0 31733 0 256198 0 15100 0 1018743 0 0 EUGENE TANGNEY 0 783757 0 93240 0 11511 0 119186 0 15100 0 1022794 0 0 HARRY GINDI 0 280028 0 0 0 4531 0 27500 0 15100 0 327159 0 0 DONNA DRUMMOND 0 479026 0 35742 0 56999 0 27500 0 15100 0 614367 0 0 EUGENE KRAUSS 801118 0 0 0 222791 0 27500 0 15100 0 1066509 0 0 0 AYAL SEGAL 803175 0 0 0 1850 0 27500 0 15100 0 847625 0 0 0 VINCENT LEONE 756234 0 0 0 2282 0 27500 0 15100 0 801116 0 0 0 BRIAN PINARD 413308 0 0 0 91201 0 27500 0 15100 0 547109 0 0 0 JAY SIMONCIC 560547 0 0 0 82298 0 27500 0 15100 0 685445 0 0 0 RALPH NAPPI 0 672088 0 150000 0 1454459 0 41995 0 18775 0 2337317 0 1389226 ANTHONY C FERRERI 0 873895 0 155000 0 20151 0 372110 0 15100 0 1436256 0 0 KEVIN F LAWLOR 0 665596 0 104400 0 29180 0 263381 0 17193 0 1079750 0 0 SUSAN KWIATEK 264260 0 19321 0 2764 0 27500 0 15100 0 328945 0 0 0 SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN 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 Michael J Dowling ($1,079,610), Ralph Nappi ($14,495), Mark Solazzo($171,000), Robert S Shapiro ($182,019), Howard Gold ($255,609), Keith Thompson ($484,450), Jeffrey Kraut ($159,061), Kathleen Gallo ($228,698), Eugene Tangney ($91,686), Anthony C Ferreri ($344,610), Kevin F Lawlor ($233,853) and Lawrence Smith ($639,534). COMPENSATION CONTINGENT ON REVENUES PART I, 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 North Shore LIJ Health System 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. BONUS AND INCENTIVE COMPENSATION 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). A DORMITORY AUTHORITY OF THE STATE OF NEW YORK 146000293 64983Q4R7 2006-10-18 1973836 2005 Bonds - CAPITAL IMPROVEME false false false B DORMITORY AUTHORITY OF THE STATE OF NEW YORK 146000293 649903LC3 2007-05-31 4604434 2007 A&B Bonds-CAP IMPROV & REFUND true false false C DORMITORY AUTHORITY OF THE STATE OF NEW YORK 146000293 649905QL3 2009-09-17 1412648 2009 A&E Bonds-CAP IMPROV & REFI 2 false false false D DORMITORY AUTHORITY OF THE STATE OF NEW YORK 146000293 649906UY8 2012-05-03 2967249 2012 A BONDS-REFUNDING 1998 BONDS false false false A 267351 0 2045962 140393 0 0 17941 0 0 69761 1817868 0 2010 true false true true B 1181059 0 4363772 296820 89586 479563 43251 0 0 1026245 2380723 0 true true false true C 0 0 1409450 154053 109238 0 22900 0 0 622696 231437 0 2012 true false false true D 0 0 3399354 0 0 0 64062 0 0 0 3335292 0 2012 true false true 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 false 0 false 0 false true B false false true true false true CITIBANK NA 25.9 true false true MBIA 18.1 true true true C false true true false false false 0 false 0 true 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 CALCULATION PERFORMED ON 9/30/2011 FOR 2005 BOND 0 PART IV, LINE 2C - REBATE CALCULATION PERFORMED ON 5/31/2012 FOR 2007 BOND 0 BOARD MEMBER RELATIONS PART VI, SECTION A - GOVERNING BODY, LINE 2 All transactions with North Shore-LIJ Health System entities are as follows: (1) negotiated at arm's 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 Eric and Roger Blumencranz. John Alexander has a business relationship with John Shall. Philip Altheim has a business relationship with Eric Blumencranz. Stanley Applebaum has a business relationship with John Shall. Michael Ashner has a business relationship with William Mack and Scott Rudolph. Eric Blumencranz has as a family relationship with Roger Blumencranz. He has a business relationship with Roger Blumencranz, William Achenbaum, Philip Altheim, Arlene Lane Fisher, Richard D. Goldstein, Lloyd Goldman, Alan Greene, James Greene, Stanley