SHORE ROAD RADIOLOGY ASSOCIATES PC: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- SHORE ROAD RADIOLOGY ASSOCIATES PC (EIN 11-2665457)
- Tax period
- 2012-01-01 to 2012-12-31
- Filed
- 2013-11-14
- IRS object ID
- 201333189349307873
- Schema version
- 2012v2.1
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2013-11-14T17:49:26-06:00 | Timestamp |
| Tax Period End Date | 2012-12-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 861065772 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DELOITTE TAX LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | TWO JERICHO PLAZA | AddressLine1 |
| City | JERICHO | City |
| State | NY | State |
| ZIP Code | 11753 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2012-01-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 112665457 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SHORE ROAD RADIOLOGY ASSOCIATES PC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | SHOR | NameControl |
| Phone | 7186307611 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 150 55TH STREET NO 2-36 | AddressLine1 |
| City | BROOKLYN | City |
| State | NY | State |
| ZIP Code | 11220 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | JAYANTH RAO | Name |
| Title | PRESIDENT | Title |
| Phone | 7186307611 | Phone |
| Date Signed | 2013-11-14 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | CHRISTINE KAWECKI | Name |
| PTIN | P00743140 | PTIN |
| Phone | 5169187000 | Phone |
| Date Prepared | 2013-11-14 | DatePrepared |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | JAYANTH RAO MD | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 150 55TH STREET NO 2-36 | AddressLine1 |
| City | BROOKLYN | City |
| State | NY | State |
| ZIP Code | 11220 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 4789621 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | N/A | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1984 | YearFormation |
| State Legal Domicile | NY | StateLegalDomicile |
| Activity Or Mission Description | HEALTHCARE PROVIDER OF RADIOLOGY IN CONJUNCTION WITH, AND IN SUPPORT OF, LUTHERAN MEDICAL CENTER. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 1 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 0 | NbrIndependentVotingMembers |
| Total Nbr Employees | 9 | TotalNbrEmployees |
| Total Nbr Volunteers | 0 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 0 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 0 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 5922860 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 4789117 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 490 | InvestmentIncomePriorYear |
| Investment Income Current Year | 504 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 2131 | OtherRevenuePriorYear |
| Other Revenue Current Year | 0 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 5925481 | TotalRevenuePriorYear |
| Total Revenue Current Year | 4789621 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 3602879 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 3406233 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 2924059 | OtherExpensePriorYear |
| Other Expenses Current Year | 3514541 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 6526938 | TotalExpensesPriorYear |
| Total Expenses Current Year | 6920774 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -601457 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -2131153 | RevenuesLessExpensesCY |
| Total Assets BOY | 795566 | TotalAssetsBOY |
| Total Assets EOY | 411210 | TotalAssetsEOY |
| Total Liabilities BOY | 884296 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 1524253 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | -88730 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | -1113043 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | SEE SCHEDULE O. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 6330585 | Expense |
| Revenue | 4789117 | Revenue |
| Description | 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 2012, SRR RADIOLOGISTSREAD APPROXIMATELY 140,426 TESTS PERFORMED ON LUTHERAN MEDICALCENTER PATIENTS, WITHOUT REGARD FOR THE PATIENT'S ABILITY TO PAY. | Description |
| Total Program Service Expense | 6330585 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 0 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 0 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 0 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 0 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 0 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 1 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 0 | Hospital |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 1 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 6 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 9 | NumberOfEmployees |
| Employment Tax Returns Filed | 0 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 1 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 0 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 1 | MembersOrStockholders |