Grey, Richard Guarasci, Richard Horowitz, M. Allan Hyman, Jeffrey Jurick, Arthur Levine, Stuart Levine, David Mack, Bradley Marsh, Charles Merinoff, Ralph Nappi, Dennis Riese, Michael Slade. Roger Blumencranz has a family relationship with Eric Blumencranz. He has a business relationship with Eric Blumencranz, William Achenbaum, Mark Claster, Alan Greene, James Greene, Stanley Grey, Richard D. Goldstein, Richard Horowitz, Jeffrey Jurick, Stuart Levine, David Mack, Ralph Nappi, Mark Solazzo, Donald Zucker, Barbara Zucker. David Blumenfeld has a family relationship with Edward Blumenfeld. Edward Blumenfeld has a family relationship with David Blumenfeld. He has a business relationship with William Mack. Steve Braun has a family relationship with Richard Sims. He has a business relationship with Cary Kravet. Robert Chasanoff has a business relationship with Michael Sahn. Alan Chopp has a business relationship with Patrick McDermott. Mark Claster has a business relationship with Roger Blumencranz, Richard Goldstein, Saul Katz, Robert Rosenthal. Philippe Dauman has a business relationship with Thomas Dooley. Daniel deRoulet has a family relationship with Lorinda deRoulet. Lorinda deRoulet has a family relationship with Daniel deRoulet. Thomas Dooley has a business relationship with Philippe Dauman. Leonard Feinstein has a business relationship with William Mack. Anthony Ferreri has a family and business relationship with John Shall. Arlene Lane Fisher has a business relationship with Eric Blumencranz. Lloyd Goldman has a business relationship with Eric Blumencranz, 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 family relationship with James R. Greene. He has a business relationship with Eric and Roger Blumencranz. James R. Greene has a family relationship with Alan I. Green. He has a business relationship with Eric and Roger Blumencranz. Stanley Grey has a business relationship with Eric and Roger Blumencranz. Richard Guarasci has a business relationship with Eric Blumencranz. William Hiltz has a business relationship with Jeff Maurer. Richard Horowitz has a business relationship with Eric and Roger Blumencranz and M. Allan Hyman. M. Allan Hyman has a business relationship with Eric Blumencranz, Richard Horowitz, Saul Katz 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 Saul Katz and Seth Lipsay. Michael Katz has a family relationship with Saul Katz and David Katz. He has a business relationship with Saul Katz, Curt Launer and Michael Slade. Saul Katz has a family relationship with Michael Katz and David Katz. He has a business relationship with Mark Claster, Michael Katz, Curt Launer and Michael Slade. Cary Kravet has a business relationship with Steve Braun. Jeffrey Lane has a business relationship with William Mack. Curt Launer has a business relationship with Michael Katz and Saul Katz. David Lehr has a business relationship with Ronald Mazzucco. Arthur Levine has a business relationship with Eric Blumencranz. Stuart Levine has a business relationship with Eric and Roger Blumencranz. Seth Lipsay has a business relationship with David Katz. David Mack has a family relationship with William Mack. He has a business relationship with William Mack, Eric Blumencranz, and Roger Blumencranz. William Mack has a family relationship with David Mack. He has business relationships with David Mack, Michael Ashner, Edward Blumenfeld, Leonard Feinstein, Lloyd Goldman, Jeffrey Lane, Barry Rubenstein, Richard Goldstein and Roy Zuckerberg. Bradley Marsh has a family relationship with Jack Ross. He has a business relationship with Eric Blumencranz. Ronald Mazzucco has a business relationship with David Lehr. F.J. McCarthy has a business relationship with Robert Rosenthal. Patrick McDermott has a business relationship with Alan Chopp and John Shall. Charles Merinoff has a business relationship with Eric Blumencranz. Richard Murcott has a business relationship with Barry Rubenstein. Ralph Nappi has a business relationship with Eric and Roger Blumencranz. Dennis Riese has a business relationship with Eric Blumencranz. Robert Rosenthal has a business relationship with Mark Claster, F.J. McCarthy and Nancy Waldbaum. Jack Ross has a family relationship with Bradley Marsh. Barry Rubenstein has a business relationship with Mark Claster , Richard Goldstein, William Mack and Richard Murcott. Scott Rudolph has a business relationship with Michael Ashner. Michael Sahn has a business relationship with Robert Chasanoff. John Shall has a family relationship with Anthony Ferreri. He has a business relationship with Anthony Ferreri, Patrick McDermott, John Alexander, Stanley Applebaum, and Joaquin Gonzalez. Richard Sims has a family relationship with Steve Braun. Michael Slade has a business relationship with Eric Blumencranz, Saul Katz and Michael Katz. Mark Solazzo has a business relationship with Roger Blumencranz. Nancy Waldbaum has a business relationship with Robert Rosenthal. Barbara Hrbek Zucker has a family relationship with Donald Zucker. She has a business relationship with Roger Blumencranz. Donald Zucker has a family relationship with Barbara Hrbek Zucker. He has a business relationship with Roger Blumencranz. Roy Zuckerberg has a business relationship with William Mack. EXECUTIVE COMMITTEE PART VI, SECTION B - POLICIES, LINE 11 All North Shore-LIJ Health System Inc. and affiliated entities prepare the annual Return of Organization Exempt Form Income Tax (Form 990) with input from various departments including Corporate Compliance, Finance, Human Resources, and Legal. Before filing the returns, the documents are electronically made available for review to members of the Executive Committee. 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. CONFLICTS OF INTEREST PART VI, SECTION B-POLICIES, LINE 12C The North Shore-Long Island Jewish Health System ("Health System") has several control mechanisms to mitigate conflicts of interest. The Health System's 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 Health System business in a manner that places the interests of the Health System ahead of their personal interests. In addition, the Health System 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 the Health System are required to filled 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 the Health System's Audit and Corporate Compliance Committee and other applicable committees. In addition, the Health System 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. OFFICERS COMPENSATION PART VI, SECTION B-POLICIES, LINE 15 The by-laws of the Health System 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 the System 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 others 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 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. DISCLOSURES PART VI, SECTION C-DISCLOSURES, LINE 19 CURRENTLY THE ORGANIZATION MAKES IT GOVERNING DOCUMENTS, CONFLICTS OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. NON-COMPENSATED TRUSTEES PART VII, SECTION A - LINE 1A Richard S. Abramson Lloyd M. Goldman F.J. McCarthy William Achenbaum Richard D. Goldstein Patrick F. McDermott John W. Alexander J. Joaquin Gonzalez James McMullen Philip