| Election Of Board Members | 1 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 1 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 0 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | NY | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ALAN SICKLES | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 7186307611 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 150 55TH STREET | AddressLine1 |
| City | BROOKLYN | City |
| State | NY | State |
| ZIP Code | 11220 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (5 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|
| JAYANTH RAO MD | |||||||
| PRESIDENT | 40.00 | X | X | 645321 | 0 | 22740 | |
| WILLIAM NGUYEN MD | |||||||
| PHYSICIAN | 40.00 | 316065 | 0 | 27233 | X | ||
| JEN-FONG SHEN MD | |||||||
| PHYSICIAN | 40.00 | 324893 | 0 | 27233 | X | ||
| YEVGENIY MARGUILIS MD | |||||||
| PHYSICIAN | 40.00 | 326510 | 0 | 11534 | X | ||
| KOPRESH A GUDI MD | |||||||
| PHYSICIAN | 40.00 | 348915 | 0 | 22482 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 1961704 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 111222 | TotalOtherCompensation |
| Number Individuals GT100 K | 9 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| BARTON & ASSOCIATES | |||||
| 10 DEARBORN ROAD | PEABODY | MA | 01960 | LOCUM TENENS | 898827 |
| TELERADIOLOGY LLC | |||||
| 3520 PIEDMONT ROAD NE SUITE 250 | ATLANTA | GA | 30305 | LOCUM TENENS | 855580 |
| JEFFERY FARKAS | |||||
| 43 WESTMINISTER AVENUE | BERGINFELD | NJ | 07621 | PHYSICIAN SERVICES | 456996 |
| CADACEUS INC | |||||
| 30 MONTGOMERY STREET SUITE 7 | JERSEY CITY | NJ | 07302 | BILLING SERVICES | 185960 |
| MD EVERYWHERE | |||||
| 26 CENTRAL AVENUE | HAUPPAUGE | NY | 11788 | BILLING SERVICES | 164309 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 5 | NumberOfContractorsGT100K |
Program Service Revenue ProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | PATIENT SERVICE REVENU | Description |
| Business Code | 622110 | BusinessCode |
| Total Revenue Column | 4789117 | TotalRevenueColumn |
| Related Or Exempt Function Income | 4789117 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 4789117 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 504 | TotalRevenueColumn |
| Exclusion | $504 | ExclusionAmount |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 4789621 | TotalRevenueColumn |
| Related Or Exempt Function Income | 4789117 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $504 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | X | InfoInScheduleOPartIX |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 645321 | Total |
| Program Services | 645321 | ProgramServices |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2453102 | Total |
| Program Services | 2453102 | ProgramServices |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 71236 | Total |
| Program Services | 71236 | ProgramServices |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 118578 | Total |
| Program Services | 118578 | ProgramServices |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 117996 | Total |
| Program Services | 117996 | ProgramServices |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 100951 | Total |
| Management And General | 100951 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 21649 | Total |
| Management And General | 21649 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2424165 | Total |
| Program Services | 2424165 | ProgramServices |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 15996 | Total |
| Program Services | 15996 | ProgramServices |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 484191 | Total |
| Program Services | 484191 | ProgramServices |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Management And GeneralManagementAndGeneral |
|---|---|---|
| BILLING EXPENSES | 350269 | 350269 |
| STAFF CHARGE BACK | 114075 | 114075 |
| PAYROLL FEES | 815 | 815 |
| FILING FEES | 275 | 275 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2155 | Total |
| Management And General | 2155 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 6920774 | Total |
| Program Services | 6330585 | ProgramServices |
| Management And General | 590189 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 10532 | BOY |
| EOY | 0 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 673210 | BOY |
| EOY | 283688 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 111824 | BOY |
| EOY | 127522 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 795566 | BOY |
| EOY | 411210 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 526009 | BOY |
| EOY | 833308 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 358287 | BOY |
| EOY | 690945 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 884296 | BOY |
| EOY | 1524253 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -88730 | BOY |
| EOY | -1113043 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -88730 | BOY |
| EOY | -1113043 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 795566 | BOY |
| EOY | 411210 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | -2131153 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 1106839 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
FS Audited Basis FSAuditedBasis