S. Altheim Michael Gould Charles Merinoff Stanley A. Applebaum Albert L. Granger, DDS Richard D. Monti Michael L. Ashner Alan I. Greene Richard Murcott Beverly VP. Banker James R. Greene Ralph A. Nappi Ralph M. Baruch Stanley Grey Richard B. Nye Frank J. Besignano Richard Guarasci, PhD Clyde I. Payne, EdD Elise M. Bloom Paul B. Guenther Arnold S. Penner Eric S. Blumencranz Amy M. Hagedorn John J. Raggio Roger A. Blumencranz Ira Hazan Lewis S. Ranieri David Blumenfeld Linda W. Heaney Jay R. Raubvogel Edward Blumenfeld Marlene Hess Dennis Riese E. Steve Braun William O. Hiltz Terry P. Rifkin, MD Dayton T. Brown, Jr Gedale B. Horowitz Robert F. Rose Allen E. Busching Richard A. Horowitz Robert A. Rosen Jonathan S. Canno M. Allan Hyman Marcie Rosenberg Michael Caridi Mark Jacobson Robert D. Rosenthal Rev. Carolina Sr,EdD Jeffrey Jurick Bernard M. Rosof, MD Rudolph C. Carryl David M. Katz Jack J. Ross Robert W. Chasanoff Michael Katz Barry Rubenstein Alan Chopp Saul B. Katz Herbert Rubin Mark Claster Lisa A. Kaufman Scott Rudolph Diana F. Colgate Robert Kaufman Michael H. Sahn Daniel M. Crown Cary Kravet Frank W. Scarangello,Sr Philippe P. Dauman Stanley Kreitman Lois C. Schlissel Daniel C. de Roulet Seth Kupferberg John M. Shall Lorinda de Roulet Jeffrey B. Lane Marc V. Shaw Thomas E. Dewey, Jr. Curt N. Launer Sean G. Simon Thomas E. Dooley Laura Lauria Richard Sims Michael J. Dowling Kevin F. Lawlor Michael C. Slade Robert N. Downey David W. Lehr Phyllis Hill Slater Melvin Dubin Jonathan W. Leigh Howard D. Stave Patrick R. Edwards Sylvia Lester Russell Stern Michael A. Epstein Arthur S. Levine John B. Thomson, Jr. Leonard Feinstein Stuart R. Levine Peter Tilles Michael E. Feldman Seth Lipsay Sandra Tytel Anthony C. Ferreri David S. Mack Frederick A. Volk Arlene Lane Fisher William L. Mack Nancy Waldbaum Catherine C. Foster Linda Manfredi Emmett F. Walker, Jr William H. Frazier James S. Marcus Gary Walter Eugene B. Friedman,MD Bradley Marsh, D.P.M. Lewis M. Weston William J. Fritz,PhD Jeffrey S. Maurer Barbara Hrbek Zucker Sy Garfinkel Ronald J. Mazzucco Donald Zucker Roy J. Zuckerberg AVERAGE HOURS PER WEEK PART VII, SECTION A - LINE 1A, COLUMN (B) This organization is affiliated with the North Shore Long Island Jewish Health System (the "Health System"). The Officers, Directors and Trustees listed on Schedule J hold similar positions with both this organization and other affiliates of the Health System, 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 the entire Health System 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 the Health System and its affiliates. GOVERNING BODY PART VI, LINE 7 North Shore Long Island Jewish Health Care, Inc. ("Health Care") is the sole corporate member of the organization. Health Care has the right to elect or appoint members of the organization's governing body and has the right to approve or ratify certain corporate decisions. This organization and Health Care are part of the North Shore Long Island Jewish Health System, an integrated health care delivery system. RECONCILIATION OF NET ASSETS PART XI, LINE 9 CHANGE IN EQUITY UNDER FAS 136 1,291,421 GAIN/LOSS ON REFINANCING OF LONG TERM DEBT (188,429) TRANSFER FROM AFFILIATE (28,488) INCREASE IN AUXILIARY ASSETS 7,425 TOTAL 1,081,929 NORTH SHORE-LIJ HEALTH SYSTEM 972 BRUSH HOLLOW RD WESTBURY NY 11590 113418133 SUPPORT ORG NY 501(C)(3) 11, TYPE 1 NA false NORTH SHORE-LIJ HEALTH CARE INC 972 BRUSH HOLLOW RD WESTBURY NY 11590 112965586 SUPPORT ORG NY 501(C)(3) 11, TYPE 1 NS-LIJHS false NORTH SHORE UNIVERSITY HOSPITAL 972 BRUSH HOLLOW RD WESTBURY NY 11590 111562701 HEALTH CARE NY 501(C)(3) 3 NS-LIJ HC false LONG ISLAND JEWISH MEDICAL CENTER 972 BRUSH HOLLOW RD WESTBURY NY 11590 112241326 HEALTH CARE NY 501(C)(3) 3 NS-LIJ HC false FOREST HILLS HOSPITAL 972 BRUSH HOLLOW RD WESTBURY NY 11590 112163522 HEALTH CARE NY 501(C)(3) 3 NS-LIJ HC false PLAINVIEW HOSPITAL 972 BRUSH HOLLOW RD WESTBURY NY 11590 113241243 HEALTH CARE NY 501(C)(3) 3 NS-LIJ HC false FRANKLIN HOSPITAL 972 BRUSH HOLLOW RD WESTBURY NY 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NY 501(C)(3) 7 SIUH false THE HEART INSTITUTE 475 SEAVIEW AVE STATEN ISLAND NY 10305 311757254 INACTIVE NY 501(C)(3) 11, TYPE 1 NA false CHAPS COMMUNITY HEALTH CENTER 1 EDGEWATER PLAZA 6TH FLOOR STATEN ISLAND NY 10305 113345477 INACTIVE NY 501(C)(3) 9 SIUH false HOSPICE CARE NETWORK 99 SUNNYSIDE BLVD WOODBURY NY 11797 112925757 HOSPICE NY 501(C)(3) 9 NS-LIJHS false HUNTINGTON HOSPITAL 270 PARK AVENUE HUNTINGTON NY 11743 111630914 HEALTH CARE NY 501(C)(3) 3 NS-LIJ HC false HUNTINGTON HOSPITAL DOLAN FAMILY HEALTH 284 PULASKI RD GREENLAWN NY 11740 113368503 HEALTH CARE NY 501(C)(3) 3 HUNTINGTON false PHYSICIANS OF UNIVERSITY HOSPITAL PC 1 EDGEWATER PLAZA 6TH FL STATEN ISLAND NY 10305 200096809 HEALTH CARE NY 501(C)(3) 11, TYPE 1 SIUH false LENOX HILL HOSPITAL 100 EAST 77TH ST NEW YORK NY 10021 131624070 HEALTH CARE NY 501(C)(3) 3 NS-LIJ HC false LHH CORPORATION 100 EAST 77TH ST NEW YORK NY 10021 133272016 SUPPORT NY 501(C)(3) 11, TYPE 1 NS-LIJHS false THE ELMEZZI GRADUATE SCHOOL OF 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SERVI NY LENOX HILL C false PARK LENOX MEDICAL PC 100 EAST 77TH ST NEW YORK NY 10021 133575380 MEDICAL SERVI NY LENOX HILL C false PARK LENOX ORTHOPEDICS PC 100 EAST 77TH ST NEW YORK NY 10021 264634966 MEDICAL SERVI NY LENOX HILL C false PARK LENOX PEDIATRICS PC 100 EAST 77TH ST NEW YORK NY 10021 133755683 MEDICAL SERVI NY LENOX HILL C false PARK LENOX SURGICAL 130 EAST 77TH ST 13TH FL NEW YORK NY 10021 133397814 MEDICAL SERVI NY LENOX HILL C false VIVOHEALTH INC 972 BRUSH HOLLOW RD WESTBURY NY 11590 264118016 INACTIVE NY NSH ENTERPRISES C false AUTOIMMUNE RESEARCH THERAPEUTICS 972 BRUSH HOLLOW RD WESTBURY NY 11590 270701489 INACTIVE NY RESEARCH C false NORTH SHORE-LIJ CARDIOVASCULAR MEDICINE 972 BRUSH HOLLOW ROAD WESTBURY NY 11590 275078717 MEDICAL SERVI NY NSUH C false NORTH SHORE-LIJ CARDIOLOGY PC 972 BRUSH HOLLOW ROAD WESTBURY NY 11590 275078531 MEDICAL SERVI NY NSUH C false NORTH SHORE-LIJ HEART SURGERY PC 972 BRUSH HOLLOW ROAD WESTBURY NY 11590 275078838 MEDICAL SERVI NY NSUH C false NORTH SHORE-LIJ INTERNAL MEDICINE PC 972 BRUSH HOLLOW ROAD WESTBURY NY 11590 275078361 MEDICAL SERVI NY NSUH C false NORTH SHORE-LIJ MEDICAL GROUP URGENT MED 972 BRUSH HOLLOW ROAD WESTBURY NY 11590 275078426 MEDICAL SERVI NY NSUH C false LENOX HILL HOSPITAL MEDICAL PC 972 BRUSH HOLLOW ROAD WESTBURY NY 11590 452661543 MEDICAL SERVI NY LENOX C false NORTH SHORE-LIJ MEDICAL PC 972 BRUSH HOLLOW ROAD WESTBURY NY 11590 453023019 MEDICAL SERVI NY NSUH C false NORTH SHORE-LIJ OCCUPATIONAL MEDICINE P 972 BRUSH HOLLOW ROAD WESTBURY NY 11590 451004103 MEDICAL SERVI NY NSUH C false NORTH SHORE-LIJ OB-GYN PC 972 BRUSH HOLLOW ROAD WESTBURY NY 11590 461382916 MEDICAL SERVICE NY LIJ C false NORTH SHORE-LIJ ANESTHESIOLOGY PC 972 BRUSH HOLLOW ROAD WESTBURY NY 11590 461617561 MEDICAL SERVICE NY SSIDE C false NORTH SHORE-LIJ HEALTH PLAN INC 972 BRUSH HOLLOW ROAD WESTBURY NY 11590 461617516 INSURANCE NY NS-LIJ HC C false false false false false false false false false false false false false false 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