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | 1 | AuditCommittee |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supporting Organization509a3 | X | SupportingOrganization509a3 |
| Supporting Org509a3 Type3 Func Int | X | SupportingOrg509a3Type3FuncInt |
| Certification Checkbox | X | CertificationCheckbox |
| Written IRS Determination | X | WrittenIRSDetermination |
| Contrib By Controlling Individual | 0 | ContribByControllingIndividual |
| Contribution By Related Party | 0 | ContributionByRelatedParty |
| Contrib By35 Controlled Entity | 0 | ContribBy35ControlledEntity |
Supported Org Information SupportedOrgInformation
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | LUTHERAN MEDICAL CENTER | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 111839567 | EIN |
| Type Of Organization | HOSPITAL | TypeOfOrganization |
| Listed In Governing Doc | 1 | ListedInGoverningDoc |
| Supported Organization Notified | 1 | SupportedOrganizationNotified |
| Organized In US | 1 | OrganizedInUS |
| Amount | $6,920,774 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Number Of Supported Orgs | 1 | TotalNumberOfSupportedOrgs |
| Sum Of Amounts | 6920774 | SumOfAmounts |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 0 | TotalOfBookValueLandBuildings |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | DUE TO AFFILIATES | Description |
| Amount | $690,945 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 690945 | TotalOfAmounts |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | X | CompensationCommittee |
| Independent Consultant | X | IndependentConsultant |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 0 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (5 entries)
| TitleTitle | Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| JAYANTH RAO MD | ||||||||||||||
| PRESIDENT | 645321 | 0 | 0 | 0 | 0 | 0 | 10000 | 0 | 12740 | 0 | 668061 | 0 | 0 | 0 |
| WILLIAM NGUYEN MD | ||||||||||||||
| PHYSICIAN | 316065 | 0 | 0 | 0 | 0 | 0 | 9850 | 0 | 17383 | 0 | 343298 | 0 | 0 | 0 |
| JEN-FONG SHEN MD | ||||||||||||||
| PHYSICIAN | 305585 | 0 | 0 | 0 | 19308 | 0 | 9850 | 0 | 17383 | 0 | 352126 | 0 | 0 | 0 |
| YEVGENIY MARGUILIS MD | ||||||||||||||
| PHYSICIAN | 326240 | 0 | 0 | 0 | 270 | 0 | 9850 | 0 | 1684 | 0 | 338044 | 0 | 0 | 0 |
| KOPRESH A GUDI MD | ||||||||||||||
| PHYSICIAN | 348915 | 0 | 0 | 0 | 0 | 0 | 9850 | 0 | 12632 | 0 | 371397 | 0 | 0 | 0 |
Schedule L IRS990ScheduleL
Form990 Schedule L Part IV Form990ScheduleLPartIV
Name Of Interested Person NameOfInterestedPerson
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | HEMALATHA RAO | NamePerson |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship | BOARD DIRECTOR & OFFICER | Relationship |
| Amount Of Transaction | 88063 | AmountOfTransaction |
| Description Of Transaction | THE ORGANIZATION'S 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 THESE PHYSICIAN SERVICES FOR THE YEAR ENDING DECEMBER 31, 2012 WAS $88,063. | DescriptionOfTransaction |
| Sharing Of Revenues | 0 | SharingOfRevenues |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (13 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| ORGANIZATION'S MISSION | FORM 990, PART III, LINE 1 | 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, 2012. 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. | |
| OTHER FEES | FORM 990, PART IX, LINE 11G | OUTSIDE PHYSICIAN SERVICES: PROGRAM SERVICE EXPENSES 2,299,465. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,299,465. OUTSIDE MEDICAL SERVICES: PROGRAM SERVICE EXPENSES 124,700. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 124,700. |
| CHANGES IN NET ASSETS OR FUND BALANCES: | FORM 990, PART XI, LINE 9: | TRANSFERS OF NET ASSETS FROM RELATED ENTITIES 1,106,839. |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (11 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Direct Controlling Entity NADirectControllingEntityNA | Controlled OrgControlledOrg |
|---|---|---|---|---|---|---|---|---|---|---|
| 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 |
Form990 Schedule R Part IV Form990ScheduleRPartIV (2 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | Primary ActivityPrimaryActivity | Legal Domicile StateLegalDomicileState | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Type Of EntityTypeOfEntity | Controlled OrgControlledOrg | Direct Controlling Entity NADirectControllingEntityNA |
|---|---|---|---|---|---|---|---|---|---|
| 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 | C | 0 | N/A | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 0 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 1 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Dividends Related Organization | 0 | DividendsRelatedOrganization |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 1 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 1 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 1 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 1 | SharingOfFacilities |
| Sharing Of Paid Employees | 1 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 1 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |